Started TRT .... Looking forward (updated w 8/20/18 Labs)

[AntCon]

Hey all , Just wanted to say what's up and that I've finally took the dive and began the TRT journey. ( I started Monday the 11th actually , sorry I'm a little late on the thread)


I'll give some background first. Or you can just scroll past the background, straight to the protocol if you'd like ;].


Well I'm 29 and about to be 30 this year. Almost 3 years ago I began experiencing some really weird and unexplainable health issues. I began feeling very tired and out of it, started getting anxiety (which I've never had before), developed depersonalization and derealization, extreme fatigue, brain fog , lack of motivation, and really low libido. This all caused depression and increased anxiety which in turn basically made every symptom even worse, creating a vicious cycle.


After hardly any help from my PCP and every test and lab work coming back fine, I thought maybe I needed to try the natural way and see a naturopath.. I started seeing a naturopath , who did a bunch of lab work and noticed my testosterone was very low at 281 ng/dL. He said it was the lowest he'd seen personally in a guy my age. He immediately wanted to treat me with some hormones but I'm a research first kind of guy. And thankfully my research led me to here.


After joining here and listening to recommendations from members and mods, I began with Dr. Saya at Defy. We got me on a clomid protocol , along with some DHEA and NatureThroid. My T numbers did go up, but unfortunately I wasn't getting any symptom reduction. I eventually tapered off the clomid and the rest of my meds and then just sat for a few months , medication free, to see how my body would act. And weirdly, I felt the exact same and maybe even a tiny bit better after stopping everything.


About a couple months ago I finally got fed up with all my symptoms , again , and just said eff it , I'm going to get in touch with Defy. I called, order labs and set up an appt. I did my labs in the afternoon as this is when I usually feel worse and TT came back @ 152 , Range 250-1100 and FT came back @ 29.4 , Range 35.0-155.0 pg/mL. After discussing everything with Dr. Saya, we decided to go the TRT route. I know , finally right!! Well , I have my fingers crossed and pray everything goes well.




My protocol:

• 60mg Test Cyp every 3.5 days
• HCG 500iu every 3.5 days
• 0.25 mg Anastrozole every 3.5 days

Taking meds Monday mornings and Thursday nights.


Just an FYI:


SHBG was tested last year and came back @ 13 , Range 10-50 nmol/L

E2 came back @ 24 , Range <or=29 pg/mL

Also I keep my PCP in the loop on things and he had me do another set of testosterone labs 2 weeks ago but in the AM. Those numbers were:


8:30 AM
TT = 398 , Range 250-1100 ng/dL
FT = 97 , Range 35-155 pg/mL




So far , Week 1:


Right after first injection I started feeling some anxiety and just a little off the rest of the day, which I kinda expected is normal being it was my first time self injecting anything into my body.


I haven't noticed anything different as far as reduction in symptoms. I do however feel a little more tired this week and feel like today I've been a little more impatient / short tempered than in the recent weeks prior.. Could just be me overthinking about it though. Idk.


Other than that I can't wait for what the upcoming weeks have in store. I will update weekly and look forward to all of your guys feedback.

 

[FeelingLost]

Man with a FT = 97 , Range 35-155 pg/mL
I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.

 

[AntCon]

Man with a FT = 97 , Range 35-155 pg/mL
I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.

Hey , yea I'm pretty new to all this so still learning a lot ... When I did the afternoon labs though (basically when I start to feeling my worse) my FT was at 29 which is below the range. From your knowledge do you think this is way too far of a drop?

 

[equel]

Man with a FT = 97 , Range 35-155 pg/mL
I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.

Lol no this is false.

 

[FeelingLost]

Lol no this is false.

How about elaborating equel. Which part of my statement is false? Does the body use or need all the T that is boundup?

 

[FeelingLost]

Hey , yea I'm pretty new to all this so still learning a lot ... When I did the afternoon labs though (basically when I start to feeling my worse) my FT was at 29 which is below the range. From your knowledge do you think this is way too far of a drop?

I'm no doctor I can't say. Naddy T does move around a lot during the day. Did you workout have sex a bad nights sleep it all effects your natural T lvl.

 

[AntCon]

I'm no doctor I can't say. Naddy T does move around a lot during the day. Did you workout have sex a bad nights sleep it all effects your natural T lvl.

Yea , no none of that. It was just a normal day for me, where I begin feeling drained in the afternoon so I decided to see what my labs looked like then.

 

[FOX1]

It must have been a very difficult decision for you at 29 years old, very young to be on TRT, I hope your doctors gave you sound advice

 

[Vitamin_C]

Man with a FT = 97 , Range 35-155 pg/mL
I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.

Both TT and FT are important, you could argue FT is perhaps "more" important, but TT is not a useless measurement by any means.

 

[madman]

Yea , no none of that. It was just a normal day for me, where I begin feeling drained in the afternoon so I decided to see what my labs looked like then.

As you may know a healthy young males endogenous testosterone level peaks in the early am and than gradually declines in the late afternoon/early evening due to the 24hr circadian rhythm.

Labs for testosterone should be done fasted and in the early morning between (7-10am) as you want to test during the peak.

Levels will fluctuate throughout the day and testosterone levels can be up to 25-30% lower in the afternoon.

Your other labs were done at the wrong time and any doctor should know that blood work for testosterone is done in the early am.

Sure you may have wanted to look at your levels later in the day but it has no bearing to your peak levels.

 

[Deleted member 16042]

As you may know a healthy young males endogenous testosterone level peaks in the early am and than gradually declines in the late afternoon/early evening due to the 24hr circadian rhythm.

Labs for testosterone should be done fasted and in the early morning between (7-10am) as you want to test during the peak.

Levels will fluctuate throughout the day and testosterone levels can be up to 25-30% lower in the afternoon.

Your other labs were done at the wrong time and any doctor should know that blood work for testosterone is done in the early am.

Sure you may have wanted to look at your levels later in the day but it has no bearing to your peak levels.

Tangent,

I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.

 

[FeelingLost]

Both TT and FT are important, you could argue FT is perhaps "more" important, but TT is not a useless measurement by any means.

Thanks Vitamin C, I could have worded my post better.

 

[FeelingLost]

Tangent,

I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.

Here's a conspiracy theory for you BlackHawk.

I think the whole trough thing was started so guys could get away with taking more.
I recently did a peak T blood test since Nelson has the TT/FT test on sale for 30 bucks.

I believe when you have HCT issues FT peak plays a big roll. You can't let your FT peak go above range.

I have my E2 under control and that is the only reason I can think of for TT/FT trough numbers since E follows T.
So your T trough is you E2 peak.

I plan to ask Defy if I can do peak TT/FT on future blood test the trough has no value to me.

 

[AntCon]

It must have been a very difficult decision for you at 29 years old, very young to be on TRT, I hope your doctors gave you sound advice

I know :/ .... It took me a while to finally make the decision to start. It was a hard but I've tried many different things to get my health in order with no luck. And Yea, I am very confident in my doctor and his advice.

As you may know a healthy young males endogenous testosterone level peaks in the early am and than gradually declines in the late afternoon/early evening due to the 24hr circadian rhythm.

Labs for testosterone should be done fasted and in the early morning between (7-10am) as you want to test during the peak.

Levels will fluctuate throughout the day and testosterone levels can be up to 25-30% lower in the afternoon.

Your other labs were done at the wrong time and any doctor should know that blood work for testosterone is done in the early am.

Sure you may have wanted to look at your levels later in the day but it has no bearing to your peak levels.

First, thanks for the reply. .Yes, my doctor understood that they weren't done in the AM. We've already done labs in the past at early AM fasting times , so he has those too. Plus he said that even if you take in the fact that my testosterone was higher in the AM that lab day, it still would be considerably low (for a guy my age) with the added percentage

 

[Systemlord]

Low SHBG men usually need to inject more frequently, preferably EOD or for some everyday. I realize everyone is different and this is only a starting point, however is symptoms don't improve you may need to inject more frequency. I only respond well to TRT when injecting EOD even with higher SHBG levels (16-18), twice weekly my results are underwhelming.

 

[madman]

Tangent,

I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.

Endogenous testosterone production: diurnal rhythm (24hr)-episodic fluctuation in circulating testosterone levels over shorter periods (minutes to hours) carried along by pulsatile lh secretion.

Diurnal patterns of morning peak testosterone levels and nadir levels in the mid afternoon are evident in YOUNGER and healthy OLDER men hence it is conventional practice to STANDARDIZE testosterone measurements to morning blood samples on at least 2 different days.

Regarding exogenous t patches and trandermal (gel/cream) would be a close as one could get to mimicking the natural diurnal rhythm as oppose to injectables which in no way mimic the natural diurnal rhythm even when injecting daily.

When one uses transdermal and reaches steady state blood work for testosterone levels is done within 2hrs after application (peak).


Exogenous testosterone: steady state (depot testosterone injections maintain steady state delivery pattern depending on dose/injection frequency/ester used/ones shbg levels)

Regarding peak/trough ones dose, injection frequency, ester used and of course ones shbg levels are all contributing factors.

When one is injecting once weekly (higher doses) there is a big difference between peak/trough and stability of testosterone levels as oppose to injecting more frequently using lower doses.

Injecting every 3.5 days or M/W/F would result in a lesser peak/trough and more stable blood levels and when injecting EOD or daily peaks/troughs would be greatly minimized and steadier blood levels would be achieve.

Are we comparing natural endogenous testosterone (24hr diurnal rhythm) to exogenous testosterone injections resulting in steady state as in levels elevated over a period of days?

 

[Deleted member 16042]

Endogenous testosterone production: diurnal rhythm (24hr)-episodic fluctuation in circulating testosterone levels over shorter periods (minutes to hours) carried along by pulsatile lh secretion.

Diurnal patterns of morning peak testosterone levels and nadir levels in the mid afternoon are evident in YOUNGER and healthy OLDER men hence it is conventional practice to STANDARDIZE testosterone measurements to morning blood samples on at least 2 different days.

Regarding exogenous t patches and trandermal (gel/cream) would be a close as one could get to mimicking the natural diurnal rhythm as oppose to injectables which in no way mimic the natural diurnal rhythm even when injecting daily.

When one uses transdermal and reaches steady state blood work for testosterone levels is done within 2hrs after application (peak).


Exogenous testosterone: steady state (depot testosterone injections maintain steady state delivery pattern depending on dose/injection frequency/ester used/ones shbg levels)

Regarding peak/trough ones dose, injection frequency, ester used and of course ones shbg levels are all contributing factors.

When one is injecting once weekly (higher doses) there is a big difference between peak/trough and stability of testosterone levels as oppose to injecting more frequently using lower doses.

Injecting every 3.5 days or M/W/F would result in a lesser peak/trough and more stable blood levels and when injecting EOD or daily peaks/troughs would be greatly minimized and steadier blood levels would be achieve.

Are we comparing natural endogenous testosterone (24hr diurnal rhythm) to exogenous testosterone injections resulting in steady state as in levels elevated over a period of days?

Yes, that is the point, to compare endogenous with exogenous in relationship to timing of lab draws.

Yes of course, peak/trough fluctuations on exogenous do not mimic the diurnal timing.

So what can we gain from studying the peak-trough aspect of differing injection frequency for exogenous use, and of what value is knowing peak measurement as well as trough? It seems very pertinent to me but I have seen no such studied information presented.

 

[madman]

Tangent,

I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.

When screening for hypogonadism testing fasted in the early am during peak helps give a more accurate picture of ones levels especially in younger men.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681273/

 

[madman]

Another reason why testing in the am in a fasted state may help when screening for low t.

https://serval.unil.ch/resource/serval:BIB_1A470ECD303D.P001/REF

 

[FeelingLost]

Madman, I always look forward to your posts. Rarely do I not learn something.
Thank you for being a part of this community. Your detailed posts to help others does not go unappreciated.

Endogenous testosterone production: diurnal rhythm (24hr)-episodic fluctuation in circulating testosterone levels over shorter periods (minutes to hours) carried along by pulsatile lh secretion.

Diurnal patterns of morning peak testosterone levels and nadir levels in the mid afternoon are evident in YOUNGER and healthy OLDER men hence it is conventional practice to STANDARDIZE testosterone measurements to morning blood samples on at least 2 different days.

Regarding exogenous t patches and trandermal (gel/cream) would be a close as one could get to mimicking the natural diurnal rhythm as oppose to injectables which in no way mimic the natural diurnal rhythm even when injecting daily.

When one uses transdermal and reaches steady state blood work for testosterone levels is done within 2hrs after application (peak).


Exogenous testosterone: steady state (depot testosterone injections maintain steady state delivery pattern depending on dose/injection frequency/ester used/ones shbg levels)

Regarding peak/trough ones dose, injection frequency, ester used and of course ones shbg levels are all contributing factors.

When one is injecting once weekly (higher doses) there is a big difference between peak/trough and stability of testosterone levels as oppose to injecting more frequently using lower doses.

Injecting every 3.5 days or M/W/F would result in a lesser peak/trough and more stable blood levels and when injecting EOD or daily peaks/troughs would be greatly minimized and steadier blood levels would be achieve.

Are we comparing natural endogenous testosterone (24hr diurnal rhythm) to exogenous testosterone injections resulting in steady state as in levels elevated over a period of days?