T Nation

50mg Per Month TRT?


#1

Hey guys! I was diagnosed with low T this week (187 total, 6.6 free). Got my doc to prescribe me HRT… but as the title suggests… she’s starting me out at 50mg per month (yes per month, that’s not a typo… test cyp)–after doing some research, this sounds incredibly low.

I will say… my cholesterol was shit (308 total, 36 HDL, 246 LDL)… so I can appreciate being cautious (while I get that under control)… but just wondering what I should expect from this treatment? Is this enough to make any difference, any chance of this making me feel better?

I don’t get my blood drawn for another 90 days (in which time I hope to have made some good progress on the cholesterol)… any words on what I should expect from this?

Thanks for your help guys!

About me: today 205lbs ~24% bodyfat, 34 yo, 5’11"

History:
About 5 yrs ago (following testicle surgery), I ballooned from 160lbs ~10% to 260lbs ~40%… been fighting the weight off (mountaindog style) seriously for the last 1.5yrs… the whole time feeling pretty shitty… and never having much luck losing fat. I can diet hard (like 1400 cals/crazy cardio) and lose weight (read: lean mass)… but getting body fat sub 20% has been near impossible (as has getting my lean mass above 160lbs). Read: got stuck and decided to go to the doc. Also of note, I have admittedly cut corners on food sources (read: conventional, processed shit–cause I’m cheap)… so know that I was half assing (IIFYMing) the mountaindog diet.


#2

You should expect your doctor to be incompetent.

Post your labs with ranges.

Elaborate on your testicle surgery.

Your course of medication indicates you have primary hypogonadism. Has she tested your LH / FSH?

Your weight may cause you to have high E2 as you get back to normal T levels.

Welcome aboard and good luck.


#3

I second everything gonad said and if it were me I would find a new doc immediately. You would probably feel a lot better on 100mg per week split into 2x/wk doses, which is pretty much the standard TRT protocol as for most people it will put you in the high normal range and make for more steady blood levels, and until your weight is more under control you may also need an AI like anastrozole to help keep E2 in check.

Best of luck.


#4

Thanks for weighing in, and for the welcome Gonad! I suspect I’m gonna be spending a lot of time here.

Labs/ranges on my hormone panel as follows–note: I don’t see FSH:

Testosterone
Total 187 ng/dL (range 348-1197)
Free (direct) 6.6 pg/mL (range 8.7-25.1)
LH 5.6 mIU/mL (range 1.7-8.6)
Prolactin 8.5 ng/mL (range 4.0-15.2)
Sex Horm Binding Glob, Serum 16 nmol/L (range 16.5-55.9)
Estradiol 6.8 pg/mL (range 7.6-42.6)

As to the testicle surgery, it was for a hydrocele repair (epididymitis)… long story short, in my late teens/early twenties I had several hernias (both inguinal, and umbilical) and subsequent repairs/re-repairs. Ended up with hydrocele’s (essentially water between the testicle and outer/protective membrane)… I’m told an unfortunate complication from those hernia repairs. Anyway, I was told the condition was benign, and only needed addressed if it became uncomfortable… well by the time I hit my late 20’s the fuckers had slowly swelled up (one the size of a grapefruit and other the size of a large lemon)… and became terribly painful (like to the point I couldn’t sleep without taking a dozen+ advil… not to mention wrecking my appetite)… so I went in to get em cut on… for the repair, they completely removed the protective membrane around both nuts.

I never once suspected low T… I’m a hairy/masculine guy, full beard, a little male pattern baldness… zero problems getting or sustaining an erection… just thought it was depression or laziness (read: me being a bitch).

That said, looking back… I see a slightly different story… I get home everyday and I’m fucking wiped out (all I wanna do is couch surf)… getting to the gym has often required heavy doses of stims (bronkaid, caffeine etc)… I’ve gone from 2 a-days with my lady down to 2 a-months (often she initiates)… I rarely ever masturbate (read: been living like a monk). Fucking trained arms on Saturday, it’s Friday and I’m still sore (this is with intra md AND and concoction bowl… read: good periworkout nutrition, and a routine I’ve been on for 6 wks)… I’ve been fucking killing it on both training and nutrition (cutting corners on food sources or not, my macros/cals have been on point), getting good sleep/hydration… and just getting nowhere (except ran down).


#5

FSH would be listed as folicle stimulating hormone. It’s unusual to see LH without FSH.

Your LH is decently midrange, I don’t recall whether LH or FSH is the more predominant one for determining primary vs secondary.

Prolactin is good, pituitary tumor is unlikely. E2 is good and low.

I’d look for someone else to weigh in, but my impression is that you are primary hypogonadism possibly due to damage from hydrocele… I’m not very familiar with the treatments and nuances for primary.


#6

Thanks for responding Juggs!

I’m going to give my doc (and her group) an opportunity to get it right first (read: just called to push for higher dose/frequency)–she’s been my doc since I was a teenager, knows my history, and honestly I just like her. I will say, she didn’t seem all that up to speed on test (was asking nurses which test was typically prescribed etc)… BUT she did give me the freedom to self inject (when their practice is to have patients come in), and I think (read: hope) I might get her on board for dosing around my requested level. I know she’s got a couple guys working under her who focus on men’s health–I’m encouraging her to get a consult from one of them too.

I guess my biggest concern is my high cholesterol read: does that put me at risk for negative (life threatening) sides? I wanna feel better, but living is obviously a higher priority :stuck_out_tongue:


#7

Normally I would point out that getting your T corrected can help with other health issues. However, in your case, it sounds like you do also need to clean up your diet if you are concerned about your cholestorol (you should be).


#8

Just an FYI… reached out to my doc’s office, and they agreed my initial prescription is very low (by design)… ultimately, I’ll likely end up in the 100-200mg weekly range (or until total and free t are on the high side of normal).

Apparently my doc is very cautious and wants to see how well I tolerate TRT before throttling dosage/frequency… not to mention giving me the opportunity (that I begged for) to control cholesterol with diet/exercise–she wanted to put me on Lipitor the moment she saw those labs… but I convinced her to give me a shot at lowering on my own.

So… I’ll be cleaning up my diet/cholesterol, while dabbling my toes in the water of TRT–sucks that I’m probably 90 days out from seeing any real benefit… but I appreciate her caution… and considering I’ve been dealing with this for years… another 3 months really isn’t the end of the world.

Anyway… thanks to you guys (and the info on here) for helping me to ask the right questions!

Assuming my next blood draw is good, I’ll push hard for minimum 100mg/wk Rx at my follow up.


#9

You are primary.

Please follow these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Ask for this:
self inject 50mg T cyp twice a week
0.5mg anastrozole at time of injections, wait for first labs, seek to be near E2=22pg/ml
250iu hCG SC EOD will prevent testes from shrinking and preserver fertility


#10

If I’m not concerned with testicle size, or fertility… can this be omitted? My insurance doesn’t cover HRT until I hit my (ridiculously high) deductible… and even with goodRx, that stuff is expensive/way outside my budget.


#11

Its really an option if you want it. Note that some get a weak 24x7 ache in their testes with shutdown and hCG can fix that. With a high deductible plan, at least your premiums are low and with HSA contributions, your TRT costs are from tax sheltered money. hCG can be a lot less costly from some compounded pharmacies where the product will probably include Vit-B12.


#12

I get 5,000 IUs of hcg+b12 and all the syringes for $34


#13

I’ve got some minor legal stuff going on, and have zero interest in taking any Rx drug without an Rx, proof of purchase etc… very unlikely that I’d be drug tested, and probably even less likely that I get pinned for hcg if I did… but I want to make sure I keep myself squeaky clean (until it’s over).


#14

I have an Rx for everything I’m taking.


#15

Gotcha… so I just need to find a better source than goodRx… any suggestions?


#16

I have been on TRT for 18 months without Hcg. Balls shrunk, but no other issues. Frankly, a helluva lot more comfortable with small balls.


#17

Correct me if I’m mistaken, but hcg has other positive effects beyond preventing testicular atrophy and maintaining fertility. I believe that it will help promote some natural T production and can help with libido and the feeling of well-being in some men.


#18

Costco pharmacy seems to have the best prices for generics around. I don’t think you need a membership to go to the pharmacy, but if you do, it would be worth the 50$.


#19

There is a chance, albeit a slight one, that getting your test level into a good range might even have an indirect positive impact on cholesterol, but as a general rule, the higher the test the higher the cholesterol. Regardless, you can make quite a positive impact on cholesterol and triglyceride levels with diet and intense exercise. I’ve done it myself, and if you’d like more details on how I did it let me know. But here are the Cliff Notes: One thing that will surely help your lipid profile, as well as carb cravings, inflammation and so many other things is taking in massive amounts of omega 3’s. Such as in the form of 12-16g (yes g, not mg) of fish oil per day. Or less if you take a high quality fish oil like Flameout or Super DHA. Also switching to grass fed meats and wild caught cold water fish (i.e. salmon) will increase your omega 3 intake as well. Finally, eat slower digesting carbs, and if you normally eat a lot of carbs, maybe decrease your intake by 10-25% and then reevaluate after 8 weeks or so. I made a huge shift in my diet a few years ago, mostly just what i mentioned above, and my cholesterol and triglycerides improved substantially. Far beyond what my doctor said would be possible without drugs.


#20

So… called my doc (about changing my dose), and they completely blew me off… so I took the advice here, and found a new doc.

This new one started me off on 200mg 1x weekly IM (no SC, no splitting doses)… no hcg (not needed unless I want to preserve fertility/experience discomfort), no AI (because my estradiol was so low to begin with, but may add it in next time). Check back in 3 months… we’ll adjust up/down accordingly.

Anyway… I’ve been on this protocol since 4/13, low T symptoms have eased considerably (more sex drive, more energy, and just generally feeling better) BUT the last couple of days I’ve started to notice some nipple sensitivity.

So… my new question… is 200mg high enough dose to cause gyno? Is it something I should be concerned about, or is it something that can wait to be addressed during my July follow up?

Thanks for your help guys!