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Dialintrt - TRT Journey Log

Hello all,

I am a 43 year old male who has been feeling like crap for 7-8 years. I will use this to track my journey and ask for assistance.

Age - 43
Weight - 173
BF - around 25%
Height - 5 foot 7 inches

Symptoms - extreme fatigue, dark black circles, skinny fat, loss of motivation, loss of libido, useless boners, depression and loss of hope feelings, eye lids heavy and slam shut all day even when I sleep good long hours, stopped working out due to exhaustion was going to get me killed on my long drives to work, very stressful executive job.

5 years ago I dedicated everything I did to eating right, counting macros, trying 6 day strength training, no results, tried 3 days HiiT and 3 days strength, no results, 5 days cardio, lost any signs of muscle and stayed a skinny fat ass. This took 2 years of my life. Prior to this, getting in shape was cake since I had always been fit. Nothing worked anymore.

3 years ago I decided to go to the doctors thinking maybe I had adrenal fatigue or god knows what. Here are the results from those blood tests (Hormone and Thyroid):

Hormone Blood Test

Thyroid Plus Adrenal

Do you see anything there standing out besides low T that’s alarming? This was my first attempt at using Labs to fix my issues.

After those results, they put me on special diets, supplements etc. Nothing worked and they refused to even discuss TRT. We did genetic testing, blah, blah, blah. Didn’t work. I moved on.

for the last 3 years I kept dedicating my life to working out but stopped eating as perfectly as I was losing hope and just felt like dog shit all the time. I researched and felt I had potentially Adrenal Fatigue and Low T since every one of the symptoms they mention I had. I decided to find a Dr. that specializes in TRT and went to see him. They put me on a bunch of natural supplements for 5 weeks and asked me to come back to see if it’s helping. They also had me do an adrenal saliva spit test and some finger prick blood tests etc. They did explain to me that I would probably need TRT therapy but we will wait on the blood tests. Here are the blood tests from my second appointment:

Labs Blood Testing 7-17-2018

On 8-7-2018 we met again to discuss the results from my 7-17-2018 Labs. On this very same day we discussed TRT and my options and I chose to do injections. The nurse came in and did my first injection for me of .30ml Test Cyp in the buttocks. The doctor also injected HCG .30ml in the abdomen fat.

He sent me home doing 1 injection per week (Tuesday) of .30ml (200mg/ml) testosterone cypionate in sesame seed oil and HCG .30ml x 3 times weekly (M-W-F). No AI.

I felt incredible migraine headache pain and flu like symptoms but yet, I still felt amazing underneath it all. It was odd, I felt a headache like never before but deep in my body I could feel my life coming back to me. I called them and told them how I feel and they asked me to come back in and do a blood test for Test and Estrogen. I also researched and found that some people get these headaches in the beginning but they go away. This ended up being true for me. Here are the results from that test:

Labs Blood Testing 8-21-2018

Interestingly after getting the above numbers and symptoms, he pushed on. He told me to up my doses of HCG and Test to .35ml each shot from the original .30ml. He asked me to return 5-6 weeks later for another complete testing. Here are the results:

Labs Blood Testing 10-3-2018

What jumps out to you about this Lab? This is the Lab that got me TANKED on my next follow up and where I am today. The doctor seen the E2 levels rise and at this point reduced me to the following:

  1. .30ml Test Cypionate (200mg/ml) 1 x per week (down from .35ml)
  2. .35ml HCG 2 times per week (down from 3 times per week)
  3. Put me on Anastrozole, 1MG Slow Release 2 x weekly (Tuesday and Friday after shots)
  4. Added Supplement called Estrogen Blocker Pro - 2 times daily

Now, I immediately could feel the difference and started feeling like complete horse shit! I wasn’t feeling really great yet anyway but WOW, now I was going downhill fast. TOTAL loss of energy and all symptoms magnified from original symptoms.

Testosterone worked for about 3 days and then each of the remaining 4 days were awful. By the last 2 days, I was full force crash, anxiety, depression, extreme fatigue etc.

He asked me to come in and do another blood test and here are the results:

Labs Blood Testing 11-13-2018

Now to me, that looks like a complete TANK of my E2? Not to mention, the drop in Test levels are huge from my last numbers. They are basically 100 away from being where I started day 1.

At this point, I feel all the symptoms of hopelessness, extreme fatigue, agitated easily, heavy eye lids, and even some strange tightness/heavy fatigued lungs.

I was thinking I would completely stop taking the Anastrozole. I also went ahead and changed myself to 2 shots per week (.15ml x 2 times weekly). Next time we meet on next Thursday 1-17-2019, tell him I want to stop taking the Anastrozole, divide my Test potentially even EOD if necessary (this is where I hope you all can chime in).

I am losing my mind literally from exhaustion and need your help to make sure I lead my own charge with my doctor. I was thinking focus on getting my E2 back up, Test and Free test up and force myself to workout again. Can I get some good feedback please?

Thank you!

P.S. I have been reading the forums for some time now and trying to filter through all the information which seems to be changing (such as what people though before about E2 levels being between 20-30 versus now I am seeing some new theories on what’s actually good is a nice ratio between E2 and Free T.) I will continue to post everything here and read more posts.

hey dialintrt
So your doc see your D vitamin in 18 and did nothing ? omg… you need 10k UI per day , up that lvl to 70 at least .
also, your triglycerides are bad! fat liver is real, take care. cut sugar and refined carbs, choose low Ig carbs, add more leafy greens (C vit) ,Kelp, olive oil , coconut oil and cruciferous vegetables to cleanse your liver and help your guts eliminate more efficiently your estrogen. at your E2 lvls AI is a no go, drop it.
E2 many times feels great 2x your free T . but the most important, its how you feel.

Your pre-TRT Total T is low and HCT is already 50%, you may have to donate blood often to keep HCT under control. Once weekly injections isn’t the best route for most because levels peak in 24-48 hours and begin to decline after, often you experience highs and low at different times throughout the week.

Once weekly injections can also cause HCT to rise higher than if injecting smaller more frequent doses, my HCT dropped dramatically by increasing injection frequencies. If levels are swinging, high in the beginning of the week and low by the end of the week, you may not feel well.

The majority of doctors are not skilled enough to be able to do TRT effectively, especially concerning the usage of AI’s. All you need to do is increase injection frequencies, this will lower estrogen without you having to take a drug designed to crash estrogen to zero for women with breast cancer.

In my experience, the more frequent and smaller the dosage, the lower the estrogen. Some men do not tolerate HCG well and moods and bloating can be a problem. HCG also increases estrogen on top of converting testosterone to estrogen through the aromatase enzymes in fat tissue, so decreasing your levels of fat can be crucial.

More estrogen isn’t always better, balance and a lack of symptoms is key.

My estrogen was lowest injection 10mg daily using 29 gauge insulin syringes injecting in the shoulders and quads. If you’re still injecting into the glute, it’s completely unnecessary and you risk hitting the sciatic nerve.

I would recommend 40mg twice weekly or even better 20-25mg every two days. Drop the HCG and the AI, you can always inject FSH if looking to have children which I assume is why you’re on HCG.

I inject 21mg every two days (84 weekly), no AI, no HCG and response well to TRT.

As it stands now, you’re doctor isn’t doing a very good job at managing your TRT protocol.

I have a couple of things to add to what has been mentioned:

  1. I’m a little surprised you did as well as it seems with 60mg/week dosing. Would have started you higher.

  2. Why hCG?

  3. I would not have changed anything, certainly not as early as you did.

  4. No aromatase inhibitor.

  5. I think tweaking dosing .05ml is kind of silly, if anyone can be that precise drawing this up on a 3cc syringe, good for them. If you are using an insulin syringe, I still don’t think that small of a change is significant.

  6. I think once weekly dosing is fine, but two will not hurt you.

  7. You do not need to donate blood, especially with your platelet count. You can, of course, but do not have to do so.

  8. Give whatever you do a fair chance, unless you are just feeling awful, before making another change.

  9. Perfect TRT candidate.

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Hi Straff,

Originally the doctor put me on 10,000 UI and it still didn’t get me where he wanted. So he then said take 20,000 but you can’t stay there long. It helped and then he immediately put me back down to 5,000 a day. I work an office job and get very little sun so perhaps that’s playing a role and perhaps I am screwing up and not taking it with enough fat. I will have to up it for now to get it up and be sure to add fat with it.

Thanks for the triglycerides information. He to was worried about this and asked me “How many carbs are you eating”?. I told him a lot, and asked him if I should move to a Fat/Protein type diet or what I find on the internet called the bacon and eggs diet type stuff. Why am I eating so many dam carbs you might ask? Maybe it’s bro-science, but I did the “DNA” test and it told me I was a sugar burner and that I should avoid to many fats and eat a high carb diet. I wonder how true that really is, versus what my body has adapted to. I will work very hard to change my diet to a high fat and protein with much lower carb ratio while making sure they are good carbs. I went and bought all kinds of nuts, oils and red meat/eggs etc. today.

I am stopping both the AI and the supplement he put me on to block estrogen. I was reading today that it’s better to have higher than lower E2 and that if it elevates during an increase to Test Cypionate dosage, just stay with it, change nothing else and let the body take it’s time adjusting to the new increase and it should adjust itself and reduce naturally over time. Then increase Test Cypionate again after it settles into good numbers and repeat until optimum feeling/health is achieved. Sound like a legit thing to do?

I will watch my numbers over time to see how long it takes my E2 to climb up again after tanking it so hard.

Thanks!

Hi Systemlord,

Thanks for helping me buddy. Here’s my answers.

The doctor told me I would need to donate blood. I went to donate blood and they asked me if I have ever let a doctor draw blood for any reason period in the last few months. I said yes, to run a blood panel to see how my general health is. They threw me out. Lesson learned. I will adjust for that.

Interestingly I started to find very conflicting information about whether you really do or do not need to even do this. Really makes taking a decision difficult sometimes with so much what appears to be positive argument on both sides of the fence. I am really interested in hearing what others have seen/know about this very thing. I hope it doesn’t sound ungrateful for your contribution as I am very thankful. I just want to be sure that if it’s a natural body response that isn’t even “bad” per say I am making good medical decisions.

I changed my protocol for injections myself 2 weeks ago choosing to do 2 injections a week and what I notice is that the crash isn’t as bad, but the high is never present. I just feel low all the time but not quite “a walking zombie”. I am going to stick to the multiple injections per week, I am just thinking that perhaps my dose is just to low to really be of any true effectiveness.

Thanks for the information about the E2, you were one of the posters I had found originally talking about E2 along with some others and got me realizing I had really screwed up letting him Tank me like this. I sure hope others heed this warning before they feel like I do right now. I hope it starts bouncing back quickly but on such a low dose, I am not sure how fast this is going to happen. I have read some horror stories of many months to 1 year. Hope that’s not me.

I definitely have to much bodyfat at this point. I really need to figure out how I can drop it while struggling with such low levels of test and extreme fatigue along with shitty recovery. It’s been impossible up to this point for me but maybe dropping my carbs to no more than 20% total and only being quality carbs maybe this will have some positive effect. I still worry about how to even do the workouts while I am so brain dead and basically walking asleep and depressed lol.

I have no problem injecting every day or EOD etc. Whatever works I am willing to try and follow. I am using 23g x 1 to draw the serum and then 27g x 1/2 subq into the belly fat for both HCG and Test Cyp. I stopped doing it in my glutes a few months ago because I found it easiest to just stab myself right in the belly fat. So far it’s been great. Pain free and no large lumps and injection site issues.

The doctor put me on HCG because he said it will help my boys to produce Testosterone naturally and help us get it up faster than with just Test Cypionate alone. He also said it protects fertility even though I already have all the children I want and told him I don’t want any more kids.

So knowing I am using Cypionate 200mg/ml, everything is the ml’s in the syringe x 2 correct? (i.e. I draw .10ml into the syringe, this is 20mg of Test Cypionate)? That translates to 3 of these injections per week giving me a total of 60mg per week (.30ml x 2 = 60mg per week)?

Thanks for all the information and hopefully I am getting this right. It will be interesting to see how he responds to my education and requests for protocol. He’s a great guy but impossible to get in touch with other than my appointment. His office sheep doing all the calling and relaying messages (including screwing stuff up).

Thanks again!

Hi Highpull,

  1. To be more clear, I felt inside of me something improving and certainly waking up. However, even to this day I have never felt good since that first week. Migraine headache but for 3 days, I had a boner that would have made a porn star cry and run out of the room. Other than that, I have still been fighting extreme fatigue and all the symptoms since. I have yet to have a moment I though to myself “I feel great”. Only felt “something is improving”. Then it would crash and fade away.

  2. Doctor asked me do I want kids. I said nope. He said let’s start you on TRT and HCG as I find the HCG helps the boys produce/increase production of natural test and other hormones that should help speed up our process to getting higher levels.

  3. Looking back now, I am concerned he panic’d as much as he did and then tanked my protocol so quickly. The symptoms I have now, are WAY worse than they were when I had somewhat higher Test and E2 levels. Perhaps the best course would have been to just split the dose over 2-3 injections and give the body time to adjust.

  4. Dropping it. I am scared of this medication now. I have never wanted to hate life so much or feel so useless, depressed and fatigued. The other day I actually had a suicidal thought cross through my mind. I shook it off, but this stuff is no joke.

  5. I am using 1ml insulin syringes so it’s a bit easier to adjust. What I do know is, lowering that dose, and tanking my E2, it dropped my overal Test level by hundreds and oh my god am I feeling it.

  6. I am going to try the 2-3 times a week for now. I read a few posts of people going to every day and while that may be obsessive, I did like the logic of “giving my body a little each day just like it would have done naturally”. Might be total horse dung, but sounds a little like it might be an intelligent play for someone who seems to just hyper respond to estrogen levels. I have no scientific proof.

  7. This is an interesting topic I am going to research more. I have read some people who donated, and it drained them of iron and some other things which in turn made them feel bad so there always seems to be two sides to most stories.

  8. This. I know I need to learn patience. Not my best quality, but doable if I know I am on the right path. As it stands right now, I have never felt worse in all my life. I feel worse than when I started with this process hands down. I am afraid of really affecting my life/job I feel so bad. My current state must change so hoping dropping the AI and Blocker will help me start to get closer to a normal state.

  9. That’s encouraging.

Thanks again!

Hi again Highpull,

Those are great videos. He makes the argument seem very plausible. Can I ask if this is universally accepted and believed/supported by many other doctors as well?

Thanks!

Thanks. Welcome to the world of TRT. You’ll find “experts” in every corner and some on each side of the fence. Just look at the different advice you’ll get here.

Neal Rouzier is presenting at a sold out conference this weekend, so, many doctors are listening to him.

Read and learn as much as possible, consider all sides to an issue and go with what makes sense to you. Keep in mind that we are all different and respond differently to TRT protocols. A frustrating and interesting aspect to this.

Glad I could help, you’re welcome.

You have a good grasp on dosing, .10ml ~ 200mg/ml cypionate is 20mg. My estrogen was lowest on a daily protocol even when compared to an EOD protocol. You also may be able to lower HCT by injecting daily, on 20mg EOD my HCT was 50%, 10mg daily it was 46%.

You may be able to kill two birds with one stone, lower estrogen and lower HCT.

Some doctors appreciate patients who take an interest in their health and research their own condition, other doctors will not like an informed patient usually because it makes them feel inadequate.

I use the Easy Touch 1ml 29 gauge insulin syringes.

great to know that your doc was watchful.
Considering your body fat, i bet no more than a week to stabilize your E2 lvl.
keep your home work , consider add some cardio (20 min), its helps in insulin resistance and reduce your triglycerides, sure plus diet.
Sounds Super legit to me. GL!

Hey there my TRT brothers, I have been out for a few days as I crash so bad at the moment I can’t think straight for about 3-4 days of the week.

My appointment with the Dr. is on Thursday and I want to make sure again I am ready for what I should recommend for adjustments to settle into for my next 6-8 weeks:

When I arrive at the appointment, I will be agitated, anxious and feeling really down. It’s 12 hours before my injection timing so I will be very crashed.

  1. I am going to suggest to move to EOD injections after meeting with him and drawing blood (no change until after appointment and blood draw). How do I interrupt the number that is important in my blood test that tells you “yup, you should do frequent injections because SHGB is blah blah blah”? Is there a common knowledge article I missed?

  2. Is my current dosage even a legitimate dose to be on/start with? It’s .30ml of 200mg/ml per week. I moved it to 2 x per week (.15ml each time) 2 weeks ago hoping it would help my crashing mood. I don’t see this low of a dosage being a normal script for anyone here. Is there something in my last blood report that would scare you away from a suggestion of 100mg a week (.25ml x 2 times weekly or .17ml EOD)? I think you all seem to agree the smart thing is to start slow and gradually build up so looking for you advice here.

  3. Tell him I do not want to take the AI anymore until I stabilize better. I also think “1mg slow release pills x 2 times weekly” is way to much after researching this. Perhaps get a script for really small ones like .125 pills to only take if I feel the effects of Estrogen (libido issues, crying/sadness, brainfog etc.). I want to give myself the option of not taking this at all and letting my body self adjust if possible.

  4. I will be reducing carbs from my diet and forcing myself to work out again (start small and build up again). Going a high fat/protein diet. Already started the diet, exercise starts tomorrow.

  5. Should I be taking the HCG? Is his reasoning even accurate? I don’t care about fertility. Will dropping it, drop my testosterone even more? Not sure I could take an even deeper crash.

  6. Will my HCT Levels drop on their own as things dial in or should I donate once to get it down and pay attention to it over time while dialing in? I am not interested in getting caught into a circle of donating to find out I am now iron and other things deficient. I want to try to make this as smooth and simple long term as possible.

Thanks everyone and best of luck on your journeys!

Usually when Free T is high normal, you can assume Free E2 is also high normal and if you are experiencing symptoms of high estrogen, then the course of action is clear. Then you would need to break up the injections into smaller more frequent ones, take the shortcut and do it right the first time. I wish I had but I didn’t want to inject that often in the beginning.

Testosterone binds to SHBG, so it can be another factor in your protocol because if it’s not binding, then you are dumping it, but not the estrogen as it lingers in the body far longer. Drop the HCG and estrogen will likely drop some as well, you’re not interested in kids so I don’t understand why you’re on HCG.

I’ll never be on HCG, if I want kids, I’ll just inject FSH which doesn’t complicate my TRT protocol by throwing more estrogen on top of more estrogen. My Dr. asked about fertility and told him I had no plans for kids for now, he never spoke of it again. You’re on TRT, you want more testosterone, you don’t need HCG to increase testosterone, inject more T.

More often than not CBC levels will drop by simply injecting smaller doses more frequently, everytime I change to smaller dosage per injection, hematocrit declines quickly (within days). I have anastrozole in 0.050 from hallandale pharmacy, you couldn’t ever convince my to take it again.

Hi all. I had my doctors appointment just now and here is my update:

  1. Doctor was very receptive to my new found knowledge. Actually told me I am 100% correct.

  2. Agreed to work with me to adjust my dosages and medications to fit my own profile.

  3. We both agreed that we would keep each other 100% up to date as to why or when we make a change.

  4. Told me that some people just respond differently to AI’s and estrogen conversion. He told me he was sorry for how I feel and how it affected me and we will stop taking it completely, rest for one more week which will give him a 2 week break from the AI and then we will draw blood to see how my estrogen is reacting to the anastrozole being flushed out of my system. He is also adding another 20mg of Test per week to help raise my Test and estrogen from the crash.

  5. He told me that he has tons of patients and I am the first one that meets the criteria of what he has studied (that some people are hyper sensitive to estrogen, AI’s etc.). He told me that we will work to micro manage that part of the process and he promises to not respond so aggressively to E2 fluctuations. He said we can talk about how I feel and go from there. He said some patients have the ultra low E2 like I do today and do not have the life changing crash I am experiencing. He said some of my patients just absolutely need to be around 30 for optimal health.

  6. I expressed my interest in doing multiple injections per week and again said, I have no one that needs that but, if it works for you we can do whatever it takes. I promised him that if he did decide to increase my dose to what most people seem to start at (100mg vs my 60mg) that I won’t abuse it and take more than that, but I will want to break it up into 3-4 shots per week and see how I respond. He said that’s absolutely fine and we can trak the data. He said, I just need you to take blood draws every 4 weeks for me while we dial it in so that he doesn’t miss something that might aggressively build up since I seem to respond very sensitive to his treatment. I think this is good advice and something I can give without any argument.

  7. We discussed HCG. He told me that he just doesn’t feel comfortable at this moment taking it away from me even though he agreed with me that it might affect my estrogen. He said his first fear is that it shuts down my natural process. He said it’s not about the fact I don’t want kids as I have all I want already, it’s about if you change your mind on TRT or find yourself unemployed or not able to take it anymore he’s not ready to destroy my natural process. He also said that if I work with him, he will dial me in while being on it and we should be able to get where we both want to be while protecting my natural process. I think with how he’s acting towards me and so willing to guide me, listen to my ideas/new knowledge and allow me to also be the decision maker I am going to trust him on this for now and give him a chance. I feel comfortable with that.

So I walked out of there with an increase in Test Cyp from 60mg to 80mg a week (said I will get more AFTER we test next week. Just wants to give me a little boost to help with the crashed E2). Said I can take it anyway I want but he felt that it’s possible if you inject to frequently, it will build up. I explained to him that if the high point peak is 48 hours after injection, injecting every 48 hours it seems that to some degree of logic the high coming down will crossover the next injection ramping up. He was not apposed to my logic but said this is not something any of his patients do or have needed to do. But did say he’s ok with it and we will just keep track of how I feel and how the blood tests come back. I don’t think I can ask for much more in terms of an understanding professional who smiled at me when I showed him my knowledge. Think I will stick with him.

How do I feel leaving there? Exhausted, brainfog, E2 crashed, anxiety like a mother but a positive outlook that he promised to personally be the one to review my labs and call me himself personally until I am out of this fog.

Crosses fingers, hopeful

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What’s the immediate effect on your Test levels after donating blood? If I donate during the week, and then do my bloodwork within a few days of that time, will it give inaccurate results?

Can my HCT just naturally drop itself without donating blood, if I find the right dosage frequency etc.?

Anastrozole can have an E2 rebound effect that is short lived once you stop it cold turkey, but intense in my experience.

Thanks @systemlord. I can finally feel the effects wearing off. That was the worst period of my life. Very scary dark place I never want to see again.

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Had my blood drawn today after giving 2 weeks for Anastrozole to clear out of my system. Still feeling really tired. I feel a chest fatigue/tightness on the last 2 days of the shots wearing off. Feels sort of like a small child is sitting on your chest when trying to breath. Once my next shot kicks in this feeling goes away. These are just notes for myself. I will post results next week when I get them and what my new protocol will be.

2 weeks on .15ml EOD shots now and definitely the crash feeling is almost completely non-existent (90mg weekly). It’s far better for me at least than 2 x weekly. I am sticking to this frequency for a while. I am also over the intense feeling of dropping the AI cold turkey. Quick blood test came back with:

Hemacrit dropped from 56% to 49% (never donated blood)
Estradial - 29 (11.8 to 39.8 range)
Total T - 472 (240-870 range)
SHGB - 36 (14.55 - 113.13 range)
Free Test - 9.7 (3.2 - 19 range)

I am starting to get good boners again and anxiety almost gone. I was able to workout 3 days this week so far and plan to do 5. I am going really light weight but at least i feel enough energy to show up again. Also cleaned up my diet. 4 more weeks on this regiment and then a full blood panel.

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