Quantcast

Author Topic: No improvement on TRT...  (Read 2301 times)

Smokdu

  • Jr. Member
  • **
  • Posts: 85
    • View Profile
No improvement on TRT...
« on: November 27, 2016, 11:14:27 pm »
Hey everyone, first time posting. I'm 43, 5'8", 175lbs. Body fat around 12%. Total T was at 338, Free T was really low end of normal (don't have labs in front of me), Estrone was high (Estradiol was around 18, I think), SHBG was low end of normal as was LH, Cortisol was upper normal. Prolactin was middle of normal. Everything else (TSH, T3/4) was right in the middle of "normal", and my doctor seemed okay with the readings.

I started TRT (with a HRT specialist) 4 weeks ago using pellets. I have not had my 6 week follow-up bloodwork yet. I was given 12 pellets and prescribed .5mg of AI weekly, which I split and take on Mondays and Thursdays. I have to do pellets as my job has me traveling away from home, (with no access to refrigeration) so there's no way I could keep up with an injection regimen, nor getting frequent refills.

The reason I started on TRT was due to numerous symptoms; loss of libido, lousy erections, ZERO spontaneous erections or morning wood, loss of muscle, night sweats, etc., for about the last year. The loss of libido and lousy EQ was the worst part.

So, at the 1 month point, the only improvement I've seen is the return of morning wood and a little more energy. EQ hasn't changed much, but I know that can take up to a year to improve. I have also changed my diet after reading this website, to lower saturated fats & maximize NO2 production, got back in the gym, and started running again.

My concern is that I haven't really felt ANY increase in libido, which was one of the most disconcerting symptoms I had. All the studies I've read say that libido generally starts improving around 3 weeks and peaks at about 6 weeks. At 4 weeks now, is it likely that I just am not going to see any change? Is this normal not to feel a huge improvement? Maybe I was expecting too much? Or is it just way too early to panic (so to speak)? Could it be that even with 12 pellets, my levels are still not high enough to make a difference yet? All the studies relating to improvement @ 3 weeks are using injectable T, not pellets. My doc did say the pellets peak at 6 weeks, so maybe with pellets its just a bit delayed? Should I suggest skipping a dose of AI to see if I feel better with a little higher Estradiol level? I think 18pg/ml is kinda low, isn't it?

I was taking the .5mg of AI every Monday morning, but I read that if Estradiol levels get too low, that can cause issues as well. I did not feel any different on Sunday night than I did on Wednesdays when the AI is at its peak. But just to be safe, I split the dose, figuring it couldn't hurt to have a steadier flow.

I know there is a lot of knowledge here. I like and trust my doctor, but as we all know they are very busy. If there are any suggestions I could take to her, that would make my time with her more productive. Appreciate any input.
« Last Edit: November 28, 2016, 12:09:32 pm by Smokdu »
43 y/o
5'8", 183lbs
Around 13% BF and goin⤵
Started TRT 10/10/16 with a baseline of 338,
Last labs at 1120. Still working out the bugs

golfboy307

  • Hero Member
  • *****
  • Posts: 741
    • View Profile
Re: No improvement on TRT...
« Reply #1 on: November 28, 2016, 12:43:57 pm »
I am in month 7 of IM injections, so my experience may not be entirely relevant, but... it took me at least 4-6 weeks to notice anything.  Then, I started to have much better energy, mood, anxiety vanished.  Morning wood got better (slowly).  Venous leak improved.  I would say libido has been the most inconsistent symptom.   Sometimes I am crazy horny, and other times its like I never started TRT.  But the other psychological improvements have been worth it so far.  Don't prejudge until you see your blood levels.  I continue to have to preach patience to myself as well. 

Hang in there..
Age 49, 5'10, 155 lbs
Cholesterol 167 (HDL 47, LDL 114, Trigs 78, LDL-P 1235 Borderline)
Fasting Glucose 90 (down from 97 pre TRT)
A1C:  5.2 (down from 5.7 per TRT)
Homocysteine:  12.4 > 11.0 > 10.2 using B vitamin therapy.  MTHFR positive 

BP  120/78 (using plant based diet and 10 mg Lisinopril ACE Inhibitor)  145/90 prior to meds.

Current protocol:  60 mg Test Cyp IM every 5 days. Adding 0.25 mg Anastrozole 1/wk. 
2/15/17 labs:  Total T (peak day): 1169 (250 - 1100 ng/dl).  Free T 198 pg/ML (46-225).  Sensitive E2: 40 High.  PSA 0.2  Hemocrit 44.2. SHBG: 32

Pre HRT numbers:
Total T  440 >> 375 >> 512 (Mar 16)
Free T  50 pg/ml (35 -155) LOW (Mar 16)
SHBG:  45 (HIGH Normal)  (10-50 nmol/L)
Estradiol (Ultrasensitive):  14 LOW (15 - 26 pg/ml)

Supplements:  Multivitamin, plus additional B12, B6, D, K2, Fish Oil, Magnesium, and Coq10

Evening stack:  2g Arginine, 100 mg Pycnogenol, 2.5G Kyolic garlic, 2g Vitamin C.  2 mg Cialis EOD

Peak Testosterone Forum

Re: No improvement on TRT...
« Reply #1 on: November 28, 2016, 12:43:57 pm »

Cataceous

  • Moderator
  • Hero Member
  • *****
  • Posts: 2609
    • View Profile
Re: No improvement on TRT...
« Reply #2 on: November 29, 2016, 07:38:25 pm »
Various thoughts: IMO you're setting yourself up for problems if you're not going to do regular monitoring of T, E2, etc. And related to that: I don't think it's wise to take an AI prior to knowing that estradiol is elevated. There are studies showing a positive correlation between estradiol and libido in men on TRT. Testosterone should not be refrigerated and a bottle can last at least a month or two at usual dosing rates. Self-injecting a couple times a week may be more of a nuisance than the pellets, but the cost is much less and it allows for better fine tuning and more stable hormone levels.

It's worth waiting at least two to three months to see if libido improves. You may not like this, but in some cases it takes adding hCG to TRT to get a decent boost in libido. Unfortunately hCG is relatively fragile and does need refrigeration, so it would be a hassle for you.
« Last Edit: November 30, 2016, 05:42:52 am by Cataceous »
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 56, Ht: 5'10", Wt: 154 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 6.25 mg DHEA orally bid
5/2017 test results: TT: 800 ng/dL (348-1197), FT: 16 pg/mL (7.2-24), E2: 50 pg/mL sensitive (8.0-35.0), DHEA-S: 278 ug/dL (71.6-375.4)

Smokdu

  • Jr. Member
  • **
  • Posts: 85
    • View Profile
Re: No improvement on TRT...
« Reply #3 on: December 01, 2016, 04:07:10 pm »
Thanks for the input.
I think my doctor is pretty good, but when I read on here about low SHBG,and emailed her, she didn't seem concerned. She said low was good, and we should only worry if it was high. Mine was bottom of "normal" range. Could this be something to worry about?
I am getting my blood drawn this week, so should know my #s soon. I guess I will just allow more time to see if my libido comes up some. I am not flatlined, just not how I was even a year ago.
43 y/o
5'8", 183lbs
Around 13% BF and goin⤵
Started TRT 10/10/16 with a baseline of 338,
Last labs at 1120. Still working out the bugs

PeakT

  • Administrator
  • Hero Member
  • *****
  • Posts: 36890
    • View Profile
    • Peak Testosterone
Re: No improvement on TRT...
« Reply #4 on: December 01, 2016, 06:54:21 pm »
Thanks for the input.
I think my doctor is pretty good, but when I read on here about low SHBG,and emailed her, she didn't seem concerned. She said low was good, and we should only worry if it was high. Mine was bottom of "normal" range. Could this be something to worry about?
I am getting my blood drawn this week, so should know my #s soon. I guess I will just allow more time to see if my libido comes up some. I am not flatlined, just not how I was even a year ago.

Lots of guys (imo) seem to have trouble if their SHBG is less than 15.  15-18 is the grey area.  Here is some information as to why:

http://www.peaktestosterone.com/how_to_cure_low_shbg.aspx

http://www.peaktestosterone.com/low_shbg.aspx
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements. Yes, low T and E.D. are usually medical conditions.

Peak Testosterone Forum

Re: No improvement on TRT...
« Reply #4 on: December 01, 2016, 06:54:21 pm »


Cataceous

  • Moderator
  • Hero Member
  • *****
  • Posts: 2609
    • View Profile
Re: No improvement on TRT...
« Reply #5 on: December 01, 2016, 07:05:29 pm »
...
I think my doctor is pretty good, but when I read on here about low SHBG,and emailed her, she didn't seem concerned. She said low was good, and we should only worry if it was high. Mine was bottom of "normal" range. Could this be something to worry about?
...

In general lower SHBG means you use/excrete testosterone at a faster rate. With injections it means more frequent dosing is required to maintain relatively stable hormone levels. Pellets may be useful in this situation. This post attributes the following quote to Dr. Marianco:

Quote
If frequent dosing of testosterone cannot be achieved with transdermals or injections, then a constant dose solution may be needed. This includes testosterone patches, the buccal system, or testosterone pellet insertions. Testosterone pellet insertions may be viewed as fairly drastic since it involves regular minor surgical procedures, but does give the most stable levels - so is a viable solution for the men with problems due to highly variable hormone levels resulting from low SHBG.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 56, Ht: 5'10", Wt: 154 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 6.25 mg DHEA orally bid
5/2017 test results: TT: 800 ng/dL (348-1197), FT: 16 pg/mL (7.2-24), E2: 50 pg/mL sensitive (8.0-35.0), DHEA-S: 278 ug/dL (71.6-375.4)

Hdrider

  • Newbie
  • *
  • Posts: 3
    • View Profile
Re: No improvement on TRT...
« Reply #6 on: December 02, 2016, 08:15:29 am »
I had a similar issue when I started.  My protocol is test cyp and HCG.

The doc added compounded DHEA.  25 mg 2x daily.  Libido picked up right away.

Also .5 mg of anastrazole Weekly may be too high.  I don't take any.  It seems like most guys don't need any.
« Last Edit: December 02, 2016, 08:20:55 am by Hdrider »

kcrunner

  • Hero Member
  • *****
  • Posts: 682
    • View Profile
Re: No improvement on TRT...
« Reply #7 on: December 02, 2016, 11:36:37 am »
1.  If you are 5,8 and 175, your body fat is not 12%, its more like 20% or so.   If you get a little leaner, your E2 should come down.

2.  You probably would feel better on injections.   Test cyp does not require refrigeration.   I have injected on backpacking trips before in the middle of the wilderness.

Diet, running, getting back into the gym will help a lot over time.     
Age: 40
Height: 6,1
Weight: 176
Total Testosterone: 829 ng/dl
Free Testosterone: 22 ng/dl
Current Meds:  Levothyroxine 137mcg, Testosterone Cyp Intra-Muscular 100 mg every 7 days.
Supplements-
Multivitamin
Vitamin E
Milk Thistle

Peak Testosterone Forum

Re: No improvement on TRT...
« Reply #7 on: December 02, 2016, 11:36:37 am »

PLEASE SUPPORT THE SITE AND GIVE AN AMAZON REVIEW IF POSSIBLE:


James

  • Full Member
  • ***
  • Posts: 140
    • View Profile
Re: No improvement on TRT...
« Reply #8 on: December 02, 2016, 12:07:39 pm »
Normal ranges for SHBG can only be understood with respect to other steroid hormones.  You can't call it low SHBG when it's seen with < 350 ng/dL of testosterone.  It's supposed to be at the low end of normal if your testosterone is also at the low end of normal!

It's most likely low SHBG when your testosterone is normal, but SHBG is not. 
It's nearly guaranteed to be low SHBG if both testosterone and estradiol are high, but SHBG hasn't moved.
It IS low SHBG if your total testosterone is normal, but free testosterone is out of range high.

IOW, you need another blood test.

The fact that your doctor doesn't understand the role of SHBG is an enormous red flag.  Ask her to read the study about the sister and brother with a  homozygous  missense mutation that prevents SHBG production.  Normal androgenization, but no sex drive and unable to gain muscle.  Only intracellular AR signalling is affected by free hormones.  Extracellular AR signaling requires SHBG.  Free (excess) SHBG is also required for extracellular SHBG-R signalling which either amplifies or attenuates the AR response in both intracellular and extracellular signaling in tissue specific ways.
« Last Edit: December 02, 2016, 12:21:25 pm by James »

Smokdu

  • Jr. Member
  • **
  • Posts: 85
    • View Profile
Re: No improvement on TRT...
« Reply #9 on: December 02, 2016, 01:52:00 pm »
@kcrunner- As to BF%, I was 14% back in September when I began all this, and have substantially changed my diet and exercise routine. I can see a good difference on my abs, so I am assuming around 12%+/-. I have been a gym rat my entire adult life and have been as low as 8% @207 lbs, while bench pressing over 450lbs. I am still well-muscled, but it was getting harder (impossible) to maintain the muscle mass, and I could see the ab ship was sinking. My Estradiol levels were not high, only my estrone.
@James- I don't know that she doesn't understand the role of SHBG, might be that she just doesn't think it's low enough to cause concern.  I am getting a blood draw Monday, so I'll know more soon. I will definitely discuss it with her on my next appointment.
I will also discuss where exactly my Estradiol level should be. I was at the low end of normal. I wonder if I wouldn't feel better a little higher. If my levels are the same this time, maybe I'll cut back to .25mg a week. If I was at 18, I should have some wiggle room, right?
Other than much improved sleep, which has led to more energy, I haven't noticed much of a difference. Morning wood is back strong, but through diet changes, I've increased my NO2 intake by a bazillion, so who knows if that's the cause.
Maybe my expectations were just too high due to all the great experiences on here. I have no choice but to wait and see.
43 y/o
5'8", 183lbs
Around 13% BF and goin⤵
Started TRT 10/10/16 with a baseline of 338,
Last labs at 1120. Still working out the bugs

KnobGoblin

  • Newbie
  • *
  • Posts: 35
    • View Profile
Re: No improvement on TRT...
« Reply #10 on: December 02, 2016, 03:31:44 pm »
1.  If you are 5,8 and 175, your body fat is not 12%, its more like 20% or so.   If you get a little leaner, your E2 should come down.

2.  You probably would feel better on injections.   Test cyp does not require refrigeration.   I have injected on backpacking trips before in the middle of the wilderness.

Diet, running, getting back into the gym will help a lot over time.   

Agree completely on all this advice. And I'd add 5'8" 175 at 43 with a very large emphasis on 43 and a secondary emphasis on 175. It's certainly possible to get to 12% at 43 but you'll probably have to accomplish that by getting very lean like 150 or so. a 5'8" dude thats 175 at 12% looks jacked as heck.

Any way for reference this is what 12% body fat looks like



« Last Edit: December 02, 2016, 05:43:08 pm by PeakT »

PeakT

  • Administrator
  • Hero Member
  • *****
  • Posts: 36890
    • View Profile
    • Peak Testosterone
Re: No improvement on TRT...
« Reply #11 on: December 03, 2016, 12:33:17 pm »
Thanks for the input.
I think my doctor is pretty good, but when I read on here about low SHBG,and emailed her, she didn't seem concerned. She said low was good, and we should only worry if it was high. Mine was bottom of "normal" range. Could this be something to worry about?
I am getting my blood drawn this week, so should know my #s soon. I guess I will just allow more time to see if my libido comes up some. I am not flatlined, just not how I was even a year ago.

The fast majority of doctors including endos is do not know about low SHBG.  Low SHBG is functional and preventative medicine and doctors do not concern them selves with that in the vast majority of cases.  In addition low SHBG affects TRT as mentioned above.  You have to take charge and learn about low SH BG and understanding yourself so you know to watch.  As an example I have seen many many men who burn from this testoserone very very fast because they are low SHBG.
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements. Yes, low T and E.D. are usually medical conditions.

Smokdu

  • Jr. Member
  • **
  • Posts: 85
    • View Profile
Re: No improvement on TRT...
« Reply #12 on: December 13, 2016, 07:14:47 pm »
So, I just had my first follow-up blood draw so don't know the results yet. I did a little experimenting on my own and wanted to post. My energy levels and sleep have improved tremendously on TRT. Erections seem better, though not any more numerous. Yet my libido is still lagging.
My doc put me on .5mg AI once weekly, which many people on here don't seem to agree with. I noticed that I seemed to feel better at the end of each week, when the AI should've beend at it lowest level. I split the dose into .25mg twice a week, and didn't really feel any difference. So, I thought I'd try to skip a week and see if that helped.
What I saw was my sleep went to shit, and my joints started aching, contributing to poor sleep. Of course energy dropped as well as I wasnt sleeping. Otherwise, nothing else changed. No change in erections, libido, etc. I don't know if that would change in a week, but I wasn't willing to go any longer. I felt awful all week. (It actually ended up being 11 days without the AI.
I've been reading a lot, and I'm thinking it may be my Cortisol. It was "high" in the mid-morning, and "elevated" the rest of the day. She tried to prescribe something for that, but it was another $100 a month, so I passed. Imy thinking I may have to bite the bullet and try it.
Here's what changes/additions I've made since starting TRT 7 weeks ago.
-Hitting the gym again 3x week weights/cardio
-6 oz. POM juice a day
-750mg L-Citruline 2x day
-?mg Horne Goat weed day
-Garlic, Vitamin C,  D, Panax Ginseng, Zinc, Magnesium, Fish Oil, (tried Tongkat Ali, didn't work)
-Lots of green leafy salad stuff, mostly Spinach & Arugula.
-Just started taking Acetylcholine/Inositol daily
Am I missing anything? Any suggestions?
43 y/o
5'8", 183lbs
Around 13% BF and goin⤵
Started TRT 10/10/16 with a baseline of 338,
Last labs at 1120. Still working out the bugs

James

  • Full Member
  • ***
  • Posts: 140
    • View Profile
Re: No improvement on TRT...
« Reply #13 on: December 13, 2016, 08:14:51 pm »
What did she prescribe for the high cortisol?


Smokdu

  • Jr. Member
  • **
  • Posts: 85
    • View Profile
Re: No improvement on TRT...
« Reply #14 on: December 13, 2016, 11:45:45 pm »
@James- you know I can't remember the name of it since she told me it was $300 for 3 months.

I haven't had a follow-up with my doctor since that was my initial dose, but she seemed like she really wanted to address the cortisol issue. I was so consumed with my low testosterone levels that I blew off the high cortisol. I was convinced that raising my test level would fix everything. I do feel better, but not $3000/year better.
My next appt is January 30th, at which time I expect an ass-chewing  (deservedly so) for being a tightwad and skipping out on the Rx she wrote.
I think I'll call the office tomorrow and see if I can get it filled. In for a dime, in for a dollar I guess.
43 y/o
5'8", 183lbs
Around 13% BF and goin⤵
Started TRT 10/10/16 with a baseline of 338,
Last labs at 1120. Still working out the bugs

Peak Testosterone Forum

Re: No improvement on TRT...
« Reply #14 on: December 13, 2016, 11:45:45 pm »