50mg twice weekly or 25mg every 2 days is a good place to start, retest is 6 weeks to see where you are, adjustments may be needed.
You need to target mid normal Free T levels or higher, higher testosterone is shown to be more cardioprotective than mid normal levels.
Unfortunately there is a good chance the endo is going to refuse to treat you and tell you that your levels and symptoms are fine and just part of aging. If and when this happens please look into telemedical treatment. I had a Dr who didnt even want to do my simple physical because it was for Defy. He eventually relented but not before telling me that taking T would give me prostate cancer testicular cancer and make my testicles shrink. When i told him i was aware of the testicular atrophy and was fine with it he then said oh your penis will shrink too. His actual word was “dinky” which really just lowered my opinion of him that much more. Again i wasnt asking him for controlled medications wasnt asking for any kind of treatment just a basic sports physical listing my vitals and height weight ECT. But he must have been worried i would come back and sue or something.
For the record TRT doesn’t cause prostate cancer, studies show men with low Free T get more aggressive prostate cancer, incidences of prostate cancer are far higher in men with low testosterone versus high testosterone.
Since doctors were taught in medical school that TRT causes prostate cancer, most will be hesitant to prescribe it. This false belief was base on In 1941 Huggins & Hodges report: (1) Reducing T to castrate levels caused prostate cancer to regress, (2) Administration of exogenous T caused prostate cancer to grow.
When you look at the study you’ll see it’s based on a single patient! The doctor responsible for this study went onto win a nobel prize so no one dare question his study until now.
I dont think many men would be taking Test if they thought it would give them prostate cancer a possible death sentence. I dont think the Dr even believed it. Im pretty sure he was just worried about a lawsuit if one of the actual possible complications transpired
I disagree becusse you need a doctor to manage and dial you in. Otherwise you are on your own and the doc simply scripts your medicine. He will not look at labs and find potential issues or have the ability to achieve a successful therapy. TRT can be complicated.
After you are dialed in go ahead and save a few bucks and use any doc to give you the script.
His endo will likely be unable to help remedy any symptoms encountered and will be of no use except to write the prescription. The last thing you need is a doctor that’s anxious to direct a TRT protocol out of fear.
I hate to be so negative, but this is the world we live in right now because androgen therapies have been all but ignored in favor of expensive prescription drugs versus low cost, low profit bioidentical hormones that will not pay this doctors mortgages or send doctors children to college.
Good point.
The level of knowledge a place like Defy has, is enormous compared to most family doctors.
I still think educating his doctor has value. Maybe work with both the family doctor and Defy if possible.
I agree. Let’s hope he wins the doctor lottery and accidentally finds an endo who follows dr. Rouzier or Crisslers methods.
He’s servicing his 350k Ferrari at a jiffy lube when he needs to be going to a speciality shop. Waste of time.
I would just give the doc a few links and guide him towards the data needed to self teach. It has value yes. I would love to see a doc learn trt and dose it properly for future patients. Good for nothing. Help others after you. Sad he doesn’t do it himself.
There really is a lot of misinformation in this thread - both from posters’ experience/reading, and from what their doctors have told them.
Common sense would also indicate that a person would take past experiences into account in order to develop wisdom. It is wise to use spell check and to capitalize proper nouns, especially where credibility is concerned.
I still think it would be wise to
I doubt he is cutting edge, but we don’t know the context of the case - history, co-presenting pathology, allergies, etc… Hence, since the doctor is a family friend, and an MD, asking the question would be a better idea than writing him off as an idiot.
He may be an idiot, but because we lack context, that’s a bit of a leap at this point. Personally, I have a lot of faith in doctors. Many do not have any idea about TRT - even Endos - as they need a much broader depth of knowledge to treat their entire practice, of which TRT is likely a small percentage.
We’ll just have to agree to disagree on this. If someone is intelligent, has been taught to use spell check, but doesn’t, well that indicates a cavalier attitude with respect to establishing credibility. If they don’t care about their reputation, they sure aren’t going to care about my reproductive health. We like to call doctors idiots for their mistakes, but then get very defensive when our own are pointed out.
This is true. However, there are also studies that indicate 300mg every two weeks is the most effective dosage. These studies are peer reviewed and considered the gold standard for treatment, yet we all know they are not a one size fits all protocol.
I would double check that script once again. I am in the US, and most pharmacies stock 200ml per mg, in which case you would be getting 100mg every two weeks. Still, probably a shitty protocol, but it makes more sense.
Take a look around - there is a lot of ignorance, so don’t feel bad about it. Frankly, I appreciate your willingness to admit ignorance, and I think it’s really important for all of us to admit our ignorance. In this day and age of managed health care, you have to educate yourself and advocate for yourself. The doctor’s don’t have the time to become experts on all of the variables of every patient (they have to move the meat in order to generate enough billing to pay for all of the coders they need to get paid so they can pay their malpractice insurance). You have to take responsibility for your own care. It sucks, but it is the brave new world in which we live.
This isn’t relevant actually, since the dosage is every two weeks. It will be 26 shots per year - some months will have three shots, so the 4.33 weeks per month doesn’t apply. The OP did mention his dosage as monthly, but he clarified it as every two weeks.
Agreed. My father doses 300mg every two weeks, and his Endo is one of my brother’s best friends. I have discussed this with my father, and he has spoken with his Endo, whom I know very well, but his Endo sticks to his protocol. My Endo writes me a script for the same - it’s the manufacturer’s recommendation based on studies so it protects them from malpractice. However, my Endo knows I inject 100mg E5D. I also do it SubQ, take no AI, and no HCG, and have been vilified on this board for sharing that. Lately, the pendulum has swung and more and more people are avoiding AI’s and questioning the need for HCG, recognizing it is a personal preference.
I humbly disagree. This doc is a family friend and appears to be willing to work with the OP. It took me a long time to find a doc that would let me self inject, and I am sticking with him despite his shortcomings (doesn’t test E2, big no on HCG, prescribes 300mg E2W). I stick with him because he takes my insurance (12 weeks of T costs me $5), and lets me self inject. I can work around the other stuff. If I want HCG for aesthetic reasons, I either go to a men’s clinic or order online. OP definitely needs to get the doctor to work with him, and if he doesn’t, well then he needs to move on.
Humbly disagree. Why spend hundreds when he has a doctor he can work with? If he does call Defy, he still has to educate himself to manage his own care. The men’s clinics are in the business of maximizing profits through TRT and love to blood test, sell supplements, add AI’s, etc… You are a revenue stream, and if you don’t believe that, you will be taken for a ride. In my experience (five years on TRT), learning to manage your own care and finding an in network doctor that can work with you is much more efficient than a men’s clinic. (Edit - OP doesn’t have insurance)
Very well known contributor KSMan always said ideal E2 is 22 - so OP is pretty close to that. However, many others have said that ideal E2 is a function of TT. We are all special snowflakes, so don’t assume E2 of 20 is low, especially since your T is low as well. When your T goes up, so will your E2.
A T level of 150, with a higher E2, and the OP would begin menstruating shortly. I think you meant a weekly dose of 150ml, not a T level of 150.
I think this is good advice, and what I was saying in my original post. I said it poorly because it was just a quick response while at work, and for that, I apologize.
As a final note, I’m beginning to wonder if Defy sponsors this forum. I’m sure they are a good provider, but the number of mentions in this thread alone is disturbing. Remember, if it sounds too good to be true, it probably is.
As far as credibility goes, as mentioned above, I have been on TRT for five years, about the time I joined T-Nation. For the first year of TRT I was an avid reader of the forum and soaked up quite a bit of information. However, I soaked up that information as a reader, and not from my own experience, so it’s a lot of regurgitation of what I have read, both on the forum, and journal studies. A grain of salt.
I have had great success on TRT - cognitive function and mood improved, body composition crazily so. I went from 6’1", 176 pounds and 20% BF to 196 and 15% BF (Tanita scale and Omron handheld).
I have been off T for twelve weeks now. I separated and have started dating, didn’t appreciate the atrophy and didn’t want to start chasing HCG. I also wanted to detox a bit, see if my nuts would grow back (they did mostly), and see if my endogenous production would come back higher (highly unlikely). I am awaiting a call from my Endo now to find out what my levels are.
One thing I regret is jumping into TRT without checking all of my other systems to find out the cause of my low T. Once you start, it’s hard to go back and find the cause. I think the OP made a good decision to decline the commencement, and I would strongly encourage him to seek ways to restart his own T production. I skimmed many of the posts so I may have missed it if he is aware of the cause. I was 51 years old when I started, so I didn’t have a lot to lose.
Sorry this is so verbose!
Peace out.
Dude you just lost a rediculous amount of time and your life with that. Most guys here are probably on the run writing messages from a mobile phone out of bordom. Im killing time while welding, in between rods while I let my joint cool for a min. Im not getting paid to write on tnation so why would i go out of my way to go crazy with spelling grammar and punctuation. Maybe im Just dumb as shit and cant spell but you know what helps me sleep? The fact that bullshitting in between rods im making probably 2-3× what you make an hour. So obviously it hasnt hindered me too much.
Were you replying to me?
I think he is. Cause your were taking about his comment that you quoted.
I also misspell on here. Jimmy has a point. I use the swipe keyboard and it screws up sometimes. I usually don’t have time to proof read what I wrote. I still post comment because the guys get what am saying.
And if they judge that am incompetent based on grammer and spelling…oh well. Their lose. 
I think there a few different types of responses - some require attention to detail, others don’t. When giving advice, or recommending a medical protocol, I think it’s important to establish credibility.
Otherwise, I guess just fuck it and let it roll.
I spend a lot of time in the lifting forums as well, and a lot of those guys give great advice with poor grammar and spelling. but there advice is spot on, and based on experience, not having read this or that.
If you’re just telling a guy to go out and get laid, or to give up drinking, I don’t think spelling or grammar is that important.
But when you are recommending a course of medical action, I think it becomes a little more important, as does context.
So, for the OP, I doubt I would take advice from someone that can’t spell or capitalize. It doesn’t make them stupid, it just shows they are careless, and that is a bad trait in someone giving medical advice.
I also think it is sloppy to post without quoting, or without bothering to hit reply - it’s just unclear what the post is about.
So, no, Jiimmy does not have a point. He’s sloppy and careless (I hope to god he is not welding jets). That’s all good when talking shit with your buddies over beers, but when recommending anything having to do with AAS or hormone replacement, it’s just a bad idea.
The point of my post was not to demean Jimmy, it was just to point out that the OP should do his own research. I quoted several people. However, you and Jimmy seem to feel disrespected. I think that is a reflection of your own opinion of yourself - it certainly wasn’t my intention.
Again, just trying to help the OP navigate a very difficult situation. I didn’t mean to cast aspersions on any of my friends posting in this thread.
How is a doc without Trt exp going to help this friend of ours? Only an expert can do so. You trust your health to an amateur and I will avoid them.
My health is worth the money. without my health I have nothing. So at the very least 10% of my income can be spent on keeping myself healthy and ready for a long successful life.
I’m not a defy patient. My doc is Dr. Nichols. Until he can offer telemedicine visits it’s hard to refer. I suggest more than defy but for this case he really needs to start somewhere besides a pc.
It is not the patients job to get dialed in and teach a medical doctor how to dispense trt. The doctor should say “let me refer you to a specialist”. This is the professional way to operate. Admit your lack of experience so that your patient receives the proper care.
I wonder what would happen if he had normal estrogen. The body might behave differently and start producing t. I agree that one should look at all Options before starting Trt.
Hormone optimization is complex. Every case is unique. I would find a doc that specializes and I receive life long therapy with confidence without having to learn and teach my doc. So many folks go long periods of time and never feel good. They go the cheap route and do not work with experts.
E2 at 22 is a myth. KSMan was a great asset but he had made absolute statements, which later bit him in the ass… There is no proof that 22 works. Plenty of folks are at 35 ,45, 65,90 and they are fine. The body is unique person to person. It’s been proven through individual examples on this forum. I do agree that if estrogen is an issue do something about it. I do not agree that any level of estrogen is ok. You’ll never know if you are scared of estrogen.
Shocked low e2 is horrid for men. It’s painful. Sucks horribly. Anything below 20 is a problem. Even someone with the 22 myth in their head would say so.
I am not going through a topic that’s been rehashed numerous times here. You should revisit the topic and see what all the docs are saying. Many folks have realized, as stated above, that estrogen is not the enemy. It’s not bro science it’s real and backed by almost every doc out there who actually stays on top of industry knowledge.
You are being so picky with wordage that it makes no sense. If you have some form of ODD please keep it to yourself. If you cannot get past a grammar error to see the message there is a problem. Continue reading a book by its cover and I shall read the book. No disrespect intended. This complaining and nitpicking takes away from the help folks are trying to give.
So far only amateurs have posted and regurgitated information. I hope that is clear as day. One had better research suggestions before following through. Or just find a good doc and trust and follow.
Let me be perfectly clear - I was only recommending that the OP consider all of his options.
I tried to augment this point by providing examples of past expert opinions that have turned out to be fallacious after further review.
Posters are often picked apart because they do not provide evidence or identify the issues, hence my attention to detail. I am not being “nitpicky.”
Here are a few issues. You write
You are correct. Unfortunately, it is the reality. You can choose to go to a men’s health clinic and spend ten percent of your income, and that is your choice - don’t force it on the OP - he has options.
Your choice is a good choice if it works for you. Mine is also a good choice if it works for me.
Also a great idea, but not reality in my experience.
What is normal? Am I being “nitpicky” to ask that question. According to the following article, normal is between 10 and 82.
How would you feel at 82 (normal). At 10 (also normal). That is a peer reviewed journal. So what is normal?
If I was at 1000 TT with an E2 of 20, both normal, I would likely feel like shit. That is why I talk about context - the whole picture.
I think we are on the same page here. It is not one size fits all.
It was for me. My TT was 600 and my E2 was <5, so I know.
Humbly disagree. I think it is important to write concisely when dealing with the complexity of hormone optimization (your words). It is complex and requires accurate diction to properly convey your message. Being sloppy is unforgivable. Unintentionally unclear, a different story.
It’s not just grammar, it’s also diction and syntax. That is a problem. Just fucking up on grammar isn’t a big deal. Being sloppy shows a tendency - if you’re sloppy in one area, you will be sloppy in others, and if you can’t capitalize a proper noun, I am not going to take medical advice from you. If you can’t spell protocol, I am not going to follow yours.
We both agree on this.
I think this is impossible today.
Just my opinions, and remember, opinions are like assholes.
Everybody has one.
And they all stink.
Peace.
Just for shits and giggles, I am willing to bet you do not make what I make, and certainly not
You make more as a welder than I make? Twice what I make? Is that right?
Would you care to make a wager on that?
Peaceful. Humblenss. Humility. Experienced. These are some of the characteristics I like in people who I call friends and mentors.
Judging a dozen books by their cover is what’s happening here. It’s unfortunate. I’m using my mobile and on the go half the time. Waiting or taking a break. I was about to respond but it’s pointless.
Take it down a notch. Humble yourself and appreciate every man for what they bring to the table. A thousand years ago full books and knowledge was passed by word of mouth. Eventually they figure out how to write on paper. Ye
I still like the analogy of judging a book by its cover. Hell they don’t use proper grammar. Half the time there is no period and all of the words are capitolized. Yet within that book is a ton of work , research and creativity. But since we judge a book by its cover we are blind due to our mindset.
Keep digging baby you’ll be in China in no time.
According to this site, no doc has a clue what TRT is, so yay, ye of little faith, why are you so afraid?"
This was my point exactly.
I have to say, this is the most contentious forum I have posted in. You just try to suggest that a poster think for themselves, and all you get is vitriol.
You cast aspersions, but can’t be bothered to be edified by other posts.
Fuck it, I’m out.
Let the OP do what he wants, call Defy, spend hundreds for shitty advice, start injecting tomorrow, don’t bother finding out why you have low T, and when you have problems, look to Matthew 8:26 and have faith.
I’m sure your faith will restore your hormones.
Peace out.
It appears that the OP is primary, that is a case of testicular failure. His pituitary gland is strong indicated by his healthy high normal LH, but testicles are barely functioning.