T Nation

Npcaldwell's TRT Thread


#1

Edited: 9/26/2015 as per advice for new guys sticky.

Age 32
Height 5'10"
Weight 205lbs
Waist 36"

Hair growth: Average hair growth on arms and legs not coarse or thick, light hair growth on chest and abdomen, no back hair. Can grow facial hair but not thick or dense.
Hairline is receding on the corners, have same hairline as father and both grandfather's.

Body fat distribution: I mostly carry fat around my midsection this began in my mid 20's, love handles are the first to come and the last to go when dieting down. Arms and legs stay fairly muscular looking no matter my bf%

Health conditions: Seasonal allergies, chronic sinusitis. Use claritin, fluctonosal nasel steroid, and augmentin or amoxicillin if alergies turn into a sinus infection. Never used any hair loss drugs, prohormones, or AAS drugs.

Initial labs drawn at 1730 Date 9-11-2015 ran by lab corp
Total testosterone 82 ng/dl (348-1197) Low
Estradiol 11.0 pg/ml (7.6-42.6)
PSA 0.2 ng/ml (0.0-4.0)
Hemoglobin 14.8 g/dl (12.6-17.7)
Prolactin 9.8 ng/mL (4.0-15.2)
FSH 3.5 mIU/mL (1.5-12.4)

These were my initial findings. Leading up to the decision to have my levels checked I was showing some symptoms of hypogonadism low libido, weak erections, fear of losing erections, hit or miss waking erections, no spontaneous erections, weight gain, fatigue. These symptoms seemed to manifest rather gradually from my mid 20's till now. Not sure whether or not it could be related, from adolescence until 31 I've had very regular nocturnal emissions (1-2 times a week) regardless of sexual activity, since I've began training hard again these have ceased which is completely fine by me but is outside of my "normal".

Diet and nutrition: At the beginning of 2015 I weighed 256 lbs, at which point I decided to get back into competition shape as a new years resolution. I've been steadily losing 1-2 lbs/week with carb cycling and weight training, I've intentionally kept the fat loss slow and steady in an attempt to retain as much muscle as possible, I still incorporate enough carbohydrates to keep up my workout intensity and still get a pump. Currently my average calorie intake is 2370/day with ratios of 50% protein, 30% carbs, and 20% fat. As stated above I'm now at 205 lbs and roughly 10% body fat (according to the calipers) Throughout the diet process I've tried to only keep the calorie deficit around 200 below my BMR. Back in 2009 when I decided to enter a natural bodybuilding contest, I began the process weighing 254 lbs on 2/1/2009 and by 5/15/2009 I was down to 184 lbs. I started with an Atkins style diet and dropped 33 lbs in the first month. Looking back this may have started the ball rolling for hormone problems.

Training: I began weight training when I was 15 and trained very hard until I was 19. I then got married and work took priority over training. A few years later I found a new job that allowed for regular training and picked back up on training at age 26. I competed twice in 2009 and kept training hard until almost 2011 when it became a strain on my family and marriage. I trained intermittently between 2011 and 2015. I now train an average of 5 days a week from 1-1.5 hours each day, I train each body part once a week and sometimes twice for whichever lagging body part I feel needs the emphasis. I go to failure or beyond on the last set of nearly every exercise.

My aching balls: I was diagnosed with a varicocell on my left testicle at around 11-12 years old, doctor checked it out said it was common and not to worry, it aches from time to time. I've never had any testicular trauma. I do get a dull ache in my testicles and pelvis with a fever. (KSman I'm particularly interested in the correlation between this symtom and low testosterone)

This is the first time I've ever had testosterone levels checked, my intention was to establish a baseline for future testosterone levels, from my labs it looks like the future is here. I thought I would have been on the low side of normal but not 82! At this time it appears that I will be going on testosterone.

I went into my PCP on 9-17-2015 for an annual physical, the prior test was done at an "anti aging clinic". I showed him my first test and discussed TRT, at that point I brought up the use of hCG and anastozole in conjunction with testosterone cypionate, he didn't balk at the idea, said the hCG "made sense" but said he would look into it. He tells me to do two more testosterone level checks before he will prescribe the testosterone.

The second test was pulled at 1100 on 9-17-2015 and was 163 ng/dl. The Dr. personally called my wife with my testosterone number, and made mention that all he could find about hCG was it's use in fertility treatment not specifically TRT. I get the feeling he will work with me if I could get him some more information on the subject. I've done some digging but haven't found any "clinical trials" per say on the subject. If you guys have any good links or reading material for me to share with the doctor I would really appreciate it.

I'm going for my third draw on Monday 9-21-2015 early morning and fasting, will set up an appointment for Tuesday or Wednesday to discuss the protocol further. It looks like the testosterone should be no problem, should I just take it one step at a time with him, with the stipulation that we treat unacceptable estradiol levels and testicular atrophy should it occur? Or just source my own hCG and anastrozole and self regulate in conjunction with the prescribed testosterone?

Thanks for any advice, couldn't have imagined I'd be going down this road at 32 years old but looks like I am.


KSman is Here
#2

I don’t know if external links are allowed here, but search google for “hCG ITT”.

You should find a pubmed link for a paper called:

“Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression.”

Its about the preservative effects of hCG on the testes during TRT. The same group also did a follow up on hCG and sperm production during TRT.


#3

You seem to be on the right track.

Please read these stickies:

  • advice for new guys AND note the first paragraph
  • things that damage your hormones
  • protocol for injections

Many of your symptoms are also consistent with low thyroid function often caused by iodine deficiency from not using iodized salt.

Check your body temperatures as per the thyroid basics sticky. THIS IS NOT a trivial request.

Labs: - you have some now
TT
FT
E2
LH/FSH
prolactin
TSH
AM cortisol
IGF-1 [ to eval HG]
CBC
hematocrit
AST/ALT
fasting cholesterol - can be too low
fasting glucose
A1C to eval average glucose levels
PSA if older

Your hypogonadism is clear, suspecting that there is more than one thing going on.
Feel cold easily or easier now?
Sparse outer eyebrows?
Thyroid sore, enlarged, lumpy or asymmetrical?
Consumed a lot of citrus drinks with bromated vege oils?

Get copies of labs with ranges, need ranges.


#4

[quote]Sephadex wrote:
I don’t know if external links are allowed here, but search google for “hCG ITT”.

You should find a pubmed link for a paper called:

“Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression.”

Its about the preservative effects of hCG on the testes during TRT. The same group also did a follow up on hCG and sperm production during TRT.[/quote]

Thank you, thats exactly what I was looking for in regards to hcG.


#5

[quote]KSman wrote:
You seem to be on the right track.

Please read these stickies:

  • advice for new guys AND note the first paragraph
  • things that damage your hormones
  • protocol for injections

Many of your symptoms are also consistent with low thyroid function often caused by iodine deficiency from not using iodized salt.

Check your body temperatures as per the thyroid basics sticky. THIS IS NOT a trivial request.

Labs: - you have some now
TT
FT
E2
LH/FSH
prolactin
TSH
AM cortisol
IGF-1 [ to eval HG]
CBC
hematocrit
AST/ALT
fasting cholesterol - can be too low
fasting glucose
A1C to eval average glucose levels
PSA if older

Your hypogonadism is clear, suspecting that there is more than one thing going on.
Feel cold easily or easier now?
Sparse outer eyebrows?
Thyroid sore, enlarged, lumpy or asymmetrical?
Consumed a lot of citrus drinks with bromated vege oils?

Get copies of labs with ranges, need ranges.
[/quote]

Thank you, looks like I have a few mor labs to acquire, will monitor temperature as instructed. I use either iodized or canning salt whatever is handy at the time.

I don’t feel cold or colder than normal.
I’d say my eyebrows are not sparse.
No thyroid soreness or abnormalities.
Un sure on the citrus drinks or bromated vege oils? I take 3g of acetyl L-carnitine, 5g glutamine, 1T lemon juice with 12oz water upon waking each morning for the past month. I’ve also incorporated 1T of vegetable glycerin with my pre workout regimen, 5g Agmatine sulfate, 7.5g L-citrulline DL-malate 1:1, 5g creatine monohydrate, 300mg caffeine, and 12.5mg ephedrine hcl (I use only use the stimulants occasionally for morning workouts)

My original labs from 9/11/2015 were as follows, non fasting at approximately 17:30 p.m.
TESTOSTERONE 82 (328-1197 ng/dL)
ESTRADIOL 11.0 (7.6–42.6 pg/mL)
PSA 0.2 (0.0-4.0 ng/mL)
HEMOGLOBIN 14.8 (12.6-17.7 g/dL)
PROLACTIN 9.8
FSH 3.5

Here are my latest labs pulled on 9/17/2015 non fasting at approximately 11:00 a.m.

CBC
WBC 7.22 (4.8-10.8 K/mm)
RBC 5.00 (4.70-6.10 mill/mm)
HGB 14.7 (14.0-18.0 g/dL)
HCT 45.0 (42.0-52.0 %)
MCV 90 (80.0-94.0 um)
MCH 29.4 (27-31 pg)
MCHC 32.7 (32-36 g/dL)
RDW-CV (11.5-14.5 %)
PLATELET COUNT 229 (130-400K/mm)
MPV 9.9 (7.4-10.4 fL)
NEUTROPHIL % 72.5 (45-70%) H
LYMPHOCYTE % 21.7 (20.0-48.0%)
MONOCYTE % 4.7 (0.0-8.0%)
EOSINOPHIL % 0.6 (0-4%)
BASOPHIL % 0.4 (0-2%)
NEUTROPHIL # 5.23 (K/mm)

COMP METABOLIC PANEL

SODIUM 135 (133-145 mmol/L)
POTASSIUM 3.9 (3.3-5.1 mmol/L)
CHLORIDE 104 (98-107 mmol/L)
CO2 24.2 (23.0-29.0 mmol/L)
ANION GAP 6.80 (5.0-15.0 mmol/L)
GLUCOSE 93.0 (70-115 mg/dL)
BUN 32 (6-19 mg/dL) H
CREATININE 1.4 (0.6-1.5 mg/dL)
TOTAL PROTEIN 8.3 (6.4-8.2 g/dL) H
ALBUMIN 4.0 (3.5-5.0 g/dL)
CALCIUM 8.9 (8.8-10.5 mg/dL)
BILIRUBIN TOTAL 0.5 (0.0-1.0 mg/dL)
AST (SGOT) 34 (15-37iU/L)
ALT (SGPT) 42 (30-65 iU/L)
ALK PHOSPHATE 85 (50-136 iU/L)
ESTIMATED GFR 59 (mL/min/1.73m2)

TESTOSTERONE 160 (348-1197 ng/dL) L

VITAMIN D, 25-HYDROXY 38.0 (30.0-100.0 ng/mL)

Thank you again, you help so many of us.


#6

5,000iu vit-D3, find tiny oil based caps

There is no iodine in canning salt. Check the table salt container to see what it says. The non-iodized and iodized salt containers look similar.

Don’t get carried away with “12.5mg ephedrine hcl” as it can mess with your neural transmitters just like other stimulants.

Bromines accumulate and interfere with iodine. Bromated vege oils were common in a lot of “sports drinks” and citrus sodas.


#7

[quote]KSman wrote:
5,000iu vit-D3, find tiny oil based caps

There is no iodine in canning salt. Check the table salt container to see what it says. The non-iodized and iodized salt containers look similar.

Don’t get carried away with “12.5mg ephedrine hcl” as it can mess with your neural transmitters just like other stimulants.

Bromines accumulate and interfere with iodine. Bromated vege oils were common in a lot of “sports drinks” and citrus sodas.[/quote]

I don’t drink any sports drinks, pretty much just water, green tea, and herbal tea. Looks like I need to up the game on vitamin D, the Dr said he sees a lot of people in our area who are deficient, that’s why that test was on there too. I have some 12.5 mg Iodoral tabs on the way now, my waking temperature this morning was 96.6, I’m thinking you’re on to something.


#8

My most recent total testosterone level was 255 at 0930, so I scheduled a consultt with my PCP. He walks in ans says “Looks like you get to start testosterone”. We then talked a little more about anastrozole and hCG, he said he didn’t feel comfortable with that protocol right now, I got the impression that we’d cross that bridge when we get there kind of thing.

He wants to re check my levels in four weeks and adjust dosage as needed, one thing he did say that gave me hope was that he would take how I was feeling into account as much as the test results.

As of now he wrote for a 10mL bottle of testosterone cypionate 200mg/mL, 100 mg/week divided into 2 doses. I started this protocol on 9/22/2015.

My questions are these, with my test numbers being 82,160, and 255, and my estradiol being 11 (only E2 number I have); how likely will it be that I get to a point of needing anastrozole at a dose of 100 mg testosterone a week?

Will both testosterone and estradiol levels raise proportionally, theoretically?

Should I source the anastrozole elsewhere as a precaution in case he’s unwilling to even treat a high normal E2?

How important is the hCG being that I’m diagnosed with primary hypogonadism?

P.S. KSman my waking temps have been 96.6,96.6, and 96.2 the last three mornings.

Edited dosage wording to eliminate confusion.


#9

Please read these stickies:

  • advice for new guys AND note the first paragraph
    …^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
  • things that damage your hormones
  • protocol for injections

200mg/week is just stupid and that much T sort of makes high E2 a probable result.

Even with primary, your testes are probably going to shrink and fertility is a risk. Also may get 24x7 dull ache in your testes.
You should know this from the stickies

Body temperatures, need mid-afternoon as well, indicate hypothyroidism. You should know from the stickies that this can also lead to hypogonadism.

Need these labs:
AM cortisol
IGF-1
fasting cholesterol - can be too low
TSH
fT3
fT4
rT3 is you have a notable history of stress or stress events that can also be medical/surgical etc

Please read the thyroid basics sticky.
These problems can be from not using [enough] iodized salt or iodine in multi-vits.

  • are outer eyebrows sparse?
  • get/feel cold easily
  • dry skin
  • generalized hair loss/thinning - not male pattern baldness
  • thyroid sore, enlarged, asymmetrical, lumpy
  • difficulty swallowing some times

Note that hypothyroidism and hypogonadism have many symptoms in common!

And get that vit-D3 on board.

Ping me at KSman is here thread.


#10

[quote]KSman wrote:
Please read these stickies:

  • advice for new guys AND note the first paragraph
    …^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
  • things that damage your hormones
  • protocol for injections

200mg/week is just stupid and that much T sort of makes high E2 a probable result.

Even with primary, your testes are probably going to shrink and fertility is a risk. Also may get 24x7 dull ache in your testes.
You should know this from the stickies

Body temperatures, need mid-afternoon as well, indicate hypothyroidism. You should know from the stickies that this can also lead to hypogonadism.

Need these labs:
AM cortisol
IGF-1
fasting cholesterol - can be too low
TSH
fT3
fT4
rT3 is you have a notable history of stress or stress events that can also be medical/surgical etc

Please read the thyroid basics sticky.
These problems can be from not using [enough] iodized salt or iodine in multi-vits.

  • are outer eyebrows sparse?
  • get/feel cold easily
  • dry skin
  • generalized hair loss/thinning - not male pattern baldness
  • thyroid sore, enlarged, asymmetrical, lumpy
  • difficulty swallowing some times

Note that hypothyroidism and hypogonadism have many symptoms in common!

And get that vit-D3 on board.

Ping me at KSman is here thread.
[/quote]

Thank you, I have edited my first post as per the advice for new guys sticky, I’ve also read each and every sticky you have authored front to back. I just figured I may have a somewhat unique situation with a starting E2 of 11, I guess if things start aching and shrinking I’ll go in and have the arimidex and hCG talk again.

My dose is 50mg testosterone cypionate 200mg/mL twice a week as suggested in your protocol, sorry for the confusion. I’ll go in for more labs the last week of October, which will be 4 weeks into my TRT.

I’ve started with the Vitamin D, Zinc, Iodoral, and got rid of the non iodized salt. I will ask for orders to have the labs you suggested on my next visit as well.


#11

Aching testes can indicate very low FSH/LH, vascular problems or an infection.

Testicular pain with a fever can indicate that an illness is affecting or harming the testes.

And there can be a problem of this nature with hernias too.