T Nation

New Protocol, New Endo, Not So Sure


Hello everyone,

I have had a bad string of luck with my TRT doctors and decided to join Kaiser Permanente and I feel like my new doctor is paying too much attention to the numbers and not interested in how I’m feeling. I was originally on 200mg E3W which was never going to work, I saw my new endo and I told her I wanted weekly injections to reduce the peaks and valleys. So that same day she lowered me from the 200mg every three weeks to 75mg every week, I started with the 75mg injection roughly a week after my last 200mg injection and I had my best week ever since starting TRT! That was four weeks ago and I’m feeling lower each week since then, I told her that and she said I’m right where I need to be. How can she determine I’m where I need to be by simply looking at my numbers and not bothering to ask how I actually feel? I told her I feel quite low on injection day and the day after, I’m also starting to feel cold all the time even though my thyroid is fine! My last doctor told me the same thing when I was at 1200ng/dL with my E2 at 52 and now I’m where I need to be at 531ng/dL? I can only guess where I’m at on injection day, likely half! I know the reason I felt great that first week was because I already had test in my system when I receive the 75mg injection which likely added to what I already had putting me at a sweet spot. I’m losing hope of ever getting better!

4 Days after Injection 75mg Cyp

TESTOSTERONE, TOTAL [B]531 ng/dL[/B] 240 - 871 ng/dL
TESTOSTERONE, FREE, CALCULATED [B]15.2 ng/dL[/B] 7.0 - 36.7 ng/dL
SEX HORMONE BINDING GLOBULIN [B]18 nmol/L[/B] 11 - 78 nmol/L
CHOLESTEROL 163 mg/dL <=199 mg/dL
HDL 28 mg/dL >=40 mg/dL
LDL 91 mg/dL <=99 mg/dL
HGBA1C% 6.8 % <=6.9 %
IRON 61 mcg/dL 59 - 158 mcg/dL
TOTAL IRON BINDING CAPACITY 425 mcg/dL 250 - 425 mcg/dL
IRON SAT 14 % 20 - 50 %
WBC’S AUTO 6.4 x1000/mcL 4.0 - 11.0 x1000/mcL
RBC, AUTO 5.37 Mill/mcL 4.70 - 6.10 Mill/mcL
HGB 16.0 g/dL 14.0 - 18.0 g/dL
HCT, AUTO 46.0 % 42.0 - 52.0 %
MCV 85.7 fL 80.0 - 94.0 fL
MCH 29.8 pg/cell 27.0 - 35.0 pg/cell
MCHC 34.8 g/dL 32.0 - 37.0 g/dL
RDW, BLOOD 12.9 % 11.5 - 14.5 %
PLATELETS, AUTOMATED COUNT 269 x1000/mcL 130 - 400 x1000/mcL

KSman is Here

Waist size:

If you have low thyroid function, you can feel bad, even with very good T levels. Sometimes with thyroid issues, one can feel worse on TRT because body cannot meet the increased/restored demands of restored T levels.

Please see last paragraph in this post to eval your thyroid.

Are you been treated for low insulin sensitivity or diabetes?
A1C, low SHBG

You appear to be iron deficient. Any ideas about your diet that may be doing this. Males typically hord iron, so when it appears low, we are concerned about possibility of a GI blood loss. Any digestive issues? Or a blood doner? You can get an occult blood test to detect any blood in your poop.

Oddly, your blood work HTC, RBC etc do not reflect a lack of iron or a GI bleed.

Ferritin not tested. This can reduce thyroid fT4–>fT3 conversion.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


Age: 45
Height: 6’
Weight: 230
Waist size: 34"

I have type 2 diabetes and being treated for it, also one of my low -T symptoms was feeling cold all the time (feet and ankles even colder) even when it was warm outside, I could be wearing a sweater and be fine even though it was 80 degrees outside. I also had trouble with digestive issues and with diarrhea before starting TRT, however now not nearly as much. When my endo lowered my test dose for the first two weeks the diarrhea vanished, but since I started feeling cold again it has returned somewhat. When I feel cold my appetite suffers quite alot! No blood in stool. My feet right now are super cold right now and only getting colder, socks don’t even help. I’ll head over to the link you provided for thyroid.

Much appreciated!


You cannot see blood in your stool, that is why the word occult=hidden is used.
What now?

Diabetes: A1C could be better. TRT usually improves insulin sensitivity.

You should get higher T dose and get to top of TT and FT ranges.
However, that will increase E2.

Are you using a statin drug for cholesterol?

Circulation in feet could be a complication of diabetes. Any numbness or tingling?

Cold hand and feet is also classic for low thyroid function, sparse outer eyebrows too.

Have you been using iodized salt for years? Very important for thyroid hormone production.

Ever had TSH. T3, T4, fT3, fT4 tested?

Need those body temperatures!


Days before my feet started getting cold I felt a cold tingling in my feet that made it feel like they were cold, but weren’t, then a days later they actually got colder to the touch. A few nights ago I realized the cold drinks at work seemed much colder when drinking and around the same time my feet started feeling colder. I had to stop my Metformin 500mg for diabetes weeks ago because hours after taking my first dose I got a nasty persistent cough and hoarse voice that came to a stop a week after stopping it. However my morning blood test are showing that my averages are getting better the longer I’m on TRT. My blood meter shows improvements starting after my dosage and frequency changes to weekly injections.

However when I told my doctor about the possible allergic reaction he seemed to dismiss it as the cause and doesn’t even know I stopped taking it. Whenever my doctors don’t listen to my concerns I tend to stop going to them, so I decided to sign-up at 24hr Fitness and deal with it myself since my doctor is ignoring a possible allergic reaction. No medication for cholesterol after discussing a completely new diet and exercise. I’m having difficulty locating an old mercury thermometer, all I got is a digital. Got urine test results look good.

A few days ago I woke up to find my shoulders hurt from laying in bed all night, this happened also before starting TRT and went away completely after starting TRT. I sleep on a Tempur Pedic so I shouldn’t be having issues, also sometimes I also wake up with tingling numb hands depending if there was any pressure left on for long periods of time. The numbness, coldness feeling, mild diarrhea just started up again recently after my endo lowered my test dosage.


Sleep and numb hands: May be pillow is not right for you. Sounds like neck and traps. Tense muscles?


Alright on thursday I had a blood test 4 days after my shot and my TT was 531 ng/dL on 5/11 and now today (5/14) 442 ng/dL, and last night I experienced a significant improvement in my libido only. However today it seems a bit weaker and was wondering if that’s because of my hormones still adjusting to the treatment or could it be because I’m now I’m hovering just above what would be considered low-T? Also would you expect anyone to fall to a lower point the day of or the day after my injection?

I’m not thrilled to be so near what’s consider low T (350 ng/dL), I’ve also read some have symptoms in the 400’s. Thyroid function is normal, it’s my diabetes causing my coldness. I look at the averages on my blood meter and its showing an improvement in the last four weeks since starting TRT.


Normal thyroid?

Without the body temperatures, you really do not know and normal thyroid lab results is a very poor criteria.


I’m going to be checking body temps over the next few days, I’ll report back soon. If doctors know labs are poor in determining thyroid function why don’t they tell me to check my body temps? Also what values are related to thyroid function?


Simple, doctors are idiots :joy:. Well some…

Anyway, get an oral thermometer and check temps first thing in the morning, mid day and afternoon.

For thyroid labs you want TSH, Free T4 and Free T3.


All my problems started after I weaning off Klonopin after 30 years, testosterone lowered and became chilly cold all the time wearing sweatpants and sweaters with it being 85 degrees outside, ankles felt as if I had soaked them in a bucket of ice, doctor dismissed it as type 2 diabetes. Feet become cold after protocol changes, then return to being warm once a stable state is reached.

I’m 4 weeks from a Defy consult and have extensive labs, I do have some questions. I have thyroid concerns, rT3 is elevated and realize it should be below 15 ng/dL. I’m not sure how this effects thyroid functions considering oral body temperatures are excellent using KSmans favorite basal body temperature thermometer and oral glass thermometer, both dead on balls accurate.

Wondering if elevated estrogen could raise rT3 do to mood imbalances and jitteriness could be considered as mental and physical stress, when estrogen is elevated I become weak and easily exhausted, mental slow down and memory problems. Shouldn’t rT3 be blocking fT3 lowering body temperatures?

Next concern is antibodies over reference ranges, is this a concern or should I monitor closely over time since body temperatures are good? I’ve had a chronic cough for 6 months and haven’t been able to shake it, is showing signs of weakening after Qvar inhaler usage for 1.5 months.

All temperatures are only taken on rest days. I’m reaching 98.6 by 12pm, sometimes by 10am, sometimes reaching 99.1 by 2pm. Probably do to chronic cough 6 month long cough. On some occasions it takes me longer (3pm) to reach 98.6.

Prior sciatica injury, still get muscle twitches all over body which aren’t painful, prior sciatica affected everything below waist, not upper back/shoulder area, neck and arms. Klonopin did something to muscles during withdrawal, leg muscle were like concrete for months.

-age 46
-height = 6’ foot
-waist 36" inch
-weight 233 pounds, unable to lose weight by diet changes for 20+ years.
-fat distribution = midsection, skinny fat, body fat 33%
-Rx and OTC drugs SSRIs = Klonopin 30 years, 1 year on Ritalin+Kpin cause extreme weight loss, dropped 32 pounds in 30 days. Medication free for 3 years.
-describe diet = Better than pre-TRT, added more whole foods to the mix.
-ionized salts = always, big milk drinker and dairy.
-morning wood = Only when injecting EOD, hypersexuality.
-Diagnosis = ADHD and Tourette Syndrome, the latter zero symptoms.
-Body temperatures = morning 97.7 - reaching 98.6 by 12pm/sometimes 99.1 = cough?
-Outer eyebrows = sparse
-Lower eye lashes = less full versus top eyelashes
-Stool = been hard for as long as can remember, normal color.
-Skin = semi dry, no lotion needed
-Hair = some areas around head/face are dry and frizzy in places, sideburns.
-Body hair = longer than before TRT
-allergies = seasonal allergies

Labcorp Results - 50mg twice weekly, 400mg DIM twice daily, 1000mg Calcium D glucarate twice daily. Already started new protocol today, 16mg EOD (64mg weekly).

Total T = 677 ng/dL 264-916 ng/dL

Free T (Direct) = 29.2 pg/mL 6.8-21.5 pg/mL

Calculated Free T = 19.6 ng/dL = 2.9 %

SHBG = 16.2 nmol/L 16.5-55.9 nmol/L - Previously 18 nmol/L

Sensitive E2 = 70.6 8.0-35.0 pg/mL

TSH .902 0.450-4.500 uIU/mL Pre-TRT .580 uIU/mL

Free T4 1.37 0.82-1.77 ng/dL

Free T3 3.6 2.0-4.4 pg/mL

Reverse T3 22.4 9.2-24.1 ng/dL H

Thyroglobulin Antibody 1.1 0.0-0.9 IU/mL H

Thyroid Peroxidase (TPO) Ab 10 0-34 IU/mL

Hemoglobin 16.7 13.0-17.7 g/dL

Hematocrit 48.8 37.5-51.0

RBC 5.58 4.14-5.80

DHEA-Sulfate = 224.1 - 71.6-375.4 ug/dL

AM Cortisol = 14.2 6.2 - 19.4 ug/dL

IGF = 153 67-205 ng/mL

Prostate Specific Ag, Serum 1.0 0.0-4.0 ng/mL

Magnesium, RBC 5.7 4.2-6.8 Supplemented day before labs, 300mg x2 daily.