32 Years Old, on TRT for 5 Months

Pharma TRT
1

Hello - I have been on Angrogel 1.62% 2 pumps per day for 5 months now. During my last pharmacy visit I was informed that my new insurance would not cover the drug. My out of pocket expense was $400. I have an appeal pending with my insurance but I would like to explore other cheaper options that may be more beneficial to me. I am thinking about going the injections route (100mg T, 250iu hCG, 1 mg Arimidex…) and think that my doctor will be open to this but I wanted to solicit feedback from the real experts to see if they think this would be a good approach for me.

I would like to see an improvement in sexual performance and also increase muscle mass. Weight training 3X/week for 2 years has not resulted in much gains.

MY INFO:
-age:32
-height: 5ft 10in
-waist: 29in
-weight: 140#
-describe body and facial hair: light body/facial hair, no head hair loss.
-describe where you carry fat and how changed: relatively thin but have fat on stomach and sides
-Rx and OTC drugs: Been on 2 pumps/day of Androgel 1.62% for 5 months. Take Zyrtec every day.
-lab results with ranges
Provided by Quest Diagnostics 3/26/09 prior to TRT
TT 283 ng/dL (250-1100)
FT 45.1 pg/mL (35-155)
E2 never testes

Additional Lab results 4/15/13
Total cholesterol 148 mg/dL
DHL 59
LDL 78
Triglycerides 53
fasting glucose 81

-describe diet: Eat a high protein low fat diet ~2000 calories/day during the week and eat out on the weekends often high fat foods with alcohol
-describe training: Work out with a trainer 3X per week for 1hr per session
-testes ache, ever, with a fever? No
-how have morning wood and nocturnal erections changed: Noticeable improvement during the first few months on Androgel. Benefits have subsided.

2

Androgel is crap. I used it for a year and my T was never above 380 on 4 pumps.
Libido picks ups a little, but no muscle gains.

Read the stickies and for shits (and $) sake
Switch to injection, its a whole different world.

3

I ordered some lab results on my own from directlabs.com. I was a little surprised by some of my results and wonder if my strategy of requesting TRT injections per this protocol. http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/trt_protocol_for_injections?id=3172990&pageNo=0

Here are my results with test range (while still on Androgel)
Glucose, Serum 91 mg/dL 65-99
Uric Acid, Serum 4.8 mg/dL 3.7-8.6
Therapeutic target for gout patients: <6.0
BUN 18 mg/dL 6-20
Creatinine, Serum 0.80 mg/dL 0.76-1.27
eGFR If NonAfricn Am 118 mL/min/1.73 >59
eGFR If Africn Am 137 mL/min/1.73 >59
BUN/Creatinine Ratio 23 HIGH 8-19
Sodium, Serum 138 mmol/L 134-144
Potassium, Serum 4.3 mmol/L 3.5-5.2
Chloride, Serum 102 mmol/L 97-108
Carbon Dioxide, Total 22 mmol/L 19-28
Calcium, Serum 9.6 mg/dL 8.7-10.2
Phosphorus, Serum 3.2 mg/dL 2.5-4.5
Protein, Total, Serum 7.2 g/dL 6.0-8.5
Albumin, Serum 4.8 g/dL 3.5-5.5
Globulin, Total 2.4 g/dL 1.5-4.5
A/G Ratio 2.0 1.1-2.5
Bilirubin, Total 1.1 mg/dL 0.0-1.2
Alkaline Phosphatase, S 49 IU/L 44-102
LDH 145 IU/L 0-225
AST (SGOT) 25 IU/L 0-40
ALT (SGPT) 29 IU/L 0-44
GGT 26 IU/L 0-65
Iron, Serum 111 ug/dL 40-155
Cholesterol, Total 193 mg/dL 100-199
Triglycerides 74 mg/dL 0-149
HDL Cholesterol 64 mg/dL >39
Glucose, Serum 91 mg/dL 65-99
Uric Acid, Serum 4.8 mg/dL 3.7-8.6
Therapeutic target for gout patients: <6.0
BUN 18 mg/dL 6-20
Creatinine, Serum 0.80 mg/dL 0.76-1.27
eGFR If NonAfricn Am 118 mL/min/1.73 >59
eGFR If Africn Am 137 mL/min/1.73 >59
BUN/Creatinine Ratio 23 HIGH 8-19
Sodium, Serum 138 mmol/L 134-144
Potassium, Serum 4.3 mmol/L 3.5-5.2
Chloride, Serum 102 mmol/L 97-108
Carbon Dioxide, Total 22 mmol/L 19-28
Calcium, Serum 9.6 mg/dL 8.7-10.2
Phosphorus, Serum 3.2 mg/dL 2.5-4.5
Protein, Total, Serum 7.2 g/dL 6.0-8.5
Albumin, Serum 4.8 g/dL 3.5-5.5
Globulin, Total 2.4 g/dL 1.5-4.5
A/G Ratio 2.0 1.1-2.5
Bilirubin, Total 1.1 mg/dL 0.0-1.2
Alkaline Phosphatase, S 49 IU/L 44-102
LDH 145 IU/L 0-225
AST (SGOT) 25 IU/L 0-40
ALT (SGPT) 29 IU/L 0-44
GGT 26 IU/L 0-65
Iron, Serum 111 ug/dL 40-155
Cholesterol, Total 193 mg/dL 100-199
Triglycerides 74 mg/dL 0-149
HDL Cholesterol 64 mg/dL >39
LDL Cholesterol Calc 114 HIGH mg/dL 0-99
T. Chol/HDL Ratio 3.0 ratio units 0.0-5.0
TSH 2.050 uIU/mL 0.450-4.500
Thyroxine (T4) 7.1 ug/dL 4.5-12.0
T3 Uptake 32 % 24-39
Free Thyroxine Index 2.3 1.2-4.9
WBC 4.2 x10E3/uL 4.0-10.5
RBC 5.37 x10E6/uL 4.14-5.80
Hemoglobin 17.0 g/dL 12.6-17.7
Hematocrit 49.0 % 37.5-51.0
MCV 91 fL 79-97
MCH 31.7 pg 26.6-33.0
MCHC 34.7 g/dL 31.5-35.7
RDW 13.4 % 12.3-15.4
Platelets 233 x10E3/uL 140-415
Neutrophils 54 % 40-74
Lymphs 36 % 14-46
Monocytes 8 % 4-13
Eos 2 % 0-7
Basos 0 % 0-3
Immature Cells
Neutrophils (Absolute) 2.2 x10E3/uL 1.8-7.8
Lymphs (Absolute) 1.5 x10E3/uL 0.7-4.5
Monocytes(Absolute) 0.3 x10E3/uL 0.1-1.0
Eos (Absolute) 0.1 x10E3/uL 0.0-0.4
Baso (Absolute) 0.0 x10E3/uL 0.0-0.2
Immature Granulocytes 0 % 0-2
Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1
LH 1.0 LOW mIU/mL 1.7-8.6
FSH 1.1 LOW mIU/mL 1.5-12.4
Testosterone, Serum 464 ng/dL 348-1197
Free Testosterone(Direct) 9.2 pg/mL 8.7-25.1
DHEA-Sulfate 112.8 LOW ug/dL 160.0-449.0
Prolactin 4.2 ng/mL 4.0-15.2
Estradiol 15.1 pg/mL 7.6-42.6
Prostate Specific Ag, Serum 0.6 ng/mL 0.0-4.0

I was expecting my Estradiol levels to be high. With them only being 15.1 pg/mL, do I need Arimidex/anastrozole to be part of my protocol? I am no longer sure what I should request from my Dr and what justification to use.

4

I have a Dr appointment this afternoon and would appreciate any feedback from one of the experienced forum members. Thanks in advance!

5

I went to the Dr yesterday and he was not interested in doing anything other than increasing my Androgel dosage from 2 to 3 pumps per day. They filed a claim with my insurance company to cover the drug and gave me a prescription for 6 more months of Androgel (still at 2 pumps per day). At this point I am not really sure what I want to do.

There is a Dr. nearby that at least one person on here has recommended that apparently really knows his stuff. The downside is that he does not take insurance and charges $1,500 per year. http://www.viplongevity.com/shaun_holt__md

Does anything from my recent blood work stand out to you? Blood was taken a 7:45 AM after fasting for ~13 hours.

6

[quote]imgaym wrote:
I went to the Dr yesterday and he was not interested in doing anything other than increasing my Androgel dosage from 2 to 3 pumps per day. They filed a claim with my insurance company to cover the drug and gave me a prescription for 6 more months of Androgel (still at 2 pumps per day). At this point I am not really sure what I want to do.

There is a Dr. nearby that at least one person on here has recommended that apparently really knows his stuff. The downside is that he does not take insurance and charges $1,500 per year. http://www.viplongevity.com/shaun_holt__md

Does anything from my recent blood work stand out to you? Blood was taken a 7:45 AM after fasting for ~13 hours.[/quote]

Some do fine on androgel. I actually felt better on androgel than I do on injections and my libido was great, but I experienced insurance issues as well.

You would probably do best at 4 pumps a day rather than 3. Your doctor is mostly interested in getting you into the “range”. Here, we strive to alleviate symptoms. Low 400 TT generally does not do that.

I would hold off on the anastrozole with your E2 being so low. At your weight, you aromatase less than guys with more fat on them.

As for the money issue, injections will be your best bet. One 10ml @ 200mg/ml costs me $5.00 and lasts me three months. $1.66/month.

7

[quote]imgaym wrote:

Does anything from my recent blood work stand out to you? Blood was taken a 7:45 AM after fasting for ~13 hours.[/quote]

The only things that stand out to me is lowish sodium and low DHEA-S, which might indicate some degree of adrenal fatigue.

4-point cortisol test can confirm that.

I’m no thyroid guru, so someone else will have to interpret those numbers to see if there is an issue.

8

You don’t need an AI with an E2 of 15.
Reading the clinical trial data on the Androgel insert shows men with 3 pumps do better
than those on 4 (total T and free T). That said, you will get a little lift from the 3 pumps, but it
won’t build any significant muscle.

Your Free T is very low along with your E2 which leads me to believe that you aren’t
converting much to DHT (raises libido and builds muscle). To raise all, you will need a lot more
Testosterone, way more than you would get even if you were to be prescribed 4 pumps A-gel.

After a year of Androgel, my copay with the Androgel coupon went from $10 to $50. I told my doc that
my insurance also informed me that they were no longer paying for it and I wanted shots (I lied). He tried to
give me a new coupon, but I told him that the coupon is only good for 12 discounts and then its over (this is true)
plus insurance will no longer cover it.

  • I don’t know if they checked with my insurance, but they ended up bending and switching to injection.

If you can’t get them to switch, you can try another GP. You could also just order Hcg from safemeds4all
which would raise your natural Test and E2 levels, but it won’t get you to the free T and total T levels needed
to build significant muscle. Call around to local compound pharmacies and ask for names of local Dr’s that
prescribe a lot of Test, than make an appointment with that Dr.

Good Luck.

9

PKNY and others - Thanks for taking the time to read my post and provide feedback. It is greatly appreciated! Assuming I hear back soon from the insurance company I will stay on the Androgel and call around to try and find a Dr that prescribes Test.

10

As posted above, my test levels were as follows in 2009 prior to TRT:
TT 283 ng/dL (250-1100)
FT 45.1 pg/mL (35-155)

Today (Aug 2013) on Androgel my levels are:
Testosterone, Serum 464 ng/dL 348-1197
Free Testosterone(Direct) 9.2 pg/mL 8.7-25.1

Can the FT levels be compared directly to each other even though they were tested by different labs and have different ranges? Am I correct in reading the my FT went down? If so, is there a good explanation for this? Generally speaking, if I target a TT of 800-900 ng/dL, what would be a ballpark target for FT?

Thanks!

11

In both cases you are at the very low end of the range for the active part of T (free t).
Very high SHBG is the culprit, and for the most part the level you have is genetic
(be it low med or high). Its the reason that you are a hard gainer, have lower sex drive
etc.

There are a few ways to lower it, but they involve other steroids (Proviron, Winstrol).
Each is somewhat easy to get in the underground lab market, but your
first course would be to get larger doses of Test. More total Test will equal more Free Test.

Given the choice between having high SHBG and low SHBG I would take your case.
I have low SHBG and it presents its own set of issues.

You will do very well on nothing more than 150-200mg test Cyp per week.
I’d start at 100mg per week and get bloodwork after one month than go from there.
Due to your high SHBG, I would just do one injection per week, no need to split it up.
At 100mg per week, you still may not need an AI, but let your bloodwork (and the way
you feel…mood, libido, erection strength, morning and nocturnal wood) dictate that.

Get thee a new Dr pronto !!

12

There is a sticky for finding a new doc.

Poor response to T-gels is a symptom of thyroid problems and your TSH is not pretty, should be nearer to 1.0, T4 is a bit low. Really need fT3 lab.

See the thyroid basics sticky, check body temperatures and report history of use for iodized salt or vitamins that list iodine.

So if thyroid issues mean you cannot absorb transdermal T very well or you are simply a poor absorber, you need injections. Ask doc why he will not prescribe self injected T, it is FDA approved and absorption/delivery is always 100%.

Cholesterol is low then high. You do not want low cholesterol and low fat diets can mess up hormones. Fats are important. Get some essential fatty acids, fish oil, nuts, eggs, flax seed meal or oil. Take 50mg DHEA and test DHEA-S after 4 weeks. Take with a low fiber, higher fat meal to improve absorption [same for EFA’s and vit-D3, take 5000iu vit-D3. Extreme diets can mess with hormones, you may be too thin!

13

KSman - Thanks for your review of my post and for sharing your opinion. I greatly appreciate your feedback. I will re-read the thyroid sticky. I take men’s one a day vitamins every day and do use iodized salt. I have a digital thermometer and will start monitoring my body temperature. I am not sure why there was such a large change in my cholesterol. I have not had a large change in my diet or exercise. I already take 2X/day Now Ultra Omega-3 pills that have 500 EPA and 350 DHA. I also take 400 mg Chromium Picolinate, 10g L-glutamine and 10g of creatine monohydrate daily. I am not on an extreme diet and am not too thin!

14

I took my temperature several times last week. Attached are my measurements. Today I added 400 mcg Iodine and 5,000 iu Vitamin D-3 to my daily supplement list. I also got HCG in the mail today but have not started taking it yet. I have an appointment with a urologist next month that comes well recommended. Hopefully he can help me out and get me on meds that help me out and don’t break the bank.

15

My original Dr. wrote me a prescription for Testim %1 gel. It is covered by my insurance and along with a coupon I was able to get the prescription filled for $0 out of pocket. I am really happy about that. My dosage is one tube per day which is 50mg of test. This is about 10 mg more test than I was applying with Androgel. The increase along with the lower test concentration results in having to apply a significantly larger amount of gel. Should be manageable, just not as convenient. Hopefully the Testim along with HCG will work well and hold me over until my appointment with the urologist next month.

Do any of you have any feedback on the temperatures that I posted. As per the thyroid sticky, my temperatures are considered low.

16

Imgaym: I was on topical gels for over a year and finally got a doc to move me to shots. I take 1/4 cc twice a week and I feel better than I ever did on the gels. I dont have to worry about passing it on to anyone, take my shot and I am done. I also saved a huge amount of money moving to shots.

17

almecum - Thanks for the info. Getting on injections is my goal and hopefully the new Dr. I have an appointment with will help me get there.

I got my HCG supplies today and mixed up my first batch and administered 260 iu of it. I plan to do this every MWF.

18

I had my appointment with the urologist today. I really liked the Dr an he was very easy to talk to. I discussed my previous TRT and current meds and we decided on going with 60mg 2X weekly test cyp injections (120mg/week). We discussed SC vs. in-muscle injections and he recomended going with in-muscle. The nurse showed me how to do the injection and administered 100mg in the office. I am still a little uneasy about doing this with a 23 gauge needle into the muscle. I know that many of you inject SC with insulin needles but does anyone every have problems with lumps/cycst forming. Would .3mL SC be safe or should I stick to in-muscle as perscribed?

The Dr. and I also discussed the 250iu hCG SC EOD that I am taking. The dose is lower than what he usually perscribes to maintain fertility but I told him I was not interested in having children and he was ok with me maintaining my current dose.

They took a blood sample for running new lab work but this was done about 10 minutes after my 100mg test cyp injection in my buttock. I am curious if this will alter the (free and total t) test results.

19

I use 25 gauge no problem injecting into my thigh (use 21 to draw). Hardly feel it most of the time. I also do .3ml twice a week.

20

So I still have not done my first test injection. I am planning on having my partner do it for me starting tomorrow. I was reviewing youtube videos and looking at my supplies and realized that they gave me 3cc syringes. Seems like a 1 cc syringe would be a better match for administering 0.3cc. Wish me luck!