I’ve read a lot but as is often the case in medicine, I keep finding contrary evidence. Hopefully the questions raised in this thread will be common enough that experienced members can answer easily, and new members can benefit from. I’ve rearranged the format for readability; everything is here - I think.
QUESTIONS
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Recommendations for hCG dose/schedule for TRT purposes. I’ve heard that daily low-doses are less disruptive of T:E ratios. Inversely, I’ve heard 1,000IU, once a week is best due to Leydigs’ refractory period - you’ll retain better sensitivity to hCG/LH as well.
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Pituitary shutdown is more easily roused than testicular shutdown, correct? So SERMs have no place in TRT, correct?
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Rely on symptoms before numbers for dosing, right? What are the best (anecdotal) cues to finding the right dose for you? I’d rather not wait for gyno to consider tweaking, but I want to see improvement as soon as possible.
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Should I avoid an AI? Entirely? I’ve heard of PRN dosing but that seems anti-homeostasis. (Although if we’re in this sub-forum, chances are our natural homeostasis doesn’t really work for us.)
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Based on my phenotype (height, low body fat, low BMI) and considering my family history I don’t think I have a propensity for aromatization or DHT build-up so I’m thinking of trying to maintain levels towards the end of the free T range. Is this a reasonable thought process?
STATS
23 years old
6 feet, 140 lb.
No AAS history, no trauma, no suspicion of a tumor (skipping MRI), no testicular abnormalities, no skeletal abnormalities, no obvious symptoms of high estrogen.
Summary Labs:
TSH, LH, FSH, SHBG all low-average to average, consistently.
Testosterone:
10/11
Quest
396
11/11
Hospital A
371
01/12
Hospital B (#1)
262 (free 165)
03/12
Hospital B (#2)
312
Clomiphene test: failed/aborted
I started clomiphene 50mg 3x/week in early January.
I stopped taking the clomiphene after about six weeks. Endo asked me to trial it for twelve. I probably shouldn’t have stopped but I didn’t notice ANYTHING after six weeks. In twelve do you think I would have seen improvement? (Sincere question.)
LABS
*I’m about to start on gel but I’m waiting to have E2 and DHT tested.
**These tests were performed at three different labs, unfortunately.
Test 1: Quest
Test 2: Hospital A
Test 3 & 4: Hospital B (#1,2)
-------------------------TEST 1: Mid-October 2011
TSH 2.87
0.40-4.50 mIU/L
Testosterone, Total 396
250-1100 ng/dL
-------------------------TEST 2: Early November 2011
TSH 2.54
0.5-5.7 mU/mL
LH 3.7
1.7-8.6 mU/mL
Prolactin 9.6
4.04-15.2 ng/mL
Testosterone, Total 371.1
249-836 ng/dL
SHBG 32
10-60 nmol/L
-------------------------TEST 3: Early January 2012
-Free Testosterone-
Testosterone: 262 NG/DL
Reference Range 450-1000
SHBG: 32 NMOL/L
Reference Range 13-90
Albumin: 5.1 G/DL
Reference Range 3.6-5.1
Calc Free Test: 165 PMOL/L
Reference Range 180-900
*Is this a problem? Calculated (via T/SHBG?) instead of using analyte?
-Free Thyroxine-
Free Thyroxine: 0.9 NG/DL
Reference Range 0.6-1.2
-Prolactin, Blood-
Prolactin: 12 NG/ML
Reference Range 2-15
-Iron Profile-
Iron: 75 uG/DL
Reference Range 50-160
Transferrin: 292 MG/DL
Reference Range 200-340
TIBC: 369 uG/DL
Reference Range 250-430
Saturation: 20 %
Reference Range 15-47%
-Ferritin-
Ferritin: 56 NG/ML
Reference Range 16-287
-Thyroid Stimulating Hormone-
TSH: 2.90 ulU/ML
Reference Range 0.30-4.5 FSH
-Follicle Stimulating Hormone
FSH: 5 IU/L
Reference Range 1-15
-Luteinizing Hormone-
LH: 3 IU/L
Reference Range 2-6
-Prostate Specific Antigen Diagnostic (Monitoring)-
PSA 0.5 NG/ML
Reference Range 0.1-2.8
-IgF-1-
IGF-1: 294 NG/ML
-------------------------TEST 4: Mid-March 2012
-Free Testosterone-
Testosterone: 312 NG/DL
Reference Range 450-1000
SHBG: 32 NMOL/L
Reference Range 13-90
Albumin: 4.8 G/DL
Reference Range 3.6-5.1
Calc Free Test: 206 PMOL/L
Reference Range 180-900
-Luteinizing Hormone-
LH: 4 IU/L
Reference Range 2-6
-Prostate Specific Antigen Diagnostic (Monitoring)-
PSA 1 NG/ML
Reference Range 0.1-2.8
-CBC-
WBC 4.15 K/UL
4.4 - 11.3
RBC 5.10 M/UL
4.4 - 6.0
Hemoglobin 16 G/DL
13.8 - 18.0
Hematocrit 46.8%
40.0 - 54.0
MCV 92 FL
80 - 96
Platelet Count 230 K/UL
150 - 450
RDW 12.0%
11.5 - 13.4
DETAILS
Small side of average frame. Traditional proportions/no skeletal abnormalities (shoulder-chest-waist-hips ratio, limb length, skull proportions). Waist: 28
Low body fat (hover from 3-6% according to Tanita. [scale])
Moderate facial hair; little body hair.
Diet: I definitely eat enough calories but I can’t gain/maintain any weight beyond my current. Regarding TRT, I do want to gain weight but I don’t plan on adjusting my diet to perfection. Health/fitness is my priority.
I’ve tried supplementing zinc a number of times in recent years. And nearly every other vital nutrient. No known deficiencies, no observed benefits.
Sleep: 7-8 hours consistently, although I often need sleeping pills, which interfere with the quality of sleep.
Training: Especially in the past year, I’ve been lazy as hell. Not looking to troubleshoot anything related to training though.
Blood pressure and blood sugar normal.
No hair loss/prostate drugs, ever.
No consistent Rx
Morning wood has decreased to intermittent. This seems most highly correlated with sleeping pills - for me at least.
Testicles have never ached with fever.
Condition History: None, really. Born nearly ten weeks premature. No noted effect on development aside from low birth weight (but not low weight for that stage/timeline of development). I’ve been wondering about this one. Insight, anyone? Developmental links?
Thanks guys - I’m really looking forward to this. It’s amazing how knowledgeable some of you are: Honorary ThD’s. Hah. You help a lot of people with life-changing shit. That’s incredible. Cheers!