50 yo & I just finished my 12th week of TRT. Started because of fatigue, ED, irritability, loss of muscle mass / strength, and poor recovery after workouts. PCP tested me for everything under the sun to rule out cardiovascular or thyroid issues.
Original Total test was 396 (didn’t have free T). Went to a TRT clinic. Gave me test cyp 160 mg weekly (given as 80 mg 2x wkly) with no AI or hcg. Felt amazing for the first 3 weeks. Then mood and fatigue began creeping back in. Had significant testicular shrinkage, but ED stayed away thankfully. Workouts and strength began to fade about 6 weeks in. Just got labs after 12 weeks and looking to make adjustments to get back to closer to how I felt originally.
Everything appears “alright” with hormone levels being fairly high except for these above. Probably need to dial back dose a bit and talk to your doc about concerns with RBC/hematocrit. Tagging @systemlord who I believe has experience with these unless I recall wrong.
I agree with @blshaw, I think @Dad19 is overdosed. I feel better with slightly elevated hematocrit and hemoglobin, not everyone will, and studies show it to reduce the risk of dying.
I would also recommend ferritin testing within 3-6 months of starting therapy.
Sleep apnea can cause elevated hemoglobin and hematocrit. A sleep study was mandatory for me within the first 6 months of starting therapy, or TRT would have been stopped.
Also take into account, not every man was made to operate at high normal ranges, some feel better with Free T between 15-18 pm/mL. Too much T can actually make you feel sluggish and tired.
I would decrease the dosage by at least 20 mg, for a total weekly dosage of 140 mg. Maybe a larger reduction is necessary. TRT isn’t a set and forget therapy, you hormone levels will still vary from time to time.
The vitamin D is a bit low, might be responsible for some of your symptoms.
I do have sleep apnea. In fact, I’ve lost 26 pounds in the last 4 months and accidentally slept without my mask one night and did fine. Went a couple weeks without it until my wife said I was snoring again.
I usually give blood a few times a year, so I may do that. @systemlord have you had any positive variance from giving blood?
All of 2022 my endocrinologist forced me to get monthly phlebotomies, until a hematologist told my endocrinologist they were no longer needed if I wasn’t symptomatic. My blood pressure at the time was 110/64 with heart rates in the mid 60’s.
All my experiences were not good, a halving of my ferritin which took 3 weeks to recover, only to turn around and lose blood a week after recovering. Turns out Jardiance, a type 2 diabetes drug was responsible for extreme dehydration which elevated my hemoglobin and hematocrit.
I do have to supplement 150 mg of iron daily because TRT drags it down quickly.
This is why you feel unwell. The bottom end ferritin doesn’t bode well for symptom relief and TRT can’t work very well with lower ferritin. There are all sorts of metabolic abnormalities with low ferritin.
TRT has likely decreased your ferritin even more. I need ferritin 80> to feel good consistently.
Oh man, you’ve stepped into it. Have you discussed this with your doctor? It would be interesting to get your doctor’s take on this.
What you describe is actually common. I hear this almost every week and I probably do 8-10 six week re-evals a week Initially, you are running on your endogenous testosterone, though not great. You add exogenous test to this and, for a while anyway, run with both. Life is good. This has been referred to as the “honeymoon phase”. Once the hypothalamus determines you have plenty of testosterone, GnRH is shut down, endogenous testosterone drops and your overall testosterone decreases as you are now living on your injected testosterone by itself.
Decreasing your dose is not the answer, at least not usually. Unless the drop off is moderately severe (I do the initial re-eval at six weeks) I’ll have them ride it out for another four to six weeks, which you have. If not coming around by then, I will increase the dose. The “normal” ranges are often not high enough for guys to feel good.
Good luck figuring it out. Your doctor likely has experience with this scenario.
@highpull I have discussed it with them, which led to the recent bloodwork. I am analytical by trade and nature, so I like to have some external feedback to assess with. Wanting to ensure I am fully informed and not just blindly accepting treatment levels / changes. I appreciate the varying opinions.