T Nation

Dan-o's T Therapy Thread

T Replacement
#1

A Little Background
I’m a 39 year old male. July 2018 I finally decided to get off my ass and join a gym. Knowing I’d need the accountability, I signed on with a Personal Trainer 3x per week. I’ve always been pretty active and in decent shape up until 2008/9-ish. Since joining the gym, I’ve gotten my diet under control (eating “clean”) as well as turning up my activity at the gym to weights 5x/week in the morning and cardio/HIIT 5x/week in the evenings. Lost some weight, got healthier overall, and still felt like I hit a wall early afternoon every day. After ruling out over training, I asked my doctor to check my testosterone after doing some research on my own.

First Lab - 3/21/19 @ 10:04am
Testosterone - 348 ng/dL (264-916)
T Free Percent - 2.7% (1.5-3.2)
T Free - 94 pg/ml (52-280)
SHBG - 25.6 nmol/L (16.5-55.9)

Second Lab - 3/26/19 @ 10:11am
Testosterone - 320 ng/dL (264-916)
T Free Percent - 2.3% (1.5-3.2)
T Free - 74 pg/ml (52-280)
SHBG - 22.9 nmol/L (16.5-55.9)

After both lab results, I received a comment from my PCP (who’s actually a good doc) that I had normal testosterone. I sent a message to him essentially asking him to refer me to a specialist if he won’t treat me because even if my T is “normal”, I don’t feel normal. Didn’t hear from him for a while so I researched and found a men’s clinic here locally. Went in for consult and another set of labs even though I provided my previous two…

Third Lab - 4/03/19 @ 10:10am
Testosterone - 210 ng/dL (264-916)
T Free (Direct) - 5.9 pg/ml (8.7-25.1)
Hemoglobin A1c - 5.2%
Cholesterol, Total - 157 mg/dL
SHBG - 26.8 nmol/L (16.5-55.9)

Three days after that lab at the men’s clinic I consulted with the doc there and started TRT. Got first T-Cyp and HCG injections in clinic on 4/05/19.

Doc Prescribed Protocol
120mg (0.6cc) T-Cyp 1x per week w/ IM Injection (25g 1" needle)
500IU (0.5cc) HCG 1x per week w/ SQ Injection (29g 1/2" needle)
T-Cyp & HCG taken at same time

After some research, I decided to change the protocol but haven’t decided if I want to up my dosages on my own or not.

Current Self-Protocol
60mg (0.3cc) T-Cyp E3.5D w/ SQ Injection (29g 1/2" needle)
250IU (0.25cc) HCG E3.5D w/ SQ Injection (29g 1/2" needle)
T-Cyp on Sunday AM and Wednesday PM
HCG 24hrs prior to T-Cyp

I just received my T-Cyp this last Thursday and gave myself a 60mg dose SQ on Thursday. In wanting to get on my protocol now, I gave myself my first HCG dose of 250IU this morning and will give myself 60mg of T-Cyp tomorrow morning.

Have 6 week follow up labs and doc consult scheduled for mid-May. I plan to keep this thread updated.

On another note, my PCP ended up referring me to a younger urologist who’s “clinical interests” include hypogonadism in addition to the other men’s type of issues (ED, vasectomy, etc.). I’ll keep that appointment w/ him in a couple weeks to see what he has to say.

I’m definitely open to suggestions, criticisms, and conversation.

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#2

I think starting at 120mg/week is fine, though I would have started higher. I would have stayed with once weekly injections until it could be determined how well I responded. By far the majority of guys on TRT use a once weekly injection schedule. The majority on the internet inject more frequently.

Why are you using hCG? There are two reasons, actively trying to conceive and/or maintaining testicular size/avoiding atrophy.

You should have estradiol checked, though a growing trend among TRT practitioners is moving away from the use of aromatase inhibitors.

Good luck.

#3

One suggestion i have is that after you get yourself feeling better and have start noticing all the good changes make sure to bring a copy of your labs with you when you see your pcp again just to show him what optimal levels are and how they have improved your overall health, both mental and physical. He did refer you to the urologist, but it obviously wasnt because he was eager to help you get treatment. I Just think its important for the Drs who are against TRT, or the ones who want to get you just over the low threshold and call you fixed, to get the facts thrown back in their face when possible. A real life specimen walking into their office proves to them the benefits as oposed to print outs of studys or things read online. It may change their attitude and outlook on TRT and benefit the next guy that goes to them for help.

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#4

For no other reason than to avoid atrophy…so bare minimum to do that is my goal.

That among a host of other things are in my follow up labs in mid May. From what I understand, smaller more frequent injections can keep the estradiol down and maybe avoid having to take AI’s (which doc said he will prescribe if necessary).

Great suggestion! I see my PCP for regular wellness checkups so I’ll definitely have an opportunity to have a conversation with him about how I’ve benefited from TRT.

#5

Just remember to not fear estrogen. If estrogen is in the 40s or 50s and you have zero symptoms it doesn’t matter. If you have issues with labido and fatigue related to estrogen try lowering dose and more frequent. You sound like you know this. But make sure it’s estrogen. If estrogen is the issue youll notice quick reversal of sides.

My boys have barely shrunk. I’ve been on t for about 4 months now and stopped HCG 2-3 months ago. Yes they get a but smaller after sex but not always. For example i had a good time with the lady last night and today there still having the normal hang I’ve always had.

I did hear a study where they said guys with smaller testicles before TRT complained more often about the size of their testes during therapy than the men who had larger sizes testicles. This was dr. Nichols who found this information. Would love to read and share with the group.

HCG can cause side effects due to the chemical makeup of HCG and the estrogen it produces. A bunch of guys lcoe it and some don’t. Just keep that in mind it’s not always the cypionate that causes sides.

I did take 250iu once per week for a few weeks and that kept them full. So at the least you could try less if you have any sides.

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#6

It’s best to start TRT in isolation because there are less moving parts to analyze. HCG can cause problems with mood via increased estrogen and some men cannot tolerate it, some men feel nothing and others benefit.

Sick care doctors are idiot stupid when it comes to TRT, doctors in sick care must follow insurance guidelines and have no real decision making power who gets treatment, insurance is the one who decides who is eligible for treatment, doctors are puppets and know shockingly very little within their area of expertise.

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#7

An update:

I saw that urologist about a month ago that my PCP referred me to and I’m not 100% about him. He said my levels were “normal” based on the first two labs and somewhat dismissed the third lab as an outlier. He’s attributing my symptoms to “bad sleep hygiene” and that I need to work on it. If needed, I can get a referral to a sleep lab. But at the same time, he prescribed me clomid at 25mg EOD and wants to check labs a few months after starting clomid. My primary insurance doesn’t cover clomid and my secondary needs preauthorization. It’s been a month and I’m still waiting on that preauthorization.

I didn’t tell the urologist that I already started TRT as I’m planning on phasing out the out-of-pocket clinic if I could get insurance to pick it up. That’s still my goal, so we’ll see. If I get denied the clomid from insurance, then I’ll see what the urologist suggests next.

Also, I had my 6 week labs from the clinic last week and my result are:

CBC Panel - all look good
Metabolic - all look good
Total T - 678 ng/dL (264-916)
Free T - 22.6 pg/mL (8.7-25.1)
Estradiol - 47.4 pg/mL (7.6-42.6)
Cholesterol - normal
Prostate - normal

I took that lab the morning I was due for my injection. I’m on 60mg Test-C E3.5D and 250IU HCG E3.5D.

Doc said to continue current protocol and added 0.5mg anastrozole per week which I’ll break up on my own to take 0.25mg E3.5D w/ Test-C. Another followup lab in 6 weeks to recheck everything and make more adjustments if necessary.

Looking forward to bringing that estradiol down to see if I start feeling it a bit better.

I’m open to thoughts and suggestions if I should handle that anastrozole differently…

#8

Your testosterone is on the decline anyhow after 40, there’s little chance at having optimal levels at this age, TRT is needed to stay optimal at these later ages. Clomid is waste of time.

#9

What are the negative symptoms that you are trying to eliminate? The E2 is not that high, mine is running in the 60’s and I feel great. I’d try the anastrozole like you are planning if you think it’s E2 causing a problem, but I’d also abandon that ship after dose number 2 if it doesn’t fix anything. Anastrozole is fairly fast acting, you don’t need to ride it out for 6 weeks or anything. You might just need a little bit higher dose of T instead, like 70 x 2wk

#10

I agree that clomid is a waste of time. Was never going to take it…just go through the motions to see if I could get to insurance covered TRT.

It’s not like it’s too terribly expensive out of pocket at $1500/yr all inclusive…so no big deal if I can’t get it covered but it’s still $1500 I could keep in my pocket. Either way, I’m glad I started when I did.

#11

Still have a lack of motivation and I burn out early afternoon…like ready for a nap and/or just want to sit and not do anything. Libido is still there and morning wood is 50:50 but I’ve puffed up a bit and put on some weight. I just don’t feel like I have the full effects of TRT like I’m supposed to based on others input.

I still hit the gym for heavy weight training in the mornings 3-5 days per week and cardio in the evenings so no real reason to be putting on that much weight other than it being water.

I honestly feel like I should be upping my dose slightly as well but I’ll follow the doc’s orders for now and do a checkup in 6 weeks.

#12

You are almost certainly a little bloated, but that goes away eventually either way. I would say that based on your labs that you are still a little underdosed, but only a little. Everyone is different, it might be the E2, but you will know pretty quick if that’s it. It could just be that you need time, it is surprising how long after you start things are still changing.