describe body and facial hair: fairly hairy chest, armpits, legs and arms. Full thick beard.
describe where you carry fat and how changed: ~8% body fat, a little around lower back.
health conditions, symptoms [history]: eating disorder (severe calorie restriction) for 5+ years about 12 years ago. No massive head trauma but a series of decent head hits from martial arts. Mildly anemic several years ago, now supplement with iron.
Rx and OTC drugs, any hair loss drugs or prostate drugs ever: none
Unfortunately libido has been a real problem. My libido dropped off a cliff 1.5 weeks after starting. In the past few days it’s come back a tiny bit, but still lower than pre-TRT.
describe diet: after recovering from eating disorder (~7 years ago), have moved to very healthy lifestyle. Currently macros are:
43% protein
8% fats (I realize my fats are low and I am bringing that up to around 20%)
47% carbs.
Foods consist of sauteed chicken breasts in coconut oil, quinoa, roasted sweet potatoes, Joseph’s pita breads, Quest bars, almonds. I take a bunch of supps (multi vitamin, vitamin D, ZMA, L-Arginine, iron, fish oil, glucosamine chondoitin MSM, BCAA’s,).
describe training [some ruin their hormones by over training]:
10-12 hours of jiu jitsu per week, 3-4 hours of conditioning. Not lifting heavy, primarily bodyweight, core, athletic movement stuff. Cardio ~2 times a week, consists of 30 minutes of jumprope. I probably spend more energy than is optimal on this stuff but it’s the lifestyle.
testes ache, ever, with a fever? No. Testicles have felt soft and smaller even before starting TRT. Veins going into testes may be slightly tangled, but they aren’t big or solid feeling varicoceles. Never had these specifically checked though.
how have morning wood and nocturnal erections changed: Still having night tumescence and nocturnal emissions since starting TRT, but since my libido tanked I’ve had very few during the day (i.e. I’m not seeing women and getting erections nearly as much).
lab results with ranges
Pre TRT:
Total T: 458
SHBG: 55.2
Free T: 6.74
Estradiol: 18.3
After 4 injections of 150mg Test C (taken at trough):
Total T: 509 ng/dl (range 264-916)
SHBG: 48.4 nmol/L (range 16.5-55.9)
Free T: 8.3
Estradiol: 19.6 pg/ml (range 7.6 - 42.6)
Prolactin: 13.8 (range 4.0-15.2)
TSH: 2.800 uIU/mL (range .450-4.500)
Thyroxine (T4): 5.9 ug/dL (range 4.5 - 12.0)
T3 uptake: 28% (range 24-39)
Free Thyroxine (T4): 1.7 (range 1.2 - 4.9)
(also got LH and FSH tested; the tests are included on my labcorp report, but I think they forgot to include the test results.)
Since total test was still low, increased dose to 180mg test cyp / week. Now I’m about 4.5 months in, and just got some labs (don’t have full results yet):
*Total Test: 789
*E2 31.8
Side effects: acne on face, occasionally cystic but overall fairly minor, using Oxy pads and that works OK. Overall my TRT protocol is settling in well. I feel good. Not perfect, but good.
I have put on about 10-12lbs of muscle. I don’t lift heavy (only bodyweight and a lot of jiu jitsu).
Libido has been a bit of a rollercoaster. Still a work in progress, but overall I’m not panicking about it (like I was at first).
Libido is often the last thing to show improvement, there are so many other things that have to be right for libido to function. I’ve been on TRT for 7 months and am still not 100 percent, erection, libibo and muscles density are getting much better lately. I spent a year and a half at super low T levels (119) so I have more tissue regeneration to heal, muscles were wasting away. It was my neurologist that discovered my low T since I was sent to him for extreme muscle weakness, blood pressure and heart rate were insane. I don’t think it will take you as long to adjust to the pituitary shut down since you weren’t that low to start with, it could take months before your libido returns. You’ll notice better muscle recovery and better workouts and later a return of your libido. Keep an eye on your E2 though since you’re on a large dose. Your 4 week follow up definitely looks mediocre and you really need to get that SHBG closer towards 30 so you can improve your free T.
Thanks - I know you had said that on another post of mine (and really appreciate the info). I totally get that it will take time to optimize my protocol and how my body responds to the T. Just feels weird that my libido was good, then actually went down after being on TRT. Could be a number of things though including stuff totally unrelated to TRT (i.e. stress/anxiety etc), cause my penis is still technically functional.
It was good to see my SHBG went down a bit, so hopefully that continues to give me more usable.
You have low thyroid function. TSH should be near 1.0
Please see below re checking thyroid function via oral body temperatures.
Low thyroid function can lower libido even when T levels are high.
Your problem may be from a lack of iodine from not using iodized salt.
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.
KSman is simply a regular member on this site. Nothing more other than highly active.
I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.
The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.
Thank you - even before I had these thyroid results, after reading the stickies I assumed this could be an issue, since I have basically never used iodized salt.
When introducing iodine there are risks if not getting 150-200mcg [micrograms] of selenium. Look for a high potency B-complex multi-vit that lists trace elements including 150mcg iodine and 150-200mcg selenium.
Hey guys - I’m at about 4.5 months on TRT. Things were up and down at the start, but overall I feel like the protocol is settling in well. I feel good.
As noted, my total test is now 789 (at trough, 6 days after previous injection). My e2 is 31.8.
I have a question on e2 and AI: at 31.8, my e2 is in range, but as we know, this may be too high to be optimal. Anecdotally, my libido seems to have been better when my e2 was lower (low 20’s). I am not currently taking an AI.
In 3 weeks I will be switching to e3.5d protocol, which may help overall. But I want to experiment with lowering my e2 before then.
I’ve read the sticky about AI, recommending 1.0mg anastrozole per week. On my current 1 injection per week protocol, how should I work anastrozole in? Should I take .25mg day of injection, then another .25 every other day ish, for a total of 1mg / week?
Moving your injections closer together will lower your peaks of T and E2, see where you land after 4-6 weeks of E3.5D as your E2 might land right where you want it without an AI. I believe AI dosing should reflect your E2 score instead of acting blindly, an E2 of 40 requires a different dose than an E2 of 70. Always adjust dosages frequency first before adding an AI to the mix.
My E2 injecting E3.5D was higher than injecting EOD, I’m not teary eyed anymore and less emotional. Also 4.5 months isn’t enough time to realise maximum benefits of TRT, maximal effects happen typically after several months and even beyond a year for some.
Yes - actually got a similar suggestion from someone else already, and this is what I’m going to try.
Updated plan is to move to e3.5d and probably lower my dose a bit too (maybe 160mg/week?). With my trough at 789, my peak has to be pretty high, which I can imagine is aromatizing more test than is ideal. And I do want to avoid an AI if possible. I’ll try this, retest after a month or so, and see where e2 is at.
I think if you switch to every 3.5 days (and assuming you are doing sub q) you wont need to worry about an AI. You are already saying you feel good, your e2 isn’t insane.
Be advised, switching to 3.5 days WILL increase your TT on trough days. Injecting twice a week is almost like increasing your dose. You get higher TT by injecting more frequently.
Since you already feel pretty good, I think a slight lowering of your e2 (by lowering dose and or switching to sub q) will make you feel even better. Don’t mess with an AI if you don’t need it!
Thanks - yes that’s what I’m thinking now. When I was originally thinking about where to go from here I was overlooking the fact that (as you point out) the twice a week injections is almost like a dose increase.
TRT’s been great overall. Cost is a worry, but I’m dealing with it, and I’m moving to Defy next month, which should be cheaper than my current clinic (in addition to being expensive, my current clinic also sucks).
I went through a few months of rollercoaster dialing in dose and letting things settle. I’d been on 170mg/week e3.5d for several months, but just moved down to 140mg/week. My levels are good but were higher than needed, and my blood pressure was getting a little high too, so I was in favor of lowering the dose. But ultimately I will probably settle back at the 150-160mg/week e3.5 day range, to keep my TT around 1000.
My workouts, recover, energy, libido and erection have all been much much better. My workout output has been higher and more consistent. I don’t have any real downsides yet beyond the initial rollercoaster, and the high blood pressure, but even after 1 week of my new lower dose, my BP is back in a good range. Hematocrit’s been perfect. I only hope I can keep TRT going with no complications for the rest of my life. I’ve had some aggro and emotional feelings, but those have gone down a little since I lowered my dose (my e2 fell quite a bit, which I’m sure helped). I’ve put on about 15lbs of muscle, with no heavy lifting (but I do work out a lot).
I also uploaded my most recent labs, done as part of my Defy intake. No pressing questions, but if anyone is inclined to take a look and has input, I am very open to it. I don’t know what’s up with my high glucose and high BUN creatinine ratio, but my diet’s too high in protein, so that could be at least part of this. I realize this isn’t a TRT-related thing, but if anyone has insight on that, I’m open.
I haven’t been checking this forum a ton lately, but I really appreciate all the help and insight I’ve gotten here!
Also on 500 IU of hCG. I am not sure if I’m going to keep taking this. I’m not having kids, and my testicles already atrophied as much as they probably will, and they’re fine. I may experiment with dropping hCG for a few months.
Yeah, my SHBG is still high. I guess it doesn’t really matter a ton to me though, as long as I can keep my free test in a good spot, and not need a test dose that causes other side effects (like high blood pressure).
My free test was at 1300 at trough when I was at 170mg, and I definitely do not need that. It spiked my e2 into the 30’s, which wasn’t a disaster, but it made me moodier and more aggro. If I can stay like you, 900-1100, with e2 in low-mid 20’s with no AI, then I will be happy.
Yea, its a little more of a struggle with a higher SHBG.
Yes, its a balance, I noticed that when I first started TRT my BP increased quite a bit, but now about 2 years into it, im needing less and less BP meds.
Not sure if its because im working out consistently or just getting use to the test being a constant 1000 or so, instead of dropping lower through the day.
I know Lexapro can sometimes elevate BP. I also had my BP read within a few hours of intensive exercise, and after taking big caffeine doses. My non-expert opinion is that it was caused by 1) test being too high and putting me into overdrive, 2) stress about a new job, 3) some combo of the workouts/caffeine/Lexapro/hCG.
I got to 140/90 at one reading. That was the highest/worst, but I’m back to 130/70 now. I actually haven’t been super worried about the blood pressure; it only read high 2-3 times, and it was never an issue in the past, and it’s already down to a better place. I’d definitely try giving up hCG before trying a blood pressure med.
