Setting a Baseline

Pharma TRT
1

-age: 48
-height: 6’1
-waist: 34 increase of 2 in the past year.
-weight: 190, increase of 20 in the past year.
-describe body and facial hair: Chest-moderate, Back-almost none, Facial-I keep a close trimmed beard and moustache, Head-a little receding, getting to be a Capital M instead of a small m
-describe where you carry fat and how changed: Waist and face + visceral - changed from not carrying at all. Thighs are still very lean.
-health conditions, symptoms [history]: Psoriatic Arthritis, Carpal Tunnel, Acid Reflux, Vasectomy 2006, history of getting tennis elbow easily.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Never any hair loss or prostate drugs. Humira, Ibuprofen, Omeprozole, B-12 1000mg, B-6 800mg, Folic Acid 800mg.
-describe diet [some create substantial damage with starvation diets]: Average diet, more junk than I should eat, but less than I could eat. Occasional drink, non-smoker, 1 large cup of coffee in the morning.
-describe training [some ruin there hormones by over training]: Nothing other than weekend bike riding in the past year.
-testes ache, ever, with a fever?: Slight occasional ache since beginning TRT, no fever.
-how have morning wood and nocturnal erections changed: MW/NE returned after starting TRT and Cialis
-Symptoms (pre-TRT): Fatigue, unmotivated, almost no libido, poor concentration, hard gainer when I was working out, soreness from workouts never completely subsided from one to the next.

-lab results with ranges prior to beginning TRT:
WBC: 8.9 (4-10.5)
RBC: 5.6 (4.1-5.6)
Hemoglobin: 17.2 (12.5-17.0)
Hematocrit: 49 (36-50)
BUN: 16 (6-24)
Creatinine, Serum: 1.09 (.76-1.27)
BUN/ Creatinine Ratio: 15 (9-20)
CO2: 21 (20-32)
AST - SGOT: 44 (0-40)
ALT - SGPT: 96 (0-55)
Cholesterol Total: 240 (100-199)
Cholesterol HDL: 37 (above 39)
Cholesterol VLDL: 77 (5-40)
Cholesterol LDL: 126 (0-99)
Triglycerides: 383 (0-149) have always been high
PSA: .6 (0.0-4.0)
TT: 391 (348-1197)
FT: 9.6 (6.8-21.5)
T4: 1.04 (.82-1.77)
TSH: 2.19 (.45-4.5)
No E2 test 1st time, but adding on next labs

Have been on .25ml Test-E 200 twice weekly injections for 6 weeks. No HCG or AI and doc is hesitant to add before specific symptoms appear. I’m starting to get a little itchy nipple, but can’t discern any tissue growth and no other discomfort.

Motivation to do things has increased, but still too tired to do most of them (though improving). Fatigue is definitely higher the day before my injections. Libido is higher but not what I would consider normal. Doc has upped the dosage to .4ml twice weekly at my discretion, but I am sticking with the current dose until I get blood drawn for new labs this week. Results when available.

Am interested in getting back to the gym and changing body composition, but holing to see what effect the meds alone have (changing one thing at a time)

2

Cholesterol is not very good, and triglycerides are awful. How is your diet?

Consider Niacin to help raise HDL.

What did he say about your very high ALT?

You could consider donating blood to lower RBC/HGB/HCT.

I agree with your doctor to not add in other things until you have a demonstrated need for them.

3

Thank you for the response. I’d say my diet is middle of the road. I could do better, and obviously should, but I found certainly do worse. I’ve been taking advantage of a quasi-free cafeteria at work and indulging in too much bacon and eggs at breakfast. I’ll be switching back to a more reasonable oatmeal and/or protein shake for breakfast. It’s possible that my cholesterol numbers are skewed a little. I mistakenly broke my fast before the last test with half of a cup of coffee that included nonfat creamer and splenda about 4 hours before the blood draw. I realized what I was doing halfway through the cup but the damage was done. I get another set of labs this week can’t I will not slip up this time. My triglycerides are definitely high; they always have been. Even when I was eating extremely clean and hitting the gym 3x a week, they were in the high range. I may end up trying Lovaza to see if it helps. I’ll definitely give the niacin a try. Unfortunately, being on Humira prohibits me from donating blood or plasma until 6 months after I stop, and I don’t know when/if that will happen.

Other than achy testicles and waiting for them to shrink, is there anything I should be watching for that would indicate that it would be appropriate to try HCG? This set of labs will include an E2 test, so that will let me know about an AI. I agree that it would be great to need neither. Wish me luck on the labs. I guess I am hoping that the T levels are still on the low side, given that the fatigue is still lingering. I do feel fortunate to have a doc who seems to be wiling to treat the symptoms and not just the numbers, and supports me self-injecting.

4

bacon and eggs are certainly not a problem…especially not for TRIG. You usually see elevated TRIG in people who eat a ton of carbs, especially shitty ones with lots of sugar. Do not fear bacon and eggs man.

For HCG, also keep an eye out for midday drowsiness that can indicate a lack of testicular pregnenolone. Obviously achy/shrunken testicles are the biggest signs.

5

Well, the midday drowsiness certainly fits. Before starting TRT, I was literally sleeping in my car at lunch most days. The bacon and eggs certainly don’t do my cholesterol any good. :slight_smile: if I could just somehow learn to like the things that are good for me…hmmmm

6

Latest labs drawn 6/28 after 7 weeks of Test E 200mg/ml injections .25 TW.

PSA: .7 (0.0-4.0)
TT: 897 (348-1197)
FT: 25.7 (6.8-21.5)
TSH: 2.20 (.45-4.5)
Estradiol: 48.5 (7.6-42.6)
B-12: 337 (211-946)

I saw the doc 1 week before this draw and reported that I still had mild fatigue, he wrote my Test E refill for .4 TW and told me to self manage to get the fatigue knocked down. I did not change my dosage from the previous .25 TW level until the new labs were drawn at which time I went up to .3 TW. The fatigue has improved again at that dose and he has added 1000mg B12 sublingual based on my labs.

I am concerned about the E2 level but doc said he does not want to add an AI because the Free Test:E2 ratio is in line. I am having more incidents of testicular ache and sense some shrinkage, but he is also still hesitant to add HCG. I really like the guy and the fact that I am free to self-inject and manage my own dose to get symptoms under control, but I would like input on whether I should be pushing harder for AI and HCG at current levels. Especially since my dosage was increased 20% after the latest labs were drawn.

Recap:
First labs and began .25 TW: 5/10/2012
Doc approved increase to as much as .4 TW: 6/20/2012
2nd labs drawn: 6/27/2012
Increased injection to .3 TW: 6/28/2012
Reviewed 2nd labs with Doc: 7/5/2012

Comments please.

7

Your E2 is too high. You should either adjust your T dosage downwards, or pressure your doc for an AI.

8

Reduced Test E back to .25 TW and decided to give it a little while and see how I felt. Nipple sensitivity (feels like constant pinching) and itching have increased. Given the E2 levels, I have a call in to the doc asking for AI. Last visit he mentioned that his starting dose is typically .5 TIW. We’ll see if he goes for it or if I need to do a little “research”. Other than this issue, TRT has helped immensely! Feel better, wife feels better, etc…

BTW - still don’t have enough posts to PM. Anyone know the threshold?

9

Doc has started me on .5mg anastrozole MWF. I didn’t even have to set an appointment for it, just called and said I felt like it was time to try an AI. His PA called me back within a day saying they had already phoned in the order to my pharmacy.

I am not scheduled for more bloodwork until October. What should I be on the lookout for?

10

Am I understanding it right and you’re going to be taking a total of 1.5mg a week of anastrozole? If so, I would look out for achy joints, ED, and any other symptoms that would indicate low E2. I’m not intimately familiar with Test-E, so I don’t know if is esterfies the same as Test-C, but I know they’re so strikingly similar chemically that it would surprise me if they did.

That said, most of us on Test-C take 1mg Adex split into as many doses as possible (I do 4x.25mg). The 1mg covers me at 200mg/wk, but I know guys who have to go as high as 2mg/wk at this dose. Some say it’s a rule that it’s 1mg Adex per 100mg Test, but I’ve found that that is more of a guideline than a rule. Some guys over-respond to Adex and some under-respond, so it may take some time and a few labs to figure out where you need to be.

11

Your interpretation is correct, 1.5mg per/wk total. Having reviewed the threads here, it has me a little concerned as well. It’s easy enough to divide the pills again to get ~.25 per dose. The little buggers are small, so I’m certain there is some inherent variation in the cutting, but hopefully nothing big enough to cause issues. If I continue to have high E2 symptoms, I can always take the dose back up - if not, I only have to fill the perscription half as often. Bloodwork in October will tell me the real numbers.

Testicular ache has subsided, so I’m going to hold off on asking for HCG for the time being. I’d really like to change only one component between bloodwork if possible.

12

Cut AI to .25 MWF and high E2 symptoms disappeared very quickly. Fatigue has been creeping back up so I have increased Test-E to .3 TW and will bump AI to .25 every other day to compensate for the additional Test. Scheduling is a little harder to remember when it’s not just specific days, but I just set reminders on the phone to make sure I don’t forget - taking several other meds too, so this is almost a necessity.