T Nation

Beginner Protocol Sticky Recommendation

Don’t start with HCG. There’s too many folks that have issues with it. Start with T only so you know how you respond then later if you feel the need add HCG.

Start at TRT at 150mg/week and go from there. 100mg is going to be too little for most. You can argue those people can always adjust their dosage higher but I’ve found its much easier of a transition to decrease dose than it is to raise it. Plus a majority of folks on TRT are at 150-200mg/week and doing fine.

IA LC 15-21

IA LC 21 18 IA LC 23-23 IA LC 26-21 IA LC 28-27 clear IA LC 33-31 IA LC 37-49 IA LC 38-52 IA LC 41-53 IA LC 50-68 IA LC 55-79

I just have not found any differences in the two to be clinically significant.

ECLIA vs LC/MS/MS TESTING FOR E2

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

While some may believe the ECLIA test is for women, on the contrary, as it pertains to women on anti-estrogen therapy, such as breast cancer patients, the LC/MS/MS is the test for women as CRP levels are a consideration and it is necessary to know if the treatment has achieved an estrogen level of zero.

On the other side of the coin, LC/MS/MS equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results. Any estradiol management should not be utilized without symptoms confirmed by lab results.

Bullshit. You want this to be a sticky? Back it up with evidence. There are a half-dozen things that are questionable before I got to pellets.

Besides pellets, there are a number of gel users that would disagree with you.

I’m guessing your source for everything is t-nation only.

How about this for beginners: GO TO A DOCTOR and don’t read posts from people who think they have mastered the TRT world.

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Reading comprehension issue? Where did I say I wanted this thread to be a sticky? What I said was

“ This post does not need to be a sticky (of course it is welcome). And maybe a more experienced member can write one, but I would like to try to get this rolling.”

In the same paragraph I stated I wasn’t an expert, and not even one of the more experienced members.

“ This post does not need to be a sticky (of course it is welcome). And maybe a more experienced member can write one, but I would like to try to get this rolling.”

I think you’re trolling at this point. I stated a couple of facts about gels. I didn’t even dismiss it as a viable protocol. All I said is there are risks of it transferring, and that injections are more efficiently absorbed.

As far as pellets are concerned, I haven’t heard much good about them, only guys with complications and inadequate results. If you believe differently, then feel free to post your experience with pellets. Like I said, I only wanted to get the ball rolling on a discussion to come up with a sticky tread.

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although going to doctor is recommended, its not the end all be all.

Forums like this literally exist because doctors are failing their patients left and right.

If you don’t agree, just come with evidence to the contrary and state your opinons. Nobody said this was dogma.

But being butt hurt doesn’t help a thing.

My experience with pellets.

You are giving advice on something you admit to knowing nothing about – only “haven’t heard much good about them”.

Thread Title: Beginner Protocol Sticky Recommendation.
Just after the reading comprehension comment

Yet you feel confident in making a blanket statement that “Pellets and another therapies should not be considered”.

And Barryallan1, I am far from butt hurt. What I am is a person who wants to stop incorrect statements from being made without the slightest inkling of evidence – or even experience or knowledge.

The OP admits to knowing NOTHING about pellets, yet feels qualified to tell people to stay away from them.

You’re saying pellets are a viable option for beginners? Why? And why over other protocols?

I didn’t say I didn’t know anything about pellets. I know quite a bit. I said I haven’t heard much good about them. That is a lot different than saying I don’t know anything about them. Nice try twisting my words.

This post is about beginner protocols and I don’t think pellets should be considered as a beginner protocol. Why? Because there is no way to adjust your dose without going in for surgery. There is no way to stop your treatment without surgery. There is no way to fine tune your dose. Your dose on pellets declines over time resulting in suboptimal serum levels towards the end of the treatment cycle.

It is common sense to start with the most flexible and effective form of administration, have the ability to make changes, and know how the drug is affecting you. Pellets are not that.

If pellets work well for you, I’m am glad for you.

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Some people just can’t inject themselves with needles, others are away from civilization for long periods, so unless someone meets these specific circumstances I would never recommend pellets to newcomers to TRT.

I haven’t heard too many positive experiences regarding pellets on any forum, quite the opposite, but every now and again you hear it working well for some folks and they are in the minority and have heard the doctors make the same claims.

This is another example of extrapolating personal experiences to the remainder of the world. Are any of the doctors you have heard (where did you hear this?) using pellets in their practices? I would guess no.

I am like them. Patients I see that were using pellets are not happy with the results, so they are looking for other options. They ask around, come across a patient that I see and end up in the office with their unhappy story. I could go around saying all these former pellet patients I see are much happier on injections and pellets didn’t work. I would be correct. However, if I said, based on that, “patients doing well on pellets are the minority,” I would be wrong. Just because you do not hear of them, or the doctors you “heard” do not see them, or myself for that matter, does not mean they do not work. They do and probably for most people that try them. They just are not showing up in my office looking for injections.

Have you spoken to, or heard from, doctors using pellets exclusively? I have and guess what? They have thriving practices with satisfied patients. Pellet therapy has been around for quite a while. If it only worked for a minority of patients I think they would have lost favor with the public by now.

There are many delivery methods for TRT and many more protocols. Everyone has to find what works best for them and there is no one size fits all approach.

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I’m just stating my personal experiences and based on conversations with docs, if you have some data that shows something different, I’ll be glad to have a look at the data.

I don’t doubt it, but how many unsuccessful versus successful cases, do you know or are you only counting the successful cases?

Like I said pellets have their place.

In general, I agree with this comment. I can only speak from my own and the experiences of hundreds of guys I’ve communicated with in forums like this. Which have formed the basis of my opinions. We all have to keep in mind that what you read hear (and hear from practicing physicians) are just that, opinions.

having said that, I think the basic opposition to the use use of the injection delivery system is the antiquated protocols that many docs put patients on and (unfortunately) reverberate through these forums (even this one).

One of the first things that I usually advise guys is that frequent injections (i.e., more than once per week) of smaller doses of T esters will give you a smoother ride and with fewer side-effects. It’s also a paradigm shift in thinking regarding needle size. With these smaller volumes, you don’t need a harpoon to get it deep into your muscle. A small 28G insulin syringe will do nicely. Not much more than a mosquito bite. It’s also MUCH MUCH less expensive.

So, yeah, if you don’t mind going to a doctor’s office an a regular basis to have these implants reinserted, and you have the money to pay for the procedure, and you are afraid of mosquito bites, then implants may be the way to go. However, FOR ME, I will stick with what’s worked for the last 8+ years, which is 0.25-03 mL of T-cyp self-injected with a 28G needle into my quadriceps muscle every 3 days. Easy, quick and inexpensive with great results.

I would say the same thing. Saying the majority of pellet patients get unacceptable results, based on your experiences and those you talked to, and mine, is not correct.

Talk to some pellet doctors, you might even consider it, you’ve tried a lot things, might work for you with "stable " levels. I don’t know. Anyway, I bet pellets doctors see plenty of cases in which injections did not work out well.

Maybe they are not telling me the truth. They could always be liars. However, one of them does not take new patients and another, if you call the office, you’ll get a recording telling you to leave a message and someone will call back………………in three weeks! Must have a lot of unsuccessful cases then.

I suppose, when you question “do you know” the answer is I don’t know. All I know is what these people have told me. I did not travel to their office, interview all the patients, witness the pellet insertion, etc.

Completely agree. Wouldn’t change a thing.

Don’t tell, show me, otherwise I’ll take it as you opinion.

I will admit some could be exaggerating simply because they hated the implant procedure and scars while the therapy was effective, but I don’t think the pellet therapy is as successful are you are claiming and can’t discard my experiences for someone else’s opinion without data.

I only know what I know from personal conversations in person and experiences on these forums.

Here is an interesting read on pellets. Showing that re-implantation is done at hypogonadal levels of serum T. Take away what you will. I’m sure lots of guys do well on pellets, but it’s simply not the optimal way to administer testosterone for stability.

Guys that start TRT with pellets might feel good and stick with it. But without trying a more stable form of administration, they might not know if even more benefits or symptom relief could be had.

https://onlinelibrary.wiley.com/doi/pdf/10.2164/jandrol.111.016295

Another person still quoting TESTOPEL articles. No one is disagreeing about the issues with TESTOPEL.

Lets talk about BioTE. Thousands of certified clinics across the USA. Using the most conservative number of 1-2 NEW pellet patients per month gives a yield of at least 24,000 to 48,000 new pellet patients per year. Yet there is only a hand-full of negative comments on injectible boards like this one; or any boards that I could find.

That statement by the way, was kind of funny coming from you. Weren’t you the long-time member who had your hand slapped by a mod on another thread because you couldn’t support anything you were espousing with emperical evidence?

Better yet Systemlord, when you WERE on TRT, you held Defy Medical up to the level of a Deity. Why not talk to them – as they are now compounding their own T-pellets and are slowly pushing pellet insertion across their platform. If it has so many problems, why is DEFY doing it now?

Look at the percentage of posts on this board that are tied to body building. Pellet use is NOT for body builders.

All of this discussion is happening because one person with no knowledge or experience with pellets made a flippant statement that “pellet use should be avoided”.

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Geez, I’m not claiming they are anything. I’m trying to say for every guy you talk to (or hear about on the internet, and that includes me because what I hear from pellet users is from those in my office looking to use injections), there are doctors out there (that I have spoken to in person) using them with good results. I don’t think you know these people, but I bet if you search around you can find a pellet forum somewhere extolling the benefits.

I don’t use pellets in the practice, for a lot of the reasons mentioned here. No argument. Injections first, then creams, then pellets, then gels. Orals? Never. It’s all my opinion, based on what I have been taught, what I experience both with patients and myself, what I hear from other doctors, and what I read.

I was referring to the doctors, not patients.

Exactly. And because of this, protocol stickies recommending specific drugs, doses, routes of administration, etc, are simply not warranted. Further, because such stickies may generate a (false) impression in the mind of a naive reader that there is One Correct Protocol, they risk undermining the therapeutic relationship between the reader and his TRT provider if the provider employs a different protocol.

Thus, protocol stickies are not only unjustified by current science; they also are potentially harmful. Primum non nocere, everyone.

As a physician (note: not a TRT provider), I can attest that there are clinical scenarios for which the treatment could justifiably be called the One Correct Protocol. And it may be the case that, at some point in the future, clinical endocrinology will advance enough to justify such a protocol for TRT. But until that time arrives, protocol stickies are best avoided (as are individuals who claim to know the One Correct Protocol).

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@EyeDentist
What part of Louisiana are you from? (if you don’t mind me asking of course)

I could not disagree more! If we relay on current standards of practice for TRT in the medical community, we’d still be all injecting 200mg every 2 weeks. Or worse yet, they’d be putting us all on gells because the only source of education they are getting on this topic if from the big pharma companies that have profits to protect.

I was fortunate enough after months of searching to find an enlightened TRT specialist that put me on the road to recovery with a modern protocol to which I am happy to share as an alternative to what the relatively uneducated (in this matter) medical profession has to offer. However, I had to make a 200 mile round trip every time I visited him and he didn’t take insurance and charged an arm and a leg, but he was dam good at what he did. I am fortunate enough that I can afford this experience with those who want to take advantage of learning about alternative approaches.

We all have to keep in mind that the information we receive from the internet is unfiltered and we need to constantly challenge it. Open discussion like this provide a useful forum for advancing our knowledge through the experience of others.

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