Rate my protocol

[tropicaldaze1950]

I referred him to 4 threads where highpull plays a part in the discussion. MY understanding is highpull is an NP providing testosterone therapy. As shown above, i used his practice data as part of the plots I have made. A discussion on testosterone therapy philosophy between he and I is found in the What is TRT thread.

I've read the back and forth when he's posting on a thread. Certainly lively. Even if he is an NP, which I never saw, and his treatment philosophy is different, he provides the perspective of both a patient and prescriber.

 

[tareload]

I've read the back and forth when he's posting on a thread. Certainly lively. Even if he is an NP, which I never saw, and his treatment philosophy is different, he provides the perspective of both a patient and prescriber.

I am not denigrating him. I love the guy even though we disagree on a lot. Fair dude. Just stating what he shared.

 

[62caster]

PHYSIOLOGICAL replacement ----> TRT: Thou shall not start at 200 mg/week with absolutely no idea the patient's clearance or distribution volume.

Only in cash pay / anti-aging [sic] clinics is this a thing.

Never been to an in network PCP/provider where he/she/they/it says "well shit Bob, let's start you off at 200 mg/week TC and see how you like that." No that would be dumb as hell and state medical board would eventually nail to cross.

Agree with your comment on 100 mg/wk to start. Minimum effective dose, etc.


Enjoy this one as well:

TRT: Most Probable Weekly Dose Range for Treating Male Hypogonadism

Unburied this from another thread in case guys were curious about TRT dosing in the world of hypogonadism. Google xyosted, a vastly overpriced** testosterone enanthate (TE) sub-Q delivery system designed for mass in-network medical provider use to treat hypogonadism. Then look at the three...

forums.t-nation.com

I did not go to a place like that. My 200mg protocol was prescribed by a physician at Vanderbilt University medical center.

 

[tareload]

I did not go to a place like that. My 200mg protocol was prescribed by a physician at Vanderbilt University medical center.

Well then some would call you blessed and some cursed!!

Congrats/my condolences!

There will be some dudes that will be kicking themselves reading your experience and wondering why they cannot find an in network progressive Doc .


ROFL.

Perhaps you should continue with your protocol and share back your LMCS total T and free T by equilibrium dialysis in the name of science. No point in changing course (only few weeks) and you are doing OK and I am not advocating you self treat.

Make sure Doc orders the right tests. Good thread!

I will add you to the graph. Also get SHBG so we can calculate free T as well.

 

[62caster]

Well then some would call you blessed and some cursed!!

Congrats/my condolences!

There will be some dudes that will be kicking themselves reading your experience and wondering why they cannot find an in network progressive Doc .


ROFL.

Perhaps you should continue with your protocol and share back your LMCS total T and free T by equilibrium dialysis in the name of science. No point in changing course (only few weeks) and you are doing OK and I am not advocating you self treat.

Make sure Doc orders the right tests. Good thread!

I will add you to the graph. Also get SHBG so we can calculate free T as well.

I’m not understanding the assumed sarcasm or satire but hopefully I’ll get it worked out. I felt fine up until a week ago and have been in the rabbit hole ever since, which has sent me back into depression and anxiety.

 

[tareload]

I’m not understanding the assumed sarcasm or satire but hopefully I’ll get it worked out. I felt fine up until a week ago and have been in the rabbit hole ever since, which has sent me back into depression and anxiety.

No disrespect or ill intent. Just my prior experiences kicking in.

What side effects are you experiencing? Hang in there! I understand depression and anxiety.

 

[Hyrulewarrior1978]

Dr Abraham Morgenthaler, a Urology professor at Harvard, one of the foremost experts in testosterone has a YouTube channel.

Yes he is the ONE exception I agree although I didn’t know he has a YouTube channel. Most of these YouTube docs are full of shit.

 

[62caster]

No disrespect or ill intent. Just my prior experiences kicking in.

What side effects are you experiencing? Hang in there! I understand depression and anxiety.

None really. This all started last week when I read a comment on Reddit and I had no idea what Gyno was. That sent me into the black hole of side effects and “do I have that? Are my nipples sensitive? Are they bigger? Do I need to check every day? Will my dose cause damage? Holy crap my doctor is clueless”. I have diagnosed OCD and have struggled all my life with catastrophic thinking. This triggered it BIG time.

I just want to be a better husband and dad. Not grow boobs or shrink my testes. Just be able to be alert and not fatigued and be able to have the energy to wrestle with my kids at the end of the day instead of want a nap. To actually go to the gym and see results instead of killing myself for a year with nothing to show for it.

 

[tareload]

None really. This all started last week when I read a comment on Reddit and I had no idea what Gyno was. That sent me into the black hole of side effects and “do I have that? Are my nipples sensitive? Are they bigger? Do I need to check every day? Will my dose cause damage? Holy crap my doctor is clueless”. I have diagnosed OCD and have struggled all my life with catastrophic thinking. This triggered it BIG time.

I just want to be a better husband and dad. Not grow boobs or shrink my testes. Just be able to be alert and not fatigued and be able to have the energy to wrestle with my kids at the end of the day instead of want a nap. To actually go to the gym and see results instead of killing myself for a year with nothing to show for it.

Gotcha. Stay the course and pull the blood work. Infinitesimally small chance of any damage from staying course for next few weeks. Then you will be in better position to discuss next steps with Doc and be capable of informed consent with what treatment you are comfortable with longer term.

Get off the forums and hang in there. Any technical questions you have great resources here at EM. Now stop the ruminating .

Best wishes.

 

[Simbarn]

After not being on testosterone related forums for a considerable time, I find it hard to believe how often I read now of guys starting out with dosages around 200 mg per week.
Where has this come from?

When I first started my TRT journey about 25 years ago, we had 2 injectable options available in Australia, Sustanon 250 and Primoteston 250, being 250 mg in a one ml ampule for injection once every 3 WEEKS! It was designed this way so the patient did not have to visit their doctor too often.
Of course this resulted in levels being too low by the end of the third week and too high in the first.
It was not long before I discovered that 100 mg per week was a much better frequency and amount. Trying to convince the doctors of this at the time was a challenge as they were concerned this was going to result in too much testosterone.

Now it seems that there are many ill-informed doctors out there in the US that think doubling this amount is appropriate to start a patient with T replacement.
To the OP, the advice given here by other members to halve your dose is without question good advice and is worthy of serious consideration.
I personally would be getting a second opinion from another doctor more experienced in hormones and sexual medicine.
There is a term in medicine called homeostasis. It is incredibly important when it comes to hormones!

 

[Systemlord]

200 mg per week.
Where has this come from?

It was borrowed from 200 mg every 2 weeks->200 mg weekly.

Now knowing that the former protocol produced supraphysiological levels for the first half of the week, one would think a protocol like this done weekly would keep your levels super physiological for the entire week.

So one must conclude that any doctor prescribing 200 mg weekly is just inexperienced hasn't had enough patients to know any better.

 

[madman]

Thanks for the well thought out response.

I am having a really difficult time trying to reconcile what I read online vs. what my doctor is doing. Part of me feels like maybe my doc is not great, although I have trusted him in the past, and he is on TRT as well (and has been for 2 years doing great).

Between here and Reddit, 99% of people say “OMG 200MG YOU ARE LITERALLY TAKING A MASSIVE BODY BUILDER DOSE THAT WILL COMPLETELY WRECK YOU”. But why in the world would a 35 year old doc in a well known medical group, with excellent credentials, who is ALSO on TRT prescribe it? And tell me to wait 12 weeks for blood work?

I just can’t wrap my head around this. And it’s terrifying. Is my doc not good? Am
I doing damage? Am I about to grow boobs and shrink my balls into oblivion? Because that’s literally what everybody makes it sound like.

I’m about to completely stop and deal with whatever the consequences are. This is massively stressful and immeasurably frustrating to say the least. All I wanted to do was stop being tired, grumpy, and stop struggling in the gym. This was supposed to help. Instead I’m stuck wondering if I’m ruining my body trying to get any answer that makes sense.

F**king hogwash!

“OMG 200MG YOU ARE LITERALLY TAKING A MASSIVE BODYBUILDER DOSE THAT WILL COMPLETELY WRECK YOU”.



Relax!

You are already 10 weeks in and it would be ridiculous to drop your dose right away as you stated that you are not struggling as of yet let alone you are due for blood work in 2 weeks.

At least you can see where the high-end dosed trt protocol has your trough TT, FT, and estradiol levels let alone other important blood markers such as RBCs, hemoglobin, and hematocrit.

No point in throwing that out the window.

You can then decide on your next move.

Anyone starting someone on 200 mg T/week is an idiot!

Again would have been much more sensible to start low and go slow.

Always much easier to increase the dose slightly if need be than coming down from jacked-up levels.

As I stated previously most men on trt are using 100-200mg T/week and the majority could easily hit a healthy let alone high trough FT on 100-150mg T/week.

Far from common that anyone would need the higher-end dose.

Are there outliers?

Sure but far and few.

To be honest I see no issue with one running higher-end levels if blood markers are healthy and you feel well overall.

The downfall is that many can end up struggling with sides sooner or later when running too high a trough FT level.

Pretty much a given that you will end up needing to donate blood frequently to control hematocrit and it is a given that you will eventually crash your iron/ferritin which can open up another can of worms.

Running too high an FT level can easily have a negative effect on mood/well-being, energy, libido, and erectile function.

Again make sure when you have blood work done that you are using the most accurate assays TT/estradiol (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Testing TT, FT, estradiol, SHBG, CBC, and PSA are a given!

Post your results when you get them.




My reply from a previous thread:

As we say the best piece of advice is to start low and slow on a T-only protocol as we want to see how your body reacts let alone give the protocol enough time before claiming it was a success or failure.

Invest enough time (12 weeks) to see how your body reacts to T let alone how you truly feel overall regarding relief/improvement of low-T symptoms before jacking up your dose.

Lab work is critical.

Always keep peak--->trough levels in mind.

Use accurate assays so you know where your trough TT, FT, and estradiol truly sit.

Although symptom relief is what truly matters lab work is critical as not only do we want to see where said protocol (dose T/injection frequency) has ones trough TT/FT level let alone other hormones but also to keep an eye on the impact it has on overall blood markers as we are not only trying to relieve/improve symptoms of low-t but also to minimize/avoid any potential negative effects on overall health especially long-term.

Regarding reference ranges, they are not set in stone and should be used as a guideline to give us an idea of where hormones/blood markers sit as levels could very well be too high or low resulting in negative effects.

There is nothing wrong with one running TT/FT level above range as long as you feel well overall and your blood markers are healthy.

No one is saying you have to keep your levels in a set range as the goal is to achieve the beneficial effects of having healthy FT levels while making sure overall health is maintained long-term.

Do what you feel is best for you!


*The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low symptoms while at the same time minimizing/avoiding any potential side effects (cosmetic/overall health) while keeping blood markers healthy long-term

 

[madman]

Dr Abraham Morgenthaler, a Urology professor at Harvard, one of the foremost experts in testosterone has a YouTube channel.

Hope you are not referring to this!

Dr. Abe Morgentaler Discusses Early Testosterone Beginnings

Stay tuned for more to come! In this video, we take a look at the life and work of Base Healthcare Chief Medical Advisor, Dr. Abraham Morgentaler. Dr. Morgentaler is a world-renowned urologist and expert in testosterone therapy who has dedicated his career to helping men live healthier...

www.excelmale.com

 

[62caster]

F**king hogwash!

“OMG 200MG YOU ARE LITERALLY TAKING A MASSIVE BODYBUILDER DOSE THAT WILL COMPLETELY WRECK YOU”.



Relax!

You are already 10 weeks in and it would be ridiculous to drop your dose right away as you stated that you are not struggling as of yet let alone you are due for blood work in 2 weeks.

At least you can see where the high-end dosed trt protocol has your trough TT, FT, and estradiol levels let alone other important blood markers such as RBCs, hemoglobin, and hematocrit.

No point in throwing that out the window.

You can then decide on your next move.

Anyone starting someone on 200 mg T/week is an idiot!

Again would have been much more sensible to start low and go slow.

Always much easier to increase the dose slightly if need be than coming down from jacked-up levels.

As I stated previously most men on trt are using 100-200mg T/week and the majority could easily hit a healthy let alone high trough FT on 100-150mg T/week.

Far from common that anyone would need the higher-end dose.

Are there outliers?

Sure but far and few.

To be honest I see no issue with one running higher-end levels if blood markers are healthy and you feel well overall.

The downfall is that many can end up struggling with sides sooner or later when running too high a trough FT level.

Pretty much a given that you will end up needing to donate blood frequently to control hematocrit and it is a given that you will eventually crash your iron/ferritin which can open up another can of worms.

Running too high an FT level can easily have a negative effect on mood/well-being, energy, libido, and erectile function.

Again make sure when you have blood work done that you are using the most accurate assays TT/estradiol (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Testing TT, FT, estradiol, SHBG, CBC, and PSA are a given!

Post your results when you get them.




My reply from a previous thread:

As we say the best piece of advice is to start low and slow on a T-only protocol as we want to see how your body reacts let alone give the protocol enough time before claiming it was a success or failure.

Invest enough time (12 weeks) to see how your body reacts to T let alone how you truly feel overall regarding relief/improvement of low-T symptoms before jacking up your dose.

Lab work is critical.

Always keep peak--->trough levels in mind.

Use accurate assays so you know where your trough TT, FT, and estradiol truly sit.

Although symptom relief is what truly matters lab work is critical as not only do we want to see where said protocol (dose T/injection frequency) has ones trough TT/FT level let alone other hormones but also to keep an eye on the impact it has on overall blood markers as we are not only trying to relieve/improve symptoms of low-t but also to minimize/avoid any potential negative effects on overall health especially long-term.

Regarding reference ranges, they are not set in stone and should be used as a guideline to give us an idea of where hormones/blood markers sit as levels could very well be too high or low resulting in negative effects.

There is nothing wrong with one running TT/FT level above range as long as you feel well overall and your blood markers are healthy.

No one is saying you have to keep your levels in a set range as the goal is to achieve the beneficial effects of having healthy FT levels while making sure overall health is maintained long-term.

Do what you feel is best for you!


*The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low symptoms while at the same time minimizing/avoiding any potential side effects (cosmetic/overall health) while keeping blood markers healthy long-term

Thanks. I’ve pretty much decided to stay on 200mg until my labs. If they come back really high I’ll ask to be put on a lower dose (or just do it myself).

What I’m now trying to decide is, should I go ahead and immediately start splitting doses? I think my peaks and troughs would be better, at least from my reading here. I was thinking 100mg E3.5D. Or should I stay strict until blood work?

 

[madman]

Thanks. I’ve pretty much decided to stay on 200mg until my labs. If they come back really high I’ll ask to be put on a lower dose (or just do it myself).

What I’m now trying to decide is, should I go ahead and immediately start splitting doses? I think my peaks and troughs would be better, at least from my reading here. I was thinking 100mg E3.5D. Or should I stay strict until blood work?

No stick with your current protocol (dose/injection frequency) otherwise your labs will be skewed!

Even 200 mg T split twice weekly (100mg T every 3.5 days) would still have your trough TT/FT levels too high as that is a whopping weekly dose of T.

Need to wait on labs before tweaking anything if need be.

 

[62caster]

No stick with your current protocol otherwise your labs will be skewed!

Even 200 mg T split twice weekly (100mg T every 3.5 days) would still have your trough TT/FT levels too high as that is a whopping weekly dose of T.

Should I be concerned I will have had such a high dose for 12 weeks? If I need to back off to 150 or 100 will it be difficult?

 

[madman]

Should I be concerned I will have had such a high dose for 12 weeks? If I need to back off to 150 or 100 will it be difficult?

No, but you will have most likely driven your hematocrit levels too high.

If you end up deciding to lower your dose then your hormones will be in flux during the following weeks leading up until blood levels have stabilized (4-6 weeks) and during this time you will most likely experience ups/down but you are not going to crash and burn.

Maybe a short bumpy ride as your body is trying to adjust.

Going from 200--->100 may be harder than 200--->150 but again the transition will be short.

 

[62caster]

No stick with your current protocol (dose/injection frequency) otherwise your labs will be skewed!

Even 200 mg T split twice weekly (100mg T every 3.5 days) would still have your trough TT/FT levels too high as that is a whopping weekly dose of T.

Need to wait on labs before tweaking anything if need be.

Silly question. Is 3 additional weeks enough to cause some serious side effects (gyno, etc)?

 

[madman]

Silly question. Is 3 additional weeks enough to cause some serious side effects (gyno, etc)?

No.

If caught early it can easily be treated with a SERM such as Tamoxifen.

Usually, once it has been present for too long a hard lump (fibrous tissue) will form which may be difficult to treat with medications and surgery would be the only option to have it permanently removed.

Even then there can be a reoccurrence if the surgery was not performed correctly.

Critical to seek out a highly reputable doctor with a good track record.

Early signs/symptoms (lump/swelling/pain).

Again it is far from common when using therapeutic doses of T and genetics will play a big role!

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