T Nation

Need Help with My HPTA Restart

I am a 40 year old man who has been on TRT for just over 2 years. I am currently on 110mg of testosterone cypinate a week, and 0.3mg arimidex a week (compounded). I dont have my labs handy, but I started TRT because my total testosterone was about 350. After 2 years on TRT my levels are even lower at about 300. I can manage at these levels, but figure I do not need the hassle and side effects of TRT to maintain these levels. I asked my doc to take me off TRT, and showed him KSman’s stickie. I asked for a perscription of Nolvadex and he declined. He told me just to taper off the testosterone slowly and I will be fine. I begged him, but all he did was told me to go see my urologist. If my urologist does not prescribe it to me, what are my options. Do I just need to keep asking different doctors until one gives it to me? I live in Toronto, Canada. Any help would be appreciated, as I am desperate.


I have arimidex. If I go cold turkey on TRT, will taking arimidex help jump start my HPTA. It wont be as good as a SERM, but if I am unable to get a SERM, would arimidex be better than nothing. Or would it actually be harmful?

TRT in Ontario is a sad situation.

Sounds like you are self injecting 110mg T cyp once a week and do labs when you see your doc 7 days after your injection. Then your T levels have crashed. Please provide details and lab timing.

Can’t do much without your TRT lab work and ranges.

Note that some guys are testosterone hypermetabolizers who need 300mg T to get where most are at 100mg T.

self inject T twice a week
take Arimidex/anastrozole at time of injections

HPTA restart:
How much have your testes shrunk?

Have you read these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections

You could also not be doing well if your thyroid levels are poor. In your climate, you can also very easily not be getting enough iodine. CBC news can also cause brain damage.

Thanks for the response KSman (Although a new member, I am a long time reader and you have helped me immensely). I inject 2x a week (50/60 spit). I did the labs about 4 days after my last injection, so this would be at a slight trough. Still I dont imagine if I did the labs 2 days earlier, it would make much a difference.

My testes haven’t shrunk too much. However they were never large to begin with. I have a varicocele, which I plan to get removed after my restart in the hopes of some additional benefit.

I can get my most recent labs and post them here. In Canada we use different units, so hopefully you can make sense of them

Post labs with ranges and we are good to go.

You need to be injecting 300mg/week. And because you are a hypermetabolizer, you need to inject EOD as your T half-life is shorter than other guys. Because your anastrozole dosing needs to match serum T levels, your AI requirements are not increased relative to other guys.

If you were getting proper TRT benefits, you probably would not consider stopping TRT.

hCG will help your testes recover from surgery.

Result (Range in brackets)
Total Testosterone 9.28 (8.69 - 29)
Free Testosterone 21.5 (15.6-146.0)
Bioavailable Testosterone 3.81 (2-8.6)
SHBG 18 (10-57)
FSH 0.2(1.5-12.4)
LH 0.1 (1.7-8.6)
Prolactin 7.84 (4.04-15.2)
TSH Ultrasensitive 1.14 mIU/L (cant find range, but it was not flagged as abnormal)
PSA 1.2 (0.03-4)
Hemoglobin 183 (130-180)
Hematocrit 0.55 (0.4-0.52)
RBC 5.85 (4.4-5.9)

My doctor does not measure my estrogen, even though he prescribed me arimidex. This caused me problems initially, until I used the morning wood test to determine I was an adex over responder.

My doctor had me at 150ml and then 125 ml of testosterone for a bit. Both put me in the high-normal range of total T, but way over the range in Free T (sorry I dont have those labs handy). So he had me dial it back to 110ml and now I am low normal both. It doesnt make sense. They are using a different lab for bloodwork, so maybe one was wrong?

I have convinced myself that I am going to get off it to see what happens. I am in otherwise good shape. I strength train pretty seriously and and have lost about 25lbs of fat in the last year. I eat well and now make sure to get my essential fats, vitamin D and selenium. Although I am 40, I hope that this can help me bring my T back up naturally. I am going to gradually taper off my dose, and pray that my urologist prescribes me nolvadex.

I know this is likely a dumb question, but still want to hear your answer. Just in case. If I do not get a SERM, is there any benefit to using arimidex or DIM to stimulate the HPTA when I am completely off the exogenous T. Is there any harm?

Thanks again for taking the time to help me. It means so much more. I wish my doctors cared half as much

Your blood is way to thick and with your lower TT=9.28 and FT=21.5, we would expect thinner blood and hematocrit [HTC] to be .45 or less.
This could cause headaches. Try taking mini aspirin to thin your blood. Avoid iron fortified foods and supplements. Be a blood doner if possible. They may reject because of HTC=.55, then press doc for therapeutic blood removal. If you then feel a lot better, what does that tell you?

With the above, it is not safe to get to high normal T levels.

Blood pressure? Pulse? Hear blood pulsing in your head? Headaches?
Fish oil also helps thin the blood and improve blood flow.

The high hemoglobin was the final straw that made me want to get off. I was going to request a phlebotomy, but decided this is all too much of a hassle for 9.28 TT. I cant donate blood, because it has been less than 5 years since my Testicular Cancer (that was an important thing I forgot to mention). My TT was higher previously when I was on the higher dosage. I am sure that is what caused the high hemoglobin. I haven’t checked my blood pressure in a while, but I am typically 120/80, and my pulse is fine and no headaches. I will follow your advice and try a mini aspirin until it comes down.

Today I am due for my 50mg shot. I am going to start reducing today to get myself use to lower and lower levels of T. I know I am going to be in for a struggle

KSman, what about the arimidex. Will that do anything similar to a SERM in terms of reducing estrogen to stimulate the hpta? I am pretty sure it wont, but just want an experts opinion. If it offers any benefit to the restart, then I will try it

Please see the HPTA restart sticky for my ideas on that. You will be getting labs done and checking E2. You do not want E2 too low. Does a restart work? You need to look at TT, FT and LH/FSH.

I found a guy not too far from me, and some reviews indicate that he knows his stuff.


Has anybody here used him? Do you think he has experience with restarting HPTA. Can these anti-aging guys prescribe HCG and SERMS? His website mentions he specializes in bio-identical hormones. I assume HCG is a bio-identical hormone, but not sure about SERMs. HCG would be better than nothing I suppose

KSman, I have read the sticky and am trying to get a doc to prescribe be HCG and/or nolvadex. However, so far all I have is an AI. If I cant get the HCG and SERM, does AI do anything on its own. With no exogenous T, does reducing E somehow stimulate LH/FSH?

I spoke to his secretary, and she is pretty sure he prescribes HCG. She has never heard of SERMs, so I wont count on that. This is promising. I will know more on Monday. I know HCG without nolva is not ideal, but it is much better than what I was expecting to get. Hopefully it will at least get the testicles working again. I think I will move forward with him. It will be nice to have a doctor that at least knows something. Instead of me swallowing my dignity, and desperately begging doctors to prescribe me something they think is just for female breast cancer patients.

If nobody finds it too annoying, then I may blog my progress. I know I always found it encouraging to read other people’s journeys. Unless I crash and burn. Then I will delete this thread as to not discourage anyone.

Yesterday I cut my regular Thursday 50mg Test dose down to 35mg. Obviously it is too early to feel any difference. I know there is no way to avoid bottoming out, but I figure if I go down gradually it will not be as much of a shock when I get there

KSman, the anti aging clinic I was counting on does not have experience with restarts and suggests that I go see an endocronologist. He may have been willing to prescribe HCG, but does not think it will help. In your opinion, will HCG alone be beneficial. I realize it wont help on the top end of the axis. But prior to TRT, my LH/FSH was always high. It was just my T that was borderline low. I am pretty confident my LH/FSH will eventually come back on its own, but the testicles could use a boost. Should I go with him and hopefully get hcg? Or should I take my chances with an endo? Please advise, I am desperate

After 2 weeks since my last full dose injection (and 1 week since my last lowered dose injection), I got some pretty bad anxiety and insomnia. From what I understand, due to its half-life, it takes Test-C about 4 weeks to get fully out of your system. So I have at least 2 more weeks of getting worse, before I fully bottom out. Luckily I found some of my old Testim gel packs that have still not expired. I plan on giving myself a low dose of the testim for the next 2 weeks while the Test-C works its way out of my system. It should then only take a few days for the Testim to get out of my system. Either way, I will bottom out in 2 weeks. This should at least make those next 2 weeks more bearable. Plus the low dose I am taking, will gradually get my body use to low T levels, so it is not such a shock when I fully bottom out.

That is my logic anyways. Hopefully it works out

In the meantime, I have been referred to an endo. I am still waiting for them to call me with an appointment. Hopefully they can help with an HCG and Nolva script. But I am not counting on it.

After tapering down to half a tube of Testim daily, I stopped taking any gel for the last two days. I actually feel better now, then while I was tapering down. In terms of mental well being, libido and sexual function, I do not feel any different than while on TRT. Physically I do feel a little tired, achy and weak. But nothing major. And each day is better than the day before

I have an appointment to see an endocrinologist who specializes in male hormones next week. But if I continue to feel, as I do now, then I will not even ask for Nolva or HCG. I will just continue to rest, eat healthy and recover naturally

Now it is much too early to call the restart a success. But I am feeling much better than I was anticipating I would feel at this stage. Now I will just wait and see how things unfold. I assume I will have new labs after seeing the endo. That will confirm whether I am still running on what ever synthetic T is still in my system, or if, as I suspect, my natural T has started ramping up.

Not sure if anyone is reading this, but I know when I was contemplating quitting TRT, I found reading other people’s stories helpful. So I will continue.

I went to the endo. My labs after 4 days off all exogenous testosterone just pretty much confirmed I was shut down. My testosterone level was 2.5 where normal range is between 8.69 and 29. I was actually a little surprised by how low I was, because other than feeling a bit tired, everything else seems fine. No PCT was offered, and I didn’t request it since I am not feeling bad. It has now been just over 2 weeks since being off and nothing new to report. I still think I continue to feel a little better each day, but I could also just be getting used to dealing with the low T. I wont know until I do my next labs in September

I just continue to eat right, take supplements, exercise and rest. I like to think my body is recovering.

One thing I notice is my testicle size is fluctuating quite a bit. Even throughout the same day, it seems to increase and decrease in size. Not sure if that is normal part of the restart. I am a little concerned because I lost my other testicle to cancer, and am hoping this is nothing serious.

I am 6 months into my restart, and my labs are below. In these 6 months I have done the Iodine Replacement, as per the Thryroid sticky, and that has helped with brain fog and body temps. I can consistently get to 98.6 in the afternoon. I have been supplementing with DIM and that seems to help with ED. My only lingering issues are extreme fatigue starting in the afternoon (which I believe is due to my low PM Cortisol) and low libido (which I believe is due to my low testosterone).

Right now my symptoms are not intolerable, so I am not sure if I want to do anything drastic that will mess me up, but I will probably end up going back on TRT. Unfortunately I don’t think I will be able to get HCG. First, I have a few questions to any people out there who may be able to help

  1. Does my low PM Corisol indicate that I have Adrenal Fatigue?

  2. Should I fix my PM Cortisol before starting TRT. I have read peoples experience here where they said going on TRT stressed their adrenals and made fatigue worse. I have read other say TRT helps with the adrenals. Not sure what I should do

  3. Is it possible that fixing the PM Cortisol issue would increase my Test numbers

Total Test 8.78 (8.69-29)
Free Test 17.3 (15.6-146.0)
BioAvailable T 3.35 (2.0-8.6)
Estradiol 74pmol/L(<224)
Prolactin 11.32 (4.04-15.2)
LH 8.5 (1.7-8.6)
FSH 11.0 (1.5-12.4)
SHBG 19 (10-57)
DHT 1486 (860-3406)

TSH 1.41 (0.35-5)
FT4 20 (12-22)
FT3 5.0 (2.6-5.7)

DHEAS 5.7 (2.41-11.6)
AM Cortisol 446 (130-540)
PM Cortisol 84 (65-330)

Hemoglobin 157 (130-180)
Hematocrit 0.47 (0.4-0.52)
RBC Count 5.15 (4.4-5.9)
WBC Count 5.0 (4.0-11.0)
Ferritin 251 (30-400)

Creatine Phos 68 (39-308)
AST 20 (<38)
ALT 32 (<41)

I have seen a Naturopath who is helping me with my adrenal fatigue. I am taking supplements, stopped drinking coffee, trying to sleep better as well as making a few other changes. I have been doing this for just over a month now, and I do feel a little more energized. But I suspect I will need to start back up on the TRT

@KSman, do I need to wait until I have fully resolved my minor adrenal fatigue before starting back on my TRT protocol. Or can I continue to treat my AF while starting back on Testosterone? I am worried raising my testosterone may stress out my adrenals

I did labs recently to see if my PM Cortisol and DHEA-S have improved, but have not received the results yet. I am starting to have bad anxiety and panic attacks. For the first 3 weeks treating AF, I start feeling better and better. But then I started feeling anxious and am now getting panic attacks. I assume my cortisol has gone from borderline low to high. But that is just a guess. I should get the results shortly to confirm

My plan was to wait until AF was 100% resolved and then add back the T Cyp. But now I am experiencing anxiety, I think I am going to go back on the testosterone tonight and not wait for the lab results. I am going to start at a low dose of 30mg EOD, which should not shock my adreanls, but should hopefully help with my anxiety.

TRT can cause problems if either adrenals or thyroid function cannot manage the increased/restored metabolic demands of TRT.

Your body temps are good.

Someone here recently fixed panic attempts with iodine while on TRT.

You have AF and not tested rT3? If now getting to 98.6F, rT3 would seem to not be a problem.

What TRT protocol are you attempted to get?