T Nation

Steve Holt's TRT Journey

Hello, I recently started trying to feel better in life, and it appears on the surface to be low T. My stats are below. I’ve read through plenty on this site and look forward to learning more and helping where I can. Hopefully, others will be able to help me out along the way as well.

-38
-6’-2
-40 inches
-265 lbs
-Austin Powers has nothing on me. Hair everywhere dark and thick. I can grow a full beard in a week.
-Arms and legs have virtually no fat. All fat in midsection/gut
-no energy, no motivation, ANXIETY issues, weight gain, muscle loss, low libido, and ED, and brain fog/memory
-only take multivitamin
-Diet has been total crap. With no motivation, I ate what I wanted when I wanted except for periods of getting back in shape.
-See above, hardly any training in the last few years except for those few months of the year when working out again.
-Sometimes the right one aches, but this has happened for the last 20 years due to a hernia repair. They used mesh which I think rubs/touches something in that area. Had several docs check it out and they are not worried. I had a vasectomy in 2010 that I would imagine revealed an issue while opened up if there was one.
-Last 3-4 years morning wood and nocturnal wood is nonexistent except when I have to pee.

I have always been in fairly decent shape up to about 5 years ago. I am a stocky thick guy, but have always carried a little fat. During that time the fat has really increased especially in my gut, and I can see my muscles diminishing. I have also been feeling like crap with noted symptoms above, so after doing some reading, I decided to get my testosterone checked by my GP who is also a urologist.

It took a lot of pushing, but he finally relented and the below is what was checked.

6-6-2013 (fasting at 8:00 AM)
Testosterone 259 ng/DL 175-781
SHBG 13.8 nmol/L 13.3-89.5
Free Androgen index 65.13 % 24.30-110.20
Glucose 93 mg/dL 70-100
Creatinine 1.27 mg/dL 0.50-1.30
BUN 16 mg/dL 7-22
Sodium 143 mEQ/L 136-145
Potassium 4.1 mEq/L 3.5-5.3
Chloride 108 mEq/L 98-109
CO2 29mEq/L 22-33
Calcium 9.2 mg/dL 8.6-10.1
Bilirubin 0.4 mg/dL 0.2-1.2
Alkaline Phos 80 Units/L 34-130
AST (SGOT) 23 Units/L 0-40
ALT (SGPT) 53 Units/L 0-68
Protein 7.1 gm/dL 6.0-8.0
Cholesterol 200 mg/dL Borderline High 200-239
Triglycerides 302 mg/dL High 200-499
HDL Cholesterol 35 mg/dL Low 40-60
LDL Cholesterol 105 mg/dL Near Optimal 100-129

TSH 2.35 mcIU/mL 0.36-3.74

HGB 15.4 gm/dL 14.0-18.0
HCT 46.3 % 42.0-52.0
MCHC 33.3 gm/dL 32.0-36.5

With these results, I was told that I might be in the lower TT range, but due to my low SBHG I had plenty of free testosterone available that my body would use if needed. My doc did not really want to start me on any HRT, but said we could try it if I wanted. I really wanted to start feeling good again, but he only does monthly injections at the office, or will prescribe creams/gels, so I declined and walked out feeling more bummed out…

Fast forward to December 2013 â?? I was fed up with feeling like crap, so I decided to search for a local doc that specialized in HRT. The local compounding pharmacy led me to a doc in town that specializes and takes insurance. I went in and told her my story and showed her my labs. Based on my symptoms, previous labs, and asking to get started, she put me on 75 mg Test C/week. I know itâ??s a very low starting dose, but she did not have her own lab results yet.

The following labs are what she collected. The ALT test is a little high, but I stayed up late watching a football game with the guys the night before drinking. I really did not think I would get tested there in the office on my first visit, or I would have prepared better.

12-23-13 (around 2:00 PM no fasting)
Glucose 77 mg/dL 65-99
BUN 15 mg/dL 7-25
Creatinine 1.18 mg/dL 0.60-1.35
Sodium 142 mmol/L 135-146
Potassium 4.4 mmol/L 3.5-5.3
Chloride 104 mmol/L 98-110
CO2 25 mmol/L 19-30
Calcium 10.1 mg/dL 8.6-10.3
Protein 7.1 g/dL 6.1-8.1
Albumin 4.8 g/dL 3.6-5.1
Globulin 2.3 g/dL 1.9-3.7
Bilirubin 0.3 mg/dL 0.2-1.2
Alkaline Phos 67 Units/L 40-115
AST (SGOT) 23 Units/L 10-40
ALT (SGPT) 48 Units/L 9-46

TSH 1.51 mIU/L 0.40-4.50
Free T4 1.2 ng/dL 0.8-1.8
Free T3 3.7 pg/mL 2.3-4.2

HGB 15.8 g/dL 13.2-17.1
HCT 47.0 % 38.5-50.0
MCHC 33.6 g/dL 32.0-36.0

Vitamin B12 302 pg/mL 200-1100
Vitamin D 24 ng/mL 30-100

FSH 8.9 mIU/mL 1.6-8.0
LH 3.9 mIU/mL 1.5-9.3
Prolactin 3.7 ng/mL 2.0-18.0
SHBG 16 nmol/L 10-50
TT 272 ng/dL 250-1100
FT 68.1 pg/mL 35.0-155.0
E2 33

I have been on the injections for 2 weeks now. The prescription was for 150 mg every 2 weeks IM. I did this for the first injection on Monday Dec 23. Two days later I felt great and my libido and ED were both better than I can remember, but then the next day and on everything plummeted. I don’t know if the 2 day turnaround was placebo, or if it is due to my low SHBG metabolizing the test quickly, but I was able to have sex twice that day and erection quality was awesome. By Friday (4 days post injection) my libido, ED, and general well being were worse than ever.

I decided not to wait 2 weeks for another injection, and by the knowledge I gained here, I switched to SUBQ injections EOD while keeping the overall monthly dosage the same. After several injections of this, my anxiety kicked into overdrive, and I was feeling very bad. I ended up having the worst anxiety attack ever on January 2. On January 3, GP put me on a very low dose of Prozac, and I am taking Taurine and schizonychia berries supplements trying to ease the anxiety. Between January 3 and today (January 8), I have actually had several really good days (great mental clarity and high energy) while still having some days with lingering anxiety issues. I really don’t want to take the Prozac, so maybe this issue can get sorted out. If anyone has any thoughts, please chime in. This crap is wearing me down.

I don’t know if the anxiety is related to the TRT or not. In addition to the therapy, I have shocked my system by cleaning up my diet, quitting sodas, and exercising. I have actually been walking/hiking for the last 2 months, but recently started weights again.

Body temps are pretty normal - mid to high 97s when waking. Plus my T3 and T4 numbers are pretty much middle range. I know KSman wants TSH to be near 1, but I really don’t think Iâ??m iodine deficient. I don’t put salt on my food, but I eat a lot of fish, eggs, ect. that are high iodine foods. I’m also pretty hot natured.

As mentioned ALT level is high, but I’m hoping it’s due to drinking the night before. Is this level concerning? I will have her recheck on the next labs with no drinking.

Vitamin B12 and D levels are low. The lab report says that B12 values below 400 can lead to neuropsychiatric abnormalities. Could this be the cause of my anxiety issues?

FSH and LH seem odd to me. LH is pretty middle of the road while FSH is elevated. I’m guessing this confirms I’m primary hypo?

I have a follow up appt to my TRT doc on Jan 14. I will let her know about my experiences thus far, ask to go to 100 mg/week, and discus HGC. She will also give me an AI if needed. I’m assuming she will run labs again. Any additional tests I should request besides E2?

Looks like you are doing everything right to get on track.
Low SHBG is a thing that makes balancing TRT difficult
(mine runs between 13-16).

In addition to metabolizing T fast, it creates very high free T,
which is a libido killer, but it also spikes e2…fast.

The e2 spikes are most likely what is causing you to have the anxiety issues.
Going subQ will help, as will splitting your dose. You should try to split
that 75/wk to 25mg m-w-f, but you will need an AI for sure.

It seems you have a lot going on. I think that sudden burst of energy and sex drive may have been a placebo effect but that may not be all that bad. I think it tells you there are other issues going on.

As for 150 mg every other week, that would make me feel worse then when I started. I’m at 200 mg every week and tried to go every other at that dose a few months ago and boy did I feel a crash on day 10 after a while. So the doctor would only do injections at the office for you when it fit into their schedule? If so, what does his/her schedule have to do with your care? Really, if he/she only did it once a month, that’s what you would be getting? That’s a joke!

I was never big on the SQ idea and just didn’t want to try it for my Test.

If it were me, I would pin myself IM once a week with 150 mg a week and see how I felt in a month; not 2 days later, in a month. Hit the gym in moderation, eat in moderation, give myself a week between romps with the wife and get her something nice to put on that night :), make sure I get my ass in a pew, and since it’s me I am referring to, I’d get in the woods or grab my fly rod. Sometimes life gets in the way of living.

Hey, not dis-similar to my story - http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/high_e2_ai_not_helping_any_suggestions

I know exactly how you felt when you first took the test, I got that 4 years ago when I tried Testogel. I felt AMAZING for about 2 days, then the effects wore off and never came back.

From my more recent research, I would suspect that the aramotisation of Test -> E2 is what balances your system out quite quickly. This increase in estrogen is also probably causing the anxiety to spike. Personally, I’m trying an HPTA restart using Clomid rather than TRT to see if I can get the system running again. Unfortunately, it looks like my body wants to heavily aramotise the test which has left me dealing with really bad anxiety over Christmas.

Another factor that you’re not taking into consideration is that Christmas can be stressful for people, and this time of year is probably the hardest for people if they’re struggling with depression related issues. Hang in there :slight_smile: Will be interested to see how you get on. Get the doc to check your E2 (estrogen) levels at your next blood test. They may then prescible you an AI (Arimidex) that you can take to help control it.

Low SHBG here too. Feel best when doing 40mg MWF. That puts me right at the top of the normal range for Free T. I seem to metabolize T fast, so you might not need that much. Definitely need to get E2 tested and addressed. That’s been the key for me. HRT would be almost complete waste without dialing in E2.

You can even get order the test yourself for $25. If there’s a labcorp testing center near you, you’re golden. Order the test from LEF or privatemdlabs, take the paperwork to the labcorp testing center and wait for the results.

It would have been nice to try a SERM or HCG before jumping right in to T. Or at least test LH a few times to see if you could catch high LH with low T to confirm primary. The high FSH is decent indicator though.

Dhick,

So it looks like you inject 120 mg/week. Is this correct?

How do you feel on this? Libido/erections, etc?

That’s one of the best protocols for me so far. 40mg EOD was good, but MWF is easier to keep track of. 30mg EOD was ok.

How do I feel? Better than I have on any other protocol, but I still have other issues. Adrenal output is not good. Thyroid labs are not the best. Libido is pretty solid. Erections are no problem but I take 6mg cialis every day, a little extra on date night. Not sure if I need it for normal performance, but Cialis is great stuff. No reason not to take it.

I think the key is getting Free T and E2 to a point it should not be an issue. The dose will different for everybody, but this allows you to cruise for awhile and sort other issues. If you have energy, libido or ED issues with Free T and E2 in the 20s (labcorp testing), T is probably not your problem.

I’m taking a step back to see if HCG or SERM only are option to get me in the same range, but the concept still applies.

Dhick.

  1. What is your shbg value?
  2. do you use regular or sensitive E2 test?

Thanks for the responses. I went back for the followup appt today to go over the labs. They actually did test E2, but I just didn’t get the sheet with the other forms. It came out at 33 before TRT. Therefore, I would imagine it has crept up higher now.

I have been doing SUBQ for 2 weeks now and I am feeling a lot better as a whole and have had some intermittent excellent feeling days here and there as well as some periods of really good libido and sex cravings. Those have tapered off the last few days, as I’m sure the E2 is creeping up. No issues with anxiety lately.

So I have good news and not so good news. The good news is my doc seems open to working with me. She agreed with my decision to change to more frequent SubQ injections due to low SHBG as well as letting me continue home injections. She also wants to see my TT and FT at the upper limits of the ranges, so she will be prescribing higher doses if needed. I go back for more labs in 2 weeks which will put me on this protocol for a month before testing. She also wants to see my E2 in the low 20s, but that leads to the not so good news. To lower my E2 she prescribed some compound crysin/progesterone, and told me to start taking 50 mg zinc. I didn’t push the Adex issue in the office, but after reading up on it, I took matters into my own hands and ordered some chemicals for research.

Another issue I brought up is HCG to protect my boys. I have had a vasectomy, so more kids aren’t an issue, but I would like to preserve the way they look, and I might want to try a restart some day. Her protocol is to alternate HCG treatment with TRT treatment. Again, I didn’t push the issue as I feel like I’m lucky to be where I am with the test and home injections. Besides, that’s something else I can get on my own, and I don’t have any issues with needing that yet anyway.

I should have my AI in about 3 days (17th). If I start immediately, should there be any progress for my labs on the 27th? I plan on doing the 8 drops EOD and 10 on the days that fall in the weekend. Should I start with a loading dose?

I will try to keep this updated.

[quote]dhickey wrote:
Low SHBG here too. Feel best when doing 40mg MWF. That puts me right at the top of the normal range for Free T. I seem to metabolize T fast, so you might not need that much. Definitely need to get E2 tested and addressed. That’s been the key for me. HRT would be almost complete waste without dialing in E2.

You can even get order the test yourself for $25. If there’s a labcorp testing center near you, you’re golden. Order the test from LEF or privatemdlabs, take the paperwork to the labcorp testing center and wait for the results.

It would have been nice to try a SERM or HCG before jumping right in to T. Or at least test LH a few times to see if you could catch high LH with low T to confirm primary. The high FSH is decent indicator though.[/quote]

I have a labcorp local, and I’ve looked at both options you posted but I can’t find an e2 test for $25. Can you point me in the right direction?

ETA: Nevermind, I was looking at the wrong test. I found it through LEF for $33…close enough.

Please help me figure this out. I went ahead and ordered my own labs mainly to check out my e2 current levels. So to recap the below results are after the first shot IM @ 150 mg for one week, then subq 20mg EOD for 2 weeks solid.

Hematocrit 45.1 % 37.5-51.0 (actually went down on TRT)
TT 275 mg/dl 348-1197 (about the same since starting TRT)
LH & FSH both less than 0.2 (verified shutdown)
E2 11.5 pg/ml 7.6-42.6 (dropped way low with no ai)

They didn’t check Ft in the female panel, but using both previous shbg values I’m calculating about the same FT as when I started. With these numbers, I’m guessing my dose isn’t high enough, or is 2 weeks on a steady protocol not long enough to make a change?

The e2 value is puzzling me. How did it drop so much?? She put me on Chrysin and zinc but only 2 days before this draw. When I started TRT I was at 33. I’m not feeling as good as I did when I started, but not really feeling as terrible as I hear with low e2. Could this be a bad reading? My doc plans to run labs in a little over a week, so I will get new results.

I’m guessing I should stop the zinc and Chrysin until more labs?