T Nation

New to TRT Need Help

Hi my name is Calvin. I have been just diagnosed with low testosterone and diabetes. Here are my labs.
Total testosterone 158ng/dl
Free testosterone 4.58ng/dl
Bioavailable testosterone 40ng/dl
Estradiol 12pg/ml
SHBG 24nmol/L
Prolactin 6.3ng/ml
PSA .474ng/ml
TSH 2.581miU/ml

the more senior guys will be around to ask you to post ranges to those labs. and what ever protocol for meds your doctor has order if he has already


There should be no confusion, TRT is needed to live a normal healthy life.

Diabetes and low T are common in middle aged men, you lose the ability to drive glucose into muscle tissue and therefore higher insulin levels in the bloodstream. You should consider two or more injections per week opposed to the disastrous results of 200mg every 2 weeks, expect your doctor to be clueless and not be very knowledgeable as there is no standard of care for TRT for doctors to follow.

You may have to figure out everything on your own and self educate as your doctor may seem uninterested in learning how to do TRT. If your doctors seems anxious about more frequent injections, dosage increases and/or is afraid of high normal testosterone and wants you confined to mid normal levels, then it may be time to locate a new doctor because higher testosterone is healthier.

Elderly men often break bones easily do to low testosterone and low estrogen, having low estrogen will cause your bones to be weak and break easily. You more than likely broke your wrist because your testosterones is low, therefore estrogen also low and wouldn’t be surprised if you had a mild or moderate case of osteoporosis.

I just had my first injection of testosterone on 5-9 it was 300mg but he doesn’t want me to come back for 3 weeks. I’m concerned about the roller coaster levels of testosterone. He did say he has other guys that come in once or twice a week. Should I also be taking HCG and anastrozole? What dose of testosterone should I take if I start going once or twice a week? Thanks for your help in advance.

There is no reason why you cannot self inject at home, this practice of treating men like invalids should end and allowing self sufficiency.

You are on a course that ends in lack of symptom resolution all but for the first 4-5 days, the remainder of the time will be spent estrogen dominant and testosterone will be low. The half life is 7 days and you’re going 3 weeks between injections, this will end in failure and you will NOT notice any benefits to TRT in the long term.

There was a study that came out in 2005 where men were injected with 200mg every 2 weeks and the men were estrogen dominant 5-6 days after an injection because testosterone dropped and estrogen remained elevate for another week because we excrete testosterone much more quickly than estrogen.

This is what happens when they is no standard of care for TRT, doctors have no idea what to do and often the patient ends up the one suffering, you should find a competent TRT specialist in anti-aging or sports medicine.

Hormone profiles after intramuscular injection of 200mg testosterone enanthate every 2 weeks in patients with hypogonadism

SHBG binds testosterone and estrogen, SHBG is on the lower end so free hormones will be easily elevated, including free estrogen and is better controlled injecting smaller doses more frequently. You need a minimum two 50-60mg injections per week, 25mg EOD is recommended.

My SHBG is about the same as yours and I do well on 20-25mg EOD.

So, as mentioned above, we do need ranges with those numbers. A shot of 300 is going to shoot your T up around 2500 or so, as an estimate, and then drop off a cliff. Your E2 is going to spike shortly after the Test peak and you’ll probably swell up like a balloon. Then you’ll feel like garbage for two weeks until your doctor jacks you up again. 100 mg a week is a fine starting dose, but you cannot take 3 weeks worth all at once and expect that to work. 7-8 day half-life. You need your next dose no further than 7 days from the previous one. What was your A1C? What is he doing for your diabetes?

My A1C was 7.4% april 4th. Back on Nov. 30th it was 6%. I’m taking two 500mg tablets of metformin a day with my evening meal. I’m going to call the Dr tomorrow to see if I can come in earlier. I would like to go once a week taking 100mg or maybe every 4 days taking 60mg. Should I ask about HCG and anastrozole? I didn’t notice much difference taking 300mg all at once. Is that common on the first injection.

At some point on this journey you will want to get to a place where you can self inject - start looking around for that. My first two years on TRT I was going weekly and when I switched to and Endo, he offered to write the script but didn’t think the insurance company would cover it for self injection - they did.

Keep an eye out.

HCG is for fertility or aesthetics. If you are trying to conceive you should use it, otherwise it’s just to make your balls bigger and will cause some down-regulation that can be a problem if you do want to make a baby down the road. You have to cycle it if you’re going to use it. Anastozole is only if your E2 shoots up and causes you problems. It’s good to have just in case, but don’t use any AI unless you have to, it’s just more complications and more chemicals to keep track of and dial in. 100 mg a week is a great place to start, you level out after about 6 weeks of regular dosing and then you know where you sit at that dose and can decide if you need more or less.
The Metformin will raise your SHBG over time, and be totally unnecessary when you lose that extra weight that you just gained.

I am hoping when I start working again along with taking testosterone i will loose some weight. I don’t know if I can but I would love to get down to 180lbs from 260lbs that I am right now. I walk 8 to 10 miles a day so that should help especially when my testosterone levels go up. Should my testosterone level be around 600 for me? I’ll be 49 in September. Or will I feel better at 800 or 900? I’m done having children. My youngest will be 23 in August. I all ready have 2 grandchildren. I just heard HCG was also important when on TRT. I also hope to get rid of diabetes soon also but my diet is horrible. So I really need to make some serious changes so I can retire in 8.5 years. I want to enjoy my retirement with my family.

Your diet and weight gain are causing your diabetes issues. Lack of exercise atm is just compounding that. As for the best level for test, that’s completely individual. You’ll find out as you tweak the dosage.

Low t causes sugar cravings. My diet improved greatly after starting TRT. When i was low i would eat sugary candy 24/7. Italian ice all night. Just absolutely rediculous amounts of sugar. My first month of treatment i basically had no refined sugar or candy. The urges just went away

That’s encouraging. Thanks I hope the same happens for me.