T Nation

TRT Questions after Starting at Age 29

Hey guys wondering if someone could help me out. I just started TRT after getting my hormone levels checked after feeling some symptoms of low T. I am only 29 years old but have had low T symptoms for over a 4 or 5 year period. Previously I had lyme disease from the age of 22 and didn’t feel fully over it until around 26, when I was sick with the lyme disease at the age of 24 I had gotten a lot of blood work done and my testosterone levels at the time were at 250, my doctor at the time said it was below the lowest threshold but said the infection was causing my body to not focus on creating more testosterone, as most energy was used to deal with the infection.

To make long story short on that, I still had some issues the last few years with low T symptoms since I was better from the infection but didn’t think it was hormonal in nature, had some lab done two weeks ago and my test levels came back at the very bottom range again. Even though I sleep eight hours a night, exercise 5 times a week, eat a muscle building friendly diet, take herbal supplements to help with testosterone, avoid xeno estrogens, etc.

Doctors I spoke with theorized that the infection I had before did something to affect my natural testosterone production and prescribed me 180 mg of testosterone cypionate a week, 1000iu HCG, and 1mg of an AI split into 0.5 doses. Told me to take everything together on mondays and thursdays.

I read up about ai’s after and wanted to avoid taking it so I called my doctor and asked if I could stop taking it, and switch to every other day injections of the testosterone. They said it was no issue to stop but if I get high e2 symptoms to give them a call and take the AI I have to help with it, if that becomes an issue and to lower the hcg to 500 iu a week since I removed the ai and HCG can tend to raise E2 as well. I asked for these changes after reading the Testosterone Optimization Therapy Bible by Jay Campbell. As well as some of the stickies in the T replacement forum and some other people’s posts.

Since reading that book and reading through some of the stickies and posts on T-nation I switched my injection frequency to every other day Sub Q injections. And nearing the end of my second week on TRT. My question in regards of treatment now is how do people measure mg to ml for knowing how much to inject each time, or with different doses? Currently im doing 0.2 ml every other day as opposed to the 0.4 ml they told me to take twice a week. If my dose changes to lower or higher I don’t really know how to convert it from mg injected a day to the ml volume used for the syringes.

The other question I have is that I feel extremely tired and sore since started TRT and in some ways worse then before I started the injections. I don’t think I am suffering from low e2 as I only took half a mg one time of the anastrozole AI, and I am not on a huge dose of test either, as well as giving myself more frequent injections to reduce aromatization with larger doses given more infrequently. On top of that my body fat level is under 10 percent.

Is it common to have excessive fatigue or worse low testosterone symptoms when starting treatment? Before the testosterone has enough weeks to saturate in my body, while in the mean time my own natural testosterone production is halted because of the exogenous injections? That is the only guess I could figure out behind how I feel currently. Though I am sure once six weeks comes around I will feel awesome and much more stable with my hormone levels.

TLDR: How do you convert mg to ml on the syringes to know proper injection amounts each day with dosages, feel worse after starting TRT on the end of two weeks since starting, is that common? Doing every other day injections of 180 mg testosterone a week, no AI, hcg 500 IU a week, sub 10 percent body fat. Low testosterone symptoms feel worse since starting TRT. Yes I have read the stickies and posts on the T replacement forum, also read the TOT bible by Jay Campbell.

Yes it is common to feel tired when just starting. Your system just shut down so you may be lower than when you started. As soon as you get the half lifes built on each other and level out you should start feeling better.

It is possible also that you did crash e2 with the ai. You were already probably low already with your low t so it wont take much. Some hyper respond to ai’s also

Please post all pre-TRT labs including SHBG and estrogen. Frequenting dosing with help keep levels more stable and you’ll have high trough levels and lower estrogen. Hold off on the AI until labs support high estrogen because those just starting TRT can easily mistake high estrogen with hormonal fluctuations.

Lyme disease is stressful on the body and we see many men with lyme disease who have low testosterone. If injecting from a 100mg vial, 50mg is .5ml. That’s too much anastrozole, some are AI over-responders and need a faction of that dosage. I over-respond to 0.050 anastrozole, at any dose anastrozole wrecks me.


That makes sense, and is what I assumed about my testestorone production shutting down before the replacement T kicks in. As for the AI and my E2 I am not sure. They did not check my E2 before starting TRT and I do not know what my E2 levels were before starting and now. I am just doing frequent injections now to keep levels stable and avoid low and high E2 issues. Not sure if I am a hyper responder or not either.

You said your sore, what is sore? Joints being sore is a big symptom of low e.

Honestly all I have for pre TRT labs are total testosterone production and PSA for prostate. They did not check anything else. They want to run a full panel in five weeks from when I start TRT so I won’t know until then. Unfortunately I don’t have that info for my pre TRT labs. I am not ill with lyme disease anymore, thankfully. But I do believe like they mentioned that it caused some longer lasting issues with my hormones. Not sure if I am an over responder to the AI but I only took it the one time, and will not touch it again either way. So if thats my issue right now should resolve in time.

Joints feel fine, tendons can have things going on but never bad pain, mostly related to training. For soreness I almost feel like I have a flu without the head symptoms. It’s mainly in the muscles. Like my whole body (muscles) are sore and tired, mentally tired as well.

Even if you have crashed it you’ll be fine as long as you let it get back up which should happen with no ai. I believe your just feeling your system crash right now and should start feeling better.

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Thanks man, that’s helpful and what I figured as well.

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Not a good sign that the Dr didnt do thorough labs. Did they check free T? You need to know your SHBG also to help with your protocol. You may need to start shopping around for a new Dr. I would imagine You are probably at a T mill right? High dose no labs amd hcg and AI. Its definitely not an endo or primary.

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Yeah its basically a TRT clinic, I went there because my insurance doesn’t cover most people who work in HRT as a whole and other places were charging $350-500 for new patient consultation appointments. I was surprised after I got the TRT that they didn’t check more things before hand. I wasn’t aware until after starting TRT that there were so many other things that should have been checked out. Supposedly they are doing a much more thorough blood panel five weeks from the start of the TRT. I pay a monthly fee to be a part of their program which covers the costs of blood work, the test, HCG, ais, etc. Though no desire to touch the AIs. I do like how they allow me to self administer injections, and allow me to adjust the protocol while giving me the blood work. One of my concern with certain doctors is not being able to do anything on my own. I will definitely look into getting my SHBG reading with my next blood work though. And if my clinic does not give me a large enough panel I will look into a better alternative for sure.

You may be able to adjust your T dosage to manipulate your numbers, no AI needed.

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Gotcha thanks, also I’m still trying to figure out the best needle length and gauge size for subq injections. I was using a 31 guage 5/16 insulin needle provided to me for HCG injections but it causes leakage, takes forever to fill and is harder to inject. I saw the Dr Criser video on the 26g 3/8 needle for sub q injection but I’m even leaner then him, at sub 10 percent body fat so I am trying to find the best guage sizeand needle length that would work for me. I also noticed on the Dr Criser video that he bled a lot with the injection and thought that was odd. As ive never bled like that once using intramuscular or sub q injection. It looked like he ended up doing a shallow IM injection to me. Does the needle guage size anand length matter for different injections sites as well? I’m currently doing daily sub q injections.

The 27 gauges are very easy to fill, similar to the 25 gauges, but I like the 29 gauge insulin syringes which take a little longer (30 seconds) to fill.

The lower the gauge the more chance of leakage. A 31g hole has a better chance of immediately closing and sealing in test than a 27 g so if you experience leakage with the 31 maybe it was too shallow and you were implanting the test between layers like a TB test

Nobody mentions this but do you have full thyroid blood work with T3 and Reverse T3?

It isn’t much more then a drop or so most times, so I usually add a tiny extra amount of test to compensate. The needle is just incredibly short in length 5/16, so it doesn’t really go that far in at all. Also the gauge is so small that it takes forever to fill, and also keeps giving me these lumps I feel under my skin days after the injection, and maybe that’s where like you mentioned it is going between layers like a tb test lol. I am picking up new needle sizes today, just trying to figure out the best length and gauge for someone around 8 percent body fat.

Not yet, my next office visit to the doctor I will.

You should be subq with like a 1/4" needle and definitely IM with 1/2" it might just be the “bolus” i believe its called that you are feeling. The oil deposit. Occasionally i can feel it the next day. Leakage might just be because your bf is so low that the test just sits under the skin where my test has to seep through fat then layers of skin to come out. Might be unavoidable unless you gain fat or go deep IM

I have more fat on other parts of my body so I might just have to try the injections there. And just get a slightly longer Sub Q needle, with a 29 gauge or lower. My lower stomach doesn’t have much fat sitting around right now, which is awesome for looking lean, but a pain to find good spots to do the sub q test. The 31 gauge 5/16 insulin needle just feels way too small for injected testosterone as opposed to something with a water base like my HCG. I switched from IM to avoid poking too much holes in my muscles, and to avoid my anxieties about accidentally hitting nerves with injections.