New to TRT. Received first labs. Concerned and need help.

[SparkyNeuron]

Questions:

Why would my Total Testosterone only go up slightly while my Free shot up drastically? My previous Free Test was about 10. It's now almost 32. My previous Free % was 2.3. It's now 4.7. That's at 100mg/week of test cyp. Is that big of an increase at a low dose a bad sign?

Forgot to mention, This is meant for ME/CFS, but I think it's a really good comprehensive fatigue workup in general.

https://mecfscliniciancoalition.org/wp-content/uploads/2021/05/MECFS-Clinician-Coalition-Testing-Recs-V1.pdf

Also, to you original question, If it were me, I'd would give it 3 more months and see if it drops. Your hematocrit is fine, but if it's going to be in the back of your mind and bother you then it might be best to drop it to something like 90mg/week for piece of mind.

Speaking of mind, adding hCG at 500IU twice a week knocked a fair bit off my brain fog. Not a complete fix, but it helped enough that I'm continuing it while I'm waiting to see other specialists.

 

[Guided_by_Voices]

Sparky's comments remind me that intestinal permeability (leaky gut) could be at play here too. There are tests for that (LPS?) but it seems better to just follow a protocol that would cure/prevent the leaky gut, such as Dr. Gundry's Gut Check protocol.

 

[trtguy8]

Some comments in no particular order.

- Your Vitamin D reminds me that there are apparently some infections that use the Vitamin D receptor as an entryway into cells, and for those infections Vitamin D can make actually make things worse. Dr. Michael Ruscio (who you should also look into) did a whole podcast on that years ago. I'm a big beleiver in Vitamin D levels above 50, but you might stops the supps for a couple of weeks and see if you notice anything better. That would be a clue that you have a related infection although that is by no means definitive.
- It is well-known that endurance exercise that goes beyond an hour or so IIRC weakens the Innate immune system for a few days. I think one of the main researchers on that topic is from NC State.
- While I am not an endurance athlete, I follow some people who are and many of them stress that most people tend to train at too high of a level. The Maffetone Method is focused on that topic, or as Mark Sisson says, make your short hard workouts shorter and harder, and your long easy workout longer and easier. I think Brad Kearns wrote a book about his issues going into the runner's version of overtraining which somewhat overlap with your issues.
- The types of Doc's I mentioned should be very familiar with thyroid issues, but it is another topic with a lot of nuance and unreliable testing that doesn't correlate with symptoms. I've forgotten what the "right " thyroid tests are, but it's not TSH, and at some point experimentation may be in order if nothing else has worked.
- Testosterone is kind of a "sledgehammer" brute-force treatment which is often appropriate, but there are a lot of other issues that can require a lot more digging.
- As Chris Masterjohn has pointed out, there are enough conditions that are considered "rare" that having a rare condition is actually not all that rare.

Yes, I agree. Over exertion definitely lowers immunity in my experience and can cause ongoing symptoms. Unfortunately, I used to do that quite often. But, I now train at a much lighter level and I feel worse than I did back then.

I know some of it is aging. But, I know that something is off in me. I have always eaten well, stayed hydrated, worked out, got enough sleep, etc. I have taken care of myself my whole life. The drop off in energy, motivation, focus, etc. was drastic from the man I used to be. Drastic. I have to keep searching.

This thread alone has given me new areas to explore and for that, I am very thankful. Thank you to everyone!

 

[trtguy8]

I'm not sure what you're referring to. I don't recall even expressing an opinion on the prevalence of this side effect. I did tell you that TRT had the opposite effect on me, with higher doses being somewhat sedating and demotivating.

The side effects of excessive testosterone that I've discussed include raised HCT, sleep impairment, poor lipids, reduced libido, minor thyroid dysfunction, and degraded sexual function including penile insensitivity, ED, PE, and DE.

To my surprise, TRT has calmed me down. Nice side effect.

 

[trtguy8]

Post exertional malaise is usually what distinguishes ME/CFS from other types of fatigue. PEM can be exacerbated by physical, mental, and/or emotional exertion. Basically, if you work out too hard or do too much (physically or mentally) do you crash for a week? This is a good review:

https://www.mayoclinicproceedings.org/article/S0025-6196(23)00402-0/fulltext

For Thyroid, did they do T3/T4 in addition to TSH?

To check for B12 deficiency, methylmalonic acid (MMA) and total plasma homocysteine (Hcy) are recommended, a normal B12 level by itself is not really diagnostic: The application and interpretation of laboratory biomarkers for the evaluation of vitamin B12 status - PubMed

If you have joint pain that's worse in the morning, gets better with jogging or weights, but gets worse if you sit down for awhile, or if you have eczema/rashes, or IBS symptoms, look into autoimmune conditions, an ANA test would be a good start w/ referral to rheumatology. Autoimmune conditions can cause horrible fatigue.

While less common than thyroid, autoimmune, or B12, but if those don't lead to anything, adrenal tests would be my next idea. With non-specific symptoms of fatigue, brain fog, and especially if you have any GI symptoms. 8am cortisol with ACTH and DHEAS.

"Patients with secondary adrenal insufficiency typically have low or intermediate morning cortisol levels (5-10 µg/dL) and low or low-normal corticotropin and DHEAS levels."

FYI - LabCorp reference for AM cortisol is 6.2-19.4 ug/dl, so if you're AM cortisol comes back in that intermediate 5-10 range, it will be reported as normal, and most likely your PCP will tell you it's normal, in which case you'd need to self advocate.

https://jamanetwork.com/journals/jama/article-abstract/2835391?utm_source=openevidence&utm_medium=referral

When I used to overtrain, yes. After a long run I often was fatigued for 3-5 days.

Yes, my latest test had TSH, T4, T3, and Free Thyroxine Index. What was interesting is that when I looked at my results, they were all within range but all (4) were near the bottom of the ranges. I did some initial research that suggests this may not be directly related to something wrong with the thyroid, but with your pituitary gland. Need to research further. If anyone has experience with this, please let me know your opinion.

It has been awhile but the last time my morning cortisol was tested, it was out of range - high. Which is my experience. I think my cortisol rages in the mornings. I often wake up (way too early) with my body just ramped up. Not a great feeling.

 

[trtguy8]

Forgot to mention, This is meant for ME/CFS, but I think it's a really good comprehensive fatigue workup in general.

https://mecfscliniciancoalition.org/wp-content/uploads/2021/05/MECFS-Clinician-Coalition-Testing-Recs-V1.pdf

Also, to you original question, If it were me, I'd would give it 3 more months and see if it drops. Your hematocrit is fine, but if it's going to be in the back of your mind and bother you then it might be best to drop it to something like 90mg/week for piece of mind.

Speaking of mind, adding hCG at 500IU twice a week knocked a fair bit off my brain fog. Not a complete fix, but it helped enough that I'm continuing it while I'm waiting to see other specialists.

This is what I did. I went to 40mg per shot. I am going to give it 6-8 weeks, monitor how I feel, and get new tests. If l lose some of my benefits and don't feel better, I will increase.

I have thought about adding hCG. I have read that for some men, it can help with the mental/emotional issues better than test alone. How does adding a dose of hCG affect how much test you take? Wouldn't it increase your natural production, thereby requiring a reduction in your test dose? Would love to learn more.

 

[trtguy8]

Sparky's comments remind me that intestinal permeability (leaky gut) could be at play here too. There are tests for that (LPS?) but it seems better to just follow a protocol that would cure/prevent the leaky gut, such as Dr. Gundry's Gut Check protocol.

Will look it up. I do not feel I get the nutrients from food well. I don't seem to have celiac or gluten intolerance. May be worth exploring.

 

[Phil Goodman]

This is what I did. I went to 40mg per shot. I am going to give it 6-8 weeks, monitor how I feel, and get new tests. If l lose some of my benefits and don't feel better, I will increase.

I have thought about adding hCG. I have read that for some men, it can help with the mental/emotional issues better than test alone. How does adding a dose of hCG affect how much test you take? Wouldn't it increase your natural production, thereby requiring a reduction in your test dose? Would love to learn more.

I think the HCG aspect has to be considered on a case by case basis, which makes it difficult to give advice on. For one, it affects various hormones and pathways, often in ways unique to the individual. As far as your question, yes it will increase natural production and it’s possible that a decrease in dose would be worth trying to maintain the current level you’re at if you feel good there. What kind of testicular function you had before starting trt may give you and idea of how much response you’ll get on that front from HCG. But as mentioned, it will also effect other pathways and processes(like aromatization capacity) so it’s possible that even at the same t levels you may not feel the same(could be better or worse). And we could dive into all of those different variables, but to be honest I don’t fully understand them and again I think it can vary significantly from person to person.

Just from my personal experience, I went from 120 mg/week down to around 100 after 3-4 weeks of HCG as I noticed them coming back online. Since then(over the past 2 years or so) I’ve drifted back up to between 110-120 per week and feel good on this protocol. But honestly, it probably would’ve been fine to just stay where I was after adding HCG. I don’t think there’s a clear cut right way to do it with regard to maintaining dose or dropping to account for endogenous production coming back online, and if there is, the difference from person to person would make it difficult to give advice on how much to lower. With that being the case I’d say the main thing is to just not sweat it too much and stick with your approach for a while no matter which route you go. The main advice I’d give with regard to HCG is to not get caught up in the 500 ius twice per week or bust mentality. I think most people would likely be better off doing between 100-250 ius three times per week. But yeah, some do fine with larger, less frequent doses so it may work for you. Just be flexible with it and give your body time to adapt if you decide to try it.

 

[Systemlord]

To my surprise, TRT has calmed me down. Nice side effect.

Testosterone typically lowers blood pressure and cortisol the stress hormone.