T Replacement Timing with Workouts

Pharma / TRT Testosterone Replacement
1

Hi all- first post here. For the past few months I’ve been on a compounding test cream prescribed by my doctor. My current test level is up to 575 from 250 after 3 months using the cream. I’m applying 100mg daily in the morning on my forearms, rubbing my forearms together until it’s all absorbed. The cream is a concentration of 100mg/mL.

My question: I’m currently lifting in the gym 3 times a week (M,W,F) first thing in the morning before eating breakfast. Upon coming home from the gym I eat breakfast and apply the cream. Is this the optimal time during the day to apply the test cream? I’ve read that test level become elevated immediately after exercising. Would it be better to apply the cream before working out or later in the day?

As per KSman’s suggestion, here is my info:
-age: 34
-height: 5’11"
-waist: 31"
-weight: 163 lbs.
-describe body and facial hair: never been a hairy guy; no chest or shoulder hair, light forearm hair. I can grow a decent goatee but facial hair is patchy and sparse on cheeks. No male-pattern baldness; I have a full head of thick hair.
-describe where you carry fat and how changed: naturally slim but primary areas of fat storage are lovehandles, lower abs and butt.
-health conditions, symptoms [history]: overall very healthy and active. Over the past 2 years I had been feeling more and more sluggish and tired; at first I attributed this to getting older and not recovering as well/quickly. Finally decided to have blood levels tested and T levels came back way below normal in multiple tests (initial lab results below)
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: none
-lab results with ranges:

Initial lab results (May 15, 2015):
TT - LOW 190 (normal: 241-827) ng/dL
FT - LOW 6.1 (normal: 9-30) ng/dL
E2 - [not tested]
prolactin - 9.9 (normal: 4.0-15.2) ng/mL
LH - LOW 1.2 (normal: 1.8-8.6) IU/L
FSH - 1.2 (normal: 0.9-11.9) mIU/mL
TSH - [not tested]
fT3 - [not tested]
fT4 - 0.87 (normal: 0.70-1.48)ng/dL
fasting cholesterol - 191 (normal: 120-200) mg/dL
fasting glucose - 79 (normal: 70-99) mg/dL
DHEA-S - [not tested]
WBC - LOW 2.7 (normal: 3.4-10.8) x10E3/uL
RBC - 4.42 (normal: 4.14-5.80) x10E6/uL
Hemoglobin - 15 (normal: 12.6-17.7) g/dL
Hematocrit - 44.0 (normal: 37.5-51.0) %
MCV - HIGH 99 (normal: 79-97) fL
MCHC - 34.0 (normal: 31.5-35.7) g/dL
RDW - LOW 11.4 (normal: 12.3-15.4) %
Platelets - 203 (normal: 150-379) x10E3/uL
Lymphs - 39 %
Monocytes - 10 %
Eos - 2 %
Basos - 2 %
AST - HIGH 52 (normal: 15-37) U/L
ALT - 74 (normal: 12-78) U/L
IGF-1 - [not tested]
AM cortisol [tested at 8AM] - 22 (normal: 7-25) mcg/dL

Latest lab results 8 weeks after beginning TRT (Sept. 4, 2015):
WBC - 3.4 (normal: 3.4-10.8) x10E3/uL
RBC - 4.16 (normal: 4.14-5.80) x10E6/uL
Hemoglobin - 14.2 (normal: 12.6-17.7) g/dL
Hematocrit - 41.0 (normal: 37.5-51.0) %
MCV - HIGH 99 (normal: 79-97) fL
MCH - HIGH 34.1 (normal: 26.6-33.0) pg
MCHC - 34.6 (normal: 31.5-35.7) g/dL
RDW - 12.8 (normal: 12.3-15.4) %
Platelets - 214 (normal: 150-379) x10E3/uL
Neutrophils - 48 %
Lymphs - 41 %
Monocytes - 7 %
Eos - 2 %
Basos - 2 %
Neutrophils (Abs) - 1.7 (normal: 1.4-7.0) x10E3/uL
Lymphs (Abs) - 1.4 (normal: 0.7-3.1) x10E3/uL
Monocytes (Abs) - 0.2 (normal: 0.1-0.9) x10E3/uL
Eos (Abs) - 0.1 (normal: 0.0-0.4) x10E3/uL
Baso (Abs) - 0.1 (normal: 0.0-0.2) x10E3/uL
Immature Granulocytes - 0 %
Immature Grans (Abs) - 0.0 (normal: 0.0-0.1) x10E3/uL
Testosterone, Total, LC/MS - 583 ng/dL

I also had a pituitary MRI which came back normal.

-describe diet [some create substantial damage with starvation diets]: I’ve always eaten healthy at maintenance calories (~2300 kcal). Track my macros.
-describe training [some ruin there hormones by over training]: I used to be a professional cyclist. Lots of time in the saddle. Since then I mostly ski/run/hike/rock climb/weightlift.
-testes ache, ever, with a fever?: No
-how have morning wood and nocturnal erections changed: almost non-existent for the past few years.

Thanks for any help/advice!

2

[quote]ClimbBD510 wrote:
Is this the optimal time during the day to apply the test cream?[/quote]

It doesn’t matter what time of day you apply it.

This is bogus because the elevation in T is so small that it doesn’t do anything.

[quote]
Would it be better to apply the cream before working out or later in the day?[/quote] Again, doesn’t matter.

3

You should read the advice for new guys sticky.

4

[quote]KSman wrote:
You should read the advice for new guys sticky.[/quote]

Thanks KSman. Sorry to violate standard procedure here.

I’ve updated my original post with my stats and blood test values. Any additional input you can give as to the effectiveness of the treatment I’ve been on would be very valuable.

Thanks!

5

You MUST have LH/FSH data before starting TRT.

We know you have very low T, but at your age we need to know why.

Labs: you have some now
TT
FT
E2
prolactin
LH/FSH
TSH
fT3
fT4
fasting cholesterol [could be too low]
fasting glucose
DHEA-S
CBC
hematocrit
AST/ALT
IGF-1
AM cortisol [at 8AM please]

You seem to be someone who never had high T levels [sparse facial hair].
Perhaps this is a clue to your decline.

Please also see these stickies:

  • advice for new guys - did you read it all?
  • things that damage your hormones
  • finding a TRT doc

We have many here with low thyroid function.
You can check overall thyroid function by checking oral body temperatures:

  • when you first wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon
  • temps can be low from not using iodized salt long term and/or vitamins that list iodine+selenium
  • see the thyroid basics sticky if you have low temps or have not been using iodized salt.
6

KSman-

Again, thanks for the help! I do have my LH/FSH levels and most of the other lab tests you mentioned for my initial blood test; I updated my original post to show the values needed. My post-TRT blood test results above are all the values that were tested.

I did read through the stickies last night as well. I’m going to buy an oral thermometer today and check my body temperatures the next few mornings when I wake up. I will post those results here.

Again, really appreciate the help! This is a great resource for help on this issue.

7

fT4 - 0.87 (normal: 0.70-1.48)ng/dL

T3, T4, fT3, fT4 should be mid-range or a bit higher.
fT4 should be near 1.09
fT4 is low

You increased TT, but hematocrit went down. I am concerned that there is then a possibility of a GI bleed. Any digestive issues or food sensitivities? You can request an occult blood test that will provide a good answer.

RBC - 4.16 (normal: 4.14-5.80) x10E6/uL

  • also seems low VS your T levels!
  • TRT typically increases RBC and hematocrit

Are you using iodized salt [long term]? Iodine+selenium in your multi-vits?

AST - HIGH 52 (normal: 15-37) U/L
ALT - 74 (normal: 12-78) U/L
These are rather high. They can be elevated from sore or damaged muscles from training. The concern is that the liver might not be clearing estrogens properly. We do not have FT, E2 labs either.

Minimum TRT followup labs:
TT
FT
E2
CBC
hematocrit
AST/ALT

Keep an eye on this:
AM cortisol [tested at 8AM] - 22 (normal: 7-25) mcg/dL - seems rather high
So retest AM cortisol and also test DHEA-S, another adrenal hormone.

You have not tested Vit-D25
You can take Vit-D3 5,000iu per day then test Vit-D25 at a later date.
Vit-D3 is converted to Vit-D25 which is a very important hormone.

Energy and metabolic rate:
The key factors are typically T, E2, thyroid function and cortisol. Your T is greatly improved, but could still probably be higher. We need more complete labs to see whats going on with E2 and FT. Your cortisol does seem rather high. So that is not whats reducing your energy.

You should make sure that you are getting lots of health fats in your diet and should also get lots of essential fatty acids which can be nuts, fish oil and flax seed meal/oil.

Get that occult blood test and respond re digestion issues.

8

Thanks KSman!

I have my next follow-up with my TRT doc in December and will be doing a blood-test for that meeting; I will request to get the occult test and other values you suggested as well, as I think the current script is only for T levels.

As for iodine/selenium and healthy fats: my daily multi-vitamin is Orange Triad which has 150 mcg of iodine and 100 mcg of selenium; I don’t go out of my way to eat or cook with iodized salt though. I also have EVOO with salad just about every day, eat fish 2-3 times per week, and take a daily Omega-3 gel that has 1000 mg EPA+DHA. I try to keep my diet balanced and healthy and have been really focusing on getting all my micronutrients; let me know if you think I may be deficient.

I’ll report back when I get my next blood test; thanks again!

9

Deficient? Post body temps then ping me in the KSman is here thread.

Ask doc to setup lab work now, then do fasting labs at 8AM and have results for your appointment.

If body temps are low, test TSH, fT3, fT4 and try to avoid doc doing different.

10

Well I’ve been taking my AM and PM temperature as outlined in the Thyroid Basics thread and these are my values from the past couple of days:
10/19 PM: 97.8
10/20 AM: 97.7
10/20 PM: 97.8
10/21 AM: 97.6
10/21 PM: 98.3
10/22 AM: 97.7
10/22 PM: 97.5

While my AM temperatures seem ok, my PM temps never come up close to 98.6. Could this be a sign of Iodine Deficiency? I’m going to try to move my next appointment and blood test up to November to get results a little quicker. The tests I’m going to ask for are below. Any others I should consider requesting?

Occult Blood Test
RBC
TSH
fT3
fT4
rT3
TT
FT
E2
CBC
hematocrit
AST
ALT
Cortisol
DHEA-S
Vit-D25

Thanks!

11

Temperatures:
Place deep under your tongue.
AM temperature is from when you first wake up.
PM, avoid drinking, eating, taking for a while before checking.

Always good in a case like this to see that someone else can hit 98.6 with same thermometer.

Any symptoms:
feel cold easily
outer eyebrows sparse
thyroid enlarged, lump, asymmetrical
hair thinning, not male pattern