Blackhawk's journey with TRT

[ratbag]

Yes you have some thyroid issues there especially with the antibodies being over range, hashis is a possibility and also your free T4 should be mid range at about 1.3 so you are low there and your Free T3 is too low. Most MD's will not do anything but a good hormone specialist would start you on NDT or cytomel and synthroid.

I would also say your testosterone serum is too low and so is your free T. Seems to me there is a lot of room for improvement in your labs.

 

[Deleted member 16042]

I would also say your testosterone serum is too low and so is your free T. Seems to me there is a lot of room for improvement in your labs.

I am pretty much at the same conclusion, though with the exception of total T it is a far sight better than before. I know different guys have different sweet spots in terms of Total and Free T, but any general reference target range for these two? Is total greater than 600 and free greater than 20 a good starting point? Or try to bump even higher then maybe tweak downwards?

Seems I must be converting a lot of the gel to DHT, and am way over normal range. While I am not "afraid" of that, I have read that Total and free are more likely what I need more of for MUSCLE capability and recovery. Muscle function, general energy levels and mental depression are my main targets with treatment. Would it make sense to switch to T cyp on this basis?

 

[ratbag]

It depends if you are suffering any related symptoms to high DHT.. didn't someone ask that question already?

I say your T and free T is low because personally I take less T than most do and I've found that with my TT at 700 (free T near the top of range) I feel normal, if I go less I start to lose libido and orgasms become poorer.. less feeling. I think most TRT specialists generally keep TT near 800 or above. But again it's a personal thing. SHBG and E2 play a big part of what you keep your levels at.

Going to T cyp will definitely lower your DHT but is that a problem? And you discuss in your earlier posts all the symptoms you have... I had tons of bad symptoms too.. even went thru that Lipitor problem as well. I was really F'd up by my endocrinologist. And every physician I went to said there was nothing wrong with me and I just had to suck it up.

Yet I was in really bad shape and this began my online search for why. It was thru reading sites like this that I realised I had to find a hormone specialist and take the next leap fwd in my healthcare. I did and now it's mostly behind me. I'm a thousand percent better and enjoy a relatively normal life.

I had suffered for years previously and can't emphasise enough how critical it is to see a proper HRT specialists. I would have been healthier much earlier if I had done so. Instead I chose to try to educate my own endricrinologist and try to get them to see the light but that never worked. All they ever wanted to do was put me on anti depressants.

 

[Deleted member 16042]

It depends if you are suffering any related symptoms to high DHT.. didn't someone ask that question already?

I say your T and free T is low because personally I take less T than most do and I've found that with my TT at 700 (free T near the top of range) I feel normal, if I go less I start to lose libido and orgasms become poorer.. less feeling. I think most TRT specialists generally keep TT near 800 or above. But again it's a personal thing. SHBG and E2 play a big part of what you keep your levels at.

Going to T cyp will definitely lower your DHT but is that a problem? And you discuss in your earlier posts all the symptoms you have... I had tons of bad symptoms too.. even went thru that Lipitor problem as well. I was really F'd up by my endocrinologist. And every physician I went to said there was nothing wrong with me and I just had to suck it up.

Yet I was in really bad shape and this began my online search for why. It was thru reading sites like this that I realised I had to find a hormone specialist and take the next leap fwd in my healthcare. I did and now it's mostly behind me. I'm a thousand percent better and enjoy a relatively normal life.

I had suffered for years previously and can't emphasise enough how critical it is to see a proper HRT specialists. I would have been healthier much earlier if I had done so. Instead I chose to try to educate my own endricrinologist and try to get them to see the light but that never worked. All they ever wanted to do was put me on anti depressants.

Thanks ratbag. I am not micromanaging myself, just trying to be well informed going into next consult with Dr Saya. I think he qualifies as "proper HRT specialist".

My thoughts and questions about switching to T cyp are based on being on cream then gel since December and never reaching the kinds of total and free T levels you refer to. Seems a common thing and often reason for guys switching to injection. I don't know whether taking a daily bath in gel is a next reasonable step. I know things are not linear, but I do question if redoubling gel would be effective or just further increase the DHT without adequate Total and free T increases.

I am not worried about the DHT, really that's not the issue. I am concerned about achieving worthwhile Total and free T


P.S. I am grateful to have a long term bias against anti depressants despite admonishment from wife and a few others, and having had some pretty good psych care from docs who never did suggest meds. At this point, with current HRT, I am doing better psychologically, though not all better. I think ongoing adjustment of T, DHEA, and hopefully some appropriate thyroid treatment may even things out even more. Definitely going to ride these other hormonal treatment adjustments out for a good while before considering any psych drugs.

 

[Deleted member 16042]

Just had the consultation w/ Dr Saya this morning:

-Switching from gel to T cyp 64mg E3D (150/wk) to try and prioritize anabolic effect. My main ongoing problem is exercise tolerance and recovery. Seems I convert a lot of gel to DHT, so seeking a better balance of anabolic/androgenic is desirable.

-Regarding whether to be concerned over DHT being too high, Dr Saya said that hematocrit does tend to be higher with higher DHT. He's prescribing donating blood due to hematocrit, and hoping it's a one time thing if reducing DHT also brings down HCT level. I didn't remember Vettester Chris's post about this, iron and thyroid above… Hope losing a pint is a non issue for Thyroid uptake.

-Reducing DHEA to 25mg/day in combo with 25mg pregnenelone evening dosage.

-Starting 1/2 grain NDT first thing in the morning with possible increase to 1gr after 2 weeks, monitoring for positive effects on energy vs hyper-thyroid symptoms.

-ACTH is signalling at a good level, and cortisol diurnal curve profile is looking good except the test shows overall low cortisol. Could be related to thyroid, hopefully supplementing Thyroid will also boost cortisol. I also was a bit ill the day of the cortisol test, which may have affected results either way, so jury is still out.

-Re-assess at 6 weeks.

-With the thyroid issue and elevated thyroglobulin antibodies I forgot to ask about iodine intake.

-IGF-1 is in quite good range for my age, but if T cyp doesn't provide the needed anabolic help, semorelin is a consideration. I doubt I'll go there.

 

[FeelingLost]

Nice documentation of your journey so far Blackhawk I enjoyed the read. Looks like you are getting closer, congrats man.

 

[Deleted member 16042]

So just to keep a symptomatic record prior to starting new protocol:

-I am still not having muscle improvement. Muscles tire easily and if any more than the usual amount of exercise don't recover well. I just can't push it to achieve gains
-I had quite a down week first week of October possibly due to virus
-Due to that and both shoulders in pain I stopped lifting, though still have been walking daily and doing some HIIT sprinting. (Getting PT for shoulder mobility and it's really helping, hope to start work outs again pronto)
-The elbow bursitis has calmed down and swelling is down, but it's not gone, and it feels alike I may have some bone spurs... very rough feeling stuff on the olecranon unlike the other elbow
-Even more noticeable body hair
-Libido is high, no ED (never was any). A bit frustrated due to my wife having lower libido, she's a good sport, but our motivation is mismatched.

-Mood is more consistent, completely lost the radical mood swings, but I am tending to run a bit angry. Whereas before starting TRT and during the summer before protocol was changed and E2 was very low, I was a lot more depressed and anxious, now just cranky most of the time.

Through meditation and CBT I see most of my existential dilemmas pretty clearly now and am somewhat more stable in how I react to them rather than being consumed by the associated bad feelings. Some issues don't have clear solutions which still brings frustration and uncertainty.

The TRT issues contribute, and are double edged. I am not really "there yet" with a steady effective protocol, making physical gains, but the progress is bringing new hope. I am chomping at the bit... For now it's difficult holding back rather than pursuing the usual travel and adventure that I thrive on. Just feel like I have to get the TRT stable first. Plans are much less grand than they would be if I was fine. At least day to day I am generally doing much better than prior to the current regimen.

 

[madman]

So just to keep a symptomatic record prior to starting new protocol:

-I am still not having muscle improvement. Muscles tire easily and if any more than the usual amount of exercise don't recover well. I just can't push it to achieve gains
-I had quite a down week first week of October possibly due to virus
-Due to that and both shoulders in pain I stopped lifting, though still have been walking daily and doing some HIIT sprinting. (Getting PT for shoulder mobility and it's really helping, hope to start work outs again pronto)
-The elbow bursitis has calmed down and swelling is down, but it's not gone, and it feels alike I may have some bone spurs... very rough feeling stuff on the olecranon unlike the other elbow
-Even more noticeable body hair
-Libido is high, no ED (never was any). A bit frustrated due to my wife having lower libido, she's a good sport, but our motivation is mismatched.

-Mood is more consistent, completely lost the radical mood swings, but I am tending to run a bit angry. Whereas before starting TRT and during the summer before protocol was changed and E2 was very low, I was a lot more depressed and anxious, now just cranky most of the time.

Through meditation and CBT I see most of my existential dilemmas pretty clearly now and am somewhat more stable in how I react to them rather than being consumed by the associated bad feelings. Some issues don't have clear solutions which still brings frustration and uncertainty.

The TRT issues contribute, and are double edged. I am not really "there yet" with a steady effective protocol, making physical gains, but the progress is bringing new hope. I am chomping at the bit... For now it's difficult holding back rather than pursuing the usual travel and adventure that I thrive on. Just feel like I have to get the TRT stable first. Plans are much less grand than they would be if I was fine. At least day to day I am generally doing much better than prior to the current regimen.

Switching to the new protocol using injectable(cypionate) was a good move as you know your tt/free t were still low on the transdermal. I would say getting your total near the upper end of the range with a more robust free t will definitely make a difference in your muscle recovery /gains mind you one would have to be in the supra-physiological range to really notice increased muscle mass/strength but having testosterone levels in the high end of the physiological range with a higher free t one will notice changes in body composition adding some muscle/losing fat but what is of critical importance is your diet as if you are looking to increase muscle tissue you will need to consume slightly more calories (250-500cal/day) than you burn as the cost of building muscle tissue (actin/myosin) requires more calories than to maintain and as far as macros meeting the minimum daily protein requirements is crucial along with a good supply of complex/fibrous carbs and healthy fats. You will have to decide if your body type functions more optimally on low carbs/higher fat or moderate-high carbs/lower fat ( basically comes down to your genetics/insulin sensitivity) how well you tolerate carbs. If diet/training are not in check than being on trt and having your testosterone levels in the upper end of the physiological range you will always have a hard time building muscle.

 

[Deleted member 16042]

Diet is crazy clean and healthy and full of good calories and very high nutrient levels. I have been playing with carb/fat ratio, somewhere about 40/40 now, always keep protein around 20%. I have been a high carb guy most of my life, but have been switching to more % fat over the last couple years. I have relatively more consistent energy with more fat.

Yes of course caloric surplus to grow, yes...

I have always been a lean hard gainer, and I'm not after bulk, just want normal muscular physiology back... the ability to train to a reasonable level and recover well. While my VO2max is excellent, muscle physiology is impaired ever since I was put on statins. Been off of them for almost three years, but they f^&*cked me over. I suspect the lipitor killed a heap of mitochondria, and who knows what else happened to the muscle cells themselves? (Not to mention the havoc on my cholesterol based hormone production)

 

[Deleted member 16042]

Just had the next round of labs drawn after switching to T cyp from gel, and adding thyroid to treatment. Ramped thyroid from ½ grain to 1 grain/day. Still taking 25mg each pregnenelone and DHEA daily in the evening.

I’d like to be more comprehensively weight training, but I have been on a road trip camping and climbing for the last few weeks. When I am climbing, it leaves me too wasted for additional weight days, and climbing is more fun.

So progress? Maybe. I have had a general feeling of upswing in physical condition since starting the T cyp, seemed like a new bit of honeymoon at first, but some bumps in the road. I am eager to see the new blood test results to sort it out.

My physical recovery day to day seems a bit better, but nothing to write home about.

Starting the NDT, I had some jittery/wired feeling for a few days that evened out, and increasing dose to 1gr after 2 weeks came with some anxiety, Don’t know about actual causation, just happened at that time. I had one particular emotional event that lingered for several days and felt hormonal like the stuff I had happening when E2 was very low. Definitely over reacted to something that should not have affected me that strongly. Wondering if E2 is up due to pretty high T cyp dosing (64mg E3D).

Also, though I’ve been getting lots of sleep with the long dark hours. Sleeping on the road trip started out very well, but in the last week especially, developed some insomnia, waking at early hours, and having increased urinary frequency at night, 2-3 times before morning.

Night time erections are super strong, even to the point of being concerning when they wake me up and don’t subside for quite a while. They are not associated with sexual thoughts or feelings though. I don’t have my wife with me, so not as much cause for provoking wanting sex. Feels like libido is actually down.

I am also really unsure of whether HCG is working. Balls are still tiny and I get passing sensations like I did when they initially atrophied. Just kind of feels physically neutered. I’m wondering if the higher dose of T is counteracting the HCG.

Overall it just kind of feels like the several components: T, HCG, thyroid are competing internally.

Hope to see the lab results soon, will post as soon as I have them.

 

[FeelingLost]

Hi Blackhawk welcome back. I was wondering how your injections were going.
I got switched to injections as well. Had my consult a week ago just received my package today.

If I may ask did you get your HCG from TX or FL?

 

[Deleted member 16042]

First vial of hcg from hallandale had noticeable effect. Second from them, also
pregnyl, and empower don't seem to do anything

Re, injections, I tried IM, had too much pain in quads, delt and glute, went to sub Q in belly, and over glutes with much less pain, no lumps, I have so little fat, anyway, seems to be really sub Q, not into much fat to speak of.

 

[FeelingLost]

First vial of hcg from hallandale had noticeable effect. Second from them, also
pregnyl, and empower don't seem to do anything

Re, injections, I tried IM, had too much pain in quads, delt and glute, went to sub Q in belly, and over glutes with much less pain, no lumps, I have so little fat, anyway, seems to be really sub Q, not into much fat to speak of.

I had the same issue with our friends from Texas. I have set my preferred vender to Fl. for all future shipments.

Could you elaborate on "tried IM, had too much pain in quads, delt and glute," ?
I did my first injection tonight and got a rather heavy dull ache from the injection site down my leg to my ankle.
It lasted over an hour. Scared me a bit.

 

[Deleted member 16042]

I had the same issue with our friends from Texas. I have set my preferred vender to Fl. for all future shipments.

Could you elaborate on "tried IM, had too much pain in quads, delt and glute," ?
I did my first injection tonight and got a rather heavy dull ache from the injection site down my leg to my ankle.
It lasted over an hour. Scared me a bit.

Nothing that dramatic, just that every IM shot leaves me with aching soreness for about 3 days. Sub,Q varies from no pain to mild beesting like feeling for short duration. Much happier so far with SubQ.

 

[busgalloway]

I had a pretty different experience with IM shots in my thigh. I only experience soreness starting 24 hours after the injection. This only happened the first two weeks though and would last like 48hours, but now I have no soreness due to the injection at all.

As recommended, I inject slowly and with steady hands and a relaxed leg. After removing the needle I give a strong localized massage around the injection site using my alcohol pad. Next I do 10 leg extensions of that leg, fully flexing the thigh muscle. Next I do 10 body weight squats. It may be overkill, but it really seems to spread the cypionate out well.

If you do go back to IM do your best to dissipate the dose. I don't know how many people have even gone back to IM after switching to Subq only, it sounds much more convenient.

 

[Deleted member 16042]

I had a pretty different experience with IM shots in my thigh. I only experience soreness starting 24 hours after the injection. This only happened the first two weeks though and would last like 48hours, but now I have no soreness due to the injection at all.

As recommended, I inject slowly and with steady hands and a relaxed leg. After removing the needle I give a strong localized massage around the injection site using my alcohol pad. Next I do 10 leg extensions of that leg, fully flexing the thigh muscle. Next I do 10 body weight squats. It may be overkill, but it really seems to spread the cypionate out well.

If you do go back to IM do your best to dissipate the dose. I don't know how many people have even gone back to IM after switching to Subq only, it sounds much more convenient.

Yeah, I don't have any need for IM if subQ works fine.

 

[Deleted member 16042]

Hoo-wee! As I suspected the T cyp 64mg E3D put me higher than desired.

And yes, blood was drawn at trough.

I suspect this also contributes to the feeling that HCG is not working!:

Very happy that hematocrit and hemoglobin are in good range.

E2 is high now, and potentially confirms the possibility that my recent emotional stuff has been influenced by high E2.

DHEA is still high,

DHT is back in more reasonable range.

Of particular concern is the PSA which also correlates to nighttime urination I reckon.

Consult with Saya next Monday, My hopes and expectations:

-Hopefully just reducing T dosage will get me in proper total T, free T and E2 range, and bring PSA down.

-Expect to reduce DHEA supplementation to 10mg/day.

-Thyroid numbers looking better, especially free T3, still have the antibody issue and perhaps RT3 is high, not sure about how these details interact with each other. Don;t know if any further NDT dosage adjustment is needed, or possibly add a wee bit of T4/synthroid?

I'm actually eager to reduce the T dosage get things in normal range and see how it goes. Now have been on the very low end, and looks like very high end, seeking the middle ground and normalcy!

 

[Vince Carter]

The paste of your labs isn't readable

 

[Deleted member 16042]

The paste of your labs isn't readable

Edit: Better?

 

[ratbag]

Yes it's perfectly readable now.

I would say your FT4 is lowish... most MD's would ignore this as most of them believe because it's in range you are ok but if you read tiredthyroid.com you'll know that getting your FT4 mid range is what's optimum for most people. Midrange is 1.295

Not sure what to say about your PSA... was it in range before you changed your TRT protocol? Did you have an orgasm with 48hrs of giving blood? Personally I would leave your DHEA-S where it is but that's up to Dr. Saya. Remember ranges are low for DHEA. I notice that TT range stops at 1500... Your CBC w/diff looks great.

Has your thyrogobulin antibodies reduced since increasing T3? Are you feeling any effects from high E2?