T Nation

Dr Prescribed 200mg/Wk, Says It Wont Affect LH/FSH. Refused HCG

T Replacement
#1
  1. How long will it take for LH and FSH to go to zero so i can convince him to let me take hcg as well?
  • He doesn’t believe trt doses will suppress it and it is pointless. when i argued, he cited my high hemoglobin as the biggest reason not to put me on hcg as i could get a blood clot.
  1. Should i take this very large dosage of 200mg a week (split into two doses) ? or just go ahead and just take 100mg (50mg 2x a week)?

SHBG 14 nmol/L (10-55)
Testosterone 8.8 nmol/L (8-29)
Free Testosterone 263 pmol/L (175-700)
Estradiol 14 pmol/L (0-44) (non-sensitive)
Hemaglobin 176 g/L (137-180)
Hematocrit 0.54 L/L (0.4-0.54)
RBC 6.2 (4.5-6)

#2

TRT definitely suppresses LH and FSH.

Your gonna be in for a ride if you inject 200mg at once with that low of a SHBG.

Most start at 100mg a week, and then you can adjust from there.

#3

How long does suppression of LH and FSH take from TRT? I still have some hcg left over from a few weeks ago, if i take that will it suppress my LH and FSH further (or is exogenous testosterone the only factor?) so i can show him my low LH and FSH?

#4

LH FSH will be near 0 pretty quick. Probably a couple of weeks.

HCG will not raise LH or FSH. It mimics LH and bypasses pituitary and works directly in testes

#5

Depends was you’re cause of hypogonadism primary or secondary. If primary gonadotropins won’t be suppressed to 0, nor will HCG be of any benefit.

Secondly, SHBG has nothing to do with injection frequency, dose perhaps, but not frequency. 200mg is a large dose to start off with but it is by no means ridiculous. Try it, get bloods, reassess

Trt will raise H@H further, go donate some blood, a HCT of 54% isn’t particularly dangerous for a healthy male however you’re doc may not be happy with it. Were you dehydrated at the time of testing?

If worried about fertility… Freeze sperm.

#6

Blood clots form when you have a certain type of disease, TRT doesn’t cause blood clots in the absence of these specific diseases. A lot of doctors treat high HCT levels as polycythemia vera because they have zero knowledge in TRT.

You may very well have problems with free estrogen do to low SHBG and HCG may only cause more problems with estrogen conversion.

You need very small doses ED or EOD in order to keep free estrogen from getting out of control.

#7

Agreed with the above - 200 is too much especially with your low SHBG, LH and FSH will be suppressed a couple weeks into exogenous T being detected. If you don’t absolutely need fertility why complicate things with hcg… as for H&H I would first assess diet, exercise lifestyle factors, family history before pointing the finger at T.

#8

So I decided to start with 120mg a week rather than 200mg. Hopefully the doctor doesn’t get pissed.

After my 3rd shot of 60mg (week 2 injection 1/2). The next day in the morning i was rock hard and libido was up. But that all disappeared by the evening that day. I have also been sleeping more than normal. I also had a massive headache a few days after my shot (related to any of the hematocrit, rbc etc above?)

  • Do you think my E2 went into the ideal range and then above range? (there is no sensitive E2 test in my province of Alberta in Canada)

my current symptoms are slightly sensitive nipples to the touch, rubbing them feels strangely good
- sleeping more than normal, more tired than normal
- low libido, soft erections, ED, Lackluster orgasms

  • Or do you think because of my low shbg the T just got metabolized too fast?
#9

Everything will fluctuate at the beginning. You need to stick it out and see how things are in 6 weeks.

You will have your ups and downs (no pun intended haha) during the beginning.

#10

Happened to me too. Not so much now. They still feel good. But when super sensitive I can ejaculate real quick with nipple play and jerking.

My wife likes to play with them in general sometimes I tell her to stop or her fun would be over quick. Lol

#11

Your testosterone and estrogen levels are swinging and haven’t reached a stable state which takes 6 weeks, so until that time you will have good days and bad days. As you get closer to 6 weeks things may start to feel more consistent.

I just started a new TRT protocol and am going through the same thing.

#12

Here are my latest labs, Please Advise:

  • 120mg enanthate a week (60mg every 3.5 days), intramuscular
  • nothing else, no HCG, no AI
    -Troph measurement (morning of my injection day)

Testosterone 674 ng/dl (230 - 835)
Free Testosterone 877 pmol/L (175-700)
SHBG 10 nmol/L (10-55) (14 pre-trt)
Estradiol (Non Sensitive) 48 pg/ml (0-44) (14 pre-trt)
Cortisol AM 356 nmol/L (170-500)

I would like to reduce my dose and switch to daily SubQ injections.

  1. What dosage should I use? (84mg, 91mg)? Does going subQ result in higher levels so I should reduce my dosage more?
  2. Do I have to be concerned about my total T being really low once i reduce my dosage, since it is not that high now?
  3. I switched to daily subq a earlier in the week and felt great for the first few days, good erections and libido, energy and cognition (105mg a week daily subq). That suddenly dissapeared after 3 days. Is it a good assumption that estrogen got too high even on this dose (so I should lean more towards 84mg a week)?

I know reaching a stable state takes 4-6 weeks, but is this observation worth something since I on my 120mg a week protocol I felt great for a couple weeks then suddenly gone. Assuming it was the same estrogen problem?

#13

SQ doesn’t work well for everyone, it increased my estrogen. Daily IM injections is by far the best protocol for low SHBG men, everyone that has ever tried it has loved it.

#14

I reduced my dosage to 84 mg a week since I am doing daily subq now. If i was going to stay 2x a week IM I would probably go with 100mg. From what I understand because of the more frequent dosing most people find that less goes further. (does that make sense to you systemlord?)

Hopefully my shbg goes up and my Estrogen down. If not I will consider the daily IM, that might be tough for me though.

There is no Sensitive test in my area (alberta canada). What is the best way to monitor my estrogen? based on that lab range will mid range be a good target?

#15

It makes perfect sense because the smaller doses will aromatase less. If you have a lot if aromatase enzymes and do larger injections, you’re just asking for high estrogen.

It really depends on your genetics, some men can have high estrogen and no symptoms, the liver is responsible for the clearance of excess estrogen, so there’s another factor.

#16

I am now getting anxiety and loss of confidence on week 3 at a 84 mg weekly dose (daily injections) that i wasn’t before on 120mg weekly (2x a week injections). I am thinking it is unlikely high e2 in that case? could it be my test levels are too low? won’t be changing anything until I get blood work in a few weeks, but would like to know what your opinions on the cause are.

#17

When I changed my dose I had about 3-5 days of depression and anxiety 10-14 days in maybe more can’t remember. It disappeared and I’m back to normal. Still not feeling much benefit but I’m not worse off as I was during those few days.

#18

Not sure if everyone agrees. I’m not as experienced . Personally speaking I would of dropped from 120 to 100 not 84. Just stick with 100. Going from 120 to 80 is a 35% (your getting close to 40.% and that’s almost half) drop in dosing. Yes subq supposably become moee potent and more is somehow absorbed but by 5-10%. Not 30%.

I’m on subq and the daily dosing takes a huge edge of the one big shot. It’s weird. I kinda miss it. After this periods over I’m probably going back to twice a week or eod. Daily is allot of work.

If others agree You can easily just add the 20mg to your dose tomorrow to get the dosage back into your blood quick and then stick to the daily dosage .

#19

You can’t judge a protocol only 3 weeks in, you must give it at least 6 weeks, preferably longer. I don’t feel the full benefits of a protocol until weeks 7-8. Your Test levels have dropped do to lowering your dosage and injecting smaller doses, this is forcing your body to go through a pretty big changes.

I notice a huge difference going from 50mg twice weekly to 20mg EOD, the latter makes life a little more difficult.

Stay the course.

#20

Please advise

after 8 weeks on the protocol. Here are my labs, not so good. For some reason after going to daily injections and subQ my estrogen is even higher than when i was on a higher dose and less frequency (60mg 2x a week). looks like you were right about subq @systemlord

Protocol 12mg daily (84mg weekly) enanthate sub-Q into belly fat.

SHBG 10 (10-55 nmol/L)
Testosterone 533 ng/dl (230-835)
Free Testosterone 650 (175-700 pmol/L)
Estradiol 58 (0-44 pg/ml)

New protocol.

Switched to Cypionate from enanthate due to the small volumes I am using for daily injections. 9mg/day (63 mg a week). Instead of injecting subq into belly fat, injecting Shallow IM with a half inch needle into thigh.

Also I was expecting for my SHBG to come up a few points closer to my pre-trt shbg of 14 since I lowered my dose and reduced frequency. however it did not move. any idea why?