About to start TRT

[James B]

Really happy to find this forum.

I've got a complicated health history, including a leukemia diagnosis in 2009. Had a stem cell transplant to avoid dying from leukemia 10 years ago and have been taking prednisone for the autoimmune consequences of that ever since. Have been on thyroid hormones just as long, sometimes desiccated thyroid, sometimes synthetic T4 + T3, currently taking just synthetic T4.

About 3 years ago I started seeing a local doctor who prescribed compounded topical testosterone cream. I don't remember the dosage, but it did nothing to resolve my symptoms (primarily low energy, motivation, and sex drive) so I stopped it after several months.

Recently I had a consultation with a provider that ordered the attached blood work. It shows very low testosterone, along with about a dozen other out of range results, including high iron. Because of my health history, I cannot donate blood so I went to my local doctor and they took 500 ml of blood and discarded it. Due to my health history the nucleated red blood cells are not a concern and I'm hoping TRT will help many of the rest, like elevated fasting blood sugar, hemoglobin A1C, insulin, and LDL. With my family history, I would be surprised if cholesterol was a problem for me when my hormones are balanced.

This doctor prescribed weekly injections of 200 mg testosterone cypionate compounded with 1 mg of anastrozole. I questioned him about the use of AIs and he claimed that without it my e2 levels would skyrocket after a few weeks. He targets e2 levels of 25 to 30. Mine was 21.3 pg/ml when this baseline blood work was done. I know some here are adamant that low e2 is a bigger risk than high e2 and I am inclined to look for another provider that starts without AIs and a lower dose rather than start this regimen. Interested to hear what you think.

 

[Systemlord]

This doctor prescribed weekly injections of 200 mg testosterone cypionate compounded with 1 mg of anastrozole.

This is a recipe for disaster and you should ask for cypionate without anastrozole. Mixing Test with AI is a cookie-cutter approach to TRT.

This compounded Test/AI combo is an indication that your doctor isn't a competent one, because not all men have symptoms from high estrogen.

My estrogen is sky-high and I have no symptoms and every time I introduced an AI to treat a number on a piece of paper, bad things started to happen which include bone pain.

I'm very sensitive to stimulants and medications, even a 0.050 anastrozole caused severe bone pain in hips, knees and bad headaches.

So you're also sensitive to stimulants and medications, expect a bad outcome and also don't expect any sort of refund for the Test/AI combo.

 

[Jucaro]

starts without AIs and a lower dose rather than start this regimen. Interested to hear what you think.

That's correct. Better not to use Ai in the first place. Wait to see where your E2 will sit after you start TRT, and even being higher, it depends on the symptoms whether to use an Ai or not.
Regarding the dose of T, you probably will need to use a frequent dose schedule since your SHBG is low and you probably will metabolize Testosterone faster.
On a weekly dose as prescribed to you, you will probably need a relative high dose as prescribed, but any way it is just an assumption and it is better to start low and go slow till you feel good..

 

[Systemlord]

I'm hoping TRT will help many of the rest, like elevated fasting blood sugar, hemoglobin A1C, insulin, and LDL.

I was diagnosed with low-T and type 2 diabetes at the same time, SHBG 11 and TRT has actually increased SHBG to 18 and every time I check it it's higher.

TRT, Jatenzo has halved my A1C (12->6.4%) is 6 months and is continuing to lower it. I also had high triglycerides and has lowered it significantly.

New research shows that estrogen improves insulin sensitivity, so by your doctor including an AI with Test without a reason, a bonehead move in my book.

 

[James B]

I was diagnosed with low-T and type 2 diabetes at the same time, SHBG 11 and TRT has actually increased SHBG to 18 and every time I check it it's higher.

TRT, Jatenzo has halved my A1C (12->6.4%) is 6 months and is continuing to lower it. I also had high triglycerides and has lowered it significantly.

New research shows that estrogen improves insulin sensitivity, so by your doctor including an AI with Test without a reason, a bonehead move in my book.

Great to hear that TRT has helped your blood sugar and triglycerides. Saw Nelson's post about starting TRT that says effects on glycemic control can take 3-12 months. Will be selfishly hoping that you continue to see improvements over the next 6 months. Never heard of Jatenzo before and have read that oral testosterone is hard on the liver. I presume you've read the same and there's more to it.

 

[Systemlord]

Never heard of Jatenzo before and have read that oral testosterone is hard on the liver.

My liver testing shows low normal ALT levels detailed in my Jatenzo log thread linked below.

My Experience On Jatenzo (Oral TRT) Log

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...

www.excelmale.com

 

[tareload]

Really happy to find this forum.

I've got a complicated health history, including a leukemia diagnosis in 2009. Had a stem cell transplant to avoid dying from leukemia 10 years ago and have been taking prednisone for the autoimmune consequences of that ever since. Have been on thyroid hormones just as long, sometimes desiccated thyroid, sometimes synthetic T4 + T3, currently taking just synthetic T4.

About 3 years ago I started seeing a local doctor who prescribed compounded topical testosterone cream. I don't remember the dosage, but it did nothing to resolve my symptoms (primarily low energy, motivation, and sex drive) so I stopped it after several months.

Recently I had a consultation with a provider that ordered the attached blood work. It shows very low testosterone, along with about a dozen other out of range results, including high iron. Because of my health history, I cannot donate blood so I went to my local doctor and they took 500 ml of blood and discarded it. Due to my health history the nucleated red blood cells are not a concern and I'm hoping TRT will help many of the rest, like elevated fasting blood sugar, hemoglobin A1C, insulin, and LDL. With my family history, I would be surprised if cholesterol was a problem for me when my hormones are balanced.

This doctor prescribed weekly injections of 200 mg testosterone cypionate compounded with 1 mg of anastrozole. I questioned him about the use of AIs and he claimed that without it my e2 levels would skyrocket after a few weeks. He targets e2 levels of 25 to 30. Mine was 21.3 pg/ml when this baseline blood work was done. I know some here are adamant that low e2 is a bigger risk than high e2 and I am inclined to look for another provider that starts without AIs and a lower dose rather than start this regimen. Interested to hear what you think.

I am pulling for you man and look for another provider. With your TT level you should look for a provider that will start with reasonable and not insane weekly injections of Test +AI.

A decent physician will be put you on 75-100 mg/week test ester with no AI and reassess how you are doing in 12 weeks and safety panel blood work in 6 weeks. Run from "provider" above. I'd start at 70-75 mg/week. Especially as your Hct /RBC is pretty up there before even starting T.

Your thyroid panel is intriguing for someone on T4 monotherapy. Have you checked for hemochromatosis? What's your hematologist make of your CBC and iron panels? Something to stay on top of with exogenous T use.

Also pull off your personal stuff from the blood work. This is the internet.

 

[James B]

I am pulling for you man and look for another provider. With your TT level you should look for a provider that will start with reasonable and not insane weekly injections of Test +AI.

A decent physician will be put you on 75-100 mg/week test ester with no AI and reassess how you are doing in 12 weeks and safety panel blood work in 6 weeks. Run from this provider. I'd start at 70-75 mg/week. Especially as your Hct /RBC is pretty up there before even starting T.

Your thyroid panel is intriguing for someone on T4 monotherapy. Have you checked for hemochromatosis? What's your hematologist make of your CBC and iron panels? Something to stay on top of with exogenous T use.

Also pull off your personal stuff from the blood work. This is the internet.

Appreciate your opinion on a reasonable starting dose.

My iron was high about 10 years ago, but low around 5 years ago so I don't believe this is a genetic thing for me. Hoping it's another 10 years before my next blood letting.

Conventional leukemia doctors have not been that much help since my transplant. They view everything through the lens of autoimmunity and mostly prescribe the latest patented pharmaceuticals. The last of which decreased my aerobic capacity which persisted even after I stopped it. My CBCs are good from their point of view. They would watch the elevated liver enzymes. Don't know that they've measured iron lately. They used to watch triglycerides when I was on a medication that could raise them, but I stopped that medication.

I removed my street address and phone number from the blood work. Don't think my name or state and city are much of a secret. Could have removed the zip code, I guess.

 

[tareload]

Appreciate your opinion on a reasonable starting dose.

My iron was high about 10 years ago, but low around 5 years ago so I don't believe this is a genetic thing for me. Hoping it's another 10 years before my next blood letting.

Conventional leukemia doctors have not been that much help since my transplant. They view everything through the lens of autoimmunity and mostly prescribe the latest patented pharmaceuticals. The last of which decreased my aerobic capacity which persisted even after I stopped it. My CBCs are good from their point of view. They would watch the elevated liver enzymes. Don't know that they've measured iron lately. They used to watch triglycerides when I was on a medication that could raise them, but I stopped that medication.

I removed my street address and phone number from the blood work. Don't think my name or state and city are much of a secret. Could have removed the zip code, I guess.

So what's the deal with your thyroid? Your bloodwork looks like mine did when I was doing combo therapy with the a bunch of T3 added in. Does your TSH jump around or can your doc titrate it with T4 mono?


Raising your TT at trough to 500 ng/dl would bring your fT up to 15ng/dl from the 5 ng/dl today (via Vermeulen calculation). You could also follow up with equilibrium dialysis later to get a measurement for comparison.

Best wishes.

 

[James B]

So what's the deal with your thyroid? Your bloodwork looks like mine did when I was doing combo therapy with the a bunch of T3 added in. Does your TSH jump around or can your doc titration it with T4 mono?

I had some joint pain earlier this year and tried adding 5 mcg T3. Stopped it after a week due to heart palpitations. That was mid March. Hormone blood draw was April 7th so I would have been off of the T3 for two weeks prior to blood draw. I don't pay attention to TSH. I've had to adjust my dose several times over the last 10 years. Sometimes down, sometimes up.

 

[tareload]

I had some joint pain earlier this year and tried adding 5 mcg T3. Stopped it after a week due to heart palpitations. That was mid March. Hormone blood draw was April 7th so I would have been off of the T3 for two weeks prior to blood draw. I don't pay attention to TSH. I've had to adjust my dose several times over the last 10 years. Sometimes down, sometimes up.

Interesting your fT4 on the low end and fT3/fT4 ratio so high 2 weeks after stopping T3. How much T4 are you taking and what's your weight?

This is levothyroxine from the pharmacy? You have an Endo or is this do it yourself?

 

[James B]

Interesting your fT4 on the low end and fT3/fT4 ratio so high 2 weeks after stopping T3. How much T4 are you taking and what's your weight?

This is levothyroxine from the pharmacy? You have an Endo or is this do it yourself?

I'm taking 100 mcg of generic levothyroxine four times a week and weight around 170.

My local doctor, who is a wholistic practitioner, prescribes it.

 

[bonder]

Looks like your lh and fsh low. Secondary hypogonadism.

To confirm you can try clomid 25 mg eod. This should raise you lh and tell the testicles to make testosterone.

Though it appears even if clomid raises your t and start feeling good initially… Clomid sides kick in.

Some believe clomid May restart your hpta axis. Then you can get off clomid and see if levels maintain.

This might be a good process if you are not confident in starting trt. Cause then you may second guess yourself that you should have tried other stuff.

welcome on a board!