T Nation

Difficult Time Getting Numbers Back Up Last Few Months


Have been on trt for about 2 years now. I was a lucky fast responder from the first week. Went into things with my T at about 320, typical symptoms and general low energy and lack of zest for things. Doc started things with 200mg first week and necked down to 170mg, my first draw gave me a high 900 on my T. Felt like a million bucks.
Time goes on and dose stays at 170mg or so and am still in the 800’s. Months go by numbers drop, doc introduces hcg. Everything back to normal. Rinse/repeat add some AI when E gets high. Typical stuff.

I don’t have my labs with me right now but am hoping the general story and numbers can help with my situation.

Labs done every 6 to 8wks. 3 labs ago T number dropped from 800’s to 600’s. I felt kind of worn out. Doc added hcg. The boys got bigger but after the hcg cycle my T numbers did not really budge. Doc increases test dosage to 200mg weeks go by and labs show T in high 500’s, E at 26, hemocrit 48. I still feel worn out, doc bumps up to 210mg and latest labs have me in the mid 600’s and E up to 37. Have added an AI no but still feel beat and no motivation in the gym.

Any idea what could be going on? Anyone experience something similar before? Barring the elevated E level now I should be in the 900’s with the dosage right? Sounds odd but does the body build up a tolerance to trt and thus the dosages? I feel mediocre at best, yesterday after 20 mins of a lackluster workout I left.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

You need to explain your protocol in detail. How many injections per week? AI and hCG timing and dosing.

Lab timing relative to injections is a big factor and if injection once a week, lab timing can drive big changes in lab results.

We have some here who metabolize T faster than others and a few need three times the expected dosing.

Do not ignore possible thyroid/iodine issues.


Thanks KSman.
Some added details as requested.

1 injection per week every Thursday afternoon in doc’s office.
Finished last 6 week run of hCG about 10 weeks before last labs were run.
Blood draw was 7 days since last weekly injection.

Could ask to run thyroid panel next time. Last time they did it was a few months ago. There were 2 line items on the labs they said referred to the thyroid and it was fine. Never had any thyroid issues previously.

Interesting point about metabolizing. Is it possible that the body can change how it does this over time requiring more as time goes on?


The problem is that the thyroid normal ranges include a huge number of people who are suffering.

Getting normal on thyroid labs is not of any comfort. You can get a good idea of overall thyroid function by checking oral body temps as per the thyroid basics sticky.

Low or hyper thyroid has a set of symptoms that are mostly the same as low T.
Have you been using iodized salt to support thyroid function?
Feeling cold easier?
Outer eyebrows sparse?

You need to be self injecting twice a week and always using AI at time of injections. With injections once a week, T levels are changing too much for correct AI dosing. If you are a hyper metabolizer, half life of T is shorter for you. Yes, how you process T may have changed.

Read the stickies and you will understand a lot.


The lab reference ranges are useless and you can have problems and doc thinks things are perfect.

Check oral body temps as per the thyroid basics sticky.
Using iodized salt?


Went for my weekly visit yesterday afternoon. Discussed my concerns and requested labs to be run for thyroid THS, T3, T4, etc.
We also decided to run another round of HCG.
Will see how the results come back. Just frustrating that the first year of TRT had me in the 900’s feeling great and now on year 2 I am in the 5 and 600’s when using a higher dosage. Guess we will wait and see. If Thyroid #'s come back good I am at a loss of what to do next to get the #'s up other than increasing dosage.Hopefully the HCG will kick start things too.


Received my labs back specifically testing for thyroid.

Thyroxine (T4) Free, Direct = 0.92 ng/dL range 0.82 - 1.77
TSH = 4.110 uIU/mL range 0.450 - 4.500
Triiodothyronine, (T#), Free, Serum = 3.1 pg/mL range 2.0 - 4.4
Thyroid Peroxidass (TPO) Ab = 13 IU/mL range 0-34

All numbers seem to fall in range and doc said they are normal. Any comments?

Btw, the HCG they started me on the other week has alleviated a good number of my previous symptoms and sluggishness. Still a bit run down but feeling things getting better.


TSH should be nearer to 1.0
FT4 is well below midrange

Please see the thyroid basics sticky and check oral body temperatures as suggested.

Are you iodine deficient from not using iodized salt?
– why do I need to ask three times?
Are your outer eyebrows sparse?
Do you get cold easier now?

You need a multi-vit that lists iodine+selenium and does not list iron.
You may need more iodine than that for a while.

Yes, almost all doctors would say that your thyroid is fine.

fT3 is quite close to midrange and should support good body temperatures, If not, we suspect that rT3 is elevated and blocking fT3, that then leads into stress issues as discussed in the sticky and adrenal fatigue. Training with sheer will power and adrenalin with low thyroid function and/or low-T is a major stress factor.

Lack of selenium, especially with elevated TSH can increase Thyroid Peroxidase (TPO) as part of an inflammatory problem that can develop into thyroid auto-immune disease.

You need more T. Some guys simple metabolize it faster than others and this also then needs more frequent injections.