T Nation

Introduction - My TRT Journey at 37

Hey guys. Just thought I’d share my story.

I’m 37 now. In my late 20s, I started getting the idea that something wasn’t right (actually, my wife convinced me that something wasn’t right). Mainly, libido/ED problems. At 29, I went to my doctor (small town GP), and he ordered a testosterone check. I don’t remember the number, but I think it was 300-something, and he told me that I’m low, but still within the normal range, and since I have a good amount of body hair and the hair on my head was thinning that I’m fine. Gave me some Viagra samples and sent me on my way.

Fast forward to last year, I was 36, and my wife convinced me to go to the doctor (we had since moved to a big city where there are more options). She didn’t like having a nearly sexless marriage. So I went to a urologist, since I wanted to get my nuts cut anyway. T levels came back low (200-something range maybe?), and he recommended TRT. His protocol is to jump start patients with 200mg/wk of Test C for four weeks just to see if there is any response.

Let me put it this way… I told my wife, “if this is what it’s supposed to feel like being a man, I’ve missed out my whole life.” People talk about losing confidence, energy, motivation, etc. Well, apparently I never had it. I never did understand the whole male macho attitude, competitiveness, confidence, etc. I’ve always been pretty much the most passive guy out there. I never, ever got angry at anything. Zero competitive spirit. While on that cycle, I felt this confidence. I actually started making snarky comments on online message boards! ha.

Well, my doc is open minded, but fairly conservative. After the 4-week cycle, we tried gels. He starts me off at a low dose for a month. Did nothing. So he upped the dose, and made me try it for another month. After a couple months I felt nothing (don’t remember my numbers but they were low). Finally I took it upon myself to just about bathe in the stuff for a couple weeks. No improvement. I went back and told him that gels weren’t going to work, so he put me on injections. I don’t remember the dose he started with, but it was every two weeks. Made me try it for a month. This going on for awhile.

Luckily, he’s open minded, and I told him I needed a higher dose and I needed it every week. He says as long as my numbers aren’t dangerously high, he’s cool.

So now I’m on 200mg/wk of Test C. My TT is stable right around 650. From what I’ve gathered, that’s a fairly high dose for TRT and my T levels aren’t that high on it.

Now, over the last 8 months, I’ve had a massive increase in muscle mass (I lift weights regularly), huge weight gain (165 to 205, some muscle, some fat, partly due to TRT, partly due to quitting skoal and working from home near the kitchen). I’ve noticed some increase in body hair. Minor shoulder acne. Hair on my head was already thinning, but doesn’t seem to be getting thinner (I wish it would all fall out honestly, I shave my head and it would be easier). My nuts have shrunk (don’t care), pretty sure they don’t work anymore (don’t care about babies, I had the vasectomy); one blood test during the trials showed TT at 78 (I think it was 2 weeks after an injection).

So, yeah, that’s where I am now. I feel better, but I don’t really think I’m where I want to be. I will probably switch doctors. I like mine, but he does not prescribe at home injections. I like not having to do it, but I hate having to go to his office every week.

Welcome to the forum. Sounds like you found the protocol that works for you. I would recommend six week follow up labs after this newer protocol. Sure its high on the dosage, but if you are at 650 total T (assuming labcorp style range since you didn’t post ranges) then you are good at that dose T wise. You need to see how your other hormones are responding so get the full work up and let us know how its going!

You will most likely begin to suffer from the effects of high E2 which will totally ruin the effects of TRT. Get a full panel of labs otherwise we are just guessing.

I do agree I need more lab results. I have no idea what my doctor has been testing, they just tell me TT when they call with the results. From what I’ve gathered in the stickies I just need TT, FT, and E2 (at this stage)?

On the current protocol of 200mg/wk Test C, after 4 weeks I was at 658 and after 8 weeks I was 652.

CBC, Prolactin, SHBG, DHT, LH/FSH, TSH/T3, and ALT/ALS

Are those numbers TT or FT? Please post lab ranges as well.

Read the stickies found here: About the T Replacement Category
advice for new guys
things that damage your hormones
protocol for injections
finding a TRT doc

Your labs were done one week after injecting?

Better to self inject twice a week and take anastrozole 0.5mg at time of injections.

You do not know why T was low.
Were LH/FSH low? If so, should test prolactin.
Thyroid problems can lower LH/FSH and T and not using iodized salt can cause this.

We you using iodized salt and/or vitamins listing iodine+selenium?

Been going through the stickies, particularly the labs info.
Labs were done one week after injecting.
My doc doesn’t allow self injections, so I’ll probably look for a new doc for next year.
I’m going to the doctor’s office this afternoon, I’ll try to get a copy of my labs. I just don’t remember what was run in the beginning, and I don’t remember what was objectively ruled out as a cause.
Don’t use vitamins but salt was iodized (in the beginning of low T, some non-iodized salt showed up in our house, and once it was used up it was back to iodized).

Will update if I find out anything today. Then hopefully we can work out what labs I need to request for next week.

I got a copy of some of my initial labs from October. It was before I started TRT. Here’s what looks relevant (they gave me a pile of lab printouts, and I’m trying to make sense of it all):

CBC, everything in normal range (can post specifics if needed)
FT 6.9 pg/ml (8.7-25.1)
Test, Serum 237 ng/dl (348-1197)
FSH 3.1 miu/ml (1.5-12.4)
E2 13.9 pg/ml (7.6-42.6)

I’m pretty sure I saw a LH result on the computer screen, but the report didn’t make it to the printouts apparently.

So now I want to narrow down which labs to ask for next week. Pretty sure the doc will order whatever I ask for. The only labs I have that are current (after starting TRT) are TT, hepatic, and CBC. All unremarkable except for elevated ALT (not sure but given the timing may have been medication related). So I’m thinking I need TT (FT?), E2 for sure and ???

Order all the labs I posted above. It would have been better to get those all prior, some are not as important now because T for example will lower your LH/FSH on its own. You won’t have to get these each time moving forward. You don’t need to continue to test prolactin, thyroid, or SHBG unless you suspect a problem.

Ask if he allows insulin users to self-inject.

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He’s a urologist, so I don’t really expect him to be prescribing insulin.

He told me he doesn’t allow self-inject for “liability,” but would be happy to monitor me with labs and such if someone else, maybe a GP, wrote the script. A nurse told me he had problems with patients who self-injected and took it upon themselves to up their doses, which caused them to run out early and run into all sorts of issues, and doc didn’t want to deal with it anymore. It’s not a big deal right now for me anyway, his office is close to my house and my coinsurance is only $5 a shot. But in January my deductible will reset…

So I’m not quite clear on which labs I need at this point. From the sticky:

Labs to be done when on TRT
-FT or bio-T
-Implications of injections VS transdermals [and injection frequency]
-Prolactin [optional and almost never on-going]
-DHT [should be checked, but perhaps not on-going]
-LH/FSH [optional and one last time -do I have cancer?]
-DRE: the dreaded digital rectal exam [Your doc does not enjoy this either!]

It looks like it really boils down to TT, FT, and E2. Everything else seems to be suggested and not really needed since I’ve been on TRT for 10+ months. My FSH was tested prior to TRT (results above), and I though my LH was tested at that time too, but I don’t have the results. I don’t mind having more tests done, but I figure the fewer labs, the easier to justify with doc and insurance.

You should check prolactin at least once. DHT should be retested a couple times until you see it stabilize.

As expected:
TT 876
Prolactin 18.5
E2 54.8

On my 200mg/wk Test-C protocol, I have been at TT 658 and 653 (tested after 4 weeks and after 8 weeks), so I’m a little but surprised at the 876 number (just one week after 653). I wasn’t even that high at the beginning with an experimental regimen of 200mg/wk while I was still producing some of my own T (that’s pretty much stopped now).

Not sure how much I need to worry about Prolactin, but E2 definitely needs to come down. I knew going in that it would be high based on my symptoms. Any suggestions for medication and dosing?

I had some other things tested with that round of labs, but I didn’t get the results over the phone. I’ll get them tomorrow.