Saying hi from NY. Time for some changes.

[Louis]

What's up gents! A big thank you to the Excelmale community and the work you guys do here. The quality of your content and knowledgeable members is why I joined. Excelmale has been a fixture in my TRT journey thus far and I figured it's about time to sign up and make myself known, get some advice on my own health, and maybe be able to contribute moving forward.

A bit about me (sorry if TLDF but I like to be thorough).

I'm 43 years old, 5'9 170lbs. and have been on TRT for almost 2 years. I'm a casual swimmer but I haven't exercised in about 6 months in an attempt not to stress my body while I get a handle on these hormones. I've suffered from *migraines since my late 20's and only recently seem to have a handle on it. More on that later. I eat clean (I make everything fresh with organic ingredients, no sugars, nothing processed, I don't drink or smoke, not even a caffeine habit (which I quit about 8 months ago). I drink nothing but water and I drink lots of it. I lead a relatively stress free life which I'll attribute to a cushy job as so much stress comes from the work place. I sleep 6-7 hours a night and still wake up a bit lethargic, though once I'm in the shower (post hcg injection) I'm usually wide awake within 15 minutes so I don't think its anything really abnormal. I have an occasional bout with insomnia, but that is very infrequent.

The issues I would like to address begin with poor penis sensitivity and poor libido. I can perform, but it is never a strong erection and take forever to ejaculate. About twice a week I wake up with an erection which again, is not very strong, but it's there. Occasionally I lose my erection just switching positions and can't get it back. In addition to the sexual issues, my joints occasionally ache, and any everything from my toes to my neck cracks easily. I can tell immediately when I'm going to get a migraine because I can feel the inflammation in my neck, it starts to crack, followed by stiff neck and congestion, to blurred vision progressing to migraine. Superficial things I've noticed are extremely dry skin, blurry vision, and terrible cystic acne on my back and shoulders.

Onto TRT.

I have been on the same protocol for about a year and a half which is 3 pumps of Androgel 1.62 and 100iu of HCG every morning. Additionally, I supplement with the following supplements, which I split into a morning and dinner doses:

1000mg Source Naturals Magnesium Malate
1280mg Nordic Naturals Ultimate Omega3
800mg Primal Defense Ultra Probiotic
200mg Jarrow Ubiquinol
2000mg Jarrow L-Glutamine
2000mg Jarrow Taurine
2000mg Jarrow Arginine
10000iu Jarrow D3
20mg Jarrow DHEA

My numbers have barely moved and I always schedule bloodwork for12:30-1pm which is 5 hours after injection/application. I don't know if this is the best time or not, but it's what I read Dr. Crisler wanted a while back and that's just what I stuck with.

My latest labs from Labcorp are as follows:
*The lab forgot to run prolactin (never had it done before) and apparently ran the wrong progesterone test.

Testosterone / Estrogens
Testosterone, Total, LC/MS 620.4 ng/dL 264.0 - 916.0
Free Testosterone(Direct) 9.8 pg/mL 6.8 - 21.5
DHEA-Sulfate, LCMS 350 ug/dL 16 – 390
Dihydrotestosterone 115 ng/dL 30 - 85
DHT, Percent Free Dialysis 1.30 %0.54 - 2.58
DHT, Free 14.95 pg/mL 2.30 - 11.60
Progesterone, Serum <10 ng/dL <10-11
Estradiol, Sensitive 15.9 pg/mL 8.0 - 35.0
Estrogens, Total 74 pg/mL 40 - 115
Sex Horm Binding Glob, Serum 66.4 nmol/L 16.5 - 55.9

Thyroid
TSH 2.070 uIU/mL 0.450 - 4.500
T4,Free(Direct) 1.34 ng/dL 0.82 - 1.77
Triiodothyronine,Free,Serum 3.1 pg/mL 2.0 - 4.4

Prostate
Prostate Specific Ag, Serum 0.2 0.0-4.0 ng/mL

CBC With Differential/Platelet
WBC 4.0 x10E3/uL 3.4 - 10.8
RBC 5.84 High x10E6/uL 4.14 - 5.80
Hemoglobin 16.1 g/dL 13.0 - 17.7
Hematocrit 48.4 % 37.5 - 51.0
MCV 83 fL 79 - 97
MCH 27.6 pg 26.6 - 33.0
MCHC 33.3 g/dL 31.5 - 35.7
RDW 14.2 % 12.3 - 15.4 01
Platelets 222 x10E3/uL 150 - 379
Neutrophils 51 % Not Estab.
Lymphs 39 % Not Estab.
Monocytes 4 % Not Estab.
Eos 5 % Not Estab.
Basos 1 % Not Estab.
Neutrophils (Absolute) 2.0 x10E3/uL 1.4 - 7.0
Lymphs (Absolute) 1.6 x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.2 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.2 x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 % Not Estab
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1

Comp. Metabolic Panel
Glucose, Serum 95 mg/dL 65 - 99
Bun 18 mg/dL 6 &#8211; 24
Creatinine, Serum 1.17 mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 76 mL/min/1.73 >59
eGFR If Africn Am 88 mL/min/1.73 >59
BUN/Creatinine Ratio 15 9 - 20
Sodium, Serum 141 mmol/L 134 - 144
Potassium, Serum 4.5 mmol/L 3.5 - 5.2
Chloride, Serum 98 mmol/L 96 - 106
Carbon Dioxide, Total 26 mmol/L 18 - 29
Calcium, Serum 10.1 mg/dL 8.7 - 10.2
Protein, Total, Serum 7.4 g/dL 6.0 - 8.5
Albumin, Serum 5.0 g/dL 3.5 - 5.5
Globulin, Total 2.4 g/dL 1.5 - 4.5
A/G Ratio 2.1 1.2 - 2.2
Bilirubin, Total 0.7 mg/dL 0.0 - 1.2
Alkaline Phosphatase, S 77 IU/L 39 - 117
AST (SGOT) 18 IU/L 0 - 40
ALT (SGPT) 16 IU/L 0 &#8211; 44

Lipid Panel
Cholesterol, Total 295 High mg/dL 100 - 199
Triglycerides 81 mg/dL 0 - 149
HDL Cholesterol 50 mg/dL >39
VLDL Cholesterol Cal 16 mg/dL 5 - 40
LDL Cholesterol Calc 229 High mg/dL 0 &#8211; 99

Hepatic Function Panel
Bilirubin, Direct 0.15 mg/dL 0.00 - 0.40

Vitamin D, 25-Hydroxy 85.1 ng/mL 30.0 - 100.0

 

[Nashtide]

Wow, you've got some serious issues. Your FT sucks because your SHBG is high. Your low E2 is driving many of your symptoms. You need to get on injections of T cyp pronto. You may actually need daily injections. Also need hcg. You need to increase your TT and FT as well as your E2 before you will begin to feel better.

 

[Louis]

My E2 is low, Free T is low, SHBG is high, DHT is high, LDL is terrible, and RBC is up. At face value, I think I should address the low E2. My DHT is already high, so I don't think taking more Androgel is really an option. I could increase my HCG from 100iu to150iu daily and hope for some testicular aromatization, but is that really going to bring up my E2 enough? Maybe 500iu e3.5d?

Alternatively, my primary is not opposed to me going on Cypionate. Maybe the larger dose could bring up my T, increase aromatase activity and bring up my E2 while possibly raising free T by hopefully being a large enough dose to compensate for SHBG of 66? I am curious though, if I switch to injections would I lose any sexual benefit of the elevated DHT? I suppose I could add more DHEA later in hopes of raising DHT. So much to consider which is why I have just dealt with it.

This is quite a bit of information and may seem like I"m complaining. I certainly do not want that to be the undertone of this thread. I feel really good compared to where I was. I don't feel crappy all the time. The sexual issues and superficial things I've mentioned are persistent, but I generally feel pretty good. Having the migraines under control, I really do feel pretty good. It's just the sexual and joint issues that bother me regularly.

Not related to TRT, but to complete the migraine picture, I have been on a restricted diet for the last 2 months. I read a post by Nelson a while back regarding food sensitivities and his experience with ALCAT testing. As I looked further into it, I chose to pursue a similar avenue. Ultimately I chose the Mediator Release Testing from Oxford Biomedical. The results indicated that roughly 85% of what I was consuming regularly was something I was moderately or highly reactive to. I have since cut out basically everything and am only eating rice, fats, chicken, pork, and veggies but I am still hitting my 40/30/30 carb/protein/fat macros I always have, but I am just doing it 'intermittent fasting' style by skipping breakfast and eating my first meal at 11am. I am skipping breakfast because I am sensitive to eggs, oats, and wheat (what I basically lived on). This is the second journey I am on but cutting out everything I am sensitive to has cut down drastically on my inflammation and migraines. What I found very interesting is that although my diet has changed, my lab work has remained consistent.

I'm working with a Naturopath on this next journey. Somehow, I think there may be a correlation. I guess only time will tell.

Thanks for reading.

 

[Louis]

Wow, you've got some serious issues. Your FT sucks because your SHBG is high. Your low E2 is driving many of your symptoms. You need to get on injections of T cyp pronto. You may actually need daily injections. Also need hcg. You need to increase your TT and FT as well as your E2 before you will begin to feel better.

Thanks for the reply. I was typing up my follow up as you posted.

I agree, my FT is low, SHBG is high, and E2 is probably my biggest concern. I am currently on HCG and am also considering Cypionate but I don't think daily is the answer. I could be wrong, but it's my understanding that the more frequent doses is to lower or keep E2 in check. I think I should be hoping for the opposite effect.

 

[Nashtide]

Thanks for the reply. I was typing up my follow up as you posted.

I agree, my FT is low, SHBG is high, and E2 is probably my biggest concern. I am currently on HCG and am also considering Cypionate but I don't think daily is the answer. I could be wrong, but it's my understanding that the more frequent doses is to lower or keep E2 in check. I think I should be hoping for the opposite effect.

Folks with your SHBG need a lot more T, so T cyp is the way to go.

 

[blackebob]

When I was on two pumps of the gel my world was upright and tight. I was 30 years old again. I then had a jackass of a new doctor who was going to fix me and started me on clomiphene. My world has not been the same since. Be careful with any drastic changes.

First thing draw your blood in the morning before you put on your gel. Your T is in the middle, but you just applied the gel. There are alot of smart people on here, I am not one of them. If your SHBG is high, from what I know, it is stealing your Testosterone, binding to it, so there is not much free T. Someone else can explain that bettor.

What I will tell you in my opinion is one of the biggest mistakes I have made since my clomid nightmare. I refused to take a script for viagra or cialis because I was still in my 40's. I do not need that, I am not an old man, especially after being a rock star on two pumps of gel. You know what though, I made my sex life even worse because no matter how bad the situation was I was going to perform. Period. Luckily I have an awesome wife who tolerated me. At the first of the year I gave in, and took a script for Viagra. Up to that point while switching to cream I had great sex days, and not so great sex. Confidence played a big part for me, I mean if I told myself it would get soft if we changed spots, it would.
The doc wrote my script for 24 pills to be taken 3 at a time, over 1 month. I took one 20mg pill, and pride be damned I had the best sex I have had since I started the clomid. I burned thru that script a pill a day, everyday. I havent looked back. Its late, and I just spent 40 minutes trying to type this out so take it for what you want.

 

[Louis]

When I was on two pumps of the gel my world was upright and tight. I was 30 years old again. I then had a jackass of a new doctor who was going to fix me and started me on clomiphene. My world has not been the same since. Be careful with any drastic changes.

First thing draw your blood in the morning before you put on your gel. Your T is in the middle, but you just applied the gel. There are alot of smart people on here, I am not one of them. If your SHBG is high, from what I know, it is stealing your Testosterone, binding to it, so there is not much free T. Someone else can explain that bettor.

What I will tell you in my opinion is one of the biggest mistakes I have made since my clomid nightmare. I refused to take a script for viagra or cialis because I was still in my 40's. I do not need that, I am not an old man, especially after being a rock star on two pumps of gel. You know what though, I made my sex life even worse because no matter how bad the situation was I was going to perform. Period. Luckily I have an awesome wife who tolerated me. At the first of the year I gave in, and took a script for Viagra. Up to that point while switching to cream I had great sex days, and not so great sex. Confidence played a big part for me, I mean if I told myself it would get soft if we changed spots, it would.
The doc wrote my script for 24 pills to be taken 3 at a time, over 1 month. I took one 20mg pill, and pride be damned I had the best sex I have had since I started the clomid. I burned thru that script a pill a day, everyday. I havent looked back. Its late, and I just spent 40 minutes trying to type this out so take it for what you want.

Thanks for sharing your experience blackebob. I agree with you, there are some very educated resources and that's why I'm here. I have contemplated a PDE5 inhibitor, but I'm just not there yet. Besides, I am functional, just operating at say 70% in that department. Improving any glaring deficiencies (like my low FT and E2) without introducing unnecessary variables is the objective. If symptoms persist, then I would consider treating those symptoms. I appreciate you input.

 

[blackebob]

Thanks for sharing your experience blackebob. I agree with you, there are some very educated resources and that's why I'm here. I have contemplated a PDE5 inhibitor, but I'm just not there yet. Besides, I am functional, just operating at say 70% in that department. Improving any glaring deficiencies (like my low FT and E2) without introducing unnecessary variables is the objective. If symptoms persist, then I would consider treating those symptoms. I appreciate you input.

When my T is dialed in then I am 100% good to go and I'm getting close to getting it dialed in again but like I said I got tired of being 70 80, and I enjoy sex to much. Hell I don't know maybe when I get to one hundred percent I may take Cialis everyday any way, everybody on here says it's supposed to be good for you.

 

[Louis]

That's what I'm hoping I can say as well at some point. One step at a time, but I just need to figure out the next steps.

 

[Louis]

So I just spoke with my doctor who agreed to give me a script for cypionate. He suggested I start with 100mg cypionate and 1000iu of hcg weekly. Dosing will be 50mg cypionate e3.5d and keep my daily hcg injections going but increasing the dose to 150iu (which is technically 1050iu weekly).

Thoughts?

 

[Nashtide]

So I just spoke with my doctor who agreed to give me a script for cypionate. He suggested I start with 100mg cypionate and 1000iu of hcg weekly. Dosing will be 50mg cypionate e3.5d and keep my daily hcg injections going but increasing the dose to 150iu (which is technically 1050iu weekly).

Thoughts?

That's a different protocol for hcg. I've seen discussions about desensitizing the cells in the testes from frequent hcg injections. Not sure if there is any validity, but I'd want to know.

 

[blackebob]

There are lots of members on here who take daily HCG, when I get my next blood test I might switch over to that and try it also. One guy jumps to mind is Gene Devine, Google him and HCG and you'll probably get his daily protocol but I can't remember what it is.

 

[Louis]

That's a different protocol for hcg. I've seen discussions about desensitizing the cells in the testes from frequent hcg injections. Not sure if there is any validity, but I'd want to know.

There are lots of members on here who take daily HCG, when I get my next blood test I might switch over to that and try it also. One guy jumps to mind is Gene Devine, Google him and HCG and you'll probably get his daily protocol but I can't remember what it is.

blackebob nailed it. Btw, Gene previously (don't know if he still does) dosed 125iu daily. People typically do more frequent shots to keep spikes down and control e2. I don't need to accomplish this, but I like the idea of daily shots. First because I don't want to shoot that much hcg at once if I don't have to, and second is because I like the perceived sense of well being shortly after injection. I might have to go to a higher less frequent dose if, for example, my labs come back and e2 hasn't come up enough.

I'm also thinking that if my e2 doesn't come up high enough and my TT isn't too high, I might be able to increase my dose of T to make up for (and stay at 150iu daily) it instead of less frequent higher hcg dose. Just thinking ahead. Won't really know what the next step is until I have my labs in 4-5 weeks.

 

[Louis]

Quick update: I reached out to my doctor's office yesterday to confirm the prescription and he explained that while he is not opposed to my going on Cypionate, he prefers I increase my HCG to 150iu daily (from 100iu) for the next 4-5 weeks and re-test before switching to injections. I can appreciate the logic, change one variable at a time and maybe I'll get lucky and the 150iu works better for me in and of itself. Time will certainly tell.

 

[blackebob]

Good on you Louis, I will be looking forward to an update.