Upcoming Defy appt - feeling tired

[canaleshome]

Been on TRT for 4 yrs now. I'm 37 and just don't feel as energized as I used to. I started 3x/wk injections for total of 200mg/wk. Also take .125mg anastrozole and 400iu HCG twice/wk. I've been on this dose of test for over a year now. Here's the results of my latest labs:
SHBG: 13.9nmol/L
Ttl Test: 754 ng/dL
Free: 27.1 pg.mL
E2: 31.5pg/mL

1 yr ago I was taken off anastrozole (was taken .25 twice/wk) cause E2 was 17. I was taking 140mg twice wkly. My ttl test was 550, free 18.1 and SHBG 18.4.

Then 6 months ago, I started the lower dose of anastrozole because E2 was at 46.1. Here's from 6 months ago: SHBG - 17.1; Test ttl - 806; Free - 25.6.

My questions are: What do you think of my levels? What suggested questions do you think I should ask next week for my follow-up appt at Defy.

 

[HealthMan]

Been on TRT for 4 yrs now. I'm 37 and just don't feel as energized as I used to. I started 3x/wk injections for total of 200mg/wk. Also take .125mg anastrozole and 400iu HCG twice/wk. I've been on this dose of test for over a year now. Here's the results of my latest labs:
SHBG: 13.9nmol/L
Ttl Test: 754 ng/dL
Free: 27.1 pg.mL
E2: 31.5pg/mL

1 yr ago I was taken off anastrozole (was taken .25 twice/wk) cause E2 was 17. I was taking 140mg twice wkly. My ttl test was 550, free 18.1 and SHBG 18.4.

Then 6 months ago, I started the lower dose of anastrozole because E2 was at 46.1. Here's from 6 months ago: SHBG - 17.1; Test ttl - 806; Free - 25.6.

My questions are: What do you think of my levels? What suggested questions do you think I should ask next week for my follow-up appt at Defy.

I am assuming labs were done on trough. Given your low SHBG you are a good candidate for daily or EOD injections. That might help with your E2 as well. Your body eliminates testosterone too quickly and your peak and trough variation might be extreme. Your free testosterone is already at the top of the range (assuming you used labcorp) so your free testosterone is most likely extremely high after injection. More frequent injections can smooth things out and you might end up feeling better

 

[Systemlord]

HealthMan is correct, you eliminate most of your testosterone rather quickly. These smaller more frequent doses may have a smaller impact on your SHBG levels as large doses can have a suppressing effects that would be ideal for men with high SHBG attempting to lower theirs. We are in the same boat, my SHBG is 18 nmol/L and lose my free T fast, I'm finding injecting 50mg every 3.5 days to not be enough as some symptoms still remain.

You can achieve similar numbers and feel better since you will have more free T at any given time during the week injecting smaller doses EOD.

 

[Vince Carter]

Youre protocol is all wrong for your SHBG. HH and Systemlord offer sound advice but basically you probably need to focus on dosing that targets your Free T and not your Total T. The low SHBG guy = very high Free T also = very high Free Estrogen, too. Something that isn't getting talked about enough. But all in all your therapy is about as wrong as wrong can be for your SHBG

 

[canaleshome]

Thanks. Things felt better for a little when I was told to up my test to 200mg/wk. But it just feels like I struggle more to get out of bed in the morning, and I usually wake up early. Just feel like I'm not sleeping as good then don't have the energy thru out the day. I'm basically on EOD injections now, injecting 66mg MWF. I'm going to bring this up to Dr Calkins next week and get a better game plan going. I've been concerned and brought it up last year about my level of SHBG. That's when my protocol changed to try 3x's a week and the NP also suggested that I try daily shots. I just thought that was overwhelming having to inject that often.

 

[Vettester Chris]

Just to present another angle ... I think you are putting all your chips on Testosterone and TRT therapy as the road to complete wellness. Your test serum and free test can be optimized 5x over, but if other imbalances like your thyroid, adrenals, electrolytes/metabolic, etc.., are not in balance, no amount of testosterone is going to make the program optimal. I only say this because your thread is emphasized with "Feeling Tired", and the questions posed to the community are only focused on test, free test/SHBG, and E2.

To comment on the labs, I agree with the others, and you might find a more sustained wellness with aiming to get that Free Test down a bit (?). Not saying you will or that you need to do that, just saying in my own case, I find 15-20 to actually do quite well for the day-to-day routine of HRT. My sleep is better (that's essential), my E2 for the most part is usually stable; balanced and manageable without any AI, and obviously I feel good. However, I don't see too much benefit from any TRT protocol without a thyroid protocol, rest, donating blood and keeping my iron, HCG, ferritin in-line (carrier for hemochromatosis, so that's another story).

You're paying attention to your protocol and program, which is great, just consider giving it more of a "macro" focus when trying to achieve optimal wellness.

 

[FeelingLost]

I would also look else where for your tiredness. You've hit all the good TRT numbers and went beyond.
Might be time to dial them back a little an maybe do a complete thyroid panel. The 4 swap cortisol test might be worth checking.

What does your diet look like?
Do you work out? How about rest days?
What is your sleep like?

Are you taking other drugs for depression or anxiety like an SSRI?

I hope these gives you stuff to talk about with Defy.

 

[Systemlord]

As I understand it injecting EOD means Monday, Wednesday, Friday, Sunday, Tuesday, Thursday, Saturday, Monday.

Monday, Wednesday, Friday skipping Saturday and Sunday breaks an EOD protocol.

The entire point of EOD is smaller injections, by skipping a day over the weekend you miss out on breaking up your shots into smaller doses creating a smoother levels.

 

[blackebob]

I would also look else where for your tiredness. You've hit all the good TRT numbers and went beyond.
Might be time to dial them back a little an maybe do a complete thyroid panel. The 4 swap cortisol test might be worth checking.

What does your diet look like?
Do you work out? How about rest days?
What is your sleep like?

Are you taking other drugs for depression or anxiety like an SSRI?

I hope these gives you stuff to talk about with Defy.

Yes, what do you do to wake things up?

 

[FeelingLost]

Yes, what do you do to wake things up?

I had to do all the above and I am still working on it. TRT was my first step and it did give me the strength to start fighting again. Something I had lost.

 

[canaleshome]

Just to present another angle ... I think you are putting all your chips on Testosterone and TRT therapy as the road to complete wellness. Your test serum and free test can be optimized 5x over, but if other imbalances like your thyroid, adrenals, electrolytes/metabolic, etc.., are not in balance, no amount of testosterone is going to make the program optimal. I only say this because your thread is emphasized with "Feeling Tired", and the questions posed to the community are only focused on test, free test/SHBG, and E2.

To comment on the labs, I agree with the others, and you might find a more sustained wellness with aiming to get that Free Test down a bit (?). Not saying you will or that you need to do that, just saying in my own case, I find 15-20 to actually do quite well for the day-to-day routine of HRT. My sleep is better (that's essential), my E2 for the most part is usually stable; balanced and manageable without any AI, and obviously I feel good. However, I don't see too much benefit from any TRT protocol without a thyroid protocol, rest, donating blood and keeping my iron, HCG, ferritin in-line (carrier for hemochromatosis, so that's another story).

You're paying attention to your protocol and program, which is great, just consider giving it more of a "macro" focus when trying to achieve optimal wellness.

Yes, these are from Labcorp. I'm not sure which labs are for Thyroid, but my DHEA-Sulfate is normal (246ug/dL); TSH normal (1.29); Ferritin normal (51). 6 months ago my Ferritin was low at 16 and was advised to start taking iron and vit c twice wkly. Everything else is normal. I'm just getting concerned about my levels of SHBG always being low or near low and free being high and wondering if this feeling of not wanting to wake up and get up are connected.

 

[canaleshome]

I would also look else where for your tiredness. You've hit all the good TRT numbers and went beyond.
Might be time to dial them back a little an maybe do a complete thyroid panel. The 4 swap cortisol test might be worth checking.

What does your diet look like?
Do you work out? How about rest days?
What is your sleep like?

Are you taking other drugs for depression or anxiety like an SSRI?

I hope these gives you stuff to talk about with Defy.

Diet is fairly good. I aim for around 2200 cal; 40% carb, 35% protein, 25% fat. This varies some, but not much. I'm 6'2" and 205lbs. I used to be pretty lanky, but have watched what I eat while working out. Lift at gym 4-5 times a wk. I'm in bed by 10pm latest and alarm goes off at 5:30am. I struggle and eventually get up by 6:15am. I used to get up at 5-530 with no problem. No drugs for depression or anxiety.
Thanks for the input!

 

[1Draw]

I would definitely ask for a full thyroid panel as Chris suggested. Just because your TSH of 1.29 is in the labs range does not mean there is something else going on with you thyroid since you are feeling tired and have problems waking up.

I believe a full thyroid panel should be included with any pre-TRT blood testing. They are both very connected. Here is good article explaining how they are related be Dr Westin Childs. He states "The two conditions tend to accompany each other".

Also, he cites an optimal TSH of .5 to 1.0 so, there is something going on with your thryoid that needs further investigation.

https://www.restartmed.com/normal-thyroid-levels/

https://www.restartmed.com/thyroid-symptoms-men/

 

[looyvillelarry]

If you have time, you might want to get that full thyroid panel before the consult.. beats a followup $

 

[canaleshome]

If you have time, you might want to get that full thyroid panel before the consult.. beats a followup $

Thanks! I'm calling to put it in. You're right, I don't want to have my regular followup, do more bloodwork, then have to pay for another followup. If the results don't come back in time, I'll just need to re-schedule. Thanks all! I'll keep ya posted.

 

[Reason]

Looks like you're not getting enough sleep. But sleep quality (as opposed to quantity) could be a bigger factor. You say you struggle when your alarm goes off. Your usual 7-7.5hrs could be enough, but that's only if they're quality hours.

On weekends (or whenever you can sleep in), how do you feel?

Do you snore? Have been tested for sleep apnea?

What's your body fat %? (can correlate with apnea risk)

Something else to consider is your diet. Your macronutrient breakdown indicate a pretty high carb diet. Some people do better, have more energy, and are sharper mentally on a low carb, or even ketogenic diet. Or sort of a seasonal shift between low-to-high carb. Have you tried something like that?

It's not always hormones.

 

[canaleshome]

I'll try and rule out hormones with lab work just in case. I read that article above and I have several of those symptoms. Just when I look at them independently, I blow it off as a cause of something else. Sore joints must be from the gym; weight gain (fat just around stomach) is from Thanksgiving, then Christmas, then Mardi Gras, then Easter candy and exercise isn't keeping up it all enough; dry skin from the weather...

I've considered more of a low carb diet and may start to incorporate that. I've had low muscle definition most my life and over the past 2 yrs I've made some really good gains. So I try to stick with a good balance of carbs and protein to keep it up. If I had to guess, I'm around 20% bf. The only fat I carry is around my waist. I've researched and read many posts on this site and many others about suggested diets. The meal plan I'm on now is what I used in the past and I don't remember feeling like this.

Weekends I tend to stay up later, but get the same amount of sleep (or less). I'm up and out of bed by 7. I like my job, so it's not like I'm dreading getting up on work days.

Guess my main thought process was if feel like this and my labs show that, are they related and with an upcoming appt, what should I be discussing or trying to change with these results. For now, I'll check my Thyroid and see how that goes.

 

[Reason]

Sounds totally reasonable. I am on TRT because I tried everything else for most of my life and nothing made a big enough difference. I'm also 37 years old.

Keto was magical for me for about 6 months and then things got worse again. I still want to go back on it for a few months of the year. Your mind clears up and you have such a nice steady level of energy throughout the day. These days, I eat very low carb on non gym days and a bit higher on gym days.

Weightlifting made a huge difference in my life but my progress was abysmal after the first 6 months and I was unable to drop below ~17-18% body fat no matter what I tried. Then I started LOSING strength without overtraining and getting decent sleep (rare for me) and I realized there was something very wrong.

Checked hormones and found the missing piece: Probably lifelong low T, secondary, but at its worst now; close to female levels. I feel so much better after only 6 weeks into my treatment.

But it hasn't solved my sleep issues. I won't feel 100% until I get better sleep. I think sleep quality is a SEVERELY under-examined issue and underlying cause of a lot of fatigue symptoms.

 

[Worried]

I would like to add that magnesium can be a huge issue in some individuals. If you are deficient, it will absolutely wreck your quality of sleep. There are several forms. I take a complex on a regular basis and also Magnesium Citrate when dealing with cramps. There are other electrolytes that you may need to consider as well.

 

[Worried]

And have u checked your CBC panel? Hematocrit hemoglobin? That being elevated could definitely cause fatigue.