T Nation

38 Y/O Starting TRT

Started noticing major irritability, lack of motivation, tiredness in late 2017 and asked my GP for a Test lab. She looked at me like I was ridiculous, but she ordered them anyway. In Feb 2018 my levels were:

TT-494 Reference Range: 250-1100 ng/dL
FT-63.2 Reference Range: 35.0-155.0 pg/mL
SHBG-33 Reference Range: 10-50 nmol/L
TSH-1.45 Reference Range: 0.40-4.50 mIU/L

I guess her (and I) not knowing much about this, she didn’t order a test for E2, FSH, LH, etc. Fast forward to June 2019 and I’ve been having more moodiness, irritability, less libido, lack of motivation. Thought it was just marriage and kids taking its toll. Went to a longevity clinic and got some tests ordered:

TT-230 Reference Range: 250-827 ng/dL
IGF1-113 Reference Range: 53-331 ng/mL
FSH-5.8 Reference Range: 1.6-8.0 mIU/mL
LH-4.1 Reference Range: 1.5-9.3 mIU/mL
Prolactin-7.1 Reference Range: 2.0-18.0 ng/mL
E2-18 Reference Range: < OR = 39 pg/mL (sensitive test)
PSA-1.2 Reference Range: < OR = 4.0 ng/mL

He didn’t order FT or t3 and not sure why, i’ll ask for those next time. Dr suggested I start 150mg t-cyp, 0.375mg Anastrozole per week along with hcg (dosage still unknown until i receive it). The t-cyp and AI are compounded together (200mg/0.5mg/ml @ 0.75ml dose) so i can’t really tweak the t-cyp/AI ratio until my next 10 week round. He suggested once a week injection, but I’m thinking of splitting it into twice weekly after lurking around the forum.

After doing some reading, I was wondering if I should start at 100mg/wk t-cyp and hence 0.1875mg/wk of AI and then adjust per feel/labs from there? Which protocol seems better to start out on? I’ll probably start here in the next few days when I receive all the meds, so let me know your thoughts.

As a side note, at the clinic i’m paying $440 every 10 weeks for t-cyp, AI, hcg, syringes, drawing needles and alcohol wipes. Seems much, but I have unlimited access to the dr for questions and he’s very responsive, so seems good starting out.

This doctor seems the normal templated TRT dickhead.

You DON"T start fucking AI at the beginning and most probably you will never need it.

And HCG you can add but later and only if you want to preserve fertility.

You need to start on pure testosterone and thats it. Injections at least twice per week.

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Any clinic using Test mixed with AI’s just doesn’t get it how to put the patient first, it’s no way to optimize individual hormones and only benefits this clinic.

There are many telemedicine options which are a little cheaper and do more testing. Your IGF-1 is low and peptides can increase your natural levels if TRT doesn’t. We have no clue as to thyroid status, TSH isn’t a thyroid hormone.

It will be impossible to track your progress without testing the free portion of testosterone, you can however calculate Total T and SHBG using an SHBG calculator.

could you send me some info on those teleclinics? My current doc charges me $220 a month and not the best patient minded model in place. I just stick with them as they allow me to change things up on my own while having access to everything I need like OP. Test Cyp, and HCG mainly. Their testing is very weak though, all they tested before starting me on TRT was my total test level, and PSA. To OP, sadly most TRT doctors don’t work within insurance networks, and the ones who do usually leave you worse then you started with their more strict guidelines and poor treatment methods. There is a varying level of quality when it comes to these doctors though, and a lot of them are pretty behind when it comes to protocols that keep your health number 1 priority.

He seems pretty open about things, I’ll ask if I can get them separate next time to have a little more control over the dosing, or eliminate if needed. Its a custom mix, I think the plan was to do this for 8 weeks, get labs, then adjust from there and get a different script for the next 10 wks depending on results.

Defy Medical is probably the most popular, $1200-$200 yearly including EVERYTHING. They specialize in more area than TRT, growth hormone, peptides and excel in treating thyroid problems.

If you need it my email is my bio. I can put you in touch with a doc that does telemedicine for about $150/month which includes your testosterone and an AI (Anastrozole or tamoxifen, you don’t have to take them) and labs. They send the meds from a compound pharmacy to your door.

I just started TRT and use Royal Medical. They charge $195 a month for everything. I didn’t have extra fees for tests or anything else. I got two months of supplies up front and so far everything has been smooth.

I realize that the VAST consensus in this forum is to not start an AI ( I don’t know what AI stands for, but I think it is estrogen blockers?). However, my prescription was for 200mg test cyp per week injected intramuscular which was mixed with anastrazole, and to take two injections of 500 units of HCG per week (split throughout the week). I’m also 38 years old and went through a lot of the symptoms you describe, which is why I went to Royal. I have great medical coverage, but going to my general practitioner and urologist ended up with similar results where they said I was fine because my TT tested in range of normal. The reality is, just because something works for one or doesn’t work for another, doesn’t mean that’s how you will respond. Everyone reacts differently, despite every publication out there, so pay attention to your own results and variables.

I am on the doc’s prescribed regimen and am doing quite well (so far). What I’ve realized from lots of reading here is that everyone seems to have a unique experience with AIs and testosterone doses. Give yourself the best chance at making TRT work by getting regular sleep on a sleep schedule, cut out alcohol, minimize stress, eat good whole foods, and get good exercise.

My libido has returned with full force, I am making solid gains in the gym, and my mood has stabilized quite a bit. I never really had issues focusing, so there’s no improvement there. My gut has shrunk quite a bit too.

One thing I learned is the first couple of injections ruined my sleep for the first three weeks (on day one and two after the injection). I adjusted my schedule to inject test in the morning on a Saturday to give myself ample time to work out and tire myself out for the day so I could get sleep. I also injected my HCG at night (by recommendation). My body temp rose which contributed to my lack of sleep. Now almost a full four weeks into it, I am sleeping like a baby. Better than ever.

Also, because I am working out much harder than before, I added a men’s multivitamin and vitamin D to my schedule. And I also take a ZMA supplement at night.

The best advice I have gotten so far (from user The Myth) is to not obsess over TRT and to give your body time to adjust to your prescribed regimen.

Lastly, I also do one injection per week. First, I wanted to get used to the whole injection process. Doing it two times a week was too much for my weak mind. However, after my fourth injection, I see no reason at this point to split it up into two. I haven’t experienced the peak/trough that others have…with that being said, I will switch if my body tells me to.

Anyways, good luck with your protocol and I hope you see benefits from TRT.

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Anti-Estrogen. Anastrozole (Arimidex) or Aromasin are the standard options.

do they cover HCG if needed as well? I currently pay $220 a month which covers the expense of an A.I., the testosterone vials, HCG, injection supplies, follow up testing, and all other care included. Would love to find a lower price if possible.

$1200 to 2000 a year? I will look into it but it seems to have a big price gap, must be because of added things such as HGH.

You’re just paying too much right now.

The price is with TRT+HCG+AI, less is without the latter two. You could do TRT+HGH or TRT+peptides = more HGH.

I don’t have a need for HGH to my knowledge, though when I get older using HGH peptides could have some health benefits down the line. the HCG I thought would be needed but some people are saying you don’t have to start it until you plan on having kids. I was just worried if I went a couple years without it I would run the risk of becoming impotent if I ever did want to have kids. Paying $220 a month right now from a doctor who doesn’t know to run proper blood work and pushes out the a.i. use as hard as they do I am definitely looking to alternatives, I will check out Defy and the other telemedicine doctor that @dextermorgan mentioned.

@cstratton2
Yes they will prescribe hcg if you want it. I’m not on it so not sure on price or anything. I would think any trt place will prescribe hcg.

Aromatase inhibitors

I would recommend dr Keith Nichols.
He also has some annual plan but I cannot remember how much he charges.

This guy is a real pioneer in TRT and I don’t believe there is a more knowledgeable doctor than him currently in the world. He also treats women so his perspective is wider on the whole endocrine system.

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Dr Nichols will never give you AI and yet none of his patients suffer from E2 symptoms. HCG he will give you only if it is important for you to maintain fertility. He likes to start his patients on pure test to establish baseline, he will also check your thyroid and optimize there if necessary. Many TRT doctors fuckin miss the thyroid which is insane…

Yep. Rough day, my bad.

Yeah I have heard of him from Jay Campbell and others who mention him here, the only reason I haven’t sought him out yet is because I assumed he would be very expensive. He does telemedicine in California where I reside though.