T Nation

My Case- USA SUB

Hi everyone. I am 23 years old, 6’4, 250 lbs, 38 inch waist. My facial hair grows normally. I only carry fat in my stomach, I am pretty lean everywhere else except my stomach.

My symptoms began at 17 and a half. After being the horniest teenager ever from 14-16 my sex drive fell off a cliff and I couldn’t get hard. (I went over 2 straight years without getting a hard erection, only semis, and it wasn’t until I discovered cialis that I could even get hard at all). I had ZERO morning wood except for putrid, embarrassing semi erections. I went to my family doctor shortly after my symptoms began to have my test levels checked, and she said they were “normal”. After the education I received years later reading these forums, I strongly suspect my test levels were in the very low normal range for an 80 year old. She never told me the exact number, and I didn’t ask because I simply wasn’t educated enough at the time to know I should. I’m kicking myself now for not pushing her harder for answers, but I was young, embarrassed about my condition, stupid and didn’t know any better at the time.

My other symptoms besides ED and zero sex drive included brain fog, decreased alertness, decreased cognition, blurry vision, low self esteem, somewhat anxiety, overall feeling of crappiness, no bounce in my step, constantly tired, increased belly fat storage (despite having a ridiculously meticulous diet and obsession with dieting)…it was f**king hell. I basically felt half alive. Everything seemed so grey and less alive around me. I felt like an 80 year old in a 19 year olds body. I have been this way for 6 years and have lost much of the prime of my life due to this condition.

I FINALLY got fed up with this and went to a urologist demanding answers. After minor blood work, he referred me to an endo, who took an MRI of my pituitary gland and more full scale blood work. The MRI showed pituitary damage 4 mm big. This explained everything, I must have damaged my pituitary at 17 playing sports and my pituitary stopped producing testosterone at the rate a young man should produce testosterone at.

Here’s the latest blood work results from the endo. I should mention I used the OTC horomone Superdrol and stopped using it shortly before getting the bloods done, which may have impacted some of the numbers. However, I never touched a hormone like superdrol until YEARS after my symptoms began, and the symptoms did not change after using it, so it is unrelated to my condition.

ANDROSTENEDIONE 49 NG/DL (50-220 RANGE)

TSH 2.410 mIU/ML (0.400-4.000)

T3 70.7 NG/DL (76.0-164.0)

FT4 1.03 NG/DL (.89-1.76)

DHEA-SULFATE 97.9 UG/DL (80-560)

FSH 0.3 mIU/ML (0.7-11.1)

PROLACTIN 14.90 NG/ML (2.50-17.00)

GROWTH HORMONE, SERUM 0.47 NG/ML (0.00-3.00)

IGF-1: 167 NG/ML (116-358)

LH 0.4 MIU/ML (0.8-7.6)

ESTRADIOL <20 PG/ML

CORTISOL 17.8 UG/DL (AM: 5-25 UG/ML, PM: 2.5-12.5 UG/ML) (test done in AM)

TESTOSTERONE <20.0 NG/DL (160.0-726.0)

I also have blood count and metabolic profile if anyone needs to see those.

The endo put me on TRT, and I will use this for the rest of my life. I asked for injections but he insisted on Fortesta gel and said if I didn’t like it we could switch, so I gave in. After about 10 days of using 5-7 pumps per day, I began feeling better. However, I am an athlete and I sweat a lot and shower a lot so I didn’t want to continue using the gel as it was a hassle and I was afraid of it not absorbing fully. I just switched 5 days ago to injections. He has me on 3/4 ML per week from a 200 mg/ml vial of test E, which is 150 mg of test e per week.

After injecting 150 mg Thursday night, I felt INCREDIBLE Friday. I was super talkative, confident, had morning wood, a good sex drive, and an overall well being. I felt so good. I then stopped applying the testosterone gel due to switching to injections, and once I lost the testosterone from the gel, I CRASHED Saturday. I have felt like dog shit since then. I started “bridging” some test gel since Sunday to help with the crappy feeling and I planned on tapering off the dosage week by week until the test E builds up in my system, until finally ceasing test gel use entirely after about week 4 of injections. Is that a bad idea? Good idea? I’ve been watching out for symptoms of high estrogen and have nothing yet.

I have noticed my balls are heavily atrophied. I asked for HCG, but my doctor wants to wait 5-6 weeks and get blood work done before using HCG.

I am planning on injecting 50 mg of test E 3 times per week, M,W,F, first thing in the morning (injecting at night gave me bad insomnia). I will use a 0.5 inch, 0.5 ML, 29g insulin syringe and inject into my quad muscle. Does this protocol sound good?

I am concerned about my e2 levels and want to have an AI on hand just in case but I have to wait until I get my follow up blood work done before asking my doctor for it.

As an athlete and bodybuilder, I have a very strict diet. I never eat junk food and rarely drink alcohol. Right now I am doing a carb cycling diet in order to lose fat. I am eating egg yolks, spinach, chicken breast, skim milk, and occasionally fish.

My training is hardcore. I lift upper body MTH and lower body TF. I do cardio Wednesday, Saturday and Sunday (I will stop cardio when I switch back to bulking).

My testes do not ache. I started getting morning wood again after about 10 days of test gel, but I crashed after switching to injections and do not have them anymore.

Thank you all for everything you do for this forum, I hope I can get my life back together alongside of you guys.

Ouch 23 that is a tough break but at lest you know what’s wrong. You are on a path to restoring your hormone levels. 150 MG seems about right with no AI I would try to go as low as you can to get to the state where you feel healthy with.
One of the biggest things I have learned is to read my self first. I think how much acne I have on my back and chest tells me that I need to cut back. My night erections are the best indicator I have to tell my T level.

I inject 30 MG every 52 hours for 3 even does a week but I also listen to me body and drop the amount or increase by 20 MG depending on my personal indicators.

I would also recommend to a man of 23 before you get to deep in TRT you freeze some of your sperm. There are treatments that can help but I would want to be sure I had the good stuff if I was only 23.

[quote]ikeholtz wrote:
Ouch 23 that is a tough break but at lest you know what’s wrong. You are on a path to restoring your hormone levels. 150 MG seems about right with no AI I would try to go as low as you can to get to the state where you feel healthy with.
One of the biggest things I have learned is to read my self first. I think how much acne I have on my back and chest tells me that I need to cut back. My night erections are the best indicator I have to tell my T level.

I inject 30 MG every 52 hours for 3 even does a week but I also listen to me body and drop the amount or increase by 20 MG depending on my personal indicators.

I would also recommend to a man of 23 before you get to deep in TRT you freeze some of your sperm. There are treatments that can help but I would want to be sure I had the good stuff if I was only 23.
[/quote]

Thank you for the kind words. I am very concerned about having kids someday but my doctor assured me it won’t be an issue as he does this all the time with older patients. I wonder if my sperm count is even high enough right now to conceive because I am not using any hcg yet.

[quote]USA SUB wrote:

[quote]ikeholtz wrote:
Ouch 23 that is a tough break but at lest you know what’s wrong. You are on a path to restoring your hormone levels. 150 MG seems about right with no AI I would try to go as low as you can to get to the state where you feel healthy with.
One of the biggest things I have learned is to read my self first. I think how much acne I have on my back and chest tells me that I need to cut back. My night erections are the best indicator I have to tell my T level.

I inject 30 MG every 52 hours for 3 even does a week but I also listen to me body and drop the amount or increase by 20 MG depending on my personal indicators.

I would also recommend to a man of 23 before you get to deep in TRT you freeze some of your sperm. There are treatments that can help but I would want to be sure I had the good stuff if I was only 23.
[/quote]

Thank you for the kind words. I am very concerned about having kids someday but my doctor assured me it won’t be an issue as he does this all the time with older patients. I wonder if my sperm count is even high enough right now to conceive because I am not using any hcg yet. [/quote]

Age 23 last thing you need to be thinking about is HRT, but rather find out why you are having issuses by examining factors which may be contributing to the problem. Starting HRT at this age is just like throwing a bandaid on - its a temporary fix, but there may be other issues underlying which it can be masking which is not a good thing. As in many cases, I have dealt with Dr’s even if you go on HRT you are addressing symptoms not root causes. Example, Guy 23 years old goes on HRT feels great then 4-5 months later feels like crap digestion issues, bloating, no energy despite TRT, thyroid . 4 months when he comes into your office you start asking question. He had some digestion issues in the past but did not think it was important to tell the Dr at the time. Has dx lowthyroid, low T Dr’ puts him on HRT gets worses. You run a food allergies test possitive for gluten diary, he also was found to have some bad bugs in GI tract. Once you clear them remove food allergies his fatigue improves feels better then ever with in 6-8 weeks. Now you approach him, and ask him to possible considering a restart which will be done through a Dr I know whom I have worked with in the past. While healing the GI tract, one back fills all the missing pieces of the puzzles (2-3 monhts) then Dr pulls him off HRT for 7-10 days then you try a restart. Now on clomid hes at 600 on his own production after clomid challnege. The dr adjust the dosages then after 3-4 months stop clomid and rechecks levels 525 good SHBG, e2 ect. IMO unless you are primary striaght up your Dr jumped the gun…

[quote]Hardasnails wrote:

[quote]USA SUB wrote:

[quote]ikeholtz wrote:
Ouch 23 that is a tough break but at lest you know what’s wrong. You are on a path to restoring your hormone levels. 150 MG seems about right with no AI I would try to go as low as you can to get to the state where you feel healthy with.
One of the biggest things I have learned is to read my self first. I think how much acne I have on my back and chest tells me that I need to cut back. My night erections are the best indicator I have to tell my T level.

I inject 30 MG every 52 hours for 3 even does a week but I also listen to me body and drop the amount or increase by 20 MG depending on my personal indicators.

I would also recommend to a man of 23 before you get to deep in TRT you freeze some of your sperm. There are treatments that can help but I would want to be sure I had the good stuff if I was only 23.
[/quote]

Thank you for the kind words. I am very concerned about having kids someday but my doctor assured me it won’t be an issue as he does this all the time with older patients. I wonder if my sperm count is even high enough right now to conceive because I am not using any hcg yet. [/quote]

Age 23 last thing you need to be thinking about is HRT, but rather find out why you are having issuses by examining factors which may be contributing to the problem. Starting HRT at this age is just like throwing a bandaid on - its a temporary fix, but there may be other issues underlying which it can be masking which is not a good thing. As in many cases, I have dealt with Dr’s even if you go on HRT you are addressing symptoms not root causes. Example, Guy 23 years old goes on HRT feels great then 4-5 months later feels like crap digestion issues, bloating, no energy despite TRT, thyroid . 4 months when he comes into your office you start asking question. He had some digestion issues in the past but did not think it was important to tell the Dr at the time. Has dx lowthyroid, low T Dr’ puts him on HRT gets worses. You run a food allergies test possitive for gluten diary, he also was found to have some bad bugs in GI tract. Once you clear them remove food allergies his fatigue improves feels better then ever with in 6-8 weeks. Now you approach him, and ask him to possible considering a restart which will be done through a Dr I know whom I have worked with in the past. While healing the GI tract, one back fills all the missing pieces of the puzzles (2-3 monhts) then Dr pulls him off HRT for 7-10 days then you try a restart. Now on clomid hes at 600 on his own production after clomid challnege. The dr adjust the dosages then after 3-4 months stop clomid and rechecks levels 525 good SHBG, e2 ect. IMO unless you are primary striaght up your Dr jumped the gun…[/quote]

Thank you for the post. I have a damaged pituitary gland. I don’t know how else to fix my problems other than resorting to TRT because my pituitary does not work properly.

[quote]USA SUB wrote:

[quote]Hardasnails wrote:

[quote]USA SUB wrote:

[quote]ikeholtz wrote:
Ouch 23 that is a tough break but at lest you know what’s wrong. You are on a path to restoring your hormone levels. 150 MG seems about right with no AI I would try to go as low as you can to get to the state where you feel healthy with.
One of the biggest things I have learned is to read my self first. I think how much acne I have on my back and chest tells me that I need to cut back. My night erections are the best indicator I have to tell my T level.

I inject 30 MG every 52 hours for 3 even does a week but I also listen to me body and drop the amount or increase by 20 MG depending on my personal indicators.

I would also recommend to a man of 23 before you get to deep in TRT you freeze some of your sperm. There are treatments that can help but I would want to be sure I had the good stuff if I was only 23.
[/quote]

Then have your Dr run a clomid challenge to provide what the pituitary would be doing. If your nuts are able to recieve the signal then why shut it down by giving it endogenous testosterone. I use this as first recommendation to Dr’s in these cases. It does not hurt to try.

Thank you for the kind words. I am very concerned about having kids someday but my doctor assured me it won’t be an issue as he does this all the time with older patients. I wonder if my sperm count is even high enough right now to conceive because I am not using any hcg yet. [/quote]

Age 23 last thing you need to be thinking about is HRT, but rather find out why you are having issuses by examining factors which may be contributing to the problem. Starting HRT at this age is just like throwing a bandaid on - its a temporary fix, but there may be other issues underlying which it can be masking which is not a good thing. As in many cases, I have dealt with Dr’s even if you go on HRT you are addressing symptoms not root causes. Example, Guy 23 years old goes on HRT feels great then 4-5 months later feels like crap digestion issues, bloating, no energy despite TRT, thyroid . 4 months when he comes into your office you start asking question. He had some digestion issues in the past but did not think it was important to tell the Dr at the time. Has dx lowthyroid, low T Dr’ puts him on HRT gets worses. You run a food allergies test possitive for gluten diary, he also was found to have some bad bugs in GI tract. Once you clear them remove food allergies his fatigue improves feels better then ever with in 6-8 weeks. Now you approach him, and ask him to possible considering a restart which will be done through a Dr I know whom I have worked with in the past. While healing the GI tract, one back fills all the missing pieces of the puzzles (2-3 monhts) then Dr pulls him off HRT for 7-10 days then you try a restart. Now on clomid hes at 600 on his own production after clomid challnege. The dr adjust the dosages then after 3-4 months stop clomid and rechecks levels 525 good SHBG, e2 ect. IMO unless you are primary striaght up your Dr jumped the gun…[/quote]

Thank you for the post. I have a damaged pituitary gland. I don’t know how else to fix my problems other than resorting to TRT because my pituitary does not work properly.
[/quote]

Update; I’ve got some gyno problems.

I’ve been on for about 6 weeks now and I added HCG one week ago. I started having mild gyno a few weeks ago and now I feel a noticeable lump under my nipple and it is very sensitive.

I asked my doctor about an AI before going on TRT but he said it wasn’t necessary. I am not happy right now and plan on calling him tomorrow.

Any advice on what to take to get rid of the gyno?

look into a SERM…more info on that in the steroids section.

Need some help:

I recently had bloodwork done for total test and e2 because I’m still not getting morning wood and still having issues with the way I feel and my libido. I’m taking 150 mg test e a week with 200 iu HCG eod and I’ve been doing injections for about 2.5 months now.

Total test: 686 ng/dl (350-1200)

e2: 35.3 pg/ml (7.6-42.6)

I’m pretty surprised my total test is so low as 150 mg ew seems to be a higher dose. I’ve been doing the injections for 2.5 months now. Will it still continue to build up each week to a higher level?

After 2.5 months you should have reached an approximate steady state… Are you only injecting once per week? How long after your injection was the test done? Are you injecting SC or IM? What location? What sort of pins are you using. Need info.

Your E2 is high. no adex?

[quote]VTBalla34 wrote:
After 2.5 months you should have reached an approximate steady state… Are you only injecting once per week? How long after your injection was the test done? Are you injecting SC or IM? What location? What sort of pins are you using. Need info.

Your E2 is high. no adex?[/quote]

My endo wouldn’t write me a script for an AI. I’m in the process of finding a new doctor. In the meantime in using topical formestane, an OTC AI.

I inject 50 mg 3 times per week. I was doing IM but recently switched to subq into belly fat. My last injection before the blood test was two days before the blood work. I use .5 inch, .5 cc 29g insulin syringes to inject.

Yeah your levels are somewhat low for that protocol for sure…may want to talk to your doctor about increasing it…big key though are symptom improvements

[quote]VTBalla34 wrote:
Yeah your levels are somewhat low for that protocol for sure…may want to talk to your doctor about increasing it…big key though are symptom improvements[/quote]

Do you think my lower test levels are because of the pituitary damage affecting gh, igf, ect, causing more testosterone being needed for healing than the normal person? Is that a possibility?

No, they are unrelated. Total T is a measure of the T in your bloodstream. It doesn’t matter how it is utilized. That and I don’t think T heals pituitary damage.

USA Sub: I read quite often where a guy will start t therapy and get great results (increased sex drive, morning wood, etc) and then after a period of time this decreases.

Here is my take on that - the drug companies have worked diligently to decrease the amount of androgenic properites in the gels and the injectables. Those are properties primarily responsible for an erection, voice deepening, agression, etc. However, there are still some yet compared to the anabolic properties they are low. When you start t therapy you add what androngenic properties that are contained in the exogenous testosterone to the level of androgens produced by you. The net effect is that you have a big increase in morning wood, sex drive, well being etc.

As your own production drops due to your body trying to balance out your t levels you end up with less androgenic effects than before the t therapy however you still have a net increase in the anabolic properties as total t and free are greater than pre t therapy.

This is the reason why HCG injections are important - to keep your own production at a normal level and to get those androgenic properties. If you start HCG injections you should keep track of your estradiol levels as it appears that a lot of the testosterone that you create due to the leutinizing hormone mimicing of the HCG is converted to estradiol and the greater need therefore for an AI.

[quote]GeorgeCulp wrote:
USA Sub: I read quite often where a guy will start t therapy and get great results (increased sex drive, morning wood, etc) and then after a period of time this decreases.

Here is my take on that - the drug companies have worked diligently to decrease the amount of androgenic properites in the gels and the injectables. Those are properties primarily responsible for an erection, voice deepening, agression, etc. However, there are still some yet compared to the anabolic properties they are low. When you start t therapy you add what androngenic properties that are contained in the exogenous testosterone to the level of androgens produced by you. The net effect is that you have a big increase in morning wood, sex drive, well being etc.

As your own production drops due to your body trying to balance out your t levels you end up with less androgenic effects than before the t therapy however you still have a net increase in the anabolic properties as total t and free are greater than pre t therapy.

This is the reason why HCG injections are important - to keep your own production at a normal level and to get those androgenic properties. If you start HCG injections you should keep track of your estradiol levels as it appears that a lot of the testosterone that you create due to the leutinizing hormone mimicing of the HCG is converted to estradiol and the greater need therefore for an AI.[/quote]

I have no idea how you came up with any of this. The androgenic: anabolic ratio of testosterone is roughly 1:1 This is true no matter the delivery mechanism. Unless you are saying that somehow the drug companies have altered the chemical makeup of testosterone itself, in which case it is no longer testosterone and would no longer be advertised as such.

I really don’t know where youre going with this.

Thank you all for your time in writing me responses. I just made an appointment with a new doctor who has a good reputation so hopefully I’ll find good results.

Need more help:

I took Nolvadex (tamoxifen) to solve gyno caused by TRT. I took it for about 4 weeks. The nolvadex made my symptoms MUCH worse. My brain fog doubled and my erectile issues were much worse, blood flow was restricted to my penis even more so than before. My brain function was absolutely HORRIBLE on nolvadex, even worse than pre TRT.

It has been 2 weeks since I stopped taking nolvadex and I don’t feel any better. I can’t test e2 yet because SERMs distort it. The half life is approx. 5-7 days so the compound should be nearing the end of its duration.

Should I wait another 1-2 weeks? What should I do? I’m so sick of this, I started TRT 4 months ago and (aside from a few flashes here and there) I feel no better now mentally or sexually than I did before I started all of this.

[quote]USA SUB wrote:
Need more help:

I took Nolvadex (tamoxifen) to solve gyno caused by TRT. I took it for about 4 weeks. The nolvadex made my symptoms MUCH worse. My brain fog doubled and my erectile issues were much worse, blood flow was restricted to my penis even more so than before. My brain function was absolutely HORRIBLE on nolvadex, even worse than pre TRT.

It has been 2 weeks since I stopped taking nolvadex and I don’t feel any better. I can’t test e2 yet because SERMs distort it. The half life is approx. 5-7 days so the compound should be nearing the end of its duration.

Should I wait another 1-2 weeks? What should I do? I’m so sick of this, I started TRT 4 months ago and (aside from a few flashes here and there) I feel no better now mentally or sexually than I did before I started all of this.[/quote]

I don’t think tamoxifen for gyno is the correct way going about it. It is a serm and as such will also raise your E2 by effect once you come off it (e2 rebound). It does not even lower e2 just blocks it from the receptors. You could probably use it to avoid gyno but once you have it, I think it will not help you. Not to mention an AI is the better alternative anyway in combating gyno.

I have read many guys say that Letro is the best for gyno as it is probably the most powerful of the AI’s.

Whether you can reverse gyno with letro is a bit of a grey area. Some say yes others say no. Most conclude to get rid of it completely surgery is needed. But worth trying Letro to see if you are lucky and it reverses gyno.

How much nolva were you taking for 4 weeks?

[quote]iroczinoz wrote:

[quote]USA SUB wrote:
Need more help:

I took Nolvadex (tamoxifen) to solve gyno caused by TRT. I took it for about 4 weeks. The nolvadex made my symptoms MUCH worse. My brain fog doubled and my erectile issues were much worse, blood flow was restricted to my penis even more so than before. My brain function was absolutely HORRIBLE on nolvadex, even worse than pre TRT.

It has been 2 weeks since I stopped taking nolvadex and I don’t feel any better. I can’t test e2 yet because SERMs distort it. The half life is approx. 5-7 days so the compound should be nearing the end of its duration.

Should I wait another 1-2 weeks? What should I do? I’m so sick of this, I started TRT 4 months ago and (aside from a few flashes here and there) I feel no better now mentally or sexually than I did before I started all of this.[/quote]

I don’t think tamoxifen for gyno is the correct way going about it. It is a serm and as such will also raise your E2 by effect once you come off it (e2 rebound). It does not even lower e2 just blocks it from the receptors. You could probably use it to avoid gyno but once you have it, I think it will not help you. Not to mention an AI is the better alternative anyway in combating gyno.

I have read many guys say that Letro is the best for gyno as it is probably the most powerful of the AI’s.

Whether you can reverse gyno with letro is a bit of a grey area. Some say yes others say no. Most conclude to get rid of it completely surgery is needed. But worth trying Letro to see if you are lucky and it reverses gyno.

How much nolva were you taking for 4 weeks?

[/quote]

The tamoxifen cured my gyno pretty well. There’s still a small lump under my right pec but my nipples aren’t inflamed anymore and the pain went away entirely. My nipples look normal again.

I tried an AI before restoring to a SERM but had no success.

I dosed tamoxifen at 40 mg ed for 2 weeks, then 20 mg for 1 week, then 10 mg for 1 week. I am currently taking adex at 1.5 mg per week so I don’t expect estrogen rebound to be an issue.