T Nation

New to TRT - Looking to Get My Life Normalized


#1

Hey folks. I’m a 29 year old guy who tries to live a very active lifestyle. Seeing as I visit this website often you should assume I try to optimize my training and lifestyle to get as close to 100% as I can.

Unfortunately I’ve been fighting many low-t symptoms for 2 years and have had no luck getting doctor intervention until this week.

I’ve had blood work taken 6x in 18months and seen 4 Endos while asking my regular doctors for help with the sexual side effects I had been experiencing.

Personal Stats:

-Height: 5’7"
-Weight: 190lbs
-BF: 16% (checked with OMROM bio impedance- I know this is off…Probably closer to 18%)
-Waist:34" (I was heavily into powerlifting for a few years and I ended up with a fairly thick trunk) I don’t carry much fat in my midsection
-I carry most of my fat all over. not a lot of definition in my muscles and only my top 4 abdominals are visible

-I don’t drink alcohol, or smoke. I haven’t taken any hard drugs or experimented with PEDs aside from creatine and fish oil, etc

  • I get ~8h of sleep per night and although I’m in the military I have a fairly stress free life and try to reduce stress wherever possible.

RX:

Flonase and Reactine

OTC

Morning:Caffeine 200mg in the AM
5000IU Vit D
2g Omage 3
1g spirulina/chlorella
100mg CoQ10
Afternoon: 5g Creatine
Evening: 3mg Melatonin
25mg Benadryl
ZMA- Regular Dose +33mg 5-HTP
200mg CoQ10

I also take a greens supplement a couple times/day.

Diet:

Breakfast: 7 free range eggs + 2 slices of Ezekiel bread
Snack: 8g PeptoPro +30g Protein Isolate
Lunch: 150g Grass Fed Sirloin (Ground by my butcher) browned in cast iron with a quality coconut oil.
150g Rice (Cooked in cast iron, using bone broth as the base) From there I add tumeric, black pepper, and garlic.
200g Frozen sprinach and broccoli- Added to the beef.
Snack: 8g PeptoPro +30g Protein Isolate
Dinner: Same as lunch

~3000 Calories (I try to keep it around 40%Protein, 40% Carbs, 20% Fat.)
I eat this exactly the same every MON-FRI (Weekends I’ll still eat very healthy but my girlfriend doesn’t eat as restrictively and we don’t live together during the week)

Training:

I ruptured a L5-S1 disk in 2014 so I keep the weight lower and try to minimize re-injury.
3x/wk I do the following:
Leg extension/Leg curl: Low weight-High reps with BFR (loodflow restriction) 100 reps total/exercise
1 Squat movement (sets of 3 increasing weight to my known 5rm weight, then I’ll test varying sets/reps for a total of 24-30 working reps)
Chin-Ups: 40 total reps- varying rep schemes
Overhead Press: Same scheme as Squat movement
Reverse Lunge: 50 reps/ leg total- varying rep schemes depending on how burnt out my legs are from squats.
Loaded Carry: Usually 1 am farmers carry, or trap bar carry: Either for weight or time. I try to vary it as a challenge each training session
Torso: Hanging leg raises, palloff presses, RKC planks- I’ll do as many as possible until mechanical breakdown.

I have a puppy at home so I typically walk 10-12km/day for low intensity cardio- on my off days I’ll wear a weight vest (usually either 20, or 45lb depending how my spine feels.

Labs:

Prolactin: 7ug/l\L reference: 3-13 ug/L
LH: 2.3 IU/L reference: 1.0-9.0 IU/L
FSH: 1.1 IU/L reference:1.0-19.0 IU/L
Total Test: 7.5 nmol/L reference: 6.1-27 nmol/L
Free Test Calc: 186 pmol/L reference: 110-660 pmol/L
Bio-Avail Test: 4.4 nmol/L reference: 2.8-15.5nmol/L
SHBG: 20 nmol/L reference: 13-89 nmol/L
E2:** Will Request labs 22 Feb 16 at my next doctors apt. (Last time this was checked was 17 Aug 14 and it was 77pmol/L Range: <150)
B12: 331 pmol/L reference: 133-675 pmol/L
IGF-1: 125 ug/L range: 182-481 ug/L
25OH Vit D: 75 nmol/L range: 75-250 nmol/L

Hematocrit:0.43 (0.40-0.50)L/L
WBC: 6.5 (4.0-11.0) 10^9/L
RBC: 5.17 (4.50-6.50)10^12/L
HGB: 150 (150-180)g/L
HCT: 0.440 (0.420-0.540)L/L
MCV: 85.1 (80.0-100.0)fL
MCH: 29.0 (27.0-32.0)pg
MCHC:341 (320-360)g/L
RDW:13.0 (11.5-14.4%)
PLT: 293 (150-400)10^9/L
MPV: 10.2 (7.0-10) f:
Neutrophils: 3.6

AST:29 U/L Range: 15-45 *Labs done 9 Sept 2015 (Last time this was checked)
ALT: 30 U/L Range: 20-70 *Labs done 9 Sept 2015 (Last time this was checked)
PTH: 2.5 (1.6-9.3) pmol/L *Labs done 9 Sept 2015 (Last time this was checked)
TSH : 1.49 (0.35-4.94) *Labs done 9 Sept 2015 (Last time this was checked)

fT3: I have had thyroid hormone labs taken but don’t have copies at home- WIll request copies
fT4:

Cholesterol: 5.64 mmol/L (Last time this was checked was 17 Aug 14) My diet was always fairly good but since these labs I have been extremely strict with diet.
Ratio : 3.8
HDL: 1.49 mmol/L
LDL: 3.59 mmol/L
Non-HDL CHolesterol: 4.15mmol/L

Out of the 6 tests my Bio-Avail Test has never been higher than 4.4

I was prescribed this week Androgel 5g/day and will be going in next month to learn how to inject Test E.

I’m really excited to finally get some help with the low energy, low libido, depression, brain fog I have been fighting for a very long time.

I spoke to my doctor about HCG and this month she told me not to consider it an option as I am not planning on getting my partner pregnant.

Should I be looking into an anti-estrogen? I don’t see myself going over 100mg/week for at least a few months to see where my test levels get to.

I know there is a wealth of knowledge on this forum and look forward to learning a lot along the way.


Research to Justify Coverage of HCG
#2

Without hCG your testes could get very small and your scrotum pulled up tight like a prepubescent boy. Probably not the sexual self identify that you want and your partner may have some value concerns too.

At age 29, becoming sterile by not using hCG should not be an option.
Your doc probably does not understand low dose hCG and is thinking of high dose for infertility.

You have secondary hypogonadism.
Prolactin is not the cause.
E2 can do this, level not known.

Labs, you have some now:
TT
FT
E2 - assuming low because SHBG is lower
LH/FSH
prolactin
CBC with hematocrit
AST/ALT
total cholesterol
IGF-1 is low for your age
TSH
fT3
fT4

Please follow these links in the 2nd post of the first forum topic:

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics explained — post your oral body temperatures
  • finding a TRT doc

At your age, it would be good to find correctable causes of your low T.
Thyroid function can be a major factor.

You should inject 50mg T twice a week.
You may need 0.5mg anastrozole at time of injection
250iu hCG SC EOD will support your testes, organ failure is not an option
You can inject T SC or IM with #29 0.5ml 1/2" insulin syringes.
You can inject hCG with same or #31 5/16" syringes.
Get scripts for syringes as needed if scripts required where you are.


#3

Thank you very much for your reply. I definitely look forward to going further through the stickies you created KSman, you seem to have a wealth of knowledge.

I edited my initial post to include all of the additional labs you said I should be looking at. I haven’t had all the same tests done at the same time which I know won’t help much, but I put dates beside any of the older ones as to maybe help with the bigger picture.

Should I outline my diet, exercise, lifestyle details as well?


#4

Benadryl has a short half life. While it can help you sleep, it may wake you up as it wears off.
Also consider time release 5-6mg melatonin as fast acting wears off and its drop is the mechanism of waking up.

You are GH deficient. [IGF-1]

HGB is low, but you also have thin blood because of low T.
TRT will resolve this.

E2 target while on TRT with high normal T levels or better is 80pmol/L. As you are there now, TRT will most likely take you to E2 levels that are above optimal. With low T, you are currently estrogen dominant.

Note: - thyroid basics explained — post your oral body temperatures


#5

I haven’t been able yet to get my hands on my previous thyroid labs. My body typically runs slightly on the warmer side. I believe a consequence of cryo-therapy I do a few times a week. Upon waking my temps are ~98F and will fluctuate up to around 100F but rarely over.

As a means to boost my hormone levels naturally after my spine injury in 2014 I experimented with cold-therapy and heat-shock therapy to induce increased IGF-1 and Test production. Never saw any increases close to the clinical studies unfortunately.

I also went in today to get bloodwork done (Since E2 wasn’t checked prior to starting Androgel (13 days ago). I had E2, Free Test, Total Test, and Bio-avail drawn. I should have results within a week.

I’ve also gotten another appt with my Endo coming up to discuss concerns with testicle shutdown (E2 check today may show higher E2 than my 2014 labs) My hope is to introduce Arimidex and HCG according to above protocol with arimidex to bring E2 into optimum range. Endo is already on-board with self-injections of 100mg/week to start and has a script waiting for me at her office for 4 Mar 2016 appt.

My biggest issue now is getting my Endo to write a letter to my health plan to state “a genuine medical requirement” so that it can be covered. Although I suffer the symtoms, being within range was enough to deny coverage based on my age.

Seeing how expensive meds can get I have found a couple of compounding pharmacies in Ottawa which will work with me (especially on reducing cost of HCG).

All said within 13 days I have noticed a significant increase in mood and am pleased to have my first solid member in nearly 2 years. Although I have noticed already testicle issues you mentioned above and sensitive nipples which will be dealt with ASAP!

Will keep things posted as new info arises.


#6

@KSman, I had my labs and picked them up today for my 13day update into taking Androgel.


Labs

E2 153. Ref: 40-160 pmol/L (Up from 77pmol/L since it was checked in 2014)
TT 10.7 Ref:6.1-27.1 nmol/L (Up from 7.5nmol/L on 5Feb16)
Free T: 267 Ref: 110-660 pmol/L (Up from 186 pmol/L)
Bio-Avail: 6.3 Ref: 2.8-15nmol/L (Up from 4.4nmol/L)
SBGH 21 ref: 13-89nmol/L (Up from 20nmol/L

I’m concerned that my E2 may have doubled in 13 days so I moved by endo appointment from 4 March to Tuesday (1 March).

Since my last post I’ve noticed steep decline in my mood and energy (~3-4 days) prompting me to move up my endo appt.


#7

Transdermal T has highest potential for T–>E2.

FT while on transdermals changes vastly with time and lab results are mostly determined by lab timing.

TT is rather poor and not a good result.

Bio gets jacked around FT

E2 should be nearer to 80pmol/L for good results. 153 is raining on your parade.

Some simply do not absorb transdermals very well. If you increase T dose, E2 will increase too.


#8

Thankfully after tuesday I’ll be switching to injections and will discuss adding arimidex and hcg.

As well thank you for your replies. I have learned a lot from your stickies and previous posts.


#9

I had my appt with the ENDO.

Discussed HCG to prevent testicular failure, and Arimidex since my E2 levels were spiking and how they relate to my bloodwork. She wasn’t comfortable with the meds having never prescribed them. (red flag for me) I asked to be refered to an endo with more experience (my 5th in 3 years). Next doctor will be a urologist who specializes in hrt apparently.

The doctor also called me a week or so ago saying I could switch to injections due to cost and the inconvenience of angrogel. Today she refused to provide me with the script.

I have 5 more days left of androgel before I run out without replacement.

I’m going to call my regular doctors to discuss this as it’s unacceptable. I already feel worse than when I began TRT 3 weeks ago and this is insult to injury.

My job is to be physically and mentally fit. I’m not nearly feeling 100% and the system sure doesn’t seem too inclined to help.

@KSman, have you heard of roloxiphene before? My best friend is in the process of becoming as doctor and we were discussing TRT and he told me to absolutely steer away from arimidex and choose a serm. notably roloxiphene as it doesn’t contribute to bone density issues and the risk of fracture. All the studies I could dig up on brittle bones on arimidex related to menopausal women who weren’t resistance trained (i assume had awful bone density to begin with and throwing super low estrogen levels only made things worse)

thoughts?


#10

Finally had the meeting with my new endo today. specialist in andrology and fertility.

he was very receptive to my concerns and was eager to try a conservative approach at first.

He wants me to start 25mg/day clomid to see if my symptoms of secondary hypo improve.

I wanted to jump right onto the protocol that KSman suggests but I’ll start slow with this doctor.

For what it’s worth after my frustration in march I took matters into my own hands and begun self administering the 100mg/wk test, 1mg/wk adex, 500iu/week hcg. I’ve never felt better but couldn’t talk to the doctor about this just yet.

Any suggestions how to incorporate the clomid into the protocol to keep myself asymptomatic. if need be i can cease all meds except for clomid for the time being.


#11

So I’ve had new bloodwork done after being on Clomid monotherapy at 25mg ED for two months.

Between my self administered trt protocol I gave my body time to allow blood levels of test to drop before commending clomid. Here is where I’m at as of last Tuesday:

LH 3.0 (1.0 - 9.0 iu/L)
FSH 1.6 (1.0-19 iu/L)
E2 113 (40-160 pmol/L)
TT 15.7 (6.1-27.1 nmol/L)
FT 437 (110-660 pmol/L)
Bio Avail 10.2 (2.8-15.5 nmol/L)
SBHG 18 (13-89 nmol/L)

So previous to commencing Clomid monotherapy I was experiencing an improvement to my symptoms. Unfortunately I have experienced multiple side effects from the clomid and will be asking for alternative treatment at my upcoming endo apt on the 15th of August. I suspect my E2 is to blame for me emotional issues, but completely natural I was aromatizing to 80 pmol/L so it’s only increased 30pmol/L with the increase to FT and TT.

Thoughts?


#12

Your friend’s and your view point is misinformed and simplistic.

Anastrozole reduces T–>E2 production. The dosing is used to modulate E2 to an optimal value, close to what a young virile lean male would have. The published side effects are for female cancer patients where dosing attempt E2–>zero and the effects are not from the drug directly, but from very low E2. So none of that applies. Also note that those female cancer patients also have extremely low T levels. Men on TRT have their bones protected by T that maintains the collagen matrix of the bones; compare that to a low T catabolic state. Women on drugs that ‘strengthen bone’ do not have normal bones, a bone scan can indicate stable or increasing mineralization, but the bone becomes brittle.

SERMs do not decrease E2, typically SERMs increase E2 levels - in selected, not all, tissues. SERMs can lead to very high E2 levels if the dose is too high, for the individual, and anastrozole cannot manage that intratesticular T–>E2 production. So use of a SERM can lead to high E2 levels and the brain can have E2 side effects.

You have to be able to read though the context of published drug effects and ‘see’ what applies in a TRT context and what does not. Anastrozole’s role in TRT is E2 modulation and optimization, not elimination.

Your doctor-to-be may be on his way to becoming another idiot doctor with shallow knowledge and understanding lacking critical thought. What would happen if doctors build airplanes?

<end of rant :wink: >


#13

Agreed on all of your points. Thank you for sharing. For what it’s worth I do not trust my friend’s opinion on matters to do with my medical health.

Seeing as I have had emotional issues with clomid and my bloodwork although an improvement isn’t where I would feel optimum.

Do you think I should ask for alternative treatment or increase dose of clomid with corresponding introduction of arimidex to lower E2 production. Would lower overall E2 reduce the mental aspects of the Clomid or look into SERMS that don’t act estrogenically on the pituitary?

Unfortunately due to the nature of my job I won’t be able to go on injectable test unless I do it under radar which I would rather avoid (although I experienced excellent results with my self-administered trt this past winter)


#14

Your mood problems could be from high E2 or that plus direct effects of clomid. Some simply feel horrible on clomid. For those affected, they would feel that rapidly, not after E2 gets high. Nolvadex does not have that problem.

As LH and FSH were not high, its not easy attributing elevated E2 to effects of high LH. So elevated E2 might not be from the SERM. Your T levels look good relative to LH/FSH. So testes are responsive.

Your E2 is high, relative to FT/Bio-T, suggesting impaired clearance by the liver or something you are taking is interfering with this.


#15

Thank you for your continual responses KSman, it is appreciated!

Seeing my levels of LH and FSH have only slightly increased at 2months of 25mg Clomid ED but I was told to expect a much higher levels of both from the medication (I am not complaining as I’d rather a long-term approach without leydig cell desensitization.) But I am surprised by LH and FSH are around normal physiological range while on a SERM.

I was worried and aware before starting clomid that my mood may be affected, but I had no idea to the severity. Emotional distress, and depressive episodes which never occurred prior to clomid use. It’s been a rough couple of months and difficult to keep my mental health in check for the first time in my life.

Depression from low t is one thing and this has been an entirely different beast.


#16

Things are starting to look up. After that awful experience with clomid monotherapy my andrologist this morning agreed to put me on testosterone. He wants 200mg every 2 weeks which I argued against and won’t be following since he wasn’t willing to prescribe an AI. I’ll keep with my 50mg 2x per week injections since it has been working.

As well this afternoon I met with my new endo who agreed to prescribe hcg at 500iu/week.

Thankfully I still have an AI on hand and am really looking forward to my bloodwork in 12 weeks.