How will I know my regiment is enough? Am I just not made for TRT?

[Vithat]

Hello,

My history with trt replacement isnt long but I feel its long enough. Started in adolescense but never did it regularly then. My doctor really didnt know what he was doing considering he was injecting me once monthly but it was understandable considering my age att.

Now I am trying to be serious about hormone optimization since I still had low T. I do not remember the exact level but it was in the 200s. In april I was on clomid and arimidex but I felt they were prone to giving me mood swings. Regardless the blood test back in May showed a spike to 900-something but I still didnt feel "vigor". Starting either early July or late June, I am now injecting once a week of 1mL of Test Cypionate 200 mg/mL as well as 0.75 mL of HCG . However even now I am not entirely sure if there is any marked change. My current health reports also suggest that I may have something wrong with my thyroid and for a time I was pre-diabetic, I no longer am, but my insulin resistance might still be high. Various sources say I need to inject more or something because of these factors but Im not sure. I think they might be right since I still dont feel that much different despite the higher numbers. With no marked change and all these factors that might be in the way, Im starting to believe I may not be made for this or something. Im trying not to feel discouraged.
What should I do? How can I make sure its working correctly? Is this hopeless?

Here are relevant labs I guess.

T3 UPTAKE 33.1 %
THYROXINE BINDING CAPACITY 1.0
T4 TOTAL 4.7
FTI 4.7
THYROID STIMULATING HORMONE 1.250 UIU/ML
ESTRADIOL LEVEL 34.5 PG/ML
SOMATOMEDIN-C 129 NG/ML
TESTOSTERONE LEVEL 957 NG/DL
SEX HORMONE BINDING GLOBULIN 21.2 NMOL/L
CALC FREE TESTOSTERONE279.9 PG/ML

 

[BigBamBoo]

With your SHBG level, I would think you need to break up your injections to at least 2 times a week.

Others with more knowledge will chime in.

 

[MarkM]

With your SHBG level, I would think you need to break up your injections to at least 2 times a week.

Others with more knowledge will chime in.

I'm thinking that with a SHBG of 21.2 he might want to consider E3D (every three days) or EOD (every other day).

 

[JMP]

I would even go to 3x per wk with that SHBG. Definitely not 1x/wk. 200mg/wk should be more than enough to feel good. I very much doubt you need more. The thyroid is a huge part of how you feel so some work there is needed.

 

[Vithat]

Would asking for/treating DHEA incur any benefits as well? I understand there is medication to raise it.

 

[Vithat]

Similarly, is there any reliable way to increase DHEA to get more mileage?

 

[Blackhawk]

"How will I know my regiment is enough? "

If your regiment prevails in battle you have enough men in your regiment. If your regiment is annihilated or has to surrender, you have insufficient troops.

Sort of metaphorical to your regimen.

My choice would be to start on EOD with SHBG 21.2

Regarding taking DHEA, have you had DHEA-S tested? You can source DHEA over the counter, and good quality micronized supplements work well, but if your levels are already good, there is no reason to take it. Some people do not do well with DHEA supplementation.

Is your estradiol test the correct LC/MS sensitive test?

And, the Thyroid tests you posted really are not that useful, though your TSH is good. TSH over 2.0 with hypothyroid symptoms means you might benefit from a different set of thyroid labs

 

[Vince Carter]

IMHO all this is garbage; worthless and just wrong tests.

T3 UPTAKE 33.1 %
THYROXINE BINDING CAPACITY 1.0
T4 TOTAL 4.7
FTI 4.7

 

[Vince Carter]

Needs to be much less Cyp dose and probably EOD as stated above based on the SHBG. Free E is probably very high, noting the wrong E test was given any way.

You're Dr is extremely POOR.

 

[MarkM]

Similarly, is there any reliable way to increase DHEA to get more mileage?

Vithat,

Supplementing with DHEA will most likely increase your E2 more than anything else. Not sure that is what you need right now.

Can you provide the ranges for the following you posted above:
Testosterone
Free Testosterone
Estradiol
SHBG

Do you know if the Estradiol test was the Roche ECLIA methodology or the Sensitive test LC/MS/MS. If you have the lab results it will most likely say which one it is. If the Roche ECLIA, that is the wrong one and is for women, The proper test for men to measure estradiol is the LC/MS/MS assay (Liquid Chromatography–Mass Spectrometry). You likely have very high Free E2.

Injecting 200 mg per week is a huge dose and is rarely successful for anyone. It is just too much at one time. Until things are figures out you might want to consider discontinuing the HCG, at least temporarily.

Back to the injections.............based on your SHBG, you should probably be on an EOD (every other day) injection protocol You probably won't want to hear this but you should probably cut your testosterone dose down considerably as well. I would start off at 35 mg EOD which would give you a total of 245 mg on 7 injections across a two week period. You are currently injecting 400 mg over a two week period. So you be going from 200 mg per week in one injection to an average of about 125 mg per week across multiple injections.

Some people freak out about lowering their dose of testosterone but that is just an ego/mental thing. More times than not it is the right thing to do.

 

[Vithat]

"How will I know my regiment is enough? "

If your regiment prevails in battle you have enough men in your regiment. If your regiment is annihilated or has to surrender, you have insufficient troops.

Sort of metaphorical to your regimen.

My choice would be to start on EOD with SHBG 21.2

Regarding taking DHEA, have you had DHEA-S tested? You can source DHEA over the counter, and good quality micronized supplements work well, but if your levels are already good, there is no reason to take it. Some people do not do well with DHEA supplementation.

Is your estradiol test the correct LC/MS sensitive test?

And, the Thyroid tests you posted really are not that useful, though your TSH is good. TSH over 2.0 with hypothyroid symptoms means you might benefit from a different set of thyroid labs

It is not, I am looking to see about the LC/MS test next time I go. My doctor is Larry Lipshultz of Houston. Do you believe Nelson would know best places to go being here as well?

 

[Vithat]

I'm thinking that with a SHBG of 21.2 he might want to consider E3D (every three days) or EOD (every other day).

I meant to say SHBG instead of DHEA twice. Is there a way to raise my SHBG so I can get mileage out of the prescription?

 

[Vithat]

Vithat,

Supplementing with DHEA will most likely increase your E2 more than anything else. Not sure that is what you need right now.

Can you provide the ranges for the following you posted above:
Testosterone
Free Testosterone
Estradiol
SHBG

Do you know if the Estradiol test was the Roche ECLIA methodology or the Sensitive test LC/MS/MS. If you have the lab results it will most likely say which one it is. If the Roche ECLIA, that is the wrong one and is for women, The proper test for men to measure estradiol is the LC/MS/MS assay (Liquid Chromatography–Mass Spectrometry). You likely have very high Free E2.

Injecting 200 mg per week is a huge dose and is rarely successful for anyone. It is just too much at one time. Until things are figures out you might want to consider discontinuing the HCG, at least temporarily.

Back to the injections.............based on your SHBG, you should probably be on an EOD (every other day) injection protocol You probably won't want to hear this but you should probably cut your testosterone dose down considerably as well. I would start off at 35 mg EOD which would give you a total of 245 mg on 7 injections across a two week period. You are currently injecting 400 mg over a two week period. So you be going from 200 mg per week in one injection to an average of about 125 mg per week across multiple injections.

Some people freak out about lowering their dose of testosterone but that is just an ego/mental thing. More times than not it is the right thing to do.

Thats 200 mg/mL bottle and I inject 1 mL once a week.

 

[Blackhawk]

Lower dose, more frequently for SHBG of 21.2 is the going wisdom around here. 200mg/week single dose is considered bad protocol for you.

With low SHBG, you metabolize available testosterone fast as free T then excrete excess in your urine. Higher SHBG keeps more T bound in your system longer and guys with high SHBG can do OK on less frequent dosing. You are probably going to be experiencing a hormonal roller coaster as your free T skyrockets after injection then plummets before the next. Frequent dosage creates less peaks and troughs and amore steady state with your levels. You are also more susceptible to high estradiol and hematocrit on 200mg/week.

These are some of the most common topics on this forum from new members. Seriously, several people a week come here with the same situations and the same problems from being put on bad protocol: low SHBG, improper dosing frequency and high starting dose at 200mg/week. Very few men do well on that kind of protocol, especially those with lower SHBG.

More reasonable is starting around 100mg/week dosed EOD (every other day). However, there are some who would want to start even lower, maybe around 80mg/week EOD or daily, see how it goes then adjust upwards if needed. Starting at 100mg/week you might subsequently be faced with uncertainty whether to adjust up or down if needed.

Lower weekly dosage indeed does theoretically get you more mileage from your prescription.

There is not much of anything that works to increase your SHBG. That's just a condition of who you are. TRT may change it a bit over time.

 

[MarkM]

Thats 200 mg/mL bottle and I inject 1 mL once a week.

Yes, we have that........you are injecting 200 mg per week in a single injection from a vial of testosterone with a strength of 200 mg/ml...............and that is not a good protocol for you.

 

[Vince Carter]

Odd that we're getting this from Lipshultz patient, right?

 

[Vithat]

Well ive only visited him about 2 times. Every other with a nurse. His schedule is very booked.

 

[Vithat]

Odd that we're getting this from Lipshultz patient, right?

As a matter of fact. I just remembered that they cancelled my appointment for 29th. Earliest appointment i could get with Lipshultz himself wa November 28th

 

[Vithat]

If you guys know, is there a way to check the method on MyChart?

 

[Vithat]

He’s very flexible with letting you change your protocol as long as you are not doing any harm. Just explain what you want.

Is it advisable to try what has been suggested here on my own?