Just Started TRT, Need Some Advice

Pharma / TRT Testosterone Replacement
1

Hello!

First, some stats:

35 years old.
5’8
207 lbs
High body fat, don’t workout, but I plan to start Monday.
I have had large breasts since childhood
Testicles are small, always have been.
I Have lots of hair on body, including back.
Plenty of facial hair, but a couple of areas are thin.

I have been experiencing the symptoms of low T for most of my adult life, if not all. Symptoms are Fatigue, low sex drive, lack of motivation, anxiety, low self-confidence.

My Doctor tested me for Total Testosterone and Free Testosterone only on 3/13/14.

TT= 206 ng/dL with range of 240-950
FT= 8 ng/dL with range of 9-30

After he told me that my T is slightly low, and that he didn’t feel comfortable putting me on TRT, I decided to find a specialist. That’s when I found an anti-aging clinic and they did a much more advanced blood test on 3/25/14. Here are the results:

                     Result                 Range

Chemistries

Glucose, Serum 84 mg/dL 65-99
BUN 16 mg/dL 6-20
Creatine, Serum .90 mg/dL .76-1.27
eGFR 110 mL/min/1.73 greater than 59
BUN/Creatine Ratio 18 8-19
Sodium, Serum 140 mmol/L 134-144
Potassium, Serum 5.1 mmol/L 3.5-5.2
Chloride, Serum 100 mmol/L 97-108
Carbon Dioxide, Total 26 mmol/L 19-28
Calcium, Serum 9.8 mg/dL 8.7.-10.2
Protein, Total, Serum 7.1 g/dL 6-8.5
Albumin, Serum 4.9 g/dL 3.5-5.5
Globulin, Total 2.2 g/dL 1.5-4.5
A/G Ratio 2.2 1.1-2.5
Bilirubin, Total 0.5 mg/dL 0.0-1.2
Alkaline Phosphatase, S 77 IU/L 39-117
AST (SGOT) 20 IU/L 0-40
ALT (SGPT) 14 IU/L 0-44

Lipids

Cholesterol, Total 179 mg/dL 100-199
Triglycerides 118 mg/dL 0-149
HDL Cholesterol 45 mg/dL greater than 39
VLDL Cholesterol 24 mg/dL 5-40
LDL Cholesterol 110 mg/dL 0-99
LDL/HDL Ratio 2.4 0.0-3.6

Thyroid

TSH 3.560 uIu/mL .450-4.500
Triiodothyronine Free, Serum 3.8 pg/mL 2.0-4.4

Immunonassay

Prostate Specific Ag, Serum 0.6 ng/mL 0.0-4.0
Insulin-Like Growth Factor I 253 ng/mL 88-246
Testosterone, Serum 216 ng/dL 348-1197
Free Testosterone (Direct) 10.5 pg/mL 8.7-25.1
LH 6.5 mIU/mL 1.7-8.6
FSH 3.8 mIU/mL 1.5-12.4
Sex Horm Binding Glob, Serum 12.8 nmol/L 16.5-55.9
Estradiol 16.8 pg/mL 7.6-42.6
Roche ECLIA methodology

CBC, Platelet Ct, and Diff

WBC 5.7 x10E3/uL 3.4-10.8
RBC 5.10 x10E6/uL 4.14-5.80
Hemoglobin 14.9 g/dL 12.6-17.7
Hematocrit 44.1 % 37.5-51.0
MCV 87 fL 79-97
MCH 29.2 pg 26.6-33.0
MCHC 33.8 g/dL 31.5-35.7
RDW 12.6 % 12.3-15.4
Platelets 268 x10E3/uL 155-379
Neutrophils (Absolute) 3.1 x10E3/uL 1.4-7.0
Lymphs (Absolute) 2.2
Monocytes (Absolute)
Eos (Absolute)
Baso (Absolute)
Immature Granulocytes
Immature Grans (Abs)

Vitamin D, 25-Hydroxy 21.8 30.0-100.0

Here is the protocol they started me on:

200mg/mL Testosterone Cypionate - 1mL/wk
HCG - 400IU/EOD
1mg Anastrozole - 2 pills per week

I started the Test and HCG yesterday 4/4 at 6:00 p.m. I decided to split the Test dose and do 100mg/every 3.5 days. So yesterday I took .5mL Testosterone Cypionate and 400IU HCG. I plan to take the next Test shot Tuesday morning.The Doc told me to take 1mg Anastrozole every Monday and Thursday night. Last night I awoke from several non-sexual dreams with an erection. I didn’t get a great night sleep because of that. Other than that, I have not felt any other effects.

My biggest question, is with my pre TRT estrogen level on the low side, should I start the Anastrozole or should I wait so see if I get any symptoms of elevated E2. Any other suggestions or input that you think I might find helpful is also appreciated.

Thank you all in advance.
-Masanarchy

2

[quote]masanarchy wrote:
Hello!

First, some stats:

35 years old.
5’8
207 lbs
High body fat, don’t workout, but I plan to start Monday.
I have had large breasts since childhood
Testicles are small, always have been.
I Have lots of hair on body, including back.
Plenty of facial hair, but a couple of areas are thin.

I have been experiencing the symptoms of low T for most of my adult life, if not all. Symptoms are Fatigue, low sex drive, lack of motivation, anxiety, low self-confidence.

My Doctor tested me for Total Testosterone and Free Testosterone only on 3/13/14.

TT= 206 ng/dL with range of 240-950
FT= 8 ng/dL with range of 9-30

After he told me that my T is slightly low, and that he didn’t feel comfortable putting me on TRT, I decided to find a specialist. That’s when I found an anti-aging clinic and they did a much more advanced blood test on 3/25/14. Here are the results:

                     Result                 Range

Chemistries

Glucose, Serum 84 mg/dL 65-99
BUN 16 mg/dL 6-20
Creatine, Serum .90 mg/dL .76-1.27
eGFR 110 mL/min/1.73 greater than 59
BUN/Creatine Ratio 18 8-19
Sodium, Serum 140 mmol/L 134-144
Potassium, Serum 5.1 mmol/L 3.5-5.2
Chloride, Serum 100 mmol/L 97-108
Carbon Dioxide, Total 26 mmol/L 19-28
Calcium, Serum 9.8 mg/dL 8.7.-10.2
Protein, Total, Serum 7.1 g/dL 6-8.5
Albumin, Serum 4.9 g/dL 3.5-5.5
Globulin, Total 2.2 g/dL 1.5-4.5
A/G Ratio 2.2 1.1-2.5
Bilirubin, Total 0.5 mg/dL 0.0-1.2
Alkaline Phosphatase, S 77 IU/L 39-117
AST (SGOT) 20 IU/L 0-40
ALT (SGPT) 14 IU/L 0-44

Lipids

Cholesterol, Total 179 mg/dL 100-199
Triglycerides 118 mg/dL 0-149
HDL Cholesterol 45 mg/dL greater than 39
VLDL Cholesterol 24 mg/dL 5-40
LDL Cholesterol 110 mg/dL 0-99
LDL/HDL Ratio 2.4 0.0-3.6

Thyroid

TSH 3.560 uIu/mL .450-4.500
Triiodothyronine Free, Serum 3.8 pg/mL 2.0-4.4

Immunonassay

Prostate Specific Ag, Serum 0.6 ng/mL 0.0-4.0
Insulin-Like Growth Factor I 253 ng/mL 88-246
Testosterone, Serum 216 ng/dL 348-1197
Free Testosterone (Direct) 10.5 pg/mL 8.7-25.1
LH 6.5 mIU/mL 1.7-8.6
FSH 3.8 mIU/mL 1.5-12.4
Sex Horm Binding Glob, Serum 12.8 nmol/L 16.5-55.9
Estradiol 16.8 pg/mL 7.6-42.6
Roche ECLIA methodology

CBC, Platelet Ct, and Diff

WBC 5.7 x10E3/uL 3.4-10.8
RBC 5.10 x10E6/uL 4.14-5.80
Hemoglobin 14.9 g/dL 12.6-17.7
Hematocrit 44.1 % 37.5-51.0
MCV 87 fL 79-97
MCH 29.2 pg 26.6-33.0
MCHC 33.8 g/dL 31.5-35.7
RDW 12.6 % 12.3-15.4
Platelets 268 x10E3/uL 155-379
Neutrophils (Absolute) 3.1 x10E3/uL 1.4-7.0
Lymphs (Absolute) 2.2
Monocytes (Absolute)
Eos (Absolute)
Baso (Absolute)
Immature Granulocytes
Immature Grans (Abs)

Vitamin D, 25-Hydroxy 21.8 30.0-100.0

Here is the protocol they started me on:

200mg/mL Testosterone Cypionate - 1mL/wk
HCG - 400IU/EOD
1mg Anastrozole - 2 pills per week

I started the Test and HCG yesterday 4/4 at 6:00 p.m. I decided to split the Test dose and do 100mg/every 3.5 days. So yesterday I took .5mL Testosterone Cypionate and 400IU HCG. I plan to take the next Test shot Tuesday morning.The Doc told me to take 1mg Anastrozole every Monday and Thursday night. Last night I awoke from several non-sexual dreams with an erection. I didn’t get a great night sleep because of that. Other than that, I have not felt any other effects.

My biggest question, is with my pre TRT estrogen level on the low side, should I start the Anastrozole or should I wait so see if I get any symptoms of elevated E2. Any other suggestions or input that you think I might find helpful is also appreciated.

Thank you all in advance.
-Masanarchy[/quote]

I would start the AI with your TRT. Your scheduled dosages are just to create a baseline of what wi happen with your hormonal changes: Test / Estrogen balance, Your Dr will be doing bloods to see where your levels have elevate too.

With 200mg Test/week and having a high bf % it is safe to assume the new Test in your body will want to aromataze; bloods will determine wether to adjust your Test and AI up or down
STUPID fawkin Dr’s…NOT comfortable putting you on TRT??? Good thing you found someone more knowledgeable to deal with your problem

My Dr put me on 200mg Test Cyp without any AI and now has NO clue what to do with my extremely elevated E2 (Anyways…I posted about this earlier today - Extremely Elevated E2 Levels)
You should start feeling really amazing soon enough. Start saving your money, I bet your Ant-Aging clinic already enquired if you would be interested in HGH in the future

3

Thanks for the reply Sam. They already tried to sell me HGH, and about 10 other things. The strange thing about this clinic is that they only require blood tests once a year. But I can request one whenever I want and pay $160.00. A couple of questions I have:

  1. Should I take the AI tonight or wait until Monday night? I was thinking I should split up the AI dose, since I split up the Test, maybe .5mg every other day. Does that make sense?

  2. When should I schedule a blood test? I think I have heard people say 6 or 8 weeks.

Thanks again for your help, and I really hope you get your protocol straightened out. I think the one thing I’ve learned the most since researching this stuff is that most doctors really don’t know what they are doing when it comes to TRT. And some don’t care to learn.

-Masanarchy

4

Thanks for the reply Sam. They’ve already tried to sell me HGH and about 10 other things. I hope you get your situation straightened out.

So I decided to split up my AI dosage, since I split up my Test dosage. Here is my protocol:

Testosterone Cypionate 200mg/mL - .5mL every Tuesday morning and Friday night.

HCG - 400IU EOD

1mg Anastrozole - .5mg EOD

How does this look?

Thanks.

5

You should read the thyroid sticky and take AM temps. Fatigue, low libido, testicular atrophy, low testosterone, lack of motivation are all signs & symptoms of hypothyroidism. Really you should have started there.

Just because you’re going to a clinic that likes to through around hormone scripts doesn’t mean they’re doing you any favors. 200mg/wk to start?! How stupid is that?! You know they’re starting you at the maximum TRT dose right? This leaves nowhere to go but down. I started on 50mg/wk and gained 10 lbs of muscle in 3 months. As I become more tolerant of higher T levels I can go up 10mg at a time. You can’t. You aren’t a geriatric patient but there’s a saying for dosing in the elderly that says ‘start low, go slow’. This should be applied to your hormone therapies as well. More is not better and get ready for a hell of a kick in the balls as far as side-effects and difficulty managing your case.

6

[quote]masanarchy wrote:
Thanks for the reply Sam. They’ve already tried to sell me HGH and about 10 other things. I hope you get your situation straightened out.

So I decided to split up my AI dosage, since I split up my Test dosage. Here is my protocol:

Testosterone Cypionate 200mg/mL - .5mL every Tuesday morning and Friday night.

HCG - 400IU EOD

1mg Anastrozole - .5mg EOD

How does this look?

Thanks.[/quote]

That protocol looks fine to me, you may want to consider dropping your Test dosing to half pr even less than the 200mg/week you’re currently using. I just started 200mg/week and am going to dial it back until I hit an even keel with my hormone levels.

I was just like you thinking more would be better. To be honest just having healthy Test levels and more readily available energy should be more than enough to build new muscle

Even if you use upwards of a 1,000mg / week like in a steroid cycle you still want proper training, diet, sleep, stress management to grow.

I am JUST learning this stuff too and highly recommend you learn as much as you can. For me this place has been good

Have you read and reread ALL the stickies? I have and NEED to read them again

7

[quote]C27 H40 O3 wrote:
You should read the thyroid sticky and take AM temps. Fatigue, low libido, testicular atrophy, low testosterone, lack of motivation are all signs & symptoms of hypothyroidism. Really you should have started there.
[/quote]

So far, I am only 1 100mg shot into TRT, so I can drop down to 50mg twice per week, without a problem. Isn’t a TSH level of 3.56 an indication that I don’t have hypothyroidism? I have read the thyroid sticky and will do AM temps tomorrow. I appreciate your input.

8

[quote]masanarchy wrote:
So far, I am only 1 100mg shot into TRT, so I can drop down to 50mg twice per week, without a problem. Isn’t a TSH level of 3.56 an indication that I don’t have hypothyroidism? I have read the thyroid sticky and will do AM temps tomorrow. I appreciate your input.[/quote]

I would change it to 100mg/wk yes. Or even 50mg E3D so it can be at the same time of day. Switching morning/evening may make remembering more difficult. 3.5 TSH does not indicate hypothyroidism but it could be sub clinical or a ‘lazy’ thyroid. There are a lot of potential thyroid suppressing agents in our environment (think Japanese nuclear power plant meltdown). 3.5 just indicates that the hypothalamus isn’t seeing much T4/T3. I supplemented my thyroid with a couple pills/day and changed my body temp by almost a full degree.

9

Most places only test your lvls once a year. Take the anti estrogen as directed. Baseline is a little high when you look at how low your total serum is. When you add more test it will go up. My doc will not give test without hcgti e. Hcg about the best it tricks your pituitary gland into thinking it is not producing enough test and will make it do so. 200 a week is not very much. My doc has me on 2 pr week with 600 iu of hcg twice a week. I though i would be smart and cut my dose to 3/4 a week 4 weeks prior to blood work.

Took my last test shot 7 days before blood work and hcg6 days. My total serum of the day was 997 and my free daily was 270. Doc said it was high a needed to drop the dosage. I told him it was because of the hcg. Retested 4 weeks later. No test or hcg for 4 weeks. On test day total serum was 248 free daily was 47. Doc said i was good at the 2cc a week dosage. I found through trial hcg will stay in the system for up to 14 days. Pharma charges about 100 for test and 35 for hcg. So to dbl you lvls use hcg.

10

So it’s been 4 weeks since I started my protocol, and I still don’t feel any benefits yet, other than morning wood the past couple of days. Should I be feeling some of the other effects by now?

I just had my TT and E2 levels tested yesterday.

TT 893 ng/dl Range 249-836

E2 <20 Range <50

I didn’t get the actual E2 number, but it’s obviously below range. Could this be getting in the way of the TRT effects? Since my E2 was low at 16.8 before I
even started TRT, maybe I am one of the people that doesn’t need an AI?

I’m figuring if I get my E2 up a little, that will in turn get my SHBG up a little, and maybe I’ll start to feel much better. Interested to hear what you guys think.

11

[quote]masanarchy wrote:
So it’s been 4 weeks since I started my protocol, and I still don’t feel any benefits yet, other than morning wood the past couple of days. Should I be feeling some of the other effects by now?

I just had my TT and E2 levels tested yesterday.

TT 893 ng/dl Range 249-836

E2 <20 Range <50

I didn’t get the actual E2 number, but it’s obviously below range. Could this be getting in the way of the TRT effects? Since my E2 was low at 16.8 before I
even started TRT, maybe I am one of the people that doesn’t need an AI?

I’m figuring if I get my E2 up a little, that will in turn get my SHBG up a little, and maybe I’ll start to feel much better. Interested to hear what you guys think.[/quote]

I’m older than you (53) but everybody reacts to things differently. I would as others have suggested stick to a lower dosage of 100 mg week. I would drop the AI and see how your body responds. I have not needed an AI at 100 mg every six days and T level is at 900. Also it’s not a miracle product in my view. Changes come from diet and hard work and the T just allow the diet and hard work to produce results not available without the trt. The fewer hormonal modifications you have to make the better if you are getting the levels you want. Best of luck.

12

Thanks Gulfcoast. That’s what I was thinking. I’m going to cut my T dose in half and drop the AI and see what happens. I appreciate the response.