T Nation

New Patient Trying to Dial Protocol

Hey guys. I started TRT 7 weeks ago. Only labs taken were total and free T. Total 248 (274-916) free 7.7 (6.8-21.5). Doctor started me at 200mg weekly. I found this forum after starting and realized I should have had many more baseline labs! Uninformed Dr I guess. I felt pretty good around week 3, but have since reverted to feeling worse than before. Dr wants me to go 12 weeks before labs again but I don’t think I can wait that long to figure this out. What labs should I request now as a follow up? I’ve been tired, emotional, and have ED and cognitive issues. Thank you for the feedback.

Total test
Free test
PSA
SHBG
TSH
free T4
free T3
DHEA-S
Estradiol
CBC
Lipids
CMP

Are you on an AI of any kind? Bloated/puffy? You probably need to cut your dose, maybe a little bit of AI foe a while while your body adjusts. That E2 number will be important.

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Only on test cyp. 200mg per week. No AI

You will likely have to figure out your case on your own as your doctor based on limited lab testing suggests he is experienced and is very common. A 200mg weekly dosage is above average and think you should reduce it it closer to 100mg weekly starting out.

There wasn’t much thought into designing your TRT protocol or lab testing, this is no good for the patient and almost always ends in misery.

If SHBG is on the lower end which I suspect you are, you may do better on more frequent dosing, 2-4x per week.

Cut your dose to 150/week and see how that shakes out in over the next couple of weeks. You probably need an AI short-term, but you also may be fine at a smaller dose. Your description suggests that your E2 rose with the gradual increase of serum level test.

Do I need to taper the dose or just go ahead? I’m 46 and don’t want kids, but my nuts have shrunk by half! Is this bad?

250 IU’s every other day would be plenty, overkill for some. Dang. How much Clomid does he want you to take? A box a day? The guy does understand that this is for you, not your wife, right?
Get some insulin syringes. Tiny. Painless. You mix the HCG in bacteriostatic water and divide it up. pre-load the needles and refrigerate them. Or even freeze them and thaw one at a time as you need them. You can buy a big bottle of bac-water and use the giant needle for mixing.

As others have said, cut your dose to around 150 and split that up into 2 or 3 injections per week. At 3 weeks in you experienced what we call the honeymoon phase screeching to a halt as your natural production shut down.

Get full labs at around 6 weeks from the date of change. In the meantime, go to gnc and get you a bottle of nugenix estro regulator. See if that helps. It contains 100mg DIM, but also has a few other ingredients in there that help to regulate serum estradiol. It works great for some men, nadda for others. Won’t know if it works for you until you try, but it’s safer to help regulate E2 while changing protocols than an AI.

I use 29 gauge insulin syringes and the shoulders and quads.

You can go ahead.

Only if it bothers you, or someone important to you…

Change now and find a new doc quick. There’s Trt docs everywhere and clinics online.

Definitely some swelling! Took off my socks and it looks like I’m still wearing them! Lol. My shot is due Thursday. Should I start half dose now and then again in 3 days? Or start half dose on Thursday and go from there?

I would wait until Thursday. It’ll help you taper down a little. Your E2 is probably pretty high.

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Mine shrunk in half. I’m ok with new size. It’s personal preference.if your married doubt it will bug your wife. If your single and in the prowel and it effects your confidence then treat.

Ok guys, I got some of the lab work back.

T4 4.7 (4.5-12)
T3 24 (24-39)
Free thyroxine index 1.1 (1.2-4.9)
DHEAs 350.9 (71.6-375.4)
E2 47.5 (7.6-42.6)
SHBG 27.7 (16.5-55.9)
PSA 1.4 (0.0-4.0)

I really dont know how to interpret this. I know I feel like crap. Doctor refuses AI.Says I’m not that high and to cut dose if anything. New T numbers got lost in the mail so have to go back. I do feel less emotional after splitting dose to E3.5D. Insight?
If I do get anastrazole what would be the starting dose?

You felt good before he made the change . What was it that he gave you where you felt better?

If I took my car to a mechanic and found he was incompetent I am definitely not returning. You are and it’s with the one vehicle you get in life.

This is why you need a legitimate professional like the suggestion I made before hand. What’s stopping you from calling defy and hiring them? You will hve peace of mind knowing they know much more than the current doc.

Everyone gets some swelling, blood pressure fluxes, heart rate, water weight. Itchy nipples. It’s becusse you just have your body hormones it hasn’t had enough of. It all dissipates if you are on a good dose. Attaching every side to e2 isn’t going to get you far. Don’t make that mistake. I had all these issues and after about 4 months (lately) allot of these sides are gone. My nipples aren’t itching or sensitive anymore and my ankle hasn’t been bloated in ages.

The only thing we changed was splitting dose to go every 3.5 days. Still not good, but do feel less emotional.

T4 is the total thyroid hormone being produced by the thyroid, it is very low and this is unacceptable, this is full blown hypothyroidism. TRT will not work well for those with low thyroid hormones.

It’s like your doctor is waiting for T3 to drop 24–>23 before taking action, unreal.

200mg weekly seems like another cookie cutter protocol without any thought for pre-TRT SHBG or estrogen levels. Maybe your doctor wants estrogen very high for a reason or maybe he doesn’t know what he’s doing.

You are spinning those wheels sir with this doctor and it would be pure luck that you dial in as long as you’re with this doctor.

You feel less emotional because your estrogen isn’t sky high, 100mg twice weekly is a mistake.

Inject 50-60mg twice weekly.