T Nation

TRT Question


#1

Am 53 with testosterone in low 200's.Working out most of my life with a few cyccles when I was younger. Doctor put me on testim, didn't like it, smelly and sticky. I work outside and sweat alot. Went to test cyp at 200 mg's a month, after about 2 weeks felt bad again so went to 100 mgs once a week.

Worked pretty good, got stronger and felt good. NOW I am starting to feel the same again, low libiddo achy joints etc. Should I up the amount, take some time off the cyp or what, have been on for about 8 months.


#2

Inject twice a week at 50mg.

Have you tested E2?


#3

NO I HAVEN’T BUT WITH SUCH A LOW AMOUNT OF CYP. DIDN’t think it would be a problem. any natural products I could take to solve the problem?


#4

[quote]KSman wrote:
Inject twice a week at 50mg.

Have you tested E2?[/quote]

I have had several patients that have started TRT and then check the adrenals and thyroid which are shot to hell. One person decided to self medicate T while never checking his e2. His carelessness uncovered one of the most severe adrenal imbalances i have seen ever…His cortisol serum was 3 !! His was being treated for thyroid with synthroid, but the TSH was highest I have seen so far. As you can see the hormone system can be complexed and when issues are not addressed properly can snowball making matters 100 times worse. I was ask when will he get better. I explained to him it did not happen over night and will not be solved overnight. I was honest with him notifying him this is multilayered problem that will have to be done slow and steady. Endos had no explainations, but since I have seen similar cases (but no where near this severe) proper steps will be taken to bring him back to balance. A case this complex may take up to a year to fully rectify the issue and I was honest with him.


#5

Many who inject 100mg/wk end up having negative effects from elevated E2. Natural products are often ineffective or less than optimal.

You also need to be injecting 250iu hCG SC EOD to preserve your testes.

T+AI+hCG


#6

Thanks, wuold it be also better to go 50mgs twice per week? also anything else besides hcg that would help.ON my blood bloodwork everything was very good except low test .IT could be from the motorcycle accident I was in when I was in my 20"s. lost function of 1/2 my testicles, looks normal just doesn"t function


#7

[quote]pasqualeddpas wrote:
Thanks, wuold it be also better to go 50mgs twice per week? also anything else besides hcg that would help.ON my blood bloodwork everything was very good except low test .IT could be from the motorcycle accident I was in when I was in my 20"s. lost function of 1/2 my testicles, looks normal just doesn"t function[/quote]

That could be a major issue as your testicle may have been functioning for a while then eventually it just could not keep up. As long as you have TRT now you just have to optimize it with keeping other things in check.


#8

what other things,am in very good shape.eat well, in the gym 5 days a week. competed when I was younger am 5’6 198 with low body fat can stll squat 500 and except for rotater cuff am otherwise in pretty good shape. Just the low test results,but may have had that for a long time.Felt all around better on test just want to stay that way.


#9

You can have high range TT and FT with elevated E2, which can negate many of the benefits of the T. You need to have a serum E2 test and then use an aromatase inhibitor to lower serum E2 to near E2=22pg/ml. The aromatase inhibitor of choice is Arimidex/anastrozole aka adex. When an AI is needed, it is rare that a natural product would be effective. The natural products can be costly as well.

Get this book:

It is a great intro for what you need to know. The book has two shortcomings. Shippen was down on injections as these were every two weeks. The problems with injections are not there injecting often. Some inject EOD. The book also predates use of anastrozole.

It is very common for guys to do well with injections for 4-6 weeks, but then quickly go down hill as estrogen increases. The increased E leads to higher SHBG that then lowers FT. And the increased E interferes with T receptors reducing the effect of a lower FT levels.

No simple quick fixes and a lot to learn. Typically we see guys here struggling to find a doctor who knows how to do everything needed.

Suggest: T+AI+hCG
100mg T cyp per week, injected twice a week or EOD
250iu hCG SC EOD
1mg/week Arimidex/anastrozole

After a month on the anastrozole, obtain serum E2. Adjust the dose as follows:
new dose = old dose * new_E2/22pg/ml

That will adjust the dose up or down as needed. If your E2 is in the mid thirties or higher and you doc says that it is “normal” [in range] and refuses to do anything, you are screwed. You need an optimal E2 level.

Without hCG your testes will shrink, may ache 24x7, scrotum pulls up tight. There can be a therapy induced organ failure of the testes. You loose the single largest source of pregnenolone in the [male] body. Pregnenolone has many important functions in the body and the brain. When guys have been on TRT with HPTA shutdown, adding hCG often creates an improvement in mood, which could be from restoring pregnenolone production levels. With lower pregnenolone, DHEA levels can drop as well. Not having tiny testicles is important from a sexual self image point of view and how one is regarded by one’s sexual partner. The testes are important for reasons beyond testosterone and sperm production. At your age, fertility is not a concern. There are many guys here who are younger and want to be fathers. TRT without hCG threatens fertility.


#10

That’s alot, don’T know if my dr. will do all that.are you a a doctor


#11

If your Dr. won’t do that you need to find another. Print out articles about HCG/AI and T administration and take them to your Dr. so he can see you aren’t just making things up.

You need to do these things for long term success.


#12

How about if I just go off for a while till things go back to normal. and if so how long on and off would you suggest? BY the way thanks for your imput you have been very helpful


#13

thanks very much