T Nation

51 and Confused

After reading through the TN FB page and the forum here it seemed clear that this was a valuable source for information. I’m looking for opinions and advice no matter anyone’s age. I was diagnosed with low T at age 38 by my GP. My treatment at the time was CYP 200 MG/ML injections every 3 weeks. At age 40 I was diagnosed with prostate cancer and ceased all HRT. I went through robotic surgery to have my prostate removed and experienced very little side effects. I have been cancer free for 10 years. My urologist started me back on HRT but preferred gels to injections. I was also placed on ED drugs and took them for a few years for performance and therapy. Along the way I went to a new GP and eventually had her prescribing my HRT which were still gels. Starting in January of this year I lost 70 lbs through diet and getting back in the gym. I started paying close attention to my levels again and thought I would go back to my urologist since he was so proactive before. After receiving my test results on May 7th I just now have received notification of a new prescription. My results showed Testosterone Total at 195ng/dL with standard range at 250-1,100ng/dL. My free testosterone was 52.7 pg/mL with 35-155 pg/mL as the standard. I was sure my prescription would change but I am at the same level of medication , Androgel 20.25mg. My phone calls and emails inquiring about my levels are ignored and I asked for ED medication again as I am having slight difficulty in that area. I know the first response is to get a new doctor which I plan to do if for nothing but the communication break down. I am overwhelmed with the possibilities living in a huge metropolitan area of Atlanta. At this point I am not sure if I want to see an Endocrinologists or search for a new GP or urologist. I’m also curious about some of the men’s clinics that advertise HRT. I work out 5 days a week and eat healthy but my energy level gives out at times and the erections are not what they were. Like I said advice from guys older, my age or younger is appreciated.

Can you go back to your GP and get the inject-able test? If you are injecting at home YOU can control the frequency. Then get labs in 6 weeks and adjust from there based on how you are feeling. If thats not an option consider calling Defy Medical. They do telemedicine but dont take insurance.

If injections are a hard sell to you doctor could also try getting him/her to let you use a compounded test cream. Far better absorption than gels when applied scrotally.

This makes me so glad I have a good doctor…

Seriously, improvements need to be made in the department of testosterone replacement therapy. It’s been around for many, many decades, however after the 1980-90s protocols started becoming ridiculous.

I have an old Merck Manual which states to give a patient “1-200mg test C every 1-2 weeks and HCG to maintain fertility if secondary hypogonadism is present”… While I don’t quite agree with the HCG aspect, the protocol there isn’t terrible, yet now we have protocols in the guidebooks like “50mg every 4 weeks”… what the fuck? Or 300mg every 4 weeks… The half life of test E is like seven fucking days… seriously…

Then with regard to guidelines, like most medications (regarding individual metabolism, elimination of drugs) there is a bell curve for response a patient will have, thus it’s not a one size fits all (same goes with regard to at what level a patient will feel better/ what is optimal). Ref ranges need to be optimised rather than the 150-700ng/dl I keep seeing, treatment protocols need to be catered to symptoms and numbers (although obviously a dude with 1100TT and high FT and DHT without androgen insensitivity shouldn’t be given T even if his TT was once 1500-1600)

It makes me rather irritated, but there’s such a stigma against it that research isn’t going anywhere atm. In Australia primoteston (injectable test E) and sustanon (other inj test) were taken off PBS, now Primoteston isn’t even available anymore, sus is in short supply…

as to op, sorry to hear about the cancer, that’s a real bitch, good to hear you fought it and recovered though :slight_smile:

If you’re being ignored with a TT of 195 I’d suggest finding a new doc, if you can afford it, go doctor shopping. There are advantages over gels to injections (less chance of Polycythemia, though this can be corrected with blood donations… until you tank ferritin… also it takes a while to develop polycytehmia, research shows 600mg test for 20 weeks in older men causes a HCT rise of about 6%, thus to actually get a dangerously high RBC count (say 55%+) it’d probably take 10 months +.

If you’re on androgen 1.62% (OR 1%) AT 20 MG per day, then you’re not absorbing the medication very well and need to switch meds. The healthy male gonads only pump out 5-15 mg of pure test per day.

I’ll look into that form of medication. I never knew there were creams.

Thank you for the response. Unfortunately my previous GP moved and is no longer an option. That was on of my first thoughts actually.

1 Like

They are only made in compounding pharmacies. Because they are not a big pharma med like androgel it should be cheaper so may be a plus going that way.

I wasn’t thinking about your previous cancer though when I responded. I’m not sure how your doc would feel about scrotal applied cream as it is known to cause higher DHT levels. I would think with prostate removed it would be no longer an issue with your doc but you never know.

Congrats on beating that evil bitch called cancer.

There are some TRT specialists in Atlanta, somebody on here is going to one. Gels don’t work too well for most guys, the creams are getting good reviews. Your old protocol for injections was terrible BTW. Your dose is not related to you T level, as you are not adding to natural levels, you are replacing them. Your natural production stops when you are taking exogynous test. You will need between 100 mg and 200 mg a week, most likely. And probably somewhere in the middle of that range. And start with just the testosterone. Guys get prescribed HCG and an AI right off the bat, and you really shouldn’t add that many variables at once. Try just test, and see where that gets you as you dial in your dose. Then worry about other things if you determine that you need them.

Prostate removal can cause sexual dysfunction and is important with the first 6 months after prostate removal to get on TRT quickly according to Dr. Abraham Morgentaler.

None of the doctors you’ve had impress me at all, T gels work optimal rarely for men do to poor absorption. I’m afraid you will not find endo’s to be much help in TRT, it’s just not something they are trained to do and more often than not go for the gels do to lack of knowledge.

Injectable testosterone is the most effective and can require the most skill to manage which is why the inexperienced doctors always go for the gels, it’s easy.

Sorry this will not work, Test cypionate has a half life of 7-8 days, so this every 3 week schedule is dumb and will see levels below range by the middle of the second week leaving you hypogonadal for a week and a half.

You need to keep levels in a tight range for symptom resolution, not the hormonal roller coaster suggested by the guidelines. You need at minimum one injection per week with two or more being optimal.

SHBG levels are pretty good marker for determining an injection frequency, lower values will see more fluctuations since low SHBG men tend to have problems with secretion and can metabolize testosterone more quickly requiring more frequent shots.

Defy Medical is an option, a popular telemedicine clinic. Some of these TRT clinics are a shame and only selling a package deal to everyone and are more of the same incompetence you’ll find with your GP and/or endo.

@hammer09 I can confirm (just as your labs confirmed) that gels do not work. I did Androgel for over a year until I realized it was useless.

You have two options to make you feel better:

  1. A cream that is applied to the scrotum (yes, you heard me right). This is currently the BEST method of application for TRT, bar none.

  2. Injections (if you are able to do them yourself). SubQ injections in the belly fat with a tiny needle are very easy to do and virtually painless. This is currently the second best method of administration. To make this work well, you need to be doing as frequent injections as possible. Daily is best, every other day (EOD) would be second best, twice a week third best. Weekly just isn’t recommended and beyond that is literally pointless.

I see you’re in Atlanta. Might I ask how far away you are from Chattanooga? The best doc I know in this field is Dr. Keith Nichols and his office is located there. If it’s feasible I could put you in touch. I guarantee this man would get you feeling better in no time at all.

Just get in touch with defy. Simplest quickest and most cost effective way. Local mens clinics usually cost a ton of money and some do injections there weekly or every other week which is no good.

Thank you for your input. I’m disappointed that I didn’t look deeper into TRT earlier in my life. Unfortunately I trusted my physicians. But this does motivate me to find a solution.

After reading the posts and other research I am currently doing I agree with you on the two forms of successful TRT. I am exactly 100 miles south of Chattanooga. I checked out Dr Nichols website and his practice looks like something I am interested in. There are men’s clinics in Atlanta but so far I only see the ones selling packages and make me suspicious of their care. It would depend on the required amount of visits and cost etc. I am comfortable doing my own injections should I take that route, but being required to make monthly visits would be hard due to work.

Thank you for your input. I agree with the consensus that gels are useless and my blood test confirm that opinion. Back when I was injecting I seriously thought I was making gains in my lack of T. Reading the posts here is giving me a lot of insight into a problem in men’s health. TRT is very popular but as you’ve pointed out so many doctors have very little knowledge of what it takes and simply prescribe to go through the motions. This confirms what I have been thinking , that I need to find a doctor who truly understands men’s health and sees TRT from a different perspective.

@hammer09 100 miles from Dr Nichols! Consider yourself lucky! Take my advice and you can thank me later. Make an appointment with him and do the twice daily cream route. The guys in our group are raving about it and I’m talking about men who were long time injectors. They will never do injections again. I don’t know of any other doc who knows this stuff better than he does and his level of service is unmatched. You have full access to him by phone and email Monday through Friday when you become a patient of his.

Yeah it’s not that far at all and especially the benefit of seeing someone that can make a tremendous difference. I watched the videos on their site and have to say he sounds like the exact doctor I need. The only thing I can see being a problem would be the required frequency of visits and cost etc. I’m sure they don’t accept insurance and I doubt my insurance will cover compounding pharmacies. But if the cost are in my budget it would be well worth it. Thank you again.

@hammer09 I believe you only need to see him once in person. The rest can be done via telemedicine.

Thank you ! I’ll contact his office.

I am reading reviews that he is not at Tier 1 anymore. Is this true and if so do you have new contact information?

Of course he is. They relocated to Chattanooga however.

https://tier1hw.com