Gel > Pellets > Injections: My lessions learned and need help with next steps

[sean1971]

Great forum and have learned a lot here, but need advice in getting dialed in – I’ve been miserable. I’m 45, 6-2, 225 lbs. I go to the gym 3-4 times per week. Try to jog a mile and left for 45 mins. I was diagnosed with low t two years ago by my primary physician. I had three consecutive tests that came back under 300 (mid to high 200’s). Those three tests happened over a six-month period – it was a frustrating wait until I was finally referred to an Endo who took another blood test which was also under 300.

First year: The endo put me on an underarm applied gel. After a week or so my nuts began to ache, energy improved some, libido improved some – some morning wood. But, after a couple weeks this all went away and I felt horrible (tired all the time, foggy brain, numb face, poor gym performance, gained weight). After a month endo took bloods and my t was brought up to 402, so she maxed out my dose and three months later my t was just over 600. I still felt horrible. Read about HCG and self-administered 250 iu 2x per week. This made me feel worse. Over several months of using HCG I realized that the day after my HCG injection I felt even more miserable. Went to a men’s clinic to get a 2nd opinion and total t was 1,025 and E2 was 124! Ouch! I’m guessing the HCG boosted my t some and threw my E2 out the roof. Clinic wanted to switch me to pellets, but I declined b/c they didn’t take insurance.

Second year: Went to a urologist and he took me off the gel and inserted 18 pellets in my ass. I could barely sit down b/c of the pain and it bleed through the bandage and pants for 5-6 days. I still felt horrible (tired, no libido, soft erections, poor gym performance…etc.). Total t was in the mid 600’s during the 3 rounds of pellets (new 18 pellets every 3 months, each pellet is the size of a grain of rice). I still hit the gym 3x a week but performance is poor. My weight has gone from 225 up to 255 during these two years – gained most of it in the first year. Some is muscle but most is water weight, I think. Blood pressure has gone up and Dr. says I’m getting close to pre-diabetic.

This week: I found a low t center that accepts my insurance ($30/weekly injection). With pellets still inserted the t-center took bloods and my t was 576. Nurse practitioner said her goal is to get me dialed in at 1,000 and will give an E2 blocker once my full bloods come back to confirm my E2 is high. During the same initial visit she gave me a 200 mg injection. I was somewhat concerned she was so quick to give me the injection without my full bloods coming back – but I did give her all my past blood work papers, so she wasn't in total neglect.

Three hours after this injection I felt amazing! Seriously – I haven’t felt that good in years. I was incredibly sharp mentally, wanted to hit the gym, and libido was just where I wanted it. I couldn’t keep sex off my mind and ended up masturbating three times that day. Erection was perfect – like I was young again. <------ please tell me I can feel this good again and help me get there.

Later that night I was in such a good mood I took the family to dinner and this is where it all fell apart. I had a soda, salad and ribs. Immediately after I ate I felt miserable again (tired, lazy, numb face, couldn’t sleep). Woke up this morning – felt ok, ate oatmeal, and before lunch I was miserable again and it’s late night and I’m still miserable but slightly better. I know sugar is a no-no, but, would it really set my E2 skyrocketing or is it something else? It’s my guess it’s a combination of things. I drink alcohol rarely, but when I do I feel horrible after (tired, numb face…etc.) – for those reasons I try to drink less than once per month. I assume my E2 skyrockets after drinking.

Please share any advice for when I go back to the t clinic next week – I really want to feel like I did a few hours after this week’s injection. I feel the clinic needs to lower my injection dose, give me an E2 blocker, add HCG – I need to tighten my diet, but anything else?

Sorry for the long post - I will be sure to get a copy of my bloods and post them here. Thank you.

[kelkel]

Sean can you post up a copy of your most current BW?

[Proximal]

Hey Sean. First off, PLEASE dont take this the wrong way, BUT, is there a chance there's some underlying depression going on too? I'm not a therapist, just at my age (58) have dealt with my own depression and now have 15 months of TRT under my belt. My personal observations was that the TRT alone did very little for my mood, even while I was trying to balance my E2. Just my 2 cents, and again, I was not trying to be insulting in any way.

[sean1971]

Thanks for the feedback and not taken the wrong way. Depression may be possible. I am irritable, tired, poor libido, lack of focus, and aches. But, I'm not definitely not sad or suicidal. I'm very upbeat and work hard at most of what I do (family, work...etc.). I'll mention this to the doc and see what she says. I get my bloods on Wed and will post them here.

Thanks again for the feedback.

[gymffiti]

Later that night I was in such a good mood I took the family to dinner and this is where it all fell apart. I had a soda, salad and ribs. Immediately after I ate I felt miserable again (tired, lazy, numb face, couldn’t sleep). Woke up this morning – felt ok, ate oatmeal, and before lunch I was miserable again and it’s late night and I’m still miserable but slightly better. I know sugar is a no-no, but, would it really set my E2 skyrocketing or is it something else? It’s my guess it’s a combination of things. I drink alcohol rarely, but when I do I feel horrible after (tired, numb face…etc.) – for those reasons I try to drink less than once per month. I assume my E2 skyrockets after drinking.

Thanks for the feedback and not taken the wrong way. Depression may be possible. I am irritable, tired, poor libido, lack of focus, and aches. But, I'm not definitely not sad or suicidal. I'm very upbeat and work hard at most of what I do (family, work...etc.). I'll mention this to the doc and see what she says. I get my bloods on Wed and will post them here.

Thanks again for the feedback.

I probably haven't got the answer to your underlying problem(s), but I noticed a couple of familiar things in your posts ...

For well over a decade I've suffered, pretty much all the symptoms you have described. It got so bad for me, that I started getting panic attacks.

Only last year did I find out I'd been living with Low T.

However, throughout those years of not knowing, I figured out that certain foods exacerbated my symptoms. So my coping strategy was to go through an Elimination Diet, to see which foods I was most intolerant to.

Even now, I feel both mentally & physically at my best, when I'm in a fasted state.

Even if you don't have food intolerances & IBS (as I do), it maybe worth taking a food allergy test. Or just take notes on how you feel, before and after you eat certain foods


Anyway, good luck with it all Sean

EDIT:

My convoluted point being ... Food intolerance doesn't only affect your digestive system

[Quester]

My mood is similar to your description. My BW from 5 Jan included DHT for the first time. All other sex hormones are in normal range, IGF-1 is low. Get DHtT checked with BW, also include Adrostenedione, cortisol, and DHEA (these three are the adrenals).

[sean1971]

Here is my blood work. Any feedback would be appreciated. I’m sure there’s a lot I need to work on, but where would be the best place to start?

I also wanted to add that the numbness in my face is likely due to another underlying condition. I saw a neurologist this week. He did more bloods and ruled out Lyme disease, low vitamin D and low B12. Those were all in-check.

The Neuro said the numbness is likely due a possible mini-stoke or more likely irritation with my Trigeminal nerve. My blood pressure has elevated since being on TRT to 140/100. Neuro said there is a blood vessel right next to the Trigeminal nerve and when my blood pressure rises the nerve becomes irritated and my face gets numb. Trigeminal Neuralgia usually causes face pain, but also could cause the numbness I am feeling says the neuro.

Also wanted to note that my TRT doc began 200 mg injections once per week and 250 iu of HCG 2x/week and this has made me feel much better than the gel and pellets.

EDIT: Wanted to note that since I switched to injections two weeks ago I've lost 8 lbs and down from 255 to 247 lbs. Mood and energy is up so definitely headed in the right direction.

Neurologist blood work (in addition to the attachment) is Hemoglobin A1C 5.9 (std range 4.8-5.6, >5.6 pre-diabetes), vitamin D 41.7 (std range 30-100 ng/mL), B12 566 (std 211-946 gp/mL).

Is 5.9 Hemoglobin a major concern? I obviously need to get out of the pre-diabetes range, lower sugar intake and lower blood pressure.

[flatscat]

Your doc said you were pre diabetic right? Maybe some of your symptoms are associated with your blood sugar levels.

[kelkel]

Your Hemo shows 13.9 on the lab report?
Be careful starting with 200 mgs per week. It's very high end TRT which most do not need. It's much easier to start at about a 100 per week and titrate based on BW. At 200 it's almost a guarantee that you will need an AI to control estrogen. Starting lower normally helps you to mitigate sides.

[sean1971]

Oh goodness, idk where I got 5.7 from. 13.9 is correct. I've been going every Monday for my TRT shot. The first Monday they gave me 200. The 2nd week I went and got my shot and went on with my day. The 3rd week (after seeing Kelkel's advice) I asked if 200 was too much for me and the PA said they gave me 200 the first week, 140 the 2nd week and will continue to get 140 until my next blood work.

I saw a neurologist about the numbness in my face and neuro scheduled an MRI which ruled out blood clot or mini stroke. Neuro said my high bp is likely aggravating my Trigeminal nerve and this is the root cause of the facial numbness. He gave me 300 mg Gabapentin daily and boom, after 1st day the numbness is gone. My bp is 130/85 in the morning when I wake up, but jumps to 145/100 around 11am and stays there until 11pm when I wind down. So, apparently stress, diet, weight and maybe trt is contributing to my high bp so I'm on an immediate mission to get it down - more cardio, improved diet...etc.

This forum is wonderful. I've read and learned so much. Ty