T Nation

New Guy - Question on TRT


#1

Just recently started TRT, Doc seemed to be on top of things. Just have a question on prescribed protocol. He started me on 40mg IM cyp eod, 30mg B12 IM eod, 50mg clomid weekly in 2 doses, and 1mg anastrozole Eod. Is this too high on the anastrozole? seems like I have read that it should be 1mg weekly in divided doses. I asked him about HCG to keep the testes stimulated and he said that the clomid does the same thing. Does it?


#2

Clomid and HCG are 2 different things. EOD Test injections is good. What kind of lab numbers do you have? 1mg Anastrozole EOD is way too much. That is 3mg weekly which is outrageous. 1mg Weekly sounds more like it, So .25mg EOD
But you should really post up your blood work so we have a better idea what kind of values your doctor is dealing with.


#3

I agree that I'm not sure why you would utilize the clomid in order to preserve the testes. I suppose it COULD maybe possibly kinda work (via keeping the HPTA feedback loop in tact) but I honestly have never seen anyone utilize this and I have no idea why you would when HCG is a proven methodolgy and a way more direct route to stimulating the leydig cells.

Agreed that 3.5 mg Adex a week is probably overkill. Only seen one guy that needed anywhere close to that amount and he was a very unique case with a high test dosage.

Your doctor doesnt appear to be as switched on as you give him credit for


#4

Weird, you don't normally see Clomid as part of TRT protocol. I don't really know enough about it to answer your question though. But it is commonly used to restore HPTA function after a cycle, so I guess it could conceivably maintain function while on TRT. Maybe.

Everyone is different but I certainly would not start with that high of an anastrozole dose. It's powerful stuff. I'm still on .25mg EOD, the normal starting recommendation around here. I bumped up to .5 EOD when I was on cycle and it was definitely overkill, but that's me. I get joint pain and crap moods when I've dropped my E2 too low.


#5

Clomid can raise LH and FSH to stimulate the testes to produce testosterone and HCG acts just like LH does. Now...if they are comparable, I am not sure but I see where the logic comes from. If your fsh and lh are low or low normal I wonder why he didn't just give you clomid to start off with.


#6

OK, sorry that I didn't post all info up but the AC was out and have been working on it.

The avatar pic was in '86, trying to make a comeback.

52 yrs old
5'9"
38" waist
216 now, down from 280 in April 2010
Have always had light facial and body hair
Carry fat mostly from armpits to mid thigh
Good overall health, High BP-runs in the family
amlodipine besylate 10mg daily, adipex 37.5 daily
No hairloss or prostate drugs ever
Diet is good-approx. 2000 cals a day. No bread, potatoes, white rice, sugar etc...
Train 1 1\2-2 hrs 4-5 times week, including cardio 3 times for 30min(I hate cardio!)
No aches or pains in testes, they tend to pull up most of the time
morning wood non-existent until starting TRT

Latest blood work 6-15, new Dr. and not many tests and not correct estrogen test
TSH 2.120 0.465-4.680 mlU/L
PSA 0.31 <3.00 ng/dl
Test, total 637 250-1100 ng/dl
Test, free 63.3 35.0-155.0 pg/ml
Estrogen, total <50 130 or less pg/ml
FT4 1.59 0.78-2.19 ng/dl

These tests were from the last Dr., NOT the Dr. I am using now.

VT, this is the 5th Dr. I have seen and the only one to even agree to TRT, he may not be as "switched on" as some but at least he is willing to work with me. He does understand, he looked at my T and FT numbers and said, "those are in range but they suck". He ordered tests for E2, LH and FSH, and a few more.

I felt like the anastrozole dose was too high, so I have been taking 1/2 mg EOD but may go to 1/4 EOD since that seems to be the norm. I asked him about HCG and he said the clomid would do the same thing. I keep getting mixed signals on that. I have found a few places that say it does the same thing and more that says it is different and will not.

Since I started this 2 weeks ago libido and morning wood have returned, overall I am feeling much better, workouts are great, work is easier. Still tired a lot but I work nights and try to sleep in the day.


#7

Just a quick note, "less than 50" is meaningless for men. You need the sensitive E2 test because for us, the difference between 25 and 50 is HUGE.


#8

I know, the new Dr. I went to on 7-26 requested the Quest 4021x.
The previous Dr. who got the Total serum Estrogen was supposed to be an expert in this area. The new Doc is the 5th one I have tried. I hope it works out.


#9

The first week on this program I felt like an 18 yr old, libido through the roof, raging morning wood, workouts like a maniac. Now not so much, morning wood is lackluster at best, libido is waning again, erections won't last. The first week I was taking AI .5 mg EOD(Doc said 1.0mg EOD), the second week and until now I have been taking .25mg EOD. Just wondering if I should take it back to .5MG?


#10

Any of your docs ever test 8am cortisol? Maybe your body isn't ready to handle extra T.

Would have been good to know FSH/LH before you started taking test. Suppose that's water under the bridge now.

As far as AI dosing, I'd think you'd need more than a week to know what your sweet spot is. It would be hard for me to guess whether you need more or less without knowing the results of your E2 lab.


#11

Negative on the cortisol, this is actually the 3rd week.


#12

FN, your story is common...I have read a lot of stories where TRT didn't improve their sexual performance even with everything looking 'okay'. Libido is something that is very complex involving several factors...dopamine, testosterone, estrogen and even prolactin. Maybe there was something else at work causing your sexual issues.


#13

I would think an 8am cortisol draw would be pretty vital... you'll want DHT tested as well, very important for libido


#14

Thanks guys, have an appt. on the 29th at 8am actually and will suggest this or at least raise the issue.

OK, here is a question that has made me wonder if something else is amiss. I seem to "run" hotter than most people, I will be sweating when no one else is. In the winter, I am comfortable in short sleeves when everyone else has on a coat. Sometimes the sweating is embarrassing, I will be soaked and no one else has even broken a sweat. I have never thought about asking the Doc about this.


#15

That was happening to me prior to TRT. Once my levels went up, I started to run less hot and no longer wake up soaked from sweating. It took about 3 months for that symptom to completely subside. I also had 0 libido when I was at my hottest, prior to TRT.


#16

Galen, how long did this happen for you. I know that I have experienced it for at least 15 years.


#17

On and off through puberty... which lasted noticeably until about 18. Then it hit me again at 25 when I started working out regularly, so I brushed it off as having to do with reawakening my metabolism. By 26 I could not ignore the issue any longer and went to the doctor. My test levels were dropping at times, and at their lowest would be when I experienced the most night sweating etc.

I'm 29 now, and have not had the issue in a few years, but can still clearly remember what it felt like. I can't believe you've been able to put up with this for 15!


#18

It seems to fluctuate, sometimes it is worse than others. I just put up with it and go on. I am going to talk to the Doc on the 29th about it.


#19

Do that for sure. Simply describing the level of physical discomfort I was in, and the way that sudden sweating outbreaks would make people at the office ask me if I was feeling ok 24/7 was compelling enough for my doc and I to work out a regimen that she has allowed me to tweak on my own these past few years. She just asks me for more blood when I make changes to monitor my overall health.

Best of luck!


#20

Your labs are valuable, if the lab timing is appropriate and consistent. Your dosing needs to be consistent for a period of time before the labs. You can be changing and doing lab work. Serum E2 can then be used to refine your anastrozole dose. Use the method described in the protocol for injections and other threads.

That initial anastrozole dose was stupid. Stick to the stickies.

Clomid will work, but some get bad estrogenic side effects. Nolvadex does not have that problem and works just as well. Use smaller amounts, we are not trying to make the testes do the heavy lifting. Too much LH is just as bad as too much hCG: AI resistant elevated estrogen.