Worst case of trying out TRT for 6 months?

[zillapod]

I'm trying to weigh the pros and cons of TRT, and I'm curious of any possible long term or permanent implications of a 6 month trial with TRT? It seems like 6 months is a good timeframe to assess what positive results may be experienced with TRT, but if I'm feeling nothing I'd probably just get off it. Other than some type of withdrawal/readjustment phase, whether going cold turkey or using any meds, any longer term implications? I'm not concerned with fertility, I have children already.

Any chance of your own production not coming back to at least the sub-par level it was before TRT, or other impact to testicular function?

I had a hip surgery a couple years ago that I greatly regret because I was so focused on the positive, I figured worst case it would just be the same as before surgery, but I was wrong and it can definitely be worse than before. That is why I'm a bit paranoid and really thinking of what the WORST case possibilities are.

Thanks!

 

[Systemlord]

I stopped TRT back in April after two and a half years, stopped cold turkey and recovered my natural production four and a half weeks later ending up exactly where I was scoring years earlier.

As far as the 6 months time frame to determine if TRT is right for you, I had undiagnosed conditions which forced me off TRT temporarily, what I'm trying to say is if you have other medical problems TRT may not be what you hoped and it will take time to make everything right.

That is why I'm a bit paranoid and really thinking of what the WORST case possibilities are.

TRT can become a new obsession is you let it, often guys with this mindset tend to struggle the most on TRT. I've seen guys with this mindset before, if they so much as get a sinus infection or sneeze, everything that happens is blamed on the TRT.

 

[Vince Carter]

I like to tell guys that its not a trial, it's a marathon and if you can't commit to it for the long term, more than a year, then you shouldn't even start. It just takes a lot longer than 6 months to really flesh out some things.

 

[zillapod]

I guess overall for worst case then, eliminating the 6 month time frame. Say after several years of TRT, you wanted to stop for some reason (cost, other health issues, not working, whatever the case may be). I'm having a hard time finding out what the possible permanent implications are from doing TRT. Natural production never "turning on", irreversible cardio issues, other? The benefits are all very well documented so I'm just curious about the possible negative outcomes. I probably get too analytical about this, but I'd hate to picture a future me frustrated that I didn't ask these negative based questions before I started. I've asked at the TRT clinics but they whitewash things.

 

[S1W]

I think you're going about this the right way - it's good to question these things before undertaking such a serious commitment.

My $0.02 - and I'm far from a doctor - if you are otherwise healthy and have low/low normal T, you should be able to recover if you decide it's not for you. Plenty of guys have done just that.

If I were you, and I was starting TRT with the attitude that it is just a trial run, I'd start with compounded cream, no more than 100mg/day. If you choose to start with injections, do not use any more than 100mg/week - and split that up into at least 2 injections per week. T only - no AI or HCG.

You will more than likely feel amazing for a few days after you start - this is dopamine related and short lived. Your balls will ache - this is also short lived. It'll be hard, but try not to seriously think about how you feel until you've been on a stable protocol for at least 6-7 weeks.

There are plenty of guys who have abused test (way higher doses than we use) that are not able to recover. So my advice is to keep the dose as low as reasonably possible to avoid that. Plus, it seems some guys are starting on too high of a dose in the first place and end up battling sides right out of the gates.

But - since you asked about the "worst case scenario" - well, that would be that you don't recover and you will have to use T for the rest of your life. Unlikely, but that is the worst case scenario.

 

[Vince]

I guess I would have to agree with a lot of the members. You're 40 years old and it's pretty hard to raise your levels naturally. Find a clinic that you could stick with, in case you decide to do it long term. If you're not going to make any more babies and don't have to remain fertile. Trt is pretty simple, inject testosterone twice a week along with some HCG and if you have high estrogen take a low dose AI. I think the younger you are, the harder it is to get dialed in. Also if you have low shbg, which I believe you don't. It would also be hard to get dialed in.

If you decide to your trt is not for you, you're probably go back to your old levels in a short time. From looking at your past post, that won't be a very high level.

 

[zillapod]

Thanks all. I did find a clinic that I like, and the provider was listed in this forum's "Dr's who prescribe TRT list" so she seemed knowledgeable. Expensive ($300/month) but seemed to be the most experienced provider in the San Diego, CA area. She actually recommended NOT including HCG right off the bat, as I checked off anxiety/nervousness on the paperwork and she said HCG could possibly make that worse so I should wait and see. They do however include an AI right off the bat for everyone.

My SHBG was 41, so on the higher side it seems, so hopefully that will make dialing it in a little easier? Time will tell. I've got two more appointments with an endo and with a local PCP who listed TRT on his focus areas of interest, those are in 2 weeks. I think I know the answer I'll get, which is that my T is in the "normal" range so don't fret about it, so odds are I'll be in the clinic in a few weeks starting TRT. I figure at least i'll be set up with a knowledgeable primary care Dr. who can help me with monitoring things (even if he discourages me from starting TRT) moving forward.

 

[madman]

I guess overall for worst case then, eliminating the 6 month time frame. Say after several years of TRT, you wanted to stop for some reason (cost, other health issues, not working, whatever the case may be). I'm having a hard time finding out what the possible permanent implications are from doing TRT. Natural production never "turning on", irreversible cardio issues, other? The benefits are all very well documented so I'm just curious about the possible negative outcomes. I probably get too analytical about this, but I'd hate to picture a future me frustrated that I didn't ask these negative based questions before I started. I've asked at the TRT clinics but they whitewash things.

Highly unlikely there would be any permanent negative consequences from trt.

Regarding the hpta in most cases you would just return to your previous natural baseline levels as it would be rare that there is dysfunction to the point that natural baseline levels are lower than before starting trt.....maybe in cases of men who use/abuse testosterone for bodybuilding purposes (cycling, blasting-cruising) using high doses long-term.

Regardless aging in and of itself can have a negative effect on the hpta and if your T levels are sub-par now they may very well be worse down the road.

Having healthy FT levels is critical to a man's overall health (physically/mentally).

Testosterone let alone it's metabolites estradiol and dht are responsible for the beneficial effects they have on mood/libido/erectile function/immune system/bone health/brain health/body composition.

Everyone always speaks of testosterone when in fact I would say it's metabolites estradiol and dht are more important as they are needed in healthy amounts in order to truly experience the full spectrum of beneficial effects.

Side-effects which can happen on trt the most common being increased hematocrit/hemoglobin, others such as oily skin/acne (genetically prone), male pattern baldness (genetically prone), increase psa when first starting (minimal and returns to baseline in most cases), increase body/facial hair, gynecomastia (genetically prone), water retention, possible lowering of HDL (usually from high doses of T), testicular shrinkage, reduced fertility.

Regardless if one does experience any side-effects in most cases they can be minimized or eliminated by using ancillary medications let alone lowering T dose if ones testosterone levels were too high.

Aside from increased hemoglobin/hematocrit, reduced fertility and possible lowering of HDL (usually from higher doses of T) a majority of the side-effects would be cosmetic and even than it is not a given that one will experience such as genetics and how one reacts to said dose of T will play a big role.

If you went on trt and down the road decided to come off than if anything the only permanent sides would be the increased body/facial hair growth and hair loss if one was genetically prone and experienced such.

Regarding gynecomastia it is not common on trt and it would only happen in the genetically prone let alone if caught early it could be prevented.....worst case scenario is in cases where it is not caught early and treated with ancillary meds than surgery may be needed to have it permanently removed.

If your testosterone levels are sub-par and you are suffering from low-t symptoms than it would be in your best interest to get treatment as your overall health/quality of life should be priority!

 

[madman]

Thanks all. I did find a clinic that I like, and the provider was listed in this forum's "Dr's who prescribe TRT list" so she seemed knowledgeable. Expensive ($300/month) but seemed to be the most experienced provider in the San Diego, CA area. She actually recommended NOT including HCG right off the bat, as I checked off anxiety/nervousness on the paperwork and she said HCG could possibly make that worse so I should wait and see. They do however include an AI right off the bat for everyone.

My SHBG was 41, so on the higher side it seems, so hopefully that will make dialing it in a little easier? Time will tell. I've got two more appointments with an endo and with a local PCP who listed TRT on his focus areas of interest, those are in 2 weeks. I think I know the answer I'll get, which is that my T is in the "normal" range so don't fret about it, so odds are I'll be in the clinic in a few weeks starting TRT. I figure at least i'll be set up with a knowledgeable primary care Dr. who can help me with monitoring things (even if he discourages me from starting TRT) moving forward.

"They do however include an AI right off the bat for everyone"

- sounds like a T-mill and if they prescribe an aromatase inhibitor of the hop than they will most likely be starting you on a high dose of T 200 mg/week

- I would be cautious here and first off avoid the a.i. and regarding T dose the best piece of advice is to start low and go slow

 

[sebastian_r]

Last year I was off TRT for 6 months after I was on it for 3.5-4 years. Had one blast / steroid cycle during my TRT time as well. Had learnt a lot about lifestyle and nutrition and wanted to see what I can do naturally.

Took around 4 weeks and everything was back to baseline. Was taking only some AI during the recovery time.

If you want to do a test run, I would take creams or test prop. Shutdown will be less severe on short ester compared to Enanthate / Cypionate / Undecanoate.

The recovery from it will be more pleseant, since your body can start recovering the day after the last application vs. 2-3 weeks on Enanthate or Cypionate.

 

[S1W]

Thanks all. I did find a clinic that I like, and the provider was listed in this forum's "Dr's who prescribe TRT list" so she seemed knowledgeable. Expensive ($300/month) but seemed to be the most experienced provider in the San Diego, CA area. She actually recommended NOT including HCG right off the bat, as I checked off anxiety/nervousness on the paperwork and she said HCG could possibly make that worse so I should wait and see. They do however include an AI right off the bat for everyone.

My SHBG was 41, so on the higher side it seems, so hopefully that will make dialing it in a little easier? Time will tell. I've got two more appointments with an endo and with a local PCP who listed TRT on his focus areas of interest, those are in 2 weeks. I think I know the answer I'll get, which is that my T is in the "normal" range so don't fret about it, so odds are I'll be in the clinic in a few weeks starting TRT. I figure at least i'll be set up with a knowledgeable primary care Dr. who can help me with monitoring things (even if he discourages me from starting TRT) moving forward.

$300/month?! In perpetuity, as long as you are a patient? Gotta tell ya that's crazy man. So is a blanket policy of starting everyone on an AI.

You've received good advice on this thread. I'd follow it if I were you.

 

[zillapod]

Any suggestions on where else to go? Is Defy the only option to actually get sound treatment? Both clinics I went to have a blanket starting protocol including either HCG or AI, are expensive, and of course no traditional MD will prescribe. Is Defy going to be that much better than the local clinics? I'm just nervous not having someone I can physically go in and see if I have problems, and having someone show me in person how to do the injections, etc.

Crazy that there would be only one choice to get knowledgeable, customized treatment. What if Defy goes out of business?

 

[S1W]

Any suggestions on where else to go? Is Defy the only option to actually get sound treatment? Both clinics I went to have a blanket starting protocol including either HCG or AI, are expensive, and of course no traditional MD will prescribe. Is Defy going to be that much better than the local clinics? I'm just nervous not having someone I can physically go in and see if I have problems, and having someone show me in person how to do the injections, etc.

Crazy that there would be only one choice to get knowledgeable, customized treatment. What if Defy goes out of business?

A traditional MD might prescribe. Often GPs want nothing to do with it, but sometimes endos will, especially if you approach them as you have here, saying "I've had several low readings and I just want to try it and see if it makes a difference for me". In fact, that is how I started TRT - with a local endo.

A second option people might not consider are naturopaths. That was where I went after I realized my endo was not very knowledgeable in regards to TRT. A local naturopath wrote me an rx for compounded cream, which was very affordable - something like $55 for 30ml 200mg/ml from a local compounding pharmacy. Overall, I liked working with him a lot more than the endo, but he got all hung up on numbers (to boot, the wrong one) and was on a "I want everyone in the 500s TT" program. So I switched to Defy.

A third option that some pursue is to open their scope of choices nationwide and people actually travel across the country to see a doc of their choice in person.

Note that even with Defy, there is an initial upfront cost (don't remember how much) and they are also not immune to starting people on high doses and sometimes adding in HCG and AI right out of the gates. So just grab the reins and tell whoever you're working with, "No I don't want to start with that, and I'd like to start on as low a T dose as reasonably possible".

As for self-injecting - don't worry about that. There are youtube videos and tons of images online showing exactly how to do it. You'll be nervous the first few times but it becomes easy pretty fast. If you get to that point, come back and ask us for tips etc and you'll get all the advice you need. That said, I still think compounded cream is the best place to start for several reasons.

 

[zillapod]

THanks! I've got an appt in two weeks with a new primary care Dr. i found that specifically lists "primary care with special interests in men’s health, testosterone replacement therapies" on his bio so I'm hoping he'll either prescribe himself or be willing to work with me as my local primary care Dr. while I go through Defy or another clinic.

I'll also be more assertive when starting TRT about starting low and simple. I'm taking what I read here as fact, but is it generally accepted that you should start low and not add HCG and AI out of the gate? If that was an accepted truth, why would Defy and these local clinics do higher doses and the other meds straight away?

 

[ncsugrad]

I’m not even sure why people are saying defy does that right off the bat. Dr Saya did not start me with an AI and only included HCG because I’m trying for kids next year. Even with my high e2 he didn’t recommend or push an AI since I didn’t have any symptoms.

So, my experience goes against what is being said in regards to a cutter program they start everyone with.

 

[S1W]

I'm taking what I read here as fact, but is it generally accepted that you should start low and not add HCG and AI out of the gate? If that was an accepted truth, why would Defy and these local clinics do higher doses and the other meds straight away?

The cynic in me would say more money for these clinics. Thinking about higher doses, if you're a lifetime patient and need ___ more refills over say a 35 year period due to higher overall dose, that adds up to a lot of money. The cynic in me would also say the same thing about AI and HCG - why sell just one drug when you can sell 3?

Trying to be fair, it may be that guys read bro science on the internet and think that they absolutely need an AI or HCG with T and expect to be offered those things. And the clinics are just trying to meet expectations and have happy customers.

As for Defy, they did not start me on an AI and I don't think that is their norm FWIW. And I've been very happy with them. They do sometimes start guys on what seem like high doses, but again, that wasn't my experience and I feel like I'm in very good hands with their staff.

As to why to start with T only: AIs make a some guys feel terrible. I'm one of them. HCG also doesn't sit well with me. So suppose you're like me and also don't do well with those drugs, start TRT with all 3, and say "hey I feel like crap" - maybe you would have been fine with just T, but now how can you tell what the real problem is? Is your T dose too low/too high, or is HCG dose too low/too high, or maybe the AI is tanking your E2? Having 3 variables right out of the gates sets you up for a long road of trial and error IMHO.

Starting low and going slow with T only is the way to do it. And FYI I don't really consider 100mg/week to be "low" - it's just a good starting point. Then once you get settled into that and have some labs, you can increase/decrease your T dose and see how that feels. Once T dose is totally dialed in, then you can add HCG if you feel like you need it, same for AI. And going about it this way, you'll know exactly how the HCG and the AI are affecting you.

And don't worry about your balls disappearing because you didn't use HCG or growing D cups because you didn't use an AI.

 

[S1W]

I’m not even sure why people are saying defy does that right off the bat. Dr Saya did not start me with an AI and only included HCG because I’m trying for kids next year. Even with my high e2 he didn’t recommend or push an AI since I didn’t have any symptoms.

So, my experience goes against what is being said in regards to a cutter program they start everyone with.

I don't recall anyone here saying Defy has a cookie cutter approach - I believe the comments above (like madman's) were in reference to strip mall T clinics, which do seem to have a blanket approach and are known for prescribing high doses of test, hcg, and ai right from the beginning.

Defy often does start guys on HCG though. The only time I've read about them starting guys on AIs were when that guy had high E2 pre-TRT.

 

[Systemlord]

I was specifically asked if fertility was a concern by Defy's medical director Dr. Saya, he then said HCG isn't necessary. I was not prescribed an AI until I demonstrated a need for one, I turned out to be an over-responder and this altered the direction of my TRT protocol.

 

[Larry P]

The doctor you are going to see if ripping you off charging you $300 a visit. I agree with others have said you do not start using AI until you have your labs back and see what your E2 and other hormones levels are at. Also you should start very low on doses. I started at .25ml/.50mg every seven days and that was too high and I dropped to .20ml/40mg every five days that is working great. As others have said some people respond very well to low doses and others need much higher doses. Everyone is different. Using AI when it is not needed will ruin your hormonal balance and cause many additional problems beyond low T.

 

[ncsugrad]

You don’t start AI until you have symptoms that don’t resolve on their own with time