T Nation

Occamsracer Case April 2013

Thanks in advance for any input!

Summary and questions:

Started TRT about a year ago, first with Axiron then with T cyp. After last blood test showed pretty high T, doc told me to back off from 1.0 - 0.75. Going in for a consult/blood test with my doc on Wed and wanted to get advice.

Pros of TRT (for me):

More “robust” feeling
Increased sex drive (up from 1x/wk to 3-4x/wk)
Feel stronger/more capable
Chest and arms have filled out nicely

Cons:

Very rapid weight gain after starting t cyp inj. I didn’t record things, but I had very gradually lost about 20lb over the previous year eating paleo and I gained it all back in the span of 6-8 weeks after t cyp. Waistline didn’t change really, so must be water/muscle, but I haven’t really been able to lose more than a few lbs since.

Don’t know how to describe this one. A period of “loud” blood pumping through my body. Could feel my heartbeat in many places. For a while, especially after a glass of wine, I’d get a real thud-thud-thud in my head. This has subsequently moderated quite a bit.

Random small-scale acne outbreaks

Questions:

  1. Any advice about weight gain? I’m not overly concerned, but I really had my heart set on getting down to 200lb and staying there.
  2. Any concerns out there about the loud heartbeat?
  3. I’ve read through the stickies and it seems I should be pushing for add’l blood testing, particularly Estrogen. Any other must-haves and how regularly?

Recap

-46 yo
-6’ 3"

  • 34" waist
    -220 lb
    -~19% body fat
    -medium body hair, robust facial hair
    -Carry fat in mid section
  • No major health issues. Complained about moderate loss of vitality to doc. Got tested and started TRT. Axiron first, then when that didn’t go anywhere, T cyp 200 mg/ml inj (quads), 1ml 1x/wk.
    -Only Rx is Ambien for infrequent sleep help when traveling
    -lab results with ranges

May 2012 (before trt)

Glucose, serum 94mg/dL (65-99)
BUN: 18mgdL (6-24)
Creatinine: .91mg/dL (.76-1.27)
eGFR: 101 ml/min/1.73 (>59)
BUN/Creatinine Ratio: 20 (9-20)
Sodium, Serum: 141 mmol/L (134-144)
Potassium, Serum: 4.4 mmol/L (3.5-5.2)
Chloride, Serum: 104 mmol/L (97-108)
Carbon Dioxide, Total: 25 mmol/L (20-32)
Calcium, Serum: 8.9 mg/dL (8.7-10.2)
Protein, Total, Serum: 6.5 g/dL (6.0-8.5)
Albumin, Serum: 4.4 g/dL (3.5-5.5)
Globulin, Total: 2.1 g/dL (1.5-4.5)
A/G Ratio: 2.1 (1.1-2.5)
Bilirubin, Total: .7 mg/dL (0.0-1.2)
Alkaline Phosphatase, S: 51 IU/L (25-150)
AST (SGOT): 23 IU/L (0-40)
ALT (SGPT): 18 IU/L 0-55
Cholesterol, Total: 142 mg/dL (100-199)
Triglycerides: 29 mg/dL (0-149)
HDL: 65 mg/dL (>39)
VLDL: 6 mg/dL (5-40)
LDL: 71 mg/dL (0-99)
Free T (direct): 3.9 pg/mL (6.8-21.5)
T, Serum: 353 ng/dL (348-1197)
TSH: 2.37 uIU/mL (30.0-100.0)
Vit D, 25-Hydroxy: 33.2 ng/mL (30-100)

June 2012 (on Axiron)

T: 212 ng/dL (286-1510)
WBC: 7.3 10^9/L (3.9-10.6)
RBC: 4.48 10^12/L (4.4-5.9)
HGB: 14.5 g/dL (13.5-17.7)
HCT: 42.2 % (40-53)
MCV: 94.1 fL (80-100)
MCH: 32.3 pg (26.3-33.8)
MCHC: 34.3 g/dL (31.5-36.3)
RDW: 12.9 % (11.5-14.5)
PLT: 212 10^9/L (140-444)
MPV: 8.1 fL (6.8-10.8)

Aug 2012 (on Axiron)

T: 312 ng/dL (286-1510)

WBC: 5.8 10^9/L (3.9-10.6)
RBC: 4.49 10^12/L (4.4-5.9)
HGB: 14.8 g/dL (13.5-17.7)
HCT: 42.3 % (40-53)
MCV: 94.4 fL (80-100)
MCH: 32.3 pg (26.3-33.8)
MCHC: 34.2 g/dL (31.5-36.3)
RDW: 12.9 % (11.5-14.5)
PLT: 201 10^9/L (140-444)
MPV: 7.8 fL (6.8-10.8)

*Dec 2012 (4wks on T cyp 200 mg/ml inj (quads), 1ml 1x/wk)

T: 890 ng/dL (286-1510)

Feb 2013 (on T cyp 200 mg/ml inj (quads), 1ml 1x/wk)

T: 934 ng/dL (286-1510)
ALT (SGPT): 29 (6-42)
AST (SGOT): 28 (11-39)
WBC: 9.0 10^9/L (3.9-10.6)
RBC: 4.49 10^12/L (4.4-5.9)
HGB: 16.0 g/dL (13.5-17.7)
HCT: 47.7 % (40-53)
MCV: 97.0 fL (80-100)
MCH: 32.5 pg (26.3-33.8)
MCHC: 33.5 g/dL (31.5-36.3)
RDW: 13.0 % (11.5-14.5)
PLT: 208 10^9/L (140-444)
MPV: 8.0 fL (6.8-10.8)
Neutrophils: 63.8 % (40-81)
Lymphocytes: 27.0 % (20-53)
Moncytes: 8 % (1-10)
Eosinophils: 0.8 % (0-6)
Basophils (0.4 % (0-2)
Neutrophils abs: 5.7 10^9/L (1.8-8)
Lymphocytes abs: 2.4 10^9/L (1-4.8)
Moncytes abs: .7 10^9/L (0-.8)
Eosinophils abs: .1 10^9/L (0-.5)
Basophils abs: 0 10^9/L (0-.2)

April 2013 (on T cyp 200 mg/ml inj (quads), 1ml 1x/wk)

T: 1065 ng/dL (302-903) - this was the same lab so not sure why range changed

-Paleo diet
-Workouts:3d/wk 1hr brisk walking, 2d/wk 20min body weight exercise, 1d/wk 1hr group bootcamp class
-no testes aches or fever
-Morning wood went from maybe sometimes to 99% of the time after t cyp injections

Your lab results heavily are a result of lab timing relative to last injection. So we need more info.

Recommend:

  • read advice for new guys sticky again with consideration of other issues
  • thyroid basics sticky, report iodine intake and oral body temperatures
    –inability to absorb transdermal T is a symptom of hypothyroidism
    – thyroid function can have many adverse effects, including inability to loose fat
    – we see a huge proportion of thyroid function here with TRT guys
  • vit-D3 10,000 iu/day for two weeks then 5,000
  • inject T twice per week, do labs 1/2 between injections
  • report blood pressure, your blood is thicker now
  • report cholesterol
  • get PSA baseline
  • sleep: 5mg time release melatonin
  • get E2 labs, make sure not total estrogens
    – E2 can have many adverse effects, including inability to loose weight.

Your initial labs should have included LH/FSH. Should have been doing some diagnostics to determine if low T was a symptom of something else that needed to be fixed.