Need help to do TRT right

Hi All...I am a new user here (of the forum ) and I come to you guys with my hat in my hand so to speak...

I am a 45 yo male who had been successfully using Test En for TRT for a while (To confirm, I was put on this by my GP after he tested my T levels only)...as these things go, I quit about 2 years ago...and boy do I feel it now.

I am wanting to go back on to TRT as my quality of life has gone down the loo...difference is, this time I want to do it right. The previous time, I was inexperienced and did not do my research correctly, made use of the wrong medical professional, had the wrong goals etc etc.

I am hoping to look at all my sex hormones, and perhaps even cortisol / thyroid, but my point of departure is definitely checking out test, est, progesterone etc.

So, my question to you guys is, which type of medical professional should I make use of? Also, is there a specific Dr. that can be recommended (if that is allowed by the forum rules, if not, please forgive this faux pas). I am looking for a Dr. that understands what a male wants to achieve via TRT and also understands what the process entails. i.e. what the optimal levels for the hormones are and that what we are trying to achieve is optimal levels of all the hormones, i.e. balance. To reiterate, at this point in time, I am not interested in going the Adonis route, I just want to get my life back...I should be in my prime, but I really feel like an Oupa. I am based in the Jo'burg region btw.

I have a reputable source for the gear that would be required...I am not anti patched and creams, it's just that they work out to be expensive, and I do not mind the jabs.

Thanks for taking the time to read and I look forward to any help / advice that anyone could give.

Thanks

OupaHans.

Hi All, I would like to apologise for my forum name, when registering my profile, I did not know that there was already an "Oupa" here, or should I say THE "Oupa"...please, no disrespect was meant.

In future, please refer to me as OH (OupaHans). That should clear up any confusion.

Thanks

OH

You are going to hear many different 'best' ways to do TRT. Ultimately, it's best to educate yourself to make your own decision and make changes according to how your body reacts. Every guy's body will react a bit differently. Just make sure to get regular blood tests to make sure your haemotocrit and estradiol are at acceptable levels. I recommend joining Dr John Crisler's forum at www.allthingsmale.com/community/ .

You will get better advice there than you'll get from most doctors. Give this a watch as well:

Welcome to the forum OupaHans. You’ll find some great info here. Start of, you might want to search for my and Ondier’s TRT related threads. I am by no way an expert on this, but it might help fill in some details that haven’t crossed your mind yet.

First off; a GP is a really bad idea for TRT advice. This is a take home message regarding any medical issues: see a specialist. You won’t regret the expert opinion. Among the steroid community doctors are not always held in high regard, this is because the term “doctors” has become synonymous with General Practitioner. A urologist is your best bet regarding HRT advice .I’ve seen endocrinologists (most reputable and demanded in GP) and urologists many times and their insight is worth the investigation. Please, only consult a GP regarding this if you need a referral for your medical aid to cover a specialist visit, or if you trust your GP to recommend a good specialist.

Second; an increasingly popular product is Nebido (testosterone undecanoate). It requires 4 injections a year making it very comfortable and easy to manage. You probably only get hold of this through a pharmacy though. If you want to go the other route, I’d choose cypionate over enanthate for the longer ester.
I’ll always opt for pinning over oral, patches or topicals. I've read many complaints regarding the latter two. Sweating, contact with others, continuous application, ect. If you are comfortable pinning yourself, I don’t see a reason not to.

Otherwise MA above gave you some good material to start reading. Hope it helps mate.

Nice concise advice Furk. Thank you. +1 for the effort.

And OupaHans, I wouldn't worry about getting confused with Oupa - he is a total original! Smiley face!

Nate

Hi guys, many thanks for your kind replies.

Nope, I did not disappear . I had my bloods done, woohoo.

The results? Not so woohoo :blink:

Okay, below is a table of the results and, to me they confirm what I already knew with one or two wrenches in the works just for kicks:

Test Result Reference Indication
Kidney Function Normal
Liver Function Normal
S-PSA 1.46 ng/ml 0.0 - 4.0 Normal
S-TSH 0.91 uIU/ml .35 - 4.94 Low
S-Progesterone <0.3 nmol/L 0.4 - 3.1 Low
Estradiol (E2) 72 pmol/L 40 - 161 Normal
Total Test 6.7 nmol/L > 12 nmol/L Low
Free Test 196 pmol/L 180 - 739 Low
SHBG 12.8 nmol/L 11.1 - 78.1 Normal
DHEA 2.29umol/L 3.8 - 13.1 Low
LH 4.0 U/L 1.8 - 8.2 E/L Normal
S-Cortisol 64 nmol/L 101 - 535 Low


So I'm glad that my liver, kidneys and prostrate are all in good order, given my age and everything I have done in my 42 years (that's another looooooooooooooong story).

However...my thyroid, test, progesterone and cortisol are very low, too low...

From my limited research, it would seem that treating the low progesterone would be a good point to start as it works in tandem with test, works against est. and could assist with the thyroid.

Whaddya think? It may also be an easier route than doing TRT? Albeit more expensive.

Anyway, I am here for advice and opinions please, does anyone have anything based on the above results?

Thanks as always

OH

Come to think of it, my E2 might actually be very high in relation to the level of Total T and Free T, so maybe an AI would be necessary as well? Not to sure how powerful the AI effects of progesterone would be...

Oupahans u are very right about that e2 level. It should be around the 40 mark really. I would use aromasin at your ai of choice and at 12.5mg eod to start. If you willing to hold off on the trt and try something for a month, run tamoxifen and aromasin and then have bloods done again. See if that shifts the e2 to test ratio.

Also you only got your tsh levels done here not your free t3/t4 levels. The higher estriodal can have affect on your t3/t4. If your tsh was high the thyroid would be under stress and they would have administered t4 as replacement.

Pregnyl has been known to boost tsh levels too. So maybe you need to run a pct and see if u can balance out the body? Probably have nothing to loose running 250iu hcg with 20mg tamoxifen and 20mg aromasin and at the same time run solals thyroid support formula with 1500mg of ltyrosine and 200mcg of selenium daily. That might change alot of things for you.

Thanks SteveC...

May I ask what the various items you listed would do and what they are?

Ideally my 1st prize is to balance out my hormones at the upper level of the reference ranges (for the "good" stuff) and at the lower level for the not so good stuff. If I can achieve that without resorting to HRT then that would be even better. However, I am willing to do what is necessary to get my life back...(within reason of course :blink: )

Hold on, I just did what I hate...ask someone else because I'm to lazy to find out for myself

So, if I understand you correctly you are recommending the following:

1) Pregnyl (HcG): to jump start own production of T
2) Aromasin : to reduce conversion of T to E and to improve T:E ratio
3) Tamoxifen : same as for aromasin?
4) Solal thingy : to support thyroid function

Okay, that sorts out part of the problem, what about

5) Progesterone : suggest compounded cream maybe? As the "mother of all hormones" restoring this should go a long way to straightening everything out?
6) Cortisol : (This may improve by itself if the other parent hormones are balanced?)
7) Low LH : This is a problem, and together with the low progesterone might be the cause of the low total and free T, how to improve this? with the HcG?
Low DHEA : Will this improve if total and free T is improved?

OH

If I understand correctly you haven't been using steroids for 2 years? If that is the case, your testicles are not responding to the message from your brain (LH) to make testosterone and after 2 years you should have recovered. Your LH is normal - an LH of 4 should result in MUCH higher T. When my LH is 4.3 my T is arond 20nmol/L. If you have been off anabolics so long then you have primary hypogonadism and should see a doc for it. HCG is an analog of LH and would increase your T equivalent to your body producing more LH (eg LH of 4 -> total T of 7, add HCG -> total T of maybe max 15 but this is not sustainable long term)

Progesterone is not "the mother of all hormones" :S, and low progesterone does not cause low T.

Pregnyl is not the answer. You do not take HCG to treat your thyroid. Anyway bud, a low TSH level does not mean your thyroid is underactive. It strongly suggests the opposite. Your body produces more TSH when your thyroid hormones (T3, T4) are too low. It's not dangerously low but one should also go by symptoms rather than just what the numbers say for TSH. Get your T3 and T4 tested if you are concerned about your thyroid.

Your E2 is on the high end for someone with such low T but should not cause any significant side effects. You could try a PCT3 and see what happens but I wouldn't expect magic.

Thanks for the reply Muscle Addict...

So, what would be the solution for me then? Especially if a PCT3 (sorry, could you elaborate on what a PCT3 is? I'm really lower on the rung than a layman...) would not bring about fireworks...

I would dearly like to sort out the low T, high E (in relation to the low T) and of course the progesterone. Forgive me if I sound like a broken record, but from what I have been reading it seems to me like starting off with progesterone cream first and re-evaluating after x period seems to be the way forward. Of course, all of the information that I have gathered has come from the internet, and if it is on google then it must be true, right?

...Primary hypogonadism you say, what would be the solution for that? TRT? If so, then I suppose I should look at controlling E as well?

Okay, HcG is not an option iro a solution and I am not concerned with fertility, so I can cross that off of the list, correct?

Thyroid seems to be okay you say, if symptoms persist whilst on TRT & Progesterone I should have the T3 & T4 tested? I say this because many of the symptoms for low thyroid correspond to low T, high E & low progesterone...except for the cold extremeties, which I do not have anyway...So it's okay if I cross this off of the list for the time being as well?

So, if I understand you correctly, that leaves me with the following protocol

1) TRT
2) AI
3) Progesterone cream

I am looking at increasing it if it is too low, and decreasing it if it is too high

Then, I will re-evaluate after 3 months with further bloods etc.

Is that closer to the mark you think?

If you think so, then we can talk about esters, dosages etc

Thanks

OH

Hi OupaHans

PCT3 is a post cycle therapy the help start your natural test production. See link for more info on PCT3, take a look at the "NO.3"

anabolicsteroids.co.za/articles/informat...9-post-cycle-therapy

MuscleAddict suggest to run this protocol to see how you respond. After 6 weeks finishing the PCT3, have tests done, then we can see what the next step is from there. As MA said Primary Hypogonadism means your testis are not responding to your brain to produce testosterone. Ultimately at the end of the day you probably will have to resort to TRT with this condition. But let a good specialist who is well practised in TRT suggest this to you.

With regards to the other drug profiles you mentioned, your best bet is to consult an endo. or Urologist.

Thanks Gains, will do so...

I will try to keep everyone up to date....

Hi Guys, just a quick update.

I am going for new bloods tomorrow to see how my original regimen has affected my various hormone levels.

I did have one or two very good days in the last 8 weeks, feeling strong, happy, horny with no joint pain...then I had one or two days feeling very depressed and pretty much the opposite of the aforementioned.

Right now I feel "balanced" again in that I am not moody, but I am still weak, lethargic etc etc. So I am interested in seeing what my blood work will reveal.

Depending on the results from the latest blood work, I am going to run the PCT3 as per your suggestion, however, I will have to make use hCG as I cannot get a hold of Ovidrel with my current supplier. Can my Dr. write a script for Ovidrel? I am assuming it will be very expensive irt an ug supplier.

I have read that some guys get fully restored and go on to live happy productive lives, and others have no joy...we will see, but I will keep updates coming, I am looking forward to the PCT.

Of course, I am keeping my age, current diet, weight and other factors in mind when it comes to the results of the PCT and whether it sticks or not, but if I can break the vicious cycle by balancing hormones then the rest will fall into place.

Cheers

OH

I've never gotten hold of Ovidrel underground. I did 3 months on it, specialist doctor (urologist) prescription. Costs a f#ck-ton, did 1 shot per week. Concentration of Pregnyl and Ovidrel are different so just make sure you are administering the correct amount.

Unless you're GP is extremely well versed in endocrinology and hormones he probably won't know you need it/ how to approach your problem.

Okay, it seems that I will not be able to get hold of, or afford Ovidrel, so I am leaning towards Dr Scallys' retstart protocol which has the following:

1) 2000iu's hCG EOD for 10 shots
2) Clomid @ 50mg daily for 20 days
3) Nolvadex @ 20mg daily for 30 days

Or should I do PCT3 but replace the Ovidrel with hCG even though Doctari said not to...

Will post lab results once I have them.

OH

Hold on, I may have been able to get Ovidrel...a very reasonable price for the right amount needed in the PCT3, will just have to get a script from my Dr...

Will keep all up to date.

OH

Hold on, apparently Ovidrel is off the market? This is according to the Locum at my local pharmacy...how now?

This really is a schlep...blech.

Given that I have been "off" for so long, there are no longer any AAS in my system, what would you thing if I went with PCT2 instead and see how I respond? PCT3 is obviously 1st prize but it does not seem like I am going to be able to get all the ingredients, I will however keep on scratching around to see if I can find something...

OH

Hi Guys, herewith my latest labs (thyroid results to follow tomorrow)



1st Test / 2nd Test Comments



Progesterone: <0.3 / 6.00 Will reduce dosage, happy with result

E2: 72 / 60 16.5% reduction, too high

tT: 6.7 / 4.9 26% decrease, low, not acceptable

SHBG: 12.8 / 17.3 35% increase, acceptable in range

fT: 196 / 126 35% decrease, low, not acceptable

DHEA: 2.29 / 9.98 Happy with result, will keep stable

LH: 4.0 / 3.0 Concerned about this...still too low

FSH: DNT / 2.6 Too low

Cortisol: 64 / 142 Nice increase, still to low



So, my progesterone and DHEA levels increased nicely due to the supplementation, I can safely half the dosage of progesterone that I am using at the moment and still be in the upper ends of the range, DHEA is already in the optimal range so no change there.



Cortisol is up nicely as well, albeit a bit low still. It probably has to do with the increase in reserves from the DHEA, pregnenolone and progesterone supplementation to the hormonal cascade. Not planning any changes there except for dietary ones...



I am concerned about the drop in tT & fT, as well as LH. At least the drop in the T figures lined up with the increase in SHBG, and the lower T could be explained by the lower LH, so at least it looks like my testes and my LH know about each other, that is a positive, possibly taking primary hypo out of the picture. Now that I have further base numbers I plan on doing the Scally restart protocol. Will retest tT, LH, FSH & E2 at the end of the hCG shots and then retest after finishing with the Clomid & Nolva and then 4 weeks after that to see if it stuck, then I will make my decision re TRT...



Does that sound like plan?



Cheers



OH

Okay, walk with me here...



I am E dominant, my T levels walk in lockstep with SHBG, LH, whilst E follows T lower.



In my layman mind, I am not Primary. I would like to restore T:E Ratio and simultaneously increase T (whilst boosting other hormone levels as well with current regimine.)



I am proposing to do the following:



Day 1- 14



Aromasin @ 20mg ED to reduce dominant E levels, test E2 & T levels



Day 15 - 45 (doses dependent upon above labs)



Aromasin @ 20 mg EOD to keep E levels in check

Clomid @ 50mg EOD to stimulate FSH, LH Levels

Nolvadex @ 20 mg EOD to stimulate FSH, LH Levels



Stop, test E2 & T levels for new baseline and recheck in 6 weeks in tandem with clinical symptoms...



Does this sound like a plan or is my logic / idea flawed?



Some help would be appreciated, thanks



OH