Tuscans HRT

Pharma / TRT Testosterone Replacement
1

Hello,

I have been reading this site for about three months trying to learn as much as I can. I was just beginning to work with a local doctor on some TRT when I discovered this site. Here is a bit of my history.

Age: 53
height 6’1"
waist: 34"
weight: 188
Hair: Full head hair, no chest hair, light to medium hair on legs and arms and face
Mild belly fat coming on over last two years
Body fat probably close to 12%-14%
Symptoms: For many years general fatigue especially when idle, more recently lower libido, lack of mental toughness and drive, social withdrawal, Have been getting post work out muscle soreness over last couple years which has progressively become more evident with age

Have taken oral DHEA for 8 years, now on 50mg dhea and 100mg 7 keto dhea per day which helps, have tried stopping for periods and get a set back, but despite taking the DHEA, i feel my symptoms gradually increasing
Exercise: I work out on stationary bike most everyday with interval training for half hour, stretching, pushups, pullups, abdominal work
Diet: Very clean for years, lots of fresh vegetables, lean proteins, whole grains, two to three meals a day,
Work: Desk work mostly
Testes: some intermittent aching when starting trt, hcg, ai
Morning wood intermittent until starting trt, now morning wood, but erections typically not sustainable, however biggest issue is lack of libido or desire for sex or even the urge to have sex despite having an erection and of course orgasms not as intense or pleasurable.
I take no prescription drugs, just supplement with D3 2000, Vit C, Zinc,

I have high bilirubin suggestive of Gilbert’s syndrome
I have high cholesterol total, but High HDL’s at 102, so excellent ratio
All other labs are in good shape, no prostate issues.

Have been working with an open minded doctor, has given me dhea creme which i did not notice a change with.

With no improvement with DHEA creme, we did blood tests:

Unfortunately I have never had any testosterone testing done prior to this year so I do not have a younger life baseline.

Starting levels: Testosterone total: 632, normal 280-800
Free test: 22.2 normal 7.2 -24

		Dhea Sulfate        118.4		Normal 44.3-331

		Estradiol: 		23.1			7.6-42.6
		SHBG		32.9			14.5-48.4

		Igf-1			180			94-252
		Prolactin		8.4			2.6-18.2
		T uptake		.69			.65-1.3
		T4			6.2			4.5-12
		T4- T Uptake	8.99			6-11.8
		TSH			1.46			.30-5.0

Doctor prescribed Testosterone creme at 100mg per day, titrated up over a couple months, as dose increased I noticed improvement which quickly went away until next increase in dosage, which of course I learned when I found this site was because of estrogen going up, and sure enough my next blood test shows the increase in E2 and drop in total T. Post work out soreness did improve, had days of improved wood, but libido still depressed

		Total T:		473			193-740 (not sure why range changed within a couple months)
		Free T:		19.6			7.2-24
		SHBG		32.9			14.5-48.4

Doc now has me on Injectable Testosterone 150mg per week which I self pin three times a week, Hcg 250iu two times per week and
Anastrozole 1.5mg per week divided doses eod.

I haven been transitioning from creme to injections this past month so I am still do not necessarily feel that I have been dialed into any sweet spot yet. I am four weeks in on injections and will be getting blood tests within two weeks. libido is still about the same, morning wood a bit better but desire and mood and energy still about the same with some days intermittently that I do feel a bit better. I am still having some post work out soreness, but not as bad as if I were on nothing.

If you have any suggestions or comments I would appreciate it. If any recommendations for next blood tests to be done I am open.
I have been reading as much as I can off of this site and my doctor is flexible to incorporate any new ideas that he can support.

Thanks

2

Here is my update and my current blood test results:

Total testosterone: 935, range 348-1197, There is a note to reference lab corp’s change to this range
Free Testosterone 26 Range 7.2-24
Estradiol: 40 Range 7.6-42.6

As far as symptoms, I believe I passed through the sweet spot a couple weeks ago as my libido has gone down with my energy somewhat, but my post work soreness has been improved.

I was taking 150 mg testosterone three SQ injections per week and 1.2 mg anastrozole per week and twice a week 250iu hcg

I am going to up my AI to 2.4 mg per week, I am using liquid and dropper as per formula to target roughly 20 for E2.

Any comments or suggestions are appreciated for this next four week period.

Thanks to all, this is a great site.

3

Hey Tuscans,

looks like you are moving forward. my main advice is that you really need to track/measure your other systems as well (TSH, 8am Cortisol, etc.) as extra T will stress those systems and if not monitored they could crash one day (or could easily be contributing to your overall symptoms).

any tests for ferritin, VitD-25OH, etc.?

4

Purechance,

I have done some of these tests in the past and they were fine, but will update their results now that I am on hrt.

I was curious on a couple things, I have front loaded my ai in the past week to help drive down my e2, i believe or possibly suspect that I am now getting closer to that sweet spot, though I was wondering if anyone has a recommendation for how long I should front load a double dose of ai for? I will intend to do it as long as I feel improvement at this point.

Another question I had if anyone has any idea about, when I started trt without an ai, i began with a test total of mid 600’s and e2 of 23, when follow up was done, my testosterone total went down to mid 400’s with e2 going to mid 50’s, is this an unusual response or is it purely individual? It would seem that if anything, the added testosterone would remain stable or go up slightly with the rest being pushed to e2. it appears that it was all being pushed to e2. I was just curious if there was some explainable mechanism.

Thanks

5

everything is individualized and it is hard to know how anyone will react or respond… darn genetics… it really is an individual trial and error for most things.

6

I obtained my history of blood tests during the last ten years and wanted to share some of the more recent results with you. These were chosen to be tested by my local doc over the years.

I am posting in light of some of the recommendations that some of you have been suggesting, and I thought I would get your feedback on if they were in appropriate ranges for health rather than being normal according to the labs. They had not been done with the beginning of HRT since they were in range as far as normals and the doctor were concerned. I previously said some of these tests were ‘fine’, but maybe not on reconsideration.

2009:

Lipo protein 9 range 0-30
Vit D OH 39.5 range 32-100
Free Test 19 range 6-21
IGF-1 113 range 94-252
Estradiol 35 range less than 54
DHEA SO4 109 range 70-310

2007:

DHEA SO4 163 range 95-530
IGF-1 180 range 94-252
Ferritin 217 range 22-322
Iron 65 range 40-155
TIBC 400 range 250-450
%Saturation 16 range 15-55
TSH .853 range .35-5.5
T Uptake 37 range 24-39
T4 6.7 range 4.5-12
T4 uptake index 2.5 range 1.2-4.9

2005:

Ferritin 117 range 22-322
Iron 72 range 40-155
TIBC 368 range 250-450
%Saturation 20 rage 15-55
TSH 1.44 range .35-5.5
T Uptake 39 range 24-39
T4 5.9 range 4.5-12
T4 uptake index 2.3 range 1.2-4.9

I understand that it would be in order to get updated ferritin, vit d, free t4, free t3 and reverse t3, am cortisol and others you might recommend.

I am taking 4000 units of D 3 each day, DHEA, B complex, zinc, and will be getting methyl b12.

7

skip

8

interesting how your ferritin correlates with your TSH levels.

High ferritin = low TSH (which supports what people on here and elsewhere have been saying)
and
lower ferritin = higher (worse) TSH

T4 uptake is outdated.
you really need the free and reverse tests with 8am cortisol, Vit D25-OH, etc. per the blood test sticky.

9

Question for folks,

I have been getting labs done with LabCorp, and I contacted them and did searches but could not find what the current ranges are for free T and total T.

I know we are supposed to target the upper end of youthful ranges of these, does anyone have the current ranges for the T levels for twenty year olds?

Being 53 my current range is listed by LabCorp at 348-1197

Thanks

10

The free T assays seem to be performed differently at every lab, and each lab has drastically different ranges…Quest even has two different ranges that are considerably different depending on how the assay was performed…

So short answer, there isn’t a good way to figure this out IMO

11

Here is my current symptom and blood test update.

I had been pinning 60mg testosterone three times a week, every 56 hours for last six weeks. Hcg eod and .85mg adex eod (using dropper to administer)

Symptoms were improved slightly during first couple weeks after with this new protocol of test, hcg and adex. During last three weeks I have noticed some increase in DOMS, libido down, energy down, mood down.
Have been taking 5000 IU of D, 225mcg Iodine, 1000mcg B-12 per day
DHEA sublingual 50mg per day

Blood test results: Blood tested 8am just prior to next scheduled injection of testosterone

Metabolic panel results showed an increase in triglycerides and a lowering of HDL’s from 102 to 63 since last test three years ago, but still within a normal ratio.

Ferritin: 167 range: 30-400
Iron : 84 Range 40-155

TSH: 3 Range .45 - 4.5
fT3 : 3.2 Range 2-4.4
fT4: 1.08 Range .82-1.77
rT3: 405 Range 90-350

Free T: 21.5 Range 7.2-24
Total T: 756 Range 348-1197
Estradiol: 31 Range 7.6-42.6
SHBG: 18.8 Range: 19.3-76.4
DHEA-S 430 Range: 44-331
AM Cortisol: 16.1 Range 6.2-19.4

Vit D 25OH: 54.2 Range 30-100

From the thyroid rt3 site my ratio is low and I am doing further reading on this issue.
I have ordered a serum B-12 Test.

Thanks for input into my situation. My testosterone levels went down despite a slight increase in dosage

12

one possible cause - excess T using up your cortisol leading to poor thyroid functions.

your rt3 is horrible.

can you get the 4x daily saliva cortisol test? Quest offers one, I am not sure about LabCorp. Even though your morning cortisol looks good,it may be crashing later in the day… or some seem to experience issues with higher TSH when supplementing with iodine. Not sure if there is any correlation to iodine supplements and rt3 levels.

350 - 1200 is the general range. I don’t know specific age ranges.

be careful with DHEA supplements, some like me react to DHEA by converting it directly to estrogen. might want to stop for a short time and see how your body react and if any symptoms get better or worse.

having 700’s as your low seems good. it would be helpful to see it the day after or the afternoon of just to see how high it is getting… could be 2000 the day of and 700 on day three which is what I was getting injecting 100mg E3D. I am now on 50mg E3D and doing much better without those wild swings.

13

PureChance,

Thanks for the suggestions. I did two weeks of the temperature test and it is swinging more than .2 degrees day to day, and not often at 98.6, most typically on the low side.
I was surprised by my DHEA levels as I have never had it come in high before, always on the low end of the range, even in saliva testing.
I will stop the DHEA for now.
I will do blood mid way between dosages next draw.

I had some additional tests ordered which are in
Vit B12 415 Range 211-946
Folate 15.9 Range > 3

THyroid Antibodies
THryoid Peroxidase (TPO) 9 Range 0-34
Antithyroglobulin Ab <20 Range 0-40

I will be switching to methylcobalamin 1mg per day unless someone suggests otherwise, like shots etc

I will get the 24 hour cortisol ordered.

14

PureChance,

Thanks for the suggestions. I did two weeks of the temperature test and it is swinging more than .2 degrees day to day, and not often at 98.6, most typically on the low side.
I was surprised by my DHEA levels as I have never had it come in high before, always on the low end of the range, even in saliva testing.
I will stop the DHEA for now.
I will do blood mid way between dosages next draw.

I had some additional tests ordered which are in
Vit B12 415 Range 211-946
Folate 15.9 Range > 3

THyroid Antibodies
THryoid Peroxidase (TPO) 9 Range 0-34
Antithyroglobulin Ab <20 Range 0-40

I will be switching to methylcobalamin 1mg per day unless someone suggests otherwise, like shots etc

I will get the 24 hour cortisol ordered.

15

.2 degree swings are normal. 1 degree swings could indicate insufficient cortisol.

a B12 result of 400 is terrible however… most want to be in the 700-800+ range at minimum (I think).

16

Purechance,

Yes, the swings are daily averages compared , but during the day I see 1.5 degree swings not uncommon.

I had been taking cyanocobalamin 1mg per day, but will switch to methylcobalamin.

How much do you think I should take and or do I go with injections?

Been on the thyroid site and they say to get cortisol fixed first before thyroid.

17

Why do you think you have a cortisol issue?

Your am was at the very top of the range (good).

Your temps don’t fluctuate much from day to day (good), they instead rise during the day, I presume?

18

temps should rise 1-2 degrees from waking to a high above or around 98.6.

19

Blood tests in December determined my thyroid results dysfunctional.
I have consulted with the thyroid and adrenal yahoo groups.
I have been prepping for the T3 treatment by taking 200mg iron and 3mg of B12 per day.
My iron stores and B12 are in range to begin T3 treatment to clear out rT3.
I upped my D3 dosage to about 12-18,000 IU’s per day and now have my vit D in the high end of the range.
I discontinued DHEA as recommended by adrenal group until adrenal and thyroid stable
I discontinued exercise as recommended by adrenal group until adrenal thyroid function is stable
I did a 24 hour saliva cortisol test via Diagnostechs but adrenal group said their testing is unreliable, so they suggested zrt.

I almost suspended T treatment until adrenal and thyroid showed stability but I kept treatment at about 140mg T per week, 3 pins per week separated by 56 hours. The current test was mid way between pins. My E2 was always high and I was taking up to 3mg per week Adex, so I suspected that HCG at 250iu 3X per week was too much as I must be a heavy aromitizer with HCG, so I cut dosage to 175iu 2x per week, with 1mg of Adex broken up into three dosages per week, and I finally got my E2 below 30, in fact below 20 so I think I am heavy aromatizer of HCG

Current Symptoms:

I still have same symptoms of morning fatigue, heaviness in arms, foggy brain, lack of focus, low libido, especially since discontinuing DHEA and exercise as recommended by Adrenal group. The adrenal group is suggesting that high ferritin shows inflammation and i need to take krill oil.

My strategy at this point is to get adrenal and thyroid right, introduce exercise and maybe DHEA as I clear out rT3.
Does anyone think I should suspend T treatment until these are resolved or just continue to keep T in upper end of range?
Any feedback at this point would be appreciated.

I will adjust Adex dosage down to bring up E2.

Protocol prior to this test for six weeks:

140mg T per week 3 divided doses
Adex 1mg per week 3 divided doses
HCG 175iu 2x per week
approx 15,000 IU D3 per day
3mg B12 per day
200mg iron per day

Current Body Temps: Avg 98.2-98.4 per day

Current Blood test results:

Iron: 128, range 40-155
Saturation%: 39 Range 15-55
Ferritin: 177 range 30-400
TIBC 330 range 150-375
UIBC 202 range 150-375
B12: 923 range 211-946
DHEA: 143 range 44-331
Vit D 99 range 30-100

Total Testosterone 972 range 348-1197 Tested midway between pins
Free T 22.8 range 7.2-24
E2 17.4 range 7.6-42.6

20

I did saliva testing ZRT labs,

Results:

Cortisol AM: 5.3 range 3.7-9.5
Cortisol noon: 2.4 range 1.2-3
Cortisol Eve: 1.3 range .6–1.9
Cortisol night .5 range .4-1.0

I have T3 and have started the so called clearing of my rT3, I have been doing only for 7 days and I am titrating up from 13mcg at 6.25mcg increments every five days if my temps remain stable. I am taking a morning dose of adrenal cortex as my morning cortisol is low.
My temps were averaging 97.8 plus or minus .1 degree prior to starting T3 (about two weeks prior to starting T3 the were avg 98.3 and then just dropped and stayed steady at 97.8, don’t know why. The temps are stable so far into T3 treatment.

How do I feel? I was doing various forms of testosterone replacement for ten months and only had few days where i might have felt better, probably the biggest benefit was less soreness post work outs, but libido, desire, motivation, energy, drive in the mornings to noon was just not better. The clearing of T3 is said to take up to 12 weeks. I have not noticed any changes since T3 started though it has only been for a short period.

I am suspending Testosterone replacement until my adrenal and thyroid tests are within range as I just do not see the reason to continue it. I worked within ranges of 100 to 200mg per week but did not ever notice benefits to continue.

I know some forums discuss using higher dosages to achieve better results, but I just do not know how high one should go to test it out. My mid injection tests never showed total T out of the range.

Any comments or feedback are appreciated.