Hi - I am looking for advice to help dial-in TRT medications as well as a couple of current side effects. By way of background I am 61 yo active white male diagnosed with low T when I was 53. Classic presentation during late ages 45-53 despite active lifestyle (weight training 3-4 week; spin class 2-3 week) I was diagnosed with metabolic syndrome. My HBA1C hovered around 5.8, hypertension, and high cholesterol. I was also experiencing lower libido and weaker erections. My primary care finally ran T levels and my Total T was 361 ng/dl, Free T was 28 pg/mL, and SHBG was 52. All Thyroid functions were within normal limits. Initially used Axiron for first year and a half and then on advice of primary care provider switch to pellets. Due to higher SHBG I was getting 12 pellets very 16 weeks. Labs just prior to next implants were lower than when initially diagnosed. I also did not like the roller coaster of emotions when on pellets plus I experienced significant testicular atrophy, they were the size of grapes, which I struggled with. I shifted to T injections in Nov 2017 and have generally been pleased and saw restoration of testicular size with 1,500 U of HGH per week.
Since starting injection therapy my protocol has been fairly consistent with twice weekly injection every 3.5 days with weekly dose of 140 mg T-Cyp, 1,500 U of HCG and 0.15 AI twice a week. In December 2019, I was on the same protocol except dosing except I shifted to EOD injections and decreased T-Cyp to 100 mg and HCG to 1,200 week and dropped AI. In addition to TRT medications, I take 5 mg Cialis daily for ED management.
In June of this year, facing higher DHT levels (951.8 pg/mL Normal: 102-719) and increasing Estradiol Ultra Sensitive (48 pg/mL Normal: 11-80) and not wanting to go back on AI, TRT provider recommended adding Nandrolone to my protocol. In June my Total T (LC-MS) was 998.5 ng/dL (278 points above Normal limit) Free was 282.8 pg/mL (38 points above normal limits), SHBG was 35. I ultimately decided to go on Nandrolone at weekly dose of 70 mg, decreased T-Cyp to 70 mg weekly, and increased HCG back to 1,500 U due to some testicular atrophy at 1,200 U dosage.
In July 2020 I contracted COVID-19 and was hospitalized to receive Remdesivir, decadron, and convalescent plasma. I was off all TRT medications while in the hospital. In September 2020, I unexpectedly retired when employer offered early retirement option. Since retiring, I have been enjoying increased time for daily workouts, learning crossfit workouts, and indoor cycling. I have seen improvements in total body weight and % body fat. I've dropped 15 pounds down to 182 and % body fat is at 13.9%.
My December 2020 labs highlight the following results:
Total T = 1,378 ng/dL (Normal 300-720)
Free T = 310 pg/mL (Normal 47 - 244)
Bioavailable T = 810 ng/dL (Normal 131 - 682)
% Free = 2.3% (Normal 1.6 - 2.9%)
SHBG = 38 nmol/L (Normal 11 - 80)
Estradiol High Sensitivity = 21.1 ng/mL (Normal 10 - 42)
TSH = 1.329 mIU/L (Normal 0.270 - 4.2)
DHEA = 322 ng/dL (Normal 42 - 290) (I take 25 mg per day 5 days a week)
Of particular concern to Primary Care Provider my Creatinine levels climbed 0.3 points to 1.4 mg/bl (Normal 0.6-1.2) and my GFR dropped to 54ml/min (Normal > 60). My blood pressure has been running in the 140/90 range despite 20 mg of ramipril daily. Of note, I use L-Arginine and L-Citrulline as NO booster as a pre-workout. My usage of these supplements has increased with increased workouts.
Based on concerns from PCP regarding T levels, higher BP, and potential lower renal functioning based on creatinine and GFR levels, I made the following adjustments to medication protocol with plans to retest in March. Dropped T-Cyp and Nandrolone to weekly does of 50 mg each and decreased use of NO supplements.
I have never had that "dial-in" feeling that many of this forum described. Any thoughts would be helpful.
Since starting injection therapy my protocol has been fairly consistent with twice weekly injection every 3.5 days with weekly dose of 140 mg T-Cyp, 1,500 U of HCG and 0.15 AI twice a week. In December 2019, I was on the same protocol except dosing except I shifted to EOD injections and decreased T-Cyp to 100 mg and HCG to 1,200 week and dropped AI. In addition to TRT medications, I take 5 mg Cialis daily for ED management.
In June of this year, facing higher DHT levels (951.8 pg/mL Normal: 102-719) and increasing Estradiol Ultra Sensitive (48 pg/mL Normal: 11-80) and not wanting to go back on AI, TRT provider recommended adding Nandrolone to my protocol. In June my Total T (LC-MS) was 998.5 ng/dL (278 points above Normal limit) Free was 282.8 pg/mL (38 points above normal limits), SHBG was 35. I ultimately decided to go on Nandrolone at weekly dose of 70 mg, decreased T-Cyp to 70 mg weekly, and increased HCG back to 1,500 U due to some testicular atrophy at 1,200 U dosage.
In July 2020 I contracted COVID-19 and was hospitalized to receive Remdesivir, decadron, and convalescent plasma. I was off all TRT medications while in the hospital. In September 2020, I unexpectedly retired when employer offered early retirement option. Since retiring, I have been enjoying increased time for daily workouts, learning crossfit workouts, and indoor cycling. I have seen improvements in total body weight and % body fat. I've dropped 15 pounds down to 182 and % body fat is at 13.9%.
My December 2020 labs highlight the following results:
Total T = 1,378 ng/dL (Normal 300-720)
Free T = 310 pg/mL (Normal 47 - 244)
Bioavailable T = 810 ng/dL (Normal 131 - 682)
% Free = 2.3% (Normal 1.6 - 2.9%)
SHBG = 38 nmol/L (Normal 11 - 80)
Estradiol High Sensitivity = 21.1 ng/mL (Normal 10 - 42)
TSH = 1.329 mIU/L (Normal 0.270 - 4.2)
DHEA = 322 ng/dL (Normal 42 - 290) (I take 25 mg per day 5 days a week)
Of particular concern to Primary Care Provider my Creatinine levels climbed 0.3 points to 1.4 mg/bl (Normal 0.6-1.2) and my GFR dropped to 54ml/min (Normal > 60). My blood pressure has been running in the 140/90 range despite 20 mg of ramipril daily. Of note, I use L-Arginine and L-Citrulline as NO booster as a pre-workout. My usage of these supplements has increased with increased workouts.
Based on concerns from PCP regarding T levels, higher BP, and potential lower renal functioning based on creatinine and GFR levels, I made the following adjustments to medication protocol with plans to retest in March. Dropped T-Cyp and Nandrolone to weekly does of 50 mg each and decreased use of NO supplements.
I have never had that "dial-in" feeling that many of this forum described. Any thoughts would be helpful.
