T Nation

Need Advice on Starting TRT

Hi,

I’ve been lifting weights with a trainer over the past 3 years, and have noticed somewhat slow results despite frequent and intensive work outs, frequent cardio, and a good diet. Also, I’ve noticed a big drop in libido over the past year and difficulty maintaining erections. I’ve resorted to Viagra 95% of the time. I consulted with my general practitioner in January and asked for a hormonal panel. He said he would only run certain tests, basically accused me of drug seeking, and said to watch more porn. Below are the blood results from Quest Diagostics last January.

Lipid profile, Chem, and CBC: normal.
Total Testosterone=446 (241-827ng/dl)
SHBG=32 (8-48nmol/L)
Free T=98 (34-194ng/dl)
Free and weakly bound T=211 (84-402ng/dl)
PSA=0.60 (<4.0)
TSH=1.58 (0.40-4.5)

My trainer than referred me to a longevity doc (also a boarded cardiologist) who agreed to run more complete testing, and is interested in pushing my T levels to the upper limits of normal. Here are the blood results from Westcliff Labs this September.

CBC normal, no lipid or chem profiles.
Homocysteine 19.0 (3.7-13.9umol/L)
TSH=1.324 (0.350-5.5)
Free T3=2.9 (2.3-4.2)
Free T4=1.23 (0.80-1.80)
Direct Pregnenolone EIA=287 (10-340ng/dl)
Estradiol-6=17.0 pg/ml
DHEA Sulfate=237.9 (88.9-427.0ug/dl)
Test=527.7 (241-850ng/dl)
Free T=0.88 (0.62-2.81ng/dl)
T, %calc=0.17 (0.32-0.50%)
PSA=0.51 (0-4.0)
IGF-1=217 (109-284ng/ml)

I will meet with the new longevity doc 10/02 to discuss the results and consider TRT. I would also like to consider HGH. My goals are increased libido, energy, and muscle mass.

Also, I’m planning on getting married next year and potentially starting a family, and am concerned about the effects of hormonal therapy on fertility.

Additional info: I’m 38 yrs. old, natural (never cycled, no TRT, no HGH).

I would appreciate any wisdom that you are willing to share.

Thanks!

Do you have any symptoms? What time was your test? It’s recommended to have your t tested before 10am. If you plan on having kids they probaly are not going to give you testosterone and might not anyways since your at mid-range. What they could give you is clomid or HGC which are fertility drugs that would boost your t also.

Good luck on that if your symptomatic if not I wouldn’t even worry about it.

I think your numbers look good. Personally, and I’m on TRT, with numbers like yours I wouldn’t mess with my hormones. How do you feel overall beyond just the sexual issues?

If you really want higher T levels in your position I would consider HCG mono-therapy. I was on it for a while with good results but now that Dr Crisler is my Dr I’m on his protocol.

Your free T is a little on the low side.
You could try some natural herbs ( Stinging nettle) and see how that works. Just about ANYTHING you inject, or rub on, will hinder your natural T production. (THis includes testtosterone supplementation, as well as HCG)

I was in the SAME boat a couple yrs back, at age 46.

I took the plunge to total T replacement therapy.
T-Cyp, HCG, and A-dex. (Like most on the program)

I did NOT like how I felt when my T levels wer mid or low range. I am MUCH happier near the upper range. (Much more energy, better mood, and libido)

A lot of couch potatoes are happy with a 500 T level. If you do not miss the “edge” than it is no big deal. (Some guys run at 110% at these levels … I don’t) I have a buddy my age (49) who has no interest in excercise, women, or fitness, and is happy as a clam.

I personally am not wired that way, hence my TRT protocol. I still ride motocross/supercross every weekend, and hit the gym at least 4 times a week. Not to mention the responsibility of keeping my wife (who is 15 yrs younger) happy.

It is a major commitment once you start it, so do your homework … and decide what is best for your interests and goals.

Read everything you can find, and ask a lot of questions.

Good Luck !

I really enjoy this site and appreciate your knowledge and feedback.

To respond to a few questions: I think I’m having symptoms of T deficiency (e.g. low energy, moody, low libido). Also, my Free T is on the low end and the T, %calc is low. Do you place much value on the T, %calc result?

The blood was drawn around 2pm, and I’m not on any natural T boosters at this time (although, I’ve never really felt an effect from any of these things).

Any thoughts on HGH, and any experience with it increasing T levels?

Thanks once again!

Well I can tell you a Dr that is the leader in TRT only accepts 24 hour urine hormone profile as an initial lab. His logic makes sense and that is trying to make a diagnosis by blood work is difficult.

You’re looking at a snapshot of your current hormone status. The 24 hour panel gives you the true picture of your current status. How about giving that a shot?

I can’t comment on HGH. I haven’t tried it or looked into much. I do know that it’s quite expensive.

KSman may chime in on that one.

As Rapt said, your comment about wanting to start a family could indeed be in conflict with complete TRT. At least that was the main caution I received when starting.

So, I would definitely bring that up with your new doc. And if you’re not wanting to start the family thing soon, perhaps you can still try some TRT for a few months and see if your symptoms improve.

I suspect it’s the long-term use that your doc will be concerned about. Kids first. TRT later–and when you REALLY need to be on your game just to keep up with them!

And have you ruled-out that you might be over-training? I think many on this site, by self-selection, tend to hard charging, motivated bastards. Over-training is easy to slip into and can affect mood and slow your progress.

You might try backing off just a bit, allowing more time for recovery, then assess how you feel. Again, that can definitely affect mood and progress just as low hormones might.

Great advice guys. I really appreciate the input!

Doesn’t HCG keep the baby-making machine going ???

Yes and if that doesn’t work you can always add in HMG. Having kids on TRT shouldn’t be an issue.

It’s nice to know that HCG and HMG can help when TRT alone would otherwise have one shooting blanks.

But this whole thread got me to recalling how I had read once that Testosterone has even been considered as a birth control method (though best in combination with Progestin):

Bottom line: tell your TRT doc that you want to be a father.

[quote]mazzie666 wrote:
I really enjoy this site and appreciate your knowledge and feedback.

To respond to a few questions: I think I’m having symptoms of T deficiency (e.g. low energy, moody, low libido). Also, my Free T is on the low end and the T, %calc is low. Do you place much value on the T, %calc result?

The blood was drawn around 2pm, and I’m not on any natural T boosters at this time (although, I’ve never really felt an effect from any of these things).

Any thoughts on HGH, and any experience with it increasing T levels?

Thanks once again![/quote]

You might want to get your adrenal and thyroid function more closely investigated. You could be “burning out”. Your T3 is kinda low, and T3 is the active form you need for energy. T4 is a just more of a storage form. Remove one iodine then you get T3 and it becomes useful. All these different systems are related. A good doc will look at the entire endocrine picture.

How is your cortisol level and adrenal function?

BD

I agree, thyroid levels are down and one would expect higher TSH in that situation. Enough iodine in diet? Avoiding salt? Sea salt has no iodine unless it states that iodine has been added.

Homocystine is too high which suggests cadiovascular inflamation - the process of heart disease. Are HDL levels low? You can increase that with B vitamins, folic acid and niacin.

What are your lipid levels?

Also test for C reactive protien CRP

Thanks for the threads drmcmc. I’ll definitely talk to my TRT doc.

Saliva cortisol testing in September:

Morning: 22.6nM (13-24)
Noon: 7.8nM (5-8)
Afternoon: 3.7nM (4-7)
Nighttime: 4.2nM (1-3)

Cortisol Sum:38.3nM (23-42)
DHEA-S average: 2.65 (2-10)

Total Corisol/DHEA-S Ratio: 14.5 (5-6)

Also had a nutritional test through Spectracell Labs in September:
Deficiencies: Vit B2, Magnesium, Insulin, Chromium, Zinc, Vit C, Spectrox (antioxidants)

Lipid panel last January:
Triglycerides: 53 (<150mg/dl)
Total Cholesterol: 146 (125-200mg/dl)
HDL: 52 (> or =40mg/dl)
LDL: 83 (<130mg/dl)
Chol/HDLC ratio: 2.8 (< or =5).

CRP last January: <0.10 (<0.80)
CRP in September: 0.19 (<1 is a low cardiovascular risk)

BTW, I have a pretty stressful job, working graveyard shifts over the past 10yrs. So, burn-out could be a factor.

Not avoiding salt per say, but don’t add to anything either.

I’ll be meeting with the TRT doc (also a bodybuilder BTW) and a nutritionist that works out of his office next week.

Once again, thanks so much for the knowledge and review guys!

Hey Guys,

Just consulted with my TRT doc. Based on my borderline low free T, and low %calcT, he’s recommending weekly Test injections of 100mg with a goal of pushing my free T to the high end of normal. He said he generally gives periodic HCG injections rather than weekly, and only utilizes an AI based on follow-up E2 testing. Do you think I should push for HCG + AI up front despite my normal E2 level?

Also, on the nutritional testing I was deficient in Vit C and Vit B2, so I’ve started supplementing for these. My Vitamin D level was mid-range, but he recommends closer to the high end of normal and recommends supplementation. He also started me on DHEA.

Thanks. The valuable input is much appreciated!

I think the every three day HCG protocol is defiantly the way to go and you’ll probably at least need a little of an AI. If he insists on waiting for the next labs I suppose that’s ok. You might also want to consider injecting the T every three days. Everyone is so different that you’ll have to tweak the protocol yourself.

I’m curious how you’re going to make out. Your labs are all midrange which isn’t bad.

Thanks for the input brentf13!

Having problems posting, so I’ll apologize up front for double posting. I’ve been researching for over a year and am about to start TRT next week. I talked with my endo about my test results but won’t see him until next week. Would appreciate any feedback I can get. I am 42 and had every low T symptom on the list. My test results are as follows.

Total T 427
Free T 70
Thyroid 282
Estrogen 75

He is suggesting biweekly test cyp injections as well as biweekly hcg injections. Basically he wants to push my total testosterone level the the high end of the range up around 1200. He says estrogen level is way to high and he hopes to get it under 25. Also mentioned something about a script for an anti estrogen medicine and another for the thryoid. He really pushed to know if I ever wanted another child, that we will discuss that next week before I start. Not sure what that’s about.

I would really appreciate anyones thoughts/comments.

Greg

I seriously doubt you’re going to need TRT. E2 at 75!!! Holly crap. Get some Arimidex and start at 1mg a week in divided doses. I bet you’ll get your T back into the 550-600 range and free T will also increase.

Your endo is an idiot. His plan for TRT is horrible. Google this and start here: MY CURRENT BEST THOUGHTS ON HOW TO ADMINISTER TRT FOR MEN Maybe you can educate him. Since he’s willing to use T+AI+HCG he mind as well do it right.

brentf13, thanks for the advice. I looked that up and read it twice! Now I’m armed and dangerous when I head to my doctors appointment next week.