38 YO Starting TRT

Pharma / TRT Testosterone Replacement
1

Hey all, decided to make a post to keep track of things since I’ll be starting TRT next Tuesday.
First the basics -

age - 38
height - 5’10"
waist - 36
weight - 165
body and facial hair - normal, no issues growing facial hair, always had fairly hairy back and chest.

describe where you carry fat and how changed - mostly in the belly, when i was heavier was fairly well distributed.

health conditions, symptoms [history] - insulin resistance, prone to reactive hypoglycemia. fatigue, brain fog, little to no libido.

Rx and OTC drugs - metoprolol succinate er (25mg/day), prescribed by cardio after goig to the E.R. with a bad episode of PVCs. Take a mutivitamin.

describe diet - after finding out I have blood sugar issues, I went low carb and lost 45 pounds in less than 6 months. Don’t think I usually get enough calories though.

describe training - hardly none since lwo T symptoms started.

testes ache, ever, with a fever? no

how have morning wood and nocturnal erections changed - few and far between.

I’m 38 and was diagnosed with secondary hypogonadism back in July 2012. Here are some results from the labs taken then:
Total T - 85 ng/dl (262-1593)
Free T - 7.38 (9-47)
LH - 1.8 (1.4-11.1)
FSH - 5.2 (1.6-17.8)

The Endo put me on clomid (25mg/day) which raised LH and FSH levels and kept my total T just under 500. Free T or estradiol was not tested. Felt better but not as good as I know I should. I stopped taking the clomid on Jan 24, 2013. After a few weeks I started feeling real crappy again. Went last week for labs and here are those results:

Estradiol - 6 (8-43)
LH - 2.5 (1.7 - 8.6)
FSH 3.1 (1.5 - 12.4)
Total T - 350 (250-1100)
Free T - 45.3 (35-155)

When the doc called to give the results he said we would start TRT (injections) at my next appointment which is next Tuesday, the 19th.
The root cause for everything appears to be hypopituitarism, which is causing me issues with water regulation as well. I’m trying to get insurance to approve a pituitary MRI to check for tumors.

A few more labs from a December wellness check:
TRIGLYCERIDES-86 mg/dL (<150)
CHOLESTEROL-223 mg/dL (125-200)
HDL CHOLESTEROL-52 mg/dL ( > or = 40)
LDL CHOLESTEROL-154 mg/dL (<130)
CHOL TO HDLC RATIO-4.3 (< or =5.0)
CARDIO CRP-0.9 mg (<3.0)
TSH,3RD GENERATION with reflex-1.37 mIU/L (.40 - 4.50)

By the way, if anyone should happen to know a good TRT doc in the Phoenix area, please let me know. I like my endo, and am going to give him a chance, just want an alternative in case it doesn’t work out with him.

Thanks

2

Please read these stickies:

  • advice for new guys
  • protocol for injections
  • thyroid basics
    – check body temperatures and list your history of iodine intake [vitamins listing iodine and iodized salt]
  • finding a TRT doc

When on clomid you should have checked LH/FSH. A HPTA restart with a SERM[clomid, nolvadex] requires that the SERM be tapered off, not stopped suddenly and an AI man be needed to prevent estrogen rebound from causing a shutdown.

3

[quote]KSman wrote:
Please read these stickies:

  • advice for new guys
  • protocol for injections
  • thyroid basics
    – check body temperatures and list your history of iodine intake [vitamins listing iodine and iodized salt]
  • finding a TRT doc

When on clomid you should have checked LH/FSH. A HPTA restart with a SERM[clomid, nolvadex] requires that the SERM be tapered off, not stopped suddenly and an AI man be needed to prevent estrogen rebound from causing a shutdown.[/quote]

My temp usually runs about 97.6 - 98. Thats been my normal for as long as I can remember.
The daily multivitamin I take has 150mcg of iodine.

LH and FSH was checked while I was on the clomid and they both did go up. I just cant find the copies of those labs right now. I never expected a restart to work for me. From what I’ve read, it seems like the main group who have success with it or those who shut it down themselves via drug/steroid abuse.

4

Well, had the first injection a few hours ago at the endo’s office. Injection site is a bit sore (outer thigh). Gave me a prescription for 100mg/week injecting once a week with 19 and 23 ga needles to draw and inject. Having me test for total and free T and estradiol a day before the 6th injection and we’ll go from there.

Unfortunately he feels that HCG is not needed and is reluctant to prescribe it. Looks I’ll be needing to find another doc. Anyone who knows of a good one in the Phoenix area please let me know.

Now to just wait and see how long it takes to notice the effects.

5

Try the search function for Phoenix

There is the sticky that I suggested for finding a doc

We have seen some guys restart from normal situations.

You can inject more often, see the suggested sticky. No need to back fill syringes at all. You can load #23 1.5" direct from the vial.

6

Well, just got finished doing my first self-injection. Many thanks to the contributors of this site who took a lot of the worry out of it. The doc’s assistant didn’t really tell me much on injecting. 100mg T-Cyp, drawn with 21g and injected with 25 in the left thigh. I’ll admit I was a bit nervous when it came time to actually poke myself. The only mistake I made was forgetting to sterilize the stopper before drawing, but since I switched needles anyway I’m not really concerned about it.

This is only my 2nd injection of TRT so far. Feeling kinda crappy at the moment but actually wasn’t doing too bad over the weekend. Guess I’ll see what this week holds.

7

Did 3rd injection on Monday. Still feeling like crap. Hate just waiting to see what happens.

8

Try drawing and injecting with #25. Many here inject with #29, 0.5" 0.5ml [50iu] insulin syringes. Those do take time to load.

I swab the stopper for a new vial and do not swab the stopper very often after that.

You never supplied waking body temps. If one gets iodine deficient, you cannot climb out of the hole with 150mcg iodine per day. See the sticky. Thyroid problems can mean that TRT is not the expected fix.

9

I had thyroid tests by my endo back in June which was a couple months after symptoms started.
TSH - 1.46 (.30-3.0)
FT3 - 4.8 (1.5-4.1) High
FT4 - 1.29 (.80-2.00)

The endo said the FT3 was OK even though it was over the lab range. Never really looked into it again.

10

Starting to notice a pattern that makes no sense to me. I’ve been starting to feel a bit better, but only a couple days before the next weekly injection. Happened again this time. Was feeling pretty decent on Saturday - Monday. Had the injection yesterday(monday) evening and am now feeling like crap again.
It’s the exact opposite of what I was expecting, and getting frustrating. What could cause that? Possibly E2 going too high the first few days after injection?

11

No iodine supplements?

Yes, you may be getting E2 issues, perhaps not. Or thyroid not supporting the demands of T.

If one gets iodine deficient, you cannot climb out of the hole with 150mcg iodine per day. See the sticky. Thyroid problems can mean that TRT is not the expected fix.

Try injecting twice a week and SC will less abrupt than IM.

you “My temp usually runs about 97.6 - 98.”
me “You never supplied waking body temps.” need waking and mid afternoon oral body temperatures, did you read "thyroid basics "

rT3 can block your nice fT3 level, so is there a lot of stress in your life or past stress events that wore you down? We are looking for a root cause problem, but you seen disinterested.

12

Not at the moment as I have no idea if I’m even deficient yet.

I’m seriously considering it

[quote]you “My temp usually runs about 97.6 - 98.”
me “You never supplied waking body temps.” need waking and mid afternoon oral body temperatures, did you read "thyroid basics "[/quote]
This mid-afternoon was 97.8. I’ll start checking more often.

I couldn’t be more interested in the root cause, which everything points to an issue with the pituitary and/or hypothalamus. I’m trying to get into a pituitary center to see what they can find. I’m not willing yet to accept the general opinion of the docs that 'sometimes we just don’t know what it is, but it’s(pituitary) not working right.
I’ve seen more docs and had more lab tests done in the past year than probably my entire life prior(I seriously don’t think that’s an exaggeration). The only things that have shown up wonky were:
-Iron deficency anemia (brought on by frequent blood donations) iron supplementation took care of that, and I’m avoiding donating for now.

  • elevated blood sugar - not real high, the ‘pre-diabetes’ stage. I’ve switched to low-carb diet to keep that in check.
  • low lh, fsh, and test levels - which is what brought me here.

Only other issue is water regulation (also controlled by pituitary). I drink a lot of water/thirsty. Tests have ruled out things like diabetes insipidus. And it’s not blood sugar related (my numbers don’t get high enough to cause those types of symptoms)

You asked about stress. Yeah, I have been regarding my health, but that wasn’t until after all the symptoms started.

13

No iodine supplements?

Not at the moment as I have no idea if I’m even deficient yet.

And you have no idea that you are not.

14

Just got the results of my first labs since starting TRT. They were taken the end of the 6th week, a few hours before my weekly injection of 100mg T-Cyp.

Total T - 778 ng/dl(250-1100)
Free T - 191.4 pgMl (35-155) HIGH
Estradiol - 13 pg/mL (8-43)

Was nice to see a good total t level for the first time in about a year. I was surprised at the high Free T however. Is that anything to be concerned with? I’d assume I’m even higher than that the first few days after injection right?

Also expected to see estradiol higher than that.

EDIT: Forgot to mention how I’m feeling. Overall, better than I was when I started, but not as good as I figured I would feel by now, especially now that I know the numbers. Libido has increased, but there’s still fatigue and brain fog at times.

15

Dr. Charles Evans.

Fantastic and open-minded TRT doc who will listen to your particular needs and expectations of TRT. I wouldn’t use anyone else if you’re in the phoenix area. He’s in Scottsdale.

16

Thanks for the recommendation. I was thinking of trying Dr Eric Honing with BodyLogicMD. I’ve read good things about him.

17

Hey folks, been a while since I posted. I just got a lot of labs done but wont be seeing the
hormone specialist for a few more weeks. I’m now taking 40mg t-cyp twice a week. Still not
feeling very well though. Still waiting on the total/free t results but here are some of the
others. Im most concearned about the cardio CRP and my HCT is a bit high. A lot of labs I know, but thanks for any input.

TSH 1.19 (0.40-4.50 mIU/L EN)
T4, FREE (1.2 0.8-1.8 ng/dL EN)
T3, FREE 2.9 (2.3-4.2 pg/mL EN)

CBC (INCLUDES DIFF/PLT) EN
WHITE BLOOD CELL COUNT 9.8 (3.8-10.8 Thousand/uL)
RED BLOOD CELL COUNT 5.35 (4.20-5.80 Million/uL )
HEMOGLOBIN 16.3 (13.2-17.1 g/dL )
HEMATOCRIT 51.8 H (38.5-50.0 % )
MCV 96.7 (80.0-100.0 fL )
MCH 30.4 (27.0-33.0 pg )
MCHC 31.5 L (32.0-36.0 g/dL )
RDW 13.4 (11.0-15.0 % )
PLATELET COUNT 231 (140-400 Thousand/uL )
MPV 9.1 (7.5-11.5 fL )
ABSOLUTE NEUTROPHILS 6968 (1500-7800 cells/uL)
ABSOLUTE LYMPHOCYTES 1695 (850-3900 cells/uL
ABSOLUTE MONOCYTES 931 (200-950 cells/uL)
ABSOLUTE EOSINOPHILS 176 (15-500 cells/uL)
ABSOLUTE BASOPHILS 29 (0-200 cells/uL)
NEUTROPHILS 71.1 %
LYMPHOCYTES 17.3 %
MONOCYTES 9.5 %
EOSINOPHILS 1.8 %
BASOPHILS 0.3 %

DHEA SULFATE 378 H (110-370 mcg/dL)

ESTRADIOL, ULTRASENSITIVE 7 (< OR = 29 pg/mL)
DIHYDROTESTOSTERONE, 43 (16-79 ng/dL)

LIPID PANEL
CHOLESTEROL, TOTAL 251 H (125-200 mg/dL EN)
HDL CHOLESTEROL 74 (> OR = 40 mg/dL EN)
TRIGLYCERIDES 48 (<150 mg/dL EN)
LDL-CHOLESTEROL 167 H (<130 mg/dL (calc)
CHOL/HDLC RATIO 3.4 (< OR = 5.0 (calc)
NON HDL CHOLESTEROL 177 H mg/dL (calc)

CARDIO CRP(R) 18.2 H mg/L
(For ages >17 Years:
cCRP mg/L Risk According to AHA/CDC Guidelines
<1.0 Lower relative cardiovascular risk.
1.0-3.0 Average relative cardiovascular risk.
3.1-10.0 Higher relative cardiovascular risk.
Consider retesting in 1 to 2 weeks to
exclude a benign transient elevation
in the baseline CRP value secondary
to infection or inflammation.

10.0 Persistent elevation, upon retesting,
may be associated with infection and
inflammation.)

COMPREHENSIVE METABOLIC PANEL
GLUCOSE 71 (65-99 mg/dL )
Fasting reference interval
UREA NITROGEN (BUN) 9 (7-25 mg/dL )
CREATININE 0.74 (0.60-1.35 mg/dL)
eGFR NON-AFR. AMERICAN 117 > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 136 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc)
SODIUM 137 (135-146 mmol/L )
POTASSIUM 4.1 (3.5-5.3 mmol/L )
CHLORIDE 99 (98-110 mmol/L )
CARBON DIOXIDE 26 (19-30 mmol/L )
CALCIUM 10.0 (8.6-10.3 mg/dL )
PROTEIN, TOTAL 7.7 (6.1-8.1 g/dL )
ALBUMIN 5.2 H (3.6-5.1 g/dL )
GLOBULIN 2.5 (1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 2.1 (1.0-2.5 (calc)
BILIRUBIN, TOTAL 1.3 H (0.2-1.2 mg/dL )
ALKALINE PHOSPHATASE 52 (40-115 U/L )
AST 16 (10-40 U/L )
ALT 13 (9-46 U/L )
HEMOGLOBIN A1c 4.9 (<5.7 % of total Hgb)

VITAMIN D, 25-HYDROXY, SLI
LC/MS/MS
VITAMIN D, 25-OH, TOTAL 37 (30-100 ng/mL )
25-OHD3 indicates both endogenous production and
supplementation. 25-OHD2 is an indicator of exogenous sources,
such as diet or supplementation. Therapy is based on measurement
of Total 25-OHD, with levels <20 ng/mL indicative of Vitamin D
deficiency, while levels between 20 ng/mL and 30 ng/mL suggest
insufficiency. Optimal levels are > or = 30 ng/mL.
VITAMIN D, 25-OH, D3 37 See Below ng/mL
Reference Range: Not established
VITAMIN D, 25-OH, D2 <4 See Below ng/mL
Reference Range: Not established

18

fT3 is a bit low, body temperatures are low, rT3 unknown, brain fog and we know that is not from a lack of testosterone. Your high readings posted 06/06 could have been from rT3. Possible iodine deficiency and rT3. You can try IR. If you feel better, cheap and diagnostic.

Guys on effective TRT can feel bad from thyroid and ID problems. So you are no different.

Take 5000iu vit-D3 per day.

Blood is too thick. Can you donate blood? Take aspirin. You may need to reduce T dose. Injecting smaller amounts more often may be a lot better than injecting once a week.

CRP is high, but is not arterial specific. Can be from other inflammation or disease process. Follow up with homocystine that is arterial specific.

Need cortisol lab data, do AM cortisol, lab at 8AM after a normal night’s sleep.

This drug can make some feel sick:

19

Whoops, completely forgot to include the cortisol:

Morning Cortisol (Saliva) - 5.9 ng/ml (3.7-9.5)
Noon Cortisol (Saliva) - 1.5 ng/ml (1.2-3.0)
Evening Cortisol (Saliva) - 0.8 ng/ml (0.6-1.9)
Night Cortisol (Saliva) - 0.6 ng/ml (0.4-1.0)

You said I can try IR…what is that, I’m assuming an iodine supplement?

I’ve already reduced T-dose down to 80mg/wk (40mg every 3.5 days). I used to donate blood regularly, but it made my ferritin levels too low, so I stopped and the iron levels returned to normal. But I’m willing to again, just have to watch how often.

I stopped taking the metoprolol about a month ago.

Also, can there be any negative effects from the consistently low E2 levels?

20

Yes negative effects from low estradiol.

Achy joints, bone loss ect look this up

IR: check thyroid antibodies- tgab and tpo and an added tsi test before loading large amounts of iodine.

Also recheck previous thyroid labs plus an added rt3 test

Look at www.stopthethyroidmadness.com and search rt3 conversion factor

With hemoglobin and hametocrit high and ferritin low are we sure iron is low?

Low ferritin could implicate elevated rt3 or cortisol. You have already checked cortisol properly so we can rule that out depending on when it was done and how things have changed since then.

Be careful with iodine… If you do it buy loguls iodine with iodine/iodide mixture one goes directly to the thyroid the other works the cells in the rest of the body… Start slow… Not something I recommend at all as i had a bad experience but iodine is important… Do the thyroid labs I suggested to rule out hashimotos and graves . Good luck sir