T Nation

I've Been a Passive Patient


#1

Okay, so straight off the bat here, I'm going to admit that I've messed up. I've been receiving TRT for around 2 years, and had always assumed that I should just be leaving my treatment in the hands of my doctor, as he would know best. The past couple of years have been particularly streseful for me, and if I'm honest, I neglected actively following my treatment in order to prioritize my other issues (largely because I assumed the doc's would be able to sort it.) During the 2 years, I have seen my T levels rise to normal levels, at which point I was taken off, only then to see them plummet again and thus have my treatment resumed. Having read around these forums and the stickies, I now know how foolish I've been, and that I've really only got myself to blame. With an appointment scheduled later this week with my doc, I want to be able to go back there and ask him questions based off my newfound knowledge; however, I would like some feedback as to whether my questions are suitable and whether I'm missing something...

Firstly, regarding bloodwork, I have thus far only ever received readings for Total T, prolactin, FSH and LH (even when on treatment- eeeesh...) I would like to request readings for Total T, Free T, E2 (particularly due to bodyfat storage tendencies) and for my Thyroid levels (TSH/fT3/FT4.) I would also like to ask about getting a results for DHEA, largely to rule out any possibility of adrenal fatigue (of which I have also been researching and seem to be displaying symptoms of.)

I would like to talk about the possibility of being prescribed a branded Aromatase inhibitor (if they are available in the UK?) Although I, as yet, have no bloodwork to back it up, I would be inclined to say that my E2 levels are increased, based off physical factors (e.g. bodyfat distribution.)

I have thus far been receiving a Testosterone undecanoate injection under the brand name Nebido, with an intramuscular shot every 12 weeks. I would like to ask about receiving subcutaneous injections in the form of a lighter ester (cypionate/ethanate) on a more regular basis, to avoid the fucking awful highs and lows from the undecanoate shots, as well as having a needle jammed deep into my asscheek.

I would like to enquire further about hCG shots, in conjunction with the Test. Although I'm a younger guy (22), I would like to be able to maintain a possibility of having kids in the future, and this (if I'm correct?) may help me counteract an increased liklihood of infertility.

I'm just basically looking for feedback as to whether or not I'm on the right track with things I should be approaching my doc with. I'm fed up with things not having been sorted, and furious with myself for my own lack of input into my treatment. If any of the more knowledgable posters around here have any pointers for me, whether I'm missing something or have too soon jumped the gun with something in particular, please help set me right!

Many thanks to those who have taken the time to read this!


#2

welcome on board

1) Get the right blood tests first if at all possible. Talking to your doc about possible treatment without any ammunition will get you laughed out of the office (or told to take an antidepressent).

2) you're in the UK, and from what I have read from multiple other posters is that you are screwed unless you can get care (out of pocket) outside of the national health system.

3) depending on your symptoms and depending on your blood tests results, your suggested treatment plan might make sense, but you need a good doctor who will work with you, the right tests, your actual results in your own hands, and a lot of personal reading and researching to be able to have an intelligent discussion/partnership with your doctor.


#3

Why do you think your current protocol is not working for you?


#4

To be honest, I really don't know. Before I started my TRT, I had been anorexic for over a year; I had gone to my GP a couple of times during this time before it was suggested I had bloodwork done for checking my Testosterone. For a while after I started TRT, I was still fighting my eating disorder- as I result, I only saw minimal increases in my Test levels. However, after I managed to get over the worst of it, sort out my training/diet and gain about 50lbs, my Test levels increased quite dramatically (whilst still on TRT.) As mentioned in my first post, I had been taken off treatment once I reached more normal levels and had been hopeful that I could maintain them at such levels, given that my eating was finally under control (from the stickies, I can see that eating disorders are cited as possible causes for low Test.) However, that wasn't the case, and my levels went right back down. My levels only seem to stay elevated when I'm receiving the treatment.


#5

so what is wrong with your treatment? did you not feel right on it? not everyone has to be on the super secret T-Nation protocol...thousands of men do just fine on standard ones


#6

In terms of how I felt, I would go through the highs and lows it seems that many people would experience with less frequent injections. Particularly near the end of the 12-week gap, I would tend to feel like complete shit in terms of everything from strength, to mood, to libido. Energy would sometimes take a dive, depending on what I was attempting to do physique-wise; in the last few weeks prior to my previous injection, I had attempted to drop a couple of pounds on a slight calorie deficit (250-500). Things went fine at first, but eventually my energy levels dropped so bad that one or two days I couldn't even get out of bed. I'm not going to point to my Test levels being the sole reason, but I would at least cite it as being a contributing factor. I'm also aware that many people do manage to make great progress whilst receiving standard treatment (why else would doctor's keep prescribing it?) but given the fact that, on the standard treament, my Test levels appear to be all over the place, and remain incapable of staying at a normal level once I go off treatment (*), I would like to consider other options to see if I may have more success.

(*) Also will point out that I have had an MRI done to rule out pituitary defects. Scans all came back clear, ruling out that liklihood. I have also been told that my diagnosis was of secondary hypogonadism, as everything was in full working order down south. Long story short, my doc can't tell me what's causing my low Test.


#7

Ok then it looks like you weren't doing well on your protocol...I don't think you mentioned this in your OP, but I may have missed it...

Since you were secondary, did you try a SERM restrat or hcg monotherapy prior to TRT? That probably would have been the best course of action.


#8

Sorry, I hadn't put that in my OP, so it's my bad.

I didn't try any other course of action before initiating the TRT. In all honesty, I didn't know any other options lay open to me... Really, I just left it to the doc to sort me out. It was only recently that I read up on some of the literature on this site and actually did some of my own research; I'm only just finding out that I could have followed the other protocols which you have mentioned.


#9

Following my appointment, I've come away from it with the following;

  • I have persuaded my doc to switch me from the Nebido (Testosterone Undecanoate) to Testosterone Enanthate. However, according to him, dosages are only available which will permit me to inject once every 4 weeks (3 weeks at the very least.)

  • I have questioned him about my previous bloodwork. Having only received readings for Total Test, I asked him about readings for Free Test. According to him however, nowhere here will test for it.

  • Bringing up the subject of Aromatase Inhibitors, he says he will consider putting me on them if my Estradiol levels come back elevated, although overall it's not something he's "too keen on."

  • He told me I would need no more tests for Thyroid function, as my previous readings have all come back normal. I asked him if he could test for DHEA-S; he said he would do so, but didn't know what we would be able to do if they didn't come back normal.

  • Having enquired about everything I could think of which may be causing my low Test, he has told me that it seems to be idiopathic. Nothing in my bloodwork seems to be suggesting a causitive factor, and my pituitary and testes are in full working order. In short, he doesn't know.

Does this look anything like a productive consultation? I know I've persuaded him to change my treatment, but I still feel a little lost.


#10

Testosterone Enanthate is different (supposedly longer lasting) compared to Testosterone Ethanate, but I am very leery of any drug maintaining "ideal" blood levels for that length of time. More than likely you would be overdosed the first week, within a good range for two weeks (hopefully), and underdosed for the last week.


#11

Huh?? As far as I know, these are the exact same thing--one is spelled correctly (enanthate) the other one isn't. If you have information to the contrary, I'd like to see it.


#12

I think Pure meant to say undecanoate is the longer lasting.

To watermelon sounds like this doctor is at least listening to you. I think he looks like a doctor you will be able to work with. These types of doctors are hard to come by if you don't live in the states. He also seems open to an AI if you need it. Maybe discuss with him that you would like to keep E2 below 30 and he might come to the party. But to me he sounds like if you will need an AI he will prescribe.


#13

That's what I thought too; Undecanoate is just a heavier ester, no?

I did feel that he was taking on board what I was saying- it wasn't as if he was trying to dissuade me from anything. There wasn't so much a disapproval of me going on the AI, but rather a preference to see if I could avoid having to use it, unless necessary. He did say he had a couple of guys on them, so it's definitely not ruled out; I just need to wait and see how my E2 levels measure up on my latest bloodwork


#14

Some articles suggest 1 injection every 12 weeks. Apparently the injection is 1000mg and that is good for around 12 weeks.


#15

I had searched around the site for "Testosterone Undecanoate" and found a couple threads. The main issue with it (from what I gathered) was that although the recommended time-gap was 12 weeks, the Undecanoate had a half-life which didn't extend that long.


#16

Which is why it is a ridiculous product and thankfully not approved for use in the U.S.

IIRC, the half life is about 20 days, so a 1000 mg shot every 12 weeks is going to send you from above range high to right at the bottom of the range, if you're lucky. But by gawd, you're in range and that's all these jokers care about.


#17

Which probably explains why I feel like shit these past two weeks, as I'm due my next shot any day now...


#18

Managed to get hold of some of my returned bloodwork results; my Mum's a nurse so was able to access the system instead of me having to wait for my doc to get back to me with them...

Total Testosterone (since they don't measure for Free Test);
6.9 nmol/L (which I think converts to around 199 ng dL)

Estradiol-17B;
Less than 50 pmol/L (didn't give any specific number as a result)

I'm unsure of ref. ranges for the Estradiol, so don't know whether it's high, low, or right where it should be. Anybody help me out? However, I know the Testosterone is still pretty fucking low... Still waiting for my DHEA-S reading to be returned.


#19

Following some advice given to me from members of another forum, I wanted to bring it up here to see what anybody thought...

It has been suggested to me that I should consider ending my TRT and begin some form of Post-Cycle Treatment, with a combination of a SERM (preferably Nolvadex), an AI (preferably Aromasin), and hCG; hCG to stimulate the LH mechanism to increase testosterone production and limit shutdown, Nolvadex to increase the amount of LH to continue the mechanism after the end of hCG, and Aromasin, to help fight off the catabolic effects of estrogen by destroying the enzymes that cause aromatization, and also to further increase natural testosterone production. I was told that coming off TRT whilst attempting to stimulate natual Testosterone production by way of treatment would probably be my best path forward. Any thoughts on this?


#20

HCG should not be used with a SERM, as hcg is suppressive so it would at least partially negate the benefits of the SERM. You could try hcg monotherapy for a bit to see if your testes respond (confirmed by bloodwork) and by that point, your testes would be working you could discontinue the hcg and try the SERM restart. This intermediate step would probably make it easier for your recovery so as to not try to turn too many things back on at once.