T Nation

Just Started TRT and Now Have Very High T Levels. Normal?


#1

I took a blood test for total testosterone before starting TRT:
480

About 1.5 months later, I repeated:
410

I then consulted my doctor who suggested to move ahead with TRT in the form of Testoviron 250mg.

I took one injection.
1.5 weeks later I took another injection
2 weeks later I took a third injection

I was told the second was part of the pre-loading? And after the last injection, to continue at 250mg per month.

3 days after I took the third injection I had a blood test done for total testosterone that showed 1700 ng/dl (which is high).

So my questions are:

  1. Is it normal to be that high soon after the injection and this is nothing to be concerned about (just retest again in a week or two and I should see normal).

  2. Is it normal to be that high after starting and once on a monthly cycle it should reach a more ‘normal’ peak ?

  3. Anything I should do or avoid doing while I wait for this to drop down to a more normal level?

Note: I do plan to go in again for another blood test to confirm the results above.

Thank you all.


#2

Testoviron is just test prop which has a half life of 7-10 days. A drug is clinicly considered inert after the passing of five (5) half lives.

The short answer is yes, peak plasma concentrations will typically be achieved with 3 to 3.5 days. Is it something to be concerned about? I would argue no as the drug is releasing as designed. Dosage is a different concern.

Peaks after initial injection are normal in the sense that the drug is being absorbed as it was designed. The monthly cycle is a poor decision that will likely result in a greatly reduced tolerable of side effects for the patient. Remember I stated the drug has a 7-10 half life. This means four half lives have passed since the drug was introduced, while not clinically inert at that point it is functionally inert. As when testosterone is introduced that is not created by your body as part of the feed back loop your natural production will shut down. This means by the time of your next injection your testosterone levels will be severely depressed. Doctors who are educated will often proscribe weekly dosages (100mg of 1ml for example). This smooths the peaks and valleys associated with drug to achieve a more steady state of plasma concentrations thus reducing side effects of extreme low or high testosterone. With that said, many very educated members of this site recommend twice weekly injections to further smooth out the peaks and valleys. In addition, many here recommend sub-cutaneous injection over intra-muscular as it has shown correlation to lower rates of T—>E conversation. With that said I found sufficient symptom abatement with a single intra-muscular weekly injection. However, others are not as fortunate so they do twice weekly sub-q injections.

I hope you find these responses helpful


#3

Thank you kindly for the info!

My doctor, who is the local TRT ‘expert’ (at least in the sense its one of the main things his clinic does), suggested monthly injections of 250mg.

For what it’s worth, i’m not looking to have high doses for the sake of bodybuilding, but more to have a ‘normal/better’ range (800-1000 would be great).

Even in this case, is the consensus really to consider weekly injections?

Note: Not sure I can get 100mg injections here, they seem to be only available in 250mg doses.

On the plus side, glad to see having a very high Total T level is not an issue (3 days after injection). I’ll check again and again over the next few weeks to see how it goes. (At least I can get Total T tests easily here).


#4

Monthly injections, expert in TRT?! You need a new doctor, wow. You need to read the sticky threads.


#5

Here, people recommend twice weekly, personally I find weekly fine. I feel great at weekly so I do not see the need personally to mess with success.

Then get the 1ml of 250mg twice monthly and self inject .5ml of the 250mg ester weekly. Another issue with the large increase of T is the high potential for T --> E conversion.

It is recommended generally to have blood drawn at the mid point between medication doses to see the plasma concentrations at the mid point. 3 days after injection on a monthly protocol of anything does not provide an accurate reflection of plasma concentrations.


#6

T once a month is stupid, your doc is clueless. If he is doing the injections, he is after the $$$.

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.


#7

Thank you all for the feedback. So far I’ve gathered the following key points:

  1. My doctor may not be a specialist in this area despite this being his ‘main’ thing. (I’m holding out on the possibility that he mainly deals with patients who are 65+ )

  2. Monthly injections is not realistic and either a weekly or fortnightly approach is best.

  3. Smaller frequent doses is better than larger infrequent doses.

Fortunately I’m not scared of biochemistry and can happily read the subject matter. Also fortunately, the doctor is more than happy to teach me how to self-inject and I can buy Testoviron from him or anywhere else (although his prices are cheaper than the pharmacy).

I wanted to add some of my metrics and see if anyone had some feedback for me:

Prior to starting, I had Total T @ 410.
I then did three injections, each of 200 each. Following the third injection I did blood tests:

T+4 : 1676
T+18 : 345
T+23 : 284

So at 18 days after the injection, the Total T is far lower than what I would like and lower than pre-TRT. This heavily suggests that going 18 days without administration is too long to go.

Based on the rate of decrease, it would seem a full injection weekly might actually be needed to keep me at 1000 level. However, it might be worthwhile to try every 2 weeks with 200mg (or weekly with 100mg) to see how that stabilizes.

Additionally, after 23 days I’m down to 284… is that bad or expected? At this rate, in one more week (which brings me to T+30) I should be at -136 (or as close to zero as one can go). Is that normal/expected?

On the plus side, I can go and get blood tests pretty cheap & easily and usually get results same day, so it makes it easy for me to monitor. I may well have to be my own ‘doctor’, which I’d rather not, until I can find a better specialist.


#8

Just a little update: My doctor is now suggesting 250mg every two weeks for a couple of months (with a blood test just before I get the injection) to see how things progress. He was not happy with the big difference between peak and trough.

Anyone have any further suggestions for me?

Thank you.


#9

In time you’ll come to know why an injection every 2 weeks is horrible for the patient, you need to ditch your doctor as he isn’t knowledgeable enough to administer TRT. What are you going to do when you’re presenting with possible symptoms since your doctor is clueless? The answer, get a new doctor. Why wait?


#10

One problem is there is no real other doctor around here. This is Thailand, and due to the ready availability of Testosterone for sale everywhere, everyone just self-medicates. This leaves very few people going to doctors and thus few who have actual experience.

I think mine is experienced with it, but mainly with older retired non-active people who seem to be okey with once a month. The only other choice is a clinic that is built on the sole purpose of selling you stuff (thus I do not trust it).

I may have no choice but to do it on my own.


#11

Jaybird99,

I am in BKK and had similar issues as you. Thai men don’t do trt for the most part so doctors do not understand it and/or are overly fearful imo.

Started out at 250 mg testoviron every 3 weeks per doc. Then went to 250 mg every 2 weeks and felt like crap. Switched on my own to 125 mg every week and felt good until estradiol shot up to 75. Now at 100mg every week and feel good and blood is good. HB and HC are also ok at this level. Got to monitor those and lipid panel too.

Every time I make a change I do blood testing at Sukhumvit hospital which I prefer and get the results emailed to me in 3 days.

I break the 250 mg vial and load 2 syringes at 100mg each. Inject one and carefully store in clean baggie and small box (keep dark) the other syringe until the next week and just discard the leftover in the vial.

Still watching my estradiol which has come down with the help of arimedix (bought at pharmacy suk15) but am looking into twice weekly SubQ if estradiol goes back up. We have no choice but here but to figure it out ourselves if we want to get this right. Thai doctors cause more trouble than help imo. 555


#12

Yes, I decided the best approach is to be my own doctor (sadly). I’ve gone with the regiment of weekly injections of 125 mg (0.5 ml). So far I have not noticed any negative side effects of this, and only positive.

My E2 seems to inch up a bit, hopefully I do not need more injections (are there alternatives?).

Some useful facts (for people in Thailand):

I can buy Testoviron Depot from Boots or Fascino, comes to about 180 THB/ampule (no discount if you buy the box). These are about as ‘safe’ and good a pharmacy can be. Not sure if you can get it at Boots Bangkok, but you can in Pattaya (I think different provinces have different rules).

I go to a clinic and they charge me 100 THB to do the injection (they supply syringe, nurse, etc.) I give them the ampule, they split it, load up 0.5ml, and throw away the rest (I’m not too bothered about 90THB being tossed every week, as it saves me the bother of storage or concern of contamination).

I can do a comprehensive blood work at the blood test clinic (not a hospital, they ONLY do blood test and e-mail you the results). I believe I do a full hormone panel (including Free & Total Testosterone, E2, Cortisol, Prolactin, CBC (Hematocrit, platelet, etc.) for 5,000 THB. I’m presently thinking of doing this quarterly.

So the total comes to about 14,560THB for the injections, and 20,000THB for the blood tests (or just above 1,000 USD/year for all).

Not sure what prices for this would be in the US or Bangkok. (The biggest part is the blood test and I suppose an argument can be made that you don’t need Free T every quarter, which was the most expensive part of the blood test. Without Free T, the total for blood work would be less than half).