T Nation

Just Started TRT Today. Have Some Questions

Hey all. Brand new to TRT here. I was just officially prescribed it yesterday and will receive my first injection today. Let me go ahead and give you guys my blood work results and some stats so you know what I’m working with.

Age: 30
Height: 6’
Weight: 227lbs
Body Fat: 23%
Estadiol: <11.0 pg/ml
FSH: 5.3 mIU/mL
LH: 7.2 mIU/mL
SHBG: 27
Progesterone: .36 ng/mL
Testosterone: 210 ng/mL
Free Testosterone: 4.47

I hope all of that helps with the questions I have. Before I start, I’m an avid gym goer, but I have declined in strength, stamina, ambition, and overall drive over the past few years, as well as suffering from sexual disfunction, and cognitive recall issues. I’m holding on to body fat like I have never in my life, and I have always stayed away from steroids/Prohormones, and pretty much most of the junk you could buy at a GNC.
I feel like I have done quite a bit of research, because honestly this scares me a bit.

Question #1: My doctor has prescribed a dose of 100mg of Testosterone Cypionate a month, 50mg once every 2 weeks. Most resources I have checked often state a common TRT dosage is 100mg per week, either in one or two doses. Is this a common starting dose? Does 50mg every two weeks provide any benefit, or could it be a starting point to see how I react to it? I do see 50mg when it comes to boys going through puberty to help them grow, but I haven’t seen that number thrown around for grown men.

Question #2: I see Anastrozole and HCG thrown around, and am somewhat familiar with what they do, but my doctor hadn’t brought either of them up. With so low a dose, are they necessary or would they be worth mentioning?

Question #3: How soon did you notice the affects of the treatment? I’m sure the more you get the quicker you’ll feel it. I’m just at the end of my rope and am desperate to feel better. I see some testimonials of men having to jump through hoops for years to even get their medication adjusted.

Am I being paranoid too early on in my treatment? I’ll have my first blood work done after 6 weeks of treatment, which is obviously what this all depends on. But I don’t want to hit a “normal” level of 300 and have him be happy but not me. I’m honestly shy to talk about it to him in person (which I personally believe is another sign of low test.)

If anyone has any references they could give me, personal testimonials or anything would be great. This whole thing just freaks me out.

Thanks guys!

im new but every thing ive read on here states that is a low dose. mine started me on 80/ 10 days. my concern was the same. insurance will see I hit bare minimal t levels and now pay for dose increase. its early in the am. in a little bit some of the experienced guys will be along to tell you your dr is a idiot and to go private. they are just better at explaining why. but if your like I was you hitting the refresh button every 5 min looking for answers.
What I recommend is to post all of your labs while you wait for them to wake up. because that’s the first thing captian and systemlord will ask you to do.

1 Like

Dont even bother taking that injection. Your T is going to be lower than it is now amd you will feel awful. It will shut down your natural production and not suppliment you with anything close to enough. Just find a new Dr. Before you end up hating your life with a total T of like 25. I take 140mg a week 40mg every other day and many guys are on much more than that. Depending on my uocoming labs i may need to go up more.

1 Like

That dose sucks big time go find another dr you need atliest 200 week

1 Like

Thanks for the replies guys. Luckily, I don’t have to deal with insurance as it is a direct primary care doctor. The cost to me is only $67 for a 10ml vial. This doctor has actually been a family friend for a while, and I would totally stick with him if I can. Would it maybe worth questioning the dose based on research? I’m not a doctor so I hate the thought of contradicting him, but it really doesn’t seem correct to me. Maybe I’ll just have to muster up some balls and ask about it when I go.

I would question the dose. I take 50 mg 3X per week, and feel really good. I could not imagine feeling good on 1/6th the dose.

50 mg / week is kinda the lowest I have seen anyone take. 25 mg / week shows that your doctor does not understand trt. I would show him research, and be really nice. If he does not budge, find a new dr.

1 Like

Since you would like to keep working with your Dr. on this. Look into setting up a consult with Defy or Dr. Nicholes and you and your Dr. It might be $3,4,5 hundred bucks, but it’ll be worth it and it would help get more Doctors trained on the current state of trt therapy.

Just a thought.

1 Like

Oh my god, please find a doctor who doesn’t live under a rock! Your doctors has prescribed what’s referred to as the hormonal roller coaster which will see no benefit, in fact you may feel even worse than pre-TRT.

A clinical study came out in 2005 men who were injected with 200mg every 2 weeks and the result were poor, your doctors has done far worse. When these men’s testosterone was measured after day 6, levels were in the low normal ranges.

Your levels are going to be very low (<100) by week 2 and weeks 3-4 testosterone will be zero.

Hormone profiles after intramuscular injection of 200mg testosterone enanthate every 2 weeks in patients with hypogonadism

I inject 24mg every 2 days (96mg weekly) do to low SHBG, I see your doctor didn’t bother with this important test. You’ll more than likely have to seek a private specialists for your TRT because those with incompetent doctors struggle the most here.

There are few doctors in sick care who are good at TRT, most are clueless and have no understanding of endocrine disorders or sex hormone education. I was force to seek private care with a telemedicine clinic who staffs true specialists.

The T-cypionate on paper has of 12 days, in the real world it’s 5-7 day half life, so this idea of injecting once a month is mistake.

1 Like

I’m sorry, I accidently omitted my SHBG, which comes in at 27 (I’ll edit and add it to my original post)

I’m going to request holding off on my injection today. Would you mind linking me your studies so I have something to bring him to make my case a little stronger? I very much appreciate all of your replies!

BTW, you have testicular failure, primary hypogonadism indicated by high LH and low testosterone, LH stimulates the testicles to produce testosterone and you testicles are on the verge of failure. TRT will make you infertile in the short term, freeze sperm now if you have any before it’s too late.

SHBG binds testosterone and estrogen, the higher this value the more testosterone you’ll require elevate Free T which is where the rubber meets the road, it’s the free hormone circulating in the bloodstream and is what does all the amazing things like build muscle, high libido and builds a strong heart.

Total T has no effect on your bodies tissues, it’s bound to SHBG and not bioavailable. Most men see SHBG decrease after TRT commences which will probably decrease to around 20, low SHBG guys tend to do better on more frequent dosing than twice weekly, not always but most of the time.

There are a few who see SHBG increase after starting TRT which is do to high insulin levels suppressing SHBG, 4 weeks after I started TRT SHBG was 16, started working out at the gym, dropped 10 pounds and SHBG increased to 22 do to improve insulin levels.

There really isn’t any studies on proper dosing other than what was already provided, everyone will require a dosage and injection frequency that will be unique to you, what makes one guy feel amazing will make another man feel terrible.

Staying with this doctor can’t be an option, you should have already started your search for another.

1 Like

I’ll begin the search. Thank you for being so concise. I’m envious of your knowledge here!

Just call defy. Its the easiet route. You will have meds on the way in like a week if you do everything fast. You could even get your first script with your Dr filled and start defys protocal with it while you are waiting for their rx to arrive

1 Like

Before you take any medical advice from internet warriors, check their misspellings and ask yourself - if they can’t spell, should I trust them with my nuts?

I would ask your doctor what his intent was with such a low dose. He may be ignorant of current protocols, or he might be cutting edge. One never knows.

I suspect he is not fully versed in all things TRT, but you should know, just a few months ago, everyone insisted on the need for Arimidex and HCG in every protocol.

Cooler heads have prevailed, and most people recognize the differing views.

I’d suggest doing more research before starting TRT, before dropping your doctor, and before making any decision. You’ve been Low T for a while, you don’t have to make a decision today.

2 Likes

You don’t need a doctorate or a Webster dictionary to be able to make a choice based on common sense. I have been in double digit t scores and free t so low the Dr thought the labs were faked. I would never allow a Dr to expirement in a way that would make me feel even worse just because he was nervous or wanted to tank my numbers to get insurance to cover a $25 bottle of T

2 Likes

Proficiency in spelling is a poor indicator of intelligence. Mathematical ability is a better indicator, but still not the best. In this case experience probably trumps spelling or intelligence.

I could care less if someone can spell, it is their argument / position that matters. Can they defend their position without using flawed logic?

They have studies on dosages, and 25 mg a week (more than OPs dosage) has been shown to have many negative outcomes.

Here is evidence of my claim:
https://www.physiology.org/doi/full/10.1152/ajpendo.2001.281.6.E1172

25 mg per week resulted in below lab ranges for total testosterone, losing 1 kg of lean mass, gaining 3 kg of fat, and a lowering of libido among other things (all in 16 weeks). OP’s dosage of 23.3 mg a week is not going to cut it.

Edit: after reading OP’s initial post, it is unclear what his dosage is. 100 mg a month is not the same as 50 mg every two weeks (4.3 weeks in the average month). Probably does not matter, as both are too low.

1 Like

The prescription slip called for 100mg 10mL .5 cc every 2 weeks. I just assumed that was 50mg every 2 weeks.

I really do apologize for my ignorance. I know you guys deal with this day in and day out around here. I have always been a healthy person, rarely having anything worse than a yearly flu. but I’ve crashed over the last two years and this is actually just pretty scary to me haha

With that said, you guys have offered me the feeling of reassurance that I need to A.) do more research and B.) explore further treatment options. I can’t say how much I appreciate that.

Don’t worry to much about the mix up in dosage. Many people assume 4 weeks a month. I pay for powerlifting coaching per month, but end up getting programming for 4 weeks. I don’t really care, because it is a good deal with a good coach.

If your protocol is 50 mg every two weeks, I would not even bother starting that. You will likely show no improvement. It sounds to me like your protocol is 50 mg every two weeks. You most likely have a 10 mL bottle of test that is 100 mg/mL. I would avoid any protocol that involves injecting every two weeks. It works for some (who are injecting closer to 200 mg), but it is probably not optimal.

I think a lot of the people who are on TRT are the type that are training and eating healthy. They are the ones who question why they feel down, why they don’t seem to lose weight (before TRT I have gained weight on weight loss diets), why they don’t ever wake up with erections, why they have insomnia (this was the worst thing for me). These are the things I noticed that made me look into and start TRT.

I have only been on TRT for about a month now (and feeling great, BTW), and my first post was over a year ago. It takes a long time to be able to tell the difference between good sounding BS, and actual good advice. I would generally avoid the advice from people who are dogmatic.

1 Like

Everyone will most likely agree with the flllowing comments and suggestions

Where are you located?

  1. Don’t use this doc. I hate to be harsh but this docs an Absolute idiot to be giving you 50mg every two weeks. You are better off not starting. No really. I’m not exxagerating. You will never build up enough t in your system for a therapeutic effect. A waste of money.

  2. Call defy or low t nation an online trt clinic and get proper trt under a proper doc. If you want a trt specialist not a clinic tell me and I’ll refer some names you can cal.

  3. You are correct don’t use ai. Because Your estrogen is already so low. You want more than 20 e2 . I bet you feel like shit right now and more estrogen will help you feel healthier

  4. Most guys on HCG use it two to three times per week or the day of or after a weekly shot. 500iu per shot down to 200 iu twice a week.

  5. At your age you want more T to feel the beneficial effects. I would shoot for 150 at the least. Not a big deal as long as you start somewhere. Actual dose that will work for you is hard to find but a minimum of 100 is a good starting point. You can always increase Or decrease but your current doc is not capable of managing a trt protocol.

So please find yourself a legitimate trt doc. Don’t use this guy. He’s causing more harm than good and should be sued for medical negligence. He obviously has not researched the therapy or taken any courses or seminars on how to properly dispense a trt protocol for patients.

My goal is to help you achieve success sooner than later. This happens by finding an experienced Trt doc. Someone you do not have to second guess.

1 Like

I am of the opinion that the patient needs to be very knowledgeable about any drug they are going to take. Historically, medicine does not have a good track record.

I am a engineer, and in that field there are still only a few who actually know what they are doing (they know more than general public, but they really should not be designing stuff). I assume medicine is similar.

I think you should try to educate your doctor. Be nice, and give him outs for his short comings. If you can educate him even just to the point of the correct dosages and correct lab tests, you are helping the next guy out.

If that fails go to Defy.

2 Likes

Thank you all so so much for your replies and advice. Just a quick update, I declined my shot, and asked for a referral to an endocrinologist which he did not take offense to. I dont have insurance so I’ll have to front the 250 bucks for a consult (small price to pay by the looks of it).

He said he would work in tandem with the endo and follow a protocol designed by him to make me more comfortable with the situation, and also release all blood work to the endo and confer with him about adjustments to save me some money.

To be honest, I don’t think my doctor is incompetent or stupid, but rather like many of you suggest, he probably isn’t as familiar with TRT as he should be. He has been very helpful in the past, and I trust him about most things - it’s just that this situation is basically the most serious thing medically I’ve ever dealt with.

My appointment is next week, so we will see where this goes.

Once again, thank you all very very much. The insight I have received here in such a short amount of time has really opened my eyes to the importance of research. I hope to have some better results to share next week.

Cheers!