T Nation

Need Advice, About to Start TRT

Good Day,

This all started about 2014 I quit my job and got depressed. I started Extreme sweating at this time. I would soak thru my shirt and pants if I went out in public. I had a lot of problems during these 3 years. Things got a little better and was able to get a job, but still was sweating alot.

Got tested about at my regular doctor in 2018 and Testosterone levels were 208ng/dl. I am 32 years old. My doctor said to try diet exercise. Got Tested again about a month ago. I was 298ng/dl. My Doctor said I was within normal range. Will not do anything.

So I called a health clinic. Talked to them and going to get retested again Monday and if I am below 550ng/dl. I will Start TRT.

This is the Labs I will be doing Monday.

“Lab tests/Blood work - Estradiol (E2), Complete Blood Count (CBC) with Differential/Platelet, Thyroid Stimulating Hormone (TSH), Regulatory Factor X (RFX) on abnormal to free T4, Prostate Specific Antigen Serum (PSA), Total Testosterone Serum (TTST), Comprehensive Metabolic Panel (CMP) with 14 subpanels”

Medications - (pharmaceutical grade) - Testosterone Cypionate, Human Chorionic Gonadotropin (HCG) and Anastrozole (Aromatase inhibitor/Estrogen Blocker)

Prescribed medications and dosage frequency typically will include:

Testosterone Cypionate - (1) self-administered intramuscular injection per week *
HCG (2) 500 IU - self-administered subcutaneous injections per week
Anastrozole *

Can you Help me with what are the Correct Questions I should ask my new Doctor So I start out at a livable dosage. Also should I ask to start a blood thinner? Both my father and mother have had blood clots. Sorry for the editing I am at work

Tell them you only want to introduce one compound at a time. Suggest that you want to start with 50mg cypionate injected twice per week(100mg/week total). Reevaluate in 6 weeks. Your goal should be to never use an AI(anastrozole). I’m very low SHBG and am still able to use T and HCG with no AI.

Will do thank you

No you are not, the endocrine society recommends TRT to those <300 and you had it below this value twice which is what’s required. Doctors mistakenly believe in range is normal, but not for testosterone. I wonder was free testosterone is range, I bet he didn’t even test it.

The ranges for testosterone is 264-917 per Labcorp, but if you go to another lab company, you might find the reference ranges are different, some lab companies have the bottom end of the ranges at 250, but to an ignorant doctor ignorance is bliss.

So you actually qualified for TRT, but you doctor doesn’t believe in reading guidelines.

There are a lot of these TRT clinics popping up all over the country, sadly most are in it for the money, or just don’t know how to manage men on TRT, yours being the latter. You can’t design a protocol without SHBG and free testosterone levels being tested.

This TRT protocol is ill advised, you should start TRT in isolation and AI’s shouldn’t be prescribed right away, you will hear horror stories about anastrozole, you should listen. I’m an AI over-responder and 1/8th of a n anastrozole 0.050 mg (something like 50th of a mg) is enough to cause knee and joint pain and a host of other mental and physical symptoms.

It’s best if you adjust your injection frequency to lower estrogen if need be, some people will need them, but most will not and I hate to see you struggle for months on end before you figure this out. HCG has a varying effects everyone, a smaller percentage feel good on it, some can’t tolerate it at all and others feel nothing from it.

I’m a low SHBG guy and HCG would fu** my up is a real bad way. You find low SHBG men doing well on daily protocols and not so good on weekly protocols, now you understand why you need these tests that your doctor thought a good idea to skip entirely.

All the more important that you seek advice from someone competent.

Thank you

I just got my new Lab results in today. So I will call my new doctor today and ask him to just start me on testosterone. Sorry I have not responded sooner, but I have been working 12-14 hours days at work and when I go home I just go to sleep.

Testosterone, Serum 266 ng/dL 264 - 916

Estradiol 23.6 pg/mL 7.6 - 42.6

TSH 3.310 uIU/mL 0.450 - 4.500

Hematocrit 43.1 % 37.5 - 51.0

I am just hoping starting TRT will help me mentally some. I will update this once I talk to my new Doctor.

Your TSH is too high and I would dial down your expectations with these TSH levels, this is subclinical hypothyroidism territory and will make TRT less effective. TRT may very well increase TSH since testosterone increases metabolic rates which can then expose other weak endocrine glands.

TRT doesn’t work very well when there are thyroid problems, you don’t even have any thyroid free hormones testing. Whoever ordered these thyroid labs doesn’t know anything about how to properly diagnose and treat hypothyroidism.

When TSH is this high, the pituitary gland is signaling it is in a degree of distress, optimal TSH is .5-1.5, fT3 50-80 percent of the ranges and rT3 <15.0 ng/dL.

  • TSH - TSH tests pituitary function and can be used to diagnose thyroid disease.
  • Free T3 - Free T3 may be the most important measure of thyroid function in the serum because it measures the free and active thyroid hormone. T3 is more biologically active than T4.
  • Free T4 - Free T4 measures the amount of free T4 in circulation. In order to be activated, T4 must turn into T3 so T4.
  • Total T3 - Total T3 includes measurement of bound T3. Bound T3 is not considered active like free T3 but total T3 gives you a more stable long-term marker of T3 in circulation.
  • Thyroid Antibodies - The thyroid antibodies include thyroglobulin antibody, thyroid peroxidase antibody and thyroid stimulating immunoglobulin. The presence of these antibodies in your serum may indicate an autoimmune disease which is damaging your thyroid gland.
  • Reverse T3 - Reverse T3 helps measure the conversion capacity of your thyroid gland. High reverse T3 may be a sign that your body is having trouble converting T4 into the active thyroid hormone T3. High reverse T3 is commonly seen after rapid weight loss, in obesity, and in euthyroid sick syndrome.

Reference ranges for TSH and thyroid hormones

First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L. There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group.

Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis or other causes of elevated TSH.

This is bullshit, the lab ranges don’t always reflect population reference ranges, in range doesn’t mean you’re not experiencing a testosterone deficiency, your individual DNA and biochemical individuality will determine if testosterone is low for you. The endocrine society states levels <300 are levels at which TRT is recommended, but even those above this value can be prescribed TRT if there is a substantial benefit to your health.

Long post short: you have thyroid issues and testosterone issues more than likely. You’ll need to address both to feel 100%.

Going for this to endocrinologist or a t-mill(the common TRT clinic) will most likely result in a disaster except if you are very educated about hormone optimization.

I would advise you to go to a proper really experienced physician that will charge more, but trust me will save you a lot of time, money and suffering.

You need testosterone and thyroid optimisiation but you cannot do that by advice from a forum and working with an incompetent doctor.

Thank you everyone

I have been back to my regular GP I finally got him to order a full thyroid panel. I had to argue with him for awhile to do it. Then when I went to go get my blood take I asked her what she was testing and my GP did not put down reverse t3. I told her that I needed that test and to double check. That made me frustrated, because I dont feel like dealing with this doctor any more but he wont send me to a endocrinologist.

I have been having pain in my thyroid. so my GP sent for a ultrasound today and the nurse doing it told me my thyroid was very large but not the worst she has seen and told me I needed to get my medication right.

I am trying to get everything right but it is difficult because I am a industrial electrician and my plant is doing shutdown work so it is 12 hours a day for the next month. I have been trying but I also am 3 points away from losing my job.

Also had my virtual appointment with the health clinic doctor. Very rushed but he seemed to listen to me more then my GP. Asked him to remove the AI from the testosterone. He said ok and prescribed pills instead. He told me my thyroid was not right, but he seemed to care about what I had to say even thou I could tell he was rushed and pretty much doing a premade speech.

200mg test c everyweek.

Should be getting my supplies after christmas. Will update as soon as I get my thyroid labs. Trying to find a new doctor

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3rd day on trt and I woke up this morning with no brain fog and my eyes wanted to stay open. I feel really good today. Injected 100mg 1st day and I will start injecting 25mg every day once my needles come from amazon.

Worked all 12 hours today and felt really good. I feel very blessed. Will update soon, because I am going to get labs done for myself in 6 weeks and also my trt doc wants to do labs in 13 weeks.

Just to update sense starting alot of things have changed.

Sleep quality has gotten about 3x better. I wake up now and feel recharged.
Alot of energy.
Can work 12 hours and my back thighs are no longer sore.
All my muscles feel stronger and are fuller.
The best benefit has been the mental ones I feel more confident and can do complex problems with less stress

Sexually I am Ethier rock hard or can not get a erection
BP has increased to 129/89 from 121/79.

I started today taking 5mg of cialis so I hope that will help with my BP and sexual sides. I had bad ED before trt but it was not a real problem because I have not been sexually active.

Just been doing test 25mg every day.
I will keep this updated and post labs when I get them. Thank you all.

@systemlord HI. Can i ask what are really the good ranges with thyroid .
ih have been ranging (4years span) : t4 from 16.8 - 14,3 AND TSH 3,7 - 2,6 . Latest one is that 2.6 Is that ok ? My doctor have always been saying that these are totally normal ranges and there is no mediaciton for these numbers. I Used nebido the whole time i got these results.

These labs don’t provide a clear picture of your thyroid since the Free T3 were not included. The Free T3 is the active hormone that makes into the cells.

Some people with thyroid problems actually produce plenty of T4 hormone (inactive) but fail to convert enough T4-> Free T4-> Free T3.

Doctors seem be a little narrow-minded when it comes to these normal ranges, not realizing that if a person has been at the top end of the ranges for Free T3 most of their life and are now significantly lower but in range that this means the person is fine because levels are in range.

To answer your question, normal looks a little different for everyone, that’s why the reference ranges are so broad.

I tried thyroid treatment recently with the labs below and after only my second dose, I experienced the beginning of hyperthyroidism.

TSH .45, Free T4 1.0 (.8-1.77), T4 9.5 (5-12) and Free T3 3.8 (2.0-4.4) T3 101 (80-180).