New to TRT, Jumping Into Something Unsafe?

Hi all. Apologies for what I am assuming is a pretty beaten to death thread topic, but I’m looking for a little reassurance I suppose. I’m 40 years old 6’2 185 lb. workout 4 times a week. I’ve been experiencing ED, and extremely tired all the time for years. Finally got insurance and had all my labs taken and my T was at 330. New primary care doc poo pooed the idea of TRT. Said I’m within “normal” range and wouldn’t order a second test.

I work with a trainer sometimes and he referred me to Regenerative Sports Medicine and Dr Rand McClain. They aren’t local to me so it was done via telephone. I sent over my labs and when I consulted him his opinion was my case was a “no brainer”

He has me on once weekly injections of 200mg and 1mg of an Anastrazole every other day. He said we would use the anastrozole aggressively at first and then reevaluate at our 90 day checkup. I just did first injection Saturday.

In reading through some threads it seems some of you are strongly against the use of anastrozole. I’m just wanting to make sure I’m not jumping into something that’s unsafe. We didn’t even test estrogen to begin with. That said I felt very comfortable with the doc and felt he had my best interest at heart as opposed to primary care who couldn’t give two shits about how I felt.

Does it seem safe on the current program I’ve outlined and then reevaluate in 90 days? Or should I test sooner and evaluate? Historically I tend to be “skinny fat” with a bit of man boob syndrome so I obviously don’t want any exacerbated breast growth. Thanks so much in advance. Glad I found this forum.

Opps, hard to argue in favor of taking a medication until proven it is needed. I would ask for the rationale behind this recommendation.

That is a very high dose.

No doubt.

Perhaps this is the reason for the aggressive, proactive approach.

You can always make adjustments later.

Good luck.

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Yea I guess that was my feeling as well. He seems to want to err on the side of better to use it than not. If I start feeling off in any way i suppose I’ll address it, otherwise evaluate after 90 days. Seems wild to take the leap for some reason even though I’ve been thinking about it for several years. “Normal” doesn’t mean anything. It’s also normal to get old and decrepit and wither away and I sure as shit don’t want to do that.

I like him, he seems like a decent guy, but his ideas regarding e2 management are f@cked. Please don’t take that much AI. Start with test once a week, wait a few weeks and see how you feel. If you feel like e2 is an issue get a quick lab run and see. If it is, take .25-.5mg of Anastrozole the day after your shot, that’s it, and check again in a few weeks. This takes time and monitoring, and Rand should know that. But he’ll tell you to get e2 around 22pg and that’s very old school thinking

You will find out very quickly that low e2 sucks, it’s probably a big part of why low T sucks. And it’s a few weeks to recover. Many guys have found that a little higher e2 is waaaaay better than low

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Thanks for the response. I think I will go get a lab. It’s difficult because symptoms cross over with high estrogen and low t. As I said earlier I’ve always had kinda man boobs and soft nipples so I’m wondering if it’s always been naturally high. I’ll try and get the lab run ASAP. I want to do this correctly. Maybe my insistence on not wanting gyno effected his decision but it was never even considered to not use it. I’m at the very beginning so starting on the right foot is paramount.

He doesn’t like using SERMs, thinks AI’s are more “elegant” lol. But that would be the better course if gyno is a major concern.

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It is honestly. Always been a big source of self consciousness so I was worried it would get worse.

You can get TRT but your insurance isn’t going to pay for it, too many barriers put in your path by insurance companies to denying treatment these days. Steroids in our society are frowned upon and together with doctors that have a limited understanding in male hormones, limited education and with all the misinformation out there regarding safety, a lot of doctors hear the word TRT and want nothing to do with it.

Add that TRT makes a minuscule portion of a providers business, I wouldn’t expect many doctors to be well versed in TRT, there out there but are few and far between.

Rand McClain is very knowledgeable, but I think his use of anastrozole is too aggressive. Nothing wrong with starting on .125 mg anastrozole if the need arises, but only for the short term until you get a handle of things.

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This doctor put you on a dose of 3.5 mg of anastrozole per week, and wants to wait 90 days before reevaluating you? And you think this guy has your best interests in mind?

He gave you an extremely high dose of a medication that he never tested to see if you need it?

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I know insurance won’t cover the trt I was just saying that I finally got insurance and started to see a primary care etc. I’m going to call today and have them order the e2 test

@cliteastwood yes I did feel he had my best interest at heart which is why I was so surprised to read the info here. Chalk it up to me not researching enough before going into this and just taking his recommendation at face value.

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Should get E2 tested prior to starting TRT so you know your baseline and how you felt at it. Biggest mistake i made.

Also, i would start with the 200mg test alone, get tested after 6 weeks, and then reassess.

Your DR is being way way too aggressive here with the ai and likely the 200mg/week dose. It’s not a sprint.

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What were the issues you faced? I’m going to order test today. Have already taken 2 1mg anastrozole. One Saturday and one yesterday. Will consult with him, maybe test and pause the anastrozole for a few weeks and test again. How frequently are you guys getting bloodwork done?

I’ve also watched a few of his clips. He does seem to mean well. I always thought his e2 management was over the top but he has been treating men for years so surely this starting approach must be justified in some way.

I must admit I don’t agree with the high e2 squat for the most part. From what I can tell high e2 causes a lot of issues for a lot of men. The issues are often subtle and guys chase their tails trying to figure out why they have ED or high blood pressure. Low e2 in my experience is blatantly obvious and easy to diagnose. You feel like utter shit and you cock is numb. Less tail chasing maybe. Just a thought

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Meaning you’d just stick with his program barring feeling like shit and having a numb dick? :rofl:

Totally agree, but if I had to chose, I’d take high e2 over low, based on my symptoms at least. And yeah maybe he’s got a reason for keeping e2 management so aggressive. I get the idea he treats a lot of athletes and competitors, so maybe they all do better with it lower? IDK

Haha, no quite the opposite, it would be intolerable and I’d be calling him ASAP. Often guys seem to feel ok with high e2 and it’s the secondary issues that become a problem like blood pressure etc

You’re right it is a bit of a mystery because I doubt anyone has every anecdotally heard of someone needing 1mg/day on TRT doses but he’s the doctor…. Does he work up from low e2 maybe? Adjust dose until the patient begins to feel their dick again lol

Maybe that’s it, start low and work up rather than the reverse?

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Just called the office. Lady I spoke with said “estradiol levels aren’t necessary for the first labs. They will certainly be tested at the 90 day check up” I explained I had some concerns and would like to schedule a consult with the doc. $200 consult fee since it isn’t part of the plan. Kind of an eye roll there. I’ve got an online patient portal I can message him through for free. Going to try that route first.