T Nation

Started TRT 6 Months Ago. Lot of Side Effects


#1

Hello -

I consulted Dr. Crisler about 6 months ago and got my TRT protocol as follows:
-> 0.75ml (3 clicks) of 20% Testosterone cream (from compounded pharmacy), daily
(cream because I was too afraid of injections)
OR
-> 70mg of Test Cyp twice a week (total 140mg)
(his preference)

-> 200 IU HCG twice a week
-> .25 mg Anastrozole twice a week
-> Dostinex .10mg once a week

Then I left the US again and meanwhile I read a lot and heard injections are better. But since I had already left the US, I consulted a local doctor and got Testosterone injections and started this protocol:

  1. Test 100mg twice a week (total 200mg)
  2. HCG 300iu thrice a week
  3. Anastrazole .25 mg 4x a week
    in addition, local doctor based on my blood work, also put me on
  4. statin to control cholestrol
  5. metaformin 500mg to control sugar - she said I was pre-diabetic
  6. NOTE: I was already on 100-125mcg Levothyroxine for Thyroid
    NOTE 2: I started taking both statins and metaformin. At first, I was following the prescription and then I got lazy and I’d just take it maybe once a week.

I wasn’t religiously following this TRT protocol. Sometimes I miss doses - quite often I missed HCG doses.

Anyway, I got back to the US now and learnt that Dr. Crisler has passed away! My deepest condolences!

Now I’m looking for a new doctor and be disciplined about TRT. So far I’ve just been irregular in both frequency of my doses as well as amount of doses. Been winging it.

Here are side effects:

  1. My head hair has become curly. Went from super straight to curly and thinner (weaker?). I didn’t notice it at first but in the last 2-3 months, my hair has become curly and the only thing new is TRT.

  2. Hair loss has accelerated

  3. Acne but not a lot and instead of face, it is on my back / shoulder

  4. Erectile Dysfunction - for a period of maybe 4 weeks, my ED was almost fixed. Meaning, I’d take cialis and I’d get rock hard. But now ED is back. Even with triple my normal Cialis dose, I dont get 100% hard. Maybe 50% hard and lose erection mid sex.

Ultimately, the original problem I went to doctors was ED and then TRT was prescribed. I’m now back on ED and I don’t have a doctor to continue and adjust my TRT protocol and fix my ED.

I’m thinking, I’ve a lot of all these medicines still left over. So, I can maybe start this for next 3 weeks and then go to a Doctor (keep researching for doctors in the meanwhile) and let him order blood work and adjust dosage from there. Here is my proposed dosing after reading a lot of forums and bro-science (so to speak):

  1. Test Cyp 50mg twice a week, for a total of 100mg
  2. HCG 300 IU twice a week (same time as Test)
  3. No anastrazole - AI
  4. Statin 20mg with dinner daily
  5. Metaformin 500mg morning with breakfast
  6. Levothyroxine 100mcg first thing in the morning
  7. Clomid low dose twice a week - because I hear Clomid stimulates your system to produce SPERM. With HCG alone, you are producing no sperm, just testosterone.
    _NOTE: My blood work always shows low SHBG. _
    Note: I may be high DHT (given hair loss/mpb and I’m 36 years old now)

My goals are:

  1. Fix ED
  2. Stop or slow down hair loss
  3. Preferably get my original (non-curly, flat, thick) hair type back!
  4. be on as less medication as possible
    Stretch goals:
    -> get off TRT completely, eventually
    -> get off Thyroid medicines completely, eventually

#2

You don’t have blood tests to back up any changes. You don’t know why you feel the way you do. With all those meds it’s very hard for yourself to ever pinpoint what’s happening.

I would get labs and figure out what imbalances I hve, how high my t and free t + e2 rises with the protocol. How do you feel on that. Then make appropriate changes and after 6 or so weeks take blood again.


#3

Forgot to mention. Right before crissler left us, he decided to stop ai. He came off the medicine himself and probably would of told Most of his clientele to as well.

That’s why bloods are so Important. Maybe your e2 is low and your taking to much ai. Most would drop the ai and lower their test dosage to manage their ai. I don’t suggest doing this outside of doctors care or Simply because I suggested it. However I would say this is the right step forward. You don’t want this medicine ruining your health as you age and continue trt for life.


#4

Thanks. Yes, definitely, agree with you. Problem is that I’ve been so irregular in sticking to the protocol that if I were to go to a doctor now, I really have no way to say, I was taking X med at Y dosage Z number of times.

I don’t have health insurance right now so I dont wish to pay for blood work multiple times. So, I’m thinking:

For a few weeks, follow conservative TRT protocol (50mg twice a week, hcg twice a week, no AI) along with my other medications (metaformin, statin, synthyroid). After a few weeks (I was thinking 3, but you’re suggesting 6 weeks?) go to doctor and do the blood work and let doctor adjust my dosage/protocol from there.


#5

What if that is the problem. Not taking your meds on time. I would not make huge changes until I thought about it more and got more feedback.

Don’t you have any blood values from when you were on this protocol you stated?

i Would go to discounted labs and pay 70$ and get the basics e2 test and etc…


#6

I did get blood work done a lot of times but because I was irregular with my protocol, I am not sure they are valid.
Pre TRT: my T was around 200
Post TRT (very irregular protocol, sometimes 70mg shot, sometimes 100mg shot, sometimes once a week, sometimes thrice a week, sometimes Testosterone Cyp and sometimes Sustanon etc), My T ranged from 571 to 1200. Most times above 800.

My e2 ranged from 30s to 60s (again, sometimes I’d take .25mg Anastrazole twice a week, sometimes once a week, sometimes I’d skip a week etc)

cc: @physioLojik , @KSman, @systemlord


#7

Damn man what a mess!! 50mg twice a week would be a good starter for trying to get stable. Drop the HCG and the AI. You can add the HCG back later after you stabilize.

As far as statin, what did your lipids look like before this?

Metformin, what was your A1C telling you?

Synthroid, T3, RT3, TSH?


#8

My A1c was high which is why doctor prescribed Metaformin.

Attached test results before TRT and only a couple of weeks of TRT:

When I got tested again in September, A1c was pre-diabetic level and LDL/HDL were bad so doctor prescribed me Metaformin + Statin (Crestor 20mg). She asked me to continue Levothyroxine but reduce dosage but I didn’t reduce the dosage as much as she wanted because I felt good at 125mcg. So, some days I take 125mcg and some days I take 88mcg or 100mcg. Average about 105mcg a day, if you average the week.

But as far as TRT is concerned, since September, I’ve been very irregular in my compliance to medicines and TRT shots. Sometimes I’d skip medicines multiple days in a row and sometimes I’d miss T shots, sometimes I’d double the T injection to makeup for missed dose, sometimes I’d miss HCG shots. Same for Anastrazole, Metaformin, Crestor - I’ve not been regular.


#9

You know the answer now… I’m sure every body agrees that You can’t fix much until stable.

Otherwise it’s gonna be a shit show. Why would you change your dosages so regularly? To me that’s self harm.


#10

In my mind, I was trying to make up for missed doses etc and figuring out optimal dosage for myself. and going by symptoms. For eg: I hate injections so I skipped on HCG for a few weeks. Then I noticed eventhough my T was in 800s, I wasnt feeling horny at all. I added HCG and after two shots, I started to feel sexual again. So, I went overboard and started taking HCG everyday for a week and then sexuality disappeared. So I was like wtf, maybe I have too much estrogen so I took large dose of anastrazole and so on.

Ultimately, lot of my irregularity came from the fact that I wanted to avoid injections. And then my ED returned and I kept trying to make adjustments to get back to normal sexual state.

ED is still not fixed. I’m still chasing a fix for it. But now I’m going to be on a simple TRT protocol religiously for next 4-6 weeks to stabilize everything, then get blood work done and consult doctor for any adjustments, instead of self-adjusting and chasing quick fix to ED. For next 4-6 weeks, I’ll be taking:

1. Test Cyp 50mg twice a week
2. HCG 200 IU twice a week (only because I remember when I skipped HCG for couple of weeks, I lost interest in sex altogether. It wasn’t just ED but loss of interest in sex altogether)

I won’t take any Anastrazole or AI or clomid or Nolvadex for next 4-6 weeks. And then consult a doctor to see what to do next. Dr. Crisler’s office has suggested to transfer files to Defy Medical. So, I’m going to look into that.


#11

There ya go. 6 weeks… i have never heard of anyone recommending 4 weeks.


#12

Alright. I’ll get labs done in 5 weeks mark and consult doctor in the 6th week.

Week 1: 1/27/2019
Week 6: 3/9/2019 - to consult doctor with blood work
Protocol:

  • Daily morning: 100mcg Levothyroxine
  • Daily Supplements: Iron (because I was low in Iron), B-Complex (because I was low), Vitamin D3 2000 IU
  • Daily with breakfast: 500mg metformin XR (for prediabetes, as prescribed)
  • Daily with dinner: 20mg Crestor (for cholestrol, as prescribed)
  • Sunday & Wednesday: 50mg Testosterone Cypionate + 200 IU HCG

NO AI/arimidex/anastrazole will be taken in these 6 weeks.

Sometime in Week 5 (2/18/2019) - I’ll get lab work done.
Sometime in Week 6 - I’ll see a doctor


#13

I believe it takes 6 weeks for your blood levels to stabilize not 4 or 5. Get blood test at week 6. Patience … it’s hard I know but 6 weeks is what every trt doc says for stability. Never before .


#14

2 weeks in - noticed slight improvement in erection. Like 20% hard this morning. Not a full fledged morning wood but signs of life.

But I feel no sexual desire whatsoever. Physical stimulation makes me a little hard - upto 50% hard but mentally no desire whatsoever.

Let’s see what next 4 weeks bring.


#15

Been consistent past 6 weeks but still suffering from loss of libido and erectile dysfunction. Labs attached after 6 weeks of consistent TRT protocol as follows:

  • 50mg Testosterone Cypionate twice a week for total 100mg/week
  • 250 IU HCG twice a week, total 500 IU/week
  • (no ai/arimidex)
LH 1.5 -9.3 mIU/ml 0.5
FSH 1.6 - 8.0 mIU/ml <0.7
SHBG 10-50 nmol/L 11
Free Testosterone 35.0-155.0 pg/ML 283.1
Total Testosterone 250-1100 ng/dl 997
Estradiol E2,LCMS Ultrasensitive < = 29 pg/ml 66
Total Estrogen 60-190 pg/mL 298.4
Prolactin 2.0-18.0 ng/ml 17.7
DHT 16-79 ng/dl 35
DHEA Sulfate 106 - 464 mcg/DL 596
IGF-1, LC/MS 53 - 331 ng/ML 190
FT3 Free T3 2.3 - 4.2 pg/ML 3.3
FT4 Free T4 0.8 - 1.8 ng/DL 1.2
TSH 0.4 - 4.5 mIU/L 1.0
Reverse T3 rT3, LC/MS 8-25 ng/DL 16
PSA, % FREE >25% 31%
PSA, FREE unknown range 0.5
PSA Total <OR=4.0 ng/ml 1.6
Ferritin 20-345 ng/ml 49
Hematocrit 38.5-50% 48.90%
CHOL/HDLC RATIO <5.0 (calc) 3.9
Cholestrol TOTAL < 200 mg/dl 196
LDL/HDL ratio 2.5
HDL cholestrol > 40 mg/DL 50
LDL cholestrol < 100 optimal 124
Non HDL Cholestrol < 130 mg/DL 146
TRIGLYCERIDES < 150 mg/dl 114

Any help would be appreciated!


Low Libido on Long Term TRT?
#16

Have you tried trt without HCG or its been 6 weeks since you started and this is first bloods?

Allot of guys here don’t like HCG because of sides. I wonder if labido is one. Many docs however like HCG they say it benefits labido haha… i personally would try a couple weeks without. It won’t hurt and you should notice a difference if it is a good change.

What’s the doc say?


#17

@enackers been on TRT for over 6 months but just been inconsistent with the protocol. Due to inconsistency, yes, there were weeks without HCG as well. I think I was a LOT better when I was taking HCG along with Testosterone, although inconsistently.

So, I haven’t seen a doctor yet - waiting for an appointment from Defy Medical. I figured it’d be pointless to see a doctor without having been consistent. So, that’s why, I followed the above protocol for last 6 weeks so that doctor can then analyze my blood work and do whatever needs to be done to help me dial-in.


#18

This twice weekly protocol of yours is making you estrogen dominant, your SHBG is low and should be injecting more frequently. The HCG is another factor in driving estrogen higher. If you want to dial-in without using an AI you’ll need to consider 20-25mg EOD or 12mg everyday protocol is recommended.

You’re converting a lot of your testosterone into estrogen and the driving factor behind it all are these large moderate injections, smaller injections will lower estrogen and keep levels steady.

This is the same advice Defy Medical is going to give you.


#19

Thanks @systemlord yeah, I’m willing to add AI, if Doctor advises me to do so. I’m unwilling to split the dose further. As it is, I hate taking injections and taking twice a week is already burdensome to me. I wish I could get away with once a week.


#20

Dude get on the cream then!!! I’m on it and love it. Just rub your balls with cream for good luck everyday. It dried up quick and levels peak around 2-3 hours depending on your physiology. No more 6 weeks of waiting shit and one dose raises your levels to where it’s gonna get to with that dose. Twice daily am and pm.

Estrogen is also not as big an issue from what I’ve noticed and been told. The study they did also showed no estrogen spikes worthy of mentioning. Better labido is also a benefit many of the guys on creams have confirmed due to DHT conversion.

I say this because I heard defy and they offer it. Go for it bro… no more stabbing yourself :slight_smile:

Your not a great candidate since you don’t do anything consistently but applying cream might not be as big a deal. Put it next to the tooth brush and apply after shower :slight_smile: