T Nation

Restarted TRT a Month Ago, Side Effects

So i had started TRT back like February of this year. First my urologist started me on 2ML shot every three weeks. At the end of the 3 weeks got my labs and T was super low again like 280ish. So we went to 100mg every week which resulted in labs in the 400s at the trough. Had some family problems and didnt see the doc or do any TRT for about 4 or 5 months. Went back first week of october and doc said he wasnt happy with my T in the low 400s at the end of a week so we went with 200mg a week which i split into two shots using an insulin needle shallow intramuscle. Feel great after 5 weeks havent had any new labs but have two annoying side effects.

#1 is a ridiculous amount of weight gain. I have lost over 100+ lbs in the past two years so weight has been under control and still dropping however when i first went on trt i noticed i gained like 4 or 5lbs which the doc said was not related to trt but i knew it had to be because i have been in a calorie deficit and had steadily been losing weight until i started trt. Anyways when i stopped the shots the weight came off over the next 10 days or so. This time i started TRT and i also started taking 5mg creatine a day both of which i know can cause some weight gain however this is absurd. In the past month i am up 15lbs. Diet has been ok maybe 1 or 2 lbs of actual fat gain i could believe since i had some cheat days and a few parties etc. But i generally really watch what i eat and count every calorie as i still had about 15lbs to lose to hit my goal weight. I was 173 october 3rd when i started the 200mg a week. Started taking creatine that friday the 5th. I was almost 188 this morning. I lift weights heavy 5 or 6 days a week i do cardio 2 or 3 times a week and i do yoga 3 hours a week. Anyways i am very puffy and feel bloated and with a gut now. How the hell do i fix this lol?

#2 is my libido is a bit down and my erections have gone from 100% to maybe 80-85%. Still enough to get the job done but my wife has commented how she is the one who has had to initiate the last couple times. She is right we typically have sex maybe 4 or 5 times a week but its been about 3 or so a week the last few weeks and thats been mainly cause she has asked for it. When she does i am always down and like i said am hard enough to get it done she hasnt commented or noticed about the less then full erection but i feel as if its not as firm as always.

Want to catch things early before they become a problem. So what should i do? Other wise i feel great i have good amount more energy then normal and my work outs have been fantastic lately i am really killing it with the weights. Dont want to decrease the dosage if i dont have to as i finally feel better mentally and physically but dont want to cause any issues either.

200 per week is considered pretty high. I’m on a similar dose. It wouldn’t surprise me if the erection issues and possibly weight gain are due to e2. I’m on anastrazole which has helped.

It sounds like you’re estrogen maybe a bit high, you can expect soft erections, less sensitivity and lowered libido.

Water weight is expected when estrogen is high via water retention.

I can tell you right now you’re not working with an experienced doctor for the fact he started you out on injections every 3 weeks which is ridiculous.

I suggest you find an experienced trt doctor and not some garden-variety doctor that doesn’t know what he’s doing or how to manage your symptoms.

I’m able to tell what’s wrong with you just by you mentioned in your symptoms and your doctor should be able to do that as well.

Catch 22, the majority of doctors do not know how to do TRT. This the was the reason I went private, I would rather pay out of pocket then fumble around in the dark wondering what the hell is wrong with me.

Problem is my doc sucks. I brought up hcg and doing anastrozole which i had read about on another forum and he told me google is no replacement for a medical degree lol. My PCP referred me to him and just tells me he is the specialist so he defers to his judgement. My PCP was the one who first started me on 2ML every three weeks and took some blood work including prolactin which was 8.5 three weeks after the first time getting 2ML and shgb which was first 18 then 26. This new doc just tests TT free T and PSA.

The doctor who first put me on trt was my pcp who did a shot every three weeks but he admitted he knew very little about that and referred me to this urologist who supposedly is an excellent doctor. He immediately said a shot every 3 weeks was absurd and did weekly at 100mg but that resulted in still kinda low T so he upped it to 200mg.

I am assuming the same thing you are that my e2 is high from what ive read on here just need to find a doctor to at least order the test for me and do something about it. However the weight gain seems crazy to me. 15lbs is a lot of weight to be water i guess i just dont see how i could be gaining so much water weight. I expected a few lbs maybe 5 max since i know both creatine and trt can cause minor weight gain but 15lbs and still going makes me think something is wrong.

Just because someone is a specialist doesn’t automatically mean they will be good at what they do. The problem is medical school doesn’t even teach anything related to sex hormones so it’s not hard to understand why the majority are so clueless.

Urologists don’t normally do TRT, they are more about procedures and prostate treatments. Endocrinologists are more into thyroid and diabetes, occasionally they do TRT but it isn’t their specialty. They are specialists, just not in TRT.

There really doesn’t exists a doctor in the mainstream medical community that is properly trained how to do TRT well. This is why I joined Defy Medical, a telemedicine clinic and has been doing TRT for decades, they would know actually what going on with you.

Post some labs and I can recommend a protocol.

Your e2 is probably just a little high. Easy fix. You don’t have itchy nipples, so you are still in a “safe” zone for now.

All you have to do it drop your dose slightly. That’s it. Don’t mess with E2 any other way. You are literally almost zeroed. You just need a slight bump down. Plus labs will help. And a better protocol is every 3 days, but it depends on your SHBG.

But if this is working for you, just inject less. Your doing 200mg a week. Try 150-180 a week. Do 75mg instead of 100mg a shot. You will definitely feel a drop in e2, and you will probably still feel great.

Dont have many labs as i havent gotten many done. First set is after a couple of shots with my PCP. She was doing 400mg every 3 weeks. The labs are the day my next shot was due so had already been 3 weeks without a shot. Initial labs i were like 224 total test with free test like 5.X and shbg at 18 and that was before any trt.

Second set of labs was taking 100mg a week with a shot once a week. Had done like 3 or 4 weeks of that by this point and was taking the shot monday morning and this test was taken the following Wednesday in the morning. Not ideal since i was supposed to take the test the following monday morning but was out of town. After that lab i didnt take any more trt from june through first week of october.

Now I am at 200mg a week but i split that into two shots of 100mg each. One sunday morning the other wednesday night. Is there anything I could do to keep E2 low while keeping my dose where it is? I feel a huge difference from going to 200mg a week to 100mg where i was. Really happy with everything now except those two things. Also of note my wife was concerned about me becoming infertile on TRT since we may want more kids. Monday i had a semen analysis and it was on the low end of normal. The thing is 7 years ago i had a semen analysis done at the same place because we were worried about fertility(turns out my wife was the one struggling at the time with that) and anyways 7 years ago i was 12% above the high end of normal range. So is that normal aging or is that the trt starting to shut me down?

The Roche ECLIA methodology is for females, the Liquid Chromatography–Mass Spectrometry is for males and is more sensitive since men have significantly lower estrogen than females. Your estrogen is to low, it needs to be higher.

Low levels of estradiol may cause greater water retention. We have some guys here who seem to have low estrogen syndrome on high doses of Test and find injecting doses EOD to increase estrogen.

TRT can affect fertility, adding FSH to a TRT protocol can dramatically increase sperm production.

You are indeed shut down by now, your testicles are taking a long nap.

Too low? I thought the opinion was my E2 was probably too high? The estradiol test i put up was taking a single 100mg a week shot. Now i am taking 200mg split twice a week so could thst help raise my estrogen to a better level? I will hopefully have better labs ordered next week. If my estrogen is still too low could i increase my trt dose to say 250ish to raise it?

Hello. How happy are you with Defy Med? What’s their typical costs for treatment? I used a place here in MN that cost about $200 for labs then another $400 to see the doc in person to go over those labs…twice each year. The only up side is the prescriptions can get called into my pharmacy and are covered by my medical insurance. Thanks for any insight…

Defy Medical is awesome, they really know how to do hormones well. Average cost for consults, medicine and labs is $100-$150 monthly or $1200-$2000 yearly. Its pay as you go, not all up front.

I talked to defy today. Might be making the switch before my next med order. Any other info about them? I’ve heard they’re good people.

Dr. Saya, the medical director of Defy Medical suggested after hearing of my symptoms that I may be allergic to the cypionate/cottonseed oil, he was right. That is something my previous doctor wouldn’t have known and who knows how long the suffering would have continued if not for a knowledge doctor.

Interesting. And what do you use now?

Ethanate with sesame seed.

Why do some have an e2 increase when they move to eod protocol?

Just wondering bc it happened to me and I always thought in order to lower e2 one needs to go to smaller more frequent shots.

May depend on if they lowered their dose when they went EOD.

EOD should keep levels more steady so it may appear it’s higher if you checked the other protocol at trough

Thanks Charlie. I was 25mg eod. That yielded 49 on e2.

I’ve since dropped to 20mg eod hoping to reduce it.