T Nation

Saw 5 Doctors with Different Advice. Help?

Hi everyone,

I am new to the forum. I am from Bulgaria and have been suffering with low T symptoms for 7 years:

  • Libido - No existent

  • Erectile Dysfunction

  • Gained a lot of weight during the last couple of years

  • My hair fell off

  • Energy is terrible

  • Feeling fatigue all day

  • Depression (Am on Venlafaxine and Quetiapine and this does not seem to help at all)

Went to a private lab and my Total Test is 9.75 nmol/l (281ng/dl). Been to 5 doctors and had no success at all:

  • Doctor 1, 2 and 3 did not want me on TRT as I am pretty much just under the low end (240ng/dl is the current low)
  • Doctor 4 wanted me just on Nebido (Testosterone undecanoate 1000mg every 12 weeks with no loading phase and no HCG :frowning:)
  • Doctor 5 wants me on Omnadren (Sustanon 250) 1 amp every 3 weeks, no HCG as well

More Info:

31 years old, 228 lbs, 23% bf. Dropped down from 270lbs with Metformin prescribed by my doctor and slight diet. Doing cardio in the morning but have no energy at all. Going to the gym is an impossible task.

Not sure where to go from here on.

Don’t get me wrong, I would like to do all the bloodwork and start TRT as soon as possible but…

What would you do if you were me? Been miserable for the last 7 years and really want to get my life back. Going to the USA or UK for TRT doctor would cost me over 2000$ (tickets, labs and consultation fee)

P.S: Every drug here, including TRT drugs are over the counter but we have only Nebido and Omnadren (Sustanon 250). Is Sustanon 250 that bad of a choice when it comes to TRT.

I was thinking of the following protocol:

  • 50mg Sustanon E3.5D
  • 250IU HCG EOD
  • 0.5mg Anastrozole with my T injections

Please give some feedback :frowning:. I would do whatever bloodwork necessary.

HCG has a biphasic pattern. When you inject HCG testosterone is stimulated and then the testes go into a refractory period for up to 72 hours. There is no reason to inject HCG more than 3x per week and 2 is sufficient.

sustanon has a few short esters so frequent injections would be best, from what i’'ve been reading is that most here dial in there protocol that AI is not needed, cant tell if this goes with Sus and HCG, but why not choose another test like cyp…i guess that you have to do your own TRT, or did you mean that your gonna take the Sus. from the doc and tell him that you need more?

You really need to find out the root cause (primary or secondary) and get full thyroid testing before we can recommend a good course of action.

This fact is most doctors prescribe drastically different TRT protocols because there is no standard of care for TRT, only what the pharmaceutical companies suggest which do not take into account everyone’s needs will be different and cookie cutter protocol will not work for the majority of men.

Everyone has different CAG receptor repeat lengths, or sensitivity to androgens, some guys will develop anxiety of larger doses on infrequent dosing and depending on the severity will need more frequent dosing. Dosing any further out than once weekly is likely only going to work for a very, very smaller percentage of men.

See if you can get your SHBG test, this is a reliable biomarker and is a good predictor of which type of protocol will work best, infrequent dosing (once weekly) or more frequent dosing and if SHBG is <15 nmol/L daily dosing is recommended.

Sorry for not being clear enough. I don’t need a prescription for drugs here. Cyp cannot be find in pharmacies. Only Sustanon and Nebido. There is a way to obtain enanthate from Serbia but it is hard and against the law. What bloods do I need for TRT? Thanks so much for the info. :slight_smile:

Whenever I’m checking progress I always include four tests, Total T, Free T, SHBG and estrogen. These four testing influence each other and is a balancing act. The enanthate is always recommended when cypionate is not available, single esters are best. Sustanon should be your next choice and stay away from Nebido.

If looking to find out the cause of low testosterone, start with these tests. You would need an MRI to check for tumors where prolactin would be elevated which can lower testosterone. Most never find a cause for low testosterone, testosterone is just low. The only guys who seem to get an actual reason for low testosterone is those who have a pituitary tumor or have primary hypogonadism.

Total T
Free T
SHBG
Estradiol (E2)
LH-Luteinizing Hormone
FSH-Follicle stimulating hormone
Prolactin
Cortisol
Ferritin
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel

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Thanks guys. I will do all the tests first thing on Monday. At least that is inexpensive here. Should I then put them here or create a new thread.

I would just edit this thread by clicking on the pencil icon.

In regards to your options, Omnadren is better than Nebido IMO. Here is where I disagree with many though. I don’t believe in split injections of blends like Omnadren or Sustanon. It has a measured quantity of short and medium esters. You will feel better getting the full dose of those esters in one go. The short ester is not going to do what you want if you only get 25% of it at a time, it’s meant to carry you to the medium ester kicking in and then the long ester will build up over several injections. I would look at the whole 250 every two weeks and see where that gets you. It puts my T at 479, which isn’t enough. If that’s the case with you, try every 10 days instead of 2 weeks.

Hey guys. Sorry for the delay. I finally managed to do my bloodwork. My doctor saw it and though my lipid profile improved a lot since I started Metformin and dropped 30 pounds but he wants me to double my Omega 3s from 2g to 6g and add 2g of Inositol Hexanicotinade (some form of Niacin). Anyone had any expirience with this combo? I don’t drink at all given the fact that I am using SSRI and Quetiapine. My main protein sources are beef medalions and 4 - 5 whole eggs a day (could the eggs be the problem). Is there any chance my lipid profile is that bad cause of low T?

And to the main point - TRT. I managed to find Test E in Serbian and Macedonian pharmacies and got a hold of 40 ampoules of 250mg/ml. Was thinking of the following protocol:

  • 50mg Test E E3.5d
  • HCG 500IU E3.5d
  • Anastrozole 0.5mg with my Test E injections

Could you guys help me with the aforementioned questions… Of course if you have some other feedback I am open.

Testosterone - 11.55 nmol/l (9.90 - 27.80) - That translates to 333 ng/dl
Free Test - 6.82ng/dl = 2.05%
Albumin - 46.30 g/l (35 - 52)
SHBG - 29.46 nmol/l (18 - 54)
LH - 7.20 IU/l (1.7 - 8.6)
FSH - 2.82 IU/l (1.5 - 12.40)
Estradiol - 92.73 pmol/l (94.80 - 223)
Prolactin - 166.10 mIU/l (85 - 325)

FT3 - 4.20 pmol/l (3.20 - 6.80)
FT4 - 13.95 pmol/l (12 - 22)
TSH - 1.87 mIU/l (0.3 - 4.2)

Glucose - 5.4 mmol/l (3.6 - 6.1)
Cholesterol Total - 4.95 mmol/l (up to 5.2)
Cholesterol LDL - 2.83 mmol/l (up to 3)
Cholesterol HDL - 0.96 mmol/l (over 1.45)
Triglycerides - 2.55 mmol/l (up to 1.8)

Cortisol - 301 nmol/l (124.2 - 662.4)

CBC
WBC - 8.64 x10^9/L (3.50 - 10.50)
Ly% - 26.4 % (20.0 - 48.0)
Mo% - 8.6 % (1.0 - 11.0)
Eos% - 2.1 % (Up to 6.5)
Baso% - 0.70 % (up to 2)
Neu% - 62.2 % (40 - 70)
Ly# - 2.28 x10^9/L (1 - 4)
Mo# - 0.74 x10^9/L (up to 0.8)
Eos# - 0.180 x10^9/L (up to 0.5)
Baso# - 0.06 x10^9/L (up to 0.140)
Neu# - 5.380 x10^9/L (2.000 - 7.000)
RBC - 5.58 x10^12/L (4.40 - 5.90)
Hemoglobin - 161 g/L (135 - 180)
Hematocrit - 0.477 L/L (0.400 - 0.530)
MCV - 85.5 fL (80.0 - 96.0)
MCH - 28.9 pg (27.0 - 33.0)
MCHC - 338 g/L (300 - 360)
RDW - 13.2 % (11.5 - 14.5)
Plt - 281 x10^9/L (130 - 440)
MPV - 10.2 fL (6.1 - 13.5)
Pct - 2.90 ml/L (1 - 4.80)
PDW - 12.9 fL (8.0 - 23.0)

You’re looking to be primary, testicles are functioning poorly and is only a matter of time before they fail to function at all. Now is the time to freeze sperm. HCG will not do much for testicular atrophy when testicles finley do to sleep.

You don’t need anastrozole, estrogen is bottomed out.

That sounds pretty bad. I am now really hesitant to start TRT. Do you guys know if there are any online doctors that can help with that? I mean telemedicine or something? Thanks a lot for the feedback!

There’s Defy Medical, but you would have to travel here to get treatment unless a doctor in Bulgaria is willing to work with a Defy Medical doctor. As far as being hesitant, it is a common in men with low testosterone to be afraid and not take action. You really have no choice because your situation is only going to get worse as more time passes.

Thanks a lot mate. What do you mean working with a doctor? I do not need prescriptions as everything is over the counter? Could you give me some more info please please?

All of those doctors are offering terrible advice.

There IS a standard for care for TRT but 99% of the doctors out there are clueless on the subject.

  1. Get your free T levels up. Once they are approaching 30 ng/dL you should start feeling much better.

  2. Frequent dosing is essential. If you think you’re going to get optimized by taking one injection every few weeks you’re dreaming.

  3. Stay away from anastrozole. E2 is absolutely crucial for health, libido, and erection strength.

  4. Google World Link Medical. There is a directory of doctors trained by Dr Neal Rouzier who are qualified to give you proper care.

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I got that I would need frequent injections. I was not expecting though that things were that south. The chance that I would not have kids is scaring the shit out of me. Thanks for everything guys.

Once you need to start trying for kids, you can add HCG about 3 months prior at 500iu twice weekly. I was on TRT for 3 years, added HCG later, got my wife pregnant, and immediately got off the HCG (and felt much better). Just add it when the time comes. Nothing to worry about!

You can do consultations only with Defy Medical and will guide your TRT protocol, it sounds like you have access to medicine needed and only need a doctor to advise you on a course of action.

Defy Medical will often suggest taking an AI. Politely decline.