T Nation

High Dose Everything


#1

Hi everyone, new TRT patient here. I sought out a clinic because I’ve been having several symptoms for the last several years ever since I had severe complications from a vasectomy, but what finally spurred me to action is the extreme difficulty I’ve faced with attaining/maintaining gains, and fat gain. Poor sleep, lack of well-being, decreased libido, soft erections have all become pretty normal for me. I just assumed I was getting old (I’m only 30, about to turn 31). Testes ache a lot, ever since my vasectomy. Ejaculation is very painful, and gives me a kicked-in-the-nuts feeling.

I’m 5’10", 208lbs, about 22% BF, 38in waist at the love handles (I’ve always very been thick around the middle, even when I had very visible abs). I was at 26% by BodPod, and lost 8lbs recently. I just had a major shoulder surgery, and started watching my diet better to counteract the lack of exercise. My training history has been intermittent for about the last 15 years, with countless changes in priority mostly due to military service. Through it all I’ve always considered myself a powerlifter, but more recently have taken an interest in “looking like I lift” so I’m interested in more hypertrophy training and wanting to lose some fat. To be clear, I won’t be able to do any upper body training for the next 5 months.

Anyway, I saw a clinic, got some tests done, which I’ll post below, and was prescribed what seems to be a very high dose of everything:

test-c 210mg/wk
adex - 2mg/wk
hCG - 2000iu/wk

Apparently the high dose of hCG is also supposed to help me with fat loss initially, but the other two seem to be high as well, which honestly I don’t mind. 210mg test-c per week and 2mg of adex. I know most will say that is very high by TRT standards, but I feel really good so far, and barring and complications (which as of now are zero) I might plan to stay on this dose indefinitely, especially if it will make a desirable body comp. a little more attainable.

I’ve been on for nearly two weeks now. Things I’ve noticed so far:

a) Sleep is better. I still have trouble falling asleep, but once asleep I sleep like the dead and wake up like flipping a light switch. No more groggy laying around feeling sorry for myself for an hour trying to wake up.

b) Boners completely ceased for about the first week. Now they are back with a vengeance and I can get hard like it’s my f$#@ing job.

c) Appetite has decreased slightly. Hunger pangs don’t happen until much later in the morning than before if I go without breakfast. I still need to adjust my food intake and break the habit and/or mental addiction to eating when not hungry.

So far I’ve experienced no side effects. I’ve never taken hair loss drugs, though I have had thinning hair in the front for years; don’t care. I never get acne. No issues with aggression or mental instability. I take blood pressure meds, for what i can only assume is hereditary hypertension. I say assume because I was adopted and don’t have a family medical history, but I’ve had hypertension since I was very young. Back when I was single digit bodyfat and played sports year round.

I just wanted to start this thread to document my condition and progress, to get advice, and hopefully help someone in the future who has a similar situation. I know the “clinics” are known for prescribing high doses, and to be honest that’s exactly what a lot of people want, including myself. I’ve considered AAS for years, but never wanted to break the law and put my career or family’s financial well being in jeopardy. Personally I think they should be legal for grown a$$ people to decide what to do with their own bodies, but a high dose TRT prescription may just be the next best thing for me. Who knows, maybe I will try 100mg/wk someday and see how I feel but for now I’m doing as prescribed and giving it at least 6 months before I reassess.

I know I need to get LH, FSH, a sensitive E2 assay, prolactin, etc. but here are my initial bloods. Followup will be in 6-7 weeks.

TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB
CBC With Differential/Platelet
WBC 6.1 x10E3/uL 3.4 - 10.8 01
RBC 4.80 x10E6/uL 4.14 - 5.80 01
Hemoglobin 15.2 g/dL 12.6 - 17.7 01
Hematocrit 44.3 % 37.5 - 51.0 01
MCV 92 fL 79 - 97 01
MCH 31.7 pg 26.6 - 33.0 01
MCHC 34.3 g/dL 31.5 - 35.7 01
RDW 12.8 % 12.3 - 15.4 01
Platelets 289 x10E3/uL 150 - 379 01
Neutrophils 45 % 01
Lymphs 44 % 01
Monocytes 8 % 01
Eos 2 % 01
Basos 1 % 01
Neutrophils (Absolute) 2.7 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 2.7 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.5 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Comp. Metabolic Panel (14)
Glucose, Serum 86 mg/dL 65 - 99 01
BUN 9 mg/dL 6 - 20 01
Creatinine, Serum 1.00 mg/dL 0.76 - 1.27 01
eGFR If NonAfricn Am 101 mL/min/1.73 >59
eGFR If Africn Am 116 mL/min/1.73 >59
BUN/Creatinine Ratio 9 8 - 19
Sodium, Serum 139 mmol/L 134 - 144 01
Potassium, Serum 4.4 mmol/L 3.5 - 5.2 01
Chloride, Serum 98 mmol/L 97 - 108 01
Carbon Dioxide, Total 24 mmol/L 18 - 29 01
Calcium, Serum 9.5 mg/dL 8.7 - 10.2 01
Protein, Total, Serum 7.3 g/dL 6.0 - 8.5 01
Albumin, Serum 4.6 g/dL 3.5 - 5.5 01
Globulin, Total 2.7 g/dL 1.5 - 4.5
A/G Ratio 1.7 1.1 - 2.5
Bilirubin, Total 0.5 mg/dL 0.0 - 1.2 01
Alkaline Phosphatase, S 55 IU/L 39 - 117 01
AST (SGOT) 34 IU/L 0 - 40 01
ALT (SGPT) 60 High IU/L 0 - 44 01
Lipid Panel With LDL/HDL Ratio
Cholesterol, Total 175 mg/dL 100 - 199 01
Triglycerides 73 mg/dL 0 - 149 01
HDL Cholesterol 55 mg/dL >39 01
Comment 01
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 15 mg/dL 5 - 40
LDL Cholesterol Calc 105 High mg/dL 0 - 99
LDL/HDL Ratio 1.9 ratio units 0.0 - 3.6
Please Note: 01
LDL/HDL Ratio
Men Women
1/2 Avg.Risk 1.0 1.5
Avg.Risk 3.6 3.2
2X Avg.Risk 6.2 5.0
3X Avg.Risk 8.0 6.1
Thyroid Panel With TSH
TSH 1.010 uIU/mL 0.450 - 4.500 01
Thyroxine (T4) 9.4 ug/dL 4.5 - 12.0 01
T3 Uptake 30 % 24 - 39 01
Free Thyroxine Index 2.8 1.2 - 4.9
Testosterone ,Free and Total
Testosterone, Serum 302 Low ng/dL 348 - 1197 01
Comment:
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) 12.5 pg/mL 8.7 - 25.1 01
Estradiol 19.6 pg/mL 7.6 - 42.6 01


#2

I’m no expert but I would check estrogen a little sooner and see if you need the arimidex. You probably do, but there’s no reason you can’t go blow $45 at privatemdlabs.com (add their facebook account and they give you a code for 15% off) and get an estrogen test. That seems to be the one thing that makes or breaks the experience for guys.

I’m sure others will have plenty to say about the rest of your post!


#3

You thinking I might not need the adex? Or need a lower dose?


#4

Well first off - your arimidex dose is pretty high. I think normal dose is 0.5 to 1.0 mg per week.

Second consideration is that it may not be needed at all. But probably will.

That means - its good to have it on hand, because you don’t want your estrogen going too high (above 28). But at the same time - Estrogen is always the big “question mark” in situations like these. It may not rise at all. It might be perfectly fine where it is. Or it might go high.

Doctors typically have no clue about actually monitoring a patient during a regimen. They’ll just prescribe like your guy did, and send you on your way for 6-8 weeks without another thought.

My suggestion was to do your regimen (with or without the arimidex) for a week or two, then simply run an estrogen test to see where it’s at. If its getting high, consider 0.5mg to keep it normal.

Im more into micro-managing situations like this because i consider it a far more intelligent approach to test, tweak, retest, tweak … than to just throw caution to the wind, and shovel pills. This is a balancing act, and estrogen is the most sensitive and important part of it that needs to be balanced.

I’m mostly just thinking out loud, and will let the smarter guys here chime in to correct me or confirm. But this is the approach I would take.


#5

I believe Adex is dosed at 1mg per week per 100mg of test, not positive, but that would put your adex script in line.

However - you still want to get tested. I take no adex on 140mg per week and my estrogen is usually a bit low. Everybody’s different, you might need more, you might need less, only blood testing will tell.


#6

Yeah from what I’ve seen in the Pharma forum, some guys prefer less adex than I’m using even for 500mg/wk or more of test. I guess I’m just going to have to figure it out by trial and error.

Krands I don’t believe in just shovelling pills and throwing caution to the wind either, I was just under the impression that given the long ester of test, it would take a while for downstream hormone levels to stabilize. I was planning to wait the 6 weeks because I figured that is how long it would take for my levels to stabilize based on overlapping half-lives of the T injections. If you think it’s worth checking E2 sooner I will give it a try.

One major concern I have is letting my joints get dry and achy from low E2, especially my knees. I’ve had cranky knees for years which seem to correlate with how many hours per week I spend sitting in a chair. When I go on vacation for a week or two and don’t sit much my knee pain completely disappears. When I go back to work they get noticeably hot to the touch and painful enough to affect my workouts. I work a desk job and I’m in grad school, so I spend 60-70hrs per week seated at a computer. I’ll be done with grad school middle of next year, and until then I need my knees feeling as healthy as possible.


#7

You’re right - it does take several weeks sometimes to stabilize. Reality is if something’s amiss, you’ll know it within a couple weeks. I rarely go more than 1.5 weeks on a new regimen before I settle into what I know will be my “new groove” … and waiting 6 weeks to check it just annoys the crap out of me because I know its not going to be any different. You know your own body though. Check it when you think you’re at your new plateau maybe. And then again at 6 weeks if funds allow. Or just do it at 6 weeks. If you’re miserable though - that’s a good time to check too. Might be the “E” and you can adjust.


#8

Please follow and read these stickies in 2nd post of 1st forum topic:

  • advice for new guys
  • things that damage your hormones
  • protocol for injections

We typically see clinics pushing 200mg T per week.
Are they selling you the drugs directly ?$?

High dose T risks high hematocrit and RBC.

That amount of anastrozole might work; if you are a normal anastrozole responder.

There is no need for that much hCG. Your high T levels will lead to fat loss if you manage E2 near E2=22pg/ml.

250iu hCG SC EOD is adequate. You are not looking for testicular production of T.

You will need more protein.


#9

Thanks KSman. I’ve read those stickies a couple of times, and noted.

They are not selling to me directly, but seem to have an arrangement with the pharmacy.

I will keep an eye on hematocrit and RBC, and adjust accordingly.

Regarding E2. You mean as close to 22 as possible, or below that level?

I’ve been told by several people now that the hCG is too high. Will probably drop by 50%.

Thanks guys!


#10

E2=22pg/ml with high-normal TT and FT seems to be the best balance of:

  • libido
  • emotional calmness
  • fat loss
  • energy

This applies well to almost everyone. However, there are two guys here who feel a lot better with higher E2 levels. Not everyone is wired up the same and recommendations cannot cover all possibilities.


#11

Out of curiosity, how much lower than that do people typically tolerate well?

I was at 19.6 prior to TRT, and I know guys here in the TRT forum seem to think that 1mg of adex per 100mg of test is likely appropriate, but I wonder how many are speaking outside of their range of experience in reference to higher doses, because over in the Pharma forum and other sites guys who are taking 600mg/wk and above regularly report successfully controlling E2 with adex doses like 0.25mg EOD.


#12

I think it’s hard to have exact prescribed doses when it comes to managing hormones. Each person is different. A 55 year old guy with a huge gut and sedentary life style can’t possibly be the same as a 35 year old guy in good shape. Also, each of comes to this with different TT, FT, E2, SBHG, etc.

Seems like the protocol talked about here should be a guideline. After that, tweeting should be based on symptoms and lab work.


#13

My recommendations are part of a cycle of labs and dose corrections. Guys need to start somewhere. What I suggest works well for most guys. The exception is the anastrozole over-responders and there is not way to know about that in advance.

If guys do the recommended reading, they should be aware of all of the details.

Unfortunately, this forums “About T replacement” sticky has vanished and we now have a ship without a compass or a rudder.


#14

KSman I appreciate your recommendations and I did read all the posts you recommended multiple times and did absorb the information therein. That still does not excuse me from the need to be inquisitive and ask questions. This is a major change in people’s lives and as such we feel the need to question advice and talk through things to make sure we truly understand what is going on.

It doesn’t help that I’m an analyst by trade and question things by my very nature. I’m only two weeks into TRT and am just now approaching the time when it would be appropriate to get tests re-done and re-evaluate. I’m not asking you to rehash things you’ve probably already said a million times to other people. I was just interested in the potential effects of low E2 because of the conflicting information I’ve seen elsewhere, and the fact that my dick stopped working for the first week of my TRT. It’s now been two weeks and unless someone objects I think it’s been long enough to get another blood test done and see what’s what. I appreciate your patience.


#15

I think everyone here is very appreciative of all the work and time some of the senior forum members put into making this the best site on the net.

For me, I tried the exact protocol for 8 weeks with almost no change in the way I was feeling. My doc had prescribed 200mg/wk right from the beginning. So I started injecting 100mg twice weekly and really have noticed lots of improvements in a few weeks. I will confirm my numbers with labs soon. But at this point it’s going in the right direction for me.


#16

E2 that is too low or too high will mess with sexual function.


#17

I don’t want to hijack this thread…

So, if my libido is really high and I’m having morning wood everyday and having no problems getting or maintaining an erection can I assume my E2 must be in the right range?


#18

NASH:

Yes, or at least good for you.
But that is all relative, could be a better level perhaps.


#19

Just a quick update for record-keeping sake…

Ordered labs early as advised. Getting them drawn on Thursday. I know the sensitive E2 assay is recommended, and I will do that in the future, but for this one I want to have an apples to apples comparison with what my levels were before, so I’m having the same tests done at the same lab as pre-TRT.

With that out of the way, I did notice some oily skin at first, which disappeared after about the first week. I also noticed my dick stopped working for about the first week then slowly came back online. Night boners are back at teenage levels. Pretty sure I pitch a tent in my sleep the entire night now. That hasn’t happened in years. It’s pretty subtle but I might be sleeping a little better than before. My energy levels are not bad, but highly dependent on my sleep (obviously), but that is something I’ve had problems with for as long as I can remember and didn’t expect TRT to make much of an impact on.

Oh one last thing - I gained about 8lbs when I first started and am just now getting back down to pre-TRT weight. Hoping it continues to get better from here. That’s all for now. I’ll update when I get latest blood results.


#20

Labs are in.

TT/FT is at 2645/37 on prescribed dose. Yeah, astronomical for TRT, I know. Gonna cut my dose in half on everything then retest in 3-4 weeks.

E2 is 17.5, just barely lower than pre-TRT level, and I feel pretty good.