Labs at Six Weeks: Little Total T Improvement

[rhino5169]

Background:

Started trt just over 6 weeks ago. Protocol is .2ml test cyp m-w-f along with 250 units of hcg 3x / week same days.
Tested in tough on monday morning before injection.

Before I started on this 6 weeks ago I was on hcg from another dr at 500units a week split 2 doses. I had labs drawn at that point for starting with defy and my test serum was 457, free test dirrect was 9.3 and shbg was 41.
Now the test numbers surprised me because that was after a couple months on hcg but before that was consistently from 137 to 294.

Fast forward to now, after 6 weeks on this protocol my test only went up approx 100 points to 560.
SHBG is 30.3
Estradiol sensitive is 30.6
DHEA-S is 105 - low normal
DHT is 25 - LOW

Nothing has improved in these 6 weeks as far as no / low motivation / libido / erections / ability to lose weight or add muscle / fatigue / etc etc...

Good news is CRP is better and now in the normal range.
Lipoprotein a still high but got better
PSA only raised slightly from .4 to .6
Hemoglobin and hematocrit still fine
Lipids raised a hair, nothing to even really look at.

I am diabetic so let's skip that part of the results. I went for labs the morning after Easter.
Looks like I will be taking B12

Please tell what you think and how to get to where I need to be, feeling wise not so much numbers.
Also, how do thyroid numbers look.
Thanks

 

[Vince Carter]

so you're shooting 40mg (.2mL is not a dose, that's a volume) on M/W/F...when was your blood draw? If it was the day after Easter, Mon, I have no doubt your trough was pretty weak. If you stick with M/W/F I would only test on Wed or Fri AM right before your shot.

 

[rhino5169]

Yes 40mg on m/w/f and yes draw was on monday before injection

 

[rhino5169]

Will DHEA help?
Will DHT help?

 

[CSI007]

It's taken me 6 months to start to see body composition changes. Libido for me was almost instant though. If you read my thread you will see that I am still battling some things like ED and other stuff. Keep at it. Don't stop until you give it a chance to make a difference. 6 weeks is not nearly enough. My labs from my first 6 weeks changed over the next 6 weeks. So your body is still likely in flux.

 

[ERO]

You may just need a higher dose of T. 120mg/week is a decent dose but TRT can be up to 200mg/week.

Also, in terms of "feel" TRT does not live up to the hype for many guys, myself included. It is nearly always "sold" with the implied promise of rock hard erections, feeling years younger, super libido, high energy, more muscle, less fat, etc....Yeah, if you get all of that consider yourself one of the very lucky ones.

 

[Vince Carter]

So long as you're on this M/W/F and monday bloods this is what you've got. I would suggest that if you're committed to more then E3.5D that you go to EOD injections and this little problem should resolve itself.

 

[rhino5169]

So long as you're on this M/W/F and monday bloods this is what you've got. I would suggest that if you're committed to more then E3.5D that you go to EOD injections and this little problem should resolve itself.

Isn'tm/w/f
Isn't m/w/f basically eod, a little more over the weekend.

 

[rhino5169]

You may just need a higher dose of T. 120mg/week is a decent dose but TRT can be up to 200mg/week.

Also, in terms of "feel" TRT does not live up to the hype for many guys, myself included. It is nearly always "sold" with the implied promise of rock hard erections, feeling years younger, super libido, high energy, more muscle, less fat, etc....Yeah, if you get all of that consider yourself one of the very lucky ones.

Thanks Ero,
I'm also wondering if a higher dose is needed.

I KNOW I can be a lot better. How I know this is because after years of feeling like a turd, last summer it changed for a few weeks.
It happened gradually but I was taking supplements and without going into all those details into must have raised either my testosterone or dht or both. Now I must explain I've been taking supplements for a few years so it's not like I've took something and expected something to happen. No placebo effect, especially when you rewd below what changed. It actually came on gradually and no foreseeable signs until I've was happening and I realized it.
For all 3-4 week span I was human again. Not just a little better, but a night and day difference.
I could sleep through the night
I had morning wood first time in years
Rock hard erections through the day
Mood greatly improved. No longer did i isolate myself but wanted to spend time with my family.
Energy through the roof. Was going things like I was in my 20's, not feeling tired at all. No fatigue whatsoever.

Here's the last few which tell me it was a higher test or dht level:
Slight acne behind my shoulder.
I had acne "smell" about me that suddenly appeared. Not a bad shoulder mell and not a sweaty smell just more like my body was musky. I noticed it but didn't think anything of into but then my wife commented. I looked into up and intents anything sign of higher testosterone.
In that 3-4 weeks I lost a few pounds and put on muscle and my workouts were like they were 20 years ago.

So, I know I'm close I just need to figure out how to get back there.

According to my labs my dhea is low - someone at defy suggested and ordered dhea for me.
Same thing for b12, they ordered me injections as my rdw is high.
I haven't spoken or heard from a dr yet, so I can't do anything but my dht is extremely low, so I'm wondering and hopeful that maybe the compounded cream will help.

I haven't learned how to interpret my thyroid numbers so along with the rest of the workup I'm hoping someone will let me know how they look.

 

[rhino5169]

Wondering if this would help?

"SOLUTION:Dr. Shippen recommended that he use a transdermal compounded testosterone once every seven days to boost DHT in conjunction with his cypionate injections. They found that his DHT actually went too high with this protocol and so then they switched it to every two weeks and that worked very well. It is amazing that the effect of the transdermal cream lasts this long but that is the case. Just Askin commented on this solution here:"I found thru many labs ran that my libido is like in my twenties when my DHT is around 105. Caution: If you take 2 Grams of L-Citrulline when your libido is high, it will get so hard it actually hurts." [1]
By the way, I will add that JustAskin is in his 60's and so this turned back the clock about four decades! No one can promise that will happen for any given individual - JustAskin's arteries are clearly in decent shape for example - but I'm just passing along information as to what has worked for some men on the Peak Testosterone Forum."

 

[ERO]

It may help, although a better idea would be to apply small amount of T Gel to the scrotum every day. That is a tiny amount of T - its just for increasing your DHT at that dose. The injections will providing the T you need to get to a high enough level overall. The topical is just to increase DHT and (hopefully) make you feel better and increase libido.

The only way to know for sure is to give it a go for a solid 6 weeks with no other changes and see how you feel.

 

[rhino5169]

Holy Schneikes guys. Somehow I missed posting 2 pages and posted page 1 three times.
Can I attribute that to brain fog!?

I fixed it so all the pages are there now.

 

[Vettester Chris]

Holy Schneikes guys. Somehow I missed posting 2 pages and posted page 1 three times.
Can I attribute that to brain fog!?

I fixed it so all the pages are there now.

Looks like the lab forgot to include free t3, I just checked and it was on the RX but they didnt run it.

Free T3 is on your last page, "Triiodothyronine Free Serum", at 2.9pg/ml.

Going on that subject ... FT3 is at 37.5% of Ref Range, FT4 is at 48% of Ref Range. In a perfect world, you'd probably like to see both of these somewhere between 50% -to-80% of Ref. Range, with both labs relatively close to each others percentage (%) of the reference range, e.g., FT4 at 62%, FT3 at 59%, etc.

TSH is at 3.21, so there appears to be a demand for the thyroid to produce more hormone, so that and the noted free serum levels do IMO exhibit some form of primary hypothyroidism.

Couple things to look at first ... One factor is comparing FT3 and Reverse T3, and finding the ratio. Yours is 18.2. A ratio of 20 or higher is usually the goal, but you're just right on the edge. Most of the time when the ratio is real low (your isn't), it's more times than not a notable problem with Iron and/or Ferritin, and/or Cortisol. I didn't see any iron, TIBC, etc. IMO, that's the quickest and closest place to look ... Getting iron in the 130 range or a bit higher is good, plus ferritin needs to up over the 100 mark.

Checking cortisol will cut into the pocket a little bit, but if you haven't had it done it would be good to run and review. The Gold standard is a 4x Saliva kit w/DHEA Correlation. Again, I doubt there's major issues with any of these, but if you can detect any imbalances and tweak it so that Free T3 can do its thing at the cellular level, then your wellness program will be that much better, and you will have greater knowledge of where to look for answers within your own body!

Antibodies are fine. I don't know if you take selenium and/or supplement any iodine/kelp? I would look into both of these, regardless if you ever end up taking thyroid meds or not. With the symptoms you have described, and based on your results, I thinks it's worth talking with your physician about treatment.

If it you and your physician feel good going forward with treatment, get his/her feedback on what their protocol suggestion is, post it up in this thread, we'll weigh it out and I'll give you my .02 (as will others). The thyroid gland can be a fickle creature, so it's key to have a good protocol that you can grow into, and an understanding of other critical areas that will make or break a protocol (cortisol, iron, etc...).

 

[rhino5169]

Thanks Chris, Much appreciated!

I dont take any selenium or iodine supps.
Fwiw, had cortisol checked twice few months ago and it was an 8 and a 12.5 reference range
[FONT=&quot]Cortisol AM 6.2 - 19.4
It was a morning test at 8 am.
I know that's not the correct test but threw it in here in case it helped any.

I will definitely look into the things you mentioned.

Havent spoken with Dr. yet, follow up in few weeks but assistant suggested and ordered b12 injections along with dhea, though I dont know the dosage yet.
When I speak with him i'll see what he recs. for the thyroid and update here.

Should I not be extremely concerned with DHT, no one has mentioned yet but I think it may have a lot to do with my current state?
Going to ask him about the gel as well as increasing T dose.

Thanks![/FONT]

 

[Vettester Chris]

Rhino, yes, B12 is one of those variables that will help promote healthy thyroid productivity. When you're talking with him, ask him to check your total iron serum, TIBC and ferritin.

ZRT has the saliva kits for cortisol. It would be good to see the 24 hour circadian profile ...

 

[rhino5169]

I just ordered that ds+cx4 test kit.
Even though symptoms haven't improved I feel like i'm making some progress.
Thanks Chris.

 

[rhino5169]

Ok Chris / guys,

Just got the cortisol / dhea results.

Thoughts?

 

[rhino5169]

Nobody

Bueller....Bueller....


Anyway, im starting on 1 grain naturethroid daily.

 

[rhino5169]

Update - need some help.
I've been on np thyroid 1 grain daily and 2 clicks compounded test cream daily for 2-3 weeks now, in addition to raising my test cyp dose to 180 mg weekly split into 3 doses plus 900mg ? Weekly also 3 doses same as the test.
also injecting 100iu lipo c daily and 200iu vit b12 once a week.

Just to clarify, the test cream, np thyroid and increased dhea dose were added after those last labs I posted in first post, 2-3 weeks ago.

was hoping to have more of am positive effect.
Doc said it would take 2-3 days to notice thyroid meds working but into would be subtle. He was right, at 3 days I noticed I wasn't dragging my andddedgoss andddedgoss 3 in the afternoon. I clarify reman go longer inn the day. Not with abundant energy by any means but just able to go longer without wanting to go to sleep. I am still fatauiged though.

I'm still not losing weight, in fact I've gained a few more pounds.
Last couple of days I've been very agitated / moody, which most of that had subsided previously.

Any ideas? Is 1 grain daily enough, should I increase? If increases not working increases can't see waiting another month for my next lab work then another other 3 weeks before the dr review.

 

[Vince]

The only thing I might add, how do you sleep. Are you getting enough sleep. A good night's sleep makes a big difference in the way I feel.