OK, new guy trying to hack my current, just-begun TRT approach.
--has recommended TRT for a few yrs but have held off until now because of fertility issues.
--says indirect via clomid won't work b/c natural FSH already pegged high to no avail
--just wrote Rx for 100mg/wk cyp IM, targeting 700-800 total T.
--when asked about HCG/HMG to preserve testicular size & sperm count, said not good because requires EOD IM injections (=hassle) & insurance probably won't pay.
--soft-pedaled concerns about shrinking testes and ejac volume, saying he doesn't see it much in his pts & not big concern b/c not boosting above physio levels.
--says doesn't measure free T because calculation via Total T & SHBG levels give more accuracy than the typical direct assays
--doesn't want to do Arimidex unless/until E2 levels become concern...leery b/c of side fx, also says AI not a natural hormone like T, and therefore is more of an intervention than merely supplementing T.
We'll see how I do on the main TRT regimen... but what (if anything) is the best way to preserve the boys, ejac volume & swimmers--HCG? HMG? Clomid? nolvadex? Something else? Already saw from reading here that HCG could go subQ, which I'd be OK with doing EOD
If my doc isn't receptive to mods, is there a good SF/Oakland/norcal alternative who might take insurance?
Here are the vitals/history/labs as asked for in the noob sticky:
-describe body and facial hair: tall, overweight [but no longer obese], somewhere between meso and endo type. Full beard/mustache, fairly hirsute overall.
-describe where you carry fat and how changed: primarily abdominal, also back, face, upper thighs. I recently lost 115 lbs thru eating LCHF & walking, but am sorta stuck with another ~30 lb yet to go (stubborn beer gut)... which I hope TRT will help resolve.
-health conditions, symptoms [history]:
History of classic "diabesity"--ie., borderline T2D fasting BG, morbidly obese, high blood pressure, lower leg edema. Also severe obstructive sleep apnea, GERD, frequent URIs, migraines, fatigue, low libido & mild depression.
All of the above symptoms have largely disappeared with weight loss, except for the low libido, depressive outlook and motivational issues. Low T (in ~330 range) was confirmed 3 years ago and remains low; I now suspect it's been an issue for much longer. I apparently have one testicle w/ abnormally low volume--possibly related to varicocele and birth-related physical trauma.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
No to last 2 items. Prior to changing diet, I took many meds--ssri, ppi & bulk antacids, beta-blocker, nasal decongestant sprays--but weaned off all in 2011 as I lost weight and am drug free since start of 2012. I have zero history with any kind of AAS cycling but did once take Clomid for about 5 weeks (see below).
-lab results with ranges
December 2009 (NB: body weight 325lb)
E2 43 pg/mL [10-50]
FSH 9.2 mIU/mL [2-12]
LH 6.5 mIU/mL [<10]
TSH 2.28 uIU/mL [0.40-4.0]
Prolactin 7 ng/mL [2.6-13.1]
Total T 338 ng/dL [200-1200]
PSA 0.5 ng/mL [<4.00]
SHBG 20 nmol/L [10-60]
Feb 2010 (NB: body weight 330lb and after TAKING CLOMID 50mg EOD for 5 weeks)
E2 51 pg/mL [10-50]
FSH 14.0 mIU/mL [2-12]
Total T 701 ng/dL [200-1200]
Fasting BG: 105 mg/dL [70-100]
TChol 262 mg/dL [0-199]
Triglycerides 208 mg/dL [20-150]
LDL (direct measured) 205 mg/dL [<130]
HDL 33 mg/dL [>35]
I stopped clomid in Feb 2010 and haven't taken it since
June 2012--baseline before TRT (body wt 230lb):
E2 40 pg/mL [20-75]
FSH 14.7 mIU/mL [1.3-19.3]
LH 3.1 mIU/mL [1.2-8.6]
TSH 1.74 mIU/L [0.45-4.5]
Prolactin 2.0 ng/mL [2.6-13.1]
Total T 341 ng/dL [175-781]
PSA 0.36 ng/mL [0.00-4.00]
SHBG 38.70 nmol/L [13.3-89.5]
Free T (calc) 61.8 pg/mL
August 8: began T cyp IM 100mg/wk
Aug 31 2012--3 weeks into TRT 100mg/wk (body wt 230lb):
E2 not reported
FSH not reported
LH not reported
TSH 1.73 mIU/L [0.45-4.50]
T4, Free 0.98 ng/dL [0.60-1.20]
Prolactin not reported
Total T 764 ng/dL [175-781]
PSA not reported
SHBG not reported
Fasting BG: 94 mg/dL [70-100]
HbA1c 5.1% [4.6-6.2]
TChol 208 mg/dL [0-199]
Triglycerides 35 mg/dL [20-150]
LDL (Friedewald calc) 155 mg/dL [<130]
LDL (Iranian calc) 113
HDL 46 mg/dL [>35]
Sep 5 2012 - began 250IU hCG SQ EOD to combat receding & pain
Sep 12 2012--5 weeks into TRT 100mg/wk & 1wk of 250IU hGC EOD (body wt 230lb):
This is day 7 just before weekly T injection
E2 44 pg/mL [20-75]
FSH 0.4 mIU/mL [1.3-19.3]
LH <0.2 mIU/mL [1.2-8.6]
Total T 615 ng/dL [175-781]
SHBG 40.8 nmol/L [13.3-89.5]
Free T (calc) 118 pg/mL
Sep 13 2012--5 weeks into TRT 100mg/wk & 1wk of 250IU hGC EOD (body wt 230lb):
This is 1 day (24h) after weekly T injection
E2 48 pg/mL [20-75]
FSH 0.6 mIU/mL [1.3-19.3]
LH 0.2 mIU/mL [1.2-8.6]
Total T 776 ng/dL [175-781]
SHBG 41.6 nmol/L [13.3-89.5]
Free T (calc) 154 pg/mL
from 2000-3500 total daily calories, 66% fat, 12-15% protein, total carbs capped at 50-100gr/day
whole meats, fish, nuts, eggs, low-starch vegetables, low-glycemic fruit, fermented full-fat dairy;
NO grains, bulk sugars, milk/soda/fruit juice, corn, legumes, soy, vegetable oils, or processed food.
I try for organic/pastured stuff, but am not fanatical about it. If it comes in a box or has more than 3-4 ingredients, I probably don't eat it. My natural tendency is to fast ~20 hours and consume bulk of calories in one evening "window".
I hike, a LOT. Started walking daily along with diet change and worked up to longer distances & hills. Currently I walk up a steep 4.5-mile trail and back down 3-5x per week (2500' gain with most of it in 1st & last miles) and do a flat 6-miler other nights with the wife. I just hit 1000 total miles for the year. I don't lift, but I know I should--legs look great; upper body, not so much. I don't run or do any "chronic" max-HR cardio, nor do I intend to. With weight plateauing, however, I do plan to start HIIT (sprinting or hill repeats) approx once/wk.
-testes ache, ever, with a fever?
EDIT 8/17: 2 weeks in, am experiencing aching and pullback...no fever though.
EDIT 9/21: hCG has helped some with these symptoms
-how have morning wood and nocturnal erections changed
reliable MW, dunno about nocturnal.
EDIT 9/6: update labs, add lipid panels.
EDIT 9/21: update labs.