Low T Protocol

[chally9]

Hi all,

So I've been a reader for the last year and a half. Excel has been instrumental in my trt journey. I've been able to be educated, and actually suggest things to my Dr. Who is awesome by the way.

So I started trt late 20's. #1 reason was due to low sex drive. I was good with about once a week. Been on it about 1.5 years now.

Baseline Labs Before T:
Vit D 16, on a 30-100 scale. ( Started supplementing with Vit D)
Test 340.6. (Appeared within scale so I didn't start treatment)

8 months later, I pulled.
B12, 676 (232-1245 scale)
Free T of 6.19(3.3-26.8 scale)
Total t of 387.6
SHBG of 42.6 (9-68 scale)
Albumin 5.1 (2.5-5 scale)
Prolactin of 17.3 (4.04-15.2 scale)
LH 13.8 (1.40-7.70 scale) (FSH was also high,by double the scale IIRC, but I don't see result here)
DHEA 515 (160-449 scale)
Vit D 30 (30-100 scale) (Doubled from previous lab!)
Estradiol of 31 (No range given)

Following this I was given a primary hypo diagnosis. Started on TRT, .5 ml 1x per week.

1st labs after starting (Maybe 4 weeks later)
Estradiol: 27 pg/ ml
Test: 853 ng/dl
Free 18.8 ng/dl
SHBG 29.5 nmol/l

2nd labs appx 8 week mark , think dose was .6 or .7 ml 1x week
Prolactin 17.1 ng/ml (4.04-15.2 scale)
Estradiol 50.7 pg/ml.
Test 777 ng/dl
Free 18.78 ng/dl
SHBG:24.6 nmol/l

Labs at appx 6 month mark
Prolactin 22.5 ng/ml (4.14-15.2 scale) (Dr. was thinking prolactinoma)
Estradiol 27 pg/ml
Test 595 nd/dl
Fee 13.46 ng/dl
SHBG 23.7 nmol/l

Labs at 8 Month Mark ( Started HCG roughly around this time. 500 IU, 2x a week. Day 5/6 of cycle.)
Prolactin 12 ng/ml (4-15 scale) (Prolactinoma no longer suspected)
Estradiol of 27
Test of 720
Free 18.19

Labs at about the 12-13 month mark: Taking roughly .7ml 1x per week, and 2x 500 iu of HCG
Vit D 26 (30-100 scale) ( I suspected my supplement was not a good one, as I double my dosage to 10k iu, from 5k iu to get previous of 30)
DHEA of 411.0 ug/dl (160-449 scale)
Estradiol Less than 25 pg/ml
Test 581 ng/dl
Free T: 12.37 ng/dl
SHBG 25.5 nmol/l
Albumin 5.1 g/dl

After these results my Dr. was thinking I changed protocol. I said I had not.

So Dr. amped me up to .8ml 1x week, same 2x 500 iu of HCG day 5/6. ( I switched to insulin pin, and shallow im/sub q at this time, due to injection anxiety). Its been a couple of months on this protocol. I've noticed what I would consider is like pec pain/burning, and ever slight discomfort. Not present all the time, but makes me think hmm is something going on with E?

Most recent labs on same .8 ml dosage:
FSH Less than 0.3 ml/ml (1-14 scale)
LH Less than 0.3 ml/ml (1.4-7.70 scale)
Prolactin 16.8 (4-15.2 scale) (Creeping up again)
DHEA 371 (160-449 scale)
Estradiol 40 pg/ml ( Not the highest its been)
Test 838 ng/dl
Free 20.04 ng/dl
SHBG 25.1

I detailed my concern about E/suspected gyno to the Dr. as I had never noticed any signs like this. He is suggesting starting a 2 week trial run of anastrazole, 1 mg pill, 1 x week to see if that helps.


Other questions:
I take HCG but my FSH/LH are basically below scale. Strongly suspecting meaning I'm infertile. Isn't HCG supposed to amp these up? My goal for HCG is to prevent this.

My DHEA crashed 100 points from previous labs to latest. What causes this?

With my suspected gyno pain, should I be doing anything different with injections?

 

[Systemlord]

Strongly suspecting meaning I'm infertile.

A primary hypogonadism diagnosis usually means infertility as well.

 

[Systemlord]

I take HCG but my FSH/LH are basically below scale.

HCG mimics LH, it doesn't increase it. If you want FSH higher, you need FSH injections.

 

[Systemlord]

With my suspected gyno pain, should I be doing anything different with injections?

I used to get burning pain on injections when androgens are too high, but never got gyno. A 1mg AI is a big dose may crash your E2.

 

[chally9]

Thank you for clarifying that.

I did have a semen analysis done before starting t. Concentration was less than range, by about half. Count was nearly within standard range.

I'm semi confused as to how given estradiol of 31 prior to treatment, and then an estradiol of 40 after treatment would lead to weird things like gyno.

I guess in theory my labs are taken on day 7/trough day. So my estradiol is spiking as much as my total t throughout the week, and 40 is troughed out.

Is it normal to see LH/FSH numbers like this, despite supplementation with HCG?

 

[Systemlord]

I did have a semen analysis done before starting t. Concentration was less than range, by about half. Count was nearly within standard range.

Odds are you're infertile already and the problem isn't with the LH and FSH, but the testicles.

Is it normal to see LH/FSH numbers like this, despite supplementation with HCG?

Yes it is and the only way anyone would see them increase is stopping TRT, HCG because these are HPTA suppressive . Normally LH and FSH are <.3 for those on replacement therapy.

As far as gyno, I'm not convinced that's what you're experiencing.

 

[Cataceous]

You may be interested in a treatment variation. One of the long-time members at PeakTestosterone.com has primary hypogonadism and is able to tune his TRT dose such that his LH is normal. This eliminates the need for hCG. It also means your HPTA becomes mostly functional, and testosterone levels are closer to what your body would produce with fully functioning testicles. I doubt it would work with weekly injections, however. With these, peak testosterone can be two to three times higher than trough levels. More frequent and smaller injections would smooth things out, knocking down the large peaks that would otherwise continue to suppress the HPTA.

Natural daily testosterone production runs about 3-9 mg. You are currently averaging 16 mg per day. For this to work you would likely need to cut your dose by at least half. It will also take some time to restart LH production, perhaps a month or two.

In a couple of posts I speculate about some possible issues with leaving the HPTA suppressed:

Is GnRH suppression hurting us?

Admittedly the last thing we need is some other nebulous danger to worry about that may not even exist. Read on at your peril. TL;DR: Testosterone replacement therapy suppresses the production of GnRH. Receptors for GnRH are found in places besides the pituitary. One animal model suggests GnRH...

www.excelmale.com

Kisspeptin suppression under TRT: Can it affect mood and libido?

TD;LR: Kisspeptin may affect how we act and feel. It seems plausible that a TRT-induced reduction in this hormone is a problem for some men. I’d previously asked if suppression of GnRH by TRT is a problem. The literature at least hints that it is possible. The situation with kisspeptin may be...

www.excelmale.com