T Nation

Help with TRT - Newbie


#1

Hey guys, new here and asking for some help. I went to an endocrinologist to get my T levels checked (gp referral) because of fatigue, no libido, anxiety, belly fat I could not lose (everywhere else I am trim and cut), and finally the fact that I have had low T in the past. We did a couple tests before the ones below about a year ago and my test was under 200 ng/dl both times. I didn't go on TRT b/c I was scared to for some reason. Now I am on TRT and just feel worse. I take 100mg testosterone cyp shots once per week. I began shots on 7/29, so that is a total of 8 injections so far. I feel really depressed and lethargic. My anxiety has surprisingly gone away and I have a better libido. But this depression is crazy.

After doing research, I know my doctor needs to test some of my other hormone levels and would just like an idea of what I should tell him to check being I feel so crummy.

Here are my first test results - this is all they tested. (had one test before this which was very similar but can't find the results

Testosterone, Total - 203.1 ng/dl - Range (348.0 - 1197.0)

Free Testosterone (Direct) 7.9 - Range (8.7 - 25.1)

Thyroxine (T4) Free (Direct) - 1.09 ng/dl - Range (0.82 - 1.77)

Cortisol (AM) - 27.3 ug/dl (HIGH) - Range (AM 6.2 - 19.4)

TSH - 3.160 uIU/mL - Range (0.450 - 4.500)

LH - 2.9 mIU/ML - Range (1.7 - 8.6)

FSH - 0.8 mIU/mL (LOW) - Range (1.7 - 8.6)

ACTH, Plasma - 62.8 pg/ML (on the higher end) - Range (7.2 - 63.3)

Prolactin - 16.2 ng/ML (High) - Range (4.0 - 15.2)

Second Blood Test after 1 month of T Treatment - (100mg test cyp shots per week)

Hepatic Function Panel

Protein, Total, Serum - 7.0 g/dL - Range (6.0 - 8.5)
Albumin, Serum - 4.4 g/DL - Range (3.5 - 5.5)
Bilirubin, Total 0.6 mg/dL - Range (0.0 - 1.2)
Alkaline Phosphatase, S - 70 IU/L - Range (39 - 117)
AST (SGOT) - 15 IU/L - Range (0 - 40)
ALT (SGPT) - 19 IU/L - Range (0 - 44)

Testosterone, Serum - 1045 ng/dL - Range (348 - 1197)
*(why didn't they check free test?)

ACTH, Plasma - 15.9 pg/mL - Range (7.2 - 63.3)

Prolactin - 19.5 ng/mL (High) - Range (4.0 - 15.2)

Cortisol (AM) - 5.8 ug/dL (LOW) - Range (AM 6.2 - 19.4)

WBC - 8.2 x10E3/uL - Range (3.4 - 10.8)

RBC - 4.86 x10E6/uL - Range (4.14 - 5.80)

Hemoglobin - 15.2 g/dL - Range (12.6 - 17.7)

Hematocrit - 44.8 % - Range (37.5 - 51.0)

I am looking for a place to start so I can feel better. I know there MANY different issues I can be having because of other hormones, I just need to know where to start. I know this is going to be a long process and am not expecting to feel better overnight. I am patient and just looking for help. Consider me a newbie at this point as I am just starting my journey. Any and all help is appreciated. I have an MRI on Friday to check for a pituitary tumor so will see what happens there as well.

Thanks guys and god bless.


#2

You'll need to post ranges to get good feedback - labs differ.

You're probably missing a few others, but glaringly obvious, there's no Estradiol (E2) result. Was it tested?

Are you on an AI? If so, how much?


#3

Do not have anymore labs done that don't include E2 and SHBG. Best guess is your E2 is too high. But can't say for sure without labs. Also, labs are tough when you inject once per week. The results are timing artifacts. IOW, your hormone levels will fluctuate too much to get a true reading.


#4

I just updated my post with the ranges. I knew I should add them...sorry about that.


#5

I can definitely change my injection timing. What do you recommend? More than once per week? If so how many mg and how many days? Thanks for taking the time to reply. I thought I was going to type all that information out and everyone was just going ignore it.


#6

You should be injecting twice weekly. Every 3.5 days to be exact. That protocol delivers the most steady levels which is key to managing side effects. Then you run labs halfway between injections and you get very accurate picture. So I inject on Sunday mornings and Wednesday afternoons and I pull labs on Friday around noon. This really allows for adjustments based on what's really happening. Many here also inject subq.

Are you also using hcg and an AI?


#7

First labs freaked you out, ACTH surged increasing cortisol hiding low AM cortisol.
2nd labs, low AM cortisol now exposed.

TSH too high, should be nearer to 1.0 because
fT4=1.09 is well below mid-range
ft3 needs to be tested
Problem may be from not using iodized salt, at least that is the better cause to have

TRT increases/restores metabolic demand and if adrenals [cortisol] and thyroid cannot keep up, some will feel worse.

Please read these stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • thyroid basics - check oral body temperatures as suggested
  • finding a TRT doc

Please post info about long term use of iodized salt and/or vitamins that list iodine
Post oral body temperatures
Read the stickies, that is the best thing for you to get things under control

Labs needed:
FT
fT3
Estradiol [E2]
prolactin if <35
PSA if >40
fasting cholesterol - can be too low
fasting glucose

Do labs half way beween labs.
Self inject T twice a week. You can use #29 1/2" 0.5ml [not 1.0ml] insulin syringes and can inject IM or SC. Best to inject in belly fat or SC or IM upper leg where you can see what you are doing.

You cab also feel crappy from elevated E2 and most guys need anastrozole to get near E2=22pg/ml where most feel optimal in terms of energy, mood and libido.


#8

Thanks a lot guys, great advice and great place to start.

So I inject every 3.5 days, with how many mg/ml per injection? On bottle it says 200mg/ml. Walgreens gave me plenty of syringes so I won't run out anytime soon. I rotate IM upper thighs every other injection.


#9

Nashtide - I am not on HCG or an AI. I understand the E2 and needing the AI if E2 is too high. SO will get that tested and go from there. As for HCG, how do I talk to the doctor about adding HCG? He's going to ask why I think I need it.


#10

If you are supposed to do 100 mg/week, you are injecting 0.5 mL of test since. 1 mL=200 mg, so 0.5mL= 100. If you were to split it up twice a week, you'd want to do 0.25 mL for 50 mg. I'm doing this routine now after reading thru this forum. I also add in 0.25 mg Arimidex on injection days.


#11

Do not use large needles.

Self inject T twice a week. You can use #29
1/2" 0.5ml [not 1.0ml] insulin syringes and can inject IM or SC. Best
to inject in belly fat or SC or IM upper leg where you can see what you
are doing.

Insulin syringes do not need an Rx in many USA and Canadian jurisdictions.
$14 for 100 at USA Walmart/SAM's


#12

Hcg helps maintain fertility if you care and also prevents shrinkage of the boys. Just explain how important the boys are to your sex life and your self esteem.


#13

Note that wife/GF can have a strong interest in how the boys are doing. It is that way in my home and a wife of another TRT guy we know cares about the boys as well. Makes for interesting dinner table conversation.