lowTengineer looking for help

[Nelson Vergel]

Numbers look good. Get free T3 and free T4 done next time. It's not rare to see increases in TSH in TRT users.

How are you sleeping? Have you tried low dose Cialis or increasing your HCG dose to 500 IU every other day?

 

[Weasel]

Personally i think your numbers look pretty good. Honestly the only thing that would concern me personally would be the BioT and FT numbers, bother double the top of the range.

 

[lowTengineer]

Numbers look good. Get free T3 and free T4 done next time. It's not rare to see increases in TSH in TRT users.

How are you sleeping? Have you tried low dose Cialis or increasing your HCG dose to 500 IU every other day?

When I get free t3 and free t4 tested is it also a good idea to test tsh at the same time, or does it not matter what tsh says?

I sleep pretty great. For the most part I can sleep through 1 and/or 2 toddlers screaming and arriving in our bed. Any middle of the night wake ups for me are due to a kid.

I have not tried low dose cialis. My thought was I should try and get my high free t and bioavailabe t, and probably likely free e2 down before resorting to another medication.

I have also not tried increasing hcg. I added the hcg in sept. due to pain from atrophy that lasted for the first 12 months. I added it and in 2 weeks the pain was gone. I lowered it last time and thought I would try and lower it again. Its the most expensive thing in my protocol that I'd love to get as low as possible.

Personally i think your numbers look pretty good. Honestly the only thing that would concern me personally would be the BioT and FT numbers, bother double the top of the range.

Last time they were high so I dropped my weekly dose 10% but the injection frequency increased from 3x to EOD. It looks like the 2 changes together resulted in staying the same.

 

[lowTengineer]

Have you considered looking at prolactin levels? All that data and this one is left out for some reason.

I had prolactin tested back when I was originally diagnosed with hypogonadism. Since it was fine then I have not rechecked it.

 

[Vettester Chris]

Yes, get everything done at one time with TSH, FT3, FT4 and RT3. It would also be good to know your antibodies TPO & TgAb, since there are fluctuations in the TSH.

 

[lowTengineer]

After my Jan appt we discussed lowering my test dose a little (48mg to 40mg EOD) and see how I feel with e2 slightly lower. Back to april of 2018 my e2 was 70, then 40, then 30 most recently. He wanted to see if I felt better closer to 20. He told me if I didn't like how I felt to go back to 48mg.

I'm currently on week 6 of my new protocol:
40mg test cyp eod
240iu hcg eod
0.125mg anastrozole eod
25mg DHEA
iron supplement

I have lost most feeling in my penis. I get morning erections everyday, but after than goes away it doesn't happen until next morning. I can get an erection for sex but it takes forever to climax and it seems like I have lost sensitivity. My wife has tried sex 3 times this week and all 3 times I lost my erection. Is now the time for something like cialis?

After I lowered the dose I had acne pretty bad on my back for about 3-4 weeks. It did clear up in the last couple days.

I can't decide if I should get blood work to see where I am at since I know I don't like it. Should I get blood work now? I think it would be good to see if my free and bio t went down closer to range. Instead of increasing my t dose to raise e2, maybe I leave t dose lowered but reduce the AI to bring e2 back up.

At my last appointment we also discussed that I would add prolactin, dht, and the rest of the thyroid tests. Is there anything else?

 

[YBWV]

At my last appointment we also discussed that I would add prolactin, dht, and the rest of the thyroid tests. Is there anything else?

Almost unbelievable that you could be on TRT ~18 months, with high levels of hormones, but not getting where you need to be, and now your doctor might order these tests - Prolactin, DHT, Thyroids - like they're some sort of curiosity.

Look at the DiscountedLabs ED Bloods Panel - all these are included and for good reason - they are the essence of the matter and not a curiosity at all.

Looking at your protocol and symptoms, if I were you, I would discuss with my doctor the prospect of replacing some of the T Cyp with T Cream.
25 mg per day, 1 click of the 100mg/ml Cream dispenser, applied mostly to Scrotum with a small amount to shaft of Penis, would prospectively see improvement of the symptoms you descibe.

 

[lowTengineer]

Almost unbelievable that you could be on TRT ~18 months, with high levels of hormones, but not getting where you need to be, and now your doctor might order these tests - Prolactin, DHT, Thyroids - like they're some sort of curiosity.

Look at the DiscountedLabs ED Bloods Panel - all these are included and for good reason - they are the essence of the matter and not a curiosity at all.

Looking at your protocol and symptoms, if I were you, I would discuss with my doctor the prospect of replacing some of the T Cyp with T Cream.
25 mg per day, 1 click of the 100mg/ml Cream dispenser, applied mostly to Scrotum with a small amount to shaft of Penis, would prospectively see improvement of the symptoms you descibe.

I had prolactin tested at the time of diagnoses. Possibly it has changed. I don't know if testosterone has an impact on prolactin changing or maybe it can just go up on its own. 6 months ago I had a complete thyroid testing. At that time it was fine. Reverse t3 was a tiny buy high but they weren't convinced it needed treatment at that time.

DHT is the only thing in that list I haven't ever had tested. You mentioned the cream, is that because you suspect that my dht is low? If it isn't low would the cream still make an impact?

 

[YBWV]

DHT - your TT is ~1,100 so if you were converting to DHT @ 10% (the average for healthy eugonadal males) your DHT "should" be around 110.
Most Lab ranges top at 85-90 so that would put you above range; your other hormones are above range so why not DHT?

Yes, even if your serum DHT isn't low I still believe the T Cream could make a significant impact.
DHT in serum, according to studies, only gives a "hint" of activity in peripheral tissue (DHT is largely a paracrine - as opposed to endocrine - hormone). We know, from studies, that transdermal application, particularily to Scrotum, gives a disproportionately high conversion (via 5a-r) to DHT.

What precise effect the topical application of T Cream has in genital tissue I don't know.
I was looking for the answer to what the mechanism of action is when I, happily, stumbled across Excelmale.
I have seen enough anecdotal and empirical evidence to convince me that there are potential benefits to such topical application beyond the concomitant rise in serum DHT.

Prolactin - not routinely monitored but perhaps should be where sexual function issues persist in the presence of otherwise "good" Labs.

 

[lowTengineer]

I went to my local doctor and I had testing done at the end of 6 weeks. I was also given a script for 5mg cialis.

At the time of labs I was taking:
40mg test cyp eod
240iu hcg eod
0.125mg anastrozole eod
25mg DHEA
iron supplement

Here are the labs I had last week. I also am showing the same ones from last time just for comparison. Both times were taken on the morning of injection, prior to the injection.

			1/21/2019	3/8/2019
			48mg EOD	40mg EOD
total test	ng/dl	240-950	1120	1150
bioavailable test	ng/dl	72-235	526	524
estradiol, enhanced	pg/mL	10-40	31	28
DHT	pg/mL	112-955		700
prolactin	ng/ml	2.6-13.1	8.2 (Sept 2017)	4.7
TSH	miU/ml	0.300-4.000	3.0	1.8

The only change from the last labs was 48mg test EOD to 40mg EOD, everything else remained the same.

My DHT results have not come in yet. Its been 7 days and I was told today I should expect it next week. I'll update when it does come in.
edit: results came in. 700 pg/mL (range 112-955)

I am surprised by the unchanged t-level and very slight e2 lowering. I thought I was going to see my bio-t get closer to the top of the lab range. Based on the symptoms in my post on 2/28, I thought I was going to see my e2 much lower.

I think I should lower my test dose a little more to try to get bio-t closer to the range since it is still higher than double. I can't decide if I should lower to 36mg EOD, or should I go lower?

 

[lowTengineer]

I updated the table above. My dht result came in at 700 pg/mL (range 112-955). Isn't this pretty decent?

 

[YBWV]

As a standalone number 700 is decent and many guys would have good function at that level of DHT.
However with continued libido and erection issues you would potentially find improvement by getting the level up to ~10% of your TT; 1,100 (110 ng/dl).

 

[lowTengineer]

As a standalone number 700 is decent and many guys would have good function at that level of DHT.
However with continued libido and erection issues you would potentially find improvement by getting the level up to ~10% of your TT; 1,100 (110 ng/dl).

The prolactin was good too right?
I was thinking of lowering my dose to get free and bioavailable t closer to top of range. Do you think it's a good idea? I assume dht will also go down with it.

 

[YBWV]

A dose reduction might help. Your DHT would normally go down with a lower TT though the reduction would not necessarily be linear. Prolactin looks fine.
My belief remains that you should discuss your DHT levels with your healthcare provider.

 

[lowTengineer]

A dose reduction might help. Your DHT would normally go down with a lower TT though the reduction would not necessarily be linear. Prolactin looks fine.
My belief remains that you should discuss your DHT levels with your healthcare provider.

Sounds good. Thanks for the input. I was trying to decide on an appt with defy right now; or a dose change for 8 weeks, new labs, then an appt.

 

[madman]

As a standalone number 700 is decent and many guys would have good function at that level of DHT.
However with continued libido and erection issues you would potentially find improvement by getting the level up to ~10% of your TT; 1,100 (110 ng/dl).

The amplification pathway converts ~4% of circulating testosterone to the more potent, pure androgen, DHT (50, 52). DHT has higher binding affinity to (109) and 3-10 time greater molar potency in transactivation (110-112) of the androgen receptor relative to testosterone. Testosterone is converted to the most potent natural androgen DHT by the 5a-reductase enzyme that originates from two distinct genes (I and II) (113). Type 1 5a-reductase is expressed in the liver, kidney, skin, and brain, whereas type 2 5a-reductase is characteristically expressed strongly in the prostate but also at lower levels in the skin (hair follicles) and liver (113). Congenital 5a-reductase deficiency due to mutation of the type 2 enzyme protein (114) leads to a distinctive form of genital ambiguity causing under masculinization of genetic males, who may be raised as females, but in whom puberty leads to marked virilization including phallic growth, normal testis development and spermatogenesis (115) and bone density (116) as well as, occasionally, masculine gender reorientation (117). Prostate development remains rudimentary (118) and sparse body hair without balding is characteristic (119). This remarkable natural history reflects the dependence of urogenital sinus derivative tissues on strong expression of 5a-reductase as a local androgen amplification mechanism for their full development. This amplification mechanism for androgen action was exploited in developing azasteroid 5a-reductase inhibitors (120). As the type 2 5a-reductase enzyme results in over 95% of testosterone entering the prostate being converted to the more potent androgen DHT (121), blockade of that isoenzyme (the expression of which is largely restricted to the prostate) confines the inhibition of testosterone action to the prostate (and other urogenital sinus tissue derivatives) without blocking extra-prostatic androgen action. DHT circulates at ~10% of blood testosterone concentrations, due to spillover from the prostate (122-123) and nonprostatic sources (124). Whereas genetic mutations disrupting type 2 5a-reductase produce disorders of urogenital sinus derived tissues in men and mice (125), genetic inactivation of type 1 5a-reductase has no male phenotype in mice and no mutations of the human type 1 enzyme have been reported. Whether this reflects the type I enzyme having an unexpected phenotype or an evolutionarily conserved vital function, remains unclear. A third 5a-reductase enzyme (type 3, SRD5A3) has been described (126) but is widely expressed in human tissues, lacks steroidal 5a-reductase activity and has other roles in fatty acid metabolism (127).
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Take home point:

The amplification pathway converts ~4% of circulating testosterone to the more potent, pure androgen, DHT (50, 52).

DHT circulates at ~10% of blood testosterone concentrations, due to spillover from the prostate (122-123) and nonprostatic sources (124).

 

[lowTengineer]

Take home point:

The amplification pathway converts ~4% of circulating testosterone to the more potent, pure androgen, DHT (50, 52).

DHT circulates at ~10% of blood testosterone concentrations, due to spillover from the prostate (122-123) and nonprostatic sources (124).

Is this telling me that my dht of 6% is low?

 

[madman]

Is this telling me that my dht of 6% is low?

No as you stated "I updated the table above. My dht result came in at 700 pg/mL (range 112-955). Isn't this pretty decent?

The reference range is 112-955 pg/ml.....so the mean is 533.5 and your at 700.

......................................................................AMPLIFICATION PATHWAY
...........................................................................5α-reductase enzyme

Testosterone 5-7 mg/day--------------------------------------------------->DHT (5-10%)

 

[lowTengineer]

It's been awhile since I posted labs or updates. I have labs from 9/4/19 and 3/12/20 to compare.

At the time of labs I was taking:
36mg test cyp eod
240iu hcg eod (9/4/19) --> 400iu eod (3/12/20)
0.125mg anastrozole eod (9/4/19) --> 0 (3/12/20)
25mg DHEA
5mg tadalifil
iron supplement

Here are some of the major labs:

lab	units	range	9/4/2019	3/12/2020
hgb	g/dl	12-18	17.3	16.9
hct	%	42-52	48.4	47.7
glucose	mg/dL	70-105	111	102
a1c	%	4-6	5.1	5.5
SHBG	nmol/L	10-57	23	22
total test	ng/dl	240-950	755	633
free test	ng/dl	4.85-19	21.1	19
bio test	ng/dl	72-235	370	285
TruT calc			25.75	20.58
estradiol enhanced	pg/ml	10-40	23	30
estrone	pg/ml	10-60	27	42
ferritin	ng/ml	23.9-336.2	50.1	not tested

I felt great in Sept 2019. I had been on that protocol for 6 months, so I didn't make any big changes. I did stop taking the small dose of anastrozole. I was slowly tapering off the AI. I was feeling great still until about Feb 2020. I realize now that it was about 3-5 weeks after changing to a new vial of test from Sun Pharma. I started feeling tired after noon into the evenings.

After my consult with Defy, I was recommended to change my dose up to 40mg EOD test until this vial is gone. (If I was going to stick with testosterone only)

I have experienced back pain most of my adult life for an unknown reason. It has gotten way better since I lift weight everyday (except now due to the damn covid19). I have been prescribed nandrolone to help with joint pains. I will take 20mg EOD (70mg/wk) and can go up if I need to. I was suggested to drop my testosterone from 40mg EOD to 30mg EOD. I'm excited to give the nandrolone a try. It arrived today so that was exciting.