T Nation

TRT Protocol. Help Appreciated. 29 YO

(edit corrected the mg per ml of the enanthate I am using. Primoteston is 250mg per ml and not 200mg. )

Hello All.

Looking for some advise on my protocol.

Very briefly, symptoms began about 18 months ago with extreme fatigue, depression and low libido. Those are the major but not the only symptoms.

29 years old, commenced TRT mid Jan 2018 at 0.5ml (250mg a ml enanthate) every week which has since increased to 0.5ml e5d. To control high SHBG i am taking 200mg Danazol e5d. My T level still appears to be slightly low.

Ranges:
Testosterone (8.3 - 29 nmol/L)
SHBG (11 - 71 nmol/L)
Oestradiol ( <150 )
TSH (0.4 - 3.5)
FT4 (9-25)
FT3 (2.6 - 6)

Body Temperatures:
Regardless of time of day, consistently less than 36.5c. Over the last 3 days, 3pm temp has been between 36.2 and 36.5

My results prior to commencing TRT
Date Test SHBG Oestradiol
13/11/2017 17 51 125
28/12/2017 11 58 79

Date TSH FT4 FT3
31/7/2017 1.5 17 5
13/11/2017 1.1 18 4.5

Results 6 weeks in, on protocol of 0.5ml e7d, no AI

Peak at 24hr post injection:
Test: 27.2
SHBG: 42
Oestradiol: 122

Morning (day 5 of 7) at the request of doc:
Test: 16.4
SHBG: 39
Oestradiol: 124

Current Protocol as of beginning March 2018:
0.5ml (250mg ml) Enanthate e5d.
0.5 Anastrazole at time of injection. (I will be changing this to 0.5mg e3.5d)
200mg Danazol e5d to control SHBG

Not too concerned with testicular atrophy, hence no HCG.

Latest results as of yesterday, 24th:

4 days after injection, 1 day before next injection:
Total T: 15.6
SHBG: 36
Oestradiol: 120
TSH: 1.5 miu/L
FT4: 16.1
FT3: unfortunately they didn’t test it

I am still experiencing profound fatigue which is my main concern. Testosterone appears a bit low on my protocol which surprises me considering my relatively high SHBG.

I am getting some Lugols tomorrow in an effort to improve thyroid function. I would prefer not to have to inject test more frequently than every 5 days if possible.

Just some further test results should they be useful. Attached image is of a FBC about 6 weeks into TRT. Blood count before TRT was very similar.

06/01/2017
ACTH: 5.0 pmol/L (<11)
Growth Hormone: 2.2 mIU/L (<3.1)
IGF-1: 27 nmol/L (12-34)
Prolactin: 71 mIU/L (40-450)

24/03/2018:
9am Cortisol: 305 Nmol/L (110-550)
DHEA-S: 7.2 umol/L (4.8-13.9)

My current fatigue is almost debilitating, i am also taking Wellbutrin in an effort to boost energy. I have taken an SSRI in the past, which i stopped due to limited benefit with significant side effects.

Your SHBG isn’t really that high. Your testosterone is a bit low, see if you can convince your doc to bump up the dose a bit. What was your shbg without Danazol? Get lipids and liver enzymes checked periodically if the Danazol is to be used long term. DHEA-S is also on the low side, maybe supplementing with exogenous DHEA will help, never know until you give it a shot. Have you been tested for autoimmune diseases such as lyme disease?

SHBG before Danazol was in the 60-70 range. No haven’t been tested for any autoimmune diseases besides Hashimoto’s. I also had C-reactive protein tested to check for inflammation in the body, there was no indication of inflammation.

Although I haven’t been to any known Lyme disease areas, it may still be worth a shot.

I will give it another 2 weeks on my current T dose, making it 6 weeks on the current protocol, and get retested. if the T levels are still low I will try get a dose increase. I am already on the equivalent of 175mg a week though.
On a side note, I have started Lugols supplementation and will get my thyroid retested in 2 weeks and I will post the results if anyone is interested.

175mg is quite a bit! A TT of 15.6 nmol is low for 175mgs weekly, however everyone metabolises testosterone differently, you may be a hyper metaboliser, I have reason to believe I am also a hyper metaboliser. Post new thyroid results when you get them, what was your TT and FT before you started TRT?

The last test prior to starting TRT my Total T was 11 nmol/L, Free T was 140.4 pmol/L (range 200-600). Yeah the 15 nmol/L result on 125mg test e5d surprised me, that result was on day 4 after the injection, so the trough level would have been even lower.

Well some people just need more, you mentioned you are on primoteston? Are you in Australia? Who in Aus would prescribe danazol to lower SHBG, docs suck at trt here, if u are in Australia and a doc is prescribing danazol and an AI you have yourself a doc who knows his shit.

Danazol: I cannot see that is decreases SHBG but is can occupy SHBG so there is less FT lost to SHBG+T. We have guys feeling great without Danazol and perhaps you might too.

I suggest that T dose be increased to get to top of range and anastrozole increased to get near E2=80pmol/L. Both will tend to reduce SHBG.

fT3 near 5.0 should support good oral body temperatures and energy and mood. When fT3 is ~midrange and body temperatures are low we suspect that elevated rT3, reverse T3, is blocking fT3. fT3 is the only active hormone; there is no receptor for T4. See the thyroid sticky for references to rT3 and stress issues that can lead to elevated rT3.

Blood seems a bit thin for TRT and PCV, packed cell volume aka hematocrit HTC is low. MCV is elevated. This suggests possible low level GI bleed, blood loss. Do you have any gut or digestive issues. You can ask for test that detects low levels of blood in your poop. Ferritin lab work would also have some bearing. Serum iron results are often not useful as this can be dominated by recent meals.


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

  • advice for new guys - need more info about you
  • things that damage your hormones
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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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

@KSman
Thanks for the reply, i have had a read through the stickies.

I had an appointment with my doctor today and indeed my dose as been upped to 125mg e4d, anastrazole he said to start at 0.5mg twice a week and to retest and adjust from there, opinions on the anastrazole dose? Willing to adjust this as necessary.

My RCC did worry me, I have had a stool sample tested in the past and have never had a bloody/black stool. The RCC has remained at the same level over 2 years pre-TRT. My thought is Macrocytic Anemia, perhaps as a result of long term low T levels? Time will tell, will do a FBC in a few weeks.

Regarding the Danazol, it does appear to lower SHBG and has anti-estrogenic properties, although I am taking it in low dose compared to its intended usage.
“In addition to binding to and occupying SHBG however, danazol also decreases the hepatic production of SHBG and therefore SHBG levels, and so downregulation of SHBG may be involved as well”, https://en.m.wikipedia.org/wiki/Danazol#Inhibition_of_steroidogenesis_enzymes

Having said the above i am considering dropping the Danazol, contrary to the docs advise, to see what, if any, effect it will have on my wellbeing.

On another note, i started supplementing with 50mg Iodine (Lugol’s) 3 days ago. Although FT3 was mid range, my TSH had increased to 1.5 and i felt my T3 could be at a more optimal level. Placebo effect perhaps but energy levels markedly improved as from yesterday. I shall continue with the Iodine, have bloods taken in 4 or so weeks, and report back on the results.

@unreal24278
I am in Australia, i take it you are to? My doc does seem to be a lot more knowledgeable on these issues than most in Aus. The endo’s I saw in Sydney were complete idiots…
Aus is very backwards in regards to HRT. My doc told me he has, on numerous occasions, had to defend himself against the medical board for his prescribing of Testosterone, he has also been in long standing, bitter disputes with endo’s in Sydney.

I don’t know if I’m allowed to do this, however can I possibly have the name of your doc or a hint or something? I have been unable to find a competent doc when it comes to TRT and I’ve turned to self medication to stop the nadirs I get from a shot of sustanon every 3 weeks. PM me on reddit or something if you have reddit. I’d rather get my future testosterone prescribed than from the black market. Reddit username is unreal242