The Intelligent & Relentless Pursuit of Muscle™
T Replacement
 
Advice for New Guys
1
 

KSman
Level 1

Join date: Aug 2006
Posts: 8368

NOTICE: [11/09/12] We are seeing that a many guys who find there way to this forum have thyroid problems and/or iodine deficiency. Please pay attention to the content below that addresses such issues. See: http://tnation.T-Nation.com/...thryroid_basics

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This site has a lot of valuable information that you need to study. And there are a lot of dedicated guys here who provide extensive input and recommendations. While we want to be helpful, explaining the following issues over and over again gets old and frustrating. These recommendations will help us help you and will maintain the value of this forum.

There is a huge learning curve. Most seem to be able to absorb this material easily, but it takes time.

You may have found your way because you have low levels of testosterone [hypogonadism]. However, you can have other conditions that make you feel unwell. The can make the condition of low testosterone worse, or can be why your testosterone levels have dropped. We try to help sort that out so you can identify and treat root causes and not be simply covering up symptoms.

Recommendations:

1) When you open a thread [post] for your situation, you need to be using that same thread forever to maintain your "case". So choose the title with some care, you need to live with it.

2) Put all of your updates and questions into that one thread which is your case. We can then have complete context to best interpret and respond. If your case is all over the place, we can't do a very good job and we really are not interested in searching for your mess of different threads.

3) Read the stickies. There are basics in the 'protocol for injections' sticky http://tnation.T-Nation.com/..._for_injections that apply to all forms of TRT [testosterone therapy]. The Estradiol [E2] thread http://tnation.T-Nation.com/...you_should_care is a must study for any form of TRT.

Some do ask: Stickies are threads that are stuck to the top of the forum because they are important and should not be overlooked. Threads are the collection of posts that are collected under one topic.

4) Read the posts of others. You can find guys with similar issues and you can see how the threads progress and you can learn a lot from that.

5) Please do not inject your "case" into other threads. If the thread is a sticky, you are off topic and you reduce the value of the sticky. If the thread is someone else's case, that would be hijacking. You will not want others taking your case on a tangent either.

6) Your doctor is probably an idiot. If he/she is an endocrinologist or urologist you will probably have one of the worst idiots. This means that finding a good TRT doc is somewhere between difficult and impossible. There is a sticky for that: http://tnation.T-Nation.com/...nding_a_trt_doc

6a) Also see http://tnation.T-Nation.com/...docs_do_and_say
and add your own stories

7) We need you lab work in your case WITH LAB RANGES. If you doc tells you that something is normal, we still need the numbers because we see docs missing problems all of the time. There is also a sticky for lab work: http://tnation.T-Nation.com/...d_blood_testing

8) Do not accept "normal" from your doctor concerning any one lab reading or the whole report. You need to understand things deeper. Most of the time "normal" means that a particular result fits into a statistical measure derived from test subjects. "Normal" typically does not mean healthy or optimal. In a few cases, the ranges have been changed to recommendations such as fasting cholesterol and fasting glucose [blood sugar]. Doctors are really bad for thinking that lab normal means normal state of health.

9) If you are here trying to find sources for gear or someone to prescribe large doses of testosterone, go someplace else, we cannot help you in this forum. Do not post sources of drugs. Do not request that others post sources. What you do in PM's is your business. Bro-speak, bro-knowledge and bro-science will get you far on this forum.

10) You need to actively manage your own health care. Do not be a passive patient, which rarely has a good outcome when TRT is involved. Review your health conditions, symptoms and drugs your self. Many here will assist you. You also have to be proactive about your diet and supplements. You need to review drugs, Rx and OTC. Some make you feel worse, some make your hormone worse or cause the hormone problems. We can also review your meds.

11) Do not present what you know unless you are very certain of the facts. If you post crap, we will crap on you and we have to refute what you state so it will not mislead others. If you are not authoritative, don't be. Link to outside sources if needed. Be prepared to support things that you state. Otherwise, contribute!

In your case/thread opening post:
-age
-height
-waist
-weight
-describe body and facial hair
-describe where you carry fat and how changed
-health conditions, symptoms [history]
-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*
-- real dangers! see this http://propeciahelp.com/overvi...
-lab results with ranges
-describe diet [some create substantial damage with starvation diets]
-describe training [some ruin there hormones by over training]
-testes ache, ever, with a fever?
-how have morning wood and nocturnal erections changed

Note that you can edit all of your posts. In the lower RH corner, click 'edit' make changes and submit.

The language:

idiot -see doctor
T - testosterone
E - estrogens in general
E1 -estrONE
E2 -estraDIol - our main interest, you can basically ignore E1, E3
E3 - esTRIol
aromatase - enzyme that converts T-->E2
aromatization - action of aromatase
AI - aromatase inhibitor, reduces/modulates T-->E2 aromatization
anastrozole - AI
Arimidex - Brand/marketing name for anastrozole
DHT - dihydrotestosterone, a metabolite of T, mission critical for libido
5-alpha reductase - an enzyme that does T-->DHT
5-alpha reductase inhibitor - as implied, in hair loss drugs, very dangerous for a few
libido - sexual desire
T4 - thyroid hormone containing 4 iodine atoms
T3 - what you get when you remove one iodine atom from T3, the active form
rT3 - a non functional form of T3, creates serous problems if elevated
fT4 - amount of T4 that is not bound to thyroid binding protein
fT3 - guess
cholesterol - the starting point for all steroid hormones
mitochondria - ancient bacteria within cells that is symbiotic in most life forms
pregnenolone - made from cholesterol by mitochondrial bodies in your cells
CoQ10 - made in liver, reduced by statin drugs, essential for mitochondrial function
progesterone - made from pregnenolone [adrenals]
cortisol - made from progesterone [adrenals] - dead without it
ATCH - signals adrenals to make corticosteroids http://en.wikipedia.org/wiki/A...
DHEA - made from pregnenolone [adrenals]
T, testosterone - made from DHEA, mostly in the testes
Estradiol [E2] - made from testosterone in the testes and in the body
injected T: vegetable oil with dissolved testosterone esters and BA [~1%]
testosterone esters - chemicals that can be dissolved in oil
bio-identical testosterone - same molecule that occurs in the body
esterase - enzyme that removes esters, in this context, from testosterone esters
BA - benzyl alcohol to prevent bacterial growth
iu - international unit, definition varies with the drug/vitamin involved
vitamin D3 [vit-D3] - an essential vitamin
Vit-D25 - vit-D3 converted into the active steroid hormone
hematocrit - part of a CBC, fraction of blood cells that centrifuges separate from liquid.
CBC - complete blood work
FSH - a gonadotropin that is needed to make sperm
LH - a gonadotropin that is needed to make T in the testes
hCG - a gonadotropin that has one part that is identical to LH, weakly acts like FSH
peptide hormone - FSH, LH, hCG and growth hormone [HGH], amino acid based
prolactin - a peptide released by orgasms or in high amounts from a pituitary andinoma
adinoma - another word for a behign tumor
steroid hormone - based on cholesterol
doctor - see idiot
EFA - essential fatty acid, fish oil, nuts, flax seed etc, good for endothelium & more
endothelium - lining of blood vessels http://en.wikipedia.org/...iki/Endothelium
endothelial dysfunction - a mechanism of arterial/heart disease
Clinical research - yields info that can guide diagnosis, treatment and dosing
medical research - yields info about processes, very often misleads, may not be human
in-vivo - research based in living organisms, sometimes useful
in-vitro - research in "glass" as in test tubes etc, rarely of practical use
SERM - selective estrogen receptor modifier, leads to more LH. FSH, T, and E2
clomid - a SERM that is old with many functional research studies
nolvadex - a newer SERM that is better than clomid, but old research distorts the truth
transdermal - drug delivered through the skin, typically very inefficient and costly
QOL - Quality of Life
endothelium - lining of blood vessels http://en.wikipedia.org/...iki/Endothelium
endothelial dysfunction - a mechanism of arterial/heart disease

T+AI+hCG - a protocol that includes those three items

EOD or E2D - drug dosed every other day
E3D - guess

half life - how long a drug takes to fall to half of its peak level
clearance time - how long it take for a drug to be basically gone from your system

serum - pertains to blood levels
saliva - pertains to levels in saliva
tissue levels - can't do that on humans, saliva levels are thought to be similar to tissues

Rx - prescribed meds
OTC - over the counter meds

HPTA - Hypothalamic Pituitary Testicular Axis, regulates levels of steroid hormones. T and E inhibit the HPTA leading to less LH and FSH peptide release from the pituitary. E is much more repressive than T. Prolactin and progesterone are also repressive.

Hypogonadism: Your HPTA is broken or weak.
Primary hypogonadism: Your testes [testicles] are weak or failed.
Secondary hypothyroidism: Your pituitary+hypothalamus are producing little or no FSH & LH

Adrenal fatigue: AKA hypoadrenia or adrenal dysfunction. You will see this and other adrenal issues been discussed. Your adrenals can be weakened by long term stress, loosing your job, a death in the family, auto accidents or other trauma, chronic infections, chronic inflammation [like gum disease], parasitic diseases and more. This book is a really good reference: http://www.amazon.com/...TF8&s=books One of the signs of this is general weakness and feeling that stressful events wear you down or make you feel physically weak. Many docs do not believe that this condition exists, partly because there is no billing code for it.

Injections: Testosterone injections can be IM [intramuscular] or SC [subcutaneous] sometimes written as SQ. Injectable testosterone is most always 200mg of T ester per ml. To inject 100mg/week, you would inject 0.5ml/week. But report your dose in mg's, not ml's. The two most common T esters are testosterone cypionate and testosterone ethanate, also known as cyp and eth. As the dose also includes the weight of the ester group, once the ester group is removed in your body, the mg's of testosterone is less than the mg's of T ester injected. The result is around 70% bio-identical testosterone. There is more T in a T eth dose than a T cyp dose as eth ester groups weigh less, leaving more T per unit dose. T ester injections are time release delivery systems. Heavier esters release more slowly and lighter esters faster.


To read more, Google [term wiki] to easily find Wikipedia articles. While there explore the many links in the articles. IE http://en.wikipedia.org/...Steroid_hormone

If in doubt, Google and read.

A good first read: But predates use of hCG, anastrozole and has antiquated understanding of how T should be injected: http://www.amazon.com/...e/dp/087131858X

Info about hCG that might influence your doc:
http://tnation.T-Nation.com/...cg_linksstudies

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VTBalla34
Level 5

Join date: Mar 2009
Posts: 7536

I would add a definition of "adrenal fatigue" or hypoadrenia or adrenal disfunction or similiar, with a link to Wilson's book on amazon.

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KSman
Level 1

Join date: Aug 2006
Posts: 8368

Maybe you can link this to: http://tnation.T-Nation.com/...23&pageNo=0 by editing your first post.

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VTBalla34
Level 5

Join date: Mar 2009
Posts: 7536

KSman wrote:
Maybe you can link this to: http://tnation.T-Nation.com/...23&pageNo=0 by editing your first post.


Done.

It may be worthwhile to transfer some of my notes in my Cheatsheet to your definitions. When I was first researching all this, not knowing anything about it, it was information that I found useful at the time to help me put the story together.

Now that I am well versed in those terms, the info seems a bit silly, but was beneficial at the time.

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KSman
Level 1

Join date: Aug 2006
Posts: 8368

I will check that out later.

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VTBalla34
Level 5

Join date: Mar 2009
Posts: 7536

We seem to have a few new guys on here that are completely new to forums and how they work. This sometimes leads to frustration from members who have seen the same questions asked thousands of times or experience pushback when asking simple questions for clarity.

While I think the below article is a bit elementary and condescending, someone completely new to the forum scene may find it beneficial. If this is your first go round on a forum, you do not know what a "stickey" is, or you are used to asking questions in a chat room format, then this link is probably beneficial for you:

http://www.ehow.com/...line-forum.html

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brazilianguy
Level

Join date: Sep 2012
Posts: 115

I don't know if I should post it here but I think adrenal problems is a thing that everybody should look and I think what I've found maybe good to the people that are hopeless to read because a lot of people fixed their ED with that.

However, once I got recovered from the flu, I started to feel great. Amazingly great. My libido came back, I felt happy and energetic...and this awesomeness lasted for 3 full weeks, until a business trip stressed me out and I wound up back at square one. I'm pretty sure the Cortef was responsible for the jump in energy, zest, etc. So I don't understand how it is said that HC only lasts a few hours in the body...mine lasted weeks. I have not had libido in 4 years and suddenly it comes back? I am sure it was the Cortef.


Prednisone took care of my ED and morning wood completely, E2 never really made a difference.....I had low cortisol

For SIX YEARS the only response from doctors that I got was that I have mental problems causing my symptoms, like loss of libido,
ED, tiredness, lack of motivation to do things. It was not just one or
two doctors, but SEVERAL. So yeah, I'm not at all surprised. It seems
most doctors are either imcompenent or just don't care. Luckily, my
problem was not something that would kill me because of late diagnosis,
like cancer. I turned out to be hypothyroid and have adrenal fatigue, and respond
excellently to thyroxine and hydrocortisone. Thanks to internet and
messageboards like this, I solved this puzzle.

BTW,
after only a few days on adrenal extract I have noticed a huge
improvment on my sex drive too, which was an unexpected but welcome
surprise! :D

i had ED with high-normal IGF-1 and Testosterone....the cure for my ED was prednisone treatment due to low cortisol...

I can tell you from personal experience that once i started treating my
adrenal fatigue with Cortef my sex drive started to come back, muscle
strength and size and energy levels also much better fat loss without trying.
I have my free T and total T levels before treating adrenals and im
getting them tested now during treatment im sure they will be much
higher.

Is it possible to lose libido with low Cortisol? I got a Cortisol Stim
test where they inject you with cortisol and they take a few blood
readings and when they gave me the cort, I had a noticable libido jump a
few minutes later. I thought this was odd.

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KSman
Level 1

Join date: Aug 2006
Posts: 8368

There are many health conditions that can interfere with libido and energy. Glad to hear that you found your weak link. Unfortunately, some have multiple weak links.

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ajthomas
Level

Join date: Apr 2013
Posts: 11

52 year old male
5'11
190 lbs.
33 in. waist
22% body fat
hairy but waxed regularly
moderate beard
balding, shaved head
BP 130/70
I recently went to an Age Management doc. I am including my labs in the body of this post.
He established the following protocol:
1cc test cyp 210 mg once a week IM with 23 gauge x 1.5 needle
1 tamoxifen 20 mg tab 4x's per week
1 anastrazole 1mg tax 2x's per week
all the above for 10 week cycle
Week 11 alternate tamoxifen and anastrazole for 6 days
Week 12 alternate tamoxifen and anastrazole for 6 days in addition
1200 units HCG and 1 55mg clomiphene capsule for 10 days beginning week 12

TESTOSTERONE, TOT.,S. 738.7 193.0-740.0 ng/dL
SEX HORM.BIND.GLOB. 72 HI 10-57 nmol/L
TESTOSTERONE, FREE, SERUM 4.76 3.84-34.17 pg/mL
% FREE TESTOSTERONE 0.6 LO 2.0-4.8 %
LH 4.0 1.7-8.6 mIU/mL
FSH 11.1 1.5-12.4 mIU/mL
ESTRADIOL 20.37 7.63-42.60 pg/mL
IGF-I (SOMATOMEDIN-C) 118 81-238 ng/mL

Total Protein 7.3 5.9-8.4 g/dL
Albumin 4.5 3.5-5.2 g/dL
Globulin 2.8 1.7-3.7 g/dL
A/G Ratio 1.6 1.1-2.9
Glucose 99 70-99 mg/dL
Sodium 138 133-145 mmol/L
Potassium 4.7 3.3-5.3 mmol/L
Chloride 101 96-108 mmol/L
CO2 30 HI 22-29 mmol/L
BUN 12 6-20 mg/dL
Creatinine 0.96 0.90-1.30 mg/dL
e-GFR 82 >60 mL/min
e-GFR, African American 99 >60 mL/min
BUN/Creat Ratio 12.5 10.0-28.0
Calcium 9.4 8.6-10.2 mg/dL
Bilirubin, Total 0.3 0.1-1.0 mg/dL
Alk Phos 78 40-156 U/L
AST 35 <40 U/L
ALT 48 HI <41 U/L
-* CARDIOVASCULAR/LIPIDS *--
Cholesterol 211 HI <200 mg/dL
Triglycerides 206 HI <150 mg/dL
HDL CHOL., DIRECT 45 >40
HDL as % of Cholesterol 21 >14 %
Evaluation: AVERAGE RISK
Chol/HDL Ratio 4.7 <7.4
Evaluation: AVERAGE RISK
LDL/HDL Ratio 2.78 <3.56
LDL Cholesterol 125 HI <100 mg/dL
VLDL, CALCULATED 41 HI 7-32 mg/dL
------* HEMATOLOGY *--------
WBC 5.43 3.40-11.80 x10(3)/uL
RBC 4.61 4.20-5.90 x10(6)/uL
HGB 14.4 12.3-17.0 gm/dL
HCT 42.1 39.3-52.5 %
MCV 91.3 80.0-100.0 fL
MCH 31.2 25.0-34.1 pg
MCHC 34.2 29.0-35.0 gm/dL
RDW 13.5 10.9-16.9 %
POLYS 54.2 36.0-78.0 %
LYMPHS 30.0 12.0-48.0 %
MONOS 8.5 0.0-13.0 %
EOS 6.4 0.0-8.0 %
BASOS 0.7 0.0-2.0 %
IMMATURE GRANULOCYTES 0.2 0.0-1.6 %
Platelet Count 129 LO 144-400 x10(3)/uL
MPV 10.2 8.2-11.9 fL
-----* MISCELLANEOUS *------
TSH 3.950 0.270-4.200 uIU/mL
PSA 3rd. GEN. 0.48 <4.00 ng/mL

Any input would be greatly appreciated!!


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KSman
Level 1

Join date: Aug 2006
Posts: 8368

One of the first things stated in this sticky is not to post your case into any stickies.

Create your own thread and keep all posts about you, over the weeks and years, in that one thread.

In your post, replace the text with "delete" using the [edit] in the right hand lower corner, after you copy and paste it to your own thread.

Stickies are for topic specific info and general clarifications only please.

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forgiven1
Level

Join date: Apr 2013
Posts: 16

I'm right there with you Brazilianguy, I went the route of raw pituitary and adrenal caps, bovine and porcine alike and started taking a male complex supplement. it seem to work wonders. I'm going to re read and reread and reread your Siri but I would love to talk more on the subject. I feel you hit the nail on the head and would like to know what you know as this is still a new discovery to me. But a discovery nonetheless that has beyond amplified my lifestyle. You know what I'm talking about haha

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diazium353
Level

Join date: Jun 2013
Posts: 11

I am thinking if there are any good TRT except the ones that need us to inject it to our body.. I mean, I got a serious phobia with needles and am thinking to take a gel kind of treatment.


What do you guys think?

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KSman
Level 1

Join date: Aug 2006
Posts: 8368

We mostly advocate for self injection for these reasons:
- 100% delivery VS 10% if you are lucky for transdermals [creams, gels], 90% waste=$$$
- least cost
- least T-->E2, transdermals can be the worst
- [note the suggested protocols]

Note that millions are injecting, mostly diabetics. You can inject T with the same tiny insulin needles [see the stickies]. I was needle adverse. But I decided that there was no real reason why I could not do this myself. The insulin needles are quite painless, sometimes I do not feel anything when injecting SC [under the skin, not into muscle IM]. There is no need to inject into muscle and cause damage from decades of that.

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snedwick
Level

Join date: Jul 2013
Posts: 4

I will post my own thread to describe specifics of my scenario, however, I wanted to post a big thanks in this sticky. I found this forum and thread earlier this year when I initially had blood work come back with extremely low T. This thread was clear and I followed the guidance (after seeing a useless endo). I ultimately found the right doc by following the steps in this thread. It works. So thanks.

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brazilianguy
Level

Join date: Sep 2012
Posts: 115

I don't know if its here that I should ask something like this. But I'd like to know more about DHEA, because I saw some people here saying that it did nothing to their ED and libido problems but I'm sure the people here were taking high dosages like 50, 100mg or even more. I was talking to a man about adrenal fatigue and he said that just 5 to 15mg make his libido and energy excellent and he doesn't feel good on more. I know the conversion to E2. So the question is: Is it better to take in lower miligrams? Because there are many man taking it for more than 10 years and saying it fix their libido and ED. I'm waiting for some good advice specially from KSMAN.

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KSman
Level 1

Join date: Aug 2006
Posts: 8368

DHEA has no direct effects on libido. If one has a deficiency, that may have mental effects and might rate limit one's DHEA-->T production and then taking DHEA might have some effect on those issues. Low DHEA is strongly associated with low one year serviceability after a heart attack, as with low T. DHEA seems to have good health benefits, but typically, not something that one would feel. If one gets benefit from low dose and more negates that, DHEA-->E2 with higher dose is a probably reason.

Your question: Depends on whether you are on TRT or not. If on, DHEA would not affect T levels. Best to do labs for DHEA-S and get in the .75-1.00 of high normal range. If DHEA causes E2 issues, you need to reduce DHEA.

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rca
Level

Join date: Sep 2013
Posts: 8

Any advise would be greatly appreciated. My post has been up for a few days but I haven't had any responses. Am I on the right track? I wrote 1ml of Test, but my dose is actually 200mg.

Thanks in advance!!

http://tnation.T-Nation.com/..._old_new_to_trt

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KSman
Level 1

Join date: Aug 2006
Posts: 8368

Not here please, tag me at the KSman is here thread.

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DrJekyll
Level

Join date: Oct 2013
Posts: 1

First of all, I want to apologize if I use this forum incorrectly. This will be my first attempt.

6'1". 280lbs. true waist 42. body fat would be probably around 40%. I would guess. I was diagnosed with Low T about two years ago. My dr. prescribed every gel and patch known to science for the first two year, after failing to bring my T levels to a normal range. Finally she prescribed injectable Test. have seen some improvements but after two increased dosages, my T level is still low(160). any suggestions to help increase my T level?? Thanks

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IareChaz
Level

Join date: Apr 2013
Posts: 70

What is your dosing protocol?

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carlos_anton
Level

Join date: Mar 2014
Posts: 21

Thank you for the newbie references and stickies.

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