Guidance on Labs & Switch to Testim

Pharma / TRT Testosterone Replacement
1

I’m fairly new to Testosterone treatment; about 1 year consistently after I was diagnosed with extremely low T. I was taking Cypionate; 1 injection every 3-4 days of 40mg or 0.4 ml. I was taking about 75mg twice a week but my T levels were really high and my mood was out of control (up down) so my Endo lowered the prescription dosage. I was up and down mood wise even on the lower dosage. The day of and day after my injections I felt like I was going nuts with anger / irritability / and anxiety no matter what my dosage of Cypionate was. Basically TRT hell. Which is all causing depression, fatigue, anxiety, etc… So my Endo wanted to switch me over to Testim. I agreed this should be trialled given my current circumstance. I started Testim 2 days ago.

My base level before starting Testim 2 days ago (and 4 days after my last Cypionate injection) are as follows. Be advised that I live in Canada and they don’t test for everything I probably need tested and I don’t really know who to contact or go to here in Ontario to see a TRT specialist.

TSH 2.04 (0.32 - 4.-00) MIU/L
FREE T4 13.0 (9-19) PMOL / L
FREE T3 4.1 (3.1-6.2) PMOL / L
FSH <0.1 IU/L
LH <0.1 I IU/L
ACTH 3.7 (<14.0) PMOL / L
PROLACTIN 5.6 (4-19) UG/L
CORTISOL AM 275 (135-537) NMOL/L (8AM - 9AM)
ESTRADIOL 71 (<162) PMOL/L
PROGESTERONE 1.1 (<1.7) NMOL/L
TESTOSTERONE 16.1 (8.4 - 28.8) NMOL/L

25-HYDROXYVITAMIN D 96 (75-250) NMOL/L
PARATHYROID HORMONE 3.2 (1.6 - 6.9) PMOL/L

There are a bunch of other blood markers but not related to hormones. Out of these, I will note what was flagged as low or high / outside of range here:

WBC LOW 3.7 (4 - 100) XE9/L **MY WBC HAS TRADITIONALLY BEEN ON THE LOW END
BUT GP DOESN’T SEEM CONCERNED AND SAYS IT NEEDS TO BE <1 TO SEE A BLOOD SPECIALIST.
CREATINE KINASE HIGH 322 (44-275) U/L

…so as I said there are a bunch of other tests (Glucose, Cholesterol, etc…) which I have but they all fall in range. I can reference them if need be.

Daily Temperature monitoring (2 days):

Day 1:
8am 36.4 C
10am 35.8 C
2pm 35.6 C
6pm 36.4 C
Day 2:
8am 36 C
10am 36 C
2pm 36.3 C
6pm 35.5 C

So this is the info I have. Not sure what else might be needed for someone to form an opinion about my current treatment but again, there’s only so much blood information I can get here in Ontario. My main symptoms are fatigue, depression, anxiety, hot flashes sometimes during the day and more often in the mornings, cold hands and feet, broken sleep, early morning awakenings (cannot fall back to sleep), can’t gain weight, tinnitus (this is from medication I was taking about a year and half a go which I’ve been off for 16 months now). My diet is good; no sugar, very little caffeine if any, very little gluten if any (I’ve been tested and I don’t have a gluten problem but I’ve cut it out anyway), no dairy, no nightshade vegetables, Vitamin B12 Hydroxy, Small amount of Methyl folate, Vitamin C, 1000 iu of D3, some Magnesium here and there but my levels are good and have been tested, multivitamin once in a while, IronVegan Gainer mostly every day.

So I have a few questions if there’s anyone who can answer…

  1. I’m not sure if my hormone levels look somewhat normal for my age - I’m 43
  2. It would be great to hear from anyone who has switched from injections to Testim and what your results were like
  3. Can I apply Testim at night / in the evening as opposed to the morning
  4. My Endo doesn’t want to give me any HCG or other types of hormones at this point. She says they are not needed but I’m not so sure

Thank you everyone who replies for your insights, suggestions, experiences, and opinions as I try to get out of this nightmare. I have no energy and sleep is horrible and not refreshing / regenerating. I don’t have apnea but snore through my nose… tried many things to get better over the past year but nothing seems to work… even AD’s (which I can’t really tolerate at all)

All the best, and good health…

2

Your experiences are all too common. You’re missing SHBG which is a gold standard for sex hormones testing, if your SHBG is on the low end it could explain your reaction to high doses of T-Cyp.

Low SHBG guys tend to have a lot of free hormones which converts to estrogen, high estrogen will cause bad anxiety, anger and mood swings. Your doctor switching you from T-Cyp to Testim shows a lack of knowledge, it’s like “let’s try this and see what happens”, you can’t operate like this.

The difference between a clueless doctor and a good one greatly determines how you respond to TRT, bad doctors usually always end in suffering because they don’t know what their doing or know how to manage symptoms.

Your big disadvantage is no proper male E2 testing in your country, even more important you find a good hormone specialist. Once you begin TRT you must monitor estrogen levels, if estrogen gets high you can bet on that you’ll feel bad.

Usually guys feel terrible for about a month after starting TRT, it’s normal as your pituitary gland detects testosterone in the blood and assumes your testes are producing again, so pituitary shuts down. This is way you feel bad, this is a time where you must be patient and wait for the injectable T-Cyp to go to work.

You’re iodine deficient and is why TSH is slightly elevated, you need iodine and selenium.

Your state healthcare is ill equipped to deal with TRT, as of right now it’s to complicated for them.

3

Thank you Systemlord… yes lacking is being gratuitous. My Estradiol level didn’t look too high; I mean it’s 72 pmol/L and the top end of the range is 162? Maybe it should be way lower? What’s the ideal # pmol/L… not sure how to manage to get that down. My endo said that the blood tests for Estradiol aren’t even that accurate and should be taken lightly. Not sure what that means either. Over the past 1.5 years, the highest it’s been is 114 (114 022017, 46 052017, 52 062017, 88 122017, 71 022018). Anyway, I’ve never felt too good on injections which is why I made the switch… I’ve read a few forums and there are some people who do better on the gels… not sure why that is but I thought I would give it a try; at least for a couple of months.

I’ll give the Iodine a shot. Do I have to take it with Selenium every day or is this something you do once a week. Just not sure how much Iodine to take. I have some already in a dropper delivery system. It says to take 1 drop per day but not for how long. I don’t have Selenium yet though.

I can ask my Naturopathic Doctor to prescribe a blood test. If she will do it, what should I ask her to test for?

Thanks again to everyone who provides their insights and experiences.

4

Are you eating any meat? - describe protein sources

TSH should be near 1.0, the lab ranges are useless.
fT3 and fT4 should be near mid-range or a bit higher.
You might also have dry skin, sparse outer eyebrows, low energy, mood issues.

The above could be caused by not using iodize salt.

It is very important that you understand that you need selenium to prevent thyroid auto-immune diseases and that introduction of more iodine is a period of great vulnerability.

Find a high potency B-complex multi-vit with trace elements including 150mcg iodine and 200mcg selenium.

Describe history of [not] using iodized salt.
Typically iodine deficiency affects whole households.

Your thyroid state can easily contribute to fat gain.

We need:
RBC
Hematocrit [HTC]
hemoglobin
total cholesterol = can be tool low
albumin
total proteins

I am concerned that you are getting 14mg iron with Athlete’s GAINER. Men typically do not need any supplemental iron unless there is a GI bleed etc. The female blueprint requires that the body horde iron because they have iron losses when fertile/cycling. Men can easily have too much iron. The foundation of men’s formula vitamins is “iron free”. There is too much background iron in fortified: flour, pasta, rice, breads, mixes etc.

TRT with thyroid problems can make some guys feel worse as the increased/restored metabolic demands of TRT can exceed what the low thyroid function body can deliver. fT3 regulates the energy production, ATP, that powers the cells and thus everything in your body.

E2=71 pmol/L on 150mg T per week seems low and does not explain your mood issues, so back to thyroid.

Your thyroid labs were normal so doc does not have anything on his radar. Bu the problem is there and I have only seen one report of a doctor asking about iodine or iodine deficiency concerns.

Testim will produce sharp short duration FT spikes every day. So watch for a daily pattern. Transdermal T products are ~10% absorbed at best, remaining 90% can be part of transfer to wife or kids by skin transfer. Injected T is 100% absorbed.

There is a strong pattern of guys with thyroid having very low transdermal T absorption as the skin is affected. So you might not be able to use Testim. Docs do not known and drug reps don’t or won’t say.

Testing LH/FSH on TRT is dumb as these–>zero.

Magnesium: Your body will maintain calcium and magnesium levels in your blood by demineralized your bones if need be. So the labs basically will almost always show levels required to stay alive. Forget lab normal for these. If you get leg/foot cramps or can tense a muscle and make it lock up, you are magnesium deficient. See “ZMA” in this sites Biotest store for a reference. The amounts in a multi-vit cannot be enough because of the amounts needed.

Magnesium also affects muscle tone in arteries and can thus effect blood pressure. May also impart some mental calmness.

5

Thanks KSman,

Yes… eating meat (mostly chicken) about twice a day. Mostly just cold vegetables and rice. Some potato, fruits (Apples, Banana, Blueberry, Strawberry), Gluten free everything else. About a handful size portion of meat for lunch and triple that at dinner time. Red meat about 2-3 times a week. No fast food. No alcohol, no drugs… some CBD here and there.

I have Iodine in a dropper; it says to take one drop per day. I don’t have any selenium as of yet. I have a multi-B complex; Natural factors Complex B 50mg… but no Selenium or Iodine in it. So should I stay away from just Iodine and Selenium supplements and get the B complex with these minerals as you suggested or should I just pick up some Selenium and take that with the Iodine I have? I don’t use a lot of Iodized salt or salt period so that can be a problem. I have very little fat on my body but I work-out at least 4 times a week. 5’ 10" but only 146 lbs… so fairly ripped but I could care less about that based on how I feel every day.

RBC 5.34 (4.5 - 6.0) XE12/L
HEMATOCRIT 0.490 (0.4 - 0.5) L/L
HEMOBLOGIN 165 (135-175) G/L
TOTAL CHOLESTEROL:
CHOLESTEROL 3.87 MMOL/L
HDL CHOLESTEROL 1.32 MMOL/L
NON HDL CHOLESTEROL 2.55 MMOL/L
LDL CHOLESTEROL 2.25 MMOL/L
ALBUMIN 45 (35-52) G/L
TOTAL PROTEINS *I don’t have this marker

In regards to Iron, I only have a Ferritin value. Noted in regards to your point and I will stop the gainer I guess. I was using it to try and hold my weight so I don’t lose anymore than I already have. I should be 160 lbs and I’m 146.

FERRITIN 184 (22 - 275) UG/L
B12 558 (138-652) PMOL/L **This was in the same grouping so I thought I would throw it in.

I have Magneisum Glycinate; Naka PRO MG12 200mg. My current blood marker on Magnesium is:
MAGNESIUM 0.9 (0.7 - 1.0) MMOL/L

I understand in regards to the Testim vs. the injections. But I was going nuts on the Cypionate… I wonder if I’m allergic to it. Anyway, I will give the Testim a try and see if it’s effective. I can go back to injections if there is no success to be had with Testim. Not sure what you meant by FT:

“Testim will produce sharp short duration FT spikes every day”

…also wondering if it makes a difference to apply it at night or in the morning. Not sure if anyone has any experience or insights here.

Thank you for your help… I really appreciate any support I can get at this point.

best regards,

6

RBC good.
Hemoglobin good.
HTC is sort of strong VS T levels.
No -ve effects of iron seen above, but ferritin is more than strong enough.

If you get base line levels of iodine and selenium in a multi-vit you can avoid products for single minerals.

You can take larger amounts of iodine for a replenishment phase for a while, selenium must be there as a mater of safety. See the sticky, I can’t cover everything there in this thread.

7

Hi KSman,

Do you have any recommendation on how long I should take the Iodine for? I’m assuming it has to do with body temp. so maybe when my temp. get’s to a certain level? I’m taking Liquid Iodine (Trophic) 14.2mg (each drop contains 640mcg Iodine). 1-2 drops a day. I’m also taking Selenium; NOW 200 mcg 1-2 capsules per day.

thank you for your help,