Expertise on my TRT needed

[M!ck]

Hi everybody,

I’m from Germany and struggling to find a good doc in my region, that’s why I’m looking for help online.

To my person, I’m 40, doing bodybuilding since 20 years, no cycle ever.
With age 30 I had my test checked and have been at the lowest end, but still in range. Since a couple of years my body composition changed to more belly fat and the main thing is, I am tired af and have no energy.

So I went to my doc who is not an expert and got my test measured again, it was 2,01 , so below range (2.49 - 8.36 μg/l)

another test 2 years ago showed 2,93. So I went to see my urologist, he made a screening of my balls, they are ok, measured Lh 3.4 (range 1.1-7) with test 3.84 this time.
i was still thinking that I need that damn trt and started with it with my home doc. I injected e3.5d about 50-60mg. No hcg, no ai. I felt good for 1.5 years, had energy, could feel my muscles again, my body comp changed, all good. Test on trough 5,95 (maybe too high)
But now my hematocrit was creeping up to .53 and I was having constant headaches and was short of breath. So I wanted to give blood which was denied of high hemoglobin. My doc and I did a phlebotomy 4 weeks ago where I collapsed. i developed a bad sleep apnea which made me gasping for air during the night.That all made wanted to stop injecting stuff and I stopped. After a week I started 20mg Ed tamoxifen to start my hpta again, but now 2 weeks later it’s hard for me to find energy for something, when my wife and I are on the couch I fall asleep at 9pm, think my restart is not kicking. My balls do not really grow.
Yesterday I was in a so damn mood that I injected 40mg test and immediately I felt better.
that was a mistake I guess. Next week I will see my doc to check where’s my hematocrit is at. And I have absolutely no idea about how to continue.
Get hcg to kickstart my balls?
For health concern I would love to live without test, but I sneed energy.
Sorry for my long first post, hope somebody has some good points to me.
Thanks.

 

[Vince]

Did you get a complete pre-testosterone panel?

 

[Cataceous]

It may take more time to restart your natural production of testosterone. I wouldn't bother with hCG at this point. Unfortunately you may continue to have the same low testosterone levels you had originally. Have you measured your SHBG? It is useful for estimating your free testosterone. Your problem with hematocrit and TRT suggests excessive free testosterone, at least at the serum peaks. If you resume TRT I would try smaller, more frequent doses along with a reduction in the total testosterone delivered. For example, 24 mg TE/TC every other day. You're looking for a level that resolves your low-T symptoms without causing side effects.

 

[M!ck]

I got some pre trt measurements, here’s the most important one I guess. Sometimes I think that I jumped on the trt wagon too quick.

my trough level has been 5,95 μg/l on my last injection protocol, was feeling good, think if I go lower I could be better off totally, I don’t know.

 

[gerardo]

It may take more time to restart your natural production of testosterone. I wouldn't bother with hCG at this point. Unfortunately you may continue to have the same low testosterone levels you had originally. Have you measured your SHBG? It is useful for estimating your free testosterone. Your problem with hematocrit and TRT suggests excessive free testosterone, at least at the serum peaks. If you resume TRT I would try smaller, more frequent doses along with a reduction in the total testosterone delivered. For example, 24 mg TE/TC every other day. You're looking for a level that resolves your low-T symptoms without causing side effects.

Hello @Cataceous seeing this testimonial on hematocrit do you think the increase in hematocrit is proportional to the dose of T? Example: 5mg cypionate EOD would increase the hematocrit by how many% compared to 15mg cypionate EOD in the same patient with SHBG 18 and hematocrit 49.

 

[Cataceous]

Hello @Cataceous seeing this testimonial on hematocrit do you think the increase in hematocrit is proportional to the dose of T? Example: 5mg cypionate EOD would increase the hematocrit by how many% compared to 15mg cypionate EOD in the same patient with SHBG 18 and hematocrit 49.

I don't think it's nearly that simple. There's also some evidence that larger swings in serum testosterone over some days raises hematocrit more than having more stable levels, even at the same average dose of testosterone.

 

[M!ck]

short update from my end:
PCT done for 8 weeks (20mg Tamoxifen ed), 14 weeks later here's what my blood work looks like now:

HCT 49
TEST 3.11 ug/l (ref 2.49-8.36)
SHBG 22.4 nmol/l (ref 18.3-54.1)
ALBUMIN 46 g/l (ref 35-52)

my balls have gained back size, i am getting some night erections sometimes, Libido is tanked again and my energy and motivation level is low again which is the worst part for me.

If i calculate my free T its 2,1% (249 pmol/l) - is that also too low?
Looking forward for your opinions.

 

[Cataceous]

Using the Vermeulen free T calculator I get a figure of 7.3 ng/dL. I view 10 ng/dL as the start of the healthy normal range. Being below this doesn't automatically mean you're hypogonadal, but it does suggest symptoms are possible. The Tru-T free T calculator is more pessimistic. It results in a figure of 9.8 ng/dL, but the healthy normal range is 16-31 ng/dL.

I suggest trying Natesto. It's a testosterone nasal gel that's administered two or three times a day. It boosts your serum testosterone for relatively short periods, which allows your natural production to continue. Having these testosterone pulses appears to alleviate the symptoms of low overall testosterone, and the reduced exposure to exogenous T lessens the chance of side effects like high hematocrit.

 

[M!ck]

@Cataceous thanks for your update. Yeah I am having lots of symptoms even if I’m still in the lower range. Before my trt I was having even worse total T levels, so at least my restart had kind of success.

I am reading a lot about T benefits and risks, what is also worrying me is a sleep apnea I had while I was on T. Do you think that it might be a result of the high hematocrit?
I’m in Germany and could not find any provider who is providing Natesto unfortunately.

do you know how fast the hematocrit should go down again? In February I was on .53, did a phlebotomy, went off T and I am still on .49. Consider doing another blood donation.

 

[Cataceous]

It's puzzling you can't find a provider of Natesto in Germany considering that the product is manufactured there.[R] Also, "Acerus Pharmaceuticals Corporation (TSX:ASP) today [2017] announced the signing of an agreement granting medac Gesellschaft für klinische Spezialpräparate mbH (“medac”) the exclusive right to market NATESTO® in 15 European countries (Germany, United Kingdom, France, Italy, Czech Republic, Slovakia, Spain, Sweden, Finland, Denmark, Norway, Poland, Austria, Netherland and Belgium). medac is a German pharmaceutical company with business in 80 countries and more than 1,200 employees worldwide."[R]

If your hematocrit is at 49 then I don't think you need to do another blood donation. Give it another couple months, and even if it doesn't drop further it seems as though most doctors are not too concerned when the figure is below 50.

 

[M!ck]

Looking for that pharma company brought me up to this Site. Stating that the approval has been withdrawn in 2020.

my doc is not concerned about my actual hematocrit, but for myself its too high to start TrT again. Did you see success in reducing Test-E dose for hematocrit issues?

 

[Cataceous]

I took a quick scan through my hematocrit numbers. I'll need to plot them to be sure, but it seems more like a binary relationship, with pre-TRT values at 44%, and TRT values bouncing around from 46-49% seemingly independent of dose. Perhaps peak serum testosterone is better correlated.

 

[M!ck]

So, almost 3 years later i still struggle with myself to finally jump into TRT again and i need some advise or some good arguments to convince me. Seems i have an internal blockage.

Feeling tired all the time, libido is almost 0, maxed out the ADAM score test. low motivation to do something. My wife is also pro TRT as she sees me struggle.

Catched up Covid in November and had a hard time, resulted in Asthma caused by infect. Interestingly my total T was 400, after not working out for 10 weeks. I'm all the time saying to myself that a better T level would make me more healthy and boost my immune system.

Could someone have a look at my labs and point me to the need of T? I felt so much better on it.
Meassured & calculated free T has always been around 7-8, which is technically in range.

thanks!

 

[Systemlord]

Could someone have a look at my labs and point me to the need of T? I felt so much better on it.

You answered your own question, you felt better on TRT, what’s the hold up?

You fail to measure the only test that matters, the Free T, because Total T doesn’t define testosterone deficiency.

 

[M!ck]

@Systemlord, good question, i am just unsecure about it as my level is not that low anymore. When i was down to 200, it was a no brainer to me.

Have meassured free T, pls see attached:

 

[Systemlord]

@Systemlord, good question, i am just unsecure about it as my level is not that low anymore.

Your Total T may not be low in the sense of a deficiency, but rather an insufficiency and that doesn't mean it's high enough to function normally.

Your Free T is either below range or barely above it, and many experts say that Free T in the bottom 25 percentile is a sign of hypogonadism, especially at age 40.

Also, you give too much credit to laboratory testing. You can take one sample of blood, split it into to samples, and get a plus or minus 70 ng/dL. So you get labs testings done, one is 240 and the other is 310, and you make the conclusion your levels are higher on the second test, when in fact the blood samples are exactly the same, only the lab testing is flawed.

A diagnosis of low-T is made by weighing the symptoms and labs, you're fixating on the labs which are flawed.

 

[M!ck]

Also, you give too much credit to laboratory testing. You can take one sample of blood, split it into to samples, and get a plus or minus 70 ng/dL. So you get labs testings done, one is 240 and the other is 310, and you make the conclusion your levels are higher on the second test, when in fact the blood samples are exactly the same, only the lab testing is flawed.

thats true, i am looking too much on the numbers.
The last time i was on trt i developed sleep apnea and passed out during giving blood, these 2 conditions make my inside me to have fear about the trt i think. Hard to get over it.

But i also feel that these lowish test levels might be bad for my health as well.

 

[Systemlord]

The last time i was on trt i developed sleep apnea and passed out during giving blood, these 2 conditions make my inside me to have fear about the trt i think.

There’s the hold up. None of this means you don’t need TRT.

These issues are minor, treat the sleep apnea and dial-in your dosage better to where you don't have to donate.

If you ask me passing out after giving blood seems worth the price of admission compared to feeling unwell 24/7, 365 days a year.

But i also feel that these lowish test levels might be bad for my health as well.

Men with low testosterone were more likely to die from Covid. I don’t know about you, but when the next pandemic hits, I’d rather have high testosterone.

 

[M!ck]

These issues are minor, treat the sleep apnea and dial-in your dosage better to where you don't have to donate.

If you ask me passing out after giving blood seems worth the price of admission compared to feeling unwell 24/7, 365 days a year.

Reading this from your view, that absolutely makes sense.
Id forgot that i was also having massive headaches, maybe due to HcT? I dont know that. Or could be from low ferritin? Second one didnt get checked by my doc unfortunately.

Thanks for your replys @Systemlord !

Do you have a provider? In my area im kind of my own, my pcp is writing my prescription and doing the blood that i want/need.

 

[Systemlord]

Do you have a provider?

You might be able to get someone at Defy Medical to help direct treatment decisions.

I think they do consultations only as well as full treatment.