Newb from PeakTestosterone forum - low t since 15 - years old

[chriskchris]

Good day everyone

Came across this site when looking for a replacement to PeakTestosterone forum thanks to a note from Nelson Vergel.

I've had low T- since around 15-years old - secondary. Now 38. Still never found the culprit but have tried multiple treatments (clomid, hcg, now on testosterone cypionate) with regular bloodwork over the past decade.

Recently my drugs have failed me. I don't have any evidence of high e2 but can't think of anything else.

Will be pursuing a new regiment with multiple injections per week and hopefully come across some good feedback on this forum from others who have tried this. I am out of tricks and it is frustrating to have inconsistency.

Thanks.

 

[Cataceous]

Welcome to ExcelMale—we probably interacted over at PeakTestosterone, as that's where I started too.

If you like, share some details about your situation: Previous protocol, new protocol, lab work, and what you mean by "drugs have failed" you.

 

[chriskchris]

Welcome to ExcelMale—we probably interacted over at PeakTestosterone, as that's where I started too.

If you like, share some details about your situation: Previous protocol, new protocol, lab work, and what you mean by "drugs have failed" you.

Hi. Yes, you were a great help over there for many and I do remember you. Very happy to see you active here continuing on with the mission. My handle was ChrisCanada.

My original dose was 200 mg every 2-weeks of Cypionate; like many, I swung to 100 mg every week before that felt like it tapered off from working. Did that dose for about 6-years since my experience with Clomid (which had worked but caused E2 problems.)

In the past couple months I increased my dose to 140 mg/ week via one shot. For the first few weeks it worked like nothing before, but stopped bringing my symptoms to as bad as they were when my E2 skyrocketed on Clomid. Could swallow an entire pack of Viagara and nothing would work - constant feeling of tiredness. Cold, lifeless penis, a hallmark symtom of low testosterone (or high e2) from my experience.

LABS (January 10):
E2: 88 PMOL/L
PROLACTIN: 17.3 UG/L
TESTOSTERONE (FREE): 17 NMOL/L (on day 6 after injection)
BIOAVAILABLE TESTOSTERONE (FREE + WEAKLY BOUND): 12.44 NMOL/L (HIGH)

I felt pretty good on these labs but have now the opposite effect quickly. Was getting morning erections again and feeling energetic at the gym/jogging, but now feel like I have out of testosterone again or high e2, even though my last test was normal e2.

So, I feel like after all these years I am out of tricks. Thanks to the online advice I've read from forums like this, I think my next step will be to break down my dose with two IM injections per week of 60 mg cypionate. Something I've never tried before

Would definitely appreciate your advice as always.

 

[Cataceous]

What you describe is not so unusual, at least based on reports in the forums. I went through something comparable. My hypothesis is that these difficulties are the eventual result of TRT's disruption of other hormones. The other hormones can include LH, FSH, GnRH, kisspeptin, DHEA, progesterone, pregnenolone, cortisol, aldosterone, T3, T4, prolactin and SHBG. Treatment consists of trying to return to levels that are appropriate for your physiology. As we generally don't know what these levels are, a first order approximation is average levels for healthy young men. Now I'm not advocating an attempt to micro-manage everything—as this gets complex and impracticable in a hurry. There are some simpler approaches, still requiring patience.

It does make sense to start with a variable that's easy to control—the testosterone dose. Did you mean to say that 17 nMol/L is your total serum testosterone? That would make more sense, and implies that your peak may be over 35 nMol/L, which is very likely above what's natural for your physiology. So the first order of business is to dose such that your testosterone stays physiological throughout the dosing cycle. More frequent injections do help to smooth things out and allow lower, more natural doses. Your current protocol provides an average of 14 mg testosterone per day. The natural production range is more like 3-9 mg. Therefore it behooves you to also lower the dose as you increase the injection frequency. Possible protocols include 50 mg TC twice a week or 24 mg EOD. Bear in mind that with dose reductions it's common to feel worse before feeling better, and the process can take months. However, many men do get better results after such reductions. I have a list of anecdotes here. If you have the patience then don't be afraid to try doses resulting in below-average levels. There are a lot of men functioning perfectly well with total testosterone in the range of 15-20 nMol/L. Ideally free testosterone is monitored to ensure similar results relative to reference ranges.

Your current prolactin is high enough to cause problems for some. It may improve as you lower the testosterone dose. You can also micro-dose some cabergoline to test whether pushing prolactin below 10 ng/mL is helpful. Personally I saw improvements when I pushed down prolactin this way, but they were limited in scope, as if I were only attacking one subset of symptoms.

I can't recall if you'd used hCG. That is something else to consider and is very helpful in some cases. But sometimes it's hard to find a dose that resolves some symptoms without causing other problems. I would start with 200 IU twice a week and increase slowly from there.

It's useful to measure progesterone. Sometimes this is low under TRT, and can be improved with supplementation via topical application or injections.

I've done all of these things and others without achieving my goals. This led me into a complex protocol that does try to "fix" many of the disrupted hormones. If I were starting over I would try a simpler approach, changing over to short-acting testosterone. Short-acting testosterone has the large advantage of greatly reducing the effects on other hormones. Research on Natesto, a testosterone nasal gel, has shown that the HPTA can continue to function, even as symptoms of hypogonadism resolve. So consider this as a possible backup plan if your other tinkering is unsuccessful. I'm not sure what's available in Canada. In the U.S. there is generic testosterone nasal gel for those finding Natesto to be too expensive. Compounding pharmacies also offer troches, which appear to provide similar pharmacokinetics to nasal gel, and might be more user-friendly for some.

 

[chriskchris]

I can't recall if you'd used hCG. That is something else to consider and is very helpful in some cases. But sometimes it's hard to find a dose that resolves some symptoms without causing other problems. I would start with 200 IU twice a week and increase slowly from there.

Thanks for the great information here, Cataceuous!

Yes, I did initially use HCG (1500 iu/week) which is how I fathered a child.

My hematocrit climbed on HCG.

There were times I felt unbelievably amazing and times E2 also climbed.

When I stopped, I never had elevated hematocrit or E2 again.

The rise of prolactin has been in the past few tests as I increased test-c dose.

Those results came from 140 mg/testosterone per week in one shot, which gave me the highest free testosterone levels I ever had in 7-years of HRT. Always on the very low side of SHBG and never had elevated albumin.

I will keep everyone posted and try to contribute here with my own results. It has been quite a ride. Bulked up tons since HRT, better endurance than ever, but sexual side effects still linger at times while being fully cured at times (after a near lifetime of problems stemming from early teenage years.)

 

[chriskchris]

What you describe is not so unusual, at least based on reports in the forums.

One thing I recently noticed with my results is that my SHBG is very low. Forgot to include it in the original post for this bloodwork but it came in at 14.6 nmol/l (ref range 13-71). Going back multiple years, my SHBG always came in low while my albumin never changed much within range.

Seen your old posts and others suggesting low SHBG means it could mess with half life time and cause higher free e2. My bioavail free testosterone was out of range this time (high) which is the first time I've seen this.

Noticed increasing my dose to 140 mg/cypionate a week has made me feel much worse after the initial week of being amazing. Total crash across the board.

Starting on Friday I will revert to 100 mg/cypionate a week and give it a couple weeks; if that does not work I will re-initiate HCG.

Running out of ideas but the low SHBG is one I did not ever notice until doing more extensive research of my own bloodwork.

I know the testosterone therapy "works" but I have never been able to master the dosage in my six years of HRT. Had it going fairly well with enanthate and hcg but then came the drug shortage so switched to cypionate, never mastered it since.

 

[Cataceous]

I had to add the following caveat to those older posts about low SHBG:

The premise of free estradiol increasing relative to free testosterone at low SHBG is based on an assumption of total estradiol being driven directly by free testosterone. But it seems more likely that free estradiol follows free testosterone, making total estradiol the dependent variable. In other words, neither free estradiol nor free testosterone changes much when SHBG is reduced in isolation. It's still plausible that lower SHBG leads to reduced androgenic activity relative to estrogenic activity—without a dependence on the free hormone levels.​

It should also be emphasized that SHBG does not affect the apparent half-life of an injected testosterone ester, which is tied to the absorption rate. Factors affecting the latter include the carrier oil, other excipients, injection site and activity level.

I still encourage you to explore doses that maintain serum testosterone in a physiological range. Chances are this will require a lower average intake along with more frequent injections.

 

[seppuku]

I'm guessing the Peaktestosterone.com site's now gone for good?

 

[Systemlord]

I felt pretty good on these labs but have now the opposite effect quickly. Was getting morning erections again and feeling energetic at the gym/jogging, but now feel like I have out of testosterone again or high e2, even though my last test was normal e2.

Pregnenolone deficiency can cause someone to not be able to tolerate an optimal levels of free testosterone. In this case, an optimal TRT dose causes - anxiety, overstimulation, restlessness, insomnia, high heart rate, feeling cranked.

If one lowers the TRT dose, above symptoms improve temporarily, then low testosterone symptoms resurface.

I also believe large to moderate dosages may be causing your inconsistent response to TRT. You may need small daily or every other day doses.

 

[Guided_by_Voices]

One thing I recently noticed with my results is that my SHBG is very low. Forgot to include it in the original post for this bloodwork but it came in at 14.6 nmol/l (ref range 13-71). Going back multiple years, my SHBG always came in low while my albumin never changed much within range.

Seen your old posts and others suggesting low SHBG means it could mess with half life time and cause higher free e2. My bioavail free testosterone was out of range this time (high) which is the first time I've seen this.

Noticed increasing my dose to 140 mg/cypionate a week has made me feel much worse after the initial week of being amazing. Total crash across the board.

Starting on Friday I will revert to 100 mg/cypionate a week and give it a couple weeks; if that does not work I will re-initiate HCG.

Running out of ideas but the low SHBG is one I did not ever notice until doing more extensive research of my own bloodwork.

I know the testosterone therapy "works" but I have never been able to master the dosage in my six years of HRT. Had it going fairly well with enanthate and hcg but then came the drug shortage so switched to cypionate, never mastered it since.

Following up on Cataceous' suggestion, I am one of the people on here who do better with lower dosages, specifically in the 50-90mg range. There is also some evidence that older men do not clear T as fast as younger men, and hence a lower dose produces higher levels over time, and that seems to be the case from my blood work. You may want to try a several week washout with only HCG and then go back to a lower dose such as 50-60mg per week. You may have always been at too high of a dose and will need to reset back to a more "normal" level.

 

[Cataceous]

I'm guessing the Peaktestosterone.com site's now gone for good?

Most likely. According to Nelson, Curt Moyer's widow would not provide full access to the servers, leaving him unable to maintain the site.