T Nation

New to TRT, Prescribed High Dose to Start, Got Questions


#1

All,
I’m looking to this group for some advice on how best to proceed given my situation and lab results. More information below:

Vitals

  • 26 Year Old Male
  • 5’6", 157 lbs (166 lbs during first set of labs, down from 213 at start of year)
  • Symptoms: General fatigue, poor sleep quality, inability to concentrate, awkward body shape/fat distribution (pear shaped, have had significant gynecomastia since my teens)

First Set of Labs (Drawn 7-30-16 at 10:55AM)

Details here

All results were normal except for Testosterone, Vitamin D, and Vitamin B12

  • Testosterone: 342 ng/dl (Reference Range: 348-1197)
  • LH: 5.9 mIU/ml (Reference Range: 1.7-8.6)
  • FSH: 1.8 mIU/ml (Reference Range: 1.5-12.4)
  • Estradiol: 33.2 pg/ml (Reference Range: 7.6-42.6)
  • Vitamin D: 18.8 ng/ml (Reference Range: 30-100)
  • Vitamin B12: 200 pg/ml (Reference Range: 211-946)

My PCP actually recommended that I start TRT immediately (200mg Test Cyp once a week) but I wanted to hold off while I made some additional lifestyle changes. Namely, I wanted to start a weight training routine (bodyweights) and supplement D and B12 and retest to see if it made a difference.

Second Set of Labs (Drawn 10-27-16 at 11:37AM)

Details here

My B12 and D levels were now well within the normal range, but Testosterone dropped further:

  • Testosterone: 302 ng/dl (Reference Range 348-1197)
  • Free Testosterone: 10.3 pg/ml (Reference Range: 9.3-26.5)
  • LH: 3.2 mIU/ml (Reference Range: 1.7-8.6)
  • FSH: 1.6 mIU/ml (Reference Range: 1.5-12.4)
  • Estradiol: 21.6 pg/ml (Reference Range: 7.6-42.6)
  • Vitamin D: 62.6 ng/ml (Reference Range: 30-100)
  • Vitamin B12: 408 pg/ml (Reference Range: 211-946)

Current State

Based off of these results, I decided to start TRT this week, but split the dose. I took 100mg Monday morning and 100mg Thursday afternoon. I also added 0.5mg Arimidex after taking my Thursday dose. My doctor wanted to re-do labs at 6 weeks and adjust dosage at that time if needed.

My Concerns

  • Test Dosage: I was initially nervous about starting at such a high dose, but my PCP seemed experienced and so I went with it. However, the more I’m reading, the more I’m debating whether I should continue what I did this first week (100mg E3.5D) or drop to a more traditional starting dose (50-70mg E3.5D). Does that make sense? Should I treat this first week as a loading dose?
  • Arimidex Dosage: My PCP initially said 1mg EOD, but that seemed like I lot, so I thought I would start with just 0.5mg/week. However, after additional research, even that seems high. I’m wondering if I should hold off on any AIs until the next set of labs (and make sure to get sensitive E2).

Thanks again for any advice, I would really appreciate it!


#2

200 mg/week is relatively high. Concerns with a higher dose long term is higher DHT levels which mean faster rates of hair loss if predisposed. Increased risk of higher hematocrit levels which increases the risk of strokes and blood clots which can be managed by reducing T levels, donating blood and high doses of fish oil.

It would have been nice to know your e2 starting point. I would probably start with 50 mg E3D and 0.25 mg adex E3D at the same time as injection. I would then get lab word done in 4 weeks to see where my e2 was at. Using simple algebra, you can then determine your new adex dose (if necessary) based on how you feel. Many feel best with their e2 between 20-30 pg/ml.

If you turn out to require very little adex/anastrazole, you’ll need to micro dose by dissolving the adex in vodka and using a dropper to dispense orally.


#3

Hey, thanks for the feedback. As I now understand it, the standard E2 test I got (which said 21.6 pg/ml) is not helpful compared to the sensitive assay, is that right?

Since I already started with 200mg this week (broken up into two shots), are there any risks with me dropping to 50mg E3D? I used steroidcalc.com and it looks like 65-70 mg E3.5D would prevent any sort of drop in serum levels from where I am now.

I haven’t really noticed any changes this first week (took second shot yesterday) except that I’m sleeping less. No big boost in energy or anything like that yet.


#4

You may “feel” something if you’d been on 200 mg/week for a few months, but not after one week. I think you’d be fine to drop it down to 50 mg E3D starting the next injection.

The standard e2 test from my understanding (which is limited) isn’t as sensitive, so if you took the male sensitive array test, it may come back slightly higher.

Some take longer to notice any changes (weeks to months). I personally felt an immediate boost in energy and confidence the day of the shot (placebo perhaps).

Did you also have your CBC, cortisol and thyroid tested (tsh, ft4, ft3 and rt3)? Do you feel cold easily? Can you take your body temps for three days in a row, twice per day? Once right when you wake up, before you eat, drink, talk etc (should be higher than 97.4) And once later in the day (should reach 98.6). If you do not, it could mean thyroid issues. If you also have thyroid issues, it’s going to be a limiting factor for your TRT.


#5

Please read the stickies found here: About the T Replacement Category

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

I think that E2 will go too high with 200mg T and 1.0 anastrozole per week.

Your doc did nothing to find the cause. Low-T is the symptom, not the disease.
With young guys, the need to to see if the problem can be fixed.

Get these tested:
TSH
fT3
fT4 - please not T3, T4
CBC
hematocrit
prolactin
AM cortisol - at 8AM please
AST/ALT
fasting cholesterol - can be too low
fasting glucose

T levels are not static and will vary from time to time.

Energy:
Do you use iodized salt to support thyroid hormone production?
Do you get cold easily?
Outer eyebrows sparse?
If yes to any of the above, use oral body temperatures to evaluate overall thyroid function. If temps are good, you can skip TSH, fT3, fT4 labs.

In the stickies you will find what is needed to avoid infertility. Injecting 250iu hCG SC EOD is the best solution.

If prolactin is elevated, can promote gyno, this can be from a prolactin secreting pituitary adinoma than can typically be easily manages with 0.5 mg/week Dostinex/cabergoline. Need a MRI to eval/confirm. Do not want to ignore as a larger adinoma can press on optic nerves creating a loss of width of peripheral vision or other artifacts. Prolactin reduces LH/FSH and reduces dopamine which is depressing. With young guys, this should always be investigated when LH/FSH are low.


#6

Thanks all. Just a heads up, did get a full CBC panel along with some of the other tests you’re talking about, see here:

Since all of those were normal, my doctor told me that I’m likely primary and that a restart wasn’t feasible, hence TRT. If I continue, is 200mg/week too high a dose in this group’s opinion?


#7

It is a high starting dose but I have seen it before, some guys need that much. It might be better to start at half of that for 4 weeks, take a blood test and see if you need more.

You are young you could try a restart then take blood tests to see if your T levels went up. If so you are not primary. A lifetime of injections when the problem is elsewhere is not good.


#8

Dude, read my prior post.


#9

Thyroid has problems, the ranges are useless.
TSH should be closer to 1.0

Energy:
Do you use iodized salt to support thyroid hormone production?
Do you get cold easily?
Outer eyebrows sparse?
If yes to any of the above, use oral body temperatures to evaluate overall thyroid function.

fT3 is the active part of the body’s temperature control loop. fT3 is good, so if body temps are low, we suspect that rT3 is elevated and blocking fT3. Then we want to know about your stress levels and past stress events. See the thyroid basics sticky and note references to iodine, iodized, stress, adrenals, adrenal fatigue.