T Nation

T Advice for Competitive Biker

Hey Fellas. I am not a lifter but I am a competitive mountain biker and I was hoping you could offer a little insight concerning my case. First off a little background. I am 42 years old and in good shape. I ride 50 to 60 miles a week (off road). My diet is pretty tight, mostly green, with no processed food. I am 6’2" and 195. About two years ago I went through a divorce that was pretty bad. During those two years I got into the habit of drinking 1-2 glasses of wine a night. Early this year I noticed that my energy was getting low and that I was becoming forgetful. My sleep was restless and my libido which was high started to take a nose dive. I suspected that my T level may be the culprit so I did the following blood work.

10 May 2012

TSH 1.38 (.450-4.5)
T4 8.1 (4.5-12)
T3 38% (24-39)
Free T index 3.1 (1.2-4.9)
Glucose 98 (65-99)
LH 4.9 (1.7-8.6)
FSH 2.7 (1.5-12.4)
Testosterone 294 (300-890)
T, free 61 (47-244)
SHBG 25 (11-80)
T free % 2.1% (1.6-2.9)
DHEA 258 (95-530)
E2 10 (3-70)

Fortunately for me my PCP is a patient and friend of mine who admitted that she did not know much about HRT for men and that she just prescribed gel for her patients. I dove into the literature, particularly Shippens work in an attempt to educate myself on HRT.I started off with gel per my MDs request but my T levels went down over the next few months. My E2 never got above 23 as I increased my gel to 81mg/day. My T got as low as 276. During this time I was/am supplementing with the following:

Zinc 50mg/day
L-Carnitine 500mg/day (I believe)
Vit C
Fish oil 3g/day
Magnesium
Vit D
Ginko Biloba
Alpha lipoec acid

Six weeks ago I decided that my ability to absorb gel may be a problem and I stopped taking the gel and did Shippens HCG protocol. His protocol is 500 units of HCG a day Mon through Fri for three weeks. After the end of three weeks my T was 405 and my E2 was 16. Still feeling crummy.

During the last 2 months I limited myself to 4 glasses of wine a week. My gut feeling is that between life stress, age, and my moderate drinking my system just started to shut down. I do have a epididymal cyst on my left testicle that my urologist buddy assures me is not a factor. My sex life is ok with no erection issues but I do notice a significant loss of sensation and morning and nocturnal erections are absent without stimulation whereas before just a thought got the engine going. With the changes I have made I do feel better but I am a far cry from where I was 5 years ago. I have tried my best to address this with lifestyle and nutritional changes but it feels like I’m stuck.

I have been lurking on this board for three weeks reading. I am very impressed with the level of knowledge but more so with the prudent application of that knowledge. So, if you guys can overlook me not being a lifer and maybe worse yet a mountain biker I sure would appreciate any input you may have.

Thanks

Please read the advice for new guys sticky and come back with more info about you.

Most here are not lifters, just guys like you who got here because Google things it is a good site.

T3 and T4 are sort of useless as we are really wanting to see the free amounts fT3, fT4.

Was this typed in correctly? “Free T index 3.1”

LH varies a lot. FSH is more indicative about what is going on.

Shippen is a good introductory read. But he did not like injections because they did not work and all he understood was in-office injections every two weeks. Read the protocol for injections sticky.

And Shippen’s book predated use of aromatase inhibitors. You will find what you need here.

Alcohol reducing T? Yes that can happen and we might see an increase in ALT/AST. Other things can limit the liver’s ability to remove E2 from the blood and thus drive down T. But with your E2=10, it does not seem possible that this is a factor for you.

Labs:
DHEA-S, DHEA varies by the minute
fasting cholesterol

Suggest: T+AI+hCG

Thank you for your response KSman. I guess I left out that I am fairly hairy with the ability for facial hair. I do have moderate male pattern hair loss. My waist size is 35 and what fat I have is in my small love handles. My training consists of riding and I don’t do any kind of fad or crash diets. I don’t do any type of drugs. I meant to say Free Thyroxine Index 3.1 (1.2- 4.9). My last fasting cholesterol was 176 mg/dl.

With regards to my statement with alcohol consumption I was more concerned with direct pituitary inhibition rather than inhibition of the P430 system.

http://pubs.niaaa.nih.gov/publications/arh25-4/282-287.htm

I left out my prolactin, 8.9 ng/ml (4-15.2)

What are your thoughts on specific dosages to start out with?

Thank you again for your advice.

Doses for TRT:

Standard doses, can be adjusted based on labs/symptoms:

T+AI+hCG

100mg T cypionate [cyp] or ethanate [eth], injected SC twice a week or EOD/E2D
250 iu hCG SC EOD
1mg anastrozole per week in divided doses, taken when you inject as above

If injecting hCG EOD, which suits its half life, then injecting T at the same time makes sense.

Target E2 is E2=22pg/ml
Target TT is 900-1000
Target FT is near top range for non age adjusted [youthful] range

If already on T, introducing hCG might increase T by 15-20%, variable!

T eth is shorter acting and has more T per mg than T cyp. In any case, if you adjust dose to achieve target levels, you may find that T cyp is more cost effective and available. In other countries, T eth is more available.

This is covered in the protocol for injections sticky.

Other issues:
-anastrozole over-responders [a few have this, not rare] --> 1/4th expected dose
-anastrozole intolerance, cannot find a dose that works or low libido --> aromasin
-hCG over responders, cannot control E2 [sort of rare] --> smaller doses

Thank you for that recommendation. Just for clarification in regards to Tcyp, do you mean dividing 100mg/week into 33mg injections EOD a week or 100mg EOD?

What are your thoughts on saliva testing for T and E2?

Thank you.

You will find that there is a lot of experience with serum hormone tests here and about none with saliva based.

For 100mg/week, inject 100/3.5 mg EOD. That will be around “14.3” on an insulin syringe for 200mg/ml.

Hi KSman. I have a six week update and need a little advice. I had my panels redone after six weeks on your recommended protocol.

31 Jan 13

Total Test 813 ng/dl 348-1197

Free Test(direct) 24.0 pg/ml 6.8-21.5

Estradiol 7 pg/ml 3-70

First off, I’m excited to be where I’m at. Energy level is much improved. I have had an issue with going flaccid a couple times during sex since starting the injections. This has never happened before to me and I suspect it is related to my estradiol being so low. I was thinking of reducing the anastrozole to 1/2 mg a week split between T injections. What do you think about this? Also, are there any adverse considerations to my free T being too high?

Thank you again for your help, I finally feel like I’m getting close.

Injecting twice a week or EOD?
Labs done between injections or before next.

If you modify anastrozole dose by 7/22 [1/3rd] you will probably have a better result.

Don’t worry about the FT, when you correct E2, it will probably drop to some extent.

I inject Testosterone on Mondays and Fridays and HCG EOD.

Labs were done Thursday morning.

Thank you.