22 Year Old Male. Just starting TRT but wondering if there's more I can do.

[Vithat]

Hello, this is my first post here.

Im 22 and was diagnosed with hypogonadism when I was younger, about 16 or so. I was going through some treatment at the time of gel patches, but Im sure I dont need to elaborate on how annoying that was to you all. Thus my doctor and I talked and I was switched to cypionate injections (200 I think) once a month, but as life happened, it was fairly difficult to keep up with it.

Now, all these years later, I been trying to get my health together. I went to a new doctor, supposedly best in my city. My test results are as follows for the hypogonadism panel.

[TD="class: nameCol srchbl"]LUTEINIZING HORMONE[/TD] [TD="class: valueCol"]4 mIU/ml[/TD] [TD="class: rangeCol"]6.0 - 19.0 mIU/ml[/TD]

[TD="class: nameCol srchbl"]FOLLICLE STIMULATING HORMONE[/TD] [TD="class: valueCol"]3 mIU/ml[/TD] [TD="class: rangeCol"]4.0 - 10.0 mIU/ml[/TD]

[TD="class: nameCol srchbl"]DHEA-S[/TD] [TD="class: valueCol"]3661ng/ml[/TD] [TD="class: rangeCol"]1449 - 3999 ng/ml[/TD]

[TD="class: nameCol srchbl"]SHBG[/TD] [TD="class: valueCol"]13nmol/L[/TD] [TD="class: rangeCol"]10 - 55 nmol/L[/TD]

[TD="class: nameCol srchbl"]FREE TESTOSTERONE-CALCULATED[/TD] [TD="class: valueCol"]8.85ng/dl[/TD] [TD="class: rangeCol"]ng/dl[/TD]

[TD="class: nameCol srchbl"]ESTRADIOL[/TD] [TD="class: valueCol"]5 ng/dl[/TD] [TD="class: rangeCol"]0.5 - 5 ng/dl[/TD]

[TD="class: nameCol srchbl"]TESTOSTERONE LEVEL[/TD] [TD="class: valueCol"]296ng/dl[/TD] [TD="class: rangeCol"]200 - 1000 ng/dl[/TD]

After I have gone to this doctor only once and in our preliminary trials, he's having me take 2 types of pills, half a pill for stimulating test production 5 days a week, and an estrogen blocker once a week. So far I am not noticing much of a difference in the 3-4 weeks of this but I have come here to further understand what more I can do.

To bring context, I am a bit overweight and have been working to improve this condition. Ive lost about 52 pounds so far. However, a concerning factor that I am thinking on is SHBG and insulin sensetivity. If that is a major factor, how to quickly get it corrected. Additionally, it might also tie into stubborn belly fat and what seems like gynocemastia on my torso.

I understand that injections are the optimal way of solving this, my doctor however was hesitant to go there in regards to my age and potential fertility issues. Would it be beneficial to still insist on a injection schedule? Also could someone please inform me of the purpose and nature of HCG, if that is also something to ask about?

Thank you in advance.

 

[Systemlord]

Low thyroid hormones would be a reason why your SHBG is so low. Do you have any Free T3, Free T4, Reverse T3 or antibodies labs? I notice no prolactin tested, this is troubling!

Injections is the most effective form of TRT and if you're just one of those with genetically low SHBG, you would need to inject small micro doses every day, otherwise TRT will not work for you. 200mg once a month is just plane dumb when you consider the half life of the medicine you're injecting is 5-8 days or less when you account for those with lower SHBG such as yourself.

My SHBG is 18 nmol/L and if I do not inject small doses every other day TRT doesn't work for me, results injecting twice weekly (every 3.5 days) provide mediocre results and I'm still left with symptoms. Your SHBG will dictate how often you inject, men with high SHBG levels can get away with injecting once weekly, because they hold onto their testosterone better than we low SHBG men do.

HCG can provide mood benefits and most importantly can keep your testicles producing sperm should you want kids someday, they also keep your testicles from pulling up tight which can be embarrassing when it's time to get intimate with that special someone.

Working out and eating diets rich in veggies is known to raise SHBG levels and will improve your situation.

 

[Vince]

I would forget about the estrogen blocker for now. I would consider injecting testosterone and HCG twice a week, after changing protocol you can have labs in 6 weeks.

 

[Vithat]

Low thyroid hormones would be a reason why your SHBG is so low. Do you have any Free T3, Free T4, Reverse T3 or antibodies labs? I notice no prolactin tested, this is troubling!

Injections is the most effective form of TRT and if you're just one of those with genetically low SHBG, you would need to inject small micro doses every day, otherwise TRT will not work for you. 200mg once a month is just plane dumb when you consider the half life of the medicine you're injecting is 5-8 days or less when you account for those with lower SHBG such as yourself.

My SHBG is 18 nmol/L and if I do not inject small doses every other day TRT doesn't work for me, results injecting twice weekly (every 3.5 days) provide mediocre results and I'm still left with symptoms. Your SHBG will dictate how often you inject, men with high SHBG levels can get away with injecting once weekly, because they hold onto their testosterone better than we low SHBG men do.

HCG can provide mood benefits and most importantly can keep your testicles producing sperm should you want kids someday, they also keep your testicles from pulling up tight which can be embarrassing when it's time to get intimate with that special someone.

Working out and eating diets rich in veggies is known to raise SHBG levels and will improve your situation.

Well, this is some news. Bad news for the intense depression Im going through as well, been going to therapy for that, already got some intense feelings over the litany of other medical issues ive got. I been trying to fix my diet, mainly rice, ground beef and mixed vegetables. This is very stressing considering that I wanted to fix this to help with the depression and health but now you're telling me I may have to prick myself every day....

I have this result from a test back in January.

[TD="class: nameCol srchbl"]Triiodothyronine,Free,Serum[/TD] [TD="class: valueCol"]2.5 pg/mL[/TD] [TD="class: rangeCol"]2.0 - 4.4 pg/mL[/TD]

[TD="class: nameCol srchbl"]T4,Free(Direct)[/TD] [TD="class: valueCol"]0.95 ng/dL[/TD] [TD="class: rangeCol"]0.82 - 1.77 ng/dL[/TD]

[TD="class: nameCol srchbl"]Thyroxine (T4)[/TD] [TD="class: valueCol"]4.3 ug/dL[/TD] [TD="class: rangeCol"]4.5 - 12.0 ug/dL[/TD]

[TD="class: nameCol srchbl"]TSH[/TD] [TD="class: valueCol"]1.370 uIU/mL[/TD] [TD="class: rangeCol"]0.450 - 4.50 uIU/mL[/TD]

[TD="class: nameCol srchbl"]LH[/TD] [TD="class: valueCol"]5.6 mIU/mL[/TD] [TD="class: rangeCol"]1.7 - 8.6 mIU/mL[/TD]

[TD="class: nameCol srchbl"]FSH[/TD] [TD="class: valueCol"]2.3 mIU/mL[/TD] [TD="class: rangeCol"]1.5 - 12.4 mIU/mL[/TD]

And here's prolactin. Sorry for not providing it. This was April.

[TD="class: nameCol srchbl"]PROLACTIN[/TD] [TD="class: valueCol"]8.6 NG/ML[/TD] [TD="class: rangeCol"]4.0 - 15.2 NG/ML[/TD]

Im unsure how to interpret this data, but according to what you said, it seems I have a degree of low thyroid activity, what is there to do? What can I do?

 

[CoastWatcher]

In regard to injection schedules, here is the gold standard study proving that injections every two weeks are doomed to fail. Injections once a month, as you were prescribed, are the sure sign that the doctor you are consulting is utterly clueless. https://www.excelmale.com/forum/showthread.php?12771&p=88718#post88718

 

[Vithat]

Well that was my previous doctor, when I was 16-19 or so. He was probably being very cautious considering I was in the height of puberty changes and stuff.

My current doctor is supposedly the best in my city, he's the one who's got me on the half pill to stimulate T production in the testes, and the estrogen blocker once a week. He's likely being cautious as well considering my age and im still "growing" at 22.

 

[Systemlord]

Well that was my previous doctor, when I was 16-19 or so. He was probably being very cautious considering I was in the height of puberty changes and stuff.

My current doctor is supposedly the best in my city, he's the one who's got me on the half pill to stimulate T production in the testes, and the estrogen blocker once a week. He's likely being cautious as well considering my age and im still "growing" at 22.

It sounds like this doctor may be a little better than the first, but an estrogen blocker once weekly isn't ideal. The half life of the estrogen blocker is shorter than 7 days, it's this reason no one takes an AI once weekly, twice weekly is prefered otherwise your estrogen in the first half of the week will be different than the second half. Clomid has zero chance of working in the hands of a doctor that doesn't have a clue, sure hope you're not taking Clomid 50mg every day or every other day.

Are you on thyroid treatment? Reason I ask is because your thyroid hormones are low, T4 is exceeding low. Free T3 and Free T4 aren't optimal and may be in hypothyroidism territory which would more than explain your low SHBG. Your thyroid just isn't pumping out enough total thyroid hormones (T4) and is why Free T3 and Free T4 are both on the low end.

Most doctors do not understand the thyroid as they should, often failing to take action. There are lots of people out there with hypothyroidism who are scripted SSRIs instead of doctors addressing thyroid issues, low thyroid hormones can absolutely cause depression and anxiety. Low testosterone can also cause depression, a double whammy it you're unfortunate to have both low thyroid and low testosterone.

A doctors inaction can have many reasons, one the insurance company has rules regarding the cutoff point where they will pay for treatment and will not take action until you're so low you can barely function and doctor states that you're within normal ranges (you're fine) or second inexperienced doctors who have a poor understanding of hypothyroidism.

 

[Vithat]

It sounds like this doctor may be a little better than the first, but an estrogen blocker once weekly isn't ideal. The half life of the estrogen blocker is shorter than 7 days, it's this reason no one takes an AI once weekly, twice weekly is prefered otherwise your estrogen in the first half of the week will be different than the second half. Clomid has zero chance of working in the hands of a doctor that doesn't have a clue, sure hope you're not taking Clomid 50mg every day or every other day.

Are you on thyroid treatment? Reason I ask is because your thyroid hormones are low, T4 is exceeding low. Free T3 and Free T4 aren't optimal and may be in hypothyroidism territory which would more than explain your low SHBG. Your thyroid just isn't pumping out enough total thyroid hormones (T4) and is why Free T3 and Free T4 are both on the low end.

Most doctors do not understand the thyroid as they should, often failing to take action. There are lots of people out there with hypothyroidism who are scripted SSRIs instead of doctors addressing thyroid issues, low thyroid hormones can absolutely cause depression and anxiety. Low testosterone can also cause depression, a double whammy it you're unfortunate to have both low thyroid and low testosterone.

A doctors inaction can have many reasons, one the insurance company has rules regarding the cutoff point where they will pay for treatment and will not take action until you're so low you can barely function and doctor states that you're within normal ranges (you're fine) or second inexperienced doctors who have a poor understanding of hypothyroidism.

Yeah, it's looking like I might have to set up an appointment to talk about it. I been going through some extremely bad depressive episodes lately. A lot of excruciating pain, left me frequently thinking of ending it. I'm in a hospital treatment center program right now with other severely depressed people, they put me on Effexor last week and I been on Lexapro for 6 years. Do anti depressants interact with this stuff in any way?

With the hyperthyroidism and t level, and also high insulin resistance/pre-diabetes. This means like 5 pills, and shots every other day, and hospitalization? Am I painting this picture clearly. How quickly could the medicine work do you think in fixing this.

 

[Vithat]

It sounds like this doctor may be a little better than the first, but an estrogen blocker once weekly isn't ideal. The half life of the estrogen blocker is shorter than 7 days, it's this reason no one takes an AI once weekly, twice weekly is prefered otherwise your estrogen in the first half of the week will be different than the second half. Clomid has zero chance of working in the hands of a doctor that doesn't have a clue, sure hope you're not taking Clomid 50mg every day or every other day.

Are you on thyroid treatment? Reason I ask is because your thyroid hormones are low, T4 is exceeding low. Free T3 and Free T4 aren't optimal and may be in hypothyroidism territory which would more than explain your low SHBG. Your thyroid just isn't pumping out enough total thyroid hormones (T4) and is why Free T3 and Free T4 are both on the low end.

Most doctors do not understand the thyroid as they should, often failing to take action. There are lots of people out there with hypothyroidism who are scripted SSRIs instead of doctors addressing thyroid issues, low thyroid hormones can absolutely cause depression and anxiety. Low testosterone can also cause depression, a double whammy it you're unfortunate to have both low thyroid and low testosterone.

A doctors inaction can have many reasons, one the insurance company has rules regarding the cutoff point where they will pay for treatment and will not take action until you're so low you can barely function and doctor states that you're within normal ranges (you're fine) or second inexperienced doctors who have a poor understanding of hypothyroidism.

Ive looked at the labels, it is Clomid 50mg hes got me taking every day though, as I said, its half a pill. What is wrong with taking it every day? Whats gonna happen?

The estrogen blocker is Arimidex, 1mg. Is this good enough, or am I better trying to get something stronger?

What is the best treatment out there for Thyroid stuff? My current doctor is primarily a Urologist, should I be looking for an Endocrinologist instead to address this issue?

Sorry for the many questions.

 

[Systemlord]

Ive looked at the labels, it is Clomid 50mg hes got me taking every day though, as I said, its half a pill. What is wrong with taking it every day? Whats gonna happen?

The estrogen blocker is Arimidex, 1mg. Is this good enough, or am I better trying to get something stronger?

What is the best treatment out there for Thyroid stuff? My current doctor is primarily a Urologist, should I be looking for an Endocrinologist instead to address this issue?

Sorry for the many questions.

Half a pill sounds like 25mg which isn't necessarily bad. Surprised you weren't referred to an endo by now for the thyroid issues, T3 and T4 medicine is common for thyroid treatment. It's common for low SHBG men to have problems with anxiety, something hormone specialists see a lot.

 

[Vithat]

Half a pill sounds like 25mg which isn't necessarily bad. Surprised you weren't referred to an endo by now for the thyroid issues, T3 and T4 medicine is common for thyroid treatment. It's common for low SHBG men to have problems with anxiety, something hormone specialists see a lot.

You say "not necessarily bad" but what is the context of bad and good you're talking about? What does it even look like?

I went to an Endo to get the test but haven't followed up. It's looking like there's a lot more here to it that's causing a perfect storm of severe anxiety and depression.

How long does it usually take with T3 and T4 medications until changes happen?

 

[lowe2sucks]

good luck with clomid+anastrozole I would rather shoot myself straight away than to use this combo it would make feel worse than any low testosterone can make you feel and I swear this combo will give you insulin resistance and low shbg with time

it probably will raise your testosterone numbers on bloodwork and according to that piece of paper your doctor will tell you you should feel awesome with these testosterone levels but you will feel worse than low T

If you are still "growing" and stuff like that I would just wait a bit until it's over and than do injectable testosterone if its still needed maybe freeze sperm before doing that

 

[Systemlord]

You say "not necessarily bad" but what is the context of bad and good you're talking about? What does it even look like?

I went to an Endo to get the test but haven't followed up. It's looking like there's a lot more here to it that's causing a perfect storm of severe anxiety and depression.

How long does it usually take with T3 and T4 medications until changes happen?

Well typically experienced doctors will do 25mg Clomid EOD or 12.5mg EOD and not the old school 25-50mg everyday. Sounds like you're having a typical response to Clomid. It takes 6 weeks for everything to stabilize.

 

[Vithat]

good luck with clomid+anastrozole I would rather shoot myself straight away than to use this combo it would make feel worse than any low testosterone can make you feel and I swear this combo will give you insulin resistance and low shbg with time

it probably will raise your testosterone numbers on bloodwork and according to that piece of paper your doctor will tell you you should feel awesome with these testosterone levels but you will feel worse than low T

If you are still "growing" and stuff like that I would just wait a bit until it's over and than do injectable testosterone if its still needed maybe freeze sperm before doing that

I guess I'll Just have to wait and see. Is there any known interactions between test and thyroid stuff and ssris and other anti depressant? I'm worried I'm having a bad reaction is all, never been this out of it and borderline suicidal. In a bit of a crisis.

I'd like to move on to Injections to get this fixed as fast as possible.

 

[Vithat]

Well typically experienced doctors will do 25mg Clomid EOD or 12.5mg EOD and not the old school 25-50mg everyday. Sounds like you're having a typical response to Clomid. It takes 6 weeks for everything to stabilize.

What typical reaction is that. What are you talking about.

 

[Systemlord]

What typical reaction is that. What are you talking about.

Most feel well in the beginning but soon tapers off and you start feeling unwell, for some it is the driving force for depression episodes and emotional problems for some who have never had these problems before, some have to quit. It is this reason why experienced doctor have you do 12.5-25mg EOD, anything more it just creates too many problems for men.

If it were me in your shoes and I was borderline suicidal on Clomid, I would talk to my doctor about stopping. It isn't worth it if you end up hurting yourself.

 

[Vithat]

Most feel well in the beginning but soon tapers off and you start feeling unwell, for some it is the driving force for depression episodes and emotional problems for some who have never had these problems before, some have to quit. It is this reason why experienced doctor have you do 12.5-25mg EOD, anything more it just creates too many problems for men.

If it were me in your shoes and I was borderline suicidal on Clomid, I would talk to my doctor about stopping. It isn't worth it if you end up hurting yourself.

Well tried to make an appointment but the only time they could get me in was 23 of July. What should I do until then? Theres simply so much medication pumping through me im not sure what to do.