T Nation

I'm on TRT in the Military

-age 33

-height 6’1

-waist 39

-weight 260

-describe body and facial hair- fairly hairy

-describe where you carry fat and how changed. I carry almost all my fat in my gut

-health conditions, symptoms [history] In the late 2000’s i was exposed to a variety of fairly gnarly chemicals in the course of my job that were undisclosed and was not wearing the proper safety gear for them. About six months later i started to feel like a can of hot garbage. In 2013 I was diagnosed by a Military doc with low test at the time it was 90 ng/dl he wouldn’t order a test for estrogen levels . He wrote me a script and promptly retired. I was serving at an isolated duty station in Alaska so they were unable to replace the doc for about two years and sent us to a local nurse practitioner. When the new doc got here she promptly took me off test and said the paperwork for a waiver had never been submitted properly and refused to restart the script. We later found out that she had spent her entire career as a prison doc and had the bedside manner of a russian terrorist negotiator. It was three long years when until she retired. The new doc showed up and promptly put me back on test, still no test for estrogen. I finally got some cash together and went to the local lab to pull a test for estrogen. Surprise it was high Doc started me on exemestane as an AI. Other health conditions include multiple bulging and herniated discs from a tsunami some of which will hopefully be fixed in an upcoming surgery, bad knees and ankles caused by the same accident, messed up neck, multiple shoulder dislocations, insomnia, mild ptsd.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
200mg of testosterone cypionate weekly in three doses
25mg exemestane daily (just started)
50mg nortriptyline nightly
10 mg cyclobenzaprine 3x daily
2mg eszopiclone nightly
500mg naproxen

-lab results with ranges
Test Name In Range Out Of Range Reference Range
TSH 2.47 0.40-4.50 mIU/L
FSH <0.7 L 1.6-8.0 mIU/mL
LH <0.2 L 1.5-9.3 mIU/mL
ESTRADIOL 50 H < OR = 39 pg/mL
DHEA SULFATE 105 L 106-464 mcg/dL
INSULIN 52.3 H 2.0-19.6 uIU/mL
TEST, TOTAL, MS 854 250-1100 ng/dL
TEST, FREE 206.7 H 35.0-155.0 pg/mL

-describe diet currently around 2200 calories a day about 240g protein
-describe training, lift heavy and often. i have two clown around days where i help out friends and work in with their light weight
-testes ache, ever, with a fever? not yet
-how have morning wood and nocturnal erections changed. yeah just started up again 2 years ago when i got back on test.

Current doc is most definitely uniformed but is now willing to defer to the studies i bring him after our last conversation.

Im looking for any advice especially with the AI now that I am on it.

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TSH isn’t really a thyroid hormone, it’s a stimulating hormone similar to LH which stimulates the testicles to produce testosterone, what your doctor effective did with your thyroid testing would be like to determine T status LH was checked without regard for testosterone, you couldn’t determine T status on LH alone, but that’s what your doctor did by only testing TSH.

Free T3 is the only active thyroid hormone, Free T3 (not TSH or Free T4) speeds up every cell in the body, increases metabolism and increases body temperatures. DHEA is low for your age and should be significantly higher as should testosterone. Start 50mg DHEA and order DHEA-S for lab testing. DHEA can increase estrogen, so bear that in mind.

SHBG binds sex hormones testosterone and more loosely binds estrogen, SHBG should be considered before a protocol is even considered, higher end SHBG men may be able to get away with one or two injections per week, lower SHBG two or more injections per week. Your Total T and Free T ratios suggest SHBG is about midrange or slightly higher which is great.

LH is suppressed while on TRT, no need to waste money testing it. TRT can make you infertile, HCG and even more so FSH injections can increase sperm production while on TRT, no need to stop TRT unless both fail to increase sperm. It’s best and cheaper to get FSH from compounding pharmacies.

You could do better on your protocol, first you’re having to overcompensate with an insane dose of exemestane, you could inject two 60mg doses per week and decrease the exemestane significantly or eliminate it altogether. Injection smaller doses more frequently will lower estrogen and hematocrit while maintaining steadier levels.

The dose of exemestane your taking has been shown to cause osteoporosis in men after only several months, it removes minerals from bone and you have multiple bone injuries, estrogen is needed for joint health as well. I seriously doubt you’ll have any estrogen inside a week at this dosage, stop it immediately and find another doctor!

You need to locate a knowledgeable doctor that is more experienced, local doctors are difficult to locate and expensive, I can recommend a couple of telemedicine clinics with experience TRT specialistas who have been prescribing TRT for decades. I’m with Defy Medical since my Kaiser doctors are rather incompetent and can’t afford local doctors. Defy is pretty popular and also there’s Entourage Medical as well.

Cost is between $1200-$2000 yearly for everything, medicine, labs and consultants.

I cut up my aromasin (exemestane) into 20 pieces and is effective, I couldn’t imagine taken an entire pill because 1/10 is enough to drop my E2 too low as I’m an over-responder to all AI’s

Hey brother, it sounds like you’ve been through the ringer, I’m glad your here. A lot of guys on here are very knowledgeable even though some opinions differ between members of this site.
Don’t worry to much if you run into conflicting opinions. Many of the things discussed on this site are up for grabs but there are a few things everyone agrees with.
It’s late, so not a lot of guys are responding to posts right now.
I’d suggest that you get as much information from as many guys on here as you can.
I don’t disagree with systemlord, he is a very knowledgeable member, but get a lot of information from all the members with a lot of time doing this before making to many major decisions.

That being said,
Please, please, ditch the Exemestane right now. You can always pick it up later if you change your mind. Please listen and let me explain:

Exemestane is an Estrogen blocker (we call them AI’s or Aromatase Inhibitors) of the worst kind. It is referred to as a “Suicide Aromatase Inhibitor”. Sounds bad? That’s because it is nasty s***.
If you would like an explanation as to why you shouldn’t be on that one in particular, let me know and I’ll explain.
I have some opinions about different thing regarding TRT but what I’m saying about Exemestane is a fact. Exemestane has the potential to make your life a living hell and possibly much worse.

There are much better AI’s if you need to take one to block Estrogen and decide that is for you. Look around the posts here first and then decide if you need an Estrogen blocker but stop taking Exemestane.

Secondly, I’m glad your on Testosterone. Based on the numbers before you got on Testosterone, you needed it.

As far as Estrogen goes, very high ratios of Estrogen to Testosterone in men is bad. Very low Estrogen in men is 3×s as bad. You are NOT so high on Estrogen that I believe you should be using Exemestane though. You might find out you don’t need an AI, but if you do, please don’t use that one. Personally I don’t think anyone should touch that s*** except women with breast cancer. I think a lot of guys on here would agree with me.
Better to be a little high on Estrogen and have the option of blocking it than to be to low and to try and drag your levels up.

Are your E2 readings before or after you started taking Exemestane?

Aside from getting your Testosterone numbers back up in lab work on paper, what are your goals on TRT?

I started because of my primary symptoms being ED, no libido for 4 years, insomnia, somnolence, and s*** energy.

Testosterone alone hasn’t solved all my symptoms. My ED issue has improved a lot but there are more moving parts than just Testosterone. Systemlord makes a good point about your DHEA levels for example.
Your Free Testosterone is great. What are your goals melthir?

Your doctor is also willing to learn from you…IMO that is HUGE. Guys on here would kill to get a doctor that listened to their concerns on TRT.

Please stick around and listen to everyone. Medical science is not very evolved concerning mens hormone optimization therapy. There are a few really good doctors in the US who are pioneering the way through this…and they don’t always see eye to eye.

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I think Exemestane is just a brand name for Aromasin.
200mg/wk of T is a lot I would be surprised if an AI will not be needed to keep E2 in check.
I have never tried Aromasin I have always used micro doses(.125mg) of anastrozole.

Thank you for your service melthir it sounds like you have been thru alot.

The test dose is split up to three shots a week sorry I didn’t specify. The estrogen is pre AI. I’m stuck with the Doc I have, from what I’ve been told so far is military medical dosnt play nice with others and there is a shortage of actual docs on the island that are taking new patients much less part time patients. I’ll go try to get bloodwork done on Monday and see if I cant get the dose cut or get switched to a different AI. As long as I come to him with proof the doc seems cool with me managing my own problems. Hes pretty much a golden goose as far as mil docs go and I’m hesitant to burn him. Telemedicine is to much for me and tricare dosn’t cover shit.

E2 readings are pre exemestane.
As for the suicide aromatase inhibitor if you have the time to explain please do, if not I can start reading.

My goals for try is basically to stop feeling like a steaming pile of lethargic crap every day. I understand that part of it is I’m damn near crippled outside of very controlled motion but it would be nice to not wake up tied and feeling like crap every day. Since I’ve started taking test is been noticeably better and the ability to have the plumbing work is another plus. I’m starting to supplement my DHEA. Currently if I can get my levels all within normalish range I’ll be good.

Anastrozole blocks the aromatase enzymes from converting testosterone to estrogen, exemestane kills the aromatase enzyme in the fatty tissues until you make more. Some however rare has reported they are unable to make more aromatase enzymes after long term use at high dosages.

You can do advice only consultants with experienced doctors and they can even work with your current doctor if he’s willing. It’s a lot cheaper than going with one of these telemedicine clinics.

systemlord summed up the difference between the 2 AI’s. Anastrozole, when needed blocks the enzyme. Exemestane kills the enzyme. There are several types of Aromatase Inhibitors to block Estrogen. Suicide Inhibitors are bad news overall. All AI’s were created for a purpose other than Hormone Optimization in men.
We only know about them because of what bodybuilders adapted them for, namely Post Cycle Therapy. We don’t cycle Testosterone course, but we adapted them for our uses from them. Anastrozole is the one we use most when we need them. There is also options like Clomid or Tomoxifen to discuss with your doc.

A lot of guys get here with an urgency cause we know something’s definitely not right. For me, balancing my hormones is clinically necessary to get everything else in order, it might be the same for you.
You’ve obviously been through some serious shit melthir. How many civilians do you know who have been doused with industrial chemicals? I have a friend that got soaked in jet fuel. There was multiple things he had to do to get to feeling right.

If my hormones aren’t properly balanced, the rest of the games over. I got a lot of other things to deal with but for now I’m focusing on this like all the new guys are. I’d suggest creating some more threads focused on HRT and ask where to start with a specific Hormone that’s out of ranges. Guys here are very intelligent and even more importantly, many are experienced.

This stuff will take time to work out. If HRT isn’t the magic bullet, it’s at least a big piece of the puzzle for you as indicated by your previous and even current lab numbers.

Guys hear will mostly feel out of their depths with issues other than hormones but if you ask for help straightening out your hormones, they’ll start helping with that.

No one here can probably even imagine some of the crap you’ve been through and might be worried about giving suggestions where they don’t feel qualified. But you feel like your drowning every day right? So let’s see if some of the gentlemen on here can lend a hand with this hormone shit first, yeah?

How long have you been on Testosterone this last time you started, 20 months, 30 months? You said about 2 years.
How often has your dose changed since you began? Have you tried anything else aside from Exemestane? Any Pregnenolone, DHEA, hCG?
Have you had good days/bad days since you began or has life been ate up with suck every day?
Any sides from the Testosterone aside from increased Estrogen?
Do you sleep well?
Do you notice a time during the day or between injections when you have a harder time than others?
This could all be potentially useful information for some of the guys on here. You got to get involved here with others. Check out threads and ask questions.
Let’s see if any other experienced members like systemlord has the balls to look at your numbers and throw out some questions or ideas.

Hey what do you guys think of his labs?

Yeah, it’s Aromasin. IMO nobody in TRT should be taking Suicide AI’s. Unless suicides behave differently from other suicides, their method of action scares the crap out of me. I haven’t taken them, I’m weary enough about Anastrozole though.

Go get the trt bible by jay cambell on kindle. It will help you inform the doc. It’s not perfect but points in the direction most men here try to follow.

The book has tons of information on how to live a healthy life in 2019. It speaks on every facet from diet, supplements, boood tests, what to watch out for and even the false narratives of trt.

Another great doc to read up on is dr rouzier. I will dig up the proper spelling. Does anyone know if I spelt his name right? This doc has a website and has many articles. You cannot go wrong with what he says. I’m told he’s the doctor of trt doctors.

Glad your feeling good. Stick with it and it only gets better. I’m with you on optimizing dhea. I believe we should fix all the hormones so that they are optimal and supportive of our T levels.

Your diet is good and you are fit. Your on a path to good health. Let’s hope this doc sticks around :slight_smile:

TSH - would need free T3 and free T4 to know more about thyroid status.
FSH and LH - expected to bottom out on TRT.
E2 - any elevated E2 symptoms? My E2 was 55 last test (take 200mg test) and I’m good.
DHEA - needs DHEA, would take 50mg every day.
INSULIN - fasting glucose? A1C?
TT and FT - looks good, similar to me, 884 total, 202 free with 55 E2.

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I use to divide E2 into TT and if I got 15-25 and had no high E2 side effect, like loss of libido or ED I’m good to go. YMMV

That said I have found lately I prefer my E2 in the 22-27 range. I believe it is because my SHGB has dropped over time since I started TRT (used to be 38) and when you have low SHGB you have a lot of free T which is good but you also have a shit load of Free E2 which is not good.

I just had my clinic consult and did not want to drop my T dose so I am back on anastrozole for a little while. I’m not in the camp of AI are dangerous. They are only dangerous when people don’t know how to use them correctly.


“No one here can probably even imagine some of the crap you’ve been through and might be worried about giving suggestions where they don’t feel qualified. But you feel like your drowning every day right? So let’s see if some of the gentlemen on here can lend a hand with this hormone shit first, yeah?”

No worries dude, I’m not supper bad off and I’m fairly open to suggestions. The main thing with my current Doc is that due to the nature of the Coast Guard drugs even prescription drugs end up being a bigger deal then most people would believe, so he makes small changes and requires proof. He is not afraid to tinker he just needs some kind of study or test results to get the ball rolling. After reading what you guys wrote i doubt I’ll have enough estrogen to even show up and the man isn’t a fan of giant shifts.

“How long have you been on Testosterone this last time you started, 20 months, 30 months? You said about 2 years.”
The first time i was on test was a year and 9 months first at 200mg every two weeks then 100mg a week doctor injected . Then doc retired and the nurse practitioner wouldn’t adjust prescription regardless of what test results came back as. Then the prison doc showed up and tossed the script.

“How often has your dose changed since you began? Have you tried anything else aside from Exemestane? Any Pregnenolone, DHEA, hCG?”
Under the new doc twice over about a year or so he started with the original dose then bumped it to 150mg for about 6 months then to 200mg after thanksgiving. after this last set of labs i started supplementing DHEA, doc doesn’t seem to want to write a hCG script as im not feeling any pain in the boys and they didn’t really shrink to much and he isn’t worried about me not having children due to being snipped. No other drugs related to low T.

“Have you had good days/bad days since you began or has life been ate up with suck every day?”
I’ve had plenty of good days, after the first month or so at 150mg shit started working shit really turned a 180 when doc stuck me on 200mg a week and i felt i had enough energy to do a lot of things again. Had lots of bad days to but those were mostly due to lack of sleep from nightmares.

“Any sides from the Testosterone aside from increased Estrogen?”
Bit of bloat and sore nips in situations that they didn’t use to be sore in. Reduction body fat and gains in strength for the first time in eight years or so.

“Do you sleep well?”
For about an hour at a time then either the legs start spasming or some kind of nightmare the nortriptyline has helped a bit i don’t normally remember all the piculars anymore just the feeling.

Do you notice a time during the day or between injections when you have a harder time than others?
Sunday evenings are rough sometimes, i get tired. Figured it was because I dose monday wednesday friday.

Good to note, thank you.

Also very useful. My SHBG level has my Free’s all tied up at the moment but I’m hoping that all changes soon. I’ll keep this in mind as I go.

I am still deciding for myself if AI’s are dangerous. I’m leaning towards the idea that smal doses (Example: 0.25mgs Anastrozole E2-3D) scheduled for short term use is acceptable for me if my E2 becomes noticeably high and is affecting me. Different AI’s and SERMS behave differently from the information I’ve read…and of course there is anecdotal concepts worth some consideration…I flat out don’t like Suicide AI’s personally, their mechanism of action is way to hard to control for TRT. Aromasin and Arimidex are 2 easily confused but very different AI’S

It’s great that you are open to suggestions, that’s very important.
I don’t think you’re bad off and I wouldn’t label anyone, but you’ve been through enough, just based on your OP. Your OP is only a snapshot of the shit you’ve been through in your life as it pertains to optimizing your hormones.
I have PTSD and it took a Vietnam war vet, an Afghan/Iraq war vet, and many psychologists to convince me I had any trauma issues stemming from my history, that it affected many parts of my life, and that my issues weren’t a big deal.

I had lots of guys say suggest that I had trauma issues, but when a 2 year P.O.W. in Vietnam who was brutally tortured, a Special Detachment Army ranger who did HVT hunting in Iraq and Laser Painting in Afghanistan, and a private Combat PTSD psychologist told me I’ve probably got a lot more trauma than I thought, I finally started to listen and open up.

I’m not saying your current difficulties are or not related to your lifes history…it’s not my business, and issues, if we have any stemming from our past experiences are often private for many people. I personally don’t care anymore if anyone knows my shit but that’s only me.
If you can ask me about most things.
If you want to email me, feel free to do so.

That’s what I’ve heard.

The guys here have made a few good suggestions. Ask for studies supporting these suggestions in your comments and posts and do some digging on the internet as well.

Not true. Even insensitive E2 tests will show a regular amount of Estrogen present. The test will also dictate whether Estrogen is off the scale high or dangerously low.
I thought mine was super high 3 weeks after when I started Testosterone injections cause of some side effects of Exogenous Testosterone, but it turned out in a test that my labs showed it to be contrarily fairly lower than average.
If it’s way out of range the test will say it’s above X number or below X number. As far as studies to support this, your doctor may accept articles by leaders in Testosterone treatment or he might show bias, in which case prominent University articles, PubMed, and National Medical Journals might be the way to go.

Great topic content for another post. Post this and ask if anyone else has experience with this.

More good information to ask about in topics

Do the spasms have anything to do with the hormone changes? Do they fluctuate when dose changes occur, introduction of DHEA? Have you always had them? When did they start? When did they get bad?

Very possible. You could ask others if they have had a related problem and if a change in dosing schedule helped them. Ask what was their dosing schedule before, what happened after.

I’m still getting a feel for this site and probably post too much, but damn if I haven’t gotten some relief from other members posts and comments.

Get the trt bible like I said above. That’s all you need to present to your doc.

Federally appointed doc is what he has to work with cause he’s in the Coast Guard. The doc may be open to listening to what’s in Jay’s book, or studies by docs who are pushing forward in this field, but they may not.
Doctors who stick to regulatory medicine practices established decades ago are typically not willing to budge from their positions.

melthir didn’t avoid TRT after his prescribing doctor left and the newly appointed doctor arrived where he was posted (in the OP). melthir didn’t have a choice…and so he was off Testosterone because he had no other options.
I think he’s limited still where he’s at.

He might need to substantiate these with .Gov articles. Maybe not.

They are discussing how to present this to the physician and I suggest the trt bible. Many docs keep it on there desk and have co authored it. There aren’t many other options as good as this.

Sucks about the doctor situation. Some of the clinics can ship medicine and treat a man In almost all the stares. Maybe not In Alaska but worth the try. If there’s no other option ofcourse.

Not really sure why people believe this.
Anyway ive ALWAYS used aromasin. Whenever i cycled gear, as and when needed not every day, and ive always used it the same way during trt.

Ive noticed that the longer ive been on trt the more i need an ai. Pretty obviously thats down to trt bringing my shbg levels down really low freeing up not just free test but free estrogen. At the moment im on 12.5mg twice weekly which i think is about right although very recently i spiked my estro running hcg but i imagine once the estro is back down (which i think it is by feel) then the twice weekly aromasin is probably enough but ill let lab numbers guide me on this one instead of guessing.

Point being ai’s are most definitely needed sometimes and in my experience aromasin has been the better choice.
I have used anastrazole before but just didnt feel as good on it. Purely personal observations

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