Intro - New to TRT

Gents - just wanted to intro myself with my first post to this forum. Read most of the stickies and used what I learned to facilitate my TRT adventure. Some smart bros on this forum and I value your experience and opinions. Apologize up front for the long intro…my future posts will be much more concise.

About me: I’m 42, 69 in and 195 lbs. Not as lean as I’d like to be at ~18% BF, but in very good shape otherwise with 20 years weight training. Total Test was <200 ng/dL before TRT. Lipid profile is very good as well as PSA, thyroid, blood pressure and other vitals. Diet is tight, but nowhere near perfect.

I considered myself lucky when my endo acknowledged that Androgel wasn’t the only protocol for everyone and she actually agreed to approach my treatment as a partnership. She started me on 200mg Test Cyp every 2 weeks and let me do the shots from home, so of course I split the doses up appropriately (once a week is best I can do). I couldn’t get her to understand why E2 was important for my follow-up blood test, but she agreed to do it anyway…the sticky “Estradiol: Why You Should Care” was definitely going to my printer for her to read, along with common protocols for Arimidex and HCG.

Six weeks in, I got another blood test at Quest on the day of my weekly injection and just BEFORE the shot. Total Test was at 488 ng/dL and Estradiol was at 41 pg/mL. She didn’t run a Free Test and my other values came back normal.

I was ready for my return visit last week, armed with good info and quantified, conservative goals for my lab values, shooting for the top quartile of TT (850+) and E2 of 15-30. Subjectively, I felt better but still just “okay” and I was anxious to work with her on how we would proceed to hone my results. Unfortunately, I got the proverbial “your lab results are exactly where I want them to be”. Very disappointing and deja vu for many on this forum. She wouldn’t even read the research I gathered and everything in range meant “perfect” in her vernacular, just like happydog warned in his post. So adjusting dosages and adding an AI was out of the question. When I mentioned HCG and its benefits, she said we could discuss family planning if I wanted to have children – what?? After I reminded her of my vasectomy that I’m very happy with, she ended the discussion and told me to come back in six months. I just felt lucky to get the script and walked out of the office realizing I’ll be self-administering some things from now on.

I ordered 30 mL Liquidex (1 mg/mL) to start my AI routine and got my hands on some Arimidex to get me started while I wait on the shipment. Doing 1 mg/ week divided up EOD. I also began taking 50mg zinc daily, for what that’s worth. Still stuck with no HCG and will probably approach my GP about that when I can. Might just have to find it on my own as well.

A few questions I have for the gurus:

  1. Can I reasonably expect the anastrozole (Arimidex/Liquidex) to elevate my TT? I ask this with respect to AI effects on androgen receptor uptake.

  2. Given HCG effects on TT, should I start an HCG protocol and retest before I increase my Test Cyp dosage? Again, I’m trying to go from 488 to 850+ ng/mL

  3. Any other suggestions?

Thanks
CD

hey there

  1. everyone is different, but yes Arimidex has been known to boost Total and Free T

I think that:
less E2 = less SHBG = higher free T
less E2 = less negative feedbcak = higher total T

  1. I personally would start HCG before increasing T dosage to see how it impacts you. HCG = increased natural pregnenelone production which can convert to DHEA which can then covert to T.

  2. Are you sure you know the root cause of your problems? Have you had tests for Vit D, Thyroid, ferritin, cortisol, etc. (man, i am starting to sound like a broken record on all of these threads.)

Thanks much for the feedback. I’ve read in other forums what you described about Arimidex effect on T, and was wondering if anyone had personal experience of this. But it’s like you said, “everyone is different” and that certainly is true. So I’m going to stay conservative and see how that affects me personally. Likewise with the HCG, but I have yet to get my hands on that as the “Endo vs TRT” war continues. For those that are interested, I’ll report on my progress and provide more data points for discussion.

Frankly, I’d love to find the root cause of my problem and I’m sure others would as well, but the frustration of getting nowhere reaches a culmination point after time. When a full, repeated panel of blood work (along with lipid and thyroid profiles) reports that youâ??re healthy as a mule, but the doctors shrug when your T-levels are those of a little girl, what do you do? Reject the offer of TRT and insist on more blood tests? Not a chance…I’m lucky to get an Estradiol test, let alone anything else. Despite that sad reality, your advice is spot on and I’ll certainly keep peeling the onion back until I learn more, but it’s going to be me calling the shots with help and advice from guys like you. The docs are only getting in the way.

wouldn’t life be so much simplier if the doctors took the time necessary and actually listened to their patients?

I also started on HRT without knowing the full picture. my endo said the same thing… me “I don’t feel like it’s working” him: “well come back in six months for another blood test” me: “well gee doc thanks, but no thanks”

There is middle ground between (1) no HRT until you insist on all of the “best practice” blood tests AND (2) starting HRT and then doing no additional research/tests.

I was on HRT when I found out about my Vit D, ferritin, and cortisol deficiencies. I only started feeling better when I addressed ALL of the issues and am still not at 100%. My case may be more complex then most (I’m not sure). It also took me seeing 8 different doctors all testing for new things, until I think I have finally covered all of the bases.

Most people take years to slowly eliminate all of the possible causes, see multiple doctors, and suffer the entire time. I hope you can shorten your journey by confirming (or disproving) potential issues by a couple of simple blood test.

If you are on HRT, fine… but don’t just stop there. Have your other tests run (if you can find a willing doctor or pay for them yourself through lef.org if that is an option) and see what else is wrong. Some people do fine on limited treatment. Others feel horrible until everything is in balance. Some are in-between.

[quote]Changdao wrote:
When a full, repeated panel of blood work (along with lipid and thyroid profiles) reports that you’re healthy as a mule [/quote]

Did you test for ferritin and iron levels? What about Vitamin D, cortisol, Reverse T3 (if you have Thyroid issues/symptoms), DHEA, Pregnenelone, Magnesium, ACTH Stim Test to confirm Cortisol response? If all of those are normal, then you start getting into heavy metal poisonings, blot clotting factors, and other tests (some that I have had done, but I still have no idea what they are testing for really.)

what about your LH? are you primary or secondary? if secondary (pituitary caused), did they rule out a pituitary tumor?

It is a fight and a struggle. Good doctors, truly good doctor are extremely rare.

At the end of the day you are the PAYING customer. You should decide what treatment you need and what is working and what is not. Yes, the doctor has a say, but not the final say. Print out helpful info to give to your doctor (which you tried. I also failed once or twice with trying to educate doctors - so I switched), talk with your doctor, argue with your doctor (what’s the worse they can do? not give you the medicine that they already refuse to give to you?), call compounding pharmacies for referrals, etc. and when all of that doesn’t work - which it probably won’t, go find the next doctor until you find one that will finally listen.

it is ludicris<spl?> how many doctors go by lab test result ranges and ignore their patient’s symptoms.

most people are not harmed by taking 1,000-2,000 iu VItamin D, 25mg DHEA, 30mg Pregnenelone, 25mg Zinc, Probiotics, Fish Oil, 25mg Ubiquinol, 100mg Resveratrol, 100mg Green Tea extract, and a good multi-vitamin (not from wal-mart usually). You may want to see if those help as well. I take double this dosage, but I am being conservative without blood test levels.

It seems there are a lot of tests I still need to run, some of which I need to learn more about and others I never heard of. So I’m not as educated as I thought and have some work cut out for me. I think at this point, I’m going to return to my GP and explain the whole situation. Maybe I’ll get some more traction with them now that the endo has already prescribed TRT.

A solid list of applicable blood tests like you mention will be a good segue for discussion. I’ve got a few weeks to sort this out before I go overseas, so it canâ??t hurt to try.