New to TRT... so much to learn!

[Ronin]

Hello all, apologies in advance for the long post!
Been researching TRT for the past couple of months after stumbling on a couple of podcasts discussing low T and testosterone therapy. I've read the TOT Bible and have been listening to the TOT Revolution Podcast. It is hard to get a handle on all of the information but think I've got the basics.
Visited a doctor a couple of weeks ago who has been helping my wife with her hormone issues-thyroid and adrenal fatigue. Got my blood work done and after our follow up yesterday injected my first dose of Cypionate last night. It was overwhelming and I think I stressed myself out about it and felt like I was going to pass out afterward. Stress management has never been my strong suit lol!
I have always been fairly fit and healthy but had struggled with low libido and erectile dysfunction since my 20's, I'm 39 now. ED has much improved since quitting drinking and really diving into the rabbit hole of optimizing my health February of 2018 but my libido is worse than ever. I figured my testosterone would be tanked but...

Testosterone 594
Free T 10.99
% Free 1.9
SHBG 44.58
Albumin 4
Estradiol 53.87
Hemoblobin 13.9
Hematocrit 42.2
Prolactin 6.85
TSH 1.36
Free T3 2.36
Free T4 1.07

So testosterone is mid-range, obviously not going to get any better but not what I expected. Estradiol level is definitely high but I don't think it was a "sensitive" test so from what I understand that reading may be inflated?
My cortisol levels are tanked and T3 is low, not sure of the effects on testosterone?
The doc wanted to start me on an estrogen blocker rather than T since estradiol is high but I was not comfortable with that and felt the number may be inflated. Felt going straight to testosterone and seeing how I feel in a few weeks would be the better course of action.
Please let me know if there is anything I am leaving out that may help me make sense of all of this, again, this is overwhelming to say the least!

I appreciate you all taking the time to read this post and thank you for any feedback you may have.

Thanks!

 

[Ronin]

I should add, dose is 67 mg testosterone Cypionate 2X/week.

 

[Vince Carter]

Estradiol level is definitely high but I don't think it was a "sensitive" test so from what I understand that reading may be inflated?

Post the lab range and we can tell you if it's right or wrong. It's not a rule that it's overestimating E, that's the common way to look at it but never a rule. For instance my Sensitive test is the same or higher than the ECLIA test.

 

[Ronin]

Post the lab range and we can tell you if it's right or wrong. It's not a rule that it's overestimating E, that's the common way to look at it but never a rule. For instance my Sensitive test is the same or higher than the ECLIA test.

Thanks Vince, it looks like the range is 27.1-52.2 pg/ml. First time reading lab results so I could be wrong.

 

[Vince Carter]

Ya that's the wrong test...look for the Sensitive or Ultra Sensitive LC/MS/MS

 

[Cataceous]

Except for estradiol your numbers are similar to this guy's. My advice to hold off on TRT would apply. If estradiol were confirmed high with a sensitive test then small doses of an AI would be a reasonable thing to try before TRT.

 

[Ronin]

Cataceous, thank you for the thread link, definitely similar to his situation. Seeing as I've already begun the injection protocol, any harm in seeing it through until my next set of labs in 6-8 weeks?

 

[CoastWatcher]

Well, in six to eight weeks you will have shut down your endogenous production. Hardly the end of the world, but it’s important that you recognize the consequences of initiating androgen replacement.

I agree with Cataceous, you’re rushing into something that may well be unnecessary.

 

[Ronin]

I appreciate the feedback CoastWatcher. If in fact my estradiol is elevated would that be the cause of lack of libido and mood swings/irritability? Or maybe my low thyroid and cortisol levels? Something's got to change and I definitely don't want to rush into TRT if unnecessary. Of course, while at mid-range now, my T levels are not "optimal" and they aren't going to get any better, not getting any younger. Thoughts?

 

[CoastWatcher]

I appreciate the feedback CoastWatcher. If in fact my estradiol is elevated would that be the cause of lack of libido and mood swings/irritability? Or maybe my low thyroid and cortisol levels? Something's got to change and I definitely don't want to rush into TRT if unnecessary. Of course, while at mid-range now, my T levels are not "optimal" and they aren't going to get any better, not getting any younger. Thoughts?

Elevated or suppressed estradiol can be responsible for problems, and sorting out libido-related issues are some of the trickier challenges men face. There isn’t, sad to say, a linear relationship between testosterone levels and libido (or erectile function). Think of testosterone as frequently necessary, but not necessarily sufficient, in these areas.

In your specific situation, I would do nothing until I repeated the e2 test, this time with the appropriate methodology (sensitive, LC, MS/MS). If it comes back high I’d ask your doctor for a prescription for anastrozole (filled by a compounding pharmacy), 0.25mg once weekly. Evaluate.

Thyroid isn’t called the master gland for nothing. An underperforming thyroid can sabotage a TRT protocol. Addressing the muted lab values you present should be done.

TRT may well be in your future. But no need to jump over other issues. By the way, I suppose fertility was addressed? Was your LH and FSH captured, along with a PSA?

 

[Ronin]

So I scheduled a sensitive test to be drawn next Tuesday. Fertility is not an issue as we are done having children, had a vasectomy a couple years ago. LH and FSH were not tested. PSA was at .584, free PSA at .164, 28% free PSA. Can you expand on how this factors in? Thanks!

 

[Ronin]

Is it too late to test LH and FSH now? Will the single injection performed Thursday night already had an effect on these levels? Just wondering if I should test for those as well on Tuesday or if the results would be compromised...? Thanks.

 

[Vince]

Is it too late to test LH and FSH now? Will the single injection performed Thursday night already had an effect on these levels? Just wondering if I should test for those as well on Tuesday or if the results would be compromised...? Thanks.

Once you inject is too late to check your LH and FSH. I'm surprised they didn't do it on your first set of labs. Increasing testosterone above your previous level would not increase your libido. You have other issues going on you need to take care of.

 

[SilverSurfer]

Is it too late to test LH and FSH now? Will the single injection performed Thursday night already had an effect on these levels? Just wondering if I should test for those as well on Tuesday or if the results would be compromised...? Thanks.

Yes, it’s too late. My LH and FSH were significantly lowered already as by happenstance I needed bloodwork done just after 2 weeks on TRT.

Also, T at 600 is pretty decent unless you have a known history of higher T. Going from 600 to 900 let’s say, may not boost your libido at all.

My libido doesn’t change whether my T is 432 or 1432. Obviously, my results don’t mean yours won’t. But libido issues seem to be the biggest challenge for men on TRT.

Hopefully this works for you, but even odds, it won’t.

 

[Ronin]

Thanks for the feedback. My plan moving forward is to run the sensitive estradiol test, may as well look at testosterone levels again while I am at it. Going to hold off on any more injections for now. Return to my doctor to discuss the results and talk more about thyroid and adrenal issues. I may have already convinced myself of the outcome of my lab work beforehand and didn't allow enough time and thought to consider all of the treatment options, reinforced by his willingness to prescribe the cypionate. If anyone has any advise for additional points to discuss with the doctor during the next consult I would definitely take note. Thanks!

 

[Vince]

Make sure you get a complete thyroid panel. TSH, free T4, free T3, reverse T3 and both antibodies. Your doctor should have told you if you are primary or secondary hypogonadism.

 

[Ronin]

Make sure you get a complete thyroid panel. TSH, free T4, free T3, reverse T3 and both antibodies. Your doctor should have told you if you are primary or secondary hypogonadism.

He wouldn't be able to comment on hypogonadism without testing LH and FSH correct? I wish I would have asked him to specify exactly which tests he was going to run beforehand, seemed like he knew what he was doing though. A couple pieces of the puzzle left out and now i've muddied the waters with the injection. Which antibodies are you referring to? We tested only TSH, T3, and T4. T3 is low... Thanks!

 

[CoastWatcher]

Libido is the result of multiple integrated factors; one is rightly hesitant to assure anyone considering testosterone replacement that they will restore libidinal function through TRT alone.

I’m a patient that, through androgen therapy, found my sex drive at age 55. It can happen. It does happen. But why some find success and others don’t is certainly frustrating.

 

[Mr S]

He wouldn't be able to comment on hypogonadism without testing LH and FSH correct? I wish I would have asked him to specify exactly which tests he was going to run beforehand, seemed like he knew what he was doing though. A couple pieces of the puzzle left out and now i've muddied the waters with the injection. Which antibodies are you referring to? We tested only TSH, T3, and T4. T3 is low... Thanks!

You’re only 39 years old so I’m sure your issues with libido will be sorted out. The fact that ED improved by controlling drinking it’s very positive. Your Dr seems to care and that’s another plus.

 

[Vince]

He wouldn't be able to comment on hypogonadism without testing LH and FSH correct? I wish I would have asked him to specify exactly which tests he was going to run beforehand, seemed like he knew what he was doing though. A couple pieces of the puzzle left out and now i've muddied the waters with the injection. Which antibodies are you referring to? We tested only TSH, T3, and T4. T3 is low... Thanks!

when you first test your thyroid you normally test your antibodies for hashimoto's or Graves disease