Advice on whether or not to start TRT or look for other causes

[madman]

I think it is more the unknown of what will happen. not like anyone other than spouse will see anyways. It adds significantly to the cost if I keep getting it from the clinic ($260 for 10,000 iu or 10 weeks worth). If I switch to reliablerx it is cheaper.

Yes, it comes down to how you truly feel.

There are cheap sources of hCG.

 

[VA-Hiker]

Think of all those so-called real men sporting those fake builds jacked up on those artificial T levels who were abusing testosterone/AAS back in the day when no one was using hCG!

Big, tough, strong, and manly they say.....LMFAO!




Fig. 9 Testicular atrophy in a 30-year-old AAS abuser (right) compared to normal size (left)
View attachment 40488

wow!

 

[FunkOdyssey]

I think it is more the unknown of what will happen.

Let's talk about what could happen then. It is 3 months from now and you're on 60 mg of test twice a week and 500 mcg hCG twice a week. You feel like garbage. What's causing it? Not so clear is it?

 

[VA-Hiker]

Let's talk about what could happen then. It is 3 months from now and you're on 60 mg of test twice a week and 500 mcg hCG twice a week. You feel like garbage. What's causing it? Not so clear is it?

Quite true. More substances and the more the picture is clouded.

 

[VA-Hiker]

I was trying to use the search function on the site but seem to not be able to find the info, maybe I'm just not digging enough.

What labs are you all doing at 6 weeks? Then 12 weeks? I know it takes a while to see changes in Hct/Hgb and what not along with the other variables.

Thanks again

 

[whiting1986]

Did you manage to start TRT ?

I am in the same boat with low FT. High SHBG and low E2.

Considering my options and getting great advice from the wonderful Forum.

 

[VA-Hiker]

Did you manage to start TRT ?

I am in the same boat with low FT. High SHBG and low E2.

Considering my options and getting great advice from the wonderful Forum.

I did go ahead and start, but not with the protocol I was given. I opted to take the advice on this forum and start at a lower dose with just testosterone cypionate. I did discuss it with my provider again prior to starting and sent them my new labs so they have them.

The protocol I was given was as follows:
Testosterone cypionate 200 mg/wk (100 mg Monday, 100 mg Thursday)
HCG 500 iu twice weekly
Anastroloze 0.125 mg up to twice a week (only as needed)
DHEA 25 mg daily (I've been on this for a while and my levels were on the low side when I started)

After talking with the clinic they stood by their recommendation but were ok with a slightly lower dose of 0.4 mL (80 mg), twice a week for a total of 160 mg/week. Reason was the high SHBG.

After a lot of reading on this forum and reading research, along with the advice I received here I went lower.

I started with 140 mg/week, 70 mg on Monday morning, 70 mg on Thursday afternoon. That is probably still on the high side but seems to spilt the difference a bit. I am doing labs again on 2/12 (six weeks).

So far it is still too early to tell, but I do seem to sleep better and have noticed do things through the day is easier, along with a few other improvements, things in bed are better. I don't know if this makes sense or not, but I don't feel completely apathetic anymore.

I'm only completing week 3, so it is really too early from what I'm reading. There was a really good paper on timelines here somewhere that I saw.

I'm still working on keeping my diet clean, exercise with cardio and weights, and all the other healthy habits I started before I began TRT.

You taking a cautious approach with this is the right way. I started this journey almost a year ago when I realized things had gotten bad and weren't getting better. My labs early March supported started TRT. I made every opportunity to work on other aspects. Eliminated alcohol, increased exercise, cleaned up diet, lost weight. Did I do everything right, nope, the continued calorie deficit wasn't the best idea. But it is a journey. I'm happy with my decision, prepared for ups and downs and adjustments to the protocol over time. I might add in HCG eventually, but thanks to forum, I believe having one variable at a time to deal with is the better approach.

With your SHBG being high and free T being low it might help you, certainly the other labs are important also. There was a good paper here I think madman posted on the SHBG and Free T relationship on another thread that is worth reading if you haven't seen it.

Best of luck in your journey and I'm happy to answer questions from my standpoint as a neophyte. The others in this forum are quite knowledgeable and willing to help too, it has been invaluable to me.

 

[whiting1986]

I did go ahead and start, but not with the protocol I was given. I opted to take the advice on this forum and start at a lower dose with just testosterone cypionate. I did discuss it with my provider again prior to starting and sent them my new labs so they have them.

The protocol I was given was as follows:
Testosterone cypionate 200 mg/wk (100 mg Monday, 100 mg Thursday)
HCG 500 iu twice weekly
Anastroloze 0.125 mg up to twice a week (only as needed)
DHEA 25 mg daily (I've been on this for a while and my levels were on the low side when I started)

After talking with the clinic they stood by their recommendation but were ok with a slightly lower dose of 0.4 mL (80 mg), twice a week for a total of 160 mg/week. Reason was the high SHBG.

After a lot of reading on this forum and reading research, along with the advice I received here I went lower.

I started with 140 mg/week, 70 mg on Monday morning, 70 mg on Thursday afternoon. That is probably still on the high side but seems to spilt the difference a bit. I am doing labs again on 2/12 (six weeks).

So far it is still too early to tell, but I do seem to sleep better and have noticed do things through the day is easier, along with a few other improvements, things in bed are better. I don't know if this makes sense or not, but I don't feel completely apathetic anymore.

I'm only completing week 3, so it is really too early from what I'm reading. There was a really good paper on timelines here somewhere that I saw.

I'm still working on keeping my diet clean, exercise with cardio and weights, and all the other healthy habits I started before I began TRT.

You taking a cautious approach with this is the right way. I started this journey almost a year ago when I realized things had gotten bad and weren't getting better. My labs early March supported started TRT. I made every opportunity to work on other aspects. Eliminated alcohol, increased exercise, cleaned up diet, lost weight. Did I do everything right, nope, the continued calorie deficit wasn't the best idea. But it is a journey. I'm happy with my decision, prepared for ups and downs and adjustments to the protocol over time. I might add in HCG eventually, but thanks to forum, I believe having one variable at a time to deal with is the better approach.

With your SHBG being high and free T being low it might help you, certainly the other labs are important also. There was a good paper here I think madman posted on the SHBG and Free T relationship on another thread that is worth reading if you haven't seen it.

Best of luck in your journey and I'm happy to answer questions from my standpoint as a neophyte. The others in this forum are quite knowledgeable and willing to help too, it has been invaluable to me.

That's awesome my friend. Thanks for the update and good luck with the journey

 

[VA-Hiker]

Just thought I would give an update with my 6 week progress (labs done on Monday 2/12, at the end of week 6, beginning of week 7 prior to my injection in the morning). I started with testosterone cypionate 140 mg/week (70 mg Monday morning, 70 mg Thursday evening) on 1/1/24. Feel better than before I started overall. I did notice my fasting blood glucose has not really dropped any (108 mg/dL). The total and free testosterone did increase as noted below, SHBG so maybe that explains why the free testosterone isn't higher.

I have kept up with the excercise and weight lifting (before I broke my hand this week so that will cause some issues for a few weeks). With that and paying attention to my nutrition I was able to gain weight, 152-->160 lbs.

I am wondering about just continuing on this dose until 12 week labs and then reevaluate?

Here is a spreadsheet over time from before starting TRT until now.

 

[FunkOdyssey]

I am wondering about just continuing on this dose until 12 week labs and then reevaluate?

If you feel better than before you started and you aren't in a big hurry, there's a good argument for staying here the full 12 weeks.

Personally, if these were my labs I would increase the dose at this point on the basis of the mediocre free T.

 

[VA-Hiker]

If you feel better than before you started and you aren't in a big hurry, there's a good argument for staying here the full 12 weeks.

Personally, if these were my labs I would increase the dose at this point on the basis of the mediocre free T.

I will say there was a bit of a honeymoon period around week 3/4 or so that is gone. Like I said, I do feel better than before, but that couple of weeks was great lol.

I was hoping for a higher free testosterone and also wondering about a higher dose. I almost wonder if 160 mg/week (80 mg x 2) would be worth trying, or just sit tight. Thanks for your reply!

 

[madman]

I will say there was a bit of a honeymoon period around week 3/4 or so that is gone. Like I said, I do feel better than before, but that couple of weeks was great lol.

I was hoping for a higher free testosterone and also wondering about a higher dose. I almost wonder if 160 mg/week (80 mg x 2) would be worth trying, or just sit tight. Thanks for your reply!

You need to sit back and think this through.

You are only 6 weeks in.

You are hitting a very high trough TT 1225 ng/dL and even though your SHBG is very high your trough FT tested using the most accurate assay (ED) almost doubled (6.6--->12.5 ng/dL) due to driving up your TT.

Shitkicker here is this is your trough FT which means that your peak TT, FT, and estradiol will be higher.

Most healthy young males would be peaking (short-lived) around 13-15 ng/dL based on (cFTV) and if it was tested using Quests ED assay or a standardized ED assay it would be a little lower!

Your trough cFTV is 15.9 ng/dL which is close to the top end of the reference range for cFTV.

As I have stated previously as of now cFTV tends to overestimate when compared to a standardized gold standard ED assay.

Your trough FT tested using Quests ED assay (most accurate) came back lower at 12.5 ng/dL which is still healthy.

Yes, many tend to aim for higher-end troughs but again you need to pay attention to your injection frequency as there will be a big difference in peak-->trough injecting once weekly vs daily/EOD!

Even when injecting twice weekly there will still be a noticeable difference in peak--->trough especially when injecting strictly IM.

Yes, you have room to bring up your trough FT if your goal is to aim for high-end/high levels but keep in mind that your peak TT, FT, and estradiol will be higher.

I would give it a few months before driving up your dose as you are only 6 weeks in.

You have not even given your body enough time to adapt to its new set point!

No way you can gauge how you truly feel regarding relief/improvement of low-t symptoms/overall well-being 6 weeks in.

If you are dead set on driving up your trough FT off the hop then go nuts.

Again be prepared to start over as it will take another 4-6 weeks for blood levels to stabilize and you are going to have to get beyond that short-lived mini honeymoon which is temporary when one starts TTh or tweaks a protocol (increases the dose of T).

Do not get caught up in chasing this as the body will eventually adapt and everything will level out including any significant boost in libido.

Do what you feel is best for you!

 

[VA-Hiker]

thanks @madman, I do overall feel better than before which is nice. I am not in a hurry and was on the fence about whether to increase or not. The 12 week labs are due 5 weeks from now, that isn't that long to sit tight and wait, gives me more time to adjust and judge symptoms anyways.

I will say, I'm glad I listened to the advice here and started with a lower dose (140 mg/week vs 200 mg/week), still no HCG (didn't want two things to adjust, I might add it eventually, but it will be a while). still no AI. after all, it is easier to adjust up.

 

[VA-Hiker]

My estradiol level came back overnight, it is higher as expected, which it was quite low before starting. Any thoughts?

 

[FunkOdyssey]

My estradiol level came back overnight, it is higher as expected, which it was quite low before starting. Any thoughts?

Expected, and needs to be considered in the context of your SHBG. Just like testosterone, free E2 is what matters, not total E2. You will need to drive your E2 up to high levels with this 85 mol/L SHBG in order to have a respectable free E2.

Could be a lot higher, and maybe should be, if you make further adjustments down the road. Your T/E2 ratio is quite high also.

You've got 99 problems but high E2 ain't one.

 

[VA-Hiker]

Thanks so much @FunkOdyssey! This makes perfect sense. Any implications for the high T/E2 ratio or source you prefer where I could educate myself a little more?

 

[FunkOdyssey]

Thanks so much @FunkOdyssey! This makes perfect sense. Any implications for the high T/E2 ratio or source you prefer where I could educate myself a little more?

Typically, you will hear something between 14:1 and 20:1 is a good ratio for T/E2 and yours is 38:1. I'm not familiar with the evidence defining an optimal ratio so you will need to search the board for that, or someone else can chime in. Certainly though, compared to others and compared to averages, your ratio is quite high.

Vince has a similar ratio and does very well so it doesn't necessarily have negative implications. I point it out mainly to emphasize that high E2 is definitely not a concern of yours.

 

[VA-Hiker]

@FunkOdyssey, thanks so much!

 

[Systemlord]

An E2 at 32 pg/mL is perfectly normal as those ranges for estrogen are poorly established. LabCorp has E2 ranges all the way up to 46 pg/mL.

 

[VA-Hiker]

An E2 at 32 pg/mL is perfectly normal as those ranges for estrogen are poorly established. LabCorp has E2 ranges all the way up to 46 pg/mL.

Thank you!