Hi all,
Please bear with me as I have a story to share and a number of questions. I'm 29 years old, about 6'1 215 20-22% BF, and been on TRT for over 7 years. I was diagnosed as primary with low testosterone (270 ng/dl), very high LH and FSH, small testicle volume (< kidney bean size), and sperm count of zero over three sperm analyses. Cause unknown, mumps suspected, though it appears I went through puberty somewhat normally.
At the time of diagnosis, I had diminished ability to perform sexually and near inability to put on muscle but otherwise no negative symptoms.
Since I started TRT, I've been on Androgel. For the first 2 years, I was on 4 pumps of the 1% gel. I know this doesn't work for many, but this shot my test above the upper limits - >1500 ng/dl. I was testing around 1200 ng/dl even 8 hours after applying the gel. Despite this high test, I had bottom of the range estradiol (10 pg/ml), and oddly still had LH/FSH higher than the normal range. Given the high LH, my doctor suspected I was still producing some testosterone adrenally or in my testicles. But the doctor seemed mostly baffled and never really certain about anything.
FWIW it's worth, I felt great at this point. I was down to about 175 at 13% BF, though still found it somewhat difficult to build muscle.
Then my doc switched me to 2 pumps of the 1.62% out of fear that high testosterone might affect cholesterol. My LDL was high though HDL and Triglycerides were excellent, so this made little sense to me. Anyway, the 2 pumps dose leads to a more normal level of 600-900.
I've been on that dose for 5+ years with no major issues. The main problem is I do not feel as good in the late afternoon and evening. I sometimes lack energy to go to the gym and struggle to get through the routine I did when I first started TRT. In some cases, I also have difficulty maintaining an erection in the evening, leading me to supplement with Cialis and Arginine.
Also recently had these labs that were a little troubling:
Taken at 4pm:
Testosterone, Serum was 843 ng/dL (348 - 1197)
Free Testosterone(Direct) was 10.2 pg/mL (9.3 - 26.5)
Estradiol was 15.0 pg/mL (7.6 - 42.6)
Obviously total test was good. The free test was lowish. A year after TRT I think free test was very high, so not really sure what happened. Is it true that gels tend to lead to less free test than shots? I also wonder if my increased BF% is contributing to higher SHBG.
My estradiol also seems to be on the low side. I've read that this could be stunting muscular development in part due to its relation to IGF-1, in my case which is also on the lower side, and perhaps affect the quality of my erections or mood. My estradiol is not clinically low, nor do I really have any issues with mood. But I've learned from experience that most doctors know little if anything about the purpose of estrogen, nor do lab ranges give any hint at what is optimal.
So the most important question: where to go from here? I want to increase free test and optimize estradiol. Obviously, avoid the crashing energy at night.
There are numerous drugs, ancillaries and supplements that I've come across but never tried. For instance, Danazol, Exemestane (Aromasin), DHEA, etc. I am also very willing to switch to injections. For years, I figured if it ain't broke, stick with Androgel, but now I am finally reconsidering.
My reason to consider Danazol or Exemestane would be to spike free T, and in the case of Exemestane increase IGF-1 from what I read. The concern though is they would lower my estradiol further, so I tend to lean against using them. Not to mention, these are drugs, which have their own side effects and could affect pathways in ways I do not currently know. Impact cholesterol, etc.
My reason to try the injections would be to ideally increase free T and avoid the mini crashes I'm experiencing in PM. Crashing in between biweekly injections would be better than every evening, but perhaps there's no need to crash at all.
I came across a “clinic” in Florida that's willing to give me 100mg test cyp injections e3d, though they also want me to take (buy) what I think is a high amount of Arimidex and HCG. “Normally we give 1mg eod of Arimidex but you only need 0.5.”
Given my lowish estradiol, that seems irresponsible without seeing how I respond. At any rate, I'd be willing to start injections without Adex and reevaluate estradiol later. Anecdotally, it would seem I have low aromatase as even when my test was >1500, my estradiol was 10 pg/ml. But that was on Androgel, which has a much shorter half life than test cyp.
I'm also unsure if HCG would be needed in my case. I know HCG raises LH & preserves testicles, but my testicles are already dysfunctional (no sperm, < kidney bean sized) and my LH is already high. My thought is HCG would only be needed if my LH goes low. Am I right? It does seem likely my LH would go low on 200mg test per week, though my case has always defied common wisdom.
Finally, anything else I should consider? Perhaps, I should try DHEA to optimize my estradiol?
I'm sorry to ask so many questions. Appreciate any advice. I also hope that someone can relate to my case, and perhaps benefit as I share my experiences moving forward.
Please bear with me as I have a story to share and a number of questions. I'm 29 years old, about 6'1 215 20-22% BF, and been on TRT for over 7 years. I was diagnosed as primary with low testosterone (270 ng/dl), very high LH and FSH, small testicle volume (< kidney bean size), and sperm count of zero over three sperm analyses. Cause unknown, mumps suspected, though it appears I went through puberty somewhat normally.
At the time of diagnosis, I had diminished ability to perform sexually and near inability to put on muscle but otherwise no negative symptoms.
Since I started TRT, I've been on Androgel. For the first 2 years, I was on 4 pumps of the 1% gel. I know this doesn't work for many, but this shot my test above the upper limits - >1500 ng/dl. I was testing around 1200 ng/dl even 8 hours after applying the gel. Despite this high test, I had bottom of the range estradiol (10 pg/ml), and oddly still had LH/FSH higher than the normal range. Given the high LH, my doctor suspected I was still producing some testosterone adrenally or in my testicles. But the doctor seemed mostly baffled and never really certain about anything.
FWIW it's worth, I felt great at this point. I was down to about 175 at 13% BF, though still found it somewhat difficult to build muscle.
Then my doc switched me to 2 pumps of the 1.62% out of fear that high testosterone might affect cholesterol. My LDL was high though HDL and Triglycerides were excellent, so this made little sense to me. Anyway, the 2 pumps dose leads to a more normal level of 600-900.
I've been on that dose for 5+ years with no major issues. The main problem is I do not feel as good in the late afternoon and evening. I sometimes lack energy to go to the gym and struggle to get through the routine I did when I first started TRT. In some cases, I also have difficulty maintaining an erection in the evening, leading me to supplement with Cialis and Arginine.
Also recently had these labs that were a little troubling:
Taken at 4pm:
Testosterone, Serum was 843 ng/dL (348 - 1197)
Free Testosterone(Direct) was 10.2 pg/mL (9.3 - 26.5)
Estradiol was 15.0 pg/mL (7.6 - 42.6)
Obviously total test was good. The free test was lowish. A year after TRT I think free test was very high, so not really sure what happened. Is it true that gels tend to lead to less free test than shots? I also wonder if my increased BF% is contributing to higher SHBG.
My estradiol also seems to be on the low side. I've read that this could be stunting muscular development in part due to its relation to IGF-1, in my case which is also on the lower side, and perhaps affect the quality of my erections or mood. My estradiol is not clinically low, nor do I really have any issues with mood. But I've learned from experience that most doctors know little if anything about the purpose of estrogen, nor do lab ranges give any hint at what is optimal.
So the most important question: where to go from here? I want to increase free test and optimize estradiol. Obviously, avoid the crashing energy at night.
There are numerous drugs, ancillaries and supplements that I've come across but never tried. For instance, Danazol, Exemestane (Aromasin), DHEA, etc. I am also very willing to switch to injections. For years, I figured if it ain't broke, stick with Androgel, but now I am finally reconsidering.
My reason to consider Danazol or Exemestane would be to spike free T, and in the case of Exemestane increase IGF-1 from what I read. The concern though is they would lower my estradiol further, so I tend to lean against using them. Not to mention, these are drugs, which have their own side effects and could affect pathways in ways I do not currently know. Impact cholesterol, etc.
My reason to try the injections would be to ideally increase free T and avoid the mini crashes I'm experiencing in PM. Crashing in between biweekly injections would be better than every evening, but perhaps there's no need to crash at all.
I came across a “clinic” in Florida that's willing to give me 100mg test cyp injections e3d, though they also want me to take (buy) what I think is a high amount of Arimidex and HCG. “Normally we give 1mg eod of Arimidex but you only need 0.5.”
Given my lowish estradiol, that seems irresponsible without seeing how I respond. At any rate, I'd be willing to start injections without Adex and reevaluate estradiol later. Anecdotally, it would seem I have low aromatase as even when my test was >1500, my estradiol was 10 pg/ml. But that was on Androgel, which has a much shorter half life than test cyp.
I'm also unsure if HCG would be needed in my case. I know HCG raises LH & preserves testicles, but my testicles are already dysfunctional (no sperm, < kidney bean sized) and my LH is already high. My thought is HCG would only be needed if my LH goes low. Am I right? It does seem likely my LH would go low on 200mg test per week, though my case has always defied common wisdom.
Finally, anything else I should consider? Perhaps, I should try DHEA to optimize my estradiol?
I'm sorry to ask so many questions. Appreciate any advice. I also hope that someone can relate to my case, and perhaps benefit as I share my experiences moving forward.
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