T Nation

TRT Plan Started in 2012


#1

Her are opening notes:
-age:48
-height: 5' 10"
-waist: 32"
-weight:190
-describe body and facial hair: Body: fairly hairy from the waist downward, light hard around navel and chest, medium beard thick head of hair
-describe where you carry fat and how changed: decent lean until around 3-4 years ago (estimate today is 23-26%). fat started around belly and is now in upper chest, pelvis, upper back and so forth
-health conditions, symptoms [history]: glucose always in mid-high 90's and recently 106, creatinine levels higher and kidneys are lower end of filtration capability
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: currently taking 100mg Cyp weekly, kelp (450mcg)
-- real dangers! see this http://propeciahelp.com/overvi...
-lab results with ranges: have LOTS of results but will include most recent:

see attachment (only figured out how to attach 1 image)

-describe diet [some create substantial damage with starvation diets] : Things I know do not help: sweets, ice cream, pizza, red wine, fast foot, etc. Also try to eat as freshly prepared meals as possible consisting of brocolli, grean beans, baked/barbequed chicken, etc and not have junk food more than 2 or 3 meals a week.

-describe training [some ruin there hormones by over training] : I used to swim 4-5 times a week for 6+ years (competitive swimmer) but 6 months ago, I found myself unable to wake up early enough (sleep quality decreasing). Most recently, I swim 1 time per week.
-testes ache, ever, with a fever? Started out with Testim and found them achy...could not stand the scent so I quickly stopped using it and went on to androgel. I did not have much more aches but noticed a small bit of shrink (size is restored within a few weeks of no T).

-how have morning wood and nocturnal erections changed : loss of these were what led me to investigate and research low T. Since I started TRT, I have noticed increases in both but now both are fleeting (probably on a hormone roller coaster). When I was less than around 42, 4-6 days of wood per week was normal.

Summary: Around 2011 my normal doctor noted potential creatinine issues (kidney function slightly lower than normal. We tested and the end result was that I was taking too many NSAIDS and test result was likely skewed by extreme swim work outs (sore muscles spike creatine levels which work the kidneys and result in higher than normal creatinine). Once I stopped freaking out, I started research in TRT (a couple of years earlier, a urologist found low T ~250).

Started therapy over a year ago with a renown endo in SF (measure LH, Prolactin, FSH...secondary was diagnosed). Had classic signs of low T but mostly found myself unable to sustain my focus at work (my work requires intense concentration...a moments laps could mean I have to spend 20 minutes re-organizing my thoughts). I also noticed that my swim performance was dropping off as compared to similar aged swimmers. My recovery times were increasing and I was starting to sustain over usage injuries (shoulders...typical in older swimmers). I also noticed libido had gone down and morning wood wasnt there, and climaxes were taking longer and longer.

Initially started with Testim. It seemed to have immediate impact and found had teen libido but could not stand the scent or the stickiness. Plus, it took too long to prep (jump out of the pool, come home, apply, wait to dry, then off to work). I tried Andro 1.6 but could not get my levels up whatsoever do went on to injections (initially 200mg/2 weeks, then 100mg/1 week on my own). All along, I read information and tried to get ahead and become aware of my therapy.

I ask several times about estrogen but my doctor seemed to sidestep the topic. The straw that broke the camel was that he wanted me to undergo a physical in addition to that of my normal practitioner (his cost: ~1200...my insurance will cover 1 per year).

So I spoke with my normal doctor and got a doctor nearby. As it turns out, I was correct in my assumptions on E2/Estradiol levels at 100mg/week Cyp injections. I decided to join this site and post my results and solicit feedback and suggestions. It is clear that some people are "givers" on this site which is really appreciated and is what compelled me to tell my story.

I've met with the new doctor and it seems like he is ok adding on AI as this was discussed. Thanks to this site, I knew what to discuss! Thanks.

Should I work toward balancing T and E2 or go on Metformin to lower glucose?

As of 7/12, I am on .5mg anastrozole EOD.


#2

Hi

Welcome to hormones 101 lol

It’s apears you have a thyroid problems, this should have been Dealt with before starting TRT.

Tsh over 2 indicates something is wrong

You have tpo antibodies which could mean it is an auto immune thyroid problem which isn’t in full bloom yet as they seem to be in range which I haven’t seen before usually from what I have seen the labs look like <40 or < 20 but if you have them at all this is a sign

You have a spot for tgab but no numbers,

I would test tgab and tsi and get a thyroid ultrasound. Also ft3 woul be very important

Look up hashimotos and graves desiese.

Thyroid conditions can share symptom with low T or cause low T do a degree if full blown.

Hope this helped a little

Good luck


#3

“Should I work toward balancing T and E2 or go on Metformin to lower glucose?”
Both.
Get a glucose meter.
That high glucose was fasting and more than a single test result?

Get this lab done: Glycated hemoglobin (Hb A1C) ≥ 6.5%

There are non drug things that will improve insulin sensitivity.

  • diet
  • vitamins that improve your metabolic health
  • TRT done right.

This is standard advice maintained here:

There is a huge amount of knowledge in the stickies. Please study these. Start with the advice for new guys sticky.


There is a lot to read there, so read carefully. There are suggestions for things that are root causes of low testosterone [T]. Low T is a symptom, not a root cause itself. But low T itself is a root cause of many of the symptoms one experiences. Note that other things cause the same spectrum of symptoms, so do not have T tunnel vision. Many docs are guilty of that and they only treat the symptom [low T] and do not attempt to find the real problem. If you go to a clinic that specializes in low T, you will get T tunnel vision for sure.

Post info about yourself as suggested in the above sticky. We need labs, almost all of your labs, not just hormones. We also need the lab ranges.

We see a very high number of thyroid issues in the population of guys that show up here. So there is a strong focus on that. Most people are iodine deficient to some degree. Your history of iodine intake from iodized salt and vitamins that list iodine is important. If you become iodine deficient, the RDA [recommended daily allowance] is inadequate for recovery of iodine stores. Please see the thyroid basics sticky for more information.


You do not want to suffer from subclinical hypothyroidism or get Rx thyroid meds to treat iodine deficiency.

If you are injecting T or contemplating that, read the protocol for injections sticky.

There are stickies for finding a TRT doc, estradiol [E2] and lab work.

Do not place your history or treatment details in the stickies! That belongs in your thread. Keep all of your posts in your thread so we can have a clear picture of your situation and needs.


#4

Thank you for your thoughts and quick response. I have long suspected thyroid issues but after numerous doctors (non of which said anything) nothing was ever proposed even despite them knowing and hearing about my body temp and charting same. BTW, I have known for years that I had low body temperature (around 97.7 is typical). Nobody has EVER said anything about thyroid hence my research and membership here.

Here is more data (tgab <3) via attached image.


#5

Confused by your lab work and don’t see an easy answer. What other thyroid symptoms are u having? Are you hot or cold? Eyes bulge at all? Do you get hot flashes? Does your neck feel thick swollen or lumpy? Dry skin? Brittle nails? Dry or harder skin with dots on the front on shins? Hair loss anywhere?

Ft4 is on the very low end of spectrum I believe I don’t see ranges for your labs and we use different units where im from.

You need a full thyroid panel with units and ranges and that’s only thyroid wise. Your doc is an ass for starting you on trt

Has he confirmed you primary or secondary?

Look like a problem with the testies as lh and fsh are not deprived enough to cause this.

Hcg challenge should have been tried and after that a serm restart.

Your E2 needs to be addressed with an aromatase inhibitor.
Hcg is recommended here to keep ur balls working and prevent testicular atrophy


#6

I have had lower basal temperature for years. I have noticed a slight increase to cold sensitivity over the past year (noted this after TRT started). I do not have classic signs of Graves (eyes, tremors, excessive sweating, weight loss, hair loss, itchy skin, etc). Most often, I am normally always ok with warmer temperatures compared to others. My neck area feels normal, skin before TRT was slightly dry but not overly, shins are fine.

I do have some signs of hypothyroidism (low basal temp) but not the classic signs such brittle nails, depression/racing thoughts, etc. I am going to ask the doctor about this on my next appointment. Thanks everyone!


#7

I have a report after having having started 0.5mg anastrozole EOD on 7/11/13

My energy level seems up (up till then, it has been hard to avoid mid afternoon naps but no more). I seem more motivated to do things that need to be done (work stuff, around the house stuff).

First night while initial in bed produced wood just with thoughts which is very rare. I did not notice anything nocturnal but has slight morning wood. Subsequent erections in nights/mornings are tapering off.

Overall I feel better and quality of sleep is better. Today I noticed that my ring is a bit looser but I think it is too soon to say anything about bloating.

I am trying to not overshoot my sweet spot. Does anyone have thoughts? Thanks.


#8

No thoughts on over shooting. This is individualistic and depends on your body’s reaction to the drugs.

Glad to hear your feeling better!! :slight_smile:


#9

I would beware using that much anastrozole. 1mg/week is recommended here if you’re not an over-responder. You’re currently on 1.5mg/week. Anastrozole takes a little time to work, so you might be in the sweet spot now, but you are probably going to tank your E2 with that dosage very quickly.

That said, we are not all the same and that dosage might work for you. Just be cognizant of how you’re feeling. If you start feeling bad, you’ve probably overdone it. Stop for a week and cut the dosage back to 1mg/week.


#10

Since I had quickly lost nocturnal events, I decided to reduce dosage to 0.25mg EOD which was started on the 7/15. I noticed several nocturnal events last night so it seems like the correct move. I think I may operate at this level for a couple of weeks and consider dropping to 0.25 E3D.

Thanks for continuous guidance. I will continue to note experiences and in the hopes that someone else can benefit as I am from others here! :slight_smile:

I still plan to cover thyroid issues with my new doctor in a few more weeks. I am somewhat excited about the prospect of discovering a better treatment although if I were to go on thyroid hormones I’d hope to reduce/eliminate TRT due to the inherent complexity of balancing another medicine (havent even begun to consider HCG).


#11

I came off T myself and honestly I had a couple days of “shutdown” but I don’t feel any different and its been 6 weeks since my last injection. I was dumb and stopped cold turkey I have clomid and nolvadex on hand but I want to see what my labs look like and I drew blood yesterday so ill find out soon.

Thing is not one day did I not have some sort of nocturnal something going on.

I think the whole erection business is a lot bigger then testosterone and E2 and a lot bigger then we can understand.

I’m glad your going to keep the thyroid in mind and I think if you can get that figured out you may see a lot of improvement if you find the right doctor.

I believe tunapancake is from California and one of the best thyroid doctors is there… If I can find the video and name of this guy later I will post it for you.

Maybe tuna will chime in here in the meantime

As far as hcg, I never did it myself and I could not even handle injecting 2 times a week… Drove me nuts having to do this shit all the time. I couldn’t imagin adding in more and more and more drugs. I have no idea how ksman adds in hgh and all the stuff he takes or where he gets the money for it but fuck that is how I look at it. At the same time if he feels better all the power to him

:slight_smile: hope everything works out for you with the new doc


#12

Steady as she goes…still taking 0.25mg Anastrozole EOD and 150mg Cyp each week (SC fat injections). I am noticing multiple nocturnal events per night and in the mornings. Everything appears to be good downstairs although getting to the finish line is taking much longer than normal. I have not had labs to confirm anything since before starting Anastrozole but will soon as I have a follow-up appointment in a few weeks. My bloating has almost left.

I’ve lost around 5lbs in the past few weeks although I am eating a bit more healthy (higher protein, less carbs, more salads, etc). I am hovering around 189 lbs and have plenty to grab onto around my waist. I’ve not had anything in the way of joint soreness and am finding myself pretty emotionally stable although work has my anxiety level through the roof. My swim performance seems to be up (a bit faster and slightly more endurance) although it is hard to gauge since I am in the water 1 time per week…my body is loafing at this work load.

I plan to discuss thyroid and glucose during my next visit. The current thought is that I should go on Metformin. I am a bit freaked out about diabetes as it is somewhat rampant in the latino community. Assuming the doctor prescribes it for my higher than normal glucose, should I continue 0.25 mg Anastrozole and 150mg Cyp? Does the answer change with the addition of thyroid medication?

All in all, I am doing ok. I’d like to know where my E2 is given the current 2 medications/dosages before I change anything out. I suppose all bets are off once I introduce another variable (additional medication).

Thoughts?


#13

Any Thoughts?


#14

Anyone looking at this?