T Nation

My Current (and Past) TRT Journey


#1

Back story: Started TRT in Feb 2014 for low T symptoms. Mostly fatigue, inability to shed weight or make muscle gains despite busting my butt in gym and diet. Came across this site in Mar 2014. My pre TRT labs were as follows:
FSH 3.1 mU/mL (1 - 10 mU/mL)
LH 8.6 mU/mL (1.0 - 7.0 mU/mL)
Testosterone 321 ng/dL (220 - 1000 ng/dL)
Testosterone Free % 2.4 % (0.5 - 3.2 % )
Testosterone Free 78.0 pg/mL (40 - 240 pg/mL)
Prolactin 11.3 ng/mL (2.0 - 14.0 ng/mL)
TSH 4.100 uU/mL (0.400 - 5.500 uU/mL)
Thyroglobulin Ab 1.7 IU/mL( <14.4 IU/mL)

Based on these labs my endocrinologist started me on 100mg Test Cyp weekly. My next visit in May 14 (after reading this site), I suggested an Estradiol level. These were my results 5/27/14

Estradiol 17B 45 pg/mL (10 - 60 pg/mL)
Testosterone 502 ng/dL( 220 - 1000 ng/dL)

Arimidex was added per my insistence. Then things went south. My next labwork was not until October 2014. I over responded to the arimidex and got to the point where I was fed up/depressed and quit everything cold turkey for 16-20 weeks!!

Obviously was back to square one. Started back on TRT in 2/15 after Total Test levels came back lower than pre TRT levels. Have had up and downs over past 2 years. I did add HCG for 2015 at recommended dose of 250 iu/EOD but in 2016 got a job traveling overseas and while I could bring my testosterone and adex, could not bring and store HCG.

My current regimen for 2016 looked like this. Test Cyp 50mg twice a week IM with 0.5 mg Adex with each dose.
Here are my labs in 2016. (Doc tests my levels every 3 months and includes Total Testosterone, Estradiol, Hematocrit, Vitamin D (I am on supplementation), and PSA.)

Total testosterone (193 - 824 ng/dL)

432 (01/08/16)
256 (04/11/16)
624 (7/7/16)
351 (10/18/16)

Estradiol (10-60 pg/ml) (same draw dates as above)
18
12
7 L
<25

Hematocrit (39.0-51.0)
52.8 H
52.4 H
48.5
50.8

So I went off arimidex for awhile then restarted at 0.5 mg every 2 weeks and I started donating blood. I still was injecting test cyp 50mg 2x/wk

My latest lab draw was on 01/18/17 with the following results:

Testosterone 240 ng/dL
Estradiol 25 pg/mL
Hematocrit 48.9 %
Vitamin D 25 Hydroxy 38.2 ng/mL (31.0 - 80.0 ng/mL)

My next appointment is not until 04/20/17. I emailed my Dr. asking if my Test Cyp should be increased. What frequency should I adhere to for Adex, and should I try and add HCG while I am stateside 6 months out of the year. I am getting to the point where I am contemplating stopping TRT but obviously following an HPTA restart with HCG and Clomid/Nolvadex (while I am home). Any suggestions from veteran TRT people would be appreciated. Sorry for the long post. A few more details.

I workout 3-5 x/wk mostly weight training and some treadmill work
I am nearing 45 y.o. in March
I have noticed my blood pressure climbing from my baseline of 120/80’s to 140s/90’s
My cholesterol is slowly climbed to 220’s with LDL in 150’s
I am on no other routine medications other than supplements and vitamin D: multivitamin, co-q 10, fish oil

Thanks for reading this far.


#2

I don’t yet know enough to offer any advice, but suffice to say, you definitely seem to be an adex over-responder. And your testosterone levels being all over the map like that is pretty crazy (yet never very high). I’ve had my own challenges but my testosterone levels are pretty damn predictable given whatever dose I’m on. Another interesting thing to add to the mix is your very high hematocrit levels, especially since your testosterone levels never got very high. It would seem to make sense to increase you testosterone dosage and do maybe 0.5 to 0.75mg of adex a week, split into the times of injection.

Out of curiosity, how much water do you drink?


#3

On days I workout, usually a gallon give or take. Should probably be more though!


#4

TSH 4.100 uU/mL (0.400 - 5.500 uU/mL)
This is horrible. The lab ranges are overly broad and include many who are not feeling well with their thyroid status. You did not appear to have any sign of thyroid auto-immune issues, so perhaps this problem is a result of not using iodized salt and iodine deficiency, causing TSH to increase in an attempt to overcome the problem. Your thyroid may be visibly enlarged. Feel to see if asymmetrical or lumpy.

Low thyroid function:

  • feeling cold easily
  • sparse outer eyebrows
  • general hair thinning
  • dry skin
  • brain fog, low libido, mood problems - all similar to low-T

Guys with perfect T and E2 profiles can feel like crap with low thyroid function.

You can eval overall thyroid function by checking oral body temperatures.
97.7-97.8 when you wake up is OK, higher is OK, lower is not
need to hit 98.6 mid-afternoon

see the thyroid basics sticky

Get TRT right, cholesterol and BP may improve
Please get a good magnesium supplement, see T-nation Bio-Test store ‘ZMA’

HPTA restart may not yield acceptable results.

Some are, or develop, testosterone hypermetabolism and some here need 300mg to get where others are at 100mg.

Please 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

#5

Thanks KSman.

Another wrinkle added is that I swing shift days and nights. Only work 36 hrs/week but messes up my schedule. I am sure this doesn’t help as my body, awake time, sleep hours, etc get all out of whack.

To answer your questions, outer eyebrows are not sparse, and full head of hair. I have noticed as I have gotten older that my hands and feet do get cold. Skin isn’t super dry but I have started using moisturizer post shower. Brain fog, mood, and libido have had flux states over past several years. Part of the reason I got tested in the first place, and after starting TRT assumed the ups and downs were attributed to not being dialed in.

I will invest in an oral thermometer and start checking temps and look into adding iodized salt. I have also suggested to my endo that lab work needs to be monthly and not every 3. I will ask him to add TSH, t3, t4 to see which way those are headed too? Any other suggestions other than what I can find in the stickies?

I will look into ZMA but I have read they can give you trippy dreams and my sleep schedule, circadian rhythm is jacked up as it is.
Thanks!!


#6

ZMA is only a mineral supplement, nothing to dream about. May helps with BP. Will also fix leg or foot cramps, a sure sign of deficiency. In any case, most are deficient without supplementation.

Those thyroid labs would be good. But your oral body temps may define if needed.

You were not using iodized salt?
Get a multi-vit that lists iodine 150-180mcg and selenium 100-200 mcg.
Selenium is vital for thyroid, danger of auto-immune if deficient in selenium.


#7

Sorry for the slow reply KSman. I was not using iodized salt. I am taking a Multi that has 150mcg iodine and 100 mcg of selenium.


#8

It’s quite possible that the low estrogen is actually negatively affecting your BP ( now the hematocrit is another story). I would’ve told you to simply bump your testosterone dose, if it wasn’t for that. You should probably get a full set of thyroid labs done. By the way, I had the same TSH level as you. My Endo didn’t even think it was worthwhile checking any further, but an anti-aging specialist had me run the full thyroid labs and turns out I have Hashimoto’s disease. You can try supplementing with iodine and selenium – as this is great for the thyroid (assuming no auto immune issues in which case just go with selenium).

Regardless, I think you need a full set of labs – I would recommend going to the TRT specialist or antiaging doctor that could run other labs which may indicate why you were not responding to the T and can control the E better.


#9

But have you taken that for years non-stop.
Such maintenance amounts are not very good for climbing out of a deficiency hole.

Please get iodize salt and use for cooking and at the table.
Are others in your dwelling also affected by this?
Restaurants and prepared foods are typically not made with iodized salt.
Your travel is a iodine risk factor.


#10

Overseas currently until March. I went to grocery store and picked up iodized salt. Reviewing the stickies now for dosing. Plan on having thyroid rechecked when I return state side. Been on the multi sporadically. Will also buy a bottle while I am away to take everyday while overseas. Thanks for the help. Trying to stay positive. Will update with next set of labs and endo discussion in April.


#11

As a side note, I do eat quite a bit of sushi wrapped in nori/seaweed. By quite a bit of sushi, I probably eat it 4-6 times a month 3-4 rolls with each sitting. What can I say, I love the stuff.