T Nation

TRT for One Year, Levels Still Low


#1

Hi all,

Male, 39 yo, 216 lbs.

Been hypogonadal for 10+ years, cause unknown. Tried to correct with diet, exercise, and supplements to no avail. Been on TRT for almost a year and still low. In fact, with TRT, I only go as high as pre-trt levels, sometimes lower (~200-300)- weird

Started with 50mg/2 weeks now at 200mg/e 5 days. Injecting in glutes using 23G 1 inch needles. Under care of endocrinologist. Good guy but cant seem to figure it out.

Experiencing horrible crashes by day 4. Cant get E levels to go up either so get symptoms like joint pain. I’m aware 200mg so often is a high dose- still not seeing benefits like increased muscle mass and weight loss. Memory and cognitive functions are shit.

Losing weight is impossible despite diets, gym and intermittent fasting. Lost weight in the past with modafinil but not practical.

Only other abnormal test is thyroglobulin which is always low.

Is it practical to use a higher dose? Is there something wrong with receptors? Considering getting off TRT altogether.


#2

Have you tried more frequent shots? Try 100 every 2 days or something and see how you respond. What does your SHBG look like? TSH? How is your vitamin D? How is your sleep?


#3

You’re going to have to provide labs with each protocol or we may never know why you’re having problems. Your SHBG level will dictate injection frequency, large doses of T for a low SHBG guy is a ticket to disaster.

You may be a hyper metabolizer requiring larger doses than most men, then 40-50mg EOD may be needed. We have a member here who has middle range SHBG and is a metabolizer and doesn’t feel good unless doing 50mg EOD to keep his estrogen in range.

Horrible crashes every 4 days is an important piece of info, it is key to the injection frequency needs to be closer together.

You need SHBG test asap.


#4

Some labs from when I was dosing 200mg/week. Have not re-tested since starting e/5days.
Forgot to mention I have mild sleep apnea but I’m very symptomatic. Sleeping on my side with two pillows helps avoid the zombie state some.

From June, 2018

  • Free test (direct) - 7.4 (low) Reference Range: 8.7-25.1 pg/mL

From January, 2018

  • Estradiol 12.5NORMAL Reference Range: 7.6-42.6 pg/mL

  • LH 1.6LOW Reference Range: 1.7-8.6 mIU/mL

  • FSH 0.6LOW Reference Range: 1.5-12.4 mIU/mL

  • SHGB - 33.8NORMAL Reference Range: 16.5-55.9 nmol/L

  • Testosterone, Serum 305NORMAL Reference Range: 264-916 ng/dL

  • Free Testosterone(Direct) 14.5NORMAL Reference Range: 8.7-25.1 pg/mL

First test with this doc July, 2017

  • Testosterone, Serum 310NORMAL Reference Range: 264-916 ng/dL

  • Free Testosterone(Direct) 8.9NORMAL Reference Range: 8.7-25.1 pg/mL

  • Estradiol 7.3LOW Reference Range: 7.6-42.6 pg/mL

  • LH 3.6NORMAL Reference Range: 1.7-8.6 mIU/mL

  • FSH 2.6NORMAL Reference Range: 1.5-12.4 mIU/mL

  • 25-Hydroxy, Vitamin D 23LOW - Tried to correct this. Using Vitamin D causes serious cramps in my back and next that can be debilitating. Even eating dairy will do this so I stopped.
    Magnesium (been taking for years) and vitamin K doesn’t help so I left this alone for now.


#5

Also diagnosed with Bilateral Varicocele and repair surgery a couple years ago. Didn’t change anything.


#6

Some thyroid labs from 7/20/17

Thyroglobulin by IMA - 1.1 LOW - Reference Range: 1.4-29.2 ng/mL

TSH - 1.860 NORMAL - Reference Range: 0.450-4.500 uIU/mL

T4,Free(Direct) - 1.22 NORMAL - Reference Range: 0.82-1.77 ng/dL

Prolactin and others are normal.


#7

A lot to look at here.

Thyroid, get complete workup, especially fT3 and rT3. Sleep apnea, do you need CPAP? IGF-1? CBC? Regardless, I’d try more frequent injections.


#8

I’d like to learn more about this. Given my last SHBG test from the start of the year ( 33.8NORMAL Reference Range: 16.5-55.9 nmol/L), is a dose of 100mg E/3 days reasonable or is this too high? I’m concerned with doing more than 200mg/2 weeks total and the potential for side effects.


#9

Endo wont do fT3 and rT3. Said it’s only for “really sick people”. I can try my primary or a walk in lab.

Sleep apnea, I am mild and generally don’t qualify for CPAP. Although, if one is really symptomatic, I can push for this and the insurance might cover it.

DHEA, IGF-1, CBC- all normal. I donate blood 2-3x a year.

is 100mg/3 days too aggressive?


#10

I have a more recent SHBG from April, 2018 - 27.4 NORMAL Range: 16.5-55.9 nmol/L


#11

That’s too bad.

I don’t know, that’s a high dose, but you have to try something different. I would do it and see if it helps and see if your lab levels respond.


#12

Hey man, don’t get off TRT, chances are you are going to be feeling just as bad without it if not worse. It takes a lot of patience and time (I still don’t have it figured out). E2 is a low, maybe get off the AI/lower the dosage. Also, what Testosterone Ester are you on? (Cypionate, Enth , undec, etc.) I’ve heard of people having an allergic reaction on other forums to certain kind of Esters and the testosterone never really increases because your body is trying to fight it off. Maybe switch esters, it’s very wierd that you aren’t responding to 200mg+ per week given that would put alot of people in semi-super physiological levels.


#13

I’m on Cypionate. You’re right. I should be a beast at 200mg every week. I even researched ways to inhibit the enzymes that metabolize T to make the levels last longer. Found 3 pathways and quercetin inhibits all 3. Doctor laughed it off.

I’m a little concerned about using such a high dose for so long. I suspect no matter what dose I put in my body, it will get metabolized in 3-4 days. So I will try using 50mg e/3 days and see how I feel. That puts me right around 250mg/e 2 weeks.


#14

Yeah that sounds about right, maybe taking a blood test on day 1 and a blood test on trough you’ll have a sense of how fast your body metabolizes T. Also, maybe request your doctor to change esters if possible to rule out any possible allergic response.


#15

Your doctor is an idiot, I have normal thyroid labs and hidden in the details is high Reverse T3. He said only for “really sick people”, that’s the stupidest thing I’ve heard to date!

Normal doesn’t mean anything in relation to you, only everyone else. I can have my Free T midrange and feel like pure crap even though it’s consider normal yet I feel far from normal.

In other words normal for you isn’t normal for someone else.


#16

Started dosing 50mg e/3 days today. I also changed the syringes. I was using a big ass 23G x 1 inch needle and switched to a 29G x 1/2 inch needle. So much more comfortable and still feel my dose. What a fucking relief! I hated shooting up with that big ass needle. Now i’ll be able to rotate my sites better and do shoulder, leg, etc.

I’ll follow up with my doc in a month to see how my levels are. I’m also going to test all the thyroid stuff next week.

Stay tuned…