T Nation

New to Forum, Somewhat New to TRT

I’ve been reading and learning a huge amount here. Thank you for all of the contributors as this info is damn near impossible to get out of the doctors I’ve seen so far.

I started on TRT about two years ago when myself and my wife couldn’t take my miserable state of body and mind any longer. I had all of the typical symptoms, moody and irritable, increased body fat, loss of muscle tone, zero libido etc. etc. I was 38 and my initial test showed that my total T was in the low 200s with a range of 302-903. I tried the gels and patches and noting worked so I requested injections. Doctor had no problem with that and I was trained to self inject. At this time I had no idea the intricacies of HRT.

Initially I was on a 200mg (200mg/ml) every two weeks dose. This resulted in a horrible crash at the end of that second week. I asked my doc if I could reduce the dose to 100mg once a week. Since it technically was not a larger dose he had no problem with this. Unfortunately he was not versed well enough in this field to also run tests for any other levels besides a PSA. So LH, SHBG, E2 and FT were never checked in the beginning. After doing my own research I found that I needed to know more info about my various levels. I returned and had my E2 and FT levels checked. They came back that they were within acceptable range. Of course I now know that tells me nothing. I also at the time had a TT level in the mid 600 range. I wanted to push that a bit farther towards 800 so increased my dose to 125mg once a week.

I’ve now been on this dose for the majority of the last two years. In the course of this I needed to choose a different doctor as mine was moving out of the area. Enter HRT ignorant doctor number two. On my first visit he wanted to know why I was on TRT and basically told me that he considered TRT to just be a “performance enhancing drug”. Needless to say that pissed me off to no end. At least he did a more thorough set of tests. The first set of results on 06/25/13 were as follows:

Comprehensive Metabolic Panel

NA 140 135 - 144 mmol/L
K 3.8 3.7 - 5.5 mmol/L
CL 104 99 - 110 mmol/L
CO2 29 20 - 31 mmol/L
ANION GAP 7 4 - 13
GLUCOSE 84 60 - 99 mg/dL
BUN 14 6 - 23 mg/dL
Creatinine, Serum 1.10 0.60 - 1.30 mg/dL
CALCIUM 9.5 8.3 - 10.4 mg/dL
ALK PHOS 55 32 - 110 IU/L
BILIRUBIN TOTAL 0.8 0.2 - 1.2 mg/dL
AST 22 11 - 39 IU/L
ALT 30 6 - 42 IU/L
Total protein 7.0 6.1 - 8.0 g/dL
ALBUMIN 4.9 3.2 - 4.9 g/dL

WBC 7. 2 3.9 - 10.6 10^9/L
RBC 5.80 4.40 - 5.90 10^12/L
Hgb 18.0 13.5 - 17.7 g/dL
Hct 53.6 40.0 - 53.0 %
MCV 92.4 80.0 - 100.0 fL
MCH 31.1 26.3 - 33.8 pg
MCHC 33.7 31.5 - 36.3 g/dL
RDW 12.1 11.5 - 14.5 %
Platelet Count 255 140 - 444 10^9/L
MPV 8.4 6.8 - 10.8 fL

TESTOSTERONE 807 302 - 903 ng/dL

My Hgb, Hct, were high and RBC was borderline. The doctor also told me that my T level was very high and to reduce my dose to once every two weeks. So he wanted to drop me from 125mg once a week to 125mg once every two weeks. I told him in the nicest way I could muster that he was crazy and in no way was I interested in dropping my dose that far. Not to mention I thought it was incredibly irresponsible. I agreed to drop it back to 100mg once a week and have my levels tested again in a few months.

At the next set of tests my Hct, Hgb, and RBC levels were still on the climb and my TT was at 696 range 302-903. He still wanted to reduce my dosage to see if he could get my blood levels down to acceptable range. I then requested a referral to see an Endocrinologist. Well after waiting another five months to get my first appointment on 03/03/14 my tests were now as follows. At least this doctor was much more knowledgeable and thorough but still not what I was expecting.

TESTOSTERONE TOTAL 526 302 - 903 ng/dL
TESTOSTERONE FREE 149 47 - 244 pg/mL
The concentration of Free Testosterone is derived from a mathematical
expression based on the constant for the binding of testosterone to sex
hormone binding globulin.
Testosterone, Free Pct 2.8 1.6 - 2.9 %
SEX HORMONE BINDING GLOBULIN 18 13 - 110 nmol/L

ESTRADIOL 52 0 - 357 pg/mL
MALE: 0-40 pg/mL

WBC 9.4 3.9 - 10.6 10^9/L
RBC 6.02 4.40 - 5.90 10^12/L
Hgb 19.4 13.5 - 17.7 g/dL
Hct 54.3 40.0 - 53.0 %
MCV 90.2 80.0 - 100.0 fL
MCH 32.2 26.3 - 33.8 pg
MCHC 35.7 31.5 - 36.3 g/dL
RDW 11.8 11.5 - 14.5 %
Platelet Count 307 140 - 444 10^9/L
MPV 8.3 6.8 - 10.8 fL
NEUTROPHILS % 73.2 40.0 - 81.0 %
LYMPHOCYTES % 19.2 20.0 - 53.0 %
MONOCYTES % 6.4 1.0 - 10.0 %
EOSINOPHILS % 0.8 0.0 - 6.0 %
BASOPHILS % 0.4 0.0 - 2.0 %
NEUTROPHILS ABS 6.9 1.8 - 8.0 10^9/L
LYMPHOCYTES ABS 1.8 1.0 - 4.8 10^9/L
MONOCYTES ABSOLUTE 0.6 0.0 - 0.8 10^9/L
EOSINOPHILS ABSOLUTE 0.1 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.0 0.0 - 0.2 10^9/L

So now my Hgb is nearly two full points above range and my Hct level is 1.3 percent high at 54.3. My RBC count is also now above range. In the first appointment I had asked about donating blood to control my high Hct and Hgb and he responded that he had never heard of that for treatment. Fantastic. During my appointment he asked many questions, one of which was if I snored or had ever had a sleep evaluation done. I do snore but don’t think I stop breathing while sleeping. At least my wife has never noticed it.

After receiving the last test results I was concerned about my E2 level being too high and thought that it could be contributing to some of the problems with my blood levels. In the past few months I have also begun to lose some of the positive results I had when my TT was at 807 and even 696. I was beginning to feel more moody and had gained about ten pounds with no changes in diet or exercise. My libido was also waning to almost nil. All things I’ve learned can be attributed to high E2 levels. I call my Endo. and talk to his assistant about my concerns and she relays the info to him. Later she calls back and says that he is not willing to change any of my current treatment until I do a sleep study for Apnea. Great.

So this is where I currently stand. I have ordered some liquidex (1mg/ml) and will try to lower my E2 levels on my own. My plan is to start off at a low dose (.50mg/wk taken E3D starting with my T injection) for a couple of weeks to play it safe in case I’m highly sensitive to the Anastrozole. I’m also considering going to a twice weekly injection of 50mg TCyp but for now will stay at 100mg every Friday evening. Right now I’m not as concerned with HCG. I will also be making plans to donate blood to get out of stroke risk territory.

With the above numbers does this sound like a reasonable approach? At some point I will have a sleep study done but for the immediate future I want to get back to feeling well again.

Thanks for any advice.

Sorry about the formatting on the tests. They looked fine in the preview window but not in the post. Hopefully they are still clear enough to read.

Bringing this back to the top to maybe get a response.

I’ve currently switched to an E3D injection of 25mg of test cyp using insulin pins. This has made my mood and well being much more stable. I have also been taking .25mg of liquid Adex EOD which has brought libido and mood back to where I feel much better from my above levels of 52pg/mL. I will have new labs done next month to see where my current levels are.

My current question is about adding in a SERM, specifically Nolvadex in liquid form to help bring the testes back into the game. They have atrophied quite a bit and are beginning to become uncomfortable. Is my understanding that Nolvadex will help in bringing them back correct, and at what dose should I use to start? From my research it seems around 10mg daily would be a place to start? The Nolvadex that I have is 20mg/mL.

Thanks for any help you can give.

10mg/day seems like a good start

You donated blood? Felt better after?

“K 3.8 3.7 - 5.5 mmol/L” suggests that you need more potassium [oops was iodine :{]

Have you read the advice for new guys sticky and noted suggestions for endothelial health?

If you are eating iron fortified foods, eliminate them. Breads and cereals can be a problem. Men should not have iodine in their vitamins etc.

[quote]KSman wrote:
10mg/day seems like a good start

You donated blood? Felt better after?

“K 3.8 3.7 - 5.5 mmol/L” suggests that you need more iodine

Have you read the advice for new guys sticky and noted suggestions for endothelial health?

If you are eating iron fortified foods, eliminate them. Breads and cereals can be a problem. Men should not have iodine in their vitamins etc.
[/quote]

Thanks for the response KSman. I was hoping you would chime in.

Yes, I have donated blood three times now. The last time a double red blood cell donation. I do feel better and my BP is a bit better and I don’t feel the pressure in my head like I was on occasion. I’m also taking an 81mg low dose aspirin each night along with about 3000mg of Omega-3 fish oil to help thin out my blood.

One result that got left out of the above labs was my TSH and FT4 levels.
TSH=3.25 range of 0.38-4.31 uIU/ml
FT4=1.04 range of 0.72-1.90 ng/dL

I had read the sticky on thyroid basics and after I saw the elevated TSH I began supplementing with a thyroid care supplement from Terry Natural that contains 30mg of iodine per day (as potassium iodide, sodium iodide, and molecular iodine from kelp). It also contains 400mg of L-Tyrosine. Hopefully That will put me closer to 1.0 for TSH in my next set of labs. My temperature is now reaching °98.6 by early afternoon (my day starts at 4:00am). Before I was only getting up to upper °97s.

I don’t eat a lot of cereal or iron fortified bread. My daily multiple from Life Extension also contains no iron. I am a meat and potato kind of guy so if the regular blood donations don’t bring my Hct and Hgb levels down I may need to modify the diet. My iron levels on the last labs were:
140 range of 50-160 ug/dL
TIBC 346 range of 246-436ug/dL
Transferrin Sat. 40% range of 13-50%

Prolactin was
4.1 range of 3.3-20.8ng/ml

IGF-1 was
170 range of 52-328ng/mL
Z score 0.4 range of -2.0 - +2.0 SD

I’ll be seeing the Endo next month so will have updated labs then.

Thanks for the IR success story!

  • you may need to take a large total iodine load
  • from my experience, TSH can be slow to get near 1.0, in my case this was complicated by a horrible infection caused by a surgical error stomach drain tube induced deep starvation, loosing 2 pounds per day. Do not have data on how TSH changes with IR with other guys.

So you were not getting iodine? Do you know for how long? Others in your household probably affected too.

I corrected my post above, I was pointing out that your potassium is low. You may need to get a supplement and/or eat more foods with potassium. [K 3.8 3.7 - 5.5 mmol/L [

Your iron levels should be getting lower.

Are you taking any medications?
Any other health issues?
Age: 38
Weight?
Waist size?

Don’t know how long I was iodine deficient. I’ve never been one to use a lot of salt on my food other than for initial cooking and then it’s always sea salt or some kind of finishing salt which has no iodine fortification. I have a feeling my wife is deficient also but convincing her to take action is not easy. She is very cold intolerant and often has low energy.

She also has a horrible immune system which is compounded by being a middle school teacher. Right now she is fighting her third case of bronchitis in about six months. I hate to see her taking antibiotics on a regular basis.

I do take 200mg of potassium a day in citrate form. If my next lab still shows deficiency I’ll double that and see how it comes out.

Here is a list of all of the supplements I take on a daily basis…

Oil of oregano-100mg
Super multidophilus probiotic 24 strain-834mg
Tart Cherry-680mg
Super K from LEF which contains three forms of K-2200mcg
Vit D-5000IU
Potassium citrate-200mg
CoQ10-100mg
Two per day multi from LEF which contains…
Vit A, C, D2, E, Thiamine, Riboflavin, Niacin, B6, Folate, B-12, Biotin, Pantothenic acid, Calcium, Iodine, Magnesium, Zinc, Selenium, Manganeses, Chromium, Molybdenum, Potassium, Alpha Lipoic acid, Boron, Choline, Inositol, Marigold extract, Lycopene, and PABA.

Iodine-30mg w/ L-Tyrosine-400mg
Vit C-1000mg
Fish oil in triglyceride form-3000mg
Super enzymes

In the evening I take
ZMA-zinc-30mg/magnesium-450mg/B-6-10.5mg
Aspirin-81mg
5-HTP-100mg

The only medication I take is on occasion an inhaled corticosteroid to control very mild asthma and Omeprazole to control acid reflux. I take the corticosteroid more in the winter when my asthma is more aggravated by cold air.

Other than that I am a fairly healthy person and very rarely have a need to go to a doctor.

I am 41 years old, 5’9" tall, 185-190lbs depending on the day and 25% body fat down from 36% when I began TRT with a 32" waist. I’ve always carried the majority of my weight/fat around the midsection and chest. Normal body hair with more the older I get, and have the start of male pattern baldness at the crown of my head and a receding hair line.

Doesn’t help that I wear a baseball cap daily. I’m working to get my body fat down into the teens and would like to be about 165-170lbs. I have a stocky build from German genes so the suggested BMI doesn’t really work for me. If I was 150lbs I just wouldn’t look right.

Do you see any issues with any of the supplements I’m currently taking that might be interfering with my TRT?

So being on TRT for nearly three years what kind of time frame should I be looking at before I start feeling a difference from the SERM? I know it will take a while after being shut down for that amount of time. Just wondering when I should think about an increase from 10mg/day if I don’t notice anything improving.

30mg iodine per day. That is a lot after a while if you keep taking that long term.

Response to SERM takes time as physical changes need to occur.

Hopefully LH/FSH responds OK. That can be tested. If testes respond nicely, there is then really no reason to care about LH/FSH lab levels.

What would be a better maintenance dosage for the iodine? That dosage is from two capsules. One would be 15mg. I have also ordered some liquid Lugol’s iodine that I can dial in a smaller dose with.

As per the stickies, I suggest an IR of 750mg. If you have consumed that so far, you should be on a maintenance dose and I suggest 6mg every week or two.

Thanks KSman. I’ve definitely reached that dose. I’ll cut it back and see if my temps maintain the correct levels.

Latest test results. I’m quite surprised at these levels compared to the last labs. With Hct still on the climb I guess the next step is to reduce my dosage of T. Currently 50mg every three days. I wonder if the elevated T level has anything to do with the 10mg of Nolvadex/day I’ve been taking for the last two weeks? Could it have made a difference that quickly? At least E2 is closer to acceptable.

TESTOSTERONE TOTAL 1086 302 - 903 ng/dL
TESTOSTERONE FREE 286 47 - 244 pg/mL

Testosterone, Free Pct 2.6 1.6 - 2.9 %
SEX HORMONE BINDING GLOBULIN 29 13 - 110 nmol/L

ESTRADIOL 30 0 - 357 pg/mL
MALE: 0-40 pg/mL

WBC 7.8 3.9 - 10.6 10^9/L
RBC 6.19 4.40 - 5.90 10^12/L
Hgb 18.8 13.5 - 17.7 g/dL
Hct 55.0 40.0 - 53.0 %
MCV 88.9 80.0 - 100.0 fL
MCH 30.3 26.3 - 33.8 pg
MCHC 34.1 31.5 - 36.3 g/dL
RDW 11.3 11.5 - 14.5 %
Platelet Count 243 140 - 444 10^9/L
MPV 8.9 6.8 - 10.8 fL
NEUTROPHILS % 69.1 40.0 - 81.0 %
LYMPHOCYTES % 22.4 20.0 - 53.0 %
MONOCYTES % 6.7 1.0 - 10.0 %
EOSINOPHILS % 1.4 0.0 - 6.0 %
BASOPHILS % 0.4 0.0 - 2.0 %
NEUTROPHILS ABS 5.4 1.8 - 8.0 10^9/L
LYMPHOCYTES ABS 1.7 1.0 - 4.8 10^9/L
MONOCYTES ABSOLUTE 0.5 0.0 - 0.8 10^9/L
EOSINOPHILS ABSOLUTE 0.1 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.0 0.0 - 0.2 10^9/L

Here’s a comparison to the last labs…

Component Standard Range 3/3/2014 -9/5/2014
TESTOSTERONE TOTAL 302-903 ng/dL 526 /1086
TESTOSTERONE FREE 47-244 pg/mL 149 /286
Testosterone, Free Pct 1.6-2.9 % 2.8 /2.6
SEX HORMONE BINDING GLOBULIN 13-110 nmol/L 18 /29

Component Standard Range 3/3/2014 -9/5/2014
ESTRADIOL 0-357 pg/mL 52 /30

What is your T protocol and lab timing relative to prior injection?

Can you donate blood?

Your E2 is still too high.

How are you feeling?

Blood pressure high?

Dehydrated for labs?

Avoid iron fortified foods.

[quote]KSman wrote:
What is your T protocol and lab timing relative to prior injection?

Can you donate blood?

Your E2 is still too high.

How are you feeling?

Blood pressure high?

Dehydrated for labs?

Avoid iron fortified foods.[/quote]

Current protocol is 50mg test cyp. E3D, 10mg Nolvadex every day in liquid form, and .25mg of Anastrozole E2D also in liquid form. At the time of blood draw it was 3:00pm two days after last injection of test. I inject at 7:30pm. I did some math last night and found that I was taking ~8% more test than prescribed by injecting E3D equaling 450mg in 28 days instead of 100mg per week/400 per 28 days.

That was at 25 units E3D where 1 unit=2mg of test. I’m using .5ml, 29G x .5" insulin pins to inject. I think I will reduce my E3d dose to 20 units which should put me at 360mg in 28 days which is closer to 80mg of test per week and see where that puts my levels. That should also lower my E2 closer to ideal without an increase in dose. Does this sound like the correct direction? Or is that too much of a decrease at once?

I have been donating blood every 56 days through Red Cross with the last donation being a double red blood cell draw. I thought for sure that would have brought my Hct level back into the safe zone. It had been about a month since the last donation at the time of these labs.

Overall I feel pretty good. Libido is great, energy is good. I think that with my test level at 1086 that the slightly high E2 levels weren’t affecting me as much as it would if my test levels were lower. Better T to E ratio. On my last labs my E2 was at 52 with test being mid 500s. I felt like crap with those numbers.

My blood pressure is slightly elevated at home with a wrist cuff. Around 135/80, heart rate averages 70bpm. I don’t know how accurate the wrist cuff is and I have a severe case of white coat syndrome so it’s always high in the doctors office as is heart rate.

I was well hydrated for the labs as I knew that could throw off the numbers on the CBC.

I don’t eat any or very little iron fortified foods that I know of but do eat more red meat than I probably should.

Thanks for the help!

Anastrozole dose:

Increase dose by 30/22 to get near E2=22pg/ml

Decrease dose by new_T_dose / old_T_dose.

I would not reduce T from 450–>360 all at once. Try 450–>400 [-11%] and let your body get used to that then 400–>360 [-10%] later.

You are on fish oil. Mini aspirin can help with the high hematocrit.

[quote]KSman wrote:
Anastrozole dose:

Increase dose by 30/22 to get near E2=22pg/ml

Decrease dose by new_T_dose / old_T_dose.

I would not reduce T from 450–>360 all at once. Try 450–>400 [-11%] and let your body get used to that then 400–>360 [-10%] later.

You are on fish oil. Mini aspirin can help with the high hematocrit.[/quote]

Thanks for the response. So you think I should increase AI even though I’m going to be decreasing T? Could you clarify the dosage you stated above? I’m taking liquid Adex at 1mg/ml. The dropper contains 28 drops for one ml of liquid. I’m currently taking seven drops or .25mg EOD. How many drops would that equal in the dosage you suggested? If I understand that equation correctly I should be taking 1.3mg/week to get to E2=22pg/ml?

What dose were you referring to in the second equation?
"Decrease dose by new_T_dose / old_T_dose."
New dose of T(400)/old dose(450)=.9%?

I’ll do a slower decrease of T as you suggested. I thought that may be to big of a move after I posted it. Over what time period do you think I should decrease down to 360mg? Couple weeks for each step? Longer?

I take a high dose of liquid fish oil (3000mg in triglyceride form) and a low dose aspirin (81mg) nightly before going to bed along with my ZMA and 5HTP. I sure hope the reduction in T dose and continued blood donations get my Hct and BP back down to where it should be.

Thanks again. If it weren’t for this site and you’re help I’d be lost in doctor ignorance.

Increase dose by the amount suggested then decrease the dose by the reduction of T injected. You apply both factors. Doctors do not know this stuff. I though that these linear corrections would work with a competitive AI and results validate that.

28 drops * 30/22 * 400/450 * 1/3.5 = 9.7 drops

  • try 10 drops EOD

Time for taper, you can do 7-10 days between steps. No science, just more comfort perhaps.

Okay, got my paper copy of the lab results which include TSH. I don’t get this at all.
My TSH is now
<0.03 range of 0.38-4.31uIU/ml
The doctor did not palpate my thyroid before blood was drawn which I seem to remember reading can affect TSH results.

How is this possible with just taking a daily dose of 30mg iodine at the time of the labs? I’m now taking 6.5mg per week. Is it just a bogus test result?? Would an overdose of iodine cause an excess of thyroid hormone? The last week I have been experiencing anxiety, heart palpitations and higher resting heart rate, but have no noticeable enlarged thyroid or weight loss. I was also having a hard time falling asleep and not sleeping sound. The heart rate and palpitations have lessened the last couple of days and last night I was able to fall asleep easily. Suggestions?

Bump?

I can’t tell how long you have been on the IR and total taken. Can you relate to timing of palpitations etc?

IR can cause some excursions of TSH. But this TSH=0 is very weird.

Do your supplements contain selenium, should, very important for thyroid function and thyroid health.

Current body temperatures?