New labs. Not sure where to go from here? Need advice.

[MNguy]

Hi everyone, not my first post but this seemed the most appropriate section to post this. I just got my latest lab work back, first full set since august. I’m approaching my 2 year mark on trt and I’m wondering where I go from here? First year I was on test cyp 140mg/week and ranged up to 160 for a short period both with 2x/week and EOD protocols. I never consistently felt great, but I had some bursts here and there where I felt really good. Last may I decided to give the cream a try and see how that went. For me the cream was a roller coaster, but I definitely felt the the highs were higher than the cyp and they lows were about the same, maybe slightly worse. I tried various protocols on the cream, but I always noticed that I felt best a few days after a protocol change, then the effect tapered off (not uncommon from what I’ve heard). Also worth noting, my levels are much higher on the cream. Practically double that of the test cyp. I could never get above free T of 23 on cyp. Eventuality I stopped having the great highs with the cream and I mostly have just been feeling like crap these days. So, I am looking for a little guidance. I’m not ready to throw in the towel just yet, but it’s crossed my mind. Obviously by looking at my most recent labs one can easily tell my levels are too high. Other things I’m considering are low progesterone, high rt3, highish TSH, lowish B12, highish prolactin.

My protocol when labs were drawn is as follows: 2 clicks test cream scrotal application (100mg) all in the AM, 25mg T3 extended release, 400iu HCG 2x week. Low dose iodine, selenium and vitamin D.

Mostly what I’m dealing with is low libido, fatigue, lack of motivation, and sometimes a bit of brain fog.

I’m not looking to wake up everyday feeling like Superman with a 19 year old libido. But I would like to find some better consistency, more energy and vigor for life.
Basically, I feel I have several options: stick with a lower dose of cream and see how that goes. Switch back to injections and start completely fresh. Quit trt altogether. Not a fan of the last option, but there may come a day where I’ve had enough.

Any input would be awesome! Sorry for the super long post!

 

[Cataceous]

It does surprise me that your pretty hefty dose of T3 isn't knocking down rT3 better. It probably is a good idea to try a smaller dose of the normal-release form. As I recall, for me 10 mcg liothyronine cut rT3 in half, from around 23 ng/dL. This did seem to resolve my problem with later-day fatigue.

I've also had low progesterone and prolactin creeping up, and I've had all the symptoms you list. What worked for me to resolve these issues is easy to state, but potentially complex to implement: I try to make the hormones under my control look like those of the average healthy young man. It's not a perfect substitute for knowing exactly what's optimal, but it's reasonable if you consider evolutionary forces selecting levels that are more likely to make an individual be successful in life. Thus being average can be a good thing: although the term "average looks" is considered somewhat derogatory, the reality is that averaging the facial features of numerous individuals results in a composite that ranks high on appearance. It makes sense when you stop to think about it: faces that are excessively narrow or wide detract from appearance. So the corresponding argument for hormones is that if something is extreme, like testosterone > 1,500 ng/dL, then there's probably a price to be paid.

The easiest adjustments are supplementing with progesterone and reducing testosterone—normalizing levels in each case. Sky-high DHT may mean a return to injections. A little more complicated is restoring diurnal variation to testosterone. Do I know this is helpful? Not for sure. But does natural do it for no reason? If all goes well these changes also result in normalization of the downstream hormones, DHT and estradiol. At this point it may be necessary to look upstream to resolve remaining problems. HCG is used to replace the missing LH, with varying degrees of success. The vastly different half-lives is a significant issue. More speculative is that TRT's suppression of GnRH and kisspeptin can create problems with libido and sexual function. Unfortunately research is lacking in this area.

 

[MNguy]

As always, thank you for the very detailed reply! You have great insight. I’m beginning to think you may be correct. It’s easy to get the impression that more is better, especially over at the T-Nation forum where everyone seems to be on 200mg/week. But I’m thinking that getting my levels more natural might be the way to go. I am leaning towards a return to injections. It seems like you and a few others are having luck with a daily cyp/prop blend. Did it come pre mixed, or are you blending it yourself?

 

[Cataceous]

As always, thank you for the very detailed reply! You have great insight. I’m beginning to think you may be correct. It’s easy to get the impression that more is better, especially over at the T-Nation forum where everyone seems to be on 200mg/week. But I’m thinking that getting my levels more natural might be the way to go. I am leaning towards a return to injections. It seems like you and a few others are having luck with a daily cyp/prop blend. Did it come pre mixed, or are you blending it yourself?

I have to blend the esters myself. The compounding pharmacies are offering blends of 80% cypionate and 20% propionate, which is nowhere near enough propionate to create the daily hormonal variations seen in young men, with troughs about 40% lower than peaks. What works for me is to get half the testosterone from each ester. In the case of cypionate this means you need 0.837 / 0.7 = 1.2 parts cypionate to 1 part propionate, or about 54% to 46% by ester weight.

One hypothesis I've floated is that some of the benefits of testosterone are tied more closely to daily peak levels, as opposed to trough or average levels. Emulating natural testosterone variation also allows for use of more natural amounts of testosterone, which generally range from 3-9 mg per day, with 6-7 being typical. I'm currently taking 4.4 mg testosterone per day, which puts peak testosterone close to 700 ng/dL and troughs in the 400s.