T Nation

Need Directive for TRT

@ksman please help!

I’ve been secondary hypo for the past 5-6 years and have tried various hpta restarts to no avail. Finally saw a reputable doc in Connecticut for trt only after originally going to my endo who gave me natesto Intranasal testosterone spray after he heard my symptoms of depression anxiety panic attacks and OCD. After around 2 weeks of use I then went to Connecticut as I wanted im trt and was given 0.5ml e5d (140mg) per week.

I’m now in week 3 (4 shots deep) and I noticed I feel extremely good immediately after injecting on injection day but the feeling almost feels as if it is tapering the next day and further the days after, I don’t know if it’s too soon as it’s not the 6 week marker yet, but is this a sign of aromatization and elevated e2?

I’ve also been told I have leaky gut so I’m trying to make gut health a bigger priority, and have experienced extreme burnout and inability to handle stress and life stress that have led me down the path of embracing trt

Here are threads with past blood work 27 Year Old HPTA Restart
I can post labs from before I started trt if you want to see those for further input but I really need help as lately it’s not even day to day stress but it’s like past stress that had been bothering me as well

I know cortisol thyroid and adrenal health are all factors

Lab Test Results
Phosphorus, Serum

Test Low Normal High Reference Range Units
Phosphorus, Serum 5.0 2.5-4.5 mg/dL

Magnesium, Serum

Test Low Normal High Reference Range Units
Magnesium, Serum 2.2 1.6-2.3 mg/dL


Test Low Normal High Reference Range Units
Tsh 3.440 0.450-4.500 uIU/mL

Luteinizing Hormone(Lh), S

Test Low Normal High Reference Range Units
Lh 3.5 1.7-8.6 mIU/mL

Fsh, Serum

Test Low Normal High Reference Range Units
Fsh 1.2 1.5-12.4 mIU/mL

Cbc With Differential/Platelet

Test Low Normal High Reference Range Units
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL
Immature Granulocytes 0 Not Estab. %
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL
Monocytes(Absolute) 0.6 0.1-0.9 x10E3/uL
Lymphs (Absolute) 2.1 0.7-3.1 x10E3/uL
Neutrophils (Absolute) 2.4 1.4-7.0 x10E3/uL
Basos 1 Not Estab. %
Eos 2 Not Estab. %
Monocytes 12 Not Estab. %
Lymphs 40 Not Estab. %
Neutrophils 45 Not Estab. %
Platelets 218 150-379 x10E3/uL
Rdw 13.7 12.3-15.4 %
Mchc 34.1 31.5-35.7 g/dL
Mch 31.5 26.6-33.0 pg
Mcv 93 79-97 fL
Hematocrit 44.9 37.5-51.0 %
Hemoglobin 15.3 13.0-17.7 g/dL
Rbc 4.85 4.14-5.80 x10E6/uL
Wbc 5.3 3.4-10.8 x10E3/uL

Vitamin D, 25-Hydroxy

Test Low Normal High Reference Range Units
Vitamin D, 25-Hydroxy 61.1 30.0-100.0 ng/mL

Comp. Metabolic Panel (14)

Test Low Normal High Reference Range Units
Glucose, Serum 72 65-99 mg/dL
Bun 10 6-20 mg/dL
Creatinine, Serum 1.02 0.76-1.27 mg/dL
Egfr If Nonafricn Am 99 >59 mL/min/1.73
Egfr If Africn Am 114 >59 mL/min/1.73
Bun/Creatinine Ratio 10 9-20
Sodium, Serum 142 134-144 mmol/L
Potassium, Serum 3.7 3.5-5.2 mmol/L
Chloride, Serum 102 96-106 mmol/L
Carbon Dioxide, Total 23 18-29 mmol/L
Calcium, Serum 9.2 8.7-10.2 mg/dL
Protein, Total, Serum 6.6 6.0-8.5 g/dL
Albumin, Serum 4.5 3.5-5.5 g/dL
Globulin, Total 2.1 1.5-4.5 g/dL
A/G Ratio 2.1 1.2-2.2
Bilirubin, Total 0.3 0.0-1.2 mg/dL
Alkaline Phosphatase, S 78 39-117 IU/L
Ast (Sgot) 22 0-40 IU/L
Alt (Sgpt) 24 0-44 IU/L

Lipid Panel With Ldl/Hdl Ratio

Test Low Normal High Reference Range Units
Cholesterol, Total 133 100-199 mg/dL
Triglycerides 69 0-149 mg/dL
Hdl Cholesterol 53 >39 mg/dL
Vldl Cholesterol Cal 14 5-40 mg/dL
Ldl Cholesterol Calc 66 0-99 mg/dL
Ldl/Hdl Ratio 1.2 0.0-3.6 ratio units

Testosterone Free Ms/Dialysis

Test Low Normal High Reference Range Units
Testosterone, Serum (Total) 291 ng/dL
% Free Testosterone (Dialysis) 1.6 %
Free Testosterone, Serum 47 pg/mL

Estradiol, Lcms, Endo Sci

Test Low Normal High Reference Range Units
Estradiol, Serum, Ms 12 pg/mL

Cortisol, Serum Lcms, Endo Sci

Test Low Normal High Reference Range Units
Cortisol, Serum Lcms 14 ug/dL

Dhea-Sulfate, Serum

Test Low Normal High Reference Range Units
Dhea-Sulfate, Lcms 205 ug/dL


Test Low Normal High Reference Range Units
Igf-1(Bl) 246 ng/mL

Prolactin, Serum (Icma)

Test Low Normal High Reference Range Units
Prolactin, Serum (Icma) 13 ng/mL

Sex Hormone Binding Globulin

Test Low Normal High Reference Range Units
Sex Hormone Binding Globulin

A poorly designed protocol will give poor results, based off your SHBG levels you need to split your shots up twice weekly as stated in the sticky threads. A good TRT doctor in Connecticut, I doubt it but unicorns do exist.

It’s going to take at least a few months before you start feeling better with continued symptoms improvement every month thereafter, TRT isn’t like medication where you get an instant feel good, tissues must be repaired and that just takes time.

Further thyroid labs needed checking fT3, rT3 and fT4. Do you consume iodized salts, if not you’re most likely iodine deficient. Thyroid require iodine, if not TSH will be elevated.

Yes this experience can easily be from E2.

SELF-Inject 70mg T twice a week and most would need 0.7mg anastrozole at time of injections. Then E2 lab results can later drive a calculated dose refinement to get near E2=22pg/ml which seems optimal for almost all guys.

Leaky gut can mean that some stuff from your gut can get into the portal vein that should have been further broken down to amino acids etc. This might cause a number of possible issues or food sensitivities.

If you have been using heart burn medications you might be getting multiple mineral and vitamin efficiencies. A high potency B-complex multi-vit with trace elements including 150iu iodine and 200mcg selenium may be helpful.

Are you over weight with a hiatal hernia causing heart burn?

You are 27 and fertility loss is a major risk. You need to inject 250iu hCG subq EOD, #31 5/16" 0.5ml [0.3ml is too small to hand].

Your TRT doc seems quite useless.

He wants to put me on hcg after the 60 day split. How frequent should I inject I thought e5d was twice a week. Should I be doing every 3.5 days 70mg instead of 100mg e5d?

Is there a bare minimum dose for the Ai? I’ve tanked estrogen with exemestane before and it was not pretty. Additionally do you believe I should change things up once I get my post 60 day labs?

Please let me know everything to request for labs as after 60 days I want to make necessary adjustments in terms of supplementation. Ai if needed, dhea, pregnalone, iodine, multivitamin etc, just don’t want anything to exacerbate by anxiety ATM. I’m also feeling more tired the days after injecting vs the day post injection and day after. I’ll also get my labs posted shortly right before hopping on trt.

I don’t have any heartburn nor hernia but am overweight imo

Edited my original post with the labs

What does that mean?

hCG should be from day 1, not delayed.

I think that everything you need to know to get started is a above and in the stickies.

How much exemestane were you dosing and in combination with what protocol?



He agreed to every 3.5 day dosing per your suggestions.

Also suspect I am hypothyroid as you see in my last labs tsh was 3.4. My mom is hypothyroid and takes synthroid

I started taking 25mg of iodine and 400mcg of selenium already feeling a difference in energy I’m beginning to think my adrenal fatigue has caused other major things like thyroid and cortisol to deviate from the norm

Body temperature at 11pm 30 mins after cardio right armpit 97.2 left arm 97.5, 98.3 oral under tounge 97.5 on tounge

Still experiencing high estrogen sides ’ little libido, soft erections, mood swings, emotions, fatigue during workout, anxiety after working out, etc. please remember I probably have high adrenal fatigue, burn out/ and can see it as my tsh has gone from 2.6 to 3.4 in eighteen months.

I am doing a salivary cortisol test tomorrow and have requested labs for intensive thyroid testing and e2 so I can see what e2 is at before I hop on an Ai. For e3.5d injections what dose of Ai do you suggest to get estrogen to 22-28. Really afraid of tanking it

Also after a week should I drop down to 12.5mg iodine and 200mcg selenium? Should I take 50mg for 2 weeks to reach IR as suggested in the stickies?



Please help! `