T Nation

Help Getting TRT Adjusted After 3 Months

Hello looking for some help/advice with my TRT. My history I’m 37(as of today) 5’10” 170-175 range. When my doctor originally tested my levels back in March I was at 210.

He started me very low .5cc of Test E 200 once a month. After a couple days and a lot of reading I went back to him and told him I thought that was going to be too low they moved me up to .5 mL every two weeks which is where I’m at now.

My last injection was May 16 and May 25 he sent me for mid cycle bloodwork being three months in. I went from 210 to 322. His message to me after my results was those levels look perfect let’s stick with that dosage.

To me I’m not feeling any results yet and I expressed that to him as well. I also still feel like that was not a big enough improvement to maintain the levels I’m at now. My hope was he would up me to at least one cc every two weeks or every week. TRT And getting my levels monitored is still very new to me as opposed to running my own cycles. So looking for advice. He did mention that we could always talk to someone in endocrinology.

When we talked about this in the beginning he had stated we’re not aiming for a number were aiming for results a new feeling better which made me feel if I was being honest and telling him I did not feel anything he would be more open to upping my dose.

.5 cc or mL, either way that’s not a dose, it’s a quantity. How many mg? 200 in how many mL? Every two weeks is useless on enanthate, and your testosterone level is pretty far from perfect. Enanthate has a half-life of roughly 7 days, which means that you have half of the dose left at 7 days, which means 7 days is basically your maximum pace between shots. Normal would be to start at 100 mg every 7 days. Get a different doctor, and get some real blood work. You should know your Total Test, Free Test, E2 (estradiol), CBC, and if possible SHBG and Prolactin, Cortisol doesn’t hurt either. And post the lab ranges with the results, lab ranges are not universally standard.

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Any doctor you have access to will not be of much help, you need to educate yourself because none of your doctors will be educated in TRT. Most men inject two or more time per week to keep levels in the therapeutic ranges. If levels are swing from high to low range between injections, I expect you will have no symptom resolution.

Men with high normal testosterone live longer and have the least cardiovascular events than those in the mid normal ranges, men with testosterone lower than 350 are at high risk for all the diseases of aging (heart attacks) and your doctor should be targeting 800-1000 Total T, his complete lack of knowledge is responsible for your suffering.

Managed health care will unfortunately be unable to manage your TRT protocol because the way it operates which focuses reference ranges where in range is normal, so when you scored the 322 it was in range (264-916) and no more thought went into it.

The endocrinology department won’t be much help either, endocrinologist isn’t the type of doctor you want managing your TRT, they are every bit as clueless. You need to seek private care for your TRT or expect to figure out everything on your own.

SHBG levels should dictate injection frequencies, the lower this value, the more frequent injections should be. My SHBG fluctuates between 16-22 and feel best injecting 25mg every other day and feel even better on 10mg daily dosing.

This may be the only bit of good news you have mentioned so far, see if you can’t get this doctor to order more labs recommended by hardartery and see if your doctor could write your script for 100mg weekly which would allow you to split up how ever many ways you prefer and base this decision on your SHBG value.

Show him these studies I’m providing below and maybe he will listen. You should also consider 1/2" 27-29 gauge insulin syringes and inject in shoulders and quads, no need for large needles in the glutes.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk.

Hormone profiles after intramuscular injection of 200mg testosterone enanthate every 2 weeks in patients with hypogonadism

Skip to figure 1 graph B, 6 days after a 200mg injection levels are below the therapeutic ranges while estrogen remains very high creating estrogen dominance in men. We men excrete testosterone a lot faster than we excrete estrogen which must be cleared by the liver which takes longer.

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When I went back after my fist week I was honest about previous cycles I had done. He thanked me for being honest and assured me he wouldn’t treat me any differently due to that. In my head that assured me if my 3 month levels we low he was up my dosing.

You did not ask any questions, but I’ll offer this:

Taking 100mg every other week will not be effective. PCPs that manage low testosterone patients typically prescribe 200mg every two weeks, though some go with every three or four weeks. Guys with 200mg every two week schedules usually can tell when they are due for their next injection, but still are happy to get some benefit.

Most TRT guys using a TRT doctor take weekly injections of 150-200mg per. Most going the underground route do the same and the dose is usually 200mg per week. You will find that most here on this site use two or three injections per week.

You would be best served by a doctor who has a hormone replacement practice. PCPs are not trained in TRT and perhaps only mildly interested. On top of that, some of the little information they do have is incorrect. It’s pretty much the same for endocrinologists and urologists.

As mentioned, you will need appropriate lab tests:

Lipids
CMP
CBC
IGF-1
DHEA-S
Vit-D
PSA
E2
Total test
Free test
TSH
Free T4
Free T3
SHBG
Prolactin
FSH and LH, but not now since you are taking testosterone.

It would be a good idea to seek out others on TRT and asking them about their experiences, keeping in mind that while valuable, do not take any one as the gospel.

Good luck.

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My prolactin was 5.4 and luteinizing was 2.1 back in March. The test is Enthante 200 so yeah .5cc is 100mg every 2 weeks. I feel good for a few days after the shot then shitty again. I explained that to him and the nurse on separate occasions. The lack of changing my dose has lead to me wanna start supplementing my own cyp 250 I have in between my scheduled injections.

That is not going to help you. Your levels will spike to healthy levels and he will want to bring you back to 300 and cut your dose furthur. Go private or self medicate

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If you only felt good for a few days after the 100mg injection, you are closer to nailing down the perfect injection frequency. When I started on 75mg once weekly, the first two days were the best and this ended up being the minimum injection frequency and went onto to inject daily which was even better.

If your doctors won’t work with you, then they can only work against you and it’s time to move on to greener pastures. If they learn you’re adding more Test to your therapy they will stop your TRT and it may be difficult for other doctors to even bother with prescribing TRT in the future.

TRT and sick care just don’t mix well, TRT is more about optimizing health status and sick care is into treating acute life threatening conditions, not preventing disease but keeping people sick until they require expensive therapies and surgeries so all these companies can do well financially.

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This all being new, I’m not even sure what kind of dr to see. A friend of mine sees a urologist who did his TRT regiment. I’m wondering if I would need a referral from my primary care physician to see someone else about it.

There are only one type of doctor that will be educated in sex hormones and it will be by choice, the type of doctors that are knowledgeable in TRT will be private doctors in anti-aging and sports medicine. This has been the home for TRT the last 70 years, think of 50 year old men optimizing testosterone later in life when levels are known to be lower.

The last place you would look for this sort of thing is a regular doctor in sick care. There are tons of anti-aging and sports medicine doctors who prescribe TRT on a daily basis and specialize in it.

Where are you located?

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Thank you for all the great info!!! I’m in Connecticut in the central area of the state

You’re unlikely to find a knowledgeable TRT doctor in Connecticut, most of the really good doctors are in the big cities. You may need to consider a telemedicine clinic for your TRT, Defy Medical is telemedicine clinic in Tampa FL who has really good doctors who prescribe TRT all day long, it’s most of what they do on a daily basis.

They also treat thyroid disorders, adrenal fatigue, fertility and the prescribe growth hormone and many other anti-aging therapies.

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