T Nation

New 53 Y/O, Learning about TRT


#1

Hello

I've been lurking and learning form everyone for the past few months and hopefully I'm headed in the right direction. I've known that there was something off with my health for awhile now and I've already gotten some progress with the IR protocol in the stickies. Looking to learn more. Thanks for the assist.

Look forward to your comments.

age: 53
height: 6’0’’
waist: 36
weight: 230/ +- 22% BF
describe body and facial hair: average on body, not a lot of facial hair on cheeks, can grow a goat-tee, but no side burns :frowning:
describe where you carry fat and how changed: Mostly on abdomen and lower back. Have not been lean for 10+ years. Just have not been able to get below 220lb not matter how much exercise I do. Could be more regimented, but stay busy with work, GF, yard projects and this nowadays. Till about 2001 I was very active, lifted 2-3x/week, played a lot of full court BB and did trail running (Hash runner) and my weight stayed at 190-195lb. Got in car wreck 2001 and L4/5 damage has prevented any regular ‘Johnny run fast and jump high’ sports.

health conditions: Was diagnosed with adrenal fatigue when I return from deployment in 2009. I know now that I was running pretty hard from 2005-2009 and have been trying to get back to a reasonable QOL every since. I have adjusted my pace to get things done and enjoy things without getting too wiped out, which I can do if I don’t pay attention to my level of activity.

Adrenal fatigue was initially treated with supplements and acupuncture till the practitioner moved back to mainland. Treatment just made things bearable. Got new doc and low t rates were identified and Andro-gel was tried for about a year and stopped for non effect and worry about transfer to GF. My Doc is an internist
and has been open to suggestions from the beginning. We tried testosterone pellets, but we were both out of water on the treatment and I was referred to another guy that was highly recommended for Low T work. He seemed very knowledgeable and very quickly determined that pellets were that way to go. Unfortunately they were not covered (outta pocket), but he assured me that it was the way to go. I remember that within a few days of the first pellets, I felt better than I’d felt in years. It did not last too long and it’s hard to admit that things don’t sometimes. I know now that I went thru the sweet spot and blah for next few months then sweet spot again as things came down. I remember asking him about it and he played it off as me not being used to the levels and that I’d get used to it. Short story, the sweet spots got less and less over the next 3 years. I did ask about estrogen levels once I remember and He said they were fine. During this time, my brain started turning off in the early afternoon about 3 PM and at times it would be at 11 AM on stressful days. Started using Nootropic supplements to maintain concentration at work and for anything.
Please understand that till this point I was not doing much research at all and I just wanted the docs to fix me so I could get on with my life. I know better now that I have to take a much more active role in my health. For about last year I’ve been slowly getting educated on Low T.

In March 2016, after discussions with my Doc, I told the Low T doc that the pellets were not doing it for me and that I wanted to try injections. He was not very supportive and finally agreed, he wrote a script and 15 seconds of instruction on where to inject 100mg of the testosterone (Cypionate 200mg/mL) a week and he sent me on my way with instruction to follow up in 3 months. Funny thing is that when I started reading T-Nation, I’d dismissed site previously thinking it was just a steroid site, my mistake. :frowning:. Wish I’d found sooner. So the last few months have been interesting to say the least. I did hit that sweet spot and it felt good, then it sucked worst then ever. T-Nation education was invaluable, I figured out that Low T doc had me on 200mg a week (too much) and so I went to 2X/Week and then lowered dosage to 100mg a week and learned about arimidex. I contacted Low T doc was told not to worry. I got labs:

Testosterone, Total 1385 H ng/dL 250-1100
Testosterone, Free 347.5 H pg/mL 35.0-155.0
Estradiol 57 ng/mL >=30 pg/mL <61

It was totally sucking, I called Low T doc and tried to explain my condition and my concerns. I was told to wait till scheduled appointment. I spoke with my doc and he wrote a script for the arimidex. Insurance did not cover, something about me not having breasts :wink:. GoodRX app coupon, got it for $12. I stopped injections for a week and started back with 45mg T E3D and .25mg arimidex on inject days. During off week, started getting morning wood after a 4 days and have since starting back with injections as well. Got new labs and waiting on results.

I did go to my scheduled appt with Low T doc just to see what he had to say and was told that all tests looked good and to schedule a new appt in 3 months. Needless to say I’m not seeing him again and my Doc and I will be getting educated together with help from here. He really seemed to lose interest once the pellet deal was off the table.

This is out of sequence, after going over the all the required reading, I started doing body temp readings. I remembered that I always had lowish body temp and sure enuf after 2 weeks of tracking I averaged 96.6 in the morning and 97.8 in the afternoons. In early June I did IR protocol as describe in the stickies and slowly after about 3 weeks my temps are 97.8/9 in the morning and at or above 98.6 in afternoon. I will continue to monitor this. There was some stinky times during the deal, I think it was the bromine coming out as discussed in the stickies. Totally weird sweating on my head and neck area. My dog would lick my neck like a salt stone.

So at this point I’m waiting for my July labs so I can make some adjustments

Rx and OTC drugs:
any hair loss drugs or prostate drugs ever: no,
Current Rx: arimidex, Testosterone, Flexeril

Current OTC: Vitamins (D3-5000iu, BioAstin, B12), Nootropic supplements (Sulbutiamine, Piracetam, Vinpocetine, Alpha-GPC: I take the GPT and rotate thru the other 3)
Fish Oil, Magnesium, Huperzine-A, melatonin, zinc, selenium, Iodine
Have ordered ZMA and a good multi-vitamin as suggested

Symptoms;
Since Sept 2009:
a.) Really have to pace workouts and other activities so as to not smoke myself.
b.) Lack of motivation to workout, work or pursue things. Unfortunately I have physical requirements for work and USAR.
c.) Brain fog, difficulty finding words, difficulty solving new problems. This can be problems at times, but I’m able to differ most times. Nootropics supplements have helped.
d.) Muscle soreness takes a few days to get over if I go too hard.
e.) Difficulty losing weight, just doesn’t seem to come off.
f.) I Difficulty to put on muscle when bulking.
g.) low libido, it has low for awhile and feast or famine in last few months.
h.) I do get more leg cramps since starting TRT.
i.) I do not snore or very little.
j.) Depression is when there’s no plan, is a hard one to gauge
k.) Got my last old filling replaced last month.
l.) I almost never get cold (Hawaii)
m.) Stressful has been kinda hardcore for later 15 years, it is exhausting.
n.) scrotum, they do look a bit small.
o.) My GF does say I can be a moody little bitch.
p.) The penis don’t work like it used to, that’s for sure.

lab results with ranges: Lab test from 05/30/2016
WBC 5.15 x10(3)/uL 3.80-10.80
RBC 5.21 x10(6)/uL 4.00-6.20
Hemoglobin 17.3 g/dL 13.7-17.5
Hematocrit 48.6 % 40.1-51.0
MCV 93.3 fL 79.4-98.4
MCHC 35.6 g/dL 32.0-36.0
Platelet 132 x10(3)/uL 151-424

Chol: 228 mg/dl ( < 200 mg/dl)
HDL: 32 mg/dl ( > 40 mg/dl)
LDL: 158 mg/dl ( < 100 mg/dl)
Triglyceride: 191 mg/dl ( < 150 mg/dl)

DHEA 167 ng/dL 61-1636 ng/dL

Glucose fasting: 102 mg/dl ( < 100 mg/dl)
Creatinine: 1.06 mg/dl ( 0.6 – 1.4 mg/dl)
25-hydroxy-vitD: 40 ng/dl (>= 30 ng/dl)
Albumine: 4.4 gm/dL (3.5 – 5.2 gm/dL)

Test Total 1385 ng/dL (250-1100 ng/dL) - 5/30/2016
Test Free 347.5 pg/mL (35.0-155 pg/mL) - 5/30/2016
E2: 57 pg/ml (<61) - 5/30/2016

Test Total     1385    ng/dL      (250-1100 ng/dL)   - 3/29/2016

E2: 57 pg/ml (0-47 pg/ml) - 3/29/2016

LH: <0.1 mIU/mL (1.7 -8.6 mIU/mL)
FSH: 0.3 mIU/mL (1.5 - 12.4 mIU/mL)

TSH:
1.55 uIU/mL (0.27 – 4.2 uIU/mL) - 5/30/2016
2.17 uIU/mL - 2/06/2016
1.69 uIU/mL - 8/20/2015
2.69 uIU/mL - 2/14/2014
1.93 uIU/mL - 9/21/2013

T4, Free: 1.41ng/dl (0.9 – 1.7 ng/dl)
T3, Total : 92 ng/dl (80 – 200 ng/dl)

T3, Free: 2.7 pg/dL (2.0-4.4 pg/dl - 02/06/2016

Cortisol, A.M. 8.2 ug/dL (6.0-25.0ug/dl)
Labs I will get next time - ?: ( I have no history of these at all)
DHT - ?
DHEA-S - ?
Prolactin - ?
Bio-T - ?
cutting
No cutting

Maintenance
- 2000-2500 calories per day.
- no fried foods, no soft drinks
- not a lot of red meat, but mostly fish, chicken, nuts, eggs, olive oil, lean meat,
- 75-100 gr protein; whey protein in my oats in the morning, fish, eggs, meat, not much diary at all
- carbs; oatmeal, watch protein to starch ratios, lots of veggies, brown rice, fruit.
- forced gluten free at times due to GF being Gluten intolerant.

describe training [some ruin there hormones by over training
I train cardio 2-3x/week and dog walking at brisk pace 2-3x/week as well. I do at home body weight exercises 2-3x/week and surf 2-3x /week when there’s waves. Used to train pretty hard in 20s & 30s when I was active duty military. Know now that I over trained a lot, young and indestructible. :slight_smile:.

testes ache, ever, with a fever?
No ache normally. Have been fairly active and have taken a few shots to the jewels in my life.

how have morning wood and nocturnal erections changed; Have started getting some morning wood since downing T dosage and IR. Libido not doing well. Used to get the nocturnals, but not for a long time.

For your review and comment.


#2

Increase anastrozole by a factor of 57/22 and you will get close to 22pg/ml

fT3 is a bit low relative to mid-range.

Adrenal fatigue increased rT3 that blocks fT3. Get rT3 tested.

Stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
* advice for new guys
* things that damage your hormones
* protocol for injections
* thyroid basics
* finding a TRT doc\

Leg cramps will probably resolve with magnesium supplements: https://biotest.t-nation.com/products/zma

Moody bitch: expected with your high E2 level

Do not test DHEA, only DHEA-S

Do not test LH/FSH while on TRT, will be zero.

What were LH/FSH before TRT?

Car wreck could damage pituitary. How does car wreck fit into your perception of when T levels started to go low.


#3

Thanks for the reply.

“Increase anastrozole by a factor of 57/22 and you will get close to 22pg/ml”

I was waiting for the most recent lab result before adjusting AI dosage. The 57 result was without any AI, so I had nothing to reference or scale from. Should have the results any day now. Just waiting on making the changes as I understood them from the stickies.

I’ve been on 45mg T E3D along with .25mg AI on inject days since taking a week off (skipped shots on 9,12,15, 18 June and start back on 20Jun). This was after the labs with E2=57.

Will get the the rT3 and DHEA-S on next labs

In my quest to track down all my Labs, did find one with DHEA-S from Jul 2014 lab that was between Testopel pellet treatment. Is this helpful?
⁃ DHEA-S (60-266 UG/DL) 159
⁃ Estradiol (0-47 pg/mL) <20
⁃ Test, Total (292-867 NG/DL) 279

I’ve not found any LH/FSH before TRT as of yet. Found labs back to 2011 and no LH/FSH.
Is that normal? Will continue to search.

On the my car wreck, no damage to pituitary I’d think, but was a lot less active after and gained weight and the rest is history.

Will continue to read and post next labs.


#4

Would much appreciate some advise on my recent labs.

Looks like the arimidex kicked in pretty hard. Am I a over responder? Only been doing .25mg E3D with 45mg T injections. That’s only .5mg a week. I’ll start working on making some liquid arimidex for next injection. Last reference I remember reading was 20 drops per ml.

Still doing Vitamins (D3-5000iu, BioAstin, B12), multi-vitamin, Fish Oil, Magnesium, Huperzine-A, melatonin, selenium, Iodine and ZMA

How have I been feeling? Hands and joints have been sore and just not a lot of energy for about the last week.

I have been reading suggested stickies as much as possible. It seems like I will need to address some possible adrenal issues before I can get any real progress. This makes me nervous and I’ll try and be patient with tweaking the the protocol.

I have appointment next week and will ask for for the rT3 and DHEA-S.

I did labs on third day before injection.

Thanks
K

Labs from 7/5/2016 07:43 AM

Glucose 99 mg/dL 70-99
AST (SGOT) H 43 U/L 0-37
ALT (SGPT) 47 U/L 7-51
Cortisol, Random 16.2 ug/dL
Reference Range:
Cortisol a.m.: 8.7 - 22.4
Cortisol p.m.: <10.0

Prolactin 9.2 ng/mL 2.6-13.1
T3, Total 1.1 ng/mL 0.9-1.8
Free T3 3.8 pg/mL 2.1-3.8
TSH 4.02 uIU/mL 0.34-5.60

WBC 5.4 10(9)/L 3.8-11.2
RBC 5.76 10(12)/L 4.4-6.0
Hemoglobin H 18.4 g/dL 13.4-17.2
Hematocrit H 53.1 % 39.5-49.7
MCV 92.2 fL 80-100
MCH 31.9 pg 27-33
MCHC 34.7 g/dL 32-36
RDW 11.6 % 11-15
Platelet Count 154 10(9)/L 150-450

DHEA 250 ng/dL 61 to 1636

Estrogens,Tot Serum 130.7 pg/mL 60 to 190
Estradiol <20 pg/mL 0-47
Total Testosterone 599 ng/dL 250 to 1100
Free Testosterone 147.2 pg/mL 35.0 to 155.0

Vitamin D (25-OH) 38 ng/mL

Progesterone 0.81 ng/mL 0.14-2.06


#5

Your FT is awesome especially considering that your TT isn't that high. I'm not following your E2. Was it 20 or less than 20 with no actual number listed? Was there a time you felt better as your E2'went down?


#6

Donate blood - hematocrit is too high.


#7

Yes, very important. Also take a mini aspirin every day to improve blood flow

5000-6000iu vit-D3, take 25,000 every day for first 5 days.
Do not take with high fiber foods.

This suggests that SHBG is low.

These are a bit high. OK if your muscles were sore from training, otherwise some concern about why.

Cortisol is good!

TSH is scary. Any idea on why this jumped up?
High dose iodine can do this.

DHEA looks low, but should test DHEA-S as DHEA can swing by the hour.

Any results with magnesium on muscle cramps and muscle tone?

You need a different lab for E2 that resolves lower that 20. A result of <20 is useless when we are looking to get near 22pg/ml. You need to research this.

Sore joins could be from low E2.


#8

First, Thanks for looking over my labs guys.

On the E2 <20 pg/ml, I do have an appointment this coming Monday and will get labs done. (Will ensure that rT3 & Dhea-S are added)

In June When I took to break on injections, I did pass the sweet spot and was nice. After starting back on 21 June with the .25mg Adex E3D along with injections. It was just 2 weeks before the labs. I was feeling better till about a week ago. Morning wood has tailed off.

Should I take a few days break from the Adex and let it rise and/or increase T to 100mg and see I pass thru the spot, then start back with halfed Adex dose? I’ve seen this suggested before. A day off at least till I figure the liquid out. Your Thoughts?

Reason I ask is that My labs next may be last ones for awhile as I will be out of country for next 120 days or so and no guaranty I will have labs available till I there in late July. Your thoughts?

I did have dose of Iodine the day before the labs. I was in dosing phase, oops.

Cramps and muscle tone are good. I usually take the mag at night, so that the when I’m most likely to miss a dose. Have been doing the ZMA and sleeping good. I do add Melatonin and a fish oil when I take.

Sore muscles ? - I did spend day at beach (include setup and tear down actions) and it was a long day. Could of affected my E2?

I will start the low dose aspirin everyday and D3 (25KIU x1week) today.


#9

IMHO, labs are only worthwhile if you are on regular protocol for a few weeks. If you are constantly tinkering with the doses of these meds, the labs can't give your a clear picture. Based on what you wrote, I'm going to conclude that your E2 is too low for you as you seemed to have passed the sweet spot. Having said that, you can't confidently alter the dose because you don't have an exact E2 level. So, if I were you, I'd get on a good protocol and stay there for three weeks then test.


#10

Nash / KSman

Thanks for your input.

I did my normal injection w/.125mg Adex (as close as I could get with halving a 1/4 tablet) on Thursday and got in tho see my Doc on Friday.

Spoke w/Doc today about he's on board with the protocol. I've shared link from the board and he has agreed that the board makes alot of sense.

Will do labs on Sat morning (aprox 1/2 way between shots) and will make adjustments from there. Hopefully we can adjust from there while I'm on the road.

We discussed my iodine loading and the increased body temps. He was interested and I will be sending him Dr Wilson's book.

DHEA-S and rT3 tests have been added to my labs, so we should get more information as requested by KSman.

Any suggestions are welcome.


#11

Sounds like you are on the right road. As far as the Adex goes, if you need to cut the pills any smaller than half, I would suggest that you just dissolve the pills in vodka and dose that way. Cutting a tiny pill into quarters or smaller will not be accurate.


#12

That's for sure. I'll be making a batch today.
Plan is to use 2ml of vodka and 1 tablet. That way I can dose below .25mg with out splitting drops. :slight_smile:


#13

Awhile back I made some liquid Adex to help speed up a drop in my E2. I dosed with a 1ml syringe. I was not confident using a dropper.


#14

Thanks Nash

Good Idea.

Do you re-use the syringe? Then just shot into a glass of water or juice, I'd think.


#15

Yes I re-used the syringe. Just cleaned it with warm water. I was drawing up 2/10ths of a ml, so I just squirted it in my mouth and swallowed. Worked great. Just be sure that you allow enough time for pill to completely dissolve and give the solution a few gentle shakes before drawing it up with the syringe.


#16

Got Labs back (at the end)

Comments always welcome gentlemen. :slight_smile:

Requested the rT3 and DHEA-S, only got the rT3. Not sure why the DHEA-S is MIA.

TSH is back down. Have started on iodine maintenance dose of 6.26 mg 2x week. Body temps have been good.

Got the D3 loading done. Did we go up enough?

E2 got a reading E2=11 (new lab)

My joints were still hurting and decided to take the week off of AI and will start back this week. They are feeling better. I will start back with .1mg AI with 50mg T E3D.

Vitamin B12 558 pg/mL 211-946
Cortisol, A.M. 14.0 ug/dL 6.0-25.0
REFERENCE RANGE:
CORTISOL AM 4 AM - 12 NOON
Vitamin D, 25-Hydroxy, Total 69 ng/mL >=30

Progesterone 1.2 ng/mL 0.2-1.4
Prolactin 10.5 ng/mL 4.1-15.2

T4, Free 1.3 ng/dL 0.9-2.1
TSH 2.39 uIU/mL 0.27-4.20
T3, Total 96 ng/dL 80-200
T3, Free 3.3 pg/mL 2.0-4.4
T3, Reverse 19 ng/dL 8-25

Glucose 114 H mg/dL 70-99
SGOT (AST) 35 IU/L 0-40
SGPT (ALT) 50 H IU/L 0-41

CBC w/ Diff & Platelet Count
White Blood Count 5.81 x10(3)/uL 3.80-10.80
Red Blood Cell Count 5.65 x10(6)/uL 4.00-6.20
Hemoglobin 18.0 H g/dL 13.7-17.5
Hematocrit 51.3 H % 40.1-51.0
MCV 90.8 fL 79.4-98.4
MCH 31.9 pg 26.0-34.0
MCHC 35.1 g/dL 32.0-36.0
Platelet Count 150 L x10(3)/uL 151-424

DHEA 215 ng/dL 61-1636

Estrogen, Total 155.0 pg/mL 60-190
Estradiol 11 pg/mL <61
Testosterone, Total 860 ng/dL 250-1100
Testosterone, Free 163.0 H pg/mL 35.0-155.0

DHT 39 ng/dL 16-79


KSman is Here
#17

T numbers look pretty good. I'll leave the thyroid to others. Your E2 is low but you seem to be on top of it. Nice work.


#18

What are you using to mix in? What were you using to shake it in?


#19

Using a small glass bottle to mix, shake and store.


#20

With E2=11pg/ml and a target of 22pg/ml, your new AI dose should be 1/2 of what it was before.

Can you donate blood?
If you cannot get HTC down, may need to reduce T dose.

Vit-D25 looks great.
Cortisol is good.
Prolactin not a concern.

fT4 is below midrange. Maybe iodine will improve that.
fT3 appears good, but rT3 may be reducing its effect.
Check oral body temperatures as per the thyroid sticky.

Was injecting 45mg T E3D and doing labs half way between?