T Nation

New TRT Patient

I’m 40, and have been feeling low T symptoms for the last year. I went to my local TRT clinic to get tested and my Total T was 187. They tested me again 3 days later and my total T was 109.

So with my T being so low, they said I’m a good candidate for TRT and my health insurance will cover my TRT due to the low numbers.

My treatment plan is 140mg of test Cyp once a week with 50iu HCG and 1 mg of anastrozole both immediately after my T injection.

Im pretty damn pumped to get back to feeling like myself again and getting my life back to normal.

They said it would take a few months to feel better, but after my first shot Friday, I woke up with wood for the first time in forever.

I know my body better than anyone else and think it could be a mental thing, but I swear my morning wood was related to the increase in total T.

For those who have been on TRT, am I going to see any changes in body composition that TRT is supposed to give such as increase in muscle mass and fat loss.

I used to workout all the time and was 5’9" and about 205 lbs with 10-15% bf and now I’m an average joe schmoe 185 lbs with 15-20% bf with a lot less muscle mass.

I dont want to have too high of expectations from TRT, but am wondering if anyone has had great to amazing results from TRT. It seems after reading many threads in this forum there are many problems with getting doses dialed in and many still feel like shit even after many months or years on TRT.

With the right protocol you will get symptom resolution, especially in your case given that you are clearly deficient in testosterone.
First of all, go by free t which is the testosterone that is available for your body to use, shoot for the top of the range, most men find resolution at 25-30 ng/dl, outliers might have to go higher.
Your protocol is terrible, focus on getting your testosterone dosage right first, then you can add hcg. Don’t do once a week injections, start with twi times a week at least. Don’t take anastrozole, it is a toxic medicine used to treat cancer, besides you do not want to block estrogen since it is needed for a lot of functions including sexual desire.
One last thing, your provider is clearly not informed about proper trt, if they don’t let you make the adjustments that I suggest then I would advice finding a new doc.

You will most likely not need that much (if any) Anastrozole. I’d wait a few weeks before taking it

That’s way too much anastrozole. It’s unlikely that you need any at all, especially at that dose.
Should that be 500iu of HCG? 50 is a waste of time, but then again so is once a week with HCG - it’s an every other day shot if you’re going to use it. That said, it’s best to introduce one new thing at a time, so it makes more sense to not use that either until your test dose is dialed in.
Lastly, yes you will likely have physical composition changes. Personally, my shoulders blew up, which I don’t consider a bad thing.

I agree on the hcg and anastrozole. I think they only put that in because insurance wont cover it and they are charging me $95/month for just those two things which would cost them like $5-10. I’ve taken hcg before but it was 250iu 3x/week. I would find a new dr, but it is the only trt clinic town and my GP wouldn’t prescribe me test.

Those are pretty low Total T numbers. It does not suprise me you are feeling better already.

Regarding the overall protocol, is this a weekly injection? If so, you may have to go up to 140mg (or possibly higher) to keep your Free T within range all week. My advice is to break the dose up into at least 2 smaller injections twice a week. Your peak values will be lower and your nadir values higher, giving you a smoother hormonal ride. Also, in my experience, you feel better with less T on a more frequent dosing schedule. However, there are some in this forum that disagree with this approach, so you should be aware that opinions vary.

I’d ditch the anastrozole all together. Guys are way too paranoid of E2. however, it’s a natural and necessary male hormone too. Without it, we go limp and lose libido. It’s a very difficult drug to dose for men and guys typically end up crashing their E2 and feeling worse, or just not feeling all the benefits of TRT. Unless you have a prior history of gynecomastia (with or without AAS use), or you are are one of those rare individuals that hyper converts T to E, you should not need an AI if you you use reasonable doses of T and keep your T values within physiological ranges.

Will you have enhanced performance in the gym? No doubt yes, you probably had lac luster performance before TRT, so now you should be experiencing the “normal” gains of a guy your age who works out regularly.

Yes it is one 140mg injection per week. I had asked about 2x weekly injections and the doc didn’t want to do that and had said only 1 out of 62 patients gets 2x weekly injections. My E2 was below 15 on my labs, but it didn’t give an exact number. I think it should be between 20-30.

If you are self injecting, I’d placate the doc. Get your script and then break it up into more frequent injections. You can adjust the frequency as you approach your labs so the doc sees the numbers he want to see for a week long injection.

You might want to do the same thing with the AI. Take the script but don’t take the meds. Your E2 is way too low, which doesn’t surprise me. That’s a lot of anastrozole. I think you’ll feel better if at least you cut the dose in half. Even better if you ditch it all together.

Right now they give me the injection in their office and hand me the ai at the same time and watch me take it as if I were a mental patient. When I asked about doing my injections at home, they said I insurance would t cover it. Seems kind of shady.

With that provider you are setting yourself up for failure, if I were you I would run the hell away from them and find a different one, even if I had to pay out of pocket.
If you are in the US check these clinics

https://tier1hw.com/

Thry offer telemed

I can’r stress this enoght, never take an AI, it does not belong in trt, not even thr tiniest dose.

Your treatment is legally your choice. You can simply say no, or even better stop going there altogether and go somewhere else.

Must be a low T clinic. I did that my first 3 months. It was a pain to make a 90 mile round trip once a week to get my T fix and it never lasted more than 5 days before I’d have a return of symptoms and had to endure the last 2 days of the injection cycle. They bumped me up as high as they would go (160mg). It sucked to be on the hormonal roller coaster.

Worse, i had a 3 week family vacation in Europe coming up in a few months and there was no way I’d make it through the vacation without my T fix. I was highly motivated to find a doc that would write me a script. With your low T numbers, you should have no problem finding a willing doc. You may have to stop the T clinic injections and retest to get a new “mainstream” doc on board. I’d suggest pushing for only a 4 week withdrawal if your doc insists on new labs. Chances are pretty good you will still be suppressed from your current protocol and that will only help you qualify.

Oh, i also wouldn’t be overly worried about insurance coverage. A script for injectable T is dirt cheap compared to most drugs. I pay $154 per year ($0.42 per day) for my T-cyp script, and this is for Pfizer branded DEPT-Testosterone. i don’t even bother submitting to to my insurance for coverage.

I’d like to find one of those mainstream dr’s. This trt clinic is supposed to do labs every 4 weeks.

This is disturbing on many levels.

First, you’ll likely be fine with once weekly dosing. In my practice, I’d say 10-15 out of 100 use multiple weekly injections, so more than 1 of 62, but certainly not most.

Second, why anastrozole, aside from it costing $95 a month? Where was your E2 when you started? It could have been below 5 with your test levels. I wouldn’t take it unless a need was established (and you probably need estrogen, not an AI) and that is fairly rare.

Third, you have to take the AI in front of them? That’s insulting. I’d walk right there.

Fourth, why hCG? Trying to conceive? Concerned with testicular atrophy? Other than those issues, no need for it.

Fifth, insurance companies are fine with you injecting at home, especially if they are being billed for a procedure every week when you come in.

Finally last, I doubt you’ll need more than once a week dosing but why would they care, other than money? (They are likely billing the insurance for the injection procedure and they won’t pay for two a week.) I don’t care if my guys inject every hour as long as their labs justify it and they are feeling the benefits. I’ve had a few advance to daily injections, but every one of them ended up back on once, or twice, weekly dosing, usually twice.

Money should never be the driving force behind treatment recommendations. If you suspect it is, they need to explain their rationale behind their plan or you need to move on.

Good luck, I think you will get amazing benefits from TRT, like most we see. I have personally, plus have seen it in many others, of course. Keep in mind guys on the internet are typically having problems and are researching solutions. Outliers, in my opinion. Nothing wrong with it, just goes to show we are not the same and some respond differently.

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Find a new doc/clinic/whatever. Seriously.

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There are a lot of red flags here, be very careful with anastrozole as it can come with serious side effects. I can’t even handle 1/8 of a 0.050 anastrozole without my knees and hips hurting 5-6 days later (AI over-responder) and it feeling like I drank 10 pots of coffee as my cardiovascular system is affected negatively be this drug.

The mainstream TRT docs are going to cost mucho denero. I’d get a telemedicine doc that is going to give you T and let you do it. After a while if you don’t feel like you should you can spend the money on a doc that is going to take some time with you. The reason most guys aren’t using insurance isn’t because they have money to blow it’s because many cases when it’s covered under insurance you’re stuck with a protocol like you’re on that has you feeling like shit. Imagine $150/month has you feeling better than you could have ever imagined. Not a bad price to pay for that considering a coffee a day adds up to likely double that. There’s a million telemedicine docs but if you need one I can put you in touch with mine. They’ve done right by me for 3 years now so I try to pay it forward. $150/month including compound pharmacy grade T & syringes shipped to your door. Stop doing a bullshit protocol to save $3/day. Once you get to feeling amazing you’ll be so pissed you waited.

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Thank you for the advice. I will talk with my clinic about more options and if they cant offer me what I need, then I will move on. I feel like these TRT clinics take advantage of Guys with low T, making them believe their clinic is their only option.

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I think you are probably attributing these symptoms to the anastrozole when it is something else. 1/8 of 0.050 mg is only 0.00625 mg. I doubt even in an over responder that dose would cause more than a point difference in E2.

Possibly you typed the wrong numbers in?

Probably should have been 1/8 of 0.5mg, but your point is pretty valid regardless.

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