T Nation

TRT Case - 43 Y/O Male, 290 lbs

Opening post:
-age: 43
-height: 6’2"
-waist: 38"
-weight: was 350 now 290

  • body and facial hair: lots
  • carry fat around midsection
    -health conditions: arthritis in hips,
    -No hair loss drugs or prostate drugs ever
    -describe diet: 30 Carb 30 Fat 40 Prot (used to be 60 carb 20 fat 20 prot)
    -training: Cardio 2-4 times week.
    -Morning wood gone. Some nocturnal erections.

Started TRT in 2011.

Was feeling listless, tired, unengaged with world, moody, unable to make decisions, brain fog, no libido and generally severely depressed.
I was also the definition of passive patient and blindly did what the doctor prescribed.

Lab Work Oct. 2010 (Pre TRT)
F TSH - 3.22 (0.2-4.0) mU/L
F Test - 8.0 (8.0 - 26.7) nmol/L
F Prolactin - 3.1 (<21.0) ug/L
F Cortisol am - 325 (120-620) nmol/L
Glucose Random - 5.2 (3.3 - 11.0) mmol/L
F Creatine - 100 (50-115) umol/L
f Sodium - 138 (133-146) mmol/L
F Potassium - 4.5 (3.5 - 5.0) mmol/L
F Chloride - 103 (96-107) mmol/L
F HGB - 151 (135-175) g/L
F RBC - 5.17 (4.3-6.0) 1012/L
F HCT - 0.44 (0.41-0.52) L/L
F MCV - 85 (80-100) fL
F MCHC - 342 (320-360) g/L
F RDW - 14.9 (<15.6) %
F PLT - 220 (140-450) 10
9/L
F WBC - 6.1 (4.0-11.0) 109/L
F NEUT - 4.1 (1.8-7.5) 10
9/L
F LYMPH - 1.4 (1.0-4.5) 109/L
F MONO - 0.4 (0.0-1.1) 10
9/L
F EOS - 0.2 (0.0-0.7) 109/L
F BASO - 0.0 (0.0-0.3) 10
9/L
F NEUT% - 66%
F LYMPH% - 23%
F MONO% - 7%
F EOS% - 3%
F BASO% - 1%

Lab Work Nov 2010 (Pre TRT)
F TEST, am - 9.1 (10.3-29.5) nmol/L
F Cortisol, am - 200 (120-620) nmol/L

I asked doctor why testosterone levels were low and was told it doesn’t matter. We will bring them up. Started Andro gel.

Lab Work Jan 2011 (TRT with Andro Gel)
F TEST, am - 11.5 (10.3-29.5) nmol/L

Lab Work Jan 2012 (TRT with Andro Gel)
Bio Test - 2.2 (2.3-14.0) nmol/L

Bitched to doctor - Started Testosterone injections 400 mg every month.
Started doing injections of 100mg every week - self injecting.
Unable to get blood work done with current doctor until 2013 when I switched doctors.

Lab Work Oct 2013 (Cyp injections 100mg every week)
Creatinine - 103 umol/L (45-110)
Uric Acid - 451 umol/L (150-430)
Cholesterol - 4.75 mmol/L (2.0-5.2)
LDL Cholesterol - 2.65 mmol/L (1.5-3.4)
HDL Cholesterol - 0.93 mmol/L (>0.99)
TSH - 3.32 mU/L (0.3-5.5)
LH - 0.2 U/l (2.0-18)
Prolactine - 4.7 ug/l (4.0-15.0)
PSA - 1.2 ug/l (<4.01)
Estradiol - 105 pmol/l (<156)
Testosterone - 16.2 nmol/l (8.4-28.7)

My current doctor wants to take me off of TRT which I’m 100% against.

My Libido is depressed and I want to figure out a better plan of action.
I have an appointment coming up with an Endocrinologist which I am hoping will help at least keep me injecting. But for now that is a month off.

I have never done an Estrogen blocker/inhibitor, nor have I used HcG. My doc was barely into the TRT. So I am hoping people here can look at the labs and help provide some guidance.

Sorry I am so minimalist. I’m trying to be no longer passive about it and this forum has helped with that.

You have a degree of hypothyroidism and that can mess everything up. Please read the opening statement in the advice for new guys sticky and read all of the thyroid basics sticky.

Inability to absorb transdermal T is typical with hypothyroidism. So that inability to absorb is a symptom of hypothyroidism.

If your thyroid problems are caused by iodine deficiency, that is easily fixed. If not using salt or if you are using sea salt; that is the problem.

In the sticky you will see advice for thyroid labs and how to check your body temperature.

Doctors ignore TSH levels until you are a total mess, then they take action. Doctors have forgotten iodine, goiter etc.

Injecting once a week is wrong. Your lab results then are only a function of when you do the labs. See the protocol for injections sticky.

Estradiol: This needs to be monitored and controlled. May be difficult to do where you are.

You have three stickies to study. Nice opening post!

This bothers me: Uric Acid - 451 umol/L (150-430), should be followed up with urinalysis and other kidney specific labs.

400mg every month… Dang I thought my doctor was an ass hat. Sheesh…

Woops. Re-read that. Was under the impression you were getting one shot of 400mg per month.

Dude, first post and you got KSman feedback. You obviously know how to follow sticky directions well.

[quote]sweet-t wrote:
400mg every month… Dang I thought my doctor was an ass hat. Sheesh…

Woops. Re-read that. Was under the impression you were getting one shot of 400mg per month.

Dude, first post and you got KSman feedback. You obviously know how to follow sticky directions well.[/quote]

400 mg monthly in 1 shot was my initial impression as well

Yes - You are correct.

400mg in one monthly shot. I could literally feel the wheels fall off the cart as the month was coming to an end…

KSman,

I don’t know how you find the time but I appreciate your input. It must be tiring having people not do any basic research and then post asking you for advice. Or ignore the info and post their case file into someone else’s. I know you are self taught and worked hard to understand these hormones and how they affect one’s body - sad that others won’t - and I am thankful you are willing to freely share your time and knowledge. Your posts on this board were what started me asking questions and realizing that I needed to be proactive about the direction I am taking in TRT.

So thank you for helping out. I never considered the Thyroid side of it. Like so many my doctor said - “Your Thyroid checks out normal” - and that was it. I will read the sticky and formulate a plan.

I know my injection protocol is off - I changed it this week to match the sticky info.

A nifty chart of intramuscular injection of Testosterone Cypionate/Enanthate

medibolics.com/freq2.htm

Ok - went to see the Endo. It was interesting - he seemed like most typical doctors who did not want to discuss. Merely get all the data and then tell me what pills to take. I was kind of un-amused.

The assistant came in and asked me all the questions, looked at my bloodwork, and recorded everything in the computer, and then the Endo came in and asked the assistant about my case file. He had her repeat to him what I had said. Didn’t make me feel confident.

And I waited 1 month for that appointment.

Absolutely nothing about my LH being way low. Was told that is normal when on TRT. I asked about HcG and was told it would only return my testicles size and not make them start producing Testosterone. I was told that clomiphene was needed in order to go off TRT and start producing Testosoterone. Hmmmmmm. Not really what I have read - I thought HcG can increase T levels as well as LH levels. Mentioned that to Doc and was told I was wrong. WTF?

I don’t know much about Clomid - anyone with experience want to chime in? I was thinking you can use T and Clomid together right?

Sooooo he gave me 2 options:

1.) Take an increased level of Test - 150mg per week instead of the 100mg I am on. Then get blood work after 6 weeks. I’m tempted.
2.) Stop TRT and use clomiphene to kickstart my system back into producing its own Testosterone. Then go in for bloodwork after 6 weeks.

I re-read the stickies about injection protocol and Thyroid issues/Iodine.

My Plan:
1.) Continue TRT at 100mg weekly divided into 2 doses of 50mg Mon and Thurs - SC instead of IM. Blood work at the end of 6 weeks.
2.) Record my temperature and figure out TSH issues - Salt with Iodine is back in the diet.
3.) Get my E2 levels checked at the 6 week interval as well. After 6 weeks if levels show E2 issues deal with that.
4.) After 6 weeks I may tell doc I want to have kids and therefore try to get HcG to increase my LH levels (and the hormone pregnenolone)
4.) Continue to not be a passive patient and continue posting here - along with reading as much as I can as there is a lot of info here.

That should get me the T+AI+HcG trifecta we all look for.

So I went off Testosterone early May 2014. My Libido was crashed, testicles were atrophied and I could not find a Doctor in Vancouver BC who would work with me on the TRT. I was seeing Dr Marshall Dahl in Vancouver BC (Endo in the above Apr 23 post) but was getting zero support. When I went back to his office in October after getting blood work done. I mentioned I was depressed, irritable and moody, etc and was told I’m not a candidate for TRT - lol. I asked about getting some help or a referral to locate a Counselor to talk about my depression and was told they would contact me. To date nothing… So I’m done with that office.

Since then I have experienced some depression. I have gained weight. I’m not really in a good place. Nothing major but not perfect.

I am going to start tracking my temperature again. I am posting blood work done in July 7, 2014 when I had been off TRT for a month and 3/4. It was based on this blood work that the Endo above felt I did not need TRT. My TSH is still low and has not come up.
KSman’s sticky on thyroid says the closer that number is to 1 the better. So iodine?

July 7, 2014

WBC 5.3 (4.0-11.0) 109/L
RBC 5.30 (4.30-5.90) 10
12/L
Hemoglobin 153 (135-180) g/L
Hematocrit 0.45 (0.41-0.52) L/L
MCV 85 (80-100) fL
MCH 28.9 (27-34) pg
MCHC 338 (323-365) g/L
Platelet Count 202 (150-400) 10*9/L

Neutrophils 3.0 (2-8) 109/L
Lymphocytes 1.7 (1-4) 10
9/L
Monocytes 0.4 (<0.9) 109/L
Eosinophils 0.2 (<0.8) 10
9/L
Basophils 0.1 (<0.3) 109/L
Grans Immature 0.0 (<0.2) 10
9/L

Ferritin 325 (>14) ug/L

Sodium 141 (135-145) mmol/L
Potassium 4.8 (3.5-5.0) mmol/L
Creatinine 101 (45-110) umol/L
Estimatated GFR 70 (>59) mL/min/1.73 sq.m

Alk. Phos. 74 (40-145) U/L
ALT 23 (< 50) U/L
FBS 5.6 (3.6-5.5) mmol/L Taken at 1015 h 12.0 h pc

Cholesterol 66.03 (2-5.2) mmol/L
LDL Chol 3.44 (1.5-3.4) mmol/L
HDL Chol 1.09 (> 0.99) mmol/L
non HDL Chol 4.94 mmol/L
Triglycerides 3.29 (<2.21) mmol/L

TSH 3.67 (0.3-5.5) mU/L

Prolactine 11.1 (4.0 - 15.0) ug/L

Testosterone 10.3 (8.4-28.7) nmol/L (Roche - Electroluminescence)

Estradiol 74 (<156) pmol/L

So off T my weight has gone up. Which is not where I want to go.

My temperature has been pretty good - roughly 97.5 in the am and 98.7 in the afternoon. I added salt in to my diet and take a multi that has iodine as well.

I’m not sure where to go next. I feel that I was better on T but have no doc or endo willing to give HcG or AI while on T.

So I went to a HRT clinic and paid for it all out of my own pocket.

They ran the pre testosterone panel on Jan 30, 2015:

TSH - 2.3 0.27-4.2 mU/L
T4Free - 11.9 10.5-20 pmol/L
T3Free - 4.8 3.5-6.5 pmol/L
Thyroperoxidase - 7 <3.5 IU/ml

Estradiol - <100 <150 pmol/L (they don’t give actual number)
Progesterone - <2 <4 nmol/L
DHEA Sulphate - 9.2 <15.0 umol/L
Testosterone - 4.9 8.4-28.8 nmol/L
Testosterone free - 152 170-630 pmol/L
Testosterone Bio Calculated - 3.6 4.7-15.0 nmol/L
SHBG - 15.9 10-70 nmol/L

Based on this I was prescribed -

Testosterone - 100mg/week
Desiccated Thyroid - 30mg x 2 daily
Arimidex - .5mg/week

Also - Vit D3 5000iu - Omega 3 4000iu - zinc 50mg/day - selenium 200 mcg/day

I have a followup blood test in 3 weeks. Will post.

And nothing for Luteinizing hormone so kinda pissed off,

Looks like your iodine was bringing TSH down a bit.

So what had been your history of using iodized salt?

You can get "zinc 50mg/day - selenium 200 mcg/day " in a good multi-vit that also contains iodine.
Probably no need for more than 25mg zinc in the long run.

http://www.mayoclinic.org/thyroid-disease/expert-answers/faq-20058114

Thyroperoxidase - 7 <3.5 IU/ml

  • might be elevated from a selenium deficiency, so you will see what happens.

Desiccated Thyroid - 30mg x 2 daily

  • may be too much if you feel agitated
  • watch where body temperatures go.

At your age, docs assume that you are not wanting to have babies, so why worry about your LH receptors. You will have to advocate for your testes. When they say that you don’t need them, ask if they would be OK if theirs were removed.

Thanks KS Man

I’m watching my body temps as per your thyroid sticky. And using iodized salt.

The Dessicated Thyroid caused my feet to swell a bit. Now they are back to normal. ?

I have a good multi-vitamin. Is there danger in taking more than 25mg zinc?

Feb 12, 2015 test results. This is on Testosterone - 100mg / Week .5 arimidex / Week

PSA 1.0 <2.5 ug/L
DHEA-S 8.8 <15.0 umol/L
Estradiol 127 <150 pmol/L
Progesterone 3 <4 nmol/L
SHBG 16 10.0 - 70.0 nmol/L
Testosterone 11.5 8.4-28.8 nmol/L
Free Test 368 170-630 pmol/L
Bio Test 8.6 4.7-15.0 nmol/L

Feel better. Nothing ground breaking but better.

You only inject once a week? If so, labs are sort of useless.

E2=35pg/ml, target is 22, increase Arimidex to 0.5 * 35/22 = 0.8mg [1.0mg is sort of expected]

Dose T twice a week and take .4mg Arimidex at that time.

If injecting twice a week, you need more T.

Is your T marked 200mg/ml and you inject 0.25ml twice a week?
Wondering if you have been dosed confused.
Exactly what kind of T is it?

Are your body temperatures recovering?
Iodized salt probably not enough. Get iodine supplements.

Ping me on KSman is here thread.

Hi KSman and all others reading this thread.

Apologies for not being as attentive to it as I should.

My Doc looked at my bloodwork and upped the Arimadex to .5mg twice per week.
I inject 50mg Testosterone twice a week - so 100mg total. It’s Depo T and 100mg/ml.
And I take .250iu HcG three times weekly.

This is perfect for me. My body temps seem to have adjusted.
I feel great and am now 45 years old.
Switched cities and jobs and am trucking along.

I will post bloodwork as it comes in.

Are you getting email notification when this thread is active?

Ask for 200mg/ml T and inject less oil.

Do lab work 1/2 way between injections, not at random time or office visits.

Thanks KSman - I don’t get email notices. I just check in at random times.

My house sitter back in Alberta is prescribed and uses 200mg/ml T. I will ask the doctor when I go in next.

I will take blood work at 1/2 way point between injections.

Thanks for all your help and guidance.

Click subscribe at top of this thread and you will get email notices of activity. There is a setting in your profile too.

Everything for me is still good. I got a supply of 200mg/ml T and now shoot less volume which makes it easier to do injections.

My weight is still creeping up so I am now watching my diet and working to get it back down. Slow process.
I’m in a different city for work and don’t have a doctor here that will do blood work for T replacement. So I usually get my GP to do it when I go back home every 6 months.

I’m glad I found this forum and sought advice from experienced people.