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T Replacement
 
TRT at 23, 6 Months of Labs Included
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Suazeey
Level 0

Join date: Mar 2012
Location: Massachusetts, USA
Posts: 6

I've read a lot but as is often the case in medicine, I keep finding contrary evidence. Hopefully the questions raised in this thread will be common enough that experienced members can answer easily, and new members can benefit from. I've rearranged the format for readability; everything is here - I think.


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QUESTIONS

1. Recommendations for hCG dose/schedule for TRT purposes. I've heard that daily low-doses are less disruptive of T:E ratios. Inversely, I've heard 1,000IU, once a week is best due to Leydigs' refractory period - you'll retain better sensitivity to hCG/LH as well.

2. Pituitary shutdown is more easily roused than testicular shutdown, correct? So SERMs have no place in TRT, correct?

3. Rely on symptoms before numbers for dosing, right? What are the best (anecdotal) cues to finding the right dose for you? I'd rather not wait for gyno to consider tweaking, but I want to see improvement as soon as possible.

4. Should I avoid an AI? Entirely? I've heard of PRN dosing but that seems anti-homeostasis. (Although if we're in this sub-forum, chances are our natural homeostasis doesn't really work for us.)

5. Based on my phenotype (height, low body fat, low BMI) and considering my family history I don't think I have a propensity for aromatization or DHT build-up so I'm thinking of trying to maintain levels towards the end of the free T range. Is this a reasonable thought process?

-------------------------------------------------------------

STATS

23 years old
6 feet, 140 lb.
No AAS history, no trauma, no suspicion of a tumor (skipping MRI), no testicular abnormalities, no skeletal abnormalities, no obvious symptoms of high estrogen.

Summary Labs:

TSH, LH, FSH, SHBG all low-average to average, consistently.

Testosterone:

10/11
Quest
396

11/11
Hospital A
371

01/12
Hospital B (#1)
262 (free 165)

03/12
Hospital B (#2)
312

Clomiphene test: failed/aborted

I started clomiphene 50mg 3x/week in early January.

I stopped taking the clomiphene after about six weeks. Endo asked me to trial it for twelve. I probably shouldn't have stopped but I didn't notice ANYTHING after six weeks. In twelve do you think I would have seen improvement? (Sincere question.)


-------------------------------------------------------------

LABS

*I'm about to start on gel but I'm waiting to have E2 and DHT tested.

**These tests were performed at three different labs, unfortunately.

Test 1: Quest
Test 2: Hospital A
Test 3 & 4: Hospital B (#1,2)



-------------------------TEST 1: Mid-October 2011

TSH 2.87
0.40-4.50 mIU/L

Testosterone, Total 396
250-1100 ng/dL



-------------------------TEST 2: Early November 2011

TSH 2.54
0.5-5.7 mU/mL

LH 3.7
1.7-8.6 mU/mL

Prolactin 9.6
4.04-15.2 ng/mL

Testosterone, Total 371.1
249-836 ng/dL

SHBG 32
10-60 nmol/L



-------------------------TEST 3: Early January 2012

-Free Testosterone-

Testosterone: 262 NG/DL
Reference Range 450-1000

SHBG: 32 NMOL/L
Reference Range 13-90

Albumin: 5.1 G/DL
Reference Range 3.6-5.1

Calc Free Test: 165 PMOL/L
Reference Range 180-900
*Is this a problem? Calculated (via T/SHBG?) instead of using analyte?

-Free Thyroxine-

Free Thyroxine: 0.9 NG/DL
Reference Range 0.6-1.2

-Prolactin, Blood-

Prolactin: 12 NG/ML
Reference Range 2-15

-Iron Profile-

Iron: 75 uG/DL
Reference Range 50-160

Transferrin: 292 MG/DL
Reference Range 200-340

TIBC: 369 uG/DL
Reference Range 250-430

Saturation: 20 %
Reference Range 15-47%

-Ferritin-

Ferritin: 56 NG/ML
Reference Range 16-287

-Thyroid Stimulating Hormone-

TSH: 2.90 ulU/ML
Reference Range 0.30-4.5 FSH

-Follicle Stimulating Hormone

FSH: 5 IU/L
Reference Range 1-15

-Luteinizing Hormone-

LH: 3 IU/L
Reference Range 2-6

-Prostate Specific Antigen Diagnostic (Monitoring)-

PSA 0.5 NG/ML
Reference Range 0.1-2.8

-IgF-1-

IGF-1: 294 NG/ML



-------------------------TEST 4: Mid-March 2012

-Free Testosterone-

Testosterone: 312 NG/DL
Reference Range 450-1000

SHBG: 32 NMOL/L
Reference Range 13-90

Albumin: 4.8 G/DL
Reference Range 3.6-5.1

Calc Free Test: 206 PMOL/L
Reference Range 180-900

-Luteinizing Hormone-

LH: 4 IU/L
Reference Range 2-6

-Prostate Specific Antigen Diagnostic (Monitoring)-

PSA 1 NG/ML
Reference Range 0.1-2.8

-CBC-

WBC 4.15 K/UL
4.4 - 11.3

RBC 5.10 M/UL
4.4 - 6.0

Hemoglobin 16 G/DL
13.8 - 18.0

Hematocrit 46.8%
40.0 - 54.0

MCV 92 FL
80 - 96

Platelet Count 230 K/UL
150 - 450

RDW 12.0%
11.5 - 13.4


-------------------------------------------------------------


DETAILS

Small side of average frame. Traditional proportions/no skeletal abnormalities (shoulder-chest-waist-hips ratio, limb length, skull proportions). Waist: 28

Low body fat (hover from 3-6% according to Tanita. [scale])

Moderate facial hair; little body hair.

Diet: I definitely eat enough calories but I can't gain/maintain any weight beyond my current. Regarding TRT, I do want to gain weight but I don't plan on adjusting my diet to perfection. Health/fitness is my priority.

I've tried supplementing zinc a number of times in recent years. And nearly every other vital nutrient. No known deficiencies, no observed benefits.

Sleep: 7-8 hours consistently, although I often need sleeping pills, which interfere with the quality of sleep.

Training: Especially in the past year, I've been lazy as hell. Not looking to troubleshoot anything related to training though.

Blood pressure and blood sugar normal.

No hair loss/prostate drugs, ever.

No consistent Rx

Morning wood has decreased to intermittent. This seems most highly correlated with sleeping pills - for me at least.

Testicles have never ached with fever.

Condition History: None, really. Born nearly ten weeks premature. No noted effect on development aside from low birth weight (but not low weight for that stage/timeline of development). I've been wondering about this one. Insight, anyone? Developmental links?


-------------------------------------------------------------

Thanks guys - I'm really looking forward to this. It's amazing how knowledgeable some of you are: Honorary ThD's. Hah. You help a lot of people with life-changing shit. That's incredible. Cheers!

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iroczinoz
Level 0

Join date: Jan 2011
Location:
Posts: 529

Your testosterone is low no doubt. What did the clomid do as far as numbers lh, fsh, test, and how much were you taking?

At 140lbs you are very light how much do you eat? Write us an example of your diet.

Those tanita scales are not accurate at all.

You might want to run more tests before you commit to TRT as you are certainly missing some.

Cortisol?
dhea-s?

Cholesterol?

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VTBalla34
Level 4

Join date: Mar 2009
Location: District of Columbia, USA
Posts: 7027

I couldn't get through your convoluted long winded post this early in the morning but picked out some things. I'll try my best to answer it, but next time think more "highlight reel" than "War And Peace" when you are asking someone for help.


Suazeey wrote:


1. Recommendations for hCG dose/schedule for TRT purposes. I've heard that daily low-doses are less disruptive of T:E ratios. Inversely, I've heard 1,000IU, once a week is best due to Leydigs' refractory period - you'll retain better sensitivity to hCG/LH as well.


Your body makes LH in pulsatile patterns daily, so why would hcg be any different? More frequent the better, considering injection pain and pain in the ass factor. 3x/week is fine and is the recommended protocol here.


2. Pituitary shutdown is more easily roused than testicular shutdown, correct? So SERMs have no place in TRT, correct?


Probably. In theory, I like the idea of SERMs on TRT to keep the pituitary alive as much as possible (LH and FSH will shut down if on exogenous test) but in practice, this doesn't appear to be the case. it seems the SERM is not able to overcompensate for the shutdown.



3. Rely on symptoms before numbers for dosing, right? What are the best (anecdotal) cues to finding the right dose for you? I'd rather not wait for gyno to consider tweaking, but I want to see improvement as soon as possible.


Yes. Good feelings, morning wood, etc. Basically what any healthy person would feel.



4. Should I avoid an AI? Entirely? I've heard of PRN dosing but that seems anti-homeostasis. (Although if we're in this sub-forum, chances are our natural homeostasis doesn't really work for us.)


Avoid unless you need it. Bloodwork and symptoms will be your feedback. I recommend starting out without it (especially for learned guys). You're right that guys that need TRT seem to usually have different "homeostasis" than what you would expect from a normal population (at least the ones that resign to seek help on a forum since they are not easy-fix cases).


5. Based on my phenotype (height, low body fat, low BMI) and considering my family history I don't think I have a propensity for aromatization or DHT build-up so I'm thinking of trying to maintain levels towards the end of the free T range. Is this a reasonable thought process?


Its hit or miss for E2, but you are at lower risk. You need to monitor. Not sure if bodytype influences DHT conversion.

------------------------------------------------------------------------------------------------------

Other notes:

You are 6', 140 pounds. No adult male should ever be this small. You simply are not eating enough. There is no way I will ever be convinced otherwise.

Your test is definitely low. Need to figure out why. Shouldn't have stopped the SERM restart, but it was too low dose and not frequent enough (IMO) anyway. I think bodybuilders coming off AAS cycles use about 100 mg clomid/day for 2 weeks then taper that down to 50 mg/day for 2 weeks, before stopping entirely. Don't quote me on that because I don't know much about PCT, but that's what I seem to remember. Either way dosing is every day and higher.

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Hardasnails
Level 0

Join date: Nov 2002
Location:
Posts: 760

VTBalla34 wrote:
I couldn't get through your convoluted long winded post this early in the morning but picked out some things. I'll try my best to answer it, but next time think more "highlight reel" than "War And Peace" when you are asking someone for help.


Suazeey wrote:


1. Recommendations for hCG dose/schedule for TRT purposes. I've heard that daily low-doses are less disruptive of T:E ratios. Inversely, I've heard 1,000IU, once a week is best due to Leydigs' refractory period - you'll retain better sensitivity to hCG/LH as well.


Your body makes LH in pulsatile patterns daily, so why would hcg be any different? More frequent the better, considering injection pain and pain in the ass factor. 3x/week is fine and is the recommended protocol here.


2. Pituitary shutdown is more easily roused than testicular shutdown, correct? So SERMs have no place in TRT, correct?


Probably. In theory, I like the idea of SERMs on TRT to keep the pituitary alive as much as possible (LH and FSH will shut down if on exogenous test) but in practice, this doesn't appear to be the case. it seems the SERM is not able to overcompensate for the shutdown.



3. Rely on symptoms before numbers for dosing, right? What are the best (anecdotal) cues to finding the right dose for you? I'd rather not wait for gyno to consider tweaking, but I want to see improvement as soon as possible.


Yes. Good feelings, morning wood, etc. Basically what any healthy person would feel.



4. Should I avoid an AI? Entirely? I've heard of PRN dosing but that seems anti-homeostasis. (Although if we're in this sub-forum, chances are our natural homeostasis doesn't really work for us.)


Avoid unless you need it. Bloodwork and symptoms will be your feedback. I recommend starting out without it (especially for learned guys). You're right that guys that need TRT seem to usually have different "homeostasis" than what you would expect from a normal population (at least the ones that resign to seek help on a forum since they are not easy-fix cases).


5. Based on my phenotype (height, low body fat, low BMI) and considering my family history I don't think I have a propensity for aromatization or DHT build-up so I'm thinking of trying to maintain levels towards the end of the free T range. Is this a reasonable thought process?


Its hit or miss for E2, but you are at lower risk. You need to monitor. Not sure if bodytype influences DHT conversion.

------------------------------------------------------------------------------------------------------

Other notes:

You are 6', 140 pounds. No adult male should ever be this small. You simply are not eating enough. There is no way I will ever be convinced otherwise.

Your test is definitely low. Need to figure out why. Shouldn't have stopped the SERM restart, but it was too low dose and not frequent enough (IMO) anyway. I think bodybuilders coming off AAS cycles use about 100 mg clomid/day for 2 weeks then taper that down to 50 mg/day for 2 weeks, before stopping entirely. Don't quote me on that because I don't know much about PCT, but that's what I seem to remember. Either way dosing is every day and higher.



Clomid even at 50 mgs a day can make the biggest grown man cry. One needs to look at possible underlying pathology to why he is having thee issues. I can see a huge number of red flags and since I have dealt with numerous cases from in that area I can pretty much guarranttee his vitamin D levels are in the 15-20 which will not all his body to produce and respond optimally to the LH as well as its receptors. Would it suck if he found out he had a simple vitamin D deficiency which may have been at the root cause of the whole thing? I have seen this sequence many times in people from above NY and in the UK. Correct the vitamin D deficiency give supporting nutritional factors VIOLA the adrenals, thyroid, and LH fire right up. I can not emphasis GET TO THE ROOT CAUSE OF THE PROBLEM. Using HRT is fine as a temporary band aid, but sticking your self in the ass or shoulder will get old after 4-5 year very quickly !! People are coming to Dr's who have been on HRT injection for years wanting to get off because they are tired of sticking them selves so we are looking to other alternatives which would be find the underlying stressors then deal with them accordingly.

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Suazeey
Level 0

Join date: Mar 2012
Location: Massachusetts, USA
Posts: 6

@iroczinoz

Clomid: I don't have actual results. If I tested at the beginning of week 0 and week 12, I took Clomid weeks 0-6.

Diet: I'll try. I've tried numerous approaches: spiking insulin with huge quick-digesting meals, eating constantly throughout the day, eating ridiculous amounts of protein, high fat to hit 4k calories/day. I don't think diet is the root cause.

I'll ask to have DHEA-S tested.

Speaking of cholesterol - does this tell us anything?
(I don't know about triglycerides but I've tested glucose with a home monitor (just to see) a few times and fasted I'm high 80's, 2-hour post-meal I'm high 90's...)

Cholesterol: 135
(118-200)

HDL: 34
(40-65)

(Ratio: 3.97)

LDL: 62
(<130)

VLDL: 39

Triglycerides: 197
(38-143)

Glucose: 105
(70-100)



@VTBalla34

You're right. I see threads where the OP has to be asked 20 questions just so people can help. I edited it.

Thanks for responding to my questions. I guess I won't try convincing you that I eat enough then. Clearly this is beyond diet though.



@Hardasnails

Exactly. I'm going to ask for a vitamin D test and I'll look into other potential factors.

For the past month and a half I've been taking 400IU of vitamin D each day. I've read little about the turnaround time, just saying.

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iroczinoz
Level 0

Join date: Jan 2011
Location:
Posts: 529

Hardasnails wrote:

Clomid even at 50 mgs a day can make the biggest grown man cry.


What do you think of clomid therapy as a substitute for HRT? Say someone responds well to clomid with their LH increasing and in turn doubling testosterone values Is this something men can be on for life? Because, from what I have read it is usually tapered off and discontinued. But if testosterone drops again and LH drops again after stopping clomid you really need to be on it for life to get the benefits.

So I guess the question is can clomid be a life long treatment for secondary hypogonadism or would testosterone shots be a better alternative after all? I understand that in some cases clomid can restart the HPTA axis but what about for those that it does not?

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Suazeey
Level 0

Join date: Mar 2012
Location: Massachusetts, USA
Posts: 6

iroczinoz wrote:
So I guess the question is can clomid be a life long treatment for secondary hypogonadism or would testosterone shots be a better alternative after all? I understand that in some cases clomid can restart the HPTA axis but what about for those that it does not?


I think you answered your own question. From what I've read, clomiphene is rarely considered aimless therapy. You try to jump start your HTPA for a period of time (varying based on preference and reason for shutdown). If it doesn't work you try something else.

To update the thread: I had to negotiate to get DHT added to an E2 requisite that he was resistant to as well. I sacrificed DHEA-S and Vitamin D. I'm going to make an appointment elsewhere. Starting gel as soon as they draw for baseline levels.

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