T Nation

Early 30s, Low T. Advice?


#1

So I made a bit of a mistake and didn’t do enough research prior to starting TRT. I fairly blindly followed my doctor’s advice because my numbers came back fairly low and I figured it was as simple as just adding more testosterone and I would be better. So the initial labs are a bit lacking and the follow up labs aren’t quite what I asked for but they’re better. I’m meeting with my doctor tomorrow to go over results but I figured I’d ask here to see if there was anything I should be cautious of before just following more possibly not so great advice. I’m currently on 100mg/wk test-c, as you can see from the numbers below that barely touched my total testosterone, a net increase ~4 days after injection of 17 seems very low. I also haven’t seen anything in any TRT forums/discussions about progesterone - and mine is very low. I assume just getting some cream formulated for men would be the best course of action there? DHEA is also low normal but I’m not sure where in the range is ideal or how much dhea to supplement to get there.

My hope is to double my test-c to 100mg twice a week to get levels up and have more steady levels. I know that will increase my E2 but from what I’ve read increasing progesterone should help even that out, I’m not sure how much so I feel this will be a check back in 3 months(or sooner depending on how I feel) and see where stuff is at.

Initial labs:

Test 1 8:00 AM 333 (348-1197)
Test 2 10:00 AM 262 (348-1197)

Followup labs(after 5 weeks):
total testosterone: 356 (348-1197)
free testosterone: 10.7 (8.7-25.1)
E2: 27.5 (7.6-42.6)
DHEA: 60 (31-701)
PSA: 0.4 (0.0-4.0)
LH/FSH: <0.2
Prolactin: 7.6 (4.0-15.2)
17-OH Progesterone: 10 (27-199)
TSH: 1.76 (0.450-4.5)
Free T3: 3.9 (2.0-4.4)
Free T4: 1.2 (.82-1.77)


#2

I am very surprised (and puzzled) that 100 mg/week doesn’t give you higher T.


#3

I was thinking it might be due to natural production falling off but I don’t know that 100mg/wk would be enough to shut down natural testosterone production or not. Or if 100mg/wk would equate to roughly the levels I’m seeing. Looking at the test results a bit further it seems as though my pregnenolone levels may be low since DHEA and 17-OH progesterone are both low and close to the top of Steroidogenesis and seem to be dependant upon pregnenolone. But that’s pretty much just my best guess at this point. I’ll follow up after the appointment to see if my thoughts are close to correct or no.


#4

There are some guys who are testosterone hypermetabolizers and nothing is known about why. Typically 300mg/week is needed and because the effective half-life is shorter, injections should be EOD - every other day.

With FT low at 10.7, FT and Bio-T --> E2 production rates are probably low, suggesting possible low liver clearance. With higher T dose, T–>E2 production rates will increase proportionately and E2 will need to be managed with anastrozole.

With short half life of T for you, please always do labs halfway between injections to avoid lab timing artifacts showing changes. Time of doctor office visit may be wrong.

Try 25mg DHEA per day, along side vitamins in USA, Rx in Canada and other Commonwealth Countries.

Your TRT has shutdown whatever LH/FSH you had, lowering pregnenolone and probably DHEA follows that. hCG injections keep testes functional. LH/FSH will always be zero on TRT and testing is stupid. LH/FSH should have been tested before TRT and failing to do that at your age is malpractice as low-T is the symptom and diagnostics were not done. Your fertility is a great risk and hCG preserves that as well. Your doctor failed to discuss this with you. It is not a side effect risk, but a problem of great certainty.

Progesterone:
I do not see units.
“Male: less than 1 ng/mL or 3.18 nmol/L”

Thyroid:

  • Lab ranges are useless, causing doctors to ignore issues.
  • TSH should be closer to 1.0
  • fT3 should be mid-range or a bit higher, 3.9 suggests possible elevation of rT3 blocking some fT3 action.
  • fT4 is oddly low re mid-range.
  • Please check overall thyroid function via last paragraph in this post.
  • If body temps are low, problem would seem to be elevated rT3 and adrenal and stress issues then need to be addressed.
  • If you have not been using iodized salt, that is a major issue.

You can get KAL brand [2%] progesterone cream at Amazon USA site, no Rx needed, grandfathered in from years ago.

Cortisol is made from progesterone in the adrenals. Low progesterone can affect that. You should do “AM Cortisol” labs at 8AM.

Cholesterol is the foundation for your whole steroid hormone cascade. Total fasting cholesterol = 180 is ideal, <160 leads to problems.

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
  • thyroid basics

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.


#5

We also had a other guy here who was a T hypermetabolizer who also had very low Vit-D3. Please do Vit-D25 lab work or simply take 5,000iu Vit-D3, tiny oil based gel caps.


#6

To do well, most TRT guys need TT and FT near or at the top of the reference ranges. So TT=900-1100. As some labs have vastly different FT ranges, I will not suggest a hard target for that.

And E2 needs to be near 22 pg/ml - 80 pmol/L

Suggested protocol:

  • self inject SC/SQ 300mg T per week in EOD injections, use #29 1/2" 0.5ml insulin syringes
  • 0.5mg anastrozole twice a week
  • 250iu hCG SC/SQ EOD, above syringes or #31 5/16" 0.5-0.3 ml

#7

Thank you for taking the time to look this over. After meeting with my doctor I’m feeling a bit underwhelmed. He’s not concerned with low DHEA or 17-OH progesterone (apparently both being low is expected with exogenous testosterone) but only getting total testosterone up to ~900. He was also opposed to AI until my e2 numbers went up. He did up my rx to 100mg every 5 days or 150mg/week but doesn’t want to re-test for another 8 weeks. I’m considering looking for a second opinion because I don’t know that I agree with this.

17-OH Progesterone units are ng/dL

My total cholesterol is actually a bit high at 220 but I maintain a very healthy diet with lower fat but I eat a lot of animal fat and nut fat and moderate carbohydrates. And I’m also very active, typically in the gym 5-6 days a week even with my testosterone bottoming out I did my best to maintain that routine but it was starting to fall off which is what really prompted the initial doctor visit.

My body temp has been steady 98.6 +/- .2 and I use himalayan salt almost exclusively, which contains iodine. I also cook most everything with Maine Cost Sea Seasoning Kelp Granules which contain iodine. My multivitamin (Animal Pak) also has 150mcg iodine.

I have started 2x 10mg DHEA while I wait for my 25mg’s to be delivered and I’ll also start 5,000iu Vitamin D again.

Does hCG have benefits other than maintaining fertility? I actually talk with him about getting a vasectomy which is probably (hopefully) why he didn’t bring up hCG. But I wasn’t sure if there was a reason to use it other than just fertility. If there is benefit I can bring it up but if not I won’t.


#8

Since I can’t seem to figure out how to send a PM. I’m actually also located in KS too, do you have any recommendations for good Endo’s in North Eastern KS, say maybe between the 2 Big 12 schools, preferably closer to the Ag side of things. Just for a second opinion.


#9

I’ve been doing some research and I’m wondering if my SHBG might be low. It would explain why the dose had nearly no effect on my total test as well as symptoms of higher E2 at a fairly normal level due to higher levels of Free E2 because there is nothing to bind it. The downside is I’m not seeing much in the way of increasing SHBG. Does anyone here have any experience with this?

I’m still feeling like crap even adding 25mg DHEA (am)/progesterone (am/pm). I’m guessing this is due to a number of factors, TT/FT are probably still low, E2 is increasing and there isn’t enough SHBG to bind to the increased E2 exacerbating the issue. But that’s just my theory. My PCP doesn’t want to see me for another 6 weeks so getting additional labs drawn in the meantime is going to be a pain. I am still looking for a second opinion locally but there aren’t any Endo’s close and the only urologist that “specializes” in HRT uses saliva testing and don’t accept insurance - both of which concern me but I might see about getting their opinion on the results I have.


#10

What does that mean?
Does not matter what med school, they all turn out TRT duds.

Recommendation? Are you prepared to pay out of pocket?
Rock Creek Wellness Center $$
Endo’s are typically the worst.

There are no PMs here for ~ 3 years.

Do your own labs at LEF.COM - products - blood testing and pay your self.

I am not concerned re your cholesterol as that can come down with effective TRT, so wait on that.