T Nation

TRT No Improvement with Good Labs, Help


#1

Hello, I have been on TRT for almost 2 years and at best it has been hit and miss. Generally speaking my labs have always been in line. Additionally, I have always kept an eye on estradiol and typically have stayed around 22-34. FT in the 30-45 range, and TT low of 900 and a high or 1200. Present dosing information:

.25ml T-Cyp E3D, weekly total of 150 MG 2.5 HCG E3D Recently I was at 120mg (20 ML E3D weekly 120MG) and had a total T of 900 and FT 31 so the doc thought a bump to .25ML might help, I've had 3 injections at .25MG and no improvement, about 10 days, maybe that's not enough time to see a difference but I don't know.

I have seen several doctors and as you can imagine the recommendations are all over the place indicating to me that they are only guessing but regardless I've tried what was recommended, and presently my endocrinologist has recommended a MRI to check the pituitary hypothalamus etc.

I was hoping that perhaps one of you guys might have a thought of which way to go, or perhaps you might know of somebody with similar results. My thought process is so exhausted that I don't even know what to ask. Any advice, or feedback would be most welcomed and I thank you in advance for your thoughts

Thom


#2

Thom, we really need more info about you to help.

Can you post complete labs with ranges ?

Tell us more about you. Height, weight, age, diet, stress, take other meds, supplements, do you exercise ?

Do you use an AI ? If so, which one and how much ?

Just a blind stab at your issue, and this is a guess but have you thought of lowering your Test dose instead of raising it ? I see a lot of guys on here that are hit or miss on 100mg T per week, when they cut down to 50-60mg per weekthey feel great. Our bodies when healthy only produce between 5mg and 10mg per day. If you had low T your whole life and suddenly you are getting the rough equivalent of 14mg per day, you probably don't have the supporting hormones to support such a large increase.

Again, this is just a guess, Post the information above and lots of guys here will help you.


#3

I'm 57 only discovered I had low T two years ago. I have a normal diet very little fast food and cook most meals. I use to work out regularly but one the low T hit I just didn't have to motivation.

Regarding upping my dose here was my thinking. As I mentioned I have been hit and miss on the whole TRT thing. The times I felt good was when I was taking 100mg weekly and the first 3 days after the injection I got that "good" feeling of male confidence. So I decided to get a blood test at the end of my 7 day cycle and my TT was 1200, therefore I'm assuming that at the time of the injection I had to be 4-500 points higher TT so I thought I was the type of guy that does better on larger doses.

For a while I was injection about .18ML E3D (120mg) and was dead in the water and I upped it to .20ML and that seemed better but not quite there, so I waited a couple of weeks and upped to 50ML (150mg) x 3 E3D and nothing going on.

LABS:
Estradiol 32 7.6 - 42

FT 31 6.8 - 32

TT 900 348 - 1197

PSA 1.2

Prolactin 3.3 Rang ??

SHBG 26 Range ??

These labs were taken when I was taking 20ML E3D(40MG) E3D and I was still flat so we bumped me to .25ML (50mg) E3D.

SymptomsEED, zero libido, very tight package a little challenge urinating and although a 36 inch waste I feel "sloppy" like I put on a few pounds but thee isn't any reason.

I hope that helps

Thanks

Thom


#4

You say .50ml ( that is 100mg if Tcyp) every third day - that would be 200 mg per week - your calculations are off


#5

Your E2 is a little high, but not way out of range. I take it that you don't use anything to help control it ?
If you lowered your dose of T, it looks like you wouldn't require an AI to control it though, and that is a good thing.

Your free T is right at the top of the range, which can give some guys ED and Libido issues.
I'm 44, and I use only 56 or so mg per week (8/day). When I have tried higher doses, I make better gains in the
gym but feel lousy otherwise (poor libido, erection strength, outlook on life).
Keeping my total T in the lower range 300-400 keeps me mid range in terms of Free T where
I feel great.

I know its natural to up a dose of something that was working, but in your case it hasn't.
As your dose gets higher, you feel worse. Been there, done that. It's difficult to admit that in
the case of Testosterone for many men, less is more in terms of feeling well. One would think
the more test, the better but it just isn't true for most.

I'd bet lowering your dose to 60mg per week would bring you the results that you want.
If your Cyp is 200mg/ml you could inject 10iu 3x per week M W F.
If you are using a 29g .5ml 1/2 slin pin to inject, the 10iu will be easy to draw and inject.
Would be a little harder if you are using a larger syringe.

Given the larger doses you have been taking, the new protocol probably won't work for
about 10 days or so based on the half life of T-Cyp. But give it a little time to work, and you
should feel much better.


#6

PNKY
Thanks for the help, really! Of course in the T game one never really knows until we try so I'm going to lower my T dose and see what happens, apparently it can't hurt. The final point of information is that I've noticed that an hour after I inject my libido does come back but after I climax I don't recover until next injection, and so on.

Regarding Estradiol. I do use Anastrozole however dosing it is more difficult than dosing T. In the recent past I've tried to lower my estradiol and after 1.75mg I went from 40 to 9.5. I was taking .5mg E3D in about 12-14 day period. Frankly, I was amazed that I could drop 30 points on 1.75mg in about two weeks, strong stuff!

The reasoning for leaning to higher doses with T was that early on with my therapy I was receiving 100mg injection weekly and had a good ride for the first 3 days. My TT would be about 1200 and Ft would be about 30 estradiol was about 26, so I assumed I was a higher T guy. Please note, the labs were taken on the 6th day after the injection, so imagine what my scores would be at the time of injection.

Lastly, to the other gentlemen who also responded to my dilemma I had a typo ML vs. MG I actually take .25ML or 50mg E3D of T Cyp, for a weekly total to 150mg but thank you for being interested in helping.


#7

I wanted to mention, ADEX can be a real killer to libido for a lot of guys.
It made it near impossible for me to balance out my e2.
Wasn't until I switched to aromasin that I could manage my e2 without crashing it,
made all the difference in the world for me.


#8

One thing with E3D - there is not 3 injection per week on this schedule - over a 30 day period you will have taken 10 shots of 50mg - 500mg total per month or 125mg per week


#9

To second what PKNY said. I have been lowering my dose in an attempt to taper but I have been holding at 60mg per week for almost a month now. I feel better, H&H seems to be staying lower, less greasy, have erections all night and no longer need cialis during the day. I will continue to try with my restart at some point but for now, 60mg is far better than when I was on 100, 120 or creams despite what the lab values said.


#10

C Cream

Thank you! You guys are the best, if fact my next injection I'm going to bring everything down slowly and keep you posted. Getting two guys to agree here is better than ten Doc's. Thanks much to both of you!

Thom


#11

Have you read these stickies?
-Advice for new guys
-Protocol for injections

Your labs and everything else are testosterone centric. You may have other issues and you cannot have energy and a good libido if there are other problems. We see a lot of thyroid problems here and some adrenal fatigue. You can read the thyroid basics sticky and eval your thyroid function with fever thermometer and decide if you might be iodine deficient.

Labs:
TSH, fT3, fT4
vit-D25
AM cortisol, do this at 8 AM

At your age, we expect age related primary and/or secondary hypogonadism. The prolactin MRI seems odd. We never see this done with old guys. And with your lowish prolactin lab, there is no justification for a MRI. Do you have head aches, reduced width of peripheral vision or other non-refractive visual artifacts? A pituitary adenoma http://en.wikipedia.org/wiki/Adenoma can lead to those.


#12

Hey KSman, thank you for you feedback. In fact I think you might be on to something. I have had my TSH checked, it was a while ago but it might give you some idea. 6/12 TSH was 0.080 range is .45-4.50 and again on 1/13 .84 .45-4.50. As you can see these were within six months of each other, and about the same score near the bottom of the range, both tests are Lab Corp.

Additionally, my Holistic Doc believed I was hypothyroid because he had me check my basil temp every morning (under arm) and said I needed to be between 97.8-98.2 degrees F when I got up in the morning, prior t moving around. Consistently I was below this range, in fact I never entered the range. Iodine levels were also checked and were very low, but he said this was a common deficiency since iodine was removed from most baked goods and replaced with bromine.

Also, he put me on Armour Thyroid and I didn't notice any improvement on 60mg daily (1 grain). after about a year he retired at the age of 104, yep 104 so I got off the Armour and here I am. So do you think hypothyroidism could be the underlying culprit of my failing TRT?

Thanks for your feed back and help

Thom LS,MO

preventionandhealing.com/articles/Basal_Temperature_Test_Check_Thyroid_Activity.pdf


#13

You do not fix an iodine deficiency with thyroid hormones or by doing nothing. It is up to you. Your thyroid numbers were horrible. Get those labs and might need to be tested for antibodies too. Note other symptoms in the thyroid basics sticky. You might also try to get rT3 done as well.

Yes, thyroid problems can cause low T and low -T is a symptom. Sometimes, I have seen where T levels normalize when thyroid is properly addressed.


#14

Will DoThank you!