My Case File

Pharma / TRT Testosterone Replacement
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Hey guys. So I have read all the stickies and have done my homework and I�¢??m creating this post to start my case file. I would sincerely appreciate any help or thoughts you guys could provide to me as I proactively try to get my health back in order. Here�¢??s my story.

I am a 33 year old male, 6 feet tall 190 pounds with low body fat (see pic). I workout 5-6 times a week with mostly hypertrophy loads. I took propecia (finasteride) from the age of 18 to 28 and was also on several SSRI antidepressants as well. My libido completely disappeared and I had severe erectile dysfunction. These symptoms improved a little bit after I quit taking these drugs but it never returned to baseline, especially libido. Currently, I still have the following symptoms:

Low libido
Low ejaculate
Erectile Dysfunction (responds to PDE-5 inhibitors)
No morning erections
Very poor memory and attention span
Sluggish cognitive tempo and brain fog
Mild to moderate depression
Lack of motivation and ambition
Social isolation/no motivation to go out
Anhedonia
VERY low morning and daily temperatures (waking temp often 96.9-97.1)
Pseudo insomnia (I wake up at least 4 times every night but I go right back to sleep. I never ever sleep through the whole night)

The only other health conditions I have is, believe it or not, is severe obstructive sleep apnea and I am on CPAP therapy. I (until very recently) ate a very low calorie, low fat diet of mostly chicken and vegetables and fruit. No fish oil, no red meat and I NEVER salted anything.

So back in April 2010 I decided to run some labs to see if my condition could be improved. I got the following results from QUEST:

TSH 1.69 (0.40-4.50)
IRON, Total 144 (45-170)
FERRITIN 47 (20-345)
CORTISOL, TOTAL 16.3 (DRAWN AT 9 am) (RR 7-9 AM 4-22)
DHEA SULFATE 278 (110-370)
PROLACTIN 5.6 (2.0-18.0)
ESTRADIOL 37
TOTAL TESTOSTERONE 499 (250�¢??1100)
FREE TEST 110.3 (35-155)

So I went on iron replacement (biglycinate form) and started on 1 mg a week of arimidex and my estradiol levels TANKED. I felt like crap. See my labs from a month later:
Labs from May 2010

T4, TOTAL 6.8 (4.5-12.5)
ESTRADIOL, ULTRASENSITIVE 11
DHT FREE SERUM 43 (25-75)
DHT FREE 3.60 (1.0-6.20)
ESTRADIOL 9 (< OR =29)
FERRITIN 103 (20-345)
FSH 6.3 (1.6-8.0)
LH 6.1 (1.5-9.3)
TEST, TOTAL 785 (250-1100)
FREE TEST 176.6 (35.0-155)

So basically I felt like hell because my E2 levels were so low and I just gave up on everything and went back to normal. Eventually I got tired of feeling like crap again and a few weeks ago I really resolved to get well for the first time in my life. So, before I consulted this site and the stickies, I ordered some more blood work. Here are my results from LABCORP from 2/10/12 Please note that this is while on 3 drops EOD of a 4:1 dilution of liquid arimidex for 2 weeks (I started back up with a very low dose just for the hell of it)

Glucose, serum (post prandial) 72 (65-99)
BUN 27 (6-20)
CREATINE, SERUM 1.33 (0.76-1.27)
TSH 1.150 (0.450-4.50)
THYROXINE (T4) 8.6 (4.5-12.0)
T3 UPTAKE 33 (24-39)
FREE THROXINE INDEX 2.8 (1.2-4.9)
T3 93 (71-180)
TOTAL TESTOSTERONE 458 (348-1197)
FREE TEST PENDING
LH 5.7 (1.7-8.6)
ESTRADIOL 23.2 (7.6-42.6)
VITAMIN D 25-HYDROXY 38.2 (30.0-100.0)
FERRITIN, SERUM 33 930-400)

So long story short I made some radical changes.

  1. I started salting my food and taking one Idoral tablet every week
  2. I added much more fat (especially saturated) fat to my diet and extra virgin olive oil and coconut oil
  3. I eliminated my morning fasted cardio
  4. I added 2000 mgs of epa and dha
  5. Added 5000 iu daily of vitamin d to a high fat meal
  6. I am taking 25 mg of iron biglycinate chelate daily for 2 weeks and then 25 mgs EOD (I can not eat red meat)
  7. I am taking 100 mg a week of test cypionate divided into EOD subcutaneous shots. I�¢??m going to add 250 HCG EOD when it arrives.
  8. I have upped my dosage to a 4:1 dilution in vodka of arimidex to 6 drops EOD and will titrate accordingly with next draws

Thanks for taking the time to read all of that.
So my questions are, how long before I will start to feel the higher testosterone? Is this a solid plan for now? When should I redraw labs (with the recommended labs from KSmans sticky) ?

I think part of my lab results was from over training because I was doing about 1.5 hours of fasted cardio in the morning and weights in the evening all while on an low fat diet. However I have had the aforementioned issues for a long time so it was also a chronic condition.
What should I make of the low temp? I do not look like someone who could have sub-clinical hypothyroidism but I know my thyroid labs are nott perfect either? I have looked at the Wilsons temperature syndrome and I do not have an opinion of that yet. I am open to trying T3 replacement at a later time if my labs do not improve.

I want to thank everyone again for any input they may have. I am going to be very proactive here so know that any advice will not go to waste.

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Here is a second image to give you guys an idea of where I am at. I do not know if it is helpful at all other than to show that I am relatively fit.

Also, I’m brand new to posting and I’ve read the stickies in the TRT thread but why can I not sure apostrophes? Thanks.

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From the E2 sticky:

"1)
We know that higher hCG doses lead to elevated or high E2 levels that do not respond very well to anastrozole. In this context, higher TRT doses of anastrozole have often been seen to be ineffective in approaching levels near E2=22pg/ml. The high doses of hCG over stimulate the testes. The concentration of T inside the testes can be up to 80 times higher than serum levels in young virile males. High hCG doses may be increasing this concentration level even higher and some males will respond more than others. In the context of TRT, for older guys we can expect the testes of many to be blunted by age. So this effect could be expected to be stronger for younger males who have secondary hypogonadism. Because anastrozole is a competitive drug that competes with T at the aromatase enzymes, the ratio of anastrozole to free testosterone determines the outcome. A serum level of anastrozole that does a good job of managing peripheral aromatization of T–>E2 is mostly ineffective inside the testes where the T concentration levels are so much higher than serum levels. From this, you can easily see that higher doses of hCG drive intratesticular T–>E2 aromatization that cannot be managed with sane or affordable amounts anastrozole. If you drive T–>E2 down to close to zero in peripheral tissues, we can expect that there may be adverse effects in the brain and elsewhere. "

I’m wondering if 250 iu of HCG EOD would be too much for someone with a baseline testosterone of 450? Should I start with a lower dose or less frequent injections?

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After reading some more stickies, it seems that this is a replacement dose from the suppression of exogenous test. This dose should be fine.

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Are you just doing a cycle? If your labs were without injecting T, I’m not sure why you would jump right in to full on replacement. Why not get tested after implementing steps 1-6 above and see where you are at?

Looking at LH, I am guessing you were not injecting T when you hit 700s and your E tanked. If this was without T injections, it’s pretty clear that your testes are fine and will produce.

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[quote]dhickey wrote:
Are you just doing a cycle? If your labs were without injecting T, I’m not sure why you would jump right in to full on replacement. Why not get tested after implementing steps 1-6 above and see where you are at?

Looking at LH, I am guessing you were not injecting T when you hit 700s and your E tanked. If this was without T injections, it’s pretty clear that your testes are fine and will produce. [/quote]

Do you think I could actually get to the 700’s with the lifestyle and dietary changes mentioned above? I might be jumping the gun a little. I just want to be in the 800-1000 range to see how I feel. I’ve never naturally been above 500, but then again both times I tested I was very lean and doing a lot of cardio.

No, I’ve never taken anything before. My TT was 700+ because I was a arimidex over responder.

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Do what you want, but your talking about a huge commitment, one you probably won’t be able to undo if you are talking about more than a cycle.

Your testes are absolutely capably of supporting 700 or you wouldn’t have hit it without injecting T.

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[quote]dhickey wrote:
Do what you want, but your talking about a huge commitment, one you probably won’t be able to undo if you are talking about more than a cycle.

Your testes are absolutely capably of supporting 700 or you wouldn’t have hit it without injecting T. [/quote]

I assumed that I had to have very low E2 levels to get that high given the whole HPTA loop. I may need to seriously reconsider this.

Are you talking about long term exogenous testosterone induced hypothyroidism?

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you testes appear to be fine. you’ve proven that they can product T, at least into the 700s. Why take T if you testes are perfectly capable of producing it? Unless you are just going to do a cycle, you could potentially cripple functioning testes at the ripe old age of 33.

You are correct about the HPTA feedback effecting T. This is where improvements could certainly be made. Your T appears to be tracking pretty well with LH, so that’s what you should address. How can I increase LH. You could also look at optimizing other hormones that provide positive benefit on their own and/or optimize T production for a given LH signal. You D and DHEA-s have lots of room for improvement.

If you are going to play around with T to see what happens, great. Probably better to take that to the steroids forum and plan out a good PCT. If you are seriously concerning permanent replacement, I would do a bit more reading and thinking. It appears to me that you are going really fuck things up for no good reason.

Hopefully one of the more knowledgeable and experienced posters here will chime in. The fact that they haven’t may be telling.

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[quote]dhickey wrote:
you testes appear to be fine. you’ve proven that they can product T, at least into the 700s. Why take T if you testes are perfectly capable of producing it? Unless you are just going to do a cycle, you could potentially cripple functioning testes at the ripe old age of 33.

You are correct about the HPTA feedback effecting T. This is where improvements could certainly be made. Your T appears to be tracking pretty well with LH, so that’s what you should address. How can I increase LH. You could also look at optimizing other hormones that provide positive benefit on their own and/or optimize T production for a given LH signal. You D and DHEA-s have lots of room for improvement.

If you are going to play around with T to see what happens, great. Probably better to take that to the steroids forum and plan out a good PCT. If you are seriously concerning permanent replacement, I would do a bit more reading and thinking. It appears to me that you are going really fuck things up for no good reason.

Hopefully one of the more knowledgeable and experienced posters here will chime in. The fact that they haven’t may be telling. [/quote]

I sincerely appreciate your feedback. I’m only doing this for quality of life, not for aesthetics. Perhaps I should try the other changes first (more fat, iodine replacement, iron, etc)and retest in 6 weeks or so and then reassess the situation based on labs and subjective personal assessment.

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That’s what I would do. I would be running naked in the streets if I could a T score in the 700s by tanking E. I’ve tested only slightly above 500 once on test boosters, and I am still really hesitant to commit to full on replacement at 36.

Start with the basics, retest, and report back. There are a bunch of things you can do before committing to full-on T replacement.

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[quote]dhickey wrote:
That’s what I would do. I would be running naked in the streets if I could a T score in the 700s by tanking E. I’ve tested only slightly above 500 once on test boosters, and I am still really hesitant to commit to full on replacement at 36.

Start with the basics, retest, and report back. There are a bunch of things you can do before committing to full-on T replacement.[/quote]

I’m going to decide on that tonight. To be fair I was only in the 700’s when I tanked my E2 and I felt like shit but both with dietary changes and supplements I might be able to get my T to an acceptable range without replacement. A lot of my issues could have been related to nutrient deficiencies. Or I could have the dreaded post SSRI sexual dysfunction. ugh.

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[quote]CJD8791 wrote:

[quote]dhickey wrote:
That’s what I would do. I would be running naked in the streets if I could a T score in the 700s by tanking E. I’ve tested only slightly above 500 once on test boosters, and I am still really hesitant to commit to full on replacement at 36.

Start with the basics, retest, and report back. There are a bunch of things you can do before committing to full-on T replacement.[/quote]

I’m going to decide on that tonight. To be fair I was only in the 700’s when I tanked my E2 and I felt like shit but both with dietary changes and supplements I might be able to get my T to an acceptable range without replacement. A lot of my issues could have been related to nutrient deficiencies. Or I could have the dreaded post SSRI sexual dysfunction. ugh. [/quote]
SSRIs (lexapro) did number on me. I was in the 200s before I got off. Same issue with SNRI (effexor). Just getting off that shit.

You keep bringing up that you only got in the 700s by tanking E2. There is an important clue here that you are missing. That is the fact that your boys are perfectly capable of producing that number. The condition under which they will produce that number is what you might want to focus on. You can also try some things to help your testes a bit. Injecting T is for guys with testes that will not produce.

If you want to know what it would feel like to be at 700 without the negative sides low E2, you try a SERM. You could also do the HCG test and keep the AI.

Nothing wrong with doing a cycle of test if you want, but I don’t think you are going to learn much about your condition.

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Man Effexor in particular was just plain nasty. I swear my libido never recovered fully after I came off that.

So again, I really appreciate your help and after some thought I’m going to take your advice and discontinue the cypionate. I’m on 75 mg in to it over 3 subQ shots so shutdown should be minimal I’m assuming. I’m going to continue to implement the previously mentioned changes and work on restoring thyroid levels and check cortisol as well. Truthfully I already feel a lot better but that could be from the extra 75 mg of test I’ve injected over the last week. Or maybe I’m just recovering from overtraining.

I would love to cruise at TT around 1000 since life seems so much better there but it sounds like if I do that for too long that I’m not going to be able to come off without some permanent or very long term hypogonadism. Is this a valid fear? Like, I’m fine with taking EOD subQ shots. To me that’s not that big of a commitment. After all, I’ve resigned myself to using that damn CPAP machine every night so taking subQ’s EOD is nothing. But aside from the long term commitment, if there are legitimate long term issues to using T replacement at an early age, I don’t want to risk it. Again this is about quality of life, not muscles.

I’m unfamiliar with the HCG test.

Do you have any idea what could cause low ejaculate? My volumes seem to be chronically low.

[quote]dhickey wrote:

[quote]CJD8791 wrote:

[quote]dhickey wrote:
That’s what I would do. I would be running naked in the streets if I could a T score in the 700s by tanking E. I’ve tested only slightly above 500 once on test boosters, and I am still really hesitant to commit to full on replacement at 36.

Start with the basics, retest, and report back. There are a bunch of things you can do before committing to full-on T replacement.[/quote]

I’m going to decide on that tonight. To be fair I was only in the 700’s when I tanked my E2 and I felt like shit but both with dietary changes and supplements I might be able to get my T to an acceptable range without replacement. A lot of my issues could have been related to nutrient deficiencies. Or I could have the dreaded post SSRI sexual dysfunction. ugh. [/quote]
SSRIs (lexapro) did number on me. I was in the 200s before I got off. Same issue with SNRI (effexor). Just getting off that shit.

You keep bringing up that you only got in the 700s by tanking E2. There is an important clue here that you are missing. That is the fact that your boys are perfectly capable of producing that number. The condition under which they will produce that number is what you might want to focus on. You can also try some things to help your testes a bit. Injecting T is for guys with testes that will not produce.

If you want to know what it would feel like to be at 700 without the negative sides low E2, you try a SERM. You could also do the HCG test and keep the AI.

Nothing wrong with doing a cycle of test if you want, but I don’t think you are going to learn much about your condition.[/quote]

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It certainly a personal choice. Plenty of people have medical/health routines that would seem impossible to others.

My life is as complicated as I would like it to be now. I’d rather not worry about regular injections and testing if I can help it. The HPTA system is pretty complex and moving target. Just getting to a consistent HRT routine seems to require watching quite a few variables.

Probably going to be tough to cruise at 1000 with exogenous T. No idea if doing that with exogenous T for few years would shut you down permanently or not. Restart might be possible, especially if you are using HCG. Seems like it might be a bit of a gamble to me, but maybe someone else here has tried.

The other consideration would be fertility. Maybe someone else here can comment on that. I already have my three, but maybe a consideration for you. I guess you could always freeze some of your boys now.

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Yeah for me personally, it?s not that big of a deal but I can see how it would be for others. But still, I take your point.

I was in a rush to get my levels up and not thinking about the long term. Objectively I know that 450 is probably not my baseline TT level and it has room for improvement, along with my thyroid and iron, etc. What?s the rush? I have access to unlimited free labs and test cypionate so after 8 weeks or so if I?m not feeling better and my labs haven?t improved I can revisit the TRT situation knowing I did what I could.

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CJD8791: Thanks so much for your post ! It’s almost bizarre to read your comments, as I am in a very similar boat. I also have ADHD-PI/SCT and have all the same symptoms as you ie (anxiety, mildly depressed, foggy mind-can’t concentrate, low self confidence, no drive in life, low libido, I also am unable to grow facial hair and have slight gynecomastia despite being 6’6 205 lbs.)

Additionally, and my most hated symptom is, I have a very difficult time conversing with people because I can’t keep up in conversations, I can’t keep a convo flowing. I feel as if it is due to my mind being under-stimulated- I have always been a slow moving person and a slow test taker/slow thinker. The most frustrating part is, in the past I have smoked medicinal marijuana sativa and when I do, it’s like I have a whole new mind. My ADHD PI/SCT vanishes and I am able to keep up in convos. Normally during a conversation I have to try sooo hard and put all my effort into concentrating on what’s being said and what to say next, only to find myself lagging behind in processing the info in the conversation and not knowing what to say. When I’d smoke I wouldn’t even have to try, I’d be able to hold a smooth flowing convo with ANYONE and even be able to think steps ahead in the conversation to drive it in directions I’d want it to go, and was able to do all this without even trying. I’ve never thought quicker and clearer in my life. And boy did people respond, everyone loved talking to me and because I was able to think so quickly, I was super confident. What I loved most about it was that people enjoyed talking to me, which isn’t the case in my life normally. I like talking to people, but normally I will avoid conversations because I simply can’t keep up/concentrate and will run out of things to say quickly or won’t be able to think of a response to what someone says quick enough, and it’s really frustrating. What’s even more frustrating is the marijuana flares up my gynecomastia, so I have been forced to quite the only thing that makes me feel like a normal human being ( I know that sounds shallow, bit it’s honestly the truth).

Anyway, (not sure if you have troubles with processing speed or conversation) I’ve had my testosterone levels checked twice, one reading was 490ng/dl and the other was low 700’s, but like you, I was taking a low dose of liquid nolvadex at the time of the 700, so I don’t know if that would have altered it at all. So, with all that said, I can’t tell you how excited I was to stumble upon your thread. I can’t tell you how EXTREMELY interested I am in your experience with testosterone cypionate, as I’ve heard low testosterone symptoms are similar to ADHD PI/SCT and, based on other people’s posts in different forums, sometimes with the introduction of TRT, the symptoms will go away or be reduced. So I was curious if you continued your testosterone cypionate regimen and if so, what results did you experience- (I’m mostly interested in the mental, but would love to hear any results you may have had). Also, if you decided to postpone your treatment, I’d really appreciate if you would keep myself and everyone else updated on your results. Thanks so much, I can’t tell you how relieved/thrilled I was to find this thread.

PS. I’m going in for another blood test tomorrow morning, if you’d like, I will post my results when I get them back.

Nate

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Nate,

Thanks for posting. I am glad my story resonated with you. For me, stimulant medication works very well (Provigil, Adderall, methylphenidate, etc) to increase cognitive acuity and speed/recall, etc but the insomnia and tachyphylaxis to the drugs rendered them untenable as long term treatment options.

If you feel marijuana is a valid therapeutic tool in your treatment, this is something you may want to consider if it significantly increases your quality of life. However, I’m sure you are aware that the marijuana could be contributing to your low RR testosterone.

I’ve been feeling better with my lifestyle and dietary changes but it’s nothing outstanding. My memory is however GREATLY improved and i am attributing this to the iron replacement as low serum ferritin levels are implicated in poor memory.

I’m still trying to dial in my arimidex dose but it has proved difficult. I’m a severe over responder and i have to use a 4:1 dilution. I can feel when my estradiol levels are in the “sweet spot” because I am talkative with a good libido and mood and then the next day my joints ache and my mood decreases. This is a sigh that the levels have gone too low. Eventually I will dial it in.

I’m not on anything but the arimidex and I’m going to retest in a couple of weeks with the complete lab work up. It sounds like you would benefit from getting the labs in the stickies, especially estradiol. Tanking your E2 levels is every bit as bad as having too high E2 which you almost certainly do if you have gyno.

My advice would be to cover your nutritional bases and focus on getting good sleep. Eat whole foods, take appropriate supplements and center yourself. Personally, I am seeing a therapist as well and it’s helped immensely with many of my symptoms so there is a connection to psychological health and physical health.

Thank you for your interest and I will keep you posted.

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Oh wait, gyno and no facial hair. You DEFINITELY have an endocrinological issue that needs professional treatment. If you have access to proper health care, consider getting a workup and post your info info in a personal case file for everyone to help you with.

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Thank you very much for the help. I went and got my blood work done today, so hopefully the results will indicate what my problem may be. When I get them back, I will post the results. Also, if you decide to go back on testosterone, would you share your results? Would really like to see how that effects your SCT.