Just Started TRT

Pharma TRT
1

Hi all, first post.

I’m 36 years old and have always had a hard time building muscle. Seeing signs of the “Low T” craze that is going on, I had my suspicions. About a month and a half ago I started having erection problems with the wife… I could definitely make it happen, but she had to start doing quite a bit of work.

As a result, I went in to my urologist and my total testosterone was 212. After some thyroid testing and consultation with my GP, I decided to go on TRT and went with the pellets (I have little kids so don’t want to worry with Testim transference, and I’m not keen on shooting myself up every day/week/two weeks).

The doc inserted 12 testopel pellets yesterday, the procedure went fine. However, I’m not feeling much different the next day even though they are supposed to take effect immediately. Can anyone elaborate on their personal experience in terms of how long it takes for TRT to start kicking in as far as libido, energy, muscle building, etc.?

Thanks!

Last BW, FWIW:

Total T: 212, normal range 348 - 1197 (for some reason the free T and % free T has the note “quantity was not sufficient for analysis”, don’t know if that means not enough blood or not enough free T)
LH: 3.4, normal range 1.7 - 8.6
FSH: 3.0, normal range 1.5 - 12.4
Estradiol: 18.5, normal range 7.6 - 42.6
PSA: 0.6, normal range 0.0 - 4.0
Prolactin: 7.7, normal range 7.0 - 15.2

T4, Free (Direct) 1.62 (ref range 0.82 - 1.77)
TSH 3.29 (ref range 0.45 - 4.5)
Triiodothronine 3.0 (ref range 2.0 - 4.4)

2

Your TSH is high. It would benefit you to get a more thorough thyroid panel. The site stopthethyroidmadness.com has a lot of info (take some of the info with a grain of salt because the people who run it are a little nutty), but there is a list of other thyroid you should get. Only getting TSH, T3, and FT4 doesn’t give a complete picture, especially considering your TSH is over 2.0. I’m sure someone will chime in with a more complete answer on the thyroid thing than me, but at least I can get the ball rolling.

There are also a number of tests you should have had before starting TRT just to see what could be causing it that you either didn’t list, or your doc didn’t order. No biggie, just get them done now. They are listed in the “Lab Work, Blood Testing” Sticky at the top of the main TRT Forum page.

I know very few people who got the pellets, and the ones I have heard of had virtually nothing good to say about them. It follows that if you rely on pellets to regulate your hormones, there is no way to make corrections seeing as they are “stuck” inside you. When your pellets “expire” I would recommend getting on the shots. With injections you can tweak the dose more easily and deal with potential issues more easily.

The top several Topics on this Forum are “stickies” in that they are permanently there. They contain a ton of information that I think you will find useful and probably generate more questions, which is a good thing.

3

Thanks for the feedback. The “Lab Work, Blood Work” is a little hard to filter, but it looks like I’m only missing the DRE on the “must have before TRT” list. I also did not get cortisol tested. Are there any specific tests beyond these two that I should have done, and would it hurt if I asked to have them done in a month when I get my T tested again?

The range I have for TSH goes up to 4.5, so at 3.29 I don’t think it would be considered too high. I’ve tried to investigate the stop the thyroid madness site before, but they seem to want you to buy the book… very much a turnoff for me. FWIW, my mom had hyperthyroidism (potentially Grave’s disease), and my grandfather was hypothyroid. I do have nodules on my thyroid that were ultrasounded last month, but they are on the “watch this for a year” list as 10% plus of the population have them (and I have felt them for years, so they are not brand new). Not saying they are not a problem… just that my GP wasn’t alarmed.

Thanks for the help!

4

Actually, one more note… my GP (who I saw after my urologist diagnosed low T) suggested that I go ahead with the TRT as the T was low, and we could address thyroid problems, etc., as needed (this was before my TSH, T3, and T4 results came back). In other words, he was saying “yes, the low T is a problem since I am below the bottom of a very wide range, and it can be treated along with other things simultaneously”. I expect that is what will happen.

5

In one of the comments on the Lab Work thread (I know, it’s a dauntingly humongous thread with lots going on, so I don’t blame you for skimming) KSman (a guy you’ll see a lot around here, one of the most knowledgeable people on the TRT subject) made a post that said user PureChance recommended these labs for thyroid:

  • Total T4
  • Free T4
  • Total T3
  • Free T3
  • Reverse T3 (excess T4 converts to RT3. High RT3 blocks free T3 - so your TSH and T3 numbers could look great, but are blocked by RT3 and you feel like @$#!)
  • Thyroglobulin Antibodies
  • Thyroid Peroxidase

Family history of thyroid issues obviously warrants staying on top of it as much as possible, but some of us get the “lucky” genes and some don’t. The above tests give a complete panel that will show anything weird. Once you get those results hopefully PureChance can chime in with how to interpret them.

The thing about range: Most “ranges” are lacking. I was at 285ng/dL of T and since the range was “250-890” I was told I was normal. The fact I was 28 belied that fact, but the first doctor I saw said there was no cause for alarm, despite 285 being on par with an 85 year old man’s levels. With TSH more and more doctors are saying anything above 2 shows something is going on and warrants further testing. I had a TSH of 2.5 and was told (by people on here) to get further tests just to make sure. When I retested my TSH had gone down below 2 and everything else was in good shape. But the thing is, it wasn’t just recommended on here: Right after I posted all my labs here and was told to get thyroid follow-ups I got a new Endo (who didn’t suck like my last one) and one of the first things he said was that he wanted to put me on thyroid meds. I opted for the re-do first, and it turned out well, but the moral of the story is often “ranges” put in there by labs are skewed in some way that makes doctors think everything is fine when it isn’t. You’ll see dozens of guys on here say they were “in range” for something, but the range doesn’t take specific individual situations into account.

Were you diagnosed with Primary or Secondary Hypogonadism? Your LH and FSH scores don’t make sense to me (and I’m not an expert so take that for what it’s worth) if your doc thinks you’re primary. Hopefully someone else can chime in with some help here. I’m Primary, and both my LH and FSH were high, meaning the brain was screaming at my testicle (lost one to cancer) that it needs to get off its ass and do its job. When LH/FSH are low it usually means the brain isn’t sending the right signals to the testicle(s) to get them to produce and TRT usually isn’t the first course of action. I may be wrong about all this stuff, but I hope something in here makes sense.

6

Thanks ctastrophe - I appreciate your time and input!

I was not given a diagnosis (or was not told) that I was hypogonadic… my urologist simply said, “Hey, you have low testosterone, and the way to fix it is TRT.” I held off from TRT to get my bloodwork done at my GP (which is where the thyroid results came from), and he agreed that I should be on TRT. I left a message today asking if there was any cause to think my TSH was high but have not heard back.

The funny thing in all this is that my libido tapered off relatively suddenly, but I have (so far) chalked it up to low T (possibly hereditary), work stress, probable dysthemia, too many nights staying up late drinking/smoking/etc., and not sleeping. I’m have been an insomniac since the libido problems started.

Apart from the T, I am apparently uber-healthy with a low bodyfat and insanely good cholesterol (my HDL is 92 and I am in my prime bodyweight for height, etc.). I exercise frequently and eat very well, etc., all the stuff you’re supposed to do (except smoke when I drink).

I agree about my LH and FSH levels. However, my dad exhibits all the symptoms of low T but has not been tested. He falls asleep sitting in a chair and does not sleep well during the night, he is not active, etc. etc. When I told my mom about low T, she said that my dad probably is, too. Of course, I can’t ask, “Hey mom, how is his libido.” Based on what I can tell, I think it is probably low.

At the very least, I expect that this one round of TRT won’t necessarily hijack the rest of my life if it is unwarranted… please correct me if I’m wrong :frowning:

Also… I’m not feeling different really at all the day after my pellets were implanted. I think it takes some days for the body to recognize and create homeostasis on the increased T, but I’m not sure. Any thoughts? Wondering when I should start “feelin’ it” if I’m going to at all.

7

I’ve heard it takes 3-5 days for the pellets to kick in. I’d seriously do the research and if you decide to be on TRT (which is for life) look into the benefits of injections over pellets. One dose of T won’t shut you down permanently, but after several months on exogenous T, you will lose your ability to produce your own.

Not having an official diagnosis is a little concerning. Your doctor should have said “you have hypogonadism (low T) because…” with the “…” being what he feels is the reason. This came up recently when a UFC fighter Chael Sonnen applied for a license to fight with a TRT exemption (which he was ultimately granted) but it came up that the doctor that gave him the diagnosis in 2008 ran no other test than a Total Testosterone test. It doesn’t make sense to treat something that’s wrong if you don’t at least try your hardest to figure out WHY it’s not working correctly.

As you go through the hormone game you’ll realize that patients tend to know more about TRT than doctors (assuming said patient puts in the time). Doctors tend to either be scared of the stuff, or know so little about it that they give weird doses at weird intervals. If you need supplemental T, it is until the day you drop dead. Make sure to do tons of research and proceed only if you know what’s going on - because your doctor(s) may not.

Read through the “Protocol” Sticky. It’s kind of the gold standard of TRT. Obviously if the gel or pellets are working for you stick with it - if it ain’t broke don’t fix it. It just seems that there’s less issues with injections (which have been around for over 60 years) than with other T delivery methods. Also, with rising T comes rising estrogen (sometimes) so make sure you keep an eye on that every once in a while. Don’t take and estrogen blocker if you don’t need one (obviously, but some people still take them even though they have no reason to and it is really stupid). Also if you get too much shrinkage and testicular pain you will need HCG (and there are other reasons to take it as well), but all of this is covered in the “Protocol” Sticky.

Push your doctor to give you a reason why you aren’t producing T. There usually is a reason. If nothing else find out if you are primary or secondary hypo, since secondary can be treated by things other than supplemental T.