T Nation

New to the Forum & TRT. Any advice?

Hey, guys. New to the forums and to TRT. I am 5’10", 195 lbs., 15% BF. 32 years old. Been on TRT for about 40 days now. I take 180mg test cyp every 10 days. Just started HCG a week ago, and I will be dosing 250 iu’s on the 5th, 7th, and 9th days between injections. Just had my first blood draw since the initial bloods before TRT. I’m sitting at:

Total T 663
Free T 9.1 (low in a range from 10-25, I think?)
Estradiol 20
SHBG 59 (high)

Before TRT, my total testosterone was at 308 and my free testosterone was at 5.5 in a reference range of 10-25 I believe (forgot the units of measurment). So I was not doing so well. And I’d had several readings like that in the past. My SHBG was and is still topped out. So, in sum, it was:

Total T 308
Free T 5.5
Estradiol 17

TSH 0.73 (.30-5.6)*usual reading, approximately

Started on the regimen because I had the following symptoms:
lack of assertiveness (feeling like a passive observer)
lack of libido
no morning/night erections (still don’t have those now on TRT; haven’t for about four years now)
body composition harder to keep optimal

I’m not happy with my numbers. Because something is weird. My TRT practitioner didn’t seem concerned that I had a good level of total T TEN days after the injection. So I must have been through the roof for about a good four days after the injection. I don’t want “through the roof” then down lower. I want stable. Furthermore, it’s all doing jack and sh*t for me if my free T is still low. He says to give things and this same protocol time, and suggested to add stinging nettle root extract.

Well, I’ve wished to know why my whole T and SHBG was out of whack anyways. Two things that I may need to look at. One, I have a varicocele on my left testicle that’s sizable. There’s no pain, and it swells only after heavy compound lifts sometimes. It’s been there for about four years now. I suspect I got it possibly from heavy deadlifting. I used to strain like a son of a gun doing 'em back when I powerlifted. Stupidly. Should have only pulled fast, not grinded nearly as much. But it’s there nonetheless. Could be compromising my test levels? But my LH and FSH levels were normal and show normal consistently, never bottomed out. I’d give an example reading, but can’t place one of them where they were on there just at the moment. Points to normal pituitary and testicular function? I can update with the readings on these after I see the doc again for another copy. Should I have this varicocele looked at? By whom? A urologist?

Anyhow, my second concern was that I was told after an ultrasound overseas that I had a fatty liver. There was a communication gap, but I was told and shown clearly that I have a fatty liver. Though my liver enzymes came back mostly normal. And usually do, except for some slightly elevated ALT (but I’ve also read that muscle damage elevates it? Is this true? And I do train) One of my recent LFT readings is as follows:

AST 27 (8-34)
ALT 38 (8-31)

Should I look at the liver again due to the numbers and the ultrasound? Is it the SHBG culprit? Who would look at it? A gastroenterologist?

Anyhow, I think that’s about everything thus far. What do you guys think? I’m kind of concerned that I’m now pinning test and potentially not seeing any real benefits. Granted, I did notice some benefits in the first two weeks (placebo?). But muscles felt harder. Recovery times improved. Clarity seemed a bit better (less re-reading of grad textbook paragraphs, but still some re-reading due to “fog”), as well as perceived assertiveness and concentration. Oh, along with the test cyp and HCG, I take 400mg I3C a day. This seems to be helping with E2, as it’s only gone up a few points.

How about the SHBG? Possible causes?

Thanks for any and all tips on optimizing this TRT regimen and getting me feeling clear, energetic, and making gains again! Happy to be part of the forum!


Your shbg is inflating your TT numbers, you should be monitoring fT or bio available T and inject more frequently. Please read the stickies about the TRT injections protocol. You would also need an AI and probably hCG if fertility is an issue. You don’t have high T 10 days after injection, you need to maintain a good level of FT and test between injections always to avoid timing problems. High FT and controlled e2(around 22-25 pg/ml) will over time drive down your shbg and give easier to interpret results.

I do monitor free T, which is still low. I am getting treated through a Low T Center, and I can’t afford to go more than once per week. Heck, right now to keep costs low, I go once every ten days. I know more frequent, lower dosed injections could be better, but I’m starting with this protocol of 10 days.

Do you have any suggestion on how I can get to self-inject with a protocol that’ll have less peak/valley? Also, I didn’t say I had high testosterone after 10 days. I said it was relatively higher (double usual numbers), which leads me to believe I’m through the roof after the inject for days and then valleying lower into normal levels.

How can I work on maintaining a better free T level? Where can I go from here? It’s 35$ every time I drop into the office for a shot, and I don’t make much money at all. What do you mean by testing between injections? What day would be best? My E2 is controlled right now. So where do I go from here?

I’m reading, basically, more frequent pinning and blood testing. This could get expensive with the provider I have now. Any alternatives? Set up with an endo and get going on self-administering, perhaps?

This all very wrong. Your doc is an idiot; but most are.

Please read these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

You need this protocol:

  • self inject 50mg T twice a week
  • 0.5 mg anastrozole at time of injections
  • 250iu hCG SC EOD if you want to preserve your testes or fertility

Use #29 0.5ml [50iu] 1/2" insulin syringes for T

  • #31 0.5ml 5/16" for hCG

Your goals are:
high normal or above FT.
TT will be high, ignore that.
E2 near E2=22pgml

Your liver clears E2 and liver problems can lead to elevated E2 and thus SHBG.
The liver makes SHBG

Read the stickies carefully.

Did you have these tested before TRT:

You say that LH was normal. So its primary hypogonadism.
Yes a varicocele can lower T.

Please post all lab work with ranges.