ON TRT after losing both testicles to testicular cancer

[Eunuch-man]

I was born with my right testicle undescended and it was lowered at about age 5. At 29, in 2006, it turned into a cancerous mass. Stage 1. Had an orchiectomy and 5 weeks of radiation to kill remaining cancerous cells.
Shortly after I went from weighing 220 lbs to close to 400 lbs within 2 years.
After a short conversation with my urologist in 2009, he diagnosed me with a prolactinoma tumor in the pituitary gland and it was giant. The size of a walnut.
Endocrinologist put me on cabergoline to shrink it and to have surgery to remove it. It shrank to a very tiny size in about 2 years. No need for surgery.
In 2010 I started TRT replacement therapy. But because it was government care it was very limited care and it wasn't in their community to use anything else other than testosterone cypionate or Androgel.
By 2013 I had lost almost 150 lbs. But unfortunately my remaining left testicle had atrophied and upon recommendation of my urologist I had a second orchiectomy since I was already on TRT for the rest of my life.
That was a mind fuck. After all I had already endured.
I did have saline testicular implants placed in my empty scrotum to look "normal." Very happy with the results.
Went through a rollercoaster of trials and tribulations on testosterone cypionate injections, dosage and frequency changes as well as on Androgel.
All the red tape to have the TRT replacement therapy was mind boggling.
I assume that the lack of testicles plays a huge part for my very low ejaculate volume. I've tried all of the hetbal supplements I investigated and learned about. Ashwanda, Tribulus, Horny Goat, Red Ginseng, Saw Palmetto, Zinc and so on. Nothing worked.
I am now on a cheap gel and I have great insurance through work. I am at pre-diabetic A1C and had a gastric bypass 3 months ago. So far down 53 lbs. 75 lbs more to go.
Erections are ok since I'm on Cialis. Libido is low. Not enough energyto workout since the energy I do have is used at a very fast paced job.
I'm looking to add anything that will supplement or add what I'm lacking and will be of benefit other than gel alone. Starting walking as excercise as much as I can tolerate since I have arthritis on the left knee.
I want to start working out again and wish I had the energy.

I am now on:
2 pumps of gel daily (20.25 mg)
500mg Metformin 2 tablets daily
Cialis 5mg once daily
Multivitamin daily
Iron
Zinc
Vitamin D
Vitamin B12

Thank you kindly for reading.

 

[Nelson Vergel]

Welcome to ExcelMale!
I am so sorry that you have gone through all that, man.

Can you post a PDF or image of your bloodwork (delete or scratch your name)? What's your height and weight now? Have you checked your thyroid function?

We have a few members here who have shared their experiences with testicular cancer.

 

[FangFang]

I was born with my right testicle undescended and it was lowered at about age 5. At 29, in 2006, it turned into a cancerous mass. Stage 1. Had an orchiectomy and 5 weeks of radiation to kill remaining cancerous cells.
Shortly after I went from weighing 220 lbs to close to 400 lbs within 2 years.
After a short conversation with my urologist in 2009, he diagnosed me with a prolactinoma tumor in the pituitary gland and it was giant. The size of a walnut.
Endocrinologist put me on cabergoline to shrink it and to have surgery to remove it. It shrank to a very tiny size in about 2 years. No need for surgery.
In 2010 I started TRT replacement therapy. But because it was government care it was very limited care and it wasn't in their community to use anything else other than testosterone cypionate or Androgel.
By 2013 I had lost almost 150 lbs. But unfortunately my remaining left testicle had atrophied and upon recommendation of my urologist I had a second orchiectomy since I was already on TRT for the rest of my life.
That was a mind fuck. After all I had already endured.
I did have saline testicular implants placed in my empty scrotum to look "normal." Very happy with the results.
Went through a rollercoaster of trials and tribulations on testosterone cypionate injections, dosage and frequency changes as well as on Androgel.
All the red tape to have the TRT replacement therapy was mind boggling.
I assume that the lack of testicles plays a huge part for my very low ejaculate volume. I've tried all of the hetbal supplements I investigated and learned about. Ashwanda, Tribulus, Horny Goat, Red Ginseng, Saw Palmetto, Zinc and so on. Nothing worked.
I am now on a cheap gel and I have great insurance through work. I am at pre-diabetic A1C and had a gastric bypass 3 months ago. So far down 53 lbs. 75 lbs more to go.
Erections are ok since I'm on Cialis. Libido is low. Not enough energyto workout since the energy I do have is used at a very fast paced job.
I'm looking to add anything that will supplement or add what I'm lacking and will be of benefit other than gel alone. Starting walking as excercise as much as I can tolerate since I have arthritis on the left knee.
I want to start working out again and wish I had the energy.

I am now on:
2 pumps of gel daily (20.25 mg)
500mg Metformin 2 tablets daily
Cialis 5mg once daily
Multivitamin daily
Iron
Zinc
Vitamin D
Vitamin B12

Thank you kindly for reading.

I don't have any answers but that took a lot of courage to tell that story. Glad you're here. Post up some blood work, and let's see if some of the forum bloodhounds can find something!

 

[Eunuch-man]

Welcome to ExcelMale!
I am so sorry that you have gone through all that, man.

Can you post a PDF or image of your bloodwork (delete or scratch your name)? What's your height and weight now? Have you checked your thyroid function?

We have a few members here who have shared their experiences with testicular cancer.

I actually have an appointment with my endocrinologist in a couple of weeks to have updated blood work done. The last blood work was from 6 months ago. I will post as soon as I have the results. Thank you all for your time.

 

[Eunuch-man]

Welcome to ExcelMale!
I am so sorry that you have gone through all that, man.

Can you post a PDF or image of your bloodwork (delete or scratch your name)? What's your height and weight now? Have you checked your thyroid function?

We have a few members here who have shared their experiences with testicular cancer.

I remember when I messaged you back in 2013 after my doctor suggested I had to remove my atrophied remaining testicle. You said not to. But I had already made the decision and my testicle was causing pain since it had atrophied and pretty much lived inside my lower abdomen. Been following you since 2012.

 

[Eunuch-man]

Welcome to ExcelMale!
I am so sorry that you have gone through all that, man.

Can you post a PDF or image of your bloodwork (delete or scratch your name)? What's your height and weight now? Have you checked your thyroid function?

We have a few members here who have shared their experiences with testicular cancer.

Ok, Nelson and the rest of the gentlemen in this group. I apologize for taking so long to respond with my bloodwork results since my initial post.
Long time to schedule appointments with my endocrinologist.
Updated results as of Monday 3/27/2023:
Total Testosterone. 152
Free Testosterone. 23.0
FSH. 0.6
LH. 0.2
Estradiol. 18.0
Prolactin. 52.3
A1C. 5.7
Total Cholesterol. 145
Triglycerides. 101
HDL. 39
LDL. 86
Magnesium. 1.9

I had gastric bypass surgery 5 1/2 months ago and lost 68 lbs since.
Ht: 5'9
Wt: 298 lbs
Thank you for your time.
No thyroid testing.

 

[Systemlord]

I’m a little confused, you’re on TRT and Total T is 152 ng/dL?

If so the gel isn’t cutting it.

Congrats on the massive weight loss!

 

[Eunuch-man]

I’m a little confused, you’re on TRT and Total T is 152 ng/dL?

If so the gel isn’t cutting it.

Congrats on the massive weight loss!

At the moment I am not on any trt due to all of the blood work the doctor wanted to perform. I did ask him if I could go back on the injections since being on the gel I am usually in the low 200s. He sent me a message after he received the labs earlier this week and is restarting me on cabergoline for the high prolactin levels and the testosterone injections. Just waiting on the Rx to be sent to my pharmacy. 2 years ago I was taken off of the trt injections because I was self medicating and my t levels were 1364 and I did have very high hematocrit levels.

 

[Eunuch-man]

I’m a little confused, you’re on TRT and Total T is 152 ng/dL?

If so the gel isn’t cutting it.

Congrats on the massive weight loss!

I just started this past Monday April 3rd injecting 100mg testosterone cypionate weekly
Cabergoline 0.5 2X weekly
Vitamin D 50,000 1X weekly
Will repeat FSH/LH tests in a month.

 

[Cataceous]

The OP reached out to me directly for comments. I'm going to duplicate some of them here in case they're of interest to others.

You have a possible advantage over guys with secondary hypogonadism in that it's likely that your hypothalamus and pituitary are capable of working normally. I have hypothesized that some men still have problems when on TRT because of the upstream hormonal disruption: TRT can suppress kisspeptin, GnRH, LH and FSH. In this view you are right to be concerned that your LH is low. The implication is that your dose of testosterone is higher than is natural for you.

There are some men with primary hypogonadism who tune their doses so that LH and FSH become normal—not too high or too low. I believe this is the safest and most natural way for these individuals to be on TRT. I'm doubtful this would work well with once-weekly injections, as there would probably be too much hormonal variation. It might work with twice-weekly injections. Every-other-day would be better yet, but the feasibility of that depends on individual tolerance.

On dosing, keep in mind that 100 mg per week of testosterone cypionate is providing more testosterone than most men could ever make naturally. The normal range of production would be covered by 30-90 mg per week. I take the equivalent of 44 mg, divided into daily doses. In my opinion the majority of men on injections are using more testosterone than they need, and frequently experience side effects as a result. In any case, if you decide to tune your dose to achieve normal LH then don't be alarmed if it requires doses much lower than 100 mg per week—this is expected. Monitor free testosterone, either directly with a good test, or indirectly by measuring SHBG along with total testosterone. You want to insure it's reasonable, which ties into my next point.

There is one caveat I can think of: Excess body weight can lower the body's natural set point for testosterone. Hopefully this won't be an issue for you much longer, as you are making good progress on that front. This could be a reason for you to initially target low-normal LH/FSH until you've reached your weight loss goals. At that time you could reduce the TRT dose further to yield mid-range LH. Unfortunately you can't entirely trust single LH measurements to tell you the whole story. LH is delivered in pulsatile fashion, and you can't be sure when you measured relative to the peak levels. I attach a picture below to illustrate.

 

[Eunuch-man]

Amazing!! Am I glad I reached out to you. Thank you very much for that wealth of knowledge and advice. Not even my own doctors have given me this much advice and education. I will definitely lower my dose as you suggested. And I am trying to normalize and balance everything as much as I can.
Will keep you posted.
Thank you once again!!

 

[Eunuch-man]

The OP reached out to me directly for comments. I'm going to duplicate some of them here in case they're of interest to others.

You have a possible advantage over guys with secondary hypogonadism in that it's likely that your hypothalamus and pituitary are capable of working normally. I have hypothesized that some men still have problems when on TRT because of the upstream hormonal disruption: TRT can suppress kisspeptin, GnRH, LH and FSH. In this view you are right to be concerned that your LH is low. The implication is that your dose of testosterone is higher than is natural for you.

There are some men with primary hypogonadism who tune their doses so that LH and FSH become normal—not too high or too low. I believe this is the safest and most natural way for these individuals to be on TRT. I'm doubtful this would work well with once-weekly injections, as there would probably be too much hormonal variation. It might work with twice-weekly injections. Every-other-day would be better yet, but the feasibility of that depends on individual tolerance.

On dosing, keep in mind that 100 mg per week of testosterone cypionate is providing more testosterone than most men could ever make naturally. The normal range of production would be covered by 30-90 mg per week. I take the equivalent of 44 mg, divided into daily doses. In my opinion the majority of men on injections are using more testosterone than they need, and frequently experience side effects as a result. In any case, if you decide to tune your dose to achieve normal LH then don't be alarmed if it requires doses much lower than 100 mg per week—this is expected. Monitor free testosterone, either directly with a good test, or indirectly by measuring SHBG along with total testosterone. You want to insure it's reasonable, which ties into my next point.

There is one caveat I can think of: Excess body weight can lower the body's natural set point for testosterone. Hopefully this won't be an issue for you much longer, as you are making good progress on that front. This could be a reason for you to initially target low-normal LH/FSH until you've reached your weight loss goals. At that time you could reduce the TRT dose further to yield mid-range LH. Unfortunately you can't entirely trust single LH measurements to tell you the whole story. LH is delivered in pulsatile fashion, and you can't be sure when you measured relative to the peak levels. I attach a picture below to illustrate.
View attachment 30817

I am trying to inject smaller doses other than 100 mg weekly. I am going to inject every other day.. I weigh 290 and I'm 5'9, 46 yrs old. What is a suggested dose I should inject every other day?? And how do I measure that in 3 ml syringe??

 

[Cataceous]

I am trying to inject smaller doses other than 100 mg weekly. I am going to inject every other day.. I weigh 290 and I'm 5'9, 46 yrs old. What is a suggested dose I should inject every other day?? And how do I measure that in 3 ml syringe??

A reasonable starting point is 70-80 mg of testosterone cypionate per week, which is around 20-23 mg taken every other day. I would not use such a large syringe. For frequent, small injections, insulin syringes are the best choice. The U-100 style is the most common, and has 100 units per milliliter. Typical sizes are 1 mL and 0.3 mL. For the amounts you'll be using the 0.3 mL size is fine. Suppose you wanted 70 mg TC per week and the concentration is 200 mg/mL. You calculate the syringe units as follows:

70 mg/week * (1 week / 3.5 EOD) / (200 mg/mL) * 100 units/mL = 10 units/EOD

The 10 units on your syringe equates to a volume of 0.1 mL, which is injected every other day (EOD).

 

[K.pietera]

Hi my friends


I am using ovitrelle 6500iu pen for 5 weeks right now for fertillity. The doc here in Belgium prescribed me the whole pen 2 x a week 3500iu. I'm also on 100mg test trough transcrotal appl.

The issue I have found recently is that since 4 dans ago I discovered a small lump onto my richt testicle... I have a echo Booked in next thursday.

Can it be because of the high dose of HCG ?... I am a bit scared right now.

The lump is smal and edgy and not painfull online onpleasant when I push against it. The size of it is really 1 or 2 mm or so