T Nation

Old Guy Starting TRT Treatment

After having a yearly blood test my doctor suggested I start TRT treatment. Not knowing anything about this and after getting my first shot I found this site. I started questioning the doctor and quickly figured out he had little knowledge of the issues with TRT.

I am 67 years old, 5’ 9" and weight is 210.
He was giving me 200 mg of Test weekly. My initial test was 417 ng/dl which is probably not that bad for a my age but he said anything below 500 should be treated.

He knows nothing about HGH and does not seem concerned about Estrogen. He said it could get too high but was usually not a problem. I asked him to check for E2 and he just checked for total and said it was high but did wanted to check it again in a month.

At my insistance I got him to run the same check as LEF does for basic hormones and explained about E2.
This was the result blood taken just before my shot so it had been a week since getting TRT.

After 4 shots

Testosterone, Free and Ttoal 1183 ng/dl (348 - 1197)
Free Testosterone(Direct) 27.9H pg/ml (6.6 -18.1)
DHEA-Sulfate 170.5 ug/dL (33.6 - 249)
Estradiol 34.2 (7.6 - 42.6)
PSA 4.6H (0.0 -4.0) (this was 3.2 last month)

He thought this was great except the PSA. I asked him to cut down the Test. He reluctantly agreed to 150 and we do another test in a month.

On my on I got some liquid Adex and HCG and started using the sugested protocol for these I found on this site. 250IU HCG and 6 drops anastrozole EOD. It has helped with the libedo.

Based on what I have read on this forum it sounds like my response to T is unusual. (what do you think?)
I was shocked that it was so high so fast!. I told the doctor I thought if it had been tested a couple of days after the shot it would have been higher. Maybe he said!

I am trying to work with this guy. The only good thing is he just files on medicare and insurance and I don’t pay anything.

At the end of the first week I felt really bad. short temper with no patience. However I seem to be able to tolerate the weekly’s ok now.

Any advise on where to go from here would be helpful.

It does not take time to get T levels up.

When did you do the labs relative to your injections?

Do you self inject? Have you read the stickies?

When injecting once a week, T and E2 levels are changing. Timing of the labs determines the results and such results are not very useful to make adex dose refinements.

Medicare pays for T or the insurance?

E2 is a major risk factor for prostate problems. Try to get E2 near E2=22pg/ml.

Reduce E2 and you will feel better. Your adex dose needs to be changed when you change T dose.

The important thing is how PSA changes when you introduce TRT.

You really need to loose weight. What are you doing to make that happen. The balance of calories and metabolism depends on many things other than T&E2.

Do you have thyroid lab results? Read the advice for new guys sticky.

Labs were done 4 weeks after starting injections same day as getting the 5th shot.
Next lab I will do mid-cycle.
Just started Adex and HCG when blood drawn for lab work. I self inject HCG not T. Doctor doesn’t seem to know about HCG.
Doc is paranoid about self injections because of law suits.
Yes medicare pays for T. Also have supplemental insurance but they won’t pay for anything that medicare won’t pay for so they must be. Nurse said they were paying.

Loosing weight. Haven’t had thyroid lab. Not sure what to ask for.

So far I have not paid anything for shots or lab work.

Most injected T is self injected. When single use needles became available, self injection became possible.

I know the concern of having guys inject into their butts, there are major nerves and blood vessels.

Tell doc that you want to self-inject T subcutaneous [SC] with an insulin needle. Because diabetics inject SC, he has no grounds for objection at all. If he says that SC T does not work, tell him that many do this and that there is a T delivery system where T pellets are injected SC. Also point that Androgel and other transdermals are not intramuscular [IM].

Read the protocol for injections sticky.

The literature for injected T are very old and predate single use needles. The literature reflects what was practical with in-office injections.

Labs after one week are catching low points that do not represent what is going on. At day two, your levels will be very high. The large T spikes promote more E2 than the even levels provided by more frequent injections.

You have to educate your doc, he does not know anything. You can ask him to talk to pharmacists about the patients that are picking up T and syringes at pharmacies.