T Nation

Help Me Understand How to Do This Right

I am 5 weeks into TRT therapy through a “men’s health” place. I have been (per instructions) injecting 50mg of test cypionate once weekly. I feel slightly more energy and slightly increased libido thus far but have not experience the full results that I anticipated.

This was brought on by an increasing loss of energy, libido, and increased depression over the last 2+ years to the point that it was effecting my marriage and other parts of my life.

A couple things of note:

_I was diagnosed with low T (300’s) when I was 36 but the possible loss of fertility made that not an option at the time. _

I was diagnosed with slight gyno when I was a teen.

I am due back for another blood test at 6 weeks. I am concerned that maybe I should be a. On 100 mg a week b. Supplementing with HCG as well due to potential pituitary issues that may have caused the gyro/low T issues at a younger age.

The “men’s health” place, has one token Doc and other “salesmen”. I rushed into signing up for an expensive plan based on referrals from a couple buddies and my desperation, I feel like maybe they started me low so they can maintain better profit margins.

-age - 41

-height - 5’10

-waist - 40 in

-weight 250 lbs

-describe body and facial hair - hairy legs, small amount of belly/chest hair, full, thick beard, thick, full head of hair

-describe where you carry fat and how changed - stocky build, carry weight well throughout body, no changes yet

-health conditions, symptoms - high cholesterol (around 300 total), BP 140/80ish

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - off and on again statin drugs (Crestor)

-describe diet [some create substantial damage with starvation diets] - recently engaged in Keto eating lifestyle, off and on poor diet over the years

-describe training- none to currently speak of, lots of lifting in my teens and 20’s

-testes ache, ever, with a fever? No

-how have morning wood and nocturnal erections changed - definitely seeing an increase in morning wood

Initial LabCorp labs:

WBC - 8.8 (3.4-10.8)
RBC - 4.85 (4.14-5.80)
Hemoglobin - 13.9 (13.0-17.7)
Hematocrit - 41.6 (37.5-51.0)
MCV - 86 (79-97)
MCH - 28.7 (26.6-33.0)
MCHC - 33.4 (31.5-35.7)
RDW - 13.2 (12.3-15.4)
Platelets - 276 (150-379)

Glucose - 88 (65-99)
BUN - 14 (6-24)
Creatine - .77 (.76-1.27)
eGFR- 114 (>59)
Sodium - 143 (134-144)
Pottasium - 5.0 (3.5-5.2)
Chloride - 100 (96-106)
Carbon dioxide total - 19 (20-29)
Calcium - 9.6 (8.7-10.2)
Protein, total - 7.4 (6.0-8.5)
Albumin - 4.7 (3.5-5.5)
Globulin, total - 2.7 (1.5-4.5)
A/G ratio - 1.7 (1.2-2.2)
Alkaline phosphate - 272 (39-117)
AST - 69 (0-40)
ALT - 101 (0-44)

Testosterone, serum - 218 (264-916)
Free testosterone (direct) - 5.5 (6.8-21.5)

Estradiol - 25.8 (7.6-42.6)

Prostate specific AG. Serum - 0.8 (0.0-4.0)

Any advice, information or experience you can share would be great.

I would like to have more intelligent conversations with the doctors and/or know when it’s time to find anew one.

Are there other blood tests? Thyroid, FSH, LH, prolactin, DHEA-S, IGF-1, VitD?

Correct, no way 50mg per week will be enough. I think you should have started at ~150mg, but 100 would have been OK. I think 50 is a waste of time. I’m not aware of anyone on that low of a dose.

Why hCG? Only two reasons, maintain testicular size, though some do not experience atrophy, or maintain fertility.

My guess is they will increase your dose following your labs. It is unfortunate you do not have confidence in your doctor, not that you should in this instance.

Difficult to expand further without complete labs.

I think this is what happened to me when I started TRT. Initially going on replacement shut down my testes therefore my levels didn’t increase appreciably. Doctor increased the dose and now I am fine.

I get testicular atrophy but it took a year or so of TRT to realize the problem and get HCG.

Yeah about that, it’s going to take several months or likely longer to see the full benefits of TRT as your tissues are damaged from low T and it’s going to take time to repair those tissues.

Onset of effects of testosterone treatment and time span until maximum effects are achieved

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These are the only labs they tested for, I pulled the data straight off the sheet.

There are a lot of men who come here with thyroid problems and low T, doctors aren’t even looking at the free active thyroid hormones. If Free T3 is low or a combination of good Free T3 and high Reverse T3, then those onset of effects will not happen for you.

Free T3 (not TSH or Free T4) increases metabolism and body temperatures, a lower metabolism and body temperatures would mean your body isn’t metabolizing testosterone and the positive effects of testosterone cannot work if metabolism and body temperatures aren’t optimal.

TSH >2.5 is indicating a problem, Free T3 needs to be midrange or better and Reverse T3 <15 ng/dL. A high Reverse T3 can prevent Free T3 from soaking into your cells no matter how high Free T3 may be.

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You need more test and injecting more often to reduce peaks and valleys in your blood levels. I was on this dose from one of my idiot Docs. Felt like shit. That’s when I decided to treat myself. In the last 4 years, I’ve recomped my body and lost a lot of fat and added muscle.

I think you’re right about them making you into a profit margin. I’d try to find a new Doc.

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