I had an interesting conversation yesterday with the main guy at my TRT clinic. I have been on TRT for almost a year and have always been seen by PA's, had never met this guy. He spoke with me at length and I thought I would share what he told me.
I started TRT in October of 2014 at 110mg weekly, no AI, after a blood test that showed my TT at 170. I'm 52 years old, 6'1", 190 pounds. At the time I started, I had cognitive issues, was tired, and depressed. My libido wasn't great, but not really dysfunctional - my primary concern was an inability to concentrate and depression.
Within four weeks the fog began to lift and my mood improved. After six weeks my TT was 710 after seven days, before injection, and I was bumped to 130mg weekly, single injection in the office. After twelve more weeks, I was tested at 660 and was bumped to 150mg weekly. My E2 ranged from 17-24. All was good.
But, I wanted to be better. My body fat had gone down, my lean body mass had gone up, but I was stuck, so I decided to do a cycle. I settled on 300mg a week of Test Cyp (including my TRT dose) and 150mg a week of Mast P (50mg EOD). I took anastrozole at .25 E4D just as a precaution. I did this for six weeks and planned on stopping so that the extra test would clear before my next blood test, but I was having such good results that I decided to switch to Test Prop at 75mg EOD to extend my cycle another two weeks, and kept the Mast P and the TRT dose of 150mg a week. I stopped everything four weeks prior to my blood test.
I had been traveling before my blood test and the way it worked out, my blood test was ten days after my last shot. I was worried about it being elevated, needlessly, and it came back at TT 260, E2 at 4 (I actually felt pretty good).
So the HMFIC sees me yesterday, sees that I just started HCG, and sits down and we talked for about 30 minutes. He explains to me why HCG is bogus in my situation, that chicks actually like your balls high and tight, and the only purpose of the testes is to make testosterone and sperm - if you are done having kids and are on TRT, you don't need them at all and so HCG isn't necessary.
He did provide a caveat, that some guys atrophy so bad that the testes can actually ascend into the inguinal canal and at that point, just jack up 750iu's of HCG once a week, on TRT days, for six weeks, then take three months off and do it again.
He shared that he was on TRT himself (he is 50), that he tried HCG, that he gained weight on it.
He then honed in on my last blood test with the TT of 264 and explained to me the following:
Testosterone affects the cells two way - membraneously and cytoplasmically. It takes a few weeks for it to affect your body on the cytoplasmic level. The body is used to receiving endogenous test daily, and we peak and trough daily. When we receive Test exogenously, the body has to retrain itself to peak and trough weekly instead of daily. If the body is overwhelmed with test, the receptors shut down and the body eliminates the excess test.
It took me awhile to digest this, but I interpreted this to mean that my low TT of 264 after ten days (he thought it was low) may have been a function of my cycle, of the Test P and Mast P EOD without giving my body time to retrain itself before my next blood test. My interpretation, I did not share with him that I had cycled.
Part of this discussion was spurred by my question regarding splitting my TRT dose into two injections to avoid peaks and troughs as is often suggested. This was what incited the discussion of the body's cycle of expecting peaks and troughs on natural T production, and that the body adjusts to the weekly peaks and troughs. He felt that if a patient was a fast metabolizer and was on 250mg per week, he would consider twice weekly injections.
I am not offering this as expert advice, just trying to share resources with those that have shared with me. Take it or leave it, your choice. I'm not even sure what this guy's credentials are, but he seemed knowledgeable.