ZTjames TRT log started March 2018

Pharma TRT
1

34 years old
5’8” and 195 pounds. About 25% bodyfat
34 inch waist
Never had much body hair on chest or back, goatee facial hair, decent head of hair with some receding hairline.
I carry most of my fat in my gut. Some perhaps in my neck and face when I’m really overweight.
Low T symptoms include: low libido and sexual desire that has slowly gotten worse over the past several months, more fat being stored in the mid-section, losing muscle mass particularly in my arms, wake up in the middle of the night for no reason and cannot fall back asleep deeply, and irritability.
No Rx drugs. Men’s multivitamin + 5000IU extra vitamin D to treat low levels. I take 3 drops nascent iodine/day with breakfast and 200mcg selenium in hopes that it will support my metabolism in losing weight.
Diet for the past couple months has improved. 1500-1800 net calories most days, trying to drop the excess weight I know I have gained the last 3-4 months. I’ve lost almost 10lbs since Jan 2018, though my clothes don’t seem to fit much better yet. I feel like I’m not making the progress I usually make by this amount of time dropping my ‘off-season weight’.
Just got back into training after a 5-month off period. Currently 2x/week lifting and 3-4x/week various cardio exercises. Really not feeling in good shape but looking forward to getting it back and trying to stay positive. Always been athletic but never a body builder or elite athlete. Glory days were 12+ years ago.
No teste ache/fever stuff.
Morning wood is occasional I suppose

The lack of libido is really the worst part. It isn’t like me at all and my girl and I both share very high sex drives. It was the same before I started dieting and trying to drop weight. It’s like the switch got turned off! This is what ultimately led me to think I could possibly have low T. I’ve heard about ‘low t’ for some time but even with symptoms, thought I’m too young to experience that. I researched a bit and found this forum. There’s a men’s clinic nearby that specializes in TRT but before I paid to have them do tests and speak with the doctor, I was curious to see if low T could even be my issue, so I ordered a very basic LabCorp test…

This was a non-fasting morning test, if that matters…
Testosterone TOTAL = 338 (264-916)
Free Test = 9.4 (8.7-25.1)
DHEA-S = 435 (139-475)
E2 = 12.7 (7.6-42.6) (Roche ECLIA methodology)
PSA = 1.3 (<4.0) (Roche ECLIA methodology)
Vit-D = 26 Low (30-100) *I started doing 5000IU/day after these results

Based on my research it seemed to me my T is lower than it should be for my age and decided to pursue the specialist, who did a thorough test about a week after those LabCorp results. These are based on like a 10-hour fast, also in the AM…

CBC
White blood cell = 4.6 (3.9-11.1)
Red blood cell = 5.18 (4.2-6.0)
Hemoglobin = 16.4 (13.2-18.0)
Hematocrit = 48.5 (38.5-54.0)
MCV = 94 (80-100)
MCH = 31.6 (26-34)
MCHC = 33.7 (31-37)
RDW = 12.7 (11.0-15.5)
Platelets = 268 (140-400)
MPV = 9.1 (7.5-11.6)
Metabolic
Glucose = 99 (65-100)
BUN = 16 (6-20)
Creatinine = 1.3 (0.7-1.3)
Sodium = 140 (136-145)
Potassium = 5.0 (3.5-5.1)
Chloride = 104 (98-107)
CO2 = 25 (20-31)
Calcium = 9.7 (8.3-10.6)
Total Protein = 7.3 (5.7-8.2)
Albumin = 4.8 (3.2-4.8)
Globulin = 2.5 (2.1-3.6)
Bilirubin = 0.5 (0.3-1.2)
Alk Phos = 57 (46-116)
ALT = 30 (<49)
AST = 17 (<39)
Coronary
Triglycerides = 125 (<150)
Cholesterol = 271 High (<200)
HDL = 71 (>40)
LDL = 175 High (<100)
Thyroid
T3 free = 3.6 (2.3-4.2)
T4 free = 1.35 (0.89-1.76)
TSH = 0.67 (0.55-4.78)

Prostate
PSA = 1.07 (<4.0)

Hormone
Testosterone TOTAL = 371 (280-1100)
Free Test = 8.6 (1.9-27.0)
DHT = 12.7 (11.2-95.5)
DHEA-S = 317 (35-569)
E2 = 22.7 (<40)
FSH = 5.1 (1.4-18.1)
LH = 3.5 (1.5-9.3)
SHBG = 22 (14.55-94.64)
IGF-1 = 181 (137-199)

I met with the doc, described my symptoms and had a nice conversation. Doctor said I have classic symptoms of low T and he wants to double my free testosterone and prescribed the following:

200mg testosterone per week broken into two 100mg doses every 3.5D, subcutaneous.
1mg arimidex per week broken into two 0.5mg half doses, take with testosterone injections
HCG troches twice per week with the testosterone.

I was concerned with starting at 200mg and he didn’t have an issue with me starting lower so that’s what I’m doing. 100mg/week T and 0.25mg AI at each injection. I’m not having more children at this point, but the HCG choice of using troche sublingual is puzzling (1000IU/tab). I asked about it and the doctor said they work great for his guys and rarely gets complaints of testicular shrinkage. I guess I’ll give it a shot. I’m only really concerned with potential aches & pains. I’ve read more bad news about these than good news, though I have found guys who claim to have success with troches. This doctor has been doing this type of work for over a decade and works with a compound pharmacy. The testosterone is a 90%/10% cypionate/enanthate @200mg/mL. Just did my 1st injection of 50mg in the belly today using a 1mL 25G 5/8in – pretty smooth!

You might notice the starting AI dose seems lower than the standard around here – I wonder if that’s because my baseline E2 is near perfect or maybe it has something to do with a low-normal SHBG? Maybe the fact that I’m doing 2 doses/week and subq versus 1 dose/week IM? Not sure but I’ll pay attention to how I feel and see how the next labs come out.

Anyways, checking in! Any thoughts & assistance would be appreciated.

2

Most men can get to midrange to high normal testosterone easily on 100mg weekly split twice weekly, there’s no need to hit a nail with a sledgehammer and that’s what your doctor is doing, thankfully you are informed.

Your numbers are very similar to my own baseline, mainly SHBG which is the more valuable labs to run before beginning treatment. The fact that your E2 looks normal baseline means you will need the AI. Me on the other hand I had dreadfully low E2 at baseline so no AI for me.

Low E2 makes being low T much worse so count yourself lucky! I have never used HCG and did have a month or two where my testes ache but it stopped after awhile, testes are hanging several months later about 30% less. No complaints as testes were pulled up super tight at baseline. You should know not every man tolerates HCG well, some feel worse on it but it will keep testes going.

You might consider injecting every other day and even every 3 days with low SHBG, I’m finding myself feeling a little low on injection day (E3.5D). Also notice social anxiety on injection day which has to do with my excreting my testosterone fast do to low SHBG.

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Should we be fasting before getting bloodwork? I see you did it both ways but my requisition lab sheet doesn’t say what to do. Should I phone them or do you guys know?

4

I wasn’t told to fast for any of these tests. I think doctors prefer a fast for cholesterol numbers. Fasting glucose is always good to know too.

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@systemlord thanks for the reply and dosing suggestions. Can you elaborate on your anxiety experiences on TRT? I’m feeling a bit anxious myself though I realize it could just be nerves from starting a new treatment. I’m going to read up more on issues guys have with HCG

When just starting out, is it common to have issues with E2 levels since you’re starting 2 or 3 new things for the first time that can impact E2? It may take a few subq doses of T before your T levels begin to increase?

6

November 2016 my vitamin D tested at 26 ng/Ml and I started dosing with 10,000iu daily. Tested 11/2017 I was at 61 ng/Ml. So you may need to up that depending on your sun exposure.

7

Wow 26-61 after an entire year at 10k/day?! I better increase my D too. I burn easily and use sunscreen in the sunny months.

8

yeah…I have a desk job so really only get sun on the weekends when the weather is warm. I don’t know if I feel better now due to the supplementation but I know its important for other things as well. I may not feel as good as I do on my current TRT protocol had I not fixed this prior. And, I mean, everyone is different so 10k may be too much for you but just wanted to let you know that sometimes you gotta crank it. I think KSman had suggested 10k as well. I will search for his post and edit this to include it if I find it.

Here we are:

9

3 doses in…thought i would update…
E3.5D…50mg T subq, 0.25mg anastrozole, 500iu hCG troche sublingual

Felt like trash last week after I did my first dose - that day and the day after. First I became very drowsy and brainfogged like I had taken a bunch of benadryl. Went to the gym after a long nap and did 30min of cardio. Felt fine, avg hr 148. Later that evening more fog and fatigue. Felt a bit unbalanced and a bit anxious too. Tired and anxious is not a fun combo. Symptoms faded day after day. Was concerned about taking the 2nd dose 3.5 days later when the time came. 2nd dose produced milder symptoms the following day - not nearly as bad. Noticed my face feels warm like it’s fllushing, especially around the eyes, but no visible redness. Mild headache too. This morning took my 3rd dose and about 5 hours later experiencing more of the same symptoms, but again less intense than last time I’m’ happy to report. I wonder what it could be? E2 going nuts? Just my body/brain adjusting to all this? Too soon for bloodwork. If it keeps getting better each time like this I don’t expect to have these post-dosing symptoms for much longer. But those 1st couple days were harsh, man.

Anyone else have a rough start like this?

10

Almost everyone goes through the same when either starting TRT or changes dosages, test blood levels fluctuate for weeks and stabilize 6 weeks later. Those who micromanage before the 6 weeks after a change usually end up quitting TRT altogether because they have no patience.

Make a change now and you’ll have to wait yet another 6 weeks for blood testing since the small change takes 6 weeks to stabilize.

11

Good call. I considered dropping either the AI or hCG to see if I could possibly diagnose what the issue could be from but from reading around the forum it seems it would a)probably not work or make things worse and b)mess up consistent dosing required for first trt bloodwork.

If I was still feeling the way I was last week I don’t think I’d be able to manage it tbh. Luckily feeling better

12

Feeling pretty good, with some minor negative sides, but overall improved lately. Weight down to 184 in the morning. Lost 11lbs since TRT; 21lbs since Jan 2018. Fitting into clothes a bit better now. Still have a terrible beer gut but love handles are way down, thinner looking face/neck too. Doing 1600 net calories/day. Last couple weeks had cheat day over weekend. 3 days/week lifting weights, 3 days/week cardio, 1 rest.

Subq twice a week…
50mg T (90/10 cyp/en)
0.25mg anastrozole
500IU hCG troche

Got my initial bloodwork. This is after 14 doses or 47 days, performed 38 hours after last dosing, 12-hour overnight fast. Posting most relevant results for now…

Glucose = 88 (65-99)
Hemoglobin = 15.9 (13.0-17.7)
Hematocrit = 46.1 (37.5-51.0)
Albumin = 4.2 (3.5-5.5)
Testosterone TOTAL = 848 (264-916)
Free Test (Direct) = 19.2 (8.7-25.1)
E2, sensitive = 15.9 (8-35)
SHBG = 48 (16.5-55.9)

My free test as a % dropped below 2% due to my SHBG jumping from 22 to 48! Is this bad, or is it okay because my direct free test is up 19.2 from 9.4?

E2 seems just a little low and I’ve been having what I believe could be low E2 sides…
*Constant dry mouth, dry throat, dry itchy dry eyes (no allergies) despite drinking 12-15 glasses water/day (not counting fluid intake from protein shakes, decaf tea, etc).
*Anxiety with near-miss panic attacks, worst a couple weeks ago. Had panic attacks a couple years in my mid twenties so I’m familiar with that crap. Heart palps too - no difficulty breathing, dizziness, or pain with these. Could be the chicken or egg
*Tired looking eyes. Sometimes I look stoned. Not a good look in a professional workplace. My eyelid has been twitching regularly throughout the day since week 5. Sometimes both eyes. Feel a bit tired during the day despite a good night’s rest.

If my math is correct I could shoot for about 1/3mg per week to get back near my baseline of E2=23. Or should I just drop the AI and test it again in a few weeks??

Good news:
*848!
*Libido/desire improved at the beginning of week 3. It was best at this time, has tapered down a little, but still better. Would love to be back at week 3 though!
*Recovery from workouts improved. I’ve always had worst DOMS 2 days after a tough workout. Now I’m a little sore the next day, maybe a little tight day 2 but good to go. I’ve been in better shape past years and less fat and still felt more beat up than I do today after the gym
*Feel strong in the gym and making decent progress I think

13

Dry eyes and tiredness is from low estrogen, when my estrogen is low I feel stoned, dry eyes and tired. Stoned feeling is because you’re depriving your brain of estrogen. If you can’t lower SHBG, you need 60-70mg twice weekly or possibly one larger inject a week.

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Thanks. I have some boron from back when I was trying all kinds of OTC things to get my libido back pre-trt. I think I’ll take it daily and see if it can lower my SHBG.

Any thoughts on how I should approach raising E2 back into the 20s?

edit: Nevermind, I see you suggested an increase in T which would increase E2