T Nation

Shaky/Confusing Start to TRT, Looking for Progress and Success


#1

Hi all

Been a reader/lurker for some time and starting my own case thread. Hoping to find some insights as have read some quality replies and posts in this forum.

Will try to summarise my journey so far as concisely as possible and convey where I’m at.

I got my T levels checked at a Low T center earlier this year at the suggestion of my trainer, and the total test came in at 157. Needless to say, I knew I wanted to start TRT but didn’t want to pay for weekly visits to this clinic.

2 weeks later, I saw my primary care doc and he agreed if my levels were that low that I would benefit from treatment. He drew a second round of labs, and the results were as follows:

Total T 303.82
Free T 90
SHBG 13.6

Test cypionate was prescribed 100mg per week. Have injected every week in the glute for the past 8 weeks.

I noticed some improvement in symptoms for awhile, morning wood, libido increase, better mood. This seemed to taper around about the 5th-6th week. I figured this was the result of my body adjusting, rebalancing etc (I am still working out if this is the case).

My follow up appointment with my doctor after 8 weeks was 3 days ago. I told him I feel ok, but felt like I had some way to go.

Heres’ what has me concerned - labs were drawn again on this visit (8 weeks after starting treatment) and these were the numbers:

Total T - 300
Free T - 86
SHBG - 14.6

The most surprising thing about these numbers is that not only had my total T levels stayed the same, but also that I injected 100mg the day before the labs and still only drew 300.

I’ve attached both lab results to this thread.

From reading on this and several other forums, my thinking is leading toward:

Low SHBG - I’m clearing the test too quickly for it to be absorbed.

Because of this, I’m going to try breaking up my dosage and injecting 3x a week.

As per KSman’s request here is my background info:

Age 38
Height 5 11
Waist 33
Weight 188 lbs
Body type - due to training am generally athletic, grow facial hair thick and easily. I tend to carry fat around my lower back and hips

My diet is a macro planned diet by my trainer. Carb cycling 3 low days followed by 1 high day then repeating. Days 1-3 are 50f 145c 290p Day 4 30f 300c 190p

I have generally been healthy with no major problems.

Train 4-5 days a week lifting and cardio as per my trainer who is a bodybuilder.

Low libido, mental fog, and general low mood and energy have been my symptoms of low T. I noticed an improvement in these symptoms after 4-5 weeks on TRT, but they seem to have tapered off after 8 weeks.

Thanks in advance for input and insight


#2

With TRT, RBC should increase, not decrease.

HTC was close to 50. When you get to some high T levels, HTC will be too high and you will need to donate blood, have blood removed or perhaps live with lower T levels. You need to avoid added iron [enriched] in vitamins, breads, rice, breakfast cereals, flour etc. The steady doses of T from dosing suggested are HTC friendly compared to the peaks of weekly injections.

You seem to be a T hypermetabolizer and such guys need to take 300mg/week to get where others are at 100mg/week. And the effective half-life is a lot shorter too. So while weekly injections are too far apart and we suggest twice a week, in this case, that is inadequate and EOD/E2D injections are required.

Self inject 86mg T EOD [every other day], subq over upper leg with #29 1/2" 0.5ml insulin syringe, slow to load. Subq is fully absorbed, but slower with smoother serum levels.

At age 38, fertility probably not a concern, but when you get on effective TRT your testes will shrink if not already. 250iu hCG subq EOD preserves the testes.

You need to be testing E2 - estradiol and almost all guys benefit from been near E2=22pg/ml and almost always anastrozole is needed for that. Try 0.5mg anastrozole twice a week. Do E2 labs after 3 weeks.

Try to get FT tested direct instead of calculated.

If you get labs with E2=30 while using anastrozole, you can get to E2=22pg/ml by dose change factor of 30/22 - the magic of a competitive drug.

Almost all doctors a rather useless at male hormone care. Doing things right requires knowledge and making an effort to understand some complexities. You can understand what is needed and why by reading the stickies. You can show some of this to your doc. Doctors are the biggest problem, so there is a link on finding a TRT doc.

You did not get TSH tested. Thyroid is a major hormone system and low thyroid hormone has most of the same symptoms as low-T. Please conform to last paragraph in this post.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thankyou KSman, this helps a lot… gives me a lot to think about and plan the next move


#4

Need explanation re “shaky” vs “generally been healthy with no major problems”


#5

By “shaky” I meant that I had starting feeling some improvement in my symptoms, energy, libido, morning wood etc… but this has tapered off and left me wondering why.

“Generally been healthy with no major problems” - by this I mean I have never treated by a doctor for an ongoing condition… as you said there may be underlying factors to explore , eg thyroid , but I don’t have a medical history to draw info from


#6

Soooooooo… this has me feeling really stupid

I went to inject this morning, and thought I’d check how much of the needle was inserted… and the answer was , none of it.

I’ve been using 23g 1.5" needles into my glute… last week before my labs I must have done the same thing, I remember not feeling the needle slide out and wondered if it had gone in at all. This would explain drawing a 300 the day after I thought I had injected…all the oil would have just drizzled down by butt cheek.

Why? Cos I’m a pussy with needles

Would explain too why I was feeling improvements in my symptoms, and last week felt like a flat tire

Anyway, will start to inject 26.6 mg EOD (15 a month = 400mg/100mg a week), as I imagine it’s still very likely I’m a hyper metabolizer. My 29g .5cc 1/2" needles are on the way in the mail

Injected this morning with the 1.5" into my glute, and gave it a good jab… will stick to the EOD injections for a few weeks and have labs drawn again , ask about my E2, hgc etc

Need to get a thermometer to measure my morning body temps as well


#7

Injecting into your butt is dangerous, large vessels and major nerves. Needs to be done right and you can’t really see what you are doing.

subq:

  1. select location on upper leg where no veins are seen
  2. press that location with a pen or needle cap to mark
  3. virtuously swab that location with alcohol prep pad
  4. pinch up a fold/mound of skin with marked site at end of fold
  5. inject to end of the fold with needle parallel to muscle layers below
  6. get through skin quickly, will probably feel nothing after that
  7. inject, is not fast
  8. after needle removed, press on injection side with finger for 10-15 seconds and the compression will prevent almost all bleed bruises

#8

Did my first subq shot today with 29g 1/2"… folded up a mound of skin on upper leg, didn’t feel a thing!

At the end of my first week of injecting EOD… morning wood was there yesterday, but not this morning… I think I do need to try a higher dose… made an appointment to see my doc next week… am planning on asking for a referral to an endo close to here

In regards to HCG, what is the cost on average? Test Cyp cost me $85 for 2000mg… which would last 45 days if I double my dose. So around $53 per month. What is the “average” cost for HCG per month? Just in case my insurance won’t cover


#9

Measured my waking body temp this morning - 96.9 … that appears to be low … will measure afternoon temp and repeat for next three days


#10

It is not clear what your dosing is.

It takes time for changes to occur in the brain and that is most of what you will perceive. Making dose changes based on short term observations is not good. If you change your dose, give it time to work. A need for higher dosing was anticipated.


#11

Dose is 100mg a week, if I break it up to 27mg EOD that will be 400mg a month. So dose is the same, only frequency has changed


#13

100mgdose/week * 1 week/3.5dose = 28.5714 mg dose


#14

Correct !


#15

So… my morning and afternoon temps the last 3 days are as follows:

6/10/2017 m 96.9 a 97.9
6/11/2017 m 96.4 a 97.4
6/12/2017 m 96.4 a 98

Have started taking 50mg iodine a day to load up, 2nd day so far and feeling no side effects

Seeing my doctor this week to have conversations re increased dose, AI and HCG


#16

Starting tomorrow will be trying protocol of 150mg a week, split up into EOD injections of 42.86mg

Must say that the EOD frequency has me feeling somewhat better mentally and morning wood , as well as spontaneous erections throughout the day have returned

My doctor is great, he was happy to tell me he needs to do some research re HCG as he hasn’t prescribed it in conjuction with TRT before.

Will stay on the new dose, in 1 month will be drawing labs and measuring e2 as well and looking at HCG if my testes are experiencing any weight loss


#17

Am experiencing some water retention/bloating, and suspect this could be due to 1 week of taking 50mg iodine a day. Have one week left to load 750mg then will see if said bloating calms down


#18

New labs , drawn last week after upping dose to 44mg EOD.

Symptom wise, feeling lots of improvement, mentally, libido and motivation are all positive. Feeling sleepy, but not tired as strange as that sounds. Have gained weight, and am over 200 lbs for the first time in my life but much of this is a good amount of muscle.

Estradiol came in high, as expected. Am going to discounted labs to take the sensitive test, but I expect an AI will be in my future.

SHBG is still low


#20

E2 levels are at 81 pg/ml within a range of 20-47 pg/ml on my latest labs… have been prescribed 1mg arimidex ED…from what I read here this is overkill…

Sooooooo… I’m currently injecting 44mg test cyp EOD… averaging out to 154mg a week.

Am going to try .25mg EOD, then do a sensitive E2 test after 4 weeks see where levels are at then


#21

Sounds like a good plan!


#22

Have latest bloodwork after inject 44mg Test Cyp EOD, and taking .25mg Arimidex 2x week. I had this bloodwork done by Labcorp… the test levels are WAY higher than those I got back from my PCP on the same dose.

Have increased adex dose to .25mg EOD and will see where that gets my E2 levels after 4 weeks