TRT is not working for me! any suggestions ?

kafahmy · Aug 9, 2017

[FONT=arial, sans-serif]Hello people,

First, let me tell you that this forum has been of a great help for me. I really appreciate the time that you guys put on here to help helpless guys like me to get where they should be. Your sticky notes, forums, Q&A are much appreciated!

I have been on TRT since April and I have been struggling with it since then. I am 28 years old, 6'1 ft, 215 lbs with body fat around 17% .

Pre-TRT , I had all the common low T symptoms :low energy, low sex drive, depression, low self esteem, brain Fog, bad body composition even with clean diet and workout...etc

blood work pre TRT is as below:

[/FONT]Hormone Panel
Testosterone,Free and Total
Testosterone, Serum 456 ng/dL 348 - 1197
Free Testosterone(Direct) 9.6 pg/mL 9.3 - 26.5 01
Estradiol, Sensitive 19.3 pg/mL 8.0 - 35.0
Sex Horm Binding Glob, Serum 31.5 nmol/L 16.5 - 55.9
DHEA-Sulfate 316.9 ug/dL 138.5 - 475.2 01
TSH 3.910 uIU/mL 0.450 - 4.500 01
Luteinizing Hormone(LH), S
LH 7.1 mIU/mL 1.7 - 8.6

I started TRT on April 6th 2017
-Protocol: 140 mg Test Cyp/week, 800 HCG , .25 Arimidex/ ( Split twice a week )

[FONT=arial, sans-serif]For the first 2 weeks, I just felt great at , it was day and night and I was so happy with where I got. Lipido was too much to handle at times, strength went up dramatically, mood was way better, it was just perfect....up until I started feeling some low estrogen symptoms. I discussed my situation with some of the very well experienced people on this site and they told me to drop the Arimidex which I did and I actually felt way better. Anyways, week after week the positive effect started to disappear for some reason but the self esteem and cognitive improvement persisted. I went ahead and got new blood work and booked an appointment with my doctor.

First Blood Work after TRT (06/15/2017) on [/FONT]trough day[FONT=arial, sans-serif]

[/FONT]Testosterone 730 (348-1197)
Free Testosterone 18 (9.3-26.5)
DHEA Sulfate 325 (138.5 - 475.2)
TSH 2.51 (0.450 - 4.50)
t4 1.25 (.82 - 1.77)
Estradiol 18.2 (8.0- 35.0)
SHBG 23.6 (16.5- 55.9)[FONT=arial, sans-serif]

I discussed my symptoms with my doctor and also added that I usually feel Good the first 2 days after my shot and then feel worse up until my next injection so he suggested that I either up my dose to 160mg T or try a Mon/Wed/Frid protocol .25ml ( equivelent to 150mg T/ week) while keeping HCG as is and definitely dropping Arimidex .

[/FONT]So, [FONT=arial, sans-serif]I have started the Monday/Wednesday/ Friday @ .25ml Test cypionate protocol as suggested while maintaining the same HCG schedule ( 400iu on Monday and Friday) I was supposed to stay on this protocol for 3 weeks before I get retested ( TT, FT and SHBG ). It's been almost 2 weeks now and I really hate the way I feel. Sex drive is non existent (it wasn't strong on the previous protocol either but now it's completely gone), no improvement in physic still ( i have not seen much change with the previous protocol either), Energy level still low. But what really bother me the most is that the ONLY positive change that I had previously (mental sharpness, good mood, confidence) has also gone !!!

I am sorry for such a lengthy post, but I just don't get why TRT is not working for me like it is supposed to do. I mean I read stories and stories on here on how TRT have changed people's life, how they've got their energy back, their sex drive back, how they dropped body fat and added muscles. Am I doing anything wrong ? should I try a different protocol ? is my trt dose too low or too high? I was thinking to just up my dose to 200mg/ week and try that for a month and if it doesn't work than just stop TRT .

Your input is very valuable to me, so if you can help please do not hesitate to do so.

Thank you very much!

[/FONT]

codus2112 · Aug 9, 2017

You will get some more detailed replies im sure but i may try getting my E2 up closer to 30 and see how you feel?

kafahmy · Aug 9, 2017

I know how to lower my E but no idea how to up it though except for uping T in a hope that it convert more E ?

codus2112 · Aug 9, 2017

Sorry, i just caught that you discontinued Arimidex. Hmm, some of the others will have to chime in.

ratbag · Aug 9, 2017

Most hormone specialists say that a TSH of over 2.0 means you are likely hypothyroid. Obviously you need an MD who will look closer into your thyroid problem. Most endocrinologists or hospital MD's only do the TSH for thyroid testing but the MD's who specialize in HRT will look much closer at your FT3 and FT4, RT3 and antibodies etc. Look at our site sponsor for example.. Defy

FOX1 · Aug 9, 2017

Kafahmy, you mentioned you started TRT on April 6th 2017,
.
this is still early days for you, your body takes time to react and it takes time to notice changes.
From April until now I expect you have had blood tests to monitor and adjust dose to suit your needs, things do not happen overnight.
.
Take a look at the attached link for the "effects tool" click on each colour and check the time course for body reaction.
.
There is also a graph for "Effects on sexual parameters" this also gives you average times for body response, select each individual parameter by colour and see how long it takes for your body to adjust
.
https://www.nebido.com/en/hcp/research/testosterone-tools/effects-tool.php
.
hope this helps

CoastWatcher · Aug 9, 2017

Your SHBG is at the lower end of the scale, suggesting that you would benefit from smaller more frequent injections of testosterone. You made that move two weeks ago - a hopeful decision. But it's only been two weeks!!!! When you're living in TRT time you have to think long-term; two weeks is nothing but a blink. Frankly, the three weeks your doctor planned to wait is not enough time either. An insufficient number of half-life cycles will have passed for serum levels to be responding to your new protocol. At a minimum, one should wait four weeks, I believe Dr. Saya suggests five weeks, and my own doctor is steadfast in holding out for six weeks. In this game you have to be patient.

A few guys hit the jackpot and see sensational results, seemingly within days. The vast majority of us have taken a good bit of time to get to where we are. I'd certainly not make ANY further adjustments in your protocol until you've given the most recent adjustments time to be evaluated.

kafahmy · Aug 9, 2017

codus2112 said:
You will get some more detailed replies im sure but i may try getting my E2 up closer to 30 and see how you feel?

ratbag said:
Most hormone specialists say that a TSH of over 2.0 means you are likely hypothyroid. Obviously you need an MD who will look closer into your thyroid problem. Most endocrinologists or hospital MD's only do the TSH for thyroid testing but the MD's who specialize in HRT will look much closer at your FT3 and FT4, RT3 and antibodies etc. Look at our site sponsor for example.. Defy

I'm actually with Defy and i love those guys, i just hate that I have to wait so long until I can actually talk to my doctor, I known they are busy and all but sometimes u feel so bad that u need to reach out to ur doctor in a week or 2 tops and not a 6 weeks wait.

My doctor mentioned the thyroid levels and said i might need to go on some thyroid medication in the future if energy level don't get better. But i honestly want to hold on this for now specially that my energy is not the only problem while on trt...i have so many other issues and I'd rather get dialed in with TRT first and see if the energy level still bothers me...i'm just too young for all of that man honestly and I was already freaking out thinking that I will have to be on TRT for life and now the thyroid medications as well ...

CoastWatcher · Aug 9, 2017

FOX1 said:
Kafahmy, you mentioned you started TRT on April 6th 2017,
.
this is still early days for you, your body takes time to react and it takes time to notice changes.
From April until now I expect you have had blood tests to monitor and adjust dose to suit your needs, things do not happen overnight.
.
Take a look at the attached link for the "effects tool" click on each colour and check the time course for body reaction.
.
There is also a graph for "Effects on sexual parameters" this also gives you average times for body response, select each individual parameter by colour and see how long it takes for your body to adjust
.
https://www.nebido.com/en/hcp/research/testosterone-tools/effects-tool.php
.
hope this helps

The problem with this infirmation is that it's out of date and reflects studies that were conducted when the protocols being evaluated were absurd. A lot of data collected for guys on injections of enanthate and cypionate give every two weeks, if not monthly, no concern for estradiol levels...the conclusions don't stand the test of time.

kafahmy · Aug 9, 2017

FOX1 said:
Kafahmy, you mentioned you started TRT on April 6th 2017,
.
this is still early days for you, your body takes time to react and it takes time to notice changes.
From April until now I expect you have had blood tests to monitor and adjust dose to suit your needs, things do not happen overnight.
.
Take a look at the attached link for the "effects tool" click on each colour and check the time course for body reaction.
.
There is also a graph for "Effects on sexual parameters" this also gives you average times for body response, select each individual parameter by colour and see how long it takes for your body to adjust
.
https://www.nebido.com/en/hcp/research/testosterone-tools/effects-tool.php
.
hope this helps

Thanks a lot for restoring my hope partially and sharing the link. I was aware that most of the noticeable changes would take time and I should keep seeing improvements over the next month. However, it appears that (and this is only based on what I've read online from others who've been on trt) that I should be seeing some positive effect after 4- 6 weeks from starting TRT ..sex drive is supposed to come back strong within a month ? at least some improvement in the gym even if it's not dramatic ?

ratbag · Aug 9, 2017

Your first post you say you have an energy problem and lack of sex drive now you say you don't have an energy problem. I had the same problem I couldn't get my TRT dialed in and then my MD put me on thyroids meds and I went from no sex drive to sex overdrive. Low energy to normal energy. Thyroid plays a bigger part than most realise. Stop worrying over this.... the fact you need TRT simply means you have some degree of metabolic syndrome... your hormones for whatever reason are not at decent levels. This is very common. It's pretty rare for TRT to solve everything. Your on trt for 5 months now, once you advise your MD of these symptoms they will probably look at your thyroid again. They know this, as they told you, you may need thyroid meds to get normal again. Of course you could deny yourself this and drag it out for years like some do but why do that? The object is to feel normal again and in the process figure out the learning curve that we all go thru.

kafahmy · Aug 9, 2017

CoastWatcher said:
Your SHBG is at the lower end of the scale, suggesting that you would benefit from smaller more frequent injections of testosterone. You made that move two weeks ago - a hopeful decision. But it's only been two weeks!!!! When you're living in TRT time you have to think long-term; two weeks is nothing but a blink. Frankly, the three weeks your doctor planned to wait is not enough time either. An insufficient number of half-life cycles will have passed for serum levels to be responding to your new protocol. At a minimum, one should wait four weeks, I believe Dr. Saya suggests five weeks, and my own doctor is steadfast in holding out for six weeks. In this game you have to be patient.

A few guys hit the jackpot and see sensational results, seemingly within days. The vast majority of us have taken a good bit of time to get to where we are. I'd certainly not make ANY further adjustments in your protocol until you've given the most recent adjustments time to be evaluated.

Thanks for ur Input, I will try to hold on to my new protocol for 2 more weeks before I get blood work. Regarding SHBG, is it low to the point I need to inject 3 times/ week as opposed to the common twice/week protocol ? I felt a little better on the 2 days split but maybe i need to hold longer and see if things get better.

kafahmy · Aug 9, 2017

ratbag said:
Your first post you say you have an energy problem and lack of sex drive now you say you don't have an energy problem. I had the same problem I couldn't get my TRT dialed in and then my MD put me on thyroids meds and I went from no sex drive to sex overdrive. Low energy to normal energy. Thyroid plays a bigger part than most realise. Stop worrying over this.... the fact you need TRT simply means you have some degree of metabolic syndrome... your hormones for whatever reason are not at decent levels. This is very common. It's pretty rare for TRT to solve everything. Your on trt for 5 months now, once you advise your MD of these symptoms they will probably look at your thyroid again. They know this, as they told you, you may need thyroid meds to get normal again. Of course you could deny yourself this and drag it out for years like some do but why do that? The object is to feel normal again and in the process figure out the learning curve that we all go thru.

Sorry if I didn't make myself clear. I do have an energy problem, I've had it pre TRT and I still have it (although it got a bit better). However, energy level it is not my main complain, I wish if it was better of course but right now it is not affecting my life quality as much as the other symptoms .

I didn't know that thyroid can also affect sex drive, thx for pointing at that! .
Is my TSH level bad to the point where it might be the root cause of all my troubles ? I know the range is a bit wide and most doctors don't like TSH to be over 2.5 but I still fall within the normal range.

I will not deny myself and will not drag it for years .I just want to rule out all other possibilities first before I start a new journey with my thyroids.

Systemlord · Aug 9, 2017

Most likely when you hear someone who started TRT felt great again within a few weeks/months, it's likely they got lucky and received the correct dose right away, others not so lucky. Once you on a dose and protocol that's perfect for you only then will you start to see changes, I was on the wrong dose for many months and felt no benefits. I'm still adjusting my protocol and once my new endo ran an SHBG blood test it was immediately clear why the protocol didn't work. I've been on TRT since February and am still making adjustments, each time I make an adjustment I feel a little better.

Your SHBG is a little higher than mine (18) so more frequent smaller injections is critical, endo instructed me to start injecting twice a week starting Monday. Lower SHBG means it takes a little longer to begin feeling normal again, I envy those quick responders! It also seems your TSH came down a bit, perhaps you can improve it with more time.

kafahmy · Aug 9, 2017

Systemlord said:
Most likely when you hear someone who started TRT felt great again within a few weeks/months, it's likely they got lucky and received the correct dose right away, others not so lucky. Once you on a dose and protocol that's perfect for you only then will you start to see changes, I was on the wrong dose for many months and felt no benefits. I'm still adjusting my protocol and once my new endo ran an SHBG blood test it was immediately clear why the protocol didn't work. I've been on TRT since February and am still making adjustments, each time I make an adjustment I feel a little better.

Your SHBG is a little higher than mine (18) so more frequent smaller injections is critical, endo instructed me to start injecting twice a week starting Monday. Lower SHBG means it takes a little longer to begin feeling normal again, I envy those quick responders!

Ok this is very helpful actually, do you mind sharing a little more details ? what kind of adjustments made a difference to you ? do you mind sharing your protocol and frequency ? thx!

CSI007 · Aug 9, 2017

You need to stick with it.

I saw improvements in libido almost immediately and it continues to this day. My energy comes and goes though. I am still trying to fine tune my protocol because my E2 skyrockets recently. However, one of the main issues I was chasing was ED. I am happy to say that my ED is much improved finally and it's taken almost a YEAR. even 6 months into TRT I could not successfully have intercourse without Tadalafil. I have been OK (not amazing for my standards) the past month and have not taken any E drugs for almost 2 months now. I hope to continue to see improvements as time goes on in other areas like blood sugar and penile sensitivity etc.

Obviously it is having some positive effects on your since your mood and cognitive function is improved.

Systemlord · Aug 9, 2017

kafahmy said:
Ok this is very helpful actually, do you mind sharing a little more details ? what kind of adjustments made a difference to you ? do you mind sharing your protocol and frequency ? thx!

In the beginning I was on 200mg E3W and it wasn't until I switched to weekly 75mg injections that I started see improvements, it took four months on weekly injections to begin to feel improvements. Four months ago all my muscles were wasting (muscle atrophy) from having T levels well below 100 ng/dL, muscle are getting firmer everyday. Monday I going to the clinic to learn how to inject at home twice weekly and endo upped my dose to 100 mg split Monday morning, Thursday evening. Pre-TRT my SHBG was 25 and four weeks after starting TRT is was 18, sure hope it's not any lower. My insulin sensitivity has improved dramatically and continues to improve, so hopefully this will increase my SHBG.

I do not require an AI, so far estrogen has been good.

CoastWatcher · Aug 9, 2017

kafahmy said:
Thanks for ur Input, I will try to hold on to my new protocol for 2 more weeks before I get blood work. Regarding SHBG, is it low to the point I need to inject 3 times/ week as opposed to the common twice/week protocol ? I felt a little better on the 2 days split but maybe i need to hold longer and see if things get better.

Testosterone isn't like an aspirin. Take an aspirin, headache goes away. Inject testosterone...and it's going rot take a while to see or feel anything for most men. I point that out because you're considering jumping to yet another protocol, a three time a week injection schedule (or it sure looks as if you might be considering doing that) before you've given the current changes you made a chance to be effective. One change, wait four, preferably six, weeks, test and evaluate.

And as for the every 3.5 day injection schedule being "common," you're right. But that can only be a starting point for all of us. This is a very individual trip we're on here along the hormone highway.

Nelson Vergel · Aug 9, 2017

I am sorry I jumped in so late. I have been on vacation.

It is so surprising to me that none of you ask the basic questions that are unrelated to blood work.

Are you sleeping enough?

What is your height, weight, waist and neck size? Any possibility for sleep apnea?

What is your blood pressure?

Are you under a lot of stress and/or possibly having depression symptoms?

What is your hematocrit before and after TRT? Have you measured your iron and ferritin?

Fatigue- When Testosterone Is Not Enough

kafahmy · Aug 9, 2017

CoastWatcher said:
Testosterone isn't like an aspirin. Take an aspirin, headache goes away. Inject testosterone...and it's going take a while to see or feel anything for most men. I point that out because you're considering jumping to yet another protocol, a three time a week injection schedule (or it sure looks as if you might be considering doing that) before you've given the current changes you made a chance to be effective. One change, wait four, preferably six, weeks, test and evaluate..

Lesson learned, I'll give it try and won't treat it like Advil

thx a lot sir!

TRT is not working for me! any suggestions ?

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