First Lab Post! “Should I stay or should I go?”...would appreciate some guidance. Thank you!

[RP McMurphy]

I’m a 45 yo male, 150 lbs. Prior to starting any testosterone therapy my labs in January 2018 were in range (Total T 601 280-1100ng/dl, Free T 10.43 1.9-27ng/dl), but I wanted to see if increasing testosterone levels would help to improve fatigue. I always had a high sex drive, with decent erections but sometimes room for improvement re the erections...

I trialed clomid monotherapy starting from March 2018 until June 2020 (50mg every three days), with positive results –increased energy, stronger erections.

In the summer of 2020 I started an injectable cypionate/propionate blend (160/40 mg/ml) from Empower. I switched from clomid monotherapy to testosterone injections mainly because clomid seemed to be dropping my IGF-1 into the 70’s, and I was also curious if I would see even better results with injectable testosterone. I also cycled in 22.5mg of clomid a few times a week, but very rarely because of my concerns regarding IGF-1 levels. I’ve also cycled in 1iu of HGH a decent amount of the time (but was not taking at the time or leadup to the most recent labwork).

I’ve experimented with different dosing regimens, mostly lowering my dose over time and decreasing the time between doses. I experienced great sexual function for the first year plus (and increased muscle mass), but the past 4-5 months I’ve had little to no sexual desire, and some ED. This is a complete 180 for me, as I mentioned I’ve always had a high sex drive. I realize that the arena of sexual desire and function is a complicated one, but I believe that this is a side effect of my TRT regimen. Systolic blood pressure also increased from 120 into 130’s on TRT, and at times felt a bit amped up, and possibly fatigued.

Here are my recent labs (trough) from Quest on April 4, 2022 after 8 weeks of dosing 20mg of the cypionate/propionate blend, every other day subq in the thigh. I was also taking my standard regimen of (alot of vitamins), 25mg DHEA, 150mg pregnenolone, 30mg armour thyroid, and I was not on HGH.

TESTOSTERONE, TOTAL, MS 806 250-1100 ng/dL
TESTOSTERONE, FREE (DIALYSIS) 151. 6 35.0-155.0 pg/mL
TSH 3.49 0.40-4.50 mIU/L
T4, FREE 1.2 0.8-1.8 ng/dL
T3, FREE 3.1 2.3-4.2 pg/mL
IGF 1, LC/MS 122 52-328 ng/mL

DHT,LC/MS/MS 56 12-65 ng/dL
HEMOGLOBIN 17 13.2-17.1 g/dL
HEMATOCRIT 50.3 38.5-50%
PROLACTIN 8.6 2.0-18.0 ng/mL
PSA 1.12 < or = 4.00 ng/mL
ESTRADIOL/ULTRASENSITIVE LC/MS 52 <OR=29pg/mL

I’m currently considering:
-Lowering my TRT dose
-HCG monotherapy
-Running a significantly lowered TRT dose with HCG
-Trying an AI

Any input would be much appreciated! And I’d love to hear any thoughts @Nelsonvergel may have. Thank you all in advance.

 

[madman]

How does Natesto not shut one down?

post#99

Official Natesto Thread

Data point for anyone interested. Natesto has been the most tolerable form of TRT for me. Typically, I get headaches with other forms. I have also noticed a more forceful heartbeat than normal after injecting. I can even feel it in my abdominal aorta (I know, that sounds really weird). I have...

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[Cataceous]

How does Natesto not shut one down?

It's believed to be due to its relatively short action. The half-life is under an hour, so that within a few hours you're back to your baseline, which encourages continued HPTA activity. There's also the prolonged trough period overnight.

 

[RP McMurphy]

The last thing we men think about when fatigued is sex, the estrogen level, excessive androgens may be responsible. Constantly elevated levels could also be the issue.

Be aware DHEA increases estrogen in men, so unless you really need DHEA, maybe try stopping it before starting on an AI.

I have problems on injections, non responder to all but daily and EOD protocols, except very bizarre symptoms (super low blood pressure when sleeping) when levels start getting very steady.

Jatenzo was a very different experience and outcome.

Great callout regarding DHEA, thank you! And good to know re Jatenzo.

 

[RP McMurphy]

If you can get it, enclomiphene is preferred over Clomid/clomiphene. Clomid is just enclomiphene and zuclomiphene. The latter is estrogenic and usually unhelpful. Resuming SERM monotherapy is a reasonable option, especially since you did well with Clomid. I would not use hCG with Natesto or a SERM because it can be suppressive and work against the HPTA function you're trying to maintain or stimulate. Natesto with a SERM is potentially viable and maybe even beneficial. Natesto still suppresses the HPTA a little and a SERM would tend to counteract that.

I believe that adding a SERM such as enclomiphene to conventional TRT will most often fail to significantly stimulate the HPTA. The matter has not been decided definitively, as there are anecdotes going both ways. It's true that estrogens form the most potent mechanism of negative feedback in the HPTA, and SERMs can block this feedback. However, androgens also provide negative feedback at the hypothalamus, and SERMs do not affect this. I use enclomiphene with TRT, but this is in conjunction with gonadorelin (GnRH), which effectively bypasses the hypothalamus and directly stimulates the pituitary to make LH. I also see a drop in IGF-1 with enclomiphene use, though not as dramatic as yours. In a way it's beneficial to me because it allows me to use ipamorelin as a sleep aid with less worry about elevating IGF-1.

-Noted re enclomiphene vs clomiphene, will do.

-Any suggestions on a restart protocol? I've now stopped TRT. I wasn't sure what the latest thinking is on this and am considering: HCG 400iu daily X 14 days, followed by enclomiphene 25mg daily X 28 days

-Post restart, and after running labs, based on your's and other's recent feedback I plan on either running enclomiphene monotherapy or Natesto plus enclomiphene. Any thoughts on dosing here? For enclomiphene monotherapy I was considering trying 12.5mg/day, and if running with Natesto, something like enclomiphene 12.5mg every 2-3 days.

-Interesting to know that you had a similar experience of IGF-1 decrease with enclomiphene. Do you think this is indicative of a negative impact on growth hormone, or only IGF-1? I'm trying to get a sense of how concerned I should be about the decrease I experience when on a SERM.

 

[RP McMurphy]

Natesto shuts down gonadotropins by a lesser degree:

View attachment 21249

Great data!

 

[Cataceous]

...
-Any suggestions on a restart protocol? I've now stopped TRT. I wasn't sure what the latest thinking is on this and am considering: HCG 400iu daily X 14 days, followed by enclomiphene 25mg daily X 28 days

-Post restart, and after running labs, based on your's and other's recent feedback I plan on either running enclomiphene monotherapy or Natesto plus enclomiphene. Any thoughts on dosing here? For enclomiphene monotherapy I was considering trying 12.5mg/day, and if running with Natesto, something like enclomiphene 12.5mg every 2-3 days.

-Interesting to know that you had a similar experience of IGF-1 decrease with enclomiphene. Do you think this is indicative of a negative impact on growth hormone, or only IGF-1? I'm trying to get a sense of how concerned I should be about the decrease I experience when on a SERM.

That seems like a perfectly reasonable restart protocol to me...

The doses of enclomiphene as monotherapy and with Natesto also seem appropriate.

I'm not sure about the mechanism behind the drop in IGF-1 with enclomiphene. Going by memory, I believe the authors of one of the Androxal studies speculated that it was due to its action in the liver. Perhaps this means minimal impact on growth hormone?

 

[Systemlord]

Great data!

I believe Jatenzo gets second place for being less suppressive to the HPTA.

 

[RP McMurphy]

I believe Jatenzo gets second place for being less suppressive to the HPTA.

re: Jatenzo...so sounds like there isn't the negative impact to organs that used to be attributed to oral administration?

 

[Systemlord]

Jatenzo...so sounds like there isn't the negative impact to organs that used to be attributed to oral administration?

Correct, Jatenzo bypases the liver on the first pass.

My Experience On Jatenzo (Oral TRT) Log

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...

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[Guided_by_Voices]

OP, I just watched the linked video with Dr. Shallenberger and he covers a lot related to eliminating fatigue, starting at about minute 17

https://www.bitchute.com/video/Oh9lVVccWEwZ/

 

[RP McMurphy]

OP, I just watched the linked video with Dr. Shallenberger and he covers a lot related to eliminating fatigue, starting at about minute 17

https://www.bitchute.com/video/Oh9lVVccWEwZ/

Been listening, great share! Shallenberger is the father of ozone....which I'm a HUGE fan of....done it alot and it's helped me tremendously.

 

[tareload]

@Cataceous , I have read that AI are not very helpfull to control estradiol when it comes from HCG use, How much of this is true?

Decent thread starting here on down discussing letrozole vs anastrozole wrt to hCG. As usual all this was partially catalyzed by something I read that @Cataceous posted.

FYI.

Help/Advice Interpreting My Labs? Fertility After Blast/Cruise

Interesting mechanistic study from a while back. Great conversation @lordgains, thanks for your time. Credit to @cataceous at the other place.

forums.t-nation.com

The whole thread is decent if you are bored or really autistic.

 

[RP McMurphy]

Was hoping to get some input...
As a reminder I was having issues on TRT (decreased libido, high estrogen, increased bp, high hematocrit etc). Because of this I stopped injectable testosterone (after close to 2 years) on April 2, 2022 and began this restart protocol:
* 5 weeks of HCG 1500-2000 iu/week, followed by enclomiphene 25mg daily, M-F for 5 weeks; last dose June 23
*Since June 23 I've been taking 12.5mg of enclomiphene daily, as well as Natesto around 2x/day (1 spray in each nostril twice a day)

Here is my latest labwork from July 28th, 2022:

Testosterone	425 ng/dL	123 - 814 ng/dL
Sex Hormone Binding Globulin	58.8 nmol/L	14.6 - 94.7 nmol/L
Testosterone, Free	5.88 ng/dL	3.06 - 15.20 ng/dL
Testosterone, % Free	1.4 %	1.0 - 2.8 %
Testosterone, Bioavailable	137.8 ng/dL	72.0 - 355.0 ng/dL
Testosterone, % Bioavailable	32.4 %	23.6 - 65.8 %

Dihydrotestosterone	54 ng/dL
Estradiol	26.7 pg/mL	<52.5 pg/mL

FSH

3.5 mIU/mL​

<=10.8 mIU/mL

LH

5.8 mIU/mL

1.2 - 10.6 mIU/mL

These numbers don't look great to me, especially free T, and I'm trying to figure out what to do next...I was hoping with a restart and while on enclomiphene I could get back to values that I had prior to TRT. I'm wondering if close to 2 yrs on TRT permanently blunted my endogenous production. I've regained a bit of libido, but it's not comparable to what it was prior to starting injectable TRT (and for the first year+ on TRT).

Some thoughts:
*Maybe my labs don't looks so hot given the short half life of Natesto, and when the Natesto is in my system the labs would look better? When are you supposed to run labs when on Natesto?
*One consideration is getting back on TRT but at a reduced dose, say 7.5 mg/day rather than 10, and see how I feel on that, as suggested by @Cataceous
*Also tempted to cycle injectable TRT with HCG 8 weeks on, and HCG or enclomiphene (potentially with Natesto) for the other 8 weeks in an attempt to help maintain production of my upstream hormones
*Another option is to continue with the current protocol (enclomiphene + natesto) for a bit and see where I land...

Any thoughts would be greatly appreciated. @Nelson Vergel @Cataceous @Systemlord

 

[Nelson Vergel]

I don't understand what your end point or goal is. Normal hematocrit with total T over 500 ng/dL and free T of at least 2 percent? Sperm production? I still don't get it. Sorry.

 

[RP McMurphy]

I don't understand what your end point or goal is. Normal hematocrit with total T over 500 ng/dL and free T of at least 2 percent? Sperm production? I still don't get it. Sorry.

Fair point, Nelson. My goals would include:
1. Subjective well being: energy, physical output, return of libido
2. Labs: Free T mid-reference range or above, with hematocrit within rr, estrogen within rr, no rise in BP
3. Doing what I can to maintain endogenoous feedback loops

Thank you!

 

[Cataceous]

...
*Maybe my labs don't looks so hot given the short half life of Natesto, and when the Natesto is in my system the labs would look better? When are you supposed to run labs when on Natesto?
...

The product monograph calls for testing between 20 minutes and two hours post-administration. Eyeballing the graphs, I'd say peaks average about 45 minutes to an hour.

Official Natesto Thread

Welcome to the Natesto thread. I have used Natesto on an off for several years, but it seems to be one of the less popular TRT options here. That said, I have seen a few readers mention it, and I thought it would be good to start a dedicated thread on Natesto where people can share their...

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