T Nation

TRT - Going Backwards Still have ED, No libido - New Bloods Are In


#1

Hi Guys,

  • 28 years old
  • 6’'1
  • 36"
    -103Kg

So I have been placed on TRT 4 weeks ago 250mg T, (Primotestion Depot) every 2 weeks, First week of two week inject I feel great, second week not to great.

I booked in with my andrologist after 4 weeks as within 4 I put on 10kgs of water weight. Pinch test confirmed.

I only booked in to discuss reducing the water weight, however as result of my ups and downs and high T / E2 in the first week and low T / E2 in the second week we have changed to 125mg T every week. Starting on Monday.

Blood work pre TRT which caused my GP to send me to an Andrologist.

Serum
Haemoly - Nil
Icterus - Nil
Lipaemia - Nil

Na - 145 mnol/L - ( 135-145 )
K - 4.8 mnol/L - ( 3.6-5.4 )
Cl - 110 mnol/L - ( 95-110 )
HCO3 - 24 mnol/L - ( 22-32 )
An Gap - 16 mnol/L - ( 10-20 )
Urea - 6.0 mnol/L - ( 2.5-7.5 )
eGFR - 90 - mL/min/1.73M2
Bili - 7 - umol/L - ( <20 )
AST - 33 - U/L - ( <35 )
ALT - 18 - U/L - ( <45 )
GGT - 14 - U/L - ( <40 )
ALK Phos - 67 - U/L - ( 50-110 )
Protein - 77 - g/L - ( 60-82 )
Albumin - 46 - g/L - ( 38-50 )
Glob - 31 - g/L - ( 20-38 )

Serum/Plasma Glucose ( Fasting )

Serum - 5.3 - mnol/L - ( 3.4-5.4 )

Thyroid Profile

TSH - 1.1 - mIU.L - ( 0.5-4.0 )

Serum Hormone Profile

FSH - 2 - IU/L - ( <7 )
LH - 3.1- IU/L - ( <7 )
E2 - 111 - pmol/L - ( <150 )
PROG - 3 - nmol/L - ( 0.9-3.9 )

Lipid Studies ( Fasting )

Chol - 4.9 - mnol/L - ( 3.0-5.2 )
Trig - 1.0 - mnol/L - ( 0.5-1.7 )
HDL - 1.3 - mnol/L - ( 1.0-2.0 )
LDL - 3.1 - mnol/L - ( 1.5-3.4 )
Non-HDL - 3.6 - mnol/L - ( 1.5-3.4 )
Chol/HDL - 3.8 - mnol/L - ( <5.0 )

Haematology

HB - 160 - g/L - ( 130 -180 )
Hct - 0.47 - - ( 0.40-0.54 )
RCC - 5.5 - x10power12/L - ( 4.5-6.5 )
MCV - 85 - fL - ( 79-99 )
MCH - 29 - pg - ( 27-34 )
MCHC - 343 g/L - ( 320-360 )
RDW - 13.5 - % - ( 10.0-17.0 )

WBC - 9.2 - x10power9/L - ( 4.0-11.0 )
Neut - 5.6 - x10power9/L - ( 2.0-7.5 )
Lynph - 1.9 - x10power9/L - ( 1.0-4.0 )
Mono - 0.8 - x10power9/L - ( 0.2-1.0 )
Eos - 0.2 - x10power9/L - ( <0.7 )
Baso - 0.1 - x10power9/L - ( <0.2 )

Plat - 259 - x10power9/L - ( 150-400 )

Androgens

Total Test (Centaur) - 11 - nmol/L - ( 8.3-29 )
Sex Hormone Binding Globulin - 32 - nmol/L - ( 11-71 )
DHEAS - 12 - umol/L - ( 3.0-10 )
Calculated Free Test - 216 - pmol/L - ( 225-725 )

Blood work Andrologist performed looking for other options then TRT.

LH - 2 - IU/L - (1-10)
FSH - 1 - IU/L - (1-10)
E2 - 90 - pmol/L - ( <150 )
Test - 8 - nmol/L - ( 10.0-33.0 )
FTest - 249 - pmol/L - ( 150-700 )
SHBG - 8 - nmol/L - ( 13-71 )
DHEAS - 3800 - ug/L - ( 1000-4000 )

First week of 250mg T next morning

Test - 28 - nmol/L - ( 10.0 - 33.0 )
E2 - 160 - pmol/L - ( <150 )

End of second week no shot in morning

E2 - 90 - pmol/L - ( <150 )
Test - 17 - nmol/L - ( 10.0-33.0 )
FTest - 488 - pmol/L - ( 150-700 )
SHBG - 19 - nmol/L - ( 13-71 )

Sorry for the inconstant bloods, I’m still trying to find the right GP for my own blood work monitoring. This first GP got offended when I said I wanted to monitor my own blood work.

In 3 weeks time I will get new blood work for the new protocol I have been placed on. which is 125mg T every week. Doc is hoping my E2 to plateau out at 120 pmonl/L and my T to 22 nmol/L.

With the water retention he has placed me on 40mg of Lasix per day

He has also prescribed 100mg Viagra if I have any issues through the transition.

What are your thoughts?


#2

You should not need Lasix.
Your labs show signs of dehydration. That messes with results. Do drink water when fasting for labs. Lasix did this?

E2=80pmol/L would be a good target and low dose anastrozole [AI] may be needed to get there.

Suggest injecting T SC/SQ, not IM, twice a week.
AI at time of injections as needed.

You can inject SC/SQ with #29 1/2" [12mm] 0.5ml insulin syringes.

You are injecting T enanthate and it cannot make 7 days!

Most need hCG or a SERM to preserve testes and fertility.

Most who come here have some iodine or low thyroid function issues that have a large effect on energy, mood, fat gain/loss and libido. See last paragraph below.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

@KSman

Thanks for the reply, the main set of bloods was performed pre - TRT and Lasix.

When fasting, I would just wake up and go get bloods done. Would not drink water that morning as blood is easy to capture.

I have been placed on Lasix at week 5 of TRT due to the 10kgs of water I gained withing the first 4 weeks of TRT.

E2=80pmol/L Can you please clarify this a little further, As I asked for an AI however was given Lasix.

Can you please explain why SQ not IM? I understand lots of people here do SQ, but I also know lots of people take T for BBing do IM. Wouldn’t SQ lose a bit of potency compared to IM? as its slower into the blood system?

I’m guessing as you have mentioned Thyroid issues this is something you have also noted in my bloods?

Regards

Nathan


#4

Lasix was a bad call. Your problem is caused by E2 You need anastrozole to lower that level and that will bring your water weight back to normal without Lasix.

Take KSman’s advice and change your protocol to the one he suggested.

About SQ vs IM. SQ causes less damage to your muscles, hurts less and releases a little slower into the blood stream. Body builders, when on gear, do not do it that way because it is difficult to inject 300% higher doses than we are using just under the skin. They would end up with a golf-ball sized lump under the skin. They use a lot more at one time than us, but they do not inject themselves a tenth as often as we do. So punching holes in muscles is not as much an issue with them.


#5

Thanks @verne,

I tried asking my doctor to place me on an AI, he said “it will create to much of a rollercoaster” so he put me on Lasix.

I know that isn’t true.

He also dropped me from 250mg E2W, to 125mg EW. I told him I felt amazing on the first week I’ve injection cycle. But he refused for me to go on 250mg EW.

I went to get my new prescription, the refilled needles only come in 250mg so the pharmacist said just use half.

I’m going to get some vials to save the other half unless there is a better way of keeping the left overs in insulin needles when I transfer.

I will look to do SQ, on Monday and split as per @KSman suggested.

How I get my doc to realize he may not know everything?

Unfortunately as I have already seen him once outside of when he scheduled me to see him in 3 months. So I’ll have to go without AIs for another 6 weeks.

I will also be asking for a hcg script too, I have already asked him and he thinks it doesn’t work.

Cheers


#6

He has no idea what he is doing. Without an AI, cutting your dose in half will do your E2 levels some good. You started all this over low T and it probably will still be low. Not that anyone will know for sure without a blood test.

If you can get anastrozole, hcg and blood tests where you are. You should clean up behind your docs bad work. It is your body. I doubt you are going to be feeling all they great. But higher dosages without anastrozole was making a mess of you so it is at least better.


#7

I have just performed the afternoon oral temperature check which was 36.8c or 98.42f


#8

Thanks @verne,

I can get anything I want, Just whether its via legal means or not. Would much prefer the legal route as Australia has the tightest boarder controls in the world. Which means either shit is expensive as hell or the quality is shit.

Essentially from what I understand the E2 will cancel out the T meaning the reasons I went to the doctor in the first place will still be present. Also if he drops my T to a sub-optimal level for my body to manage the E2 then the reasons I went to the doctor will still be present.

So I see it as a lose, lose situation.


#11

With two T injections a week and low dose anastrozole at time of injections, FT is quite steady and anastrozole is balance to those FT levels. Your steady T and E2 will leave you very balanced.

SC/SQ avoids decades of muscle damage. SC/SQ is slower release providing steadier levels. Injected T is 100% absorbed IM or SC. Be careful about what you read on BB sites, a lot of knowledge there is very suspect and PCT is typically very wrong too.

Prefilled needles? After injecting, swab the needle with an new alcohol prep pad and recap for later second dose. Do not refrigerate, not needed as the T will have 0.9% benzyl alcohol that prevents bacterial growth.

What gauge and length are the needles? Ask for #25 or #27 25mm. They will not take the time to load #29.

hCG works, if you showed him good publications, would he prescribe or is he handcuffed?

It is not that dehydration affects the blood draw, it changes all of the lab results.

Other things in your labs?
Glucose=5.3 - should be watched in the future. TRT many help.

Thyroid: I mention this because most guys who come here have some thyroid issues, including Aussies.

Need to see body temps from when you wake up AND mid-afternoon. These should be your low and high temperatures.

E2 caused your bloat. Should correct E2 levels, but system is stacked against you. Lasix was treating the symptom, not the cause.


#16

Ok so I have been randomly posting my body temps as per @KSman 's recommendation,

-This morning I woke at 8am - 36.3c or 97.34f
-30mins after the gym,
body temp 11am - 37.1c or 98.78f
-Mid afternoon 2pm - 36.9c or 98.42f
-5pm after 3 hour sleep - 36.7c or 98.09f

Any suggestions, I think the 11am test is void as it would be result of intense workout.


#17

Please see Italic response.


#18

Nice typo! :wink:


#19

Hahaha, thanks. Glad you knew it was a typo.

Edited.


#20

Hi @KSman, @verne,

Please see doctors response via email.

  1. I dont prescribe HCG.

  2. My advice remains that you should continue with weekly dose to prevent fluctuation and further adverse effect of Primoteston.

  3. Your estrogen level should be the normal range with weekly Primoteston use. So I do not see reaon for Arimedex use.

  4. Lasix is used to get rid of your fluid in the short term. I dont forsee why you will get fluid retention with weekly Primoteston.

  5. Viagra is a valid treatment for erectile dysfunction and can aid with your penile erection while you regain libido on Primoteston.

  6. I am happy for you to see another endocrinologist if you wish to pursue other forms of testosterone derivatives.


#21

My responses

  1. I dont prescribe HCG.

No problems, I’ll find a way.

  1. My advice remains that you should continue with weekly dose to prevent fluctuation and further adverse effect of Primoteston.

As I mentioned I was happy to stay on current dosage. However, is not optimal level of testosterone for my body to gain gain erections, have libido, or sense of well being in turn improving my depression.

  1. Your estrogen level should be the normal range with weekly Primoteston use. So I do not see reaon for Arimedex use.

The use of Armidex is to control my estrogen level whilst maintaining the optimum level of testosterone for my body. The decrease of testosterone have essentially voided the reason I came to see you in the first place.

  1. Lasix is used to get rid of your fluid in the short term. I dont forsee why you will get fluid retention with weekly Primoteston.

Unfortunately, this method to lose water in the short term is short sighted. The E2 is the reason I have bloated. Now you have lowered my testosterone to try an control the E2 bloat. Yet my testosterone is now lower than my body requirements for libido, erections or sense of well being and depression.

  1. Viagra is a valid treatment for erectile dysfunction and can aid with your penile erection while you regain libido on Primoteston.

This may be a valid treatment for ED, however with the optimum level of testosterone I would have my libido, I would have a sense of well being. I would not need Viagra to gain an erection. I could also have spontaneous sexual interactions with my partner. Which I can’t now.

This is a major cause of my depression. I feel you are treating me as per text book. Not actually listening to your patients concerns, needs or requirements.

  1. I am happy for you to see another endocrinologist if you wish to pursue other forms of testosterone derivatives.

At this point I do wish to continue working together but as just mention I feel you are not listening to concerns, needs or requirement. I don’t want to have to manage my own health. I will seek further advise.

Look forward to or next appointment I will continue to log my journey.

Regards


#22

Its a win they even prescribed you testosterone. Due to all the bikies and dodgy doctors in Australia abusing it for years the rules and regulations changed that you have to be under 6 nmol/L for replacement therapy.

But yeah from reading this and other Australians posts it really doesnt sound like we have any qualified people who are up to date on recent stuff.

Its like they got their degree in 1980 and never bettered themselves or advanced their knowledge at all.


#23

Hey TJ,

I was told I could wait for my test to drop to 6nmol/L which would entitle my for PBS. I was sitting at 8nmol/L I which meant i went private. It’s only $35 for 3 x 250mg shots. Which isn’t bad.

What’s bad is I’ve had to get liquid Armidex which is sold under the SARMs label as research purpose only. Looks like my lab rat will get what he needs. But $136 per 30ml this is the part which will get expensive. I got my lab rat 60ml until I can find a knowledgeable doctor.


#24

That is infuriating to hear because 6 nmol/L is roughly 150 ng/dl total testosterone for all the Americans reading here. And we all know that is very very low. I will probably be in a similar boat to you next month when I see the endo for first time

A friend of mine uses ostarine and mk677 sarms Ive seen nolvadex and clomid on those sites too so hopefully its all legit but its still pretty expensive.

Have you tried doing your own private bloodwork in Australia? I found two sources so far but I havent tried them yet…apparently they email you a request form that you take to the pathology centre and then once results are in they email it to you.


#25

I know a way of working the Medicare system I always get the bloods I want when I want. You Just have to doctor shop till you find one who understands your not just as dumb as the majority of patients they see.

You do offend plenty of doctors along the way but who cares it’s my health not theirs.


#26

Yea my lab rat has used gw501516, S4 and YK-11. GW is great for weight loss and endurance, S4 for great for protein synthesis and YK-11 has the same base molecular structure of DHT without the sides and is actually more androgenic the DHT.

So my lab rat hopes the Armidex from the source is legit.