Starting TRT - anxious

[drcrawfish]

Hello,
I recently began TRT at 49 with symptoms of apathy, fatigue, night sweats and low libido.

I had the following labs

TT 669
E2 17.6
SHBG 116.4 mol/l (reference range 16-55)

The calculated free T was 5.34. All other hormones (thyroid, FSH, LH, etc) were normal.

The doctor put me on Test cypionate twice weekly at 90mg, Anastrazole .5 mg the day after injection and HCG 500 IU. I've been on this regimen for two weeks and have noticed some minor improvements in symptoms, but I'm still hoping for more.

I'm feeling some anxiety about whether this is the best approach for me, especially after seeing the difficulty that people have getting off of TRT. I'm not sure that I want to commit to a lifetime of TRT at this point and I wonder whether I could do better to dial in my lifestyle. Also, I was eating at a calorie deficit when the labs were drawn and I'm wondering whether the SHBG could have be artificially high because of this.

My questions are as follows:
Is it a nightmare to get off of TRT if one stays on for longer than 12 weeks?
Does the HCG protect my natural supply and make this less of a concern?
If I wanted to stop at (for example) 6 months would that require months of post cycle therapy?

 

[Systemlord]

No way are you going to naturally lower an SHBG of 116 nmol/L, your liver is producing too much SHBG. Large doses of testosterone is the correct and only course of action. You will never be able to produce enough LH to make enough testosterone to overcome that very high SHBG.

Lifestyle can't lower SHBG quite that high, it's out of control. Having low bioavailable testosterone in your 40's puts you at high risk for cardiovascular issues, you need to gain control of this situation quickly!

Short of a liver transplant, TRT is your only chance at a normal life.

 

[Vince]

Inject 100 mg of testosterone cypionate once a week, 500 IU of HCG twice a week and skip the AI until you have Labs.

With high shbg you only want to inject once a week.

 

[drcrawfish]

THanks for the feedback. Why only once a week with high SHBG? My doc said that once a week dosing lead to too much up and down of testosterone levels.

Also, I've read some papers (on pub med) suggesting calorie restriction raises SHBG. What if that was a fluke lab?

 

[HealthMan]

THanks for the feedback. Why only once a week with high SHBG? My doc said that once a week dosing lead to too much up and down of testosterone levels.

Also, I've read some papers (on pub med) suggesting calorie restriction raises SHBG. What if that was a fluke lab?

You want high dosage to try to lower your SHBG a bit and get your FT up (both by increasing TT and lowering SHBG). Given your high SHBG your body takes longer to get rid of the testosterone so no need to inject too frequently and you need higher dosages per injection to try to lower SHBG hence injecting more frequently in this case would work against you. You will most likely need supraphysiological TT levels to achieve optimal FT levels

 

[BigBamBoo]

In my case...SHBG of 75+...taking two doses of 80mg a week only lowered my SHBG down to 73.

And my E2 went from around 17 to 75!

I am now on 40mg M-W-F and and although I have recently started this new protocol, I can already tell my E2 is dropping. And I feel better mood wise.

My point is, I know it is “normal” for high SHBG guys to do one large dose. In my case, it did not work.

Everyone is different.

To the OP. Stopping TRT seems to be just like everything else with TRT...everyone will respond differently and one person might go through hell when quitting, while another person might have very little trouble stopping.

Good luck to you.

 

[BenM]

I had super high SHBG (125-130) as well. After 6 weeks of 125mg enanthate once a week, my latest bloods still have it well above the ref range (66, ref range 15-48), and free t well above the reference range, but calculated free t is only a bees dick above ref and oestradiol is bang in the middle. Pretty sure I accidentally gave myself a larger than usual dose the week before the test too as free t and oestradiol both jumped quite a bit from one week to the next.

Bottom line, my n=1 is that I seem to be a typical high SHBG guy who needs higher doses weekly (or even less frequently) so you may well benefit from discussing a change in protocol with your physician.

 

[valexiz7]

Inject 100 mg of testosterone cypionate once a week, 500 IU of HCG twice a week and skip the AI until you have Labs.

With high shbg you only want to inject once a week.

not really, i decided to go hcg on my plan with defy but i had an option with going trt. i have shbg of 58 and doctor told me to do injection of 62.5 twice a week

 

[Outcome]

Once you get dialed in you will not want to stop trt. The whole process of gathering up the meds and doing the injection will soon be like shaving and putting on deodorant. Wouldn't it be better to have a strong will, better physique and better mood than to stop trt and return to baseline and apathy, fatigue, night sweats and low libido. Your shbg will be a challenge but not an insurmountable one. Good luck.

 

[JimGainz]

Once you get dialed in you will not want to stop trt. The whole process of gathering up the meds and doing the injection will soon be like shaving and putting on deodorant. Wouldn't it be better to have a strong will, better physique and better mood than to stop trt and return to baseline and apathy, fatigue, night sweats and low libido. Your shbg will be a challenge but not an insurmountable one. Good luck.

^^^^^ This.

OP - it’s natural to feel apprehensive about starting something like this that will be a lifelong treatment – but believe me – once you start you will not want to stop. It’s important, however, that you consistently get bloodwork every six months to make sure that your hemoglobin, hematocrit, PSA are still in check – other than that – you will wonder why you didn’t start sooner

 

[Tad1979]

I started TRT in early July. Like you I was very apprehensive- still am on occasion. I have a medical professional background so it has been easy to obsess and want to micromanage as many details as possible. So far though, TRT has been a godsend for my life and everything has gone as expected, which I find reassuring - I take it as a solid indication I made the correct choice by starting. I’m a lot less apprehensive, and I wish I had started sooner.

The one thing I’d stress is make sure that you have exhausted any other possible cause of your symptoms. From lurking here (no offense intended to anyone) the people who have been unhappy on TRT have indicated that it was questionable if they should have been started in the first place. Being placed on any medication you don’t need tends to backfire.