My TRT Experiences and Log

[Blitz777]

Hello:

I have been diagnosed with low testosterone levels and as an otherwise healthy 27 year old athlete this is problematic. I am able to maintain strength, endurance, and an aesthetic physique despite low testosterone levels. My primary issues lie elsewhere. I will be keeping a log of my experiences, treatment choices, and results going forward as a resource for others.

First, let me provide my stats and background:

Currently:

Stats:
Age: 27.5 years
Height: 6'2
Weight 185lbs
Bodyfat: 8.9% according to "Bod Pod" readings
**That is a recent photo of me in my avatar

Cycle History
One cycle completed over five years ago. At 22 I ran a cycle of 500mg Test E EW split 250/250 Monday morning/Thursday Night. Also t-bol at 50mg ed for the first five weeks taken every morning.
PCT included 1000 i.u. hcG administered sub-q for 10 days four days after final Test E shot. Two weeks after last Test E shot clomid/nolva was administered 100mg/20mg for one week, 75mg/20mg for two weeks, 50mg/20mg for one week, 50mg/10mg for two weeks, 25mg/10mg for one week, 25mg/10mg EOD for one week.

HPTA Restart
Two years after culmination of PCT I had my hormone levels tested. Total Test and Free Test both came back low, comparable to the levels posted below. HPTA was a standard protocol including a staggered administration of hCG/clomid/nolva/naltrexone/arimidex that lasted 87 days in total.

Essentially, I am unable to retain acceptable levels entirely endogenously. I will require support in the form of injections, clomid/nolva/torem, hCG, and an AI.

Genetic Issues:
Both my father and paternal grandmother suffer from hypothyroidism. I raised this issue with my GP, Endo, and ND with no definite conclusions reached. All proclaimed, "it may be a contributing factor."

Supplements of Note:
I have been on a peptide regiment of 100mg Mod GRF1-29 with 50mg GHRP-2 and 50mg Ipam. for four months.
DHEA taken orally in pill form at 50mg each morning.
Other standard supplements and a multi-vitamin taken but none worthy of special mention.

Concerns:
Lack of Libido
Lack of "Zeal/Zest" in/for life. Not classic depression.
Poor sleep quality
Feelings of tiredness/fatigue. General lack of motivation (aside from gym-related pursuits where motivation remains high, oddly).

Blood Levels

Component: My Value: Ref. Range: Units:
TSH: 1.78 .34 – 5.6 uLU/mL
Test. Total: 205.71 241 – 827 ng/dL
SHBG: 29.6 13.3 – 89.5 nmol/L
Free And.Ind. 24.1 24.3 – 110.2 nmol/L
Test. Free: 5.2 9.3 – 26.5 pg/mL
E2 (Sensitive): 27.7 7.6 - 42.6 pg/mL
LH. Serum: 1.6 1.2 – 8.6 mIU/mL
FSH. Serum: 7.22 1 – 19 mIU/mL
Vit. D 25Hydro: 87.7 25 - 100 ng/mL
Prolactin: 5.9 2.6 - 13.1 ng/mL
Total Iron: 85 45 – 182 ug/dL
T Iron Bind Cap.: 284 252 – 460 ug/dL
% Saturation: 30 20 – 55 %sat
Ferritin: 137 24 – 336 ng/mL
WBC: 8.3 4.0 – 10 th/mm3
RBC: 4.62 4.4 – 5.7 mil/mm3


Essentially everything aside from Total Testosterone and Free Testosterone is in line. I underwent an MRI that revealed no growths or problems with/around the pituitary nor thyroid. At this point I was referred to an endocrinologist.

Endocrinologist:
Diagnosed me as suffering from secondary hypogonadism and made a recommendation of Test Cyp injections. Self-injections permitted at 3.5 day intervals. Raised the questions of clomid/toremifene/hcg in order to promote endogenous hormone production over exogenous administration. All non-injection type drugs were dismissed by endo outside of fertility usage as ineffective/unproven in the long-term.
Naturopath:
I'm not "big" in to the ND philosophy and associated limitations, but I have access to an ND that specializes in male hormone issues who will essentially permit me to chart my own treatment course in regards to protocol and the required prescriptions. Will prescribe AIs/hCG/etc so I may make use of this.

Continuing:

This is the crossroads at which I currently reside. I will be moving forward soon with a treatment protocol and will make sure to keep you folks apprised of my choice and the subsequent results.

If you would like any further information please don't hesitate to ask.

[steroid.com 1]

Hi Blitz - Nice post, everything we need and to the point.

Your LH, while in range, is very low and points to your low Testosterone serum levels.

For an otherwise healthy young male your LH should be at or near the top of the reference range.

I would like to see a complete Thyroid work up as well; beyond just TSH which doesn't really tell us much.

You appear to be shut down.

I don't see your estradiol assay, did you get that tested?

Make sure to add in HCG to your protocol and monitor E2.

[Blitz777]

Hi Blitz - Nice post, everything we need and to the point.

Your LH, while in range, is very low and points to your low Testosterone serum levels.

For an otherwise healthy young male your LH should be at or near the top of the reference range.

I would like to see a complete Thyroid work up as well; beyond just TSH which doesn't really tell us much.

You appear to be shut down.

I don't see your estradiol assay, did you get that tested?

Make sure to add in HCG to your protocol and monitor E2.

Thanks for the reply gdevine, I was hoping to hear from you.

I knew I'd forget to include at least one component. I had my e2 tested (sensitive assay.) and it returned a value of 27.7 pg/mL with a reference range of 7.6 - 42.6 pg/mL. I've also gone back and added that information to my original post.

I also raised the question of testing additional thyroid components (T3, T4, rT3) with my Endo but these were dismissed as unnecessary as he claimed my TSH and other associated levels were in line. His response may be inadequate, so I might insist on further testing or just do it myself.

[steroid.com 1]

E2 looks ideal!

We need to see Free T4, Free T3, Reverse T3 and Thyroid antibodies. Sometimes everything looks good till we look at RT3 and it tells an entirely different story about the Thyroid.

I think you should try an restart. Dr. Crisler uses low doses daily of clomiphene long-term and sees excellent increases in Testosterone serum levels in men who otherwise did not or could not restart.

He has sticky on his forum where you can read about his novel approach and therapy.

BTW, I'd go with your ND for your protocol, your Endo seems like an ass.

[Blitz777]

E2 looks ideal!

We need to see Free T4, Free T3, Reverse T3 and Thyroid antibodies. Sometimes everything looks good till we look at RT3 and it tells an entirely different story about the Thyroid.

I think you should try an restart. Dr. Crisler uses low doses daily of clomiphene long-term and sees excellent increases in Testosterone serum levels in men who otherwise did not or could not restart.

He has sticky on his forum where you can read about his novel approach and therapy.

BTW, I'd go with your ND for your protocol, your Endo seems like an ass.

I did run the HPTA restart. I respond well to hCG /clomid/arimidex , but as soon as I taper down and remove the drugs my TT and FT levels return to previous levels. After the full 87 day HPTA restart I discussed in my original post no permanent gains in hormone levels were realized.

[steroid.com 1]

Go with your ND and get better my friend!

[Blitz777]

Go with your ND and get better my friend!

Thanks for your input! I'll be making a final treatment decision by Monday and will make sure to keep the log going with my ensuing results.

Also, I will be attempting to secure a prescription for the compounded cream you came up with. Seems invaluable.

[HRTstudent]

My biggest concern for you would be fertility in the short term, say 2 years. If you are not interested at all in conceiving in the next 1-2 years then you really just need to decide what option you want to go for. You may do really well on low dose clomid. They have studied this across 3 years as well, and it's safe in that period.

Ive said before, if I could go back, I would trial low dose clomid just to see how it goes. It's a lot "easier" in many aspects.

[Blitz777]

My biggest concern for you would be fertility in the short term, say 2 years. If you are not interested at all in conceiving in the next 1-2 years then you really just need to decide what option you want to go for. You may do really well on low dose clomid. They have studied this across 3 years as well, and it's safe in that period.

Ive said before, if I could go back, I would trial low dose clomid just to see how it goes. It's a lot "easier" in many aspects.

That's the issue I'm currently grappling with. I respond to clomid while it's active in my system but retain no benefits ~1 month post cessation. I am considering toggling three months clomid/three months hCG to prevent any one compound from losing efficacy. Other than that I want to just get this situation dealt with and in that sense injects seem appealing.

Aside from that, I am not concerned with fertility in the short term but the long. I raised this issue with my Endo, who replied that fertility is feasible down the road through cycling off injectables/including hCG and clomid. He seemed rather cavalier about this issue, as if it flipping the fertility "switch" would be a relatively simple task.

[Blitz777]

Just returned from an appointment with my TRT doc (the ND). Enrolled in a program utilizing hCG , clomid, and anastrazole primarily in a final attempt to restart my HPTA. Blood was drawn for an initial blood test and results will be posted. A follow up blood test will be run three weeks after starting my restart protocol, again at six weeks (cessation of restart), and finally one month after all drugs have been removed. If no marked improvement is observed, I will move to test cyp injections accompanied by hCG. I will post the exact restart protocol and accompanying blood test results as soon as I receive them at my appointment next week.

[steroid.com 1]

Excellent!!!

You got a good plan my friend!

[Blitz777]

Well, I just have to chime in to further the idea of approaching docs/endos that are inexperienced with TRT cautiously. Today I exchanged follow-up messages with my endo, who as you may recall wanted to prescribe me test cyp injections without the use of hCG or an AI. He is not opposed to them scientifically and agrees that accredited studies have been published detailing the advantages of including such compounds, but that using them is not "standard procedure" and thus will not prescribe them.

Where I have major issue with his response is that he continues to push me towards testosterone injections exclusively, claiming that "appropriate dosages of testosterone cypionate can improve symptoms without suppressing the HPTA axis or atrophying the testicles. Fertility for you will not be an issue down the road."

I just don't see where he is finding data to support this. His approach is irresponsible, in my opinion.

[Blitz777]

Updated Labs
PSA: 0.0 ng/mL Reference Range: 0.0 - 4.0 ng/mL
Testosterone , Serum: 166 ng/dL Reference Range: 248 - 1197 ng/dL LOW
Free Testosterone (Direct): 4.5 pg/mL Reference Range: 9.2 - 26.5 pg/mL LOW
LH: 3.2 mIU/mL Reference Range: 1.7 - 8.6 mIU/mL
Estradiol: 11.5 pg/mL Reference Range: 7.6 - 42.6 pg/mL
Insulin -Like Growth Factor I: 241 ng/mL Reference Range: 75 - 275 ng/mL
TSH: 1.3 uIU/mL Reference Range: 0.450 - 4.50 uIU/mL
Cortisol (PM): 11.1 ug/dL Reference Range: 2.3 - 11.9 ug/dL
T3: 60 ng/dL Reference Range 71 - 180 ng/dL LOW

Treatment Protocol
150 i.u. HCG ed
.1 mg anastrazole eod
12.5mg clomid ed
1/4 grain (16.25mg) Nature-Thyroid ED for one week, 1/2 (32.5mg) grain for second week, 3/4 (48.75mg) grain for third week
5mg tadalafil 2x/day
*Contemplating* compounded cream of 50mg DHEA, 50mg Pregnenolone, 2mg L-Deprenyl ED in the AM

Blood tests scheduled in three weeks and then again in six.

My overarching concern is that clomid/hcg/anastrazole/thyroid meds will be an adequate bridge in the short term but I will inevitably be on the injectable testosterone variety of TRT sometime soon. I'm at peace with this.

[VTX1800]

I thought it was pointless to use clomid and hcg together? I was told that they will produce the same effect.??

[Blitz777]

I was surprised by my low T3 in light of healthy TSH. Will keep you posted on Nature-Thyroid effects.

[jssmc]

Any updates? I'm curious to see how your treatment went.