New Member -- Will Take All the Advice I Can Get; Initial Questions re Dose

[regularguy]

New Member looking to take control of my TRT from a PCP who doesn't provide many options. My main question concerns dosage, but I'll take any advice I can get. Sorry if overly wordy below -- I'm not entirely sure what's relevant.

57. I was diagnosed with low T in June. I had symptoms -- poor EQ, poor sleep, lethargy, etc. I was considerably overweight and out of shape. Test came back 235 ng/dL. Total T was the only test my PCP ran. He suggested gel or 200 mg IM every 3 weeks. I went with injections. I had very significant benefits in short order -- temperament, mood, EQ, energy. I've lost about 80 pounds since, while maintaining muscle and even adding a little. It has changed my life.

After three injections or so, the peaks and valleys were too much for me, and I told him it was too much of a yo-yo. He offered gel or switching to 200 mg every two weeks. I went with IM -- I don't want the gel hassle. I've been doing that ever since. It's not ideal, obviously. But the benefits have outweighed the positives. That said, I'm ready to start managing this myself. He does not prescribe for home injections, but I've concluded that every 2 weeks if for the birds. I'm ready to move to 2x/week Subq. I've also had considerable testicular atrophy and reduced semen volume, and some sensitivity issues, so am considering HCG at a low dose.

I am looking for a doctor locally who will manage this better, but not optimistic. I'd really like to stick with my guy and have him just write me a script for vials of test c so I could inject 2x or 3x a week, but I don't think he will. I was able to get a prescription for an HCG add on through a telehealth company, and so I have a vial of compounded at home, but I haven't reconstituted it or started it. I was going to, but then decided maybe I would get my T routine down first.

My initial question is, what test C dose should I start with? (Assuming I can get a telehealth company or someone to prescribe it.) 50 2x a week seems right -- my levels are pretty good on 200 mg every 2 weeks? If I add the HCG, should I start them together? The online clinic suggests 250 mcg every 3.5 days.

Here are some recent lab results (some of these were dr ordered and some I did myself). CBC, Hepatic Function, CMP, Lipids all good. Hemoglobin and Hematocrit high normal. PSA 1.91 (<3.99 reference).

Total T about 2 months ago was high normal, 11 days after 200 mg injection -- 980 ng/dL. Then last month, I did more hormone testing 4 days after my 200 mg injection, which is when I feel a spike: Total T 1574 (250-1100 reference), Free T 260.6 (35.-155 reference), E2 (regular not sensitive) 75 (<39 reference), SHBG 49 (22-77).

So, the 200 mg every other week is giving me high levels. Maybe that's also a function of being in better shape than when I was originally diagnosed? Dunno.

The E2 was obviously high right after my shot. I kind of think maybe that's largely a function of the every-two-week protocol? Free T was also very high and ratio is almost exactly 20:1. I don't have any high E symptoms. Libido great. Nipples fine. I cry at sad movies, but I always have done. :0) I'm hoping maybe moving to a more reasonable T injection schedule at home would smooth out the E2.

Anyway, sorry if this is tl;dr. I'm really looking forward to becoming part of this community.

Edit -- I guess another question is whether I started TRT prematurely. I was in poor health. I'm sure it was a major contributor to my low levels. But even if so, what do I do about it now?

 

[t_spacemonkey]

i eventually abandoned all docs and clinics and went self managed UGL. guys here know more then docs. Tcyp sucks, i either do Tenanthate 2-3x a week or Tpropionate(for me best) ED. dosing is trial and error. my sweet spot is Tprop 20-25mg ED. good luck

 

[Phil Goodman]

I guess the first question would be “if you went the telehealth route for HCG then why just use them for test as well”?

Offering gel, starting you on a once every three weeks injection protocol, and only providing in-office injections are all red flags. Find a better provider. Your location will determine whether you’d be better off with telehealth, but I’d say there are many great options if you go that route. I’ve been with Defy for almost four years and have been very happy with them.

As far as your protocol and what to ask for, if your doctor prescribes you a dose that is higher than you end up taking, it will be possible to build up an emergency supply of your medication. I personally think everyone should have an emergency supply of all medications. Kind of curious why you want to switch to sub q though. If IM is working with your current protocol it will likely only get better with a more frequent rate of application. And generally IM works better. If you decide to switch later then fine, but I’d wait until everything else is settled in(dose, rate, addition of HCG, etc.) Otherwise you won’t have an accurate view of the difference between IM and Sub Q for yourself.

If 200 every two weeks is good, then 100 every week is probably a good starting point. Try that for a few weeks and see how you feel. Then add HCG to the mix. Note that adding it will likely cause at least a small bump to test levels(depending on how much function your balls had before starting and how much they still have).

As far as jumping on too early, I’d say your results speak for themselves with regard to improved well-being, overall quality of life, and weight loss. No need to go back and second guess it now. If you’re too concerned about it you could always stop for a few months then see how you feel. But be prepared to feel worse than you do now for some period of time. How much worse and for how long… no one can know. But if you decide to stick with it then finding a more competent provider should only lead to even better outcomes.

 

[regularguy]

Thanks to you both. I don’t know why I defaulted to subq. Hadn’t thought about it, I guess. Smaller needles and a little easier? But I take your point about not changing too many variables at once.

I like my PCP for everything but TRT. Have been with him a long time. Kind of dreading telling him I changed to telehealth. Not sure why — he probably won’t give a shit. Just might be uncomfortable.

Ok, yeah, TRT has been a huge benefit to me. No time to second guess.

 

[Systemlord]

He offered gel or switching to 200 mg every two weeks. I went with IM -- I don't want the gel hassle.

There's always oral TRT, Jatenzo and Kyzatrex gel capsules taken twice daily. The oral TRT route makes dialing in less about finding the optimal injection frequency and solely about getting the dosage right.

Steady states in 7 days, compared to 4-6 weeks as with injections, makes dialing in much faster and no yoyo for weeks on end only to find out you need another dosage adjustment.

You could spend the first 3-4 months dialing in on injections or less than 4-6 weeks on oral T, since steady states are archived in 7 days.

I've also had considerable testicular atrophy and reduced semen volume, and some sensitivity issues, so am considering HCG at a low dose.

Your sensitivity issues may be related to not being dialed in on injections. Every two week injections is likely your sensitivity issue. Rarely do men dial in on the first attempt.

Edit -- I guess another question is whether I started TRT prematurely. I was in poor health. I'm sure it was a major contributor to my low levels. But even if so, what do I do about it now?

I was you, was on TRT 8-9 years, 45 when I first started, 52 now, without even addressing the cause of my health problems, type 2 diabetes = poor diet.

Came off TRT and doing just fine. I'm far from typical case.

 

[Systemlord]

So, the 200 mg every other week is giving me high levels.

Theses protocols are ancient and stupid. These protocols see higher rates of erythrocytosis and don't maintain consistent hormones throughout the two week injection interval (works great for a smaller minority of men) and any doctor still prescribing these protocols is out to lunch!

The half-life of cypionate on average is 5-7 days, so be the end of the week, 50% is gone, days 10-14, 75% of peak levels is eliminated from the bloodstream. Hence the yoyo effects.

Ivy League people with no medical knowledge as in not medical doctors wrote these protocols for doctors to follow.

Medical knowledge is no longer the monopoly of physicians.