T Nation

DRJH1999's TRT Journey at 36 y/o. Long Story But May Help Someone


#1

Hello, new here but I’ll see if I can follow procedure here. Some history and stats:
I am 36, no history of AAS use.
-5’8" 205lbs currently, was up to 225lbs highest weight, down to 182lbs 2 years ago at my lowest
-Lots of body hair and facial hair, getting some random gray hairs all over
-I carry all my fat in my midsection and pecs, otherwise fairly muscular but not defined at all.
-If I let my gut just hang out it looks like I am 7 months pregnant. Have to suck it in conciously.
-Had a horrible diet for a long time, no fruits or veggies at all. Mostly fast food and sodas.
-I should be a 300lb fatty but I guess I have decent genetics and my job is very physically demanding
-On a busy work day plus the gym my Fitbit tracks over 20,000 steps plus up to 4700 calories burned
-Have been working rotating 12hr day/night shifts for four years, circadian rhythm nonexistent.

I had been feeling lethargic, grumpy, and weak libido with some ED for awhile. Doctor put me on fluoxetine (Prozac) at the same time I gave up sodas and did a Keto diet. Lost a lot of weight in three months, from 215lbs down to 182lbs and I felt great with noticeably improved libido. Fell off my diet, medicine quit working and I put all my weight back on plus another 10lbs. Weaned myself off fluoxetine.

Fast forward a year and I listen to the Joe Rogan Podcast where he had Dr. Mark Gordon and a vet with PTSD and they discuss hormone replacement as a simpler and superior treatment for issues that sounded like me VS pharmaceuticals like SSRI’s etc…

Have my Testosterone checked and my level was in the 140’s. Had to fight with my doctor and the insurance company to approve a topical testosterone like Axiron which is what my doctor recommended. Told me I shouldn’t do injections. By the time it gets approved I get a call saying my doctor is leaving the office to work somewhere else and there is no one else that can see me anymore. Awesome

Find a new doctor who gets me approved for Androderm patches. What a joke! After three months my level only rose to 170. I then switch to injections and they only write the prescription for 50mg every two weeks. I divide that ridiculous baby dose into twice weekly sub q injections after doing research here. Three months later and my level went from 170 DOWN to 162.

At this point I’m getting fed up. I had asked for my E2 to be checked and it wasn’t done. I asked about adding HCG to prevent testicular atrophy and I was told I could be referred to an endocrinologist for that while still seeing them for the testosterone. Now I’ve had it and after some searching I found another doctor, my third so far.

He is awesome!!! He puts me on 200mg test enanthate/week, 1500iu HCG/week and arimidex as needed. Diet is currently mostly keto and I’m in the gym doing mild cardio and lifting heavy 4-5 times a week. I feel much better, am losing belly fat and adding muscle which is nice.

Three months later these are my labs. He didn’t have time to go over all of it, mainly told me to improve my cholesterol with diet change. If anything looks off please tell me, I’m still learning here.
Total testosterone: H >1500
Free testosterone: H 49.21 (5.00-21.00)
SHBG: 19.4 (10.0-50.0)
Estradiol: 29.5 (11-44)
FSH: <0.7 (0.9-10.9)
Free T3: 3.1 (2.2-4.2)
Free T4: 1.2 (0.7-1.6)
HGH: <0.05 (0.02-1.23)
IGF-1: H 254.1 (83.0-239.0)
LH: L <0.40 (2.80-6.80)
RBC: H 6.46 (4.70-6.10)
HCT: H 55.6 (42.0-52.0) I just donated blood after the labs were taken
Cholesterol: H 232 (100-199)
HDL: L 35 (>40)
LDLCAL: H 173.20 (0.0-99.0)
Progesterone: 0.4 (0.1-0.6)
Vitamin D: 45.0 (30.0-100.0)
APOLIPO A1: 120 (95.0-186.0)
APO B: H 124.0 (52.0-109.0)
B12: 893 (200-1100)
Cortisol: 14.0 (4.0-22.0)

So my doctor is ok with me staying on the same dosage but I’m thinking I should lower it a tad, especially the HCG. I’m all ears for any advice. The estradiol test didn’t say if it was sensitive or not so I’m a little unsure if I should increase my arimidex a little. I was taking .25mg twice a week but bumped it up to .5mg twice a week a couple weeks before my blood was drawn. Probably not a good idea when dialing everything in. Obviously if I lower my doses I need to lower arimidex as well.

Also when I donated blood they did the one where they hooked me up to the machine that pulled blood out and then pumped a clear fluid back in. Is that the wrong donation to do if I’m trying to lower my hematocrit and RBC? For the next two days I was exhausted. I have done regular donations in the past and never felt any adverse effects but this one wiped me out.

Thanks and I’ll be surprised if people read this huge wall of text but I’m hoping it might help someone or I’ll learn even more from this great site. I’ve already learned a lot here and appreciate the community here for the knowledge and experience that is shared.


#2

High HTC is dangerous and high T is the major factor. So you should reduce. You also need to avoid dehydration and also for fasting lab work.

Avoid iron fortified foods: rice, flour, breads, cereals, pasta. Vitamins should not have iron.

E2=22pgml is a good target. You can increase anastrozole dose by a factor of 29/22. But then reduce by a factor same as how much you lower T dose.

  1. Suggest 80mg T twice a week, consider subq injections, objective is avoiding T peaks that drive high HTC. Many inject with #29 1/2" 0.5ml

  2. 0.5mg anastrozole X 29/22 X 160/200 = ~0.5mg
    so anastrozole dose unchanged

  3. 250iu hCG subq EOD is all that you need, save some $$$

Do not test HGH, IGF-1 is best indicator of GH status.
IGF-1 is high, odd but nice.
Do not test LH/FSH as will be zero.

Fasting glucose?
A1C?
AST/ALT?

PTSD? Damage to pituitary from blow/blast to the head? Can wreck hormones.

What supplements are you using?

Thyroid has huge influence on fat gain/loss and energy etc.
Should test TSH, fT3, fT4 [please not T3, T4]
See last paragraph to eval overall thyroid function.
Describe long term history of using iodized salt?

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.


#3

Thank you KSman! Yes I forgot to mention a few things now that you bring it up. I currently use 27g 1/2" insulin syringes for my delts exclusively. I do have some 29g 1/2" also that I will start using for sub Q.

I did have to do an MRI for a pituitary tumor and it came back negative. I have had a few concussions, my last and most serious was a decade ago when I was knocked unconscious in a car accident and had to be life-flighted by helicopter and didn’t come to for over 8 hours. A catheter being inserted did the trick unfortunately.

I made sure to drink lots of water for my fasting blood work, as I didn’t the time before and it was high but not as high as it is now

Fasting glucose was 89 (70-105)
AST: 25 (10-40)
ALT: 22 (9-46)

Supplements are just a multivitamin without iron, B-12, Vit D3, baby aspirin, and CoQ10. Protein shakes in unsweetened almond milk, BCAA powder in water, and a pre-workout powder in water.

I’m avoiding breads, cereals etc and have used iodized salt probably my whole life.

Lastly what is fT3, fT4? Is that free values or something else?