T Nation

Just Started TRT. Am I Prescribed Too High of a T Dose?

Hey Guys!

I just started TRT over a week ago. My doctor felt my T was too high to prescribe it, so I fount this local clinic that prescribed and shipped it to me. (Never saw a doc.)

10 week regimen for $790 + $350 for blood work. I was advised 1ml/200mg of Watson Cypionate 1X week. I though it was rather high based on my blood work. What do you think???

Additional Protocol: Anostrazole .5mg 2X-week / 1000mcg B-12 1X-week / 500 units hCG 2X-week

(I also threw in my IFG-1 level. I though that was in a rather healthy range and they were ready to get me rolling on HGH as well. Are they trying to throw in a kitchen sink too?)

Blood Prior to therapy. 15hr or more Fasted
Testosterone, Serum 518 ng/dL (Range: 264 - 916)
Free Testosterone(Direct) 8.7 pg/mL (Range: 6.8 - 21.5)
Estradiol 13.8 pg/mL (7.6 - 42.6)
IGF-1 140 ng/mL (83 - 233)

Thanks in advance for your input.

You’re here because most TRT clinics set you up for failure, they fail to test for SHBG which makes dosing and injection frequency a guessing game. You’re missing a lot of standard tests.

Defy Medical will treat guys at or under 550 ng/dL for the sake of lab errors and the fact there only so accurate. You give the blood sample to two different technicians within minutes of blood draw and you’ll get two different results. FT is low, SHBG is expected to be midrange or higher.

Pretty much what system said. Dosing protocol is based off of your SHBG and determining if a dose is too high takes labs. That is a high starting dose though. But do you have high shbg, which would warrant it?

If I went to a men’s health clinic and they didn’t check my SHBG I would be skeptical of their competence.

We do not even know your age.

We attempt to look at more things than almost all doctors here and many ‘clinics’ have T-tunnel vision. Can in point - most guys here happen to have some degree of low-thyroid function, if you have more lab data - we need it. Most thyroid problems seem to be from iodine deficiency from not using iodized salt.

TRT is replacement. You pre-TRT T level have zero bearing on your TRT T dosing.

Your IGF-1 is well below optimal. But can you afford $6000/year for GH? Get TRT [and thyroid] managed and see if IGF-1 changes before you commit. The clinic makes money and they are motivated primarily by that.

$350 for only the labs you posted?

Suggest that you do:
50mg T twice a week
0.5mg anastrozole at time of injections
hcg is better EOD because of half life.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

First of all, thank you for the very valuable info!!! I’m 41 by the way.

This actually leads me to an even more important question… I get slight head pressure/headache and chest pain the day after injecting the T. It feels like it’s around the heart area. I have history of heart attacks in my family so the chest pain really scares me. Last time I injected only 50mg and I got it.

It’s starts the next day around Noon. I do tend to have a couple cups of coffee in the morning, so perhaps that triggers it, but I’ve never gotten headaches before. Of course I’m not having coffee tomorrow after injecting tonight, just to test it. Interesting thing is I didn’t have these symptoms after my first injection 200mg. But I also didn’t take the supporting medications or vitamin B12. Could it be a reaction of combining

My reduced protocol 100mg a week vs the original 200mg clinic recommended.
Day 1 - Test 50mg / 0.25ml (injection)
Day 2 - 1 Anastrozole .5mgv(pill)
Day 3 - 1cc B-12(injection)
Day 4 - T 50mg / 0.25ml(injection)
Day 5 - n/a
Day 6 - 500iu hCG(injection)
Day 7 - 500iu hCG(injection)

You’re right. No SHBG and no Thyroid blood work. I’m second guessing this over-phone clinic.

Your symptoms coincide right about when your testosterone would be peaking. Approx 24 hours after your shot (its about 20 for me). My first year of TRT I had the same issue…

It was my blood pressure. It would spike when my test would spike. Im on Bp meds now, but I think a lot of it had to do with the initial feelings of test (hyper vigilance and hypersensitivity).

It caused some minor anxiety, and I believe my body was still getting use to it, so I would go up in the 140-150 diastolic range. 160 if I got really anxious about it… Check your BP for sure.

I would definitely drop the coffee. Whatever you do, don’t take Lisinopril, it increases your SHBG.

Thank you for your input.

I actually tested my BP both times and it was normal (117/70 give and 75bpm). I don’t feel anxious. I get a little rush right after injecting and that’s mental but this seems all physical.

Suggest that you co-inject B-12 in same syringe as hCG.

hCG days 6+7 is retarded from a half-life point of view. Your testes need a steadier level. Inject hCG twice a week or 250iu subq EOD.

My hCG comes with B-12 in it. Delivered to me dry and I mix. hCG should not be shipped wet.

Injecting anastrozole once a week is very wrong from a half-life point of view. It is a competitive drug that should match serum T levels. You need steady T levels and twice a week is reasonable. You need to take anastrozole twice a week. Delay of one day may create an uptick in E2 levels. I advise that anastrozole be taken at time of injections which also makes the whole routine easier.

Most need 1.0mg anastrozole for every 100mg T. So you might need two 0.5mg per week.

As you are probably injecting 1ml/week hCG, you could use B-12 to reconstitute your hCG, if the B-12 has 0.9% benzyl alcohol as a preservative.

T injected subq creates smoother and steadier T levels compared to IM. This might avoid some of your post injection day issues.

You can do T+AI+hCG two days a week, and not be dealing with 6 days of complexity.

The Anastrozle comes in pill form. Originally was perscribed .5mg 2x a week if doing 200mg/ week T. I was told to drop dosage to inly 1X a week since I cut down the T to 100mg a week. So what would be your suggested 7 day protocol if I’m doing 2X week- 50mg injections? I actually wanted to do SubQ for Test too but saw some mixed reviews on it so followed docs orders.
(The hGC is powder and I mix it with liquid solution and then has to be refrigerated. )

Everybody’s different, some prefer IM and some feel better on subq. You might feel better doing subq and then again you might not feel a difference at all, but the holes in your muscle will create scar tissue after decades of IM injections.

I don’t believe your SHBG is overly high or else your FT would be even lower, 50mg twice weekly is a great idea to keep levels stable and labs will better represent what’s actually going on. T starts peaking E2 follows, take AI on injection day.

Once weekly injections are reserved for guys who’s SHBG is well above the ranges, whoever told you to inject once weekly is acting without SHBG labs, acting blindly always leads to needless suffering.

While it’s great that suggestions are changing from one injection every 2-3 weeks, there’s still room for improvement by doctors testing SHBG and tailoring a protocol based on these values.


Hey I just wanted to give an update and THANK YOU! I did my last injection Thursday SubQ .4ml. Resulted in much milder and shorter lived headache, but NO CHEST PAIN!!!

I spoke to my doctor prior to injecting and he said, since my Estrodial was very low he recommended getting off of Anastrozle altogether but continuing to do IM. I mentioned what I read here and he said too early to experiment. SubQ was an option down the line. I took your advice vs. the doctors and SUCCESS!

His other recommendation was to do the hCG one day all 1000 units rather than 2X 500.

I also asked about why no SHBG lab. He seemed surprised that test wasn’t done,(BS IMO) but not to worry. Let’s just get some T in you, get you feeling better and then we’ll tinker with dosages. "First thing is getting you feeling better"
He wanted to do another lab in 6 weeks and adjust.

Your SHBG is going to be different in 40 days so it makes no sense to test it now, it’s just too late. Injecting 50mg twice weekly is the best option as lets say it was too much, the side effects will be very minimal vs shotgunning yourself past the tops of the ranges.

I didn’t even need an AI at 50mg twice weekly. Your pre-TRT labs shows you weren’t overly converting much of your T–>E2, you may find you don’t even need an AI.

So once you start your TRT protocol it is too late to have SHBG tested in order to appropriately dose? Does it just become a guessing game at that point? Sorry for the post on an old thread. I just started with issues of my own and I am trying to educate myself.

It’s never too late to test SHBG, it will decrease a little on TRT. Mine was in the 28 pre-TRT, now hovers between 16-22.

I wouldn’t have been able to choose a TRT protocol without knowing SHBG. Those closer to 20 tend to do best on EOD protocol, more frequent to better control estrogen.

I just saw my previous post, boy how things have changed. After the first 6 months on TRT out of the blue estrogen became a big problem.

You can estimate your SHGB if you know your total and free testosterone. Just use the free t calculator in reverse.

In my opinion I wouldn’t base your dosing protocol on your SHBG, it’s kind of a weird myth going on around here that you should. The number is going to vary so much. You should dose based on the ester of what you are injecting, So most likely 2x per week(test e or c) Start with that and go from there. It’s going to take time to dial in, sometimes a bit of trial and error.