T Nation

Not Feeling the Same After First Vial

On my first 10 ml vial of Testosterone and just took last shot out of it this last week. The last month I started noticing my libido is back doe, getting tired and struggling through workouts. Haven’t had the rush of energy and getting horny afterwards like normal. My (E) is 27.8, SHBG 23, on last draw end of March 2019. I take 100mg a week and have felt great till the last month. Going to see my Urologist this Thursday and ask him to check my levels. Thursday is my shot day and I’m waiting till after visit so bloodwork shows through levels. Have new vial to start afterwards. Going to try and go to 120mg per week if doctor is on board to get in high normal level and optimize. Will post results in a few days.

Hi Smitty I believe what you just went thru is called the TRT honeymoon. You need blood tests not a bump of 20mg to determine where to go next. No one get the honeymoon back. The fastest way to get the most out of your TRT is to monitor your Free T and keep it at the top of the range without going over. After that you need to look at your diet your amount of exersize.
If you have not already you should look into your thyroid numbers.
Best of luck HTH

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Top range in peak or trough?


Diet is pretty clean and lift 5 days a week. In addition, I do 7200 push-ups, 6000 body squats, and 60 miles a month cardio. Definitely going to ask the doctor to check my blood levels. All done on trough day prior to shot. With these numbers, any guesses what my total and free t might be at peak? Again, doing 100 mg testosterone cypionate every Thursday. Thanks in advance.

Last labs were:

SHBG 22.0 NMOL/L 16.5-55.9

FREE T. 158.4 PG/ML 47.0-244.0

PROLACTIN 15.3 NG/ML 4.0-26.0

TSH Third Gen. 3.8 0.400 - 4.95

Also, Do you shake your testosterone up prior to drawing it up? Wondering if the potency over the last four weeks in my vial was low due to not shaking it to mix well before I draw up? Could it be more of the cottonseed oil and not the testosterone?

Don’t shake it up. It’s a suspension, all shaking it does is mix air bubbles into the oil. There is somewhere around zero chance that this has anything to do with potency or a change thereof.

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Your free testosterone isn’t optimal on trough day and I believe the reason why you do not feel well is because levels are swinging too much between peak and trough. I preach weekly injections isn’t drastically different from every 2 week injections because levels aren’t consistent.

Your SHBG is on the lower end and any fluctuation in total testosterone will see even more dramatic fluctuations in free testosterone. I’m willing to bet your free testosterone is high normal at peak and now lower at trough.

You need more frequent injections, twice weekly and prefered EOD injections is best or you may be sacrificing the full benefits of TRT. Testosterone is metabolized in the liver and thyroid hormones are needed for this process, the higher your thyroid hormones, the more effective TRT will be.

TSH is no good and a TSH >3.0 is an indication thyroid problems. No actual thyroid hormones were checked, Free T3, Free T4, Reverse T3 should have been ordered along with antibody testing to investigate elevated TSH.

Medicine is always evolving and most doctors do not stay up to date and lag behind leaving the patient to investigate why they do not feel normal even though their doctor says everything looks normal. What is a normal TSH, normal continues to evolve and the TSH reference ranges is always being adjusted to a more narrow reference range. The only thing that is needed these days is a few hours of online self education to figure out your doctor is clueless.

Reference ranges for TSH and thyroid hormones

Though TSH remains the most commonly used endocrine test in clinical practice, the issue of an appropriate TSH, and to a lesser extent, free T4 and free T3 reference ranges is still under debate. First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L.

On the other hand, upper TSH reference limit is (assay-dependent) usually around 4.2-4.5 mU/L.There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter.

Going to ask my doctor to do bloodwork tomorrow. Going to specifically ask for T3, T4, and reverse T3 in addition to the others. Hopefully this will shed some light on what’s going on. I appreciate the input and will follow up once my visit is over and I have my results.

The point is you shouldn’t have to ask your doctor, the fact that you have to ask for these necessary tests is troubling. Your doctor is likely one of those that still believes a TSH <4.5 is normal, TSH is a poor indicator of thyroid status, Free T3 testing will show how much active thyroid hormone is in your cells. Reverse T3 if elevated >15 ng/dL can pool and block Free T3 from entering your cells.

My TSH shoots up to 4.0 when I start TRT (I have been on and off trying other things). There’s nothing wrong with my thyroid, so don’t get too freaked out. Probably nothing to discover there, just extra blood work. It’ll calm down after a while on it’s own most likely.

I agree. I am currently seeing a urologist and I am not happy with the way he’s monitoring me. Just not sure of a good TRT doctor in Austin, Texas area. If anyone has any recommendations it would be greatly appreciated. I am kind of scared of the TRT clinics that make you go win for your shots. I prefer to do mine on my own and go in for blood work

You should consider reputable telemedicine anti-aging clinics, Defy Medical has excellent TRT doctors and is mostly what they do on a daily basis which is more than I can say for your urologist who more than likely doesn’t specialize in TRT, few do.

Urologist usually treat the prostate and fertility concerns, TRT causes infertility and is the opposite of what they do. TRT is more along the lines of hormone treatments, sady many endocrinologists who are thyroid hormone doctors and treat diabetes do not specialize in TRT.

Strange considering new studies show bad news for the prostate with lower levels of testosterone and also low testosterone in middle age is a cause for type 2 diabetes.

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Your last labs kinda suck. No wonder you don’t feel good any more

Can you elaborate a little??

We see guys in here everyday looking to go on TRT for having the numbers that you have now do to the symptoms of low testosterone, your Free T is suboptimal.

Healthy young men score Free T in the high normal levels or higher, you know those guys looking ripped in the gym. Those guys also have a TSH <2.5 closer to 1.0 and Free T3 high normal and Reverse T3 <15 ng/dL.

The problem with sick care doctors is they’re not going to optimize you, they’re only gonna keep your levels normal or suboptimal and care not if you feel like your 21 again.

They only care about the numbers, in range is normal only the ranges aren’t normal at all.

Your numbers are not right for someone actually being treated. They’re all middle of the road numbers that a slightly overweight office-worker who doesn’t exercise would have. Your dose is probably too low.

Thanks for all the input everyone. Going in to see my doctor today and will see how it goes. Already lined up a backup doctor if my current doctor isn’t more proactive. I basically interviewed the new doctors office on bloodwork protocols and their approach to see if they are educated in TRT treatment. I’m still sympathetic regardless what the numbers read in my opinion. Hopefully more bloodwork can shed additional light as well. I’ll keep the thread updated. Feel like this is important to post as others may be fighting the same battle. Thanks again everyone!

How long have you been on TRT with this Dr. If he has already seen those results and didn’t raise your dose that day then there’s a very good chance if not a guarantee that he is happy with those numbers and does not want you any higher.

Four months. Started January 24, 2019. If that’s the case, he will be losing a patient today. Hopefully, he listens and is open minded with his protocols. I’ll keep you posted.