Questions about my TRT regimen and way to help things along

[Vithat]

Hello ExcelMale Forums.

Ive finally managed to switch to injections. I have risen from 200-something to 957 using clomid. I feel hardly different and I feel it might be because of the fact I was using Clomid, which ive heard it has effect on mood which is the main reason im switching to injections over it.

My regimen for now is 1ML of Test every 7 days and 0.75 ML of HCG and Arimidex too. Is this a good regimen? How long would it typically take for this regiment to start taking effect?

Im hoping that things get better from here on. However, I want to know what else can help things along. I consume Zinc and stuff already. Would it be helpful to continue take clomid with this even with mood effects? Or is that not advised.

Also, I am curious about the benefits of metformin, I took it briefly when younger as I was pre-diabetic. Im fortunate enough to have been given the news of no longer having that condition after rigorous diet and exercise. I never really remembered to take it and I am glad I have overcome the condition naturally. But I have heard its insulin lowering properties can be very helpful for hormone optimization wonder if its worth it to take. I found it here.

Please let me know what you guys think. Thanks.

 

[Sean Mosher]

Can you post your labs?
If you're still not feeling better with these new numbers we need to see what else might be going on.

 

[Systemlord]

1ml of testosterone could be 100mg or 200mg, injecting testosterone once weekly has it's problems. You levels peak and start dropping rapidly leaving you lower at the end of the week, try splitting up your injections two or more times a week to keep levels stable. SHBG labs are recommended as this is a tool for dosing and injection frequencies.

A full set of labs would provide a good meaningful discussion.

 

[CoastWatcher]

And what is .75ml of anastrozole? Do you mean .75mg? Taken how often? In response to what estradiol/sensitive value? Labs will sharpen things for all of us.

 

[Vithat]

Alrighty then, these results are from May 31st

[TD="class: nameCol srchbl"]

[/TD] [TD="class: valueCol"][/TD] [TD="class: rangeCol"] [/TD]

[TD="class: nameCol srchbl"]CHOLESTEROL[/TD] [TD="class: valueCol"]146 MG/DL[/TD] [TD="class: rangeCol"]<200 MG/DL[/TD]

[TD="class: nameCol srchbl"]TRIGLYCERIDES[/TD] [TD="class: valueCol"]93 MG/DL[/TD] [TD="class: rangeCol"]<150 MG/DL[/TD]

[TD="class: nameCol srchbl"]HDL CHOLESTEROL[/TD] [TD="class: valueCol"]37 MG/DL[/TD] [TD="class: rangeCol"]>39 MG/DL[/TD]

[TD="class: nameCol srchbl"]LDL CHOLESTEROL CALCULATED[/TD] [TD="class: valueCol"]90 MG/DL[/TD] [TD="class: rangeCol"]<100 MG/DL[/TD]

[TD="class: nameCol srchbl"]LDL/HDL RATIO, SERUM[/TD] [TD="class: valueCol"]2.44 RATIO[/TD] [TD="class: rangeCol"]<3.55 RATIO[/TD]

[TD="class: nameCol srchbl"]SOMATOMEDIN-C[/TD] [TD="class: valueCol"]129 NG/ML[/TD] [TD="class: rangeCol"]94 - 291 NG/ML[/TD]

[TD="class: nameCol srchbl"]TESTOSTERONE LEVEL[/TD] [TD="class: valueCol"]957 NG/DL[/TD] [TD="class: rangeCol"]300 - 1080 NG/DL[/TD]

[TD="class: nameCol srchbl"]SEX HORMONE BINDING GLOBULIN[/TD] [TD="class: valueCol"]21.2 NMOL/L[/TD] [TD="class: rangeCol"]16.5 - 55.9 NMOL/L[/TD]

[TD="class: nameCol srchbl"]CALC FREE TESTOSTERONE[/TD] [TD="class: valueCol"]279.9 PG/ML[/TD] [TD="class: rangeCol"]47.0 - 244.0 PG/ML[/TD]

[TD="class: nameCol srchbl"]ESTRADIOL LEVEL[/TD] [TD="class: valueCol"]34.5 PG/ML[/TD] [TD="class: rangeCol"]<=60.7 PG/ML[/TD]

[TD="class: nameCol srchbl"]T3 UPTAKE[/TD] [TD="class: valueCol"]33.1 %[/TD] [TD="class: rangeCol"]24.3 - 39.0 %[/TD]

[TD="class: nameCol srchbl"]THYROXINE BINDING CAPACITY[/TD] [TD="class: valueCol"]1.0 [/TD] [TD="class: rangeCol"]0.8 - 1.3[/TD]

[TD="class: srchbl, colspan: 3"]NOTE: THYROXINE BINDING CAPACITY IS INVERSELY RELATED TO T-UPTAKE, DECREASED WITH HYPERTHYROIDISM AND LOW THYROID BINDING GLOBULIN (TBG), INCREASED IN HYPOTHYROIDISM OR WITH HIGH TBG.[/TD]

[TD="class: nameCol srchbl"]T4 TOTAL[/TD] [TD="class: valueCol"]4.7 UG/DL[/TD] [TD="class: rangeCol"]4.5 - 10.5 UG/DL[/TD]

[TD="class: nameCol srchbl"]FTI[/TD] [TD="class: valueCol"]4.7 UG/DL[/TD] [TD="class: rangeCol"]4.2 - 11.6 UG/DL[/TD]

[TD="class: nameCol srchbl"]HEMOGLOBIN A1C[/TD] [TD="class: valueCol"]5.5 %[/TD] [TD="class: rangeCol"]4.2 - 5.6 %[/TD]

[TD="class: nameCol srchbl"]THYROID STIMULATING HORMONE[/TD] [TD="class: valueCol"]1.250 UIU/ML[/TD] [TD="class: rangeCol"]0.400 - 4.100 UIU/ML[/TD]

 

[Systemlord]

You require more thyroid tests to determine why T4 is so low, it should be midrange and is the total thyroid hormone being produced. Some of these thyroid labs are obsolete and tells me your doctor is a little behind the times, you need Free T3, Free T4, Reverse T3 and antibodies. Free T3 is the only active thyroid hormone, it's the stuff that makes the magic happen, where the rubber meets the road.

You can tell alot about a doctor by the labs he/she orders and it's easy to predict the level of care you will be receiving. I doubt that's the correct E2 sensitive LC/MS/MS method designed for men. You need to inject at a minimum twice weekly, EOD may help lower estrogen and keep levels even more stable.

 

[Vithat]

You require more thyroid tests to determine why T4 is so low, it should be midrange and is the total thyroid hormone being produced. Some of these thyroid labs are obsolete and tells me your doctor is a little behind the times, you need Free T3, Free T4, Reverse T3 and antibodies. Free T3 is the only active thyroid hormone, it's the stuff that makes the magic happen, where the rubber meets the road.

You can tell alot about a doctor by the labs he/she orders and it's easy to predict the level of care you will be receiving. I doubt that's the correct E2 sensitive LC/MS/MS method designed for men. You need to inject at a minimum twice weekly, EOD may help lower estrogen and keep levels even more stable.

I have no idea what those abbreviations mean. I ran the idea of hypothyroidism to my doc and we tested for it here. He said its normal range.

 

[Systemlord]

I have no idea what those abbreviations mean. I ran the idea of hypothyroidism to my doc and we tested for it here. He said its normal range.

You need to understand the word normal gets thrown around a lot, most doctors have no idea what normal thyroid numbers look like, so they follow these labs ranges which has been thought for some time now to be far too broad as they have people within these ranges clearly experiencing hypothyroid symptoms. So forgive if I don't believe your doctor.

You show your labs to many different doctors and some will see a problem where others do not. It's called reference range endocrinology and it makes it to where the doctors have no need for critical thinking or reasoning, it ends all decisions simply because you are within the normal ranges. It creates robots who ignore symptoms, "you're in range, you must feel good". It's not that simple.

EOD is every other day.

 

[CoastWatcher]

I have no idea what those abbreviations mean. I ran the idea of hypothyroidism to my doc and we tested for it here. He said its normal range.

It means you didn't get the right tests run to determine your thyroid status. You absolutely need to know where your Free T3 sits - as was noted, it's the essential test for the indispensable hormone. It was nice to run those other tests, somebody made some money as a result, but they don't shed any genuine light on the fundamental question of your thyroid function. They were superseded years ago.

The LC, MS/MS (that's the methodology) test estradiol is the only one that is appropriate for men. It's known as the sensitive or ultra-sensitive test in common discussion. It wasn't run (the reference range is a dead giveaway).

 

[Vithat]

Should I go to the same doctor and ask for the test or where can I go to get it done?

If it is low, what is there to be done that can raise it? What are the benefits of doing so?

 

[CoastWatcher]

Should I go to the same doctor and ask for the test or where can I go to get it done?

If it is low, what is there to be done that can raise it? What are the benefits of doing so?

Am I correct in thinking you're younger, in your 20s?

 

[Vithat]

Yes, Im 22

 

[dnfuss]

Yes, Im 22

Your posted labs reflect HgbA1c of 5.5%. That equates to an average blood glucose of approximately 111. That, especially in one so young, is not normal blood sugar. The American Diabetes Association's guidelines (which many feel are across-the-board too high) diagnose pre-diabetes beginning at HgbA1c of 5.7%. Many doctors would say 5.5% is pre-diabetes.

But don't focus too much on HgbA1c. It is a good measure of relative progress (I have it run every time I pull labs), but only that. Far more important are post-meal blood sugars (1 and 2 hours), followed by fasting blood sugars. The goal is to have truly normal blood sugars, the same as healthy non-diabetics have their entire lives, i.e., fasting blood sugar in the mid-80s, 100 or below one hour after a meal and below 90 or even fasting blood sugar by two hours. These are the numbers for healthy non-diabetics with truly normal blood sugars no matter what they eat or how much (or how little) they exercise.

 

[Vithat]

Your posted labs reflect HgbA1c of 5.5%. That equates to an average blood glucose of approximately 111. That, especially in one so young, is not normal blood sugar. The American Diabetes Association's guidelines (which many feel are across-the-board too high) diagnose pre-diabetes beginning at HgbA1c of 5.7%. Many doctors would say 5.5% is pre-diabetes.

But don't focus too much on HgbA1c. It is a good measure of relative progress (I have it run every time I pull labs), but only that. Far more important are post-meal blood sugars (1 and 2 hours), followed by fasting blood sugars. The goal is to have truly normal blood sugars, the same as healthy non-diabetics have their entire lives, i.e., fasting blood sugar in the mid-80s, 100 or below one hour after a meal and below 90 or even fasting blood sugar by two hours. These are the numbers for healthy non-diabetics with truly normal blood sugars no matter what they eat or how much (or how little) they exercise.

Well Im not sure how id measure that or what most of that means. Are you saying theres no way to keep it normal? Additionally, does this mean I would still qualify for Metformin as a medication to treat it?

 

[Vince]

Well Im not sure how id measure that or what most of that means. Are you saying theres no way to keep it normal? Additionally, does this mean I would still qualify for Metformin as a medication to treat it?

It means stop spiking your insulin, go low-carb.

A low-carb diet for beginners

https://www.excelmale.com/forum/showthread.php?14206-A-low-carb-diet-for-beginners[SUB][SUP]
[/SUP][/SUB]​

 

[dnfuss]

Well Im not sure how id measure that or what most of that means. Are you saying theres no way to keep it normal? Additionally, does this mean I would still qualify for Metformin as a medication to treat it?

Sorry for taking so long to reply.

HgbA1c may, or may not, accurately reflect your actual average blood sugar levels (see https://bit.ly/2to6G0t).

The definitive test that doctors use to diagnose pre-diabetes and diabetes is an Oral Glucose Tolerance Test (see https://mayocl.in/2ltKBJl). But you can do your own testing to get a good idea of what your blood sugars actually are. Get a blood sugar meter and some test strips, no prescription required. The Freedom Freestyle and Freedom Freestyle Lite meters and test strips are highly accurate and recommended. There are many others. Test yourself upon arising and one, two and three hours after meals. Here's is some helpful information on that process: https://bit.ly/2Iixe87

If the resulting blood sugars are completely normal, congratulations! If blood sugars fall into the category of pre-diabetes (or diabetes), they need to be brought under control. The causes of pre-diabetes are unclear (although inflammation is often involved), and it is true that the majority of pre-diabetics do not progress to diabetes, about 35-40% will do so. But pre-diabetes is not a benign condition. Pre-diabetics, e.g., experience serious cardiovascular events (stroke and heart attacks) at significantly higher rates than those with truly normal blood sugars.

For solid information about high blood sugars and how to normalize them, I highly recommend the book "Diabetes Solution" by Dr. Richard Bernstein. It explains how everyone, including pre-diabetics and diabetics, can and should have normal blood sugars. The protocol (highly simplified) laid out therein for achieving truly normal blood sugars in a nutshell is as follows (note that each step includes all the previous ones, i.e., if #1 isn’t enough, you add #2, if still not enough you add #3, etc.):

1. First and foremost, a low-carb diet. No one with blood sugar control issues can achieve truly normal blood sugars without it, no matter what medications they're on. Dr. Bernstein's diet calls for less than 30 grams of carbohydrate per day for average-sized adults. I try to adhere to that, but it is pretty tough and may not be necessary for everyone. If your blood sugar control is only marginally compromised, you might first try below 100 grams per day. If that's not enough, try going down to 50 grams per day, then 30.

2. If diet alone is insufficient to achieve normal blood sugars, add exercise, both resistance and cardio.

3. If still insufficient, add oral agents. Metformin first and foremost. If that doesn't work, there are others to try.

4. If still insufficient, add insulin.

Good luck.

 

[Deleted member 16042]

Some of this just echos what's already been said, but:

At least your total and free T numbers look good on paper, and hematocrit isn't high

But: when was the blood drawn relative to your T injection/dosing schedule?

-Your SHBG is 21.2 indicating you need more frequent dosing. 1 time per week is terrible with SHBG that low. If it was me I'd start on every other day and possibly move to daily if that doesn;t do the trick. With that SHBG level, you need to monitor Total and Free T , focusing on Free T at trough (Blood taken in the morning before your next dose.) It's critical for lower SHBG to know what Free T levels are.

-You need to communicate your dosages in mg, mcg and iu, not ML! As already stated testosterone comes in 100mg/ml and 200mg/ml concentrations. HCG can also be mixed at different concentrations.

-what form of T? the most usual in the US is Testosterone cypionate, but in other countries, other esters are more common.

-You don't state a dose for anastrazole either, this is very important. And, I am assuming this was prescribed at the onset of your treatment? You should not be taking it to begin with based on your estradiol number which is just fine and is also most likely a falsely high reading due to it being the wrong test. anastrazole should only be considered after being on TRT and re-assessing E2 level, not from the beginning

-And echo what's been said about thyroid.

Once again, self education time: please refer to Orrin's list here: https://www.excelmale.com/showthread...250#post111250

And refer to Nelson's discounted labs list of tests: My post here: https://www.excelmale.com/showthread...911#post110911

 

[Vithat]

Some of this just echos what's already been said, but:

At least your total and free T numbers look good on paper, and hematocrit isn't high

But: when was the blood drawn relative to your T injection/dosing schedule?

-Your SHBG is 21.2 indicating you need more frequent dosing. 1 time per week is terrible with SHBG that low. If it was me I'd start on every other day and possibly move to daily if that doesn;t do the trick. With that SHBG level, you need to monitor Total and Free T , focusing on Free T at trough (Blood taken in the morning before your next dose.) It's critical for lower SHBG to know what Free T levels are.

-You need to communicate your dosages in mg, mcg and iu, not ML! As already stated testosterone comes in 100mg/ml and 200mg/ml concentrations. HCG can also be mixed at different concentrations.

-what form of T? the most usual in the US is Testosterone cypionate, but in other countries, other esters are more common.

-You don't state a dose for anastrazole either, this is very important. And, I am assuming this was prescribed at the onset of your treatment? You should not be taking it to begin with based on your estradiol number which is just fine and is also most likely a falsely high reading due to it being the wrong test. anastrazole should only be considered after being on TRT and re-assessing E2 level, not from the beginning

-And echo what's been said about thyroid.

Once again, self education time: please refer to Orrin's list here: https://www.excelmale.com/showthread...250#post111250

And refer to Nelson's discounted labs list of tests: My post here: https://www.excelmale.com/showthread...911#post110911

This blood was drawn at the end of May as I said.

As I am just learning on how to inject, I dont know how particularly smart that would be atm. I do not know how to divide up the dose and whatnot for one. And my inexperience injecting might lead to an increased chance of infection or waste.

Ill have to get back to you on the measurements specifics. I do know its Cypionate and at 200mg/ml concentration.

This is just a lot information right now. Im trying not to feel overwhelmed.

 

[Vithat]

Sorry for taking so long to reply.

HgbA1c may, or may not, accurately reflect your actual average blood sugar levels (see https://bit.ly/2to6G0t).

The definitive test that doctors use to diagnose pre-diabetes and diabetes is an Oral Glucose Tolerance Test (see https://mayocl.in/2ltKBJl). But you can do your own testing to get a good idea of what your blood sugars actually are. Get a blood sugar meter and some test strips, no prescription required. The Freedom Freestyle and Freedom Freestyle Lite meters and test strips are highly accurate and recommended. There are many others. Test yourself upon arising and one, two and three hours after meals. Here's is some helpful information on that process: https://bit.ly/2Iixe87

If the resulting blood sugars are completely normal, congratulations! If blood sugars fall into the category of pre-diabetes (or diabetes), they need to be brought under control. The causes of pre-diabetes are unclear (although inflammation is often involved), and it is true that the majority of pre-diabetics do not progress to diabetes, about 35-40% will do so. But pre-diabetes is not a benign condition. Pre-diabetics, e.g., experience serious cardiovascular events (stroke and heart attacks) at significantly higher rates than those with truly normal blood sugars.

For solid information about high blood sugars and how to normalize them, I highly recommend the book "Diabetes Solution" by Dr. Richard Bernstein. It explains how everyone, including pre-diabetics and diabetics, can and should have normal blood sugars. The protocol (highly simplified) laid out therein for achieving truly normal blood sugars in a nutshell is as follows (note that each step includes all the previous ones, i.e., if #1 isn't enough, you add #2, if still not enough you add #3, etc.):

1. First and foremost, a low-carb diet. No one with blood sugar control issues can achieve truly normal blood sugars without it, no matter what medications they're on. Dr. Bernstein's diet calls for less than 30 grams of carbohydrate per day for average-sized adults. I try to adhere to that, but it is pretty tough and may not be necessary for everyone. If your blood sugar control is only marginally compromised, you might first try below 100 grams per day. If that's not enough, try going down to 50 grams per day, then 30.

2. If diet alone is insufficient to achieve normal blood sugars, add exercise, both resistance and cardio.

3. If still insufficient, add oral agents. Metformin first and foremost. If that doesn't work, there are others to try.

4. If still insufficient, add insulin.

Good luck.

So the best thing to do is add keto dieting? Again, this is simply a lot to digest. I have contemplated doing a keto and military hybrid diet. Accompanied by intermittent fasting.

 

[Vithat]

Some of this just echos what's already been said, but:

At least your total and free T numbers look good on paper, and hematocrit isn't high

But: when was the blood drawn relative to your T injection/dosing schedule?

-Your SHBG is 21.2 indicating you need more frequent dosing. 1 time per week is terrible with SHBG that low. If it was me I'd start on every other day and possibly move to daily if that doesn;t do the trick. With that SHBG level, you need to monitor Total and Free T , focusing on Free T at trough (Blood taken in the morning before your next dose.) It's critical for lower SHBG to know what Free T levels are.

-You need to communicate your dosages in mg, mcg and iu, not ML! As already stated testosterone comes in 100mg/ml and 200mg/ml concentrations. HCG can also be mixed at different concentrations.

-what form of T? the most usual in the US is Testosterone cypionate, but in other countries, other esters are more common.

-You don't state a dose for anastrazole either, this is very important. And, I am assuming this was prescribed at the onset of your treatment? You should not be taking it to begin with based on your estradiol number which is just fine and is also most likely a falsely high reading due to it being the wrong test. anastrazole should only be considered after being on TRT and re-assessing E2 level, not from the beginning

-And echo what's been said about thyroid.

Once again, self education time: please refer to Orrin's list here: https://www.excelmale.com/showthread...250#post111250

And refer to Nelson's discounted labs list of tests: My post here: https://www.excelmale.com/showthread...911#post110911

I have the exact numbers now. Anastrozole is 1mg tablet once a week. It was prescribed at the beginning of my treatment when I was taking Clomid.

Not very good at math. So the answer the internet gave me concerning my injection of 1ML of test cypionate every week is 1000 mg it told me.

Im trying to find an endocrinologist that works better for me (dont like the one im currently with) so I can get the test done about thyorid and pre-diabetes.