T Nation

TRT Not Working

Hello, this is my first post.
I was prescribed trt after having all the symptoms related to low t and testing around 300 total t and 10pg/ml on free t.
At first I was prescribed 200mg every two weeks, and i was like 4 months on that but couldnt feel any change and when i tested it was 250 on total t, so it went down a little bit compared to before starting trt.
So my doctor decided to take me to 200mg cypionate a week and I have been with that dosage for a month; and still dont feel any change in symptoms.
My SHBG is 15nmol/L.
I would want to know why couldnit be that it isnt it working and what should i do?
Thank you!!!

Do you get shots at the Dr office? If not split into two shots.

Do you have e2 measured? How about shbg?

Here’s the problem and your protocol is inappropriate given this low SHBG value, you need daily injections and don’t need high testosterone, high testosterone will just increase symptoms because low SHBG men tend to have very high free estrogen even when estrogen is above ranges.

You will only need about midrange TT to have healthy FT levels. If you’re not willing to inject daily, then I’m afraid TRT isn’t going to show you good results. I have low SHBG 13 and didn’t respond well to TRT injecting once or twice weekly, I did respond well to EOD and daily injections.

Low SHBG men just don’t do well on infrequent dosing, it’s a simple as that. You should be using 27-29 gauge insulin syringes to inject your testosterone, you can inject in the shoulders and quads.

Was the SHBG test done prior to TRT or after you started TRT? If SHBG was tested before TRT then I would expect SHBG to be closer to zero on this protocol and that might make you a TRT non-responder if suppressed low enough.

Your prescribed protocol is usually reserved for someone with high SHBG with the intent of suppressing SHBG. Your doctor isn’t very good at playing this hormonal game.

You should be feeling sometime, actually you should feel worse. If your thyroid is underperforming then this would be a reason why TRT isn’t working, T is metabolized in the liver and if thyroid hormones are low, then TRT would feel as though you are injecting water.

You only listed a TT and SHBG value, it’s hard to know what’s going on inside your body when testing is limited to these two biomarkers, we need more extensive testing to see what’s going on inside you body.

  • Total T
  • Free T
  • SHBG
  • Estradiol Sensitive (E2)
  • Prolactin
  • Cortisol
  • Ferritin
  • Thyroid Panel -> TSH/Free T4/Free T3/Reverse T3/antibodies
  • Comprehensive Metabolic Panel
  • Lipid profile/panel

Welcome to the forum!

Before changing anything related to your protocol, stick with the current dosage of 200mg/week for at least another 2 weeks and get complete labs. This will give us a better idea as to why you are still not feeling symptom relief. Then adjustments can be made based off of labs, not assumptions.

1 Like

Whats your age? 21?

Hello man, its great to find someone with the same SHBG characteristic.
I have no problem on trying by injecting every day, but i have a few questions: how long does it take to work or should i feel effects? How much should I inject each day? Im actually using 23 gauge, is it necessary to change it? The most important thing to me is to know how long should i expect to feel changes by injecting every day so i can try it knowing this.
The SHBG testing was done prior trt.

The values I have:
TT: 300ng/dl
FT: 10pg/ml
SHBG: 16nmol/L
Albumin: 4.24g/dl
TSH: 1.06 UI/ml
Free T3: 2.68pg/ml
Free T4: 1.08ng/dl
So thyroid seems to be working correctly I believe and lipid profile was ok when i tested some months ago.
Thank you!

Thank you

1 Like

@matias21cabrera
Anytime you change your protocol expect to not feel great for 6-8 weeks. You’re already at least halfway there on your current protocol. Stick with it and then assess. Give each protocol 8 weeks.

Onset of effects of testosterone treatment and time span until maximum effects are achieved

Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond. Changes in erections/ejaculations may require up to 6 months. Effects on quality of life manifest within 3–4 weeks, but maximum benefits take longer. Effects on depressive mood become detectable after 3–6 weeks with a maximum after 18–30 weeks. Effects on erythropoiesis are evident at 3 months, peaking at 9–12 months.

Prostate-specific antigen and volume rise, marginally, plateauing at 12 months; further increase should be related to aging rather than therapy. Effects on lipids appear after 4 weeks, maximal after 6–12 months. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3–12 months. Changes in fat mass, lean body mass, and muscle strength occur within 12–16 weeks, stabilize at 6–12 months, but can marginally continue over years. Effects on inflammation occur within 3–12 weeks. Effects on bone are detectable already after 6 months while continuing at least for 3 years.

The time-course of the spectrum of effects of testosterone shows considerable variation, probably related to pharmacodynamics of the testosterone preparation. Genomic and non-genomic effects, androgen receptor polymorphism and intracellular steroid metabolism further contribute to such diversity.

The answer will be different for everyone, TRT is like no other field of medicine and is what makes if difficult for doctors because they are used to prescribing what usually works for everyone. No one could have guessed I would do well on 7mg daily (49mg weekly), the only way I found out is through trial and error.

Only you can tell us what works for you, we can only guess. If I had to guess I would tell you to inject 14mg daily.

Completely unnecessary, no reason to use mini harpoons, it will just create more muscle tissue damage through the decades.

It takes 6 weeks for the half-life to build up in the bloodstream, longer to notice results from dosing changes. TRT is a game of patience, it’s a marathon not a sprint.

The 200mg weekly protocol more than likely suppressed your SHBG into the single digits, not good because low SHBG men struggle the most on TRT.

Looking at your TT and FT ratios, your SHBG binds androgens well given your low SHBG number. Now if only we can get it to increase by injecting smaller doses more frequently.

TSH looks good, but Free T3 and Free T4 looks low, it would be helpful if you posted lab ranges.

You should continue with what you are doing for a few more weeks and get follow up labs to compare with initial labs, which hopefully are sufficient.

Also, for follow-up labs, the “sensitive” E2 test is not necessary and is more expensive.

Don’t get hung up with SHBG and injection frequency. The vast majority of TRT patients, or gym guys doing it black market, take one injection a week with 150-200mg, usually 200. TRT clinics test FT, SHBG and E2, PCPs, uros and endos maybe not, underground guys definitely not, and these guys are doing fine and they do not even know what E2 or SHBG is.

Each example below is taking 200mg once a week with all doing very well.

SHBG%203

SHBG%2011

SHBG%2021

SHBG%2023 !!

Muscle damage? Never heard of this, not when competing in the high octane 70s and 80s or with any of the guys I know who have been on TRT for 20 years. Back in the days, we used the harpoons…………….20-22g, 1.5in.

This is simply inaccurate. Most men on TRT are not struggling and they are taking 200mg once weekly. Among them, unless supervised by a TRT doctor, it is doubtful they even know what SHBG is.

@highpull [quote=“highpull, post:11, topic:263069”]
Don’t get hung up with SHBG and injection frequency. The vast majority of TRT patients, or gym guys doing it black market, take one injection a week with 150-200mg, usually 200.
[/quote

That’s because the vast majority of guys don’t have low SHBG. The biological and anecdotal evidence for low SHBG guys supports smaller more frequent doses and an overall lower total and free T.

No it does not.

If you were to inject pure testosterone, so not the ester, then yes.

But by injecting the ester form it only gets slowly released from the side of injection and cleaved - so the amount of cleaved T that SHBG needs to ,grap’ isnt that high actually. Thats the whole point of using an ester.

If your assumption were correct a molecule like T undecanoate wouldnt work at all in low SHBG men.

All the frequent injection does is, it lowers the fluctuation of T and subsequently of E2.

My SHBG is also low, I went from e3d at 100mg a week, to ED injections and 150mg a week, and in a week I felt better. When I was doing 100mg split to e3d, I would occasionally have a good day but 90% of the time I felt awful. So on 5 months of TRT doing e3d, I had no benefit besides body hair and some muscle definition. Doing ED injections seemed to help alot, I woke up today and smiled, because I felt so much better than before. I believe that I’m now experiencing the effects of 100mg a week that I wasn’t getting before, and in a few more weeks my levels will stabilize at my new 150mg a week dosage, and I’ll feel either better or worse. And no it can’t be placebo because I’ve consistently felt like shit for a long time, and have felt incredible the past few days, my friends and family have already commented on it, because I’m normally a hide in the corner and avoid conversations person, but now I’m initiating most conversations, and am just way more positive. I wouldn’t believe it myself because I understand it takes weeks to kick in, but I have not felt anything like this in a long time. Try daily injections, I believe there is truth to it, and if it doesn’t work, try something else. Also if you’re injecting daily it’s preferable to use a smaller needle reduce tissue damage.

Frequent injections quite a bit more than that, low SHBG men usually don’t do well with high testosterone, they need to keep their levels about midrange, to do this without having levels drop too low between injection, frequent injections is needed.

Also excess androgens suppresses SHBG, great if you’re a guy with high SHBG, but if a guy has low SHBG, these excess hormones (150-200mg once weekly) will suppress SHBG especially is already low. This is a protocol for high SHBG men, not low SHBG men.

I’m also seeing a trend with low SHBG and very high free estrogen even when estrogen is in range in some individuals. When I had a TT at 697 ng/dL, FT was at 29 pgm/L (6.8-21.5) which is excess free hormones which is then converted to estrogen and you can expect to see why we low SHBG men are having problems at these high testosterone levels.

The majority of men are struggling if they have low SHBG and inject big doses once weekly. You are not paying attention because you are overly focused on what you and your gym buddies are doing and are ignoring what we are seeing on these forums. Sr. Saya who has treated over 10,000 patients is seeing the same thing.

Go ahead, I employ those seeking answers use the search function on T-Nation and Excelmale and see your statement fall apart. “low SHBG and TRT”. You basically have eliminated options for the OP to take to resolve his issues by basically telling him to not get hung up with SHBG and frequent injections which sounds like you are telling him to ignore SHBG and frequent injections.

This is a perfect example, you/I represent a typical low SHBG guy. Highpull says the majority of men inject doses weekly and do fine, I’m not talking about the majority of men, I’m saying the majority of “low SHBG men” do much better on very frequent dosing.

Look at a graph of T cyp injection and T levels over time. Peak levels are reached very quickly. 24-48hrs after injection. It isn’t a bell curve with the peak at the mid point of the half life. The pharmacokinetics are such that the test isn’t released at a constant rate. The challenge for the low SHBG guy is to manage that peak. The most effective way to accomplish this through smaller more frequent injections.

Hey, what was your SHBG level? So one week into daily injections and feeling the change? Thats great

What do you mean by this? Because i never really felt the effects of “high t”, i didnt feel a change at all.
In your case how long did it take to kick in? Can you remember?

My SHBG was 13 and yes, I’m very happy that it was so quick I was prepared to wait 6-8 weeks for any noticeable difference, so it was a pleasant surprise.

Im doing blood test next week, what should I expect after this month of 200mg/week? High t and high free t?