T Nation

Is This The Correct Startup TRT Protocol?

42 year old male, overall healthy, 6’1”, 196lbs with 17% BF. My Doc wants to start TRT on me to optimize my Test levels to help me with my low energy and low libido. She prescribed 100mg of Test-Cyp to be injected once per week. She did not prescribed Arimidex nor HCG. She said that I’m lean enough and the dose is small enough that she’s not concerned. She wants to see lab work first in 6 weeks and then adjust. I read the pinned post on TRT and this worries me a bit. Should I start the protocol without the Arimidex and HCG and see what happens in 6 weeks? I actually wanted to SC twice a week instead of what my Doc is recommending. I read it releases better into the bloodstream and also that it doesn’t aromatize as much as IM. Is this true? If it is, maybe I won’t need the Arimidex.

Your endo is likely a little behind on TRT protocols, once weekly shots still cause high and lows and labs are more a result of timing than what’s actually going on. You’re not going to dial in on weekly shots, your levels will fluctuate too much. I’m on 100mg weekly and do to my low SHBG I require shots EOD, twice weekly wasn’t enough. If you have no clue what your SHBG is, then how are you supposed to know how many shots per week you require? Guessing?

Your endo likely has little experience prescribing TRT, this is typical. You need to educate yourself and take things into your own hands if your doctor doesn’t listen to your concerns, inject more often.

Thanks for the reply. She did check my SHBG, but didn’t say anything about it. Here is my number:

SHBG 29.3 (16.5-55.9 nmol/L)
Estradiol (sensitive) 21 (8.0-35.0 pg/mL)
PSA 0.7 (0.0-4.0 ng/mL)
AST 21 (0-40 IU/L)
ALT 23 (0-44 IU/L)

It is within the range, but I don’t know what that tells me about frequency of shots. I will look into it.
Also, she has me on 81mg aspirin during the treatment. Is that necessary?

Your mid range SHBG is probably ok for once a week shots. I have done both and honestly feel no difference. Guys with low SHBG need to pin more often, even EOD. I would agree with your doc and see how you respond before adding AI. Most need it but some don’t and you can crash your E2. See what your 6 week labs look like and post them.

I would highly recommmed to shoot twice a week. So every 3.5 days at 50mg. Example Monday morning then Thursday evening is the protocol I’m on. Do not start with arimedex/E2 blocker wait for your first results and adjust from there. The only thing I’m not a fan of is the lack of HCG. I do believe it’s nessary to minimize testicular atrophy. I shoot mine twice a week right after the test shots

Would starting Test without the HCG set me back too much in 6 weeks? That’s when my first blood work is on TRT. My Doc did tell me that if anything comes up between now and then, that she will re asses me and do labs earlier to add HCG or/and Arimidex. At least she is willing to do it, just not right now until she sees how I respond to the TRT.

Not sure, I was told by my doc once you can go for up to 2 weeks without HCG before you start noticing symptoms. Try it out but if your testicles start to ache or become smaller then it’s time to hop on the HCG.

I will do that for sure. I’ll keep an eye on those bad boys. Good thing I’m done with kids though. So not too concern about fertility. I already have a vasectomy anyway. But the shrinking and pain, doesn’t sound too good.

I dont see an issue starting first and see where the lab works comes back in six weeks. If your doctor is willing to review based on the data then I do not think the argument is worth having. Six weeks without HCG is not a big deal. Also HCG only provides benefit if you are secondary, I did not see where you mentioned if you are secondary or primary.

I never got my LH or FSH levels checked. My doctor called it Andropause, however. So I supposed that’s primary since it is the testis reducing the production of testosterone.
I did my first injection on the 14th and so far so good. Doing a weekly injection of 100mg of cypionate. Didn’t feel anything the first day, but by Friday I was more energetic. Nothing dramatic though. Today I still feel good and no issues with my testis. Next injection tomorrow. Labs will be done at 4 weeks actually. Still not sure about taking the 81mg of aspirin daily. I rather go donate blood depending on my labs.


Weekly injections won’t cut it, you need to inject at least twice weekly to avoid the peaks and valley between injections as you will feel low by the end of the week the more time passes. Your doctor sounds like a moron, never heard of anyone place on TRT with no LH or FSH tested. You’ll likely be forced off TRT at some point to look for a cause to your Andropause, insurance companies will demand it. Your doctor is failing you!

Some people do fine with weekly injections, personally I find them to do quite well. Without LH and FSH tested prior to beginning therapy one can not determine if you are secondary or primary. The treatment is roughly the same, just if you are primary HCG will provide somewhere between no and marginal benefit. Most doctors do not seem to test LH or FSH prior to treatment, just a repeated “low” blood test result on total test. An educated doctor would do the full panel to see what the root cause may be prior to beginning treatment.

Should I not inject the second injection and ask the doctor for the proper labs? Or is it too late now? So far I feel good. I’m due for the second weekly shot today. Thanks.

You’re likely going to experience a crash soon once your pituitary gland sees you’ve got plenty of test floating in the blood, when this happens you’ll know it. We call it the TRT honeymoon phase and it usually last on average 3 weeks, it will then take months to start feeling good again.

@systemlord is correct you will see a crash soon in that your FSH and LH will stop being produced in the pituitary gland. Some people feel worse than others. For many though because you are used to having low testosterone you do not notice a difference or a sort of hey, I feel like I did before I started. For many though if the body has been so used to low serum testosterone the receptors are not going to be all be activated to bind in the first place so it takes time to “feel” the benefits as your body begins to utilize the (exogenous) testosterone with greater efficacy.

Well, that would really suck. I’m felling good. I’m changing my protocol, however. I will start injections twice a week and going sub Q. I will update when I get my blood work next. Thanks for the responses.

I am on the same protocol as you and I stick to once a week (pardon the pun). SQ twice weekly 50mg is the recommended protocol here though.

Hi , first post ever . Being as it’s first time I’ll give some background. First off , I’m a 52 yr old man that’s a novice with trt. Any questions that you need to ask but I’m such a newbie that I probably won’t have much but make it my business to get it . About a year ago I went to urologist for ED . Came out of nowhere . He checked and couldn’t find anything except to say my T #'s were low … 216 . Went to another and was told the same . He said let’s put you on trt , it does good . Said ok … is it safe etc… yes it is … no problem why not . I also was tired and didn’t have much energy . Put me on 100mg every week of cyp… this was beginning of Sept, 17 … by Oct 17 I told him I felt like shit … Moody , tired , no sex drive etc… he said I don’t know why … your #'s are 673 . I said I felt better with my low numbers … what’s going on ? He shrugged and said I don’t know … so I left and came on here and was said over and over that one should split their shot , so I did . From what I read it seemed like my E2 levels were way to high . I felt that even more true because a sign was also sweating at night . So I split shots and felt abit better but not normal if you will. I went back and he said what do you wanna do ? I said shouldn’t you be running test to see how my levels are ? Said no… I said what about an E2 test ? He said I didn’t need one . Told him to take it now ( my blood ) felt like I was roid raging … so he did and I’m waiting on the results. I’m sure by tomorrow. I walked outta that office the last time . I have another well known Dr now that I’ll be see Dec 5 17 . I need to come in and make sure he will do the right thing as far as finding the right dose so that I can feel good and not like shit . Anyone can help ? Btw… I still don’t know I feel like crap but I’m thinking some level is high or low and the last Dr only looked at numbers and not harmone .
Thanks !

A lot of inexperience doctors believe TRT is just about giving a guy testosterone and only checking TT, it’s a huge mistake and a red flag your doctor isn’t knowledgeable enough to sort your hormones out.

Four week update. Changed to twice a week injections Sub Q. Injecting 50mg Test C in the Nelly. First injection was a disaster and got bruised up. The next 3 were better. I guess it takes practice. Sub Q is not bad at all. Painless once you get it right. It’s a small volume being injected (0.25ml) so its great. Using a 25ga 5/8” needle. I guess I could go smaller but it is a pain drawing the man oil out of the bottle. Still not using HCG nor Arimidex. I feel great, however. No issues and no peaks nor crashes. Getting labs next week and see. Since this is going to be a lifetime commitment, I have to make sure I get everything right and make it as convenient and painless as possible. On that note, has anyone here ever tried shallow IM? Or even injection HCG and Test in the same syringe doing shallow IM? It seems like a great concept. Thanks.