TRT a Year Later, Still Not Dialed In

Pharma TRT
21

Cholesterol total is too low. <160 is associate with increased all-cause mortality. 180 is ideal. Oops, I said that before.

Are you taking a statin drug?

Glucose is fine.

Cortisol is low leading to fatigue.

TSH, fT4, fT3 appear good. Low body temps then imply elevated rT3 and adrenal fatigue issues, one of which would be low cortisol, possible DHEA. You would test DHEA-S, not DHEA. Low thyroid function [temperatures] and low cortisol can be profound fatigue.

When on TRT with low thyroid function and low cortisol, one can feel bad because the increased/restored metabolic demands of TRT are more than the body can support.

Go back to the thyroid basics sticky and note references to:
stress
adrenal fatigue
cortisol
Wilson’s book that you need to read

Get these labs:
rT3 - reverse T3
DHEA-s [another adrenal hormone]

Note that more T4 can mean more T4–>rT3.

The one thing that does not make sense is that TSH should be higher, not lower if/when rT3 is blocking fT3 at the hypothalamus. So the story may have more wrinkles.

Adrenal fatigue can be difficult, no simple pill. Oral cortisol -hydrocortisone- medication is a good bridge in this situation.

Alkaline Phosphatase:
Men with recent heart surgery, malnutrition, magnesium deficiency , hypothyroidism, or severe anemia

Magnesium deficiency often shows up as leg/foot cramps. A good product “ZMA” is sold in this site’s Biotest store. Most people are deficient.

  • not B-12 deficiency
1 Like
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UPDATE:
I personally changed my dose on 8/5/2017 to 6ml of test and 10ml of HCG eod (42mg test per week and 70 Units HCG).

I was struggling too much with my prior dose (110mg T-Cypionate per week and 700UI HCG / 20UI HCG EOD) and honestly just picked a random number to back down…not sure where I came up with 6ml test and 10ml HCG…

Here are the labs on this dose that I started on 8/5/2017:

Testosterone, Serum 264-916 ng/dL F 506
Free Testosterone, (Direct) 8.7-25.1 pg/mL F 13.6
Dihydrotestosterone 30-85 ng/dL F 45
Estradiol, Sensitive 8.0-35.0 pg/mL F 16.6
DHEA-Sulfate 139-475 ug/dL F 360.1
SHBG 16.5-56 nmol/L F 38.5
PSA 0-4 ng/mL F 1.0

TSH 0.450-4.500 uIU/mL F .681
T4 .82-1.77 ng/dL F 1.66
T3 2.0-4.4 pg/mL F 3.4

Cholesterol, Total 100-199 mg/dL F 125
Triglycerides 0-149 mg/dL F 69
HDL Cholesterol >39 mg/dL F 46
VLDL Cholesterol Cal 5-40 mg/dL F 14
LDL Cholesterol Calc 0-99 mg/dL F 63

WBC 3.4-10.8 x10E3/u L F 3.6
RBC 4.14-5.80 x10E6/u L F 5.23
Hemoglobin 12.6-17.7 g/dL F 15.6
Hematocrit 37.5-51.0 % F 45.1
MCV 79-97 fL F 86
MCH 26.6-33.0 pg F 29.8
MCHC 31.5-35.7 g/dL F 34.6
RDW 12.3-15.4 % F 12.8
Platelets 150-379 x10E3/u L F 139
Neutrophils % F 59
Lymphs % F 29
Monocytes % F 10
Eos % F 2
Basos % F 0
Immature Cells X NP
Neutrophils (Absolute) 1.4-7.0 x10E3/u L F 2.1
Lymphs (Absolute) 0.7-3.1 x10E3/u L F 1.0
Monocytes(Absolute) 0.1-0.9 x10E3/u L F 0.5
Eos (Absolute) 0.0-0.4 x10E3/u L F 0.1
Baso (Absolute) 0.0-0.2 x10E3/u L F 0.0
Immature Granulocytes % F 0
Immature Grans (Abs) 0.0-0.1 x10E3/u L F 0.0

Glucose, Serum 65-99 mg/dL F 93
BUN 6-20 mg/dL F 10
Creatinine, Serum 0.76-1.27 mg/dL F 1.07
eGFR If NonAfricn Am >59 mL/min/1 .73 F 91
eGFR If Africn Am >59 mL/min/1 .73 F 105

BUN/Creatinine Ratio 9-20 F 9
Sodium, Serum 134-144 mmol/L F 142
Potassium, Serum 3.5-5.2 mmol/L F 5.1
Chloride, Serum 96-106 mmol/L F 101
Carbon Dioxide, Total 18-29 mmol/L F 26
Calcium, Serum 8.7-10.2 mg/dL F 9.5
Protein, Total, Serum 6.0-8.5 g/dL F 6.6
Albumin, Serum 3.5-5.5 g/dL F 4.5
Globulin, Total 1.5-4.5 g/dL F 2.1
A/G Ratio 1.2-2.2 F 2.1
Bilirubin, Total 0.0-1.2 mg/dL F 0.6
Alkaline Phosphatase, S 39-117 IU/L F 38
AST (SGOT) 0-40 IU/L F 11
ALT (SGPT) 0-44 IU/L F 12

Any input would be really appreciated…My symptoms are deceiving because for the first time my erections are good once aroused…
However, in general I feel apathetic towards everything, literally zero emotions and no desire to do anything.
Surprisingly energy levels are good and sleep is good…
No libido.
The apathy is killing me though, I am excited about nothing anymore…

Thank you for any input!

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It seems you’re in the same boat as me, it looks like libido will be the last to improve. I don’t think you issues are dose related, I think your receptors are just slow to respond. Where is your E2 typically cause it looks a little low on your last set of labs. The penis take the longest time to repair, how long were you low T for?

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E 2 fluctuates depending on my dose. I have been on TRT for about 18 months.

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Thyroid: Lab numbers could be suggesting a degree of hyperthyroidism. Please eval via oral body temps as discussed above. Sometimes iodine deficiency with higher TSH+years can progress to this. So your history of using iodized salt is important information.

When you report doses in ml’s, we do not know what that means. 6ml’s is ~1/4 ounce. You are confusing insulin needle iu marks with ml’s?

Are outer eyebrows sparse or full.
Do you get cold easily now or did in the past.
Thyroid enlarged, sore or lumpy?

Do you get over heated easily or heat intolerant.

Cholesterol is too low. <160 is associated with increased all-cause mortality. Cholesterol is your basis for making all steroid hormones, that includes cortisol and also Vit-D3. Oops, said that a 3rd time. Are you changing your diet?

Better to test free hormones fT3, fT4
Bound hormones are not bio-available.

You are not responding point per point to my posts. Seems like a waste of time.

26

KSman, I don’t want you to think your efforts are a waste. You are helping tremendously. I just got lost in all of the info and didn’t get the thorough bloodwork. I will get the correct ones this time around.

To answer your questions:

  1. Yes I was going off the needle size. But I guess you can just look at the mg’s of test that I put to make more sense. Is that a legitimate measurement or should I do something else?
  2. Eyebrows are full.
  3. I get hot easy…thyroid is not large or lumpy. (Please note I had issues with hypothyroidism before getting on trt, although that seems to have worked itself out.)
  4. I have been eating vegan pretty much since I have crohn’s disease, possibly why my cholesterol is low.

Here is what I will get done before I post another lab (per your previous posts):

  1. rT3 - reverse T3
  2. DHEA-s [another adrenal hormone]
  3. fT3 and fT4
  4. I will start to monitor my basal temp again in the morning upon awakening. (Last time I did it, it was consistently low).

Is there anything I am missing? Maybe a 24hr cortisol test? Let me know if you can add anything.

Eternally grateful to you man, thanks!