Long-term TRT

[sparverius]

I recently found this site. I wish I'd found it years ago. Here's my intro.

I'm 51. Seven years ago I was terribly run down. I was a fit endurance athlete but I could barely walk up a flight of stairs. I was really depressed. Went to the doc who did blood work and found low T (low end of normal range). Doctor's theory was that job stress was causing it. I wound up on 8 squirts of 1% Androgel. That worked fine but after a year I felt I should be better and I didn't want to be on TRT. So the next spring I tried to ease off, without much success. I tried it each spring/summer and the best I could do was 6 squirts and even then I could tell it affected my athletic performance. (T levels generally around 400). Last fall I decided I really wanted off and no longer had a stressful job so I got a recommendation for a local expert doc who put me on Clomid and Anastrozole. That was horrible- low T (250-350) and when he doubled the Clomid after three months, also high E. Suddenly I could understand chick flicks but I had no interest in sex. I gave up after 5 months and went back to Androgel.

Reading here it sounds like once you're on TRT, you're stuck on it for life. I wish my doctor had told me that at the beginning although I'm not sure what else I could have done. I wouldn't have messed around trying to get off it if I'd known it wouldn't work.

I went back to 8 squirts of 1%. Two months ago I switched to 1.62%. Doc prescribed 4 squirts saying that it's absorbed better so it should be equivalent. I'm sluggish and depressed and have low libido. Got my test results and I'm at 294 (this lab gives 129-767 as "normal" for 50 and over). I've had a couple instances of sudden severe depression, which has happened at other times I've been low. It's truly awful- you know that life is never ever going to get better and you'd kill yourself if only you could get up off the floor. I have an appointment tomorrow. I'm going to ask for more of the 1.62% stuff or go back to 1%.

These labs did not measure E but did check TSH (ultrasensitive) which was 0.02 u/ml on a 0.34-4.00 normal scale. Not sure what's up with that either.

Should I ask for HCG? Does it have significant benefits other than reversing testicular shrinkage (which I'm resigned to at this point. It's the least of my problems).

Since my Clomid/Anastrozole experience I have not felt as good as before, either athletically or libido-wise. Could it have damaged me permanently?

[warchild]

try for injections
measure E2 for sure
yes hcg keeps testes functioning and provides a good feel when taking with test
the clomid/adex could have made you not recover and but odds are it could just be your test was low and there is is no rebound for natural test.

[bass]

welcome here Sparverius! apparently you don't absorb the gel well enough, i highly recommend injection as most of us are on injections. you need a complete hormone panel to see whats going on then make decisions as to what you need done. typical TRT protocol is,

100-200 mgs test cyp ew, most o us split the dose to twice a week.
AI (anastrozole) 1 mg per 100 mgs test, split.
250 iu eod or 300 iu three times a week or 500 iu two twice a week two days before your test injection. hCG to keep your testis functioning and healthy. read about it in the stickies, also a new post by GDevine regarding hCG. good read!

if you live near Michigan try to see Dr. John Crisler or go to his website and learn more about TRT.

[kelkel]

Exactly what the above guys said. As a matter of fact, I just switched from agel to cyp yesterday. I went through the 1% then the 1.62%. I held out as long as I could but knew eventually I'd be on the shots. Had nothing to do with the good natured harassment from GD and Bass. TRT is for life. Accept it, read and learn all you can as you are in charge of your health, not your doctor. It would benefit you to post current bloodwork with ranges. Members here are very adept at interpreting them and will definitely help get you on the right path. Keep in mind that path may include finding a new doctor.

Welcome and good luck!

[bass]

Exactly what the above guys said. As a matter of fact, I just switched from agel to cyp yesterday. I went through the 1% then the 1.62%. I held out as long as I could but knew eventually I'd be on the shots. Had nothing to do with the good natured harassment from GD and Bass. TRT is for life. Accept it, read and learn all you can as you are in charge of your health, not your doctor. It would benefit you to post current bloodwork with ranges. Members here are very adept at interpreting them and will definitely help get you on the right path. Keep in mind that path may include finding a new doctor.

Welcome and good luck!

well you switched to the dark side, now we have to find someone else to harass!

[sirupate]

Yeah...maybe you should try the injections and see if that works better for you. The gels don't work well for everybody...and if you believe most here, the gels work well for darn few guys. If your doc won't go for the injections, find another doctor who will. Oh...and don't let the doctor tell you that you need to go to his office for the injections.

[sparverius]

E It would benefit you to post current bloodwork with ranges.

total testosterone: 294 (129-767 for 50 and over)
t3 free: 3.78 (2.3-4.2)
t4 free: 1.49 (.89-1.76)
TSH (ultrasensitive): 0.02 u/ml (0.34-4.00)
SHBG: 43.1 (13-71)

My thyroid hormones have been normal in the past, not sure what's up with the TSH.
The lab didn't measure E2 or bioavailable T. I'm going to ask the doc why these are not measured.

I've had good levels on Androgel in the past. 4 squirts of 1.62% is .081g of T. 8 of 1% is .01g. I'm not not buying that 4 squirts of 1.62 is the same as 8 of 1%.
I realize that I may eventually have to switch to injections but I am leery of the weekly up and down cycle.

How long after a change in dosage do you get tested to make sure it's working correctly?

[steroid.com 1]

I don't get your TSH assay at all! I have a suspicion that it's incorrect...and why an "ultra-sensitive"??? That's usually reserved for Estradiol (E2).

FT3 and FT4 are solid and converting well...FT3 is what your body uses and like to see this in the high range which you are.

Your Total Test is clinically low and your current protocol is doing you no good...very bad symptoms as you explained.

Are you Primary or Secondary Hypogonadal? I would guess the later...

IMO, you need to be completely reevaluated by a Physician who understands TRT protocols in men. This is so very critical to your health and well being for the rest of your life.

Do you know how to search for such a Doctor?

[steroid.com 1]

You need to see if your TSH level is correct; it's concerning it's so low.

Consider, the release of TSH is regulated by a TSH-releasing hormone (TRH) produced by your hypothalamus. The levels of TSH and TRH are inversely related to the level of thyroid hormone. So, when there is a high level of thyroid hormone in your blood, less TRH is released by your hypothalamus, so less TSH is secreted by the pituitary.

The opposite action will occur when there is decreased thyroid hormone in your blood. This process is known by many of us as a negative feedback mechanism and is responsible for maintaining the proper blood levels of these hormones.

TSH levels increase when the reserves for T4 and T3 are low and need to be replaced.

So, your 0.02 u/ml would suggest that your reserves are not an issue thus low levels of TSH.

If your thyroid is overactive and producing too much thyroid hormone (which it's not) -- due to disease, or taking too high a dose of thyroid hormone repla***ent drugs (which you didn't indicate that you are) -- your pituitary senses that there is too much thyroid hormone circulating. The pituitary then usually slows or shuts down TSH production, so that the thyroid will slow down its production of hormone.

This drop in TSH is an attempt to return circulating thyroid hormone levels to normal.

So, a TSH assay to measure the amount of TSH in your system will usually show lower than normal TSH when the thyroid is overactive.

So, in general, LOWER TSH = OVERACTIVE THYROID / HYPERTHYROIDISM.

But here's the kicker; your Free T3 & T4 are in the optimal range!!! This makes no sense for the ultra low TSH assay you presented.

You should contact your physician and see if this assay could be false.

[APIs]

Hey Kelkel, congrats. Did your current Doc agree to the Cyp or did you have to switch Docs? Just curious how you handled the situation. Might be beneficial to others to hear how you accomplished it...

[bass]

Hey Kelkel, congrats. Did your current Doc agree to the Cyp or did you have to switch Docs? Just curious how you handled the situation. Might be beneficial to others to hear how you accomplished it...

here is the post/thread!

http://forums.steroid.com/showthread...13#post5839413

[kelkel]

Hey API,

I have no doc issues at all anymore. 3rd doc's a keeper. Read that thread bass provided. I will update as I progress and post BW.

Merry Christmas!

Hey Kelkel, congrats. Did your current Doc agree to the Cyp or did you have to switch Docs? Just curious how you handled the situation. Might be beneficial to others to hear how you accomplished it...

[sparverius]

My doc thinks the TSH may be an error. He also agreed that the new dose of 1.62% is wrong, apologized and gave me a new script for a larger dose.
Doc thought that I'm primary hypogonadal but now isn't so sure. I'll be going to an endo next.

I'll also do another test in 2 weeks to check levels on the new dose.

[steroid.com 1]

My doc thinks the TSH may be an error. He also agreed that the new dose of 1.62% is wrong, apologized and gave me a new script for a larger dose.
Doc thought that I'm primary hypogonadal but now isn't so sure. I'll be going to an endo next.

I'll also do another test in 2 weeks to check levels on the new dose.

Did he test LH? If Primary this panel will be sky high!

TSH has to be an error...makes not sense given T4 & T3 levels.

Great news on the corrected dosage

Do you know what to ask for on your next test?

If not use this:

Total Testosterone
Bioavailable Testosterone
Free Testosterone
Estradiol (specify “sensitive” assay for males)
LH
FSH
CBC
Comprehensive Metabolic Panel
Lipid Profile
PSA
Progesterone
DHEA-S
SHBG
Coritsol
IGF-1

[PPC]

It seems you had pretty good results on 8 pumps of androgel in the past but your reason for stopping was that you didn't want to "need" that help, not because that dose of androgel didn't make you feel better?

Hopefully you can relax and realize that at 51, there is absolutely no shame in needing T. In fact you'll be doing your body a lot of benefit by using it rather than stressing about forcing yourself to make your own. Hormonal loss will happen as we age...it's the norm rather than the exception. I think the everyday aging person just doesn't address it and in the future it will be more "bread and butter," therapy for most people.

So even though the three legged protocol of T, HCG and adex works for a lot of guys, there are many that do great on gels alone. My husand is one of them. He has used androgel alone (6 pumps along with exfoliation) and feels better than with shots, HCG and constantly fiddling with anastrozle doses. Sometimes simple gets er done. If you're in this camp I'd suggest maybe going back to slapping on your 1% and congratulating yourelf that a simple protocol works for you.

[kelkel]

^^^^^very well said!

[sparverius]

My doctors theory had been that stress had caused my original low T, so I thought that switching to a less stressful job would enable me to "get better".
It's also not legal for competition in my sport. I know other guys are doing it, and I'm not good enough to compete in the elite events where there's testing, but I'd prefer to not be on it if that's possible. I now know that it's not, but if I hadn't tried I wouldn't know.

If I can get on the correct amount of 1.62%, which I think I am since my last dr's appt, I should be ok. The 1.62% absorbs faster than 1% (you can shower after 2 or 3 hours instead of 5 or 6) so it requires less planning of your life.

[moparmuscle]

If you switch to injections to them once every 5 days, should be very little "up and down", nothing noticeable for me anyway.

total testosterone: 294 (129-767 for 50 and over)
t3 free: 3.78 (2.3-4.2)
t4 free: 1.49 (.89-1.76)
TSH (ultrasensitive): 0.02 u/ml (0.34-4.00)
SHBG: 43.1 (13-71)

My thyroid hormones have been normal in the past, not sure what's up with the TSH.
The lab didn't measure E2 or bioavailable T. I'm going to ask the doc why these are not measured.

I've had good levels on Androgel in the past. 4 squirts of 1.62% is .081g of T. 8 of 1% is .01g. I'm not not buying that 4 squirts of 1.62 is the same as 8 of 1%.
I realize that I may eventually have to switch to injections but I am leery of the weekly up and down cycle.

How long after a change in dosage do you get tested to make sure it's working correctly?

[sparverius]

New numbers, after 2.5 weeks of 5 squirts 1.6% androgel (was 4):

total testosterone: 297 (129-767)
IGF-1: 137 (87-238)
SHBG: 45.1 (13-71)
DHEA-S: 133 (80-560)

FSH: 0.4 (1.4-18.1)
LH: <0.1 (1.5-9.3)

Prolactin: 4.4 (2.1-17.7)

PSA: 0.9 (0-4.0)
ACTH: 8 (7-69)
Estradiol, sensitive: 19 (3-70)

What is up with the LH and FSH, and why is total T so low? The same amount of T in 1% agel had me at 7-800 last year.

I have an appt. with a endocrinologist in a couple weeks.

[kelkel]

Your in HPTA shutdown so your LH and FSH will be like that. When was your BW pulled? 24hrs after application and consistent with the last pull? If not at the same time relative to application then your numbers will be skewed. I agree, on 5 pumps of 1.62% I would think you would be a bit higher, although it can/will range up and down due to stress, lack of sleep, diet, etc. If you matabolized the 1% well you'd think the 1.62 would be fine as well. Do you have numbers for free and bio T? DHT?

[sparverius]

Those are all the tests that were specified. My doc doesn't like to test for free T, he usually calculates it. I looked up the calculator but it needs SHBG and albumin and albumin wasn't tested this time.

Test was done at 11am. I applied at 6 or 7am. I've normally had the test done in the morning, around 9 or 10am, with similar time of application.

I've been training a good amount but only about 3/4 of what I've been able to handle in the past.

[kelkel]

It would be good to get complete BW next time. You can pull it from the stickies or Crislers website, www.allthingsmale.com. shbg and albumin are both proteins that your "bound" test will connect to. About 2/3 or so to shbg and 1/3 to albumin. It's the free T that gives us the bang for the buck and it would be great to actually get those tested. Bio-T is the gold standard.

I'd give it a little more time and re-test first thing in the morning, 24 hrs after application and be consistent with that draw time. That way you know your trough level. There will always be physiological changes that can effect results. I think with patience you'll get there. Keep us posted.

[PPC]

Strange. Now I have read quite a few anecdotal cases of guys having problems absorbing the new percent androgel when they did fine on the 1 percent. Wonder what is up with all this?

Do you apply this gel in a different application site - under the arms?

[steroid.com 1]

Where are your Thyroid panels?

This was of concern the first time around where the TSH panel was probably incorrect.

Did you get another TSH panel?

Honestly, and no surprise, I don't think the gel is absorbing...you'd present with much better ranges than this is so.

Why many go to IM...give it some more time but at almost 3 weeks you should see improvement and you didn't.

[DaRoq]

Do you apply this gel in a different application site - under the arms?

1% - Upper Arms, Shoulders, Abdomen
1.62% - Upper Arms, Shoulders

I've been wondering why the Abdomen is not indicated as an application site for the 1.62%, and the Chest not at all.

[sparverius]

Maybe they want you to avoid the chest to keep it off the nipples?

I'm puzzled that I did well on 1% and not so well on 1.62%. Other than the application site there should be no difference, just less inert material.

No other TSH test. I like this doctor but I am going to have to start insisting/educating.

[sparverius]

I think you guys are right about the gel not working. I've been on my old dose (8 squirts, 10g) of 1% for the last week and a half and my T has 'crashed' twice. Not pleasant. I was trying to hold out till the end of the week and get tested but it's not working, so I will be back to the doctor this week. Chances are I'll be injecting in the future, assuing he's ok with self-injecting.

What would cause the gel to lose effectiveness, especially when it worked ok before?

[sparverius]

Started injections last friday with 100mg/week of test. cyp. I ran low today and had to add some gel. I've been feeling low for the last day and a half but it got bad today. Will upping the dosage make it last longer?

My GP referred me to an endo who thinks that my pituitary is not working correctly. He thinks that the low FSH and LH in my last test, even though I'm on TRT, indicates that the pituitary is not putting out like it should. I have an MRI scheduled in a few weeks to check for damage (I've had some head injuries) or a tumor.

[kelkel]

You need to give it some time for the new protocol to work. One week is not enough and I would not keep adding gel just because you feel low for a day or so. Normal healthy people with normal T levels have off days to. TRT is not a guarantee that you'll feel great every day.

Do you have old bw to review lh and fsh levels for comparative purposes? And yes, using fsh and lh levels while already on trt is odd in that aspect but it seems like he wants to get a good picture of whats going on so go with it.

Also, like gd said, thyroid panels are important!