Hi y’all, 32 years old suffered from fatigue and brain fog Since early 20s never really had a issue with libido. Went for routine check up a few months back and my T levels came back at 206 and since I was symptomatic they referred me to a urologist who put me on TRT treatment. First month he prescribed one tube of AndroGel every morning . Felt great first 5 days then it never really did much for me after that…on follow up visit he decided to put me on IM injections 100mg bi weekly because T levels were still to low. By day 6-7 on this new regiment I felt so bad and fatigued, however I stuck to what doc said and 6 weeks later my T was still low so he upped it to 200mg bi weekly. At this point I also had him check my estradiol levels which came back at 19. On 200mg bi weekly I could go about 10 days and then just feel like complete shit. My next test day was scheduled for the same day my injection would be so I decided not to inject until after they did bloodwork, I remember feeling so bad that day. The next week I go in for follow up and my T levels were a fucking 29! So now the doc has upped my dose to 200mg every week. Question is do I continue this or break it up into 2 doses? Is 200mg a week to high? I know my nuts have stopped producing T but a 29 seems extremely low although I know 200mg bi weekly is also a horrible schedule.
I’m sorry to inform you that your doctor is TRT ignorant, almost all doctors are no different. SHBG is measured and then a protocol is designed around your SHBG level, SHBG dictates dosing and injection frequency. I assure you if you bring this to his attention all you will get is a deer in headlights look.
You may be a hyper excreter and may need more frequent injections. You need a hormone specialists which do not exists inside insurance networks, suggest you give Defy Medical a consideration. They offer telemedicine, bloods are drawn and a phone consult is setup and treatment options are discussed and mailed you everything.
I’m with Defy Medical and was the best decision I could have made.
That’s great Bro I’ll look into it…how often should I been pulling my estradiol levels every time they draw blood? Have you ever seen someone’s T levels drop to a 29? Last Estrodial level I had was 19 which also seems low.
You should always do Total T, Free T, E2 sensitive 6 weeks after a dosage increase or decrease. It doesn’t matter how good Total T and Free look if estrogen is high and causing symptoms, your estrogen level plays a huge part in how you feel while on TRT. Too high causes anxiety, irritability and moodiness, too low and emotions are blunted.
GI bleed can cause testosterone to be low, those who suffer from GI bleed, bleed into the intestines losing blood and hormones in the process. Hyper excreters just need more frequent dosing, probably 30-50mg EOD.
You need SHBG tested, this will guide dosing and injection frequency. It’s not often I see Total T @29, that’s a seriously messed up HPTA.
Androgel is too weak to get men to youthful testosterone levels, it’s enough for awhile until your HPTA shutdown, then you feel nothing.
So, with all due respect to Systemlord, inject the 200mg a week and get bloods in 6 weeks and take it from there. At least your urologist knew enough to take you off of gel and get you to injections. You may end up needing more but a stabilized protocol and blood work will tell you what you need to know but more importantly it is how you feel.
Thanks y’all, great input I have been feeling a lot better since injecting 2 days ago and am scheduled for tests in 6 weeks. I will update. Also System not sure my total was 29 but doc just said my T level was 29 not sure if it was free or not. Shbg is something I would have to test somewhere else then my Urologist correct?
If your urologist doesn’t understand why he should be testing SHBG it’s a bad sign your working with a doctor doesn’t really comprehend what he’s doing. The fact he put you on TRT with testing SHBG tells me he doesn’t understand what it is he’s supposed to be doing.
You mean bimonthly, correct? If so, at least he moved you to weekly. Urologists usually follow the Endocrine Society guidelines of bimonthly to monthly injection schedules. You may do fine with weekly injections. I’d stick with it for six weeks, see how you respond and see where your levels are. As he was willing to move you to weekly, he may consider biweekly dosing if your symptoms and lab results warrant.
He started me at bi-weekly with 100mg IM then it was low after 6 week check up so moved me to 200mg bi-weekly then got blood work after 6 weeks and I was sitting at a 29 which is way low so he has me now on 200mg weekly and I will run labs in 6 weeks to see.
System here is my original tests from my primary, when they told me I had low T they referred me to a Uroligist who ran several blood tests first but there computer portal has been down since I have started seeing him so I have not seen a copy of what he tested I only know what was discussed verbally. However I will try to acquire via email tomorrow and post.
Those guidelines are so outdated and in written by morons of who really don’t know much of anything about hormone therapy. A reliable source has stated that the cut-off value 300 was chosen because it sounded like a good number, so they went along with it.
Since that time there have been many studies suggesting levels below 440 is the threshold the actual threshold where people start to have libido and erection troubles. Other Studies have backed this one up. I believe the threshold is a bit higher especially if SHBG is elevated.
Your thyroid looks pretty good, don’t see anything that would set off alarms. You can go to Discount labs and purchase and SHBG test if your doctor refuses it, then we can advise you on your injection frequency.
You may be a hyper excretor and or hyper metabolizer, it will be interesting to see where your SHBG sits.
Awesome System I will ask doc to run to test and if he does not I will take that route. Thank you. I’ll keep posted.
It is amazing, isn’t it? I do not understand it. I know a woman prescribed a 100mg test cypionate, 1/month injection. This from a hormone clinic.
You would figure these so called doctors would wonder why they’re clients are not coming back. I wonder if they just pick a dosage off the top of their head.
What’s up boss! If I were you… I wouldnt do 200 mg in one shot per week. At least split it into 100 mg every 3.5 days. Its gonna jack up your estrogen levels. This doc has got you on a roller coaster ride from hell. My doc prescribed 100 mg once a week and I immediately ignored her and started 50mg every 3.5 days. I do my own bloodwork out of my pocket so I get the right test run and I email the results to her office. I’m doing 100 mg a week like she says just not the way she wants it. She is such an idiot that when I asked for a prescription for arimidex she said I would have to go see a urologist for that script. She is an Endocrinologist!!! How do these freaking people have a practice at all?
I’ve talked to some, a lot of factors play into it. They’ll tell me 1) they aren’t trained in this, 2) they’re not interested in it, 3) they think it is risky and dangerous, believing the steroid rage, anti testosterone, political hype. My own PCP thinks testosterone is a gateway drug, addicting, and will lead to anabolic steroid abuse. They admit all of that, but will still try to accommodate a patient as best as they can.
Surgeons, urologists in our case, really don’t want to be bothered with this stuff. Sure, they’ll throw out some Viagra and test, but for them the money is in procedures. They want to do prostate, bladder and kidney procedures. It is not unlike going to an orthopedic surgeon with a strain. He/she wants to cut, that’s what they do. They’ll write you a script for an NSAID and a muscle relaxer, then quickly move on.
That’s insane man! She should be prescribing that. Roller coaster is right, I have not seen my levels get past low 200s since I started this ride in March. Keep in mind I e always tested on injection day but do labs before I inject which I was told is the correct way to do it right? Or should I inject that morning before labs? I’m definitely going to split up the dose was just thinking I should do what doc says for 6 weeks run labs and if I’m up then I’ll start splitting?
You should definitely be testing on day of before injection. This is your trough level and is an important marker. Just think peaks and valleys. Ideally you want smooth and steady levels. Not just for testosterone but for your estrogen levels as well. Before trt your body should have been producing testosterone every night while you slept. It was dosing you daily and providing smooth consistent levels or at least it should have been. On trt you are injecting and causing massive spikes and significant valleys. Totally different world. If you split up your injections you can have more consistent levels which is far more “natural”. The only exception to this are those with high shbg levels. You can drive down shbg with large weekly injections and have higher free test.