I have been reading this forum for a while now and finally joined to make this post now that I have started TRT.
I am a 33 yo IT professional with two young children (3 year old son and 3 month old baby daughter). The last few years I have struggled with (what I now think to be) low testosterone symptoms. Low energy. No drive. Nonexistent libido. Fuzzy logic and inability to make important decisions. Weight gain. Declining gym performance. All of it. When I needed it most, my sense of manhood quite literally disappeared. My relationship with my fiance is hanging on by a thread. I recently lost my job. Worst of all, I can’t keep up with my kids, and instead of enjoying them as I should be, caring for them has become an energy zapping ordeal that I often find myself dreading. Hard to admit this, but it’s true. Even the most enjoyable parts of life can become a chore when your energy level is in the toilet.
I am 6’-0" and weigh about 260 lbs. Up until my late 20’s, I weighed between 210 - 220, but then abruptly put on 40+ lbs that I have lost and gained back several times, never able to keep it off long. I workout daily. Weights 3 - 4 days/wk and light cardio on off days. Right around when I gained the weight, I lost my libido and my sense of self confidence.
I struggled for the last few years and about 7 weeks ago, my PCP drew labs to look at my thyroid. I asked that he also check my total testosterone while he was at it. My tT came out to be 231 (ref range 250 - 827). My PCP was not able to give any recommendation on what to do but gave me a referral to a local endocrinologist. I had to wait 6+ weeks to see the endo, so I found an anti-aging doc and told him about my recent blood test. He recommended that I get further blood work (see below) and suggested I start clomid @ 25 mg / day, which he promptly prescribed. I started the clomiphene the next day (June 22) @ the recommended 25 mg dose. After a bit of research I decided to reduce my clomid dose to 12.5 mg EOD (so 1/4 the prescription amt). After about 4 - 5 days or so I began to have an intense headache, which progressed to get worse each day. I had not changed anything else and the headaches were not going away so I was pretty sure that clomid was the cause. I halted the clomiphene and the headaches went away within 24 hours or so. In all I believe I took about 75 - 100 mg of clomid, in total.
These were the labs, pre-clomid:
- Total T: 231 (250 - 827)
- Free Thyroxine (t4): 1.0 (0.8 - 1.8)
- Free t3: 3.0 (2.3 - 4.2)
- b12: 355 (200 - 1100)
- Folate: 16.3 (normal >5.0)
- TSH w/REFLEX to FT4: 1.15 (0.4 - 4.5)
June 21 (day before starting clomid):
- FSH: 6.3 (1.6 - 8.0)
* LH: 4.1 (1.5 - 9.3)
- Total T: 387 (250 - 1100)
- Free Testosterone: 49.4 (46.0 - 224.0)
- Bioavailable T: 108 (110.0 - 575.0)
- SHBG: 33 (10 - 55)
- Albumin: 4.8 (3.6 - 5.1)
- SHBG (again, same day, not sure why they did this): 35 (10 - 50)
I was not able to have a follow up appointment with the anti-aging doc to discuss the clomid headaches or to discuss the new labs from 6/21 and moved from CA to Oregon about two weeks ago. I found a local trt clinic in the Portland area and had my first appointment on 7/14 and had more blood work done there:
7/14 (2 weeks post clomid) - LabCorp:
- TSH: .884 (.45 - 4.50)
- Free t4: 1.2 ng/dl (.82 - 1.77)
- LH: 9.4 mIU/mL (1.7 - 8.6)
- Prolactin: 4.2 ng/mL (4.0 - 15.2)
- hematocrit: 46.1% (37.5 - 51.0)
- PSA: .2 ng/mL (0.0 - 4.0)
- Testosterone, serum: 346 ng/dL (348 - 1197)
- SHBG: 39.3 (16.5 - 55.9)
- Estradiol: 27.7 pg/mL (7.6 - 42.6)
- Free T*: 5.86 ng/dL (9 - 29)
- glucose, serum: 84 mg.dL (65 - 99)
- AST: 20 (0 - 40)
- ALT: 26 (0 - 44)
*this was not in the lab report, but Dr. wrote it in
When I reviewed the most recent labs (7/14) with my new doctor, based on my low testosterone level coupled with high LH (9.4), he determined that I had Primary Hypogonadism, which I now understand to mean that the problem is with my testes and not my HPTA axis. He also suggested that I was smart to have stopped the clomid when I did and that the headaches may have been related to the clomiphene pushing already high LH levels even higher. I asked whether the high LH from the 7/14 labs could have been effected by the clomid, which I had stopped taking two weeks beforehand, and he said that it was highly unlikely that it could have boosted LH that high considering the short time I took it (about one week total) and the low total dosage (75 mg all together). From what I can tell, seems like he is right that clomid would not have such a drastic effect over such a short period of time, especially considering labs were taken 2 weeks after stopping. However, it looks like my labs from 6/21, 3 weeks prior, showed LH was at 4.1.
Until the doctor told me about my high LH levels, based on everything I had read, I thought I was likely to be secondary. I had a few head injuries from motorcycle and car accidents. I also used painkillers daily for the past few years. So I was not surprised to learn I was hypogonadal, but I was not expecting the Primary diagnosis (any thoughts on this would be appreciated). Is it normal for LH to fluctuate to such a degree (more than doubled in 3 weeks from 4.1 to 9.4)? Could clomid from 2 weeks prior still be effecting LH values? The new doctor here in Oregon suggested that I start TRT immediately, which I began on 7/18.
The doctor prescribed:
- Testosterone Cypionate @180 mg/week (90 mg e3.5) [+ 300 mg injection 7/18, then begin @180/wk yesterday 7/25- is this normal??)
- Anastrazole @ 1.25 mg 24 hours after each T injection, so 2.5 mg / week (this seems like a lot??)
- HCG @ 500 mg 24 hours prior to each T injection, so 1000 mg / week
At this point, my main questions/concerns are:
- Am I actually primary hypogonadal or is the clomid responsible for LH of 9.4?
- Is 180 mg of Test C/week broken up into two doses e 3.5 days a good dose for me to start at?
- Is 2.5 mg Anastrazole too much for this protocol? How about the timing of 24 hours post T injection? should I be taking Anastrazole yet or should I wait until I see how the Test alone effects my e2 before?
- HCG at 1000 mg/week a reasonable dose? Should I even be taking HCG if I do not plan on having any more kids for at least a year or two from now? (Doctors assistant I met with yesterday said taking HCG would protect me from crashing T if I ever decided to stop TRT - is she right about this? Sounds too good to be true.)
- Does this doctor seem like he knows his shit or should I look elsewhere? My next appointment is for labs in 8 weeks. (I am looking into switching to Defy Medical. Any recommendation for docs in the Portland, OR area would be appreciated, too)
- When might I expect to begin noticing effects of TRT? Any effects that come on first usually?
I posted to a few other forums and was advised to decrease the AI and was told that 180 mg Test C was a hefty starting dose.
Thanks in advance, any input is appreciated. Lots to learn!