[Case Thread] 3 Years of TRT

Pharma TRT
1

Hello,

I’ve been on TRT for about 2.5-3 years. I’m 26.

My pre-TRT labs were just this: TT: 264 (don’t remember the range), FT: 15 (4.3 - 30.4). My doctor didn’t do any more labs than this.

My doctor originally allowed me to do injections and I was injecting 33mg 3x/week with anastrozole dosing at 0.5 3x/week and HCG 250iu 3x/week, which resulted in:

total T: 660 (348-1197)
free T: 23.7 (9.3 - 26.5)
RT3 15.2 (9.2-24.1)
E2 13.1 (7.6 -42.6)

He also had me do salivary cortisol testing:
CORTISOL
AM 19 (13-24)
Afternoon 3 (5-10)
Evening 2 (3-8)
Midnight 1 (1-4)

This was about two years ago.

I weighed 205 pounds and had sleep apnea. Since then I’ve lost 15-20 pounds and suspect that my sleep apnea is significantly reduced. I don’t use CPAP.

I was on injections for maybe a year and he switched me to a cream and disallowed injections. On 100mg cream with compounded anastrozole 0.1mg in the same cream my labs were:

FT: 22.8 (4.5 - 25)
TT: 762 (348-1197)
E2: 22 (7.6 - 42)
Dhea-S 194 (0-650)
Progesterone 0 (0 - 18) (undetected)
Pregnenalone 0 (0 - 196) (undetected)
FT4 1.1ng/dL (0 - 2.6)
FT3 342 pg/dL (0 - 600)
RT3 17.5 (9-17)

Thyroid labs were pre-sustained release T3.

And had me cruise on the cream up until a month ago when he upped the dose of the cream to 120mg OD instead of 100mg. (keeping the anastrozole at 0.1mg/day) alongside the 250iu HCG EOD

I take 14mcg sustained-release T3 due to discovering wilsons temperature syndrome and finding that being a minimal-effective dose and cruised on that instead of escalating. This significantly improved my energy where I was practically bedridden when not working because of this.

Pre-TRT I had a history of panic attacks and stimulant (ab)use. I was on ritalin for a year and had tremendous emotional stress and mental health issues. I didn’t exercise.

In the past 3 months I’ve lost 20 pounds on the ketogenic diet going from 205 pounds to 185. For the past month I’ve successfully lifted weights and ran alternating every other day. I also meditate daily now and my energy and mental health have improved.

Wondering where to go from here. I am considering doing a PCT and seeing if my natural T levels have risen. I don’t feel that great on TRT. I have anorgasmia and no libido. I still work a very stressful job, though, but cope significantly better now.

2

No one comes back from a 264 ng/dL, it’s already way to late for any recovery of natural production, maybe if you were in the 400 range. Thyroid needs good cortisol levels to function properly, yours is low throughout the day, cortisol is very important because it sensitizes the thyroid receptors.

You’re considering stopping TRT when your clearly have other systems not functioning properly, TRT requires everything else in order, cortisol, progesterone are no good.

What are your iron levels?

3

Cortisol labs were 2 years ago. Haven’t had a recent one.

Iron levels were high when they were tested ~1 year ago. But one of my supplements had iron. I gave blood, stopped taking the supplement, and now they are fine. I can find labs for this later.

4

Still using hCG I hope.

Get progesterone cream, that will support progesterone–>cortisol in your adrenals. Some find that sleep is improved while others find that cortisol release makes them wakeful. I would not compound it with the T or apply to same areas with T.

The testes make a significant amount of pregnenolone. Pregnenolone is the first step in your steroid hormone cascade which also includes cortisol.

hCG 250iu subq is used to prevent testicular shutdown. It can also stop the dull 24x7 ache that many feel as there testes shrink.

I agree with T dose increase. Watch for E2, E2=22pg/ml seems optimal for most.

Post your oral body temperatures when you get out of bed and mid-afternoon.

You should still be getting iodine from iodized salt and vitamins [250mcg iodine and 200mcg selenium].

What was your history of using iodized salt? A lack of iodine may have started all of that.

Have you read Wilson’s book on Adrenal Fatigue?

fT3 and fT4 ranges 0-x are odd. Zero fT3=death.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

**The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.**strong text

5

KSMan, I had to do an edit that I’ve been on HCG 250iu either 3x/week or EOD with the exception of 3-4 months.

Yes, I’ve read wilsons book. Seems to be a mixture of supplements (I take ADR) + stop stimulants + lower stress. I’ve followed nearly every suggestion. My caffeine intake is minimal now.

I’ve consistently both taken a supplement with iodine in it as well as use iodized salt.

When should I take the progesterone cream. Before bed? Any other cortisol cofactors (vitamin C) would be useful?

The T dose increase feels better but still pretty much zero sexual function.

6

History of using iodized salt was = always?

Progesterone as part of a going to bed routine is good if you sleep OK, otherwise in AM.

Other factors - I defer to Wilson as there is a book full of into that I do not want to attempt to address in bits and pieces.

7

Yes, still using HCG.

I have 3 days worth of body temps, maybe not enough but wondering if you think they’re low enough to consider a dose bump on my sustained T3. AM temps, first two are on the same day: 96.4 (5am) 97.6 (6am - same day); 97.3 (630, yesterday);96.4(6am, today) then 4-5 PM temps: 97.6; 97.6; 97.5.

As far as iodized salt my history was none prior to health issues so it started around the time I started TRT 2.5 years ago and I was taking a kelp supplement and more recently I was taking iodized salt capsules (1-2 grams/day) to supplement salt while on the ketogenic diet, which I know sounds weird but you shed electrolytes on that diet. Thank you for posting iodine/selenium doses as it looks like my multivitamin is insufficient (150mcg iodine, 55mcg selenium).

Wondering about prospect of HPTA restart or if that’s a fantasy. I think the internet is generally negative especially regarding health issues, but perhaps there’s something I’m missing…

8

There remains the issue that years with no iodized salt could have led to complications.

55mcg selenium is not protective enough! Try to find 200mcg selenium.

9

Ive tried taking 12.5mg iodine and 200mcg selenium and my temperatures have gone up: AM 97.5, 4:00 99.6. I also feel pretty amped from the progesterone cream. I was super paranoid a couple days ago and I read that’s a high cortisol symptom. I’ve also been hyper-salivating, wondering if that’s a cortisol symptom, too? Maybe I’m overdoing it but I feel overwhelmed and too amped but also tired and fatigued. Maybe another variable is at play here: depression causing a sleep issue. I usually wake up an hour or so before I intend to wake up and can’t fall back asleep.

10

My temps seem fine now. I’m going to try doing your pct.

Nevermind. I go one day without taking ST3 or iodine and my AM temp is 97.0.

11

Hey @KSman, can you please help interpret my labs?

I was taking 20mg tamoxifen EOD with my testosterome cream and then stopped the cream on a Friday and got these labs monday morning. A confounding thing is the fact that I take modafinil daily, which sounds like it competes for the same enzyme that converts the prodrug tamoxifen into its useful metabolites. Modafinil has a 15 hr halflife, so I stopped that on Friday as well and didn’t take it on Monday. Another complication is that this is year old liquid tamoxifen from a research chem site, so not sure how much has degraded or not. I really don’t know what these means, there is existent testosterone, yet nonexistent LSH/FSH.

Perhaps this was an exercise in futility, but maybe you see other useful data?

Also, my temperatures have normalized.

CBC With Differential/Platelet
WBC 5.3 x10E3/uL 3.4 - 10.8 01
RBC 4.89 x10E6/uL 4.14 - 5.80 01
Hemoglobin 15.2 g/dL 13.0 - 17.7 01
Hematocrit 44.2 % 37.5 - 51.0 01
MCV 90 fL 79 - 97 01
MCH 31.1 pg 26.6 - 33.0 01
MCHC 34.4 g/dL 31.5 - 35.7 01
RDW 12.5 % 12.3 - 15.4 01
Platelets 257 x10E3/uL 150 - 379 01
Neutrophils 47 % Not Estab. 01
Lymphs 43 % Not Estab. 01
Monocytes 7 % Not Estab. 01
Eos 3 % Not Estab. 01
Basos 0 % Not Estab. 01
Neutrophils (Absolute) 2.5 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 2.3 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.4 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % Not Estab. 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Testosterone Free, Profile I
Albumin 4.6 g/dL 3.5 - 5.5 01
Testosterone, Serum 549 ng/dL 264 - 916 01
Adult male reference interval is based on a population of
healthy nonobese males (BMI <30) between 19 and 39 years old.
Travison, et.al. JCEM 2017,102;1161-1173. PMID: 28324103.
Sex Horm Binding Glob, Serum 47.6 nmol/L 16.5 - 55.9 01
Testost., Free, Calc 89.5 pg/mL 47.7 - 173.9
PSA (Reflex To Free) (Serial)
Prostate Specific Ag, Serum 0.8 ng/mL 0.0 - 4.0 01
Roche ECLIA methodology.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory
PSA value 0.2 ng/mL or greater.
Values obtained with different assay methods or kits cannot be used
interchangeably. Results cannot be interpreted as absolute evidence
of the presence or absence of malignant disease.
Reflex Criteria 01
The percent free PSA is performed on a reflex basis only when the
total PSA is between 4.0 and 10.0 ng/mL.
T4+Free T4
Thyroxine (T-4), Serum 7.2 ug/dL 03
Reference Range:
Adults: 4.2 - 13.0
Free T4 by Dialysis/Mass Spec
1.3 ng/dL 03
Reference Range:
Pubertal Children and Adults:
0.8 - 1.7
FSH and LH
LH <0.2 Low mIU/mL 1.7 - 8.6 01
FSH <0.2 Low mIU/mL 1.5 - 12.4 01
Testosterone,Free and Total
Free Testosterone(Direct) 14.3 pg/mL 9.3 - 26.5 04
T3, Free, Dialysis, LC/MS-MS 5.45 pg/mL 03
Reference Range:
Range Mean
Children >10y
and Adults: 1.81 - 4.06 2.77
Pregnant Females:
First Trimester 1.6 - 3.3 2.5
Second Trimester To be determined
Third Trimester 1.0 - 3.2 2.1
DHEA, Serum
Dehydroepiandrosterone (DHEA)
369 ng/dL 31 - 701 04
Age
1 - 5 years 0 - 67
6 - 7 years 0 - 110
8 - 10 years 0 - 185
11 - 12 years 0 - 201
13 - 14 years 0 - 318
15 - 16 years 39 - 481
17 - 19 years 40 - 491
19 years 31 - 701
Disclaimer: 04
This test was developed and its performance characteristics
determined by LabCorp. It has not been cleared or approved
by the Food and Drug Administration.
TSH 2.630 uIU/mL 0.450 - 4.500 01
Estradiol 7.8 pg/mL 7.6 - 42.6 01
Roche ECLIA methodology
Reverse T3, Serum 22.4 ng/dL 9.2 - 24.1 04
Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab 11 IU/mL 0 - 34 01
Thyroglobulin Antibody <1.0 IU/mL 0.0 - 0.9 01
Thyroglobulin Antibody measured by Beckman Coulter Methodology

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