trt - negative side affects

[pauljw]

Newbie, first post.
Started trt just over 3 months ago.
50 yo, slim and fit, 6-1" 180lbs. allways been on skinny side even after working out for years. had bloodwork done which showed tt low/mid end of range, free t was right at bottom of range.
started transcrotal trt 20% cream 1ml/day split dose.
have put on approximately 8 lbs of muscle.
3 weeks after starting, experiencing numerous side affects.
Having heart palpation's, erectile dysfunction (ability to achieve/keep, and quality are all over the place in the same day). Have also recently been having Gerd (acid reflux) symptoms. I have never experienced these issues prior to trt, very frustrating.
Labs show thyroid as being a little hypo, just started on 82 mg Synthroid to see if it has any positive affects. labs are prior to starting thyroid meds.
Here is my latest labs (taken 10 hours after morning dose): Any input or advice is greatly appreciated, thanks in advance.



Flags
Results
Reference
Units

Hematology
WBC

5.2
4.0 - 11.0
x E9/L
RBC

4.73
4.50 - 6.00
x E12/L
Hemoglobin

150
135 - 175
g/L
Hematocrit

0.441
0.400 - 0.500
L/L
MCV

93
80 - 100
fL
MCH

31.7
27.5 - 33.0
pg
MCHC

340
305 - 360
g/L
RDW

12.2
11.5 - 14.5
%
Platelet Count

207
150 - 400
x E9/L
Differential
Neutrophils

3.4
2.0 - 7.5
x E9/L
Lymphocytes
LO
0.9
1.0 - 3.5
x E9/L
Monocytes

0.7
0.2 - 1.0
x E9/L
Eosinophils

0.1
0.0 - 0.5
x E9/L
Basophils

0.0
0.0 - 0.2
x E9/L
Immature Granulocytes

0.0
0.0 - 0.1
x E9/L
Nucleated RBC

0

/100 WBC
Thyroid Function
Thyroid Stimulating Hormone [TSH]
HI
4.47
0.32-4.00
mIU/L
Thyroxine Free [Free T4]
LO
8
9-19
pmol/L
Triiodothyronine Free [Free T3]

3.8
2.6-5.8
pmol/L
Pituitary Function
Follicle Stimulating Hormone [FSH]
LO
<0.1
1.0-8.0
IU/L
Luteinizing Hormone [LH]
LO
0.1
1.0-7.0
IU/L
Tumour Markers
Prostate Specific Antigen

0.23
<4.0
ug/L
Methodology: Abbott Architect immunoassay.
Results should not be interpreted in isolation as
absolute evidence of the presence or absence of
malignant disease.
Changes in serial results may be misleading
unless all Total PSA results are from the same
laboratory method.Reproductive and Gonadal
Estradiol

91
<162
pmol/L

NOTE: Fulvestrant has been shown to interfere
with estradiol testing by this direct
immunoassay. Results for patients taking
this medication may be falsely elevated to
a clinically-significant degree.

Some steroidal aromatase inhibitors are
structurally related to estradiol and may
interfere with some direct immunoassays.
Dehydroepiandrosterone [DHEA-S]

6.1
< 9.7
umol/L
Testosterone
HI
36.7
8.4 - 28.8
nmol/L
Total Testosterone levels may not reflect the
biologically-active testosterone when SHBG levels
are abnormal.
Testosterone Free
HI
846
179-475
pmol/L
Interpret free testosterone results with caution
in presence of significant hypoalbuminemia.
Sex Hormone Binding Globulin

36.8
10.0 - 70.0
nmol/L

 

[Systemlord]

Have also recently been having Gerd (acid reflux) symptoms. I have never experienced these issues prior to trt, very frustrating.

Same here, started experiencing Gerd after the first 6-8 months of TRT which was even causing voice changes and swelling on my vocal cords, I could feel my throat burn and it turned out to be caused by iron deficiency and the acid refluxed stopped once I got iron levels elevated.

I still have stomach acid drip out of my stomach and onto my esophagus while laying flat, still working with doctors to lower stomach acid levels. My bodily functions seem to go haywire when going past 450 ng/dL because more demand on iron stores which I was already is short supply.

I feel the full effects of TRT at 400 ng/dL, 400> and muscle development happens extremely quickly.

 

[Joe Sixpack]

Your free T is nearly 2x the high end of normal range. Many guys struggle with T levels that are too high. You could be one of them. For some guys even being at the top of the normal range is too much. I can tell you from experience that I would feel horrible at your levels. I need to be pretty close to the upper range, which is a lot lower than where you are.
If I were in your shoes, I would experiment with lower doses and see how you feel.

 

[TLR]

What Sixpack said......if I'm reading your post correctly you are taking 200 mg of scrotal testosterone a day. I'd cut it to 75-100 and give it 4-6 weeks and see how you feel.

 

[fifty]

Tried once a day cream?

 

[Gman86]

Holy $hit. If that TSH is correct, you’re very very hypothyroid

 

[pauljw]

Thank you all for your responses. Have cut my dose in half and symptoms are much better. Heart palpitations, and Gerd symptoms are mostly gone (approximately 80% better). having the odd erectile issue. Can get great erections a lot of the time, at different times I can't get a full erection or loose an erection. Like I mentioned before, this is something I never experienced before trt. I have noticed some loss of sensitivity too. Have seen on the forums that hcg may help in that regard, will bring this up with Dr.
My estrogen levels seemed quite normal, they are higher than before starting trt. is it possible that higher estrogen could be the cause of my symptoms. Have read that women can suffer from Gerd and heart palpitations when estrogen levels are increased during cycle or pre-menopause. everything I've read indicates that estrogen is helpful for healthy erections.

 

[Systemlord]

Everytime you make dosing changes testosterone and estrogen levels will be in flux for the next 6 weeks until levels tablize again.

So if you cut the dose in half on Oct. 20th, you're a little more than a week into this new protocol and you will feel inconsistent for another 4-5 weeks. As far as estrogen levels affecting erections, balance is needed whatever that may be and only you can answer what works for you.

I need estrogen <35 to have good erections.

 

[Vince Carter]

Estradiol

91
<162
pmol/L

Wrong test; Ultra Sensitive LC/MS/MS

 

[pauljw]

follow up:
reduced scrotal test cream to .4ml/day split am/pm for last two weeks. started hcg @ 100/day.
had bloodwork taken approximately 5 hours after applying scrotal cream and sub injection of 100iu hcg.
total t - 40.3 mol/l - still high
free t - 908pmol/l - still really high
estrodial sensitive - 136 mol/l top of range
Still experiencing some inconsistent ed. at times I achieve a crazy hard erections, at different times of the day its difficult to achieve an erection or keep it.
I'm thinking my high estrodial might be causing the ed issues along with the acid reflux (which has improved somewhat).
any recommendations?
Lower test cream or switch to injection? Thinking injection may give a more stable level of T and estrogen.
try low dose of an AI?
Wait for a while till everything has a chance to balance out as recommended by "systemlord"?