T Nation

New to TRT, Doc Pushing Pellets


#1

First off I've had anxiety pretty much ever since I can remember but rarely get full on panic attacks. The last one I had I ended up going to the hospital and the doctor referred me to an internal medicine doctor. They did blood work on me and it came back with a few things out of range. My Vitamin B6 was a 49.8 H, my Testosterone was a 217 L, my Cholesterol Total was 229 H, my LDL-Cholesterol was 145 H, my Non HDL Cholesterol was 175 H, my Hemoglobin Alc was 5.8 H and my Vitamin D level was 15 L. I am scheduled for a PSA test.

The doctor put me on 10,000 units of D3 a day for three months and prescribed me 200 MG Testosterone Cypionate injections weekly. She really wanted me on the Testosterone pellets but I decided against them after reading up on both. I was told I needed to change my diet as well. She also said she was going to put me on Clomid. I'm pretty confused about all of this. I try and discuss with my doctor but they seem to have an agenda with pushing the pellets so hard. Any unbiased advice? Thanks.


#2

[quote]Iceman203 wrote:
First off I’ve had anxiety pretty much ever since I can remember but rarely get full on panic attacks. The last one I had I ended up going to the hospital and the doctor referred me to an internal medicine doctor. They did blood work on me and it came back with a few things out of range. My Vitamin B6 was a 49.8 H, my Testosterone was a 217 L, my Cholesterol Total was 229 H, my LDL-Cholesterol was 145 H, my Non HDL Cholesterol was 175 H, my Hemoglobin Alc was 5.8 H and my Vitamin D level was 15 L. I am scheduled for a PSA test.

The doctor put me on 10,000 units of D3 a day for three months and prescribed me 200 MG Testosterone Cypionate injections weekly. She really wanted me on the Testosterone pellets but I decided against them after reading up on both. I was told I needed to change my diet as well. She also said she was going to put me on Clomid. I’m pretty confused about all of this. I try and discuss with my doctor but they seem to have an agenda with pushing the pellets so hard. Any unbiased advice? Thanks.[/quote]

You left a lot of the story out. such as all your stats.

But being on both clomid and TRT makes no sense.


#3

Clomid would prevent testicular shutdown. As always, some guys have nasty side effects and Nolvadex is a better choice. hCG is the best option.

Please read these stickies:

  • advice for new guys — provide more info about you AND note first paragraph
  • things that damage your hormones
  • protocol for injections

You need LH/FSH tested before any form of TRT.
Can’t go forward without more info about you.

TRT may reduce cholesterol
Your A1C means that you are becoming diabetic. That is life threatening and you must make changes.

Suggested protocol: - self injected
50mg T injected twice a week.
0.5 mg anastrozole at time of injection
250iu hCG SC EOD
Do labs 1/2 way between injections - always
Use #29 1/2" 0.5ml syringes for T
Use #31 5/16" 0.5ml syringes for hCG
Get boxes of 100 syringes, ~$14 at Sam’s or Walmart, ReLion house brand.

Labs:
TT
FT
E2
prolactin
LH/FSH
CBC
AST/ALT
TSH
fT3
fT4 [please not T3, T4]
AM cortisol
IGF-1
PSA and DRE [digital rectal exam]

Need labs in list format with lab ranges.


#4

[quote]KSman wrote:
Clomid would prevent testicular shutdown. As always, some guys have nasty side effects and Nolvadex is a better choice. hCG is the best option.

Please read these stickies:

  • advice for new guys — provide more info about you AND note first paragraph
  • things that damage your hormones
  • protocol for injections

You need LH/FSH tested before any form of TRT.
Can’t go forward without more info about you.

TRT may reduce cholesterol
Your A1C means that you are becoming diabetic. That is life threatening and you must make changes.

Suggested protocol: - self injected
50mg T injected twice a week.
0.5 mg anastrozole at time of injection
250iu hCG SC EOD
Do labs 1/2 way between injections - always
Use #29 1/2" 0.5ml syringes for T
Use #31 5/16" 0.5ml syringes for hCG
Get boxes of 100 syringes, ~$14 at Sam’s or Walmart, ReLion house brand.

Labs:
TT
FT
E2
prolactin
LH/FSH
CBC
AST/ALT
TSH
fT3
fT4 [please not T3, T4]
AM cortisol
IGF-1
PSA and DRE [digital rectal exam]

Need labs in list format with lab ranges.

[/quote]

Thanks for the info. Yes she told me my levels were right at pre diabetic. I think pre diabetic is 5.7 and I was a 5.8. She said basically change my diet. I have such a hard time eating healthy because I’m away from home so much. I’ve been trying to pack lunches but its hard to eat cold chicken. Lol. But I need to do it.

She took all my blood work today for the PSA and the other stuff you mentioned. She changed my dose from 200mg a week to every two weeks then she said after six weeks I’d get my blood tested again and she’d probably switch me to 200mg a week. I was always told to take 150mg BioDim a day and then after my levels were checked again she would put me on Clomid, which I’m going to ask about the other two you suggested. I told her I’d rather keep my levels more constant and I didn’t mind twice a week but she insisted I do every two weeks for my first six weeks to see how my body reacts to it.


#5

Your body will react badly to that.

Be sure to study those stickies. Your doctor does not know what she is doing. You need to know these things and you cannot be passive about your health care.

Also read this thread: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hormones_and_health
as it touches on insulin sensitivity.

Insulin sensitivity factors:
metabolic rate
cell wall permeability and essential fatty acids
CoQ10, antioxidants
thyroid function, iodine, selenium
testosterone
favorable E2 levels
GH and IGF-1
Vit-D25 and Vit-D3 supplementation

Still waiting on:
Please read these stickies:

  • advice for new guys — provide more info about you AND note first paragraph
    and
    Where is info about you?
    age
    medications, Rx and OTC
    health concerns
    waist
    weight

Reading the stickies is very important. You cannot be passive about these things or with your medical care.


#6

[quote]KSman wrote:
Your body will react badly to that.

Be sure to study those stickies. Your doctor does not know what she is doing. You need to know these things and you cannot be passive about your health care.

Also read this thread: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hormones_and_health
as it touches on insulin sensitivity.

Insulin sensitivity factors:
metabolic rate
cell wall permeability and essential fatty acids
CoQ10, antioxidants
thyroid function, iodine, selenium
testosterone
favorable E2 levels
GH and IGF-1
Vit-D25 and Vit-D3 supplementation

Still waiting on:
Please read these stickies:

  • advice for new guys — provide more info about you AND note first paragraph
    and
    Where is info about you?
    age
    medications, Rx and OTC
    health concerns
    waist
    weight

Reading the stickies is very important. You cannot be passive about these things or with your medical care.[/quote]

I’m 35, 245 pounds, 6’2, 36" waist. I take no Rx drugs other than the testosterone I was just prescribed. I never take any OTC drugs. I started taking the D3 (10,000 units) and a Men’s vitamin just recently. She prescribed me 6 vials of 1mL test, so at least for the first 6 weeks I can’t really change my dosage. I’m thinking of doing what she says for the first 6 weeks then convey to her my concerns and go from there.


#7

Labs:
TT=217
FT=50.1
E2=19
prolactin=??
LH/FSH=(haven’t received my results yet)
CBC=??? (I have no number next to this but sub-categories below it)
AST/ALT=19/24
TSH=2.76
fT3=3.1
fT4=6.1 (this says T4 total on my lab work)
AM cortisol=??
IGF-1=??
PSA and DRE [digital rectal exam]=(haven’t received my results yet)


#8

Please use [edit] in lower RH corner of your post above and add lab ranges to lab data.

Hematocrit and RBC?

TSH is too high, should be nearer to 1.0
fT3, fT4, T3, T4 should be near midrange or a bit higher.
thyroid lab ranges are bogus

Please check oral body temperatures to eval overall thyroid function:

  • when you first wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon
    Not using iodized salt can cause problems. Needs to be long term.
    Your men’s vitamins probably contain some iodine+selenium, but not enough to get right again.
    If low body temperatures, read the thyroid basics sticky.

#9

Ok I will. I should be getting my other results Thursday or Friday. So when I talk to her I’ll ask for the prescription for the Nolvadex instead of the Clomid. Now as far as the BioDim goes, do I still need to take that?


#10

DIM is a weak aromatase inhibitor [AI] that reduces T–>E2 and thus reduces E2 levels. Nolvadex and Clomid are SERMs that are Selected Estrogen Receptors Modulators that block the effect of estrogens in “selected” tissues.

Many need an AI with TRT and SERM can increase that need.


#11

[quote]KSman wrote:
DIM is a weak aromatase inhibitor [AI] that reduces T–>E2 and thus reduces E2 levels. Nolvadex and Clomid are SERMs that are Selected Estrogen Receptors Modulators that block the effect of estrogens in “selected” tissues.

Many need an AI with TRT and SERM can increase that need.[/quote]

So do I need to take both or would I be ok just taking the T and Nolvadex? Thanks


#12

Until we get LH/FSH, we really don’t know if this is primary or secondary hypogonadism.

TT=217
FT=50.1
E2=19

Your TT is very low. FT may be as well, but you did not provide a lab range. FT ranges vary wildly from one lab company to another.

For your low T, E2=19 is quite high. If you increase T levels, E2 may easily exceed the levels suggested in the stickies.

Your response to Clomid depends on the dose and many doctors over-prescribe. You should be taking around 25mg EOD.
Many guys here have reacted badly to Clomid and Nolvadex is a better choice for that reason. Dosing is similar.
SERMs increase E2 and AI is then often needed.
But if SERM dose is too high, T–>E2 inside the testes can be high and a competitive AI does not work in the testes.

You have not posted body temps and I suspect that you have not studied the stickies. Make an effort please. You cannot be passive about these issues.


#13

[quote]KSman wrote:
Until we get LH/FSH, we really don’t know if this is primary or secondary hypogonadism.

TT=217
FT=50.1
E2=19

Your TT is very low. FT may be as well, but you did not provide a lab range. FT ranges vary wildly from one lab company to another.

For your low T, E2=19 is quite high. If you increase T levels, E2 may easily exceed the levels suggested in the stickies.

Your response to Clomid depends on the dose and many doctors over-prescribe. You should be taking around 25mg EOD.
Many guys here have reacted badly to Clomid and Nolvadex is a better choice for that reason. Dosing is similar.
SERMs increase E2 and AI is then often needed.
But if SERM dose is too high, T–>E2 inside the testes can be high and a competitive AI does not work in the testes.

You have not posted body temps and I suspect that you have not studied the stickies. Make an effort please. You cannot be passive about these issues.[/quote]

Sorry I have been very busy with work. I received my lab test back last Monday finally. It shows my free testosterone was 50.1 and the range was 35.0-155.0 pg/mL. My LH is out of range as well. The range was 1.5-9.3 mIU/mL and mine was 1.1 L. My PSA was in range.

TT=217 (Range 250-1100 ng/dL)
FT=50.1 (Range 35.0-155.0 pg/mL)
Total PSA=0.5 (< or = 4.0 ng/mL
Free PSA=0.2 (ng/mL)
% Free PSA=40 (>25 % calc)
LH= 1.1 L (Range 1.5-9.3 mIU/mL)

I don’t see anything that says FSH.

My temp yesterday morning was 97.0, the afternoon was 97.7, and night was 98.4

I’m going to read the stickies right now. Thanks again.


#14

LH has a short half-life and is released in pulses.
FSH has a longer half-life and is actually a better measure of LH status than LH itself.

You have secondary hypogonadism. Prolactin labs will indicate if prolactin is a factor.

Your body temperatures indicate low thyroid function.
Not using iodized salt can cause problems. Needs to be long term.
Your men’s vitamins probably contain some iodine+selenium, but not enough to get right again.
If low body temperatures, read the thyroid basics sticky.