TRT not working

[Curmudgeon]

Hi folks,

This is my first post. I'm 30 and have been on TRT for 18 months. I've had low T levels ever since I was first tested at 19. They would hover about 10-14 nmol/L (9-35). It didn't really concern me that much, but I would get tired rather quickly. I also had a hard time building muscle. At 20, I had about 7 fortnightly shots of enthanate 250 from my doctor. I put on about 9 kg over that time (20 lb) and got a fair bit stronger. But I had terrible gyno and gave up.

Two years ago I had a bone-density scan and it showed "almost osteoporosis". Now that got me worried. I saw a HRT specialist. He got me started on lipoderm testosterone cream. The dose went up to 250 mg per day, but had no effect on my T-levels. My DHT levels did go up though. So it must have been getting into the system. At the same time I started on Zoloft 50 mg which I slowly built up to 400 mg over the next 6 months. This has been my Zoloft dose for a year now.

For the last 12 months I've been getting reandron injections from my HRT doctor every 10-12 weeks or so. I also did arimidex at the start, but developed major pain in my hands which took at least 6 months to diminish. Also my oestrogen levels really really dropped. So I discontinued the Arimidex after 8 weeks. I've also been taking 1/4, later increased to a 1/3, of a 5mg Proscar tab a day to control the DHT levels.

After the first injection, my T-levels peaked at 17, but I'd had it that high in that past without any supplementation. Since then, it would hover in the 10-14 range, which is normal for me. I've had no gyno symptoms. My testes have shrunk. My DHT level got fairly high, but increasing the Proscar to 1/3 tab a day was enough to bring it into the normal range. This is my latest blood-work:

Total Testosterone: 14.2 nmol/L (9.5-35)
Dehydroepiandrosterone Sulphate: 9.9 umol/L (3.0 - 10.5)
SHGB: 18 nmol/L (13-71)
Calculated free testosterone: 390 pmol/L (225-725)
DHT: 1.3 nmol/L (1.2-4.7)
Sensitive Oestradiol: 58 pmol/L (50-150)

(My SHGB has always been at the bottom of the range.)

I don't know what my next step should be. I really don't feel like having a hip replacement in 10 years time. At first my doctor said that Zoloft should not interfere with TRT, but now says that it may. He also wants me to do thyroid tests, which I've been putting off because it's a whole 24 hours devoted to peeing into containers. I'm also a bit concerned about his injection technique. My first doc would inject primo depot into the upper outer quadrant of the buttock, while I was standing. My TRT doc has me lie down and injects almost into the side of the buttock. Now admittedly the Reandron injection is a lot bigger, but the doctor says that it's too big to inject right into the muscle and should be injected into the fatty tissue instead. He says shooting it into the muscle would hurt like hell. Well I thought that intra-muscular means just that - into the muscle.

Any suggestions?

Thanks for reading and any advice.

Curmudgeon

[HeadDoc]

did you ever have thyroid and adrenals checked?

[Curmudgeon]

Originally Posted by HeadDoc

did you ever have thyroid and adrenals checked?

No, but I do have a referral from the doc to have "24 hr Urine:; Thyroid Hormones; Human Growth Hormone" tests. It's on my todo list. I'd have to investigate this adrenals business. I was under the impression that good T levels make the andrenals function properly, rather than the other way around.

[eeso]

Where are you located?

Urine test isnt that bad - u just have a big jug that u pee into and u store it in the fridge. It's only 1 day. U should also have a blood test for TSH, Free T3, Free T4 for your thyroid.

As for reandron, instead of shooting 1000mg every 10-12 weeks, shoot 250mg every 2 weeks and save the rest. So you just get the full shot, and split it into 4 syringes and store it, using one every 2 weeks. This will keep your levels heaps more stable.

[Curmudgeon]

Originally Posted by eeso

Where are you located?

Urine test isnt that bad - u just have a big jug that u pee into and u store it in the fridge. It's only 1 day. U should also have a blood test for TSH, Free T3, Free T4 for your thyroid.

As for reandron, instead of shooting 1000mg every 10-12 weeks, shoot 250mg every 2 weeks and save the rest. So you just get the full shot, and split it into 4 syringes and store it, using one every 2 weeks. This will keep your levels heaps more stable.

I'm in Melbourne, Australia. I wonder whether it's worth just shooting enthanate every 2 weeks instead (though the gyno sides sucked, and I am not sure I'd like to take Arimidex again). I thought the whole idea of Reandron is that after 2-3 injections the levels pretty much stabilize.

BTW, is anybody else on massive doses of SSRIs with TRT? My 400 mg Zoloft regiment is double the max recommended.

[eeso]

Go see Dr. Bill Anton - he's in Melbourne:

http://www.lifesource.net.au/Practitioners.htm

[Curmudgeon]

Originally Posted by eeso

Go see Dr. Bill Anton - he's in Melbourne:

http://www.lifesource.net.au/Practitioners.htm

Thanks for the link. Is he an M.D.? Can he prescribe?

[zkt]

Originally Posted by Curmudgeon

No, but I do have a referral from the doc to have "24 hr Urine:; Thyroid Hormones; Human Growth Hormone" tests. It's on my todo list. I'd have to investigate this adrenals business. I was under the impression that good T levels make the andrenals function properly, rather than the other way around.

Everything effects everthibg else. BUT no, normal T levels dont guarantee good arenal fundtioning. Actually the adrenals contribute about 25% of total T production.
I sure dont see a problem with peeing into a jug for a dary. A 4-point salivary cortisol test is more accurate.
Thats a lot of SSRI. Do you have any libido at all ?

[jaydee]

I am not really up to speed with taking shots as I do transdermals. But seems strange that you cant get your numbers up, even with shots.

What dose of Armidex were you on and how often did you take it. You only need tiny amounts of it because it is very strong.

If your in doubt about your doctor's injecting technique, ring some pharmacies and ask if it really does need to go IM. Im no expert, but I would think that doing a shot into fat instead muscle would effect the way the ester worked. Get a second opinion from another doctor also.

If possible, I would try and get off the Zoloft for a trial period and see what happens. Its the only way you will know if it is effecting your regime or not. Of course under your doctors instructions..... I am not a big fan of SSRI's at all and I think they do more harm than good a lot of the time and you should only use them if its absolutlely necessary.

The Proscar use concerns me bigtime. I would be leaving that out all together. Others may disagree with me. Why do you feel you need to lower DHT anyway? Are concerned about prostate or hairloss or somthing? 1/3 of a 5mg tablet of finasteride is a huge dose considering how potentially dangerous it is. Its strange that your DHT is rocketing up, yet your T isnt - especially while on shots.

This is an obvious question, but hows your calcium intake? While your T is being sorted, i would make doubly sure your getting a good cal/mag supplement.

As others have said, you really need to get your thyroid and adrenals checked as well. A spit test is the best way to go for adrenals and Free T3 and Free T4 and TSH for your thyroid - not just TSH.

Can you get any HCG from your doctor to see if you can get your boys going again?

Is that all the blood tests youve got? Try and get prolactin as well.

More important than anything else.....you do you feel? You feel tired you said...how is the sex life, libido, morning erections.....?

[Curmudgeon]

Originally Posted by zkt

Everything effects everthibg else. BUT no, normal T levels dont guarantee good arenal fundtioning. Actually the adrenals contribute about 25% of total T production.
I sure dont see a problem with peeing into a jug for a dary. A 4-point salivary cortisol test is more accurate.
Thats a lot of SSRI. Do you have any libido at all ?

Libido is OK, but somewhat reduced. But then again, my idea of normal may not be normal since my test levels have always been low. Ejaculation was delayed a lot at the beginning (when the dose was much lower as well), but not so much now. I am a bit concerned about staying on such a high dose for so long, in that it may severely depress my libido, but I heard that Zoloft is not so bad in this regard compared to, say, Prozac. I do think that it takes something off my energy levels, but the drop feels pretty much the same regardless of the dose. In the past I've taken Paxil at starting doses for 3 months, and that made me incredibly tired and almost unable to ejaculate. I've also taken Remeron (not an SSRI) at starting doses for a month. That made me super-tired, and made me pile on 10 lb in a month. Good for appetite, though. Very foggy like Paxil (can't decide which one was worse). I've had the least side effects with Zoloft.

P.S.

I also take 50mg of DHEA per day, but my levels have not elevated much.

[Curmudgeon]

Originally Posted by eeso

Where are you located?

Urine test isnt that bad - u just have a big jug that u pee into and u store it in the fridge. It's only 1 day. U should also have a blood test for TSH, Free T3, Free T4 for your thyroid.

Where I live, it's kinda hard to put a jar of piss in the fridge.

[Curmudgeon]

Originally Posted by jaydee

I am not really up to speed with taking shots as I do transdermals. But seems strange that you cant get your numbers up, even with shots.

Beats me. Like I said, I definitely reacted to Enthanate (gyno side effects and all) 10 years ago. I've had no effect from lipoderm cream. None from reandron. I do feel like a small energy boost in the first week or two after the shot, but I could be imagining things.

Originally Posted by jaydee

What dose of Armidex were you on and how often did you take it. You only need tiny amounts of it because it is very strong.

Arimidex 1/2 a 1mg tab twice a week. I only took it for 2 months. I haven't taken any in 12 months now. My estrogen levels appear to be in the normal range. I think they plummeted with Arimidex.

Originally Posted by jaydee

If your in doubt about your doctor's injecting technique, ring some pharmacies and ask if it really does need to go IM. Im no expert, but I would think that doing a shot into fat instead muscle would effect the way the ester worked. Get a second opinion from another doctor also.

Actually I'm pretty sure it's IM. Then again, this site claims that shooting test into the fat is just as good: Testosterone - T-Vox

Originally Posted by jaydee

If possible, I would try and get off the Zoloft for a trial period and see what happens. Its the only way you will know if it is effecting your regime or not. Of course under your doctors instructions..... I am not a big fan of SSRI's at all and I think they do more harm than good a lot of the time and you should only use them if its absolutlely necessary.

They have helped control my OCD. I don't worry as much, take things in stride more. Also, I don't have such a catastrophic fatalist outlook on life anymore. I think it's probably worth it.

Originally Posted by jaydee

The Proscar use concerns me bigtime. I would be leaving that out all together. Others may disagree with me. Why do you feel you need to lower DHT anyway? Are concerned about prostate or hairloss or somthing? 1/3 of a 5mg tablet of finasteride is a huge dose considering how potentially dangerous it is. Its strange that your DHT is rocketing up, yet your T isnt - especially while on shots.

What's so bad about Proscar? Indeed I take it to block DHT conversion. I was concerned about hair loss. I'd never had MPB symptoms, but I thought better be safe than sorry. Also I may have genetic predisposition to prostate problems, so Proscar is insurance.

Originally Posted by jaydee

This is an obvious question, but hows your calcium intake? While your T is being sorted, i would make doubly sure your getting a good cal/mag supplement.

I take 2 tablets of a day of this stuff:
Products from BioCeuticals
Supposedly it's the best form of calcium supplement. Before TRT I took caltrate for a couple of months.

Originally Posted by jaydee

As others have said, you really need to get your thyroid and adrenals checked as well. A spit test is the best way to go for adrenals and Free T3 and Free T4 and TSH for your thyroid - not just TSH.

I'll get onto that asap. Just have to figure out where to hide the jug of piss in the fridge.

Originally Posted by jaydee

Can you get any HCG from your doctor to see if you can get your boys going again?

I think I can, but why bother? They have not shrunk that much, It's not like I'm planning on kids any time soon. Also, I heard that regular HCG may cause hypogonadism (as if I already don't have that problem).

Originally Posted by jaydee

Is that all the blood tests youve got? Try and get prolactin as well.

I think I had that done at some point. I'll try to dig up all my tests tomorrow.

Originally Posted by jaydee

More important than anything else.....you do you feel? You feel tired you said...how is the sex life, libido, morning erections.....?

When I was 20 I sought TRT primarily to help me build muscle and reduce fatigue. Now it's to ward off osteoporosis, fatigue and muscles in that order. My libido is fine, although I feel like it's been blunted somewhat by Zoloft. Morning wood is there. Although I'll check tomorrow morning just to be sure. (Come to think of it, I'm not as horny lately. I've hardly looked at any porn in weeks if not months. Hmmm... Shit! I'm looking at porn right now and find it boring.) I get tired quickly. Don't tolerate stress at all. Heavy workouts at the gym (and I don't train legs) make me tired as hell.

Thanks for the comments. I really appreciate it.

[zkt]

Citalipram is supposd to have the least serual side effests. Theres always the 4 point salivary cortisol test.

[Curmudgeon]

Just got another injection from the doc today. He used a massive needle, and the injection took 30 seconds at most. He injected pretty much as shown on SpotInjections.com, but with a much bigger needle.

He told me the following:
1) adrenals and such aren't likely to be a problem at my age.
2) Proscar is safe. It reduces chance of cancer by 25%, but those on Proscar who do get it have a higher grade of cancer.
3) No point in splitting up reandron. One German study shows that over time the levels plateu and stay pretty much constant. The long intervals between injections is the whole point of Reandron/Nebido. I'm having the injections at 10 week intervals from now on. If it doesn't work, it doesn't work, and something else must be tried.
4) Injecting right into the muscle would hurt like hell. (This injection hurt somewhat, and my leg is kinda numb 6 hours later, but it's more of an ache. A nuisance. Typically, I feel no pain at all after 48 hours.)
5) SSRIs are unlikely to be interfering with TRT.
6) I should really check my thyroid.

That's it. I'm also going up to 75 mg DHEA per day, although I'm wondering if it's worth it. My current 50 mg dose has not increased my levels appreciably. This stuff is expensive, and I don't see much value in it. I think I'll stop after my current supply is finished.

[Curmudgeon]

Originally Posted by zkt

Citalipram is supposd to have the least serual side effests. Theres always the 4 point salivary cortisol test.

Zoloft works for me, and has the least sides of all SSRIs that I've tried. I dont' want to fix what's not broken. Beating (almost) OCD is a big deal to me.