TRT at 27

Pharma / TRT Testosterone Replacement
1

Hey there,

Thanks in advance for reading. I’ve pored over the forum here for hours, and this has to be the single best resource I’ve found anywhere for people going through all of this. Apologies in advance if I ask stupid or repeat questions–I can only promise that I really did read quite a bit first.

My background: sometime around February or March of this year, I started feeling like crap–low energy, lower motivation, drastically decreased libido and brain fog. I cleaned up my diet and started incorporating plenty of exercise, but the symptoms didn’t seem to improve much. Libido, in fact, all but disappeared, which has become particularly problematic for me.

Finally, this month, I went to the doctor with the symptoms and ended up getting some tests run, coming back with quite low T. My GP is enthusiastic but doesn’t seem quite up to speed yet–I think he put me on TRT too quickly with a very bad protocol, and I’d like to guide our treatment towards something more useful ASAP.

Full stats:

27 years old
5’11" tall
30" waist
150 pounds
normal or above body and facial hair; moderate on arms/legs/back, ability to grow a full beard
fat (14-16% BF) carried on lower back, upper thighs, lower abs
symptoms include low energy and motivation; brain fog; nonexistent libido
drugs include: 3-5mg melatonin (night); multivitamin; fish oil; occasional PWO (e.g. Jack3d); protein powder, if for some reason you’d count that

Lab Results (full history)

9/9 Testosterone/CMP at 2pm
Total T: 142 (348 - 1197)
Free T: 2.4 (9.3 - 26.5)
Glucose: 86 (65-99)
ALT: 54 (<45)
AST: 37 (0-50)

9/16 Thyroid at 10am
TSH: 1.560 (0.450 - 4.500)
Prolactin: 10.19 (4.0 - 15.2)
LH: 2.3 (1.7 - 8.6)
FSH: 3.2 (1.5 - 12.4)

9/23 Cholesterol Testing (fasted)
Total: 156
HDL: 60
LDL: 84
Trigs: 50

9/30 Followup at 8am (results pending)
Total T: 699 (348 - 1197)
Free T: 11.6 (9.3 - 26.5)
Cortisol: 23.4 (6.2 - 19.4)
Estradiol: 26 (7.6-42.6)

10/15 8:40am
Total T: 170
Free T: 1.6
CBC:

10/22 7:14am
Total T: 301 (348 - 1197)
Free & Weakly Bound %: 6.7% (9.0% - 46%)
F&W Bound: 20.2 (40.0 - 250.0)
SHBG: 55.9 (16.5 - 55.9)
LH: 2.1 (1.7 - 8.6)
FSH: 2.7 (1.5 - 12.4)
TSH: 3.400 (0.450 - 4.500)
fT4: 1.17 (0.82 - 1.77)

My diet is a closely monitored 2300-2800 kCal per day centered around lots of lean meats, vegetables, and nut butters, but also includes a good deal of variety. I generally end up with ~200g of protein per day and no less than ~70g or so of fat per day, and I make no attempts to limit cholesterol intake (I do like my eggs).

I do weight training three days a week for a little over an hour each session, and complement with short bits of moderate intensity cardio (<30m) 3-5 times per week.

I’ve noticed some transient/infrequent testicle ache since my vasectomy back in late 2011, but it’s actually diminished significantly since my symptoms started.

Morning wood and nocturnal erections haven’t seemed changed to me, but I hadn’t kept close tabs.

Temperature Log (Work in progress; IR started on 9/25)
09/24 [Before Bed] 97.0
09/25 [Waking] 96.7 [Mid AM] 97.3 [Mid PM] 97.8 [Late PM] 98.8 [Bed] 97.5
09/26 [Waking] 97.0 [Bed] 97.8
09/27 [Waking] 96.9 [Late AM] 97.2 [Mid PM] 97.8 [Late PM] 97.6
09/28 [Waking] 96.9 [Late AM] 98.6 [Early PM] 98.6 [Mid PM] 98.7 [Late PM] 98.1 [Bed] 97.1
09/29 [Waking] 97.1 [Late AM] 96.9 [Late PM] 98.1 [Bed] 97.1
09/30 [Waking] 97.5 [Late AM] 97.0
10/01 [Waking] 97.2 [Bed] 97.0
10/02 [Waking] 98.0 [Bed] 96.8
10/03 [Waking] 97.2
10/04 [Waking] 97.9

As soon as my testosterone results came in, my GP (cautiously, not pushily) recommended TRT. After doing just preliminary research, I agreed and he put me on a test cyp protocol of – prepare to cringe – 300mg every four weeks. I brought up the craziness of the protocol at the time, but he insisted that we “give it a try and retest” before adopting a different protocol; he claimed that he had many TRT patients and never heard of any injecting weekly or more frequently. To top it off, no self-administration, though I’m pushing back on that and it seems likely I can get that part figured out.

Despite my suspicions, I got that first 300mg shot on Monday (a little over four days ago). After reading a bit more, I expected to feel a pretty tremendous surge over the first few days, given that my levels should have shot into the supraphysiological stratosphere as I peaked.

Unfortunately, I’ve seen very little change. I’m maybe a little less irritable, but still have no libido, little motivation, and plenty of brain fog. I do think that my weightlifting results have improved, but it hasn’t been long enough to really know–it could just be the stupid 5 pounds of fluid I’ve retained, likely from all of the estradiol I’m aromatizing.

I sent a few messages to my doctor wondering if we should be looking into any pituitary issues (very low T despite low-normal FSH/LH), but the normal prolactin levels have given him a “wait and see” and he wants me to wait the full four week course (what’s happening in weeks 3 and 4, again?) before reevaluating. I retest my testosterone levels – and only my testosterone levels, for now–at the 2-of-4 week point, where I expect my levels to be nicely tanked at baseline again.

The condensed version of this: shouldn’t I have started feeling better very quickly from a TRT horse dose of 300mg? Why do I feel very little effect? And what tricks can I use to accelerate the fine-tuning of my treatment protocol with my doctor, so I don’t have to suffer too long under this rollercoaster that I’m signed up for?

Thanks, guys.

2

It takes time to feel better as brain changes take time. Takes time even when things are done properly. You doc has no idea what he is doing.

You know the recommended protocol from the stickies.

You have no idea what the cause is. Please post more labs, with TSH, CBC, cholesterol and check your body temperatures as per the advice for new guys sticky.

Starvation diets can wreck hormones.

You have low LH/FSH, but TT is so low, your testes may be a problem as well.

You need hCG to avoid sterility.

3

Thanks, KSman.

I definitely do need to have a bit more patience here–I’ll do my best.

I just had my cholesterol tested today (posted in edit) with a total/hdl/ldl of 156/60/86. Seems a little low. TSH is at 1.56 per the original testing. I’m going to ask my doctor for some more tests (CBC, E2, maybe cortisol) when he wants to retest my TT next week.

I’m actually fine with sterility (got my vasectomy back in '11), but all of the stickies and other readings suggest a lot of benefits to keeping that cycle working anyway.

In the meantime, I’m going to give IR a try (12.5 mg tabs arrive today) and attempt to be a little more patient.

Thanks again–I’ll come back with my information when I have it.

4

Can you describe your iodine intake history and body temps as per the thyroid basics sticky before IR?

Doc will think that your thyroid is perfect.

5

As far as iodine goes, I’d be surprised if I weren’t at least a little deficient, to be honest.

My added salt intake is fairly minimal and tends towards the not-iodized sea salt stuff; I do eat a fair amount of dairy (especially yogurt), but likely not enough to meet needs. Not much seaweed or fish.

I’m buying a new thermometer today and starting a temperature log, but my 12.5mg iodoral tablets are also supposed to arrive today (one day delayed!). I’ll start with 25mg per day and monitor closely, just on the off chance that I’m not deficient at all. I’m also going to start supplementing the 5000iu caps of Vit-D3, given that the Seattle sun isn’t doing much and the laughable 400iu in my irregularly-taken multivitamin isn’t much, either.

My doc still seems open to the possibility of thyroid or pituitary issues given the low-normal LH/FSH with quite low testosterone (my understanding is that primary usually presents with elevated LH/FSH), but the not-so-elevated prolactin levels have made him less worried.

I’ll report back with temps and observations from the blind IR and Vit-D.

6

I’ve updated the OP with the last week’s worth of temperature data. I’ve definitely been waking up cold–often even a little under 97.0.

I’ve been doing vitamin D (5000iu) and IR (2x12.5mg twice a day, for 50mg per day) for four full days and, despite feeling pretty crappy the past couple of days, my waking temperature does seem to be trending upwards now, even hitting 97.5 today. We’ll see if that keeps up.

I went in this morning for a testosterone retest, 2 weeks after the first 300mg shot. They’ll also be running cortisol and e2 along with it. I don’t expect much of interest there, but I’ll update with those results (and more temperature data).

7

Results came back today from the tests 14 days after my first 300mg injection. Total T is in the mid-range (699) and Free T is in the low normal range (11.6). E2 came back at 26.

From what I understand of the half life of cypionate, the odds of a 2-week-old injection keeping my levels boosted even that high are very low. That leads me to believe that the vitamin D and iodine might be doing something, particularly since my waking temps have continued trending upwards. Subjective well-being (mood, libido, motivation) all remain depressed.

I think I’m going to ask the doc to do another re-test of my testosterone levels before we go through with the next injection. If fixing my deficiencies is all I need to do to be myself again, I should probably try to find that out before I commit to injections.

UPDATE: I’ve shared my concerns with the doc and informed him about my D3 and iodine supplementation, and separately asked for another round of checks before we inject more. We’ll see what he says.

8

You need to wait to get to a steady state and wait for whatever the IR does to occur.

When you test, retest LH/FSH.

Try taking MORE fish oil caps, flax seed meal or oil, nut in your diet. Increase cholesterol with eggs/cheese.

IR can cause some transient effects on labs. Suggest that you not test thyroid hormones for a while after IR is finished. What really caught my attention with my IR was a major improvement in mental function. My effects might have been more pronounced than others; so my relative improvement could then also be more pronounced. I had other complicating factors from a severe hospital induced infection that I was recovering from. Do not do thyroid labs at doc’s office if he has palpated your thyroid, that can skew the readings.

9

Thanks, KSman–I followed the advice and upped by fat/cholesterol intake some more. No noticeable results yet, but good idea regardless.

Another round of testosterone tests (8:40am on 10/15) came back since my last post–IR doesn’t seem to have helped, as my levels were back to 170 total/1.6 (!) free. I’m not sure how the 2-week-old 300mg shot still had my levels so high, but it really appears it did.

I finally got in to see an endo today and he seems to be a pretty good one. He said he considers my case “interesting” with the secondary presentation; he’s having me retest LH/FSH along with ft4, SHBG and T. If the results are consistent with the previous ones, he’ll want a pituitary MRI and will start me off on TRT again. So far he still seems to be in the T monotherapy camp, but I haven’t explored the aromatase or hcg questions with him yet.

I’ll follow up as I learn more, but the real reason for sharing all this at this point is to let everyone know: getting a good doctor definitely matters!

10

Latest lab results came in–total T still low (though not quite as low), but the most notable thing is what appears to be a very high SHBG level.

Followup with the endo scheduled for next week. Not sure what to make of the high SHBG level given the normal E2 test from a few weeks ago. I’m guessing I’ll be on weekly T shots soon enough.

11

Just got back from the endo followup. I’ll be doing a pituitary MRI to look for a tumor and also an iron panel to screen for iron overload (hemochromatosis). He said that it’ll most likely end up being “idiopathic” (that is, “no clue”), but ruling out the big things was good.

He seems genuinely interested in understanding the source of the secondary hypogonadism, but his treatment modalities are definitely out of date. He views hCG as an either/or with testosterone (and seems to have the cost of hCG confused with HGH), and thinks that AIs are exclusively for those “abusing” testosterone–he thinks that aromatization issues necessarily and unequivocally imply an excessive T dose.

Fortunately, he’s much more flexible than my GP on the T regimen, and I now start controlling things myself. I did my first self-administered 200mg shot today (I’ll start doing 100mg/week once I can get smaller needles than the 22g harpoons I was prescribed–which, by the way, needles require prescriptions? give me a break!) and I ordered some research chemical liquid anastrozole.

I’m going to hold off on pursuing hCG until at least the first round of labs come back from T only; I don’t want my doc to cut the T dosage because of the endogenous hCG-driven production.

I’ll keep following up with my progress. Given my SHBG, I think I’ll need some time before I start feeling better; hopefully not too long!