Low T Advice

Pharma / TRT Testosterone Replacement
1

Hi,

43, 5’11, 177, waist 29.
Fit body, 12-15% body fat(visual estimate and calipers), body hairy pretty much all over rather dense, solid facial hair.
Erections are very soft most of the time, Viagra (low doze - around 15mg my estimate) helps but not always. No morning wood in ages (may be once every few months and soft when it happens). Feeling low energy quite often. Hard to concentrate. Very strong DOMS after workouts - takes quite a while to subside. Decent diet (variant of paleo), working out 3-4 times a week(lifting for about 45 mins) for the last year at least. Very low libido - most of the time don’t pay attention to hot girls. Sex once a week on average.

Did a few months of anabolics in my late teens/early 20’s. Since didn’t know anything about them didn’t do any pct or test, just did some steroids for a few months (don’t remember what).
Requested a T test 2 years ago from my general idiot, 365 range 348-1197, was assured it’s normal.
Found a low-t clinic last week, labs as following (not all, relevant):
hematocrit 48.5 41-55
total cholesterol 239 0-199
He didn’t do the rest of lipids, so below is from the test by my gp from 4 months ago:
total cholesterol 207 100-199
triglicerydes 130 0-149
hdl 62 >39
ldl calc 119 0-99

current test continues
anion gap 22 8-20(probably ketogenic due to paleo diet)
psa .429 0-3.9
LH 7 1.2-8.6
estradiol (regular test) 13.8 23.8-52.2
TSH 3.88 .3-5.0
Total test 374.5 193-950
Free test (direct) 6.4 6.8-21.5

Was prescribed 100mg test cyp per week IM, 500 HCG twice weekly, .5mg anastrozole once weekly.

After reading some stuff here, I changed it to twice per week 50mg test with HCG same day, and split .5mg into 2 dozes twice a week (day after test injection). He didn’t care (in general I get the vibe that he’ll agree to whatever I tell him to as long as I’m paying him).

Did 100mg initial injection as a “preload”, then followed by slightly reduced (around 40mg) doze 2.5 days after, and then continued normally as described above. Morning (and night) wood showed up on day 3-4 and is there every day. Libido noticeably higher. Energy levels much better. After workout recovery is noticeably improved (after a week).

He wanted to do next blood work in 3 months, and then every 6, I said I want a retest in one month, he agreed.

So with all that - comments?

2

You may need more anastrozole, but stay the course and you can calculate anastrozole dose to get near 22pg/ml

hCG half life and twice a week is pushing things, but should work

Do labs half way between injections and do not change that. Otherwise lab timing will change results.

You have primary hypogonadism. Any pain in your testes prior to TRT? Were testes examined to check for vascular abnormalities?

Take a whey protein shake 1.5 hours before training and one afterwards. Also twice a day. This will provide amino acids that will help with recovery. This also will quench protein hunger that might drive you towards unsuitable foods.

Cholesterol is fine.

You seem to be on the right path.

3

You have hypothyroidism. The range for TSH, 15:1 in your case, is insane. TSH should be nearer to 1.0

You can check overall thyroid function via oral body temperatures:

  • when you first wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
  • also check to see if you get 98.6 mid-afternoon

Do you get cold easily?
Outer eyebrows sparse?
General hair thinning/loss?
Thyroid sore, enlarged, lumpy or asymmetrical?
Dry skin?
Mood, energy, mental clarity problems? -YES

This can be caused by an iodine deficiency from long term not using iodized salt.
There is no iodine in sea salt unless the container states iodized.
How much iodine in your supplements and for how long?
Any selenium listed in your supplements? Selenium is critical for thyroid health.

Thyroid labs:
TSH - should be nearer to 1.0
fT3, fT3 - both should be midrange or a bit higher - please do not test T3, T4
rT3 - test this if you have a history of major stress or events
If you have been getting ample iodine, test for thyroid antibodies - autoimmune problem which is linked to low selenium

Please read the thyroid basics sticky.

Thyroid problems can reduce your energy, cause mental clarity, mood and libido problems. “Feeling low energy quite often. Hard to concentrate.”

Your TRT is on the right track, now address thyroid issues.

Doc thinks your thyroid is normal!

4

KSMan, thanks for the advice first of all!

So you’re suggesting I should switch hcg to 3 times a week? Have no problems really doing that, just wanted to save some hassle - injections on 4 days of the week (t+hcg) is kinda a lot.

I did have some pain in my right testicle that was coming up sometimes after workouts, especially including deadlifts. I was concerned, went to my GP and then urologist (urologist seemed to be a knowledgeable guy), had examination and ultrasound done, didn’t find anything. Advised to stop deadlifting :wink:

I actually never want any of the unhealthy foods. Meat/fish and some veggies/salad is my staple diet. I don’t like sweets and indifferent to most carbs ( I eat them, just don’t crave them).

5

I was reading thread on thyroid yesterday all day, decided to check temps. Got completely confused. I have two thermometers - temporal (forehead IR) and liquid. Sources say temporal should be .5-1 degree lower than oral. Mine shows 1 degree higher though. 96.8 oral, 97.88 temporal. Same temperature in the evening (~10pm) and when woken up. Didn’t do afternoon yet, will do today. Not sure though what this all means - should I get a third thermometer to figure out which one is wrong?

Skin if anything is too oily, don’t get cold easily at all (usually one of the last ones to complain), don’t sweat much when it’s hot,
outer eyebrows may be sparse though. A bit hard to tell, my eyebrows are generally pretty thick. I’ll attach the image below to get a second opinion.
I have male pattern boldness since my early 30’s. Completely bold on top and forehead since I’d say 35. No other hair loss to report, pretty hairy all over.
I can’t see anything wrong with thyroid, but I’m not a doctor obviously.

I don’t use any supplements except vitamin D. And I am using some fancy rock salt for many years, yes. On the other hand I try to eat some kind of seafood couple times a week at least.

My gp has an attitude “if it’s within the range - it’s normal”. Low T clinic doc just wants his 200 a month, he’s not a sharpest tool let’s put it this way.

So should I order specific thyroid tests that you listed or is there something like “thyroid panel” that I can order? And obviously there were some major stresses or events through 43 years, who doesn’t have that? Also I’m prone to various allergies and eczemas, so perhaps should order the autoimmune part of it just in case, considering my immune system is somewhat out of whack?

6

I concur with KSMan with one caveat regarding Hcg, but only through research and not experience.

I have been on TRT for almost a year and have no sides while using just Grape Seed Extract. My E2 is typically around 17 on 140 Mg of Test Cyp weekly, single dose. I mentioned testicular atrophy to my PA and she wrote me a script instantly for 500 iu’s of Hcg 3X per week. Research revealed one doctor who suggested this dosage one week on and three weeks off. I read a few things about Hcg increasing aromatization of test to estrogen in the testes and beyond the reach of anastrozole and that causing gyno.

I know KSMan is knowledgeable on this subject and perhaps he can weigh in and clear up some of my possible “Bro science.” I’m still finding my way but am waiting to jump into the Hcg until I get it figured out a little better.

My only point is that you might want to do a little more research before getting into Hcg. My testes have shrunk but they do not ache. I am 52 and have kids so I am not worried about fertility. I am worried about gyno, so I have not started the Hcg yet, will not until I feel more comfortable with protocol.

I suspect others with more experience and knowledge will contribute.

Good luck.

7

Your rock salt is the reason you are iodine deficient.
How long using that or other non-iodized salts?

The best outcome would be that IR sets things right.
Eyebrow is sparse
TSH=3.88 is a major problem

Pain dead lifting could be a hernia to some degree.

8

[quote]KSman wrote:
Your rock salt is the reason you are iodine deficient.
How long using that or other non-iodized salts?

The best outcome would be that IR sets things right.
Eyebrow is sparse
TSH=3.88 is a major problem

Pain dead lifting could be a hernia to some degree.

[/quote]

Was using rock salt for years. Def over 5 for sure. Also I live in the middle of midwestern goiter belt, so there’s that. But I’m frankly a bit concerned about just doing IR blindly - quick check online showed decent amount of cases where hypothyroidism was made worse by increased amount of iodine. Here’s an example.

Probably some kind of monitoring/testing is a good idea. Any suggestions?

He checked for hernia, said no. Everything was very tight in all the right places.

9

[quote]The Myth wrote:
I read a few things about Hcg increasing aromatization of test to estrogen in the testes and beyond the reach of anastrozole and that causing gyno.

[/quote]

hcg + test would probably require more AI, makes sense. After all hcg keeps your own production active as well. But I can’t go without. First I like the way my balls hang now :wink: and second gf wants kids in reasonable future.

10

Also google search for “dr wilson iodine quack” finds a lot of pretty valid looking criticism. Not having enough of iodine in a diet is a valid concern, but idea of eating tens of milligrams of the stuff also bothers me a lot.

11

Most have no E2 issues at all with 250iu hCG SC EOD.

You can do IR any way that you like.

The fact that IR can increase TSH only means that hypo is worse if that is the only measure. For me and many others, improved body temperatures, mood, energy and clarity of thought says otherwise.

The reason for increased TSH on IR is now understood and its not really a problem.

You can do labs and see what’s going on while you are iodine deficient. You still need to take larger amounts of iodine.

You must have selenium during IR!

12

Thanks for the response concerning Hcg usage. My scrip is ready but still a bit reticent about picking it up because I am currently on no AI, just the grape seed extract and feel like I should have Anastrazole on hand before starting.

I know, I should start my own thread, sorry.

13

The low hCG doses suggested -rarely- lead to increased E2.

14

I’m almost a month in. Settled on 50 T sub-Q Tues/Fri, 300HCG Mon-Wen-Fri, .25 anastrozole mon/thurs. Haven’t had any repeat bloods yet. In general see lots of improvements - morning woods, better performance during sex, strength gains.

Have a weird problem though - balls. They are almost constantly slightly sore, they don’t hang out nearly as low as they used to (unless i’m straight from a hot shower) - often they are way up there bunched up, and they feel smaller (although that may be me imagining things).

I thought that was not supposed to happen with HCG? Any ideas?

15

I’m almost a month in. Settled on 50 T sub-q tues/fri, 300 HCG mon/wed/fri, .25 anastrozole mon/thurs. Haven’t had new bloods yet. Added kelp with 350ug of iodine daily.

Morning woods are excellent, sex performance is good, good strength gains.

Weird problem though - balls. They are almost constantly sore, don’t hang nearly as low as they used to, quite often are bunched up on top. May be feel smaller (but hard to say for sure, may be it’s me imagining things).

I thought that’s not supposed to happen with HCG? Any ideas?

16

Where did you get hCG?
Was is delivered to you wet or dry?
Wet shipped chilled.
What did you re constitute it with? Should be BA water, not saline.
Never shake a peptide hormone.
Keeping hCG refrigerated?

We have seen damaged/fake hCG before. Get a home pregnancy test. If negative, the hCG is now crap.
Wet hCG can be destroyed in shipping.

17

[quote]KSman wrote:
Where did you get hCG?
Was is delivered to you wet or dry?
Wet shipped chilled.
What did you re constitute it with? Should be BA water, not saline.
Never shake a peptide hormone.
Keeping hCG refrigerated?

We have seen damaged/fake hCG before. Get a home pregnancy test. If negative, the hCG is now crap.
Wet hCG can be destroyed in shipping.

[/quote]
Got it dry from a compounding pharmacy mail order. Came with ba water to reconstitute. Keeping it refrigerated and didn’t shake.

What do I do with a pregnancy test? Pee on it or put that hcg on it?

18

Urinate on it. Other TRT guys on 250iu EOD get positives that way.

19

I urinared on a stick about 24 hrs after hcg shot. Got either a negative or just barely visible trace of a line. Does it mean it’s bunk or should I test closer to the shot?

20

How long have you been taking hCG EOD?, takes a week to get to steady state serum levels.
If you were taking that way, assume bogus. You got a double test, could apply from vial to “stick”.
I have seen this before. Makes you wonder if there is a lot of bogus hCG.
Tell pharmacy and tell them to verify and get something that is not junk.