Go Ahead for TRT or Other Therapy?

Hi all,

First of all thanks for making this huge resource which is very useful for all kinds of people.

Let me write about my query, I am a 30 yr old male. I am quite active and workout with weights regularly. I consider myself healthy and fit, with only little fat. Apart from this I sometimes have some fatigue symptoms, most of which are not that consistent but will still persist. I especially suffer from sleepiness especially after carb rich meals. I did run bloods in the past and all was fine, however no hormones were assayed.

About 2 years ago I ran a couple of AAS cycles, ran these using correct protocols, PCT, etc. The following months I started to have more fatigue related episodes. I ran some tests and found that there was some thyroid issues. After a couple of months (must have been some 3 months+ since I finished the PCT) I also checked testosterone levels, which were low.

I always had some suspect that I might have low testosterone, however there were no strong symptoms.
Libido/erections were ok, energy was ok apart from that bad day, and the usual sleepiness.

I then visited an endocrinologist who ordered tests. After which he suggested starting TRT with Test E, 250mg every month. I started this but, after a couple of months began taking 100mg every week as many here do and a divided 1mg arimidex tab twice a week. I told this to the endo and he’s ordered Nebido to avoid the frequent injections and fluctuations.
I have also tried using Pregnenolone too but didn’t feel any effect. I’m also undecided if I should use HCG.
I have not done much blood checking after starting TRT but I am feeling better. Most improvements were mental (focus, drive, etc) more than physical.
I will run a follow up port trt blood test next week.

I shall post blood tests that were taken before the TRT started, so you can get an idea of how it was:

Free T4 (Serum) 9.94 L [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 1.680 [0.3-3 mIU/L] Final

Free T4 (Serum) 13.10 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 3.720 H [0.3-3 mIU/L] Final

Free T4 (Serum) 12.40 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 3.300 H [0.3-3 mIU/L] Final

Free T4 (Serum) 13.50 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 1.520 [0.3-3 mIU/L] Final

Free T4 (Serum) 12.90 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 4.580 H [0.3-3 mIU/L] Final

Last test

Free T4 (Serum) 11.10 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 2.130 [0.3-3 mIU/L] Final
Free T3 (Serum) 6.25 [2.76-6.45 pmol/L] Final

I suspect that I might have been Iodine deficient in the previous tests. Last test and since I have been taking a multivitamin with Iodine. I did take multivitamin in the previous tests but they were less strong.

Hormone tests:

FSH 1.2
LH 2.2
PRL 354.7
Test 7.0

Oestradiol (Serum) 104.0 [0-206 pmol/L] Final
FSH (Serum) 1.9 [0.7-11.1 U/L] Final
Growth Hormone (Serum) 0.07 [0-3 ug/L] Final
Luteinising Hormone (Serum) 1.2 [0.8-7.6 U/L] Final
Prolactin (Serum) 136.0 [53-360 mU/L] Final
Total Testosterone 9.36 [5.55-25.2 nmol/L] Final
Cortisol AM (Serum) 372 [119-618 nmol/L] Final
DHEAS (Serum) 6.89 [2.17-15.2 umol/L] Final

Total Testosterone 8.98 [5.55-25.2 nmol/L] Final
Luteinising Hormone (Serum) 2.4 [0.8-7.6 U/L] Final
Progesterone (Serum) <0.64 L [0.86-2.9 nmol/L] Final
Oestradiol (Serum) 110.0 [0-206 pmol/L] Final
Cortisol AM (Serum) 331 [119-618 nmol/L] Final
FSH (Serum) 2.7 [0.7-11.1 U/L] Final
Prolactin (Serum) 164.0 [53-360 mU/L] Final

A bone density test was also ordered and Femoral neck was -1.4 and Spine -1.8
Other tests such as an EEG, ECG, chest x-ray and brain MRI were all ‘OK’.
Blood pressure is 120/80.
Have quite a hairy body and got my gf pregnant easily during the months i had these labs.

A separate doctor ordered a sleep study which resulted fine, but none the less he suspected narcolepsy and prescribed Modafinil, which although helps I feel is not the solution.
So apart from the lab showing low test and low bone density, I dont have much low t symptoms except for occasional lethargy.

Do you think that I need to run any other bloods extra to the ones taken, and is it necessary that I run trt, or can I restart the HPTA and maybe get acceptable natural test levels, if test suppression was caused with the AAS use, unless this is a genetic issue.

Thanks for any feedback.

TSH should be closer to 1.0
fT3 and fT4 should be near mid-range.
How has stress been a factor in your life?

DHEA-S is low for your age. - adrenals
Take 25mg DHEA ED

E2 should be closer to 80 pmol/L and is way to high relative to FT.
E2 clearance by liver is suspect. Test AST/ALT and stop lifting for 3-4 days prior.

Do not eat iron fortified foods, breads, cereals, vitamins

Please follow these links found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics explained - POST ORAL BODY TEMPERATURES AS SUGGESTED

Low thyroid function can cause lethargy.
What is your history, years, of using iodized salt and/or vitamins listing iodine+selenium

fasting glucose
fasting cholesterol
Vit-D25 or take 5,000 - 6,000iu Vit-D3

Dear KSman, thanks for your reply.

I have moments of stress, but I don’t think they are serious enough to cause issues. Could be sleep related maybe? Since I sometimes wake during the night’s sleep.

I’ll order DHEA, as recommended. What about my Progesterone level, Is that OK? I had also tried supplementing Pregnenolone but felt no effect.

Last ALT result was: ALT (Serum) 24 [5-41 U/l] - which looks OK? I will a have updated results soon. I also refrain from training for some days before bloods. Can you have a look at the blood tests shown above fore more general info?

Btw, since it was not clear in my post - SHBG was 25.70 prior to starting TRT.

Typical fasting glucose levels, around 5mmol/l
A1C: 35mmol/l or 5.3%

Last fasting cholesterol results:
Cholesterol (Serum) 4.02 [2.0-5.0 mmol/l]
HDL Cholesterol (Serum) 1.31 [0.9-1.45 mmol/l]
LDL Cholesterol (Calculated) 2.38 [mmol/l]
Non HDL Cholesterol 2.71 [0.00-3.36 mmol/l]
Total:HDL Cholesterol Ratio (Calculated) 3.07
Triglyceride (Serum) 0.72 [0.1-2.26 mmol/l]

Morning oral temperature never exceeded 36.5 C. Tried this again during different times in a couple of days and I’m always in the same region between 36.5/36.6C. Tried different thermometers.

I have taken a blood test today which included test, e2, Vit-D25 and other stuff. I will update results here.

I have been taking multivitamins for years, but the current type I’m using for the last 2 years has a daily dose of 240mg Iodine, Selenium 150mcg, strong in B vitamins, but also contains 8mg Iron.
I also take extra Calcium, Magnesium, Zinc and Vitamin D, 4000mg Fish Oil, Whey protein, creatine and glutamine.

Could it be that I have low test due to some E2 or Progesterone/DHEA issue or other deficiency, and may get better T levels by doing an HPTA restart and supplementing DHEA and maybe arimidex?

Once again thanks for your attention and help.

Hi again,

Got lab tests result if you’d like to have a look:

Bicarbonate (Serum) - 26.1
Glucose - Fasting (Plasma) - 4.81 [3.88-6.38 mmol/l]
Alkaline Phosphatase (Serum) - 64 [0-129 U/l]
ALT (Serum) - 26 [5-41 U/l]
Bilirubin (Serum) - 8.9 [0-21 umol/l]
Gamma Glutamyl Transferase (Serum) - 23 [8-61 U/l]
CEA (Centaur) - <0.5 [0-2.5 ng/mL]
PSA (Centaur) - 0.91 [0-4 ng/mL]
Total 25 (OH) Vitamin D (Serum) - 33 [30-100 ng/mL]
Oestradiol (Centaur) - 134 [0-146 pmol/L]
Total Testosterone - 24.00 [2.5-29.57 nmol/L]
Progesterone (Serum) - <0.64 L [0.86-2.9 nmol/L]
Cortisol AM (Serum) - 295 [145-619 nmol/L]
Fibrinogen Assay - 3.84 [2.00-3.93 g/l]
C3 (Serum) - 1262 [900-1800 mg/l]
C4 (Serum) - 346 [100-400 mg/l]
Basophils Abs - 0.03 [0.00-0.10 x10^9 /L]
Eosinophils Abs - 0.20 [0.10-0.70 x10^9 /L]
Haematocrit - 48.8 [40.4-50.4 %]
Haemoglobin - 16.9 [14.1-17.2 g /dL]
Immature Granulocytes - 0.03 [0.00-0.09 x10^9/L]
Lymphocytes Abs - 1.69 [1.30-3.60 x10^9 /L]
Mean Cell Hb - 29.2 [27.0-32.0 pg]
Mean Cell Hb Conc - 34.6 [33.0-36.0 g/dL]
Mean Cell Volume - 84.4 [79.0-93.0 fL]
Mean Platelet Volume - 9.9 [9.2-12.6 fL]
Monocytes Abs - 0.45 [0.40-1.10 x10^9 /L]
Neutrophils Abs - 4.64 [2.10-7.20 x10^9/L]
Nucleated Red Blood Cells - 0.00 [0.00-0.01 x10^9/L]
Platelets - 264 [146-302 x10^9/L]
Red Cell Count - 5.78 [4.60-5.90 x10^12 /L]
Red Cell Distribution Width 12.1 [11.9-14.6 %]
White Blood Cell Count 7.04 [4.30-11.40 10^9/L]

Any further advise please?