Opinion on Starting TRT (Again)

Pharma / TRT Testosterone Replacement
1

Greetings,

Need some of the more informed opinions on TRT. I know from being here years ago, that some of the beast nutrition,supplementation, hormone and training advice on earth is here at T-Nation.

Background:

I am 41 years old. About 5’10 and a regular sized 215 lbs - meaning fairly fit with some fat around my mid section. I’m an ex wrestler so I have thick neck, traps and wide back but I am not overly muscular or jacked looking. I want to get back into lifting and even training BJJ again after a long lay off. At this point (Which I’ll explain below) I am in a serious funk.

I had tried TRT for a year (post back injury, surgery, meds, phys rehab etc) and it started well, but in retrospect the Dr. just threw me on injections, made me practically beg for HCG and beg even more when my E2 was up and I requested AI’s. I eventually ditched this Dr as I think he was in it for the money and not my overall health.

At 40 y/o I started with 200Mg Cyp a week , with nothing else added. In my mind this seemed a reasonably mild dose (comparing with what I had seen guys do before…but of course they’d cycle) The first few months were great, I was back to old pre surgery me. My test was around 1000-1100 and I was getting stronger , sleeping very well, and overall just feeling great.

Around the 6 month mark in, due to atrophy of the huevos and my wife asking about that - I asked to introduce HCG. The Dr almost tried to talk me out of it and when he finally relented it cost me another $200 for a month supply (the price we pay for doing things the lawful way I reasoned)

So still running 200 a week, I started HCG. I jumped right in and at first felt awesome, but then it turned out that 200 a week + HCG made my test around 1350-1400 and before I could recognize it, my estradiol levels were up. Enter the night sweats, hot/cold flashes and lack of quality sleep…I felt very bad during that time. Dr. then puts me on AI and it helps.

Last straw was simply that my E2 was up and down, I wasn’t feeling good and worse, my hematocrit was so high I could not even donate blood as I was instructed to. Without being able to donate, my BP was high and blood getting thicker. Around this time I moved for work and just stopped treatment once my last shot ran out. This was probably not the best move, but I was very frustrated with the back and forth I had with the Doc as well as I was just feeing like shit (sweating, high BP, E2 levels were up and down) so I partially blame my rash decision on being fed up + the estrogen levels didn’t help :wink:

My natural test for most of life was fairly high range with me being at 970 at age 34 (last test I took before starting treatment at 40)

Current Situation:
I am now 41 and about 2.5 months w.out having any cyp shots. Of course, now I am feeling weak, lacking in concentration, feel more sluggish and generally just sad overall. I looked at this time as me allowing my blood to re adjust and letting things get back to normal (which are now low of course). I have some chlomid, which I tried for a week but for whatever reason it makes me feel absolutely terrible. I would rather just have low T than take Chlomid, as an Example - I feel like crying when I see puppy dog in a commercial while on Chlomid. Terrible.

Question:
At 41 would it be worth it to try and restore my natural T or get on an improvement protocol, where I add in HCG, AI and T injections, slowly lowering the T dosage over the course of a year until I get back to feeling normal? OR should I just get back into a new TRT program , obviously with a reasonable dose and the regular use of HCG and AI’s?
Considerations:
High Hematocrit - Could it be that I am just prone to this? Or is it more likely that my higher dose, with nothing else added to counterbalance could have created this? I do realize giving blood will help and also staying very hydrated, but I don’t want to risk a stroke in my 40’s.
HCG and AI’s - It seems from my research that I should start with these items and remain on them. Is that the case? Should I use HCG alone now, to recharge my testes and then start on a new TRT protocol?

Finally - sorry for such a long post, but I wanted to be thorough as possible. I hope maybe one of you guys can give some good feedback.

Thanks

2

This scenario is unlikely, T starts declining after 30 year old and unless you have found a secret to reversing the aging process, restoring an HPTA to optimal on the natural decline at 41 is impossible. When I was injecting T cypionate once or twice weekly E2 was very high, not the case injecting 20mg every 2 days and E2 is even lower on 10mg daily injections, no AI needed for daily injections.

T-cypionate spikes T and E2 more than any form of TRT, smaller doses more frequently lowers these T and E2 spikes lowering E2 overall. You can achieve higher testosterone on less T-cypionate by increasing injection frequencies.

Anyone who has ever tried daily injections can attest to it lowering E2 and for most making taking an AI necessary. HCG as you know increases estrogen and can complicate your TRT protocol, try to increase the frequency and inject less.

Frequent T injections also lowers hematocrit.

HCG dosing 100 daily, 250 EOD.

3

Ok, good advice. I have heard people talking about frequency of injections so that is something I’ll look into.

And I hear you on the declining T levels as well. I guess my question on that is, if I am still active and “fit” at least relative to many others my age, would it be worth a try to see what running HCG alone might render? I am leaning towards that not being a good idea but wanted to get some of you fellas feedback. (Edit) I re read your statement on HCG only and I follow what you’re saying.

Related to that, I guess I need to find my perfect dose. There is a happy medium where I felt the perfect amount of libido, drive in the gym, concentration and mood was great - that’s where I need to stay. Sadly I didn’t stay in that zone very long, its either been w.out and feeling drained and slow or being on too high a dose and feeling sweaty, high BP and edgy.

4

It took me about 2 years to find the right range of dosage (20-25mg) and injection frequency (every 2 days), those working with experience doctors can shave this long process in half. The leydig cells within the testicles as we age become less sensitive and response less optimally, it may work but eventually you’ll require TRT.

I don’t know about you, but I wouldn’t want anymore life interruptions and would want to figure out a TRT protocol now rather then later in life when I’m married and is my job to please the wife. Pushing high normal T with HCG monotherapy almost always requires the use of AI’s, add to that AI’s can’t affect E2 produced inside the testicles forcing you to lower your dosage and therefore sacrifice high testosterone.

The longer you stay on an optimal protocol, the more benefit you get from TRT, if you spend the majority of time messing around with dosing not in a stable state, you see little benefit from TRT. Changing dosage is like hitting the pause button on progress.

You are on a pretty high dosage and it had room for improvement, a lot of men would have hematocrit issues on 200mg weekly.

5

Wow. Thank you, this is exactly the feedback I am looking for.

You’re absolutely right about playing around with the doses. As I mentioned, when the Dr. placed me on 200mg a week, I didn’t blink. That’s because I was used to hearing meatheads who spoke of double that as their weekly dose (of course I didn’t consider they’d cycle on/off just the number of 1ml a week sounded reasonable) I suppose for the long term, 200mg a week would be pretty high. I am thinking maybe 100 week starters.

So at this point I think I’ll probably look at getting into a better TRT program.

6

Hey systemlord, from your answers and reading other posts online which report similar to yours, the general trend is that more frequent dosing + subcutaneous use helps in thwarting off the bad sides we talked about.

But if more frequent dosing is optimal for just about every reason possible then the big question to me is why not just switch to a faster acting Test?

It makes sense how Cyp stays in the system for so long that it can peak and drop at different times for all of us and that can create the great vs not so great feelings of fluctuation, but Cyp’s whole allure is that you’re “supposed” to be able to do it once a week to get results, saving time and trouble with rigging everything up daily or 3-4 times a week.

Thoughts?

7

Cypionate once it builds up in your system which takes 6 weeks, levels are very steady if injecting 3-4 times per week. This once weekly concept is flawed most of the time, if you take a look at the majority of guys you’ll see their labs at peak and then at trough, often dropping hundreds of ng/dL. The lower the SHBG, Free T drops by a larger degree versus Total T.

It’s the pharmaceutical companies who created cypionate with the intent to inject large doses 200mg every 2-3 weeks protocols, the results in everyone was absolutely terrible in practice. The problems and push back I expect from newcomers to TRT is having to inject 3-4 times per week, often the reason so many have problems on TRT (excess E2) is because they are unwilling to do what’s necessary and rather do what they want to do.

Nobody wants to inject T 3-4 times a week, but for those having estrogen sides, it’s a must.

8

Ok that makes sense, again great feedback!

My first reaction was probably like most folks, with injecting 3-4 times a week + more if I were to run HCG being a big inconvenience (especially with work travel and airport issues) but if it helps to avoid feeling like shit, then its a small price to pay!

So, I guess I can give that a try next go around.

9

@systemlord - I have come into a months worth of T gel. I know the gel is fast acting and dosage is hit or miss, but would it be a terrible idea to take the gel for a few weeks and see how I feel? Obviously this hiatus has me feeling poorly. Thoughts?

10

Worth a shot dude! Better than not having anything in your system.

1 Like
11

Thanks Watts…btw is NH for New Hampshire?

Anyhow, yeah I will take this for a bit since its light dose (out of 50mg tube I barely feel it) but it does help my mood almost the same day I felt it (could be placebo).

I will do a Lab in Florida probably in April. Any recommendations are welcome!

12

I always test for Total T, Free T, SHBG and E2 sensitive to check progress.

13

Yes. My old stomping ground when I joined T-Nation in 2004.

14

Thanks again SL, so the SHBG is what gives trouble with T to E conversion? I’ll go check the sticky’s first as I have some questions that are probably answered already.

15

SHBG balances between bound and unbound hormones, there are other factors at play in how those hormone interact with the body, example testosterones interaction with aromatase enzymes in fat tissue converts to estrogen.

16

Systemlord - or anyone else who wants to pitch in…

If someone had arimidex and hcg at their disposal, what would be a good protocol to try out? I know about the stickies and I have read most of them regarding hpta restart and other recovery based posts, but most involve hcg, serm and later AI. Also many of the stickies assume its between cycles or that the person interested also has access to all of the things needed. If you had only AI and HCG, is that an ok start?

I know in the past (like lots of us…) I took foolish advice and ate 1mg EOD of AI’s which was too much.So at the least now, I will recommend roughly 1/4 of 1mg every 2-3 days and would probably say do lower dose HCG and start AI afterwards.

Thoughts?

17

So (if anyone is interested) I got back to the TRT and Cyp injections. Below I will give a high level overview of what my labs looked like and what my new regimen will be.

*If you’re bored by this but want to see the current dosing please skip to bottom.

Recap:
I had stopped TRT (more or less Cold Turkey) went off of any sort of hormone therapy for about 2.5 months. Understandably this wasn’t the best of ideas, but its done now … my Hematocrit came back to normal, BP was down, everything looking good, except for the obvious that I felt poorly.

Tried some crème (1% crap solution called Testim which was sticky and took forever to dry) I had one tube a day which brought my wrecked 200 T level to 456 T level (Free T was still low, SBGH was low, DHEA low, T2 very low and now cholesterol was HIGH - a problem I’ve never had before in my life. On top of that, it seemed day by day my motivation to even go for a job had escaped me. I was sluggish mentally and physically
So, I had enough and went back to a specialist.
For what its worth - I had dabbled with several tubes of the Androgel brand, several years ago. A buddy at the (redacted) military affiliated hospital just gifted me several big pumps. This was actually great, since my own test was healthy, this added a little boost, I do not think I ever felt better in my life…no atrophy, no sweats or other bad sides, just a boost on my mood, sleep and even leaned me out.

On to the point:

Current Regimen (with keeping an eye on my hematocrit):
Cyp .40 ml x 2 weekly. (.80 total which is ~180 mg Test per week) - Corrected to 160mg.
HCG.50ml x 2 weekly on same day as T shot (1.ml week / 1000iu)
AI .125 x2 weekly (said I might only need one or maybe none each week - it appears my body is sensitive and my last Dr had me on 2mg per week, which tanked my E2 which sucked as bad as having too much estrogen - hot flashes, sweats, mood swings.
DHEA 25mg every night before bed.

18

What is the dosing on your cyp per ml?

19

200mg per ml and I’m hitting .80ml a week, so my dose is ~ 180mg T per week. (Corrrection 160mg per week thanks Watts haha)

Previously, with another Dr. I was @ 200mg/ml x 1 shot a week. Once I threw in HCG at my request, we went too high with that (1000iu 2x per week) and that was the start of the issues - this boosted my T to 1400 which then had me needing an AI, which was also prescribed too high and ended up making me feel like complete crap.

20

200 * .8 = 160mg

I’m not trying to call you out on your math LOL but dosing is important :slight_smile: