T Nation

Need to Help Doc Help Me. Almost There, I Think


#1

-41
-5’11”
-Waist 42
-215 lbs
-Hair- Course black body hair, thick and throughout. Not like an animal, but present. Full beard. Full head of compliment-able hair.
-Carry body fat in waist and love handles. Can bring it down in all other areas (chest, arms) but belly/handles have always been a challenge.
-Train hard mainly with weight training. 3-5 times per week 45min to an hour each session.
-No hair loss or prostate drugs. Use Nizoral as body wash for acne. Currently on .33iu test-c every 3 days and ¼ pill arimidex the following day of pin (see below for Rx changes).
-Diet yo-yo. Trying to get back on carb-cycling (hi-protein/veggie, cycle healthy carbs with healthy fats). No carb or calorie starvation. It’s been difficult with holidays. Wife joining me for new year to help. Eat healthy 60% of the time.

-Fatigue, cloudy brain, lack of long-lasting energy, low libido.
-Testes shrunk/softened a bit and achy scrodom. No constant fever.
-Some morning wood, some no. Never throbbing (always ignorable). Sometimes it’s up and goes away quickly.
-Social withdrawal…60% of the time
-Moody in beginning of TRT…now it’s leveled off.
Adrenal fatigue.
Snoring….very bad
On TRT, something still doesn’t feel right.

Started TRT in April 2016 with a Urologist (I know), same who gave me a vasectomy.

Here are the pertinent tests I was given related to the list on the forum (more taken, but only listing those forum asks for…if not listed, wasn’t taken).
4/20/2016
PSA, Total – 0.51 ng/mL (0.01-2.90 ng/mL)
Total Test – 375 (325-850 normal range)
Started 1cc Test-C (200mg/mL) 2x per week (every 3.5 days)…2cc test c per week total

5/4/2016
Total Test – 1437
Reduced to 0.5cc Test-C 2x per week (every 3.5 days)…1cc test c per week total

5/28/2016
Total Test – 1425
Reduced to 0.25cc Test-C 2x per week (every 3.5 days)…0.5cc test c per week total

8/2/2016
Total Test – 781
Free T – 227 / 2.9%
Alumin 4.6 g/dl (3.5-5.2 g/dl)
SHBG – 18 nmol/L (14-89)
(No Change – Asked for E2)

8/16/2016
Total Test – 767
Free T – 183 / 2.4%
Albumin 4.5 g/dl
SHBG 29 nmol/L
RBC – 5.84 M/ul (4.69-6.13 M/ul)
E2 – 83 (20-75 pg/mL)
Prescribed ¼ Arimidex pill day following pin (every 3.5 days)

9/13/2016
Total Test – 585
Free T – 166 / 2.8%
Albumin 4.5 g/dl
SHBG 0.17 nmol/L
RBC – 5.45
E2 – 32
(slight change in meds) Increased Test-Cyp to .25 every 3 days (vs 3.5 days) and Arimidex to ¼ pill day following pin.

11/4/2016
Total Test – 550
Free T – 152 / 2.8%
Albumin 4.5 g/dl
SHBG 18 nmol/L
PSA 0.61, PSA Free 0.36 / 59%
E2 – 11
RBC – 5.96 M/ul
Asked for HGC (shrunk, tight-testes), Dr. didn’t want to prescribe…not familiar enough for use other than to come off TRT. Urologist said not enough research for other types of long-term use. Instead, increased Test-Cyp to 0.33cc every 3-days and kept arimidex to ¼ pill day following pin.

Changed from IM to injecting into belly-fat. Noticed less roller-coaster effect…wasn’t too bad to begin with.

12/28/2016
Total Test – 719
Free Test – 218 / 3%
Albumin – 4.4 g/gl
SHBG – 16nmol/L
PSA – 0.58 ng/mL)

Never received the DRE (dreaded finger)

I’ve been reading the forum for about a month now and realize I need a new doctor. Dr’s that specialize in TRT aren’t covered by my insurance. My Primary doc may be an option; he seems smart and willing and I’ll be seeing him in February. I’m also considering starting my own HGC of 0.10cc EOD, one-week on 3 weeks off to deal with the tight scrodum.
I’m going to ask my Urologist to increase my Test-Cyp from .33cc to .41cc every 3 days and see if HGC can be an option. Am I going in the right direction? Do I need to ask for any more tests to get me on track?

If I’ve answered my own questions or the answer is obvious by reading the posts…my apologies…my brain fogs especially when all the acronyms come together.

Brief background/history:
I was on TRT 3 years ago with a different primary care. He had me up to 2cc per week and it was great…got strong, bigger, lost some (not all) fat, high energy, wanted sex ALL THE TIME. Never any follow-up tests and had a lot of acne. Roller-coast or emotions too. Had to come off to knock-up wife…found HGC on black market because he had no idea (he’s now retired).


#2

At 200mg/ml per the beginning of your post, 2ml a week is far too much. That’s running a steroid cycle. You will have complications long term running those doses permanently. It looks like you are on the right track though in making your adjustments. You were too high at first and now too low. I personally like to be at the high end of the range to maximize the benefits since I am shut down anyway. You have to find that spot for you but most find it at 100mg-150mg per week.

As far as adding HCG its a good choice to preserve the size of your testes as well as any chance of coming off TRT should you choose to try a recovery.

Your E2 fluctuated a lot in those tests, try to adjust your dosages to keep it in the 20s for optimization.

Aside from the HCG issue and initial large dosage, it doesn’t seem like your Urologist is too bad. HCG is not likely to be prescribed outside of a TRT clinic as it currently recognized as an approved treatment for this application by the medical community (or insurance).


#3

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

We need lab ranges for FT. They vary greatly from lab to lab.

E2 lab range is very suspect. Typical is <41pg/ml
Total estrogens and E2 confused?
Target is E2=22pg/ml

You may have other health issues and urologists have a very narrow view.

Fat issues may be from low thyroid function which you can eval by taking oral body temperatures as per the thyroid basics sticky. THIS IS IMPORTANT.
You need to be using iodized salt and/or vitamins that list iodine+selenium.

SHBG 29 nmol/L (14-89)
E2 – 83 (20-75 pg/mL)
This is an odd outcome that might be suggest diabetes.
fasting glucose?

Your dosing needs to be very consistent so labs are not moving from dosing issues. Some lab changes do not make sense.


#4

Thank you both. I will continue reading and learning.