Starting TRT Therapy

Bigger Stronger Leaner Over 35 Lifter
1

This process started in 2006 when I heard an interview with a professional golfer discussing his diagnosis with low testosterone. He discussed his symptoms and I thought how they fit me to a T. I had my GP test my levels and he told me they were normal. At the time I didn’t pursue the issue further and kept plugging along feeling like crap like I had been for the past several years.

Recently I went to my Urologist for a prostatitus, something I’ve been dealing with for 5-6 years. My GP faxed my lab work to them from the last several years and he noticed my testosterone numbers were very low for my age. I’m 34 5’7" 200lbs. The labs from 2006 showed a Total Testosterone of 288 and a Free Testosterone of 65.

He ordered another test and gave me an injection of 200mg of cyp. The nurse called today and said my Testosterone level was 7.0 which was low and out of range and the Dr. wanted to discuss treatment options with me. When I told him the symptoms I’ve been dealing with the last 5-6 years he said based on my labs he understood why and he could definitely get me feeling better.

My question is what do you guys recomeend I ask him for as far as Estrogen blockers and such. Also I’m assuming I should ask for injections. He told me there were various options injections, creams, etc. I don’t work out much but plan to start and have not taken steroids in the past. I have mostly belly fat with high blood pressure and high cholesterol. Also all my other lab work came back negative ie. PSA, Thyroid, Liver etc.

Thanks

2

Typically the trajectory is to start you off with a low dose of the gel.

Then test and see where you are.

If that dose is not working, then the dosage is upped/

Then test and see where you are.

If the dosage is working, great!

If not, then another therapy is tried.

I tried a “mouth patch” called Striant that did not work for me either.

Then I was moved to the injections.

Lots of guys do great on the gels. Others, like me, apparently don’t absorb thru the skin very well.

–
The gel is very expensive but if you have good insurance that may not matter.

If you do not have good insurance then you may want to ask to go to injections immediately - generic testosterone is pretty inexpensive.

To me the injections are not a big deal. The nurse trained me on how to do them.

–

As to estrogen blockers, is your E2 high?

Typically the docs will test you after you are on testosterone for a while to see where your E2 levels are.

From what I understand and have experienced, most doctors are hesitant to prescribe an antiestrogen, especially if you are in the so called “NORMAL” range.

The two doctors I have seen do not prescribe it. The endo I saw said “you do not need it, all that matters is the testosterone to estrogen ratio. Yours is good”.

The doctor I am seeing now, when I asked how to reduce E2 said – “There is not much we can do, other than you LOSING FAT!”

The ones that do prescribe anti-estrogen prescribe ARIMIDEX ® (anastrozole).

Hope this helps. Others may have contradictory info.

–

3

Body fat equals Estrogen production, and Estrogen production equals body fat. It’s a vicious circle. We men always produce some Estrogen as a metabolite of Testosterone, just like we all produce a little DHT too. Some produce more than others.

As far as Free T goes, I’m sure you’ve read about SHBG and the role it plays along with E2, with it knocking down our Free T which is the most important. Here’s a real barometer test: (pardon the pun) do you still have dependable morning wood? If not E2 may be a big factor for you just like the rest of us.

I agree with E-loo, and have always been a proponent of using AI’s just as a “safety” net even with small amounts of HRT dosage (100mg/week). I have a friend who is 72 and started on 1mg/week of adex for three weeks, cut back to 1/2mg week and he “wakes up under a tent” every morning now. He and his wife are very happy about that too…

Losing body fat if you’re not over eating “should” be a little easier when the E2 levels are lower to not store fat. If your E2 goes down your T should go up due to the fact your body will respond to make more T with less E2. I hope I was clear.

KNB

4

Most recent Blood Test prior to any TRT therapy…

Testosterone - 7.70 nmol/L Ref. Range 9.9-27.80
LH - 3.5mIU/ml Ref. Range 1.7-8.6
Estradiol - 16.17 pg/ml Ref. Range 7.63-42.6
SHBG - 11.83 nmol/L Ref. Range 14.5-48.4
%FTI - %FAI - 65.089 Ratio Ref. Range 15.5-100
FTestosterone - 0.234 nmol/L Ref.Range 0.091-0.579
BTestosterone - 5.480 nmol/L Ref.Range 2.14-13.6
DHEA-S - 1.43 umol/L Ref. Range 4.34-12.20
Prolactin II - 16.22 ng/ml Ref. Range 4.04-15.2

Any thoughts from you guys based on experience?

5

[quote]sdmlsu1 wrote:
Most recent Blood Test prior to any TRT therapy…

Testosterone - 7.70 nmol/L Ref. Range 9.9-27.80
LH - 3.5mIU/ml Ref. Range 1.7-8.6
Estradiol - 16.17 pg/ml Ref. Range 7.63-42.6
SHBG - 11.83 nmol/L Ref. Range 14.5-48.4
%FTI - %FAI - 65.089 Ratio Ref. Range 15.5-100
FTestosterone - 0.234 nmol/L Ref.Range 0.091-0.579
BTestosterone - 5.480 nmol/L Ref.Range 2.14-13.6
DHEA-S - 1.43 umol/L Ref. Range 4.34-12.20
Prolactin II - 16.22 ng/ml Ref. Range 4.04-15.2

Any thoughts from you guys based on experience?[/quote]

My unprofessional opinion is that this appears to be primary hypogonadism. It could also be an issue with your adrenal glands.

Are you getting plenty of good oils (being a source of good cholesterol) in your diet? Your prolactin is very high, and this could be throttling everything else low.

Tell us what your fitness level is, especially body fat, and if you are on any anti-depressants.

Prolactin and the neurotransmitter Dopamine are like a seesaw. When one is high, the other is low. When dopamine is high, you’re happy, libidinous, etc., and when prolactin is up (e.g. right after climax) your sex drive is low, your body wants to make boobs and store fat. In fact “prolactin” means “for [the purpose of making] milk”.

Something high in the change of converting cholesterol to sex hormones is screwed up.

The LH being OK but your sex hormones being low could indicate primary hypogonadism (testes aren’t working), however, your adrenals don’t seem to be working hard to compensate (they also make T and E, but only female amounts of T). I say this because your DHEA-S is very low.

Tell us more about what’s going on with you if you want. I’m not a doctor, and what I’ve shared is only based on my ongoing experience with secondary hypogonadism, adrenal fatigue and hypothyroidism.

Good luck!

6

Thyroid Numbers:

TSH - 1.94uIU/ml Ref. Range 0.27-4.20
T4 - 8.1 ug/dL Ref. Range 4.6-12.0
Free T4 1.22 ng/dL Ref. Range 0.93-1.71
T3 - 1.3 ng/ml Ref. Range 0.8-2.0

The last time I had a cholesterol test my total was 206, but my “bad” cholesterol was like 160, I think. I do remember that my total was slightly high and my “bad” was very high.

Should I be concerned that my Total Test. is very low at 7.7 and my BTest. is on the low end of the range? Also I did take Lexapro for about 5 weeks, but I stopped taking it only a few days prior to my blood test. Lexapro is the only AD I’ve ever taken. I didn’t think it was helping, actually it made me feel worse. My doc gave it to me to try because I’ve been feeling like crap for so long, but I don’t think depression is my problem.

I’m 5’7" 195lbs, I haven’t worked out since my early 20s. I have the classic heart attack body, most of my weight is in my abdomen. I eat what I want when I want. I don’t smoke and rarely drink although I drank heavily from my late teens until about 26.

7

[quote]sdmlsu1 wrote:
Should I be concerned that my Total Test. is very low at 7.7 and my BTest. is on the low end of the range?[/quote]

You should be concerned because you have SYMPTOMS and the numbers support low T as the reason behind the symptoms. Don’t fall into the trap of thinking this is strictly a numbers game. How you feel is what this is all about; not numbers.

Depression is also a symptom of low T and high E.

That bodyfat is part of the problem; don’t kid yourself. If you really want to feel better, then start getting decent nutrition and exercise. It’s cheap, easy, and will do just as much to make you feel better as TRT.

8

Get your serum E2 levels checked. Probably way too high. You may have syndrome X or metabolic disorder. You should have your numbers checked for blood sugar problems. Increased E also puts your prostate at risk; and you have problems now. Using anastrozole to reduce E2 to the lower 20’s (0-53pg/ml) will help a lot. Elevated E2 is a bigger issue than T or DHT. Most doctors do not understand the E - prostate problem at all.

TRT will increase E2 levels and the use of anastrozole should never be considered optional. But most doctors have no idea.

TRT will fix your cholesterol levels a lot.

free T3 is an important number.

SSRIs will make you feel like shit and loosing what libido is left can make one depressed. Get onto Wellbutrin, it can help with weight loss and restore “energy”.

There seems to be some prolactin problems. Do not have sex or masturbate for a few days before getting that tested. If it remains persistently high, that could be from a pituitary problem. Prolactin can also kill ones libido… more depression.

Wellbutrin increases dopamine, which is what you need. If you have serious sleeping problems, trazodone is cheap, effective and also increases dopamine, and in it self as a sleep aid, 100mg/night also provides some great anti-depressant effects. These two drugs can work quite well together. These drugs can improve libido, whereas SSRIs destroy libido.

10

Specifics:

Based on body weight fat.

125mg test cyp per week, inject twice a week. With your body fat, you are not going to get IM injections with a short needle, but you could try with a 1" #25. T into fat tissue seems to work ok for those who have tried it and there was a positive clinical trial of T injected into belly fat. You probably want to avoid sell injection with 1.5" needles in the butt. With smaller needles, more frequent injections work better. As you loose weight, then IM injections with short or small needles can be done. (I and others inject T with .5" insulin needles… your doctor will not know about that option.)

You may need 1.5mg/wk of anastrozole/Arimidex per week to get your E2 levels under control. Start with 1mg/wk and get some positive results, then increase. If it seems like a step backwards, that it too much for your. Individual responses can vary greatly. Take divided doses every 2 or 3 days, or twice a week. Take anastrozole any time of day, with or without food. Arimidex can be expensive.

250iu hCG injected under the skin (SC) will stop your testes from shrinking. If they shrink, your pregnenolone and DHEA levels will go even lower.

TransDermal T creates higher E problems than injected. Some do not absorb TDs very well, and some that do well initially will later not absorb as the T changes their skin. Those with thyroid problems often will not absorb TD.

TDs are very expensive. Testosterone cypionate and hCG are relatively cheap.

Injecting is really not difficult, once you get into it. Millions do, you can too.

If you inject hCG to save your testicles, no point in doing TDs to avoid injecting T.

11

Thanks for all the help guys. I have really good insurance so money is not an issue, but as most of you know the real problem is finding a Doctor who will provide proper treatment and see the big picture. I can get the injectable T from my Urologist, although he said I need to wait until my prostate infection is cleared up. (smart) I told him point blank that I have no problem injecting the T, but from the research I’ve been doing if you only inject T without monitoring and controlling other hormones you can suffer adverse side effects. I told him unless the therapy is done right it won’t be done on me. I’m not like a lot of people, the way I figure it I’m paying the Doctor and he is working for me. If I don’t feel good about what he is doing I have no problem letting him know. At the very least he is going to have to convince me he is on top of everything.

12

[quote]KSman wrote:
Get your serum E2 levels checked. Probably way too high. You may have syndrome X or metabolic disorder. You should have your numbers checked for blood sugar problems. Increased E also puts your prostate at risk; and you have problems now. Using anastrozole to reduce E2 to the lower 20’s (0-53pg/ml) will help a lot. Elevated E2 is a bigger issue than T or DHT. Most doctors do not understand the E - prostate problem at all.

TRT will increase E2 levels and the use of anastrozole should never be considered optional. But most doctors have no idea.

TRT will fix your cholesterol levels a lot.

free T3 is an important number.

SSRIs will make you feel like shit and loosing what libido is left can make one depressed. Get onto Wellbutrin, it can help with weight loss and restore “energy”.

There seems to be some prolactin problems. Do not have sex or masturbate for a few days before getting that tested. If it remains persistently high, that could be from a pituitary problem. Prolactin can also kill ones libido… more depression.

Wellbutrin increases dopamine, which is what you need. If you have serious sleeping problems, trazodone is cheap, effective and also increases dopamine, and in it self as a sleep aid, 100mg/night also provides some great anti-depressant effects. These two drugs can work quite well together. These drugs can improve libido, whereas SSRIs destroy libido.

[/quote]

Question…

You say I need my Serum E2 levels checked, my lab work above shows my Estroidal number is this different than Serum E2?

Thanks KSman

13

[quote]sdmlsu1 wrote:

You say I need my Serum E2 levels checked, my lab work above shows my Estroidal number is this different than Serum E2?

Thanks KSman

[/quote]

Sorry, I missed this:
Estradiol - 16.17 pg/ml Ref. Range 7.63-42.6

With all of the mixed pmol units, I was not reading carefully with units that are not familiar to me.

Based on the above numbers, your e2 looks too low. But with low T, this is often seen. With TRT, that level of E would make many not feel well. With low T and low E, the T:E ratio is perhaps normal to some extent.

14

Do any of you guys know if there may be a connection with degenerative neck/back problems and Low T / Hormone deficiencies? Also the same question as related to general allergy problems. My Low T symptoms started when I was in my late 20s, I’m now 34. I have not started any TRT/HRT therapy, but I had my GP test my T levels in 2006 which came back very low normal.

About 3 weeks ago my Urologist tested my T levels in addition to other hormones and my T was low out of range and many of my other levels were either low or high. I was retested by an Endo. last Monday and will meet with him on Feb. 4 to review the results. I started having problems with my neck and back in 2005. I had an MRI in April 2006 showing severe spinal stenosis from C2-C7 with 3 disc herniations, 2 of which are impacting my spinal cord. I also have 2 disc herniations in my thoracic region of my back, one of which is very large with spinal cord impaction.

I had another MRI about a week ago. I met with my Ortho. today to review the results and my condition has worsened significantly. In 2006 my Ortho. recommended surgery on my neck but said I could put it off as long as I could stand it with injections and pain meds. My Ortho. is conservative when it comes to surgery, but he told me today if I was seeing a Neuro Surgeon they would probably hog tie me and escort me to the operating room immediately, that is how serious my condition is.

Also my thoracic has worsened significantly and his exact words were “you have a very impressive disc herniation”. I guess to get to the point he says my condition is degenerative and my spine is deteriorating rapidly. Apparently I have had very Low T and other hormone deficiencies for quite a while. Do ya’ll know of any data that would support a connection between Low T / Hormone Deficiency and my spinal issues?

The allergy issue may be a stretch, but it seems my allergies are getting worse with age which is unusual. I don’t have the lab results ordered by my Endo, but I have the ones from 2006 and 3 weeks ago if posting these would be helpful. I realize if there is some sort of connection between Low T and my spinal problems starting TRT probably won’t repair my spine but it may slow the deterioration process. My Endo also tested my IGF-1 level, but I won’t know the results until Feb. 4.

15

Low hormone levels and osteoporosis? Yes. Degenerative discs, well very possibly. I don’t have the links handy, but I will look as I’m sure I’ve seen something to that effect.

16

There’s no question of the link between hormones and bones. Google for “estradiol bone density” or “testosterone bone density” and find tons of information. The main source of estradiol is testosterone and so if your testosterone is chronically low there is a good chance that your estradiol is chronically low.

So in the course of all these tests and problems, none of your doctors have made a connection between your low hormone profile and your bone problems? What’s wrong with this picture?

I already knew about the relationship but even if I didn’t it would have taken me 0.19 seconds to do so. (According to Google results)

It’s time for you to stop letting the doctors run the show and start educating yourself and taking responsibility for your own health.

17

Hi guys, I haven’t been on this forum several months. Last time I was, I had just started Testim, once a day. I’m 46 and my total T was 370 and my free T was 8.52. On 7/17/07, my total T was 1267 and my free T was 46.54! Quite an improvement, so my endo cut me back to every other day. On 11/26/07 after 4 months of EOD, my total T was 1399 and my free T was 48.23, so NOW they’ve cut me back to every THIRD day! I’m waiting for last week’s bloodwork results.

Needless to say I’m happy, on several levels, but here’s my question: When I get my results, the baseline on my sheet are as follows:
FREE T - Males 40-59 central 95% range 7.2 -23

TOTAL T - Males 20-49 Central 95% range 262-2593

Now are these baseline/ guidelines right, or are they typical of the medical community and too conservative? What are some good maintainable numbers in YOUR estimation? Can I go higher safely?

When I first went on Testim, I lost 53 lbs in about 4 months, but that’s kinda levelled off. I wondered, how high can I go (safely)

My PSA’s went from 1.4 to 2.1 initially, before levelling off at 1.9

18

You’ve hit the nail on the head, it’s all about the “rules” the doctors are supposed to follow.
I’ve never seen a range of 262-2593, I wish my doctor had those numbers to go by…

My point is you’re 46,and your doctor wants you to be around 800-900 most likely. The real question is: what day was the blood drawn? Did you put T gel on that day? If so, your test results are wrong, and your doctor is bordering on moron status. There is NO WAY I would go every third day using gel, it’s gonna bite you eventually.

You appear to someone that doesn’t naturally convert a lot of your T to E2. That’s a good thing. The next time you do a blood test (if you didn’t do this already)is no T gel for three days (or as long as possible) before the blood test. That way your blood work will show the lowest possible number so your doc will stop cutting you back.

If you have X quantity to use every third day, divide it up to use it everyday, except once again, before testing.

How’s your hair? still the same, maybe thinner possibly? I ask because your PSA went up. You might be converting to DHT and bothering your prostrate. I already know there are disagreement over this, but if you can get a DHT test on your next blood test, you may find out what’s causing the change in your prostrate. Keep us posted.

19

Aloha,
I too just started TRT. I go in next week for a 3 month checkin. The Doc has a Life Extension specialty, so he leans towards HGH, which he imports and sells directly. I was a little sceptical, so I chose to go slow, with TRT in the form of compounded cream,
50 mg/ml 1/2 ml 2x daily. I apply it to the underside of my forearm, and then rub it to the inside of my thigh, or the side of my body. I alternate because I read on these forums that your skin can become unreceptive.

I started in Nov, and almost immediately noted an increase in energy, libido, and mood. This dissipated after a month or so, and I have not noted any significant improvement in energy in my workouts since then. I am not a “heavy” lifter, 1 hour 3x wkly. I had hoped that an increase in energy and an improvement in mood would stimulate my interest in pushing my body, but it hasn’t worked out that way.

In reading a post by KSMan I saw reference to increases in Estrogen being a probable side effect, with consequences similar to what I am experiencing; decreased (!) libido, desensitized penis, and moodiness similar to the depression I have had for some years now.

My followup bloodwork was submitted last week, I get the results next week when I meet with him. I want to approach him with a plan. It’s tough for me to assimilate the vocabulary (usually lots of acronyms) with my non-science background.
Hope to gain more knowledge from this Forum to have a solid presentation for the Doc.

My starting points:
6’7" 215 Age 53 Chol 167 54/101 3.09 PSA 0.6
Slightly anemic DHEA Sulfate 175 mcg/dL Test Total 528 ng/
IGF-1 Soma-C 209 ngmL
Total Knee Replacement '05 Depression 7 years (No meds after short term Prozac)

Thanks,
Jim

20

[quote]KNB wrote:
You’ve hit the nail on the head, it’s all about the “rules” the doctors are supposed to follow.
I’ve never seen a range of 262-2593, I wish my doctor had those numbers to go by…

My point is you’re 46,and your doctor wants you to be around 800-900 most likely. The real question is: what day was the blood drawn? Did you put T gel on that day? If so, your test results are wrong, and your doctor is bordering on moron status. There is NO WAY I would go every third day using gel, it’s gonna bite you eventually.

You appear to someone that doesn’t naturally convert a lot of your T to E2. That’s a good thing. The next time you do a blood test (if you didn’t do this already)is no T gel for three days (or as long as possible) before the blood test. That way your blood work will show the lowest possible number so your doc will stop cutting you back.

If you have X quantity to use every third day, divide it up to use it everyday, except once again, before testing.

How’s your hair? still the same, maybe thinner possibly? I ask because your PSA went up. You might be converting to DHT and bothering your prostrate. I already know there are disagreement over this, but if you can get a DHT test on your next blood test, you may find out what’s causing the change in your prostrate. Keep us posted.[/quote]

Sorry, that was a typo, I meant 1593. Well as an update, my numbers came back and my Total T has plummeted to 390 and Free T to 10.5! Needless to say, I’m pissed and stepping up my frequency to get my numbers back up! LOL My endo says, “Don’t worry, it’s only numbers” and I said, “So I should have said that to YOU when I was 1399!”

If I don’t get the results I want, I’m going to see a Dr. who prescribes TRT through a “compounding pharmacy”, that is, they make up their own topical solution. Main reason is that it’s cheaper and I’m self-pay (long story). Does anyone have any experience with a “compounding pharmacy”?

No, my hair is not thinning noticeably (yet, knock on wood!) No I did not gel the day of my bloodwork, not even the night before if memory serves… Would it fluctuate that much, that quickly?

How often do I need to cycle off? It will be a year this March… Could this be part of the reason my numbers have dropped so dramatically? Also I had broken up with my (b*tch) girlfriend that week, I wonder how much the psychological had an effect?