T Nation

In Need of TRT Advice

Endo’s don’t like to prescribe adex for people on testosterone tx. because they feel if you have a rise in estradial then your getting to much testosterone. Basically your getting more than your body can handle so it’s converting it into estradial.

Another thing the endo told me is that no matter what level your t is at getting more is going to make most people feel better even if they are not symtomatic.

First statement about the estradial makes sense although I’m not letting him lower my dose and I take anastozle myself. I’m not sure about the second statement. I will say that when I was put on the clomid and it kicked in I felt awesome where as before I just noticed a change in mood swings. My remark to him is I was at my optimal lvl heis remark was the second statement. My reply was I’m not sure I agree with that but I’m willing to test it, lets increase my dose for a couple of weeks and I will honestly tell you if I notice a difference. He told me no…

[quote]DrSkeptix wrote:
Here is your answer, from a July post:

EDIT: The insurance whore doctor they sent me to does SUCK. No adex, no HCG, back on T4 thyroid (which screws me up).

If you were hypothyroid, nothing works quite right. This alone could account for the low-ish free T. Other issues–DHT, E2, propecia–are not primary movers here, if you were indeed hypothyroid.
Correction with T4 may be sufficient to restore normal levels of testosterone.
(So far, so good.)

So why, then, would a man be both hypogonadal and hypothyroid? In your first post you do not include your thyroid story or the original TSH. I suppose a man can have low TRH and low LH, and have normal cortisol, but I sure wish I had July’s TRH level.
[/quote]

I’ve only had my thyroid tested one other time in my life. From my first post.

I bought iodized salt and have added 1/4 tsp to most meals. I’ve noticed my morning temp has, on average, risen close to .5 degrees, consistantly hitting in the low 97s.

I met with the endo to review the latest blood work. He said the thyroid doesn’t seem to be an issue and some people just run low morning temps.

Endo also said since 2 different labs ran the bloodwork and have different reference ranges, my Testosterone increase from 343 to 538 doesn’t necessarily mean a 200 point increase as the assays could be different.

We talked about DHT and how it could affect me. Endo said he’s never tested for DHT before but would do it for me.

I don’t think I will visit this endo again, he doesn’t seem very experienced but was cool about bloodwork I requested.
Endo gave me a script for bloodwork and said to run it in 3 months just before seeing him again. Bloodwork is for Test, Free Test, LH, FSH, E2, and DHT. I think I will work on getting my E2 down and run this bloodwork right before year end and let my insurance pay for it. As my company is switching insurance providers at the end of the year.

Forget about salt … if you want to add iodine, this is the way to go.

http://www.optimox.com/pics/Iodine/opt_Iodoral.htm

I started taking one tab after starting thyroid meds, and had to reduce thyroid med dose after starting Iodine supplementation.

I’d much rather take this stuff, and drop some of the Amour.

Here’s my latest bloodwork taken on 12/29, 2 hours after waking on an empty stomach, no workouts for previous 5 days.

Quest Diagnostics did the bloodwork.

Test Result Range (Increase/Decrease)

Total Testosterone 987 ng/dl 250-1100 (+ 449)
Free Testosterone 137.2 pg/mL 35 - 155 (+ 75.9)
Testosterone Free % 1.39% 1.5 - 2.2 (+ 0.25)
LH 3.2 mIU/L 1.5 - 9.3 (+ 1.9)
FSH 4.1 mIU/ml 1.6 - 8 (+ .9)
Estradiol 43 pg/ml 13 - 54 (EVEN)
DHT 14 ng/dl 25-75 (FIRST TIME TESTING)

Wow what a huge increase in T and FT. And I’m not having the previous symptoms of irritability and low libido. Been making good progress in the gym too.

I think a number of factors contributed to the increase. I was forced to take 3 weeks off in November do to a wrist injury. I think in my tests earlier in the year (Apr-Jun) I could have been in a state of overreaching or overtraining.

I did alot of research and I’ve listed at the end of this thread the dietary changes I made. I think the zinc really helped.

E2 is still high, I didn’t use adex as I’m considering some athletic competitions that are tested and I’m not sure if adex can be used, especially without a script from a doctor. I’ve read about other Anti-E’s such as DIM, Calcium D-Glucarate, Resveratrol, and Grape Seed Extract. Anyone have thoughts on these or other Anti-E’s ?

I kept my proscar dose at 1/4 tab daily so I could get baseline DHT levels. They are quite low so I’m going to cut back on the dose and taper over time to EOD, while monitoring if I start losing hair.

I think I will visit the endo one more time to see if he’ll write a few bloodwork scripts for me that I can run in the future and monitor T, FT, E2, and DHT. He was real cool about giving me the bloodwork I requested but I know he’s not going to do anything for my E2 since it is in range.

I can’t thank everyone in this forum enough for helping me, you guys are great! As I stated in my first post I would document my journey so hopefully at some point it helps someone else.

DIETRARY CHANGES

10/20
Iodized Salt
1/4tsp with each meal. On average 500mcg daily

10/25
Magnesium Citrate
600mg evening
800mg before bed

10/25
Zinc Picolinate
50mg with each of 1st 3 meals
on 12/4 switched to UberZinc 2.0
1 cap (75mg) with each of 1st 3 meals
I’m taking such high doses of zinc till I can pass the zinc tally test.

10/25
Acetyl-L-Cartnitine
1g first thing in the morning
1g pre workout or early evening

10/25
3 Cups Tea daily (1 Black, 1 Green, 1 White) previously I’d have 1 maybe 2 cups of green tea a day.

10/31
Increased Green Veggie intake so I was eating green veggies at every meal this increased my fiber intake.
(broccoli, spinach, kale, collard greens, cabbage, romain lettuc, celery, asparagus, watercress, arugula)

11/12
Vitamin D-3
1000iu am and before bed

Phosphatidyl Serine
400mg post workout, it’s supposed to reduce cortisol, I’ve been using it all year so I can’t directly give it benefit for my higher test levels.

Glycine
I’ve been using 10g post workout all year. At the end of October I started including 5g of glycine in each of my last 3 meals of the day.

Go to 2000iu D-3

I do not see any EFAs.

Go for E2=22pg/ml [0-54] and you will feel better. I do not have any idea if they test for adex. But if you feel better, the QOL is more important tban the athletic competitions.

You really need adex. Suggest 1mg/week to start, get serum E2 labs in 4-5 weeks and adust dose: 1mg [current dose] * new E2/22mg/ml. Liquid adex [l-dex] works best as you can increment dose by the drop.

E2=43 would be pure hell for most. E2=37 was killing me with TT=1025.

Lower E2 will increase TT and increase FT and FT % fraction. More FT and less E will have a big effect on libido and mind.

You can do your own E2 labs at LEF.org

Get that right and T will be as good as it can be and do not bother with TT, FT, DHT labs as you cannot do better without TRT that is not something that you even want to think about at this time.

Thanks KSman

I will double the dose of D-3 so I will be getting 2000iu in the AM and 2000iu before bed.

I take 7g Omega-3 (combined DHA/EPA) daily, also I eat 6oz wild salmon several times a week.

I take 4g Borage Oil daily which contains 1g GLA.

I have some decisions to make regarding athletic competitions and using adex or another aromatase inhibitor.

[quote]brentf13 wrote:
I agree find a good Dr. Also you aren’t a rare case at 32. I’m 35 and I’m probably 5 years overdue for TRT. The best thing to do is realize there are no easy solutions and go on TRT. Don’t accept anything less than T+HCG+AI either. T alone is useless after about a week. [/quote]

TRT is useless without HCG? TRT has been around for a long time and the use of HCG hasn’t so what did they do before HCG? were all TRT protocols useless and failures?

TRT without hCG works, T levels rise. But the induced LH deficiency leads to small testes, fertility problems and low pregnenolone levels. That in turn undermines production of DHEA and other steroid hormones, including cortisol. This can lead to mood problems. [hCG does not replace lost FSH.]

Overall, uncontrolled estrogen is probably worse than no hCG.

It is really about doing things right, not inducing other imbalances.

Is HCG available over the counter and what is the recommended dose?

You need a script for HCG. 500iu split up over a week would be a good starting point.