Hello everyone.
Like most of you probably, I am an avid consumer of the information free-for-all we call the internet, and when I first learned that my testosterone levels were low, I scoured the web for hours upon end, realizing very quickly that there are a lot of people with strong opinions about TRT, but seemingly few that grasp the endless subtleties and intricacies of the human endocrine system. All this to say I am fortunate and glad that I found excelmale.com - it has been a source of clear and reasonable voices on the topic of TRT.
Though I have read many of the forum posts, this is my first time posting, so please forgive me if this should be posted somewhere else. I'll gladly repost to the proper place if needed.
I am a 33 yo IT professional with two young children (3 year old son and 3 month old baby daughter). The last few years I have struggled with (what I now know to be) low testosterone symptoms. Low energy. No drive. Nonexistent libido. Fuzzy logic and inability to make important decisions. Weight gain. Declining gym performance. All of it. When I needed it most, my sense of manhood quite literally disappeared. My relationship with my fiance is hanging on by a thread. I recently lost my job. Worst of all, I can't keep up with my kids, and instead of enjoying them as I should be, caring for them has become an energy zapping ordeal that I often find myself dreading. Hard to admit this, but it's true. Even the most enjoyable parts of life can become a chore when your energy level is in the toilet.
I am 6'-0" and weigh about 260 lbs. Up until my late 20's, I weighed between 210 - 220, but then abruptly put on 40+ lbs that I have lost and gained back several times, never able to keep it off long. I workout daily. Weights 3 - 4 days/wk and light cardio on off days. Right around when I gained the weight, I lost my libido and my sense of self confidence.
I struggled for the last few years and about 7 weeks ago, my PCP drew labs to look at my thyroid. I asked that he also check my total testosterone while he was at it. My tT came out to be 231 (ref range 250 - 827). My PCP was not able to give any recommendation on what to do but gave me a referral to a local endocrinologist. I had to wait 6+ weeks to see the endo, so I found an anti-aging doc and told him about my recent blood test. He recommended that I get further blood work (see below) and suggested I start clomid @ 25 mg / day, which he promptly prescribed. I started the clomiphene the next day (June 22) @ the recommended 25 mg dose. After a bit of research I decided to reduce my clomid dose to 12.5 mg EOD (so 1/4 the prescription amt). After about 4 - 5 days or so I began to have an intense headache, which progressed to get worse each day. I had not changed anything else and the headaches were not going away so I was pretty sure that clomid was the cause. I halted the clomiphene and the headaches went away within 24 hours or so. In all I believe I took about 75 - 100 mg of clomid, in total.
These were the labs, pre-clomid:
June 2:
June 21 (day before starting clomid):
I was not able to have a follow up appointment with the anti-aging doc to discuss the clomid headaches or to discuss the new labs from 6/21 and moved from CA to Oregon about two weeks ago. I found a local trt clinic in the Portland area and had my first appointment on 7/14 and had more blood work done there:
7/14 (2 weeks post clomid) - LabCorp:
*this was not in the lab report, but Dr. wrote it in
When I reviewed the most recent labs (7/14) with my new doctor, based on my low testosterone level coupled with high LH (9.4), he determined that I had Primary Hypogonadism, which I now understand to mean that the problem is with my testes and not my HPTA axis. He also suggested that I was smart to have stopped the clomid when I did and that the headaches may have been related to the clomiphene pushing already high LH levels even higher. I asked whether the high LH from the 7/14 labs could have been effected by the clomid, which I had stopped taking two weeks beforehand, and he said that it was highly unlikely that it could have boosted LH that high considering the short time I took it (about one week total) and the low total dosage (75 mg all together). From what I can tell, seems like he is right that clomid would not have such a drastic effect over such a short period of time, especially considering labs were taken 2 weeks after stopping. However, it looks like my labs from 6/21, 3 weeks prior, showed LH was at 4.1.
Until the doctor told me about my high LH levels, based on everything I had read, I thought I was likely to be secondary. I had a few head injuries from motorcycle and car accidents. I also used painkillers daily for the past few years. So I was not surprised to learn I was hypogonadal, but I was not expecting the Primary diagnosis (any thoughts on this would be appreciated). Is it normal for LH to fluctuate to such a degree (more than doubled in 3 weeks from 4.1 to 9.4)? Could clomid from 2 weeks prior still be effecting LH values? The new doctor here in Oregon suggested that I start TRT immediately, which I began on 7/18.
The doctor prescribed:
At this point, my main questions/concerns are:
Thanks in advance, any input is appreciated. Lots to learn!
Like most of you probably, I am an avid consumer of the information free-for-all we call the internet, and when I first learned that my testosterone levels were low, I scoured the web for hours upon end, realizing very quickly that there are a lot of people with strong opinions about TRT, but seemingly few that grasp the endless subtleties and intricacies of the human endocrine system. All this to say I am fortunate and glad that I found excelmale.com - it has been a source of clear and reasonable voices on the topic of TRT.
Though I have read many of the forum posts, this is my first time posting, so please forgive me if this should be posted somewhere else. I'll gladly repost to the proper place if needed.
I am a 33 yo IT professional with two young children (3 year old son and 3 month old baby daughter). The last few years I have struggled with (what I now know to be) low testosterone symptoms. Low energy. No drive. Nonexistent libido. Fuzzy logic and inability to make important decisions. Weight gain. Declining gym performance. All of it. When I needed it most, my sense of manhood quite literally disappeared. My relationship with my fiance is hanging on by a thread. I recently lost my job. Worst of all, I can't keep up with my kids, and instead of enjoying them as I should be, caring for them has become an energy zapping ordeal that I often find myself dreading. Hard to admit this, but it's true. Even the most enjoyable parts of life can become a chore when your energy level is in the toilet.
I am 6'-0" and weigh about 260 lbs. Up until my late 20's, I weighed between 210 - 220, but then abruptly put on 40+ lbs that I have lost and gained back several times, never able to keep it off long. I workout daily. Weights 3 - 4 days/wk and light cardio on off days. Right around when I gained the weight, I lost my libido and my sense of self confidence.
I struggled for the last few years and about 7 weeks ago, my PCP drew labs to look at my thyroid. I asked that he also check my total testosterone while he was at it. My tT came out to be 231 (ref range 250 - 827). My PCP was not able to give any recommendation on what to do but gave me a referral to a local endocrinologist. I had to wait 6+ weeks to see the endo, so I found an anti-aging doc and told him about my recent blood test. He recommended that I get further blood work (see below) and suggested I start clomid @ 25 mg / day, which he promptly prescribed. I started the clomiphene the next day (June 22) @ the recommended 25 mg dose. After a bit of research I decided to reduce my clomid dose to 12.5 mg EOD (so 1/4 the prescription amt). After about 4 - 5 days or so I began to have an intense headache, which progressed to get worse each day. I had not changed anything else and the headaches were not going away so I was pretty sure that clomid was the cause. I halted the clomiphene and the headaches went away within 24 hours or so. In all I believe I took about 75 - 100 mg of clomid, in total.
These were the labs, pre-clomid:
June 2:
- Total T: 231 (250 - 827)
- Free Thyroxine (t4): 1.0 (0.8 - 1.8)
- Free t3: 3.0 (2.3 - 4.2)
- b12: 355 (200 - 1100)
- Folate: 16.3 (normal >5.0)
- TSH w/REFLEX to FT4: 1.15 (0.4 - 4.5)
June 21 (day before starting clomid):
- FSH: 6.3 (1.6 - 8.0)
- LH: 4.1 (1.5 - 9.3)
- Total T: 387 (250 - 1100)
- Free Testosterone: 49.4 (46.0 - 224.0)
- Bioavailable T: 108 (110.0 - 575.0)
- SHBG: 33 (10 - 55)
- Albumin: 4.8 (3.6 - 5.1)
- SHBG (again, same day, not sure why they did this): 35 (10 - 50)
I was not able to have a follow up appointment with the anti-aging doc to discuss the clomid headaches or to discuss the new labs from 6/21 and moved from CA to Oregon about two weeks ago. I found a local trt clinic in the Portland area and had my first appointment on 7/14 and had more blood work done there:
7/14 (2 weeks post clomid) - LabCorp:
- TSH: .884 (.45 - 4.50)
- Free t4: 1.2 ng/dl (.82 - 1.77)
- LH: 9.4 mIU/mL (1.7 - 8.6)
- Prolactin: 4.2 ng/mL (4.0 - 15.2)
- hematocrit: 46.1% (37.5 - 51.0)
- PSA: .2 ng/mL (0.0 - 4.0)
- Testosterone, serum: 346 ng/dL (348 - 1197)
- SHBG: 39.3 (16.5 - 55.9)
- Estradiol: 27.7 pg/mL (7.6 - 42.6)
- Free T*: 5.86 ng/dL (9 - 29)
- glucose, serum: 84 mg.dL (65 - 99)
- AST: 20 (0 - 40)
- ALT: 26 (0 - 44)
*this was not in the lab report, but Dr. wrote it in
When I reviewed the most recent labs (7/14) with my new doctor, based on my low testosterone level coupled with high LH (9.4), he determined that I had Primary Hypogonadism, which I now understand to mean that the problem is with my testes and not my HPTA axis. He also suggested that I was smart to have stopped the clomid when I did and that the headaches may have been related to the clomiphene pushing already high LH levels even higher. I asked whether the high LH from the 7/14 labs could have been effected by the clomid, which I had stopped taking two weeks beforehand, and he said that it was highly unlikely that it could have boosted LH that high considering the short time I took it (about one week total) and the low total dosage (75 mg all together). From what I can tell, seems like he is right that clomid would not have such a drastic effect over such a short period of time, especially considering labs were taken 2 weeks after stopping. However, it looks like my labs from 6/21, 3 weeks prior, showed LH was at 4.1.
Until the doctor told me about my high LH levels, based on everything I had read, I thought I was likely to be secondary. I had a few head injuries from motorcycle and car accidents. I also used painkillers daily for the past few years. So I was not surprised to learn I was hypogonadal, but I was not expecting the Primary diagnosis (any thoughts on this would be appreciated). Is it normal for LH to fluctuate to such a degree (more than doubled in 3 weeks from 4.1 to 9.4)? Could clomid from 2 weeks prior still be effecting LH values? The new doctor here in Oregon suggested that I start TRT immediately, which I began on 7/18.
The doctor prescribed:
- Testosterone Cypionate @180 mg/week (90 mg e3.5) [+ 300 mg injection 7/18, then begin @180/wk yesterday 7/25- is this normal??)
- Anastrazole @ 1.25 mg 24 hours after each T injection, so 2.5 mg / week (this seems like a lot??)
- HCG @ 500 mg 24 hours prior to each T injection, so 1000 mg / week
At this point, my main questions/concerns are:
- Am I actually primary hypogonadal or is the clomid responsible for LH of 9.4?
- Is 180 mg of Test C/week broken up into two doses e 3.5 days a good dose for me to start at?
- Is 2.5 mg Anastrazole too much for this protocol? How about the timing of 24 hours post T injection? should I be taking Anastrazole yet or should I wait until I see how the Test alone effects my e2 before?
- HCG at 1000 mg/week a reasonable dose? Should I even be taking HCG if I do not plan on having any more kids for at least a year or two from now? (Doctors assistant I met with yesterday said taking HCG would protect me from crashing T if I ever decided to stop TRT - is she right about this? Sounds tgtbt)
- Does this doctor seem like he knows his shit or should I look elsewhere? My next appointment is for labs in 8 weeks. (Any recommendation for docs in the Portland, OR area would be appreciated, too)
- When might I expect to begin noticing effects of TRT? Any effects that come on first usually?
Thanks in advance, any input is appreciated. Lots to learn!
