T Nation

Help with HRT Protocol from Clinic...

Finally managed to find a place listening to concerns over testicular atrophy, ache, health etc. Unfortunately it was a clinic and felt a bit like a candy store… Was hoping you guys could shed some light on their protocol and see if it needs some more tweaking to be closer to the norm or if i should follow as directed…

Most recent lab work: Pre-t shows blood work done the day I started HRT before Tx with Test-Cyp 200mg IM E14D/2 weeks and Nadir which shows my Nadir point taken 4weeks after starting Test on my last day before my third shot which subsequently caused my urologist to increase my dose to Test-Cyp 200mg IM E10D. After the change in does I began taking 120mg every 6 days since that works conveniently with my work schedule and split the does into two smaller does…

Pret initial labs: 4/24/12

Total Test: 326 (250-1100) ng/dL
Free Test: 70.7 (35.0-155.0) pg/mL
LH: 3.2 (1.5-9.3) mIU/mL
FSH: 4.3 (1.4-18.1) mIU/mL
Estradiol: 18 (11.0-44.0) pg/mL
Progesterone: 0.65 (range missing) ng/mL
Prolactin: 4.6 (2.1-17.7) ng/mL

Nadir Labs: 5/23/12

Total Test: 322 (348-1197) ng/dL
Free Test: 9.2 (8.7-25.1) pg/mL
LH: 0.1 (1.7-8.6) mIU/mL
Estradiol: 24 (3-70) pg/mL
Progesterone: 0.7 (0.2-1.4) ng/mL

After seeing this labwork as well as some other older lab work regarding thryroid hormones and trending they prescribed me with:

300 mg test cyp every friday

250 IU HCG every wed and thurs

0.5 mg anastrazole saturday and wednesday

Progesterone 100mg nightly for sleep due to low progesterone

and changed my hypothyroid medication from 75mcg synthroid every day to Amour thyroid 60mg BID.

On the surface seems great, they prescribed everything I could hope for and dug through old lab work and addressed my thyroid issue which I had wanted to change as well as progesterone which I wasn’t even aware of. That being said am I wrong in feeling that 300 mg a week is way too high?

Dr. mentioned increasing my dose from their standard 200mg weekly to 300mg since my nadir point was so low after test therapy started and I was on too low of a dose for therapeutic benefits.

Any help would be greatly appreciated as well as possible suggestions for working this regimen out on an more shift friendly schedule. I work 24 on and 48 off and injecting on shift days are something i’d like to avoid if possible.

Thanks in advance!

Would this schedule sound more feasible?

Day 1: 100mg Test Cyp
Day 2: 0.5 mg AI
Day 3: 125 iu HCG

repeat…

I have never seen anyone need 300 mg/week for TRT.

Your May labs were taken probably after 10 days right? Well, I hate to break it to you but if thats the case, then those labs are useless. Your protocol of every 10 days is silly (need 2x/week minimum injections to maintain steady levels) and the labwork after 10 days shows nothing more than your trough levels.

Get on a more sensible protocol and test halfway between injections.

[quote]VTBalla34 wrote:
I have never seen anyone need 300 mg/week for TRT.

Your May labs were taken probably after 10 days right? Well, I hate to break it to you but if thats the case, then those labs are useless. Your protocol of every 10 days is silly (need 2x/week minimum injections to maintain steady levels) and the labwork after 10 days shows nothing more than your trough levels.

Get on a more sensible protocol and test halfway between injections.[/quote]

That was my feeling exactly regarding the 300. I thought it was an insanely high amount…

As far as blood work goes, even worse, they were taken on day 13 of the 14 day cycle. Obviously I know they’re worthless and mentioned it to the clinic. They seemed like the understood and while they mentioned weekly injects they said they didn’t mind how I split doses if I didn’t mind the injections. The 10 day thing wasn’t my protocol, chock that up to another worthless urologist. I simply took his dosing 200/10D and injected 120/6D on my own which worked out decently.

How does this sound as far as sensible with access to what I presently have…

Day 1: 100mg Test Cyp
Day 2: 0.5 mg AI
Day 3: 125 iu HCG

repeat…

As far as blood work goes if I stuck to the E3D test rotation with the ancillaries above would I have blood drawn the morning of Day 3?

Would cutting the HCG dose be beneficial or should i stick to the 250iu E3D/ 500 a week? I’ve heard from a few people the goal with HCG is smallest dose possible to restore testicular size as a proper indication of testicular function. Any thoughts on that? Thank again for everything…

Play around with the hcg dosage until you find a dosage that works best for you…yes the goal is testicular size and symptom abatement.

Your proposed protocol still gives you 200+ mg/week of test plus your natural production from the hcg (were you primary or secondary hypogonodal?). That is a shitload. I am 290 pounds and 200 mg/week (no hcg) has taken me into the very top of the Total T range, and a bit over the Free T range. I would be surprised if you need that much.

[quote]VTBalla34 wrote:
Play around with the hcg dosage until you find a dosage that works best for you…yes the goal is testicular size and symptom abatement.

Your proposed protocol still gives you 200+ mg/week of test plus your natural production from the hcg (were you primary or secondary hypogonodal?). That is a shitload. I am 290 pounds and 200 mg/week (no hcg) has taken me into the very top of the Total T range, and a bit over the Free T range. I would be surprised if you need that much.

[/quote]
This is good trt protocol but a chop chop cookie cuter operation. Any dr makes all those changes at one time should have their head examined. The p otential for.you to do major damage is significantly increased by changing to.many.things at.one.time. You be making.some one very rich. Would have started out at 40-50 mgs 2 times a week. It may have reduce the need for an AI. HCG could be added in later when T and e2 are stablized.
You need to do things in layers not a crap shot. PRotocols I use with Dr are pretty much same, but there are alot of other issues which are being addressed and evaluate then most medical professionals. TRT protocol for more part 40-50 mgs (2 shots per week) T for 5 week no AI then remeasure. If e2 is high then add AI then retest in 3 weeks. When e2 stable for 6 weeks then add in HCG 100 ius 2-3 times a week to start then remeasure e2. If e2 goes up really high. Dump the HCG to 50 -100 2-3 times a week just to keep LH receptors alive.

[quote]VTBalla34 wrote:
Play around with the hcg dosage until you find a dosage that works best for you…yes the goal is testicular size and symptom abatement.

Your proposed protocol still gives you 200+ mg/week of test plus your natural production from the hcg (were you primary or secondary hypogonodal?). That is a shitload. I am 290 pounds and 200 mg/week (no hcg) has taken me into the very top of the Total T range, and a bit over the Free T range. I would be surprised if you need that much.

[/quote]

Based on initial labs of lh and fsh I believe I am primary. My natural T produc ton during the year I waited for my primary to treat me ranged from 197 to 325 while other hormones stayed within middle to high normal of reference ranges used.

I agree that 200 sounds like a lot to me as well. 300 seemed astronomical. I am 220 and incredibly active with work and lifting. I’ve been on everything from the popular 200 e14d to 120 e6d and now 100 e3d. Not sure where a good place to start would be but can reduce back to 60 e3d if that makes more sense to start with the HCG addition. I know blood work if the best way to tell. I don’t want to get labs back and find out I’m cruising at 1600 or anything haha. Thanks for your advice.