My testosterone replacement therapy (TRT) story... looking for advice.

[mechman02]

My TRT story... looking for advice.

I have been a lurker here for a bit, and have decided to get advice for my situation. I am 36, and am on testosterone replacement therapy (TRT). I had brain surgery to remove a tumor on my hypothalamus in January of 2012. Unfortunately, because of the complexity of the tumor, only a tiny piece was removed. Fortunately, it is benign. Anyway, because of my surgery, my body stopped producing testosterone. After the surgery, labs showed my T levels were 10 ng/dl. Yeah, basically nothing. So, I was put on Testim, which mercifully my insurance wouldn't cover, so I was switched to Androgel 1.62%, 2 pumps per day. The next labs showed my T level had increased all the way to 90! So my doseage was increased to 4 pumps per day. 6 weeks later, my levels were at 220. So my dosage was increased to 6 pumps per day. 4 weeks later, my levels were at 180. My endocrinologist was baffled, and suggested injections, which I gladly accepted. So, for the past half year, I have been injecting 175 mg of T cyp. Every 2 weeks. My first labs after starting injections showed a T level of 438. Finally, improvement.

Now, my concern. Ever since starting T replacement, my weight has increased 25 pounds, and a lot has been belly fat. I am active, and haven't been able to lose the weight. I was riding my bike 30+ miles a week, and lifting 3 times a week and couldn't lose anything. I have been able to lately, exercise routine is a bit different, but my daily calorie intake is averaging 1700. My diet is extremely clean. Also, I don't seem to notice additional muscle mass. And my sex drive is lacking.

My stats: 210 pounds, 71 inches.

Here is a bit of additional lab info (unfortunately not all completed at the same time).

March 2013
Serum T - 438 (280-1100)

September 2012
Free T - 43.7 (47-244)
Prolactin - 19.4 (3.5-19.4)

July 2012
Testosterone - 188 (280-1100)
Cortisol - 11.6 (5-23)
SHGB - 18 (13-71)
Testosterone % Free - 2.2 (1.6-2.9)
Testosterone, bioavailable - 122.8 (131-682)

I will have more lab work done on Friday, and meet with my endocrinologist next Friday. I am going to ask him about having my estradiol checked, but I suspect he will not go for it.

Any advice, interpretations, speculations, etc, would be appreciated. Thanks for reading this novel!

 

[1693]

Welcome!

I think you probably need something like 60mg of test every 3.5 days and you'd probably do better in many ways.

Could try some DIM and some zinc with copper to control estradiol since you don't have an AI.

Your protocol is very slowly getting better.

You could edit your post and put the lab reference ranges beside each lab since different labs have different ranges.

 

[mechman02]

Thank you for your input. I have edited my post to include the ranges.

 

[1693]

Thank you for your input. I have edited my post to include the ranges.

Thanks, it's much better, now a person can easily see your free T is below range, your TT could probably use some help depending on what symptoms and your prolactin is at the top of it's range and I'd guess might cause you some sexual issues.

I'd check a bunch of other labs if possible like a bunch of thyroid labs and vitamin d and B12.

Megatron just posted to a guy a pretty good list on what to get labs for, you might look for that.

 

[totalburnout]

I won't comment on the labs right now but will comment on your caloric intake. A 1700 calorie diet is extremely restrictive and likely counterproductive for an active 200lb+ male.

You do need a sufficient number of calories and should have a well thought out macro nutrient breakdown.

What blows my mind is did you put on the 30lbs while eating 1700 calories? I assume not or you've been miscalculating your calories.

What's the diet look like?

 

[riprockwell]

Yeah I am kind of baffled by the weight gain if you have indeed been hitting 1700 calories per day. I will say that if you are gluten and/or carb sensitive, that you can still gain weight on a low calorie diet. I am one of them. The best diet that has worked for me is a keto style of diet. Perhaps look in to that. Another great addition with your testosterone replacement therapy (TRT) regime is to get with 3J in the diet section and use his services. His diet plans are top notch and he works great with fellas on testosterone replacement therapy (TRT). Definitely check it out.

 

[totalburnout]

Yeah I am kind of baffled by the weight gain if you have indeed been hitting 1700 calories per day. I will say that if you are gluten and/or carb sensitive, that you can still gain weight on a low calorie diet. I am one of them. The best diet that has worked for me is a keto style of diet. Perhaps look in to that. Another great addition with your testosterone replacement therapy (TRT) regime is to get with 3J in the diet section and use his services. His diet plans are top notch and he works great with fellas on testosterone replacement therapy (TRT). Definitely check it out.

That sort of 'weight gain' with gluten is actually inflammation. If you consume less calories than you burn, you'll eventually lose weight regardless.

 

[mechman02]

Sorry, I see I was a bit misleading about my diet. I have been at 1700 calories for sure for the last month. Before that, I don't know for certain. I can say this: before my surgery my diet was not nearly as clean as it is now, but it wasn't bad either. And I was losing a bit on that diet. Since my surgery, I have eliminated nearly all sweets, particularly ice cream. Prior to my surgery I was eating probably a gallon a month. For the last year, I estimate my calorie intake was between 2000 - 2500 calories. I worked my but off as previously mentioned, and couldn't lose anything. My wife and I I really believe my weight gain started when I started TRT.

 

[Mprtz]

That sort of 'weight gain' with gluten is actually inflammation. If you consume less calories than you burn, you'll eventually lose weight regardless.

This may be somewhat of a tangent, but the notion that calorie surplus will inevitably lead to weight gain and calorie deficit will inevitably lead to weight loss is wrong, and to anyone interested I invite them to read Gary Taubes' "Why We Get Fat", or the more detailed "Good calories, bad calories".

 

[riprockwell]

That sort of 'weight gain' with gluten is actually inflammation. If you consume less calories than you burn, you'll eventually lose weight regardless.

Again, I said gluten and/or carb sensitive. I am both and even with a total deficit, I cannot lose fat if my carb intake is more than 50 grams per day regardless of caloric deficit. Again, what is not mentioned in the original post is what exactly those 1700 calories are. They could be burgers from McDonalds but I assume they are cleaner calories than that. Some people are blessed and can lose weight eating carbs all day. Some have to limit them to half a day and some have to limit the majority of them. I am in that last category. Thanks for your input though.

 

[mechman02]

I have had thyroid and other levels checked out extensively. Everything is fine in that area. My diet it's clean. We eat almost zero processed foods, thanks to my wife. My day starts with a green smoothie, have a few raw almonds for snacks, maybe a cheese stick, lunch is usually left overs from the previous night (again, low cal, low fat, unprocessed), and then repeat for dinner. I should mention that the calorie intakes I previously posted are gross intakes. They do not account for exercise.

 

[1693]

I have some what of a theory about you mech.

So far with your testosterone replacement therapy (TRT) you've mostly only got enough test into your system to replace what you shut down by using exogenous test.

438 TT is just not going to cut it in my opinion....a guy doesn't go through the hassle of testosterone replacement therapy (TRT) for that measly amount and I don't think you told us when the blood was pulled for the lab.....was it right at two weeks from your last pin or was it two days after the last pin?

As I wrote previously...think you should try this:

I think you probably need something like 60mg of test every 3.5 days and you'd probably do better in many ways.

Even if you have to switch to a different doc to get it done, I would....maybe try having a 3.5 day trough TT of 800......this might be why you are gaining weight....you are getting enough test to mess with your system but not enough to reap all the benefits....you are still operating in hypogonadual land.

 

[totalburnout]

This may be somewhat of a tangent, but the notion that calorie surplus will inevitably lead to weight gain and calorie deficit will inevitably lead to weight loss is wrong, and to anyone interested I invite them to read Gary Taubes' "Why We Get Fat", or the more detailed "Good calories, bad calories".

That is simply one opinion, just like my opinion represents a diet I stand behind. I've seen people make diets work that would essentially prove the point that a calorie is a calorie when it comes to weight gain and weight loss.

So while I don't disagree there's absolutely ways to optimize calories, I feel that's because of other benefits that aren't necessarily related to energy expenditure
Calories are obviously just units of measurement for energy. There's a million other reasons why to maintain a healthy diet but a calorie is and always will be a calorie n

I eat based on a paleo diet so I don't argue the benefits if a balanced diet and I'm highly in favor of a ketogenic diet.

The book you linked to is very to is very good and I've read it some time ago. Thanks for haring.

 

[mechman02]

Thank you for your advice. I will definitely bring this up with my endocrinologist at my appointment next week. That being said, I am quite frustrated with my him. I just had blood work completed two hours ago. On the way over, I reviewed his lab order and realized he did not check my T levels. What the...!!! That's one of the main reasons I am seeing him. Very frustrated. Anyway, all of my labs came back great. Cholesterol down 25 points, triglycerides down 60. Both almost to the high level of what is considered normal.

Incidentally, does anyone know of any good T doctors in Utah?

Also, is 1700 gross calories per day too low for me?

Thanks for the feedback.

 

[1693]

Our sponsors would like to dial you in:

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or you can search the a4m.com antiaging docs directory in your area:

a4m.com/directory.html#directory_search_form

plus you could ask the pharmacists on which docs they know of that prescribe an Aromatase inhibitor (AI) and Human Chorionic Gonadotropin (HCG) for their TRT/HRT guys along with cyp, if they prescribe the Aromatase inhibitor (AI) & Human Chorionic Gonadotropin (HCG) that says that they are more forward thinking in their testosterone replacement therapy (TRT) practice and not trapped in the stone age.

 

[OUTLAWBENDER]

Good luck, bro

 

[OUTLAWBENDER]

Find a Dr that doesn't have his head stuck up his ass is not easy!

 

[totalburnout]

Thank you for your advice. I will definitely bring this up with my endocrinologist at my appointment next week. That being said, I am quite frustrated with my him. I just had blood work completed two hours ago. On the way over, I reviewed his lab order and realized he did not check my T levels. What the...!!! That's one of the main reasons I am seeing him. Very frustrated. Anyway, all of my labs came back great. Cholesterol down 25 points, triglycerides down 60. Both almost to the high level of what is considered normal.

Incidentally, does anyone know of any good T doctors in Utah?

Also, is 1700 gross calories per day too low for me?

Thanks for the feedback.

Calories are specific for individuals but based on your weight, 1700 calories would be extremely low. That's assuming you're not underestimating portion size/calories (as many people do).

As a starting point I like to start people at insuring 12-16 calories per pound based on their metabolism and activity level. I would use 14 calories per pound as a starting point and would base it on a realistic target what. People don't seem to understand if they're malnourished and consume too few calories, losing weight actually becomes more difficult. To oversimplify things your body basically thinks its about to experience a long winter and it prepares itself to be starved.

So lets use an example. If you target body weight is 180lbs, 180x14 = 2520 calories daily.
I would then advise that you should look at your calories also on a weekly basis. You should average 7x2520 calories per week. Some will severely over or under eat on different days of the week and not understand why they're not seeing the results they want. Be consistent and use an average.

Also, starting today do yourself a favor and put yourself in a position of knowledge.

Wake up tomorrow, go the bathroom and then go weigh yourself.
Get a measuring tape and take measurements of your arms, chest, thighs, waist.
If you have calipers or another tool that will measure bodyfat, use that.

Log this info as your baseline. Take new measurements and log the info every week or 2 weeks.
Now you'll be able to tell if you're gaining weight because you're adding fat or if its because you're increasing muscle mass.

Based on your results, you can adjust accordingly.
You can also pay the person suggested above on here to develop a plan for you, if you're not willing to put in that effort or don't have the know how.

Hope this helps!