T Nation

PitchBlackProgress TRT journal

Edit: this topic was made to receive advices on my TRT. I will now use it as a journal to write down my protocol, changes, results, labs and everything in between. I welcome any advice, criticism, discussion.

Hello everyone. I’m going to try to be as exhaustive as I can.

I’m a male, 33 years old. I’ve had all the symptoms of low T since I was 12 years old. Depression, no energy, no strength, no muscle mass, low confidence, you name it. Been through major depressive disorder and tried to off myself twice before 30. Spent the most part of my twenties in therapy, and taking ssris and snris. I’ve been off meds since my 30s.

I’ve been lifting for about 4-5 years seriously but seen slow result, which made me question my hormones. Lo and behold, here are the results:

  • T total 5.40 (2.49 - 8.36)
  • T free 7.3 (8.3 - 40.1)
  • estradiol 27 (9 - 62)
  • shbg 42.40 (18.3 - 54.1)
  • free t3 2.97 (2 - 4.40)
  • free t4 1.51 (0.93 - 1.70)
  • TSH 0.5 (0.27 - 4.20)
  • IGF1 216 (111 - 244)

I have a lot more values, not sure if they’re useful. This was the blood test before starting TRT.
Now, my doc diagnosed me with hypogonadotropic hypogonadism and started me on TRT.
He prescribed me Androgel, 3 pumps a day. I did that for one week, but had really bad itching, so he switched me to IM test E 250mg / 3 weeks.

I did the first (and so far only) injection on April 4th. Didn’t feel much, but 3-4 days after I became borderline suicidal, depressed and crying, and it lasted for about 5 days. Was back to normal around 10 days after the shot.

I suspected e2 so I went back for another blood work on April 18th (2 weeks precisely after the shot). Here are the results:

  • T total 5.51 (2.49 - 8.36)
  • T free 7.9 (8.3 - 40.1)
  • estradiol 15 (9 - 62) <- that shit halved
  • free t3 2.95 (2 - 4.40)
  • free t4 1.44 (0.93 - 1.70)
  • TSH 0.95 (0.27 - 4.20)

Now I have an issue with several things. First of all, my doc didn’t ask me to check estradiol, I took the liberty to do it. It strikes me as a bit odd to get someone to inject testosterone and not even check for e2. Then, I got back to the doc, told him about the symptoms, not to mention labs being even worse 2 weeks after the shot, but he thinks it’s fine and I should keep the current protocol, which is 250mg every three weeks.

I’m also in Europe (France to be precise), TRT is way less mainstream and docs are less informed (but at least it’s free hey). I’ve read a lot about injecting lower dosage sub-q, like 50mg every 3.5 days or something. But I do not want to act recklessly and inject myself disregarding what my doctor prescribed me, but I’m so far not satisfied with the results whatsoever. I’m due the next 250mg shot tomorrow and I don’t want to have this emotional rollercoaster again.

You guys are most likely more experienced than my doctor, so how should I proceed ? Ask for a second professional opinion ? Keep the current protocol for a while and see if it improves ? Switch to weekly or every half week injections ? I also need to add that I have nurses doing the shots for me, and it will be hard to get them to disregard the standard 250mg IM protocol, so I’ll most likely have to do the shots myself. Which it’s really scaring the shit out of me.

Every 2 weeks makes zero sense, it isn’t even the original guideline for the product. The half-life is 3.5=4.5 days, the effective life is 7-9 days. Your pre-TRT labs are almost the same as your on TRT numbers. Get a different doctor.

What happened is that your body’s own test shut off, hence your lower results after only 2 weeks.

You’ll likely need more test and a less frequent protocol. At least shoot for once a week. He may go to once every other week, and try that too while you work your way to more frequent.

My pretty sttrong guess is that your endogenous test shut off, hence feeling worse.

E2 spiked with test levels, suppressed natural production, and voila. Your labs are pretty much exactly what would be expected from one shot 2 weeks ago.

So basically spacing the shots by 3 weeks as prescribed is absolutely insane, just as I suspected.

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yes.

It’s a HORRIBLE protocol… especially at that amount.

Try to get him to let you try like 100-150mg a week.

Your pre-TRT labs mirror your labs on TRT and your doc is ok with it, unbelievable! You actually had healthy estrogen pre-TRT, so if anything your pre-TRT was better. Long term an E2 level at 15 you are looking at osteoporosis.

You are likely only in the therapeutic ranges for a couple of days after your injection, you need to be in the therapeutic ranges all of the time to benefit from TRT. Your doc is useless for TRT.

The clinical study below is ammo to convince your doc he is derailing your treatment and recovery. If he doesn’t listen to reason, find another doc.

–> Hormone profiles after intramuscular injection of testosterone enanthate in patients with hypogonadism

Short version->

In fact, the present study confirmed serum levels of T which were lower than pre-ART value levels on day 14 after administration. Therefore the further decrease in serum T levels on day 14 after administration is considered to relapse of hypogonadal symptoms and to reduce the patients quality of life.

This is how often you should inject T, once weekly won’t cut it. I think you’ll need more T than average to maintain good levels and feel good.

I’ll bet your nurses are using mini-harpoons on your butt, insulin syringes aren’t very scary.

Thanks for the study, just read it. Indeed it does show that serum and free T are lower 14 days after injection, but that’s with a posology of 125mg.

I had an appointment with a second doctor this morning. For him, I’m perfectly normal, I don’t need any treatment. He told me free testosterone is basically useless on order to diagnose low T. That’s the kind of bullshit I’m dealing with here in France.

Depression, no morning wood, no muscle, no libido, no confidence, no drive, social anxiety and the energy levels of a 60 years old. Can all of that really be my natural state? I find it hard to believe.

None of that is acceptable, for a 60 y/o and especially for a 33 y/o. You’re a victim of mainstream medicine’s approach to TRT. If I am you, I wouldn’t take anything less than 150mg a week and be open to taking more. Divide it however works best for you, but do not go any longer than seven days between injections.

Alright so I’ve managed to pin myself, which is great because now I can actually change the dosage and see what works best for me without depending on a nurse or my prescription.

I’m going for 62.5mg every 3.5days, aka 500mg per month. It sounds quite conservative and I’ll increase in case I don’t notice any benefit. I’ll have to get my doc to prescribe me more but I’ll work on that.

I went to get a 3rd opinion, same as the last one. “free T is a useless metric, estradiol is useless, you’re perfectly normal, you don’t need testosterone”. There is no working with these French doctors, they just can’t accept their knowledge is outdated or non-existent in the first place.

Going to have to take matters into my own hands. I want to get another blood work in about a month. What are the crucial hormones and readings I need to check? I’ve heard free t3 and t4 are important, I also heard about reverse. I would like to check as much as I can, also vitamins and stuff. Is there a list somewhere about what to check and why?

TRT may not fix all your problems, but it may make it easier to cope.

If the Free T is the direct immunoassay, than yes its pretty useless, but if using the equilibrium dialysis or ultrafiltration, then Free T levels are useful. I don’t agree with estrogen is useless, your doc probably is still in the belief estrogen is a female hormone and men don’t have estrogen.

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total testosterone
free testosterone
estradiol
TSH
fT3
fT4
prolactin
IGF-1
DHEA-S
SHBG
VitD

My free T levels have indeed been tested by the RIA method. Does that mean my diagnostic is bogus? Doc pretty much diagnosed me based on that criteria alone.

It’s a tough call to diagnose low-T by looking at labs alone, look at how you have so many docs coming to different conclusions, you can have a guy with a levels below range and feeling perfectly fine with no symptoms.

Then you can have a guy with testosterone closer to mid range or higher with symptoms and once TRT is initiated symptoms are gone.

You never posted your LH and FSH.

Ah yes my bad.
LH 2.4 (1.7-8.6)
FSH 2.2 (1.5-12.4)

Pinned 62.5mg on Thursday morning, and again yesterday (sun) evening. I feel completely shit. Super depressed, tired and no energy. It’s really weird.

The majority of secondary diagnosis have an LH <3, FSH is useful as well and having it low is confirmation.

Pinned Thursday morning, the next morning felt like absolute garbage again for a few hours, then it got a bit better. My life is also pretty shit right now so that might not help. I’m going to stick to the 62.5mg E3.5D plan until end of May, and get another lab.

What is the general consensus regarding fasting? Several people have advised me to drop intermittent fasting, which I’ve been doing for 3 years, in order to reduce my SHBG. I’ve been on IF for so long that I can’t really remember life before, but I think it did help a lot with hunger control, so not sure I’d be keen on ditching it.

May 31st.
On TRT for: 8 weeks
Protocol: 62.5mg E3.5D (125mg weekly) SQ, 5mg cialis
Protocol since: May 3rd
Protocol for: 4 weeks
Overall well-being: 3
Energy: 3
Libido: 2
Sleep: 4
Side effects: Headaches, cramps

Doctor added daily 5mg cialis to help with loss of libido. After 4 days of use, seems to be causing headaches and cramps. Will continue for a week and stop if side effects persist. Libido hasn’t been affected, but erections are of better quality, and morning wood is back. Mood swings are still occurring, albeit less frequently, for shorter periods of time, but with the same intensity.

Cialis doesn’t do anything for libido. If you have low libido because of performance anxiety I suppose it could help but by itself does nothing for libido. Maybe break it in half and take 2.5mg per day if 5mg is giving you sides.