1. #1
    Junior Member
    Join Date
    Jan 2017
    Location
    COLUMBIA,MD
    Posts
    7

    TRT for 3 years, little improvement.

    Hi,

    I've been on T replacement for 3 years with little improvement. I started on Androgel for 6 months, but it did nothing. I've been on Test C @100mg/week for the past 2 1/2 years. Initially I started out injecting weekly, but I am now at every 3.5 days for the past 1 1/2 years. My Uro also prescribed HCG last year, but insurance denied coverage. Through reading this site I discovered Empower and have started HCG 2 weeks ago.

    My mood has improved some on TRT, but I still have sexual side effects: low libido, weak erections.

    My most recent labs are from December 29th prior to starting HCG and prior to my T injection.

    Total T- 597 ng/dL 250-1100
    Free T- 152.2 pg/mL 35-155
    E2- 25 pg/mL </=29
    E2 Free- .63 pg/mL </= .45
    TSH- 1.73 mIU/L .40-4.50
    Glucose- 92 mg/dl 65-99
    Triglycerides- 201 mg/dl <150
    Hematocrit- 44.4% 38.5-50.0

    I'm 40 years old, 5'11" and weigh 190. I carry most of my weight in my upper body, primarily in my stomach. My legs are very skinny. I feel like I've probably had low T my whole life. Even in high school, when I worked out, I never gained muscle.

    I plan on new blood work in a few weeks to see what the HCG does. Other than that, any suggestions?


  2. # ADS
    Purchase From Our Affiliates
    Join Date
    Always
    Location
    Houston, TX
    Posts
    51
    Help Excelmale

    Defy
     

  3. #2
    Your total testosterone at trough is a bit lower than might be expected. Do you have an SHBG value? Consider dividing your weekly dose, 100mg, into two shots of 50mg delivered every 3.5 days. You may boost your total testosterone and achieve a stronger subjective response to therapy.

  4. #3
    Quote Originally Posted by greg76 View Post
    Hi,

    I've been on T replacement for 3 years with little improvement. I started on Androgel for 6 months, but it did nothing. I've been on Test C @100mg/week for the past 2 1/2 years. Initially I started out injecting weekly, but I am now at every 3.5 days for the past 1 1/2 years. My Uro also prescribed HCG last year, but insurance denied coverage. Through reading this site I discovered Empower and have started HCG 2 weeks ago.

    My mood has improved some on TRT, but I still have sexual side effects: low libido, weak erections.

    My most recent labs are from December 29th prior to starting HCG and prior to my T injection.

    Total T- 597 ng/dL 250-1100
    Free T- 152.2 pg/mL 35-155
    E2- 25 pg/mL </=29
    E2 Free- .63 pg/mL </= .45
    TSH- 1.73 mIU/L .40-4.50
    Glucose- 92 mg/dl 65-99
    Triglycerides- 201 mg/dl <150
    Hematocrit- 44.4% 38.5-50.0

    I'm 40 years old, 5'11" and weigh 190. I carry most of my weight in my upper body, primarily in my stomach. My legs are very skinny. I feel like I've probably had low T my whole life. Even in high school, when I worked out, I never gained muscle.

    I plan on new blood work in a few weeks to see what the HCG does. Other than that, any suggestions?

    Do you happen to have any other test results? I noticed a hematocrit level so presumably a CBC, CMP, and possibly some others. It's best to list all tests, as even ones you may not think are relevant, can be helpful.

    I take it as you're injecting 50mg E3.5D and this was tested day of injection but before injection.

    You seem to be low SHBG, hence the high free E2, and that would explain your symptoms. Can you expand a bit on your symptoms? Are those the only ones? Low libido and weak erections?

  5. #4
    Junior Member
    Join Date
    Jan 2017
    Location
    COLUMBIA,MD
    Posts
    7
    Quote Originally Posted by CoastWatcher View Post
    Your total testosterone at trough is a bit lower than might be expected. Do you have an SHBG value? Consider dividing your weekly dose, 100mg, into two shots of 50mg delivered every 3.5 days. You may boost your total testosterone and achieve a stronger subjective response to therapy.
    I don't have any current SHBG values. It was tested by my first Uro 2 1/2 years ago. I can dig that up if it would be relevant. I plan on adding it to my next blood work at the end of the month too. I do inject 2 shots of 50mg per week already. Looking back at my post, I could have said it more clearly.

  6. #5
    Quote Originally Posted by greg76 View Post
    I don't have any current SHBG values. It was tested by my first Uro 2 1/2 years ago. I can dig that up if it would be relevant. I plan on adding it to my next blood work at the end of the month too. I do inject 2 shots of 50mg per week already. Looking back at my post, I could have said it more clearly.
    I wonder if you're simply clearing testosterone too quickly due to a lower SHBG value - a very common situation. Were prolactin and DHT measured when therapy was initiated?

  7. #6
    Junior Member
    Join Date
    Jan 2017
    Location
    COLUMBIA,MD
    Posts
    7
    Quote Originally Posted by johndoesmith View Post
    Do you happen to have any other test results? I noticed a hematocrit level so presumably a CBC, CMP, and possibly some others. It's best to list all tests, as even ones you may not think are relevant, can be helpful.

    I take it as you're injecting 50mg E3.5D and this was tested day of injection but before injection.

    You seem to be low SHBG, hence the high free E2, and that would explain your symptoms. Can you expand a bit on your symptoms? Are those the only ones? Low libido and weak erections?
    RDW 13.9% 11.0-15.0
    Platelet Count 293 thousand/uL 140-400
    MCHC 33.3 g/dL 32-36
    MCH 29.8 pg 27-33
    MCV 90 fL 80-100
    Hemoglobin 14.8 g/dL 13.2-17.1
    RBCC 4.96 million/uL 4.20-5.80
    WBCC 4.2 thousand/uL 3.8-10.8
    PSA, Free 0.3 ng/mL No range given
    PSA, % Free 33% >25%
    PSA, Total .9ng/mL </= 4.0

    Those are all of the current results I have.

    Yes, I inject 50mg E3.5D and this was before injecting on day of injection.

    My other symptoms are feeling tired/low energy, lack of motivation, procrastination, difficulty concentrating and just being grouchy.

  8. #7
    Junior Member
    Join Date
    Jan 2017
    Location
    COLUMBIA,MD
    Posts
    7
    Quote Originally Posted by CoastWatcher View Post
    I wonder if you're simply clearing testosterone too quickly due to a lower SHBG value - a very common situation. Were prolactin and DHT measured when therapy was initiated?
    I am not sure about prolactin or DHT. Is it still something I should have checked, along with SHBG, next blood draw?

  9. #8
    Quote Originally Posted by greg76 View Post
    I am not sure about prolactin or DHT. Is it still something I should have checked, along with SHBG, next blood draw?
    Prolactin is a standard test that should be run during the initial, pre-TRT workup. If elevated, the possibility of a pituitary tumour would have to be considered. Elevated prolactin is a libido-killer, as well. DHT should be checked as well as, if low, it can impede your libido.

    Was your thyroid evaluated? Not just TSH, but t3, t4, rT3, and thyroid antibodies. Is your recent 597 testosterone trough typical?

  10. #9
    Junior Member
    Join Date
    Jan 2017
    Location
    COLUMBIA,MD
    Posts
    7
    Quote Originally Posted by CoastWatcher View Post
    Prolactin is a standard test that should be run during the initial, pre-TRT workup. If elevated, the possibility of a pituitary tumour would have to be considered. Elevated prolactin is a libido-killer, as well. DHT should be checked as well as, if low, it can impede your libido.

    Was your thyroid evaluated? Not just TSH, but t3, t4, rT3, and thyroid antibodies. Is your recent 597 testosterone trough typical?
    Looking back through my Patient Portal for Chesapeake Urology, I see that Prolactin was checked in 2013. It does not list a specific value though, only "in normal range." I have never had thyroid labs in addition to TSH. The 597 TT trough is higher than usual. I'm usually in the 475-550 range.

    I'm hoping for some improvement from the HCG. It's only been a few weeks, but at least I already have a sense of having testicles again.

  11. #10
    Quote Originally Posted by greg76 View Post
    Looking back through my Patient Portal for Chesapeake Urology, I see that Prolactin was checked in 2013. It does not list a specific value though, only "in normal range." I have never had thyroid labs in addition to TSH. The 597 TT trough is higher than usual. I'm usually in the 475-550 range.

    I'm hoping for some improvement from the HCG. It's only been a few weeks, but at least I already have a sense of having testicles again.
    SHBG IMO is the main problem here. It's probably low, and while I'm not positive on the accuracy of free estradiol tests, yours is rather high. That could cause your symptoms.

    Coastwatcher is right though, all of the tests he listed would be a great idea, and some of your symptoms may not be from one cause(E2) but multiple.

    Having an incomplete picture will leave you with more questions than answers.

  12. #11
    Quote Originally Posted by greg76 View Post
    Looking back through my Patient Portal for Chesapeake Urology, I see that Prolactin was checked in 2013. It does not list a specific value though, only "in normal range." I have never had thyroid labs in addition to TSH. The 597 TT trough is higher than usual. I'm usually in the 475-550 range.

    I'm hoping for some improvement from the HCG. It's only been a few weeks, but at least I already have a sense of having testicles again.
    If a trough reading of, essentially, 600 is higher than normal, I can't help but wonder if you're simply in need of an adjusted dose of testosterone. That's where your SHBG comes in. If low, quite possible, you may need to inject more frequently (typically no more than every other day - though I inject 16mg every morning); if SHBG is high, I would guess that's not nearly as likely, larger amounts in your current protocol might be in order. SHBG is not a nice-to-have value - it can make or break a protocol.

    I hope hope it's that simple.

  13. #12
    Junior Member
    Join Date
    Jan 2017
    Location
    COLUMBIA,MD
    Posts
    7
    I hope so as well. I don't see my Uro until March, but I can get blood drawn whenever. Labs I will need then are TT, FT, E2, Prolactin, SHBG, DHT, fT3, fT4, rT3. Am I missing anything? Should I have CBC checked again? I had a CMP last year. Should that be done again? What about DHEA-S? I'm assuming that PSA can wait until next year?

  14. #13
    Is your uro open to a higher dose of T? 100mg/week is a good starting dose, but your trough readings are on the low side (in a relative sense) - a more up-to-date protocol typically shoots for trough readings in the upper quartile of the normal range or 825 to 1100 on a scale where 1100 is the top of the range.

  15. #14
    Junior Member
    Join Date
    Jan 2017
    Location
    COLUMBIA,MD
    Posts
    7
    Quote Originally Posted by ERO View Post
    Is your uro open to a higher dose of T? 100mg/week is a good starting dose, but your trough readings are on the low side (in a relative sense) - a more up-to-date protocol typically shoots for trough readings in the upper quartile of the normal range or 825 to 1100 on a scale where 1100 is the top of the range.
    Yes, she is open. I was waiting for my next blood work to see what HCG does before taking that step.

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. 22 Years Old - Starting TRT - HELP ME NOT **** MY LIFE
    By tarnation in forum Testosterone Basics & Questions
    Replies: 64
    Last Post: 12-18-2016, 03:21 PM
  2. 25 years old and considering TRT
    By heyguise in forum Testosterone Basics & Questions
    Replies: 4
    Last Post: 11-17-2015, 10:14 PM
  3. 46 years old Considering TRT - What Do You Recommend
    By sandman in forum Blood Test Discussion
    Replies: 3
    Last Post: 07-27-2015, 09:15 AM
  4. Replies: 0
    Last Post: 04-29-2015, 11:00 PM
  5. Hello, everyone! TRT of 15 years
    By cbusguy in forum Introductions
    Replies: 0
    Last Post: 02-06-2015, 10:41 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •