I have been lurking on this forum as well as others over the last couple of weeks to try to get answers to my situation. I have read through many of the stickies on this site, and have acquired a couple of books on TRT. In short, I have attempted to figure out how to handle my situation but have not found the answers I have been looking for. Sorry in advance for the long post, I just want to try to give a full picture of my situation.
I am 41, 6'0 and 162#. Over the last 2-3 years I have noticed increasing tiredness, loss of libido, mental "fog", poor memory, general slight "grey" mood, and some ED. Last January, I went to see my primary care physician (Internal Medicine) to see if I could find an explanation. I suspected thyroid, vitamin D levels, or testosterone insufficiency. He ran a full panel for liver, thyroid, vit D, chemistry, and CBC. TT was found to be ~530, vit D levels on the lowest end of normal, all liver/thyroid/chemistry normal. Sorry for the lack of values, but nothing was out of the ordinary. He said testosterone wasn't the problem. I did start taking vitamin D supplements in addition to my MVI and fish oil in hopes that it would improve things. I also decided to "get off the sofa", since I hadn't found any real culprit. At the time, I had not started to experience any real ED, just a lack of morning wood. I had spent most of my 30s not getting any exercise at all, so I thought that being more active would probably solve the problems. I started running last spring, and have since completed many races of varying distances up to 1/2 marathons. Over the last year that I have been running, I haven't noticed any improvements in my symptoms....they actually worsened. I could never seem to get enough sleep, and was exhausted throughout the day and started using caffeine as a crutch ( Im not overtraining). I would take naps after work several days per week, and weekend naps were a regularity. My ED also got markedly worse, with a lot of "half staff" or worse. I have let all my hobbies fall by the wayside, and really just want to go home and stay home when given the opportunity. I would not call myself "depressed", but I don't have the zest for activities that I used to have.
Fast forward to January 2013:
After the increasing symptoms over the last year despite regular exercise and taking care of myself, I became determined to find the cause of my problem which I suspected was low T based on all of my symptoms. On a Monday I found a testosterone clinic a few minutes from my house, and in a spur of the moment decision decided to go in to get evaluated. After talking with the nurse staffing the clinic and explaining that I had not tested "low" a year earlier, he decided to draw a SHBG level as well as TT and PSA. He also went ahead and gave me 160mg Test Cyp in anticipation that that was the most likely problem (and wouldn't hurt). My results came back the next day as TT 691 (348-1197), SHBG 61.8 (16.5-55.9), Hgb 15.1, free T 10.1. In talking with the RN about the results, he said that the consulting physician for the clinic felt that in absence of any other problems that the high SHBG was likely genetic. It concerned me, so I made an appt for my yearly physical to try to eliminate other causes. ( I had a MRI of the brain last spring r/t headaches that was normal). Two days after the Test Cyp injection, I had my first morning wood in recent memory. This continued for the rest of the week, as my energy and libido also improved. Voila!
My second injection (160mg) was one week later the next Monday. Over the course of that second week, libido was still good, less frequent morning wood, and energy levels were lower. I wasn't taking naps, but did feel a lot more tired than the week prior. The next Monday for injection #3, I talked with the RN about the course of the previous week and he thought it might be related to E2 conversion. He sent me home with Anastrozole 1mg cut in half and instructed me to take half the tablet every 3 days if the tiredness continued/got worse or if I had any high E2 symptoms. On Wednesday, my nipples started "burning" continuously over the course of the day. I took the 0.5mg Anastrozole to see if it helped. By Thursday (this week), no more nipple problems and slightly? increased energy. By Friday, my energy levels were significantly better and I had awakened overnight twice with morning wood. Great, i'm thinking, now I have to take an ADDITIONAL drug to combat that problem. It's now Sunday, libido is low, energy not the best. I feel a bit like I'm going down the rabbit hole, so to speak. I have been very healthy my whole life, and don't really like to take medications.....looking at the side effects of AI therapy isn't comforting. I got my lab work back on Friday from my physical: thyroid panel and liver panel normal, TT 1029 (3 days post injection), all other labs in normal range, cholesterol 178.
So on to my questions:
Assuming my high SHBG is genetic and all other things are in check, is TRT my best option? I have always been slim and found it difficult to gain any significant muscle. I always ended up small/modest increases but more toned. Possibly this was related to low free T?
If my SHBG was related to high E2 from the start, what are the odds that I didn't have any obvious physical appearance symptoms?
They are going to draw an E2 level on Monday when I return for my next injection. I realize this will give my current level based on TRT so far including conversion, but I am concerned that I didn't know what my baseline was before TRT. I guess I will never know if E2 might have been my only problem? Should I have them discontinue TRT, restart my natual system with HCG and allow things to stabilize to get a full baseline endocrine profile?
If I have to continue TRT, I would love to avoid the use of an AI if possible. My body fat is under 10%. I have read of other individuals that have been able to get by without an AI by going to a more frequent dosing schedule of testosterone, E2d or E3d to avoid the peaks/troughs. I talked to a Urologist I work with that would be willing to let me self inject and follow my labs every 3 months. He does TRT, but is not a specialty for him. My goal is to figure out how to manage this myself in as physiologically a manner as possible, so I really want to get away from the weekly dose. I plan to use insulin syringes to minimize muscle damage from the more frequent injections.
I'm not sure how I feel about the addition of HCG. I had a vasectomy, so kids are not an option. I don't mind a little atrophy as long as it is not excessive. I am more concerned about an increase in aromatization leading to the necessity of Anastrozole. Is it absolutely necessary?
Any help would be appreciated, thanks in advance.
The reason I did not originally post lab results was that I did not actually have them in hand at the time. I had them faxed to me this afternoon:
Hgb 15.5 (12.9-16.5)
Hct 47.7 (36-51)
Plt 208 (131-435)
Wbc 5.3 (3.7-10.1)
Albumin 4.4 (3.5-5)
Alb/Globulin ratio 1.9 (1.0-2.1)
Alk phos 76 (40-150)
BUN 16.7 (8.4-25.7)
BUN/Cr ratio 16.5 (6-22)
Calcium 9.5 (8.2-10.8)
Cl 103 (95-113)
CO2 26 (22-31)
Cr 1.01 (0.72-1.25)
eGFR calculated 8 (>60 ml/min/1.73 msq)
Globulin 2.3 (2.2-3.9)
Glucose 77 (70-99)
Potassium 4.1 (3.5-5.3)
SGOT /AST 23 (5-41)
SGPT / ALT 26 (6-55)
Sodium 140 (136-145)
Total bili 1.062 (0.200-1.200) mg/dl)
Total protein 6.7 (6.4-8.3 g/dl)
Cholesterol 178 (50-199)
HDL 51 (>39)
LDL calculated 117 (0-130)
Triglycerides 51 (25-149)
VLDL 10.2 (0.0-40)
Chol / HDL ratio 3.5 (1-4.5)
Testosterone (total) 1064 (3 days post injection 160 mg Test Cyp)
Total PSA 0.9 (0.0-4.0)
TSH 0.34 (0.35-4.94 uIU/L) In January 2012 this was 1.214 (0.35-5.5)
25OH VIT D 35 (32-100) ----This result from Jan 2012, and is the latest I have