Technical Test Cyp Question from Newbie

Pharma / TRT Testosterone Replacement
1

48 year old white male. Lifelong athlete (wrestler, Brazilian Jiu-jitsu, swimming). 6 feet tall, 220lbs. Was pure vegetarian for first 35 years of life (no meat/fish/eggs). Now eat meat/fish/eggs.

About 2 years ago, came down with crippling pain in hips, knees, shoulders and neck. Diagnosed with “Polymyalgia Rheumatica” and “Rheumatoid Markers”. Placed on high-dose prednisone for almost 18 months. In words of Wellness Doctor, “That dose is really going to do you in, negatively impact your kidneys and liver and surge your cortisol. It will be a long road to recovery just from the side-effects of the prednisone, and it will also impact the value of your TRT.” Went up to 250lbs while on prednisone. Giant gut. Been off that now for over 6 months and back to normal weight. Pain is gone, Polymyalgia and Rheumatoid issues are “cured”.

Been on TRT (specifically, Testosterone Cypionate 2,000mg/10mL injectable only) since July of 2018 under the supervision of a Health & Wellness Consultant who is an MD. I get a full blood panel done every 3-5 months.

Additional supplements include: hydrolized gelatin (2,000mg/day), DEHA (25mg/day), Magnesium Chelate compound (1,200mg/day), CoQ10 (100mg/day), Vitamin D (5,000IU/day), Metformin (1,000mg/day), Aged Garlic Extract (1,200mg/day), Vitamin B12 (5,000mcg), hydration protocol of 120oz of water/day.

Daily exercise (weight lifting and Kettlebells) good; overall activity could be improved (more walking, wrestling).

Diet not as clean as it could be, though, I’ve discovered that near-elimination of grain-based carbohydrates is very favorable to my gut and reduces fatigue.

2018 bloodwork showed my T levels as:
TOTAL T = 216
FREE T = 4.0

Original T dose in July 2018 was 0.5cc @2x/week injectable, total 1cc/week.

By July 2019, 1 year later, T-levels were consistently above 900.

July 2019 blood panel shows T levels at:
TOTAL SERUM = 1090
FREE = 34.7

Cycled off/tapered off to take a “T vacation” and used HCG for several months, then went back on the same injectable Testosterone Cypionate 2,000mg/10mL at the same dose (0.5cc @ 2x/week, total of 1cc/week).

June 2020 blood panel showed T levels at:
TOTAL = 644
% FREE DIALYSIS = 3.5
FREE SERUM = 225
SERUM = 643

Doctor reduced T dosage to 0.25cc @ 2x/week, total of 0.5cc/week.

February 2021 blood panel showed T levels at:
TOTAL = 421
% FREE DIALYSIS = 3.0
FREE SERUM = 126
SERUM = 507

Doctor said, “Your T is a bit low. I’d like you to ‘live’ around 600.”

Doctor then increased T dosage to 0.25cc @ 3x/week for total of 0.75cc/week.

PROBLEMS: Feb 2020 blood panel revealed
(1) High cholesterol, specifically:
LDL-P = 1904
HDL-P = 34.4
SmallLDL-P = 827

(2) High Insulin Resistance Markers, specifically:
LP-IR SCORE = 82

(3) High Creatinine, specifically:
CREATININE = 1.37

Doctor’s exact quote, “That level of cholesterol tells me that it is very likely the particles are sticking to your artery walls. That cholesterol, in combination with your Insulin Resistance score is a recipe for heart disease and stroke. The high creatinine level also tells me your kidneys are taking a beating. If this doesn’t change by your next blood panel, I’m sending you to a Kidney Specialist. Move to a more plant-based diet, reduce your red meat consumption, and start drinking tons of water” (hence my hydration protocol above). That was VERY unsettling news as I imagined myself to be a person in excellent health. Freaked out for a little bit.

QUESTIONS:
(1) If T use enhances cholesterol, why did he increase my dose to 0.75cc/week?
(2) Many holistic nutritionists (Chris Kresser is my primary example here) do not frown on cholesterol. Moreover, they say that eating foods high in cholesterol do not cause cholesterol surges in the bloodstream. They claim cholesterol is intimately related to insulin levels and that the worst thing one can do is be on a high-fat/high-protein diet that includes grain based carbs. Their solution is to eliminate grain-based carbs. I had done that previously and felt great. Thanksgiving and Christmas did me in and I went full-steam ahead on the grains. As of Feb 2020, I’ve eliminated them again and am already feeling better. How might the cholesterol/diet/T leves/insulin be related to one another?
(2) I don’t want to do 3 injections per week. Can I do 0.5cc for my first injection and then 0.25 for my second injection?
(3) There is a large discussion to be had about half-life here. We can get into that, but, it will impact the “spacing” of my 2x weekly injections. What’s the best schedule for 2x/week?

2

Beware of targeting a total t number , you should be looking at symptom resolution, “I want you living at 600”, that may be fine for you, it may be very low. For instance I didn’t feel much for t replacement until I got my total T over about 1200 on a dose of 180mg/week in 3 inj.

My cholesterol runs about a total of 160 but I take a statin. First thing I’d have asked for is a retest of cholesterol panel, that LDL seems extremely high, but you didn’t give the units/lab ranges. Different labs use different units so it’s tough to make a call about them without that info.

Can you do 2 shots a week with one at .50 cc and the other at .25cc, sure, but why not 2 at 37.5 or there abouts, I think you’ll be happier with more consistent dosing. Roughly evenly space your doses, Sun & Wed, Mon & Thur, etc. If you are pretty much on schedule you’ll be fine. If it moves around a bit, that’s fine too. Sometimes I miss one of my 3 doses, I don’t typically notice, though some people do. If I was going to be traveling, if tried both taking the whole weeks dose at once and just skipping when while away, didn’t notice much difference either way. YMMV.

The half life is between 6-8 days for both test cyp and enanthate but everyones is a bit different. You can get away with wider spacing of doses with them than say prop.

Also, In my opinion your creatine isn’t “very high” assuming it’s the same range on my last test which was from .76-1.27mg/dL also dI’d you have a hard workout before or the day before the blood test, that can elevate that level as can dehydration.

As usual, not a doc not medical advice.

3

Answers

  1. Because he knows cholesterol is easier to bring down vs trying to get your T up. Changing testosterone levels in a trt patient involves literally one thing: administering more testosterone. Much easier to up your dose and then hope to manipulate your cholesterol post hoc.
  2. Yeah, cholesterol isn’t the boogeyman that it’s made out to be. A high percentage of the problems associated with it are genetic. Plenty of people who eat everything right get high cholesterol and what do you know, their dads had the same problem. Red yeast rice is a good supplement that is proven to act as a mild statin. Give it a read and see if it fits your goals. It may be enough to bring your numbers in line.
  3. Guys on here are going to hate this answer because this place is packed to the rafters with princesses who can feel a pea under a dozen mattresses, but if you split your dose that way there’s a good chance that you’ll never even notice a difference.

I’m surprised you’re having insulin resistance even with the metformin. Have you looked into berberine? Some diabetics are advised to take both as they do nearly identical things and work wel in conjunction with one another. That’s something you could look into if it sparks an interest.

4

Yes, please give this a try. It is a fantastic supplement with a lot of research supporting it.

Also agree here. I’ve settled on dosing 120mg once every 5 days. Works very well for me, no different than when I was dosing every day.

As far as diet, dietary cholesterol will not increase blood cholesterol. However these things can or will: trans fats, sedentary lifestyle or being over fat, sodium, alcohol, and perhaps saturated fats (not a lot of huge evidence there, but some).

Your best dietary choices for lowering cholesterol will be high in fiber, low in sodium, lots of fish/omega-3s, lean meats, and take it easy on the dairy.

5

I have ultimately decided against the red yeast rice. There are simply too many potential inherent dangers to using it to the opportunity cost is not worth the potential benefits. I have no doubt that it works, but it is not for me.

I settled on 3.75 at 2X/week and it’s working wonderfully for me.

It’s very interesting that you mentioned fiber and a list of dietary recommendations. A little more than two weeks ago, I committed to a diet which includes a bare minimum of 25g of fiber per day.

As much as I dislike introducing any grains into my diet at all, I now start the day with a giant bowl of oatmeal filled with one banana, one apple, a handful of walnuts, some almond butter, peanut butter, and some cinnamon. The oats have not disturbed me at all, and they are a mere 27g of grain-based carbohydrates, so I think I can live with that. :slight_smile:

I’ve also reduced red meat intake and massively increased my intake of fruits and vegetables, thus averaging 25-32g of fiber daily. The positive impacts have been immediate, so it’s nice to hear confirmation. We shall see in 3 months from now whether or not it had a positive impact on lowering my cholesterol.

P.S. Drinking approximately 120oz of water daily, and starting each day by chugging a 12oz glass of water with lemon juice, as well as tightening up my sleep hygiene, have also been beneficial. I just “feel better” generally.

6

Thank you for your very helpful and knowledgeable reply. Regarding:

  1. I’ve researched the red yeast rice and decided not to use it. Too many potential negative side effects and, after speaking with a number of individuals personally known to me who have taken it, yes, achieve the lowered cholesterol results they were seeking, but the tradeoffs in fatigue and weakness and potential organ damage were not a low enough opportunity cost to continue ingesting it. Based on my well-researched evaluation, I’m sure it works and I’m also sure it’s not for me.

Your comment that, “A high percentage of the problems associated with it [cholesterol] are genetic. Plenty of people who eat everything right get high cholesterol and what do you know, their dads had the same problem.” is an intriguing one. I do wonder if genetically high cholesterol means that the body is not in an unnatural state despite the high level of cholesterol the sub served, and therefore the high cholesterol itself does not have a negative impact on aggregate systemic health in such individuals.

  1. I’ve opted for 3.75 at 2X/week, and that solved the problem.

Finally, regarding the Metformin, I am not, and never have been, diabetic, nor is there a genetic transmission danger of diabetes. However, 18 months on a high dose of prednisone nearly guarantees you’ll end up in a pre-diabetic state which is precisely what happened to me, and the Metformin was prescribed to control that. The entire time I was on the high-dose prednisone, the Metformin did its job. Suddenly, that does not seem to be the case, and my wellness doctor was quite concerned about it particularly in light of the high creatinine level. His exact quote was, “I really cannot explain this. The Metformin should be protecting your kidneys.” He also noted that despite there being an insulin resistance problem, my blood sugar levels were quite normal, two data points which he noted as being in contradiction with one another.

I have not looked into barberine yet, but will do some reading. Thank you for the suggestion.

That said, I am very unlikely to pursue that line; I’m not diabetic and I’m not interested in resolving all of the holistic issues through non-holistic methods. I’ve had quite enough of allopathic doctors fixing the problems caused by one supplement or medication by adding another supplement or medication into the mix. Those days are over.

7

Thank you for your insights; they were very helpful, particularly your suggestion to evenly split the 2x/week dose. I’ve been doing that and feel quite good about/as a result of it.

8

Very glad to hear that you’re feeling better and especially that you’re so much in charge of your own health and not relying on others. It’s important that each of us be our own best advocate when it comes to our health. Good on you, man.