Starting TRT with Unusual Protocol?

Over the last year or so I have suffered an increase in the severity of most of the common low-T symptoms with exception of ED, and that seems to be on the way. I also had two morning tests with Total T levels of 226 and 344 ng/dL. The second test included a Free T by LC/MS of 5.8 pg/mL.

With these results in hand I met with a doctor who runs an anti-aging clinic and is a body builder. I have actually seen the guy at the gym a few times. He looks and lifts like he knows what he is doing.

Anyway, he looked at my labs and commented that my T is definitely low but not shockingly low. Nothing else on my labs caught his attention. He moved right away to set me up with a protocol without further comment. From his point of view another aging guy with decent health, low-T, and limited to no results from lifting weights is pretty routine I think.

My key lab numbers are:

Testosterone, Free+Total LC/MS:
Total 344 (264-916, updated LabCorp ref. range as of July 2017)
Free 5.8 Low (7.2-24.0)
Estradiol, sensitive 14.4 (8-35 pg/mL)
LH 8.2 (1.7 to 8.6 mIU/mL)
FSH, Serum 7.0 (1.5-12.4 mIU/mL)
TSH 1.62 (0.45-4.50 uIU/mL)
T4, Free (Direct) 1.27 (0.82-1.77 ng/dL)
T3, Free, Serum 3.0 (2.0-4.4 pg/mL)
Hematocrit 44.5 (37.5-51.0%)
DHEA-S 85.8 (48.9-344.2 ug/dL) this is low from my research, should be >180
SHBG 33.2 (19.3-76.4 nmol/L)

Anyway, my starting protocol is somewhat different from most of the “optimized” dosages I have read on this site, as follows:

Testosterone Enanthate IM inject 100mg 2x/week, a bit on the high side?
HCG 75 IU/week, subQ inject 1x/week, this seems low
Anastrozole 1mg capsule 2x/week, this seems high and why from day 1?

Thanks for comments.

200mg is a high dose for most and usually sends guys T levels past top of the ranges unless you are a hypermetabolizer, meaning you shoot through your T quickly. If I were you I’d do smaller more frequent injections so you don’t push your SHBG downwards too much, you would do well on twice weekly (every 3.5 days) injections. These heavier doses are typical of the anti-aging clinics and are overly aggressive, I’ve never seen anyone from an anti-aging clinic on a more reasonable dose. Their more about the money than health and are overly expensive, you might try Defy as their a lot cheaper, there are many who get tired of overpaying and switch over to Defy Medical if you have difficulty locating a doctor who understands male hormones.

This TRT Dr. is actually an orthopedic surgeon that has a sideline “Longevity” practice. He charges $150 for the initial visit and $75 for all subsequent visits. I won’t see him again for another 3 months.

The prescriptions come by mail from Empower Pharmacy and will cost me $175/month. I think these costs are fairly reasonable compared to my other alternatives.

I may have not been clear in my initial post - I am supposed to inject T 200 mg/wk divided into 2 100 mg doses, so it will be 100 mg every 3.5 days. I told the Dr. that 200 mg/wk seemed high for initial dosing, but his reply was that “most people under-dose Testosterone initially”. His goal is high-normal Total T levels (around 1000). He did not provide any rationale for the HCG and Arimidex dosages.

My thought is that I might want to make an interim check of blood levels since 3 months is a long time to wait in case adjustments are needed.

In my opinion that’s not a good idea, because going slow and low allows “some” not all to skip the AI altogether. If you shoot for the moon I promise you so to will your E2 and you’ll likely have to lower your dose anyhow, so why not start on a medium dose. I was originally put of 200mg weekly, holy hell my E2 skyrocketed and it took 4-5 days for it to drop without an AI. Note most can’t clear out their E2 so quickly without an AI, I’m a rare case. Unless you are a T hypermetabolizer you will feel quite bad from that high dose, I don’t hear of many T hypermetabolizer on these forums, probably as rare as those who would not require an AI on moderate T doses.

Time for another doctor.

I will be taking 1mg Anastrozole twice a week, on the days following my T injections. This I think is supposed to prevent E2 from rising too much.

In threads on this site I read that smaller doses are common (especially 0.25 mg) in order to prevent E2 from going too low.

Typical AI dosing is 1mg per 100mg of T-cyp, otherwise most will end up crashing your E2. Some are over responders to AI’s.

Systemlord is correct on the AI doing. A rule of thumb is 1mg per 100mg of test. Currently I take 200mg of test c a week and I feel very well so do not feel to scared of it. The biggest issue I see is 75IU 1x weekly is joke. I assume you meant 750IU (7.5 on 1ml syringe)? Here most people find 250IU EOD the best for them. Again however the recommendations here are based on experience coupled by lab results to create a sort of bell curve. Not everyone falls on the bell curve nor feels well at towards the tails of the bell curve. After all, if doctors paid attention to those details there would be a much lower need for great forums such as this one.

The prescription is for 75 IU 1x/week, however I should check math/units as you mention.

The 11,000 IU powdered HCG was mixed with 5.5ml of water.

The syringe for the HCG is marked in major increments of 10 IU to a total of 100 IU. I filled it to the 75 line (equivalent to 75 IU in “syringe units”).

Since the powdered HCG was diluted to 2000 IU/ml (11,000 IU / 5.5 ml) and the syringe holds 1ml, I actually injected 1500 IU (75/100*2000 IU)? Confusing…

If you add 5.5ml of bac water to an 11,000IU yes you have 2000IU per 1 ml. So if you are pulling the 1 ml syringe to .75ml you are injecting 1500IU’s of HCG which is…well a lot. And once per week is also not good because it has a half life of 24-36 hours. 250IU EOD is the recommendation I see here on the site. Your math in your post tonight was correct. I would adjust the dosage and frequency.

OK, I called Empower Pharmacy to review my HCG dosage. They confirmed that I am actually injecting 1500 IU 1x per week. They also stated that it was not an unheard of dosage and timing for HCG.

I will review with Dr. at my next appointment.

I am glad you followed up. 1500IU 1x per week may not be unheard of but that does not make it a good idea. HCG has a half life of 24-72 hours. So if we mate the middle and say 48 hours, that means in six days you are well below the threshold of a therapeutic dose. Next if we consider the high dose running the risk of desensitizing the leydig cells we are looking at a dosage schedule that not only will not provide benefit (not enough peptide for a consistent therapeutic dose), it may in fact bring harm, even if temporary through the leydig desensitization from the higher than necessary dose of an LH analogue. I believe you would be well found to discuss your concerns with your doctor.