What should I do to get T levels to normal

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If you have come this far, you owe it to yourself to, at the very least, do a small course correction to see the real benefits of TRT.

As I said, at your age, low testosterone levels are detrimental to your longevity and your quality of life. I respect what Guided By Voices advised you regarding seeking an overall medical profile, and you should do that. However, age related decline is just a different situation. I am 66, I understand where you are in life my friend.

I have learned to give age related advice over the years. I would not tell a 20 year old the same things I would tell you. The reality is that at your current age, the chances of increasing testosterone levels naturally are not so good. Yes, there are some methods and supplements that you may employ to see a small increase, but it wouldn't be enough to make a difference. I can personally attest to you that there are indeed methods to greatly improve your lifespan and your healthspan. You should seriously take a good look at the Deprenyl / Selegeline link I gave you.

So, back to TRT (testosterone replacement therapy), I will give you explanations of the acronyms so you can familiarize yourself with them. So while we are on the subject, it is a better acronym to refer it to HRT (hormonal replacement therapy). Not only will this give you the knowledge, but it will give you the ability to express to any medical professional that you are someone to be respected. But be advised, most medical professionals are clueless on this subject.

The very first thing you need to do is find a doctor who will work with you. Many on this forum use Defy Medical. Defy specializes in HRT. You stated you are in an area of limited access to physicians. Defy does the majority of their work remotely. This is just a recommendation, you may have more options than you know. There are networks of doctors that we can access to see if there is anyone in your area with the expertise in HRT.

To keep things simple, testosterone cypionate is most likely what you will be prescribed. Your initial dose is something that will most likely be adjusted. 100 mg per week is the usual starting dosage (as was stated by the Funkmeister). That can be a single weekly IM dose, 2 bi weekly IM doses or subcutaneous, Sub Q (under the skin). We discussed the peak and trough above. By doing a weekly, or bi weekly injection you are keeping your testosterone levels from tanking. This is extremely important. You do not want a yo yo effect with your hormones.

Natural testosterone production is controlled by the HPTA (hypothalamic pituitary gonadal axis). Rather than go into all of that here, here is a link that will explain that function:


It is essentially a feedback loop that regulates testosterone production. Again, there are multiple variables to what can affect this process, but we will stick to the age factor. Age just naturally slows this process down. This is where exogenous (not your own) testosterone becomes beneficial.

As was stated above by myself and others, total testosterone levels are only a small part of the equation. There is a hormone that binds to testosterone, SHBG (sex hormone binding globulin) that decreases the amount of free testosterone. "Free T" levels are what we are after. But... that's not all we are after. Men need estradiol (E2) just as much as women do, albeit at a much lower level. Testosterone converts to E2 via aromatase (an enzyme). Testosterone also converts to DHT (dihydrotestosterone). Both of these need to be in balance with your unique genetics. This is why testing, and time are critical to make this whole symphony come together.

It seems to be an overwhelming and complicated process, but taken logically, with the right testing, dosage and protocol, you can get yourself dialed in in a few months and at that point you would most likely not regret making the decision.
BadassBlues,

Thank you so much for the explanation and education. I am going in to see my doctor on Wednesday and I will share this information with her.
I think what I will plan is a weekly dose of 100mg instead of the 200 every two weeks.
Try this for 4 to 6 weeks and get retested. Hopefully I will see some improvement.
Thank you again and I will keep my fingers crossed.
 
Defy Medical TRT clinic doctor
BadassBlues,

Thank you so much for the explanation and education. I am going in to see my doctor on Wednesday and I will share this information with her.
I think what I will plan is a weekly dose of 100mg instead of the 200 every two weeks.
Try this for 4 to 6 weeks and get retested. Hopefully I will see some improvement.
Thank you again and I will keep my fingers crossed.
Give it 8 weeks, it takes time...and some patience ;)
 
Give it 8 weeks, it takes time...and some patience ;)
Well That didnt go as well as I had hoped. Went in to the doc with my newfound information and she immediately went on the offensive! Told me that "People on forums are not doctors!"
I explained that the majority of folks I talked to are people using HRT and this was their experiences, not medical direction!
I did convince her for the time being at least to change my dose to 100mg once a week!

Looks like Im going to have to search out a new doc. I couldnt believe how snippy she got even after telling me to do my own research!

Thanks, will keep you posted.

Dave
 
I am 56 years old, 5'6" and about 150lbs. About 6 months ago I had a battery of blood tests done and everything looked really good except my T levels. They were very low in the 150 levels. My general doc put me on 200ml of ciponate injection every two weeks. I have not noticed much of any changes except my ED has gotten slightly better, about 50/50. Energy levels have not really gotten any better. Muscle fatigue has not really improved and regeneration has not improved. I had my T levels checked yesterday (1 week after injection) and it was a whopping 1133!

I am wondering if I should decrease my dose and extend intervals between injections? I spoke to doc this morning and she recommends 100ml once every 3 weeks to try to get my levels into the normal range.

I am not into body building but I am fairly active. Work on my feet all day and restore cars in my spare time. Im not trying to build bigger muscles, just trying to feel better and get my body working better across the board.

This is all new to me so please be patient with me. I dont know all of the lingo so any explanations or advice is greatly appreciated.
every two weeks is nuts, I do daily subc with insulin syringes around 100mg /week split in to daily, gives very even counts, you dont want troughs and peaks, or even other day or at worst twice a week is doible, although I hear some prefer once a week, if your doc likes injections once every two weeks it might be worth reviewing if your doc knows his stuff, doesnt sound like it
 
I couldnt believe how snippy she got even after telling me to do my own research!
Some doctors can't stand an educated patient, because it makes the doctors look bad when the patient is more informed.

Told me that "People on forums are not doctors!"
This isn't people on a forum. ->Diagnosis and management of testosterone deficiency

The problem here is your doctor has an inability to deal with her inadequacies as a doctor, her pride, ego took a big hit today!
 
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I am 56 years old, 5'6" and about 150lbs. About 6 months ago I had a battery of blood tests done and everything looked really good except my T levels. They were very low in the 150 levels. My general doc put me on 200ml of ciponate injection every two weeks. I have not noticed much of any changes except my ED has gotten slightly better, about 50/50. Energy levels have not really gotten any better. Muscle fatigue has not really improved and regeneration has not improved. I had my T levels checked yesterday (1 week after injection) and it was a whopping 1133!

I am wondering if I should decrease my dose and extend intervals between injections? I spoke to doc this morning and she recommends 100ml once every 3 weeks to try to get my levels into the normal range.

I am not into body building but I am fairly active. Work on my feet all day and restore cars in my spare time. Im not trying to build bigger muscles, just trying to feel better and get my body working better across the board.

This is all new to me so please be patient with me. I dont know all of the lingo so any explanations or advice is greatly appreciated.
Every 2 weeks injecting?!?! That’s a ridiculous protocol and you should get a new dr. You’re doing more harm than good. Your test level will spike and naturally will go down daily. At 2 weeks you are in a trough or valley. You need weekly or even 2-3x per week injections to avoid peaks and troughs (valleys). 200 mg per week is what a lot of drs start at but honestly it’s probably too much. Try 140mg divided into 2 or 3 doses per week. So 70mg on Monday am and 70mg on Thursday pm. This gives you every 3-1/2 days. In addition, your free test should stay up as opposed to just a higher test level.
 
Well That didnt go as well as I had hoped. Went in to the doc with my newfound information and she immediately went on the offensive! Told me that "People on forums are not doctors!"
I explained that the majority of folks I talked to are people using HRT and this was their experiences, not medical direction!
I did convince her for the time being at least to change my dose to 100mg once a week!

Looks like Im going to have to search out a new doc. I couldnt believe how snippy she got even after telling me to do my own research!

Thanks, will keep you posted.

Dave
You’re better off with a new dr. She’s clueless. My words would have been, “look at my labs, they’re not normal, they’re less than normal. Clearly what you’re doing is not working and I don’t feel good. Change the protocol or refer me elsewhere!” But at least she is doing 100mg week now. When your labs go up be sure to tell her, see you were wrong!” I’m sure she’ll like that lol. At the end of the day it’s not just labs. It’s how you feel! If you’re feeling good, then you’re on the right track. If you’re not then something needs to change.
 
Well That didnt go as well as I had hoped. Went in to the doc with my newfound information and she immediately went on the offensive! Told me that "People on forums are not doctors!"
I explained that the majority of folks I talked to are people using HRT and this was their experiences, not medical direction!
I did convince her for the time being at least to change my dose to 100mg once a week!

Looks like Im going to have to search out a new doc. I couldnt believe how snippy she got even after telling me to do my own research!

Thanks, will keep you posted.

Dave
Yeah, not surprising. She is likely a good doctor for most of your medical needs, but clueless with regards to hormonal issues. That is typical of mainstream medical professionals. It's a waste of time and energy to argue with her, you just need to find a new doctor for your HRT.

Keep us posted.
 
Yeah, not surprising. She is likely a good doctor for most of your medical needs, but clueless with regards to hormonal issues. That is typical of mainstream medical professionals. It's a waste of time and energy to argue with her, you just need to find a new doctor for your HRT.

Keep us posted.
Thank you for the reply and I couldnt agree more.

I am on my 3rd week of the 100mg/week and I think I am noticing a slight improvement in how I feel. I dont seem to get fatigued as much as before and I just generally feel a little better from day to day. ED is still a 50/50 crap shoot but Im keeping fingers crossed for some improvement in that department.

When it comes time to get my labs checked in 7 weeks or so, WHAT all should I get her to order? We have only been checking free Testosterone and as you can imagine it has been all over the place. Also, in relation to the day I get my injection(Every Wednesday) how soon or when should I get my lab work done to not show false readings?

Thank you for all the help so far. Im still hoping for the best!

Dave
 
Thank you for the reply and I couldnt agree more.

I am on my 3rd week of the 100mg/week and I think I am noticing a slight improvement in how I feel. I dont seem to get fatigued as much as before and I just generally feel a little better from day to day. ED is still a 50/50 crap shoot but Im keeping fingers crossed for some improvement in that department.

When it comes time to get my labs checked in 7 weeks or so, WHAT all should I get her to order? We have only been checking free Testosterone and as you can imagine it has been all over the place. Also, in relation to the day I get my injection(Every Wednesday) how soon or when should I get my lab work done to not show false readings?

Thank you for all the help so far. Im still hoping for the best!

Dave
The basic labs are:

Testosterone total
Free testosterone
E2 sensitive (be certain to get the sensitive test)
CBC panel

You can also add:

DHT total
DHT free
SHBG

As for the ED, get a script for 5mg daily Cialis. And do yourself a favor, read back and order some Selegeline ;)
 
Vince,
Thank you for the reply.

Would you self administer 50mg by injection? Currently I am getting the 200ml every two weeks thru injection by the doc.

Im not sure about injecting myself. Not a big fan of needles.

Dave
@Gunner@1911 I'm not sure if anyone really likes getting stuck with a needle, but an autoinjector works amazingly. The first time I used it, I thought wait, did it go in. It did, all 25g 1in of it. Felt nothing. I don't think I'd be on TRT if not for the auto injector. BTW only sidearm I carry is 1911 :)
 
The basic labs are:

Testosterone total
Free testosterone
E2 sensitive (be certain to get the sensitive test)
CBC panel

You can also add:

DHT total
DHT free
SHBG

As for the ED, get a script for 5mg daily Cialis. And do yourself a favor, read back and order some Selegeline ;)
Thank you again for the reply.

I will talk to my doc next Wednesday when I go in to get my shot. Show her the recommendations for tests and she how she reacts.....

Since Im getting injections once a week now, when would be the best time to get the bloodwork performed?

I will also mention the daily dose of Cialis but I imagine she will want to start me on the 2.5mg dose for the ED but I will see. Im not full blown ED but like I said earlier Im about 50/50. Sometimes it works, sometimes it works for a little while and other times it wont work at all. Im starting to think the mechanics are okay as Im still experiencing nighttime erections but sometimes when Im horny as hell the little guy just wont cooperate. It is very frustrating! Thank God my girlfriend is very understanding.

The saga continues, I will keep you posted.

Dave
 
Thank you again for the reply.

I will talk to my doc next Wednesday when I go in to get my shot. Show her the recommendations for tests and she how she reacts.....

Since Im getting injections once a week now, when would be the best time to get the bloodwork performed?

I will also mention the daily dose of Cialis but I imagine she will want to start me on the 2.5mg dose for the ED but I will see. Im not full blown ED but like I said earlier Im about 50/50. Sometimes it works, sometimes it works for a little while and other times it wont work at all. Im starting to think the mechanics are okay as Im still experiencing nighttime erections but sometimes when Im horny as hell the little guy just wont cooperate. It is very frustrating! Thank God my girlfriend is very understanding.

The saga continues, I will keep you posted.

Dave
"Im starting to think the mechanics are okay as Im still experiencing nighttime erections but sometimes when Im horny as hell the little guy just wont cooperate."

Read back... Selegeline. Dopamine levels at your age have fallen. Selegeline / Deprenyl is the answer.
 
"Im starting to think the mechanics are okay as Im still experiencing nighttime erections but sometimes when Im horny as hell the little guy just wont cooperate."

Read back... Selegeline. Dopamine levels at your age have fallen. Selegeline / Deprenyl is the answer.
BadassBlues,

I will read up on it some more.

Thanks
 
Your doctor is going to shit if you tell her you want an E2 sensitive test. And despite many claims that it's necessary, I've never seen its results differ much from the standard assay when people have run both simultaneously. All things considered I would just ask to have your E2 tested and leave out the word sensitive.
 
As you can see, the subject of HRT has it's many varied opinions. It's always best to do your homework and research things before deciding what is best for you.
And still after all the homework is done only trial and error will work as we all unique and so different. It would be easy if how all looks on paper would be all that we need. Sadly thats far from being true.
 
As you can see, the subject of HRT has it's many varied opinions. It's always best to do your homework and research things before deciding what is best for you.
Badass,

My labs are back and they are the following:
Testosterone free 29.4 NG/DL (HIGH)
Testosterone total 622ng/dL
Estrodial 34pg/mL
SHBG 16 nmol/L
DHT 361.2 pg/mL
PSA .83 ng/mL
Everything in my CBC panel was within normal limits nothing low or high
Had a PNL done at the same time and everything was within normal limits except I had slightly elevated chloride

This is after 12 weeks of 100ml testosterone/cypionate once a week. I also started 5mg of Taladafil about 5 weeks ago with slightly improved results with the ED

Let me know what your thoughts are about this. Going to the doc today at noon to get her take on it.

Thanks in advance,
Dave
 
My labs are back and they are the following:
Testosterone free 29.4 NG/DL (HIGH)
Testosterone total 622ng/dL
Estrodial 34pg/mL
Your calculated Free T when plugging in your Total T and SHBG into the Free T calculator is 18.8 ng/dL, not high, so I must assume you used the inaccurate Direct method to measure the Free T.
This is after 12 weeks of 100ml testosterone/cypionate once a week.
It's very important, when did you draw labs in relation to your injections?

Because if these labs are your midweek levels, trough levels are much lower and if these are peak levels, trough levels must be dreadfully low by the end of the week.

For reference, you should always draw labs at trough, right before your injections!
 
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