hi all, new to trt and this forum

[Snorky]

Hi all, am new to this forum and to trt, but have started this thread to say hello and get your thoughts and comments.

I'm 51 yo, 5'9", 243 lbs (solid build but also fat) and a paramedic on Australia's east coast (shift work, stressy etc).

I'm in fair health, but have metabolic syndrome (obesity, blood lipids, blood pressure), non-alcoholic fatty liver, labile blood pressure (hot reactor), a few old injuries - had a medial and lateral meniscectomy a few years ago, ankle injury, occasional crook back, etc, also hyperhidrosis and facial flushing, and hypogonadism. Over the last few years I've put on about 16 kg, had increased laziness/apathy, reduced libido/mild ED, reduced interest and joy in life etc. This led me to an anti-aging Dr who has put me on trt - initially 250 mg test enanthate imi every fortnight (I halved the dose and injected weekly about 2 months into program).

Blood results as follows (SI units):

Sodium 139 mmol/L (135-145)
Potassium 45 (3.5-5.5)
Chloride 102 (95-110)
Bicarb 24 (20-30)
Ca (corr) 2.33 (2.10-2.55)
Phosphate 1.1 (0.8-1.1)
Urea 5.2 (3.5-8.5)
Uric acid 0.49 (0.20-0.50)
Creatinine 84 um/L (60-110)

Fasting glucose 5.8 mmol/L (3.6-6.0)

Total protein 71 g/L (63-80)
Albumin 45 (36-47)
Globulin 26 (20-39)
Bilirubin 15 umol/L ((4-20)
Alk Phos 98 U/L (35-110)
AST H 65 U/L (10-40)
ALT H 122 U/L (5-40)
Gamma GT H 85 U/L (5-50

Haemoglobin 158 g/L (135-175)
Haematocrit 0.46 (0.40-0.54)
Red cell count 5.7 x10^12/L (4.5-6.5)
MCV 82 fL (80-100)
White blood cell count 4.1 x10^9 (3.5-10.0)
neutrophils 1.96 (1.5-6.5)
lymphocytes 1.68 (1.0-4.0)
monocytes 0.33 (0-0.9)
eosinophils 0.10 (0-0.6)
basophils 0.01 (0-0.15)

LDH 205 (120-250)

Chol H 6.8 mmol/L (3.9-5.5)
trigs 1.5 (0.6-2.0)
HDL 1.2 (0.9-1.5)
LDL H 4.9 (0.0-4.0)
Total chol/HDL H 5.7 (0-4.5)

Apolipoprotein A1 1.37 g/L (0.90- 1.80)
Apolipoprotein B H 1.72 (0.70-1.30)
ApoB/ApoA1 1.25

CRP 2 mg/L (0-10)

HBA1c (NGSP) 5.9% (4.0-6.0)
HBA1c (IFCC) 41 nmol/mol (20-42)

Haemolysis index 11 (0-40)

Homocysteine 7.4 umol/L (0-15.0)

Blood chromium L <10 nmol/L (10-100)

S-Insulin 12 mU/L (95-20)

IGF-1 19 nmol/L (11-31)

25-OH Vitamin D 59 nmol/L (50-150)

Active B12 >128 pmol/L ( >35)

TSH 1.3 mU/L (0.3-4.0)

Total PSA 0.71 ug/L (0.25-3.0)

Cortisol 333 nmol/L (160-650)

Oestradiol L 44 pmol/L (55-165)

DHEAS 4.6 umol/L (1.2 9.0)

Testosterone L 9.3nmol/L (11.0-40.0)
SHGB 25 (11.0-70.0)
Calc free Test. L 206pmol/L (260-740)

LH 2 U/L ( <9 )

Since this blood work, I started IM test E monotherapy and had further blood tests 3 months later (before Xmas) and will see doc in a couple of days to get these results. For the first 6-8 weeks I had great improvement in energy, libido, ED, joy of life etc, but hypersensitive nipples, my nuts shrivelled and possible increase in skin redness. After about 6 weeks I halved the IM dose to (125 mg) IM weekly. All this coincided with reduction in nipple sensitivity but also return (but not as bad as pre-trt) of some emotional flatness and also increased irritability (nuts still tiny). Doc has indicated he would like to add DHEA to my trt and we will discuss at next visit. i've asked him to look at hCG plus pregnenolone and he said he will research this (I think it's not something he has used, but he seems open minded).

I think that maybe I should have started off on hCG in the first place (low LH, low T, low E2, lowish DHEAS), and see how that went before trt, but better late than never. Depending on latest blood work, my thoughts were to now introduce hCG (what dosages/timing for IM Test E weekly? Does anyone have experience with intranasal hCG? - a compounder nearby makes it) and possible AI (Arimidex ? dosage? or Chrysin/piperine?) if E3 has increased from it's previous V.low levels to troublesome levels (would it still be high if nipple sensitivity has gone?). I think it makes sense, if the new levels of DHEAS are still lowish, to first supp with pregnenolone (as a hormone feed stock and for it's other benefits) and see how it goes before supping with DHEA (which is better, 7-keto or straight DHEA?). Are there any other tests that you think I have missed?

Many thanks in advance for any comments or advice you can give me. I appreciate this forum and it seems the best of the bunch that I have found.

all the best from Oz

[steroid.com 1]

Surprised on one commented on this already.

Want to know what I think is going on?

Read the sticky at the top of the forum on Estradiol and Management...it will unlock the truth.

Your labs don't show what your Estradiol (E2) levels are and when you read the sticky you will see why you need it.

Hint: E follows T

[kelkel]

What GD said. Read those stickies and really most of what you asked will be answered! In addition, add Vit D3 to your protocol. You'll read about the importance of DHEA and Preg in the stickies!

Snorky remember that lifestyle plays a large part in your overall health and testosterone production as well. TRT is a wonderful thing for those that need it but it is only a part of an overall lifestyle that contributes to maximum health and well-being.

Welcome to the site. Read up and contribute!

kel

[Snorky]

Thanks Kel and GD for your comments.
My estradiol levels WERE low 44 pmol/L (SI) = 12.7 pg/ml (I think the conversion is right!), along with low Total T and Free T, with lowish LH, SHBG and DHEAS. Not much happening in that pathway at all! I take your point in the stickies about E following T and presume that was what was happening in the first few weeks after trt with the sensitive nipples. Would be interesting to know why the nipple issue went away? Much will be revealed with the next lot of bloodwork, which I'll post.
If I do start with hCG and restart endogenous testicular production, does anyone know what sort of quantities of chol are converted in the process? Enough to make a significant impact on serum chol? My pregnenolone levels are unknown, but I gather that a lot more conversion of chol to preg takes place in adrenals and nervous system via other tropic hormones (ACTH) than in testes via LH stimulation.
I appreciate your comments.