2 Months After Starting TRT

Been lurking for a while now and thought I'd introduce myself. I'm 49, live in in South Orange County, and have historically been pretty active -- lifting weights 2-3 times a week, running 2-3 times a week, golfing on the weekends, walking the dogs for an hour every morning, etc. In the last year or so, I stopped running, managed to gain 30 lbs. and started feeling terrible, which I put down to long hours, little sleep, and an inconsistent diet. I finally went to have bloodwork done late last year and both my thyroid and test levels were way low. My initial labs showed total test 307 ng/ml, and free test 7.4 ng/ml.

I've been on TRT and thyroid since December 20, 2013 -- current protocol is 200 mg. test cypionate injected intramuscularly Mon/Fri, plus 1 grain Armour and 50 mg. DHEA every morning. Had my first full-blown checkup with new bloodwork on February 7th, and my total test is 647 ng/ml, free test 29.2 ng/ml. I am down 8 lbs. (251 to 243) and a pants size, and all my lifts are up a bit, though my sex drive is still in the toilet. I'm still putting in 80 hour weeks, and my cortisol's elevated despite cutting back on caffeine (from 2-3 cups down to (mostly) 1 cup a day).

I'm consistent with my weightlifting and have been doing a powerlifting split, but just bought a Concept C2, and am going to try and row 2-3 times a week to help shed the pounds. I'm 5'11 and pretty big-boned, but the extra 20-30 lbs. is like carrying a sack of potatoes everywhere. I'm thinking the increased cardio has got to help with the sex drive -- certainly can't hurt.

Welcome to our buddy community!

It seems that you are on your way to better body shape and quality of life even with your hectic work hours. It is remarkable.

When I have too much work it does not matter how good my hormones are. I just get "in my head" and do not feel sexual at all. In fact, I think sex is a distraction that sometimes I cannot afford when busy LOL

However, having said that, when I want to really jump start my sex drive when I am not fully physically "turned on" I usually start low dose daily Cialis at 5 mg twice a day with my TRT+ 500 IU HCG twice a week. Sometimes I add arginine at 1000 mg per day. This combo makes my package really full and even when I am too busy I have this hyper awareness (and sensation) of my gonads. I try to hear loose underwear to let them hang better. That awareness really ignites my sex drive.

Welcome to Excel. I'd really like to see your cortisol labs if you get a chance. Elevated cortisol can have a negative effect on your thyroid productivity, so hoping your Armour therapy isn't causing any adverse issues like pooling. Let us know if you have labs, we can talk more.

OP - Are you injecting 200 mg of Test Cyp each Monday and Friday for a total of 400 mg a week?

Or is it 100 mg Monday and Friday?

You need to space out your injections like Monday mornings and Thursday nights...more consistent serum levels this way.

I inject 100 mg. test Monday and 100 mg. Friday. That's the most my HRT doc said they would let him prescribe, even though it's only getting me to around 650 ng/ml total test.

I'm still having libido issues and have started taking Relora (3/day) to deal with cortisol [don't have the numbers with me at work but will post tonight] but I'm having trouble cutting back to less than 3 cups of coffee per day. I don't sleep that much (4-5 hours/night), so I'm chronically on the edge of being tired, which doesn't help matters much, but I just can't sleep.

As a libido assist, I am taking Cialis on an as-needed basis, and have some oral testosterone troches that work so-so. It's 30 troches for a 10 week cycle, to be taken on non-injection days (3 per week), but that doesn't really do anything for me. If I take 3 at a time my libido goes up, so it's really more of a Friday night special.

hamletshead said:

I inject 100 mg. test Monday and 100 mg. Friday. That's the most my HRT doc said they would let him prescribe, even though it's only getting me to around 650 ng/ml total test.

I'm still having libido issues and have started taking Relora (3/day) to deal with cortisol [don't have the numbers with me at work but will post tonight] but I'm having trouble cutting back to less than 3 cups of coffee per day. I don't sleep that much (4-5 hours/night), so I'm chronically on the edge of being tired, which doesn't help matters much, but I just can't sleep.

As a libido assist, I am taking Cialis on an as-needed basis, and have some oral testosterone troches that work so-so. It's 30 troches for a 10 week cycle, to be taken on non-injection days (3 per week), but that doesn't really do anything for me. If I take 3 at a time my libido goes up, so it's really more of a Friday night special.

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What are your estrogen levels at those high doses?

Remember E2 follows Testosterone; if there is significant aromatase activity you could be converting a lot of that Testosterone into unwanted estrogen.

Low libido is a sign of both elevated and suppressed E2 levels.

I'm looking at my first follow up test from January 28, 2014, and it doesn't look like they tested for estradiol. I was thinking I might have E2 issues, but I don't have any nipple sensitivity or incipient gynocomastia, nor do I have any joint pain. And it doesn't appear that it's converting to DHT and giving me any side effects -- no acne, no hair loss, no mood swings. All my max lifts are up a bit, and while I'm not breaking any world records I'm totaling just under 1100 in the big three (bench/dead/squat).

But while my mood and appetite are generally good, my sex drive still hasn't reared its head. I did a little late night porn surfing a la Don Jon to see if that did anything, and while its still interesting, I'm not exactly popping high school wood. I did get a bump when I took three of the testosterone troches and a Cialis one day post-injection, but that was the only day that I actually felt sexually interested in any real way. Which is a drag.

My initial cortisol levels back on December 4, 2013 was 19.2 ug/dL -- so it's obviously elevated. My doctor didn't retest cortisol when they did follow up bloodwork after five weeks on TRT, thyroid, and DHEA. The follow up results are as follows:

TSH 0.900 (previously 1.37)
T4, Free 1.01 (previously also 1.01)

WBC 6.7
RBC 5.28
Hemoglobin 16.9
Hematocrit 47.7
MCV 90
MCH 32.0
MCHC 35.4
RDW 13.4
Platelets 291
Neutrophils 63
Lymphs 28
Monocytes 8
Eos 1
Basos 0
Neutrophils (Absolute) 4.2
Lymphs (Absolute) 1.9
Monocytes (Absolute) 0.6
Eos (Absolute) 0.1
Baso (Absolute) 0.0
Immature Granulocytes 0
Immature Grans (Abs) 0.0

Testosterone, Serum 681 (up from 305)
Free Testosterone 24.2 (up from 8.8)
DHEA- Sulfate 847.5 (up from 293)

I told my doctor my sex drive was still in the toilet after 5 weeks on this protocol, and he seemed to think it was potentially due to elevated cortisol levels. He put me on Relora, testosterone troches and Cialis, and told me to cut back on the caffeine (but I'm non-compliant here), but it's still not doing much for me now some 7 weeks after my follow up with him. My workout schedule is consistent -- weightlifting 4-5 days a week pretty heavy, a little GPP work at the end of every workout (heavy bag, jump rope, farmer's walks), a cardio only day (20 minutes rowing + 1 hour walking the dogs) and a day where I do nothing physical at all. I'm still working 60-70 hours a week and sleeping 4-5 hours a night, but that's nothing new. Maybe it's systemic stress and burnout from trying cases for 20 years, but since the job part is not going to change, I would welcome any alternative suggestions. Seems like I'm closing in on a solution, just need a little tinkering to get it right.

OP, your thyroid numbers unfortunately don't give us any true picture of what's taking place. We need reference ranges for starters, plus Free T3, Reverse T3, and antibodies TPO & TpAg. Presuming that cortisol lab is a morning serum? The ideal cortisol test would be getting a 4x saliva, followed with a circadian profile, scaled in contrast to the top and bottom values of the reference range. Iron serum, TIBC, ferritin, magnesium, B12, D3 are others just to name a few. If your cortisol is indeed elevated and over productive, you could be experiencing issues with T4 conversion to T3, excessive RT3, which in turn will reflect poor T3 activity at the cellular level.

Elevated Cortisol will crush Libido like elevated estrogen.

That said, I don't see a Cortisol lab here.

Best for lowering Cortisol is Cabergoline.

I take .25 g twice weekly and my Libido is generally off the charts...all the time

Get Cortisol tested and talk to your Doctor about low dose Cabergoline.

BTW, this will crush Libido as well: "I'm still working 60-70 hours a week and sleeping 4-5 hours a night" As we age there are a lot of other things that come into play with regards to Libido so while these working hours, even a few years ago might not have effected your Libido, it may now.

Cortisol was 19.2 ug/dL in my original (pre-TRT) bloodwork. Where's a good place to get Cabergoline? I have an online pharmacy I use that sells 8 pills (0.5 mg/ea) for $92, but I assume it can be gotten cheaper by using a compounding pharmacy.

You mean prolactin, right Gene?

Excel Male said:

You mean prolactin, right Gene?

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Yea, my bad...meant Prolactin not Cortisol.

hamletshead said:

Been lurking for a while now and thought I'd introduce myself. I'm 49, live in in South Orange County, and have historically been pretty active -- lifting weights 2-3 times a week, running 2-3 times a week, golfing on the weekends, walking the dogs for an hour every morning, etc. In the last year or so, I stopped running, managed to gain 30 lbs. and started feeling terrible, which I put down to long hours, little sleep, and an inconsistent diet. I finally went to have bloodwork done late last year and both my thyroid and test levels were way low. My initial labs showed total test 307 ng/ml, and free test 7.4 ng/ml.

I've been on TRT and thyroid since December 20, 2013 -- current protocol is 200 mg. test cypionate injected intramuscularly Mon/Fri, plus 1 grain Armour and 50 mg. DHEA every morning. Had my first full-blown checkup with new bloodwork on February 7th, and my total test is 647 ng/ml, free test 29.2 ng/ml. I am down 8 lbs. (251 to 243) and a pants size, and all my lifts are up a bit, though my sex drive is still in the toilet. I'm still putting in 80 hour weeks, and my cortisol's elevated despite cutting back on caffeine (from 2-3 cups down to (mostly) 1 cup a day).

I'm consistent with my weightlifting and have been doing a powerlifting split, but just bought a Concept C2, and am going to try and row 2-3 times a week to help shed the pounds. I'm 5'11 and pretty big-boned, but the extra 20-30 lbs. is like carrying a sack of potatoes everywhere. I'm thinking the increased cardio has got to help with the sex drive -- certainly can't hurt.

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OP Update 2/4/15:

Here are the results from my labs taken 1/20/15 after 1 year on TRT with a current weekly protocol (split Mon/Fri) of 200 mg. test cypionate, 1000 iu HCG, 1 mg. arimidex, plus 1-2 pumps per day of Androgel (the last five months), and the occasional week of 300 mg. test cyp (when I've got surplus from under-injecting at the end of a 10 week cycle). I'm still taking Armour every day, and DHEA 3 days a week, have dropped another 8 lbs., and am feeling pretty good.


Total test: 1202 ng/dL [ref range 348-1197]
Free test: 28.5 pg/mL [ref range 7.2-24.0]
PSA: 0.6 ng/mL [ref range 0.0 - 4.0]

Cortisol: 4.0 ug/dL (last year 19.9) [ref range 2.3-19.4]

DHEA-Sulfate: 302.4 ug/dL [ref range 71.6-375.4]
Vitamin D, 25-hydroxy: 105.0 ng/mL [ref range 30.0-100.0]
IGF-1: 162 ng/mL (last year 174) [ref range 67-205]

Total cholesterol: 199 mg/dL
LDL-P: 1830 nmol/dL (last year 2363)
LDL-C: 126 mg/dL (last year 165)
Small LDL-P: 831 (last year 837)
HDL-C: 44 mg/dL (last year 48)
HDL-S: 30.3 umol/L

Homocysteine: 7.1 umol/L (last year 7.4) [ref range 0.0 - 15.0]
C-Reactive Protein: 0.50 mg/L (same as last year) [ref range 0.00 - 3.00]
Hemoglobin: 17.4 g/dL [ref range 12.6 - 17.7]
Hematocrit: 51.1 [ref range 37.5 - 51.0] [gave blood after lab tests]
Hemoglobin Alc: 5.1 (last year 5.3) [ref range 4.8 - 5.6]

Glucose, serum: 81 mg/dL (last year 98) [ref range 65-99]
Insulin, fasting: 10.3 uIU/mL (last year 19.1) [ref range 2.6- 24.9]

TSH: 0.013 uIU/mL [ref range 0.450-4.5]
T4, free: 1.11 ng/dL [ref range 0.82-1.77]
Triiodthyronine [T3], free, serum: 5.0 pg/mL [ref range 2.0 - 4.4]

Question - on Erections / Libido

Nelson Vergel said:

Welcome to our buddy community!

It seems that you are on your way to better body shape and quality of life even with your hectic work hours. It is remarkable.

When I have too much work it does not matter how good my hormones are. I just get "in my head" and do not feel sexual at all. In fact, I think sex is a distraction that sometimes I cannot afford when busy LOL

However, having said that, when I want to really jump start my sex drive when I am not fully physically "turned on" I usually start low dose daily Cialis at 5 mg twice a day with my TRT+ 500 IU HCG twice a week. Sometimes I add arginine at 1000 mg per day. This combo makes my package really full and even when I am too busy I have this hyper awareness (and sensation) of my gonads. I try to hear loose underwear to let them hang better. That awareness really ignites my sex drive.

Click to expand...

I heard you on Jay Campbell's hangout (which has been a great resource for me across the board). I really enjoyed your input. You guys make a great combination on that show.

I have tried Viagra and it did nothing for me other than what I would describe as a "head on" vs. a hard on. This was with a half a table (50 mg). Head was pounding, heart was pounding, my face got flush, and my eyes were swollen a bit. Couldn't tell you in impacted my erection much at all. I wouldn't take more given the uncomfortable symptoms.

I've recently tried Cialis - did 5 mg. Did nothing. Tried 10 mg, it did have some impact, but not rock hard. After several minutes of intercourse, it felt a bit desensitized and couldn't ejaculate as it would have taken forever. I also seemed to lose my libido after a few minutes of intercourse. I did get a flush face, but didn't have the other symptoms I had with Viagra.

I am going to try the protocol you mentioned above. I am probably 70 pounds overweight which I'm sure impacts my erections and libido. It appears as though taking the L-Carnitine and HCG will potentially help make a difference. When you say 500 IU's twice weekly, you are talking about a total of 1000 IU's?

Just to give you some context, I'm currently on .60 cc's of cypionate weekly (I was previously only .80 cc's every 5 days - I ended up gaining 8 pounds of water weight within two weeks and I my blood pressure was really high). I'm now taking .5 mg of Arimidex MWF with the .60 cc's of test weekly. I also am taking Armour thyroid 60 mg. I've also starting taking 500 mg of Metformin 2 x's a day for the last few weeks now.

Besides your suggested protocol, do you have any other recommendations for increasing my libido? Herbs don't seem to do the trick for me. Quite frankly, nothing does - nor has the test or the Arimidex (now on that for two weeks), but I know it can take time and be a process. I am exercising (not overtraining) and eating healthy (eating healthy green veggies as carbs and not eating carbs that spike my insulin) and trying to get the proper sleep, as well as avoid stress, to get my weight down (and I've lost all my water weight + 8 or 9 pounds as well), so no need to address those topics. Thank you and I look forward to learning more on your site and seeing you on Jay's site more often.