T Nation

Help with Disappointing First Test Results

Hey guys. Got my first set of bloods done after 6.5 weeks on TRT and they weren’t what I hoped for.

Protocol is 30mg Test E EOD (105mg per week) and 250iu HCG EOD. Both SubQ and on alternating days.

Reason for starting TRT is I came off Finasteride due to sides after 3.5 years. My test levels predictably crashed. Gave it 3 months to recover whilst feeling pretty awful and still no improvement so started TRT and happy to commit for life.

November 2019 (On Finasteride). Total Test 19.2 nmol/L

Feb 2020 (3 months after quitting Finasteride). Total Test 13.1 nmol/L

April 2020 (6.5 weeks after starting TRT). Total Test 16.2 nmol/L

My level is lower than before I was on TRT! Also concerning FSH and LH are so low when I am using HCG. Is this normal?

Cortisol being high. Whilst I have felt generally better since starting TRT I don’t feel great and the main time I feel bad is first thing in a morning. Very on edge, slightly neurotic and just don’t feel good. Any tips or advice regarding this?

I am clearly going to up my T dose as was hoping to be more in the 25 nmol/L range. Maybe try 45mg EOD to start?

Things to note. Healthy lifestyle, lift heavy 4x per week. 6ft, 168lbs, 11% BF, low stress job, healthy diet, try to get 8hrs sleep per night. Due to Corona virus it wasn’t a hospital blood test, but it was the same test as I did in November and Feb and followed the rules of taking the blood sample first thing after some water etc.

Many thanks in advance!!

Very normal.

Total test is not as important as free test. What are the differences between FT and SHBG before and after starting trt? Those will tell you a lot about whether or not your protocol is working well. (Also, being less than two months in it’s hard to expect things to be just right; some guys take a while to dial in, so don’t be discouraged)

Thanks for the response. Glad to hear the FSH and LH results are to be expected so thats one thing I can put to one side.

Unfortunately the tests I did prior didn’t include FT or SHBG.

If you don’t mind I have a more general question trying to get my head around the shutdown of natural test situation. Are the results I have now indicative of only the exogenous test I am injecting with zero natural contribution? Or as I am using HCG are they a combo of my natural production plus exogenous test? Unsure on how that relationship works as know HCG keeps testes working but are they still producing test or just semen for fertility?

After a few weeks—so you’re now in this category—nature production stops. The numbers you see represent your body’s response to the exogenous dose you’re taking. The effect that HCG has on production in a state of shutdown is extremely small. It’s main purpose is, for lack of a better analogy, to keep the grid running but at the lowest wattage possible. It keeps your testes doing their job at some very low level, enough to avoid atrophy, but not enough to make a Measurable difference in the total amount of testosterone.

Based on your levels I’d say you may end up needing to up the dose. 105mg is on the lower end anyway, and if you don’t seen improvement from it after about 8-10 weeks you and your doctor may have to re-examine the dose.

Great thanks for clearing that up for me. I’m in the UK which isn’t too TRT friendly so going solo. Logically wanted to start at the lower end and then increase if results suggested that was needed. Will try 45mg EOD (roughly 158mg per week) for a good stint, see how I feel and then get another blood test. Cheers.

Regarding your thyroid labs, your TSH is a little on the high side and a thyroid problem can increase prolactin. The TSH isn’t very reliable, the Free T3 is the active stuff, we must make the assumption that because Free T4 is good that you are converting to Free T3, except some people with thyroid problems don’t convert thyroid hormones correctly.

Also note the beginning of thyroid disease with see normal TSH and mid-high normal free thyroid hormones.

Your estrogen is low, might try increasing the HCG or TRT dosage.

Thanks systemlord. Should probably have mentioned my age (33) in the initial post. Will have a read re the thyroid stuff and keep an eye on it. Is the prolactin reading not a direct result of being on TRT / using HCG or is that reading actually a cause for concern?

Definitely plan to increase T dosage as of next injection (Friday). Would you also suggest increasing HCG dose? Everything I have read has 250iu EOD down as a reasonable dose to maintain fertility (planning to try start a family next year) but open to an increase for sure.

Any thoughts on the high cortisol? No wonder I’m at my worst in a morning. Just not sure what to do in order to try lower it aside from the obvious things which I think I do a pretty good job of (sleep,diet,exercise).

Yes, don’t waste your money checking this as long as you are taking testosterone and/or hCG. It should bottom out.

BINGO!

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Estrogen is a key regulator of prolactin, but your estrogen is low so I believe something else is causing the high prolactin. Subclinical hypothyroidism is defined by high TSH and normal thyroid hormones.

TRT suppress my cortisol, I stop TRT and cortisol increases, maybe increasing your dosage will make a marked improvement and lower your cortisol. The Finasteride can screw with the pituitary gland and wreak havoc on just about every system that relies on DHT.

Increasing your TRT dosage will also increase DHT normally, but for people who were on Finasteride, there are no guarantees.

HCG mimics LH and suppresses the HPTA which is why LH and FSH is low. This is expected.

Thanks. Yeah who knows just how much damage 3.5 years on Finasteride did. I feel like the worst side effects - brain fog, irritability, inability to speak fluently, forgetting words are much improved since stopping take it at the start of Jan so hopefully that trend continues.