Looking to Alter or Shake Up TRT Routine. Advice?

Hey guys, 30 year old guy here. I’ve been on TRT for 6-7 years without breaks. I take 37.5mg of Test E every other day, injecting it with an insulin needle into my belly. My pre-TRT levels were about 7 nmol/L. I have a lot of health issues, pre-diabetic, very high blood pressure and anxiety/depression. I’m aware all of these issues compound and I can’t blame my TRT or anything like that. The issue with that is that for the past half year I’ve had barely any sex drive, my morning erections are almost non-existent and my erections are 70% at best. I’m lethargic, tired and my testicles are smaller than they used to be as expected. I also feel like my mood and sex drive is better when I miss days, this might be placebo though and my estrogen seems to be in check.

My recent levels are:

Total Testosterone 15.8/nmol/L (10.0-35.0)
DHEA-S 12.1 umol/L (3.0-10.5)
Sensitive Oestradiol 67 pmol/L (55-150)

4 years ago:

Total Testosterone 23.2nmol/L
SHBG 15nmol/L (13071)
Free testosterone 716 pmol/L (225-725)
TSH 0.99 (0.5-5.5)

Basically I’m thinking about adding hcg into my routine or maybe even getting off TRT and trying hcg monotherapy. Can someone advise me how to go about doing this? What dosages would I need to aim for? I try to use the minimal amount of any medicine possible, and would rather avoid adding a AI where possible.

Missing an injection and feeling better might point to an injection frequency that may be inappropriate.

The HCG mono will more than likely be a mistake, men typically feel much better on TRT vs HCG. I’m not seeing any indication of high E2, in fact yours is on the bottom of the ranges.

You just need to adjust your protocol.

Do you take dhea supplements?

Cause it’s high.

If you do, stop taking them and see how you feel before you tweek your trt protocol.

If you don’t take dhea, then maybe you have something going on with your adrenals and need to check waking cortisol.

You introduced any new medicine or supplements? That could change stuff and require a protocol change.
You should do comprehensive labs and check all again.
Including thyroid. Prolactin, iron, ferritin, metabolic panel, estradiol, cbc, DHT, etc

If anything from the few labs you posted you appear to have lowish free t and you estradiol is lowish.

I was under the impression that EOD was good for people with low SHBG, What kind of changes would you suggest making? I guess I could at least introduce HCG alongside TRT to maybe salvage my fertility if I still have the capacity for it?

I would try adding hCG. Interesting that your levels were 50% higher four years ago, assuming you are now using the same dosing as then. Some, probably most, do better with higher E2.

The only thing I changed since those readings is I went from injecting every 3.5 days to EOD. I thought that would make more sense if I’m low SHBG. Maybe adding HCG EOD will balance the E2 out?

Nothing like that, the only thing I introduced was blood pressure medication (atenolol). Perhaps it was a bad reading or something so will have to get another test. I did have high adrenals in another test, as well as some kidney and liver issues. Might have to look into that more thoroughly!

1 Like

This isn’t universal, I have low SHBG and inject moderate dosages (50mg) twice weekly and feel great.

I have found zero correlation between SHBG and injection frequency. I have guys with single digit SHBG injecting 200mg once a week, and guys with 40+ injecting three times a week. Go with whatever dosing frequency makes you feel the best.

I second this. Adding HCG really helped out my libido and well being. Also, I would switch to IM injections as another first course of action.

Why switch to IM? Is there something wrong with doing Subq into belly? Curious as that is method I use as well and it is easy and painless.

Much debate over the two methods there is.

I’ve tried both over extended periods, doesn’t make any difference to results for me

It may or may not make a difference for you. But you get more control over absorption rates. Injecting into the fat will take a longer time for the testosterone to hit the blood stream, and the rate at which it does varies. I’m suggesting it because you asked for a way to switch up your routine. Some guys see significant difference injecting IM vs SubQ.

Some have tried HCG, but did not continue. I found it essential, for me. I feel much better after having added it to my TC.

As to dosages, there is one study, comparing 125 units, 250, and 500, around 3 times a week, mono therapy, and charting the impact on blood levels of T. 500 took it above prior natural level, 250 took it up close to prior natural levels, 125 took it partly there.

Because I continued TC at 110 mg a week, I added the lower dosing of HCG, even getting it down to 80 units 3x a week. My doc had given me a script for 1,000, 3xs a week! That is what is typically given to try to remedy fertility issues. I said I would like to start lower, 300 units 3xs a week.

I felt terrific on that,with 110 mg TC, total, a week. It took my TT to around 1,300, but with E2 put of range and, later, a couple related sides. I dropped down and experimented between 80 units and 200, 3xes a week.

My general thinking is, “run the minimum necessary to get the desired result.” So, I would add 300 units HCG week, in three divided doses (100 units a shot) on top of your T, and be prepared to adjust the HCG up or down, maybe later lowering the amount of T a bit if indicated.

What I did was after reaching a stable “feel good” level was to gradually back down, to the minimum necessary to sustain that feeling. I also did not try a new adjustment every 6 weeks, but more like every 10 to 12 weeks, after seeing that in me long term impacts took a while to manifest.

Lastly, I did not rely solely on drugs, but did psychological/spiritual, fitness, and nutritional work, too. Long hikes, head clearing, clean food, some movement toward humility and appreciation, intermittent fasting, resulting weight loss, etc. It created a new me. Or, rather, the more real me, LOL.

1 Like

I like the way you think about it and am likely to go on the same path - so I’ll give this a try, thanks!

Do you draw the substances with the same needle, and do you IM or Subq it?

I adopted what one fellow theorized would level out blood levels best: Inject T IM and HCG subq, as T is almost always in oil (diffuses slowly) and HCG is in water.

The theory sounds good, but that does not mean it IS good. But, I have no complaints and, minimally I end up with more injection locales, therefore better rotational variety.

Hi. I don’t mix the HGC (it’s suspended in water) with the T (suspended in oil). I use two different syringes:

T: Injected shallow IM, in delts or in quads where there is not much fat: 27g, 1/2 inch, 0.5 cc barrel volume (I am looking for 0.3 cc syringe, in the stated gauge and needle llenght.

I have in the past used 30 or 31g. Takes a while to load, not a problem when I have had a rack to hang the bottle and syringe from while the syringe SLOWLY (LOL) loads while I do something else for a couple minutes.

HCG: SubQ. 30 or 31g (marvelous, zero pain), 6 or 8 mm needle lenght, 0.3 cc barrel volume (easier dosage control).

All are one piece insultin syringes, no wasted medicine.

With the small gauges, 27g and higher, sharps disposal is easier: BD sells a needle clipper, cheap. I still put the clipped syringes in a heavyweight laundry detergent bottle, for eventual disposal at designated sharps disposal locations.

1 Like