T Nation

Dealing with a New Endocrinologist

Hey guys! New to t-nation but not new to TRT.

I’m 39 and let myself go about 8 years ago after we had some kids. Got fat and developed some bad habits. Was tested about 18 months ago at a TRT clinic and had a T level of 215.

Got a weekly t-cypionate shot and some anastrazole. Things were good but it was a 1.5 hour drive round trip and cost a friggin fortune…so I decided to go to an endocrinologist and let insurance pay.

He convinced me to drop the injections and go with a T-Gel. My T tanked into the low 300’s so he doubled my dose…still in the low 300’s.

So I’m back on injections, starting next week. Thing that sucks is he is “by the book”. Wants me to inject, IM, 200mg every 2 weeks.

Faaaaaaawk. Here we go again. I’m going to buy some extra syringes and inject once per week to start. When I get my next labs back I’ll probably go to twice per week.

Any tips on dealing with an MD that is conservative? He’s the type that wants to fix an issue and get you back to average values, not the type to optimize.

When I brought up an AI he looked at me like I had a degree in google medicine. Any advice?

And endocrinologists that do TRT don’t grow on trees around me. My choices are limited and I like him. So I’d like to work with him.

Thanks!

  • Drop the AI, you dont need it.
  • Inject weekly, or more if needed (like you plan on doing) but be sure to go to his protocol before labs
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Just play along to get along. Act like you’re listening to him, ask a few questions and then take your script and go home and do what’s right. Pin twice weekly, forget the AI and make sure you’re at trough levels when get blood work, even it means skipping a shot.

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Thanks guys. Despite the RX, I’m not injecting every two weeks, the hell with that. I could feel the highs and lows with once weekly injections at the TRT place. I’ll start with once weekly and adjust after my first labs.

Back at the TRT place, 100mg weekly put me at about 525. Eventually 140mg per week which had me in the 800s. I liked that.

Estrogen was always a problem. In the 70’s on 100mg weekly, went on .5mg anastrazole weekly and it had me in the low 30’s. Went to 39 with the same dose AI but at 140mg.

I’m excited to try twice weekly IM to see how things level out. Might eventually move to SC but we’ll see.

Thanks!

When you say trough levels…so if I pin on Fridays…get tested on Fridays before I take my shot?

No it wasn’t. Nothing wrong with those numbers.

I had some water retention in the legs and I think I was a bit bitchy, but it could also have been my body getting used to the T.

At what estrogen number do you consider time for an AI? Thanks!

There isn’t such a number. AIs are not necessary for 99.9% of TRT patients. Bro science held over from BB cycles. Estrogen is nothing but beneficial.

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@NH_Watts Just skimmed through your thread about your journey. Sounds like I am in a similar boat as you when you began. Thanks so far!

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Nearly 4 years in now man. Lots of stories here and a lot of info. Ask questions and keep reading.

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Yup, this is the place to be! Hard to pinpoint exactly how it happened but I gained like 80 lbs over the past 8 years. Was enjoying those double IPA’s way more often than is healthy, and have been eating like shit. All from bad habits.

I finally realized I felt like crap and it was time to get my ass in gear and man up! I’m 39 now and don’t need to turn into my father lol.

Start watching your food intake and hit the weights pal. With the Test the weight will come off. Might want to consider cutting way back on the alcohol. I know its hard those DIPAs are tasty.

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Exactly.

Maybe injections 2x a week will help. But I would do a cardiac check that includes an echo ultrasound to make sure it’s not hear causing retention.

You mentioned having put on bodyfat. Estradiol helps to reduce visceral fat. So why would you want to lower the thing that helps you lower visceral fat when one of your goals is to lower visceral fat?

Seems counterproductive to say the least.

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After reading through a lot of posts here, it seems the tide has turned on AI since I last visited 18-24 months ago. I’m perfectly fine with that. Less drugs is better anyways.

I remember everyone preaching 0.5mg of anastrazole per 100mg test or something like that. Glad things have changed and people are still seeing good results.

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You can thank ksman or whatever his name was for that one.

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You doc doesn’t have any clue what he’s doing, endocrinologist are the worst at TRT from my personal experience. Your story is typical, the gels are used and levels are back to pre-TT levels, then the hormonal roller coaster from hell is prescribed and suffering begins and most feel worse than pre-TRT and quit TRT thinking it doesn’t agree with them.

You want insurance to pay for your TRT, this is what you get more often than not. The newer endocrine guidelines are more up to date, 75-100mg weekly, but even this is sometimes inadequate and protocols need to be tailored to the individual.

My advice don’t deal with them at all, find a telemedicine clinic.

Last question. I’m willing to give the endocrinologist a shot since he is willing to put me on injections. What would be the best course of action:

  1. Start on his protocol, 200mg every 2 weeks. Ya, it’s stupid…and when I get tested after 4 weeks I’ll be in the trough and maybe he will bump my dose.

  2. Get the 200mg injection. (First shot ia in his office). Then go weekly after two weeks. Get my test done before my weekly injection.

After my 4 week test results I’m going on my own and going to inject weekly or twice weekly. Just wondering how I should handle the first 4 weeks and his silly protocol.

When is he wanting to test again? 4 weeks? Not a great sign for this guy

But… I mean I’d try every other week as long you aren’t absolutely miserable… you know your levels will be super low if he tests at trough with that protocol so maybe that will help get a higher dose. If you start injecting more often and your trough isn’t as low then he may be less willing to work with you on dose. Play the game, get the dose you want that works, then inject however you want to once you’re free to do that. If you have to, skip however much you need to to get the lab results you need to keep him happy. It shouldn’t be very often that you have to do that once you get through the beginning.

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