T Nation

New to TRT

Finally got tested for testosterone levels last week, after a couple years of always being tired, moody, low sex drive, and not sure if a result of low-T, but very low to no gains lifting. Here’s all the stats.

Dr. did go ahead and perscribe me testosterone. She gave me the option of topical vs injections, and I chose injections. Originally wanted to do every 2 weeks, but agreed to weekly. Dropped the script off, but they had to order so I’ll get it tomorrow, so I don’t have the exact details. Pretty sure though it said 200mg/ml, and it will be 1ml per week. Could be wrong though, and will update tomorrow when I pick it up. For now, I’ll be doing the injections at the clinic (doesn’t cost me anything), but will probably opt to do them myself down the road to do them twice weekly.

Going to start shots (probably tomorrow or Friday), and then have my blood drawn in 4 weeks on a Monday. They will be checking TT, FT, and PSA.

Asked her about AI, and this is were it got difficult. She told me none of the books/protocols covered testing E2, and that it would only be a problem if I took a bunch of DHEA. She wouldn’t test for it, and said she’d have to refer me to an endo for that. I didn’t bother asking about hCG after that. I think I’ll go with her through the initial consultation, then switch back to my normal family doctor. I think he’d be more open to testing E2, and discussing AI and hCG. If not, I’ll figure something else out.

-age–32
-height–6’
-waist–wear size 36 pants, but think actual waist is 38 or 39"
-weight–215 lbs
-describe body and facial hair–can grow decent beard, and overall fairly hairy (hair on chest, legs back). facial hair does seem to grow fairly slowly though.
-describe where you carry fat and how changed–fat is mostly around midsection, little in chest/face. very little on rest of body. hasn’t really changed that I’m aware of.

-health conditions, symptoms [history]–Tired a lot, low energy, low sex drive, moody/depression (sometimes fairly severe). Brain seems fuzzy at times.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever–Take advair for mild asthma, otherwise nothing except occasionally ibuprofen or allergy pill.
-lab results with ranges
Testosterone, serum—164 ng/dL—348->1197
Free testosterone (Direct)—6.2 pg/mL—8.7->25.1
TSH-ICMA—1.4 uU/mL

-describe diet [some create substantial damage with starvation diets]–Eat roughly 2,000 cals a day. Not super healthy, but not terrible.
-describe training [some ruin there hormones by over training]–doing 5/3/1 3 days a week. Tried to do cardio a few days a week, but not energy/motivation
-testes ache, ever, with a fever?–sometimes ache, not noticed that its with a fever.
-how have morning wood and nocturnal erections changed–Rarely have either, but do occasionally.

[quote]cj7jeep81 wrote:
Finally got tested for testosterone levels last week, after a couple years of always being tired, moody, low sex drive, and not sure if a result of low-T, but very low to no gains lifting. Here’s all the stats.

Dr. did go ahead and perscribe me testosterone. She gave me the option of topical vs injections, and I chose injections. Originally wanted to do every 2 weeks, but agreed to weekly. Dropped the script off, but they had to order so I’ll get it tomorrow, so I don’t have the exact details. Pretty sure though it said 200mg/ml, and it will be 1ml per week. Could be wrong though, and will update tomorrow when I pick it up. For now, I’ll be doing the injections at the clinic (doesn’t cost me anything), but will probably opt to do them myself down the road to do them twice weekly.

Going to start shots (probably tomorrow or Friday), and then have my blood drawn in 4 weeks on a Monday. They will be checking TT, FT, and PSA.

Asked her about AI, and this is were it got difficult. She told me none of the books/protocols covered testing E2, and that it would only be a problem if I took a bunch of DHEA. She wouldn’t test for it, and said she’d have to refer me to an endo for that. I didn’t bother asking about hCG after that. I think I’ll go with her through the initial consultation, then switch back to my normal family doctor. I think he’d be more open to testing E2, and discussing AI and hCG. If not, I’ll figure something else out.

-age–32
-height–6’
-waist–wear size 36 pants, but think actual waist is 38 or 39"
-weight–215 lbs
-describe body and facial hair–can grow decent beard, and overall fairly hairy (hair on chest, legs back). facial hair does seem to grow fairly slowly though.
-describe where you carry fat and how changed–fat is mostly around midsection, little in chest/face. very little on rest of body. hasn’t really changed that I’m aware of.

-health conditions, symptoms [history]–Tired a lot, low energy, low sex drive, moody/depression (sometimes fairly severe). Brain seems fuzzy at times.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever–Take advair for mild asthma, otherwise nothing except occasionally ibuprofen or allergy pill.
-lab results with ranges
Testosterone, serum—164 ng/dL—348->1197
Free testosterone (Direct)—6.2 pg/mL—8.7->25.1
TSH-ICMA—1.4 uU/mL

-describe diet [some create substantial damage with starvation diets]–Eat roughly 2,000 cals a day. Not super healthy, but not terrible.
-describe training [some ruin there hormones by over training]–doing 5/3/1 3 days a week. Tried to do cardio a few days a week, but not energy/motivation
-testes ache, ever, with a fever?–No
-how have morning wood and nocturnal erections changed–Rarely have either, but do occasionally.
[/quote]

First question I ask clients or Drs I am working on their cases with
“how are you sleeping”
You are young enough correcting other issues will probably resolve your hormone problems.
Correcting sleep patterns resolves a lot of current health issues we are having. It helps the immune system, cortisol levels, neurotramsmitters, and the endocrine system
you need proper evaluations on all areas by a good dr

[quote]Hardasnails wrote:
First question I ask clients or Drs I am working on their cases with
“how are you sleeping”
You are young enough correcting other issues will probably resolve your hormone problems.
Correcting sleep patterns resolves a lot of current health issues we are having. It helps the immune system, cortisol levels, neurotramsmitters, and the endocrine system
you need proper evaluations on all areas by a good dr
[/quote]
Sleep is generally good. Work gets busy sometimes, but typically I’m in bed by 10 or 10:30, and sleep till 6. Generally sleep through the night, but have a 2 year old so am occasionally woken up. I do snore, but not too bad typically, and wife has never heard me stop breathing, making choking noises. So I’m pretty sure I’m good on sleep.

If I am able to see my doctor tomorrow, anything in particular I should ask them?

[quote]cj7jeep81 wrote:

[quote]Hardasnails wrote:
First question I ask clients or Drs I am working on their cases with
“how are you sleeping”
You are young enough correcting other issues will probably resolve your hormone problems.
Correcting sleep patterns resolves a lot of current health issues we are having. It helps the immune system, cortisol levels, neurotramsmitters, and the endocrine system
you need proper evaluations on all areas by a good dr
[/quote]
Sleep is generally good. Work gets busy sometimes, but typically I’m in bed by 10 or 10:30, and sleep till 6. Generally sleep through the night, but have a 2 year old so am occasionally woken up. I do snore, but not too bad typically, and wife has never heard me stop breathing, making choking noises. So I’m pretty sure I’m good on sleep.[/quote]

You sleep, but quality of sleep is shitty. If you get 8 hours of sleep, if quality of sleep sucks then it will result in being tired and having no energy, putting weight on you do to proper insulin production.

How can you tell quality of sleep is shitty? I’ve had much worse sleep years ago, and not had problems (was on a project where for 6 or 7 months I averaged 3-4 hrs a night, every night), and didn’t have the problems I’m having now. Also, as to weight, it has been steady (+/- 10 pounds) for the last 4 or 4 years. 10-15 years ago I probably weighed 180, so not much different since then.

also, would poor sleep/insulin production cause my testosterone to be that low?

[quote]cj7jeep81 wrote:
How can you tell quality of sleep is shitty? I’ve had much worse sleep years ago, and not had problems (was on a project where for 6 or 7 months I averaged 3-4 hrs a night, every night), and didn’t have the problems I’m having now. Also, as to weight, it has been steady (+/- 10 pounds) for the last 4 or 4 years. 10-15 years ago I probably weighed 180, so not much different since then.

also, would poor sleep/insulin production cause my testosterone to be that low?[/quote]

Yes in younger guys I have worked with correcting sleep issues, detoxfication, modfications of lifestyles and nutrition resolved the hormone levels. Again every case is different. It depends on multiple factors. Solution get to reason why and have clinical testing to verify it. I am not a dr but rather a person who educates MD, DO and ND as well as other medical professionals for over 7 years on areas of medicine they may not be familar to help their patients. From doing this I have created a huge net work of medical professionals across the united states and around the world…

Welcome CJ7.
I had to start out kind of the same way you did - on test only. I finally found someone to prescribe the testosterone but wouldn’t do anything else. After 4-5 weeks on injections I felt amazing! But around weeks 7-8 I felt crappy again. - My estrogen was on the rise and eliminating the benefits of injections. - So eventually you will want to get an AI. I still haven’t been able to get HCG yet but want it badly.

LISTEN TO HARDASNAILS!! Try to get to the root cause before you start.
My blood tests confirmed that my testosterone was low and I was deserate to feel better so I started on injections. - I am realizing now that my test levels were affected by other issues (still trying to figure those out) and injecting was just putting a band aid on a deeper problem. I feel crappy again even with the test and AI. - I’m back at square one but also have to deal with the fact that I will eventually need to taper off the testosterone as well as dealing with side effects of injecting. (my balls are aching at the moment)
Again, before you become dependant on the injections, take at least another week and do some more digging.

Good luck man. - you have come to the right place for guidance on this!

Joe

Thanks, I’m hoping I’ll have a better idea of where to go in a few hours. After doing a lot of reading, one thing I realized (that I hadn’t told the doc), was that my balls do ache occasionally (started again last night, and still is today). Its not constant, but it just started in the last 6 months. Sometimes it lasts a few days, sometimes less. No clue if its related, but I’ll mention it to the doc today. Before, I just assumed I’d squished them, or did something like that, but I really don’t think that’s the case.

[quote]cj7jeep81 wrote:
Thanks, I’m hoping I’ll have a better idea of where to go in a few hours. After doing a lot of reading, one thing I realized (that I hadn’t told the doc), was that my balls do ache occasionally (started again last night, and still is today). Its not constant, but it just started in the last 6 months. Sometimes it lasts a few days, sometimes less. No clue if its related, but I’ll mention it to the doc today. Before, I just assumed I’d squished them, or did something like that, but I really don’t think that’s the case.[/quote]

Could be lack of LH which is being suppressed for a REASON…

I know what is from an imbalance from one of the following areas
Neurological
Biological
Environmental
Structural
Lifestyles and nutritional
Psychological
Genetics

I explore each on of these areas in every case with Drs and it has never fail yet !!

Got my bloodwork results, which tested PSA and LH. Left the paper at work, but both were within normal range, and if I recall correctly, PSA was 1.4 or 1.9, and LH was in the middle of the range (I think).

Went to my normal doctor this afternoon, and he did a testicular exam. Not lumps or anything (some cysts on my right which he thinks is from my vasectomy). He did say that the right one was a good bit bigger than my left, and the left is the one that aches. Like I said, it doesn’t ache all the time (but has been today), but when it does its always the left.

here are the exact numbers.
PSA–0.3 ng/mL range 0.0->4.0
LH–4.9 mIU/mL range 1.7->8.6

Just realized something. I know I have been having these symptoms for 18-24 months now (at least the depression part, not sure about all of it). I had my vasectomy just over 2 years ago (June 2010). Any chance this could be related? No clue what my testosterone numbers would have been back then. I do know one symptom (slow growing facial hair), has been there forever, but don’t really remember about the other stuff.

Hi that’s great,it’s probably a 200mg’s at 5c.c. vial.I believe injectable is the only way to administer testosterone.As pill’s are hard on the liver,and gel/cream/pellet’s are garbage.All bodybuilder’s use injectable.plus pill’s.Your dosage is not to little as why develope a tolerance prematurely.We can only assimulate so much of anything.A new person will get really good result’s,as your receptors are open and ready too absorb the needed medication.Also take some extra protein as t works with protein to build muscle tissue,and you will burn extra fat.goodluck johnnyk53

Just an update. The doc put me on weekly injects, taking 1ml per week. Since the bottle is 200mg/ml, that works out to 200mg/week, correct?

I’ve now been on shots for 10 weeks (first shot was 9/14), and have ranged from “Is this doing anything?”, to “Maybe it’s doing something?”. I had a follow-up with the doc last month, and re-did my labs. When they drew my blood, I had had 4 injections. I generally get my injections on Thursday mornings, and the blood draw was on a Monday morning, so right in the middle of it.

On re-test, my PSA was .05 ng/mL, in the range of 0.0->4.0
My total testosterone was 473 ng/mL (range 348->1197), up from 164.
Free testosterone was 16.5 pg/mL (range 8.7->25.1), up from 6.2.

Based on how I’m feeling, I really don’t think this is working, and want to start looking for a new doctor. Right now, scheduled to have my blood drawn again on 12/12, and talk to the doc on 12/19.

If this stuff was working, I should know it by now, shouldn’t I?

When you say youre not feeling good do you mean you notice no difference in the way you feel, or its an up and down thing?
Your numbers have improved enough that I think you would have noticed something.
High E2 could be making you feel crappy still but usually before your E2 gets too high you hit a sweet spot and feel good for at least a week or two.

Are you doing IM injections? Where?

You are correct that youre getting 200mg/wk. - From the stickies on here, thats high. I started at that dose and felt awful. 100mg/wk is suggested.

Two things you need to do:

  1. Inject more frequently than once a week. -Ideal is 100mg/week (.13 ml - 3 times per week or something similar.)

  2. Get your E2 tested. - That will tell you if youre E2 has gone up with the testosterone levels.

Actually- now that I think about it, your T levels have not gone up to the point that your E2 would be skyrocketing.

And for 200mg/wk your numbers are very low. - (I started at 193TT and did 200mg for a month. When I got my labs at 5 weeks my TT was 1160 range.)

Your levels should be quite a bit higher for that dose.
I guess its possible that your body is not responding to it for some reason or just responding slowly.

Someone else will hopefully give some input.

As for feeling, I have not noticed any increase in energy. Still completely worn out at the end of the day, and never have much energy during the day.

Change in depression is about the only thing I’ve noticed. Its not gone, but on some days it seems to be better. Never good, but just seems liek sometimes the edge is taken off.

Yeah, I take it IM in the hip/top of the glutes area. Doc was pretty adament about not testing E2 when I first talked to her. If things don’t change, I’m going to ask for a referral to another doc in December when I check back in with her.

Get E2 tested from privatemdlabs or LEF.org, I can almost guarantee it is a problem. Once you get those results you can start an AI to get E2 in check if it is an issue. You really need to test your thyroid and adrenals as poor thyroid and adrenal function can make you feel like shit. Without getting them sorted out all the testosterone in the world won’t get you feeling better. Check the stickies for the recommended labwork.

What you really want to know is the functional state of the thyroid system, which includes the balance of rT3 and fT3. If body temperatures are low, you probably have a functional state of hypothyroidism. So check temperatures first, cheap fast and informative.