T Nation

Looking for Advice....TRT


#1

Started TRT back in May 2014. Very typical of other cases here. Dr. precscribes 100mg test weekly IM. Nothing else.. Things go great for awhile then fall apart near the end of November. Trying new Dr. in hopes of fixing my issues. Feel like things are turning in the right direction. looking for your opinions/suggestions..
As of Dec 9th here we go!

44 y/o male
6'0
38
227
Grow beard in 2 weeks, moderate leg, arm, chest hair, receding hairline since mid-late 20's
carry weight around midsection/chest
Did an 8 on 8 off 8 on cycle of 200 mg 1ml testosterone back in 1993 then ran 12 weeks Deca in 1997..Trained heavy body building style workouts for years
Rogaine for appx 6 months 2012
kidney stones/surgery 2006,
slightly enlarged heart 2011, WNL after 8 months increased/intense cardio,
L shoulder impingement surgery 2010,
moderate high cholesterol 201/220, moderate to high blood pressure 140/80's,
yearly sinus infection,
vasectomy 2014
Vit D 5000iu daily,
niacin 1000mg slow release for 3 years per cardiologist, recently stopped per cardiologist,
5 grams fish oil per day

Started 100mg Test Cyp May 2014 TT212, side effects started Nov 2014 Shrunken testicles, testicular Atrophy, Onset Gyno, Low Libido, brain fog, ringing in ears, etc...

Just started the following Dec 9th with new Dr.
200 mg test cyp inject 1.0ml IM Weekly
Anastrozole .5mg M/W/F
Danazol 20mg 1x per day under tongue
HCG 0.5ml SQ 2x per week
Liothyronine 5mcg 1x per day
25mg DHEA
ZMA w/theanine
Donate Blood till hgb under 15.5

-lab results with ranges
CBC w/DIFF
White Blood Cells 5.5 3.6-10.2 k/cu mm
Red Blood Cells 5.2 4.4-6.0 m/cu mm
Hemoglobin 16.1 13.2-18.0 gm/dl
Hematocrit 46.5 41.0-55.0 percent
MCV 90 82-99 fl
MCH 31 27-33 pg
MCHC 35 31-34 percent
Platelets 193 150-450 k/cu mm
MPV 11.2 9.8-12.7 fl
RDW-CW 12 11-15 percent
Neutrophils 57 37-72 perc
Lymphocytes 32 16-48 perc
Monocytes 10 4-14 perc
Eosinophils 1 0-9 perc
Basophils 0 0-2 perc
Neutrophil Count 3.2 1.1-6.0 k/cu mm
Lymphocyte Count 1.8 0.7-3.4 k/cu mm
Monocyte Count 0.6 0.3-1.0 k/cu mm
Eosinophil Count 0.1 0.0-0.6 k/cu mm
Basophil Count 0.0 0.0-0.1 k/cu mm

Hemoglobin A1C 5.5 4.0-6.0 percent
Ferritin 161 13-400 ng/ml
Uric Acid 3.9 3.4-7.0 mg/dl
Total Protein 7.4 6.0-8.3 gm/dl
Albumin 4.5 3.5-4.8 gm/dl
AST 26 14-54 iu/l
ALT 38 11-51 iu/l
Alkaline Phos 52 40-129 iu/l
Total Bilirubin 0.7 0.0-1.0 mg/dl
Direct Blilrubin <0.2 0.0-0.3 mg/dl
Glucose 102 70-99 mg/dl
Urea Nitrogen 17 6-20 mg/dl
Creatinine 1.3 0.5-1.2 mg/dl
GFR 77 60-300 ml/min/1.73 m2
GRF other 64 60-300 ml/min/1.73 m2
Sodium 139 136-145 mEq/l
Potassium 5.0 3.5-5.1 mWq/l
Chloride 102 98-107 mEq/l
CO2 25 23-31 mEq/l
Anion gap 17 8-20 mEq/l
Calcium 9.2 8.4-10.5

Total Cholesterol 201 125-199 mg/dl
Triglycerides 58 30-49 mg/dl
HDL 65 40-135 mg/dl
LDL 124 0-129 mg/dl
Non -HDL 136 0-159 mg/dl
PSA total 0.411 0.00-3.90 ng/ml Roche Diagnostic
Prolactin 7.39 4.04-15.20 ng/ml
Progesterone 0.49 0.20-1.40 ng/ml
LH 0.6L 1.2-8.6 miu/ml
FSH 1.00L 1.27-19.26 miu/ml
Estradiol 31 0-47 pg/ml
Free T4 1.05 0.80-1.80 ng/dl
T4 5.45 4.50-11.70 mcg/dl
TSH 1.98 0.30-5.00 mciu/ml
Free T3 3.1 2.0-4.4 pg/ml
Cortisol 11.1 6.7-22.6 mcg/dl AM Specimen
Homocysteine 6.9 0.0-15.0 umol/l
Insulin 5.5 2.6-24.9 mu/ml
Testosterone Total 806.30 193-950 ng/dl
DHEA Sulfate 139 89-427 mcg/dl
T3 Total 0.9 0.8-2.0 ng/ml
Thyroglobulin Antibody Anti TG 18 10-115 iu/ml
TPO Antibody 8.5 5.0-34.0 iu/ml
Insulin-like growth factor 1 211 75-216 ng/ml
T3 reverse 15 8-25 ng/dl
T-uptake 1.1 0.8-1.3 tbi
SHBG 37 10-80 nmoles/l

Diet is fair to poor high protein, mod to high carbs and fats
Strength train 4 days a week followed by Crossfit style 12-30 minute workout
Testes ache, never with fever
Morning wood was great when TRT first started then disappeared when other symptoms started.

This forum and KSman are what got me looking for another Doc/route. The information is great just a little over my head at times.
Thanks to all the people out there giving sound advice,. It is greatly appreciated!


#2

I should add, when symptoms started my doc ran blood work Nov 23rd. My estrogen level was 79. TT was 987 which he said was to high so he backed me off to 100mg every other week. That's when I made appt with new Dr. I have taken my morning temp 3 different weeks 4 consecutive days, first thing upon waking 97.1 to 97.3


#3

You need to self inject twice a week.

These look OK, hematocrit seems a bit low:
White Blood Cells 5.5 3.6-10.2 k/cu mm
Red Blood Cells 5.2 4.4-6.0 m/cu mm
Hemoglobin 16.1 13.2-18.0 gm/dl
Hematocrit 46.5 41.0-55.0 percent

What prompted this and what T dosing was involved?:
Donate Blood till hgb under 15.5

Your lab T and E2 values are useless when injecting once a week. Levels are changing and labs are one frame in the movie. Inject twice per week and always do labs 1/2 way between injections.

200mg per week is insane.

Estradiol 31 0-47 pg/ml
You should be trying to get near E2=22pg/ml, so anastrozole should increase to 1.5mg/week X 31/22 = 2.11mg/week. The standard "rule of thumb" for normal responders to anastrozole is 1 mg/week for every 100mg T ester per week. So you fit that. However, there is some uncertainty about your labs.

You can self inject T with #29 insulin needles. Try SC instead of IM and see what works better for you. SC and IM both release the same amount of T.

You have a thyroid condition or are iodine deficient?

Please read these stickies"
- advice for new guys
- protocol for injections
- thyroid basics

Are lab results based on the Dec 9th protocol or something else?


#4

You need to self inject twice a week.

These look OK, hematocrit seems a bit low:
White Blood Cells 5.5 3.6-10.2 k/cu mm
Red Blood Cells 5.2 4.4-6.0 m/cu mm
Hemoglobin 16.1 13.2-18.0 gm/dl
Hematocrit 46.5 41.0-55.0 percent

What prompted this and what T dosing was involved?:
Donate Blood till hgb under 15.5

Your lab T and E2 values are useless when injecting once a week. Levels are changing and labs are one frame in the movie. Inject twice per week and always do labs 1/2 way between injections.

200mg per week is insane.

Estradiol 31 0-47 pg/ml
You should be trying to get near E2=22pg/ml, so anastrozole should increase to 1.5mg/week X 31/22 = 2.11mg/week. The standard "rule of thumb" for normal responders to anastrozole is 1 mg/week for every 100mg T ester per week. So you fit that. However, there is some uncertainty about your labs.

You can self inject T with #29 insulin needles. Try SC instead of IM and see what works better for you. SC and IM both release the same amount of T.

You have a thyroid condition or are iodine deficient?

Please read these stickies"
- advice for new guys
- protocol for injections
- thyroid basics

Are lab results based on the Dec 9th protocol or something else? (yes)

According to the Dr. "all patients" on TRT should donate/give blood. TRT/Testosterone thickens the blood and raises the red blood cell count causing blood pressure to rise.

At the time of the Dec 9th lab review I hadn't had an injection for 16 days/Nov 23rd.
I had switched Dr.'s and had labs done on Nov 26. The Dec 9th date was the review of labs and new Rx written by the new physican.

I assumed my thyroid function was a little low from the morning temps I documented. But here is where I'm confused my TSH test shows
1.98 with lab ranges of 0.30-5.00. Where should it be?

I am currently taking 5mcg liothyronine 1x per day. I am scheduled for another lab test Jan 7th. Should I wait for the follow up labs or start some iodine now?

I have read and will continue to read the stickies

I will switch to 2 injections per week.

Thanks for taking the time KSMAN. Your knowledge is priceless. I have learned so much with your posts in a short amount of time. If your ever in Central Illinois let me know and I'll buy you a beer!


#5

TSH around 1.0 is common when everything is working right. You will find more in the sticky.

Central Illinois is so flat and people make fun of Kansas!

Can you ask why doc prescribed "Danazol 20mg 1x per day under tongue"


It is used to shutdown LH and FSH, but TRT does that anyways. So I can't see that it has any function and can't see any reason for this at all. I have never seen any reference to this in TRT. It would induce secondary hypogonadism in a normal male. I can only see a need for this in a male who has a LH or FSH secreting pituitary adinoma [tumor]. You were off of your TRT for the labs and LH/FSH were low at that time. Danazol will not affect gyno in a guy on TRT, anastrozole is sufficient for that.


#6

01-16-15 follow up appt....Back to Dr. after 01-07-15 blood draw.

01-16-15 TOTALS
TT 659 193-950 ng/dL
ESTRADIOL 27 0-47 pg/mL
SHBG 23 10-80 nmoles/L

12-09-14 TOTALS
TT 806
ESTRADIOL 31
SHBG 37

**12-09-14 Rx
200 mg test cyp inject 1.0ml IM Weekly
Anastrozole .5mg M/W/F
Danazol 20mg 1x per day under tongue
HCG 0.5ml SQ 2x per week
Liothyronine 5mcg 1x per day
25mg DHEA
ZMA w/theanine
Donate Blood till hgb under 15.5

**01-16-15 Rx changes:
Anastrozole 1mg M/W/F
HCG 50 Units M/W/F
200 mg test cyp per week inject 0.5 ml 2x per week Sun/Thur IM or SC
**01-16-15 No change:
Liothyronine 5mcg 1x per day
25mg DHEA
ZMA w/theanine

**12-09-14 Danazol 20mg 1x per day under tongue was prescribed to lower SHBG and raise FT. 30 day Rx no refill.

I return in 3 months for full work up blood draw. As of today I feel decent. Good energy, libido better.. I am still having some negative mild side effects, itchy sometimes puffy nipples. Also, atrophy and shrunken testicles have not returned fully. I hope the new Rx will take care of these issues.

Seems impossible to lose any weight. 235lbs today. Plan to kick the cardio up a notch!

I appreciate everyone who posts their issues and accomplishments. Thank You to the "Wise Men" of the forum. Your advise is paramount. There is so much to learn!


#7

I think that your anastrozole 3x 1mg per week will take you to E2=13 which is too low.

To get to E2=22pg/ml your anastrozole dose should be uncreased by a factor of 27/22 or 1.84mg/week. Based on the rule of thumb of 1mg anastrozole per week for each 100mg/week, 1.82 is quite close to 2.0, if you take 1/2mg every other day, that will be close.

When looking at your labs based on injecting once a week, we have uncertainty of what the labs mean as your levels were changing a lot. Next labs will be more meaningful. Please to all labs 1/2 between injections and don't change that otherwise lab changes may be from lab timing effects.