Test Levels Still Low - What to do???

[Matty]

Hey All,

I had blood taken two weeks ago and got my test results last night: The blood was taken 3 weeks from my last 1 cc injection of delatestryl (Test Enanthate).

Old Test Level (7/01): 188
Current Test Level (5/30/02): 201
Normal Range (nurse provided): 241-827

I have an appointment today to discuss the results and am not sure what options I might have. Any suggestions? I think the enanthate is putting more fat on me - is this possible? My doctor is pretty flexible so I may be able to steer my therapy a little. Is there a better test I can ask for? What about something to get rid of the fat?

I feel like I may be spinning my wheels with such a low test level. I've been training pretty hard for a couple years and have made some gains, but not nearly what I think I should. Starting to get frustrated...

Anyway, please let me know your thoughts!

peace.matty.

[righton]

I wonder why your doc would start you at 2 week intervals!! Most ppl on HRT usually go 200mg/week with the enan or cyp. Ask your doc if it's possible to go to 200mg/week, not only will you feel better ( give it about 3 weeks) but if you train properly and eat right( check out the diet section on this board) you'll put on some lean body mass AND lose some b/f!! You should'nt put on ANY fat unless your not training properly and eating right. AAS are not magic pills (or shots), you have to do ALOT of research( use the search button) and check out this boards archives, everything you need and want to know is there!!

[Matty]

Actually, he started me on .5 cc a month, but that did nothing. Then he did 1 cc a month - but I crashed after 2 weeks. What is the conversion from cc to mg? How many mg = 1cc?

Which test is "better"? cyp or enan?

Thanks!

peace.matty.

[TNT]

Originally posted by Matty
The blood was taken 3 weeks from my last 1 cc injection of delatestryl (Test Enanthate).
Old Test Level (7/01): 188
Current Test Level (5/30/02): 201
Normal Range (nurse provided): 241-827

Simple solution: Less test per injection, but more often. Now, Matty, read this carefully. There will be a quiz at the end.

Okay, we'll drop the quiz. Instead, you have to read the AACE Guidelines on Hypogonadism, which you'll find in a PDF (Adobe Acrobat) file at this link. AACE is the American Association of Clinical Endocrinologists, and if your doctor knows about testosterone replacement at all, this is what he or she should have read. And since it's your body we're talking about, you might as well learn the same things as your doctor.

One little gem hidden in the guidelines is that test injections are best when done weekly. They help avoid the peak-and-valley effects of testosterone.

I assume that you just started out with test injections recently - that's because 200 mg. every three weeks is the most commonn first dose of test. Once the doctor sees how you do, he or she will increase the dosage, most likely to 200 mg. every two weeks, but splitting the shot into 100 mg. (1/2 cc) per week.

Now, let's talk Delatestryl for a second. Delatestryl is the only legal brand of enanthate in the U.S. As you're probably aware, it comes 200 mg/ml. There is another brand of testosterone made in the U.S., Depo-Testosterone, and it's cypionate rather than enanthate. Two two are functionally the same, having only one different link on the chemical chain - both are long-acting testosterones. There is one other major difference, however: cost. Both retail for about $75-80, but you get 5 ml in a vial of Delatestryl and 10 ml in a vial of Depo-Testosterone. In other words, Delatestryl costs twice as much ounce-for-ounce as Depo-Testosterone. Something to consider when you need a refill.

(By the way, Depo-Testosterone is available in both 100 mg/ml and 200 mg/ml strength. Obviously, you would want to go with the 200 mg/ml, just like the Delatestryl. If you end up injecting 100 mg at a time, which I think you will, you only have to use 1/2 cc instead of 1 cc, which makes the injection easier and more cost effective.)

And now, the big moment . . . Let's discuss your TT (total testosterone lab) results. There are two ways of measuring test levels - at peak and at "trough" (as in a horse's trough, when empty - this is the valley of the peak-and-valley). The TT test done three weeks after your injection is a trough level; what you don't know is what your peak level was. Most doctors don't order the TT this way, but the most effective way to tell how you're doing is to have the lab work taken twice: First, at trough level (which you did), then at peak level (about two days after your next injection). That will show how effective the test injections are, and I think you would find that they are actually very effective.

(I've experimented with this, and found that when I have taken 150 mg. per week, my levels fluctuate from the low 300's at trough to about 900 at peak. That's a wide range, and it's over the course of only a week.)

So your low levels are not an indication of how effective the injections are - they only indicate how low the levels went three weeks after a 200 mg. injection.

As for the test enanthate putting more fat on you, yes, it is possible. But it is more likely water weight - there is some water retention with test (but not much at your dose). You mentioned that you have been training hard - the key question is what type of training you have been doing. If you have not included cardio, guess what - this is the time to start. Plain ol' burning calories to lose fat.

The enanthate should, in fact, help to reverse your ratio of body fat versus lean muscle mass - in other words, you can use the test to put on muscle rather than fat, but it requires a comprehensive workout routine that includes both cardio and weight lifting or circuit training (combined with a healthy eating routine). Put them together, and you should end up exactly where you want to be - the test will help you bulk but not gain fat. (In other words, look at the big picture rather than just a part of it.)

You mentioned your diet in another post, and it seems healthy (although you're going a bit heavy on the optimum whey - on the other hand, I don't know what optimum whey is in the first place ). If you belong to a gym, one thing I would recommend is to substitute the 20-minute fast walk with more calorie-burning cardio. Normally, I recommend something like the Precor Eliptical Crosstrainer (a cross between a stair climber and a treadmill - most good gyms now have them) - the best calorie burner that does not cause impact on the feet or knees (like a treadmill or some stair climbers do). (I recommend Precor because, unlike other brands like Reebok, Life Fitness or StarTrac, the Precor has adjustable resistance and angle.) Walking is better than nothing, but there are some routines better than walking. Past that point, I compliment you - your diet is already healthier than the average American who hangs out at McDonald's. An important thing if you have not already done so and you want to cut your fat and water retention - drop all added salt from your diet. (Also, be careful of the sodium used in processed foods. You should be getting a maximum of 2,400 mg. of sodium per day. And yes, because of the water retention capacity of sodium, that will make a big difference.)

Finally, make sure your doctor has done other lab work that indicates whether there is a peripheral cause for your low test levels - this should include LU hormone, follicle stimulating hormone, prolactin, and other lab work. Also, most doctors order an MRI of the pituitary gland (done with gadolinium, or dye) to rule out any pituitary disorders, especially at your age. It's only after those tests are done that most endocrinologists will prescribe test in the first place, and if you're not seeing an endocrinologist, it's likely that your doctor didn't do the full run of lab work. Certainly, your TT numbers indicate that testosterone replacement is appropriate, but it's important to rule out any unknown causes.

[Matty]

Got it - 1cc=2mg

I'm going to ask that I get 1cc/week???

Got this from Drug Profile section for enan:

"An additional problem when taking Testosterone enanthate is that the conversion rate to estrogen is very high. This, on one hand, leads the body to store more fat; on the other hand, feminization symptoms (gynecomastia) are not unusual. However, it must be clearly stated that this depends on the athlete's predisposition."

Is there anything my dr can prescribe to help with this???

[Matty]

Damn! Thanks, TNT!!! This is excellent information - just printed the pdf, will read and bring with me to the appointment.

[TNT]

Originally posted by Matty
Got it - 1cc=2mg

I'm going to ask that I get 1cc/week???

Got this from Drug Profile section for enan:

"An additional problem when taking Testosterone enanthate is that the conversion rate to estrogen is very high. This, on one hand, leads the body to store more fat; on the other hand, feminization symptoms (gynecomastia) are not unusual. However, it must be clearly stated that this depends on the athlete's predisposition."

Is there anything my dr can prescribe to help with this???

No, no, and yes-but. In that order.

1 cc = 200 mg, not 2 mg. You will probably end up with 200 mg. every two weeks, and should ask your doctor whether you can split it into 100 mg. (1/2 cc) each week until your next lab work. If he or she follows the AACE guidelines, the answer should be yes. The once-a-week dosing helps ameliorate the peak-and-valley effect of test.

As for the enanthate write-up in the drug profiles, remember that this profile was written for people who are doing much heavier doses of test. Most people who use AS strictly for weight lifting or bodybuilding do much larger doses (400-1,000 mg. per week). But they do it for a finite period - usually, 8, 10, 12, or 15 weeks - and then their cycle ends. When you do testosterone for HRT (hormone replacement therapy), you're on it for the long haul rather than for a finite period, and at lower (therapeutic) doses.

The usual remedy for gynecomastia by guys who do AS cycles is Nolvadex or Arimidex. (There is an A.R. drug profile for Nolvadex.) However, the clinical indication for both of these drugs is the treatment of metastatic breast cancer in women (and, on occasion, in men). It is strictly a breast cancer drug, and is overused by a lot of guys who take it to prevent rather than treat gynecomastia. (Chances are that they would not get gyno in the first place, but obviously, even the mere notion of getting gyno makes a lot of guys paranoid.)

In fact, at therapeutic doses, it is highly unlikely that you will experience any gyno at all (even though it is listed as a possible side effect of testosterone therapy). As with any drug, if you don't need Nolva - and you don't - don't take it. If, and only if, you begin to experience it, then talk to your doctor about treating it.

By the way, it's a good idea to take a copy of the AACE Guidelines with you to the doctor in case he or she hasn't read them. It will also demonstrate that you've done your research, and may help the doctor leave more of the decision making to you. I happened to have a copy with me when I saw my endo after I read them, and she was impressed as hell.

[Matty]

Thanks again, TNT. You, Sir, are the Man! I will take your advice and request the dosage you listed.

Will ongoing HRT have an affect on possible future cycles?

[TNT]

Originally posted by Matty
Actually, he started me on .5 cc a month, but that did nothing. Then he did 1 cc a month - but I crashed after 2 weeks. What is the conversion from cc to mg? How many mg = 1cc?

Which test is "better"? cyp or enan?

Ooooops, just noticed this post, so let me address it before the cycle question.

The conversion from cc to mg depends on the specific test. In most cases, for enanthate and cyp it will be 1 cc = 200 mg. However, remember that Depo-Testosterone (cyp) also comes in a 100 mg/ml strength, but this is not as cost effective and you have to inject twice as much (in volume) to get the same bang for the buck.

As for which is better, they are functionally the same. Some juicers have a preference for one over the other, but that is strictly anecdotal in nature. (My own preference is enanthate. Again anecdotally, I find that it has less of a zit factor. But test is like a word processing program - you tend to prefer the one you started out with, and I started with Delatestryl. I also like the name more - Delatestryl sounds so much more classy than Depo-Testosterone. )

As for the effect of HRT on cycles, negligible when it comes to other drugs (such as the clen or winny you mentioned in another thread). The main thing you will want to avoid is anything that will bump your test level too high, in order not to skew your lab work and make your doctor think that you are getting too much test (which might make him or her cut back on your prescription).

Also - and this is a big temptation for everyone who does test for the purpose of HRT - try to resist bumping your test dosage too high for the sake of a cycle, especially around the time you are due for lab work. Same reason - it will skew the results and make the doctor cut back on your prescription. If you do bump the test at all, make sure you cut it back to therapeutic levels about three weeks before getting labs done - you want the TT labs to read as low as possible so your doctor doesn't cut your dosage.

In case you haven't figured it out yet, you have an opportunity to do something that a lot of bodybuilders would give anything for - to use testosterone under prescription, which means that (1) you are doing it legally instead of illegally, and (2) you are able to use the best test on the market - good ol' U-S-of-A prescription-grade testosterone. Make the most of it, but don't make it too obvious.

[Matty]

Excellent!!!! Well, I'm off to my appointment - I'll post the outcome shortly...

[Matty]

Dr agreed to do .5cc every week for a month - then up to 1cc every week. He said the goal is to get my test levels up in the 400 range - long way to go. He also mentioned possibly using injections in combination with other test (gels, etc.) My initial bloodwork (7/01) indicated normal FSH and LH levels. More bloodwork to be done in 1 month...

[TNT]

Well done! The key question will be which level the doc wants in the 400 range. I assume it's the trough level, but keep in mind thaht if you do this, you may end up with higher peak levels than normal (the norm ranges for Quest Labs, as you noted, are 241-827).

Now that you're doing the injections, chances are that you will not find the gel significant. In most cases of which I am aware, a low dose of Androgel (5 mg., or one packet per day) do not do anything significant (and sometimes nothing at all - I know of a few cases where guys have started Androgel and their test levels have dropped). Androgel is very expensive if you don't have a prescription plan (about $175 retail for a 30-day supply at 5 mg/day - most guys need 10 mg. per day, or two packets, for any results). Androgel is the most consistent delivery system, but there are many variables, including the absorption rate of each individual's skin.

(For newbies, Androgel is the only FDA-approved testosterone gel made. Individual pharmacies used to compound test gel, but most stopped doing so after the release of Androgel. The gel is rubbed on the upper abdomen and/or shoulders once daily, and the manufacturer recommends wearing a shirt during sex so it doesn't transfer to your partner. There are also testosterone patches available - transdermal patches, which tend to irritate most people's skin, and transscrotal patches, for which you have to shave your balls and blow dry the patch when you apply it. I kid you not.)

Matty, it's hard to say where your trough level will be in 30 days, but it's good your doc is checking it in 30 days instead of 90 days. It may not be as high as 400, but should be higher than your previous 201 because you'll be having the labs done a week after your injection instead of three weeks after. Keep us informed!

[Matty]

Yeah - I've tried the Testoderm patch (non-scrotal) and pills. The pills did nothing and the patch was a huge pain to deal with. I'm pretty sure my dr.'s going to want my trough levels at 400ish.

This really sucks - I work my ass of in the gym, try to eat the right things at the right times, take my multi and protien, and just can't seem to make decent gains. Hopefully HRT will push me through this!

Thanks again TNT for all your help!!!

peace.matty.

[TNT]

. . . since you're set for the next 30 days (until your next labs).

I assume that your doctor is not an endocrinologist because he originally had you on the pills. Oral testosterone is almost never prescribed in the U.S. and Canada, although it is available, because the pills have a much harsher impact on liver function. Injectable test is still the "tried-and-true" delivery method in terms of both results and safety.

(By the way, if you haven't done so, you should have a Comprehensive Metabolic Panel, or CMP, done when you get your TT labs. The CMP is a combination of the Basic Metabolic Panel and the Hepatic Panel, and will provide an indication of how your kidneys and liver are functioning while on test. Also make sufre your doctor orders up a Prostate Specific Antigen, or PSA, since test can have prostate-related side effects. Neither is anything to worry about, just a standard precaution for guys on HRT and, if you haven't had these labs done previously, they'll provide a baseline for the future.)

I also happened to notice righton's post in this reading. While righton is generally pretty accurate, I think it's important to note that test dosages are highly individualized, and the average is more in the 100 mg. per week area. The recommended dosing for both Delatestryl and Depo-Testosterone is 50-400 mg. every two to four weeks. That indicates that the maximum therapeutic dosage is 800 mg. per month. However, the proper dose is the one that puts your TT levels in acceptable range. While the Quest lab specs are the norm (241-827), the best number to shoot for (pardon the pun) depends on the individual. For some guys, 300 is adequate, for others even 827 may be low. It depends, in part, on your medical history.

By the way, if you want some more interesting reading, you'll find the official prescribing information for Depo-Testosterone on Upjohn's web site. Clinck on this link and use the search feature at the top of the screen to do a search on Depo-Testosterone, where you'll find a link to the PDF (Adobe Acrobat) file. The prescribing literature is pretty much the same for Delatestryl.

[Matty]

I'll mention the CMP on my next visit. I cannot begin to tell you how helpful you've been.

[BigLad]

Matty,
Out of interest has your doc determined the cause of your hypogonadism? I ask because I see no mention of your oestrogen levels having been checked. High oestrogen levels can significantly reduce endogenous testosterone production. In fact oestrogenic inhibition of the HPTA is an often overlooked factor when hypogonadal testosterone levels are found.

Many docs will do the basics (free and total testosterone, prolactin to rule out hyperprolactinaemia, LH and FSH, yet stop short of measuring the most potent inhibitor of the HPTA – oestrogen). If you have your oestrogen levels assayed and they are found to be elevated then you may not even need exogenous testosterone. You may be able to raise your endogenous production by the use of aromatase inhibitors such as Arimidex. If your oestrogen levels were not checked then ask for the assay – you may save yourself a lot of hassle.

I was alerted to this possibility by the mention you made of bloating. At the supplementary testosterone levels you are using bloating should not be a factor – but could be if you already suffer from excessive aromatisation. Aromatisation is the process by which testosterone is converted to oestrogen, mediated primarily by the enzyme aromatase which is found mainly in fatty tissue. Guys carrying a lot of body fat often have high levels of aromatase and hence high oestrogen. This oestrogen inhibits the hypothalamus by negative feedback mechanisms, reducing the pituitary output of LH, and thereby resulting in diminished testosterone production.

Just thought I’d throw that in the ring in case it rings any bells. You may think that your ‘normal’ levels of LH would militate against this possibility, but believe me when I say that ‘normal’ covers a very wide range. Also, lab reference ranges are rarely quoted as ‘age matched’ reference ranges. This means that they quote a physiological range for testosterone etc. but this range covers the levels found in men from 16 to 70. And we all know that your testosterone levels etc. decline with age. So your ‘normal’ LH measurement doesn’t necessarily mean as much as you may think.

Just something else to consider besides the excellent advice you’ve already received from the knowledgeable guys above.

Let us know how you get on mate.

[Matty]

Thanks, Biglad! He has not indicated a cause - I'll definitely bring this up to him. He keeps telling me that my body is metabolizing the test too quickly - this might suggest the reason why, couldn't it?

[BigLad]

I'd certainly ask him to clarify what he means by 'matabolising the test too quickly'. Test is aromatised into oestrogen as described in my post above, or reduced by 5-alpha reductase to dihydrotestosterone (DHT). It's the oestrogen that is the most potent inhibitor of endogenous testosterone production and that may therefore be contributing to your low test levels.

Both aromatase and 5AR can be inhibited by easily available products - anastrazole, letrazole etc. for the former and finasteride/dutasteride for the latter.

I'd certainly look into the oestrogen angle with him. Keep us posted mate.

[Soldier225]

Great response and info from TNT!

Just wondering what your Estradiol (estrogen) and Free Testosterone levels are through all of this. I assume the numbers you listed were Total Test, not Free (bioavailable) Test. My 2 cents worth is this: You need to have a picture of your overall hormone levels, including estrogen, T3 Free, and even SHBG (this one is not a hormone).

If you seem to be gaining weight, it's likely due to increased aromatization of Testosterone into Estradiol, which can and will lead to increased estrogenic fat patterning. If indeed you estrogen levels are rising (which they probably are), then your SHBG will also be higher. SHBG is Sex Hormone Binding Gobulin. Simply put, SHBG binds to free testosterone and prevents it from exerting its biochemical effects in the body. In other words:

Increased Testosterone = Increased Estrogen = Increased SHBG = Decreased Free Testosterone.

You may want to ask your doc about this, and maybe he could add some Arimidex/Liquidex to your cycle.

Increased fat may also be due to hypothyroid, which is a condition that is grossly undiagnosed and misunderstood in this country.

Bottom line? Find out if your doc's following your Estradiol, SHBG, and T3 levels. He should be familiar with these. I would educate yourself on them, however, because in my experience, nobody's got your best interests in mind like YOURSELF!

Hope this helped.

Soldier225

[Matty]

I faxed over this info to him - hopefully hear something soon. The possibility of higher estrogen makes more sense to me since LH and FSH levels are normal. I'll keep you posted.

peace.matty.

[Matty]

Dr just called - I'll be going in a few weeks for additional bloodwork which will include checking estrogen levels. Thanks to all!

[BigLad]

Good stuff mate. Please keep us updated with the outcome.

[Soldier225]

Good stuff, Matty! Keep that doctor in line...your health depends on it!

Also, the HRT doctor I go to has been keeping my Total Test levels in the 800-1100 ng/dL range...you sure you're only going to about 400? That sounds really low to me! Also, let us know what your Free Test level is...the upper range of healthy males age 20-29 years old should is 21-26.5 pg/mL. Estradiol level should be between 10-30 pg/mL.

Let us know how it goes.

Soldier225

[BigLad]

Soldier225 I'm mightily disappointed with you - why haven't you responded to my thread in the main forum regarding TRT and testicular atrophy? Come on now, don't be shy

[OverDrive]

oldie but a goodie!

[x_rick_x]

Bump for the good info.