T Nation

Beginning TRT - Protocol Question

Hi everyone! I will be starting TRT hopfully very soon (all the classic symptoms). but I was looking for some advice. I posted my labs here and am wondering what the best protocol would be. My endo prescribed 50 mg subq E7D and said that twice a week injections would lead to too high hematocrit (I know this is not true). I emailed her yesterday asking if shed be open to upping it to 100 mg and then reevaluating me in a few months and making adjustments if needed. I was also speaking to a clinic who was going to start me out on 100 mg E3.5, but I thought that may be too much to start (long story but I am not dealing with that clinic anymore). I would most likely end up injecting 50mg E3.5 on my own if she agrees to this increase (which I doubt she will). I was just wondering if someone would take a quick look at my numbers and see if 100 mg a week looks OK to start. I really appreciate everyone’s time here!

Most endos are complete idiots when it comes to TRT. Your Endo sounds like the experience I went through before I started with a private clinic.

50mg/wk is way too low, most guys need 120-200mg to see symptoms go away. I had similar bloodwork as you before TRT and just bumped my dose from 140mg to 175mg/wk, and think I finally found the sweet spot. As long as you don’t go over 200mg/wk your hematocrit should be fine, but it’s worth checking this every few months.

About frequency, once a week isn’t ideal. I’m injecting EOD and feel great. Some can get away with once a week but most feel better on twice a week or EOD. Your SHBG is on the lower side at 17, so I would recommend EOD or at least twice a week.

This is true most endo are idiots and are clueless! You want to work with an experienced doctor, it won’t be inside your insurance network, it will be private and out of pocket or get used to figuring everything out on your own.

There is no standard of care for TRT, everything in medicine has a standard of care, dosing instructions, expect TRT dosing will be different for everyone.

This will not work, most men are closer to 100mg weekly, some more. Your endo doesn’t specialize in TRT, most do not and most are clueless. Endo’s specialize in thyroid and diabetes, not the type of doctor I want managing my TRT.

You will need injections ED or EOD do to low SHBG, inject twelve weekly and watch levels swing wildly between injections and no benefit from TRT. TRT will lower your already low SHBG, probably <10 by your next scheduled checkup.

If I dose EOD I lose a little benefit to TRT and lose even more benefit when dosing twice weekly. You won’t even need Total T very high, low SHBG men can have excellent Free T levels with Total T about midrange, but if you target a high Total T, I expect sides do to excess testosterone and estrogen.

I only need Total T at or below 500 to have sufficient Free T levels, I have low SHBG 15 and I’m one of those are men who see an increase in SHBG on TRT when dosing daily which sees SHBG go from 15–>22.

If you start out at 50mg weekly, you’re wasting your time and I expect zero benefit on TRT. Your endo will probably prescribe 18 gauge syringes, do yourself a favor and use 27-29 gauge insulin syringe and inject in the shoulders and quads.

Thanks guys… yeah that’s kind of what I figured. I think I’m probably pushing it by asking her to double her recommended dose, never mind tripling it. I have no problem at all going private but figured if I could get it covered under insurance then it’s worth a shot. Do you think starting at 100mg a week would bring benefits then maybe trying to get her to increase in a few months is a good strategy? Or just go straight to out of pocket private doc? Sorry if these questions have been answered before but I’m not sure what the best decision is here. Thanks.

What you are being offered doesn’t resemble treatment, it’s androgen deprivation therapy. The standard of care for TRT is 200mg every 2 weeks, then logic dictates 100mg weekly. Your doctor has no critical thinking, TRT requires thinking outside the box, a problem solver.

So if you encounter symptoms while on TRT, are you going to go to your clueless endo for help expecting them to have an answer? They will not know what to do.

A few months of suffering very low testosterone, is this really an option?

There goes your entire summer down the drain.

Systemlord - excellent point…trusting my health to someone less knowledgeable than me (and I’m clearly far from an expert) is not worth the $$$ savings. Private it is. Thanks for responding. :smiley:

This would be worse than doing nothing. That’s jut not enough to help you, but it is enough to hurt you.