T Nation

Conservative TRT Protocol

I went to urologist for ED and have ended up starting TRT for low t symptoms. ‘problem’ is my levels aren’t unusually low, 470 total t, 11 free t. Not great, but also doesn’t warrant 100mg EOD injections.
The urologists nurse is the one in charge of my TRT and seems a bit inexperienced, I’ve wasted a considerable amount of time dealing with a protocol of 100mg injections once every 3 weeks, waiting on her insistence for positive effects at 8-10 weeks that I knew would never happen. After many months, I started this week on 25mg twice a week. The other problem is I have very little frame of reference for what works. Everyone on this forum and others seems to start with 1-200 total t etc., so although everyone is different, I don’t have anyone in my boat that can say what worked for them, at least haven’t heard from anyone yet. When the T works, it works, and my symptoms are greatly reduced, but I’ve only found moderate success with a short period of self medicating when I did 75mg every other day. I’m wondering when / if 25mg will ‘kick in’. My thinking is since TRT is for life, as treatment stops your body’s production, I’ll eventually be on the same dose as everyone else, and the slow ramping up / increase of dosage will be nothing more than a break in period as the slowly increasing dose slowly disables my body’s natural production, leading me to low baseline t levels, at which point I can start a normal protocol. But not sure if that’s the case. It’s just taking so long, and the doc is so conservative and inexperienced, it could take a considerable amount of time of super low doses showing no effect over a course of months, with painfully gradual ineffective increases, before hopefully achieving results. But they take insurance and are willing to treat me, so I guess I’ll stick with it. I did go to a t treatment clinic and they were more willing to put me on a slightly more aggressive protocol, but without insurance, the price difference was considerable. It’s been six months since I started treatment with them (clomid was 1st attempt) and have made zero progress to date.

To do this properly, more information is needed, health history, labs, particularly thyroid, SHBG, IGF-1, E2, DHEA-S, VitD, CBC, lipids, CMP.

From what I know, the vast majority of guys take 100-200mg per week on various protocols, once a week to every day, and in between. You’re correct in that everyone is different, and it may take some trial and error to determine what works best for you. Some need estrogen management, some do not.

Some insurance plans will only approve lower dosing at first. After documentation demonstrates a poor outcome, they may approve increased dosing. Obviously, 100mg every three weeks will not suffice. Sometimes, you get what you pay for. I doubt you’ll be happy with split doses of 50mg per week.

Clomid, while maybe reasonable to start, is rarely a long term solution.

You need proper labs to determine the correct protocol for you, a protocol for a low SHBG guy is vastly different from a high SHBG guy. A 20mg EOD protocol gets me to Total T of 500 ng/dL and Free T is at the top of the ranges and SHBG is lower (22), a guy with higher SHBG will need almost double the Total T to achieve the same Free T as me.

When estrogen is out of balance (low or high) it may seem like TRT isn’t working, almost certainly mood will be affected negatively and erections and libido will be dampened. If you have a high body fat percentage, TRT can become a little more challenging and an aromatase inhibitor may be needed for a time until body fat is lost if lowering the Test dosage isn’t enough.

There aren’t many doctor who know how to do TRT, the majority are clueless. Beware of these TRT clinics or Low T Centers as they are bad news and offer overly aggressive protocols that worsen your condition as they are profit driven and selling large quantities of drugs is the name of the game, hence the overly aggressive protocols.

I’ve come to the conclusion insurance is almost useless for those on TRT because none of the doctor know what the f*** they are doing and neither do these T-mills. They will f*** you up!