T Nation

Newbie Questions, Adjusting Dose. What to Tell Dr.?


#1

I am in the middle of gathering all of my readings so I can ask more ‘intelligently’… however I wanted to get a quick opinion here.

My test levels were 300 (Estrogen not tested) at first test. Prescribed 200mg/1ml cypionate every other week.

2nd test was screwed up as I took a shot the day before the reading and it came out test 1100 and estrogen very high (numbers not on hand at the moment). Dropped to 150mg/.75ml every other week. My general symptoms of low t started to return around the 3-4th week/shot during this phase.

After 6 weeks of 1 shot a week I just tested again and my readings are 700 test, mid 100 estrogen (doc said estrogen was slightly above normal. He said I could either lower dose to .6ml or keep it at .75 and go see an endo for the estrogen issue.

I know I want to see an endo, but I feel I should be raising the cypionate back to 1ml a week and that I am assuming my unknown ideal test level to counter my symptoms would be around 900. I have no idea how to articulate and justify that number when I go to see the endo or urologist again.

Any help here is greatly appreciated, and I will work to get the actual test results so I can post them here.

34 year old male.
6’0" 215lbs


#2

Your test cyp is 200mg/ml, not 2000mg/ml.

2000mg/ml would be a specific gravity of 2.0 and a solid. [T specific gravity is ~1.17]

A 10mg vial would be 2000mg per vial.

Please understand your dosing and we need mg’s, not ml’s because mg/ml is variable.

Try:

  • inject 50mg T cyp [1/4ml] twice a week subq, not IM, over upper legs using #29 1/2" 0.5ml insulin syringes
  • always do labs halfway between injections so that lab changes are not from lab timing changes
  • take 1/2mg anastrozole/Arimidex at time of injections
  • inject 250iu hCG subq EOD to preserve testes and fertility

Endo’s are the worst. Having a good experience with an endo seems to be quite rare.

Target/optimal is E2=22pg/ml - 80pmol/L. A bit above normal is horrible. The word “normal” is from a statistical normal/bell curve where range cut-offs capture 95% of the sample group. E2 near high-normal is very poor quality of life. Confused? Most doctors are and they think that lab normal means a good result. Optimal is completely different.

Most guys here have to educate their doc, often impossible, or try to find another doc. There is a sticky for that.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#3

Sorry i corrected my 200/2000 error in my first post, thanks for catching that. I am getting my actual test results, all of them, monday so I can post actual data. Thanks for taking the time to respond.

I have been sorting through the stickies so I know I should have had that, just trying to get as much info as I can before contacting the endo.

I will ask the endo for anastrozole per your recommendation, and should I accept clomid if they refuse hCG? I have scene almost 90% of people on TRT also taking clomid to maintain testes health (although I have already had a vasectomy I would still prefer to keep the testes healthy).

I am very curious as to why I should inject at upper legs instead of buttocks? I have not heard or read that as a better location. Can you tell me or direct me to the specific sticky where that information is? (trust I am still committed to reading them all but that takes time obviously).

I am worried the endo will not care about treating my symptoms but just go after numbers, is there truth to that? My symptoms returned when I lowered cypionate from 1ml to .75ml. If lowering E2 will fix this then great. Is there any generalization I can apply here so that I at least sound educated when I speak to the endo?


#4

its been hell waiting on my endo appointment but I followed all of your advice (all that I could) and I wanted to follow up with you and ask a couple of questions… if you find the time to get back to me at all I will great-full but I understand there are many asking for help.

-Firstly, I switched to 50mg twice a week with the #29 insulin syringes and did that all the way up to the endo appointment.
-my last lab in october was between injections as noted
-I have been unable to talk my urologist or endo into prescribing hCG or arimidex (or any AI), she did however take the information I got here plus all the pubmed and nihb articles I found in the stickies supporting it, she said she would look into it.

At the end of my endo appointment she concluded she wants me to discontinue the trt and wait until march so she can test me again. Stated I needed the 5x half life to rid my body of everything to get an accurate measure. She wants to do this due to the fact that my urologist not only tested my levels in the afternoon every time (2-3pm) but also switched my dosage from 200mg every other week, to 75mg every week. She was also upset the doc let me test the day after an injection (understandably). Long story short, she doesnt trust the test results my urologist gave her.

So here are my questions:

  1. Should I keep on the trt and seek out a new endo (seriously no other endo’s in my area so this would be tough).
  2. Go ahead and stop and go cold turkey until march
  3. Stop and start PCT? (I have access to un-prescribed clomid and tamoxifen so my only option would be to PCT with those two substances).

Here is the blood work in totality that my urologist ran, I was only able to acquire these from the endo, as the urologist office wanted me to jump through hoops to get them.

Blood work for trt

10/05/2017 (tested 5 days after last injection of 50mg)
Estrone, serum = 107 (12-72 normal)
Test serum = 717 (264-916)

08/08/2017 (tested 36 hours after last injection of 200mg)
Hemoglobin = 14.7 (12.6-17.7)
Estrogens total = 247 (40-115)
Protein, total, serum 6.9 (6.0-8.5)
Albumin, serum = 4.7 (3.5-5.5)
Bilirubin, total = .4 (0.0-1.2)
Bilirubin, direct = .12 (0.0-0.4)
Alkaline, phosphatase, s = 50 (39-117)
AST (SGOT) = 27 (0-40)
ALT (SGPT) = 32 (0-44)
Testosterone, serum = 1078 (264-916)
NO ESTROGEN TESTED ON THIS LAB

06/20/2017
Hematocrit = 45.1 (37.5-51.0)
Prolactin = 8.1 (4.0-15.2)
LH = 4.2 (1.7-8.6)
Testosterone, serum = 310 (348-1197)

06/01/2017
Testosterone, serum = 155 (348-1197)
TSH = .545 (.450-4.5)
T4,Free(direct) = 1.42 (.82-1.77)


#5

It sounds as if she believes you might not even be low T due to the fact that your doctor tested you at 2 and 3 p.m. in the afternoon, still 300 in the afternoon is still low T. You might be sorry if you follow through with her advice as she might deny TRT at a later date and then you’ll be sorry.


#6

she did elude to that. I am not opposed to her finding another way to treat me, she wants to rule out the possibility of the pituitary gland being the culprit I believe. I will look for another endo just in case.

For the other question, do i need to start PCT? I have taken my last shot 2 days ago and they are not going to refill the prescription obviously.


#7

This is retarded, your HPTA will be messed up and you will suffer.
Yes T will wash out, but that has no intrinsic value. T is gone in 10 days, then your HPTA does or does not do something useful.

Testosterone, serum = 310 (348-1197)
Testosterone, serum = 155 (348-1197)

Why do you need an endo, they are mostly not available and do not know what they are doing.

Your T was low. FT was not even checked.

You had symptoms of low T and these were resolved?
Describe what parts of your flawed TRT seemed to work or worked for a while.

What is your doc trying to prove?

If pituitary is the problem, low LH/FSH, you still need TRT.

You cab test prolactin now to see if a prolactin secreting pituitary adinoma is there. Blows to the head can damage pituitary too.

We have lots of guys here your age. Your case is not unusual and she should not be second guessing.


#8

My low symptoms were resolved yes, but after my urologist reduced the dosage to 150mg every two weeks (splitting it up to twice a week) the symptoms came back. He stated between that and the E2 being high he was done with me and I had to go to the endo.

The times I felt the best was when I went from every other week to every week pinning (not twice a week). I was on 100mg a week at that point. But the only blood work I have was the test the day after an injection which made the doc lower the script.

What is the endo trying to prove? That my problem could be related to something much different than testosterone (pituitary, or estrogen alone).

I looked at my results at each test and LH was always within the normal range, I do not have any personal inferences on LH with regards to my testing.

She never once mentioned prolactin.

So I am guessing your recommendation is to find another endo?


#9

The reason why you felt better injecting every 2 week was because by the second week your E2 started dropping. You’re dealing with a bunch of retarded doctors who pass you on to the next doctor at the first sign of actually needing an adjustment to your protocol, so yeah you need a new doctor. You need an AI together with your protocol or you will have to deal with high E2 again. You also need to realise you will probably feel like crap for the first couple of months while your body attempts to adapt.


#10

the times i felt best was every week not every 2, but I am sure you are 100% correct about the E2 dropping and my mood improving. Thanks for the input. Hopefully I can work this out soon. Impossible to get an appointment anywhere. Basically off TRT at the moment.