Beginner TRT Protocol Advice

Kevinbou · Nov 2, 2017

Hi all, I have just begun TRT and have received one injection and will be self-injecting. I was originally prescribed 200mg E2W. From reading this site I asked my GP if I could switch to 100mg once weekly to be proactive against higher spikes and lower troughs, and he ok'd it. My question is this. What are you opinions on staying with the once weekly protocol until stabilized and first blood work, or go ahead and start E3.5D protocol? Maybe I am just too anxious about high E levels from all of the reading I have done and am having a hard time making a decision. Also worry about the Dr seeing my blood work on the E3.5D and getting pissed. If there is a sticky on this I'm sorry, please send me there.
Thanks

Deleted member 16042 · Nov 2, 2017

Look into whether your SHBG level is high/low/mid... High means less frequent dosing, low means more frequent.

Also depends on the ester. What form of T are you injecting?

CoastWatcher · Nov 2, 2017

Welcome to Excelmale. Don't apologize for asking questions - almost everyone here showed up with confusion and questions. We hope we can help. It would open discussion of you could post whatever lab results you have, including reference ranges. A bit about yourself, age, what suggested to you that androgen issues might be at the root of some of your health problems?

We we hope you'll be an active member.

Saul · Nov 2, 2017

I would stick with what your Dr said. Build a relationship with him and build the trust. Maybe once per week works for you. I like E3D better personally, but its about what works best for you. There are years for you to adjust your protocol.

Systemlord · Nov 2, 2017

I'm going to assume your GP is struggling here with TRT administration, why don't you get someone with more knowledge so when you do present with side effects you already have a skill physician to help you rather than wait for side effect to hit you and your GP sends you somewhere else anyhow. Unless your SHBG is super high you really need to inject at least every 3.5 days to keep levels more stable.

Kevinbou · Nov 2, 2017

Hey guys, thanks for the quick reply, will do this evening. Got to get back to work at the moment!

Kevinbou · Nov 3, 2017

Hey guys, sorry I was on-call last night. I'm 34, 5'8", 180. For the past year or longer I have been having symptom that turned out coincided with Low T.... Low energy level,depressed outlook on life,Low libido, no random erections, erection not 100%, have a timidness at times performing my job (Power Lineman) and moodiness. I was prescribed Test Cypionate. My pre TRT labs are as follows.

Free T= 10.52 (4.6-22.40)
Total T= 393 ( 350-781)
SHBG= 19 (10-77)
Estradiol= 20 (7.6-42.6)
DHEA-SO4=44 (38-313)
Thyroid Stimulating Hormone = 2.36 (.4-4.5)

Not sure if that is high for SHBG. I have only had my initial injection and just want to be proactive about high E levels, but maybe I sure just try the once weekly until stabilized. Like was said by Saul, I will have plenty of time to make adjustments. For some reason I just don't like the idea of having to also take an AI,and I guess I will have to see how mytesticles react regarding HCG. So much to consider and keep an eye on, I'm really thankful you guys are willing to help out and give your knowledge and experience. This is something that definitely takes an individual to be very self regulating and proactive for best results I believe.
As far as changing doctors that was mentioned, money is a factor and I don't believe my insurance will cover at my levels (waiting on authorization) so paying out of pocket, a GP makes most economical sense for me I think.

Regards

TheDude · Nov 3, 2017

Kevinbou said:
Hey guys, sorry I was on-call last night. I'm 34, 5'8", 180. For the past year or longer I have been having symptom that turned out coincided with Low T.... Low energy level,depressed outlook on life,Low libido, no random erections, erection not 100%, have a timidness at times performing my job (Power Lineman) and moodiness. I was prescribed Test Cypionate. My pre TRT labs are as follows.

Free T= 10.52 (4.6-22.40)
Total T= 393 ( 350-781)
SHBG= 19 (10-77)
Estradiol= 20 (7.6-42.6)
DHEA-SO4=44 (38-313)
Thyroid Stimulating Hormone = 2.36 (.4-4.5)

Not sure if that is high for SHBG. I have only had my initial injection and just want to be proactive about high E levels, but maybe I sure just try the once weekly until stabilized. Like was said by Saul, I will have plenty of time to make adjustments. For some reason I just don't like the idea of having to also take an AI,and I guess I will have to see how mytesticles react regarding HCG. So much to consider and keep an eye on, I'm really thankful you guys are willing to help out and give your knowledge and experience. This is something that definitely takes an individual to be very self regulating and proactive for best results I believe.
As far as changing doctors that was mentioned, money is a factor and I don't believe my insurance will cover at my levels (waiting on authorization) so paying out of pocket, a GP makes most economical sense for me I think.

Regards

I'd give the 100mg per week a try and see how you feel. You can always go down to E3.5D or EOD after you see how you feel on 100mg per week. No reason to give yourself more shots unless you have to.

JMP · Nov 3, 2017

Not to contradict thedude, but my test and shbg level (which is considered on the low side) were virtually identical to yours when starting out. Defy started me on a M/W/F protocol which has worked great, a huge improvement from where I was as far as how I feel. Now I have no clue whether I would have been just as good on a weekly or bi-weekly schedule as I have yet to try them.

Deleted member 16042 · Nov 3, 2017

I'm working with Defy, and would certainly ask them first for my own care, but personally, I'd opt for more than 1x/wk at SHBG 19, Mine's at 49 and I am doing every 3 days. I might do OK at 1x/wk but I don't want any deep troughs. At SHBG 19 I might be more after EOD or daily.

I would not be worried whatsoever about E2 yet at 20.

Also TSH is borderline as a possible concern (anything higher than 2.0). Might want to run T3, T4 and antibodies, but the typical endo wouldn't even bat an eyelash, probably will say no, you're mid range, no problem.

Systemlord · Nov 3, 2017

Your SHBG is low enough to where you should be injecting at least EOD, your SHBG is only one point higher than mine and recently just hit the 7th month mark since I started TRT and always wondered why things were going so slow. Two weeks ago I made the decision to go from twice weekly to EOD and wish I had done it sooner because my body is starting to respond well to TRT only two weeks after I started EOD injections. Guys with low SHBG excrete most of the testosterone through their kidneys into their urine, this is why more frequent injections are important. Smaller injections do not suppress SHBG nearly as much as larger injections, more T less SHBG. If your SHBG was higher you might be able to get away with injection once weekly.

https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/

CoastWatcher · Nov 3, 2017

How open is your doctor to your "broadening his/her horizons?" There's material here in the Forum, studies, reports, and so forth, that you could share with him. It may not be ideal, but if he is open - and fees are a challenge (understandable) - it can be done.

Kevinbou · Nov 3, 2017

Great input guys, thanks for enlightening me on the SHBG, I will be doing some more reading on it. It looks like more frequent would be more beneficial, I'm also going to look deeper into the bad thinks that low SHBG could be pointing to such as fatty liver and diabetes! Never would have thought that with my health. I guess I need to try and get my Dr on board with a more frequent protocol.If I start even the E3.5D my labs might look suspicious to him, am I right with that or could it slide? Guess I will be finding some concise literature to share with Dr and see how it goes.

Kevinbou · Dec 23, 2017

Hey guys, so I need your thoughts on which way to go. I just got my first follow up labs. I have been taking 150mg (prescribed 200mg) once weekly but have not been feeling much better at all. Here are my first follow up labs, 7 weeks post starting TRT, 3.5 days after injection..

Total T -1697 (264-916)
Free T- 33.7 (8.7-25.1)
SHBG - 50.2 (16.5-55.9)
Estradiol(sensitive) - 46.4 (8.0-35.0)

My Pre TRT labs were...

Free T= 10.52 (4.6-22.40)
Total T= 393 ( 350-781)
SHBG= 19 (10-77)
Estradiol= 20 (7.6-42.6)
DHEA-SO4=44 (38-313)
Thyroid Stimulating Hormone = 2.36 (.4-4.5)

I think I am going to try twice weekly injections but wanted y’alls input. Waiting to see The doctor as I type this.

I appreciate the help!

Systemlord · Dec 23, 2017

Kevinbou said:
Hey guys, so I need your thoughts on which way to go. I just got my first follow up labs. I have been taking 150mg (prescribed 200mg) once weekly but have not been feeling much better at all. Here are my first follow up labs, 7 weeks post starting TRT, 3.5 days after injection..

Total T -1697 (264-916)
Free T- 33.7 (8.7-25.1)
SHBG - 50.2 (16.5-55.9)
Estradiol(sensitive) - 46.4 (8.0-35.0)

My Pre TRT labs were...

Free T= 10.52 (4.6-22.40)
Total T= 393 ( 350-781)
SHBG= 19 (10-77)
Estradiol= 20 (7.6-42.6)
DHEA-SO4=44 (38-313)
Thyroid Stimulating Hormone = 2.36 (.4-4.5)

I think I am going to try twice weekly injections but wanted y'alls input. Waiting to see The doctor as I type this.

I appreciate the help!

The problem with some guys if your T levels are too high you end up feeling nothing, also if E2 is elevated you don't feel as good as you could because it inhibits T effects on the body. This is what happens when doctors shoot for the moon on these absurdly high protocols, high T and high E2. My E2 last week scored within a few points to yours and I felt as if TRT had stopped working, testes had shrunk up do to the high E2 effectively lowering what little LH and FSH production I had after starting TRT. Right now weekly injections is best considering your SHBG levels, lower your dosage. TRT usually lowers SHBG, but yours is elevated after starting TRT. Weird!

Vince · Dec 23, 2017

Usually labs are done on injection day before you inject. Not after three and a half days, what was the reasoning behind it.

Kevinbou · Dec 23, 2017

Thanks for the input! The Dr. wanted to see my mid trough numbers. I just saw the Dr and he wants me to lower my dosage by 40mg and he wrote a script for Anastrozole 1mg 3 times a week. So my weekly injection would be 110mg. I am kinda scared about the AI...I gues I have read horror stories about it, and my prescription seems like a lot. But he does think I am dropping down to 160mg/wk , but really I will be dropping to 110mg. I probably should have been totally honest about taking less than was prescribed initially.

Deleted member 16042 · Dec 23, 2017

If you don't have high E symptoms, taking any let alone 3mg.wk of anastrazole may not be good at all. Read around here, a lot of guys have their E crash at much lower doses than that.

Your E level in comparison to your total T looks just fine to me!

Kevinbou said:
I probably should have been totally honest about taking less than was prescribed initially.

Uh, yeah.

How can your Dr make properly informed decisions if you aren't being truthful about your actual dosage?

Vince · Dec 23, 2017

Kevinbou said:
Thanks for the input! The Dr. wanted to see my mid trough numbers. I just saw the Dr and he wants me to lower my dosage by 40mg and he wrote a script for Anastrozole 1mg 3 times a week. So my weekly injection would be 110mg. I am kinda scared about the AI...I gues I have read horror stories about it, and my prescription seems like a lot. But he does think I am dropping down to 160mg/wk , but really I will be dropping to 110mg. I probably should have been totally honest about taking less than was prescribed initially.

That's a pretty scary thought, Anastrozole 1 mg 3 times a week, that's definitely going to crash your E2. Doesn't he want to know what your levels are at on injection day?