T Nation

Trt Advice Newbie


#1

I guess im just looking for some sort of advice from some that has more knowledge the the three drs ive tried to work with and myself. To somewhat catch up to my situation, about five years ago (nov. 30th 2010) i suffered a major accident where i broke my hip, neck, ripped my skull open among other broke parts and internal injuries including sever brain damage. over the years the drs keep throwing lorazepam and other anxiety, depression meds at me. to get to the point i finally found the link to my brain injuries (tbi ptsd blah blah) and low t. was able to get the dr to test me and came back a 220, 150 so he put me on 200mg every two weeks. my test after starting was 347 tt and a 85 free with 2.3 fsh and a 3.7 lh, pth 23, t4 1.1, t3 111.

i wasnt feeling any better and asked about e2 dr 1 said it doesnt matter so i went to see a specialist who changed the prescription to 3/4 (75 mg) weekly and checked my e2 weeks later and total. (he says free dont matter) my e2 came back a 42 seven days after shot with a tt of 427 and hematocrit 46.3. psa .9 thats all he chacked. i was prescribed 1mg anastrozole to be taking day of injection. i asked about adding hcg and was told its a waste of time and money but again with my brain injuries ive read different. dr 2 seems to be uneducated to this topic also. i seen one other dr and he seen me and said hes not giving me t before even checking my blood, hearing me out etc. all three have expressed concern treating me saying my baseline was never checked bs and the fact im not overweight. im 6'3 260p ive been lifting 7 days a week sense my accident to be able to perform my job as a lineman with screws and plates in my hips.

sorry for the long story and i understand to a degree i need more blood work plus im going to say i should be on hcg also with a higher t level at my size and age (31). but where is good? desperate for any advice thank you for your time any advice on steps to take is appreciated. the major mood swing, anxiety attack, panic attacks etc. has became old to say the least.


#2

ill give any other information i can give to get more accurate advice.


#3

Wow sorry to hear about your accident. As far as TRT goes, your TT is too low and your E2 is way too high. The 1mg of Adex will bring the E2 down over a few weeks especially if you stay at 75mg of Test.

I would find another doc


#4

Thank you, i recovered well other than this. there saying my pituitary gland wasn't affected due to my brain injuries. I'm trying to find a 4th dr. hopefully he has a little more knowledge on this. Damn shame I've learned more from the forums than the Dr's can tell me.


#5

You need A better TRT doc. Ideally, your TT would be 800 or above and your E2 between 20-25. This usually requires twice weekly T cyp injections of 50-60mg and 0.5mg of adex twice weekly. Of course these are just guidelines. Everyone is different. Also be nice to find a doc that will prescribe hcg as well.

But before all that, you need a proper diagnosis. Are you primary or secondary? Are you a candidate for a restart?


#6

When doc had me at 200 mg every two weeks I changed it to twice weekly. 50 mg every 3.5 days. At this my anxiety became worse and when I asked about checking my e2 he responded this is why people that don't need it shouldn't be on it. That was my primary I've sense went to an urologist who seems even more lost than him. The urologist won't even check free t. But I do have adex now so I'll realign my schedule and try 50 mg every 3.5 days. Oh and if it matters I'm on test email but he's changed it to cyp just been finishing that last of the enanthate I had


#7

I have no personal experience with ethanate, but I don't think there's much difference between it and cyp.

You will NEVER feel good with an E2 level like you have right now. Makes no sense to pay a doc who doesn't understand or care about that!


#8

Please read these stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

So you can do battle with the idiots.

  • Advice for new guys
  • Things that damage your hormones
  • Protocol for injections
  • Finding a TRT doc

Please post your labs in list format, less obscure and with lab ranges.

Your LH/FSH should go to zero, waste if time+$ to test on TRT.

Suggest:
* 50mg T cyp/eth twice a week
* 0.5mg anastrozole at time of injections
* 250iu hCG SC EOD
* use #29 1/2" 0.5ml insulin syringes
* get Relion house brand at Walmart/SAMs, ~$14 per 100
* inject SC over upper leg or IM in vastus lateralis

Thyroid:
test TSH, fT3, fT4 [please not T3, T4]

check oral body temperatures as per thyroid basics sticky, this is best overall measure of overall thyroid function

You need iodized salt in diet to support thyroid function.

After those injuries, you should check all major hormones mediated by hypothalamus and pituitary:
thyroid - as above
adrenals - AM cortisol, at 8AM please
IGF-1 to check GH production
LH/FSH was probably low

Feeling right will require that T levels be good, E2 near 22pg/ml, decent thyroid function and good cortisol levels.

Elevated E2 on TRT can make guys short tempered and takes away energy, libido and mood.


#9

Thank you, treatment began in early December 2015.
i will start reading the stickies tonight and get the blood levels I have posted. I changed my dosage to 50 mg every 3.5 days and .25 of the anastrozole eod. One week into this and seeing improvement. Currently injecting into glutes, is there a benefit to injecting into vastis lateralis?

Getting hormones checked isn't working through the dr, none of them. My next blood work is in six months and he's checking estradiol and total testosterone. Is there somewhere anyone could recommend to get all hormones checked? I've come to acceptance I'm on my on getting things checked.


#10

First test I was aware of

Levels. (Range)

Tsh-3.04 (.40-4.50 miu/l)
Glucose-94 (65-99)
Urea nitrogen-22 (7-25)
Creatine-1.05 (.60-1.35)
Sodium-138 (135-146)
Potassium-4..4 (3.5-5.3)
Chloride-101 (98-110)
Calcium-9.3 (8.6-10.3)
Carbon dioxide-30 (19-30)
Absolute lymphocytes-2325 (850-3900)
Monocytes-5.8%
Absolute Monocytes-470 (200-950)
Eosinophils-3.2%
Absolute Eosinophils-259 (15-500)
Basophils-.5%
Absolute Basophils-41 (0-200)
Mpv-9.3 (7.511.5)
B12-734 (200-1100)
Follett serume->24.0
Ast-21 (10-40)
Alt-34 (9-46)
Testosterone-150 (250-827)
Free test-not tested

Returned for another blood test after I had been taken an cellucore testosterone product unaware a) it even worked and b) she was gonna check my blood again.

Testosterone-350 (250-1100)
Free test-72 (35-155)
Prolactine-11.2 (2.0-18.0)

After this visit was told to take a multi vitamen, fish oils and start an testosterone diet and exercise, I've been doing this sense my accident. (4 yrs at this point)

Third blood test (day of last dose of cellucore)

Testosterone-347 (250-1100)
Free-85 (35-155)
Fsh-2.3 (1.6-8.0)
Lh-3.7 (1.5-9.3)
Calcium-9.3 (8.6-10.3)
Pth intact-23 (14-64)
T4, free-1.1 (.8-1.8)
T3, total-111 (76-181)
Psa-.7

Returned to see my primary and was notified he had already checked it after my accident at age of 26. This test returned a 220 but it didn't alarm him because I wasn't complaining of low test symptoms. Instead was prescribed many different anti depressants, anti anxieties over the years. At this appt. Was put on test enanthate at 200 mg every other week. Was moved to 100 mg a week and month later by my request.

4th blood 4 days after 100 mg shot
Hematocrit-46.1 (38-50)
Testosterone-490 (250-827)
Tsh-2.08 (.40-4.50)
Free test-not tested.

Things improved but then became worse. I researched and found yall, returning and asked him to check my estradiol. Told it was unnecessary, testosterone and e2 is a balancing act, act etc. Went to another urologist. He changed my prescription to 75 mg a week.

Blood ran 3 months later 6 days after shot.

Testosterone-427 (250-827)
Free- not tested
Hematocrit-46.3 (38-50)
Estradiol-52 (less then 39)

He was alarmed of my e2 this long after shot. Prescribed anastrozole 1mg at time of shot. I'm currently following suggestion of 50 mg every 3.5 days and .5 mg anastrozole. No hcg, asked urologist about it was told it's a waste of time. Awaiting test in 5 months to check.


#11

Your TSH=3 and T4, fT3 below mid range is low thyroid function.

Check oral body temperatures as per the thyroid basics sticky and we will get a measure of overall thyroid function.

Are you using iodized salt to support thyroid function?
I tried to get you on these thyroid issues a week ago.

Why inject in you gluts where you can't see what you are doing comfortably?


#12

Blows to the head can damage the pituitary!


#13

I've been going through the stickies beginning the learning process that drs should know better than me but I'm learning that's asking to much.

Yes, I have added iodized salt to my diet sense your last post and started a new multi with 200mcg of selenium in it and 150 Mcg of iodine. Going to start checking body temperatures in the morning and work on taken your advice through the stickies and post. Will see how everything goes come next blood work and going to get dr to add hcg. He didn't seem against it just expressed to me it was a waste of time. But I've learned differently sense that visit.

I've changed my injection site the past week also.


#14

I have asked the Dr's about my pituitary gland function from my head injuries. The response was, if my pituitary gland was damaged my prolactine would be off and it's not, Ends there.
Ive been diagnosed with ptsd, severe tbi and showing signs of cte according to the drs. My brain injuries are far from minor. I ripped my head open fracturing my skull suffering frontal lobe damage. Spent some time in a coma after being revived multiple times from what I'm told. Also breaking or fractured the vertebraes in my neck and a steering wheel and motor being shoved into my pelvic area breaking my hip. They cut the steering wheel off of me at the scene.

I Have absolutely no memory of the accident and time after it is foggy at best. 14 months total before I was walking and functional again. Not sure if this matter but figured I'd add it just incase it helps.


#15

Checked temp this morning at 0930 upon waking. (I work 2nd shift) checked orally twice both times showed 95.1.


#16

Taking maintenance doses of iodine when one has been deficient is going to take a long time.

After those injuries and stresses if recovery and on-going, I would test rT3 to see if that is blocking your fT3. See the thyroid basics sticky references to rT3, stress, injuries, surgeries, adrenal fatigue and Wilson's book.

If adrenals are stress, these should be tested too:
AM cortisol
DHEA-S

TRT can sometimes make/restore metabolic demands that the body cannot support if thyroid and adrenals are not good.


#17

I'll add that to the list to be tested. Hopefully with a new dr. Attempting to find one in my state (fl) now. Been dealing with this for 5 plus years. Going to assume this is going to take some time.


#19

Get a new doc, when i upped my test 100mg wk to 200 i felt better, 100 aweek my free test was 135. Head trauma has been proven to lower test levels, gh, etc. Dont feel bad after i had major pulmonary embolism i couldn't bemore than 10 feet from phone for two years, and I've had panic attacks, the first year after, on clozapam now at this point probably don't need, you are putting out numbers i cant interpret medicine is a business, some doc get offended if you want to go somewhere else , fuck them my gp don't get offended when i go see my gastrointestinal doc, you might need a neurological doctor, if you're doc don't authorize than he is a quack.


#20

The dr i have now would never give me 200 a week. Wouldnt even give me a 100, im going against him. Going off just the way I feel when I would take a 200 mg dose, every other week. I would feel good for about 5 days then slowly start a decline. Went to 100 mg a week and at this dose would feel good about 3 days before a decline. Now doing 50-60mg 3.5 days and I feel a decline two days after shot.

I've read article after article on tbi and hormones. I've brought the evidence to the drs I've worked with but they have some reason to contradict everything.

This is the very first article I found that started me trying to learn and finally got some relief.


#21

Great find!

Please post a link to the source. We have a few guys here in the same boat.

I need to point out again that low thyroid levels can undermine every cell in the body, thus affecting every organ and the hormone producing organs. Looks like HG and IGF-1 have similar effects which is no surprise when you consider how GH replacement in adults is revitalizing.