T Nation

First Shot 9-12-2013: Need insight

-age: 22
-height: 6.0 ft
-waist: Major Abdominal Fat
-weight: 230
-describe body and facial hair: Lots of body hair, Facial hair is thick on neck and really patchy on cheeks
-describe where you carry fat and how changed: Lots of abdominal fat and large breasts
-health conditions, symptoms: Low Total Testosterone of 292
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: No
-lab results with ranges: Total T of 292 after two separate labs currently waiting on results of a MBC Panel and CBC Panel
-describe diet: horrible fast and processed foods until lifestyle change two months ago. Now its fish, chicken breasts, veggies, cottage cheese, whole foods, etc
-describe training: was super lethargic and lazy until i got off my ass two months ago and began a very active landscaping job along with training twice a week.
-testes ache, ever, with a fever: Sometimes they do ache although its very rarely
-how have morning wood and nocturnal erections changed: Lots of nocturnal emissions and morning wood, no problem with libido ever.

I will keep this short as possible.

I am 22 and recently thought about why I am so tired and gain weight so easily and why my voice never really dropped or penis grew during puberty. This led me to hypothyroidism and eventually to this forum then to a general practitioner. On our first meeting i explained my symptoms and he felt around my thyroid and ordered blood tests to check for under active thyroid and testosterone levels. I called a few days later and the receptionist told me this.

“Your blood work shows no sign of under active thyroid but you have low testosterone levels.”
“What were my results/levels?”
“Well, your T3 and T4 levels are in range but your total T is at 322 and that is a little low”
“Okay whatâ??s the next step?”
“Come in for an AM confirmation Lab test”

I go in and give an AM blood draw and wait a couple days to call for results. That phone call went like this. Again with secretary…

“Mr. Radass, Your blood results came back and showed Low total t levels. You can come in and get your prescription for Androgel and we’d like to see you in two months to do a follow up check are you available on xx-xx-xxxx date?”
“Well, if itâ??s possible id like to talk with the GP about my options and a few other issues before I start any routine. is that possible?”
“Sure, howâ??s tomorrow?”

That follow up meeting just happened today.
Based on a quick glance through the stickies here and some other websites I wrote down some questions to bring along with me for this meeting. here they are.

  1. What is the root cause of my Low T and can we fix that so I can avoid TRT altogether?
  2. I’d like to go on an Aromastaze inhibitor, I believe I am estrogen dominant and want to keep my estradiol levels in check
  3. Don’t you need to do some more lab work and a prostate exam before I begin TRT?
  4. What are my options of TRT and the pros and cons of these options?

Now I had read a good portion of the stickies and was expecting an ignorant doctor but nothing like what I experienced at the appointment today. Here is a quick review of appointment.

Doctor walks in room and begins explaining what androgel is, how to use it, and reading the fine print of this androgel pamphlet. He is basically selling me the androgel like a used car salesman would. I stop him and ask,
“I am interested in the root cause of my Low T, is there anything we can do to figure out what that might be?”
He Replied, “well I checked for primary and secondary causes and didn’t see any so TRT is the next step for you.”
He then continued to ramble on about this Androgel pamphlet. I stopped him again and said,
“I have an intimate relationship and am worried about the transfer of gel to her I don’t think the androgel application is the most affordable either, don’t they make compound creams?
He continued to explain that,
“After two hours it won’t transfer and more general bullshit about not having any other cream besides Androgel or its generic brand.”
I stopped him again and said,
“What other options are there that dont include daily application?”
He replied, " Ohh well theres a shot we can do once every two weeks.”
I said “I’d prefer that over daily application.”
He replied, “Okay the nurse will be right in to administer that and come back in two weeks two get your next one and well see each other in two months for a follow up appointment”
I said,
"Doc, if you have the time Iâ??d like to discuss a few more concerns with you. From what Iâ??ve read, an aromastaze inhibitor is often used to prevent estradiol from becoming dominant, I’ve read that arimidex is often used as an off label inhibitor. I believe I am already estrogen dominant and would like to explore my options with an AI along with testosterone. "
He then pulled out his iphone and looked up arimidex and said,
“no no that is prescribed for breast cancer and the like and i’ve never heard of it being used with testosterone we usually just give the testosterone as is and nothing along with it okay?”
I bit my tongue and moved on to the next concern,
“don’t you need more lab work to check before I go on TRT?”
“weâ??re going to draw for a GBC panel and MBC panel today but were just going to start the Testosterone today as well”
I bit my tongue and moved on,
“Okay doctor, what exactly are you using and at what amount” (notebook and pen in hand)
He replied, “I’m using Testosterone cypionate at 150mg every two weeks, then in two months we will draw blood and check T levels and readjust if we have to.”

I then asked about the effects he expects and he told me the general increased libido, attitude, energy, etc. I asked if it will have any effect on a strict weight training program and diet i’m on and if it will affect my weight loss or muscle gain and he said no it wonâ??t effect that. So then he tells me okay i’m going to prescribe you the vial and I want you to bring it in every two weeks to your appointment and i’ll see you in two months. Thanks bye!

By this point I was pretty upset but also eager to begin TRT to help facilitate weight loss and help increase my mood and energy levels and such. So I got the 150mg shot and decided to turn here for insight.
So now i’m hoping that he prescribed me the vial of T which means I can self-administer if this board directs me too. I’ also planning to bring in multiple peer reviewed studies on Aromastaze Inhibitors and there effect on Estradiol and application with TRT and get him to prescribe me an AI but that wonâ??t be for two months.

Thoughts on this situation/doctor/TRT/anything else?

Sorry for the super long post but I felt it necessary to explain my situation
Thanks for everything you guys do

You must have saw one of the doctors I saw in past - lol . But seriously , you have valid concern with AI . I could not get rx for one and was forced to buy via Internet chemical research company . Also you will need once a week injections minimum . 100 mg per week is usual dose . I would try another dr that would support self administer of rx at home -

I agree with sir toddington. Self administer at home more frequent is the way to go 100mg per wk or 50mg twice per week to minimize spikes. Do you have to pay a co pay at every injection?

[quote]krazymatt wrote:
I agree with sir toddington. Self administer at home more frequent is the way to go 100mg per wk or 50mg twice per week to minimize spikes. Do you have to pay a co pay at every injection?[/quote]

No, problem is my doctor might not go for it and wont prescribe me arimidex or an hcg and is ignorant as fuck and brushes off my input like its some bizarre backwater shit. He has me on 100mg once every two weeks and a check up appointment in 2 months to check T levels. Should I just wait for that appointment and bring up arimidex, self administration, more frequent administration, and other concerns or should I schedule and appointment right away and again try to re-address these issues?

I think you desperately need to find a new doctor. This doctor does not sound invested in your problem, or in helping you find the root of it. To say you have neither primary nor secondary hypogonadism makes no sense. If you are not producing enough Testosterone then you have to have one or the other.

Primary meaning your testes are not functioning properly for some reason and secondary meaning something is wrong with the function that is responsible for sending the hormones that signal your Leyding cellls (in your testes) to produce natural testosterone. At your age it is not something you want to deal with I’m sure, but I’m glad you are doing it now rather than in ten years.

I felt much like you in my teens and twenties. Im now thirty-four and just had my levels checked about five weeks ago. I’ll elaborate on my situation later.
I’m wondering what your test results were? You can often figure out by interpreting your own results whether you are primary or secondary. High levels of FSH and LH with low T is indicative of a primary problem because you are producing enough of the hormones that signal your body to make your own T. If FSH and LH levels are low to low-normal, with low T, then it is likely secondary hypogonadism and you can explore what is causing your pituitary to have an imbalance.

Also, through a blood test you can check your Prolactin levels. High Prolactin in males causes many symptoms and makes T levels plummet. Low levels of FSH LH and high Prolactin levels would be reasons to explore if there is a pituitary problem, such as an adenoma (tumor). This can be checked through an MRI of your brain.

If your doctor did not give you a copy of your results then you must call and request (demand) it. I have a very good doctor, but I’ve realized that even in saying that I can get more information online. I then guide him in the right direction and he is able to make things happen. Such as the MRI.
It sounds to me like your doctor gave you a RX for Testosterone Cypionate? You are right about the topicals. My doctor first suggested Androgel and I imeediately asked for IM Cypionate. He agreed and also prescribed a topical. I chose Axiron as an alternative to Androgel because it is applied to the Axilla (armpit) which reduces the chance of transfer.
My total test level on my first blood test was 152.8 (175-781 reference range). I had always suspected I had some type of problem. I say this because my genitals did not gain much size through puberty and I never grew much body or facial hair. However, I never had a problem sexually or with libido. Also, I impregnated two different women so I know everything works. However, I had all the other symptoms of low T. Such as lack of energy, drive, self confidence, and over all well being. Just to name a few.

For a long time I used recreation drugs to mask the way I was feeling. This only exacerbates the problem from what I understand. Since starting the Axiron and bi-weekly cypionate shots (200mg/ml) my test level has gone from 152 to 563 (reference 175-781) I am in week five and since the beginning of the week my doctor discontinued the Axiron. He actually wanted to stop the injections, but I pleaded with him to stop the Axiron instead and he agreed.
I haven’t noticed a huge difference in body composition (I too carry a lot of extra abdominal fat), but I must say I feel drastically different. My overall mood, self-confidence, and drive have improved. As far as sex drive it has always been great, but now it is even better. My girlfriend is extremely attractive and that helps, but throughout the day I’ve noticed I constantly have erections and I’m constantly mind fucking all the women at work. I don’t mean that in a sick way, but it’s true! I’m sure you know what I’m talking about.
Anyhow, I could post all my info as I’ve been wanting to do that, but this is your thread so I’ll hold off. I just wanted to tell you a couple things…

As I said earlier I suggest you find a new doctor. If not, make sure you get your results and do the foot work yourself so you can know what you want out of your doctor. The fact of the matter is it is fairly simple the way hormones work in the body and once you’ve learned all about it you can interpret your own results better as well as any doctor. The most important thing I think is to be informed and just use the doctor as a vehicle to get the RX, treatments, etc. that you are interested in. A lot of people say they need to inject weekly rather than bi-weekly, but to be honest I haven’t noticed a drop off before the two weeks are up. This could be due to the fac that I was using Axiron on top of the injections. I’ll find out next week when I take a blood test. I will have been relying solely on the injections for two weeks at that point. While I’m thinking of it I want to mention that Costco sells 10ml (200mg/ml) vials of Test Cypionate for $66.00. CVS is $111.99 and local pharmacies will be even more than that. Ten ml. is effectively 20 weeks of 200mg bi weekly or 100mg weekly. If you divide the $66. its 3.00 and change a week. Topicals are several hundred dollars a month without insurance, and even with insurance are your highest copay tier.
You are correct in wanting the injections as opposed to the topicals, but if you can get both you may want to try that. My numbers went up drastically in a matter of weeks with both. If my test was 563 after ten days (when I had it checked it had been ten days since my last shot) then I would imaging they were much higher for the first week or so following the injection.

As for an AI you shouldn’t need one. I know you said you felt like your estrogen levels have always been high. You can confirm that either way by looking at your Estradiol E2 level on your blood work. It is standard on most hormone tests, as are the others I mentioned earlier (FsH, LH, etc.) If your estradiol is real high then it would be cause for your doctor to prescribe an AI. If it is not high, then i wouldn’t think you need it. From the reearch I have done, I would not think you have to worry about that amount of testosterone coverting to estrogen. That being said everybody’s body works differently. The only way to be sure is to have your E levels checked. E2 is the easiest and most common way to test this.
If you have low test naturally then just an AI may not help. It makes sense that HCG may stimulate your Leydig cells enough to produce more test, but you wouldn’t be able to say if thats a possibility without knowing your FSH and LH levels. They may already be high? If they are low, however, I would want to explore HCG or another option before carrying on with the testosterone treatment. This is something I regret not doing. However, once you start you cant get an accurate reading of these levels due to the exogenous test shutting down your normal production. I would want to see my original test results to get an idea of whats going on with my body. If you’ve already started TRT and he didn’t originally test you for these things, then he really screwed you over. My best advice to you is get a copy of the tests asap and go from there. Sorry if my comments have been boring and tiresome, but I hope some of it helps. It sounds like you have ruled out the thyroid as an issue but it may be a pituitary problem as this is the gland responsible for these specific hormones (TEST, LH, FSH, ESTRADIOL,PREGESTERONE).
One other suggestion after re-reading your post is to consider taking 100mg weekly rather than 75mg. You can do 200 bi-weekly or 100mg weekly (like I said everybody swears they need to do inject weekly as opposed to bi-weekly). Injecting weekly actually makes more sense when I think about it and if you have the vial at home you may as well. As for your doc asking you to bring the vial with you that isn’t a problem. If you are taking 200m instead of 150mg and your test levels are within range then he can’t have a problem with it. As for the difference being visible it will not be. Once your levels go up and are within range just tell him you increased it and your numbers should justify that. Or you can stick with the 150mg bi-weekly dose, but with my experience in these last weeks and from what I’ve read that’s just not going to cut it. My levels at 562 are still a little low for age 34 and I’m doing 200mg bi-weekly and that was also with Axiron daily. I’m assuming I may need to increase the amount of CYP I’m using once I see how this blood test I’m getting next week turns out.

Hope some of this helped and I hope you are starting to feel the difference with the treatment. You are on the right track for sure. Best of luck…

Wow Speter, thank you for the time and input you put into my situation. I really appreciate it.

  • Seeing as I have already started the TRT am I now fucked for trying to find the root cause of this?
  • My doctor said that he wants my T levels to be about 500 - 600 which seemed low for a 22 year old. Thoughts?
  • I had 150mg of Test C injected on 9-12-13 and haven’t noticed a change in my mood, libido, confidence, or anything, I basically feel no different from before the shot. Will it take a couple shots to notice its affects?
  • Would you please bullet point your main insights regarding my case so I can easily reference them?
  • do these docs make profit off the gels and thats why mine pushed it so hard?

I am meeting with my doc in two months to go over my T levels then, I did draw blood for a Metabolic blood count and a General hormone panel too I believe were the two panels he drew blood for before he decided to go ahead and give me the shot. Should have those results soon!

I also was addicted to illegal drugs from 15-22 because of my symptoms and general feeling of shit which I now believe was due to low T.
Its amazing how similar our stories are despite my doctor being an idiot.

Thank you very much for taking the time to read my topic and type up a response of your own. I really do appreciate the input man as I’m new to all of this. We do have a lot in common besides your cooperating doctor and my ignorant one. I too suffered from illegal drug addiction, particularly opiates, to mask the symptoms I now realized were from Low T. My genitalia are the appropriate size but my penis was severely hampered in the growth Dept.

Yes my doctor prescribed me Test Cypionate at 150mg every two weeks. I had my first shot on 9-12-13. he drew blood after he decided to start TRT and when I asked what he would be checking he said a General Blood Count and a Metabolic Blood Count. When I have those results I will post them. My first two labs were for T3 T4 and Total T. I don’t have the results in front of me but the T3 and T4 were in “range” but the total T was 292. Does this lead you to believe It’s secondary or primary?

I haven’t noticed any major changes in attitude, mode, motivation or self confidence yet. In fact, I feel almost the same as I did before the Test dose. Does this bring any assumptions to your mind about dosage or anything else?

When is an appropriate level to get on an AI if 150mg every two weeks isn’t worth it? Is there any reason not to be on one just in case?

Please feel free to give me more feedback and thanks again it really cleared the air on a lot of issues and made me feel not so alone in this TRT ordeal.

Thanks Friend.

I responded to this like three times, but the response never made it online. Not sure if this will either, but I’ll give it one last shot. I may make it brief only because I literrally reponded three other times!

  • Seeing as I have already started the TRT am I now fucked for trying to find the root cause of this?
    Not necessarily…From what you said your doc did a hormone panel prior to you getting your first IM injection. That info can lead you in the right direction. Please post these results asap. When you see your doc demand a copy of all your test work. They can print it there no problem.

If you’re interested in trying to fix the problem before getting dependent on TRT I would suggest not taking another injection. Once your body gets used to the exogenous test then natural production shuts down. This will make it difficult to try and tune your own system because its like taking the battery out of a laptop and running it on the cord. As soon as you remove the cord the laptop is shut down. However, unlike a computer, you cant start your own production by simply putting the battery back in. Having only had one injection your body is most likely not shut down yet, especially at such a low dose.

-My doctor said that he wants my T levels to be about 500 - 600 which seemed low for a 22 year old. Thoughts
I started at 152 and I’m now at 563. I feel pretty damn good. Although you are 12 years younger, the differences in optimal levels are not so vast, especially when you are talking about adding hundreds to your total serum level.

The only way to know for sure is to see how you feel at that number, but it is definitely a great goal for now. It would be double what you’re starting with.

-I had 150mg of Test C injected on 9-12-13 and haven’t noticed a change in my mood, libido, confidence, or anything, I basically feel no different from before the shot. Will it take a couple shots to notice its affects?
It’s been five days now, and I’m wondering if you feel anything. I had at five days. The first couple of weeks I noticed a difference physically when it came to mood, libido, and overall energy.

Don’t get discouraged it takes time and the effects are very subtle with the doses we are on. After five weeks I have noticed a change in self-confidence, emotional stability, as well as the physcial benefits.

It may be due to the low dose. I was on 200mg/ml bi weekly with axiron daily. So, I was getting more than twice what you are and I barely got to 563 in one month. I would ask to increase the dose without a doubt. I would tell him you want to do the injections yourself.

-Would you please bullet point your main insights regarding my case so I can easily reference them?

  • do these docs make profit off the gels and thats why mine pushed it so hard
    The docs are what they say “in bed” with the pharmaceutical companies. While they don’t directly profit from writing you a RX for a specific topical, each doc has a pharmaceitucal rep for the companies who make the stuff. Believe this…they do “nice” things for the docs. bring them lunch promos, etc. I’m sure depending on the docs specialty and number of RX’s he could potentially be writing, they make do more or less for the doc.

That is how the chain works…the RX companies come in and push their product and the docs write RX for tha product and the cycle continues.
I find if you know what you want they can’t really push a certain brand or product on you. Most topicals have a patent which means there is no generic. This is why they often want to use topicals over injectables. The injectables are generic and very cheap. Costco has a 10ml bottle of Test Cyp for $66.00. That’s less than 3.00 a week at your dose.

My doc wanted to use Androgel but I told him everything I read says Test Cyp is better so he agreed. Thats when he offered the topical as well and I asked for Axiron instead. This is because it is applied to the armpit and has less chance of transfer to others.

-haven’t noticed any major changes in attitude, mode, motivation or self confidence yet. In fact, I feel almost the same as I did before the Test dose. Does this bring any assumptions to your mind about dosage or anything else?
I think 75 mg a week (150mg bi weekly) is much too low. Again, I am on 200mg bi weekly and was also using a topical every day to get to 563 in one month.

I would suggest a higher dose and/or adding a topical. Your test results will confirm this assumption, or prove it wrong. I would request blood work each time you go in. this is to make sure your dose is right and also to check for other things. see below

-When is an appropriate level to get on an AI if 150mg every two weeks isn’t worth it? Is there any reason not to be on one just in case?
If your estradiol E2 level is high then you nee an AI to make sure it doesnt convert to estrogen. However, you need estrogen as well. So, yes, adding one for the hell of it can cause a problem. If your body doesn’t aromatase what it needs to and you have too little estrogen then you can suffer from some of the same symptoms.

With my dose my E2 levels are still good. If they go up I will add one. None of this stuff happens overnight. What I mean is you have time to add an AI and don’t have to worry so much. When you get your next blood test check your E2 level and discuss with your doc or here online to see if your assumption is right. I sincerely doubt you would need an AI. WHen it comes to TRT unless you are using real high amounts your E2 levels usually stay in check.

You will see all kinds of info from people who take it as part of their normal regimen, but good luck getting yoru physicain to prescribe it. Most of these guys are going to TRT anti-aging doctors and spending cash. So the doc uses it and they feel they are getting state of the art treatment. With that being said however, if your hormone levels call for it then your doc wil give i to you.

It’s really a balancing act with everything and it all takes time
----Don’t be discouraged if you haven’t noticed much. Once your numbers get up there you will know there is a difference. I may just take time and more fine tuning with your doc. Sounds like hes opted to take a slow, careful approach. Either way once you’re numbers are at 500-600 you will feel different. And make sure he doesnt test real soon after your injectin.

Whether you end up going weekly or bi weeily your test shoudl be half way mark between shots. This is to get the most accurate reading as your levels will be spiked right after your injection.
Let me know if I missed any of your questions… Hope this helped some.