Considering TRT with Blood Work Questions

[Scrumhalf]

38 y/o former natty BB (very amateur) 185 lbs, ~ 8% body fat, clean diet, 3-4 training sessions per week, cardio, rugby (however many mediocre years I have left), etc.

I am embarking on TRT and have questions as to blood work and my physician's recommendations. I have spent many hours reading this forum and appreciate the time and detail many of you have invested in answering questions from guys like me.

Please see my posted results and the corresponding ranges, but here is the shorthand with the "feedback" I was given from my physician:

- Total T = 347 ("optimal range is 850-1200")
- Free T = 53 ("optimal range is 250-300")
- Estradiol = 31 ("should be reduced to 20-25")
- DHEA = 189 ("optimal 300-500")
- IGF 1 = 114 ("optimal 250")
- Glucose = 102 ("high from a 16 hr fast but likely due to coffee")
- T3 = 2.9 ("slightly deficient")

Physician recommendations:

- Test C - 150 mg/week split between 2 semi-weekly injenctions
- iPamoralin (0.3mg daily injections)
- Arimidex (oral AI twice weekly to offset my already too high Estradiol)
- Desiccated Thyroid (weekly oral to improve T3 levels)
- DHEA (as oral)
- hCG recommended but not required

Questions:

1. Any thoughts on the physician's recommendations? This seems fairly standard from what I have read on this forum.

2. I'd like to end up with 200 mg/week Test (more the merrier, right?) so how big of a *real* difference is 150 mg vs. 200 mg?

3. Should I hold out / switch docs in order to secure HGH? I would rather not settle for a peptide but this clinic tells me it is very difficult to prescribe HGH in my state (Texas) and thus, this clinic does not offer it.

Thank you for reading as any and all feedback is much appreciated!

[kelkel]

Is this a normal doctor or a clinic?

I don't see your T3 as deficient at all and would not start on thyroid meds without more testing. Don't medicate for "slightly."
For the test dose I'd start a bit lower and titrate up based on blood work.
The goal is to not have to use adex. Starting with it immediately not knowing whether you actually need it or not is ridiculous.

Your estrogen level is not even close to being to higher, assuming it's accurate. You are always better a little higher than lower. Your doctor should be using a Sensitive Estrogen Assay as standard estradiol is inaccurate in men and tends to read higher, thus causing uneccessary dosing of AI's.

Nothing wrong with Ipamorelin. But if he's selling it to you no doubt you can get it cheaper elsewhere.
Oral DHEA needs to be micronized to survive the first pass through the liver. I'd wait on this and see where you end up and how you feel after a few sets of labs down the road. No need to throw the kitchen sink at your body just starting out.

Everyone here will recommend HCG . Only reason not to is if you don't care about your testicals. Read the sticky thread here on it. It's why all the top TRT docs in the country recommend it.

"The more the merrier" really isn't good in the TRT world. Less is actually more. The less you can use and have solid numbers the better you will be. More only causes more ancillaries to be needed and more problems to mitigate. Such as elevated hematocrit causing frequent blood donations.

My advice would be to start one thing at a time. This way you know what's working for you. I wouldn't worry about Ipa, DHEA or GH right now.

This has got to be a clinic or a doc that sells his own products, right?

[Scrumhalf]

Is this a normal doctor or a clinic?

I don't see your T3 as deficient at all and would not start on thyroid meds without more testing. Don't medicate for "slightly."
For the test dose I'd start a bit lower and titrate up based on blood work.
The goal is to not have to use adex. Starting with it immediately not knowing whether you actually need it or not is ridiculous.

Your estrogen level is not even close to being to higher, assuming it's accurate. You are always better a little higher than lower. Your doctor should be using a Sensitive Estrogen Assay as standard estradiol is inaccurate in men and tends to read higher, thus causing uneccessary dosing of AI's.

Nothing wrong with Ipamorelin. But if he's selling it to you no doubt you can get it cheaper elsewhere.
Oral DHEA needs to be micronized to survive the first pass through the liver. I'd wait on this and see where you end up and how you feel after a few sets of labs down the road. No need to throw the kitchen sink at your body just starting out.

Everyone here will recommend HCG . Only reason not to is if you don't care about your testicals. Read the sticky thread here on it. It's why all the top TRT docs in the country recommend it.

"The more the merrier" really isn't good in the TRT world. Less is actually more. The less you can use and have solid numbers the better you will be. More only causes more ancillaries to be needed and more problems to mitigate. Such as elevated hematocrit causing frequent blood donations.

My advice would be to start one thing at a time. This way you know what's working for you. I wouldn't worry about Ipa, DHEA or GH right now.

This has got to be a clinic or a doc that sells his own products, right?

Great feedback, kelkel - thank you for taking the time. I'll do my best to address your points below:

I believe this to be more of a clinic than traditional doctor. The way I found it was through a Google search for local TRT / anti-aging physician, found a local office, directed to a national provider where intake of medical history / labs / etc. are all completed prior to a visit with the local doc. This health provider deals with hundreds of labs throughout the county and staffs "experts" for initial consults and blood work analysis. The feedback I received was from one of these experts. They are not on commission but do sell all products through their standard "monthly membership fee" which includes test, AI and hCG. Additions can be included but it does seem fairly "cookie cutter." The person I spoke with also informed me that his recommendation might be changed by the doc I am to next visit at a local office. Although all seems legit, I have already scheduled an appointment with another local doctor (who performs everything in-house) as a comparison / second opinion.

I appreciate your aspect regarding my thyroid and "not medicating for slightly" and will get further feedback.

I have also previously read your recommendation for a Sensitive Estrogen Assay, which seems to be the best indicator of true estrogen levels. If my prescribing doc does not order this specific test, would it be worth ordering my own private test to discuss these results with my doctor? I guess I am concerned that if a doctor does not initially order a Sensitive Estrogen Assay, would he/she appreciate its results or even know enough about it to make recommendations accordingly?

The hCG was indeed recommended to me but I was under the impression (through prior postings) that it could inhibit progress and was not entirely necessary outside of aesthetics. I will check the sticky on it to get better informed.

I really appreciate your feedback on the test levels regarding a "less-is-more" approach. I think I need to mentally clear that "more-is-more" hurdle knowing if I am going to be on treatment for years, I'll have time to adjust if necessary. It also makes great sense to mitigate non-critical / unnecessary ancillaries as well.

If you "wouldn't worry about Ipa, DHEA or GH right now" can you give me your perspective as to when this treatment might become feasible? I have read some fairly amazing things about GH and since it takes so long to take effect, I wanted to start sooner rather than later. (and this question may be best proffered under a separate thread / section)

Again, many thanks for the feedback as it is a tremendous value to me.

[kelkel]

Some clinics can be great. That said, many have a "more is better" approach but the "better" aspect is their bank account. The more they sell you the more they make.
I'd always recommend a regular doctor to monitor TRT and overall health. Assuming they understand hormomes and will treat you how "you" want to be treated and not like a number. Plus hopefully insurance covers most of it. Clinics usually won't accept insurance.

You basically need three things:

Testosterone : 2 x pw for best results and steadiest levels. Self-injecting
HCG : 2-3 x per week at 250 IU's. Self-injecting
Adex: If labs indicate a need

The problem with standard estradiol is that it may or may not be correct. Personally, I can't live with "may." You can obtain labs privately via www.discountedlabs.com or similar and the cost is dirt cheap compared to what your insurance pays Labcorp. Most states allow this and you can still use Labcorp. Ask your doc specifically for the E2 Sensitive Assay. He should accommodate you. It's not out of his pocket. If not, tell him to check his ego at the door. He works for you and you're paying for it.

I've got no problem with dhea, gh, etc. I just see no need to immediately start with them when commencing TRT. DHEA is a precurser (to testosterone) hormone. So, if beginning TRT then worrying about dhea to boost test is insignificant. Know that it can also be shunted elswhere in the hormonal chain as the body sees fit and can even increase estrogen. In my past I used to worry about dhea, preg, etc and supplemented the crap out of them. Never saw or felt one bit of difference whether my levels were normal or elevated. I stopped some time ago.

My point being is to not be so quick to micro-manage every little detail. Get on TRT if needed, get dialed in and see how you feel. You're not a number.

[Youthful55guy]

38 y/o former natty BB (very amateur) 185 lbs, ~ 8% body fat, clean diet, 3-4 training sessions per week, cardio, rugby (however many mediocre years I have left), etc.

I am embarking on TRT and have questions as to blood work and my physician's recommendations. I have spent many hours reading this forum and appreciate the time and detail many of you have invested in answering questions from guys like me.

Please see my posted results and the corresponding ranges, but here is the shorthand with the "feedback" I was given from my physician:

- Total T = 347 ("optimal range is 850-1200")
- Free T = 53 ("optimal range is 250-300")
- Estradiol = 31 ("should be reduced to 20-25")
- DHEA = 189 ("optimal 300-500")
- IGF 1 = 114 ("optimal 250")
- Glucose = 102 ("high from a 16 hr fast but likely due to coffee")
- T3 = 2.9 ("slightly deficient")

Physician recommendations:

- Test C - 150 mg/week split between 2 semi-weekly injenctions
- iPamoralin (0.3mg daily injections)
- Arimidex (oral AI twice weekly to offset my already too high Estradiol)
- Desiccated Thyroid (weekly oral to improve T3 levels)
- DHEA (as oral)
- hCG recommended but not required

Questions:

1. Any thoughts on the physician's recommendations? This seems fairly standard from what I have read on this forum.

2. I'd like to end up with 200 mg/week Test (more the merrier, right?) so how big of a *real* difference is 150 mg vs. 200 mg?

3. Should I hold out / switch docs in order to secure HGH? I would rather not settle for a peptide but this clinic tells me it is very difficult to prescribe HGH in my state (Texas) and thus, this clinic does not offer it.

Thank you for reading as any and all feedback is much appreciated!

Agree with all of Kel's comments. Let me reiterate the ones that I think are most important:

1) I would not start thyroid treatment with your labs. You are within range and using adding in thyroid hormones my increase you SHBG levels, which would drive Free T down further. Although adding in TRT would compensate for this.

2) Definitely agree that 200 mg/wk is on the high side of TRT. I am fairly certain that within a few months of continuous use at that level you will have excessive hemoglobin issues, probably more than can be addressed with the maximally allowable blood donations. Even their proposed 150mg/wk is high for a starting dose. With TRT it is always best to start with the minimum amount necessary to get you well within range and then SLOWLY adjust from there and ONLY if the follow up labs indicate you should. Most guys only need 100 mg/wk if the dose is split into a 2X per week protocol (I prefer every 3 days). The more frequent you inject, the less you need on a weekly basis to keep you in range.

3) It takes time for hormones to come to a new equilibrium. Unless there is a problem, you should stay on a protocol for a minimum of 6 weeks before doing follow up labs and making dosing decisions.

4) Guys need estrogen too. Probably the most common mistake I see in these forums are guys being so paranoid of this hormone that they drive it into the ground with anastrozole. It's one of the ironies of nature that guys need a certain level of E for normal erections and libido. Without it, you go limp. Bottom line, is NEVER use an AI or E blocker unless you are out of range. Also, as with T, you need to be on protocol for a minimum of 6 weeks before follow up labs to ascertain where you are at.

5) I used to be a critic of peptides for GH elevation. Long story that I don't care to go into, but I ended up in the hospital from using what most people consider 'normal' dosages. It turns out that I'm one of the guys hypersensitive to both GH (I've tried it) and peptides. I tend to retain A LOT of water when I first start. It takes me about 3 months for this effect to stabilize and drop the excess water. I have to be very careful about using doses lower than what you see in the forums.

6) I consider HCG more than cosmetic. You need the LH signal it provides for other functions including seminal fluid production. The Seminal Vesicles and prostate which produce the bulk of the ejaculate require both an LH and T signal to produce fluid. Without it, you will not that in a few months you will begin to dry up. Not good. Also, the LH signal is needed for the adrenals and testicles to produce DHEA and Pregnenolone, although both of these pre-hormones can easily be supplemented orally. For me the big issue for HCG is promoting normal ejaculate volume. My advice is to layer this in after you optimize your T.

7) I'm not a proponent of these Low T companies that are willing to prescribe over the internet and have "club-like" membership. They may or may not be around tomorrow and then where do you get your hormones after you become dependent on them? Developing a good relationship with a local doc is best.

[Scrumhalf]

Kel and Youthful - I can't tell you how much I appreciate each or your perspectives. I have much more clarity and understanding about this process, treatment options, effects, etc. A big thanks to each of you as I will be using all of your information moving forward.

On a related but separate note, what advice or considerations would you give to anyone considering a cycle on TRT? Blasting & Cruising seems very synergistic combining cycles on TRT, but I wouldn't want to bite off more than I can chew. My plan is to sustain TRT at least a year with clean labs before considering a cycle. I know my natural limits with a clean diet and consistent training and am greatly intrigued as to what limits I can surpass on a cycle. I've read plenty on this forum and the prospect of a cycle is exciting and always in the back of my mind. (see: "more is more" regarding 200mg of test above!)

Essentially, if you were a TRT newbie like me who is interested in a future cycle, what would you do?

Thanks again for your time!

[Youthful55guy]

Kel and Youthful - I can't tell you how much I appreciate each or your perspectives. I have much more clarity and understanding about this process, treatment options, effects, etc. A big thanks to each of you as I will be using all of your information moving forward.

On a related but separate note, what advice or considerations would you give to anyone considering a cycle on TRT? Blasting & Cruising seems very synergistic combining cycles on TRT, but I wouldn't want to bite off more than I can chew. My plan is to sustain TRT at least a year with clean labs before considering a cycle. I know my natural limits with a clean diet and consistent training and am greatly intrigued as to what limits I can surpass on a cycle. I've read plenty on this forum and the prospect of a cycle is exciting and always in the back of my mind. (see: "more is more" regarding 200mg of test above!)

Essentially, if you were a TRT newbie like me who is interested in a future cycle, what would you do?

Thanks again for your time!

I'm not judgmental when it comes to guys using T and other steroids to bulk up. However, I have zero experience with it and do not provide any advice in this area. I do get a little upset when guys post in this TRT forum and say they are talking about TRT when they are actually talking about hormone augmentation (often called blast and curse). Again, I'm not judgmental, but there is sooooo much confusion among the newbies, and discussion of hormone augmentation as TRT just adds to it. I'd like to see the owners of the forum create a separate forum for those interested in this topic, but I digress.

I wish you luck in your endeavors.

[kelkel]

Honestly, TRT makes cycling easier as pct is never required. I'm not saying that as encouragement, just a fact. That said, guys who are just initiating TRT should really wait about a year before initiating something like this. TRT takes time to dial in and remember, with restored youthful T levels you can make a ton of progress. If you're not then you have to blame nutrition and training.

Take some time and read the Successful First Cycle Sticky thread at the top of the AAS Q & A Forum. It will answer many of your questions or simply post the question in that forum.