T Nation

Ronin48's TRT Thread


#1

Age: 43
Height: 5ft 8in
Waist: 38in (at the navel)
Weight: 197 (and dropping, was 215 in April, got down to 188, fattened back up to 204)
Hair: Some MPB that has been occurring over the last 15 years (slowly) small bald spot in back and some ‘horseshoe’ thinning in the front, full beard, ‘normal body hair’ sparse on back)
Fat: Gut and developing moobs (!). When I was much fatter – face, neck, and chin as well.
Health: Generally good, high cholesterol in the past
Drugs: No current Rx, statin in the past for cholesterol - 7 years ago (I did not do well on that - fatigue and muscle pain - bailed on the drug and got in much better shape)

Lab results: (not sure if I should list everything - let me know and I will update)
Glucose: 83 (65-99 mg/dL)
Carbon Dioxide: 18 (LOW) (19-30 mmol/L) *listed because Low
AST: 28 (10-40 U/L)
ALT: 44 (9-46 U/L)
TSH: 4.57 (HIGH) (0.40-4.50 mIU/L)
T4, Free: 1.2 (0.8-1.8 ng/dL)
T3, Free: 3.0 (2.3-4.2 pg/mL)
White Blood Cell Count: 7.3 (3.8-10.8 Thousand/uL)
Red Blood Cell Count: 4.92 (4.20-5.80 Thousand/uL)
Hemoglobin: 15.3 (13.2-17.1 g/dL
Hematocrit: 46.1 (38.5-50.0%)
MCV: 93.7 (80.0-100.0 fL)
MCH: 31.1 (27.0-33.0 pg)
MCHC: 33.3 (32.0-36.0 g/dL)
Total Testosterone: 418 (250-827 ng/dL)
Estradiol: 33 (<=39 pg/mL)
PSA: 0.4 (<=4.0 ng/mL)

*Unfortunately, my blood panel did not include FT, LH/FSH (unless listed under a different name), or Cholesterol.

Diet: 183g P, 200g C, 80g F (2252 cal), mostly clean eating now based on IIFIYM. Losing 2 lbs/week for the last 2 weeks. As an aside, I also checked nutrients and I am low on Pantothenate (B5) and K2. I am now taking a liquid multi, zinc, and magnesium.

Training: Jiu Jitsu 2-3x/week, Weights 3-4x/week (just started back in the gym), goal is to be <180lbs (so I’m not looking to get huge - beach body would be just fine - no moobs, no gut!)

No issues with testes or sexual function. Morning Wood and Nocturnal erections very regular, but not daily.

Concerned about the TSH being high despite the T3 and T4 being in range. Not sure that I understood everything in the Thyroid Basics thread and how it would apply to my situation. Of the listed symptoms (Dry skin, Brittle nails, Low body temperatures, General hair loss [not MPB], Thinning of outer eyebrows, Hormone problems, Brain fog, Low energy) only Brain fog and low energy (at times) applies to me.

[b]I still need to check my AM Temperature[/b]

Started TRT via pellets today. T + AI pellets (plus a T-shot for the road).

I get that 2x/weekly injections are the golden standard, but I was more comfortable starting with pellets (and I want nothing to do with orals, gels, creams, or patches). This is my first foray into TRT and may move to SC in the future.

[b]Question:[/b] Should I look to start supplementing with ZMA, DIM, D-Glucarate, Grapeseed extract, and Rez-V now, or should I wait for my next blood test in 45 days so that I don’t throw of the results of what has been implanted? (Assuming no bad effects between now and then.) Looking to get my T > 650 and E2 < 25

[b]Question:[/b] I held off on getting hCG injection at the time of the implant (but can go back any time). Was that a mistake? Do I need to see where I am first in 45-days or should I have just gone forward with it.

[b]Question:[/b] Are there specific test name(s) that I should be asking for to get the additional needed data?

Sorry for the noob questions, but there is sooo much information here and I just found the forums and I can’t process it all quickly enough (although I’ve known about TNation for some time).

-Ronin48


#2

Can’t seem to edit original post. Edits don’t take and preview throws error:

Height: 5ft 8in

AST: 28 (10-40 U/L)
ALT: 44 (10-40 U/L)

-Ronin48


#3

Can’t seem to edit original post.

AST: 28 (10-40 U/L)
ALT: 44 (9-46 U/L)


#4

Some posts and edits take a while to show up.

TSH: 4.57 (HIGH) (0.40-4.50 mIU/L)
T4, Free: 1.2 (0.8-1.8 ng/dL)
T3, Free: 3.0 (2.3-4.2 pg/mL)

TSH should be closer to 1.0
fT3, fT4 should be near mid range or a bit higher.
Do you feel cold easily? [No]
Not been using iodized salt? <<<<<<<<<<<<<<<<<<<<<<<
Check overall thyroid function by checking oral body temperatures:

  • when you first wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
  • also check for 98.6F/37C mid-afternoon

Get a thyroid antibody panel done.

Your E2 is way too high from the start and with TRT will only get worse. You need anastrozole to survive. You cannot get to your target fat pattens without controlling E2.

T levels change over time with pellets and that makes anastrozole dosing problematic.
What are AI pellets?

With a proper AI dose, you do not need DIM or other things targeting aromatase.

LH levels go to zero in a few days. You need hCG from the start.

Statin drug took your CoQ10 levels too low and that compromised mitochondrial production of ATP and that reduces metabolization of lipids and sugars. You would be OK taking 50 or 100mg ubiquinol form of CoQ10. Must be ubiquinol.

You can expect MPB to increase.


#5

Thanks, KS.

Don’t feel cold, but preliminary temps seem low. Got a 96.7 this morning and haven’t gotten above a 97.7. Bought a new thermometer to be sure I will update once I feel certain about my results.

I don’t really have a significant source of iodine. Don’t use iodized salt and I just started taking a liquid multi that contains iodine, but they don’t list how much, so I’ll consider it nominal (they just list it under one of many trace mineral included). Will look into Iodoral once I confirm my results.

Will look to get a thyroid panel done and post here when I do. Is rT3 generally included in a thyroid panel? If rT3 is elevated, is the IR the same or is the treatment different?

Regarding the AI, the T pellets are coadminstered with AI infused T pellets (I’m not 100% sure in what form though). I believe that I received 10 - (100 mg) T pellets and 4 - (60mg/4mg) Testosterone/Anastrozole pellets, but that is a little bit from memory and a little speculative. Waiting to hear back from the dr on what exactly was administered (But this is in the right ballpark).

Called the dr’s office and they’ll either send me hCG to self administer or I will stopping back in for them to do so.

Will look into supplementing with CoQ10, but I had a Micronutrient panel done as well and for CoQ10 I was 92 with a range of >86%. Also, Selenium was at 78 with a range of >74%. Do you still think there is a need for supplementing? As I said, the statin use was only on it for a short period and that was years ago.


#6

Quick update:

Blood Tests on Monday:

  • Thyroid Comprehensive +Adrenal
  • Male Hormone Panel
  • Lipid Panel

Supplements added:

  • 100mg Ubiquinol w/40mg Resveratrol (Rez-V) and 115mg blend of red grape and seed extract
  • 400mcg K2 (deficient in K2)

Supplements currently taking:

  • 200-400mg Magnesium (at night on workout days)
  • 20mg Zinc (zinc bisglycinate chelate)
  • 2oz Nature’s Nutrition Energize (multi-v, multi-min, etc.)

-Ronin48


#7

The amount of iodine in typical supplements is a maintenance amount that will not get you out of the hole.

Please read the thyroid basics sticky.


#8

Thanks, KS.

Read the sticky and agree. I was indicating that the amount included was marginal and that I’d be looking into Iodoral.

On that note, my waking temperatures have been 98.6, 98.4, and 98 over the last 3 days. Not sure if that 1st day was an anomaly or if it was an issue with the old thermometer.


#9

For those of you curious about the implanted pellet process:

I went with pellet therapy because of the claimed benefits: trouble-free, reliable option that does not require 2x/weekly injections and lasts 3-4 months. Not that I may not move in that direction, but as a starting point, it was much easier and convenient to go with pellet therapy. I may remain with pellet therapy, I may using it as a stepping stone to SC therapy. But mentally, my starting point was not going to be self-injections, even though, having done this, that initial objection is all but gone. Also, there was no convincing of drs or dr shopping to get a dr to prescribe and allow self-injection.

The procedure was as claimed - quick and painless. Probably took 15 minutes. Local anesthetic to the area and 15 pellets inserted into 3 “tracks” (5 per track) - 10 - (100 mg) T pellets and 5 - (60mg/4mg) Testosterone/Anastrozole pellets. Zero pain during the process and through the next day. They did a great job with the local. I was expecting pain during the entire process and it never occurred. Some discomfort in the area for the last 3 days (feels like a deep muscle bruise). I have been periodically icing with the ice pack they provided, but it was more for a matter of comfort and not out of necessity. The dr also administered a T shot to “get things going” as the effect of the pellets would not be immediate.

It was recommended that I not exercise for 5-7 days, but that was to ensure that I didn’t do anything that would cause any pellets to be expelled. In reality, I was back in the gym 2 days later but avoiding anything that would put undue pressure on my butt cheek or cause me to utilize the muscle (so not a leg day!). I’m taking 2 days off and plan on being back in the gym on day 3.

I had the option of adding hCG and in hindsight (had I educated myself better), I would have started with it at the outset. I’m in the process of having hCG sent to me, but am waiting on the dr’s approval, which won’t come until Wednesday. The good news is that once I start self-injecting hCG, it will remove any objection that this dr may have in self-administering T, as what would the difference be. If I can inject 1, I can inject both.

My only objections with the dr (so far) was his lack of concern over my high TSH number, the fact that Free T was not included in the test provided, and that he, while willing, didn’t push me in the direction of using hCG. It was my choice, he was OK with it, but I just didn’t feel informed enough to make the decision and punted. I should have gone forward with it, though.

Since I’m very early in the process, I can’t really make any judgement calls on the therapy until further along and I start to look at where my bloodwork ends up/trends. I can say that immediately post procedure (remember, they gave me a T shot), that I felt a little “amped” - but that’s probably not the right word for it. I was also very aware of my testes! A very low-level “blue-ball” -like feeling. Both of which could be complete psychosomatic. Both feelings have tapered over the last 4 days.

Ronin48


#10

OK, so the latest lab results (more complete - different lab) came back.

Got a Thyroid test because of my high TSH number on my pre-TRT blood test. That doctor seemed unconcerned about that high number, but I was not satisfied with letting it go.

Comprehensive Thyroid plus Adrenal Report
DHEA-S: 205 ug/dL (80 - 560)
TSH: 5.200 uIU/mL (0.358 - 3.740) HIGH
T4, Total: 5.4 ug/dL (4.5 - 12.5)
T3, Free: 3.3 pp/mL (2.2 - 4.0)
T4, Free: 0.99 ng/dL (0.76 - 1.46)
Cortisol: 12.7 ug/dL (3.1 - 22.4)
Anti-TPO Ab: >1000.0 IU/mL (0.0 - 35.0) Through the Roof
Anti-Thyrogobulin Ab: <20 IU/mL (ND - 40)
Thyrogobulin: 9 ng/mL (<=55)
TBG: 13 ug/dL (14 - 31) LOW

My understanding is that the extremely high Anti-TPO Antibodies points to Hashimoto’s Thyroiditis

I also got a Cholesterol test as I was surprised that it was not part of my pre-TRT blood work:

[u]Lipid Panel[/u]
Cholesterol: 201 MG/DL (<200) HIGH
Triglycerides: 75 MG/DL (<150)
HDL: 45 MG/DL (>39)
LDL, Calc’ed: 141 MG/DL (<100)
Risk Ratio LDL/HDL: 3.13 (<3.55)

This is actually a good cholesterol reading for me. About 7 years earlier I had a cholesterol around 300 with “bad” cholesterol (LDL) of 198! The bad cholesterol alone almost exceeded what total cholesterol should be. This is when I went on a statin, which I subsequently abandoned due to how it made me feel. I self corrected by diet and exercise after bailing on the statin.

Open to suggestions for reducing LDL and increasing HDL from the collective wisdom of this board.

I also ran a more complete Hormone test as I realized that the one performed pre-TRT fell short on some important numbers. It should be noted that this was 4 days after my TRT started (pellets with an on-the-spot SC injection to “get things going” as the pellets wouldn’t be immediate). This was also before my first hCG injection (more on that in my next post).

[u]Hormone Balance Report[/u]
E1: 5.5 pg/mL (9 - 36) LOW
E2: 38 pg/mL (ND - 56)
LH: 0.6 mIU/mL (0.8 - 7.6) LOW
FSH: 1.4 mIU/mL (0.7 - 11.1)
Prolactin: 7.9 ng/mL (2.5 - 17.0)
T, Total: 1045 ng/mL (160 - 726) HIGH
T, Free: 29.1 ng/mL (9.0 - 30.0)
SHBG: 23 nmol/L (10 - 57)
Androstenedione: 1.5 ng/mL (0.6 - 3.1)
DHEA-S: 205 ug/dL (80 - 560)
IDF-1: 141 ng/mL (101 - 267)
PSA: 0.4 ng/mL (<=4.0)

Expected the T, Total to be high post SC Test. Expected the LH to be on it’s way to 0 because this was before hCG was added in.

My current plan is to try to go to an Endocrinologist, ASAP to look into my Thyroid numbers and potential treatment options. Will be re-reading the Thyroid sticky.

My hope is that I can get the above doc to play ball on the recommended protocol from this board and then I will move away from pellets and to SC. It seems that pellets are turning out to be a much quicker stepping stone to SC that I had anticipated.

I also have a follow up at 45 days with the original TRT doc for more blood work which I may or may not go forward with depending on my results with the Endo.


#11

Current body temps?

Thyroid problems can be caused by not enough selenium which is needed for enzymes that prevent production byproducts from causing inflammation of thyroid tissue which can lead to an auto-immune response. High TSH makes this worse. TSH can be high from a lack of iodine. But overall, your thyroid panel is a mixed bag.

E2=38 is too high, you need anastrozole to try to get near E2=22pg/ml. Suggest EOD dosing with a liquid where you can have by the drop dosing increments. Aim for 1mg/week.


#12

Wait to see how cholesterol responds to your TRT and getting thyroid and E2 managed. Then you will be burning fats differently.
TRT often reduces LDL. Exercise also burns lipids.

HDL can be uncreased with high potency B-complex multi-vits, DHEA if labs indicate need, fish oil and other EFAs as well as anti-oxidants.

Total cholesterol 201 is not something that is a major problem.

Higher T levels, lower E2 and good body temperatures will enable weight loss. Ubiquinol form of CoQ10 may improve mitochondrial metabolic rare and lipid burns. Ubiquinol would have eliminated your adverse reactions to statin drug. Perhaps that experience is disclosing a lower level of CoQ10.

IGF-1=141 is definitely sub-optimal and may reduce weight loss potential.


#13

Month 2 Update:

I have been self-injecting 250 IU of HCG (1x/week) for the last 8 weeks. My testes remain normal but early on I did notice that they were shrinking, but the HCG is clearly working from my perspective.

Follow up Blood Work with TRT Center (Limited):
Estradiol: 44 (<= 39 pg/mL) HIGH
Test, Total: 1270 (250-1100 ng/dl) HIGH (Happy with this)
Test, Free: 305.0 (35.0-155.0) HIGH (Happy with this)

As a result of the above, was prescribed 1mg Anastrozole (oral) per week to lower the Estradiol into the normal range split into two 0.5mg dose/week. I plan on starting this Monday as I am getting over a cold and don’t want to mask any potential side effects.

My endocrinologist appt for my thyroid is not until the end of the month, so there’s been no advancement there.

I still plan to shift to SC injections for my test, rather than pellets in the coming months. If I cannot find a Dr. to allow self-injections, then I wouldn’t hesitate going with pellets again until I can find an amenable Dr. (but I believe I have already located one).

Pellets: The pellets have been fine. No adverse effects. I can still feel that they are there with my hand, but otherwise they are unnoticeable. I did have pain in the area for the 1st week, but nothing after that. There is a very small scar that I can see, but only because I am looking for it.

Sex/Sexual Performance: My sex drive has gone through the roof. I did not have issues in that area to begin with, so that is not necessarily a benefit that I was looking for. No performance issues going into this or as a result of it.

Mood: My mood has been excellent and my temper is so much better now. I was worried that going into this that the additional test would cause severe temper issues as I would get very angry, very easily before the TRT. However, it has had the exact opposite result. It has clearly brought me into hormonal balance. Things that used to set me off in the past I can now see for what they are. I get angry/upset far less often and when I do it is many degrees lower. All bouts of depression have gone away!

Brain Fog: What still remains is my brain fog and memory issues. But I believe this is wholly due to my currently untreated thyroid issues.

Physical Performance and Appearance: I’m able to actually lift weights 3x/week and do jiu jitsu up to 4x/week. I was barely able to manage only going to jiu jitsu more than 2x/week prior to the treatment. I’m noticeably stronger. I have clearly added muscle mass to my chest, shoulders, and back as my waist gets smaller. My body fat is dropping, but my overall weight remains the same as I am trading fat for muscle. I’ve put aside my goal of getting to 180 lbs (currently 199lbs) for as long as I am noticeably trading fat for muscle. Once this starts to slow or I plateau, then I will look to cut down my overall body weight.