T Nation

New Here and New to TRT

Hello everyone,

I’ve been a lurker here ever since start TRT about a month ago. Finally joined up as this seems to be the most knowledgeable place on the net when it comes to TRT and my doc (VA clinic) doesnt seem to have a clue. KSman, Why are you not a doctor? You know everything!

I had been feeling really down in the dumps, fall asleep at the drop of a hat damn near, shrunk an 1", joint pain all the time, virtually NO short term memory ETC. For years the VA chalked all of this up to PTSD. I finally requested a different doc at the VA this past summer and we this is where we are now.

I started TRT at 100mg IM of test cyp injected weekly about a month ago, The first 3 days after the 1st injection i felt great! Tons of energy, drive to lift again (which i did, man im outa shape) Day 4-5-6-7 sucked again, I was hot, sweating all the time, clammy skin when not sweating etc. I also noticed my nipples itching a little bit but maybe it was in my head as i was concerned about it with what i had read hear and my being hot all the time.

I took the initiative myself and started injecting 50mg 2 times per week and this seems to have helped a little with the sweating, although im still hot most the time. This past week i talked to my doc about Arimidex and HCG, She acted like she had never heard of them but said she would schedule a consult with the VA endo, he’s a crusty old guy so my hopes arent great that he knows about anything either.

Let’s get started,

28yrs old
6’2"
36" waist
225-230lbs
facial hair is sketchy at best, I couldnt grow a beard if i tried. Shaving once a week takes care of it without looking scraggly. No chest hair(tiny bit around nipples) arm and leg hair seems normal.

-i seem to carry most of my fat around my stomach, and thighs. it has increased greatly over the years but i have no doubt that this is in fact to to my lack of exercise as i just lost motivation and energy to go the gym for the last 6-8yrs
-never had any real health concerns before now.
-Been prescribed oxycodone for back pain but hate the stuff as i can see how it hooks people in a hurry. Maybe take 20 5mg tabs of it a year when my back is acting up.

-I try and eat a healthy diet but will be the first to admit its not always great. I usually have cereal for breakfast, at leat a protein shake for lunch(muscle milk) and whatever the wife cooks for supper. (pastas, tacos, homeade pizzas, steaks, chicken, etc)

-describe training [some ruin there hormones by over training]
I usually am running a very mild fever when at the doc, like 99.0 99.2 98.9 etc
-erections have had a noticeable change since starting TRT. For the better for sure.

Labs before starting TRT:

LH 2.36 RANGE 1.51-9.36
FSH 2.09 1.55-9.74
TT 274 300-623
FT 10.09 8.8-27
E2 never tested
prolactin 10.9 3.7-17.9
psa .0672 0.0-4.0

WBC 4.0 4.0-10.8
RBC 4.98 3.95-5.79
HGB 14.3 12.5-17.0
hemacrit 42.3 38-52
MCV 84.9 81.8-98.6
MCH 28.7 27.2-33.6
MCHC 33.8 32.4-34.8
RDW 13.9 12.3-15.9
PLT 276 150-400
MPV 10.3 6.6-11.8
NEUTROPHIL 1.5 1.5-7
NEUT % 43.4 50-70
LYMPH A 1.3 1-4
LYMPH % 37.5 25-40
MONO .4 .2-.8
MONO % 12.8 3-8
EOSINOPHIL .2 0.0-.3
EOSINPHIL % 4.5 1-3
BASOPHIL .1 0.0-.2
BASOPHIL % 1.8 0-2
SED RATE 8 0-15
SHBG 25 10-50
C REATIVE PROTEIN 5.8 <=10
ANION GAP 10 7-16
EGFR 80 >60
EGFR CREATININE 1.1 .7-1.4
GLUCLOSE 107 70-100
UREA NITROGEN 16 9-20
SODIUM 139 137-145
POTASSIUM 4.5 3.5-5.1
CHLORIDE 103 98-107
CO2 26 22-30
ALBUMIN 4.4 3.5-5.0
ALK PHOS 71 38-126
ALT 52 13-69
AST 38 15-46
BILIRUBIN TOTAL .6 .2-1.3
CALCIUM 9.4 8.4-10.2
MAGNESIUM 2.1 1.6-2.3
VIT D 30 30-74
TSH 1.95 .465-4.68
CHOLESTROL 202 <=200

Thanks for the help gentlemen!

We need ranges for the lab work.

Definately get your E2 checked. Thats probably why you stopped feeling good after a few days.

-Joe

I feel ya, Ned. When I got off active duty I was in a similar situation. I was dealing with a VA GP who referred me to an Endo. I was trying to switch delivery methods since I still felt terrible despite being on TRT for 6 months at the time. They only seemed to want to do Androgel. This is way before I learned about hCG and adex.

As for the doctors not knowing about hCG and adex, many don’t. You’re looking at a long road until you find a doctor (read the finding a doc sticky near the top of the thread list) who will be willing to do this. And like Joe said, get your estradiol checked. You’re going to have to specifically request it, and when they say they “don’t do that and it’s unnecessary” just tell them to humor you. I sincerely doubt you will ever get the treatment you need from the VA. I gave up on them.

PM’d you some more stuff.

I have a call into a local urologist, receptionist said they deal with trt but couldn’t give me any specifics as the nurse was out so I’ll call back Monday.

Any specific way I need to word things when I talk to them about the hcg and arimidex?
I plan on telling them they I need the hcg for fertility as my wife and I are still planning on kids at some point. how would one explain the need for arimidex need without belittling them?

I’ll keep you guys informed on any progress.

I’ve never experienced a urologist. Guys on here don’t have many good things to say about them in general. I lucked out because I have a family friend who is a doctor and has been intrigued by my journey for homeostasis. BUT, even with that, he took a little convincing. Honestly, you’ll learn more from the TRT veterans on this board than anywhere else. There’s a lot of great info (ammunition) to present to your doc. Everything will be dependent on how receptive he/she is. If they are combative from the get-go, it’s find a new doc time. Like I said, this won’t be an easy path, so prepare yourself.

As for what I said to my doc, my testes had been aching pretty consistently for a few months (I’m at 13 months now). The first time I noticed they were significantly smaller and felt soft was last Christmas, so I had been on TRT (androgel only) for a couple of months. Eventually, they can actually atrophy and then you’re fucked and it’s primary hypogonadism until forever. Also, whenever I had an orgasm it felt like my left testicle was trying to retract into my body.

I said these terrible things no man wants to hear out loud to him, THEN I explained the benefits of hCG. Increase in size of testicles. They drop back down. No aching. Increase pregnenolone (happy hormone). Increase in sense of well-being. Honestly, with the recommended dosage, THERE IS NO DOWN SIDE. Only positive.

And for the arimidex, it took a couple of blood tests (which I had to request estradiol be added to) in order to plea my case that I needed it. To be honest, this is week one of adex for me. I can’t speak from experience of the wonderful effects of having an E2 level of 22 as opposed to 100, but guys on here know better than me, and to quote KSman “it’s the difference between superman and suicidal”.

If I were you, I would study up (everything you need is on this site), sit down, and type up all the things you want to say; The case you want to present. If he already knows a little bit about the subject (not just the “throw testosterone at it and the problem goes away”), or if he’s open minded and you present a good case, you shouldn’t have a problem.

Now, all that being said, did you get my PM? It will save you a lot of time and hassle. One thing I have learned with age is that learning from others experience saves you a lot of heartache.

Hey guys - thanks for your service!
Vets deserve the better healthcare IMO.

As far as talking to your doc, I used fertility as the reason for needing HCG too. It’s important!
Initially he only prescribed test. The next time I saw him I told him I felt well when I started then crashed and that I think it might be my estrogen levels. He had ever heard of Arimidex for trt before but was open to it.
When I first asked about hcg he said no but the next appointment I emphasized fertility and he finally gave it to me.

I think you will know how to approach your doc. Try to read into how he feels about it and approach it accordingly.
Make your doc feel smart, important and appreciated then manipulate him. Jk

It is worth it- even if you have to shop around. It took me a year to get both but it’s worth it they both made a big difference for me.
Good luck man.

Kaynon311,

I did NOT receive your PM, Maybe i dont have that privilege yet since im a newb.

It just blows my mind that so few doctors know the ins and outs of TRT.

Thanks for the reassurance guys, good to know im not the only one in this situation. Unfortunately…

Ned - one more thought. - looking at your labs again - almost everything is at the very lowest part of the so called normal range.
Some of the most important things though are your LH and FSH. Those low levels indicate your pituitary isnt functioning how it should be. LH stimulates production of testosterone in the testes. When your LH is low, your testes aren’t getting the signal they need to produce testosterone.
I would guess you are a case of secondary hypogonadism- meaning your testicles probably work fine but your HPA axis has an issue.

Ideally you could look into this before starting TRT but I did the same thing.

Keep us posted and let us know what questions you might have.

Also,

I have read through he stickies, Good info and it will come in handy when i start my search for a doc who knows what they are doing.

Thank you JoeyB. I will do some reading up on that and bring it up with the doctor.

What are some causes for pituitary malfunction?

Ned, the advice for new guy’s sticky. We need TSH, fT3, fT4. Check and post your oral body temperatures. Do you use iodized salt?

Your diet, as described, seems like a bad combo of carbs. Your 36" waist is a problem. Need fasting glucose and cholesterol. Get E2 tested. You can do some labs on your own if needed.

What are some causes for pituitary malfunction? The advice for new guys sticky and there is a sticky concerning things that damage one’s hormones.

Taking vitamins or supplements?

Go to Walmart and get 5000iu vit-D3 tiny oil caps. Take one a day, your wife too!

[quote]KSman wrote:
Ned, the advice for new guy’s sticky. We need TSH, fT3, fT4. Check and post your oral body temperatures. Do you use iodized salt?

Your diet, as described, seems like a bad combo of carbs. Your 36" waist is a problem. Need fasting glucose and cholesterol. Get E2 tested. You can do some labs on your own if needed.

What are some causes for pituitary malfunction? The advice for new guys sticky and there is a sticky concerning things that damage one’s hormones.

Taking vitamins or supplements?

Go to Walmart and get 5000iu vit-D3 tiny oil caps. Take one a day, your wife too![/quote]

KSMAN,
been waiting for your reply.

I dont use salt very often but when i do it is iodized salt. Small quantities though. Fasting glucose has been between 80-107 on all of the different lab reports that i have from the last 8 months or so. All of the lab results posted have been fasting labs, right away in the morning.

I have tried multi vitamins on and off for a few years but i believe they are the cause of terrible headaches that i get. I only get headaches when i take multi vitamins. I guess i decided they werent worth the headache(pun inteneded) and havent touched them in a year or so. I have also been taking vit D3. I started that right after the lab results indicated that i was borderline low.

Looked through the stacks and stacks of papers i have from the VA and found a couple more #'s that you have asked for. Doesnt look like i have FT3 for you though.

TSH 1.95 .465-4.68
ft4 .99 .85-2.37
cholestrol 202 <=200

Just got done with supper, Went and took my temp via oral digital thermometer. 98.2f

KSMan,

I know i read it somewhere on T Nation over the last few days but i cannot find it again, what is the significance of wanting to know body temps?

I just got off the phone with the urologist that i spoke of earlier in this thread, well his nurse actually.

I asked her about hcg for the fertility issue and she said it wasnt something that they currently did but that the Dr was open to new things and had no problem doing some research on new stuff. I mentioned E2 tests and she said they did that for sure.

She also mentioned clomid but it wasnt clear as to whether or not that was for E2 levels or if she was saying that was for the fertility issue.

Am i correct in thinking that I want no part of Clomid?

I decided to meet with him on Jan 2nd. as it seemed he was somewhat open to the idea of hcg and AI’s.

So now if you guys would be so kind as to give me any and all credible ammo/links for these 2 items so i can take them with me when i go to the doc it would be appreciated.

Here is a link for the temps question. It is KSman discussing his thyroid. Temps can help indicate thyroid function.

Regarding the question you asked about pititary problems, I think a whole slew of things can cause them. In my particular case I think it was extreme stress for several months due to a family situation, averaging 4 hours sleep, poor diet, no exercize etc. I also know I have a weak thyroid and that may have contributed.

Clomid or other SERMS are used to try to correct a pituitary problem. They essentially re-start it (if successful). It prompts the production of LH/FSH so that your body can produce t on its own.

I started on test injections when I realized I had low T. About a year later I am figuring out the cause and that I should have first tried to correct the problem at the source.

For people with primary hypogonadism, this isnt an option. Their problem is in the testicles so trying to fix LH etc wont help.

Because it sounds like you are secondary, Clomid might be worth looking into. - Except people on here suggest Nolvadex rather than Clomid. It has fewer side effects.

Todays temp reading is 98.6f

Ned, please double check your fT4 result and range. From what you posted, you are way off from mid-range and mid range is where one should be.

TSH also creates concern.

Low iodine is a major concern as there is less and less in peoples diets now. But your 98.6 is good, for mid afternoon. When you wake, 97.7 would be ideal. Where are you?

The problem is that we see so many guys with low T who have subclinical hypothyroidism.

So we have concerns with low fT4 and elevated TSH, but 98.6 puts a cap on the problem. Waiting for waking body temps.

SERMs may or not have a role to play, definitely avoid clomid as it can make some guys fell really bad, use Nolvadex, for what it is been asked to do, it will get the job done.

97.2f @ 7:08am. I woke up @ 6:45 today.

I will recheck and post FT4 again a little later today.

Your intolerance of vitamins is odd and should be considered as a symptom, not an inconvenience. Wondering if you have a gut problem. Any digestive issues? If so, probiotics might be useful. [Most probiotics are junk, you need a product that has many different bacteria types and should be sold refrigerated, need to get from a health food store.]

We know that your iodine intake is low and your status will be low. Time to consider iodine replenishment. You can see what is available at the health food store.

The checking of waking body temperatures is the norm. I added checking afternoon temperatures as a second indicator. I think that low AM and normal PM is a lesser problem than the inability to warm up during the day.

KSman,

I havent noticed any digestive problems, I pretty much can eat anything i want and not have a problem with digestion. I used to have a constipation issue but that seemed to be cured by making sure i was eating fiber everyday.

I feel that i have pretty much nailed down the headache problem to vitamins. Its strange though as when im taking vitamins i can have a headache one day and not again for another week sometimes. Other times its a daily occurance. I very very seldom have a headache when im not taking vitamins though so i think i can comfortable say that there is a correlation between the headaches and the vitamins.

Are there fillers in vitamins to give them their pill shape? Could a certain filler be the problem?

I will look into iodine replenishment options.

Question for KSman,

The new doc im going to see on the 2nd likes clomid instead of hcg and Anastrozole. How do i best plead my case to him.

I think i can make a pretty good case as far as the estrogen concern goes. Why even let the T get converted to E like clomid lets happen. Why not just keep it as T like it should be?

How about the HCG aspect of it? From what his nurse told me it seems like he tries to kill 2 birds with one stone by using clomid. Jump start the Testes and keep E at bay with one med instead of the 2. What should my counter attack be?

I want to thank everyone who has contributed. Ive learned more in the past couple weeks around here than i can comprehend right now. It will all sink in though…eventually!