T Nation

First 6 Months on TRT

I started TRT 6 months ago via a “mens clinic” after testing with 600 level Test but super high SHBG. I’m 40, with about 12% body fat, 5’10" 170lbs.

Here was the protocol:
200 mg test C weekly, 1.0 mg AI weekly.

I saw good results with the first few months, increase lean mass, mood, drive, etc.

Months 2-4 started to see some sides of cystic acne on my forehead, balls shriveled to peanuts, moody at times. The PCP at the mens clinic also advised me to check my liver as the liver enzymes came back double the norm. (Blood work every 3 months)

Months 5-6 started Clomid to help with the nut shrinkage (cant remember the dosage) (Same sides as months 2-4 but overall still happy with things) Liver enzymes came back again high and the PCP took me off all TRT cold turkey. He asked I resolve my liver enzyme problems before continuing to treat. My lab results came in at TT=627, E2 = 12.9, LH = almost 0, SHBG = 56

Doesn’t the almost zero LH mean that Im completely shutdown at that point, testes are producing nothing? hCg would be used to offset this by increasing LH correct? This would allow my testes to still produce some of their own natural test? Also seems like Im taking this only to be in the same place I was before 600 TT before vs. 600 TT after, the only difference being one is natural without sides and the other is not natural with some sides. I thought the point was to get your test high enough to overwhelm the high SHGB? But adding 200mg of test weekly really just eventually replaced what my body was already doing. How would you get to the 1000 TT range? Increase the test?

Its now been 1 month, increased some body fat, lost some lean mass, mood has been poor, acne is gone and my babies are back to normal.

My liver enzymes I believe are due to possibly a few things, 1) I took a shit load of pre workout supps before working out very early in the morning 2) Possibly working out hard before all lab tests 3) Possibly nonalcoholic fatty liver - which you don’t do much about. I don’t drink hardly, I don’t have Hep, I’m completely healthy.

Anyone concerned about the higher liver enzymes? I stopped the pre workouts and had blood done and liver enzymes were still higher but not double the normal like before. I have a GI apt in a month.

Im considering starting self treatment but trying to be educated. I’ve read the newbie stickies, wrote down the protocols from Ksman. Is that where you’d restart? 100mg test with 250 hCg and 1mg of AI?

Appreciate the help

Sore muscles can easily create high AST/ALT and doctor should be aware of that issue and asked you to get muscles recovered, stop working out, and do AST/ALT labs again. And consider that young guys with high T levels do not have liver problems cause by that and neither would you. The issue with liver was from body builders taking high doses or oral testosterone products that are hard on the liver. Doc is not knowledgeable to understand.

Yes that suggested protocol:

  • self-inject 50mg T twice a week, SC/SQ with #29 1/2" 0.5ml insulin syringe
  • 0.5mg anastrozole at time of T injections, adjust after labs to get near E2=22pg/ml, which works very well for almost all guys
  • 250iu hCG SC/SQ EOD

Stopping TRT suddenly can shut you down.

Yes, TRT shuts down LH/FSH and almost all will get testicular shrinkage. 200mg T vs 100mg T is same result.

Labs: - on TRT
LH/FSH - do not test
fasting cholesterol
fasting glucose
Prior to TRT, should have DRE prostate exam, repeat at 6 months and annual after that.

Please check overall thyroid function via body temps as per last paragraph.

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

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.

So if taking trt with hcg does it keep the body producing whatever it normally does and then adds to it?

Is there any way to get levels to 1000 TT? If on 200mg weekly it seems I just replaced 600 TT naturally for 600 TT with trt. Will the hcg be the difference when starting again? Or is the only purpose behind the hcg is to keep normal anatomy down there?

Thanks again

You need to inject twice a week and then always do labs halfway between injections.

Injecting once a week makes T levels ho high then fall and lab results are strongly determined by when you do the lab work.

hCG is mostly to keep the testes functional and fertile. The amount of T made depends on age and condition of the testes. For me at age 54 it increased TT by 17%

You should know this if you read the stickies.

A few guys need 300mg T to get what other get on 100mg T. So they need ~ 300mg/week. We have a few guys like that here.

Do not neglect thyroid issues. Hypothyroidism can increase SHBG and starvation diets can too. Estrogens increase SHBG and higher T levels reduce SHBG. SHBG is made in the liver. High SHBG can also be from liver disease or liver stress.

My update on high liver enzymes and TRT:

I was removed from TRT by my doc, I removed all sups and retested bloodwork 2 months later. Enzymes close to normal range after being more than double. I also lowered intensity of workout schedule. Getting back on TRT without any other sups. Stickies mention 100mg weekly, starting there. Doc is prescribing 200mg weekly, just gonna save the extra test. He won’t prescribe hcg. I will self treat there as well as the AI because he won’t give enough there, he only gives 1/2 the recommended amount for the test prescribed. If i end up going back to 200mg weekly Im assuming I will not increase the hcg dosage only the AI dosage. Hcg dosage is standard no matter what your taking correct?

Yes, hCG dose is invariant.

Repeating: Sore muscles can easily create high AST/ALT and doctor should be aware of that issue.

My wife worked out all major muscle groups to very sore and one of AST or ALT [can’t remember] was over 300. Did you fight back on this issue?

So you want to ignore the thyroid and iodine issues. Such problems are very common here. Thyroid controls your energy levels and has a huge impact.