T Nation

HRT and Implants

I just wanted to run this scenario through for everyone and to get some opinions.

The patient: 35 yr old male with androgen deficiency

ART: utilize testosterone implants to bring back to high normal range for a male of that age.

ART establishes a baseline level much higher than the patient had before and removes the symptoms of decreased libido, poor concentration etc.

The question is would this person get increased estrogen production (from aromatization of test) and require anti-estrogen trt if at the high range of normal test levels for a male of that age?

[quote]m0b1liz3 wrote:
IThe question is would this person get increased estrogen production (from aromatization of test) and require anti-estrogen trt if at the high range of normal test levels for a male of that age?
[/quote]

I found an answer to the above question after searching a little:

“Many on HRT will not develop an estrogen problem. The only way to know is to do the TRT and then watch for effects as well as doing blood work that also includes estrogen levels.”

It makes sense that this would be relatively random since developing an androgen deficiency is not exactly predictable either.

I suppose the next line of questioning would be would there be any need for HcG if someone on TRT did a cycle or would it all be pointless since the baseline of test would always be maintained?

HCG: It might not be pointless if the patient does not want to become infertile of have shrinking nuts that also might then be painful. The HCG, at 250IU EOD will preserve the baseline production. If LH was low, the test production might be significant. If LH had been normal and the testes were low producers, the HCG might not lead to much T production. HCG improves mood for many; perhaps directly or indirectly via increased T. If one has to self inject HCG, why not self inject the T?

Estrogen problems: Gyno is one thing, optimal levels are something else again. Much will depend on the %BF. Alcohol and smoking make this worse. T should restore nocturnal wood. The absence of morning wood may be an indicator that E is too high. In that case, try arimidex and morning wood may begin in a week or so. When morning wood returns, libido should be significantly improved.

I think alot of what determines that is what preexisting levels where at as far as estrogen goes. If your pre-existing levels were in the shitter, say below 200, and your not dosing any more than say, androgel 5 or maybe test at 100mg per week, you May be able to get away without an anit estrogen, at least for awile.

But if you like your balls, and want to keep them, your going to have to use hCG. and with hCG use, especially combined with any Test, your going to need an anti-E anyways.

Aside from that, as you age, say past 50, estrogen will probably become an isssue anyways. Blood results is the best indicator.

Bottom line - hCG is a cool little drug anyways, why not jump in :wink:

[quote]m0b1liz3 wrote:
m0b1liz3 wrote:
IThe question is would this person get increased estrogen production (from aromatization of test) and require anti-estrogen trt if at the high range of normal test levels for a male of that age?

I found an answer to the above question after searching a little:

“Many on HRT will not develop an estrogen problem. The only way to know is to do the TRT and then watch for effects as well as doing blood work that also includes estrogen levels.”

It makes sense that this would be relatively random since developing an androgen deficiency is not exactly predictable either.

I suppose the next line of questioning would be would there be any need for HcG if someone on TRT did a cycle or would it all be pointless since the baseline of test would always be maintained?
[/quote]

One of the problems with injecting test is that the levels are all over the place depending on the schedule you are on. Implants provide more steady levels but as I search through these pages I am not seeing many people using implants and I wonder why this is?

[quote]m0b1liz3 wrote:
One of the problems with injecting test is that the levels are all over the place depending on the schedule you are on. Implants provide more steady levels but as I search through these pages I am not seeing many people using implants and I wonder why this is?

[/quote]

With weekly or longer injections you are correct. With more frequent injections that is not the case. The injected testosterones are mostly testosterone esters. That makes them soluble in oil. The solution is injected into muscle and the oil is slowly absorbed and the release T esters are converted to T. That is a time release mechanism. I inject test cyp EOD with my HCG EOD.

The rate of release from implants will not be rock steady and some fade can be expected during the life of the implant. But I agree that that might be better than weekly injections.

If you want or need to preserve the testes for fertility reasons, you will need to inject HCG. If one were to do that, then test injections EOD would be a logical choice and the least costly as well.

I think that implants are a better way to go than both weekly injections and gels due to the fluctuations in levels. However you are right that the levels do decrease over the 3-6 month period. Perhaps implants + gel in the later months would be the most convenient method. EOD injections seems like too much effort.

TRT becomes a serious hassle if you are in a job that requires overseas travel (or if you vacation alot).

[quote]m0b1liz3 wrote:
I think that implants are a better way to go than both weekly injections and gels due to the fluctuations in levels. However you are right that the levels do decrease over the 3-6 month period. Perhaps implants + gel in the later months would be the most convenient method. EOD injections seems like too much effort.

TRT becomes a serious hassle if you are in a job that requires overseas travel (or if you vacation alot).

[/quote]

I agree with the travel part if you have HCG which needs to be refrigerated. If you have injectable test and the box with the script info, you will have no problems with customs etc.

If you are wanting to keep your testes from shrinking… you need to be injecting HCG in any case. The best info that we have is to inject 250iu EOD. So if you are injecting EOD for the HCG, injecting test cyp at the same time is not an issue at all.