T Nation

1 Year Therapy, Still Having Hard Time Dialing In

Hi all,

A little about me. 44. waist is 46. Been overweight for a long time even though I eat clean, 1500-2200 calories, workout 3-5 times a week and started running recently. I have hair on back, chest and face though some small patches where beard isn’t coming through.

I feel tired. labido comes and goes.

I also take Montelukast SOD 10mg for my allergies (singulair)I take Iron suplements D3, fish oil as well.

I’ve been on therapy for about a year. I started with a total T leve of 330 and now I’m up to 880. I receive 220 ml of T every week and 1.5 pills of anastrazol. I started with 120 ML of T and felt great then back to tired, then they upped it and same thing. Great the back. My doc says my body keeps using all the T.

I have thalasemia minor, an anemia, so I take Iron for that, but it also causes my red blood cell to be smaller than usual but more of them. Don’t let the test results lead you anywhere else.

The blood work from 11/8 was

T 486
SHG 17.7
Free T was 13 and my last bloodwork was 18.

I’m going in for blood work next monday so I’ll update with new results.

Doc insists on giving me the shots on a weekly basis.

Any advice would be greatly appreciated.

Assuming you mean mg and not ml. At what point in your injection cycle was the blood taken for the labs?


Blood work is usually drawn every 3 months, but I’ve been complaining about my energy so 6 weeks. It’s taken fasting first thing in the morning.

But at what point after your last shot?

I get shots on a weekly basis, so the same day, week before.

I guess Im not being clear, sorry. When the blood was drawn, how many days had it been since your last shot?

7 days.

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The problem with weekly injections is that T levels peak then drop and then lab timing in days past prior injection greatly determines the lab results making them quite useless.

Anastrozole is a competitive drug to T and its serum T levels need to match serum free/bio T levels. So guess what happens with your changing T levels?

If you are needing higher doses of T, you are metabolizing faster, so levels drop faster than other guys and from peaks that are proportional to your high dose.

Repost labs with ranges:

Get a new doctor. He is making $$$, diabetics inject, why not you.

Self-inject T twice a week, subq, not IM, with 1/2" #27 gauge. Pinch up a mound of skin and inject into end of mound with needle parallel to muscles below. Subq is smoother T levels. Take half of your anastrozole at time of T injection. Do labs always 1/2 way between injections, get lab order and do when needed 10 days before office visit so you and ?new? doctor can discuss results at that time.

Low SHBG and once weekly injections, no wonder results are mediocre. Your SHBG is same as mine, we excrete most our our T into our urine and you seem to also be metabolizing T quickly which is why we must inject multiple frequent injections.

Inject T EOD to keep T stable subq or shallow IM in shoulder using 27 gauge insulin syringes. Subq is great for low SHBG guys as it provides smoother release. Doctor is being unreasonable and greedy, ditch the bitch!

Your doctor doesn’t have your interests, he’s making money off charging insurance for weekly shots. Are you an invalid, can you not learn how to self inject like everyone else?

Here are my last results.

TT 880 NG/DL 300-890
FT 18 10-30
E2 27.8 PG/ML <=60.7

Agreed. I used to give myself alergy shots. It’s not a big deal. He says he doesn’t want to do it because of “liablity” from the FDA or some crap like that. I was thinking of sticking with him until shit got stable and then finding someone else.

You will not get dialed in unless you start injecting more frequently, when I started TRT 9 months ago I was on once weekly injections, I didn’t start feeling great until I started injecting EOD. T levels peak within 48 hours and start falling thereafter, these dips in levels affect mood, energy and is the reason why you feel mediocre.

Your doctor is full of shit, he’s making everything up. This doctor doesn’t understand TRT, that is clear. Low SHBG guys take a long time to dial in.


I’ll look for a new doc.

BTW, I have a weight issue. No matter what I do I can’t drop the fat.

Can this be related to my T issue?

Yes. But it can be the thyroid too. Need thyroid labs. TSH, Ft3, ft4, rt3


Found a new doc that will let me self inject.

Last protocol was 220mg once a week. New one is 100mg at 3.5.

Did bloodwork with the new doc to get a baseline. I was used to the old format. Old doc said free t should be over 15. Also what’s the difference between bioavailable testosterone vs testosterone?

Lastly, I had the new Dr test my thyroid. He only tested tsh3 and said it was in range. It’s off. What kind of Dr would specialize in thyroid health?

I am also suffering from low SHBG and for me even e3.5d isn’t suitable. I have been trough e3d and currently in the begining of EOD.

A doctor that only checks TSH is clueless and unable to help you if he doesn’t understand the importance of actually checking thyroid hormones, it would be like only checking LH and FSH to determine if a guy is low T or not.

Male hormone is the most misunderstood area of medicine and it’s on purpose, you can thank big pharma.

No kidding.

So should I look for an endocrinologist or something else.

T went from 880 to 376 back to where I started

When you get tired of dealing with clueless endo, give a real hormone specialist a try. Defy Medical has doctors that know what their doing, they would understand what’s going on with you better than anyone.