T Nation

Help! Our Quest to Fix Fatigue

Hi all, my partner started on TRT therapy 2 weeks ago, however there’s a few issues:

  1. The dose is 250mg/ml every three weeks. The script comes like that ie it all must be shot a once and can’t be reused.
  2. He didn’t subscribe an AI.

The doc seems pretty open-minded to suggestion, but we’d like to go back to the follow up appointment armed with factual studies to convince him that we’d like to try 100mg/ml weekly, combined with a small amount of Arimidex.

Everything I’ve learned here says thats a good place to start and take it from there.
I’m wondering if anybody could provide any links to research papers supporting this ie weekly is best, and an AI is necessary?

So far I’ve got the following:
http://www.dspace.hsl.washington.edu-dspace-bitstream-2012-52-1-JCEM_2005_Low_Dose_Human.pdf

http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

[quote]Foxen wrote:
Hi all, my partner started on TRT therapy 2 weeks ago, however there’s a few issues:

  1. The dose is 250mg/ml every three weeks. The script comes like that ie it all must be shot a once and can’t be reused.
  2. He didn’t subscribe an AI.

The doc seems pretty open-minded to suggestion, but we’d like to go back to the follow up appointment armed with factual studies to convince him that we’d like to try 100mg/ml weekly, combined with a small amount of Arimidex.
Everything I’ve learned here says thats a good place to start and take it from there.
I’m wondering if anybody could provide any links to research papers supporting this ie weekly is best, and an AI is necessary?

So far I’ve got the following:
http–dspace.hsl.washington.edu-dspace-bitstream-2012-52-1-JCEM_2005_Low_Dose_Human.pdf

http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

[/quote]

I’d suggest posting this in the Steroids forum, you may have better luck with the vets knowing some studies.

The best TRT resources are here, not the steriod board.

Your doc does not have time to read what can be produced. You need to sell and argue your point, if that does not work, your doc might not be receptive in any case.

The best argument is that health young normal males do not release T from their testicles one every three weeks. The more stead the serum T levels, the better the results will be.

Large infrequent doses create huge changes that do not feel right, over doses followed by crashed levels. The high T spikes create E2 levels are are higher than from more frequent lower doses. The elevated E increases SHBG that reduces the FT fraction. It is FT that does the heavy lifting.

E needs to be controlled and ideally should be in the lower 20’s (0-53 pg/ml). Elevated amounts, in the upper 30’s can lead to low libido, low engergy, brain fog, depression etc, while TT and FT numbers are high. E2 is often ignored, but is a critical success factor.

Suggested:
100mg/wk test cypionate injected IM.
1mg/wk arimidex/anastrozole in divided doses, EOD prefered
250iu hCG injected SC EOD

Many inject T more than one a week, I inject T EOD. You should be free in that regard to do whatever seems to work best for you.

You’re looking at this the wrong way. It’s your life and your body and your doctor doesn’t own your health. You’re the one having the problems; you don’t have to prove anything to him, he needs to justify his crappy treatment to you!

“I’ve been reading information from guys on TRT who have the best results from weekly injections and that’s what I want. Can you show me proof that weekly injections are harmful?”

I’d suggest you get Dr. Crisler’s protocols and show them to your doctor.

http://www.allthingsmale.com/publications.html

Click the link: TRT: A Recipe for Success

The most important thing to keep in mind is that your doctor doesn’t own your health. If your doctor doesn’t give you what you need for successful TRT, then you need to find a doctor who will (screen them by telephone) or you need to do it yourself. Aromatase inhibitors can be purchased legally over the counter. You don’t need your doctor to get them. PM me for sources if you need to.

I actually had a big argument with my doc last time…he finally agreed to try twice weekly shots after I do every two weeks and then once a week…I won’t do once every two weeks, that sucked. He would not do an AI or HCG, but he agreed to find me a urologist who would perscribe it after arguing some more. I kept an ai on hand since the beginning on KSman’s advice. Happy is dead on, this is our body and it’s up to us to make sure we get the right treatment. My doctor sucks but if I push enough I’ve found that I get what I want. Not perfect but getting better…

Thanks heaps fellas and you’re absolutely right - it’s his health not the docs. Guess we’d just like to go in prepared from all angles rather than waste the $60 consult fee!
I forgot to mention that unfortunately we’re in Australia, so no over the counter AI’s here :(:(:frowning:

Does it have to be cypionate or is enanthate okay??

Thanks heaps fellas and you’re absolutely right - it’s his health not the docs. Guess we’d just like to go in prepared from all angles rather than waste the $60 consult fee!
I forgot to mention that unfortunately we’re in Australia, so no over the counter AI’s here :(:(:frowning:

Does it have to be cypionate of is enanthate okay??

[quote]Foxen wrote:
Does it have to be cypionate of is enanthate okay??[/quote]

Enanthate is okay.

Unfortunately, the use of an aromatase inhibitor in conjunction with TRT didn’t come from published studies, it came from the trenches, so to speak.

I’m guessing that your doctor didn’t check estradiol levels prior to starting TRT but you should insist that he do so immediately so you can compare as time goes on. Any rise in estradiol would indicate that an AI is needed.

Since most doctors will try to pass off any estradiol level in range as normal, here’s an indication that it is the ratio of T to E that is important:

http://www.rmalab.com/index.php?id=60

I think your best bet is going to keep the focus on symptoms and keep insisting that the doctor do better. Don’t get bogged down in the science. The point, after all, is to feel better. If that isn’t happening then your doctor needs to do a better job and you need to be clear about that and make sure that he knows you’re clear about that. If the TRT isn’t working as it should, the blame can only lie with the doctor. Keep hammering that point. The is no medical reason not to use an AI and so you need to push the point and force him to give you a medical reason not to do something that will help.

Update:
Had our follow up appointment with the endo yesterday - success!

Suggested to the doc that we’d like to try 100mg in weekly shots, and to introduce arimidex as he’s now having all the symptoms of high E - libido through the floor, brain fog, fatigue etc, and doc agreed to give it a try :slight_smile:

So now we’ve got Sustanon 100mg/ml per week, and he also prescribed armimidex 1/4 tab every day - however I’m pretty sure he did this based on what I suggested (which was actually 1/4 tab EOD) so is that probably a bit too much initially?? Everything I’ve read usually starts at 1/4 EOD. Blood work will be done in about 6 weeks of this new routine.

Also brought up the subject of HCG, but it’s a bit early yet, as we’re yet to see if this new routine will even make him feel better (fingers crossed!) Fortuneatly the doc is open to suggestion (particularly for an old dude!) so we may investigate that for the longer term. HCG, and even arimidex, is not common practice here in Australia (we’re behind the times) so we’re pretty happy with this result…

Can anyone tell me if Sustanon will go through a 27 gauge needle?

Edit: Also, when can he expect to feel the effects of the arimidex? Should he have a slightly larger initial dose to kick things off?

[quote]Foxen wrote:
Update:
Had our follow up appointment with the endo yesterday - success!

Suggested to the doc that we’d like to try 100mg in weekly shots, and to introduce arimidex as he’s now having all the symptoms of high E - libido through the floor, brain fog, fatigue etc, and doc agreed to give it a try :slight_smile: [/quote]

Cool.

[quote]
So now we’ve got Sustanon 100mg/ml per week, and he also prescribed armimidex 1/4 tab every day - however I’m pretty sure he did this based on what I suggested (which was actually 1/4 tab EOD) so is that probably a bit too much initially?? Everything I’ve read usually starts at 1/4 EOD. Blood work will be done in about 6 weeks of this new routine.[/quote]

1/4 tab (.25mg) EOD is a very common starting point. If your husband has a large body mass, you might consider a larger dose. The problems associated with a too small dose are little relief from the symptoms of high E2. However, with too large of a dose, you run the risk of plowing right past the “sweet spot” and going from the problems of too much E2 to the problems of too little E2. I think the risk/benefit analysis weighs in on the side of caution. Try the 1/4 EOD dose for a couple of weeks and then adjust if necessary.

[quote]
Also brought up the subject of HCG, but it’s a bit early yet, as we’re yet to see if this new routine will even make him feel better (fingers crossed!) Fortuneatly the doc is open to suggestion (particularly for an old dude!) so we may investigate that for the longer term. HCG, and even arimidex, is not common practice here in Australia (we’re behind the times) so we’re pretty happy with this result…[/quote]

hCG and an AI are not that common in TRT treatment here, either, so don’t feel alone.

Yes, it will. I have best results with small gauge needles by warming the oil first. I use a heating pad to warm the syringe to body temperature before injecting.

[quote]
Edit: Also, when can he expect to feel the effects of the arimidex? Should he have a slightly larger initial dose to kick things off?[/quote]

There are no cut and dried answers. Some studies in men have had dosages as high as 1mg ED without lowering E2 to unhealthful levels so you’re probably safe no matter what you do, but people respond differently to all medications and anastrozole is no exception. It’s best to not get too crazy until you see how you’re going to react. I don’t think it would be a problem to start off with 1/2 a tab and then go to 1/4 tab EOD. Results can be anywhere from a few hours to two weeks. You’ll just have to jump in and see how it goes.

I know from my own experience how stressful this whole thing can be with not knowing what’s going to happen, but you just have to keep the faith and keep working toward the goal of getting it all sorted out and feeling great.

I wish you both nothing but the best!

Thanks for that Happydog - we ended up giving him .5 to start off last night - can’t wait until he feels some positive effects :slight_smile:

I guess our greatest fear is that TRT won’t actually “fix” him, and that something else is causing his fatigue etc…only time will tell.

The effects of Arimidex/anastrozole on a guy with estrogen poisoning can be profound. 1mg/wk is a typical starting dose. 1/4EOD is .81mg/wk

Libido and vitality can be roaring back in 7 to 10 days. Most benefits will be in place in 6-8 weeks, and by 3 months, one will probably not be aware of any further gains.

The brain changes with the hormone balance and habits of thought take time to adjust. While thought patterns are changing, a positive attitude can help shape the results.

This post was flagged by the community and is temporarily hidden.

So after two weeks of the new protocol, all systems seem to be improving!
The strangest change so far is his callipers readings are down 5mm and he’s lost approx 1kg of fat in the last 2 weeks, especially given that we just increased calories…seems to be what was “maintenance” isn’t going to cut it anymore. But then again maybe he was just holding extra water because of high estrogen that’s throwing our readings off perhaps?

Bushi - thanks for that, we’ll try and have it changed back to enanthate next visit.

Can’t wait to see what his levels will be when he gets a blood test in about a month, maybe there’ll be room for more improvement :slight_smile:

[quote]happydog48 wrote:

Can anyone tell me if Sustanon will go through a 27 gauge needle?

Yes, it will. I have best results with small gauge needles by warming the oil first. I use a heating pad to warm the syringe to body temperature before injecting.

[/quote]

Happydog,

Can you tell me where you get such a heating pad? Doesn’t seem to be any in pharmacies around here…online?

Or would dunking a vial/syringe in hot water do the trick, and is there any danger of overheating the liquid?

Update: Okay so we had our 3rd visit to the Endo yesterday, after 5 weeks of being on 100mg Sustanon p/w, and 1mg arimidex p/w.

Blood was taken the day before the weekly injection, and the result for T was 7 (range 10-30)??? Lower than before we started!!! (which was 10)
Estradiol was 43 (range 40 - 100&something) so that was fine - perhaps we should back that off a little?

I know Bushy mentioned that the different compounds in Sustanon means unstable weekly levels, but still isn’t 7 a little low???

So with this in mind we’ve now been prescribed 125mg p/w test-e and will see how that goes…

As test-e only comes in 250mg/ml pre-packaged in Australia, the Doc has recommended we use half, and throw the other half away. Obviously we don’t want to do that, and would rather “stock up for a rainy day cough cough”. Can anybody tell me how to go about using half one week, and half the next? Don’t want it to become contaminated…it comes in little syringes with a rubber cap on it.

Any advise/comments appreciated - sorry for the long post!

Cheers, Foxen

I would try injecting half into a sealed sterile vial, just be carefull and sterilize the needle and cap prior to injecting the saved half and using a spare needle in the cap as a vent. And just stock up

No way would I throw it away, nice and handy for a rainy day :slight_smile:

[quote]Foxen wrote:
Update: Okay so we had our 3rd visit to the Endo yesterday, after 5 weeks of being on 100mg Sustanon p/w, and 1mg arimidex p/w.

Blood was taken the day before the weekly injection, and the result for T was 7 (range 10-30)??? Lower than before we started!!! (which was 10)
Estradiol was 43 (range 40 - 100&something) so that was fine - perhaps we should back that off a little?[/quote]

No. Leave it where you’re at. You’re not trying to hit the middle of the range, you’re trying to keep it low.

This isn’t strictly a numbers game. How you feel is more important than what the numbers say. If you drive estradiol too low, you’ll know not from the numbers but by how you feel. Loss of libido, pain in the joints, etc. will tell you that estradiol is too low.

[quote]
I know Bushy mentioned that the different compounds in Sustanon means unstable weekly levels, but still isn’t 7 a little low???[/quote]

The human body isn’t a machine and it isn’t a computer and it isn’t simple. It’s a highly complex system and it reacts to anything you do to it, so it’s going to take a while to get things sorted out. The lower T is most likely the result of the exogenous T you’re taking causing the shutdown of all natural T production. Understand? Now the injections have to make up for the “lost” T as well as trying to get it above previous levels. This is actually a perfectly normal reaction.

[quote]
So with this in mind we’ve now been prescribed 125mg p/w test-e and will see how that goes…

As test-e only comes in 250mg/ml pre-packaged in Australia, the Doc has recommended we use half, and throw the other half away. Obviously we don’t want to do that, and would rather “stock up for a rainy day cough cough”. Can anybody tell me how to go about using half one week, and half the next? Don’t want it to become contaminated…it comes in little syringes with a rubber cap on it.

Any advise/comments appreciated - sorry for the long post!

Cheers, Foxen [/quote]

First off, anything your doctor has written on the prescription about how you inject should just be ignored. Inject EOD and be done with it.

Ok, so your T is coming to you in a rubber stoppered vial, right? I don’t mean to be pedantic about the jargon, I just want to make sure I understand and the jargon all means something specific.

You take a syringe with a sterile needle and draw out your dose for that day. If you want to be extra careful, you can swab the stopper with an alcohol wipe before you pierce it with the needle. Then simply leave the unused portion in the vial for use later. The only thing that is coming into contact with the testosterone is a sterile needle, so you’re not contaminating it and the rubber stopper on the vial “self seals” as soon as you withdraw the needle. Look at it and see. Do you see a gaping hole or is the place where the needle went in sealed back up?

This is really common sense stuff. Think about what you’re doing and pay attention and you’ll be fine. Obviously you want to keep things sterile. If the vial self=seals, you’re fine. If it doesn’t, then draw out a dose into as many syringes as you need and put the needle covers back on the needles and store the “extra” T right in the syringes you’re going to inject with.

Good luck and don’t hesitate to PM me if you need more specific help.

“it comes in little syringes with a rubber cap on it.”

HappyD seems they get it in pre-filled syringes.

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