T Nation

My Case - Need Help/Advice Please


#1
  • Hi - new to t-nation. I’d really appreciate your advice on my situation. Sorry for the long winded info but it’s good to give as much context as possible.

I’m a male - 34 years of age - ~200ish lbs ~20-25%BF (currently).
-age = 34
-height = 5’9"
-waist = 36"
-weight = 200lbs
-describe body and facial hair = lots of body hair and facial hair. Bit of bald/thinning hair on the top of head.
-describe where you carry fat and how changed = around the abdominal
-health conditions, symptoms = Diagnosed with Hypogonadism - read in detail below
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - no
– real dangers! see this http://propeciahelp.com/overview
-lab results with ranges - see below in detail
-describe diet [some create substantial damage with starvation diets] = usually clean - lots of protein, complex cabs, and good fats (40/40/20 rule)
-describe training [some ruin there hormones by over training] - 4 x a week weight training - 200km/week cycling
-testes ache, ever, with a fever? Yes - ready below
-how have morning wood and nocturnal erections changed - Yes, not as often/at all when not on HRT. Read below for detail

I spent most of 2014 focusing on my Nutrition and Fitness. Eating clean and counting calories, I was weight lifting 5 days a week and getting my cardio from ~150km/week worth of cycling. I was hovering around 210lbs and around 27%bf. Months went by and I was feeling exhausted, a bit depressed, sex drive was low, was very moody and short fused. On top of that, I wasn’t seeing the physical changes that I was hoping for. Very little in fact. I thought it all had to with the fact that I was unhappy with my job at the time. I was living in Singapore at the time and when I went home to Vancouver for Christmas of 2014, I decided to buy some herbal Test boosters for $40/bottle. When I went back to Singapore in January, I decided to take a baseline of my T levels before I start taking the herbal stuff and check again after a month to see if they were worth buying more of. This is where my journey start as my first set of results highlighted very low T levels.

First set of blood work - Don’t have them with me, but the results came back with a TT of 8nmol/L.

I immediately started researching what it meant to have Low T levels and was so surprised to tie so many of my symptoms to this problem. A problem that no GP would have tested me for, unless I had asked. I was lucky to be in Singapore as it’s all privatized and I could just go into a lab and ask for blood work. Worried about my levels and now knowing that my symptoms weren’t potentially because work was crap, I asked my GP what I should be doing next.

My GP suggested I’d see a urologist. I found, who I believed, was the best men’s health doc in Singapore. He was the chief urologist for one of the best Hospitals there as well as an adoroligist. He ordered another set of more complete tests to see what’s going on.

Jan 29 2015 - My first blood work


You’ll note very low T levels. He had a listen to my testicles and suspected that I had varicocele on my left scrotum. Ultrasound confirmed I had varicocele on both my testicles as will as a small cyst. Within a week, he had me in his OR to remove the cyst and perform a double varicocelectomy.

The Operation, early Feb 2015, was successful. In order to stimulate my testicles, he started me on daily 5mg (I think that was the dose) of Clomid. Then another set of Blood work.

March 14 2015 - After being on a daily dose of Clomid

You’ll notice an increase in Testosterone but at this point, it wasn’t enough for me. I had done a bunch of reading by this point and wanted my Test to be in “optimal” range. So I asked my Doc to Test. He suggested I give hCG a shot instead of Test. He said it has a more natural effect as it triggers your brain to tell your Testies to make more Testosterone. He said because of my young age, he didn’t want me to risk infertility. I took his recommendation and also asked him for some HGH as I had read that the combination of higher testosterone and HGH is very beneficial.

He put me on, what I’m learning now, a very high dose of hCG (Pregnyl) and a very small dose of HGH (Ginotropin - man that stuff is expensive). The Pregnyl vials were 5000iu each and he said to inject 2-3 times a week. HGH was 1iu daily at the time. More blood work was ordered up:

April 1 2015 - 5000iu of hCG 3 x a week + 1iU HGH (sometimes I would do 1.5iU)

You’ll notice that my Test levels sky rocketed, but so did my E2 and as expected IGF-I. I had noticed a massive improvement in my mood and how I felt. I was stronger at the gym and wasn’t as exhausted anymore. I was always alert and could actually think again without a foggy mind.

Because I had gotten good results from the hCG I decided to continue but reduce the dose to 5000iu only 2 x a week. To control the E2, he put me on Aremed 1mg daily for a week, then cut to 0.5mg daily. I had run out of HGH already by this point. To check to see the effect of Aremed, more blood work was ordered up:

April 25 2015 - 5000iU hCG 3xweek + 0.5mg of Aremed daily

You’ll notice an decrease in E2 but also a decrease in Test. However, I was feeling really good and was already seeing a lot of gains at the gym. The fat around my belly started melting away again. I upped my dose of hCG again 2 5000iU 3xweek and got some HGH again (2-3iU daily) and continued with 0.5mg of Aremed. More blood work:

May 23rd 2015 - 5000iU of hCG + 2-3iu of HGH daily + 0.5mg of Aremed daily

Not much change here. T levels were still not “optimal” (I was chasing the number) however I still felt good. Sometime in June, I got the news that I’d be moving my family to Perth Australia in Aug 2015. I decided to come off all the meds so that I could have one more set of blood work with this Doc to see if my natural testosterone production had come back as he was hoping it would. Whilst I had stopped from June onward, I started feeling crappy again. I stopped going to the gym, primarily because we had already moved out of our apartment and into temp accommodations, my routine was shot, and we didn’t really have a static life to do our own cooking etc. I was on moments notice whilst I was waiting for my VISA to come through. So I thought maybe my mood was effected by that stress as well as bad nutrition and lack of exercise. I had been off the meds for 5-6 weeks. Last blood work in Singapore:

July 11 2015 - No Meds - Last set of blood work in Singapore

You’ll notice that everything was down again. I was sad to see that my natural test production wasn’t back on and that my levels were low again. I decided not to go back on the meds till I had made my move to Perth.

The move happend on the 17th of Aug 2015 and I was back on 5000iU of hCG 2-3x a week and once in a while I would take 1mg of Aremed as well. I hadn’t made it a priority to find a doc in Perth but I was feeling really good. My mood was good, my workouts were strong, and best of all I was seeing big composition changes in my body. Mid Oct 2015, I was around 200lbs and ~15% BF. I had also sourced more HGH (Jintropine) - 3iU daily for a few weeks.

Come November, I decided to go off again as the holidays were approaching and I knew my nutrition and gym routine would be impacted. By mid December I was feeling my worst ever. I was still going to the Gym, eating relatively clean, but I was very exhausted all the time. People at work started noticing that I wasn’t my bubbly self. First couple weeks of Jan 2016, it was really really bad and I was going to go back on the meds. But because I only had a few more boxes of hCG left (about 15 vials left) I decided it’s time to find a local Doc. I found a clinic that specializes in Men’s health.

I gave him the history of the past year and he was very surprised hat I was on so much hCG. He said it’s not normal practice for him to give hCG, specially that dose. (note he’s a GP that does TRT). He looked up Pregnyl 5000iU and said that in order to give me more hCG he’d have to get written permission from a government body! Apparently Australia doesn’t like hCG much… and only use for IVF.

Anyway - more blood work.

Jan 2 and Jan 3 2016 - 2 sets over 2 days

At first he offered Androgel. I remembered having read that Cremes are no good. So I asked for injections. He said he offers a testosterone undecanoate (forgot the brand) and a testosterone enanthate (Primoteston). I had done some research on Test U and remembered it being a very long half life. I had heard it’s good for TRT, but the idea of it didn’t please me. Also, he would have had to do the shots in his clinic and I would return every 3 months for more. So I asked for Test E, knowing that it’s one of the esters that’s most popular for bodybuilding.

He gave me 3 prescriptions for Primoteston. Each box has 3 x 250mg injections. He said to do 1 of the shots now, next one 14 days after and the 3rd 2.5-3 weeks after that and go back and see him for more blood work. He wrote up my blood request but didn’t include E2 this time as he said it wouldn’t move much and not to worry about it at this stage.

Leaving the clinic without much confidence in his protocol, I decided to start Googling. This is how I found T-Nation and this forum.

So here I am now asking for advice and feedback on where to go from here. I did have a read at KSman’s TRT Protocol and am keen to start that. Aside from general feedback on my case, here are some pointed questions I’d like answered.

1 - I want to incorporate what’s left of my hCG into my protocol. KSman’s protocol specifies 250iU of hCG via SC every other day. My problem is that my hCG vials are 5000iU. Once i reconstruct the powder with 1mL of sterilized water, I get 5000iU. How long can I leave the reconstituted fluid in the fridge? The instructions don’t make a suggestion either way. Is it reasonable to take the following approach?..

  • reconstitute the 5000iU vial with the 1mL of water in a 3mL syringe and draw 0.05mL of the fluid (1mL/20) for equivalent of 250iU?

2 - Since this will be my first Testosterone injection - should I start with the full 250mg load and then change to 100mg a week (split between 2-3 injections)?

3 - I’ve noticed the studies out of Canada about Test E being injected SC. I do my hCG in my abdominal fat, about an inch off my belly button. Can I use a 30 gauge needle and do the same with the Test E or is the oil too thick for that?

4 - I have 1800iU of Jintropin HGH left. I’d like to make sure I get the most optimal use out of this because it’s very expensive. So any help with dosing would be much appreciated.

Keep in mind, I’d like the best protocol to see gains at the gym again. I weight train 4 times a week + cycle about 200km/week. When I’m active and feeling good, my nutrition is also on point.

Any additional advice/suggestions/feedback would be much appreciated. I’m still reading through the vast amount of information on this forum.

Many thanks in advance.

Cheers

H


#2

I’m in a similar position to you I’m also living in Australia and the requirements to obtain trt on the pbs ( government subsidised ) have been tightened again as of around October I think last year . They want 2 reading below 6 nmol or a lh that’s 4x your total test nmol I think or something like that . I’m currently on reandron test u 1000mg 4ml but want to change to test cypionate as it seems you can control e2 a lot better with injections every 3.5 days .

A lot of guys buy sterile vials and suck out what’s in the ampules and transfer it to the vial . Reandron worked for me when I took it back in late 2014/early 2015 but you will have a hard time controlling e2 and will also take some time to dial in the time between injections I was at every 8 weeks .

As your doc has offered test e I’d be going that over the Reardon , putting the ampules contents into a sterile vial and doing your dose split up over the week injecting every 3.5 days . You will find e2 will most likely keep in check and by doing it this way you’re giving it the best opportunity to stay in a good range , also you won’t experience the peaks and troughs to the extent of reandron or injecting every 2 weeks as most docs / endos will prescribe .

As for the needle gauge I’m not sure but I’m confident someone here will help out as I’m also curious about Sq test injections and if they are as effective as Im.

Hope it goes well for you mate best thing I’ve done in my journey is read and arm yourself with information as some of these medical professionals are absolute rogues and may make you feel worse , this site is a wealth of information make the most of it .


#3

hCG: Do not use sterile water. Must be BA water, 0.9% benzyl alcohol.

hCG dose was too high and LH then too high. That causes high T–>E2 inside the testes and anastrozole has limited effect because it cannot control T–>E2 inside the testes. Stupid thing that doctors do. This high dose can also desensitize the LH receptors in the testes and that is really a bad outcome. See if you can get hCG in multi dose vials. You can load multiple syringes and store. You can inject part of a syringe, wipe with an alcohol prep pad and return to refrigeration.

You do not need high dose hGH. 1.0 - 1.5iu will produce good levels of IGF-1.

You have a good degree of hypothyroidism.
Have you been using iodized salt or sea salt?
Do you get cold easily?
Outer eyebrows sparse?
Thyroid enlarged, asymmetrical or lumpy?

Thyroid labs:
TSH should be closer to 1.0
fT3, fT4 should be mid-range or a bit higher.
Please read the thyroid basics explained topic.

The stickies are now linked in the 2nd post of the 1st topic in this forum.

I think that you are over training which can:

  • lower your hormone levels
  • cause adrenal fatigue and elevated rT3 that interferes with fT3

Your level of training with this thyroid problem is another stress on you adrenals. Cortisol is OK for now and can be increases during adrenal fatigue, until the adrenals collapse. Your lower DHEA level might be pointing to an adrenal issue.

fT3 regulates your base metabolic rate and body temperature.
Evaluate your overall thyroid function by checking oral body temperatures:

  • when you first wake up, should be 97.7-97.8F, higher is OK, 97.3 is a problem
  • also check for 98.6F/37C mid-afternoon

Any tropical diseases/illnesses?

It would be interesting to see if cholesterol is low. That can adversely affect hormones.

Do you get much sun exposure. Vitamin D is important. You could supplement.

ALT can be elevated by training and/or sore muscles.

If you can get insulin syringes, inject T enanthate twice a week.


#4

Thank you. I’ve put my responses in bold above in line


#5

[Hashimoto’s: Your wife may have progressed into that from a lack of iodine. Whole household probably affected.

You can SC into belly far or over you quads. Whatever is most comfortable.

hCG is in multi dose vials with rubber stoppers or in glass ampules that you crack open. If vials, simply load as needed. yes, good for 20 injections. Keep refrigerated at all time.

Please check body temperatures. Body temps for your wife will be interesting too. Is she is cold, she is under medicated.


#6

I’ll check our Temps and report back.

hCG is in glass tubes that I Crack open.

Thanks!


#7

And yes she is often cold. She was put on a small dose of (50mg) of thyroxine last year. Initially saw positive results then started fading again.

She was told last week that her T3’s were not converting to T4 so now she’s on 60mg of natural desiccated thyroid (NDT). She was also just diagnosed with fatty liver. She can’t catch a break. Her cortisol levels are through the roof. She stresses out very easily and our 3 big moves in 4 years have not helped her


#8

@ksman - is it beneficial if I start a small dose of thyroxine? I have 25mg and 50 mg tablets left since my wife isn’t taking then and switched


#9

Ask pharmacist if they can get hCG in multi-dose vials. What you have was created for women to use to force ovulation in IVF, injecting the whole amount at once.

If NDT does not elevate your wife’s temperatures, she probably has a problem with rT3. Then the more T4 she takes, the more T4–>rT3 happens. In that case, taking T3 alone for three weeks sometimes resets things a bit. But she may gave deep rooted adrenal fatigue.

You need iodine replenishment, with selenium. T4 meds might provide some faster relief, but your goal is to not be medicating and trying to get a normal state.

Can you report body temperatures for your wife and yourself?