Weight gain, snoring and Upcoming doctors visit

[MR. evil]

I have an appointment with my endo coming up next week and just had some blood drawn for labs. There are several things I want to bring up with my doc based on how I'm feeling and my reading on this site.

My current dose is 125mg TestCyp once per week which I have doing for the past 18 months. Up until about 4 months ago i was feeling great, and had a steady weight loss of a couple pounds per month. Then sometime in late July or August I started gaining weight (not the good kind) and feeling more sluggish. All this while cycling (the kind on a bike) about 75 to 100 miles per week at a high intensity. I also started snoring really bad at this time and my wife is ready to kill me. During the past couple of weeks I have also been retaining a lot of water. My weight is up over 10lbs, my wedding band is very tight and my face puffy. I am wondering if all of this is related to estrogen and need if I should be put on an an AI. In total I'm up about 20 lbs since early July with 10 of those pounds being the water weight I previously mentioned.

Things I am going to discuss with the doc:

1. Switching to shallow IM injection with 1/2" 27ga needle instead of the 1" 25ga needles I currently use.
2. Splitting my does into two weekly injections. From my reading on this site this may help with E2.....If I have a problem with E2.
3. Starting a course of an AI.
4. Asking if my sudden snoring is related to my TRT course or my weight gain.

And what labs should I have regularly done? My doctor has labs done every 6 months. Getting blood work the other day I saw my lab sheet and all he requested was total T, free T, PSA and hemocrit. Given how I have been feeling I want him to do some additional lab work to see if anything else is out of wack.


Last blood work 06/2017
Total T. 830 (taken 3.5 days after injection)
Free T. 25
PSA. 1.2

 

[CoastWatcher]

Untreated apnea, as has been documented time and again, is an impediment that can derail a TRT protocol. Dr. Saya commented that there are countless men dealing with undiagnosed apnea - and the associated health and lifestyle challenges that accompany it. Weight gain, snoring...I hope there's a sleep study in your future.

 

[MR. evil]

Untreated apnea, as has been documented time and again, is an impediment that can derail a TRT protocol. Dr. Saya commented that there are countless men dealing with undiagnosed apnea - and the associated health and lifestyle challenges that accompany it. Weight gain, snoring...I hope there's a sleep study in your future.

I had an at home sleep study done in September. The results were that while I had loud snoring my breathing and blood oxygen levels did not indicate sleep apnea. Looking back I was very anxious that night and barley slept which could have screws my results. I might need to have another study done.

 

[CoastWatcher]

I had an at home sleep study done in September. The results were that while I had loud snoring my breathing and blood oxygen levels did not indicate sleep apnea. Looking back I was very anxious that night and barley slept which could have screws my results. I might need to have another study done.

I know how uncomfortable - and anxiety-provoking - a sleep study can be. Hook up to leads and wires, feel absurdly self-conscious, then...relax, sleep normally. Not likely to happen. In spite of that I'd raise it again with your doctor. However, were these the only lab results you had? Last blood work 06/2017
Total T. 830 (taken 3.5 days after injection)
Free T. 25
PSA. 1.2

They raise a lot of questions. Since you're on a weekly injection schedule, not exactly cutting edge, you had blood drawn at the wrong time. You want to always test in the trough, just prior to next injection. This at the mid-point of you injection cycle, is close to a peak and it suggests your trough may well be anemic. So: where's the SHBG value? It's a key, not to be missed test that needs to be run in order to design an effective protocol. If SHBG is low testosterone clears quickly - best to schedule small injections frequently (every 3.5 days, EOD, daily). If SHBG is high you need larger fewer injections. What was your value before therapy began? Was it captured? What about your estradiol (as measured by the sensitive test, LC, MS/MS)? Your thyroid? Not only TSH, but ft3, ft4, rt3, and the antibody panels.

You were inadequately evaluated prior to therapy and handed a cookie-cutter protocol. Time to dig in and find out what's really going on with your hormones (and your snoring).

 

[MR. evil]

Just logged into my online medical records and saw my most recent labs were in


Albumin 4.5 G/dL
TESTOSTERONE 586 ng/dL
SEX HORMONE BINDING GLOBULIN 15.2
FREE TESTOSTERONE 17.2 ng/dL
BIOAVAILABLE TESTOSTERONE 421.3 ng/

 

[CoastWatcher]

Just logged into my online medical records and saw my most recent labs were in


Albumin 4.5 G/dL
TESTOSTERONE 586 ng/dL
SEX HORMONE BINDING GLOBULIN 15.2
FREE TESTOSTERONE 17.2 ng/dL
BIOAVAILABLE TESTOSTERONE 421.3 ng/

Your SHBG is low. A single, weekly injection of testosterone isn't going to do the job. Posting at 15.2, ideally we'd like to see the reference ranges as every lab establishes its own - and your doctor will be reacting to the ranges, it's low. Injections every 3.5 days would be the next step, I would suggest. You didn't test estradiol and didn't dig into thyroid?

 

[Systemlord]

Your SHBG is low. A single, weekly injection of testosterone isn't going to do the job. Posting at 15.2, ideally we'd like to see the reference ranges as every lab establishes its own - and your doctor will be reacting to the ranges, it's low. Injections every 3.5 days would be the next step, I would suggest. You didn't test estradiol and didn't dig into thyroid?

No doubt, I made little progress on weekly injections. My SHBG is a little higher than yours and twice weekly was alright, but EOD made a bigger difference for me. After doing this I started noticing lots of improvements that just accelerated. A weekly protocol better suites someone with high SHBG, your current doctor is failing you! You're going to feel better after you start injecting more often.

 

[MR. evil]

Below are the test results with the lab reference ranges. I don’t see my doctor until this upcoming Monday and at that visit will be asking for the Thyroid and Estradoil testing.


Albumin ***4.5 G/dL (3.2 - 5.0 G/dL)

TESTOSTERONE ***586 ng/dL (241 - 827 ng/dL)

SHBG ***15.2 ***( 17.3 - 65.8 mol/L)

FREE T ***17.2 ng/dL ( 4.6 - 22.4 ng/dL )

BIOAVAILABLE T 421.3 ng/dL (110.0 - 575.0 ng/dL)

 

[MR. evil]

No doubt, I made little progress on weekly injections. My SHBG is a little higher than yours and twice weekly was alright, but EOD made a bigger difference for me. After doing this I started noticing lots of improvements that just accelerated. A weekly protocol better suites someone with high SHBG, your current doctor is failing you! You're going to feel better after you start injecting more often.

My doctor is very open to suggestion and I have no doubt he will let me change to twice a week or EOD injections. Before All my previous visits with him after starting TRT I was feeling great and there was nothing to change. This will be the first visit we’re things have regressed and I am confident he will pull out all the stops for me. I am just here getting as much feedback as possible so I go into hr appointment somewhat educated.

 

[MR. evil]

Is high or low SHBG genitic or are there contributing factors such as Estradiol or other hormone fluctuations?

 

[CoastWatcher]

My doctor is very open to suggestion and I have no doubt he will let me change to twice a week or EOD injections. Before All my previous visits with him after starting TRT I was feeling great and there was nothing to change. This will be the first visit we're things have regressed and I am confident he will pull out all the stops for me. I am just here getting as much feedback as possible so I go into hr appointment somewhat educated.

If we aren't our own advocate, we are at risk. The vast majority of us here at EM learned that lesson and had to delve into the ins and outs, the ups and downs of how the TRT game is played. At the very least I would advocate for twice weekly injections based on your SHBG levels. Fifty to sixty milligrams every 3.5 days is an excellent starting protocol. Wait six weeks for serum levels to balance, see how you feel, run labs. When you run those labs be sure you measure your estradiol with the Sensitive Test (as it's called at LabCorp) or the Ultrasensitive Test (as it's known at Quest). It's LC, MS/MS and accurately measures estradiol levels in men. Any other estradiol test is inaccurate for use in men (or children, for that matter). Be slow to adopt the use of an AI. It's a good drug, but estradiol is a necessary hormone. Symptoms PLUS elevated lab values are the only way to determine the need. The thyroid. I hope it's just fine, but it's so necessary to have it in optimal shape. TSH, ft3, ft4, rt3, and the antibody panel. A CBC needs to be done regularly as HGB and HCT can climb dangerously for men on testosterone replacement. A CMP would be a good investment as well if one hasn't been done recently.

 

[CoastWatcher]

Is high or low SHBG genitic or are there contributing factors such as Estradiol or other hormone fluctuations?

SHBG is almost impervious to intervention. We play the card we were dealt. It's just another factor to consider.

 

[Dr Justin Saya MD]

Untreated apnea, as has been documented time and again, is an impediment that can derail a TRT protocol. Dr. Saya commented that there are countless men dealing with undiagnosed apnea - and the associated health and lifestyle challenges that accompany it. Weight gain, snoring...I hope there's a sleep study in your future.

Amen to that!

 

[Dr Justin Saya MD]

I had an at home sleep study done in September. The results were that while I had loud snoring my breathing and blood oxygen levels did not indicate sleep apnea. Looking back I was very anxious that night and barley slept which could have screws my results. I might need to have another study done.

Unfortunately the in-home sleep studies are notoriously inaccurate as the conditions of the testing are uncontrolled.

 

[MR. evil]

Unfortunately the in-home sleep studies are notoriously inaccurate as the conditions of the testing are uncontrolled.

Scheduling another sleep study will be a priority and I will make sure to have it done at a testing center and not at home.

 

[MR. evil]

Calculating my dosage for twice a week injections is straight forward, but how should it be done for EOD injections when a week is an odd number of days?

Then only thing that comes to mind is to do the calculation on a 2 week / 14 day interval because is an even number of days

Weekly dose 125mg
Two week dose 125mg x 2 = 250mg
EOD dose = 250mg / 7 injections over 14 days = 35.71mg

One other thing, for the past 8 months I have been using a double strength solution of test cyp, 200mg per ML. So my weekly dose of 120mg is a concentrated 0.65ML injection. Are there any downsides to a stronger solution like I’m using? Could it be causing any of my issues?

 

[CoastWatcher]

Calculating my dosage for twice a week injections is straight forward, but how should it be done for EOD injections when a week is an odd number of days?

Then only thing that comes to mind is to do the calculation on a 2 week / 14 day interval because is an even number of days

Weekly dose 125mg
Two week dose 125mg x 2 = 250mg
EOD dose = 250mg / 7 injections over 14 days = 35.71mg

One other thing, for the past 8 months I have been using a double strength solution of test cyp, 200mg per ML. So my weekly dose of 120mg is a concentrated 0.65ML injection. Are there any downsides to a stronger solution like I'm using? Could it be causing any of my issues?

Two hundred milligrams/ml is the standard dispensed in North America (though we here in Canada receive enanthate). Your calculation will serve your purpose.

 

[Systemlord]

What I do for EOD protocol is set my phone up for a daily reminder every 14 days per injection day, there will be 7 different timers, otherwise with the days swapping around each week I would mess it up. If you do decide to switch to an EOD protocol and you're have not been prescribed enough test to account for dead loss and or are using non-insulin syringes you will run out of medicine before your next refill.

 

[captain]

I have seen blood pressure meds cause sudden snoring. losartan and Lisinopril caused my wife to have sudden snoring. If you take them it will take a week or so for it to stop after you quit taking them.

 

[MR. evil]

I have seen blood pressure meds cause sudden snoring. losartan and Lisinopril caused my wife to have sudden snoring. If you take them it will take a week or so for it to stop after you quit taking them.

The only meds I'm on is TRT