T Nation

Trying to Figure Out TRT at 35


#1

Hello everyone, I am 35 yrs old, I have been having symptoms of Low T for years, tired all the time, depressed, anxiety, belly fat, lose of strength etc., my doctor has prescribed me a variety of anti-depressant medications over the years and NONE seemed to help at all, all I got was junk in my body I didnt need and side effects of them. Needless to say I never stayed on any of them for too long before giving up and thinking well this is just who I am.

this past Feb I joined a gym with a friend of mine and noticed how long it was taking for me to see any results or lack there of, he is actually the one who told me about low T, I had never known of this problem and things have just been getting worse for me, depression is bad, lack of caring about anything is bad, fatigue is horrible. So I called my doctor and told him I wanted blood work done, my total T came in at 317 which per the charts is in the normal range however from charts I have found it is normal for an 85yr old man. The funny thing is ( not that this is a funny issue) I have been telling my wife for years I feel like an 80yr old man.

anyway he prescribed Androgel 1.62 for me, 1 pump each shoulder daily. I did this for 3 weeks. Now I also have 2 little girls and a wife so the thought of even the remote chance of transfer was playing hell on me, not to mention I was feeling worse on the Androgel then before.

I called the doctor after 3 weeks or so and told him I felt worse and needed to know what to do and also that I think for me and my situation shots may be better, due to the whole transfer issue. after a week of calling and bs I got them to call in shots and went to get new blood work, it had gone down to 307. Not sure if its worth mentioning or not but that test was at 10:45 am the previous test I had that was 317 was 1:45 pm. it is my understanding that T naturally goes down as the day progresses so I can only assume that had I tested again at 1:45pm the 307 would have been even lower still. I was not aware until reading the test myself that T levels should be checked between 8-10am since T is highest in the morning.

I am now 5 days with 100mg shot of cyp which I was scheduled to be taking weekly ( after my request, I dont want crahses) the doctor originally prescribed biweekly. I still feel NOTHING. I am super tired even after a good night sleep, not that any of them are really that good but after 7-8 hrs of sleep I would think I should be feeling better.

I talked to another doctor in the office who I am going to be switching too who says he does 200mg shots weekly, and retests 6 days after the 4th shot, so basically right before the 5 week shot he wants to check levels. I have an appt with him Friday.

My questions or concerns are is it normal not to feel any better at all after over a month of treatment? I started the Androgel on 7-12-13.

None of my blood tests checked free T or estrogen levels. I am worried that the E levels may be high which is working against the T. is this possibly what is happening? Wouldnt my levels have to go up with injections since its directly put into my body as opposed to absorbed?

This is just so frustrating cause it almost seems like I know more then the doctors and thats just from reading the internet. I have an appt with an Endo but thats not till end of Sept. I am wondering if I should just go to a BIO Identical Hormone replacement clinic although I dont imagine they are covered under insurance?

any thoughts or similar experiences would be greatly appreciated as I am starting to think I am in the percentage of guys that fixing T levels does not fix.

-age - 35
-height - 5'11"
-waist
-weight - 210lbs
-describe body and facial hair - thin, not very thick at all, never has been
-describe where you carry fat and how changed - belly, chest, neck
-health conditions, symptoms [history] - tired, depressed, exhausted, fatigue quickly, weaker, lose muscle mass, weakening legs etc.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - NO

-lab results with ranges
latest labs, my doc will only check testosterone levels, I have tried to get others, I will post labs from original as they did have some other work done.

TT - 963 range 250-1100 ng/dl
FT - 269.9 range 35.0-155 pg/nl
-describe diet [some create substantial damage with starvation diets] - wide variety, breakfast bars in the morning, yogurts, chicken, pastas, apples, shakes, steaks.
-describe training [some ruin there hormones by over training] - when i was going was doing 4-5 times a week, weight lifting and running
-testes ache, ever, with a fever? - YES NO FEVER that I ever noticed
-how have morning wood and nocturnal erections changed - do not have them all the time. sometimes


#2

I have new blood work now. I have been on 200mg cyp for 4 weeks and got blood work

total - 963
free t - 269

I am not sure why my free is so high, I had to tell the doc I wanted free done this time cause they never checked it the last time, he basically told me the checking E2 was a waste of time, however I am thinking if my E2 is inline and my SHBG is inline I should feel on top of the world right now with those levels, and the fact is I still do not, I still have tiredness, though less, but I do not see any great effects of raising my T levels from 307 to 963.

why would that be? could to much be converting to E? my sex drive is not up, infact now I am experiencing problems with erections worse then before TRT.

This is all driving me crazy. I have another appt with doc this coming Friday. Any help or advice would be a great help


#3

If checking E2 is a waste of time, you are better doctor than your doctor. Fire him. I was first treated by uro. My E2 came at 39, he commented it is in range. These clowns are clueless.


#4

so do you think it could be E2? I really think there has to be something else out of wack here. How can I have TT of 963 and FT of 269 and still not feel much much better? I am thinking I should be walking around like I was 20 again, especially physically, as far as libido and all is concerned and that just is not the case here

I do have an appt with endo on Sept 30th so hopefully he will have more insight for me if my GP doesnt

any thoughts from anyone with experience would be greatly appreciated.


#5

Don't burn any bridges with the dr that gave you 200 weekly - self injections ( that is a high dose ) you won't find many who will do that . My suggestion is find a dr who will treat the E2 if you can . If not keep the 200mg dr and buy your own AI via the web .


#6

j5775, I am also struggling with my TRT right now. All I am saying is - your hormones are out of whack. It is NOT as simple as thrown in some testosterone and send the patient home. I would say you need to check your E2, thyroid, cortisol, SHBG, DHT, prolactin. If your doctor says - estrogen is not a problem, then he is basically a monkey with MD diploma. A lot of them are. You need to find a TRT specialist. Alternative would be to self-treat. Read sticky posts on this forum, there is a lot of knowledge posted. This will clear out a lot of your questions.


#7

Based on your ratio of total to free T you have low SHBG.
With no AI you will also have higher E2 and the combination of
High Estradial and High Free T are making you feel like crap.

You do need to get the proper labs to see where you are, but
in the meantime you need to lower your T dose.

If 100mg cyp puts you at 963 total and 269 free, 50mg (25mg Mon, 25mg Thurs)
split twice per week will put total around 480 total, and more
importantly it will being your free T into range around 130.

Splitting the dose to twice a week will benefit you greatly, but you
need to be able to self inject, once that is done you may or may not
need an AI, but it should be based on how you feel and what the

's in your labs say at that point.


#8

I certainly dont want to burn bridges, I have been going to this doc since I was a kid, but at the same time I want to make sure everything that needs to be done is getting done and being told E2 and costisol and other tests are pointless just doesnt set well with me.

@ PKNY I am currently on 200mg weekly, this was for 4 weeks after Andrgel for 3 weeks actually dropped my TT to 307.
what causes low SHBG? is that a bad thing? can that be fixed? I am currently self injecting. What does splitting the doses do? Also just to note my doc wanted the blood drawn PRIOR to my injection so I can only imagine those numbers go way up after I inject another 200mg

Would low SHBG be causing the ED issues I am having as this is just playing hell on me I had some minor issues before TRT but this is new, I dont know if its performance anxiety or what, I have been married for almost 11yrs but have always kinda worried about that anyway. Or would high E2 cause that? I am still really tired, really anxious, depressed, feel like doing not a whole lot of anything.

Thanks Kwn for your reply, I will talk to the doc about getting those tests run.


#9

If your doc does not authorize those tests (which is a possible scenario), then you can do them yourself. I use private lab MD web site. Of course, they will not be covered by insurance. Plus test interpretation will be up to you. I do not want to impose my views on anyone here, but my personal opinion is that urologists are useless in TRT.

Endocrinologists, surprisingly, are even more useless. Possibly because they have huge ego of 'hormone specialist', which makes them look at you like you do not know anything. Surprisingly, again, PCP's may be more useful than both uros and endos, maybe because they do not have an illusion that they know TRT, and they tend to be more open minded. But TRT clinics tend to be more knowledgeable about TRT than anyone else.
I am just saying it to maybe save you some frustration. This was my path: undo->uro-> another uro (stupid me) -> TRT.


#10

On low SHBG, some say the cause has to do with hypothyroid others feel its genetic.
Having the same issue myself, I'm leaning to the side of genetics. Every attempt I have
made to lower my TSH from 2 to 1.5 or 1 (in an effort to increase my low SHBG) has made
me tired and ruined the balance that I have in my protocol.

200mg is way too much for most guys on TRT. If you had very high SHBG say 45+,
you would need that much in order to raise your free T to a level that would benefit you.
Having low SHBG means your body cannot bind the T that you inject and it's converted to
e2 and free T (which causes ED). Your body goes about getting rid of it fast at that point.
To compound things, high levels of androgens can also push SHBG down more.

If you're at 963 total and 269 free 7 days after injection your #'s have got to be way higher
closer to your the day you get it. You can easily go back to 100mg per week, which still may be too much. One of the benefits of low SHBG is that you need less T to get into your target zone.Injecting 200mg all at once for guys with low SHBG is the same as trying to pour a gallon of water into a 4oz tea cup all at once.

With 4 200mg Injections over a month it'll take a little time for your levels to come down,
for now I would cut back to 35mg Mon and 35mg thurs (think just enough to fill the tea cup without it overflowing). Injecting smaller doses will keep your body from converting what it cannot use into e2 and free t . With the half life of CYP, you are looking at 2-3 weeks to get back to levels that will give you the therapeutic effect (libido, mood, erection strength and quality, clearness of thought) that you are looking for.

You will also need to get an AI to control your e2...but you really need to know where it is before you start taking it. If your Dr will RX it, I recommend aromasin over adex.


#11

PKNY,

I cannot express how thankful I am for your time in trying to help me with this. It can kinda get out of hand trying to figure everything out in a short a time span as possible, fact is I have been feeling like total dog crap for years as I stated in the my first post and docs always wanted to push depression meds and all till I finally said they are doing nothing for me and I just thought this is who I am and how I will feel. until which point I learned I was low T.

so I have been like a pea on a piss pod hoping that this is what my issue is and I will finally feel better. It has been a long 8-9 weeks or so since all of it has begun and I just really appreciate your time and everyones time who have taken to reply and try and help me understand what needs to be done and so forth. I think my GP may end up being the way to go but I feel I need to go into my appt Friday with some real knowledge of what I am talking about and explain why I want to do what I am saying.

I hope he does go through with the tests, if not I will pay to have them done somewhere else, I have read alot of guys saying the same thing about Endo's pretty much they suck so I am not all that optimistic about that appt on the 30th.

I am going to go back and get all the test results I have had done since the beginning of this in mid July and post those in order maybe they might shed some more light on somethings, however I know E2 and SHBG were never tested. I had to even ask for a PSA this last time around cause from what I understand you should have them before start TRT to have a baseline.

thanks again everyone who has taken time to help me..


#12

Fact is I have been feeling like total dog crap for years as I stated in the my first post and docs always wanted to push depression meds and all till I finally said they are doing nothing for me and I just thought this is who I am and how I will feel. until which point I learned I was low T.

~I hear ya brother. I'm 44, married, 2 daughters. It seemed as the years past I got more tired with each season, felt pissed off,resentful and down right bitchy most of the time. All this despite a good diet, and a lot of exercise..just chalked it up to age
and accepted that I was going to get more miserable as I grew older.

Had a vasectomy at 42 and got an infection from the procedure. I went back to my uro, and after a bunch of tests my T came back at 288. That got me wondering and landed me here at T-Nation.Too bad for me that I didn't fully grasp what wad really needed before I started TRT..uro just gave me a script for Androgel and said see ya in three months.

I went through the ringer trying to figure out what I needed, what was going wrong, why I wasn't feeling better and my questions, observations and appointments with my uro we're largely fruitless. What a GOD send this site and forum have been for me, and for many thousands of guys needlessly suffering.

When you go back to your doc, insist on the tests you want, don't take no for an answer. Remember, YOU ARE PAYING HIM, he needs you to continue to be his customer not the other way around.


#13

ok its been over 6 weeks now and I am on 100mg of Cyp per week. My doctor ran new tests and this is what came back today. I have an appt scheduled with him and am hoping someone can help me prepare for it. I am starting to think this TRT thing is not helping. Note this test was done at 7:30am before my scheduled injection. Doctor wants to know what my lowest levels are before injecting.

TT - 483
TSH - 1.69
Cortisol - 13.9
Prolactin - 7.9
E2 - 36.0

This was a Quest Diagnostics test, I had the nurse give me the results over the phone so I knew them and could research, however I did not get the ranges, all she said was everything is in range.

my libido is near NOTHING and pretty much cant keep it up. this is insane cause till I started the injections I would say I was not having strong strong erections but least I would have them, and I would still want sex, now its like ugh just thinking about it, dont know if cause now I have performance anxiety or its just i dont care, I certainly dont really think about it anymore. This is horrible. I am also feeling more tired again, not sure again if thats cause the TT is at 483 and not 963 like it was? although I wasnt feeling great then either.

I am not sure this is the right thing for me to be doing or if its just a matter of getting some other things correct. I know the stickies say E2 should be around 20 so I dont know if 36 is too high or not to make a difference, I assume though once I inject the E2 will rise as well?

any help is greatly appreciated


#14

I also am wondering if since these labs were done prior to injection on injection day is it safe to say or come to the conclusion that my E2 levels will be even higher after injecting my 100mg? I can only assume that since that is the "lowest" my TT is going 483 ng/dl before injection the same holds true for E2 as well and both will rise after injecting.

The only test the doctor did not run that I wanted was SHBG, I did not push to hard for it as in the stickies I believe I read that it is not normal to run SHBG anyway after TRT has started, he also told me he didnt want to run FT either because he the ratio when he last ran the TT and the FT together was good, which originally I thought was too high but my TT was 963 ng/dl and FT was 269.9 pg/ml which is 2.8% FT when converting FT to ng/dl. I did not want to push to hard as he did run the other tests that I requested.

I just think that after my injection E2 levels are going even higher and this is why I still feel like shit and am having all these ED issues which I NEVER had like this before prior to starting injections.


#15

Yes, trough TT will be a fairly low point for E2, as well--the E2 peaks an valleys may come a day or two after the corresponding peaks and valleys of TT (this is going to depend on an individual's aromatization characteristics), but if you're at 36 pg/ml right before your injection, it's safe to say that you'll probably peak in the 40s or even a little above, again depending on individual aromatization characteristics.

If you're concerned about it, why not obtain an AI on your own and try an experimental dosage protocol (e.g. the 1mg/week in divided doses, as recommended in the sticky) to see if you notice any subjective changes?


#16

thanks for your time Nyrin, to answer your question why I dont just get an AI on my own. To be honest I am not sure if the E2 is what is causing my problems, I think they may be suspect but Im not sure and beings that I just started this whole TRT in July first with Androgel 1.62 which absolutely sucked for me, and then switched to injections 100mg cyp for 1 or 2 weeks I cant remember then switched doctors to the doctor I am much more comfortable with and put more faith in who switched me to 200 mg cyp for 4 weeks and then we lowered back to 100 mg Cyp per week for now the past 6-7 weeks I am hesitant to just start mixing things in myself with out some thought and input from experienced guys.

I also will be discussing AI with my doc on the 11th so Im hoping he is onboard with writing for it so that he too knows what all is going on. He has been pretty willing to work with me for the most part so far so I dont think I am to the point that I should just be adding things to the mix without his knowledge at least.

I am absolutely feeling more fatigued though since the TT has gone down, by late afternoons I smoked, and getting out of bed in the mornings is a complete nightmare, I could snooze the alarm for hrs if I could. I just have no energy to get up and get going, not to mention the libido and ED issue which in my mind is the worst. I am just not me anymore.

so I guess if the consensus is E2 is the problem child here I will push for the AI and yes I have read the stickies, several times over and I know it states E2=22 is optimal especially for libido, I am just wondering if 14-16 points higher at my lowest I am assuming would really cause this issues I am having along with how freaking high could it be getting now thinking about it after injection? these are the questions I have.

Thanks again for your time replying, I now everyone is busy with their own lives and issues and i really do appreciate it.


#17

Ok so I had my doctor appt today. He is sending me to endo. I told him I did not think that was going to help from the research I have done on TRT most guys are not getting much help from them.

He believes per my latest test results I should be feeling great. They are as follows with ranges since now I have them

TSH - 1.69mIU/L range .40-4.50 mIU/L
Cortisol - 13.9mcg/dl range 4.0-22.0 mcg/dl between 7-9am blood was drawn at 7:30am
Prolactin - 7.9 ng/mL range 2.0-18 ng/mL
TT - 483 ng/dL range 241-827 ng/dL
Estradiol - 36 pg/ml range < or = 39 pg/ml

He was honest with me and told me messing with E2 is out of his league and he does not know anything about AI's for men. He has heard of them and their uses for women with breast cancer and such and understands they are are an estrogen blocker but is not comfortable prescribing one or messing with it as he is not trained in it. I actually told him how to drop the E2 from what I have learned here and he just said if you want to start splitting hairs of estrogen I need to refer you to a specialist.

Again this test was done on the 7th day before injection. I am on 100 mg Cyp per week and feel horrible along with low to no sex drive and serious ED problems along with fatigue very bad again since dropping down from the 200mg cyp. He told me my levels after injection of TT would be in the 1000's at my current dose since I am 483 before injecting. When I asked him what my E2 levels would then go to he did not know.

Please if someone could confirm this is why I feel like complete shit I would appreciate it or tell me NO thats not causing you to feel like shit. He told me it could be depression, well as I said in my very first post I have been down that road and nothing worked....

Thanks guys


#18

After re reading my posts and some other posts, I think I am going to try and inject twice a week. So that would mean I am on 100mg CYP a week I would be injecting 50mg on Friday ( this is my normal injection day ) and then again 50mg on Tues. I am hoping this will reduce my E2 levels as PKNY had suggested.

One thing that did not make sense to me was my doc said T has absolutely no bearing on erections or libido. Is this correct? is it because my E2 level is high that my libido and erections suck? He told me its a psychological problem that I am having. He also told me he is not concerned with me having any secondary cause of the low T to begin with, its just how my body is. He said my thyroid has been checked my adrenal has been checked and my prostate ( blood work) has been checked and all are fine, so he thinks my ED issue is mental even though I told him it did not start ( like this ) until couple weeks after my injections started.

any more help or advice would be greatly appreciated on lowering E2 with out AI's since he wont prescribe and now I have to wait and see if an endo will help with the E2 which from everything I read is going to be a waste of time..

Thanks