Starting TRT Over Soon

Posted before that my GP started 300mg shots once a month and after 4 to 5 months I felt really bad with headaches, twitching, roller coaster emotions. Haven’t had a shot in over 2 moths and my T levels crashed and then recovered some. I still have zero motivation, depressed, anxious, and fatigue all of the time even when I sleep well. I am just not me.

I see a urologist at the university men’s health clinic tomorrow. To be honest guys I am afraid to start something new and afraid not to. That one large shot was destabilizing for me but right now I feel terrible too.

I am sensitive to medications so what do you think I should do if offered a heavy opinion in my treatment? Not sure I can get compounded cream from the doctor and would rather do smaller doses a few times a week or everyday of shots. I will do anything to feel better but i trusted by GP and she wreaked my health last time. Tomorrow at least is a specialist and a male.
Thanks

I’d try starting with 100mg per week. Split it into two doses every 3.5 days if you want. Wait at least 8 weeks, and evaluate from there.

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thank you. I don’t mean to bash my doctor but she did say she wasn’t an endo and didn’t have many male patients as an excuse. I really like her but she didn’t have a clue what she was doing in regards to TRT.

Good conclusion.

But she was half right in terms of weekly equivalent dose. Take the 300 /4 which gives you 75 mg per week of test ester.

Given we know nothing about you the responsible estimate for suggested starting dosage per week would be 75-100 mg/week of test ester. No, not a starting dose of 150 mg/week and no not a starting dose of 200 mg/week.

Nice job @cliteastwood!

For more info, see here and below:

Get your bloodwork done in the timing @cliteastwood shared and if you really want to be diligent check your peak and trough and dial in your protocol based on (1) symptom relief along with (2) prior knowledge of your (if applicable) eugonadal TT/fT range, and (3) constraining your TT/fT levels based on your risk tolerance understanding that the higher you go outside the male reference range the more risk you may be taking on in terms of long-term cardiovascular health.

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Talk about cardiovascular…after the last 300 mg shot in February I thought I was going to have a stroke. I am a slow metabolizer of medications so they build up over time.

Excellent reading and thank you. I just want to fee normal again, not trying to be 20 again in all Departments. I am 56 and don’t want super high levels. 10 days after the last shot I was at the upper range of free and total, 214 and 755 based on the scale they used. 14 days after that I went from a free of 214 to 17. The peaks and troughs were making me insane.

I may even start a little more conservative if I can. I’d rather pin insulin needles as I can’t see myself doing IM. I have seemed to do well when my levels are actually toward the low side of the ranges. Just think the lower end or middle is going to be better for me based on how the high end made me feel.

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If she is receptive and you feel knowledgeable enough I would tell her how you would like to be treated. That is what I did, My doctor wanted me on cream and I asked for shots and told him the frequency I wanted and they listened.

What about Jatenzo?

Sorry, I am seeing a male urologist tomorrow he heads the University Medical Center for men’s health. My GP is female and she is the one that did 300 mg shots once a month. I will ask them about the protocol I desire and advice on it.

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I wish you the best. More reading on various administration options and their estimate PK profiles vs a hypothetical young and old males:

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I don’t know what that is. It wasn’t offered. I’m good with the protocol we settled at. They pretty much let me run the show and keep an eye on my bloods to make sure all is going good. I pay cash for their service. Feels good to have a doctor work for me instead of my insurance. I actually get good treatment. Wish I could say the same about my GP.

I know a little about it but I have always had issues with oral medications since I am a slow metabolizer. It would all depend if there is a low enough dose available.

Good luck. Keep this updated!

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Anything you need let me know.

Thank you all for your time and knowledge, I appreciate it very much!

I thought about cream since one may be able to mimic the circadian rthym better but I don’t know if that is a necessity or not. I do want to make sure I get good sleep. I just want my motivation, depression, and fatigue to get better.

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Actually you are a pretty typical eliminator of free T if the data point you provided is TT in ng/dl after 10 days. Also you have to consider that if the upper reference range for the assay is ~800 ng/dl it may not have parity with gold standard LC/MS-MS assay (LC/MS-MS assay may read higher or lower than your assay). It’s all very arcane.

Nevertheless I’d place you below 50% of age adjusted study study group given your data point meaning you are a reasonably good eliminator of fT. Testosterone will build up over time in every patient based on the elimination half life of the ester (in this case I’m assuming about 4.5-5 days for Testosterone Cypionate/Enanthate).

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Wow, thank you. One questions I struggle with is is better to have some peaks and troughs to mimic natural T? I have no problem doing subq every day if it makes me feel better but wondered if twice a week would be better or EOD? Maybe this is person specific. I wonder because would have it lower at night make sleep better?

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As shown, if you want to best mimic young male physiology (circadian rhythm) you’ll need to go with an application route that has short apparent elimination half life (1-6 hours) that comes with using pure testosterone instead of the ester. Either oral troche (buccal) admin, cream, nasal gel, test suspension, capsule all come with their pros and cons and once daily admininstration in the AM will insure your levels are back to baseline by night. Nasal gel has also shown promise in restoring HPTA function in some men that may also have subjective benefit.

You don’t have that flexibility with the injectable ester but if you inject everyday you will have near constant blood levels of T 24 hours a day. For some men this is problematic for sleep.

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When I had the higher levels and they were dropping I did ok with sleep so I am hoping if I end of with injections again I can find a good spot. Thank you for all the information.

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If you are on it how is it working for you? Thank you.

I think going from the shot frequency you were at to once or twice a week will be a world of difference.