There are telemedicine options for those unable to find good knowledgeable TRT doctors.
@systemlord and @dextermorgan make some wise points here. I did send a note off to my doc documenting a lot of what we discussed here and (based on the response) I do believe I am ultimately heading for telemedicine or other provider and have started looking at defy. Anyone else I should look at?
He did agree with my 100mg/wk to start, but thinks I’m going to have to use 20 or 22 ga needles which has caused previous patients of his to switch back to lower frequency or quit altogether. I plan to inject with smaller than that…though I may use needles that size to draw the dose.
I guess I’ll have to pull my own estrogen panel in advance if I want it…which I do. I will probably spring for that and the sensitive estradiol. Debating if I should pull the full thyroid panel at this point or not.
I recognize you guys are right and that 100mg/wk will not be the optimal end result for me and I may be setting myself back a little bit if I start on that path…but do you really think I’ll end up worse off than I am now?
I’m sure I’m coming off as hard-headed now and I really don’t mean to…I’m conceding that you guys are probably right about the way I should go but I’m having a hard time committing right now. The advice is appreciated and noted.
You can draw with 29 or 30g needles. It’s slower, but works fine. If you’re using syringes with removable needles you’ll waste a lot more. Don’t do that.
@louiststeinhil
I think 120mg is where most people should start. The issue with your doc would be getting him to raise it after that if needed. You might as well start with defy or whoever so you know you’ll get what you need. If money isn’t an issue look into Tier1 (likely comes out to around $2-3k the first year). I like the one on one you get with a doc that is top of the line in TRT (in my opinion).
Defy Medical is awesome, Dr. Saya is top notch! The intake staff at Defy can run circles around most endo’s in the sick care system as far a knowledge. Dr. Rob Kominiarek is a force to be reckoned with and does telemedicine, he is king in the hornome world as far as I’m concerned, he costs a little more than Defy ($2300year +medicine+labs), but his knowledge is exceptional.
He can balance all hormone levels without labs, he is that good because he pays more attention to symptoms than any doctor I’ve seen. You can see him in action on YouTube.
Well, I can’t say I’m impressed with the pharmacy system either. Picked up my script. Doc had prescribed a 10ml vial and some 20g harpoons. I asked if they could sub in 25g. They said I’d have to have the Rx changed for that. Then they asked if I’d ever had this medication before. I answered ‘no’. They charged me and sent me on my way. No pharmacist consult or anything for the first time someone picks up injectables. SMH. Now…injections, be it IM or SQ aren’t exactly rocket science but you’d think they’d want to make sure to give me some advice there, not to mention side effects etc. Not to worry, I was a licensed EMT and had some training/practice in giving injections along the way (glucagon, narcan) so I know the drill. Just struck me as odd.
So then I realize they only set me up with a single 1ml bottle. I guess THAT they felt they could contradict my doctor on. Lolz.
20g isn’t that bad, I routinely inject with 21g or 19g, (in my opinion) people tend to seriously over-react in relation to needle size, dosage intervals, dosage etc.
Whatever you feel good on, go by that… screw numbers, or what others “tell” you is where you should be etc. The only numbers you should be concerned about are health parameters such as lipids, CBC etc
The only form of injection I’ve noticed any type of adverse effect to stem from is legitimately… sub q shots, given pharmaceutical testosterone preparations (aside from one of the new ones) aren’t formulated for Sub Q shots, the reaction one has to such shots can build up scar tissue at an accelerated rate. Smaller needle size helps tremendously for sure in this instance though
Heh. So my doc (PCP) goofed up in my favor in the end. He initially wrote the script for 200mg, every 4 weeks. I knew right off (and had it confirmed reading here) that that was a horrible idea. I told him I’d rather go with the Endocrine Society guidelines and start at 100/week (double the initial Rx over time) and re-evaluate in a couple months. He said go ahead, but cautioned me that most give up on proto like that due to injection pain mostly.
So I’ve shot the last of the first 1ml vial I got from the pharmacy. Told him I couldn’t get more with Rx as is. He updated the script at the pharmacy doubling it up again, to 1ml/wk of 200mg/ml C. Not gonna start using that amount at this time. I’m strangely curious if he’ll catch the error.
2 weeks in I’m assuming whatever changes I’ve felt (minor, though positive, if anything) are all in my head.
The minor changes I had in the first 2 weeks carried through for me, but I’m only on week 5 so maybe too early for me to tell also.
With this low SHBG that you have man, in my humble opinion you need to inject at least every other day and on once per week you will feel horrible.
Any specific reason why you don’t have any thyroid values?
Seriously? That’s a new one.
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That’s pretty much what I’m doing (splitting it up), and for that reason (SHBG). A dose too much larger than I can process at once is going to either be wasted/pissed away or aromatised.
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But if you continue two times per week this is way to rare for your SHBG again.
Misunderstanding? Where did I say 2x week? Just said I was splitting it up. Mostly EOD but I did already violate that a little bit when I went out of town for a few days and didn’t feel like going through the TSA hassle with pins. I got TSA Pre to avoid the slowdowns. I’m still so early in this game I didn’t expect to even notice the difference and I haven’t. Like I said I’m feeling slightly more normal / jazzed up overall but it’s probably purely psych at this point rather than anything the T is doing, plus it’s not the only variable in my life. The trip was something I’d been looking forward to for a while, etc.
I know. It’s very concerning. I know quite a few BHRT doctors and most are in it because they want out of the insurance game. I don’t blame them for that. Various delivery methods are used and as many of us know there are pros and cons to each. However, the ones that use pellets do so because of……………….profit margin.
Sorry, the way to do it is what is best for the patient. Period.
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A bit of an update on my case…call it food for thought for the guys wondering “Do I need to do this?”
I can probably trace the symptoms that got me here back 6-7 years, perhaps longer. At that time, we were trying to get pregnant and sex got to feeling like a chore. Started being less interested and it was always based around fertility timing. In roughly the same time period I got diagnosed with T2 diabetes, so I was attributing some to that as well. I was also into my 40s at that point and figured things were starting to slow down, etc. etc.
Symptoms did seem to get better for a while…but then around 2-3 years ago hit a new low in terms of libido and being able to keep an erection long enough to be useful. Talked to Doc…he blamed it on blood sugar and said he’d write me for the little blue pill. I was thinking about it and then symptoms seemed to get somewhat better again for a year or so. Then they got worse again despite me having my blood sugar well under control.
To put it bluntly, most of the time I just flat out wasn’t interested at all in sex, which is quite unlike me. Then when we would go for it…it’d take a long time to get it up and the slightest distraction would cause me to lose it. Starts to weigh on confidence not to mention enjoyment. Quite a few times I never got beyond a soft-on. How much of that was mental vs physiological, I don’t know right now. So at my physical I asked the doc about checking T and we did, and here I am. Total was about 20-30% below the bottom of the normal range, although free/bioavailable were (barely) in range.
So at this point, I’m 4 weeks in, injecting 100mg of T. Cypionate a week to start out with. I wouldn’t begin to presume I’m optimal yet (don’t know and not going to change anything until I do a round of labs in another 3-4 weeks).
Most recent round of sex, it was as if the recent years’ issues never happened. Most definitely was interested rather than feeling obligated to keep the wife happy. Popped a rager on cue and had no problems maintaining it.
That’s the biggest difference so far for me. Everything else that I could even possibly consider a change is either very minor or attributable to any number of other factors in my life.
In terms of cost…I’m spending about the same on insurance as I would be without it - about $15-16 per 1ml vial (200mg Cyp).
LS
Congratulations. I think many guys, after starting TRT, would say they wished they did so sooner. I wish I did.
Well, I guess I wasn’t quite so lucky. Mr. ED reared his ugly head again.
I’ve generally never been one to talk much about sex online but in this discussion it has its place.
Things got great at about the end of the 4th week. Had the drive of a teenager and the hydraulics to match. One look at my wife and I could’ve flipped a quarter as I sprang to attention. That lasted just under a week. Staying the course without changing things up until I get a full run of bloodwork in another week or two. Could be:
- I had just gotten good as my natural was shutting down.
- overshot optimal.
- Random luck and I need to wait longer for it to come back (based on reading I expected ED issues to take a few months to resolve, so I was happy when I had some action)
- That was all I get? 4-5 days?
LIbido is still OK, but not in overdrive like it was for a few days…still wake up feeling like i could shove my morning wood through a brick wall, so I know it’s not a blood flow problem.