T Nation

T Replacement Protocol

Hey Everybody-
Newbie here and I started TRT about 6 months ago. I’ve done gear in the past (last time about 10 years ago) and always cycled properly but I was shocked to find out that I had low T. I’ve been lifting, powerlifting and bodybuilding for over 25 years and I had no idea I had low T until the test came back and it was 176. My Doc put me on 1 cc Test Cyp every 2 weeks. As you can guess, there was a roller coaster effect. He then added A-dex.

As of today he wants to go weekly at 1cc Test Cyp and see if we can’t get my levels in the optimal range. I’m reading different protocols and I’m interested in hearing opinions on what’s worked for some of you. (VTBalla34, you seem to know a lot about this so I’d appreciate your input.) I’ve discussed all options with my Doc. He’s not a fan of Androgel (too hit or miss) or pellets (too much of T spike and E2 levels are tough to get in line. His words not mine) He likes Test Cyp and thinks we can get me in the optimal range with some tweaks. I welcome all advice.

Thanks
clarkster

Welcome.
We need more info- info requested in stickies. Age, symptoms and a bunch of stuff.
Ask specific questions if you have them.

It sounds like you’re off to a good start and headed in the right direction.
The fact that your doc even acknowledges E2 makes him better than most IMO.

One other thing you have going for you is the fact that youre familiar with injections and balancing hormones and that stuff from doing gear (assuming). When I started TRT I was like “estra what? Stick the needle in where?!”

Good luck.

Joe

Hey Guys- Been doing TRT for almost a year. Have done much gear in the past, too much if I’m being honest. Just turned 43. First 6 months: 200mg of Test Cyp every 14 days. Felt good for about 7-8 days then crash and was just holding on to get to the next shot. My T levels starting were around 175. My Doc switched me to 200mg (and added Arimedex) every 7 days. No brain fog. Felt great. t levels about 780. He was stoked at that number.

BUT, then came the shutdown. He had no solution on how to fix this, said it happens with age. I showed him the TRT protocol on here and he agreed to give it a shot. Two weeks in doing 50mg of Test Cyp 2X a week with 1/2 Arimdex and EOD of hCG. I’m feeling fatigued (brain fog) and lethargic and sex drive hasn’t returned.

Any suggestions?

You’re taking .5mg of arimidex EOD, so about 1.5mg a week? Anastrozole is very powerful and there’s not much room for error. A lot of guys on here use liquidex and have the sweet spot narrowed down to drops. Your E2 levels are probably bottomed out right now. Joints aching at all?

Also, when in relation to the weekly T shot was the test done where you came back at 780? The reason I ask is because you went from 200mg/week and feeling great to 100mg/week and not feeling so great. TRT is all about how YOU feel. So you may need more than the 100mg to really see the benefits.

read the advice for new guys sticky and come back with labs+ranges and more data

There can be issues other than T

Do not expect things to happen in two weeks.

Sorry for the confusion on the Arimidex. I would take it 2X weekly at a dose of .25 each time. So, half a tab a week. I started out at 2 tabs a week and felt fatigue like I’ve never experienced until now.

Agree with you KSman, of course I don’t expect things to happen in two weeks, but I got concerned that after going from 200mg of Test Cyp and half a tab of Arimidex a week to the TRT protocol listed here, AND the fatigue and the brain fog came back in that two week span.

My Doc agreed for me to try this new protocol (Test, Arimidex, hCG) for 2 months and then run labs again. I called this morning to get a copy of my last blood test (about 2 months ago) after reading your response today and HE’S NO LONGER AT THE PRACTICE. So, I might be really screwed if I can’t get a doctor within that practice to continue with the TRT.

My t levels were 780 and E2 was 26. I’ll see if I can get my hands on the rest of the numbers (I’m kicking myself for not requesting a copy, but he seemed happy at T levels of 780) and if not, the next time I do bloods I will have them for you. My situation is pretty simply, I’m a 43 year old full time, stay at home dad of a 5 year old girl with special needs just trying to keep my head above water, so I welcome and appreciate all advice.

So you were injecting 100mg/week with TT=780 [your posts are confusing me]. If so you should not be going to 200mg/week and with E2=26, you were in pretty good shape.

If you inject once a week, T levels change a lot and anastrozole dose needs to match your T levels.

Suggest 50mg T twice a week
1/2 mg anastrozole when you inject
do lab work 1/2 way in between injections

If T levels not good enough [focus on FT], then 50mg three times per week and 1/2mg anastrozole when you inject.

If you are not a normal anastrozole responder, its a different game.

Try injecting SC with insulin syringes, see the advice for new guys sticky and protocol for injections.

Your testes will shrink and pull up tight. T+AI+hCG

Sorry for the confusion, KSman. As of 3 weeks ago, I was injecting 200mg. of Test Cyp once a week, as well as .25mg of anastrozole twice a week for a weekly total of .50mg. of anastrozole. I first started with 1mg. of anastrozole twice a week and I crashed. My Doc tinkered with my dosage and he settled in on .25mg twice a week. All of this while injecting IM 200mg. Test Cyp once a week. This gave me the T level of 780 and E2 level of 26. He never mentioned Free Test results. Testes began to shrink and pull up tight. He really didn’t have an answer for this. And that’s why I showed him the T+AI+hCG protocol and he agreed to do so and we’d test my blood in 2 months.

So, I read your protocol for injecting SC on your advise for new guys sticky and began THAT protocol over 2 weeks ago. 28 guage insulin needles in the thigh (injecting 50mg. Test Cyp twice a week with .25mg anastrozole each time I pinned Test Cyp and hCG EOD) was pain free and a breeze.

Basically, I went from one protocol to another. I know things can’t happen in just 2 weeks but my concern was going from feeling great, except the shrunken and pulled up testes, to feeling extreme fatigue and brain fog.
I hope this makes sense to you.
If I confuse you, then I’m screwed. So, I hope this makes sense.

This is not a normal situation, the rules do not fit the same.

If you had TT=780 on 200mg T/week, I would stay there. But at what day were the labs done???

TT=900-1000 is a good target.

Your response seems to be indicating that you are a hyper metabolizer of T. We do not know what that means other than the effec that a few guys need twice as much T as others.

Given the above, you would be feeling a large drop in T levels, brain fog etc.

And anastrozole needs to match T levels. In your case, we cannot match anastrozole to T dose as your response is not typical.

Recommend that you inject 100mg twice per week and take anastrozole at the time of injection for simplicity. Then do labs later, 1/2 way between injections.

SC will provide smoother release curve than IM. 1/2ml T SC will create a good bump on your skin that you will have to live with.

The shrinking testes are a direct effect of TRT and hCG is the solution. The direct result of inaction is harm and your doc may have trouble seeing the fact that inaction is a decision with negative consequences. hCG is a natural hormone and one lobe of the hormone is identical to the active lobe of your LH.

[quote]KSman wrote:
This is not a normal situation, the rules do not fit the same.
(Don’t know if that’s good or bad.)

If you had TT=780 on 200mg T/week, I would stay there. But at what day were the labs done???
(Labs were done 7 days AFTER my previous shot of Test Cyp @ 200mg. and right BEFORE my next shot.)

TT=900-1000 is a good target.
(Maybe with hCG now in the mix, I can hit that.)

Your response seems to be indicating that you are a hyper metabolizer of T. We do not know what that means other than the effec that a few guys need twice as much T as others.
(I was originally on 200mg. of Test Cyp every 2 weeks. Went to get my labs done right before I took my next shot and my T levels were 175 and that’s when my Doc switched my to 200mg. Test Cyp every week.)

Given the above, you would be feeling a large drop in T levels, brain fog etc.
(I was afraid of having that old familiar feeling come back.)

And anastrozole needs to match T levels. In your case, we cannot match anastrozole to T dose as your response is not typical.
(I took .25mg of anastrozole on Tues and Fri, for a weekly dose of .50mg of anastrozole.)

Recommend that you inject 100mg twice per week and take anastrozole at the time of injection for simplicity. Then do labs later, 1/2 way between injections.
(Are you saying, if inject on Tues and Fri to test on Thurs? Next time I get my labs done, I will make sure and request all the paperwork, instead of just taking his word for it, that everything ‘looks good.’)

SC will provide smoother release curve than IM. 1/2ml T SC will create a good bump on your skin that you will have to live with.
(Does the bump go away before I have to inject in that area again?)

The shrinking testes are a direct effect of TRT and hCG is the solution. The direct result of inaction is harm and your doc may have trouble seeing the fact that inaction is a decision with negative consequences. hCG is a natural hormone and one lobe of the hormone is identical to the active lobe of your LH. [/quote]

(My doc, again he left the practice this week and I need to find a new one, was not clear on hCG and the benefits. I mentioned it to him and he kept thinking about hCG from a diet perspective and not helping out restore normal testes function, but he prescribed it for me anyway. Being that I was on 200mg. of Test Cyp weekly for about 3 months, is 250iu of hCG enough to restore function? I have no problem waiting this out.)
I can’t tell you how much I appreciate your help with this.

SC is a good way to go when injecting T cyp. To avoid a skin bump shoot it on the side of your hip/butt. If you feel almost no sting when the nettle goes in you’re in a good spot. Shooting SC on the thigh always causes irritation.

Don’t go crazy with the HCG. Once size is restored experiment with how low you can go on the dose. HCG can really raise E2 and make it difficult to manage.

Arimiidex isn’t for everyone. If it makes you feel like crap, as it did for me even at good E2 levels, try Aromasin. Everyone is different but that was a great switch for me.

“Shooting SC on the thigh always causes irritation.” for you perhaps, cannot generalize on how people react.

If hCG will work, 250iu SC EOD will probably do a good job. Prospects are not so great for cases of primary hypogonadism where LH/FSH were high.

KSman- Just tried to post a reply to your reply from the other day. I put my thoughts in parenthesis. So, I hope it goes through.

Here’s what I noticed today. I missed my dose of .25mg anastrozole on Friday as Costco didn’t get it in. Today I was supposed to have another dose of .25mg. But, my head feels amazingly clear and don’t have any fatigue that’s been plagueing me the last couple of weeks. Tough question to answer, but do you think it’s because I’ve had no anastrozole for 72 hours or do you think the effects of T+hCG+AI are kicking in? How should I go about finding the answer to this?

You cannot separate those possible effects. You can try less anastrozole and allow all factors to get stable, then go back to higher anastrozole and see where that takes you. Nothing carved in stone. Pick a path and follow it. No changes before lab work, you need to have lab work representing an known end-point.

Note the the effects of a given dose of anastrozole are almost, however with a step change of E2 production it takes a while for a new serum E2 level balance to occur as the liver clears E2. And when you reduce the anastrozole dose, the half will slow down the reduction of the serum level of anastrozole. So nothing was changing drastically in 72 hours.