T Nation

Low Dose TRT Prescription. Advice Needed

Thanks to all who may share some insight and guidance.

I just recently was diagnosed with idiopathic hypogonadism by my endocrinologist. There have been a few instances during my consultations with them where I’ve been unsure to their experience with TRT, but I appreciate their concern for starting me on what would appear to be a very low starting dosage of injectable testosterone. My prescription is for 100mg of test enanthate once every two weeks. I had told them I’d prefer once/week injection but they requested every other week. I am having follow up blood work done after 6 weeks, and the doctor requested I draw one week after injection (halfway from one injection to the next).

I have just done my first injection this week and I am self-injecting at home. I have read lots on this board about how a once every other week protocol doesn’t work so I’m doubtful it will work for me as well. My question to you is whether you think I should stick to my prescribed protocol or try doing 50mg once a week instead. Obviously I do not want to jeopardize losing my prescription but I also am just tired of feeling like shit and would prefer avoiding a hormonal rollercoaster.

Thanks for your time!

This is a sign it’s time to find a new doctor as yours are incompetent! These every 2 week protocols don’t work and a clinical study published in 2005 proves it.

You don’t really stand a chance going to your sick care doctor/insurance network for TRT.

Endocrinologist are the worst type of doctors for TRT, sex hormones is paid about 20 minutes in medical school so the knowledge of any Endocrinologist is about zero. TRT isn’t their area of expertises, endocrinologist specialize in thyroid and diabetes.

You don’t just pick a protocol off the top of your head, you have certain biomarkers measure and base your decision on protocols based off those results, your endocrinologist will not know how to do that which is why you need to go private as these are where the TRT experts practice medicine.

Once weekly injections isn’t much better than once every 2 weeks, levels peak in 48 hours and decline at rates determined by your SHBG levels, so if SHBG is on the lower end, you’ll be high and dry long before weeks end.

50mg once weekly would get you about 150-200 ng/dL!

Where are you located? If in the US you have other options, Defy Medical is a telemedicine clinics who specializes in TRT. Testosterone cypionate is the prefered choice, not enanthate.

200mg every 3 weeks was my very first protocol, it became clear doctors inside my insurance network were all brain dead when it came to TRT, I joined Defy Medical and it changed everything. I inject 20mg every 2 days, if I inject any less frequently, I don’t respond to TRT at all.

Appreciate your response system.
I’m located in Canada where we don’t have different options. I have asked my primary caregiver to refer to a private men’s health clinic (pay out of pocket for consultation but my insurance would cover everything else). Wait time is one year though!

I’m willing to give my endocrinologist a chance if they ultimately see my poor results and change the prescription to something better, but I am actively working on my plan B! To the endocrinologists credit, they did test my thyroid, pituitary and adrenal gland function, had ultrasound on my testicles, and an MRI on my pituitary. They tested everything they should before prescribing testosterone.

So I stick with 100mg every two weeks and enjoy momentary relief followed by a crash? Seems like the lesser of two evils at this point.

You don’t really have a choice, you weren’t prescribed enough testosterone to do your own homegrown protocol. See if you can get at least 100mg weekly allowance for your testosterone enanthate. Canada is one of the worse places for TRT.

The half-life of enanthate is 7-10 days, varies individually. For simplicity’s sake let’s say seven for you. As an example, hypothetically, if you inject 100mg, and your total testosterone goes to 1000, it will be 500 on day seven, and 250 of day fourteen.

The standard accepted protocol for testosterone is 100-200mg every two weeks. Some even do three or four week dosing. Most of them are quite happy with this approach, in part because they do not know any differently. Sure, they may start to feel a little run down, etc. as they go into their second week, but that only assures them that it works and they need it.

I skipped injections for three weeks, as an experiment, and while I could tell be the end of the second week I was overdue, I was fine, still lifting heavy and still very interested in my wife. By the end of the third week, experiment over! Point is, a whole lot of guys taking test through their PCP, urologist or an endo are just fine with it. The majority of guys doing underground TRT take 160-200mg once a week. Standard for TRT clinics is 200mg once a week. Keep in mind many require you to go in and get your injection.

Keeping in mind everyone is different, the vast majority of men on TRT take once weekly or twice monthly 200mg injections. So, 100mg every two weeks won’t cut it, and pulling labs at seven days will be misleading as your levels will be much lower at day fourteen. You should start with a minimum of 100mg/week.

Maybe, the doctor will come around after it becomes apparent this 100mg every two weeks dose is not working. Good luck.

Hi, maybe bringing your doctor this paper may help with the conversation. Don’t know where your levels are but you may end up lower than now by suppressing your endogeneous production even with the inferior dosing:

https://www.ncbi.nlm.nih.gov/pubmed/16912120

See Fig 1 and 2: these guys are right on the mark with suggestions, at least once weekly dosing. Your equivalent weekly dosing is 50 mg to compare with Fig 2 but it’s worse than that because you’ll have a 14 day trough. Bump dosing up to 100 mg / week for your provocative trial and adjust from there. Sometimes you have to help your Doc.

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Appreciate your sensible advice highpull.

I get the fact that tnation forum members are a subset of those on TRT, and likely those who experience more complications (or those who just ask more questions!). A once every two week protocol COULD very well work for me, but I’m very sceptical of it working at a dosage of 100mg. My hope is that the endocrinologist will see the halfway point blood work and increase my prescription dosage. If they don’t see any issue then I’ll be finding a new doctor.

Why is everyone doing blood work at their trough? Wouldn’t midpoint give you just as good of an assessment of average testosterone level? Ideally you could look at peak, midpoint, and trough to see but that is obviously extra expense.

Thanks for sharing this study.
I’d seen a not totally dissimilar one that systemlord had posted that was done in Japan, but the study was only done on 9 individuals. Probably not enough sample size to draw major conclusions from. IMO at least. Still helpful to me but if I were in the medical research field I’d question it.

Another helpful study on TRT protocol: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182226/#!po=0.819672

It would appear that they recommend drawing blood one week after injection for both Test Cyp and Test En… Lots of other helpful info contained. A must read!

Two reasons, one is to make sure you have a consistent reference point from which to evaluate response. Mid point would do that, but it may be a little more of a challenge with the timing, exactly three and a half days, etc.

The real reason doctors want to see you at trough is on the off chance someone (like a state medical board) decided to look into their practice. Let’s say it was reported you were prescribing “legal steroids” for example. Auditing files with a bunch of guys running 2000ng/dL total testosterone levels may raise some eyebrows. Those working with insurance would want to keep levels in range too. I am a good example, I usually come in with around 900 total T at trough. I am well aware that I am higher earlier in the week.

That is definitely correct. In fact, that is how I found this place. A guy having problems with his protocol came to me for help. He mentioned some things (some inaccurate) the average TRT patient would not know about or even know to ask and I asked where he got his information. The internet, and this forum. Out of curiosity, I decided to check it out. Still here. Hormone junkie I guess.

Crazy stuff here. Guys freaking out if E2 goes from 25 to 31. Or, their test levels are not “stable”. Fortunately, I was around a lot of AAS users in the day and saw a lot of varying reaction to them, so I get it. I saw guys taking very high doses of multiple items with undoubtedly very high estrogen conversion, which did not bother them at all. Others, yeah, they were hormonal psychopaths.

If you end up having these discussions with your doctor, mention things like the half-life of the ester and pulling blood at trough. An educated patient is more enjoyable to work with.

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This is the proper way to do TRT, test at trough. Peaks are irrelevant as they are short lived and causes anxiety for clueless doctors.

But wouldn’t the midway point give you a gauge as to “average” test levels, so how you’d be feeling more often than not. This is assuming test is excreted in a linear fashion (which I don’t know if it does).