T Nation

50, New to TRT, Opinions?


#1

I'm 50 and am generally fit and healthy, exercise regularly (strength training & cycling mostly). Energy level and libido really dropped off over last couple years and I get pretty bad night sweats most nights now. My urologist suggested we check my hormone levels and while I don't have the results handy I recall that my total testosterone was 218 six months ago and 230 two months later on the confirmation test.

He suggested that I consider TRT but that I find a local doc to work with me on that since I am only in his state once a year now. My GP referred me to a local (Scottsdale, AZ) urologist, and I saw him five weeks ago. I told him I was open to trying TRT if we could keep the cost down as I am between jobs at the moment and have only minimal health insurance.

He said that ruled out the gels because they cost about $300/month. He gave me a 400mg shot in the glute of testosterone cypionate and I paid a $35 copay for the office visit. Today, 32 days later, I went back for my 2nd shot and paid another $35 copay. Didn't see the doc, only his nurse. Same with the next monthly visit, then I'll see the doc on the 4th month and we'll do more labs.

I've been reading about TRT on this forum and other sites for a month now, and this much seems clear to me: although the labeling information for testosterone cypionate states dosage frequency at 2-4 weeks, most patients/users and many docs advocate more frequent dosing to achieve a steady level of free testosterone (because the drug's half life is only eight days). The more frequent dosing certainly seems to make logical sense to me, a layperson, but I don't have a doctor's level of understanding of how testosterone really works in the body. I would also like to avoid the peaks (where side effects are of greater concern) and valleys (where you feel like crap) of monthly dosing, if in fact that is what I would experience. Time will tell on that - I plan to try this doc's apporach until we meet and do more labs at least.

Questions:

If in three months I want to try more frequent dosing, what should I say to the doc? I am not sure if he will be agreeable. The nurse didn't say much but when I pried she seemed to indicate that monthly is the only way they do it there. Would I notice a big difference dosing every two weeks? $70 a month I can swing.

For those of you on doc-supervised TRT who self-inject weekly or semi-weekly, what are the rough costs of the drug itself and the needles and syringes? I'm not sure I will be able to afford this approach right now even if the doc agrees, but would like to know the cost.

If I need to find a new doc, can anyone recommend a good TRT doc in the Scottsdale, AZ area who is open to patient feedback and who would be comfortable working with me on a self-injecting program? There are MANY 'aging male clinics' here in Scottsdale, and they all look super-expensive. I just want a good doc who will take payment for office visits and order labs and write appropriate scripts and not sell me an expensive 'TRT package' for thousands.

I understand that I may need to stick with monthly injections for now based on cost alone, at least until I am pulling paychecks again. Hoping there might be better options, though.

Thank you,
JohnAZ


#2

There is a BodyLogicMD, Doctor Eric Honing, in North Phoenix who is a very knowledgeable guy on TRT, thyroid, and adrenals. He IS an anti-aging doctor and can be a bit pricey, though. He’s pretty open and if you want to do something and it makes sense, he will probably go for it.

I think first visit is $400, but they also want a full spectrum blood test prior to the visit. Don’t remember how much is was, but it wasn’t cheap.

Once a month injection protocol is ridiculous. You’re getting a huge swing in both testosterone and estradiol. Test cyp half-life is roughly 7 days. Once every two weeks is terrible as well. We recommend AT LEAST 50mg testosterone cypionate 2x/week.

Also, without hCG you’ll experience testicular atrophy, and without an aromatase inhibitor you’ll probably have elevated estradiol, which will negate all the positive side-effects of your TRT.


#3

Thanks for the response, Kanyon. I do appreciate your thoughts, though I’m surprised that you think monthly and semi-monthly injections are “ridiculous” and “terrible”. I’ve felt a little better and more energetic overall since starting this six weeks ago, and have not noticed any ups-and-downs, mood swings, etc. I can see why more frequent injecting might have advantages as far as keeping one’s T level steady, but if the costs are as prohibitive as you suggest to see one of these docs who is OK with frequent dosing, then I imagine there are a lot of patients like me whose choice is a monthly injection for the cost of an office visit or no TRT at all. While I respect one’s right to earn a living and charge what they can get for their services, I personally wouldn’t pay a ‘mens health clinic’ for a ‘package’ of services that includes a consultation that costs several hundred $$ up front. Perhaps that includes labs, I don’t know. IMO, a ‘consultation’ should always occur on the first visit to a new physician anyway, and this should be included in the office visit for the co-pay fee. No offense to you or the doctor you mentioned, but to me, there is no justification for a separate ‘consultation’ fee.

Also, I’m aware that an AI and hCG are often taken with testosterone and why, but wouldn’t you want to wait for the next lab results before deciding to start one of those? Aren’t there many guys who take test cip and never have a problem with their estradiol levels? And what are the concerns with testicle shrinkage? Fertility? Asthetics? I don’t wish to have kids and I couldn’t care less what my balls look like (nor does my wife), so is there some other reason why it would matter for me?

Has anyone experienced changing their dosing frequency from monthly to more frequent, or vice versa, and how did that go?

Thanks,
JohnAZ


#4

The downside to monthly or bi-weekly injection is the inevitable roller coaster of testosterone and estradiol. With your 400mg injection, your T is skyrocketing and E2 along with it. We recommend every other day injections to maintain stable levels.

Many initially feel better after beginning TRT. This is due in part to the dopamine receptors being hypersensitive. This will normalize over time. You may feel the roller coaster a bit more then. I’m not trying to discourage you. Just letting you know.

That said, I’ve known guys on bi-weekly injections who are asymptomatic. Everyone is different.

True, you might not need an AI, but many do. Some would rather have higher E2 and work their way down, and some would rather have lower E2 and work their way up. Mid-20s is the recommended goal. That doesn’t mean you might not feel better with E2 in 40s, etc.

hCG prevents testicular atrophy. Some say they want to keep fertility, testicle size, but the kicker for me was the constant aching. That’s when I added hCG.

Just two cents from a guy who’s run the gambit of TRT. I always encourage guys to do their own research and make informed decisions. We are just here to help you along the way if you want.


#5

This is the type of actionable advice, care, and consideration that I find “comforting”…

Very noble.


#6

Kaynon is telling you the right things sir…

If whatever your doing works for you all the power to you and it’s your body and your world so kick it around!!!

So many factors to be considered and we know nothing about you…

Read the advice for new guys sticky

Good luck in good health

Monthly injections are plain dumb… 2 weeks is awful…
One week is ok for some… 2 times per week and eod is a must for some!!!


#7

If you get a doc to give you scripts, the costs of T cyp and syringes is trivial. Get T at Sam’s Club if you have a business membership, otherwise costco is good. 100 insulin syringes costs $13 at Walmart. Lab work can be a large cost.

Urologists are often real idiots. You got one. What does any of this have to do with urology? An enthusiastic GP is always best if you can find one. There is a stick for finding a TRT doc. The male health clinics can be costly and often over-prescribe. They are willing, greedy and often incompetent.

Get more data here as per the advice for new guys sticky.


#8

Solid advice all around. Thank you for sharing your experiences and knowledge. Yeah, that sounds like the trick - to find a doc who is knowledgeable and willing to ‘work with you’, not just “this is the way we do it here”, and more concerned with your well-being that maximizing profits. Perhaps I will find that the urologist I’m seeing is in fact more knowledgeable and flexible that I realize.

I’ll give him the benefit of the doubt until the next labs and discussion at least. But if I start experiencing things like aching testicles, emotional lows, etc., and he is unwilling to make any adjustments, I will be using the ‘find a doc’ sticky. I may even check out the guy Kanyon suggested, but he might be out of my budget.

If the monthly injections turn out to be more trouble than they’re worth and I can’t find a doc I can afford, I will just have to get used to feeling old and tired until I can afford proper TRT. That might be better than the ‘roller coaster’ I am hearing about.

BTW, I think TRT is within the domain of urologists because they are as expert as anyone about reproductive health and when patients have problems in this area, it can lead to looking at and treating hormonal levels. At least this is how I came to be treated by a urologist for low testosterone. Since I am fit and active and generally healthy and strong, it would never have occurred to me to look at my testosterone level had the urologist not suggested it during a prostate exam.