Is This TRT Protocol Overkill?

I live in Europe and went to multiple doctors due to low T. After multiple interventions that didn’t really help (losing 20kg, more sport, etc.) I talked to some doctors who wanted to give me TRT. Here where I live the current regimes are quite conservative however. Low dosed testogel or test injections every three weeks were the only options I was presented.

Now I found a doctor who was more open to other options however, yet I am bit unsure about him. He prescribed me this:

20% testosterone creme every morning
DHT 20% cream every morning
Mesterolone 50mg every morning
DHEA 50mg every morning

I checked online and saw that most people really only get the normal testosterone cream or injections. This seemed a bit overkill to me. It’d be nice to hear from some people with experience however.

Thats far from a replacement protocol. Not sure why you would get started on DHT cream plus Proviron (Mesterolone) at the same time or at all. DHEA supplementation is fine if you’re low but I would start lower than that dose. What do your pre-HRT labs look like?

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Here’s my pre-HRT blood work. This has not changed much over the last two years. But these are the last results:

Testosteron: 1,92 ng/ml
Free T: 2.99%
SHBG: 14,3 nmol/l
TSH: 2,64 mlU/l
Prolactine: 11,9 ng/ml
Red Blood Count: 43%

I had no DHEA checked. So I am bit unsure about why this was offered here either.

Exactly. Why supplement with something you are not deficient in? That includes the DHT etc. I would ask if you could just start on the T-cream / T-gel until you take follow up labs. Explain you want a conservative approach until labs dictate the need for further medicine.

Once your T levels are up, your DHT will increase as well. I just don’t see why you would supplement at this point.

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Any thoughts on the 20% cream? Is that an okay dosage? I want to go to injections eventually but he said to go with the cream first.

I am quite scared of potential cardiovascular side effects. At the same time, I’ve been feeling like shit for multiple years now and all previous interventions have had no positive effect.

You haven’t told us what the dosage is. My 20% cream is 200 mg/mL and I applied one click or 50 mg. I could apply 10 times that and never achieve therapeutic levels.

You’re right! Sorry about that. Here’s what the cream says: 20% 35ml. I was ordered one pump per arm in the morning. (It does not say more than that.)

Edit: 200mg

That’s still not a dosage.

Sorry, the packaging itself wasn’t all that helpful. Had a call with the pharmacy, it’s 200mg/ml.

My T cream dispenser turns and every click is 50 mg, so four clicks is 200 mg. I’m not familiar with Testogel.

If I had to guess, I would say you’re on 100 mg, 50 mg per arm.

DHEA starting dose is way way too high. Start low and adjust up based upon labs and symptoms. Only supplement DHEA if there is a deficiency!

Difficult to say with the 20% T cream. How many mg are in an application (pump)? That will determine the daily dose, but you cannot compare topical dosages with injectable dosages due to differences in absorption between people. About the only way to determine if this is a good dose, is by lab tasting after you get to a stable level. For most folks, topical applications do not get nearly the same response as injectables.

Unless you have labs to indicate that you are low on DHT, I would not start down this road. There are notable side-effects of high DHT (BPH, Hair Loss, Excessive RBC production, etc.). My recommendation would be to get to a stable dose with the T cream and then test your DHT and that will determine if you need more. Keep in mind that elevating T will also elevate DHT, which is a metabolite of T.

I have no experience with Mesterolone. Not even sure what it’s use is supposed to be. I’d need to research it more.

50mg DHEA is a good standard dose for guys on TRT. I do 25 mg daily, but I also use HCG, which allows the testicles to produce it’s own DHEA.

The differences in lower extremities in lean muscle mass between topicals and injections is noticeable. Injections wins in this department.

If you have subpar DHT on injections and don’t absorb enough of the topicals, if you’re lucky enough to have insurance cover Jatenzo (only available in USA), DHT will be higher on Jatenzo.

I talked to the pharmacy again and it’s the same scheme here. 50mg pro click basically. Can I ask you where you apply it? Doctor said inner wirst up the arm but I hear some people doing on the scrotum or legs or on the sides to their rip cage. So would love to know what you think.

I went to get my cardiovascular system checked today and all is fine, so I will start the treatment tomorrow morning, but will leave out DHT and Mesterolone for now as people here don’t seem to consider it necessary and doing research online I also haven’t found any place where anyone actually made a good case for it.

I was told by Empower Pharmacy (in USA) to apply the T cream to the inner thigh and not the scrotum, and as a last resort scrotum application. The wrist and arm application risks transfer to others.

I tend to sweat more on my arms which versus my thighs. The last thing you want is to sweat at the area of T application.

Topical applications see the highest DHT levels versus injections and orals.

How quickly are you allowed to shower, e.g. wash off that area?

According to the Mayo Clinic, 2-5 hours depending on the percentage of Test, the higher the percentage, the less time you have to wait to shower or swim. That may including going to the gym as well, because you’ll sweat it off.

That would put a hamper on my lifestyle.

I’ll be trying for 2 months. If it doesn’t get me any results, I’ll switch to injections, I think.