T Nation

TRT: Test Still Low - Help Please?


#1

Hi guys;

I've been on my TRT journey for a few months now but I'm still not seeing the results I would like. Any advice would be appreciated.

STATS:
Age - 30
Height - 6'4"
Weight - 205 lbs.

WHY & HOW I STARTED TRT:
Even when I was a teen my parents were concerned that I suffered from low testosterone because I never had any energy. I wasn't very social and spent a lot of time sleeping. I went to several different doctors throughout my 20's to get my testosterone levels checked but they came back just barely in the "normal" range so therefore they wouldn't even discuss it. After years of going absolutely nowhere in the gym despite spending a fortune on supplements, gym passes, and personal trainers, I'd had enough.

My first idea was to go to a naturopath/nature path. Hundreds of dollars and some very expensive vitamins (that I probably just peed out anyway) later I wasn't feeling any better.

Then I decided to see an endocrinologist. Surely an expert in hormones could help me out. But it was Dejavu all over again: "Oh these numbers are all in normal so you're fine". She even told me that getting tired and fat was "the natural order of life"! Even for a 25 year old? Really?!?!

I stumbled on this website eventually and learned a LOT.

My current doctor is awesome. He's open to any test I want and is now open to helping me get my T levels back where they should be. Finally!

THE JOURNEY SO FAR:
My labs before beginning treatment were:
Total Testosterone: 59pg/ml (Saliva Test) ("Normal" Range: 60-110)
Estradiol: 9 pg/ml (Saliva Test) ("Normal" Range: 1-3)

My doctor started me on 2 pumps (2.5mg) of Androgel per day. After one month:
(All tests from this point on are blood tests not saliva tests)
Free Testosterone: 37 pmol/L ("Normal" Range is 32-92 pmo/L but I'm aiming for over 50)
Total Testosterone: Not tested.
Estradiol: 117 pmol/L ("Normal" range is 0-146)

Added 0.5 mg Arimidex twice weekly. Next month results:
Free Testosterone: 33 pmol/L ("Normal" Range is 32-92 pmo/L but I'm aiming for over 50)
Total Testosterone: 14 nmol/L ("Normal" range is 9-37)
Estradiol: 309 pmol/L ("Normal" range is 0-146)

Change Androgel to 4 pumps (5 mg) daily.
Change Arimidex to 0.5 mg every other day. Next month results:
Free Testosterone: 24 pmo/L ("Normal" Range is 32-92 pmo/L but I'm aiming for over 50)
Total Testosterone: 9.8 nmol/L ("Normal" range is 9-37)
Estradiol: 60 pmol/L ("Normal" range is 0-146)

Ok, Estradiol under control but Testosterone is worse than when I started.
Change Androgel to 3 pumps, twice daily (15 mg daily dose). Next month results:
Free Testosterone: 34 pmo/L ("Normal" Range is 32-92 pmo/L but I'm aiming for over 50)
Total Testosterone: 13 nmol/L ("Normal" range is 9-37)
Estradiol: <44 pmol/L ("Normal" range is 0-146)

A slight improvement but still not better than before I started!
Switch to INJECTIONS!
Delatestryl (Testosterone Enanthate): 200mg intramuscular injection every 14 days.
(Arimidex stays the same)
Free Testosterone: 37 pmo/L ("Normal" Range is 32-92 pmo/L but I'm aiming for over 50)
Total Testosterone: 9 nmol/L ("Normal" range is 9-37)
Estradiol: <44 pmol/L ("Normal" range is 0-146)

I thought injections would help a lot more than that!
Change Testosterone Enanthate to 300mg every 10 days
Change Arimidex to 0.25 mg twice weekly.
-This is where I've been for the past 4 weeks. Blood tests conducted next Monday.

OBSERVATIONS AND CONCERNS:
-Androgel did very little for me but after reading these forums I'm not surprised.
-Getting my estradiol under control didn't help nearly as much as I thought it would.
-When I switched to injections I noticed two improvements almost immediately. First, I was able to sleep better at night. Before I would lay in bed exhausted and unable to sleep. Now I can fall asleep normally. Secondly, although still not where I want it to be, my energy level has improved significantly.
-Since switching to injections my testes have shrunk considerably. Feels like maybe half the size?
-Sex life hasn't changed much but this was never a primary concern because I've always had a decent sex drive despite low energy and crap performance in the gym.

QUESTIONS:
-300mg /10 days seems like a normal dosage of T from what I've been reading. Should I be expecting better results?
-I'm pretty sure I need to start HCG injections, what kind of dosage should I be looking at?
-Is it reasonable to expect TRT to get my testosterone in the "high-normal" range?
-Any other feedback/advice is greatly appreciated. Lots of intelligent people on this forum and I sincerely appreciate your time.

Thanks guys.

-Scott
EDIT: Researched units of measure for labs.


#2

Do they want to get paid? Then they should report the units expressed in the estradiol and testosterone tests. Otherwise, you have the moral right to discharge your debt by saying "42" to their invoice.

You know that we are going to ask for the information requested in the stickies. And it would be nice to have had the tests done to establish a baseline before taking any hormones. At 30, maybe hCG or an aromatase inhibitor might have been a better first choice. T supplementation means you've pretty much given up on all other options.


#3

You're right about that...you appear to be a non absorber which is highly correlated with thyroid issues...you may want to investigate this with TSH, Free T4, Free T3, Reverse T3, iron, ferritin, iodoine...but truthfully, i can't recollect a single case where someone had thyroid issues that resulted in low testosterone that just magically restored testosterone levels by intervening with thyroid...on the contrary, I can think of a few cases where someone started taking Test and improved everything significantly to the point that thyroid improved or was no longer a concern because they felt so awesome on test...

That's because your test is still in the shitter...

HPTA suppression...probably because your Test injection dose is too high (see my post later)

This is not at all a normal dose and I have no idea how you arrived at that conclusion. NORMAL dose is about 100 mg/week, so you are about 2.66x that amount. Not normal at all. BUT you are above 200 pounds and are relatively young, so you probably need slightly higher test than some of the lighter greybeards around...but 300 mg E10D is slightly high. For reference, I am 280 pounds with pretty high muscle mass and I take 160 mg/week (in divided doses) and seem to do pretty well on that amount.

Your other problem is your injection (in)frequency...if you read the stickeys as you claim, you would know that 2-3x/week injections is the best option...I personally do just fine on injections on Monday morning and Thursday nights for a total of E3.5D...with the half lives and such under consideration, I think this is fine.

You can't make this determination since your Test dosage is too high currently, thus making your balls shrivel more and leading to more aromatization...once you get a (lower) optimal test dosage, you may not even need HCG

Your test results are also bogus due to your infrequent injection protocol...once you get on a sensible injection protocol (at a lower test dose) you can infer more from your bloodwork...but for the given bloodwork, you did not provide us with any timeframe between last shot and bloodwork, so we have to assume that since it is low your injection was far separated from blood draw...once you get on a sensible injection plan, this will level out and your bloodwork will reflect such...either that or you are screwing up your injections somehow...

Allevation of systems is primary goal, high normal T levels is secondary...both have a valid purpose, but if you feel great at X amount, dont shoot for X+Y


#4

Sorry, should have specified. Blood tests ordered by a doctor are free in Canada. I guess we get what we pay for.

As you see in my first post I provided some point of reference before starting TRT therapy. I can pull up older Testosterone blood work but the numbers are always the same - within a few points of the low normal threshold.


#5

Thanks for the response VT;

When I was first looking at my hormones over a year ago and considering TRT I had blood work done to check for possible thyroid issues and can post those results if it would help.

My doctor directed me to inject every 10 days because that is the release time for testosterone enanthate. But I do agree that twice weekly would be better. (For the record, the 300 mg/weekly is from the book Testosterone: A Man's Guide by Nelson Vergel where he states that the dose is between 100-300 mg weekly)

About the bloodwork: Should have provided this, sorry. I always get my labs done right before my next dose. So on an injection day I get my labs done late in the afternoon and inject that evening. That way I know what my Test levels are at their lowest level.

It's been 10 days since I last injected 300mg. I will have my bloodwork done Monday and then change dose to 80mg twice weekly. That will put me at 640mg monthly compared to 900.

Thanks for the insight. Any further comments/suggestions appreciated.


#6

Hi C_Guy,

VTB is giving you some good advice here. you may want to check out this link http://www.medibolics.com/freq2.htm it pretty clearly shows why you want to inject every 3 1/2 days or so.

You may want to check out my thread "Primary or Secondary? And Does It Matter?" as there are some interesting similarities in our cases. Below is what I used for protocol and it gave me a nice balance of both lab numbers and general quality of life for many months. I won't quote exact lab numbers right now as obviously every person's body reacts differently. I am currently at 195 pounds, I will have to get in and update my thread soon.

-160mg/week in 2 shots
-0.5 mg Anastrozole EOD with
-250 iu HCG SQ EOD

Good luck to you.


#7

Thanks Excelerate for the response.

UPDATE:
My November bloodwork came back and reflects injecting 1.25 ml Delatestryl (250 mg testosterone) once every 10 days.

Free T: Not measured
Total T: 20.4 nmol/L (Range: 11-40 nmol/L)
Estradiol: 70 pmol/L (Range: 45-146 pmol/L)

I asked my Dr. why the Free Test wasn't measured. He said that lab won't test that anymore and provides "bioavailable testosterone" instead. My test came back as:

Bioavailable T: 27 nmol/L (Range: 10-38 nmol/L)

It appears that everything is in the mid-normal range but I would definitely like it in the "high normal" range. I spoke to my Dr. about prescribing HCG but he refuses - says I would need to see an endo for that but I've been down that road before, won't go down it again.

So now that I'm stuck with no Free T test and no hcg (still experiencing some shrinkage in my testicles though not quite as bad as when injecting every 10 days), I am wondering:

-Should I be getting LH, SHBG, and/or measured? (LH to asses whether I need hcg and the other two to determine free testosterone)
-How big a concern is hcg? The shrinkage isn't severe. I would like to reverse it but don't know if its worth putting up a fight with my dr. It was hard enough to find a doc willing to prescribe Test and AI.

I will be getting blood work updated in a couple weeks and that will show me how the 2x weekly injections have been going. Since the November blood work I have been:

-Injecting 0.4 ml Delatestryl (80 mg testosterone) twice each week
-Increased my Arimidex to 0.25 mg, three times weekly

Any comments or advice is greatly appreciated. Thanks!


#8

Was this bloodwork taken on Day 10, before your next shot, as you had previously indicated? If so, you have absolutely nothing to worry about...by that point, these values are approaching half of what they were after the injection...so you are only NOT in the high normal range that you seek due to lab timing...

Now that you are on a more sensical protocol, your labs will hold more value...

Bioavailable T is just as good, if not better, than Free T...and it looks good...

No...LH will be 0 since you are on exogenous T and will not indicate whether HCG is needed...HCG is needed if your balls have shrunken and it is an issue for you, or you have signs of low pregneolone (midday crashes, brain fog, lower cortisol, etc.)

As mentioned, SHBG and all that is unnecessary since you know Bio-T...Free T is just calculated at most labs anyway instead of being measured as a direct assay...

You may have luck emphasizing the desire to remain fertile...you can also source it online from overseas pharmacies, depending on your tolerance for engaging in 'grey market' activities...

Be sure to get this either half way between injections, or just prior to your next injection...the former will give you an "average", while the latter will tell you your troughs...depends on how you and your doctor want to approach things...


#9

Thanks for the feedback VT.

I had forgotten that the blood WAS taken on Day 10 just before my next injection so of course the numbers will be a little lower.

For my next test (in one week) I will wait until just before my next injection since my doctor is nervous about my testosterone going "too high".

I will post those results soon. I'm very curious to see what the numbers will be now that I'm on 2x weekly injections.


#10

Next round of blood work (Taken immediately before my next injection)

TOTAL Testosterone: 29.7 nmol/L. Lab flagged this as high but I use a broader range - 11 - 40.
BIO-AVAIL Testosterone: 31.7 nmol/L (Range is 10-38)
ESTRADIOL: 92 pmo/L (Range is 45-146)

CHANGES FOR NEXT MONTH:
Increase Anastrozole to 1 mg weekly (0.5 mg twice weekly)

My Dr. is happy with this and sort of gives me the "Ok, you're good. Now go away." kind of impression. I'm still debating whether to push for HCG. The testicular atrophy is really starting to bother me.

OTHER FEEDBACK:
-Gym performance: It's difficult to say as I've only been back to the gym seriously for a month but I think the T is helping a little.
-Energy wise I am much better but still not where I'd like to be. I'd say 50% there but a huge improvement over where I was before.
-The only change in sexual performance is significantly softer erections.

GOING FORWARD:
-Wondering if I should try bumping up the T to 200 mg/week (0.5 ml/100 mg twice weekly)
-Really want to try my luck again talking Dr. into HCG
-Any other hormones I should be worried about?

Any thoughts or feedback based on these results is greatly appreciated. THANKS!


#11

you never posted your TSH or other thyroid results, did you? have you ever tested your cortisol levels?

more T will result in more E2 - which is already a problem.

have you tested your D25-OH levels?


#12

Hey PureChance;

Yes, more T = More E2 but I should be able to manage that by increasing my Arimidex dosage to 1 mg weekly.

TSH: My most recent TSH test was April 2011 and was 1.67 mIU/L (Range: 0.35 - 5.5)

CORTISOL: My first 4-point saliva test was several years ago and indicated adrenal exhaustion. My cortisol ranges were so low they were literally off the chart (sorry, don't have those numbers). My most recent saliva test for cortisol was February 2011 and showed lower than normal cortisol at 8 AM and Noon, a normal level at 4 PM and above normal at midnight. I also had a saliva test for DHEA which came back at 20 ng/ml (Reference range: 3 - 10 ng/ml)

THYROID/Other: Other blood tests go back as far as late 2010 so I don't know if they're much use now but here they are anyway:

Free T3: 5.1 pmol/L (Range: 3.5 - 6.5)
FSH: 4 mlU/mL (Range: 1-18)
Free T4: 14.1 pmol/L (Range: 11.5-22.7)
Growth Hormone: 0.1 ug/L (Range: Less than 2.0)
Prolactin: 8 ng/mL (Range: 2-18)

VITAMIN D: In late 2010 my D25-OH test came back at 48 nmol/L (Range: 75-200). Since then I've increased my Vit. D to 1800 IU/day.


#13

I've scheduled an appointment with the Dr. next week. Any advice on how to proceed?


#14

if your cortisol is in the tank, then adding more T will add more stress and demands on your adrenals.

with low cortisol, there are potential concerns about high RT3. (more info at thyroid-rt3.com)

most have found that it take around 6,000iu (liquid not powder) D3 daily to get D25-OH into the upper range.

you really need to get your adrenals in order first because you will never be able to balance your testosterone levels until they can support the increased demands you want to place on them.


#15

Thanks for the reply PureChance. Good call on the adrenals, I'm doing what I can to heal them.

Just a quick update. Saw my Dr. and didn't put up much of a fight to get HCG. He was pretty impressed that I knew exactly what I wanted so was prescribed 250 IU of Pregnyl EOD. (VT: Thanks for the tip on mentioning fertility I think that helped my case)

Took just about a week before I felt the effects of the HCG and I am happy to say mood has improved a bit and the testicular atrophy has gone away. Will check the numbers in a month to see where I'm at but I'm pretty happy at the moment.


#16

Not a "little"lower.

The maximum serum level of testosterone (reached a day or two after injection) is about DOUBLE what you measure on day 10.

So my sense is that you don't need more testosterone. More T is also likely to cause more sexual problems like the softer erections you mentioned, not less. In fact, now that you are on HCG, you may need to reduce your injected testosterone to keep you maximum level sane.


#17

I am taking androgel 5mg daily and starting 250iu hcg eod this week. I take the androgel in the morning but I'm not 100% sure when the best time of the day is to take the hcg. Would anyone have a suggestion as to what time of day would be best?
I would greatly appreciate the help as I want to make sure this is done correctly.
Thanks


#18

A long overdue update:

Blood was checked back in April. These numbers reflect a continuation of:
-250 IU of HCG EOD
-0.4ml of Delatestryl 2x weekly (160 mg weekly total)
-1/2 tab Arimidex 2x weekly (1 mg weekly total)

Bio-Available Testosterone: 35.7 nmol/L (Range is 10-38)
Total Testosterone: 35.9 nmol/L (Range is 11-40)
Estradiol: 98 pmol/L (Range is 45-146)

All the numbers look acceptable to me so I haven't gone back for another test recently. Will re-test in July to see where the numbers are at.

Now that my numbers have been stable for a few months I can say that TRT has really helped with my energy and focus but unfortunately I'm not seeing any improvements in physique. As I mentioned in my opening post, I can't seem to make any progress in the gym despite working hard and eating clean. I thought getting my T in order would help at least a little. Might be time to re-test the cortisol levels again and see how healthy my adrenal function is.....


#19

Glad to hear you're feeling better.

You say you're working hard and eating clean, but what is your training like and what/how much are you eating? You may have this dialed in already but you didn't mention it earlier. Obviously, it will be hard to make progress if you're overtraining and/or on a calorie deficit. No offense intended - just want to make sure you're not ignoring a simple solution.

Sorry if this is getting off topic - it might be better to discuss it on another forum here.


#20

Hi Jl;

No offense taken. Currently I'm following a diet and training program by Kris Gethin but you're right - that would be best discussed on another thread.

My intention with this thread was to get my Testosterone and Estrogen in order (done!) and then to consider any other hormone obstacles that might be in my way. As PureChance recommended, I'm going to check my cortisol levels and make sure my adrenals are working like they should.