TRT + Thryoid

[sortingoutoptions]

I am looking for some experiences of others. I think my doc is not expert in TRT...

Me - mid 40's, no health issues. BMI high, but active and BP low, Sugar normal, PSA 1, etc. No insurance, no $.

Nov 2015 got a physical for first time in a few years.
All normal and good, except Thyroid (4.5) and testosterone(327). Doc put me on thyroid med and low dose test (100mg 1x/mo).

Feb 2016 - Thyroid good (.5). Test lower - 212. Altered injections to 100mg EOW.

April 2016 - Thyroid not checked, assumed stable. test 169.

So now that I am researching more, I know that I am on a low dose. Doc does not like high dose, and is GP so may not be up on TRT.

After discussing and admitting to not know why it is going lower, gave two options.
1 - increase to 100mg weekly
2 - go off for a month and see if it bounces back now that thyroid levels are normal.

[kelkel]

Your doc's not to sharp on all this. Unfortunately, doc's don't receive hormone training (much anyway) in med school so unless they pursue it on their own the education just is not there.

When you say thyroid 4.5, I assume you mean your TSH level? Hopefully your doc examined further thyroid panels than just TSH. That said, step one should have been correcting your thyroid. Hypothyroidism causes hypogonadism. Fix one, fix the other. Take some time and do some reading at Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment as it's a great site to learn from.

Regarding the test dose initially prescribed. It's ridiculous and indicates he does not know hormones at all. Test has a half-life of about 5-7 days or so and a terminal life of about double that, metabolism dependent. Meaning that once per week dosing is the minimum you need to do. A large majority of guys split their weekly dose in half and inject twice per week for even more stable serum levels. Take a look at the below chart regarding the metabolism of injected testosterone:





Your doctor doesn't like high doses. That's understandable, but it's not the dose so much as it's the frequency as the above chart shows. The reason it's "going lower" is simply due to metabolism. This ester of test is not made to last as long as his initial dosing protocol.

Re your options:

1. Increasing to 100 per week is good! After a month re-test for total test, free test (which is more important as it's what works for you) and E2 Sensitive. NOT standard estradiol (for women.) See how levels are and adjust accordingly. Consider the twice weekly protocol mentioned.

2. Going off for a month? Cold turkey I can only presume as he does now know hormones he's really not going to understand SERMS and protocols to stimulate your Hypothalamus / Pituitary to function again. SERMS (Clomid & Nolvadex) are used when guys come off a cycle to re-start their system. At a minimum in your case you should be prescribed Clomid for a period of time to accomplish this. Clomid on it's own is also used as a form of TRT and is effective. Then you'd have to monitor blood work to gauge effectiveness. Eventually stopping the clomid and seeing if pituitary function remains at an adequate level.

All that said, at your age it's arguably "your time" for TRT anyway. No one can definitively say you'll return to normal levels pre-TRT and thyroid issues. On top of that, I seriously think this is all beyond your doctors knowledge base. You've got a decision to make. Hopefully the above helps guide you. Let us know how things go on this thread please.

Welcome to the forum!

kel

[sortingoutoptions]

Thanks for the reply. My doc thought a small dose would 'jump start' normal production. I do understand half-life, which had caused me some concern and to do more research. When the numbers were bad, I found out a friend has been on TRT for 8 years, at 200mg/week. Wish I had just addressed the thyroid first, doing one then the other. The less fiddling with hormones the better as far as I am concerned. Now that I am where I am, I am going to double the frequency, then see how it goes. In the mean time I will look for other med providers that know more, but lack of insurance is a real hindrance to getting care. (Nothing affordable in the ACA, but that is not the topic of this thread).

Assuming I get on the 1x/week. If I test right before injection, how low is 'OK'? testing right after injection, how high is OK? I get that doing 2x/w would level out the peaks...

[kelkel]

Small dose of what to jump start production?

200 mg per week is high end TRT and seldom needed by guys. It can come with problems long term as well. Goal is to find a dose that you feel good on and to avoid estrogen blockers if possible. Hence the term "less is more" in TRT. It doesn't always work out but the goal is to try. Always start low and titrate up if needed. It's always easier than going over-board and then having to mitigate issues that arise.

Most guys do pull blood work the morning of injection but before they inject. This gives them their trough level. Testing other times is fine as well if you have an astute doctor who understands metabolism. Most are better simply sticking with the former for consistency. Plus, higher numbers may scare your provider! How low or high is ok will be between you and your doctor. Always try to judge by your free testosterone level, not total level as free is what works for you.

[sortingoutoptions]

small dose of testosterone.... obviously that was wrong.

I have no desire to go too high. Is 100mg/week a decent level?

I am not sure the difference in test from free to total. Whatever the standard blood test pulls is what I have. I do understand the concept of free and total. I was 169 exactly 2 weeks after prior injection of 100mg.

I appreciate the help. I will post numbers this weekend when I get them, and then whenever I test again in a few weeks.

[kelkel]

Yes, very wrong.
100 mgs per week is a perfect starting point.
Total T is just that. The sum of all bound, loosely bound and free T. Only a very small percentage of test is free for use. Usually around 2-4% at most.
Free T is what your body gets to use and what works for us, which is why it's most important.
The reason your test is so low on your last test is simply due to metabolism. It's why I posted the graph to give you a visual of it.

Post up with ranges when you can. Be glad to review it.

Best of luck!

[sortingoutoptions]

tested 5 days after 100mg injection.

testosterone, Free/total with SHBG testosterone - 535
sex horm bind globulin - 19
calc free - 14.9

all normal according to the lab reference...