T Nation

Needing Direction with TRT


Basic Stats:
Age: 31
Height and how tall are brothers and father: 5' 11", Brother: 5'6", Dad: 6'1"
Weight: 185
Waist size: 32" (on hips)
how much facial and body hair: hard to grow facial hair, somewhat hairy chest/legs/lower arms/minimal on back
describe facial bone structure: Clean lines, small dip in chin (compared to jason statham alot)
any loss of peripheral vision: no
feeling cold often [thyroid]: no
gaining fat: no
where are you gaining fat: not gaining any
gyno: no
how long ago did these changes start: ongoing
changes in how you react to stress [adrenals]: always been hot tempered, not so much now
any history of stimulant use [adrenals]: only standard preworkout
any history of steroid use: no
deca?: No
where are you located: Charlotte, NC
male pattern hair loss: yes
drugs to combat male pattern hair loss: no

Current problems:
Low â?? almost non existent libido â?? despite very hot and sexual gf.
No morning wood ever
Hit a brick wall at 5-6pm no matter how much sleep. Really struggle to stay away when driving.
Brain Fogginess on a lot of days.
Erections not as hard as they used to be.

Current stats:
185 pounds
3,000-3,500 daily calorie intake
10-11% Bodyfat (Very visible 6-pack)

OK so I have been having loss of libido issues for a long time now, and have been discussing it with my Dr for over 18 months. Originally he said that it was mental, and that things like these come and go. About 6 months later I went back (March 2011) and told him that I was still having the issues of just not wanting sex often if at all. I asked him to check my test levels and he agreed too. Two weeks later I got a call from the Dr's office saying everything was fine, so I figured it must be diet related. I hired a nutritionist (that works with bodybuilders, powerlifters, etc) and followed his diet plan to the letter. No improvement in libido, but lifts to do go up since it seems I was under eating for a awhile. I called the dr's office and asked for copy of the test after doing some reading here. (I also started adding 10,000 IU's of Vit D per day after reading here) Test levels came back at 343ng/dl on a scale of 249-869 ng/dl. Go back to the Dr and ask for all the test that were listed on here. Explaining that I have been having symptoms of low sex drive, tired in the afternoons, I fight to stay away around 5 pm when leaving work no matter how much sleep I get. A lot of nights I then have a lot of trouble falling asleep, and general fogginess on a lot of days no matter how much sleep I get or food I eat. I asked him why he wouldn't say the 343 is low and he said because it's in "range". He does test me again, but not for everything I ask. Here's what he tested for and the results....

Test Result Flag Units Reference Interval
Glucose, Serum 86 mg/dl 65-99
BUN 30 High mg/dl 6-20
Creatinine, Serum 1.12 mg/dl .76-1.27
eGFR 88 ml/min/1.73 >59
BUN/Creatinine Ratio 27 High 8-19
Sodium/Serum 137 mmol/L 135-145
Potassium, Serum 4.3 mmol/L 3.5-5.2
Chloride, Serum 97 mmol/L 97-108
Carbon Dixoide 25 mmol/L 20-32
Calcium 9.7 mg/dl 8.7-10.2
Protien, Serum 7.6 g/dl 6.0-8.5
Albumin,Serum 4.7 g/dl 3.5-5.5
Globulin,Total 2.9 g/dl 1.5-4.5
A/G Ratio 1.6 1.1-2.5
Bilirubin, Total .4 mg/dl 0.0-1.2
Alkaline Phosphates 85 IU/L 25-150
AST (SGOT) 43 High IU/L 0-40
ALT (SGPT) 36 IU/L 0-55

FSH and LH
LH 2.8 mIU/ml 1.7-8.6
FSH 2.0 mIU/ml 1.5-12.4

Testosterone, Free and Total

Testosterone, Serum 382 ng/dl 348-1197
Free Testosterone 9.4 pg/ml 8.7-25.1

TSH 1.470 uIU/ml .450-4.5
Prolactin 4.3 ng/ml 4.0-15.2

When I finally get the test in it takes 3 calls to get the Dr to call me back. He says that everything is fine, and that nothing should require anymore action. That it is more than likely depression related. I explain I have nothing to be depressed about and my life is about as good as it gets at the moment. Great woman, great kids, good job, no money worries, etc. He continues to say it's all in range and I ask how is the testosterone in range for a guy that eats right, works out, and is only 31? He stands by his in range theory and says he can refer me to a urologist because outside of the lab standards he doesn't have anything to go by on where my testosterone levels should be. I agree and on to the urologist we go.....

Finally get an appointment at the Urologist, and he states that everything is in range as well, and that it might be depression related. I explain again that I have nothing to be depressed about, and asked again how my numbers could be normal, and he says that Testosterone, Serum really doesn't mean much as a number goes, and that my free test is normal â?? low normal.

He explains that what he will do is prescribe me a new Testosterone gel that goes under your arm for a month, and if I see improvement then he is willing to look further into it and go with shots. He says he is strongly against TRT as is shuts down your pituitary. When I mentioned HCG his response was, â??We don't do that here. It's hard to come by, and there are no dosing protocolsâ??. He actually seemed a little irritated I mentioned it. When I explained that I had been reading about other people with Low Testosterone issues and explained some of what I read he quickly rubuttled that most of the information online is by Bodybuilders (and that some online docs will prescribe test to someone with 600 test scores as long as they get paid), and that test levels in the 800 range would could yeild liver damage. He went to the extent to ask the opinion of another dr on my test levels and they said they would look at depression before testosterone.

In the end he did prescribe me Axiron gel. 60Mg day under the arms. I am to go back in a month and tell him if my symptoms have improved or not, and we will go from there.

I am a little lost here on what to do other than try what the dr said. I started the gel this morning, and I don't expect to feel anything from it yet.

Any advice would be great, and if any one knows a good Dr in the South Charlotte, Rock Hill SC area I would gladly get a second opinion.



Not surprised the urologist was pretty unwilling to push the envelope...he probably had a cute Axiron in his office earlier in the week pushing her samples and taking him out to lunch, exposing her pert breasts and firm ass...but I get ahead of myself...

You certainly have lower than normal T levels for a guy your age, which need addressing.

Some things I thought of:

-What are your cholesterol levels? Do you get a good amount of dietary cholesterol?
-Any tests for E2?
-Any tests for DHT? This along with E2 is critical for libido/sexual functioning
-any blows to head/whiplash/auto accidents?

You should also look at 8 am cortisol, or even a 4x saliva test (this from your fogginess and midday crash). Might be hard considering the comptency of the medical professionals you are working with.

Does your doctor understand that Axiron is TRT and will shutdown your pituitary just as much as shots will? Your sentence was confusing and did not make this clear.

Dr. Crisler has a protocol for using HCG...I posted this into one of the stickeys...you can probably also find some studies on PubMed where doses are listed.

Before HCG, I would try a SERM restart. Your LH/FSH levels are on the lower end of normal and may not be producing enough to get your testicles firing. This is why I asked about possible accidents (unlikely). This is advisable before HCG.

Was your bloodwork done at 8 am, or thereabouts?


My cholesterol is good I had it tested a little while back (2 months) when I was ran through a battery of test for a life insurance policy I was getting.

No test for the E2, or DHT, and no blows to the head, but I did rupture C4/C5 about 2 years ago that healed itself (the rupture was confirmed by MRI).

I will ask about the cortisol test, but I am unsure if he will do it.

Yeah he knows the Axiron will shut down my pituitary as much as shots. What he was implying was he is against TRT unless the numbers are below 300 because there's no stopping once you have started. That's when I mentioned the HCG protocol for keeping normal production at least still happening.

Blood work was done about 10AM.

How do you do a SERM restart? Do you just take Arimidex/tamoxifen for a while? Are there any negative sides to doing this?


Post it...majority of people have been lied to when it comes to cholesterol...LOWER IS NOT BETTER!

And you have been having symptoms for close to 2 years...hrmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm..............how did you rupture it?

It is similar to Post Cycle Therapy (PCT) for AAS users after their cycles...no arimidex, but clomid or nolva for 4 weeks...higher doses for first 2 weeks, tapering to lower doses the final 2 weeks...

Side effects can occur, mimicing high estrogen symptoms (moodiness, unexplained sadness, etc.). Nolva seems better for sides, but not a real consensus that it is any more effective than clomid for restart. Some people run both concurrently. YOu can get more info on that from the steroids forum here.


I am looking for all the blood work that was done with the new life insurance. I hope I still have it. I do remember them commenting on my cholesterol saying it was better than perfect?

Let me back up here a little bit on the neck injury. About 3 years ago I was going though a divorce and went on wellbutrin to combat depression. I hated taking it and asked the dr what I could do to get off of it, and he said workout. That's when I started going to the gym. About a year later I was doing heavy power shrugs and let my ego get the best of me and the weight slipped and pulled me extremely hard to one side. That was the only thing I could think that caused it to happen. I am wondering now if low test contributed to the disc issues as I also herniated L5/S1 about 15 months later.

I didn't noticed if my libido was low during the time because frankly I wasn't dating at the time as I knew I needed to work on myself first. Really I begin to wonder now if this hasn't been an on going issue that I just blamed on 60 hour work weeks and having 5 kids (when I was married her (3) my (1) and our (1). I thought most of my issues were just due to that.

Would it be a good idea to get a SERM and run it if the Dr takes me off Axrion?

I also noticed I made a mistake when I was filling out the questionare. I copied it off another post so I could fill it out and left something on there. I don't have a hard time growing facial hair at all. I actually have to shave every day. I didn't know if that made a difference or not.


I looked for the labs from the insurance check up but couldn't find them. I am going to call tomorrow to see if I can have another copy sent to me.


Needing a little help again.....

Since the last time I posted a question here a lot has changed. I tired the Axiron for a month and it dropped my T levels to 271.

DR agreed to let me self inject test, and I am doing 50 twice a week. Once on Sunday, and once on Wed.

Got tested again a month later when I was only doing one shot per week. Tested the day before pin, and it was 383. Dr said this was good since I was going to pin again on the following day.

Overall I am feeling better, and the brain fog is gone. Sex is better, but my drive still isn't what I wish it was. About the 3rd week into the shots I felt better than I have in a long time and that slowly has gone away. I still feel better than I did just not as well as I think I'd like to.

When I questioned my Dr (urologist) about E2 and HCG. He promptly stated "We don't test for that here, and we don't prescribe HCG either." Told me he could refer me to an Endo (that would possibly prescribe HCG), but it would be 3 months. He also stated since I was lean I shouldn't have E2 issues since it hides in fat. I told him there was no need to refer because I was worried that it wouldn't do any good anyway as I have read on here Endo's seem to be worse that Uro's.

Now I am about 2.5 months in on the shots and I am having these issues:

Horrible Acne on my back and chest. Cystic type like I had as a teenager. Never had chest acne before so that's new (not really cystic on chest).

Sleepy during the day at times. Quick 15 minute nap fixes the problem, but really cant do that at work.

Sex drive not quite where I'd think it should be. Never really actively "in the mood" without some visual/physical stimulation.

I'd try to get another Dr but my insurance only allows be 4 co-pays per year so I already have foot the bill on a lot, and I know how hard it is to find one that's knowledgeable.

Any Suggestions?


yes. test for E2, Thyroid function, and cortisol levels. endo's are generally of no help. best to call around to compounding pharmacies to try and find a doctor who will think a little outside the drug rep box.

talk with your doctor. even if he won't treat it, just ask to test it to see if it is an issue. if it comes back out of range, then you can go see a specialist... or at least that's what you tell him just to get the tests you need.


I asked him to Test for E2 and he is persistent that I don't need to be tested for it. Is there any way I can get the test done myself? I have tried calling the Compounding pharmacies in the area, and they all refer to an Anti-aging clinic. I can't afford those kinds of places because they do not take insurance, and charge twice what I am having to pay out of pocket at the moment.


Also I don't thin I have written that I think I narrowed down my low test to my vasectomy. My symptoms got progressively worse after had it down 3 years ago. Researching I found that this has been the case with a lot of people.




Would you know which estradiol test to use? The normal or sensitive.


I think that is in the Estradiol stickey...I can't remember but you want the one with the range of something like 10-50...somewhere through there...call them and ask the ranges.


The correct E2 test is included in here:


I imagine that purchased separately it has the same name.


Would it be okay just to get that whole package since it's only $10 more than just the single test? I only ask because it says female hormone panel and didn't know if the ranges were different for men?


Yeah you should just get the whole package. Before you checkout it gives you the option to say that you are male. All of the ranges are correct. For some reason the one labeled "female" is much cheaper than the "male" one and has all the right tests.


Awesome. Thanks for all the help. I inject Sun. AM and Wed Night. When would it be best to have the draw taken?


It depends if you want to show an average (midway between inject) or a trough (just before your next inject).


I didn't know when the best time to test for E2 was. I would think it would be highest right after you inject, but didn't know if that's the reading you should use for figuring out if you need Adex. Also after reading through the forums it seems that ADC was the choice for HCG but they no longer carry it. Can someone PM me where I can look for it?


Also, the more I look on the site they say that the sensitive estradiol test is the one for males. Would it be better to order than the other one?

Estradiol, Sensitive

Description: This sensitive estradiol assay is designed for the investigation of infertility, particularly in situations where low estradiol levels can be expected. The analytic range of the assay is appropriate for the assessment of the low levels of estradiol typically observed in men, prepubertal girls, and postmenopausal women. Estradiol levels are useful in the diagnosis of precocious puberty in females and along with gonadotropins can help establish the cause. Estradiol levels in the prepubertal range can help to confirm the diagnosis of delayed puberty in females.

This is the original one mentioned.


Description: Estradiol is a form of the hormone estrogen. The Estradiol test is usually ordered to measure estrogen levels in females who experience abnormal menstrual cycles, abnormal bleeding and fertility issues. A significant deviation from the normal range may require further evaluation by your physician.