Thoughts One Year into TRT

Pharma TRT
1

Quick backstory, 33 and was previously in pretty good health from all accounts although somewhat overweight. A few years ago I made a big move across the country, subsquently lost my job that I was allowed to “Take” with me, and reached my heaviest point…215lbs. Moved back to my hometown, started working again, and over the next few years began to slowly feel more and more sluggish and quality of life diminished.

Always tired, irritable, and suddenly depressed which was never an issue for me then in the Spring of 2013, while out of town on business, I (sorry to be graphic but this was the catalasyt for my TRT) noticed my ejaculate was extremely thick and there almost seemed to be cylndrical clumps. I knew something was really wrong so I made an appt with a Dr. my gf had heard of who specialized in HRT. So here I am. I guess I’d just like to share my experiences so far, get feedback, give feedback if applicable and hopefully learn a lot in the process.

-age 33
-height 5’11"
-waist 44"
-weight 225lbs
-describe body and facial hair:
Large midsection and chest. Not hairy, tough to grow a beard.
-describe where you carry fat and how changed
midsection and chest. Always been there to some extent.
-health conditions, symptoms [history]
None until recently. High blood pressure, high cholesterol.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Currently only TRT pellets, hydrocortisone. Previously only meds when sick; antibiotics, pain meds, etc. Always a short duration
– real dangers! see this http://propeciahelp.com/overvi…
-describe diet [some create substantial damage with starvation diets]
Average Western diet. Try to cook and eat healthy but plagued by travel and work I eat fast food. Incorporating vegetables fruits moreso than ever.
-describe training [some ruin there hormones by over training]
Running on my treadmill when I have time. Short bodyweight exercises every now and then. This is my single biggest area of weakness.
-testes ache, ever, with a fever? No
-how have morning wood and nocturnal erections changed
Since TRT, back to normal. Previously I would rarely have morning erections.

Lab Work Prior to TRT May 2013.

             Low	Normal	High	Reference Range

Reverse T3, Serum 12.6 (9.2-24.1ng/dL)

Test Low Normal High Reference Range
Igf-Bp3 4.1 (3.5-7.0mg/L)

Test Low Normal High Reference Range
Insulin-Like Growth Factor I 133 (71-241ng/mL)

Test Low Normal High Reference Range Units
25-Hydroxy, Vitamin D-2 <1.0 N/A
25-Hydroxy, Vitamin D 22 N/A
25-Hydroxy, Vitamin D-3 21 N/A

Prostate-Specific Ag, Serum

Test Low Normal High Reference Range
Prostate Specific Ag, Serum 0.9 (0.0-4.0ng/mL)

Test Low Normal High Reference Range
T4,Free(Direct) 1.07 (0.82-1.77ng/dL)

Test Low Normal High Reference Range
Prolactin 8.1 (4.0-15.2ng/mL)

Test Low Normal High Reference Range
Pregnenolone, Ms 43 N/A

Comp. Metabolic Panel (14)

Test Low Normal High Reference Range Units
Glucose, Serum 104 (65-99mg/dL)
Bun 12 (6/20/2014mg/dL)
Creatinine, Serum 1.01 (0.76-1.27mg/dL)
Egfr If Nonafricn Am 98 (>59mL/min/1.73)
Bun/Creatinine Ratio 12 (8/19/2014)
Sodium, Serum 138 (134-144mmol/L)
Potassium, Serum 4.3 (3.5-5.2mmol/L)
Chloride, Serum 98 (97-108 mmol/L)
Carbon Dioxide, Total 26 (20-32 mmol/L)
Calcium, Serum 9 (8.7-10.2mg/dL)
Protein, Total, Serum 6.3 (6.0-8.5g/dL)
Albumin, Serum 4.3 (3.5-5.5g/dL)
Globulin, Total 2 (1.5-4.5g/dL)
A/G Ratio 2.2 (1.1-2.5)
Bilirubin, Total 0.5 (0.0-1.2mg/dL)
Alkaline Phosphatase, S 69 (25-150 IU/L)
Ast (Sgot) 26 (0-40 IU/L)
Alt (Sgpt) 48 (0-44 IU/L)
Egfr If Africn Am 113 (>59 mL/min/1.73)

Cbc/Diff Ambiguous Default

Test Low Normal High Reference Range Units
Wbc 5 (4.0-10.5 x10E3/uL)
Hemoglobin 15.8 (12.6-17.7 g/dL)
Hematocrit 44.9 (37.5-51.0 %)
Mcv 90 (79-97 fL)
Mch 31.7 (26.6-33.0 pg)
Mchc 35.1 (31.5-35.7 g/dL)
Rdw 12.9 (12.3-15.4 %)
Platelets 249 (140-415 x10E3/uL)
Neutrophils 53 (40-74 %)
Lymphs 37 (14-46 %)
Monocytes 8 4/13/2014 %)
Eos 2 (0-7 %)
Basos 0 (0-3 %)
Neutrophils (Absolute) 2.5 (1.8-7.8 x10E3/uL)
Lymphs (Absolute) 1.9 (0.7-4.5 x10E3/uL)
Monocytes(Absolute) 0.4 (0.1-1.0 x10E3/uL)
Eos (Absolute) 0.1 (0.0-0.4 x10E3/uL)
Baso (Absolute) 0 (0.0-0.2 x10E3/uL)
Rbc 4.97 (4.14-5.80 x10E6/uL)

Estradiol
Test Low Normal High Reference Range Units
Estradiol 14.6 (7.6-42.6 pg/mL)

Tsh
Test Low Normal High Reference Range Units
Tsh 1.42 (0.450-4.500 uIU/mL)

Testosterone,Free And Total
Test Low Normal High Reference Range Units
Testosterone, Serum 177 (348-1197 ng/dL)
Free Testosterone(Direct) 7.3 (8.7-25.1 pg/mL)

Post TRT July 2013

Test Low Normal High Reference Range Units
Hematocrit 48.3 (37.5-51.0 %)

Testosterone, Serum

Test Low Normal High Reference Range Units
Testosterone, Serum 727 (348-1197 ng/dL)

Test Low Normal High Reference Range Units
Hemoglobin 16.1 (12.6-17.7 g/dL)

Test Low Normal High Reference Range Units
Estradiol 42.4 (7.6-42.6 pg/mL)

Test Low Normal High Reference Range Units
Prostate Specific Ag, Serum 1.0 (0.0-4.0 ng/mL)

Stress Profile
DHEA 7am-9am: 224 Range: 71-640pg/ml
DHEA: Cortisol Ratio/10,000 303 Range: 115-1,188

Cortisol:
1hr after Rising
0.74 Range 0.27-1.18mcg/dl

11am-1pm
0.11 Range 0.10-0.41mcg/dl

3pm-5pm
0.06 Range 0.05-0.27mcg/dl

10pm-12am
0.03 Range 0.03-0.14mcg/dl

Lipid Pofile: Oct 2013

Total Cholesterol: 260 Ref Val: <200
LDL: 149 Ref Val: 40-130
HDL: 35 Ref Val: >40
Triglycerides: 239 Ref Val: 30-150
Non-HDL: 225 Ref Val: <160

BioMarkers:
Apo B-100: 124 Ref Val: 40-100
C-Reactive Pro: 1.6 Ref Val: <3

Current Supplement Regmine:

Doctor Prescribed
Pregnenolone 100mg x1/day
DHEA 50mg x1/day
Ashwagandha 450mg x2/day
Hydrocortisone 5mg x2/day
Vitamin D-3 2,000IU x2/day
CoQ10 100mg x1/day
Adrenal Rebuilder (procine glandulars) 910mg x2/day
Resveratrol 250mg x2/day
Endothelial Defense (Pomegranate extraxt) x2/day
Anastrozole .5mg x2/week

My additions
Multivitamin x1/day
Fish Oil (1562mg) x1/day

I’m sorry for the long post. No tests since Oct 2013. I’m hoping to get labs run again soon.

I’m currently on 1200mg of Test Pellets. Around this time last year when they were first implanted, my Dr. gave me a free voucher for Axiron and told me to use it for a few days because it would take a few days to see any effects from the pellets. About three days after getting the pellets, and three days of using Axiron I have to say that was the best I’ve felt since I could remember. I was constantly smiling and in a great mood. It was nothing short of amazing. Almost a year later I’ve unsure of what’s happened. After the second lab work that showed my Estradiol at 42.4 my Dr. put me on .5mg x2 week of Anastrozole. I feel almost as bad as I did before starting TRT and I’m not quite sure what to do now. I have trouble losing weight and I’m extremely frustrated at this point.

Thoughts?

KSman is Here
2

How long are those Test Pellets suppose to last? How often do you have to get them replaced?

Yeah definitely time for more labs.

Estradiol 42.4 to high
The men in the balanced quintile with the fewest deaths had serum estradiol levels between 21.80 and 30.11 pg/mL

DHEA 7am-9am: 224 ideal : 350-500 ug/dL

Total Cholesterol: 260 to high.
Lowering serum cholesterol to an optimal range (total cholesterol 160 - 180)

LDL: 149 To high
Standard therapy for those at increased risk for heart disease is to keep LDL below 70 mg/dl.)

HDL: 35 to low

Triglycerides: 239 to high
triglycerides / HDL = 6.8 Not good…

2 or less is considered ideal
4 - high
6 - much too high

Combining HDL-C and TG into a ratio (i.e., TG/HDL-C) is probably the single best predictor of cardiac risk you can derive from a standard cholesterol test. The lower the ratio, the lower your chances of having an adverse cardiac event, as the medical community describes it (e.g., a heart attack).

Have A VAP Test done. Find a doctor who understands it and how to treat based on the results.

This test provides a more comprehensive heart disease risk assessment than a conventional cholesterol test. By directly measuring (not estimating) total cholesterol, LDL, HDL, VLDL, and several clinically relevant cholesterol subclasses, the VAP test allows your doctor to fully assess your risk of coronary heart disease and more effectively tailor follow-up assessments and treatment strategies.

The best way to measure your heart disease risk through LDL cholesterol is to measure the number of LDL particles in your blood. You can look at the concentration of something called apoprotein B, or ApoB for short. Every LDL particle has approximately one ApoB, so knowing how much ApoB you have gives you a very accurate measurement of the number of LDL particles you have. You get that with the VAP test.

One of the best things you can do for heart disease risk is to cut your carb intake to 50 to 100 grams a day. this will help you Lose weight also., cut out simple sugars, avoid trans fats, fast food. I’d recommend reading Mark Sisson books.

3

I appreciate the reply. My Dr. said it varies but roughly 3-5 months, 5 being at the very end of the spectrum and you’d probably begin to “crash” pretty heavily. Due to work and other things I went from Oct to April (close to 6 months) and there’s a significant dropoff in QOL. I believe he anticipates someone would get them implanted every quarter or so.

Thanks for the heads up on the VAP test. I think I’m going to get one through LEF.

4

My understanding is that the standard protocol for pellets is every 3 months. However, people start to crash during the 3rd month. My experience has been that a dosage every 2 months is better - how many pellets are you having implanted, 14? Pellets can be expensive (as you probably know) if your insurance does not cover it, have you considered switching to something that you can personally titrate a little better such as gels or injectables?

5

I was told 3-4 months but in my situation my doctor’s office is a few hours away and my schedule caused me to go longer. I think once a quarter would be perfectly fine. Pellets are pretty expensive but that will depend on how often you have them implanted. I would prefer something like Axiron but my insurance doesn’t cover it and I believe it’s around $480/month. My Dr. had been against anything other than pellets (which worries me) but after a lot of back-and-forth I’ve gotten him to consider a gel…one in particular is covered by my insurance and would be almost 10times less expensive than my current treatment. I’ve decided I’m going to try this my next go round. That coupled with my own periodic testing via lef I should be much more informed on what’s happening. Thank god for this site.

I believe 12 were implanted this last time.

6

I just had my bloodwork done and everything came back normal according to my doctor. Unfortunately I feel pretty awful. Moody, rundown, almost like I did before ever starting TRT. I honestly have no idea what to do now. I’m trying to get a sleep studt done because I’m almost positive I have sleep apnea. I hope that will make some difference in how I feel.

Via LabCorp

Vitamin-D3 38 (30-100)

Testosterone 797 (348-1197)

TSH 0.739 (0.450-5.500)

Thyroxine T4 Free 0.99 (0.82-1.77)

Estradiol 5.9 (7.6-42.6)

PSA 1.3 (0.0-4.0)

IGF-1 183 (88-246)

Reverse T3 Serum 10.7 (9.2-24.1)

Before starting Test, my Estradiaol was around 7 then jumped to 42 after I started and I’m currently on Anastrozole .50mg twice per week. Clearly that’s working. I feel like my chest is getting larger and not in a good way so the E2 number is throwing me off. Also, and I apologize for being graphic, but my semen has gotten extremely thick to the point I’m getting concerned. I’m tried drinking more water hoping that would alleviate the issue but it hasn’t helped. It was like this just before starting TRT which made me worry something had gone wrong with my levels recently.

Any ideas? Possibly any suggestions on other tests I should have run? I’m lost at this point.

7

The point of taking an AI like adex is to get your estrogen from high to normal, not normal to low. Lower the AI dose and get back to where men feel ok, closer to 20-30.

I feel like death with an E under 10. Honestly, I feel worse with low E than low T.

Also, some D3 woulden’t hurt you.

-Jim

8

It’s strange I’ve been on 5000+iu of D3 daily plus 50,000iu of D3 once a week for a year and my D3 levels rose only 15pts.

I’m going to lower the AI dose and hopefully that helps. I honestly didn’t think it would be this tough to get everything dialed in.

9

You are an anastrozole over responder. Please see the advice for new guys sticky or estradiol sticky. Stop for 4-5 days, then resume at 1/4th the dose. Hard to do that with tablets, you can dissolve in vodka then dispense by the drop. Best dosed every other day [EOD].

Your fT4 should be mid range and you are low relative to that. Please read the thyroid basics sticky, take body temperatures and evaluate your iodine intake. Your TSH does not indicate any problems, but not everyone fits the classic patterns. fT3 is what really gets the job done and you should have labs for that. You can do labs on your own via LEF.org [except in some states].

Cholesterol: TRT typically improves, but extreme low E2 can make things worse. Add high potency B-complex multi-vits that also have iodine and trace elements.

Your IGF-1 is too low for your age. Not sure what non age-related causes might be doing this.

If your metabolism is low from thyroid issues, that can explain what happened to you to some extent. Low E2 can make one feel depressed and kill libido.

You doc may be a pellet guy because it makes more $$

10

Thanks, KSman. I really appreciate you taking the time to give me some feedback.

11

Be advised that some guys here have reported that the longer their E stays too low, the longer it takes their bodies to bounce back when in a normal range. I know I took about 1-2 months to feel back to 100% after my E was around 5 for 3 or more months…

As you lower your AI dose you should trend higher and cross the sweet spot. If you crash again soon after you’ll know you need to raise the dose again and tune in. Sad that Adex tabs are so hard to split and measure, because it becomes almost impossible to know how much you are taking when you break them into quarters…

12

Thinking about this some more. Your LH and FSH were not tested. So that leaves the possibility of secondary hypogonadism. As in the advice for new guys sticky, for younger men, a MRI is often done to check for a pituitary adinoma or damage from a blow to the head etc. We also see that IGF-1 might be a bit low for your age - another reason to suspect something is wrong with your pituitary.

We also see TSH is low when we expect high with your lower fT4, another possible pituitary issue. If there is pituitary insufficiency, a rather broad and deliberately broad term, then other things can be off, such as dopamine. But prolactin was low, so we do not have any reason to suspect a prolactin secreting adinoma.

Doctors often simply see low T as the condition, not the symptom and do a poor job of diagnostics to fine the root cause. But they may be blinded by the business end of making money off of pellets.

Cortisol secretion from the adrenals is controlled by another pituitary peptide hormone. Progesterone is the feedstock for making cortisol. A good diagnostician will check progesterone levels in this situation. See this: Steroid hormone - Wikipedia - also in the advice for new guys sticky.

And a reminder that thyroid problems undermine all body and mental functions. Do not ignore my suggestions to follow those leads.

13

I’ve ordered a thyroid panel from LEF which includes fT3 like you previously mentioned. I’ll look into getting a LH/FSH and Progesterone test, too.

I did purchase a digital thermometer and have taken my temps at various times. I haven’t gotten higher than 98.1 in the middle of the day even though I feel hot. Temp upon waking was 97.4. I also picked up some 1000mcg Sea-Iodinde from LEF just in case.

I have a consultation with a sleep specialist for my sleep apnea next Thursday. I’m taking all of my labs since it’s the most current blood work and, if given the chance, might discuss my other issues. He’s a young Dr. and hopefully he’ll be receptive, maybe I’ll get good feedback but I’m not going to hold my breath.

Trust me I’m not going to ignore your suggestions. You (along with this forum) have given me the most helpful information since I started this whole process. I can’t you thank enough for the help.

14

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Got more labs done on Monday and got the results back today. Getting blood testing done with LEF is incredibly convenient.

E2 basically doubled and is slowly increasing from my previous labs. I had those done on May 9th, took about 10 days to get the labs back, and from that point until now I’ve maybe taken 2mg total of anastrazole and it’s only moved that much.

Of course the most obvious thing is my LH/FSH. I’m taking my bloodwork with me to another Dr’s appt tomorrow. Totally different doctor and I’m going to see if he has any comments or might refer me to someone else.

Thanks to KSman for recommending I get tested for LH/FSH. My HRT doctor never brought it up but constantly talked about how he wanted to know why I had low T, etc. I did one of those heavy metals tests and he swore that’s what is probably causing all of this. I don’t think I’ll be going to him anymore.

15

Your LH is low because you’re on TRT. That’s normal. Believe KS was saying you should have had those checked before…

Your E2 is low though. You should feel better once that sits around 20 for a while…

16

That was dumb on my part. I should have read more carefully that those extremely low levels would be expected while on TRT.

Met with a pulmonary dr today and he believes I do have sleep apnea but kept stressing how the testosterone could be causing it. I’m aware it can exacerbate the issue but I had it well before starting TRT. Despite reading over my pre-TRT labs he was not sold that I actually needed it. I strongly disagreed so he is referring me to an endocrinologist to hopefully determine the cause of my issues if it’s even possible at this point.

Guess all I can do now is hope my E2 levels improve because I’m still not feeling like any of this really making a difference in my QOL.

17

Saw an Endocrinologist this past Tuesday since I was becoming more and more irritated that my TRT doc didn’t test LH/FSH before prescribing me Test a year ago. Endo went straight to the “oh I see this all the time, your doc screwed you…I guess I can try to help” but seemed terribly uninterested in helping me.

I explained all of the symptoms I was experiencing and how I was at the lowest point, QOL-wise, I had been in my life. He looked at my pre-TRT labs, saw the T(177) and said it was meaningless because the test was done in the afternoon and that there’s nothing to say my T wasn’t normal. I basically had to twist his arm to come up with something or another route I could take.

Finally he mentioned he has another patient of his who just started Clomid and he was willing to prescribe me if I stopped TRT for a few months and retested to see if my body was able to recover. Granted he mentioned that being on TRT for a year might take somewhere close to a year, more, or possibly never to recover. Retest in 3 months and maybe I’ll start Clomid.

I’m done with pellets forever. Too expensive and far too much E2 management just to feel “normal”. I had been on Androgel for the past few weeks and had felt better than I had in a long time. Test T on Wednesday and it was 407 which actually seemed like a good area for me based on how I felt recently. I guess I have that to fall back on.

Missed my sleep study and have it rescheduled in a few days. I know this is a longshot but I’m hoping there’s some correlation between lack of/horrible sleep and low(er) T levels and getting my sleep under control could give me somewhat of a boost.

I will say this, I’ve been off T for three days and I feel miserable. I was told there would be a crash but this is almost unfair.

Any have any ideas on supps to take in the meantime? Should I continue to take DHEA and pregnenolone?

18

T4 is way below mid range. fT3 is good. With low body temps, that does suggest elevated rT3 which would explain TSH=1.45: BUT you reported Reverse T3 Serum 10.7 (9.2-24.1) which leaves me not understanding your situation.

I have not seen you respond to the issue of iodine.

19

I’ve started using table salt, began taking a 325mcg kelp pill, then changed to a 1000mcg pill. Got a little more bogged down in the T/E2 issue and let the iodine fall by the wayside. I’m guessing I should start again.

20

Quick update:

Have been off TRT since early August on the advice of my Endo since he was skeptical of the Low T diagnosis in the beginning. Started using a CPAP for sleep apnea in Oct. Thought that would show in others areas of my health but that’s not the case. Decided to get some labs done on my own to see where things stood. Cant say I’m surprised at this point. The low T/E/SHBG is what’s puzzling me. Cholesterol had been steadily declining but shot up again. Not sure what to do at this point.

Testosterone, Serum 216 ng/dl 348-1197
Free Testosterone(Direct) 8.6 pg/ml 8.7-25

LH 3.2 mIU/mL 1.7-8.6
FSH 2.4 mIU/mL 1.5-12.4

DHEA-Sulfate 197.4 ug/dl 138.5-475.2

Cortisol 18.8 ug/dl 2.3-19.4

TSH 0.67 uIU/mL 0.450-4.500

Estradiol <5.1 pg/mL 7.6-42.6

Progesterone 0.3 ng/mL 0.2-1.4

Triiodothyronine,Free,Serum 3.0 pg/mL 2.0-4.4

Sex Horm Binding Glob, Serum 14.6 Low nmol/L 16.5-55.9

Insulin 25.5 High uIU/mL 2.6-24.9 M

LDL Cholesterol Calc 174 High mg/dL 0-99
VLDL Cholesterol Cal 78 High mg/dL 5-40
HDL Cholesterol 37 Low mg/dL >39
Triglycerides 391 High mg/dL 0-149
Cholesterol, Total 289 High mg/dL 100-199