Newbie 57 Y/O Starting Test C Need Advice on TX and Protocol

In my medical practice we test for that mutation during initial patient screening. It’s super common. Basically think of it as insurance. You could also use SAMe. Just a place to start :slight_smile:

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Here are my test results after 3 weeks of taking Test C 50, the tapered to Test C 40 for the past 3 weeks. I was getting hand swelling and ankle fluid build up, as well as sore nipples. Testicles are now smaller after another 3 weeks of treatment after these tests were done.

(I started anastrozole .25 twice / week on the same day as my Test C injections after these labs were drawn - My hand and ankle swelling is better and I had one day of high libido, but now waned. Maybe I don’t need it since my E2 is 25 without it?)
Fasting:
Cholesterol 210 ( < 200 )
Trig 146 ( <150)
HDL 38 ( >40 )
LDL 143 ( <143)

BUN 19 (6-20)
Creatinine 1.44 High ( .67-1.30 )
GFR Afr Am 62 ml/min/1.73m2
GFR non Afr Am 54 ml/min/1.73m2 mildly to mod decreased

high creatine workup below ( 24 hr creatinine clearance being done today )

CH50 (complement activity-low with auto immune ds) 76 (60-144)
Urine microalbumine <12 (? zero )
urine creatine 59.7 mg/dl
urine Microalb/Creat unable to calculate ( 0-30 mg/gm )

sodium 142 (136-145)
Potassium 4.0 (3.5-5.0)
chloride 99 (98-107)
T CO2 30
Anion gap 13 (7-16)
Calcium 9.4 ( 8.6-10.2)
Glucose 95 afternoon, not fasting (74-100)
HGB 16.4 (13.5-17.1
Hct 48.3 ( 38-51.6)
Platlets 184 ( 144-423 )

Tot protein 7.1 ( 6.4-8.3 )
Albumin 4.6 ( 3.5-5.2)
Bili Direct ,0.2 ( 0-0.3)
Bili Total 0.8 ( 0.1-1.4)
AST 19 (< 40 IU/L)
ALT 20 ( <41 IU/L)
Alk Phos 50 (40-129)

Hormones:

LH 2.10 mIU/ml (males 1.7-8.6)
FSH 1.46 (1.5-12.4 -males)
Estradiol level 25 pg/ML
Prolactin level 6.86 (4.04-15.2 ng/ml)

TSH Reflex 1.420 (0.270-4.200 mcIU/ml)
Vit D OH 28.0 (30-120.0 ng/ml )

Any thoughts on my Test , E2, Vit D levels?

Continue Test C at 40 twice a week ?
Should I ctn anastrozole .25 twice / week (I started after these labs were drawn)
Should I start HCG?

Thanks.

Hey Guys, Sorry I forgot to include the most important results- My TT and FT levels! No wonder no one responded !
If possible can someone please look at the above results and add these below and hopefully give me some advice? I am wavering about quitting the T injections and starting clomid or sermorelin?

Thanks.

Testosterone Lvl 495 ng/dL 300 - 890 ng/dL
Free T Calc 89 pg/mL 47 - 244 pg/m
Estradiol Lvl 25 pg/mL

.Prolactin 6.86 ng/mL 4.04 - 15.20 ng/mL
LH 2.10 mIU/mL Males 1.7 - 8.6
FSH 1.46 mIU/mL Males1.5 - 12.4

I have been using Test C now for 8 weeks. Feel good , but not great. Libido was high for 1 day when I started Arimidex .25 twice a week( before these labs were back. This E2 was when I was on Test C 40 twice a week with no other meds.)

Trying to see what to do next?

Should I add HCG?
Maybe increase Test C to 50 twice a week?
What free T level should I shoot for at age 57?

My balls are getting soft and scrotum tight.

(BTW, my creatinine clearance and renal ultrasound were normal.)
Still looking to get my tendons to heal faster, better libido, and more energy, need to decrease abdominal fat and love handles.

Is sticking with Testosterone, or switching to Clomid, or sermorelin the answer ?

Thanks for any help!

I would go back to 50mg twice weekly and tune your AI around that dosage since you’re below mid range. HCG will keep your testes alive and has also been known to improve mood and libido is some guys, however some guys feel nothing from it and some can’t tolerate it. You will produce more E2 using HCG so be prepared to adjust AI dosage.

As I’m finding out erections, libido and my tendons are taking the longest to heal so please take it easy in the gym or else you could damage your joints since our muscles heal far faster than our tendons. SHBG is the most important sex hormone test and you don’t have it, it regulates your FT and activates T and E2 at the receptor sites and if low it’s going to take awhile to feel normal again especially if you’re not injecting frequent enough.

I’ve been on TRT for 8 months (80mg weekly split 20mg EOD, no AI, no HCG) and do to my lower SHBG it is taking a little longer than most to make a full recovery. If your SHBG is below 15 you might not be injecting often enough. However based off your TT and FT levels I would assume your SHBG would be just above (20-55 nmol/L) midrange.

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Thanks,
I think I will start Meth B Vit Complex plus Vit D,
go back up to Test C 50 every 3.5 days, AI .25 twice a week with the Test shots. I think I can now get the HCG, so I’ll start that when I get it.
Also wondering if I am a strong responder to the AI. When I started .25 with Test C 40, both twice a week, I had one day feeling great with high libido, then flat after that. My ankle swelling went away. After one more week of that I stopped the AI for one week, and my ankle swelling started, so my last injection, I went to Test C 45 with .33 AI and had another good day.
I guess I will see with labs that I will draw after about 4-5 weeks on my new regimen.

On another site, a pharmacist is having patients do a one week cycle of HCG for 1 week per month(500 EOD x3, then take 3 weeks off. Do you think this is enough to keep the boys going?

prilosec may be creating multiple mineral/vitamin deficiencies
Do you get foot or leg cramps or can tighten muscles and have them lock up? That is low magnesium and lab status may not be decisive. Biotest store here sells ZMA.

hCG 250iu SC EOD will preserve your testes.

You see guys struggling because their doctors are not able to manage TRT properly. We inform and things get better, often with a new doctor needed.

Thyroid fT3 is the only active thyroid hormone, there are no T4 receptors. Get fT3 tested, should be mid-range or better. T3 uptake is obsolete now that fT3 can be tested directly.

You can get a very good indication of overall thyroid function via oral body temperatures - see below.

TSH look very good, but is only one page in the book. Thyroid is very more complex than TRT.

Most thyroid problems here, and they are common, are from not using iodized salt. T4 looks good in this regard.

Low E2 can cause some to have joint pain in healthy joints. You need to avoid low E2 from too much anastrozole. Some, not rare, are anastrozole over-responders who need 1/4 the expected doses.

If E2 gets elevated you can expect low energy, mood problems, possible bloat or water gain, reduced libido. Most guys find that E2 management is mission critical. Your ankles were talking about this.

You should be on hGH and know your IGF-1 numbers. T and hGH are synergistic. Joints take a long time to improve, do not expect fast results. Takes 6 weeks to really feel what hGH doing.

Skip clomid as it typically increases E2. With hCG there is no need.

5000iu Vit-D3, find tiny oil based capsules. Take 25,000iu first 5 days. Do not take with high fiber foods.

Fish oil and other sources of EFA’s can be good for inflammation and joints.

At your age, DHEA-S will probably be suboptimal. Take with a meal +fats -fiber.

High potency B-complex multi-vits with good number of trace elements including 150mcg iodine + 200mcg selenium. If B-12 does not improve, may need sublingual.


Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

A few things on your labs - first, increase the T dose - you are not getting anywhere near a good range with 80 mg. you want 800+ Total and at least 15 Free. You will likely need to adjust Arimidex but keep it at .25 mg 2x week for now.

Definitely, add HCG if you can get it - assuming you are not primary hypogonadal. 350 IU 2x week (2 days before and 1 day before shot if injecting test 1 x / week, or else day of test injections if doing 2x week test shots).

Regarding Creatine - you should get a Cystatin C test which will clear up any questions about your kidneys. I had Creatine as high/ and higher than yours. There is a calculator at the national kidney foundation website were you can calculate EGFR using actual body weight (the one they give on labs is for someone who is 150 lbs - not you). Using this formula - your egfr rating is much higher and in the normal range. Working out effects Creatine. I’ve had all sorts of tests and then went to a uro who knew what he was doing and basically said don’t worry since I had no albumin in urin, egfr based on body weight was normal and- per the cystatin C test - all good. I suspect you would have similar results.

Thanks so much for the direction helping me going forward. I really
appreciate it as when I started reading about TRT, the information can be
a bit overwhelming. I am starting to get a better feel about this and am
taking this step by step. I am not one to be very compliant on meds or
vitamins so this is a big commitment for me.

Kaman,
I do get foot cramps on occasion and will look into mineral supplements,
also my tendon problems could be related to taking fluoroquinolone
antibiotics years ago. I am not sure if any great treatment to reverse this
damage, but magnesium may play a role.
I also think that HGH may be helpful to increase collagen formation. I am
hopeful that low doseTRT may increase IG1 levels and stimulate collagen as
well.
I had taken HGH 17 years ago and had severe anxiety(or could have been from
my failed back surgery and a pain doctor telling me I had arachnoiditis and
a possibility of paralysis) that may have been from not monitoring my
levels although I took a low dose regimen. I will look into HGH after I
reach steady state on TRT.
Not sure if I can get HCG, what do you think about sermorelin?

I am starting HCG next wrk, and have started Vit D and B complex. I will
check my thyroid temps next week and repeat my labs in four weeks including
IG1, fT3. My salt was a sea salt with only trace amounts of iodine, will
change that.

Jungian,

My creatinine clearance, urine albumin, and renal ultrasound were all
normal, so I think my kidneys are good.
I think I will do as you suggest and do the HCG 333 twice a week on the
day I do my TRT injections, that will allow me to simplify my schedule and
keep me compliant.

Physiolojik and Highpull,
Thanks for your help. I will look into the SAMe, and have started the vit D
and B complex.

Thanks guys.
Strings

Well guys,
I just got some new fasting labs from LabCorp.(Life Extension) at 900am on day 2 on my 3.5 day cycle. TestC 50, HCG 333, and Arimidex .25 all every 3.5 days.
Good news is that my T levels and E2 look good.
Bad news is that my HCT is 53.8 and I already have a hx of having blood clots on 4 previous occasions. I am feeling great on this dosage schedule. Maybe some mild breast swelling.
I don’t really feel like donating blood frequently and I may not be able to do that because of previous needle sticks from working in the medical field.

Here are my labs:

Testosterone, Serum 811 ng/dL 264-916
Free Testosterone(Direct) 19.9 pg/mL 7.2-24.0
Estradiol 19.2 pg/mL 7.6-42.6
Sex Horm Binding Glob, Serum 28.2 nmol/L 19.3-76.4

TSH 1.270 uIU/mL 0.450-4.500
Thyroxine (T4) Free, Direct, S 030-305-2620-0
Triiodothyronine,Free,Serum 3.6 pg/mL 2.0-4.4
T4,Free(Direct) 1.41 ng/dL 0.82-1.77 CB
DHEA-Sulfate 030-305-2620-0 DHEA-Sulfate 57.7 ug/dL 48.9-344.2 CB
Cortisol 030-305-2620-0 Cortisol 11.4 ug/dL CB

Prostate Specific Ag, Serum 1.5 ng/mL 0.0-4.0

Pregnenolone, MS 15 ng/dL
Dihydrotestosterone 50 ng/dL ES Reference Range: Adult Male: 30 - 85

WBC 4.5 x10E3/uL 3.4-10.8
RBC 6.23 High x10E6/uL 4.14-5.80

Hemoglobin 18.5 High g/dL 13.0-17.7
Hematocrit 53.8 High % 37.5-51.0

Platelets 193 x10E3/uL 150-379
BUN 15 mg/dL 6-24 CB
Creatinine, Serum 1.25 mg/dL 0.76-1.27 CB
LDH 167 IU/L 121-224 CB
AST (SGOT) 18 IU/L 0-40 CB
ALT (SGPT) 19 IU/L 0-44 CB

Iron, Serum 187 High ug/dL 38-169 CB

Cholesterol, Total 194 mg/dL 100-199 CB
Triglycerides 157 High mg/dL 0-149 CB
HDL Cholesterol 39 Low mg/dL >39 CB
VLDL Cholesterol Cal 31 mg/dL 5-40 CB
LDL Cholesterol Calc 124 High mg/dL 0-99
T. Chol/HDL Ratio 5.0 ratio units 0.0-5.0 CB

Also, I just donated about 500 cc of blood, so hopefully my HCT should be down to about 48.5.

I am also getting hard nipples and painful fibrocystic swelling in my breasts, even though my E2 is 19. Why am I getting Gyno with optimal E2?

I am not sure what my next step could be. I feel really good and am doing this mainly to help cure tendon ruptures and tendinitis.
Maybe I could decrease my T dose, or just switch to HCG only, or HGH, or Semorelin?

Any thoughts @KSman ? or jimgainz?

Well guys,
I just got some new fasting labs from LabCorp.(Life Extension) at 900am on day 2 on my 3.5 day cycle. TestC 50, HCG 333, and Arimidex .25 all every 3.5 days.
Good news is that my T levels and E2 look good.
Bad news is that my HCT is 53.8 and I already have a hx of having blood clots on 4 previous occasions. I am feeling great on this dosage schedule. Maybe some mild breast swelling.
I don’t really feel like donating blood frequently and I may not be able to do that because of previous needle sticks from working in the medical field.
Here are my labs:
Testosterone, Serum 811 ng/dL 264-916
Free Testosterone(Direct) 19.9 pg/mL 7.2-24.0
Estradiol 19.2 pg/mL 7.6-42.6
Sex Horm Binding Glob, Serum 28.2 nmol/L 19.3-76.4
TSH 1.270 uIU/mL 0.450-4.500
Thyroxine (T4) Free, Direct, S 030-305-2620-0
Triiodothyronine,Free,Serum 3.6 pg/mL 2.0-4.4
T4,Free(Direct) 1.41 ng/dL 0.82-1.77 CB
DHEA-Sulfate 030-305-2620-0 DHEA-Sulfate 57.7 ug/dL 48.9-344.2 CB
Cortisol 030-305-2620-0 Cortisol 11.4 ug/dL CB
Prostate Specific Ag, Serum 1.5 ng/mL 0.0-4.0
Pregnenolone, MS 15 ng/dL
Dihydrotestosterone 50 ng/dL ES Reference Range: Adult Male: 30 - 85
WBC 4.5 x10E3/uL 3.4-10.8
RBC 6.23 High x10E6/uL 4.14-5.80
Hemoglobin 18.5 High g/dL 13.0-17.7
Hematocrit 53.8 High % 37.5-51.0
Platelets 193 x10E3/uL 150-379
BUN 15 mg/dL 6-24 CB
Creatinine, Serum 1.25 mg/dL 0.76-1.27 CB
LDH 167 IU/L 121-224 CB
AST (SGOT) 18 IU/L 0-40 CB
ALT (SGPT) 19 IU/L 0-44 CB
Iron, Serum 187 High ug/dL 38-169 CB
Cholesterol, Total 194 mg/dL 100-199 CB
Triglycerides 157 High mg/dL 0-149 CB
HDL Cholesterol 39 Low mg/dL >39 CB
VLDL Cholesterol Cal 31 mg/dL 5-40 CB
LDL Cholesterol Calc 124 High mg/dL 0-99
T. Chol/HDL Ratio 5.0 ratio units 0.0-5.0 CB
Also, I just donated about 500 cc of blood, so hopefully my HCT should be down to about 48.5.
I am also getting hard nipples and painful fibrocystic swelling in my breasts, even though my E2 is 19. Why am I getting Gyno with optimal E2?
I am not sure what my next step could be. I feel really good and am doing this mainly to help cure tendon ruptures and tendinitis.
Maybe I could decrease my T dose, or just switch to HCG only, or HGH, or Semorelin?

Cortisol is low if AM at 8AM or 1 hour after waking.
Labs done at 9AM.
How long had you been awake?
Progesterone cream Amazon “KAL” brand can be used to try to improve progesterone–>cortisol in the adrenals. Low cortisol can also be part of stress and adrenal fatigue - see rT3.

Thyroid not bad for no iodized salt!
fT3 and fT4 are a bit above midrange. TSH OK.
If requested oral body temperatures are low, [2x per day] then that suggests elevated rT3 blocking fT3 at T3 receptors which plays into your history of stress - see thyroid basics sticky.

RBC, HTC, hemoglobin:
do not get dehydrated
start taking baby aspirin which makes RBC’s slippery.
avoid iron fortified foods and supplements: rice, flour, cereals, breads - read labels
you should have blood removed - Did!

Take DHEA 25mg ED
Not with high fiber foods, better with oils/fats, same for Vit-D3, fish oil.

Serum iron is high, plays into comments above. But serum iron changes a lot based on recent meals. I have had low and high - too much noise. But it is not low or contradictory to suspicion of too much iron. Any pills that are brown like ibuprofen? That is iron oxide.

Vitamins need to not list iron.

High HTC blood often rejected for donations.
Did you feel better after that?

sermorelin: Did nothing for me and my wife. Works for some people.

There can be transient breast nipple problems. But worrying.
Worried that E2 labs might be off.
You are taking less anastrozole than others need.
Are you bitchy and intolerant? - which would be E2

Thanks for the input.
I am very level headed and not having mood swings, except every once in a while feeling tired and flat, but that has always been after a poor nights sleep or after too much alcohol- maybe once every 2-3 weeks.
Do you trust LabCorp for labs? It is nice to use them as I can order my own labs thru Life Extension.
I have decreased my TestC to 30 every 3.5 days. Why do young men with higher T levels not have too high E2 levels? My nipple firmness has decreased. I have always had flat non existent nipples and they are now closer to that. Also, I have less swelling in ankles and hands. Can I dose my armidex according to nipple and ankle symptoms till I get my next bloodwork?
I just accidently injected .333 ml of Armidex this am instead of my HCG. That hurt! Must be the vodka. So, I assume I just took .33 mg and that it will be absorbed with no skin necrosis hopefully.
I felt better as the blood was draining out, I really did. But it could have been somewhat psychological as I was a bit worried about the high HCT.
I an hoping that decreasing my TestC to 25 or 30 q3.5 days will keep me in a pretty good range with lower E2 and maybe less red blood cell production.
What will DHEA do for me?
My morning temps have been pretty good. But need to document them.
My bloodwork was done after being awake about 2.5 to 3 hours. I have on occasion taken low dose decadron 2mg IM about 6 times a year when my back flares up. Hopefully not enough to inhibit natural cortisol production.
I am feeling good overall, and want to stay on this protocol, just is so foreign to me to be taking all these vitamins and injections. What happens when I get too senile to give this stuff to my self? That’s going to be a big letdown!

WTF!

DHEA has many health benefits and you are way below where you should be.

How much of dhea supplement you think converts to testosterone?

Yeah,
That’s what my wife said ! I draw it up out of a syringe and inject it in a
shot glass, was rushing and made a mistake.
Do you think lower free T levels in the low to midrange for youthful men
would result in less RBC production and a lower HCT?

I changed my protocol 4 months ago because I was fearful that my high HCT could cause me to be at risk for a blood clot( I have had 4 in the past). In addition I was getting some Gyno (fibrocystic ds)

My new protocol is below with my old protocol in ( ) :

Test C sub Q 30 twice a week (was 50 twice/week)
HCG 333 units twice /week ( no change)
AI .25mg twice a week, was going to cut it to .20 but did not ( was .30 twice/week)

I have had some insomnia and some fatigue sleepiness after work with some low energy in the past 2 months, along with low libido. I also have had some tendinitis from golfing in my left hand.

Just got my new labs back and my E2 is crashed.(less than 5!)
Test levels are lower as well, but I expected that and am OK with that for now.

Here are my new labs:

Hct 51

Testosterone, Serum 509 ng/dL 264-916 CB
Free Testosterone(Direct) 13.4 pg/mL 7.2-24.0 BN

Pregnenolone, MS <10 ng/dL ES
Reference Range: Adults: <151 Dihydrotestosterone 201-305-0742-0

Dihydrotestosterone 42 ng/dL ES
Adult Male: 30 - 85

Thyroxine (T4) Free, Direct, S 201-305-0742-0
T4,Free(Direct) 1.27 ng/dL 0.82-1.77 CB

DHEA-Sulfate 201-305-0742-0
DHEA-Sulfate 40.2 Low ug/dL 48.9-344.2 CB

Cortisol 12.6 ug/dL CB
Cortisol AM 6.2 - 19.4
Cortisol PM 2.3 - 11.9

TSH 201-305-0742-0
TSH 1.390 uIU/mL 0.450-4.500 CB Estradiol 201-305-0742-0

Estradiol <5.0 Low pg/mL 7.6-42.6 CB

Prostate Specific Ag, Serum 1.4 ng/mL 0.0-4.0 CB

Triiodothyronine (T3), Free 201-305-0742-0
Triiodothyronine (T3), Free 3.3 pg/mL 2.0-4.4 CB

Sex Horm Binding Glob, Serum 31.7 nmol/L 19.3-76.4 CB

I am planning on stopping AI completely until I get Gyno back or water retension with I had before an AI was started.

Do you think I can get by with no AI if I keep my present Test injection protocol?

Also do you think the low E2 will resolve and thus resolve my low libido and low energy?

Thanks for any suggestions.

I would increase to 40mg twice weekly do to low T symptoms and low DHEA is contributing, stop the AI for a couple of weeks, see where you are. If E2 is elevated again you could do .125mg AI twice weekly. You could easily donate blood, but the only people to suffer a blood clot on TRT are those with clotting disorders or a certain type of cancer.

You could benefit from DHEA, but it may increase estrogen which may increase the need for AI. DHEA is precursor to male and female sex hormones, including testosterone and estrogen, low DHEA has symptoms of its own.

YES!

Thanks Guys for your response.

I upped my dose to Testc50 and HCG 350 last night skipping the AI.
I will continue twice a week at Test C 30-40 twice a week.

Also, another question: What do you think about my low Pregnenolone? It is now less than 10, it was 15.

And one last question: Should I add DHEA ?

Thanks.