Starting over with my journey on Testosterone- First Labs back

[EnlightenedViking]

Hi Guys,

I'm 5 years in on TRT after going through my late 20's with mild depression, low libido etc. Sure enough had Total T around 250-300.

Got on Test Cypionate injections for the past 4 years and while it helped for the first 2 years with energy, confidence, and sex drive. I feel like I have plateaued in a big way. I have less energy, sex drive is very up and down, and I still have to deal with ED from time to time.

I want to start from scratch and could use your help

Here are my latest lab results after injecting 200mg a week. I split the dose 1/2mL twice a week. This bloodwork would technically be my trough levels. Inject on Sunday am, bloodwork done on Wednesday morning.

Testosterone, Free & Total — 682 Total - 18 Free
Estradiol, Sensitive — 21.6
Growth Hormone (GH) — .1 (yes 0.1 is it normal to have no growth hormone while on TRT?)
Estrogen, Total — 97 - Seems high?
Dehydroepiandrosterone (DHEA) Sulfate — 277
Insulin-like Growth Factor-1 (IGF-1) —191
Sex Hormone-binding Globulin (SHBG) —  32.3
Parathyroid (PTH), Intact — 33
Pregnenolone — 29
Progesterone — 0.1
Hematocrit - 52.9 - High

Although I've recently moved to another state, I am ready to get another round done in case I am missing some key tests. As you all know it is almost impossible to find someone who can interpret these results in person.

Options I have considered to go get back to the drawing board:

- Going off TRT for 3-6 months(reset)
- looking into hCG to kickstart FSH and LH and get my balls working again, follow up with semen analysis.
- Continue on this path and make minor variations to the my current protocol.

[Cataceous]

Unfortunately your situation is not so unusual, at least judging by reports in the forums. TRT can seem to be working well for a good length of time, but then problems return. You may find some benefits in hCG use; it's worth trying. It improved TRT for me, but in the end it wasn't enough. I eventually got out of the rut, but it requires a pretty drastic protocol. I hypothesize that the suppressed upstream hormones are contributing to our problems. These include kisspeptin, GnRH, LH and FSH. Normalizing these levels makes things a lot better for me.

Regarding growth hormone, my understanding is that it varies a lot, so an individual measurement isn't so useful. Instead, IGF-1 represents more of an average measurement of GH, and is what we should go by.

What's the reference range for total estrogen? I doubt it's anything to worry about. Estriol and estrone are much less potent than estradiol, so probably nothing to be worried about with estradiol on the lowish side relative to testosterone.

Is your progesterone measurement on the 0.0-0.5 ng/mL reference range? I think as part of normalizing all hormones it's worthwhile pushing this up to mid-range.

[cujet]

It's not an easy journey. I'm an older guy, but I've been near zero T since age 33 due to illness. My journey took me to compounded creme, not because it's the best, or that it gives the best results, but because it's what I can deal with.

After all this time on T replacement, the method seems not to matter all that much, and More is certainly not better. I find that I must be below 800 and above 450.

[EnlightenedViking]

What's the reference range for total estrogen? I doubt it's anything to worry about. Estriol and estrone are much less potent than estradiol, so probably nothing to be worried about with estradiol on the lowish side relative to testosterone.

Is your progesterone measurement on the 0.0-0.5 ng/mL reference range? I think as part of normalizing all hormones it's worthwhile pushing this up to mid-range.

Estrogen, Total - Estrogens, Total 97     Ref Range - pg/mL 40-115

It's on the higher side of the range but not too bad.

You might be on to something with the Progesterone. It's at .1  in the 0.0-0.5ng/mL range.

Pregnenolone was 29. After doing more research it looks like I need to step it up as well. I'm going to see if I get my hands on this to supplement.


I just ran more labs(2/22) on a few other things - here is what I came back with:


DIHYDROTESTOSTERONE, LC/MS/MS   58    Reference Range: 12-65 ng/dL

TSH 1.65 Reference Range: 0.40-4.50 mIU/L

T4, FREE 1.0 Reference Range: 0.8-1.8 ng/dL

PROLACTIN 12.7 Reference Range: 2.0-18.0 ng/mL

CORTISOL, A.M. 18.7 mcg/dL     Reference Range  Specimen: 4.0-22.0

PSA, TOTAL 0.4 Reference Range: < OR = 4.0 ng/mL


Overall it's a battle each day with my mental health.

I have low sex drive, foggy memory, lack of morning/nocturnal erections, etc.

My doctor did prescribe HcG and I compound pharmacy is supposed to be calling me early next week to mail to me.

See anything suspicious on the latest labs?


 

[Cataceous]

Your total testosterone is surprisingly low for the very large amount of testosterone you're injecting. If your absorption rate is typical then your predicted peak testosterone is bit over 1,000 ng/dL. If I were taking 200 mg T cypionate per week then even my average level would be around 2,400 ng/dL. The 200 mg TC per week represents 20 mg per day of testosterone. The typical natural man makes 6-7 mg T per day, and the reference range is considered 3-9 mg.

In spite of your serum T levels not being outrageously high, your hematocrit is suggesting they are still too high for you. I think you'd do better if your peak testosterone were knocked down to your current trough value. The problem with that is that your new troughs would be around 400-500 ng/dL. As short-lasting daily troughs these are fine and desirable levels. But they can be more problematic when they last a day or more due to less frequent injections.

I don't know how much complexity you're willing to tolerate for marginal gains. I believe the problem with testosterone levels could be solved with daily injections of an appropriate cypionate/propionate blend. This causes serum testosterone to somewhat mimic the variations seen in natural men. I suspect there are some benefits in having a normal peak testosterone of 600-800 ng/dL followed by a trough value later that's ~40% lower. For me having lower testosterone at night has also proved better for sleep.

Progesterone supplementation is another source of marginal gains. At a minimum I have better mood and sleep by raising my level from 0.1 to 0.3 ng/mL. I have used topical and injectable forms of progesterone, and both are effective.

Although your prolactin is in the reference range, some men will have problems when it's over ~10 ng/mL. While on TRT I had my level creep up from 6 to 11, which did correlate with problems. Forcing prolactin down with cabergoline improved some symptoms, but in the end much better results came with protocol modifications that seem to naturally keep prolactin lower.

HCG may be a good fit for you. Because your estradiol is a little on the low side, a boost from hCG could actually be helpful. How much will you take? Typically with TRT guys take 500-1,000 IU per week in divided doses.