(not for me?) Hombre's TRT Log: 34yo, low E2, norm SHBG and LH [Defy]

[hombre]

Height: 6ft (Lifetime underweight, never on any psych meds)

Motivation (libido mainly): tried cialis Nov 2017 after a year long break and it wasn't working the same, sudden weak erections during porn use Feb 2018 (after 6 years of minimal porn use, nofap with relapses for 6 years), 10% erection during sex for the first time last day of June 2018.

Short history:
Been tracking my TT since 2015 (360, 260) when my libido started dropping, dropped libido allowed me for the first time since 2012 to go more than 60+ days without porn use (115 days, no sex, "hardmode"). Same year finally started having sex.
Since 2012 I believed my low libido and any light ED issues were due to years of daily porn use since 2003 or so. Only this June 2018 I discovered the importance of E2 levels (even though I started tracking E2 in 2016).

Lab Work (Labcorp)

				mid bulk (all fat in belly, but low E2)	10% erection during sex, self paid testing	some ZMA for 4 days, ordering all tests through PCP (for Defy)	Experiment: 1 week break after Super loading for 2 weeks: Zinc 90mg ED, Vit D3, DHEA 20mg, B12, Iodine-	Experiment: Superloading for 1 more week
	Range / Units	2015 july am	2016 Oct am	2017 Oct am	2018 June am	2018 July am	2018 early Aug am	2018 late Aug am
Weight		150	155	177	168	167	167	167
Fat %		12	12	16	12	12	12	12
Daily Cals		1500	1500	2700	2400	2200	2500	2500
TT (Serum)	264 - 916 ng/dL	301 456	-	263	348 356	545	360	418
TT, LC/MS	(above)	-	481	-	-	474	-	-
E2, ECLIA	7.6 - 42.6 pg/mL	-	9.6	< 5	< 5	< 5	-	-
E2, LC/MS	8.0 - 35.0 pg/mL	-	-	-	8.4	11.1	16.5	14.3
SHBG	16.5 - 55.9 nmol/L	-	-	20	29	36.7	25.1	-
LH	1.7 - 8.6 mIU/mL	-	-	-	6.7	6.5	-	-
T/E2 Ratio	?	-	50	53	42	52	22	29
Free T (direct)	8.7-25.1 pg/mL	18.4	12.2	17.8	19	-	17.9	20.1
Free T, Calc	ng/dL	-	-	6.27	6.99	9.2	8	-
Prolactin	4.0 - 15.2 ng/mL	-	-	-	13.7	-	-	11.8
DHT	30-85 ng/dL	-	-	-	27	-	-	-
Progesterone	0-0.5	-	-	-	-	0.3	-	-
DHEA-S	138.5 - 475.2	-	-	-	279.9		259	-
FSH	1.5 - 12.4	-	-	-	3.6	3.8	-	-
IGF	88 - 246	-	-	-	158	-	-	-
CRP	0 - 3	2.7	-	-	-	0.91	-	-
TSH	0.450 - 4.5	2.05	2.09	1.41	2.06	2.54	-	-
Free T3	2.0 - 4.4	-	-	-	3.1	2.8	-	-
Free T4	0.82 - 1.77	-	-	-	1.55	1.53	-	-
Reverse T3	9.2 - 24.1	-	-	-	-	25.6	-	-
TPO Ab	0 - 34	-	-	-	-	18	-	-
Thyroglobulin Ab	0.0 - 0.9	-	-	-	-	< 1.0	-	-
								-
Cholesterol	100-199 mg/dL	154	195	200	173	-	-	-
Triglycerides	0-149 mg/dL	84	115	157	104	-	-	-
HDL	>39	68	75	59	53	-	-	-
LDL Calc	0-99	69	97	110	99	-	-	-
								-
Iron	38-169	-	-	-	-	92	-	-
Ferritin	30-400	-	-	-	-	129	-	-
								-
Cortisol AM	6.2-19.4	-	-	-	-	16.8	-	-
Fastin Insulin	2.6 - 24.9	-	-	-	-	4.2	-	-

(same but maybe easier on an eye)

Other testing:

• Salivary cortisol: low noon and low 4pm levels
• Low waking and 3pm body temps
• Both bilateral varicocele (ultrasound)
• Good performance on glucose load test (two hour)
• mild obstructive apnea [borderline moderate] (AHI = 14) [due to enlarged tonsils likely]

Prescribed protocol (Dr. Saya, Defy):
Cloming was not recommended due to low success rate in the presence of current (normal) LH levels.

• Pregnenolone/DHEA cream to raise noon cortisol (energy) and improve thyroid performance as a result (high reverse T3)
• Test Cyp 44 mg 3 times a week (higher frequency due to normal SHBG that is expected to go down)
• HCG 300 IU 3 times a week
• L-Tyrosine 500mg twice daily for dopamine increase (motivation)
• No AI

Results so far:
Been taking L-Tyrosine for almost 14 days and applying Pregnenolone/DHEA cream for the last 6 days (delaying starting HCG / Test Cyp injection to asses reaction to Pregnenolone first):
no noticeable increase in motivation or libido, no noticeable side-effects either. Although the weekend of starting L-Tyrosine started again approaching women in public (moderate anxiety), might be due to being away from porn finally for 30+ days at that time.

Plans:
To start Test Cyp / HCG any other day.

UPDATE Sept 12, 2018:
- added Free T (Direct) lab work numbers
- Treatment / protocol is provided by Dr. Saya (Defy Medical)

 

[MarkM]

I would not postpone starting TRT and injecting testosterone cyoionate waiting on Pregnenolone and DHEA cream to do something. It's only been 6 days and if Preg is low it will take it a while to build up but that is not going to make a huge difference in your testosterone levels.

Your Total T is low but I see no measurement for Free T. Free T is the one that matters. Total T is more or less just a number.

Your E2 is also low but will come up when you start injecting testosterone cypionate. Your SHBG has bounced from a low of 20 to a high of 36.7 so it has average about 27 to 28.

Your DHEA-s is below mid range and I see that you are using a cream to increase it. That may help increase your E2, it does in many men. If you are secondary hypogonadism then the HCG will probably help increase your E2. Increasing your e2 will help your libido. You might need to increase your HCG.

Your thyroid looks to need some attention. An under performing thyroid can give you low T symptoms. TSH should be close to 1.0 verse where it is at 2.54. Your Free T3 at 2.8 should be at 3.8 and your Free T4 should be close to 1.8. Your reverse T3 should be no higher than 15 but yours is at 25.6. This gives you a Free T3:Reverse T3 ratio of 10.9 and ou need this ratio to be greater than 20 so there is an issue with T3 pooling. You need to speak to your doctor about this. You also have some antibodies attacking your normal thyroid tissue.

I see no AI and that is good. You do not need an AI.

You need to get started on the Test Cyp.

 

[hombre]

@MarkM thanks for the input! I included Free T (Direct) results and Free T Calculated. Free T Direct is claimed regularly to be totally useless and unreliable, and I've never done more expensive version (Testosterone, Free, Equilibrium Ultrafiltration). My Free T Calculated (based on Albumin levels that are not included and SHBG) is usually around 2%+ of Total T Serum.

Dr. Saya only gave me Pregnenolone to see how thyroid would respond. I'm not aware of many other things that could help with high T3, low normal Free T3, since my antibodies were not too high I experimented with Lugol's iodine but it didn't do much so far.

 

[hombre]

Yesterday's night, Tue 9/11, I took a shot of HCG 300 IU (0.3 ml) (29g / 1/2" / 0.3cc syringe) into the left delt: first time shooting anything into the delt (I had experience doing melanotan 2 subq injections before, and some painful antibiotics into upper glutes IM).

Darted it straight in, it went without any pain, like into a butter (stomach fat subq with 31g were much more noticeable, although it was while doing them slow). 1/2" needle for the delt probably does shallow IM rather then subQ, the needle tries to pop out and is painful somewhere deep at the tip when holding it all the way in.

Results: weird feeling in the injection side of the neck after the injection. no morning wood yet, deadlifts felt easier in the morning, maybe a bit more energy, probably placebo. HCG pregnancy strips didn't show me as pregnant (but just discovered that HCG pregnancy strips only detect HCG levels at concentrations of 10,000 IU per ml, and probably that's for HCG in a vial, not in urine hehe). No any adverse reactions.

TODO: should research reconstituting HCG at a higher concentration in the future, 0.3 ml is a lot of liquid (got used to shooting melanotan 2 at only 5-6 units per shot...)

 

[hombre]

Alright. Wed 9/12 8pm. First testosterone cypionate shot. 25g 5/18" needle from Defy. 0.22ml.
Upper thigh area, quads. Darted the needle straight in, not enough force, only half in. Probably it didn't penetrate the muscle, so I was left to experience slow puncturing of muscle tissues with a seemingly loud pop. No really any pain after the injection (easier than delts hcg), no blood.

Results: waking up with some chub, and somewhat horny, no soreness (deadlifted 24 hours earlier and only ate 2100 Cals). Probably all placebo, since only 1mg of Test Cyp is expected to have been released since the injection.

TODO: either try subq or try ventrogluteal IM (some reading indicated that dorsogluteal IM is a stone age and that quads is a high risk area). Try Air-Lock or Z-tag injection techniques. Probably should switch to Tue / Thu / Sat evenings injection schedule, so I can do blood tests on Tue or Thu morning, enough time afar from injections.

Found some excel spreadsheet to do some calculations based on half-lifes. Struggling to find a correct half-life of Test Cyp: 6, 7 or 8 days???

Based on 8-day half-life, Calculations:

 

[hombre]

Apparently a terminal half life of a test cypionate is only 5 days, so the spreadsheet has to be recalculated.

Thu 13/09 Test Cyp. 31g 5/18" 0.5cc . Stomach subq
Impatient me started googling about pre-loading, loading phase, frontloading. There was barely anything, except in steroid users communities. Since switching to Tue / Thu / Sat schedule I decided to do a pin today. Later I abandoned any ideas of frontloading, probably makes more sense after having an initial experience. 31g takes a while to load, never again. Stomach subq: no pain at all, darting it in fast though, no pussying around anymore like with melanotan injections.

Results
Friday: No wood next morning. Waking up before alarm, and getting slightly horny, not able to fall asleep again until the alarm. Nothing special about Friday. Walked around for about an hour in public, very humid, didn't bring myself to talk to any woman.
Saturday: walked around for 90 minutes, stopped a young woman, 1 hour instant date on an isolated bench, touching each other, not much libido, not horny, barely got a chub. Didn't invite her home due to bad timing, and not feeling like taking that risk without some cialis. Feeling very good after the date, my first ever instant date.


Sun 16/09 Test Cyp. 29g 1/2" 0.3cc . Love handles subq
(50+ days without porn, 20 days without sex)
29g is still pretty slow to load, 0.3cc syringe is too narrow for big bubbles to travel anywhere.
Did a middate Sunday pin instead of a Saturday night to spread out a bit and be closer to Tuesday's evening pin. Not taking any more HCG for now to feel out Cypionate first.

Results
Walking around for 4 hours listening to audiobooks, 5 introductions, 1 conversation. No horniness yet. More interested in being social, rather than sexual, unless seeing those rare women with extreme hips to waist ratio, and/or with big bras and tiny waist. I haven't been 50+ days without porn since mid April, when I still was relying on cialis and not being happy with it, in either way I would be biased to attribute improvements perceived to porn abstinence.

TODO
I will do a blood collection on Tuesday morning before the evening's pin, it's going to be just past one half life, and almost a week after first injection. Hopefully 27g is going to be fast enough to load. 25g was fast, but I don't want to go down to 25g for subq.

 

[hombre]

Tue 9/18
Love handle subq pin area got pretty sore today (no bruise or anything visible), belly fat subq pin area from Thursday feels sore too but less.

 

[MarkM]

Is there a lump at the injections site? Are you injecting slow or pushing the oil in quickly?

 

[hombre]

Is there a lump at the injections site? Are you injecting slow or pushing the oil in quickly?

injecting very slow, no bump, but feels lumpy a bit to the touch. Maybe because I was doing 31g and 29g which take a while and create a lot of pressure in a small area (my guess, even during slow injection)

 

[MarkM]

I think 29 gauge would be fine as long as you are going slow. 31 gauge is surely going to create more pressure even when going slow. You may also be having a reaction to the oil. My Testosterone Cypionate is in cottonseed oil and if I inject SubQ I normally get a reaction at the injection site.

 

[hombre]

I'm probably going to go shallow ventrogluteal next, seemed like it can be tricky to "self" locate the area.

Cyp from Empower seems to be in grapeseed oil, I used to use that oil a lot for cooking, but maybe having an allergic reaction doing it subq.

 

[MarkM]

I inject ventrogluteal (VG) and it is my favorite place to inject. Here is a diagram of where the ventrogluteal is.

 

[hombre]

Thanks @MarkM !
I roughly understood where it was, but surprised that there were no photos on how to locate it using your own hand without breaking it

 

[MarkM]

The picture is actually with a hand of another person and not the individual receiving the injection.

This picture may help more. On this picture the "X" marks the injection location. I move the "X" over to the left about 1 to 1 1/2" and then inject. When you inject make sure to take the pressure off that leg so the muscle is relaxed.

 

[hombre]

Pin #4. Tue 9/18 evening. Test Cyp 0.22ml / 44mg. Shallow IM Delt. 27g 1/2" 0.5cc
27g is a nice "fast" gauge. Painless shoulder injection. Some weird sensations in some parts of a left arm during 1-2 hour after the pin. Trying second time the AirLock injection technique with 0.03cc of air, but it doesn't seem working, after pin there is a small amount of oil around the injection area, and it's tricker to measure a correct amount of oil with air in the right place.

Result: some horniness Wed morning. One spontaneous street approach after a lunch break without much of a delay.

Thoughts: been thinking here and there if I should have given Clomid a try, I keep convincing myself that my E2 was low and LH is normal for that. I knew of dr. Saya preferring to try Clomid first, so when he was against trying Clomid I was not insisting. Going to do first blood work tomorrow after starting injections, the inexpensive female hormonal panel + SHBG.

 

[hombre]

Having easy boners from random sexual thoughts this morning, and just got blood collected at the same time, would be interesting to see at what levels that happens. It also might be due to 60 days without porn and 23 days without any kind of release.

 

[MarkM]

Getting boners is a good thing, especially if you can get them while being drained!

 

[hombre]

damn! I only injected 176 mg TOTAL (4 pins, 44mg each) over the last 9 days (132mg per 7 days, prescribed), and while in a "valley" at 10 hours before the next injection my blood markers are sky high:

I probably should contact Defy, maybe I'm fast metabolizer, and I need to inject much less. Still waiting SHBG results. The amount of test cyp released the day earlier = 13mg and the planned steady state release: 17-20 mg per day, so I expect my levels to keep rising much higher, unless my testicles still produce decent amount of Testosterone, but LH is only 1.1... (and no HCG)

Pin #5. Thu 9/20 evening. Test Cyp 0.22ml / 44mg. Ventrogluteal Shallow IM. 27g 1/2" 0.5cc
Took some time to decide on a pin spot, it all felt like tendons to the touch, no pain, no soreness so far the next day.

Results: no wood Friday morning, maybe shouldn't have been "edging" so much Thursday evening.

I should have mentioned earlier that after second pin or even after the first pin to this day every time I wake up I have weird feeling around my heart and around left upper body, some sensation of tightness or thickness, and I think my breathing feels different starting second pin. My breathing pattern during deadlifts changed, I breath in/out more now during the exercise instead of holding air. I hope test cyp doesn't mess with my heart...

 

[hombre]

Scheduled a 15 min appointment with RN Damaris

 

[hombre]

Pin #6. Sun 9/23 morning. Test Cyp 0.22ml / 44mg. Ventrogluteal Shallow IM. 27g 1/2" 0.5cc
Another ventrogluteal went good. Morning wood kinda gone, along with morning horniness. Some libido is probably still there, just not too overt. Maybe it's because I was masturbating without orgasms (edging) and porn quite a bit, since Thursday. 4 weeks exactly without orgasm / sex.

Had to go to a doctor / urgent care. Confirmed that I had folliculitis on my left testicle for the last 2 weeks after scrotum hair trimming. Never happened to me before, I wonder if it was so persistent because of elevated E2.

Monday 9/24
Defy's RN recommended to decrease dosage from 44mg TIW to 40mg TIW to decrease my E2, I talked them into potentially decreasing even to 36mg TIW, but going to stick to 40mg for now.

Going to start taking HCG since my LH is only 1, or maybe wait a little bit longer until I'll do another set of blood tests.

PS. Just got my SHBG result, it's only 23 (16.5 - 55.9). My numbers pre-TRT: 20, 29, 36, 25. I hoped it to be higher than 23.