T Nation

New to TRT with a Few Questions


#1

Hey guys,

I have been reading the forum for awhile in attempts to educate myself and would really like KSman to help me out. Long story short is that I am 46 y.o. and started on TRT in Feb 2016 secondary to what I now realize were low T symptoms. Mostly low sex drive, lethargy, lack of motivation, lack of muscle mass despite working out, etc...I have experienced a very positive result with the treatment to date. It has definitely improved all of the symptoms listed above.

My initial morning reading was a total T of 129 and my second morning reading a week later was 320. I was given an initial dose of Test of 200 and felt like a new man almost immediately. I am going to a clinic that only does TRT. I have been going one time per week and receiving 160 test each week. Here are my numbers on 3-10-16 one month after starting.

Total test: 822
Free T: 16.5
Hematocrit: 48.8
Hemoglobin: 16.1
Estradiol: 68
SHBG: 42

I was then kept at the same dose and added Anastrozole 1 day after the test injection. I did this for 6 weeks and re-tested. Here are the numbers on 5-5-16.

Total T: 927
Free T: 24.1
Hematocrit: 50.5
Hemoglobin: 17
Estradiol: 41
SHBG: 28

I am still much better than when I started, but don't feel as good as I initially felt. I know that one time per week dosage isn't optimal, but that's all they offer and not sure that I can talk them into just ordering the testosterone and allowing me to do it myself.

Questions:
1. Should I split the AI dosage and take it 2x/week? Would that help bring my E down?

1.Should I possibly ask to decrease the T dosage. The labs were done 7 days after the injection so I'm assuming my T was much higher earlier in the week. Maybe too high and therefore converting too much into E?

2.Haven't talked to my Dr. about HCG. Would this maybe help my E and are there any side effects of the HCG that I should be aware of ?

Thanks for any help!




#2

Please read these links found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
* advice for new guys
* things that damage your hormones
* protocol for injections
* finding a TRT doc

Anastrozole is used to modulate E2. Serum anastrozole levels need to match T levels. Injecting once a week creates high peaks then drops that makes anastrozole dosing quite impossible.

Ask your provider for:
* self injections 80mg twice a week
* .75mg anastrozole at time of injections
* 250iu hCG SC EOD
do labs always half way between injections

Then T levels will be steadier and anastrozole can mange that.

For each 100mg/week T, typically 1mg/week anastrozole is a good starting point. In your case, 1.5mg/week. Both T and anastrozole will rise and drop together twice a week.

Clinic may object, they make money with the injections. Least cost would be a script in-hand.

You can inject T with #29 0.5ml [not 1.0ml] 1/2" insulin syringes. ~$14 at Sams/Walmart house brand Relion [made by BD]. No Rx needed in many jurisdictions. Inject hCG with #31, 5/16", 0.5ml. Avoid 0.3ml syringes, too small to hand for males.

Your labs were probably done after one week and represent your low levels for the week.

Your E2 target should be E2=22 pg/ml

Stickies will address many issues.


#3

There are other issues. We need a lot more info about you. Many things that doctors overlook. T clinics typically are not interested in your overall health. Did they test anything else?


#4

They did blood work to rule out thyroid issues and make sure that my problem was primary hypogonadism. I don't have the initial blood test with me, but I will get it and post as much information as I can. When I post the blood work I will post with health information as well.

Thanks for your help!


#5

You cannot trust thyroid normal ranges.
Have you always used iodized salt and/or vitamins that list iodine?
Do you get cold easily?
Outer eyebrows sparse?

Watch hematocrit, it may be too high and your larger dose of T may be part of that. 100mg/week works well for many guys.


#6

Ok, finally had time to get my initial lab results.

Glucose: 131 range 65-99 (I don't think I had fasted prior to this blood draw)
TSH: 1.40 range .40-4.50
Hematocrit: 48.5 range 38.5-50
Hemoglobin: 15.6 range 13.2-17.1
FSH: 14.0 range 1.6-8.0
LH: 5.0 range 1.5-9.3
Estradiol: 21 range <39
SHBG: 31 range 10-50

I am 46 years old. 5 foot 9 170lbs. I only have one functioning testicle due to an accident when I was 17. Not sure about body fat but probably in the 15-18% range. I have always been active and have exercised off and on most all of my life. (lifting, jogging, general exercise activities). I have also always been very active with kids, working in the yard and around the house. Not one to sit around much. I have no heath problems and haven't even really been to the doctor in probably 15 years. Hardly ever even have a cold. I have always had border line hypertension 135/80 range. Don't take any medication except daily allergy pill and supplements to include B-12, Fish oil and multi-vitamin. I am for the most part very careful about my diet.

I decided to have my test level checked after my wife had mentioned something multiple times about our non-existent sex life. I thought that I was just tired and over worked. I started realizing that it was a rare occasion that I would wake up with an erection and never had a spontaneous erection. I thought this was normal with age. I had become very lethargic and would basically go to work and only do the things I had to do then I would sit down on the couch and fall asleep almost every evening. I tried to exercise but just didn't have the motivation I used to have. When I had my first test I had actually been lifting pretty consistently and was making some strength gains, but not much change in mass.

I have much improved sex drive, consistent morning erections, much higher motivation and just generally feel more like my old self. Work outs are much more consistent and I have been making good gains with both strength and mass. I am not tired all of the time.

I will talk with my Dr. about twice weekly injections and decreasing my dose in hopes that this will help with my E2. I will also address HCG. I am not planning on anymore children. Are there other reasons that I should do the HCG? Never really been a big salt person and no vitamins with iodine. I have always had sparse eyebrows.

Any information would be helpful.


#7

The immediate feel good you got could be a placebo reaction. You probably did feel good simply by getting something going and knowing there would be changes. Even though your T level rises drastically in the 48 hours after injection, it takes 3-6 weeks to feel something. Stay positive, it sounds like you are on the right path!


#8

Sounds like a long term low thyroid function issue so far. Please go to the thyroid basics explained link and post your oral body temperatures as suggested. I guess we need to know if your wife cooks with iodized salt. Note that iodine deficiency can affect whole households.

With one testes, we do expect to see higher FSH/LH in guys who are otherwise normal. But we need to be concerned when FSH is strongly higher than LH. That can be indicating a FSH secreting testicular cancer. Such problems are mostly something that affect young men, but we still need to be watchful. Testicular cancers are not rare. Rarely, there are FSH secreting pituitary adinomas, mostly a younger man's problem. Your testes can be physically examined. And when you go on TRT, with HPTA shutdown, LH and FSH should go to zero. If FSH does not, time to go tumor hunting. Now that you are on TRT, test LH/FSH for this screening and the probably never again.

hCG:
* preserves form and and function of the boy(s), which at your age is not fertility, but sexual self image and some wives/GFs do care.
* supports testicular production of pregnenolone
* some men find that is strongly supports mood


#9

thanks for your input. I was going to post temps this morning, but my thermometer obviously sucks. Going to get new one today and I will post as soon as I have some appropriate readings. I will ask for a more complete blood panel on my next visit to check the LH/FSH to make sure that those levels have fallen as they should.


#10

Ok, I finally got a couple temp readings. My two morning readings just upon waking are 97.7 and 97.6 and my two evening readings on the same days are 98.6 and 98.7. Looks like from the article that those would be in range of normal.


#11

Sorry I missed this, have traveled twice.

Thryoid seems good. Iodine and selenium in vulti-vits too?

Any other progress?
Any action re FSH?

What is your current protocol and how are you feeling?


#12

Yes on the iodine and selenium in the vitamins.

Still on 160 of test cyp once per week. I have been taking 1mg anastrozole 24 hours post injection and for the last 4 weeks I have been taking another .5mg 48 hours post injection.

I just had blood drawn today so I will have more numbers in a week.

I have noticed some achilles tendinitis issues and some muscle cramping, but not sure if this is due to the meds. I don't take any other medication.


#13

You need to inject twice a week to get steadier hormone levels and lab results will then also be more meaningful. You can take anastrozole at time of injections for a simpler routine.


#14

My new numbers are better, but still looks like estradiol needs to be lower.

Total T: 723
Free T: 20.3
Hematocrit: 46.7 (I've given blood twice since last blood work)
Estradiol: 35

I will talk to the doctor about going to twice per week as you suggest. I think that will probably help level out T and E2? I am going to one of the Testosterone Clinics and don't know that they are going to be to keen on me doing my own injections so I might have to find a new doctor. Thank you very much for your input.


#15

To get on target, you would increase anastrozole dose by a factor of 35/22. However, the game may change with more frequent injections as your levels have not been steady.

Review my post of May 17