On TRT. Lab Work, Confusing. Any Advice?

Pharma TRT
21

I have been having the same problems as you with TRT.
Do you have thyroid labs? What about cortisol/DHEA?
These are extremely important. For me, TRT stopped working
due to Thyroid hormones decreasing from too much testosterone.
(Search for testosterone reduce T4 half life)

I went on thyroid meds (WP Thyroid 3gr daily divided up) and it seemed to help. (It got my Free T3 to top of the range and brought my Free T4 above the bottom of the range)
So, as you can see my Free T4 was low despite having alot of Thyroid med. Meaning,
testosterone lowers its life in the body.

I had been on TRT for about a few years (2-3 years) and despite having high Test, high
thyroid it became very clear that my body was actually getting worse. I looked into this, and came to the conclusion that my body was becoming androgen resistant. It is
a real thing that happens when the body becomes oversaturated with androgens for too long.

I made matters worse by having been on Testosterone propionate for an extensive period of time (I switched over from cypionate). I have been off all hormones since 5/1/2015 and will take at least 6 months to 1 year off. My plan would be to use Test. cypionate at no more than say 100mg per week (or whatever your dose that keeps you in your normal range) so that the adrenals and thyroid do not go out of whack.

That brings me to my DHEA/cortisol. My DHEA-S was low despite using DHEA/pregnenolone cream daily. This means my adrenal gland had become severely taxed. My cortisol was also on the lower side overall in the morning and getting very low toward bedtime.

22

[quote]TRT Phoenix wrote:
I have been having the same problems as you with TRT.
Do you have thyroid labs? What about cortisol/DHEA?
These are extremely important. For me, TRT stopped working
due to Thyroid hormones decreasing from too much testosterone.
(Search for testosterone reduce T4 half life)

I went on thyroid meds (WP Thyroid 3gr daily divided up) and it seemed to help. (It got my Free T3 to top of the range and brought my Free T4 above the bottom of the range)
So, as you can see my Free T4 was low despite having alot of Thyroid med. Meaning,
testosterone lowers its life in the body.

I had been on TRT for about a few years (2-3 years) and despite having high Test, high
thyroid it became very clear that my body was actually getting worse. I looked into this, and came to the conclusion that my body was becoming androgen resistant. It is
a real thing that happens when the body becomes oversaturated with androgens for too long.

I made matters worse by having been on Testosterone propionate for an extensive period of time (I switched over from cypionate). I have been off all hormones since 5/1/2015 and will take at least 6 months to 1 year off. My plan would be to use Test. cypionate at no more than say 100mg per week (or whatever your dose that keeps you in your normal range) so that the adrenals and thyroid do not go out of whack.

That brings me to my DHEA/cortisol. My DHEA-S was low despite using DHEA/pregnenolone cream daily. This means my adrenal gland had become severely taxed. My cortisol was also on the lower side overall in the morning and getting very low toward bedtime. [/quote]

Thanks for the help.

I think I am having those very same issues. I did TSH before and came out within range. I don’t remember the numbers right now, but the doctor told me it’s ok.

i never had DHEA or Cortisol labs. but I reviewed KSman’s thread on Thyroid Basics and I have noticed that my body temperature is low in the morning 36 C and hardly goes up to 36.5 in the afternoon. which seems to be an indication of Hypothyroidism.

another indication would be the every consistent feeling of fatigue and low energy specially in the afternoon. i never tested FT3 or FT4 though.

NOW WHAT !!!

you said something about reducing your T dose to 100 mg/w. I’ve already lowered my T dose to 125 mg/w but still have those symptoms. did you try this strategy already? or you’re planning to?

what are the outcomes so far?

What can i do from now ? Do I supplement with Iodine as KSman suggested? or should i stop TRT altogether.

If i opted for stopping TRT, what strategy should i employ? Should i keep the HCG for a while ? should i tapper down T? or what ?

i never knew whether i have primary or secondary Hypogonadism. but if it’s secondary, isn’t there any medication that could stimulate the pituitary / hypothalamus into producing more LH/ FSH?

need advice guys. I am so desperate.

23

As stated in the stickies, Letro is too harsh and its dose-response is not predicable.

Letro: “slightly soluble in ethanol; practically insoluble in water”

Dissolve one 2.5mg tablet in 2.5ml ethanol or vodka. Shake until dissolved. The filler in the tablet will make a mess. Shake before dispensing and dispense by the drop. Start with one drop EOD and see what happens and work from there.

If you can get liquid aromasin, you may also be able to get liquid anastrozole.

0.5 mg letro per week could easily be enough and many would need much less.

24

[quote]KSman wrote:
As stated in the stickies, Letro is too harsh and its dose-response is not predicable.

Letro: “slightly soluble in ethanol; practically insoluble in water”

Dissolve one 2.5mg tablet in 2.5ml ethanol or vodka. Shake until dissolved. The filler in the tablet will make a mess. Shake before dispensing and dispense by the drop. Start with one drop EOD and see what happens and work from there.

If you can get liquid aromasin, you may also be able to get liquid anastrozole.

0.5 mg letro per week could easily be enough and many would need much less.[/quote]

Thank you so much KSman,

but what about the other issues i explained later? what about thyroid hormones and the lack of energy i’m suffering from?

is there anything i can do about that?
is quitting TRT altogether a point to consider?
I read something that you wrote about PCT or TRT… can’t remember where. can you redirect me ?

Thank a million

25

Suggest that you stay on TRT and not add to your misery. Try iodine and monitor AM and PM body temperatures and note if you feel any improved metal clarity. Bill Roberts wants some guys to try 2mg/day for two weeks instead or 50mg/day. Labs would be useful.

PCT? Without any pre TRT LH/FSH data, we have no idea whats going on. If primary hypogonadism, there is no recovery.

26

[quote]KSman wrote:
Suggest that you stay on TRT and not add to your misery. Try iodine and monitor AM and PM body temperatures and note if you feel any improved metal clarity. Bill Roberts wants some guys to try 2mg/day for two weeks instead or 50mg/day. Labs would be useful.

PCT? Without any pre TRT LH/FSH data, we have no idea whats going on. If primary hypogonadism, there is no recovery.

[/quote]

Hay KSman,

Thank you for the advice. I saw an endo like two weeks ago. i wanted to see why i’m having issues with libido & erection if my numbers are fine. I also wanted to see if i have primary or secondary hypogonadism and if i have a chance to drop TRT altogether.

my endo told me to stop everything (T shots/ HCG ) for 15 days and do bloods. which i did and the results were as follows:

TT: 1.94 ng/ml (Lab Range: 2.6 - 10.1)
FT: 47.3 pg/ml (Lab Range: 50 - 300)
SHBG: 20.5 nmol/L (14.5 - 48.5)
E2: 5.11 pg/ml (up to 45)
Prolactine: 3.38 ng/ml ( -2.7 - 16.9)
LH: 0.44 miu/ml (0.8 -9.1)
Serum Albumin: 4.3 g/dl (3.5 - 5.4)

after seeing the resluts the doc was not able to tell if it’s primary or secondary. he also said that my pitutry and hypothalamas were ok since i have normal prolactin levels. he then presibed Test E 125 mg/ml once a week and 10 mg Cialic for my ED. no AI no HCG. … stupid right?

I was very mad and disappointed as i hoped he might help.

now i am off everything for like 17 days. i feel bad of course. i could go back on T, but I want to take the chance and try to find answers for some questions i have.

  • How can I know if i have primary or Secondary hypo?

  • What is the HCG challenge?

  • Has anyone heard about MERIONAL? (a mix of LH & FSH amps that come in 75 and 150 iu amps) linke: http://www.aconstantinides.com/site/index.php?option=com_content&view=article&id=21&Itemid=21&lang=en

  • can I use Merional instead of HCG for the challenge to decide on the primary / secondary issue?

  • If my hypo is Secondary can I use Merional shots to replace my normal LH/FSH? what dose / frequency?

  • Is there a way to restart HPTA ?

Thank you

27

I suspect that MERIONAL might be very expensive, even if you could get a prescription. Is it available ?where you are?

You are steroid use induced secondary. After TRT you are in the same boat, cannot start up again. You need PCT after stopping TRT.

hCG challenge is seeing if T levels increase with hCG which indicates that testes are functional. I expect that your testes are functional.

hCG will do all that is required at this point that Merional could do.

Did you do deca by itself? I have seen one guy who had HPTA damage from that and restart failed and he is on TRT now.

You could use Nolvadex, 10mg ED or EOD and your LH, FSH, T should increase. You can test for all of those. If things are working, stay on for 4-6 weeks to allow for testes to recover, you can slowly taper off of the SERM. You should be using anastrozole during the SERM and reduce during the taper and cruise on 0.5mg/week in divided doses, less if you are an anastrozole over-responder. You do not want high LH/FSH levels, that is a road to failure.

We have had others like you crash on the shore of failed steroid adventures.

28

[quote]KSman wrote:
I suspect that MERIONAL might be very expensive, even if you could get a prescription. Is it available ?where you are?

You are steroid use induced secondary. After TRT you are in the same boat, cannot start up again. You need PCT after stopping TRT.

hCG challenge is seeing if T levels increase with hCG which indicates that testes are functional. I expect that your testes are functional.

hCG will do all that is required at this point that Merional could do.

Did you do deca by itself? I have seen one guy who had HPTA damage from that and restart failed and he is on TRT now.

You could use Nolvadex, 10mg ED or EOD and your LH, FSH, T should increase. You can test for all of those. If things are working, stay on for 4-6 weeks to allow for testes to recover, you can slowly taper off of the SERM. You should be using anastrozole during the SERM and reduce during the taper and cruise on 0.5mg/week in divided doses, less if you are an anastrozole over-responder. You do not want high LH/FSH levels, that is a road to failure.

We have had others like you crash on the shore of failed steroid adventures.

[/quote]

i live between Egypt & Saudi Arabia. I think merional is available but expensive yes. But I think it would also increase ejaculate volume as it contains FSH as well. HCG only mimics LH. right ?

  • How much HCG do i need to run this challenge? and when is the best time after the shot to do bloods?

  • I have never done DECA. I only did 3 cycles in my life. they were all Test E plus Dianabol except the last cycle in which i included Primopolan for 8 weeks.this was 2 years ago. However, it is worth mentioning that my Hypo problem goes back to December, 2007 when I got tested for TT which came back at 300 (blood drawn at 6pm not am) after complaining about my erection. this was way before I do any steroids. It is also worth mentioning that I had Gynocamastia issues since puberty. I had this surgically removed in 2008. I am married with 3 children.

  • I am now on Nolvadex at 10 mg/day everyday. I also prepared some HCG shots at 500 iu and used one today. I have noticed that my Testes are a bit bigger and harder now. still no libido or erection.

  • i will test for LH/ TT / E2 in a 2 days from now. I also intend to test for Thyroids TSH, FT3, FT4 . I very much suspect i have issues in this area. But what should i be looking for? the optimal values of those thyroids?

  • Do you think i should test for other hormones? Bloods in Egypt are very cheap so i want to take the chance and do as much testing as i need. Do I need to test Cortisol / DHEA … anything else that could make the picture clearer?

  • Do you think I have a chance with this protocol (nolvadex & Ai) to raise my T levels and restore my libido & erection? how long do you think I need before i see any improvement?

  • I am so desperate and my sex life sucks. hope things get resolved soon.

Thanks

29

Hey guys
Still no advice?

30

[quote]KSman wrote:
[/quote]

UPDATED 2/AUG/2015

Hay KSman,
Hay Everyone,

Labs done again, very frustrating this time

I stopped TRT on 24th, June. I am on 10mg Nolvadex for 13 days now. i did labs yesterday 26th, July. that’s almost a month since i stopped TRT. Labs are frustrating and have numbers lower than the previous labs posted above. I think Nolva alone did not help with LH / FSH OR just needed more time/dose. LH is slightly better than previous labs. NOTE: i did labs when on Antibiotic (Amoxycillin) for a lung infection.

Thyroids:

TSH : 1.91 mIU/ml (lab range 0.27 - 4.2)
FT3 : 2.94 pg/ml (lab range 1.68 - 3.54)
FT4 : 1.15 ng/dl (lab range 0.9 - 1.9)

LH : 0.55 mIU/ml (lab range 0.8 - 9.1)
FSH: 0.79 mIU/ml (lab range 1.6 - 11)
TT: 0.48 ng/ml (lab range 2.6 - 10.1)
E2: 13.4 pg/ml ( up to 45)

UPDATES:

last week I did the HCG stimulation Test. I took 1500 UI of HCG for 3 days and then took bloods on the 4th day. Here are the results:

TT: 5.41 ng/ml (2.6 - 10.1)
E2: 35.2 pg/ml (up to 45)

The Stimulation Test shows that my TT took a big leap from 0.48 to 5.41. I think this is proof enough that my testes are working.

Now i am not sure what to do. I’m still on Nolva but upped the dose to 20mg / day. However, I did a very stupid mistake. in a moment of desperation, while waiting for the labs, i took a T shot of 250mg. I thought my testes are dead and there’s no point of living in misery all this time. However, the labs for the HCG Stimulation challenge came encouraging. Now please guys, tell me what to do?

Did I give Nolva enough time to work? am i on the right dose?
Should I incorporate any HCG or Merional?
is it really possible to restart the HPTA and reset it’s standards so that it doesn’t tell the testes to stop producing T at a low value?
How long should I wait? and when to do bloods? what bloods?
what are the optimal values of TT, FT, E2 and others for someone at my age: 38?

Should I put myself back on TRT?
Are my thyroids OK?

Guys, I am really clueless. please help me out.

Still ED and libido problems

31

hey guys… still no answer ???

32

[quote]Activator wrote:
hey guys… still no answer ???[/quote]

I’m not here to criticise you, but i read your whole 2 pages history in this thread. Quite a rollercoaster i’d say.

Are you really sure you read the stickies here?
For the reference ranges, there’s google unless it’s banned in Egypt.
With little time per day you’d do alot of research already in a week.

Not long ago in your post you state you use nolva and ai, i didn’t see any ai you listed only using nolva and hcg together…

I’m guessing you injected 1cc of 250mg testosterone ampoule.
Now your hormones are messed up again and none knows what’s happening.

I shouldn’t post i cannot help you, but i did anyway.

Your ED even might not be hormone related in the first place though i can see how your experiments would have helped it.

33

Do not use hCG and SERM at same time.
Do not use high dose hCG.

You can try 250iu hCG SC EOD. You need to allow time for recovery of testicular size and function.

ft3, fT4 is below midrange [optimal], TSH should be closer to 1.0.
You could be iodine deficient. Do you use iodized salt?
There are problems in Egypt with iodine deficiency.
Have you checked body temperatures as per the thyroid basics sticky?

34

[quote]KSman wrote:
Do not use hCG and SERM at same time.
Do not use high dose hCG.

You can try 250iu hCG SC EOD. You need to allow time for recovery of testicular size and function.

ft3, fT4 is below midrange [optimal], TSH should be closer to 1.0.
You could be iodine deficient. Do you use iodized salt?
There are problems in Egypt with iodine deficiency.
Have you checked body temperatures as per the thyroid basics sticky?

[/quote]

Hi KSman,

I am now on 10 mg. Nolva/ day and will taper it down till my stock finishes. I have been on novla for like a month and a half now.

My testes are bigger now but not as big as they used to be. my ejaculate fluid is almost back to its previous quantity.

However, I still have issues with libido and ED.

I have checked my body temperature in the morning upon wake up. it ranged from 36c to 36,4 c. The Thyroid Basics sticky suggests that anything below 36.2 could mean a problem. So I believe i might have a problem.

I am also taking Horny Goat Weed caps from ADVANTA SUPPLEMENTS. it comes with a mix of other essential herbs all in one cap (see Pic).

I have noticed some strength coming back in the gym. of course not as it was on TRT. however, i think my E2 is accumulating. i noticed some water retention and fat accumulation around the waist line, sensitive nipples too. I started to take the Letro alcohol based solution you suggested earlier. i took 2 drops on Sat and 2 more on Mon. nothing more. i am cautious not to crush my E2 altogether.

I am planning to do bloods but not now. I want to give my body some time to heal. However, I want some advice on my next steps.

  • Should I supplement with Idoine? would that help my Thyroid issue?

  • What dose to start with? any suggested product?

  • Do I need to supplement forever?

  • What do you think of supplementing with DHEA and Pregnenolone caps/tabs?

  • Will they help with my libido? Does DHEA further suppress the HPTA?

  • Will Proviron help? Dosage? Duration?

  • Should I keep using the Letro solution I prepared upon your previous advice?

Thank you Ksman
Thank you all.

35

Thyroid: please see the thyroid basics sticky for iodine dose suggestions.
Where are you located. Products here in USA may not be there.

Proviron can help with libido, does not convert to E2, but is HPTA repressive, exactly what you do not need.

DHEA and pregnenolone will not improve T or libido unless they were deficient. Got labs for those?

HCG took E2 too high, because dose was too high. This is why I say to avoid high dose hCG.

TSH : 1.91 mIU/ml (lab range 0.27 - 4.2)
FT3 : 2.94 pg/ml (lab range 1.68 - 3.54)
FT4 : 1.15 ng/dl (lab range 0.9 - 1.9)

fT3 should be mid-range [2.61] or a bit higher. This should support normal body temperatures. Your low body temperatures could be from elevated rT3 that blocks fT3. You can get rT3 tested. What can increase rT3?

  • stress
  • acute or chronic illness or inflammation
  • accidents
  • surgery
  • starvation diets
  • over training
  • …

Please read the thyroid basics sticky again and note refferences to stress, rT3, Wilson’s Book

36

[quote]KSman wrote:
Thyroid: please see the thyroid basics sticky for iodine dose suggestions.
Where are you located. Products here in USA may not be there.

Proviron can help with libido, does not convert to E2, but is HPTA repressive, exactly what you do not need.

DHEA and pregnenolone will not improve T or libido unless they were deficient. Got labs for those?

HCG took E2 too high, because dose was too high. This is why I say to avoid high dose hCG.

TSH : 1.91 mIU/ml (lab range 0.27 - 4.2)
FT3 : 2.94 pg/ml (lab range 1.68 - 3.54)
FT4 : 1.15 ng/dl (lab range 0.9 - 1.9)

fT3 should be mid-range [2.61] or a bit higher. This should support normal body temperatures. Your low body temperatures could be from elevated rT3 that blocks fT3. You can get rT3 tested. What can increase rT3?

  • stress
  • acute or chronic illness or inflammation
  • accidents
  • surgery
  • starvation diets
  • over training
  • …

Please read the thyroid basics sticky again and note refferences to stress, rT3, Wilson’s Book

[/quote]

Hi Ksman,
Hi everyone,

i am now almost 3 months without TRT. I took Nolva and tappered it all this time until recently. I just did bloods for TT and it came at 2.93 ng/ml (labs: 2,00 - 8.00)

My testes are back to normal size. my sperm volume is also back. however, libido and erection are still bad, even under 50mg viagra and Cialis 5mg together.

As i said before, i did the HCG stimulation test and my TT went up like 4 times. which means that my Testes are fine and my hypo is secondary.

my main concern is: with secondary Hypo, is TRT again the ONLY treatment option? is there anything else i could do to get the pituitary to produce enough LH/FSH on its own?

what could be my next step?

Thanks

37

You could try 10mg ED or 20EOD Nolvadex then eval how you feel and do labs later for TT, FT, E2 and LH/FSH
or hCG with AI if needed.

How much hCG and for how long. High dose does not tell you much.

Please study: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct

38

[quote]KSman wrote:
You could try 10mg ED or 20EOD Nolvadex then eval how you feel and do labs later for TT, FT, E2 and LH/FSH
or hCG with AI if needed.

How much hCG and for how long. High dose does not tell you much.

Please study: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct
[/quote]

for how long should I take the Nova in this manner before doing labs again?

I took 1500iu HCG everyday for 3 days only, then skipped day 4 and did labs on day 5. this is how I did my HCG stimulation Challenge.

i have also ready some articles about clomid for secondary hypo…

39

[quote]KSman wrote:
You could try 10mg ED or 20EOD Nolvadex then eval how you feel and do labs later for TT, FT, E2 and LH/FSH
or hCG with AI if needed.

How much hCG and for how long. High dose does not tell you much.

Please study: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct
[/quote]

hi KSman,

I did labs again today 29/11/2015 in the am. the results came out frustrating though.

TT: 2.74 (2.49 - 8.36 ng/ml)

E2: 10.42 (7.6 - 43 pg./ml)

LH: 4.37 (1.1 - 25 mIU/ml)

FSH: 2.86 (1.5 - 11.8 mIU/ml

Prolactin: 10.4 (2.5 - 16 ng/ml)

i feel terrible of course.and now i don’t know what to do. is there any other way to get the pituitary to produce more LH / FSH?

Do i have to get back to TRT? what dose to start with? and do i need an AI right from the beginning?

What are my Options?

very frustrated.

Thank you

40

Please explain what you were doing and for how long for the above labs.