Just Started TRT

Pharma / TRT Testosterone Replacement
1

Ok so some back story first.

I am 22 yrs old. 6’ and 168lbs. I was extremely run down and no libido which were both big changes for me so finally I saw a doctor. Long story short I have both hypothyroidism and hypogonadism. I have been treated for hypothyroidism for 3 months and the thyroid levels are starting to return to normal. I just started TRT with adrogel 1 week ago. My pre TRT total test levels were 59ng/dl with a reference range of 240-950. Free test was 13 range 83-257.

My questions for anyone are: How much has this been affecting my ability to gain muscle mass?
I have been gaining strength but i certainly do not seem to be putting on muscle?
Should I be raising my calories some or will this be futile and I should wait for my test to increase?

-age-22
-height-6’
-waist-32
-weight-168
-describe body and facial hair- decent amount of facial hair. Does not go far up towards my eyes. Not a dense amount of body hair but there is some
-describe where you carry fat and how changed - carry fat on my lower stomach and on my lower back.
-health conditions, symptoms [history] - hypothryroidsim, lack of motivation, no libido, “brain fog”/forgetfullness, body temp was low but has gotten better. Also had an MRI and it was clean
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - on thyroxine 100mcg and now adrogel .25mg, fish oil, costco multi vitamin, coq10
-lab results with ranges
Total T- 59ng/dl (240-950)
Free t- 13ng/dl (83-257
Sex Hormone Binding -24nmol/L (10-60
FSH- 1.9mIU/ml (1.4-18.1)
Lut Horm- 1.5mIU/ml (1.5-9.3)
Estradiol- 15pg/ml no range given
DHEA so4 -301 (89-457)
Insulin like GF -242ng/ml (116-341)
Prolactin -2.7ng/ml (2-14.5)
ACTH -21pg/ml no range
Cortisol- 12.4ug/dl
-describe diet [some create substantial damage with starvation diets] 40/40/20 carb/pro/fat eating about 3500 calories everyday. I eat healthy lean meats, eggs, and take fishoil. Carbs are oatmeal, brown rice, and fruit. I get 10 servings of vegetables everyday.
-describe training [some ruin there hormones by over training] - i lift 3 days a week and do very light morning walking on the off days.
-testes ache, ever, with a fever? none
-how have morning wood and nocturnal erections changed does not exist any more.

Any help with these questions would be much appreciated and if you need/want any more information I would be glad to provide any that I have.

And regarding your question I have not used any kind of muscle enhancement prohormones or steroids before my TRT.

Edit: New Labs from 3/28/2011
Testosterone, Total, S 405 240 - 950 ng/dL
Testosterone, Bioavail 150 83 - 257 ng/dL
SEX HORMONE BIND 21 10 - 57 nmol/L
T3, FREE 2.1 2.2 - 5.0 pg/mL
T4, FREE 1.2 0.7 - 1.7 ng/dL
TSH 2.26 0.30 - 5.00 uIU/mL

I did not realize I was not going to have the estradiol done which is upsetting up I will get it done next time. These results are after using 25mg of adrogel everyday for 6 weeks.

The labs look good but the only problem is none of my symptoms have been alleviated. I still feel run down, libido is non existent. Those are really the main two but nothing else has changed from my original posts. Any thoughts?
Also the doctor bumped me to 50mg adrogel everyday.

2

Please read Advice for New Guys - Testosterone Replacement - Forums - T Nation

Then add to this thread.

And read the other stickies [do not post there]. You questions are really general and you will learn a lot from the stickies. Also find and read other guys’ stickies, many from guys your age!!!

Your hormone problems are likely to be in the pituitary. In your age group, you need to have your brain scanned to look for problems with the pituitary gland. If there is a growth there, in some cases that can press on the optic nerves and reduce width of peripheral vision or other visual field non-refractive disturbances.

You doc is not looking for root causes.

It is possible that your HPTA is repressed by a prolactin producing pituitary adinoma. You can check prolactin levels with lab work.

What other lab results? Do you have PRE TRT LH and FSH data? Please post things in a list, not in paragraphs. If LH and FSH were very low, you might do well only injecting hCG. If you do T only, you are putting your fertility at great risk.

You will need to manage your own health care. You have made a good start, landing here.

Your concern with gaining or regaining muscle mass does raise the issue… have you used any steroids, testosterone boosters, legal steroids or other internet junk?

3

Edited to put the extra info in. Is there anything else? That wasnt on the starting guide that I should be answering?

4

Thank you for the details.

Your labs document a lack of gonadotropins. I had expected that they would have been lower that that as your T numbers are perhaps the lowest I have seen. Your E2 and prolactin levels are not responsible for HPTA repression. Your DHEA levels are good, so I assume that you prolactin levels are adequate, but should be check with next labs. So you do not have low T levels as a result of DHEA–>T rate limiting because of low DHEA.

We do see a number of cases like yours here ofen ages 19-23, perhaps one or two per month some times. Some have been playing with steroids or hair loss drugs. Some have no identifiable reason, so that is called idiopathic hypogonaodism idiopathic hypogonaodism - Google Search

Some guys have brittle HPTAs that simply break on there own. In other cases, when caused by drugs, the drugs may have simply made what was going to happen occur earlier. There will be some who are harmed by drugs that might have never had a problem if they had not taken those drugs, but we have no way of telling. Some have genetic faults that lead to problems in your age group, another class of concerns.

You can try hCG as you should be doing that anyways so you are not at [high] risk of sterility.

You can try a SERM, suggest nolvadex, not clomid. If that works, it means that your pituitary works and the hypothalamus is not working normally. If it does not work, your hypothalamus is stuck in the off position. If it works, that can be a treatment option, hCG with some novadex cycles [without hCG] at times to expose your testes to LH+FSH to protect fertility. Long term SERMs are not considered appropriate - side effects.

One thing about the nolvadex trial, we have no idea what when wrong with the top end of the HPTA. If you respond to the nolvadex, one can hopeful pushing the HPTA around like that might restore functionality. There really is no reason to expect that, but no harm giving the HPTA a whack. In keeping with the bigger hammer is better view of the world, the dose could be higher than normal, but that should be brief then go to a normal dose.

Read the protocol for injections sticky for some other basics. I apologize that it became a chat room. We try do get guys to do things differently now. As you read the stickies and posts of others, come back here with your questions.

5

So I have already gone with the androgel because it seemed to me like the smart choice. I have thought about the problems with firtility. Besides the firtility what are your thoughts on adrogel? Is it really not a good treatment option?

6

[quote]ryanbCXG wrote:
So I have already gone with the androgel because it seemed to me like the smart choice. I have thought about the problems with firtility. Besides the firtility what are your thoughts on adrogel? Is it really not a good treatment option?[/quote]

From what I’ve learned (I’m a noob too), injections are the best. Androgel is only absorbed at about 10% and has the highest conversion to DHT. It all depends what you’re comfortable with, but it seems test cyp injections give the best results.

As for fertility adding exogenous testosterone will almost surely shut down your HPTA causing your testicles to stop working and shrink. The solution is to add HCG to your regimen which imitates LH and signals your testicles to keep working. The longer your balls are not working the harder the chance of recovery, it really should be standard procedure to have this from day 1. The problem is finding a doc who will give you HCG. There are other ways to get it without the prescription, but I don’t know how safe it is or which is a good source, others here might know how to get it.

7

One issue is cost. Compounding pharmacies can supply a T-gel for less cost. So your insurance is a factor in cost concerns. I am not happy with the attitude that cost does not matter because the insurance company pays for things. Eventually all of these costs find there way back to increased costs to everyone via increased co-pays, increased premium and increased deductibles.

About only 10% of the T is absorbed. That explains the above.

Drug companies really go after an opportunity to create a costly alternative delivery system, to milk the system. Docs don’t care, unless they are HMO corporate puppies.

Some absorb OK.

Some absorb OK then after a few weeks become non-absorbers.

Some never absorb.

Those who have low thyroid levels are classic for not been able to absorb. Thus that problem is a symptom of hypothyroidism.

For non aborbers, their E2 can climb and T levels drop. That makes them feel worse.

Transdermals also create more DHT and that is good for libido. If one absorbs T-gels OK, that probably provides the best libido result. Unfortunately the highest acne and hair loss for those who are so disposed.

These gels are 1% and have to be applied in large amount, covering large amounts of skin, exposing the T to the aromatase in that larger area of skin. T-gels create the largest amounts of E2 from T–>E2 aromatization. A compounded cream is 5, 10, 15 % T, applied to smaller amounts of skin, leading to lower E2 levels. As far as transdermals are concerned, compounded T creams are the least cost option.

Injected T is the least cost option. There are many factors to be aware of, that is why there is a protocol for injections sticky.

Some do well with T-gels. I have a bit of attitude about T delivery systems that are relatively wasteful or expensive. Most of the veterans here are well aware of that. As an engineer, I can’t be any other way.

In any case, for most, they will need anastrozole to get the best response from there TRT. E2 management is mission critical to obtain optimal E2 levels. That goes for any T delivery system. And any effective TRT will shutdown the HPTA and then one needs hCG if fertility or physical preservation of the testes is desired.

So that is T+hCG+AI and one really needs to understand all of the related issues… because… drum roll… it is very very rare for a doctor to have any idea. This site is really all about education and empowering guys by getting them to know more about these things than the medical system. So there is work here for you to do, don’t look for easy answers, study.

8

So for the adrogel it really comes down to how well my body responds. If it does not respond a very good alternative will be injections multiple times a week. Even if the adrogel is absobing I should most likely start an AI. But my E2 levels were pretty low before TRT.

9

[quote]ryanbCXG wrote:
So for the adrogel it really comes down to how well my body responds. If it does not respond a very good alternative will be injections multiple times a week. Even if the adrogel is absobing I should most likely start an AI. But my E2 levels were pretty low before TRT.[/quote]

If you 22 years old your dr is a total moron for putting you on TRT because he is just to lazy to properly evaluate you. Unless there is pituitray issues you should not be given androgel, but rather rule out primary or secondary. DRs that put young guys on TRT should have their licensce revoked.

10

Could you elaborate on that at all? Like what should have been done? Do you have any qualifications (ie are you a doctor) or have you had extensive experience in this area? Just wondering. I love hearing advice from everybody but not advice is created equal.

11

KSman: I have been on the low does (25mg of androgel, 2.5g 1% cream) for a week and a half. I think i can feel the effects for a couple of hours in the day but then it disappears. I am debating 2 options at the moment: 1) ask the doctor to up the dose even though he wanted to wait 6 weeks and redo labs
2)Drop the gel and go to 2 or 3 time weekly test shots.
Do either of these seem like a smarter choice and any suggestions that might help me persuade the doctor to go with the best one other than show him what i have found and feel?

12

[quote]ryanbCXG wrote:
KSman: I have been on the low does (25mg of androgel, 2.5g 1% cream) for a week and a half. I think i can feel the effects for a couple of hours in the day but then it disappears. I am debating 2 options at the moment: 1) ask the doctor to up the dose even though he wanted to wait 6 weeks and redo labs
2)Drop the gel and go to 2 or 3 time weekly test shots.
Do either of these seem like a smarter choice and any suggestions that might help me persuade the doctor to go with the best one other than show him what i have found and feel?[/quote]

I have been designing both men and womens nutritonal, horomone, thyroid and adrenal protocol for drs patients for over 4 years. I also consult with medical drs about cases that may be complex to possible give them more areas to explore as the root causes. I have dealt with several cases such as yours in the past and a vast majority of them should not have been on TRT at all. TRT was just a bandaid effect and it never resolves the source of the problem but just masks it. I also have numerous patient and clients from T-Nation and other top forums from around the world. My freinds call me “dr house” for obvious reasons.

13

Well that is quite the resume you have. What would your suggestions be?

Also by the way I love house. Possibly the greatest show on TV.

14

[quote]ryanbCXG wrote:
Well that is quite the resume you have. What would your suggestions be?

Also by the way I love house. Possibly the greatest show on TV.[/quote]
I am just no where near as arrogant as him. Some times I just get reved up when I get young person who has been on TRT then we find out that it was never needed in the first place. I spend more time undoing endos screw ups which only results in slowing down the healing process by 6 months or more. Thats more time has been wasted. Yes you may feel better on TRT, but is that the long term solution. Do you want to rely on a drug to be able to function when it may not be needed. You may find it cool now, but tell you from personal experience it sucks after doing it for a few years. My suggestion would first on all isolate the potential cause by looking at a numerous list of factors which would be determine in the inital meeting with asking the proper questions and listing to the patient/client attentively. First need to identify are you primary or secondary hypogonadism (is it the signal or testicles that are not responding) Also examine proper thyroid, adrenal, nutriotional, sleep patterns, emotional or psychological factors, environmental, liver or gut imbalances, ect. The go from there.

15

That is understandable. I would rather not have to rely on something if I dont have to. I dont want to have to stick myself or rub cream on all the time. Its just one more thing to worry about.

From the labs it the doctor determined it was secondary. My thyroid is gone from hashimoto’s disease so I have been on thyroxine for about 3 months.

And with the other things you listed I’m not sure what information is needed or how to obtain it.

16

I updated my original post with new numbers and questions.

17

So my test is now in the “normal range” along with available test after the androgel, but I do not feel any affects from it. I figured my test was still in the tank. My doctor is now fighting with me to increase my dose. I want to increase it so that I can feel good, he doesn’t want to because the test says I am normal. Any thoughts?

18

doctors are idiots for the most part. Once you accept that, you can better deal with the advice they provide.
normal range does not equal ideal range.
normal range includes like 95% of the population including 90 year old men on their deathbeds.
yes you are normal and can have the exact same levels as they do.

you have a thyroid problem (which can blunt any transdermal absorption), probably have a cortisol issue as well as an estradiol issue (as that seems to be the typical pattern for those who experience problems with transdermal testosterone).

you need a new doctor. have you read the finding a good HRT doc thread?

19

Cortisol was measured and it was in the normal range at 8am. I do agree that most doctors do not understand or apply the knowledge that they have and many lack a lot of knowledge. I have never really had much experience with doctors because I have been extremely health up to this point. Now I am starting to realize how big a pain in the ass it can be just to get something done and get it done right.

The cream did raise my t levels from 59 to 405 and that was only a 25mg cream every day over 6 weeks. So I am not sure if I could classify myself as a poor absorber. My estradiol was normal before TRT which of course could have easily changed.

I have read all of the stickies and if I am unable to convince this doctor of what needs to happen (ie me actually feeling better) then I will be in search of a new doctor. I think its ridiculous that it has to be this hard.

20

Your thyroid meds are not working. TSH should be dropping and fT3 should be mid range. fT4 is mid range. Your T4–>T3 is low and you are a poor converted. You need to be taking T4+T3! There are dessicated thyroid products that would be more appropriate. Your TSH response to your fT4 is also abnormal, perhaps from low T4–>T3 within the hypothalamus. Confirm your hypo status by checking and recording waking body temp, when you first wake up and track during the day as well to see how high that goes. Post results back here after a few days.

When do you think that this thyroid problem started. What is your history of using iodized salt, eating sea food and vitamins with iodine.

You cannot feel well with hypothyroid symptoms, many of which are common with those of hypogonadism.

Hypothyroidism can cause hypogonadism. Your doc is treating a symptom and not trying to determine and manage root causes.

You really do need E2 data, all the more with any transdermal T. With these small doses of t-gel, your T levels are peaking and dropping every day. The lab results are very much a factor of the timing of the lab. TT levels are less volatile than FT. Bio-T is somewhere in between.