T Nation

Where to Go from Here?

Hi,
I am new to this forum. I am trying to figure out how to navigate, but it is really difficulty admittedly. I’m sure it will become easier with time.
About me:
Age: 40
Diagnosed with primary hypogonadism (and male infertility) about 6-7 years ago. Had tried gels, but decided several years ago to go to IM injections of Testosterone Cyp.
I am also a nurse practitioner, so have some medical knowledge, and even would potentially like to specialize in TRT at some point as part of a business model.
Anyways, at this time, I average 0.4-0.5 mL IM of 200mg/mL (80-100mg) every 2 weeks. I have unpredictable efficacy, with most of my improvement in libido, morning wood, energy, mood coming towards the 5-7 day mark post-injection.
However, the results are short-lived. The rest of the days, I have basically no libido or morning wood.
-I’m hairy - full beard, full chest hair, back hair- hair growth (other than male-pattern baldness) is not an issue.
-My energy and mood are variable. I do have a lot of anxiety, and take buspirone and clonazepam daily (for years).
-I managed to lose about 70 lbs initially upon getting serious 2 years ago, and have managed to keep the weight off fairly successfully - however, my BMI is still in the overweight range. I have decent muscle mass and if I can get motivated to lift, decent stamina.
I do seem to have some periods of “roid rage” where I lash out or anger easily.

I have had several episodes of 1-2 days of mild to moderate nipple tenderness (and currently experiencing this, thus, why I joined this forum).
I am assuming that in some way, I am converting free T to estradiol.
I do tend to take Zicam more in the winter, and I believe I read somewhere that zinc tends to increase E2 levels…I take echinacea daily for immune health. I take Vit D3 5000 IU daily. D level is >30. I recently started supplementing with Mag Citrate 100mg twice daily to help improve mood and for general health.
I have not had recent labs but my lipid panel, CBC, LFTs, ESR, TSH and Free T4 were all WNL recently. Most recent T was mid-200’s (a trough level, about 2 weeks after injection).
Original total T was sub-200. A very low level, and thus, why I felt like shit, and could not make a baby…
I have read some posts here about sub-q injections in smaller doses being more effective (less peaks/valleys). I’ve never tried any other medications for this.
My diet is fairly consistently 45% protein, 35% healthy fats (almonds, 2% yogurt, fish, etc), and 20% carbs - I try to maintain that ratio consistently.

I guess I am looking for advice about where to go from here. I feel like I am at a stand-still. Granted, my stress level is high, because I am in the medical field, have 3 adopted kids, etc. But I feel like some of the anger outbursts are hormonal, and certainly the sore nips and lack of consistency with regard to wood and libido are concerning.
Also, I may want to look into doing this as a profession, so any insight into this would be appreciated as well. I can order all medications, supplies, and labs…

Any help is appreciated! Thanks, and I look forward to conversing.
-Brad

I would immediately go to weekly injections of 100mg, re-evaluate with labs at trough and symptom assessment. Research the half-life of the ester. You do not want to use an aromatase inhibitor if at all possible. Some will suggest more frequent dosing, but I would hold off on that. Most TRT patients do fine with once weekly dosing.

Next time you run labs, get:
SHBG
E2
Total test
Free test
TSH
Free T4
Free T3
PSA
CBC

Your protocol is to blame for your short lived results, these every 2 week protocols are very common and sadly they don’t work according to a clinical study published in 2005.

The majority of doctors have no idea when they’re doing when it comes to TRT, the instructions written on the labels states 200 mg every two to three weeks.

The majority of men are going to do well on two or more injections per week at smaller doses, I’m on 21mg every 2 days and feel consistent from day-to-day, I did not feel consistent injecting every 3.5 days.

Thanks for the reply. I had SHBG, E2, Total T, Free T, PSA, CBC done in the past…probably 2 years. Nothing recently. Labs are so damn expensive (and I am in a post-master’s cert to become dual-certified as psychiatric nurse practitioner, so funds are tight!).
I will likely just start from scratch with a trough level and get some baseline labs.
Thanks man!

Do you inject IM or SQ?
Thanks

I tried SQ and I didn’t like how I felt, IM is guaranteed to work for everyone. I use 29 gauge insulin syringes and inject in the shoulders and and quads.

Go to discount labs, this is where I go for labs.

1 Like

Hi Brad, Welcome to the forum. Its nice having a nurse in the group I hope you will stick around we could use your expertise and opinion on so many topics.
First your protocol really sucks and your numbers and the way you feel prove that.
Klonopin is not helping. As a nurse you should know there is no benzo more addicting. You have got to find away off of that shit, it is slowly castrating you, an I believe if you can get your TRT diet and some exersize adjusted properly that can happen.
TRT saved me from depression anxiety with panic attacks. I was taking lorazepam and buspar with a natural TT of 175 just to keep my gun in its safe. Now with a properly tuned TRT, a dam good diet and 4-5 trips to the gym each week the only thing I numb my frontal cortex with is a late night whiskey.
You are closer than you think to getting this fixed.

1 Like

Klonopin cause my hypogonadism, it’s why I now need TRT for life. We don’t need drugs, what we need is hormone optimization as this will cure most mental illnesses and diseases. They have linked low estrogen after menopause to alzheimer’s in women and state starting HRT before menopause is the only way to prevent alzheimer’s in women.

Men are mostly protected since our estrogen increases with age.

1 Like

Okay, so I am a nurse practitioner, and furthermore, I work in psych. Klonopin did not cause my hypogonadism, as I was not on it prior to being diagnosed. Further, I know that some drugs can decrease testosterone levels, but what evidence do you have for Klonopin causing primary hypogonadism? I agree that drugs should be used sparingly, when benefits outweigh risks, but dude- this is awful judgmental and tangential, because I didn’t ask “how can I get off my clonazepam?”… don’t get me wrong, if somehow my TRT could improve my anxiety and panic attacks, I would give it up in a heart beat. But I take as needed, as prescribed. Thanks.

I was hyper sexual my entire life even while on the Klonopin for 30 years, started tapering off klonopin and low testosterone was almost immediate. Started losing erections and muscle right away, Total T continued on a decline until I hit rock bottom at Total T of 120 down from about 600.

Thanks for the welcome. I am actually a nurse practitioner, which is a little different than a “nurse” - I am certified and licensed to practice medicine. So, I do know that benzos CAN be addictive, but actually, clonazepam is longer acting, and thus preferable in this specific drug class to shorter acting benzodiazipines such as lorazepam and alprazolam. I think you may be right that it may not help my overall well-being, though. I would love to get off of it. And again, I agree with you that diet, exercise, and optimal TRT will certainly help.
Thanks man.

So, you are saying that when you weaned off of Klonopin, your T dropped? I don’t know how that has any direct correlation…
However, age does.
Thanks

Long acting opioids also mess with hormones. There is research out there for many. SSRI, THC,Alcohol,Opiates, and the list goes on. There is also research that blue light lowers T.

I never had T issues until I started a specific medicine. I would get checked often to make sure I was fine. However I did check recently and I had plunged into 90year old numbers. It’s all due to a stupid medicine I’m on now. I did research and there are many docs that say it probably was the cause.

I’m very athletic and eat right. No history of hypog in my family and my twin + father + uncles have zero issues. Sucks… I just woke up one day and couldn’t find the energy to live life.

I was wondering what would happen if I came off the drug . Would my system restart… maybe. Maybe not. How would I detox if I already feel like hell. How would I feel when I do detox and my hormones are rock bottom… yah recipe for disaster…

I’m afraid I’d get suicidial if I took that step. Now the goals to get my hormones right and quit the nonsense. Waiting patiently… takes a while

Any psychotropic drugs (esp SSRIs) can kill libido. I don’t know if it directly impacts T levels. However, I would STRONGLY discourage abruptly stopping any antidepressants without discussing with a provider, and definitely do not abruptly stop.

1 Like

OK now that we got the benzo’s all sorted haha.
You had a wall of questions. One that popped out at me was sore or sensitive nipples.

It’s pretty normal and not a sign of elevated E2 like a lot of guys think.
This is probably the number one reason so many guys crash their E2 using an AI aromatase inhibitor like anastrozole. My suggestion is just put some bandaids (sans the nipple hair) and they should calm down in no more than two weeks most likely one.

It is my theory when your body has been so starved of T when you finely get some your whole endocrine system goes kind of haywire and all kinds of cascading hormones are produced.

Mini blood test from places like quest and LabCorp can be purchased from the internet dirt cheap compared to your PCP’s office. That is the only way to know forsure. Never just trust your feeling when first starting out.

I will repeat myself your T protocol really sucks. It’s one of the worst I have read about. At minimum you need 80mg/wk. Ask you doc for Testosterone ethanate or cypionate. In 6 weeks get a mini blood test for TT/FT/E2/HCT/SHGB
With those blood numbers I can get you dam close to where you need to be.

I’ll go back and read another question I don’t want to put up a wall of text. haha he says writing a wall of text.

Yeah my nipples got crazy sensitive at week 3 or so and it’s on and off. Right now and in the morning they are super sensitive + hard, then towards the end of day they soften up. What your saying makes sense. Many others have told me the same over the past couple of weeks.