New to TRT, prescribed high dose to start, got questions

[TRTThrowawayAllDay]

All,
I'm looking to this group for some advice on how best to proceed given my situation and lab results. More information below:


Vitals

• 26 Year Old Male
• 5'6", 157 lbs (166 lbs during first set of labs, down from 213 at start of year)
• Symptoms: General fatigue, poor sleep quality, inability to concentrate, awkward body shape/fat distribution (pear shaped, have had significant gynecomastia since my teens)

First Set of Labs (Drawn 7-30-16 at 10:55AM)

All results were normal except for Testosterone, Vitamin D, and Vitamin B12

• Testosterone: 342 ng/dl (Reference Range: 348-1197)
• LH: 5.9 mIU/ml (Reference Range: 1.7-8.6)
• FSH: 1.8 mIU/ml (Reference Range: 1.5-12.4)
• Estradiol: 33.2 pg/ml (Reference Range: 7.6-42.6)
• Vitamin D: 18.8 ng/ml (Reference Range: 30-100)
• Vitamin B12: 200 pg/ml (Reference Range: 211-946)

My PCP actually recommended that I start TRT immediately (200mg Test Cyp once a week) but I wanted to hold off while I made some additional lifestyle changes. Namely, I wanted to start a weight training routine (bodyweights) and supplement D and B12 and retest to see if it made a difference.

Second Set of Labs (Drawn 10-27-16 at 11:37AM)

My B12 and D levels were now well within the normal range, but Testosterone dropped further:

• Testosterone: 302 ng/dl (Reference Range 348-1197)
• Free Testosterone: 10.3 pg/ml (Reference Range: 9.3-26.5)
• LH: 3.2 mIU/ml (Reference Range: 1.7-8.6)
• FSH: 1.6 mIU/ml (Reference Range: 1.5-12.4)
• Estradiol: 21.6 pg/ml (Reference Range: 7.6-42.6)
• Vitamin D: 62.6 ng/ml (Reference Range: 30-100)
• Vitamin B12: 408 pg/ml (Reference Range: 211-946)

Current State

Based off of these results, I decided to start TRT this week, but split the dose. I took 100mg Monday morning and 100mg Thursday afternoon. I also added 0.5mg Arimidex after taking my Thursday dose. My doctor wanted to re-do labs at 6 weeks and adjust dosage at that time if needed.

My Concerns

• Test Dosage: I was initially nervous about starting at such a high dose, but my PCP seemed experienced and so I went with it. However, the more I'm reading, the more I'm debating whether I should continue what I did this first week (100mg E3.5D) or drop to a more traditional starting dose (50-70mg E3.5D). Does that make sense? Should I treat this first week as a loading dose?
• Arimidex Dosage: My PCP initially said 1mg EOD, but that seemed like I lot, so I thought I would start with just 0.5mg/week. However, after additional research, even that seems high. I'm wondering if I should hold off on any AIs until the next set of labs (and make sure to get sensitive E2).

Thanks again for any advice, I would really appreciate it!

 

[Vince]

Welcome to ExcelMale. At age 26 your testosterone is very low, I wonder why? Is there any possibility of a restart?

 

[TRTThrowawayAllDay]

Hi Vince. I was told that I'm primary and that the odds of a successful restart are pretty limited, hence why we started TRT. Any thoughts on my dosing question?

 

[Vince]

I use 100mg of T and 500iu of HCG no AI every 3 1/2 days, it works great for me.

 

[trt4me]

I think a restart is always a good first try.
That dose is way too high to start as your body hasn't even shut down yet.
Your E2 isn't high and your are going to crash your e2 fast like that.
I wouldn't even use any until a month labs after starting to check e2.
An Hcg test is the way to see if your primary.
Fsh was low both times.
That's an early age to commit to trt without first diagnosing it more.

 

[ERO]

And you need more thorough labs. Get SHBG level, thyroid as well and do not start taking anastrozole when your E2 levels are fine as is. Tanked E2 is miserable and un-healthy when you see what it does to your lipid levels along with the intractable ED and joint pain that goes along with it.

 

[TRTThrowawayAllDay]

Hi Ero, I actually did obtain more thorough labs (attached), I just excluded them from the initial post. Everything else came within normal range. I did not have SHBG tested, was planning on doing that during my first follow up lab. Do you recommend dropping my dosage down moving forward? Or stopping entirely?

 

[CoastWatcher]

I wouldn't be surprised to discover you are tending toward low estradiol already. Why? Your doctor ordered the incorrect test to measure it. Men should ALWAYS order the sensitive estradiol test, LC,MS,MS, and not the standard test that you ran. The standard test overestimates estradiol in men...chances are you are down in the teens somewhere. The last thing you want to do at this point is add an AI. The fact of the matter is you doctor, through no fault of your own, has sent you down a path to possible misery.

 

[ERO]

I would give Prime Body or Defy Medical a call. They are both site sponsors and come highly recommended as a great many of us on the site use one or the other. The average GP or Endo is typically decades behind the curve on proper TRT and re-start protocols.

 

[TRTThrowawayAllDay]

Thanks guys. My only consideration is that insurance is paying for TRT now, but it looks like the clinics you're talking about are cash only? I understand $200/month isn't bad for preserving my overall health, but wanted to make sure I was evaluating my options appropriately.

 

[CoastWatcher]

Thanks guys. My only consideration is that insurance is paying for TRT now, but it looks like the clinics you're talking about are cash only? I understand $200/month isn't bad for preserving my overall health, but wanted to make sure I was evaluating my options appropriately.

Once your an established patient with Defy there is no ongoing monthly charge (I'm not a patient, but I respect them a great deal). I don't think your physician is at the cutting edge of androgen replacement - he ordered the wrong estradiol test/prescribed an AI when it isn't indicated at this point/and gave you a starting dose of testosterone that is problematic. I do believe you should, at the very least obtain a second opinion.