T Nation

New to TRT with Some Questions

Hey Everyone,

I am newly diagnosed with low T and am trying to get a grasp on all of it. I have a question or two, but first let me give you some background on myself.

41 yr old male
5’-6"
182 lbs

labs done 1 month apart:

total T: 112, 89 (range 264-916 ng/dl)
free T: 34, 27 (range 40-150 ng/dl)
SHBG: 15, 8 (range 16.5-60 nmol/l)
estradiol: 3, not tested (range 23-60 pg/ml)
fsh: 2.2, less than 0.1 (range 1.5-12.4 miu/ml)
lh: 4.1, less than 0.1 ( range 1.7-8.6 miu/ml)
prolactin: 21, 15 (range 4-15 ng/ml)
tsh: 3.64,3.8 (range 0-4.5 uiu/ml)

Now some medical history. I am diagnosed with Hasimoto’s disease which is an auto immune of the thyroid. I am on synthyroid to treat it and my endo has recently increased my mcg to bring down the tsh. I have also had an MRI of my pituitary gland to verify if a tumor was present, and there is not a tumor. I have been lifting weights for 20+ years and have never used any anabolic steroids in the past. I have be surfing for the same amount of time and considered myself quite healthy. Obviously, looking at my bloodwork, I’m not as healthy as I thought.

Now for my questions, I have been put on 450 mg of T every two weeks. What would that be the equivalent of if taken weekly? I have been told that it doesn’t equate to 225mg per week like one would think. With my total T in the double digits, is my dosage enough? Being that I barely have any estrogen, I wouldn’t need an aromatize inhibitor right?

I’d appreciate any help. thanks

Your natural T level has nothing to do with your dose, actually. 450 mg every two weeks is flat retarded, it would be funny except for the suffering the victim would undergo. Start low, up the dose as necessary. 100-125 mg per week is a good start, and you should run screaming from any and all AI’s with an E2 that low.Keep the extra T in a drawer for later, it’s good to have extra on hand in case of shortage or the urge to run a blast later.

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I certainly hope your doctor is testing the master and most potent thyroid hormone Free T3 against Reverse T3 to balance out all levels, Free T3 needs to be higher than midrange and Reverse T3 <15 ng/dL or it will negate a portion of your Free T3 and block Free T3 at the receptors.

Your protocol is common and is a mistake, these every 2 week protocol need to stop, 13 year old clinical studies show poor results for a hormone with a half life of 7-8 days leaving your testosterone low levels and estrogen levels high making you estrogen dominant during the second week.

SHBG binds androgens and is low, you will need injections every day or every other day do to low SHBG which TRT will decrease even more leaving you to deal with free hormone excess. No need to target high normal testosterone do to low SHBG, Free T should be your guide and needs to be high normal or higher. Low SHBG men struggle more than any other do to free hormone excess, mainly high free estrogen percentage which can ruin TRT benefits.

Figure 1 graph B tells you all you need to know, levels after 6 days are below the therapeutic ranges. Your doctor obviously doesn’t specialize in this area of medicine, if he did your protocol would take into account all pre-TRT labs like estrogen and if elevated when testosterone is low infrequent dosing will end in failure and increase in symptoms.

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

TRT will not work well when thyroid levels aren’t optimal, testosterone is metabolised in the liver and thyroid hormones are responsible for metabolism of testosterone.

Would it make a difference since they are testing me with cypionate?

Cypionate half life on paper is 12 days, in the real world it is 7-8 days and enanathe is 2 days less than cypionate. Infrequent large dosing will equal sky high free estrogen in low SHBG men. High Free T ->high Free E2. We excrete testosterone more quickly than estrogen, so these large infrequent protocols cause estrogen dominance in men.

Your dosage is more than twice in the clinic study, so you are on a path to great suffering if you go forward with this protocol. This protocol is expect to shoot red blood cells so very high and hematocrit very high and your doctor will be forced to stop your TRT for a couple of months leaving you with no testosterone.

We see this happening all the time, you want to work with a knowledgeable doctor, you must leave your health network and pay out of pocket for TRT. My SHBG is 16-22 and feel much better on daily dosing, on every other day dosing TRT benefits are degraded for me and is do to estrogen free estrogen excess.

Cypionate has a half-life of 7-9 days, depending on you. So, if you take 450 mg, in one week 225 mg will still be in your system, at 2 weeks 112.5 mg. Your total T will go from something you should only see on a steroid cycle for performance enhancement down to normal TRT numbers just in time to get blasted again. You E2 is going to shoot through the roof and then crash down just in time to shoot through the roof again and all of your levels will go even higher than after the first shot becasuse 112.5 mg are still in your system this time. It’s like you went and asked one of the 18 year-old Bro’s at the local gym to build you a cycle. It’s foolish.

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There protocol is injections every 2 weeks for the first 12 weeks to get some baseline numbers. After the 12 weeks, i would then be doing my own injections at home. Now based on what i’ve been reading for the past few months, I know this is not an optimal medication regimen. I would like to go to a twice weekly program at the minimum, but they will not write me a script till the end of the 12 weeks due to other patients abusing the treatment. I have been to 3 other doctors in the NY/NJ area and none of them would even consider “in home injections”. Not to mention 2 out of the 3 would only prescribe Aveed (no way in hell i’d take that) and the other prescribed gels only (not a fan of this type of administering). I have very good insurance which is covering my TRT therapy at 100% so I’m kind of stuck at the moment. Between just buying a new house and having an child recently, i can’t afford to pay out of pocket, especially since it is covered under my insurance. Should I search for another new doctor? Should i try to ride out the 8 weeks left and then set my own protocol at home?

This protocol is horrible. Contact a good doctor that will make you a fine protocol. You can make a telemedicine examination.

There has got to be a doctor in NY/NJ that will at least be willing to do once a week for the initial treatment period. I understand they may be cautious there and hesitant to just send you home with it, NJ won’t even let you pump your own gas.

Yeah, it’s tough here in NJ. I’m going to talk to them about a once a week protocol at my next appt.

Amazing you have to go through a 12 week hormonal roller coaster and become estrogen dominant just to get treatment, this is barbaric! Clinics like these need to be shut down!

It’s clear to me you have no clue what’s in store for you if you go forward with this protocol, forget about being able to function mentally, physically you will feel like you were run over by a truck because your levels will be very low in the second week and estrogen very high making you estrogen dominant like a female.

That’s not all, if you somehow managed to hold onto your sanity from the high blood pressure and racing heart rates, when you emerge out the other end of the 12 weeks and are lucky enough not to have gynecomastia, you’ll be lucky if your hematocrit isn’t skyhigh forcing this clinic to suspend your TRT treatment.

You need to think carefully about your next move.