Opinions on TRT

Ok, I’ve lurked here long enough. I’ve been on TRT for a year now. Diagnosed July 2011 with a macro prolactinoma. Probably had the damn thing for over 10 years before I finally found it. Started TRT with the patch, but made me slightly suicidal for some reason? Changed to androgel 1.62 at 2 pumps a day. I was transitioning to a different region, and after my test came back at 330, I upped myself to 3 pumps. Next test came back even lower at 301, although the test was done later in the day.

On the next test, I probably had around 3.5 pumps on that day. I was at the end of a bottle and the pumps come out at half pumps so I’m estimating it was 3.5. That test came back at 755. We decided to give Testopel a try so I didn’t have to deal with the hassle of putting on the gel, waiting 2 hours before physical activity, you guys know the drill, and my Doc started me on 12 pellets. He said that’s the “standard amount”. The next week was hell on me;couldn’t sleep, ZERO focus, and I was in the middle of a training exercise. I added one pump of androgel to help me get though it.

When I got back I had my blood tested again, which came back at 584. We have tried everything, and I’m definitely thinking that the injections are the way to go for me. I have recently started on HCG 250 iu 2x/wk as well. I noticed on my last test my estrogen levels were a little higher than the upper limit.

I have added a picture of all the pertinent blood results throughout the course of my treatment. I have learned a lot of information from this website and would like to know your opinions on my situation.

Have you read the advice for new guys sticky? There are implications for those who do not respond well to transdermal T. Come back with more data, age, weight etc.

Nice presentation!

Your E2 is around twice what we suggest. Can you get Rx for Arimidex/anastrozole?

No need to test total estrogens or estrone.

fT is very spiky with transdermals, so the number is hard to use.

Injections: Please read the sticky.

KSman, I have found the “stickies”

-age- 30
-height- 6’1"
-waist- 36"
-weight- 211 (I reached 239 before I was diagnosed with secondary hypogonadism)
-describe body and facial hair- drastic improvement since beginning TRT
-describe where you carry fat and how changed- abdominal, although much less since beginning TRT
-health conditions, symptoms [history]- prolactinoma, probably 10+ yrs

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever- cabergoline, testopel, androgel
-lab results with ranges- included above
-describe diet [some create substantial damage with starvation diets]- moderately healthy, although I fall off the wagon from time to time
-describe training [some ruin there hormones by over training]- I train hard. around 1.3 hrs a day 4-5 days a week plus cardio 3x wk

-testes ache, ever, with a fever?- not since starting HCG!
-how have morning wood and nocturnal erections changed- after 10 years of not having them at all, I have them now. Quite strong.
-haven’t tested BF recently, but I would say I’m between 15-17% at the moment

I also want to answer a couple of comments you added to your blood work sticky

-Brain fog, no one knows what that means but everyone knows if they have it!- Yep! and my memory lasts about 2.4 seconds
-On TRT and still do not feel right, something else is wrong.- I’ve come a very long way in the past year, but I know something still isn’t right. I just don’t “feel well”, or even good for that matter.

-I still wake up every morning exhausted as though I barely slept. Before TRT, I would wake up several times at night, and I had to be up at 445 am during the week, so it made since that I was tired when I woke up. Now, I sleep through the night most times, and STILL wake up exhausted. I’m married, so I know my wife would notice if I was experiencing sleep apnea. Also, with the 30 lbs I’ve lost in the past year, if I DID have sleep apnea, it should at least be better than before.

I attempted to get an AI last time I was at the doctor. He is a general practitioner who has recently gotten into the TRT world. After all the research I was the one who suggested HCG. He is a family friend so he abided. I mentioned the AI, although at the time I wasn’t entirely sure why I needed it. He said you need estrogen. I didn’t know enough to argue the point. I was even the one who finally suggested to test E2 levels. I’ve seen two endos and now him, and not one has been as knowledgeable on TRT as I would’ve liked in the beginning.

It’s been a pretty tough road, and had several ups and downs. Every time I have switched delivery methods, we always start again at the bottom, then work our way back up. This is obviously the safe route to take, but given my diminished response to every other delivery method, I’m thinking about requesting to start on 150 mg test. cyp/week, injecting using the 84 hours protocol. Logically, to me, that seems like you could completely avoid the troughs and peaks.

I’ll attempt to request adex another time. If that doesn’t work, I’ll try and find some on the dark side.

Here’s a before and after pic so you can see just how far I’ve come in the past year. In the past year, the diet has improved somewhat. The amount of training is somewhat more than before. Mostly because I do have more energy to work out. Also, I used to suffer shin pain and back problems almost constantly. They are both still around, but seem to be less and less as time goes on.

That being said, I feel like I owe most of these results to TRT and not to my own hard work and dedication.

The T pellets are still then and will release T for a long time at diminishing levels. You will be lifting the changing T pellet levels with injections. You will need to inject smaller amounts of T then increase the dose as the pellets are consumed. That will be a PIA. Or remove the pellets.

How much to inject? (1100-TT)/1100) * 125mg T cyp per week. You can assume that the pellets are gone in 6 months and increase the dose linearly. Can you do the math?

Yes you need estrogen, optimally you want E2=22pg/ml. You doc needs to consider modulation and right now all he sees is elimination. Your E2=43 will not allow you to get lean. You need 1.0mg anastrozole per week. That is 1/7th of the dose used to kill E2 levels for estrogen positive cancers. You need to sell your case.

Sleep: Try 5mg TIME RELEASE melatonin. If that is not a solution, ask for Rx trazodone 150mg. Start with 25mg, then expect to progress to 50mg in a few weeks. This generic is inexpensive and effective.

What time of day cortisol=7.14? Too low if 8AM!

Check your body temperatures.

The pellets were inserted at the beginning of August. They have significantly reduced in size. I can barely feel them now. I will not be getting them again because 1) I experienced a very large and painful hematoma as a result, and 2) this just seems like a very poor method of testosterone delivery. An arbitrary amount of pellets are inserted, only to have T levels slowly decline over the next few months. Also, every time that area was hit with something, it caused them to swell up for a couple of days.

I understand the math with this will be tricky until the pellets are entirely gone. But, having lived with little testosterone for so long, I would rather do the math to keep it up instead of waiting for them to completely deplete.

I have requested anastrozole once again. He is a GP and doesn’t know all the ends and outs of TRT yet. I’m thinking my perseverance on the topic may actually benefit him as well.

The cortisol test was done at 8am. I have run a temp around 97.2 for as long as I can remember. I haven’t thought anything about it, but since you brought it up, why is that an issue? I noticed that I had started cabergoline just prior to the test, and that it dropped to half the original amount. Could that cause it? I haven’t had cortisol tested since then.

I’m open to any and all suggestions/comments/theories.

Not sure about the issue. But this addresses the concern - Recovery of growth hormone secretion following cabergoline treatment of macroprolactinomas - PubMed

Body temperature: This is often a degree of hypothyroidism. Body temperature is largely controlled by thyroid hormone levels, mostly fT3. But, even if rT3 is mid range, considered optimal, temperatures can be low. That can happen when rT3 blocks fT3. Starvation, stress, adrenal fatigue can increase rT3.

Read the advice for new guys sticky and note the first statement. Note issues: iodized salt, sea salt, iodine, body temperature etc.

Context of iodine: KSMan? - Testosterone Replacement - Forums - T Nation

Ok. I ordered some 12.5 mg iodoral to give that a shot. If I get the E2 levels optimal, and I’m still having problems, I’ll get a thyroid panel to see where it’s at. As for the article you sent me, my IGF-1 (somatomedin) was at 203 (range: 63-373) prior to starting TRT.

I do have one other question for you. If you can refer me to another post, that’s totally fine. What benefits can I expect if I get my E2 levels within the recommended range? I mean, obviously the freed testosterone is a positive, but what is the difference of having a free test level of 150 and E2 at 50, and a free test level of 150 and E2 level of 25?

It’s ok if you have to break this down Barney style and talk to me like a small child. I’m here to learn. I will harbor no ill will towards you.

EDIT: I think I need to expound upon my question. I guess what I’m really asking is, since I can assume that I have been experiencing the side effects of elevated E2 levels for years, what can I expect as far as positive benefits from having optimal E2 levels?

Cabergoline can improve IGF-1, get that retested at some point. IGF-1=203 is decent, but higher would be good. Caber also increases dopamine and that can resolve mood and libido problems. But E2 can be a wet blanket.

I was on TRT for 6 months and I had brain fog, libido and performance problems, was short tempered, loud noises were intolerable. With anastrozole I was transformed in two weeks. My libido came back very strong. I actually used the words reborn.

Everyone is different and you will have to read your own book. Your response depends on sleep, diet, nutrition and many things that will not be evident. Your quality of life [QOL] and libido are all in your head. Take thinks that are good for the nervous system, vitamins, fish oil, anti-oxidants etc.

Did you read the protocol for injections sticky?

Aim for TT=900-1000, hCG can contribute to that number.


Standard recommendation: T+hCG+AI
100mg/week T ester [eth or cyp] injected in at least two doses per week
250iu hCG injected SC EOD
1.0mg anastrozole per week in divided doses

Based on your body weight, you could scale up T, 125mg might work, if you do that, you may have to go to 1.25mg anastrozole, but start with 1.0 and you can correct after lab work for E2. Scaling T with fat does not work.

If free test=150 [quest’s numbers] difference in quality of life for E2=50 VS E2=22 could be HUGE! Superman VS suicidal.

Older guys often need higher T to get benefits, at your age, 30, you should not need that to feel great, have high libido, loose fat, increase energy. Aiming for high T levels may not be wise, you need to reserve some headroom that you will need in 20-30 years when your receptors or whatever are not right.

I’ve read a few times (many from you, KSman) that dosage of AI is upped when dosage of T is upped. So, if the standard is 100 mg test cyp/eth, and the standard for that dosage is 1 mg arimidex, wouldn’t it make more sense to begin at 1.25 mg if you begin T at 125 mg? Scaling back after blood work?

I have read the injections sticky. I have also changed my hCG to EOD. I was on 84 hr protocol, but was consistently noticing the testicle tension on the third day after injection.

I don’t understand one thing. On this forum the general consensus is to take T/hCG/AI together EOD. THAT makes sense to me, but in John Crisler’s hCG protocol update, he has his patients take weekly T injections, with hCG being pinned two days before and one day before T injection. What are you thoughts on this? Like I said, EOD makes far more sense to me given the half-life/active lives, but why does someone with so much experience recommend this protocol instead? If TRT suppresses HPTA, and hCG activates the testes, why would this protocol be effective?

Yes to 1.25 anastrozole, if you get to TT=1000, otherwise may be too much and we do not know if you are an over-responder. I did suggest 1.25 above, with qualifications.

Crisler has guys doing it both ways. Much of his material is old. And may not be a good idea to scare prospects with injecting every other day. Many are needle phobic.

Do not understand: " If TRT suppresses HPTA, and hCG activates the testes, why would this protocol be effective? "

It seems to me that since hCG has such a short active life, pinning twice a week on consecutive days would not produce the positive benefits of using it in the first place.

So, if T shuts down the testes, and you use hCG to activate them, why would you pin using this protocol?

I’m only asking because I’m curious and would like to compare the different approaches to TRT. As I said before, the protocol you and others on this forum recommend makes more sense to me. At the end of the day, I’m the one who needs to feel comfortable with what I’m doing to my body.

You do have this understood!

KSman, could you elaborate on this statement?

I had ‘estrogen poisoning’. I had E2=37pg/ml and TT around 900 [can’t remember exactly after 6 years]. I was miserable and made those around me the same. After two weeks on anastrozole, I started to see what was wrong and apologized to others for the way that I had been. There are others who have had the same problems with E2. And my sex drive increased a lot; as E2 was causing libido problems.

Males and females are different. T levels in the womb start to ‘prune out’ part of the brain circuits that are retained in females. This accounts for females been more socially integrated, connected, caring, verbal, empathetic and nurturing. During adolescence, males have even more of these circuits pruned out, with difficult adjustment periods. When T levels drop and E levels increase in males, the effects on the brain can be quite unpleasant. The term “grump old men” does seem to reflect that. One way that I characterize this is that the brain is functionally confused and that greats frustration and intolerance of situations that increase the ‘confusion’. Now, nothing gets under my skin, I am not very emotional. One way that I characterized this was that I was more analytical. That may seem strange, but after-all, I am an engineer!

Speaking or roid rage. As JS pointed out, the bad behavior exhibited by some body builders and ‘steroid users’ may be from the effects of estrogens. Many of the bro-science crowd do not use AI’s because they do not have gyno.

If anyone is interested: There are two books by Louann Brizendine. The titles are ‘The Male Brain’ and 'The Female Brain". These books explore the effects of hormones and the differing roles and responses to neural transmitters and she goes on to explain how these effect behaviors and extremes of behaviors. I have an interesting book shelf.

If I’m completely honest with myself, I think I’m hoping that lowering my E2 with resolve some problems that TRT has yet to fix. Prolactinomas are extremely insidious. They work so slow you don’t even know there’s a problem. Then one day you start to notice that things are just “different”. You even make excuses and blame it on aging. Anyway, you really start to see how bad it had gotten once things start to improve. Then, your eyes are opened as to all the things that are going wrong.

Probably my most hated symptom of this whole ordeal has been the lack of energy. This is the biggest thing that TRT has failed to regulate. I am happy when I have energy. I am not much fun to be around when I have none. I still to this day feel, what I can only describe as hypoglycemic later in the day (around 1 pm on). I’m not sure exactly what you would call it. I’m pretty certain that it has to do with blood sugars, though. Really the only symptoms I can think of is fatigue and my eyes are difficult to fully open, as odd as that sounds.

All that being said, I’ll find out the results of my last blood test next week. E2 should have been tested as well. Regardless, last time they were tested they came back 584/43. You said yours was 900/37. Do any of these symptoms sound familiar to you?

I think that dopamine is still a possibility for you. Dopamine levels drop with increasing prolactin. Depression can result. You may have some ongoing patterns from the prolactin/dopamine imbalance. I would like to see you looking into increasing dopamine. I have written about this recently in some other post.

I use small amounts of caber, trazodone, seleginine and wellbutrin. As they are all doing the same thing, the amounts are small. Wellburtin does increase energy.

How did you get to the bottom of your rabbit hole? I ask because, every time I go see my Doc and ask for something else, I feel like I’m on a never-ending quest. How did you come to take both seleginine AND wellbutrin? Did you have to do all the leg work? Did it take years to get everything all dialed in? How about now? Can you honestly say “I feel fu@$ing GREAT!”? If yes, how long did it take to reach that?

I apologize for all the questions. Facts are great. For me, hearing from someone who has been there and some of their experiences is the best. You’ve obviously traveled this road before. Probably alone, even.

The next blood test I get I’ll throw dopamine in there to see what’s going on.

I feel a lot better, but I do not always feel dialed in.

I had a brain-med practitioner suggest trazodone for sleep, knowing that it can help with mood. And Wellbutrin. T talk to my age management doc about how that was working, dopamine etc. He was interesting. I explained my readings on seleginine and from a functional medicine point of view, he thought that it made a lot of sense. And it has the added benefit of action over a week for a single dose [ditto cabergoline]. Caber I obtained my self as the costs a Rx were way too much for my linking. I have a high deductible plan and pay for everything myself.

Wellbutrin and caber increase dopamine production. Cabergoline reduces inhibits the enzyme breakdown of dopamine. So I can use less wellbutrin and thus have less of its stimulant effects. I may be the only person on the planet doing this and I don’t have much of an expectation that others will be able to. My seleginine is Rx. However, that and caber are also research chems.

SSRI’s are really not a solution and killing one’s libido, or what remains, will really make one depressed.