I’ve been on TRT for 5 months now and am very happy with the results so far but I need some guidance as my GP is not as knowledgeable as most on this site.
Background: 48 yo 6’4” 250 recently dropped from 295 prior to TRT. High blood pressure prior to weight loss good BP now.
Reasons for TRT: low energy/libido occasional ED
Initial total T 310
Initial dose/dosage 200 mg test cipionate every 2 weeks intramuscular injection for 12 weeks.
Felt good for the first week after injection then nothing for the second. ED went away for that week and libido was good. Sides were oily skin some acne and a small amount of gynecomastia.
At my next Dr. appointment he had me test just before next dose (trough) and total T was at 278. He increased my dose to 200 mg test cipionate every week. My hematocrit was at 59 but he didn’t tell me the number only said it was a little high.
After doing a lot of reading on this site I didn’t want to make that big of a jump so I started injecting 150 mg weekly for 6 weeks and really liked the results. It didn’t seem to increase my sides and my libido improved but ED persisted occasionally.
I also started eating a grapefruit a day to help with my hematocrit with the increased dose.
A week and a half before my appointment I switched to 100 mg test cipionate every 3.5 days (trip to Vegas with the wife) to see how it affected me and all signs of ED went away and my wife and I both really liked the results and hoped my hematocrit levels wouldn’t be too high so we could keep that dose.
Got tested when I got back two days after a shot (peak) and my total T was 1436, and despite the increased dose my hematocrit dropped to 55 (still not good) so I think the grapefruit is helping.
I didn’t tell my Dr. I was taking 150 mg weekly or 100 mg every 3.5 days instead of the prescribed 200 mg weekly.
His recommendations were to try 200 mg every 8 days/9 days/10 days and watch symptoms and get checked in 3 months but check trough T levels instead of peak and hematocrit.
Some of my concerns:
The only tests my Dr. is concerned with are trough total T and hematocrit.
Dr. Didn’t mention donating blood to help with hematocrit numbers.
No mention of testing shbg or estrogen levels.
We live in a small town with no known hormone specialists.
I don’t have any complaints about my experience with TRT I’m just looking for advice on how to proceed with the breadth of experience and expertise that resides here.
Sorry about the novel I’m just looking forward to hearing any advise you might have to offer.
Initial total T 310
Initial dose/dosage 200 mg test cipionate every 2 weeks intramuscular injection for 12 weeks.
Felt good for the first week after injection then nothing for the second. ED went away for that week and libido was good. Sides were oily skin some acne and a small amount of gynecomastia.
At my next Dr. appointment he had me test just before next dose (trough) and total T was at 278. He increased my dose to 200 mg test cipionate every week. My hematocrit was at 59 but he didn’t tell me the number only said it was a little high.
You need to find a new doctor.....he is out to lunch!
You should have had a full set of labs done pre-trt including TT, FT, estradiol, SHBG, prolactin, DHT, DHEA-S, full thyroid panel, cortisol (4-point saliva), lipids, CMP, and CBC which includes important blood markers such as RBCs/hemoglobin/hematocrit.
Let alone after one starts a sensible trt protocol once blood levels have stabilized (4-6 weeks using TC/TE) blood work needs to be done to see where said protocol (dose of T/injection frequency) has your trough TT, FT, estradiol and important blood markers such as RBCs/hemoglobin/hematocrit.
He took you on a rollercoaster ride (low-t) and put you on a piss poor protocol (200 mg T every 2 weeks) which would have your TT, FT levels sky-high post-injection/during the first few days only to be followed by much lower levels to the point of being back to hypogonadal before your next injection (14 days later).
Top it off that to make matters worse he did a complete 360 and instead of starting you off on a sensible trt protocol 100 mg T/week whether once weekly or better yet split into twice-weekly injections (50 mg T every 3.5 days) he jacked your dose up to 200 mg T/week which most men would never need as such dose can easily have one's trough FT level too high.
Even then your hematocrit of 59% is absurdly high and needs to be addressed.
Definitely need to lower your dose/get on a sensible protocol and get your FT down
Regarding those struggling with high hematocrit here is my reply from another thread:
When using exogenous T RBCs/hemoglobin/hematocrit will increase within the 1st month and can take up to 9-12 months to reach peak levels.
T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).
Other factors such as sleep apnea, smoking can have a negative impact on hematocrit.
Injectable T has been shown to have a greater impact on increasing HCT compared to transdermal T.
3–18% with transdermal administration and up to 44% with injection.
In most cases when using injectable T
high supra-physiological peaks post-injection and overall T levels (running too high TT/FT level) will have a big impact on increasing HCT.
Manipulating injection frequency by injecting more frequently using lower doses of T resulting in minimizing the peak--->trough and maintaining more stable levels may lessen the impact on HCT but it is not a given.
As again running very high TT/FT levels will have a stronger impact on driving up HCT.
Although injectables have been shown to have a greater impact on HCT you can see even when using a transdermal formulation that maintains stable serum concentrations that
the impact it has on HCT is DEPENDANT ON THE DOSE AND SERUM LEVEL OF T.
Using higher doses of transdermal T and achieving higher TT/FT levels will have a great impact on HCT levels.
How high an FT level you are running is critical.
It is a given that most men on trt struggling with elevated RBCs/hemoglobin/hematocrit are
running too high an FT level.
Sure some men are more sensitive than others as they may still struggle with elevated blood markers when running lower T levels but it is far from common and many may already have an underlying health issue contributing to such.
If you are struggling with such blood markers then in most cases finding the
lowest FT level you can run while still maintaining the beneficial effects may very well be the solution.
Easier said than done as many men on trt tend to do better running higher-end FT levels within reason.
Mind you some are lucky and never have an issue or levels tend to stabilize over time.
Others will continue to struggle until the cows come home.
Unfortunately too many are caught up in running absurdly high trough FT levels due to the herd mentality spewed on the bro forums and gootube!
After doing a lot of reading on this site I didn’t want to make that big of a jump so I started injecting 150 mg weekly for 6 weeks and really liked the results. It didn’t seem to increase my sides and my libido improved but ED persisted occasionally.
I also started eating a grapefruit a day to help with my hematocrit with the increased dose.
A week and a half before my appointment I switched to 100 mg test cipionate every 3.5 days (trip to Vegas with the wife) to see how it affected me and all signs of ED went away and my wife and I both really liked the results and hoped my hematocrit levels wouldn’t be too high so we could keep that dose.
Smart move lowering your dose but even then you would have been better off splitting your dose into twice-weekly injections (75 mg T every 3.5 days).
Doubtful eating the grapefruit is going to have a significant impact on driving down your hematocrit.
Unfortunately, you made the mistake of only giving the protocol 6 weeks let alone upping your dose again weeks later to a whopping 200mg T/week split into twice-weekly injections (100 mg T every 3.5 days) which would easily have most men's trough FT levels absurdly high.
You need to be consistent and stay on the same protocol (dose T/injection frequency) as it will take 4-6 weeks for blood levels to stabilize when using TC/TE.
Keep in mind that your hormones will be in FLUX during the weeks leading up until blood levels have stabilized and it is common for many to experience ups/downs during the transition as the body is trying to adjust.
Even then once blood levels have stabilized it will take time for the body to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.
Every protocol should be given 12 weeks to claim whether it was truly a success or failure.
The only time the dose of T should be increased at the 6-week mark is if your trough FT level is too low (highly doubtful).
Got tested when I got back two days after a shot (peak) and my total T was 1436, and despite the increased dose my hematocrit dropped to 55 (still not good) so I think the grapefruit is helping.
I didn’t tell my Dr. I was taking 150 mg weekly or 100 mg every 3.5 days instead of the prescribed 200 mg weekly.
You are not even going to know where your testosterone level truly sat (1436 ng/dL) as you were previously on 150 mg T/week for 6 weeks and instead of getting bloodwork done as your levels would have been stabilized you went and increased your dose 200 mg T/week split (100mg T every 3.5 days) but highly doubtful you stayed on that dose for 6 weeks to see where your trough level truly sat.
The true peak would be 8-12 hrs post-injection.
True trough when injecting twice-weekly (every 3.5 days) would be 84 hrs post-injection.
Even then you tested 2 days post-injection and your TT 1436 ng/dL is absurdly high let alone your FT would be sky-high even if you have highish/high SHBG!
You are clearly over-medicated and need to get out of that more T is better mentality.
His recommendations were to try 200 mg every 8 days/9 days/10 days and watch symptoms and get checked in 3 months but check trough T levels instead of peak and hematocrit.
Some of my concerns:
The only tests my Dr. is concerned with are trough total T and hematocrit.
Dr. Didn’t mention donating blood to help with hematocrit numbers.
No mention of testing shbg or estrogen levels.
No comment.
