At 28, put on TRT by uro. -- Curious why my T is low? (blood work included)

[jwhit84]

UPDATE (4/24/2013): I am keeping my endocrinologist appointment next month to rule out tumor and a couple other things, but I've gotten set up with an online clinic to do my own injections. This 2x/month crap is awful, and my urologist is set in his ways. I'm also off all medications except for the Cele-a daily for anxiety. Latest T level was 816 and E2 was 32.6 on 4/17/13 (5 days after injection of 200mg cyp).

I received my medicine today. Here's my proposed weekly schedule. Any recommendations or advice?

- 100mg test cyp (50mg every 3.5 days)
- 500iu HCG (250iu 24 hours before each test injection)
- 0.5mg anastroz0le (0.25mg 24 hours after each test injection)

(click image)

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Hey guys, I've been feeling really tired, unfocused, somewhat depressed, and unmotivated for a long time now (couple of years at least). My s-- drive is also really low.

I went mid-morning to get T tested, and it came back at 124 ng/dL (280-1070 ng/dL). They suggested that I see a doctor. I then saw my GP a couple weeks ago, and she ran more blood tests because she was shocked at how low it was. T came back at 192 ng/dL. I saw a urologist who saw my results and put me on 200 mg test cyp every OTHER week. I asked if I could do 100 / week instead, but he said most people are fine with EOW dosing. I've had 1 injection 12 days ago, and I get another one on Friday. UPDATE: Got 2nd shot on day 15 and updated my daily log below.

I decide to make a post for any input/advice and to have a log. I'm curious why my T is low in the first place (as is my GP), and I will be seeing an endocrinologist when my GP can get me in. Thanks for any replies, whether it's questions/comments/advice/etc!

My experience on 200mg every other week:
- day 1 (Fri): 15m after injection, I felt nauseous and light-headed. Felt symptoms of passing out (vision going black, warm sensation started at neck/shoulders and went all the way down to my feet). 2-3 min later, I was fine.
- day 2 or 3: morning erection (rare these days, but maybe coincidence). Very tired on day 3 afternoon. Laid around most of the day.
- day 4-6: nothing noticeable
- day 7: face was oily in the morning, which hasn't happened for many years
- day 8-10: felt good over the weekend and motivated to work out (altho very short and very light b/c it's been a long time). Maybe it was just in my head ("I'm on T now, let's do this!"), or maybe actually a result.
- day 11: felt okay, but nothing special
- day 12: felt very blah most of the day
- day 13: felt terrible, slow, couldn't focus
- day 14: BLAAAAAH. Sick with sinus infection.
- day 15 (Fri): Thank goodness for injection today. Feeling crappy. (INJECTION day)
Since my 2nd 200 mg injection of Test cyp
- day 16: Stayed in bed sick
- day 17: Still sick but feeling better (doc gave me zpak and "sinus cocktail" shot Friday)
- day 18: Things looking up
- day 19: Barely slept, so felt bad today
- day 20 (Wed): Felt great today. Decided to get my own blood work done. T was 816 and E2 was 32.6
- day 21 (Thur): Feeling great still. Motivated to work out, get things done. Thinking very clearly.
- day 22 (Fri): All good
- day 23 (Sat): Worked out again. Motivated and more energy in gym.
- day 24 (Sun): Felt okay today, nothing special.
- day 25 (Mon): Felt okay, seem unfocused but not terrible
- day 26 (Tues): Same as yesterday
- day 27 (Wed): Definitely feeling slower today, pretty foggy.

Stats
-age: 28
-height: 5'-9"
-waist: 33"
-weight: 180 lbs (8-10% bf in summer, 15-17% bf in winter)

Health conditions
--- depression in the past
--- Anxiety 2 years ago
--- trouble falling to sleep (takes a while. Can't remember a time it wasn't like this.)

Symptoms
--- generally depressed (not extreme/suicidal, but very "blah" and unmotivated)
--- low s-- drive
--- difficulty focusing and thinking clearly (struggle at work even though it's low stress. hard to get things done)
--- My energy is so low that I'll just sit still for a long time even though I haven't done anything strenuous or active that day. It's not usually mental tiredness, but physical. I think of things I need or want to do (clean, shop, play bball or tennis, work out), but I instead just sit there thinking I don't even want to move. Going out for social events is often a struggle.

Rx dru-s
--- (Rx) Cita****** 40 mg/day (been on it 1.5 years)

Blood Work

3/22/2013 (at local clinic)
--- T: 124 ng/dL

3/26/2013 (from family physician)
--- T: 192 ng/dL (range 280-1070 ng/dL)
--- SHBG: 31 (range 13-71 nmol/L)
--- Free test: 38 (range 47-244 pg/mL)
--- % free test: 2.0% (range 1.6-2.9%)
--- TSH: 2.547 (range 0.350-5.500 uIU/mL)

3/29/2013 (urologist) <--- right before first injection of 200 mg test cyp
--- TT: 334 (250-1100) <-- not sure why it ranged from 124 a few days before, to 192, to 334. I didn't know it fluctuated that much (same time of day too)
--- FT: 50.2 (46.0-224.0)
--- TEST, BIOAVAILABLE: 111.6 (110.0-575.0)
--- E2: ?? (2 doctors would not check it, even after I insisted!)
--- LH/FSH: 1.8 (1.6-9.3) / 2.6 (1.6-8.0)
--- prolactin: 7.6 (2.0-18.0)
--- fasting cholesterol: 194
--- fasting glucose: 86
--- ferritin: not checked
--- TSH: 3.31 (0.40-4.50)
--- fT3: not checked
--- fT4: 1.1 (0.8-1.8)

4/17/2013 (5 days after #2 injection of 200mg test cyp)
--- TT: 816
--- E2: 32.6

[steroid.com 1]

If I had a dollar for ever guy who came here under 30 presenting with your labs and all the Physician did was put you on Testosterone replacement without any further diagnostic testing I could pay my bar tab for a year without touching my wallet...and I like to drink

You need to find a specialist in male hormones as soon as you possibly can. The Physician's you are seeing now don't have a clue as to where to even start with you.

They wouldn't test for E2 even after you insisted...what's that tell you?

I don't like your TSH nor your low FT4 labs, it suggests possibly Thyroid problems. Sluggish or Hypothyroidism will cause many of the symptoms you present with and you should know that it will can and cause Secondary Hypogonadism...hence your low Testosterone serum levels.

You need more tests done to rule everything out; there are many medical conditions and serious pathologies that can be causing your condition so I urge you to find the right care ASAP.

Most Endo's and Uro's don't know this well enough to figure it out. You need a specialist and those are the ones who usually are on the cutting edge of anti aging medicine and what some like to call "Interventional Endocrinology".

Read kel's post on finding a TRT Doc or find a Doc on www.a4m.com and get the right care.

Men your age with serum levels this low...something is wrong with you and you need to find out why BEFORE taking any meds or Testosterone.

Keep us posted here on your results in this thread jw.

gd

[HRTstudent]

Wow it sounds like you've been to an endo before with the way you talk about them lol. You pretty much described my visit to an endo, as well as many others I have read on this forum.

In reality though, it may or may not be worth trying to find out what is the root cause. For many men it is simply life with no frank disease that causes low testosterone. I believe this was my case actually. I was "relatively healthy" but my T level sucked. I've come to learn that nutrition and the current environment we live in plays a huge role. But I learned a lot of this stuff after starting T.

If I could go back, I would trial clomid first just because it's "easier" and a slew of other reasons. It certainly wouldn't cost that much (not talking money) because unlike testosterone, there is no recovery period for clomid that I know of. Just be sure to take a low dose... not this 50mg per day business some people are put on!

The biggest issues I see with you are definitely nutritional. I imagine lifestyle plays a part too, to be sure. But you listed some serious drug use. 600mg of caffeine per day? Narcotic pain killers as well...

I realize you may have to take some drugs, but my goal would be to get off them as much as possible. These do have a profound effect on your overall metabolism and thus well being. The very fact that you list a sleeping drug and a huge intake of stimulants lends credence to the idea that you are putting your body in a very toxic, whirlwind state.

I simply would not expect testosterone therapy to turn your life around, as you may wish it will. But fixing many of these areas certainly can help. TRT may be unnecessary once you work out the rest. I could not rule that out at all right now.

[steroid.com 1]

Oh, just one question I forgot to ask in my response; any aas abuse in the past?

He totally honest now!

[jwhit84]

Wow it sounds like you've been to an endo before with the way you talk about them lol. You pretty much described my visit to an endo, as well as many others I have read on this forum.

In reality though, it may or may not be worth trying to find out what is the root cause. For many men it is simply life with no frank disease that causes low testosterone. I believe this was my case actually. I was "relatively healthy" but my T level sucked. I've come to learn that nutrition and the current environment we live in plays a huge role. But I learned a lot of this stuff after starting T.

If I could go back, I would trial clomid first just because it's "easier" and a slew of other reasons. It certainly wouldn't cost that much (not talking money) because unlike testosterone, there is no recovery period for clomid that I know of. Just be sure to take a low dose... not this 50mg per day business some people are put on!

The biggest issues I see with you are definitely nutritional. I imagine lifestyle plays a part too, to be sure. But you listed some serious ---- use. 600mg of caffeine per day? Narcotic pain killers as well...

I realize you may have to take some dr---, but my goal would be to get off them as much as possible. These do have a profound effect on your overall metabolism and thus well being. The very fact that you list a sleeping dr-- and a huge intake of stimulants lends credence to the idea that you are putting your body in a very toxic, whirlwind state.

I simply would not expect testosterone therapy to turn your life around, as you may wish it will. But fixing many of these areas certainly can help. TRT may be unnecessary once you work out the rest. I could not rule that out at all right now.

Thanks for the reply! I'm only taking 1 pain pill each day, and I'll go to .5 in a few days, then 0. I just read it's better to taper than stop right away, so I wanted to do it right. I was prescribed it a long time ago, and I take it for some lower back pain I've had recently. Back is okay now, so definitely no need for something that strong.

As for the stimulants.. I started those about 2 weeks ago to assist with losing some weight. I aim for about 1 pound / week, but I definitely don't need the caff/ephedra. I have no problem quitting if it's detrimental. In past summers, I would take it for 8-10 weeks when losing weight. However, the only reason was to suppress my appetite (not to stay awake). I've had the sleep trouble since my teen years, so I got prescribed Ambi--n. It just takes me a while to drift to sleep.

I might have made everything sound worse than it is since I haven't been taking anything besides the Cita------ for any length of time. However, I appreciate the advice and will soon be only taking that until I see my doc and discuss tapering off. Anxiety was severe after personal traumatic events back then, but it's not anymore.

[jwhit84]

Oh, just one question I forgot to ask in my response; any aas abuse in the past?

He totally honest now!

Nope, not at all.

[jwhit84]

If I had a dollar for ever guy who came here under 30 presenting with your labs and all the Physician did was put you on T replacement without any further diagnostic testing I could pay my bar tab for a year without touching my wallet...and I like to drink

--- clipped due to antispam filter driving me crazy!! ---

gd

Thanks for the info! Is it weird that my TSH came back at 2.5 and 3.3 when the tests were only 3 days apart?

When researching hypothyroidism, some info even says it can be caused by low T and that TRT can correct it. What came first, the chicken or the egg?!?

If they did find me to have hypothyroid and treated me with daily Synth---- (or whichever), would that get my T up to the mid-high range you think (assuming the medicine got my blood levels in the right range)?

My dad, who is 68, got his T checked and it's 768. I don't know if it's genetic or what, but the doctor said his was very high for his age, and I'm kind of jealous . And no, they didn't mix up our test results...unfortunately! But seriously, since his is so high at his age, shouldn't mine be at least close to it??


EDIT: These anti-spam rules are killin me! I might have to stop quoting you guys because all you talk about is s--, dr---, etc. :P jk

[steroid.com 1]

You're new so the anti spam filter is a little sensitive...it will settle down over time.

Ok, let's stop all the guessing and agree that you need to find the right clinician who will conduct the correct testing on you to rule out any medical condition causing your low Testosterone serum levels.

This is the absolute best advise I can give you and I am willing others will all agree.

Find the right care as I guided you in the post above.

In most cases, it's Hypothyroidism that cause Secondary Hypogonadism not the other way around. The testes are down stream of the Hypothalamus and Pituitary Glands.

[HRTstudent]

I agree. Taking care of thyroid before testes is a good call. In some cases, it resolves the low T issues.

[Allaaro]

I know we all like to follow a professionals advice since you think it's best. Thankfully with the internet now and a brain put to use....we aren't at the mercy of someone who is running off outdated information at best.

Like others said, before lifelong TRT...vitamin D, thyroid....honestly if your doc is good(which seems like you need keep looking) he would test EVERYTHING...I think my doc got me to run 16 tubes drawn on first bloodwork lol....the med lab person was like ummm....you gonna be okay...that's lot of blood drawn.

Sadly though sometimes like myself you just need TRT since can't find the problem. But at least TRY to find it first. Try a restart, some other medication, hell maybe even try sleeping 12hrs a night for a week. Better to try various things before committing to lifelong meds.

[CMI10]

Hey guys.

I have a post a little further down the page I anyone can help.

[jwhit84]

I've gotten set up with an online clinic to do my own injections. This 2x/month crap is awful, and my urologist is set in his ways. I'm also off all medications except for the Cel-xa daily for anxiety. Latest T level was 816 and E2 was 32.6 on 4/17/13 (5 days after injection of 200mg cyp).

I should receive my test cyp, HCG, and anastrozole today. I'm doing:

Test cyp: either 80mg every 5 days or 50mg 2x/week
HCG will be 500 IU/week (take 250 iu 24 hours before each injection).
AI will be 0.5 mg/week (take 0.25 mg 24 hours after each injection).

This protocol seems to be pretty standard, and I am starting the AI because I have read that HCG will raise my E2 (which is already 32.6).

What do you guys recommend between between 80mg/5 days and 50mg/3.5 days?

50mg / 3.5 schedule
Sun AM - 250iu HCG
Mon AM - 50mg test cyp
Tue AM - 0.25mg anastr-zole
Wed PM - 250iu HCG
Thu PM - 50mg test cyp
Fri PM - 0.25mg anastr-zole
Sat - nothing

80mg / 5 schedule
Sun - 250iu HCG
Mon - 80mg test cyp
Tue - 0.25mg anastr-zole
Wed - none
Thu - none
Fri - 250iu HCG
Sat - 80mg test cyp
Sun - 0.25mg anastr-zole

[jwhit84]

Does this schedule look correct regarding the timing and dosage of HCG and the AI (anatr-zole)? Thanks

(click image)



EDIT: Also, can a mod please change my thread title to "At 28, put on TRT by uro. Now with clinic."?

Thanks!

[steroid.com 1]

I've gotten set up with an online clinic to do my own injections. This 2x/month crap is awful, and my urologist is set in his ways. I'm also off all medications except for the Cel-xa daily for anxiety. Latest T level was 816 and E2 was 32.6 on 4/17/13 (5 days after injection of 200mg cyp).

I should receive my test cyp, HCG, and anastrozole today. I'm doing:

Test cyp: either 80mg every 5 days or 50mg 2x/week
HCG will be 500 IU/week (take 250 iu 24 hours before each injection).
AI will be 0.5 mg/week (take 0.25 mg 24 hours after each injection).

This protocol seems to be pretty standard, and I am starting the AI because I have read that HCG will raise my E2 (which is already 32.6).

What do you guys recommend between between 80mg/5 days and 50mg/3.5 days?

50mg / 3.5 schedule
Sun AM - 250iu HCG
Mon AM - 50mg test cyp
Tue AM - 0.25mg anastr-zole
Wed PM - 250iu HCG
Thu PM - 50mg test cyp
Fri PM - 0.25mg anastr-zole
Sat - nothing

80mg / 5 schedule
Sun - 250iu HCG
Mon - 80mg test cyp
Tue - 0.25mg anastr-zole
Wed - none
Thu - none
Fri - 250iu HCG
Sat - 80mg test cyp
Sun - 0.25mg anastr-zole

I really like the 3.5 schedule a lot!

If it were me, I'd hold off on the AI till 1) you see and feel symptoms of elevated E2 or 2) 6 week labs.

With the way you are taking lower doses of Test and HCG over the course of the week it may not impact E2 synthesis.

[jwhit84]

I really like the 3.5 schedule a lot!

If it were me, I'd hold off on the AI till 1) you see and feel symptoms of elevated E2 or 2) 6 week labs.

With the way you are taking lower doses of Test and HCG over the course of the week it may not impact E2 synthesis.

Great, thanks! I'll do exactly that. Would you expect the HCG to raise my T a little bit more than only the 100mg/week test? I was close to 4 weeks into the 2x/month at 200mg regimen, and 5 days after shot #2, I had 816 T and felt good. I'm hoping to maintain 800+ T, assuming I consistently feel good at that level.