T Nation

TRT in order. What else could it be?

Much of this is probably is probably repeated somewhere, but I haven’t been able to find it here or anywhere else for that matter. Here is the brief summary…

My journey started 4 years ago when, after many years of problems, I figured out that I was lowT. My numbers came back at 75 and after talking to a number of doctors, found someone that started me on the gels. Of course, they didn’t work. After much more research and searching, found a doctor that prescribed Cypionate at 150mg per month by injection. WAY TOO LOW, but doctor couldn’t go any higher per the insurance. T number increased to 250 at the peak on that cycle.

Found another doctor that helped me get to 150mg per week, but out of my own pocket. That made me feel a little better, but the cycles were putting me on the T rollercoaster. Doctor convinced me to do two shots at 100mg every 3.5 days and that helped a bit. Numbers never went above 350. E was at 85 so he started me on .5 mg of Anastrozole every two weeks and one injection of HCG per week using one full shot of the insulin shots. Forget the dosage. the rollercoaster was still getting me and really got tired of doing the shots and the bruised leg feeling that never went away.

Other changes prior to the most recent and final step…

Removed caffeine from diet because of adrenal fatigue concerns
Removed alcohol from diet
Removed gluten, casein, beef, all dairy and other foods from diet because of allergies
Drinking tons of water

Finally and most recently…

Looked into pellets…had 10 pellets injected two weeks ago. Numbers prior to pellets, and after being off T for three weeks, was 87 with non-detectable E. The total injected T was 2,000 mg under the skin. They wanted to start taking 1 DIM capsule per day.


No blood work yet, which someone will yet at me for on this thread I know, but feel extremely panicky, still tired, no sex drive and brain fog is still a big problem. My blood pressure has increased to 145/85 from a normal 120/80. When I take the DIM capsule, within 4 hours my blood pressure will spike to 155/95 and recently went to the ER with chest pains and extreme panic attack alongside high blood pressure. They told me I’m fine and need to take anxiety medication. Never had anxiety before!!

I have to stop taking the DIM to keep my blood pressure low, but I’m concerned with my E numbers. My doctor stated that he didn’t want me to get blood work until at least 3-4 weeks out as things need time to take effect.

I’m hopeless at this point and have no idea how to start feeling better. Any ideas help. :confused:

Forgot some stuff…welcome to brain fog.

I’m 35, 285 pounds with a muscular build for my weight, but still fatty in places like thighs, belly and face/chin. I work out in the gym twice a week and play basketball twice a week. All of this done purely on motivational drive, not energy. My diet is ketogenic for now as I have been doing everything to lose weight.

There is more, but I’ll leave it at that for now.

We can’t get anywhere without lab work.

Was waiting for E2 labs on your prior thread. Starting a new thread breaks your case and looses context.

This may be leading you into adrenal fatigue or maybe you are there already.

Yes, I know, but I needed to start the conversation and that is why I posted prior to labs. Also, I didn’t know i started two threads as I am a first time forum person. I do have one series of tests, but they were prior to pellet insertion and won’t be much help now. My doctor stated that I needed to wait four weeks from procedure before getting new blood work and that is still two weeks away.

My previous numbers:

TT: 144
FT: 3.9
TSH: 1.32
Estradiol: undetectable
T4: 1.55
T3: 3.4
Reverse T3: 19
Anti-Thyroglobulin antibody: 11
Anti-thyroid Peroxidase: <10
FSH: 2.6
LH: 3.4

Not sure what else you would need, but they didn’t test for it if you do. :slight_smile:

Other things I have learned or suspect:

  1. When my T is low, my blood pressure is very high. When my T comes up, it goes down almost instantly.
  2. I’m pretty sure my liver is not operating effectively and have taken steps to realign
  3. I’m pretty sure I’m suffering from Adrenal Fatigue and I am addressing that as well

Overall, I’m starting to have better days as the pellets seem to take hold, but more on that as I experience more and get tests done. Please let me know what other blood work results I should request of the doctor for my next visit in two weeks.

Your labs will be soon?

Avoid training and sore muscles affecting AST/ALT.

Lab ranges please.

Yes, labs will be next week.

Pellet update If anyone is interested:

Without blood work, I’m certain that my T has come up since insertion, but that my E has increased significantly as well. Emotionally, I had two weeks of no change and then four days of feeling great. The past three days have been emotional hell and I’m tired, cranky, depressed, anxious and have no energy. It’s been three weeks since my implantation overall and I’ve gained 8 pounds. I feel as bloated as a dead deer on the side of the road.

My sex drive has not increased and ED is still happening at times. I took a half tab of anastrozole and that has helped quite a bit, but I can tell that I still need to bring my E down. The problem is that without CONSTANT blood work, which is hard, it is difficult to dial in numbers perfectly.

Many people might not believe that you could know the relative range of hormone numbers simply from how you’re feeling, but when you have been at this TRT stuff for so long, you start to know what is working and what is not…I just haven’t found the right combination yet. :frowning:

Because of the peak and slow decline of pellets, FT is changing and FT–>E2 will change. Anastrozole needs to match changing FT so that is not manageable. With frequent injections, levels are steady and labs tell what to do and that works long term.

Can you explain the request to quit training in regard to adrenal fatigue? I ask because I dont know not because im questioning you. Thanks.

Maybe two issues are getting confused:

  1. You want to avoid training and sore muscles for lab work because that can increase AST/ALT and then if AST/ALT is high you would not know a liver issue from a muscle issue.

  2. Over training can lead to adrenal fatigue, especially if one is struggling with an energy deficit such as low thyroid function, low cortisol or an extreme diet. Definition of an extreme diet needs to be in context of exercise calorie demand. Extreme low fat diets can be damaging.

I expect that the above might be a tangent.

I think this is a perfect response. A number of nutritionalists have told me that adrenal fatigue, liver toxicity and other poor functions of the body need to addressed before undertaking a serious diet or exercise program. They said it will tax your system more than it will help your system.

Currently I’m addressing poor liver function, taking B-stress hormones, taking probiotics, addressing a Candida overgrowth, taking potassium, CoQ-10, Magnesium and drinking detox tea on a regular basis. Also increasing water intake, eating a lot of green leafy vegetables and have removed sugars from my diet.

I am not doing a low-carb or keto diet anymore as it caused heart palpitations and very high BP on three different attempts. Tried regulating my potassium and sodium balance due to the dehydration that occurs with low-carb diets, but no amount of water and supplement balance could get me back to acceptable numbers. Not worth the risk, but sad because I hate the bloating that is caused by carbs.

My next blood draw is Thursday and I will receive the reports the following week. It will be good to finally see my numbers. As a point of record, prior to getting my numbers. I want to organically document my thoughts before my opinion is skewed by blood test results.

  1. My energy is definitely up and, with Anastrozole, my E feels to be better managed. Hesitant to increase my E without knowing my numbers, but I think it is affecting my ability to lose fat as I am still struggling to keep weight off and have increased about 6 net pounds since receiving pellets.

  2. Libido is still down and some ED affects still present

  3. Soreness timeframes seem to be reduced on TRT

  4. Anxiety and depressive feelings are regulated well with good anti-E protocol.

Finally, just hoping that the improvements are still coming as they say it can take a while to see improvements after years of low-T.

Are you drinking reverse osmosis water [RO]. - concern would be mineral deficiencies

Any muscle cramps? That is a sign of magnesium deficiency that could tie into an irregular heart beat.
How much magnesium are you taking?

Milks was a source of minerals and Vit-D3.

Bloat with carbs could be gluten intolerance.

Can you post?
hematocrit [HTC]

Ok finally got bloodwork numbers…

AST 19 (0-40)
ALT 31 (0-44)
Hematocrit 48.6 (37.5-51.0)
Hemoglobin 16.3 (12.6-17.7)
T 676 (348-1197)
T Free 33.3 (8.7-25.1)
Reverse T3 28.4 (9.2-24.1)
DHEA 251.5 (102.6-416.3)
Estradiol <5.0 (7.6-42.6)
FSH 0.4 (1.5-12.4)
LH <0.2 (1.7-8.6)
T4 Free 1.52 (0.82-1.77)
TSH 1.830 (0.450-4.5)
Sex Hormone Binding Glob 10.2 (16.5-55.9)
Triiodothyronine 3.4 (2.0-4.4)
Creatine, Sodium, Potassium, protein numbers and calcium good!

Also, doctor told me to stop Anastrozole of course because E so low and has me starting Boron to help raise Sex Hormone Binding Glob.

Update on how I feel: Energy feels better, brain fog is same, anxiety is much lower, depression gone, BP 118/78 after double red blood donation and sleep is somewhat better. Still having trouble losing weight and libido and ED still somewhat of a problem. Doctors want to move up my next insertion to the 4 month mark instead of waiting 6 months because they say they don’t want me to fall back down. Liver numbers are perfect now and all other macro and micros are looking good.

All in all, they said 4 weeks is still early after coming up from below 100 T and such low functions will take time to recover. Overall, I would say that my overall feeling went from a F grade to a C minus grade which is not bad. I’d be happy to get to a B+ grade if possible…don’t expect to reach an A grade on overall feeling :slight_smile:

Any thoughts?

rT3 is high, see references to rT3, adrenal fatigue, stress and Wilson’s book in thyroid basics sticky.
post oral body temps as suggested
over-training a serious concern now

what was your anastrozole dosing?
SHBG also low from high T and low E2

Get AM cortisol tested at 8AM, adrenal.

Testing LH/FSH should not be done again, zero as expected.


  1. I read the entire sticky you mentioned and I am very lost. Not sure what you think is going on, but any additional thoughts to what you are thinking would be appreciated. I’ll take your word and start taking oral body temps.

  2. Please elaborate on over-training and what is considered such. I am finally getting my T numbers up and want to finally shed pounds and gain muscle. I’d hate to sit around waiting for adrenal issues to resolve and getting doughy.

Stress can be starvation diets, over training, chronic or acute infections/illnesses/inflammation, daily stress or major stress events, low thyroid function, driving though life with sheer will power when there are problems that should be making you slow down.

Stress can wear down the adrenal glands and increased cortisol can progress to low cortisol and perhaps low DHEA as the adrenals weaken. rT3 increases which blocks fT3 and fT3 controls your energy at a cellular level by regulating mitochondria that make ATP, the universal source of cellular energy. Adrenal fatigue is complex and you cannot fix it with a pill.

Thanks for response. I’ve read the stickys and threads. You mention idoine for thyroid, but mine looks good on that front right? Also, I can look up the book you mention in those threads about adrenal fatigue, but the one gentlemen mentioned he felt better when placed on Cortef and Prednisone…does that seem right?

What I do see is that weight loss is still struggling, I’m still tired at at times, my sleep is not very good and ED and libido are still a problem. This seems to be caused by something else I’m not aware of and I’m willing to look into thyroid and adrenals if that seems plausible. Based on what you see, besides the temperature measurements, what do you think I should be doing and is the most plausible issue? If you were me, where would you start?

The TRT Doctors just felt that my T was still recovering and I just need to give it more time, but I do feel there is something else.

That can be part of recovery, but is not a cure.

fT3 is good and should support good body temperatures, but rT3 can block that and body temps can be low. And when rT3 is blocking fT3, we can expect TSH to be higher trying to compensate and can see fT3 and fT4 that are above midrange which is your case. Thyroid function can be complex. Body temperatures are a good measure of the overall balance. Low thyroid function can affect mood, energy and libido.

hCG is typically 1000iu/ml
If a 0.5ml syringe - 500iu
If a 1.0ml syringe - 1000iu
hCG should be 250iu SC EOD which fits its half-life.

As long as you are getting iodine from iodized salt and /or multi-vits listing iodine+selenium you should be OK.

Please note that when you said “All of this done purely on motivational drive, not energy.” I really picked up on adrenal fatigue as a potential problem because we see this combo quite often.

Some guys have a problem with low dopamine, sort of a state of depression. Elevated prolactin can do this and it can be a cause of secondary hypogonadism. You have not tested prolactin.

Sorry, if I’m being slow here, I REALLY appreciate your help on this as I’ve been chasing dreams of feeling better for almost a decade now. :slight_smile:

So to summarize, you think that based on everything that I should start an iodine supplement of 12.5 mg per day with selenium through a MV and measure body temps? Anything else I missed or should be doing?

Try some b12, It made a world of difference for me. TRT didnt fix my brain fog, and daily boughts with fatigue. B12 was the answer. I’m not taking shots, I’m taking 7,500 mcg/day of liquid B12 made for farm animals. It has worked fine, and I could tell a difference in energy and brain fog after day one. If you are b12 deficient you will feel the difference after just a few hours.

One other little thing I will throw out, E2 fluxuation can benefit libido. at least is does for me. I don’t take AI all the time with my Test, I respond well to an AI, and am only taking 80-100mg Tcyp/wk, so I only take a little AI when things get a little soft. If E2 creaps up, I will take some, usually gets the wood back and I ride that until it starts to wain. A friend of mine takes his AI on a 10 day schedule and that has helped his erections and libido. He is more estro dominant than I am, so he has to take it on more of a schedule. Remember everybody is different and T/E is not always the answer.

Good luck with your treatment.

Thanks JDeck. My E is undetectable so I have to let mine raise. I was using too much AI to my surprise as the Anxiety and other symptoms came back if I didn’t take it after four days. Really weird but that’s why people like KSman stress blood work.

Where did you get the B12 supplements?