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Testosterone Replacement Beginner - Glucose & BP

I am new to testosterone replacement, so please excuse me if it shows. I’m in my early 40’s and have been pretty heavy (translation obese) for a couple of decades now. About four months ago, I was feeling pretty bad as far as my energy level and mood and the inability to lose some weight using methods which previously worked. I did a pretty broad blood panel and my Total Testosterone came back in the mid-90’s. My TSH, T3, and T4 were all in the lower range, but not abnormal. Esteroidal was normal (13), but prolactin was a bit high 15.4. A1C was barely high at 5.8. Vitamin D low at 16.7. Progesterone a bit high at .19. Blood pressure around 140/80.

So the panel was done in the afternoon. I went back with my regular provider and did a morning Total T test. This time the level was still in the 90’s. I was put on Test Cypionate 200mg bi-weekly IM. I was started on 500mg per day of Metformin for the borderline A1C. After some reading, I swapped this to 100mg per week SubQ after a few weeks.

I was feeling pretty dang awesome at this point. More energy and great all around. After two months, when I went back in for a new Total T, my level was up to 301, this was the day before my weekly dose. After being on 50,000 IU a week of Vit D, I was up to 23.5, which was still below normal. My doc was out for a couple weeks, and the fill-in suggested I double my Vit D dose to twice a week and my Cypionate to 200mg/week. Blood pressure was up a bit, maybe 155/90. So, being a true overthinker, I decided to do the Cypionate twice per week (Wed/Sat) at a rate of 100mg each time. I began to not feel as well, which I attributed somehow to the upped Testosterone or the frequency (makes no sense I guess) of the injections. After a few weeks, I adjusted my dose down to 80mg on (Wed/Sat).

I went back to the doc after a month of this and had some updated blood work. However, the only appointment I could get was on a Monday, two days before my Wed dose. This time my Total T was up to 577. However, my A1C up to 6.9! My BP was around 159/101. My HDL was below normal and Triglycerides were slightly elevated. My regular doc was there this time, and I discussed my thoughts that maybe the new dose of Testosterone Cyp was too high. So we adjusted it down to 140mg weekly.

I don’t really know what to do at this point. I’ve been doing intermittent fasting 16/8, with little success on weight loss, but I have noticed I seem to be losing some belly fat. I’ve been trying to get into a pattern of walking. Guys, I make no excuses, I have an office job and was royally sedentary. So I’m trying to get 10,000 steps per day. However, my dang BP tonight was up to 179/102. I’m testing my glucose at home and fasting this morning was 135 (high). After a meal this evening, it was 181. Today, I began a modified 16/8 fast, in which I plan to do only protein and very, very low carbs for at least the first hours of the 8 hour window. This evening I emailed my doc and asked whether I should up the Metformin and possibly get on a mild pill for the BP.

So I’m open to suggestions. In retrospect, maybe I just wasn’t letting my testosterone levels get high enough. I mean the 500 range looking back is not that high. With the higher A1C and now looking at these fairly high daily glucose reading, maybe the reason I felt worse about the time I upped to the 100mg twice a week is that my blood sugar at the time may have already been running very high, as it was during and around Christmas. I was not testing at home then, so who knows. In that case, maybe I should have been going up with the Cyp or at least maintaining the higher dose, instead of backing down the dose.

Sorry, I’m blathering on. I just don’t have anyone much to talk about this with and am maybe just throwing it all out there. Just a bit frustrated that this whole cascade of events has all seemed to hit at once.

You are never going to get your levels optimized checking only Total T, which is the inactive portion of testosterone. Your Free T, estrogen and SHBG are needed as well. If you are still overweight you’ll probably need multiple smaller injections per week because you are most likely converting a lot of Free T->estrogen because of the extra body fat.

You’ll probably have to significantly decrease you dosage if you’re going to do a daily protocol. I’m overweight (Type 2 diabetes) and got to inject daily, or else I get high blood pressure and feel like dog crap. If you are feeling good at 301, then you probably have low SHBG. I see the majority of low SHBG men do much better on very frequent dosing, but the large injections tend to cause side effects.

If you felt great at 100 per week why the change?

I guess you are a perfect candidate for having serious side effects on TRT (mainly as a consequence of the developed hypertension and metabolic problems) and I strongly recommend you to significantly reduce your dose.
The FDAs recommended weekly subq starting dose for example is 75 mg.
I know many guys do good here and get away with 200 mg per week but i) they are not obese
ii) have not been sedentary and iii) did not have a baseline T level in the 90s.
And remember if T was at 300 at the end of the week it is somewhere around 800 to 1000 24h post injections.

Go down to 80 per week split into 2 or 3 injections. You will end up having average T levels of 400 to 500 and that’s still a min. fourfold increase compared to the time before TRT. After you lost weight and got in shape you can always go higher later in your life.

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The reason I didn’t stop at 100mg per week was probably my inexperience, but the way being in the 300’s had me feeling, I was like, “Heck yeah, more made me feel good. Let’s go higher and feel even better! I’m still barely in the normal range.” Again, hindsight is 20/20. When I went in for that visit the only labs I had done were the testosterone. So while I did realize my BP was creeping up, I did not yet realize my HDL was going down and my glucose was going up significantly. In short, I saw good results at getting in the barely normal range, but no big negatives. I thought let’s see how good I can feel.

This week I did 120mg SubQ, on a weekly interval again. I felt better than I did at the 100mg twice a week regimen, but still not as good as I did initially at 100mg weekly. Being a novice, I did not know whether I should push through this and give it several weeks at this level or cut back, as you are suggesting, to a lower dosage. Systemlord above also suggest a daily injection schedule worked well for him, having a high body fat. Based on your response and his, I wonder if something like .1ml of the 200mg/ml daily would be something good to try?

I feel like I am swapping back and fourth. However, I also don’t want to wreck my overall health by sticking with a schedule that might hurt my overall health.

I can see this. I plan to request a comprehensive testosterone test on the next visit. Initially, with my levels in the 96-99 range, I figured it was so darn low that there was no need to push for the more comprehensive assessment, but no doubt it would have been beneficial, even then. My doc is a bit new to much of this, but is very open to any labs I want and to discussing paths forward in care. I will get the tests you are recommending.

Have you had any issue with your glucose? I find it hard to believe the testosterone is not causing some of the effect I am seeing. However, it could be that I was on the ledge and the timing of actually beginning to fall down the diabetic path was just coincidence.

It makes me feel a bit better that you have had issues with your BP on the higher, less frequent dosing. It gives me some hope. I still think I may need to get onto some medication for the BP, as it was a bit high, even before starting the dose. My goal is to lose fat (via diet and getting off my butt), but I don’t want to do damage to my body in the meantime or generate anxiety about the effects on my health of the higher BP (same pretty much for my glucose too). Would you mind me asking what your dosing amount and schedule looked like before you moved to daily versus what it is now doing the daily? It might give me a loose frame of reference to plan how mine might convert. I felt better on the initial .5ml of the 200mg/ml cypionate weekly that I was on initially than I did when I moved to the same dose twice per week. However, if I understand your theory correctly, this might have had less to do with the frequency and more to do with the increase in overall dosage, assuming that I may have low SHBG, correct?

I want to feel good, and the testosterone has brought me much closer to that than I was before. However, I’m not giving in to the high BP and diabetes without a fight, and I know that fight will entail dropping a considerable bit of weight.

Thats 20 mg every day amounting to 140 per week. You mentioned that you felt better at 100 as compared to now the 120, so why would you go up?

I would do 80 per week split into 2 or 3 injections, or at max inject every other day. Of yourse you can also go on daily, but unless you are highly sensitive to fluctuations its not required. And with the symptoms you are describing work your way up and not the other way around.

Try 0.2 ml (=40 mg) twice per week. Give it 3 to 4 weeks and if you feel a lack of symptom relief increase to 100 and play with injection frequency to get side effdcts under control.

Great advice.
I would also do a cardiac check up. Esp with you blood pressure and weight. Ekg and echo at the minimum.
Also when doing labs always so CBC and metabolic panel.

Out of curiosity, what were those levels?

You might have to go to Discount Labs and get these labs yourself if your doctor refuses which is common because they don’t think it’s medically necessary and is just do to a stand of care in need of updating and lack of knowledge.

I scored 120, 119 and 91, my SHBG at this time was 13, but TRT increase my SHBG because it’s improving glucose and if I can reverse the diabetes, my SHBG will rise. When I see these low Total T numbers, you can bet SHBG is low.

  • 7mg daily = Total T 417 ng/dL, Free T at 15 (ranges 6.8-21.5) estrogen = 33 pg/mL

  • 20mg EOD (+31mg) = Total T 407-497 ng/dL, Free T 14.9-20 (ranges 6.8-21.5) estrogen = 53 pg/mL

  • 50mg twice weekly (+51mg) 697 ng/dL, Free T 29.2 (ranges 6.8-21.5) estrogen 70 pg/mL

Please note my case is unusual and you will likely need more T to get your numbers up. I would start somewhere around 16-20mg daily. You seem to metabolize T quickly considering how low your levels are, I think greater shot frequency will yield better results for you.

You should be using 27-29 gauge insulin syringes, not luer lock syringes though. Easy Touch is best. Also note the daily protocol above was only 3 weeks into my daily protocol and levels would have been higher at 6 weeks as the half-lives build up, but you can see the big discrepancy in the amount of T used when compared with my other protocols.

The more T I used, more aromatization and higher estrogen equaling more side effects. The daily protocol as you can see is more efficient needing significantly less T and my T/E2 ratios are better as well. The estrogen isn’t competing with the testosterone like when on my twice weekly protocol which is showing estrogen dominance.

TRT requires optimal thyroid function to get optimal results, forget about normal because normal isn’t always good. So if your levels of the active thyroid hormone is low, you can forget about ever feeling amazing and will instead feel mediocre and you’ll always be chasing that good feeling on TRT.

The Free T3 is the active hormone, soaks into your cells and drives metabolism (fat loss), T3 is inactive. The T3 is an older test and is obsolete.

Component | Value Reference | Range

Thyroid Peroxidase Antibody | <9 | <9-34

Total T3 | 0.84 | 0.80-2.00

Thyroxine (T4) | 4.98 | 4.50-11.70

TSH | 4.08 | 0.27-4.20

Testosterone Total (Adult Male) | 96.50 | 264.00-916.00

So, this was before TRT started? What is it now? Did anyone suggest changing your Metformin? Either dosing or dropping it altogether? I can’t take it, it crashes my Calcium, which is actually a known problem with Metformin. Hypocalcemia will crank up your BP, by the way.

Those were all pre-TRT. No, I have not had them run since then.

Any idea what your Calcium and Phosphate levels are? You might need a higher dose of Metformin (or twice a day if it’s not XR), or it may in fact be causing the problem.

No, I have not hard them run, post-TRT. I am on XR, once per day. I have not had any of those run since starting (Calcium or Phosphate).

If you get tingling in your face or hands, go to an Urgent Care. Find out those levels. It could be as simple as adding a Calcium supplement once a day.

You’re never going to get great results on TRT with these numbers, your pituitary is essentially screaming at the thyroid to get more out of it. Your T4 which is the total raw thyroid hormone produced by your thyroid.

The T3 is low as well which doesn’t bode well for the active thyroid hormone Free T3 and if ReverseT3 is high, then some of that Free T3 is deactivated and the situation is worse than it currently looks.

It’s more than likely these thyroid numbers are worse on TRT because more demand is place on the thyroid when testosterone levels are higher. I’ll bet Free T3 is low as well, considering testosterone is metabolized in the liver and that Free T3 drives metabolism, results will fizzle out on TRT.

Based on your complaints, it seems this has already happened and your thyroid is tired and busted. Thyroid problems and anxiety go together like peanutbutter and jelly.

Healthy people have a TSH 1-1.5, but normal ranges is 0.5-4.2 and in fact some companies/countries have narrowed the ranges down to 3.0. If you look at history TSH ranges used to go all the way to 10.0, but over time we have grown wiser.

The studies are showing normal TSH is <2.5. You’re not going to lose a significant amount of weight or get great results on TRT with these thyroid numbers and may be why you’re struggling.

I would recommend testing TSH, Free T4, Free T3 (not T3), Reverse T3.

Have free T3, free T4 and reverse T3 checked.

Thank you, sir! I appreciate that information. I’m assuming you take synthroid or something similar? Did it affect your glucose one way or the other?

Thanks for all the input!

My TSH is 0.6-0.9 and have seen it as high as 1.01 on TRT, free thyroid hormones are slightly above midrange, T4 is 8.5 midrange. So no thyroid problems.

TRT improved my glucose pretty fast even without directly treating the diabetes and would have gotten my A1C <5 if I had my diet dialed in upon starting TRT. Once I get my A1C in the 6.6 range, weight starts dropping quickly.

No, you wouldn’t. And you wouldn’t want to. Lower is not necessarily better.

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