Newbie TRT questions

[salamastreet]

Hello all - this is my first post in this forum. I needed some advice/consultation. Appreciate everyone's support!

Background:
- I started with HCG Mono 250ui 2x a week Jan 24th of this year. Didn't notice much benefits, so moved over to TRT. I still do the HCG though to maintain fertility and testicular size.
- I started TRT Feb 21st. Felt benefits like 6-7 weeks in (took sometime). Didn't feel like superman, but had more motivation, more consistent energy, better libido, etc.
- TRT dose was 150mg/week CYP, IM.

Symptoms:
- I had very itchy head/dandruff. I now use shampoos like Nizoral, biotin, etc. every day. I previously had this issue, but with TRT it got much worse.
- I get headaches in the morning sometimes. Not sure why. I can't seem to find much info on this.
- I had insomnia and couldn't get to deep sleep when I started TRT. Seems a bit better now, but I feel like it's a hit or miss. Some days I'm OK and other's I'm not. Some days I'm easily up at 5am and others I won't wake up before 6am.
- Doctor suggested pregnelenone 60mg a night (last week). I took it once, but I'm hesitant to do it, unless a blood draw shows its necessary. Same thing with DHEA. I felt weird the next morning. Not sure if it's the cause or not.
- I definitely have an increase in acne. Does not bother me though.
- Muscles feel tight in the lower back sometimes.
- Definitely more emotional with the increase in Estrogen. Music sounds better to the ears and I'm more sensitive than I used to be. Movies are more entertaining LOL. I have mixed feelings about it though.

Results so Far:
- I took a blood test 5 days after my 7th week TRT injection. I probably should have done it sooner, but my timing was off with the weekend in between. Free T went from 7.3 to 18.4. Total T went from 231 to 712. E went from 12.7 to 36.
- Don't have all the markers like SHBG, PSA, etc. Not sure why my doctor didn't include those. I'll request those next time, or get it done elsewhere to get a better picture. I'll also get blood tests done with 2-3 days of injections.
- My thyroid panels were off before starting TRT, so I started Thyroid supplements early this year. Blood tests show improvements.
- Vitamin D was very low. Taking supplements for this as well.

Changes after last blood tests and questions:
- I moved from 150mg/week cyp to 85mg twice a week about a week ago. I feel something is off since doing this. Like I don't have that same energy all day, and just feel off. What do you think the reason is? Do you think this because I changed my dose down, so there is a "transition" time before it stabilizes (like a few more weeks)?
- Anything else you see is a concern from the info above?
- Does the headaches mean anything?

- I am meeting with the doctor in like 8 weeks or so, but wanted to get inputs from some of the experienced folks here so I can be better prepared. Thank you all!

 

[CoastWatcher]

Always test just prior to an injection - you want to capture your levels in the trough so you and your doctor can determine how well your protocol is sustaining itself over the course of the week - never “within 2-3 days of injections.” When were the results you posted obtained?

SHBG is a critical value in protocol design. Once it has been determined you actually are hypogonadal, SHBG may be the most important test run since it gives you and your doctor insight into how much testosterone should be injected and how often those injections should be administered. Where did it sit when therapy was initiated?

Any change in protocol typically leaves a patient unsettled. Once again, serum levels are in flux and you feel it. Don’t be discouraged by the fact that you are finding the present weeks (and its weeks, not days) surprising.

 

[salamastreet]

Interesting. OK, I will take a note of that and take blood tests near the trough. The results above were 5 days after the last injection, therefore 2 days before the next injection since I was doing it weekly.

I never took SHBG blood tests (doctor never brought it up because of inexperience?), so I will get that checked next time. Now I'm aware. Makes sense that this needs to be monitored closely.

And thanks for the other info. I'll ride this out and see how it goes, thank you.

 

[CoastWatcher]

The pre-treatment tests to fully evaluate where things stand.

Total and free testosterone
LH and FSH
SHBG
Estradiol, Sensitive, LC,MS/MS
CBC
CMP
Thyroid evaluation - ft3, ft4, rt3
Prolactin
PSA
DHT
DHEA

 

[salamastreet]

Noted. I'll ask my doctor to check those next time. If they don't do detailed checks, then I will try discount labs. Thank you.

 

[CoastWatcher]

You don’t need to run LH and FSH - it’s too late. Those tests can not be completed once exogenous testosterone has been initiated since natural production has been shut down. They would have given valuable insight into whether you are dealing with primary or secondary hypogonadism (which would have impacted the decision to try hcg mono-therapy).

Was your estradiol the correct test? If you aren’t certain, post the reference ranges (that’s a dead giveaway).

How old are you, if I may ask?

 

[salamastreet]

Hey CoastWatcher - unfortunately did not get those LH/FSH numbers before TRT (wish I would have done my HW better), however I did do a physical a month before and attached those labs (fairly detailed and lengthy). They did have the FSH marker but not LH. It shows I was at 3.2mIU/mL in a 1.5-12.4 range.

Estradiol was at 12.7pg/ml in a 7.6-42.6 range from my physical, and I just noticed my pre-TRT blood test from this doctor did not include the Estradiol marker.

My last blood test showed:
Estrone, Serum 36pg/ml with no range
Estradiol, Sensitive, 27.8 pg/ml in a 8-35 pg/ml range.

Hopefully this helps give some additional insights.

 

[salamastreet]

And I'm 34.

 

[CoastWatcher]

You were evaluated with the appropriate estradiol test (resulting in a 27.8 value) but there is no reason for estrone to have been run, none at all. It gives your doctor no information that is actionable. Don’t pay for it again.

The FSH indicates you are likely hypogonadal as a result of secondary issues.

 

[salamastreet]

Sounds good. Thank you for the feedback.

BTW, if the FSH indicated I was likely secondary hypo, should have HCG Mono worked or not necessarily? Maybe I didn't wait long enough?