1. #1
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    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?


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  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
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    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
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    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
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    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
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    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
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    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.

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    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.

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    I think it may be time to find a new doc, again... I had my appointment on the 22nd. Maybe she was in a bad mood, but she didn't seem open to anything. She had blood drawn in the office. She also seems to now think that a trough in the 500's of T is great and the ultra sensitive E2 test is not necessary.

    While she said she was running a "full" panel, the results are less than. Also this was the day after injecting T and HCG(50mg & 250IU).

    Testosterone Total 554 348-1197 ng/dl
    Estradiol 15.9 7.6-42.6 pg/mL

    Other than those she had CBC and Hepatic Function panels checked. I can post those if necessary.

    I did get a prescription for Arimidex, because I complained of nipple sensitivity when using 500iu of HCG 2x a week. I have since dropped that down to 250iu 2x a week. That seems to have resolved the issue. Either way, I have nothing to go off of for the Arimidex. UGH!

  17. #16
    I certainly wouldn't take that AI with your E2 being at that level. It could crash and you would be miserable. The nipple sensitivity will likely resolve over time. It did with me....Though I was already on HCG mono and the nipple sensitivity really kicked in when I started the T-cyp. After about a month and a half it got back to normal.

    If that T level of 554 was the day after an injection of 100mg then your trough levels must be pretty low now.

  18. #17
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    Quote Originally Posted by CSI007 View Post
    I certainly wouldn't take that AI with your E2 being at that level. It could crash and you would be miserable. The nipple sensitivity will likely resolve over time. It did with me....Though I was already on HCG mono and the nipple sensitivity really kicked in when I started the T-cyp. After about a month and a half it got back to normal.

    If that T level of 554 was the day after an injection of 100mg then your trough levels must be pretty low now.
    My T injection is only 50mg every 3.5 days. Also, I think the E2 test was a standard instead of the ultra sensitive.

  19. #18
    Sadly, none of the doctors you have had are doing you any favors. I would try Prime Body or Defy Medical as a great many of the guys on the forum use and recommend them. They can get you on a real protocol that works.

  20. #19
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    You definitely need a new doctor.

    Are you working out at all? TRT isn't magic, you need to put in some effort to yield full benefits from it. Think of it as a performance enhancer and life optimizer, not an end in itself.

    How's your diet, are you doing resistance work and cardio? 100 mg of test cyp injected weekly will do miracles, but only if you put in the effort. Most of the guys here who are satisfied with TRT have something in common-they are working at it, and working it hard.

    Get a new doctor and start over, but do it right. Work out.

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    Quote Originally Posted by ERO View Post
    Sadly, none of the doctors you have had are doing you any favors. I would try Prime Body or Defy Medical as a great many of the guys on the forum use and recommend them. They can get you on a real protocol that works.
    I know that is likely an option I will have to look in to. My concern is the cost. As of now my insurance company covers everything except for HCG. I guess that doesn't matter much though, if I don't feel any different.

  22. #21
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    Quote Originally Posted by greg76 View Post
    I know that is likely an option I will have to look in to. My concern is the cost. As of now my insurance company covers everything except for HCG. I guess that doesn't matter much though, if I don't feel any different.
    Give them a try for one year, post about your experience. If you're not happy or you feel you're not getting your money's worth . Tell us and move on to a doctor your insurance covers.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  23. #22
    Quote Originally Posted by greg76 View Post
    I know that is likely an option I will have to look in to. My concern is the cost. As of now my insurance company covers everything except for HCG. I guess that doesn't matter much though, if I don't feel any different.
    It is a cold truth: few of our members receive the care they deserve through doctors who accept insurance. Certainly, some do. There are capable doctors specializing in androgen managment who participate in various insurance plans, but they are very hard to find. The costs associated with Defy or Prime Body may not be as expensive as you think. Call them and ask them blunt questions, they won't dodge.

    You deserve better care than you are receiving.
    Last edited by CoastWatcher; 03-29-2017 at 07:46 AM.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    Quote Originally Posted by Mountain Man View Post
    You definitely need a new doctor.

    Are you working out at all? TRT isn't magic, you need to put in some effort to yield full benefits from it. Think of it as a performance enhancer and life optimizer, not an end in itself.

    How's your diet, are you doing resistance work and cardio? 100 mg of test cyp injected weekly will do miracles, but only if you put in the effort. Most of the guys here who are satisfied with TRT have something in common-they are working at it, and working it hard.

    Get a new doctor and start over, but do it right. Work out.
    No, I am not working out at all and my diet isn't great either. I still expected to feel some difference from the T though. I don't want to make a bunch of excuses, but I have no energy. I work 2nd shift, 3pm-2am, in a machine shop. I also have 2 young kids and am putting my girlfriend through college. I feel tired most of the time and have been unable to motivate myself. I agree that I need to exercise though.

  25. #24
    Quote Originally Posted by greg76 View Post
    I know that is likely an option I will have to look in to. My concern is the cost. As of now my insurance company covers everything except for HCG. I guess that doesn't matter much though, if I don't feel any different.
    I pay for everything out of pocket. I no longer have insurance but when I did I still paid out of pocket. Your health and well being are worth more then the dollars in your pocket. TRT, labs etc won't bankrupt you I can attest to that and it will open up options for you with regards to Doctors.

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