Dialing in my Protocol... No Luck

Pharma / TRT Testosterone Replacement
1

A little back story…I am 29, 6’0, 280lb, approx. 20% BF (I know this does not help me any).
I would probably be considered hairier than average? Full head of hair. I can grow a full beard, but it grows very slowly. My BF has always been concentrated mostly in the abdomen and thigh area. I have been chubby my entire life, body comp is improving though.
I have moderate sleep apnea and of course the current hormone issues.
For at least the last decade it has been a struggle with low energy, mood swings, libido swings, mental fog, no drive, and just an overall feeling like shit. Which I always just attributed to working night shifts on and off over the years.
No RX or OTC other than for the occasional injury or cold. Never any hair loss or prostate drugs.
Diet is pretty consistent, clean carbs and animal protein, few vegetables, couple beers or glass of bourbon most nights. Eat out occasionally. Always used iodized salt, Generously.
Don’t work out much. I am a mechanic and have a 2yr. old so I usually stay pretty active.

I have little faith in doctors, so I pulled my first labs myself on 11/10/17, and found my Test was 192. After a couple weeks of researching and seriously debating if I wanted to commit to a life of TRT I decided to see a GP. The GP I ended up going to knows absolutely nothing about TRT, BUT, is completely open to all my suggestions and whatever protocol I want to do. He started me out at 200mg Test Cyp a week, which I split E3.5D.
Since I have started TRT I have seen only moderate improvements in wellbeing other than mental clarity which improved a lot. I have pulled different labs/made changes to my protocol, nothing seems to be working.
My last set of labs I pulled SHBG and found it was low. After researching Low SHBG + TRT I am getting a little discouraged. Starting to feel like I’m chasing my tail.

I am thinking switching to Test Prop and pinning EOD or maybe ED? Should I raise/lower the mg a week?

12/8/17 Started TRT 200mg/wk, Split M/F
2/23/18 Started .5mg Arimidex with each pin
3/15/18 I dropped the Arimidex so I didn’t crash my E2, also dropped Test to 150mg/wk, M/W/F and started pinning SubQ

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Your protocol is working against you, you need to consider injecting smaller doses EOD or ED given your low SHBG. 200mg would be ideal for a guy who hyper metabolizes testosterone fast as his body uses up most quickly, however a low SHBG guy needs smaller micro doses. Inject doses using insulin syringes.

Your doctor is delegating to you to design a protocol, it’s similar to giving an 8 year old keys to your family car, bad idea! You couldn’t have thought that was going to work, right? Test prop isn’t the best option, trust me as it’s has fast acting esters that can be problematic. You really need a doctor who can look at your labs and understand their meaning if you ever want to feel normal.

Do to your low SHBG you need to inject smaller doses, 15-20mg EOD and minimal AI dosage as injecting frequently can lower E2 levels in of itself. If you don’t respond well inject 10-12mg every day. Note low thyroid function can sometimes explain low SHBG, to check thyroid function check oral body temperatures using a glass thermometer per thyroid sticky.

If temperatures are low considering iodine intake, thyroid hormone would then need to be checked, mainly fT3, fT4, rT3 and antibodies. fT3 is where the rubber meets the road. A TSH of 2.95 is bad, forget about what doctors tell you. Most progressive doctors begin treating thyroid when TSH blows past 2.5, doctors with head in sand wait until things reach “disease status”.

Drinking as often as you do encourages estrogen production which you seem to have a problem in that you’re estrogen dominant where testosterone is low and estrogen is high. Contrary to what you have heard, alcohol is bad for you and does you no favors.

Do to your low SHBG it’s going to take at least a year or more for you to make a full recovery, low SHBG guys take a longer time to get dialed in. How do I know, another low SHBG guy here (18 nmol/L) still making improvements 11 months later. Slow, slow improvements in mood are first, then you’ll notice more energy 3-6 months later, then workouts in the gym will improve along with muscle recovery.

Your changes will improve if you find a doctor who knows what in the hell he’s doing, you aren’t equipped to handle this on your own! This is why you are discouraged, you have zero understanding, your doctor has zero understanding.

You should be on a Cpap machine is sleep apnea is as bad as you say it is, otherwise you’re starving your brain of oxygen.

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@systemlord Thanks for your reply.

Yea i am considering EOD or ED, and is also why i am considering switching to Prop. Would it not be better to have more frequent pins and a faster acting ester to more closely mimic the body’s natural peek and trough of test production rather than have an unnatural flat test level constantly?

I definitely understand the doc issue. I have been looking for someone better local to me without much luck. Until then I have to use the resources available.

I am discouraged due to large number of low shbg and trt threads and information i have read with very few people, if any, with solid improvements in well being. I have more than zero understanding.

The apnea is only moderate, but yes I do use a Cpap.

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The internet can be extremely helpful, it can also become a nightmare if you read too much into it all. You’re not doomed because you have low SHBG, lot’s of guys have low SHBG and feel great on TRT. I’m one of those guys who feels great on TRT, it’s just going to take awhile to get to 100 percent.

Zero understanding comment was meant to gauge our understanding versus doctors who know what their doing, we have only scratched the tip of the iceberg.

Look into Defy Medical, no travel necessary.

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Target of E2=22pg/ml works best for most guys.

With E2=8.7 you could have adjusted anastrozole dose by a factor of 8.7/22. The also apply a factor the same as T dose reduction. If you change T dose, change anastrozole dose.

Do not test LH/FSH again.

Yes, T dose was too high. With low SHBG, non-bioavailable SHBG+T reduces TT and TT then understates your T status. HTC-hematocrit also suggests too much T.

Increase in fT3 suggests increasing rT3. See the thyroid basics sticky re fT3, stress, cortisol etc.

Odd iron related changes… donated blood?

Avoid a few days before prolactin labs: orgasm, hugging babies, puppies, kittens etc. That triggers prolactin release.

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.

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Yea I definitely take most of the information i get off the internet with a grain of salt. I have read Lee Myer’s and Dr. Crisler’s books on TRT, they were very helpful.

No worries on the comment, this is definitely a learning experience!

I have considered Defy and will more than likely end up giving them a shot. I have just been holding out hoping I could find a local doc that I can deal face to face with.

If you dont mind, what does protocol look like? Do you use Defy?

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E2=22pg/ml is what i was shooting for.
The reason I decided to completely stop the Ai instead of just lowering the dose was when lowered to 150mg 3 days week, I also switched to SubQ instead of IM (forgot to note that in original post, will edit). So my understanding and way of thinking is,
Less test=Less E2 conversion added with SQ pins=slower release=Less E2 conversion should get me somewhere close to optimal E2 without the need of an Ai at all. Am i correct? Will be pulling labs again in a couple week, see what I got and go from there.

The LH/FSH just happened to be in the panel I ordered. I knew they would be 0 so i payed no attention to them.

Will read through the thyroid basics sticky again.

I was wondering about the iron changes? The only that changed between the two test was I started supplementing with vitamin D the same day I started TRT. I don’t know if that has any effect on it? Haven’t researched that yet. But other than that nothing else has change and have not donated blood.

Any labs i should test that i haven’t already? Anything else in my previous blood work seem odd/off that i should look into?