New to TRT; Need Input on Lab Results and Plan

az_jb 2016-05-27 18:52:24 UTC #1

I've been a long time member of several other forums but noticed how polite and willing members here are to give advice and discuss TRT with people that are new to it (i.e. ME).

Quick background on me..

34 years old; 6'3; 205;

I've been feeling much more sluggish and have had little to no libido over the past several months, amongst other symptoms. I am currently living with my fiance and she wants intimacy all the time and I don't even care about it anymore. I know this is not normal. I went to my PCP to discuss and he put me on Bupropion XL in hopes that improving my mood would in turn make me more active in the bedroom. Well, this so far has not worked. Also, he had me get a blood test for Prolactin and TSH Rfx on Abnormal to Free T4. Those results were

F Prolactin: 7.4 Normal: 4.0-15.2 (ng/mL)
F TSH: 1.390 Normal: 0.450-4.500 (uIU/mL)

Those values seemed fine and since he wasn't interested in trying every avenue possible, I decided to seek a consultation with an NP with specializes in HRT/TRT that had great reviews online. She has been awesome and very encouraging. She had me get lab work done that was much more comprehensive. I've put below the results that are pertinent to this thread:

Dehydroepiandrosterone sulfate: 384.9 Normal: 65.0 - 334.0 ug/dL
Estradiol: 36.9 Normal: 0.0 - 39.8 pg / mL
Progesterone: .72 ng / mL
Testosterone: 479 Normal: 241 - 827 ng / dL
Testosterone.free: 8.49 Normal: 5.00 - 21.00 ng / dL
TSH: 1.979 Normal: 0.350 - 5.500 uIU/mL

There are also results but I am not sure they matter; however please ask if there is something I missed.

I wanted to get input from you guys on the results. I have my follow-up on Wednesday and she feels that I need to get my T level up between 800-1200 where it would be optimum. I read on here how "NORMAL" range is rarely what is truly normal because everyone is different.

The NP told me she perfers to use Test C for getting the levels back up. She prescribes 10 weeks worth for me to do at home (I hate needles so this should be interesting). She also said she will put me on hCG after three months to help balance and keep my natrual T production.

I guess I am looking for some input on how this sounds, and also if I should be taking anything else while on Test C to counter any possible side effects?

Thanks for your time guys and I look forward to hearing from you all.

Nashtide 2016-05-27 23:07:18 UTC #2

Seems like a broken record. But you don't mention an AI. Your E2 is already too high and will get much higher with T cyp injections.

az_jb 2016-05-27 23:55:23 UTC #3

Not sure what you mean by broken record. Also, I'm just repeating what the NP told me. I'm not currently taking any hormone supps. Only supps I take right now are fish oil, pre workout, and a thermogenic.

The_Myth 2016-05-28 10:37:12 UTC #4

Broken record on this and other forums, not your post. Often TRT recipients don't need an Aromatase Inhibitor because the Testosterone is not above normal so it doesn't aromatize (convert) to too much estrogen.

However, your Estrogen is high (within range, but too high). The general consensus is that you want to have your Estrogen level about 22. Yours is 37. If you add more exogenous (injected) Testosterone, that's going to go up significantly, and you will feel worse.

High Estrogen levels affect libido, and in fact, that may be your issue. Adding Testosterone without an AI probably won't help, and could make things worse. In fact, you should probably explore a way to boost your natural Testosterone before starting TRT, which is for life. Fertility is also an issue (you mention the fiance') with TRT. HCG will help, but is no guarantee.

I'm sure you'll have others chime in - just listen. Try reading most of the stickies, they will help you to avoid repetition in the thread.

Nashtide 2016-05-28 12:22:51 UTC #5

I apologize for the broken record comment. I was in a hurry and shouldn't have posted. I'm just amazed and tired of docs ignoring estrogens.

gonadthebarbarian 2016-05-28 13:29:36 UTC #6

They should also be testing your LH / FSH to determine if you are primary or secondary. If you are secondary, therapy via SERMs should be available to you. T + HCG is also an option if you are secondary and want the fine-grain control that injections can provide.

You should definitely control E2. You are in the range where only controlling E2 could possibly boost your T up to better levels.

equalo212 2016-05-28 13:57:31 UTC #7

Don't do TRT right now, try 0.5mg/week anastrozole and get the e2 down to about 25. This will increase your T and reduce e2. Then based on those results and symptoms you can decide what you want to pursue. FT is low so shbg is suspected to be high, which is consistent with highish e2. More T will be freed up when you lower e2 as TT will go up and shbg will go down. How well this change sticks to be soon, If LH is required to be higher than otherwise it would be without support, then change is unlikely to stick.

If you feel you want to skip all this and want to go straight to TRT, you need anastrozole and hCG from the start to not make matters worse in terms of fertility and potential recovery if you want to get off plus for the other hormones that the testes produce. See the thread TRT protocol for injections for more information.

az_jb 2016-05-28 17:04:01 UTC #8

Also, I forgot to ask.. Is having such an elevated DHEA-S level something to be concerned about? What is it indicative of? I've tried locating this answer but can't find anything.

az_jb 2016-05-28 18:12:29 UTC #9

The Myth - Thanks for the info. I noticed that number on the high end as well but, being so new to this, I wasn't sure if it was bad since it was still "normal." I used to Prohormone cycles years back when when they legal and new. My last cycle was 4-5 years ago. I also did a proper PCT with Tamox or Torem and from blood results I received back then, I was ok. It sounds like maybe I screwed up somewhere along the lines though and created my current problem. I'll keep reading through the stickies as well. Thanks again.

Nashtide - No worries! I was just confused with your comment and didn't know what it meant

Gonadthebarbarian - Lol, great handle! I will make sure to ask her about the LH/FSH and see what she says. It's only about $25 so I might just go get the test anyways to see what it says.

Equalo212 - Good info, and thank you. I will also ask her about getting an Rx for Arimidex. If she suggests going on Test C anyways and possibly without Arimidex, what should I do at home to counteract the effects of rising estrogen while on the Test C? And what is your opinion of the other AIs on the market, both OTC and Rx? And just for clarification, your suggestion is to stick with an AI and not a SERM?

Thanks again for all of the responses guys. I appreciate it and want to be as well informed as possible given it's my own health and well-being.

equalo212 2016-05-28 19:24:54 UTC #10

If not going on TRT immediately, then anastrozole only at 0.5mg/week. If going on TRT, T+hCG+AI is the suggested protocol. You now know the reasons for all three to have a successful TRT protocol. OTC AI's SERMs don't work. You need to test LH/FSH to understand the cause of problems. If low, SERM+AI is an option but many do not feel as well on SERM so the choice is yours. Perhaps as a restart, it's a very good option, as long term TRT, I do not personally think so.

gonadthebarbarian 2016-05-28 19:25:28 UTC #11

I would definitely enquire about an AI. Your E2 will only go up.

The OTC AI seem to be ineffective and overpriced. When you get your prescription you can get the AI cheaper than an OTC AI from alldaychemist.

AIs have been proven to boost T in studies. Your T isn't terribly low, so a 150-200 boost would put you in a good spot. IMHO, trying AI only would be a worthy endeavor and would keep your therapy simple.

Remember, E2 shuts the pituitary off from producting LH / FSH which tells your testicles to produce T. T then gets converted to E2, completing the cycle. Lowering your E2 can turn the pituitary back on, boosting your T.

equalo212 2016-05-28 19:29:06 UTC #12

I agree with everything except the T not being too low. Yes, TT seems to be decent and not too low, but fT is very low for age. That's the T that matters, i had 750 TT after clomid., but 9 as fT. I feel like shit.

gonadthebarbarian 2016-05-28 19:43:24 UTC #13

Agreed, and lowering E2 should also low SHGB, boosting free T from a pretty decent T base.

equalo212 2016-05-28 19:52:06 UTC #14

SHBG inflates TT rather than eat it up, i've seen it for myself. You lower SHBG, TT goes down. This is provided LH/FSH are unchanged. Increase in LH will provide a T boost that makes it look otherwise. Seeing more cases here similar to mine, TT increasing on clomid but SHBG going off the charts with FT marginally better or same than before clomid. This happens more when LH/FSH are already high or normal on baseline though. Increasing estrogen load while not seeing an even increase in T produced by Testes can do that. So one needs to be sure they're secondary prior to using clomid or nolva, although Nolvadex does not have same estrogenic properties as clomid.

"Although a testosterone determination is the threshold test in the evaluation of suspected male hypogonadism, the total testosterone concentration may be within the normal range in men with primary testicular disorders such as Klinefelter’ s syndrome. Low production of testosterone and increased estradiol stimulate production of SHBG by the liver. The increased level of SHBG results in higher circulating total testosterone than would otherwise be present with low circulating free testosterone."- Extract from American Association of clinical Endocrinologists paper on hypogonadism. So applying this to clomid, when Testes are unable to produce enough T despite good LH/FSH, adding estrogenic clomid+ e2 increase from it can make SHBG soar and TT will be inflated and not give a good representation. Within two weeks of TRT, my SHBG has dropped from highest of 67.54 to 47 with only 100mg a week T suggesting problem is due to T:E balance.

scorpioviii 2016-05-30 22:02:37 UTC #15

Hi I'm New to the forum. I see from reading around here that you have a lot of knowledge as far as reading blood results and great advice. Can you please look at my post and blood results and help me figure out what I should do.

az_jb 2016-05-31 18:05:26 UTC #16

Just got blood drawn for FS/LSH. I will report back when I get the results. I have my appt tomorrow for follow-up as well. Thanks again for the all the information guys. I will update the thread as soon as I have more info.

az_jb 2016-06-01 04:35:52 UTC #17

Just got the results.

LH: 5.0 mIU/m
FSH: 6.6 mIU/m

I keep editing this because I keep reading different information regarding where my values fall (high or low) within the various "normal ranges". I'll just wait and see what you guys think.

gonadthebarbarian 2016-06-01 17:16:38 UTC #18

I'd say that's mid-range.

I'd go for an AI if it's available to you. It looks like your testicles are performing in line with the signaling from your HPTA. Get E2 under control and it should boost your T.

az_jb 2016-06-02 17:38:39 UTC #19

Appointment went well. She believes the ideal range for T should be 800-1100 and my free T is too low as well. She also agreed my estrogen levels were way too high, and said I should be around 22-25 if possible. My vitamin D was also very low.

I started the following regiment:
1ml Test C, once a week (200mg)
1mg Amirtrex once a week
and 50,000iu Vitamin D3 supplement twice a week.

Had my fiance do my first injection this morning.. I seriously hate needles lol. Injection site is still sore, but from what I understand, that is normal.

Thanks again for all the advice. I will be getting follow-up bloodwork done in about 8 weeks. Here's to hoping for some results!

gonadthebarbarian 2016-06-02 17:43:09 UTC #20

Suggest half dose, done twice a week for T. Same for arimidex. The half lives are too short for once a week dosing, you will have peaks and valleys.

If you care about fertility, you should also be on HCG.