T Nation

Been Prescribed TRT, Progress Thread

First of all, I’d like to thank Systemlord for his concise and detailed advice.

You may remember me from my previous post from 28Y/O Low Test, Symptomatic. Results Interpretation?

I had a second series of blood tests ran to make sure the results weren’t unclear and it came back with worse values this time, higher SHBG, high Albumin, middling testosterone and super low calculated free.T

I’m going to keep this thread updated as a progress report of how I’m doing.
My doctor has prescribed 250mg T every three weeks (he says people with high shbg tend to respond better to big doses over a longer period of time, but after my first 3 weeks he said I can adjust it if I feel it’s necessary - which judging from some users, makes him a good doc)

I’m going to get my first shot tomorrow/day after depending on when my prescription is filled.
Thanks T-nation users for having such a wealth of information on your forums. Hopefully now I can makeup for my wasted 20s.

Will keep y’all updated

Man, I think you’re in or a rough time. Yeah higher doses seem to be helpful for high shbg people but even then every 3 weeks is gonna be rollercoaster. His willingness to adjust is nice but his starting point is such, that to me, it seems he doesn’t do this much and doesn’t really know what he’s doing.

I dont think I’d do it if thats my only option. I’d look for a different doc. But you can try it and see how it goes. I don’t think you’ll be happy, but maybe you’ll be one of the lucky few.

It is protocols like this one is the reason why so many men quit TRT, these protocols are what we refer to as hormonal roller coasters. A 2005 study clearly shows why this shouldn’t be attempted and indicates your doctor is following guidelines because he doesn’t have enough experience under his belt.

The every 2 week protocols are not much different, these protocols produce hormonal roller coasters. We men excrete testosterone more quickly via the kidneys and estrogen is excreted through the liver more slowly and so these protocols create estrogen dominance in men.

This every 3 week protocol has no chance of actually working, not even the every 2 week protocol is going to show good results in the majority of men. When doctors specializes in replacing hormones they make it their business to know how to choose the appropriate protocol, this study came out 14 years ago!

The study below shows the results of 200mg every 2 weeks and you’re going every 3 weeks and all I can say is it will cause great suffering. It’s nice you doctor is willing to learn, but TRT can get complicated pretty quick and the success of TRT depends on his ability to manage and monitor other biomarkers.

You need someone who prescribes TRT on a daily basis, someone who has figured things out.

You need minimum 1x injection per week, because I have seen high SHBG men need 2 injections per week do to being sensitive to hormonal fluctuations which has nothing to do with having high SHBG.

Hormone profiles after 200mg intramuscular injection every 2 weeks of testosterone enanthate in patients with hypogonadism

In fact, the present study confirmed serum levels of T which were lower than pre-ART value levels on day 14 after administration. Therefore the further decrease in serum T levels on day 14 after administration is considered to relapse of hypogonadal symptoms and to reduce the patients quality of life.

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Well hopefully if I can get past the 3 week point, I can ask him to prescribe a 1 week pattern.

I have to keep a diary of exactly how things pan out anyway, because he wants to adjust accordingly.

I hope it doesn’t go too awry.

Not a good dr. But you can use him to get your testosterone. Minimum 1x weekly. 100 mg a great start.

It takes 5 half lives to reach a stable state, so it will take 15 weeks or 3.4 months of hell to reach a stable state and the outcome is known and it’s all for nothing. I don’t think you realize how bad it is going to get for you, if you knew you would reverse course immediately.

Once the injections shut down your natural production and the shots wear off, your testosterone will be lower than pre-TRT.

Thanks, I’ve already called and had the dosage re-scheduled, do you think starting at 80mg per week is more suitable?

The doc has said that I can modify the dosage as I see fit, the vial is essentially my prescription and because I have a lot of medical professionals in the family, he sees no reason why not to allow me to control the dosage schedule - but the dosage will stay at 250mg

For me, yes because I have low SHBG, you on the other hand bind a lot more testosterone do to having high SHBG therefore deactivating it, you will need more testosterone, probably over 100mg.

So you see you don’t have enough Test prescribed for an appropriate weekly dosage.

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Thanks - do you have any form of research or evidence I could use? My doc responds a lot better when I have that sort of stuff, though I’m pretty sure he’d just accept a 100mg weekly protocol straight away, I just like to provide evidence to maintain a healthy patient/doc relationship

Sorry, just an addition - Would it be possible to go the subcutaneous route with this? I could potentially manage my own dosage at home if that was the case, subq is easy as pie to do.

Well if you take the study I provided, 200mg in the span of 2 weeks isn’t enough, then common sense says your weekly dosage will be greater than 100mg.

SQ provides a steady slower release, you need the androgens to hit your system fast to suppress SHBG, increasing TT and therefore increasing FT. The spikes in Test is what decreases SHBG, so a steady slow release is not what you want.

You should start out at 130mg, then if you start to notice feeling low 4-5 days after an injection, twice weekly would be more appropriate.

Thanks Systemlord, I appreciate all the effort you go through to explain this stuff.

Do you know what your Estradiol was, or can you find out? A tiny bit of Adex every week and maybe a test run with HCG probably would not hurt either. One of the issues that T injections without HCG cause is your body no longer makes pregnenolone which is one of the “happy” hormones for your brain. Pregnenolone is available by capsule also.
How much do you weigh? Do you carry your body fat primarily around your belly?

my previous test was 63.9 pmol/L E
Can’t really get HCG here until I’ve shown I need it

I weigh 166 and I’m 5’7 and body composition is actually one of the few things I’ve got going well, I don’t carry fat around my belly particularly, or anywhere else, probably at 14% BF, but it’s hard to tell. (basically I don’t sag or have much pinchable fat)

You need 150-200mg/week. You also need another doc. If you go to a restaurant and the food sucks you go to another restaurant. There’s literally a gazillion docs that will give you 200mg/week.

If you had testicular pain, this is one way to get HCG, that is a medically necessary treatment.

Why does he need 150 - 200 per week? What is your basis for this dosage?

@lenono

  1. because he doesn’t have low SHBG
  2. because he has high SHBG

Not really sure that should effect the magnitude of his dose, but more the frequency.

My SHBG was higher when I started and I was over range on 125/week.

@lenono
Post the labs. I’d be interested in seeing that

I’d rather email or PM than post raw lab data here