T Nation

On TRT for 3 Months, Feeling Better


#1

About me:
-35 years old
-188 Lbs
-5 ft 7in
-BF (measured via tape test) : 22%

I went into my primary care doc back in November because I felt like crap for almost a year, had rapid weight gain after a came back from a deployment to Afghanistan (25 Lbs in 8 months), very irritable, no libido. Anyway she took a total and free T test and came back at 188 total (range 240-950) and free came back at 5 (range 4.6-18.1). After that she referred me to a urologist that tried me on Clomid at 50mg/day. After about day 4 of that I about had an emotional meltdown that then triggered a bit of anxiety, my guess was that my E2 was sky high. Came off the Clomid for a few days after that and the following week went to 25mg EOD and actually started feeling much better. I did not want to stay on Clomid long term and had too many disagreements with the urologist so found a doctor that does HRT and he got my full blood ran:

1/8/2018(while still on Clomid 25mg EOD)
CBC and CMP according to HRT doctor were great
Total T: 698 (range 264-916)
Free T: 19 (range 8.7-25.1)
DHT: 47 (range 30-85)
DHEA: 248 (range 102-416)
SHBG: 26 (range 16.5-55.9)
Cortisol: 11.9 (range 2.3-11.9, afternoon test)
TSH: 8.6 (range .45-4.5)
LH 4.3 (range 1.7-8.6)
IGF-1: 126 (range 88-246)
VitD: 43 (range 30-100)
Insulin: 8.6 (range 2.6-24.9)
Total Cholesterol: 200
VitB: 812 (range 232-1245)

So after meeting with the new HRT doctor he recommended that I come off the Clomid and start taking 50mg test Cyp every 3.5 days and 250IU HCG at the same time to keep my testes working somewhat. Took my first injection on 1/25 and felt great immediately, the minor aches I have had for a year disappeared and I just generally felt so much better and less irritable. My workout intensity skyrocketed and I finally felt like my old self again. As I was curious to keep track of my progress and correlate how I felt to my actual blood hormone levels I went in for blood a few times after starting injections:

1/29:
Total T: 1273 (range 264-916)
Free T: 32 (range 8.7-25.1)
Estradiol Sensitive: 45.4 (range 8-35)

2/12
Total Test: 894 (range 264-916)
Free Test: 35 (range 8.7-25.1)
Estradiol Sensitive: 51.8 (range 8-35)
TSH: 8.7 (range .45-4.5)
T4: 5 (range 4.5-12)
T3 Uptake: 30% (range 24-39%)
Free Thyroxine Index: 1.5 (range 1.2-4.9)

After the test on 2/12 doc wants me to move down to 35mg of test every 3.5 days which I just started. So fast forward to today (2/25). I feel like I am sliding backwards now. I am tired again, not as motivated, and generally feel like crap, and am more anxious. No libido still, feel bloated more, feel like I am probably retaining water. Gained anywhere from 4-6 lbs since starting TRT, feet and hands are a bit more swollen, especially after long walking or running, sensitive nipples. I suspect this high E2 is what is doing this but am also concerned with my thyroid levels. Read the stickies here and have been checking body temp, which in the AM has been 98.2 and goes up a little bit throughout the day so I am not overly concerned from the temp side, but don’t get why the TSH is so high. I feel like I should try a low dose AI so get the E2 back under control while also digging deeper into the thyroid levels. Think iodine can help get this straightened back out?

Think the new test dose will help bring the E2 down at all? I don’t really think it will which is why I tend to want to get on an AI. Before I reach back out to my doc figured to get a few opinions from those more experienced with this stuff. Since my free T is pretty high I am not sure if the high E2 is a direct result of that and maybe it really will lower due to lowering dosage??


#2

Thyroid is a mess, what are doctors waiting for? T4 is bottom of ranges, no fT3 tested. One can feel worse when thyroid is lagging behind as TRT attempts to restore metabolic rates thyroid can’t keep up making you feel worse.

TRT and HCG and no AI? Ridiculous! High E2 cause tons of water eight in the form of bloating and you body is hoarding water from high E2. Thyroid disorders are too complicated for most doctors, in range doesn’t mean you’re alright. No antibodies tested, why?


#3

Doc wanted to wait until I’m off the Clomid for a few weeks and I see him for my first follow up office visit to see if thyroid changes at all but said we will treat it if it doesn’t improve. It hasn’t improved so likely before my next visit will have a full panel taken to go over and see what we can figure out. Not sure how he feels about the AI but he mentioned early on we will monitor estradiol, I’m assuming he will script an AI if it doesn’t improve.


#4

Took blood again this week at my low point right prior to my next injection, here are the #s:

Testosterone F Eqlib+T LC/MS
-Testosterone total: 774 (range 264-916)
-Testosterone Free: 35.25 (range 5-21)
-%free testosterone: 4.55
-SHBG: 31.6 (range 16.5-55.9)
-Estradiol Sensitive: 35.5 (range 8-35)

Thyroid Panel:
TSH: 7.4 (range .450-4.5)
T4: 4.4 (range 4.5-12.0)
T3 Uptake: 28% (range 24-39)
Free Thyroxine Index: 1.2 (range 1.2-4.9)
T4 Free Direct: .81 (range .82-1.77)
Triiodothyronine (T3) free: 2.8 (range 2.0-4.4)
Reverse T3 Serum: 13.6 (range 9.2-24.1)
Thyroid Stim Immunoglobulin: <10 (range 0-.55)
Thyroglobulin Antibody: <1.0 (range 0-.9)
Thyroxine Binding Globulin: 12 (range 13-39)
Thyroid Peroxidase (TPO) Ab: 10 (range 0-34)

I find it interesting that with a total T at 1200, 900, and now 775 my free T has stayed right at 35 regardless. What are good free levels that balance the benefits while minimizing the downsides such as high E, water retention, etc? Looks like the reduction in my dose to 35mg/3.5 days and/or the 200mg/day of DIM, or most likely that i skipped my HCG injection last Thursday have helped to bring my estradiol down from 51 to 35 so that’s good news and a step in the right direction. Talked to my doc about my reaction to HCG and decided to let that wash out for a bit and see how I feel, I don’t really care about fertility or the risk of shrinkage at this point. On the days where I inject HCG I get I guess what most people call the “HCG rush” but for me it makes me very jittery/anxious and I don’t like it.

Probably the most bothersome symptoms right now are swollen feet, sensitive nipples, and the fact that my libido is still pretty low. I am on week 5 of test Cyp injections so I am really hoping its just the growing pains from going from free testosterone levels of a 90yr old to having free testosterone well into the high range for anyone, that’s a large increase and would assume the body will take time to adjust.

I am definitely no thyroid expert but the way I see my thyroid issues now is that I have low T3 because I have low T4 and this is because the thyroid simply cannot produce enough T4 for some reason. Reverse T3 does not appear to be a major concern as well as some of the other indicators. My body temps are still good, no issues heating up over 98.6. Does anyone with experience with this think an iodine trial might be worth it? I will probably go get an iodine blood test done soon to validate if I am indeed deficient before jumping into that.


#5

You have an update on your protocol?


#6

I do. Went down to 40mg test cyp and 125 IU HCG every 3.5 days, both injected subcultaneously in the abdomen. Take 100mg DIM 2x a day. Also am on Armour thyroid at 60mg every day. Have a follow up with my doc in a week and will discuss maybe trying some anastrozole if my E is elevated in the lab work.

Fixing the thyroid has had the greatest impact so far, energy is normal again and I am losing weight without any changes to diet, very glad for that because I couldn’t stop gaining no matter how much I worked out and I’ve always been pretty athletic and able to easily maintain weight.

If only the hand swelling would go away for good, it comes and goes and is an annoyance. Nipple sensitivity is gone, guess I’ll chalk that up to the body adjusting to TRT.

Should have my labs back tomorrow probably, will post when I get them.


#7

Got my Thyroid labs back and was surprised at how I have responded to 60mg (1 grain) of Armour over the past 4 weeks. Helps explain why I am not gaining weight now so easy and am actually losing it. Will get this panel redone in another month or two to see how it stabilizes over time.

TSH: 0.424 (.450-4.5)
T4: 5.8 (4.5-12)
T4, Free: 1.16 (.82-1.77)
Free T3: 3.3 (2.0-4.4)
Reverse T3: 15.3 (9.2-24.1)
TPO Ab: 15 (0-34)
Thyroglobulin Antibody: <1 (0-.9)

Also tested for heavy metals (lead, arsenic, and mercury) since I was in an area for a year that could have had me exposed to this, the tests came back good.


#8

Be careful with DIM. I kept my e2 way too low for way too long with that stuff.


#9

fT3 is best at mid-range. So you are good and that should support 98.6F mid-afternoon.

Could you have been iodine deficient from not using iodized salt? Only have seen a doctor ask about that once.
Thyroid enlarged?
Thyroid lumpy with nodules?
Outer eyebrows sparse?

You should try to get near E2=22pg/ml
Your lower T dose will not get you there.
Most need 1mg anastrozole per 100mg T. So .4mg anastrozole at time of injections. Dissolve anastrozole 1mg/ml in vodka and dispense by volume or by the drop. Dropper bottle suggested.

TRT with thyroid functions can make things worse, as you now know.

Your doc seems workable. Get the anastrozole and you will be in a better world.

Is fertility important? 250iu hCG subq EOD is a good dose, 250iu/week may not protect the testes.


#10

I have iodized salt in the house and we use it. Funny thing is when my thyroid was low I still could maintain a decent body temp, more so now though now that my ft3 is normal again. No eyebrow issues, thyroid enlargement or nodules.

Yeah will see how the e2 comes out in a day or so, will probably get him to get me some anastrozole if it’s still up a bit and use it little by little to get me where I need. Doc is very amendable and easy to work with (non-insurance doc of course so he can actually spend time on me). If e2 is high still and my t dropped due to the lower dose will move back to 100mg per week split twice and start the anastrozole until the e2 is under control.

Not worried about fertility at all, have 4 kids already and don’t want anymore. Taking little bit of HCG just to stave off atrophy.


#11

Testes don’t just atrophy. From my research only a small number of guys atrophy I think usually younger. If your e2 is good and free t is good balls will hang nice. Am just on t and I can say my balls just got slightly smaller and they usually hang. I only been in t for 6 months though.


#12

Yeah I was on the fence with the HCG but rather than chance atrophy I figured take it in low dose, plus will give me a little LH in my body since I won’t be producing it on my own.

Although my doc is non-insurance I still run my scripts through insurance so my HCG (pregnyl) is like $5/10,000 IU and my test cyp is $5/2000mg, both of which last me quite a while at the dose I take, and I don’t mind the extra inject, only takes me an extra minute.


#13

Good deal. I tried HCG from compound pharmacy and I did not like the way I felt. Had what appeared to be insomnia and high e2 symptoms. I stopped after 3 injections. I would try the commercial pregnyl though. But at this point it looks like I don’t need an AI and I def don’t want HCG if it forces me on ai.


#14

Updated Labs.

Surprised E is so low, will lay off the DIM some and see if it goes back up. Also SHBG went up, doctor wants me to go back to 100mg (50mg every 3.5 days) of test to bring the free T up.





#15

If you look up like 3 of 4 posts, you will see what I said a few days ago.

Dim can be dangerous for someone with higher SHBG. Your free e2 is already low, and you are drastically lowering it more.

I did this for over a year with DIM kept my e2 in the 17 range. Felt like shit, have lasting problems with my knees because of it. Stop the DIM.


#16

@alphagunner My SHBG was not high until the past few weeks and my E2 was a tad high until the past few weeks apparently. I’m off the dim and have some liquid anastrozole in case I wind up needing it later on if E2 gets high again. It’s all getting dialed in finally and I feel great now. Libido could go up some, likely will see the difference once the E2 goes back up a bit. There was a 1-2 week window where libido was great, my guess is then E2 went down to 10 and killed it.

Will probably get T, E, and SHBG labs done in 2-3 weeks and go from there.


#17

Updated the title of this thread :slightly_smiling_face:


#18

High E2 influences SHBG to climb.


#19

So my SHBG was low when my E2 was high. Now it’s the opposite. Hypothyroid is also known to cause low E, since that is fixed could be why it went up.