TRT- need help figuring this out.

[Trialstyle]

Background:
Tested for low T (15 Jun 12) with a Quest Diag. Tree/TOT, LC/MS/MS.
Results:
Total 252 ng/dl Reverence - 250-1100
Free 48 pg/ml Reverence - 35-155

This is the only test the Dr ordered at the time.

The Dr. started me on Axiron (7/12)- and used it for a month, my weight shot up 10lb to 195lb (with only doing pull-ups & push-ups as I was trying to take full advantage of the added Test).
At the end of July I asked about my weight and said that's it's likely the muscle gain and some water retention.
I voiced my concern about Axiron and the high cost of the stuff, and he allowed me to switch to Test Cyp. 100 mg/ml. at 1ml weekly with self injections (his idea). I had some information regarding the use of HCG and an AI. He assured me I wouldn't need the stuff, disputing that only people who got messed up from too much Test need it. I don't think he's educated in TRT enough to understand how it all ties together- no big surprise right?.


So starting in August is when things really started getting better, like libido and strength combined with a drastic lifestyle change for the wife and I to loose the weight. This later equated to some marked improvements in my last physical's blood work too.

I started by eliminating all alcohol, including beer, and did a GNC whole body cleansing "kit" following the included meal plan. We also started using an iphone app to track all meals.
I now weigh 177lb and still eating 2040 cal's recommended via the iphone app.
I've gained lots of strength by evident in my log book and the amount of pull up that I could do.
This increase evolved into crunches added to my normal pushups and overhand pull-ups. This would go on everyday even at work, with coworkers joining me.

At one point I was doing an average of 20 pull-ups a day and 60 push-ups and about 40 crunches. I was't doing pull-ups to failure and was only trying to get stronger by doing them daily.

So this brings me to where I'm at now,
My forearm was hurting near the elbow, which I eased up on the pull ups and work got busy and prevented the normal push-up routine. I've started feeling the lack of motivation and drive that I once had and lucky to get in 5 pull-ups and 30 pushups!


With my recent Dr visit I told him that I don't have the same "feeling" as I was experiencing when I first started. He said he'd order another test for my T levels, and if necessary would increase my T.

These are my recent Test results and have a normal liver function/physical info. Ask if you think there's some info that might be helpful.

Total T 1056 ng/dl Reference 250-1100
Free T 225 pg/ml *high Reference 35-155

So in trying to figure out what's going on I "tried" to order a blood test to E2 DHT and ended up with a test for total estrogen.
Here's the results-
Total Estrogen - 152pg/ml *high reference 130 or less
DHT E,LCMSMS - 35ng/ml Ref. 16-79
Free DHT 3.30pg/ml ref. 1.0-6.2

Since the results from the last test, 12/16, I split my dose, and do 2x week. I'm feeling better but think it's too early to tell.



That's everything to date. My fore arm is better, but still libido and strength seems to be failing to the point doing 30 pushups seems hard!
I have an apt with the Dr, on Thursday and want to order the correct blood tests.

Not sure what's going on, but would like the strength back!

What am I doing wrong?

Diet?
Laziness from not continuing my workout?

[kelkel]

Welcome Trialstyle. How old are you? And that is seriously all the BW your doc did before putting you on TRT? No offense but that's pathetic treatment. Many things can cause low T such as hypothyroid, cortisol issues, pathologies, etc. Many are correctable as well. Your doctor looked at one test level and treated the result without finding the causative factor. It would really have been nice to have a competent doc to search and find the root cause first. I asked your age to help determine if it's possibly just an age related decline in test production.

When it comes to your injection protocol. Initially the 100mg once per week was fine but your estrogen seems to have spiked up a bit. With higher or lower estrogen can come sides such as libido issues, joint pain, etc. Your next test needs to be an E2 Sensitive Assay, not total estrogens. Now, splitting your dosage will help to control your E2 as well as less injected at one time = less spike in E. Keep in mind though you very well may need a low dose AI to control your E2.

HCG should be part of your protocol as well. There is a very good sticky written by GD at the top of this forum. Read it and print it out. Get it to your doctor. Also show him Dr. Crislers HCG Protocol as well. You are in HPTA shutdown and the HCG will mimic LH production and keep your testicals functioning. Read that sticky and educate your doc. Many HCG inserts now state for Hypogonadic Hypogonadism. Alert your doc to this. HCG offers many other benefits as well.

Now, your total test level is great but your free T level is way high. Meaning quite honestly that you can probably lower your dosage to help bring it closer to range. Don't panic, it's a good thing. Less is more in the TRT world. Adjustments frequently have to be made based on BW, especially when ancillaries are added such as HCG and/or AI's.

Keep in mind also that TRT is a wonderful thing when needed. The question I have is was it really needed for you? Without complete BW and a competent doc you'll never know. If you have more pre-TRT BW please post it up. It may help us help you. When it comes to how you now feel, there's a sticky regarding what to expect when you start TRT at the top of the forum as well (GD again, he's everywhere.) It takes time to find balance with TRT. It also takes time to find a good doc. If yours won't help you further it is time to locate another that will. When it comes to BW check the Finding a Doc sticky for suggested BW.

When it comes to your joints hurting. It may be E related or may just plain be over use. It happens to all who work out. It's time to change routines. You can't expect to stay motivated and keep making progress doing the same thing over and over again. It won't happen.

Welcome Trial. Others will chime in. Slow day today for obvious reasons! Take time and read all the stickies please.

Kel

[Trialstyle]

Sorry, Im 48 years old. Been using the same Dr for a number of years now.

[Trialstyle]

I have a Dr. appointment tomorrow and will ask for the E2 sensitive Assay. Is there anything else I should have checked?
Is there a way I can use up the free T to get it lower? What is the recommended increments for lowering my dose? Should I reduce by half at each injection?

[kelkel]

Take a look at the Finding a Doc sticky and focus on the second set of BW there. Make sure you check your Vit D and DHEA-S as well. Eliminate the LH/FSH as it is really only needed one time after initiation of TRT. Regarding lowering your dose a thought would be maybe 40 & 40. Remember, as your E2 comes down your T will rise as well.

[Trialstyle]

I can't find a Estradiol sensitive at a quest lab and The link is blocked due to my low post count, but Quest Diag test code 22434P / CPT code 82670 lists the Estradiol for males at ≤39 pg/mL. Is this the same test? questdiagnostics.com/testcenter/TestDetail.action?ntc=4021

[kelkel]

I believe, but don't quote me as I use Lab Corp, that Quests is called an "Ultra Sensitive Assay." I'd call the lab your going to and ask them if it's the test specific for males. If they're not sure, have them provide a number for someone who can.

[Torqued]

I believe, but don't quote me as I use Lab Corp, that Quests is called an "Ultra Sensitive Assay." I'd call the lab your going to and ask them if it's the test specific for males. If they're not sure, have them provide a number for someone who can.

I think the correct Quest test is this one:

Estradiol, Ultrasensitive, LC/MS/MS (30289)

http://www.questdiagnostics.com/test...89&labCode=SJC

[Trialstyle]

I've read somewhere not to use the ultra sensitive, but the looking at the quest diag. website, it lists the high range only 10 pg/ml less. <=29 pg/ml and <= 39 pg/ml respectively.
So I guess you expect to be somewhat low, than the ultra sensitive would be more accurate? Not sure how it will show if your up in the high 40's or 50's? I wouldn't want the test to come back with no data available because it was over by too much.

I've got some time to do more research, as my Dr suggested I should run my new lower dose 2x a week protocol ~ 6 weeks. He also was concerned that Insurance could start complaining with all the blood tests as of recent and he wants to clearly justify them for my benefit. He pointed out that my Total Estrogen (ordered by mistake) was high, so the results for the E2 will also be high - (don't need a new test to see that).

So today I also fired GNC store for any supplements. Tired of the games, silly sales/promos and general high prices for substandard supplements.
The wife and i went to a local vitamin/nutrition center that's well known for quality supplements. Thinking they would be more expensive, we actually got better vitamins including some Vit D-3 for less money. I was surprised the sales guy seemed knowledgeable about TRT and we talked about supplements & blood work - (He was spot on with ones I already had on my list and knew why I needed them). He said there's some stuff I can take to help lower E2 without an actual AI Rx.
I'm going back later this week to see what he has in mind.

We also talked about nutrition (Another area I need help). I'll try to find a place to start a new thread for nutritional help.

[kelkel]

We have nutrition and supplement forums here as well. Check them out. Also look at B6 to help with your E2.

[Trialstyle]

We have nutrition and supplement forums here as well. Check them out. Also look at B6 to help with your E2.

Thanks, I planned on doing that. People here are friendly, knowledgable & plenty of topics to keep one busy.

[kelkel]

It's a great place to learn and have fun as well! Stick around man! Pay it forward!