T Nation

Once on TRT, How Often Lab Work?

OK, I’m going from one Doctor to another - at least the new guy is willing to look at my E2 levels. He’s saying we wants to blood work every 3 months, this isn’t something I remember reading anywhere - how often should a person be checking things once they’re on T replacement?

The only down side of the new Doc is that he wants to do weekly injections - at his office!? He made some comments like it was irresponsible of a doctor to prescribe T and give the patient the bottle and let them administer it themselves. I just don’t see the need to pay for a weekly office visit to get the injection when my wife grew up on a ranch and gave cattle shots all the time - she does a fine job on me.

Then there’s the fact that while he agrees that E2 levels need to be tracked, he doesn’t think HCG is needed unless you’re planning on still having kids. My testes have gotten a lot smaller than I’d like.

The search for a Doc continues - at least I’ll know my E2 levels.

Before I began switching delivery systems and adding in hCG, I was doing blood tests once a month. After things leveled out a bit, I would skip a month here and there. Some of that was due to moving to a different region, changing docs, etc. I would say a lot depends on how you feel.

And E2 matters. Very much so. I’m still waiting on my rX of arimidex to control my E2 levels. hCg won’t do anything to control E, except aromatase more T into E. At least that’s what I’ve gathered from all my reading.

Here’s KSman’s injection protocol. With the use of these syringes, you can inject into the quad. Super simple. Doctor office visits are completely unnecessary. He is probably more unwilling because they make money from it.

[quote]KSman wrote:
Many guys ask for these details. Here is enough info to get started. You probably will not get your doctor aligned with this without a struggle [or a new doctor]. This is really a small part of what most guys need to know.

TRT: Protocol for Injections

  • 100mg test cypionate or ethanate injected per week with two or more injections per week.
  • 250iu hCG SC EOD [every other day]
  • 1.0mg Arimidex/anastrozole per week in divided doses.

Injecting testosterone once a week induces spikes in testosterone levels followed by lows. This can make many feel bad or worse at the end of the week than their pre-TRT state. As time goes on the dead zone gets wider and they feel no relief with injections. These feel much better injecting twice a week or even EOD [every other day].

Injecting every 2, 3 or 4 weeks is horrible. You need to self inject and inject frequently. With frequent injections the volumes are very small and one can inject in the quads [vastus lateralis] with #29 0.5ml 0.5" [50iu] insulin syringes.

These are slow to load but injection times are reasonable as the small plunger diameters create very high pressures. Do not use 1.0ml syringes. This same size syringe can be used for hCG injections, which are also SC.

EDIT: Injecting EOD [sometimes written as E2D] or E3D [every third day] can be a difficult schedule. You can set up reminders or appointments in calendar software, such as MS Outlook, for E2D or E3D etc.

Small needles will reduce muscle damage. Some use #25 1" needles, but this may not be any “faster” than the above 50iu insulin needles.

You do not need to inject into your gluts with 1.5" needles!

Canadian clinical research has demonstrated that TRT by SC [under the skin injections into body fat] produce steadier testosterone levels and improves sense of well-being. Feel free to find out what is more comfortable for you.

For those who train and sweat/shower a lot, transdermal T creams and gels are not appropriate.

Transdermal T creams [and patches] are expensive. At best, only about 10% of applied testosterone is absorbed. Transdermal delivered dose is a crap shoot. Guys who have low thyroid levels are typically non-absorbers. Some absorb transdermals at the start, but skin changes can shut off absorption after a while. With injections, there are no unknowns about drug delivery.

hCG is a water based peptide hormone can be injected to replace the lost LH hormone that TRT shuts down. Without hCG, the LH receptors in the testes are no longer getting activated. The results are:

  • The testes shrink. Over time for some the testes can eventually become small undifferentiated lumps of collagen. This is drug induced organ failure. The degree of shrinking varies from guy to guy and may be more of a problem for the older guys.

  • Fertility can be greatly reduced or eliminated. If making babies is important, you need to inject hCG. If hCG is not used, its use after a long time may or may not recover fertility.

  • When the testes get smaller, some feel an ache in their testes 24x7. hCG injections can eliminate that pain or avoid the whole episode.

  • When there is no LH or hCG, the scrotum pulls up tight to the body. This has the appearance of a pre-pubescent boy. This is not good for ones sexual self image and this also affects how women perceive you sexually. Some women get very upset when they see this maleness disappear, thus affecting their sexuality and interest in you.

  • The testes are the single largest producer of the hormone pregnenolone. Pregnenolone is important for proper mental functioning, and is the precursor to all of the steroid hormones such as DHEA, testosterone, DHT, estrogen, cortisol… Injecting hCG prevents a drug induced pregnenolone deficiency and helps support the other hormones. When guys are on T without hCG and then start hCG, they report a significant improvement in mood that many attribute to restored pregnenolone levels. [If that is not the case, hCG must have some direct effects in the brain.]

When injecting hCG, you inject into the fat under the skin just the same as diabetics inject insulin. The product literature is all about use a fertility drug for women with large IM [injected into muscle] doses. There is no need for men to inject hCG IM.

Research using SC injections in men has demonstrated the effectiveness of the 250iu EOD dosing. You can seek diabetic patient educational material for insulin injection techniques to use for hCG and/or testosterone injections.

Elevated normal [30pg/ml and up] serum E2/estradiol can block many of the benefits of testosterone replacement. Serum E2=22pg/ml is near optimal and one should dose anastrozole to get close to this level. Many who start TRT have some good results that soon vanish as E2 levels increase. My recommendation is to start anastrozole at 1.0mg per week [in divided doses] starting the day of the first injection. The let the first follow up E2 lab drive any needed anastrozole dose adjustments. It is not a good idea to wait and see how high E2 levels go before taking action. Dose anastrozole EOD if possible.

A few guys are anastrozole over responders. This is not known in the drug literature. These guys will get E2 in the single digits and will feel like crap physically and mentally. They may feel a spike of short lived libido as they fall through the E2 levels sweet spot. These guys need to take 1/4th or 1/8th of the expected anastrozole dose -something to watch for. If this is suspected, stop anastrozole for 6-7 days then resume at 1/4th the dose.

The 100mg dose of injected T should get guys into the 800-900 total testosterone [TT] range. That is nice to see, but one should be looking at free testosterone [FT] or bio-available testosterone [bio-T]. Some docs, who know what they are doing, will not bother checking TT numbers at all. SHBG levels increase with age and FT ratios drop.

A TT=1000 in a young man is not the same as TT=1000 in an older man with higher SHBG levels as the FT numbers will be well below that of the young man with the same TT. This may very well create TT levels that are above the youthful lab ranges and should not be a concern. Lab ranges shown on lab reports will be age adjusted. You need to be using the ranges for youthful men.

You need to know about PSA, prostate issues and DREs [digital rectal exam]. E2 is a large cause or aggravator of BPH [enlarged prostate]. Many find that lowering E2 to near E2=22pg/ml improves their BPH and urine flow is improved.

You need to monitor hematocrit levels as part of your routine lab work.


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