What dose for me?

[OMI100]

1. Get Nelson's book and read it. It is a great source for information on TRT.
2. There are a number of papers that DR. Crisler has put out. Get them.
(MODs is O.K. for me to post here?)
3. If you have a DR that will work with you, they can read his papers and better understand what they need to do for you.

 

[Re-Ride]

"I don't want to ( expend my resources to no avail )."

If I was in your situation with no reliable care available then I'd first see what supplies were available to insure that I could dose every 2nd or 3rd day in the usual range of 130 mg to 200 mg per week. Then I'd start dosing at the lower end sticking to a consistent protocol. Edge upwards no more than 10 mg / week sticking with that for 6-8 weeks. It can take six months to a year before we adjust to TRT. People mess with their dose too much because of side effects that will often resolve on their own. Accept that and hammer through it. Most men will eventually become familiar with what the signs of E2 out of range or T too low. "Bamidbar" the Book is an alternate resource for the numbers obsessed and available at a much better price.

 

[Verdilo]

Thanks for answers. I wish i could find a good doctor in my country but its not that easy. Already got in my past 4 doctors and they dont know too much about trt, just wasted money and time.

I wanted to change my protoctol for 2xweek injections but after i took Dostinex for lower my high prolactin then i started to feel little bit better overall and my erectile started to working better etc.

Maybe i will give for this protocol (100mg/week) one more week to check if i will get slowly better or no.

Probably sooner or later i will change for twice a week for more stable T levels.

 

[OMI100]

Verdilo, See if you can PM me with your email and I will send you some papers to take to take to your DRs that might help.

 

[madman]

Thanks for answers. I wish i could find a good doctor in my country but its not that easy. Already got in my past 4 doctors and they dont know too much about trt, just wasted money and time.

I wanted to change my protoctol for 2xweek injections but after i took Dostinex for lower my high prolactin then i started to feel little bit better overall and my erectile started to working better etc.

Maybe i will give for this protocol (100mg/week) one more week to check if i will get slowly better or no.

Probably sooner or later i will change for twice a week for more stable T levels.

Hope you understand that if you are not getting your trt prescribed by a doctor and your testosterone is not pharmaceutical grade (big pharma) or compounded through a (legitimate compounding pharmacy) than if you are self treating (trt) using ugl (underground labs) testosterone than you are taking a big chance on the quality (strength/purity) as many black market products have a chance of being underdosed/overdosed or worst case scenario contaminated and bunk gear (no testosterone). You are basically shooting in the dark regarding your injection protocol (dosage/frequency) and will have to rely on blood work and even than you really have no idea with 100% confidence that your gear is the proper strength. That is one of the main reasons I stated in my previous response to you that if you do not find a doctor who specializes in treating men for low t than you could be chasing your tail regarding lab work/improvements or setbacks in symptoms as you will never really truly know what you are injecting using ugl gear (strength/purity) unless you had a way to get it tested so any protocol you choose to try is going to be some what of a guessing game! I live in Canada and am even suspicious of the quality of some compounding pharmacies. I personally feel confident in using prescribed testosterone that is big pharma- Depo-Testosterone (cypionate) or Delatestryl (enanthate).

 

[Verdilo]

@Orrin Isreal

I turned on PM's and just wrote tou You my mail.

@madman

I am not crazy, easy. I got 2 extracts documents from the hospital where i was diagnosed with hypogonadism and got several more surveys there too. Was there 2 times. This is my proof that i am sick and if i need to get more medicine, testosterone or something else then i just come to my "family doctor" (thats how he is called in Poland) and say to him that i need prescription and telling him for what exactly. I am taking only medicines from legal pharmacies, no worries .

Now i am starting my 4th week. Took Dostinex to lower my too high prolactin about 5 days ago maybe and i am starting to feeling better. I will see how its gonna be in the next 7 days. If i will see again progress and overall better condition then maybe i will stay for a time on 100mg/week and if i will not go forward then change to twice a week.

Sounds like a good plan?

 

[Re-Ride]

"Hope you understand that if you are not getting your TRT prescribed by a doctor and your T is not pharma grade..."

Two different issues there Madman! Verdllo can get an Rx.

Knowledge, consistency, patience, perseverance. A little bit of knowledge goes a long way- in either direction. Do you really have hyper-prolactinemia Verdllo? If so what is the cause? Is it transient? Most do not have access to doctors qualified to answer that let alone write down a serum goal for each hormone. "Within lab dictated range" if you're lucky. As is the case here, no news would have been the best news. Personally I would avoid the AI and cabergoline especially when initiating TRT. You're the only one on the bridge. It's a big ship.

Madman correctly calls attention to men who fail at self-piloting. Of these how many adhered to K-C-P-P? Cases that fall outside the bell curve can be difficult to treat and absolutely do require expert care. Verdllo does not have to resort to using illicit UGL medicine but what of the men that do either because access to health care is privilege not afforded to them or they can not find a doc? Extreme over-regulation of hormones serves interests not discussed rather than protecting anyone's health while driving the very black market that puts men's health at risk.

 

[Verdilo]

@Re-Ride

About prolactin - i have no clue. I was doing blood work since one year and everytime i checked prolactin - it was in range BUT probably its rising and going too high when i am starting trt. When i wasnt doing any therapy and my T levels were very low etc. then my prolactin was perfectly in range.

On clomid therapy (was taking 1 tablet EOD) which didnt help me (except of first few days) one time i decided to check prolactin and it went too high. After i took tablet to lower it i started feel little bit better but for a short time, maybe 5-6 days and after that time i didnt feel any benefits from this therapy. Prolactin never went high again on this therapy, it was all the time in range for a whole next month.

After clomid i started injecting testosterone and few days ago got checked prolactin and it was again too high.

Maybe changing protocols/messing with my testosterone is making my prolactin high, have no idea...

My head was checked too. I have no tumors there which could blocking my pituitary or something. I got only cyst at the back of my head but its nothing serious, at least thats why they told me. The only thing they found in my MRI which could causing problems with not enough hormones in my body is (i dont know if that name is correct in english) "syndrome of the empty saddle" which sometimes does nothing but sometimes can mess up with your hormones. It depend on a person.

 

[Re-Ride]

https://medlineplus.gov/ency/article/000349.htm

Verdllo, The condition of the pituitary is key in diagnoses and treatment of your endocrine system. Whoever ordered that mri should have made the appropriate referral. I often make the point on theses pages that the pt needs to ask why a test or lab is ordered and how things will proceed after the results. It doesn't sound like your physicians are communicating effectively with you. It behooves you to research and ask questions. What you describe, if I've got it right, is a system where you go to a central facility for tests then are told to hunt down a practitioner for treatment, just the opposite of what is done here. Success hinges on your willingness to acquire extensive knowledge of the endocrine system or finding a consultant outside your locale. Your recovery will come but likely will take at least a year while protocols are methodically adjusted especially if caber, AI and/or other treatments are required. A written plan can help you maintain focus.

 

[Verdilo]

My english "skills" are not that good to understand medical language perfectly and translator is often making some big mistakes in the sense of translation so its hard for me to say if we are talking about the same thing.

Main thing is that people with this "syndrome of the empty saddle" can live normally and nothing happen for them BUT this problem could affect hormones production. Its not a "must have" but there is a possibility. One person will live normal and everything is gonna be ok with hormones etc. even though they got this "empty saddle" and some other people can get problems with proper hormones production. Thats what i was told by doctor and thats what i can read everywhere on the polish internet about my case.

I think that my journey is about just being patient and adjusting best injection time for my body. Doing blood work, watching my other hormones, psa etc...

I would love to have a good doctor knowing what hes doing and not treating my self alone but well in Poland its really hard, trust me. Most of doctors in this country are using methods from 90's about trt.

 

[Re-Ride]

If your diagnostics and medicine are covered by NFZ, the national health care, then this is a major advantage others elsewhere do not enjoy. You were initially started on hCG mono which is a progressive and conservative approach. You discontinued hCG after 5 days "because you shut down". Clomid was tried next for 2 months boosting T to high mid rang but discontinued due to vision side effects and no perceived wellness benefit. Gel was tried somewhere along the way but again only briefly.

Anastrozole use varied with the different protocols. 1/2 tab E4D on clomid was mentioned. History of fatigue and weight control issues since youth. Currently 100 mg per week with fatigue the day after injection and possibly more by the 6th day.

Prolactin: normal for the last month while on TRT injection.

No mention of adrenal, thyroid or sleep apnea diagnostics.

Concerns mentioned are changing TRT dose and frequency. You don't know how to conserve the left over medicine for the next shot once the 100 mg ampule is broken.

You attribute your symptoms to serum T level . It will be wise to investigate thyroid and adrenals as well as their function can be impacted by the condition of the pituitary. If a multi-use vial for injection of T is not available will your doc prescribe 2 ampules per week where you can discard the unused 50 mg portion?

A quick search yielded this snippet (author's highlight not mine): "However, hyperprolactinemia can also be caused by anorexia nervosa, liver disease, kidney disease, and hypothyroidism. Hypothyroidism can cause enlargement of the pituitary gland, which is treatable with thyroid hormone replacement therapy. High levels of prolactin can also be caused by pituitary tumors.

 

[Verdilo]

Thanks for reply, very nice summarized my story. You must read everything in my thread, i am pretty impressed.

I will try now to clear everything if possible for better kwnowledge of me for You.

Blood work, medicines i am paying all by my own. Only 2 times when i was in hospital i got several surveys, diagnostics, many blood works etc. all for free.

In hospital they told to me to start with hcg as its a better solution for me. Story with hcg is not 100% clear. First time i got hcg it was 300 ui and i got injected in hospital. I was feeling better and better untill that 300 ui stoped work (maybe 6-7 days it was working for me) which finally did and i was weak once again. About 2 weeks later i was prescribed hcg, 300 ui E3D. First 2-3 days i was feeling better again but not as good as that time in hospital, it was better bot not as good as before. After this 2-3 days i started to crushing, estradiol was close to 100 (checked by myself as doctor would never want me to do blood work for e2 levels) probably prolactin also but i didnt check it then. I stoped hcg then and never came back to it.

Testostrone in gel was just after my hcg therapy. I started to feel better for 5-6 days and then i started to have problems with breath and probably high prolactin (didnt checked).

After this protocol i changed doctor and started clomid therapy. After clomid therapy failed he puted me on trt but hes "vision" of my trt protocol was confusing me. He told me to inject 1 ampoule (100 mg) and after 5 days do blood work, check my T level. If will be low then inject another 100 mg and check T level again after 5 days or week. If will be "ok" then dont inject again and wait some more time for next injecting. That was the time when i sad "stop" and started by myself.

In case of prolactin - I got it in normal range probably for my whole life (as i now know how my body feels when prolactin is starting to kick in) and my whole life i am 99% sure that was having problems with hormones, i almost certain about it because i was always different from other kids, mens in case of thinking, energy levels etc. but i was telling myself that "its just the way i am". I dont know how normal men is working so dont have any comparison.

It looks like my prolectin is getting high when i am trying to help my T levels and get it higher. All my life prolactin was probably in normal range but T levels were very low, lh fsh too. In my opinion trying to put my T levels back to normal is making my prolactin getting higher than i usually got in my life.

Thyroid - was always in normal range when checked. Never checked it when was trying to boost my T levels though.

Adrenal - dont know what exactly need to be checked here. I only got checked cortisol and it was in normal range.

Sleep apnea - dont know anything about it.

In Poland there is testosterone in ampoules and 1 package = 5 ampoules inside so thats not a problem i guess? The problem for me is where to keep it if for example i would like to split 100 mg for 2 injections. Can testosterone after ampoule is broken stay in syringe for few days and not lose it properties?

I was having mri of my head and i dont have any pituitary tumors but i am not sure if that was what you were refering to...

 

[Systemlord]

He told me to inject 1 ampoule (100 mg) and after 5 days do blood work, check my T level. If will be low then inject another 100 mg and check T level again after 5 days or week. If will be "ok" then dont inject again and wait some more time for next injecting.

I know I'm beating a dead horse, but this is so wrong. To date this is the dumbest thing I've ever heard a doctor say, it's just pure ignorance at it's best! This is so far outside the norm he's not even coming close to established standards. Somehow he has made all this up in his head because he most certainly didn't read in any literature. I'm not at all surprised he's not considering the half life of the drug.

 

[Re-Ride]

On hCG mono therapy you need to inject at least EOD if not daily.

Unlike T cypionate, hCG is very short lived in the body. You can view Dr. Saya's results on hCG vs time and dose on these pages. Serum T will plummet toward -0- in a mater of hours, perhaps minutes, once the Leydig cells are no longer activated by the hCG. It usually takes weeks to awaken the Leydig cells in the testes with regular hCG treatment. Perhaps that single dose in the hospital was given to confirm the hypogonatic hypogonadism. For that purpose a larger dose, say 2,000 IU, would be given.

Thyroid: You may need a 24 hour test and other tests beside TSH.

Syringe storage of testosterone in oil: Contamination is the concern not degradation. If you can figure out a way to store the open filled syringe away from heat, light, and keep it sterile you'll be fine. Do not refrigerate under any circumstances!

 

[Verdilo]

In my country i cant buy legal cypionate. There is only enanthate and propionate. I am using enanthate, think is better for trt imo.

When i was injecting small doses (like 100 ui) ED of hcg i felt even more terrible than before. But again, it could be because of high e2 and prolactin. Didnt do a blood work then so have no clue. I reacted very quickly for hcg. I remember, took 300 ui and i slept like a little baby and that was probably my best night in whole life. Woke up full of energy with better erectile etc. but it crushed forever so anyway...

What is this 24 test for thyroid? Never heard that before...

So if i take testosterone from ampoule to syringe, take needle on the syringe, close it and put it to fridge then i will be good to go..?

Thanks for answers.

 

[Verdilo]

Since 2 days from injection 100 mg in sunday i am starting to feeling worse and worse.

Improvements were most noticable just after i took Dostinex to lower my prolactin. Maybe 3-4 days of getting better, then 5th day was injection time on sunday and felt still pretty good and day after in monday was the first day when i started to feel worse again. Now on tuesday i feel worse than yesterday. Maybe its a sign of something?

My first idea is to split 100 mg/week for 50mg twice a week and see how i will react?

Any help will be very appreciate.

 

[Verdilo]

Just changed my protocol to:

65 mg e3.5d (somewhere close to this value as i cant exactly measure it in my syringe)

Here is the question. If i injected 65 mg on monday at midday, then my next injection will be on thursday at night? Or shouldnt i count exactly this "0.5" day and inject anytime on thursday...?

 

[Vince]

Just changed my protocol to:

65 mg e3.5d (somewhere close to this value as i cant exactly measure it in my syringe)

Here is the question. If i injected 65 mg on monday at midday, then my next injection will be on thursday at night? Or shouldnt i count exactly this "0.5" day and inject anytime on thursday...?

I would inject on Thursday night. When I first started TRT, I injected Sunday morning and Thursday morning.

 

[Verdilo]

Thank You for help Vince.

Also got another question. If my thyroid levels (TSH, FT3, FT4) were completly fine and in normal range before i was diagnosed hypogonadism and went on treatment then could these levels change somehow badly out of range when starting hcg/clomid/testosterone injections? Could these levels be completly different because of trt treatment? Is it possible that rising my T levels could change something for worse in my thyroid?

I will add that i also got thyroid ultrasound before and it was completly fine and good.

 

[Verdilo]

I just did blood work for SHBG.

RIP SHBG:

9 nmol/l (11,4 - 52,3)