T Nation

Year in Review and Protocol Change

I started TRT 7/29/2019. It’s been 13+ months and I still haven’t figured this out. I thought I would post my numbers and protocols to get some opinions. I see a few obvious problems but I’ll keep them to myself so as to not bias others. Main issue I am still having is libido. I mean, I have literally ZERO. This was the main reason I got tested in the first place.

Some background info… When I started TRT I was 47, 5’10, 175 with abs. Probably 12% BF. Have been lifting since I was 12. More for strength / powerlifting. Could BP 3 plates before I graduated from HS weighing 220. I thought I was well on my way to a crazy natural BP but peaked at 385 when I was 23. Best squat around 500 and DL of 575 all natural weighing between 220-240. When I started TRT my best lifts were BP 235, DL 410 and front squat of 185X3. 13+ months later, BP 245, DL 410X3, Front squat 215X3. Currently weighing 192.

Outward appearance I was in the best shape of my life. Never would have guessed low T. I honestly was mostly taking the test out of curiosity and thought I would come back higher than normal.

I was with a clinic that I was not impressed with. Labs where very minimal. Only tested Free T once when I requested it and never tested SHBG. Here are my historical labs and protocol.

Original labs 7/29/19
TT 254 264-916 ng/dl
PSA .29
Original protocol - 120mg per week one shot

First follow up labs at trough 8/30
TT 410
E2 8.8 7.6-42.6 pg/mL
PSA .4

New protocol 140mg per week. I decided to go to EOD

Follow up labs 11/22/19
TT - 1001
E2 - 19.5
PSA - .7

Same protocol but I decided to go to 150mg. 3 shots per week

Follow up labs 2/11/20
TT - 1341
E2 - 35.8
FreeT - 22.1 6.8-21.5 pg/mL
PSA - .4

Stayed with the same protocol

Follow up labs 6/27/20
TT - 1247
E2 - 25.5
PSA - .4

Just had a CBC differential, lipids and comprehensive panel. Doc said all labs looked great.

Total Chol - 193
LDL - 117
HDL - 67
Triglycerides - 47

Some values that were out of range

Nuetrophil (L) - 1.9 2.20 - 7.50
CO2 (H) - 32 22-30
Anion Gap (L) - 3 5-15
eGFR Non-African American (L) - 79 >=90
Calcium (L) - 8.4 8.5-10.1
BUN (H) - 22 7-18 mg/dl

I have left that clinic and am on my own now. I have an appointment with a urologist but he is booking way out so it is months away. I have left over supplies to hold me over. I decided to lower my dose and go to 30mg EOD (105mg / week) 6 weeks ago. No labs and don’t plan on getting any. Don’t really feel any worse or better. Trying to decide my next protocol…

Are you taking an aromatase inhibitor? My guess is yes based on your crashed E2 from last August and your nearly crashed E2 in November. It comes up a little but your ratio is super low. With a TT at 1247 you would expect E2 in the 70s at least. So what are you taking?

Libido you say?

Symptoms of low estrogen in men include:

  • Fatigue.
  • Anxiety.
  • Irritability.
  • Depression.
  • Forgetfulness.
  • Oversleeping or sleeping too often.
  • Sexual dysfunction .
  • Water retention.
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No AI. When I told my doc about my libido he actually wanted to put me on arimidex because it was 35.8. You can see why I am no longer with that clinic. I agree my E2 is too low. It was low on one shot per week, EOD, 3X a week so not sure what to do.

Libido can be tough, other than that how did you feel? Good sleep, energy etc?

Did you consider trying to bump your dose even more? Say 180 a week. I wasn’t getting much out of trt until I got to that dose, though I still have some room to improve so may discuss another bump at next apt. Though 180 gives me about 1200ng/dl and I have some other issues to work on (ie fitness) so more focus on that would be prudent for me.

If you’re still struggling with libido, don’t discount a dose bump just because your total test number is above range. Get them to run free-t at least and shbg as well or try to get them done on your own. Symptom relief is what we’re after not a number on a blood test.

I agree here though Im mixed on SHBG testing. Symptom resolution is the key. And yeah he is right you need FT measurement. I bet its lower like your E2.

I have thought about bumping my dose but my TT will go up as well. Not worried about the numbers but the ratio will probably still be the same. As you can see from my numbers the ratio has always sucked even as my TT went up.

I did get the Free T measured once. It was 22.1 when my TT was 1341 and E2 was 35.8.

I think I can assume my SHBG is high, no? Does it really matter what the number is?

When the mood does hit you how do things perform? Any ED issues?

I ask because when I started using viagra or now a daily cialis with a viagra kicker if needed, I have more confidence that I’ll be able to actually complete things and that helped me with libido.

My brain often thought, “oh what’s the damn point, I can’t even get it up”, it could be like pushing a rope uphill. Just a thought. Even if you don’t think it’s an issue maybe try a 5mg cialis a day for a month or 2 and see. It’s pretty cheap these days with a goodrx coupon.

I take 5mg of tadalafil a day. I wake up every morning with morning wood. That’s not the problem. I can’t remember the last time the mood hit.

Try to get it to 30. Heard that can be the sweet spot.

Okay, was just throwing it out there at least you don’t have to worry about that.

I’ve heard good things about adding masteron at about 100mg per week, but I don’t think you can get it prescribed in the US so you’d have to source it yourself, and that could lead to legal complications. I don’t think we’re quite there yet, though.

All I got s Test dose bump or talk to a therapist, perhaps it’s psychological, I don’t mean to offend, but my tool box is kinds shallow.

Yeah, you kinda have a point, the free T number more important, if that’s even the right word. I was just thinking that it would be useful as a check, it’s not terribly expensive, to do it once. It’s probably come down some since you started anyway.

And yeah its probably a bit higher you could figure it by plugging your other numbers in a Free-T calculator until you get to your freeT t number.
I think you certainly have some room to increase your dose NH_Watts is right try to get it up to 30-35 maybe even 40 and see how your doing. As long as everything else looks good, I wouldn’t be afraid of bumping the dose at least for a trial.

I might jump to 180mg or even 200mg a week for a couple of months see what happens. You can alway come back down.

This is what I’d say to do, for whatever that is worth