EW's TRT Journey

[Evilwhitey]

Background on me. I'm 38yo, married, 4 kids, work 50+ hrs a week, wife runs a business from home at night/weekends, and all the normal stresses of family life apply. I will say that I have a great wife and kids and my relationship with them is stellar so even though they are work, it's not the stress that many of my friends have from family life.

I workout hard 6+ hours a week (weights & HIIT) with another 10+ hrs of activity (hiking, mnt biking, backpacking, etc). 5'6" 169lbs, ~ 21% BF.

I could eat better but for the most part I eat fairly clean, avoiding processed carbs, eat plenty of beef/chicken/eggs, and protein shakes. I had my T tested in 2014 and it was 205 but I declined going on TRT and tried to clean up my life and do what I could to get levels up naturally. I worked out more, ate cleaner, focussed on sleep and got it up to 307 (see labs below) which was better, but still not feeling great.

Sleep is fairly bad, I just don't sleep well, probably averaging 5.5hrs a night with some nights being very low quality (mostly due to wife and kids waking me up). Most days I feel exhausted, and wake up feeling worse than when I went to sleep. I can't remember the last time I felt rested and full of energy. In general I feel fatigued, have suffered weight gain despite efforts to eat clean and exercise, feel week, struggle retaining muscle let alone putting it on, have fairly serious brain fog, sore joints, etc.

Consulted with doctors but none of them seemed to know what they were doing and many told me that I was in normal range and just needed to eat better and exercise more.

Initial bloodwork came back:

Testosterone 307 (was 205 in 2014) (240-871)

Testosterone Free % 2.3 (1.1-2.7)

Sex Hormone Binding Globulin 19 (13-71)

Testosterone Bioavailable 198.5 (115-407)

Testosterone Free 71.2 (37-147)

Thyroid Stimulating Hormone with Reflex Free T4 1.68 (.52-6.25)

Luteinizing Hormone 1.9 (.6-12.1)

IGF-1 168 (83-233)

E2 19.1 (8-35)

DHEA 280 (102.6-416.3)

Chol/HDL 5.9 (<4.5)

Total Chol 219 (138-199)

HDL Chol 37 (40-63)

LDL Chol 165 (<100)

Non HDL Chol 182 (<130)

Triglycerides 84 (54-149)

VLDL 17 (11-29)

Hemoglobin AC1 5

Ferritin 378 (37-400)

Hct 45.4 (41-53)

Hemoglobin 16.2 (13.5-17.5)

Vitamin D 50 (30-80)


Contacted Defy, and everything was a pleasant experience. Current protocol is:

200mg/ml T Cyp, .25ml 3x a week (150mg/week) MWF (morning, afternoon, night)
HCG 500 iu 2x week
Anastrozole .125 as needed (haven't taken any)

 

[Evilwhitey]

I'm 3 weeks in at this point and feeling good and bad.

Good: Brain fog is greatly improved, joints aren’t aching nonstop, sleep seems to be a bit better, and maybe a tiny bit more energy.

Bad: Feels like my twig n berries have deflated and I’m experiencing mild ED. Certainly none of the “I feel like a horny teenager 24/7” that some guys report.

 

[MarkM]

Welcome to the forum! You will be in good hands with Defy, good choice. Your are definitely a candidate for TRT with your low testosterone levels. Your Free T at 71.2 is really pretty good for such a low Total Testosterone level of 307. That's about 23% Free T but that is just a number. Kind of like getting a 50% return on a $1, it's still only .50 cents.

Your SHBG is relatively low, at least on the lower end of normal, so it's good you are injecting 3 times a week. The only problem with MWF is that you do have a gap across the weekend so some go to an every other day (EOD) injection protocol. The MWF is static and doesn't change and the EOD is a true EOD on a continual basis; MWFSTThSMWF.......

After you have been on TRT a while you will see your Ferritin drop. Your's is very good now but TRT protocols normally drops this especially if you have any phlebotomy's as your hematocrit rises (if it does). As your T levels increase so will your E2. It is not likely to stay at 19 like it is now. Being on TRT normally has a tendency to lower your HDL and yours is a little low now but when your E2 rises it might offset that a little bit as E2 can improve HDL. Overall your cholesterol numbers are a little high but nothing too serious. I think sometimes too much is made of cholesterol numbers. We tend to forget that all hormones in our body stem from cholesterol, the grand-daddy of all hormones. I think some push their cholesterol too low which may negatively impact the hormonal cascade f downstream hormones.

Your TSH looks okay but the thyroid is a complex organ and TSH is just one of several thyroid indicators. At some point you will probably want to have a full thyroid panel.

Keep in mind that starting TRT is not an overnight fix. It takes times and patience to get optimized and can take anywhere from months to a year for most of us. So, don't get frustrated along the way. Best wishes on your new journey!

 

[Evilwhitey]

The only problem with MWF is that you do have a gap across the weekend so some go to an every other day (EOD) injection protocol. The MWF is static and doesn't change and the EOD is a true EOD on a continual basis; MWFSTThSMWF.......

Yeah, I contemplated EOD but I think MWF will be easier and have spaced them out as much as possible so it's Monday morning, Wed afternoon, and late Friday night to try to minimize the gap as much as possible.

I really appreciate your response. I've been trying to educate myself but there's a lot to learn.

 

[fifty]

I just do mwf morning. It’s easier that way. Trying to do something mid day Wednesday is a pain in the A and I feel fine on Sundays.

 

[Evilwhitey]

I just do mwf morning. It’s easier that way. Trying to do something mid day Wednesday is a pain in the A and I feel fine on Sundays.

Mid day Wed is actually really easy for me. I work 5 minutes from home and eat lunch at home several times a week.

If I worked further from home I don’t think I’d consider it.

 

[Evilwhitey]

Six weeks in and I’ve noticed the following.

A little more energy, more clarity of mind, much easier to put on muscle and gain strength, and I gained a ton of water weight the first month that seems to have tapered off.

I went from 5’6” and 169 to 180lbs in maybe three weeks. I’ve been working out 1-2hrs a day, 5-6 days a week and haven’t ate too much more than I normally would so I’m fairly certain it’s water weight.

Last week I started getting very irritable and agro and got into a fight with my wife which is not normal at all. I also had problems “finishing” three nights in a row which has never been a problem for me.

Up until this point I hadn’t used the AI but after thinking about it I popped .125mg Anastrozole with my injection on Monday and then took one with my Friday injection as well. Those are the days when I also take HCG.

We’ll see how things go moving forward.

 

[lemonflavor]

I'd be interested to see what happened when adding the AI, and/or what next lab result shows regarding that.

 

[Evilwhitey]

Ok, here's an update with my most recent bloodwork taken while fasting Monday morning before my injection. I'm not going to list all the CBC and metabolic panel, just stuff that stood out since everything was middle of the range with the few exceptions listed below.

Since adding the AI the bloating and water retention has dropped a lot. I'm back down to ~ 172lbs from a peak of 181lbs but I may be on the low end of things since I have to pee more than I should. I'm considering trying the AI just one day a week.

In regards to how I feel, I don't feel great, but I do feel more level than I did before TRT and it certainly has helped in the gym and with muscle growth/retention. I haven't had much time to workout over the past six weeks and I haven't lost much muscle if any. Before TRT I'd shrink rapidly within a week or two.

I don't get enough sleep, so I know that's a factor in how I feel. I'm almost 40yo, work 50-65hrs a week between my 9-5 and side work, just started back to school, my wife runs a business nights and weekends and we have four kids six years old and under (one is a newborn). I'm very active in my wife and kid's lives and do a lot around the house so it's go go go all day every day so again, it's hard for me to tell how I should be feeling.

Protocol has been:

200mg/ml T Cyp, 50mg 3x a week (150mg/week) MWF (morning, afternoon, night)
HCG 500 iu 2x week (Mon/Fri)
.125 Anastrozole 2x week (Mon/Fri)

DHEA 309.4 (102-416)
TSH 1.86 (.45-4.5)
Prolactin 6.1 (4-15.2)
Hematocrit 48.6 (37.5-51)
MCH 33.4 (26-33)
SHBG 20.4 (16.5-55.9)
Total T 583 (264-916)
Free T 21.1 (8.7-25.1)
Estradiol Sensitive 14.1 (8-35)
HDL 33 (>39)
LDL 147 (0-99)
Chol/HDL Ratio 5.9 (0-5)
ALT (SGPT) 45 (0-44)

Thoughts?

 

[Sean Mosher]

Still some room for improvement in your FreeT and Total T numbers.
Might consider upping the dose or truly doing EOD (obviously discuss this with Defy as it sounds like your symptoms are not fully resolved).
Your E2 will climb with T but as of now that seems too low as well.
At some point it would help to have a full thyroid panel pulled as well just so we can get a complete picture (include RT3 as well if you can).
Sleep............ It's so important in overall lifestyle/health to see if you can find a way to resolve it (hopefully naturally).

 

[Gman86]

I would either drop the ai down to 0.125mg once a week, or try keeping the ai the way it is, and increasing your dose a little. Whatever you do though, DO NOT do both. That’s the most common mistake guys make, imo. Changing two variables at the same time.

I also agree with Sean, changing to an EOD protocol might be better to keep your levels more even. I personally do EOD injections, and love it.

Your free T has room for improvement, and your E2 is on the low side. So either upping your testosterone dose, or lowering your dose of ai, should help things.

 

[trt reznor]

Ok, here's an update with my most recent bloodwork taken while fasting Monday morning before my injection. I'm not going to list all the CBC and metabolic panel, just stuff that stood out since everything was middle of the range with the few exceptions listed below.

Since adding the AI the bloating and water retention has dropped a lot. I'm back down to ~ 172lbs from a peak of 181lbs but I may be on the low end of things since I have to pee more than I should. I'm considering trying the AI just one day a week.

In regards to how I feel, I don't feel great, but I do feel more level than I did before TRT and it certainly has helped in the gym and with muscle growth/retention. I haven't had much time to workout over the past six weeks and I haven't lost much muscle if any. Before TRT I'd shrink rapidly within a week or two.

I don't get enough sleep, so I know that's a factor in how I feel. I'm almost 40yo, work 50-65hrs a week between my 9-5 and side work, just started back to school, my wife runs a business nights and weekends and we have four kids six years old and under (one is a newborn). I'm very active in my wife and kid's lives and do a lot around the house so it's go go go all day every day so again, it's hard for me to tell how I should be feeling.

Protocol has been:

200mg/ml T Cyp, .25ml 3x a week (150mg/week) MWF (morning, afternoon, night)
HCG 500 iu 2x week (Mon/Fri)
.125 Anastrozole 2x week (Mon/Fri)

DHEA 309.4 (102-416)
TSH 1.86 (.45-4.5)
Prolactin 6.1 (4-15.2)
Hematocrit 48.6 (37.5-51)
MCH 33.4 (26-33)
SHBG 20.4 (16.5-55.9)
Total T 583 (264-916)
Free T 21.1 (8.7-25.1)
Estradiol Sensitive 14.1 (8-35)
HDL 33 (>39)
LDL 147 (0-99)
Chol/HDL Ratio 5.9 (0-5)
ALT (SGPT) 45 (0-44)

Thoughts?

The fact that you rapidly lost water weight and went from being bloated, to urinating too frequently is a pretty good indicator that your over responded to your AI. You probably went from being too high (water retention, irritability) too being too low within a week or less. Personally I am an over responder to Arimidex and can’t even handle 0.0625mg without crashing. Some guys seem to tolerate Aromasin better. Or you might just need a lower dose. HCG can also cause aromatization (T->E conversion) that actually happens within the testicles that apparently won’t be resolved with an AI.

Bring all this up to your people at Defy, they seem to be top notch in regards to TRT. My best hunch is that you could either lower your hCG dose, or try a more conservative AI dose. But, as is the general rule with TRT, only adjust one item at a time and give it awhile to see how it works.

Best of luck and keep us posted, sir.

 

[trt reznor]

The Thread for Dialed-In Dudes

This is a thread of different guys that are in their sweet spots, or at least happy with their treatments. Many are with Defy. As you look over the different protocols, you’ll see it really isn’t a one-size-fits-all approach. It takes some quite awhile before they get there.

 

[Evilwhitey]

The fact that you rapidly lost water weight and went from being bloated, to urinating too frequently is a pretty good indicator that your over responded to your AI. You probably went from being too high (water retention, irritability) too being too low within a week or less.

I think you're spot on with that one. I was feeling super bloated and overly emotional and bitchy but felt like I had more energy. After over six weeks using an AI I feel fine emotionally, maybe even too little emotion, a little more tired and certainly purging water that enters my system because I'm peeing frequently.

I'll discuss everything with Defy. I like the idea of bumping my T dosage a bit while keeping the AI where it is for the next six weeks to see how that goes. I certainly don't feel like I want to reduce my T dosage in order to go lower on the AI.

 

[trt reznor]

I think you're spot on with that one. I was feeling super bloated and overly emotional and bitchy but felt like I had more energy. After over six weeks using an AI I feel fine emotionally, maybe even too little emotion, a little more tired and certainly purging water that enters my system because I'm peeing frequently.

I'll discuss everything with Defy. I like the idea of bumping my T dosage a bit while keeping the AI where it is for the next six weeks to see how that goes. I certainly don't feel like I want to reduce my T dosage in order to go lower on the AI.

I *personally* don’t see any reason why you would have to increase or decrease your Test intake. With your E2 being in the low teens, you are likely suffering low E2 symptoms (many people report low being worse than high) which includes frequent urination, fatigue, joint pain, and loss of libido. Getting on a milder dose of your AI will more than likely solve this, but of course let’s see what your Doctor says.

 

[Vince Carter]

@Evilwhitey

There's some fair advice here and then some that is not good.

Understanding SHBG and Free Hormones, most importantly Free Estrogen, is being ignored here. And you ignore that that trough number there is a snapshot at the lowest point and is not a static value. You (should) know well enough that E follows T and will rise again.

Though as I noted the fair advice being given is to get off the M/W/F and in to a true EOD schedule though you smartly have spread this morning/afternoon/night.

My very honest advice is this: if it's affordable for you because it can be pricey, add in the test "Estradiol, Free" alongside the Sensitive Test. Too, I would hedge that your Free Estrogen is elevated/high. When you're testing only Sens E2, it's akin to only testing total Testosterone and ignoring Free T. I would continue with the AI and E2 @ 14.

With my SHBG @ ~12 I am doing the best I have been with my E2 in the single digits.

 

[Evilwhitey]

@Evilwhitey

There's some fair advice here and then some that is not good.

Understanding SHBG and Free Hormones, most importantly Free Estrogen, is being ignored here. And you ignore that that trough number there is a snapshot at the lowest point and is not a static value. You (should) know well enough that E follows T and will rise again.

Though as I noted the fair advice being given is to get off the M/W/F and in to a true EOD schedule though you smartly have spread this morning/afternoon/night.

My very honest advice is this: if it's affordable for you because it can be pricey, add in the test "Estradiol, Free" alongside the Sensitive Test. Too, I would hedge that your Free Estrogen is elevated/high. When you're testing only Sens E2, it's akin to only testing total Testosterone and ignoring Free T. I would continue with the AI and E2 @ 14.

With my SHBG @ ~12 I am doing the best I have been with my E2 in the single digits.

Any thought on bumping my dosage just a hair but keeping AI where it is now? Ideally Id like to see my free T on the upper end of things and I have some room on that front. That should also raise my E2 a bit and put it in line with my SHBG and where I was prior to TRT.

 

[Evilwhitey]

Just got my labs back. I was feeling super bitchy so I bumped am AI up from .250 to .375 every other week. We'll see how that goes. I think my E2 was pretty high. Since bumping the AI I feel a lot more in control of emotions and less agro.

In regards to my thyroid markers what's your take?

Total T 717 (264-916)
Free T 30 (8.7-25.1)
E2 29.3 (8-35)
SHBG 19.7 (16.5-55.9)
TSH 2.14 (.45-4.5)
T4 1.24 (.82-1.77
rT3 21.8 (9.2-24.1)
T3 3 (2-4.4)

 

[Gman86]

Just got my labs back. I was feeling super bitchy so I bumped am AI up from .250 to .375 every other week. We'll see how that goes. I think my E2 was pretty high. Since bumping the AI I feel a lot more in control of emotions and less agro.

In regards to my thyroid markers what's your take?

Total T 717 (264-916)
Free T 30 (8.7-25.1)
E2 29.3 (8-35)
SHBG 19.7 (16.5-55.9)
TSH 2.14 (.45-4.5)
T4 1.24 (.82-1.77
rT3 21.8 (9.2-24.1)
T3 3 (2-4.4)

Are you on any thyroid medication? If not, looks like you need some. Need to get that free T3 up, and that RT3 down quite a bit.

 

[Evilwhitey]

Are you on any thyroid medication? If not, looks like you need some. Need to get that free T3 up, and that RT3 down quite a bit.

I'm not, which could explain my fatigue and general blah despite having decent numbers elsewhere.