T Nation

Unusual T Protocol, But it Works


#1

After years of messing around with every variable I could think of, I found a protocol that works very well.

Two of my battles have been with low SHBG and poor tolerance to Anastrozole.

I endured a whole lot of deadened libido, depression, ED, etc., for the first couple years of TRT. Here's what finally did the trick:

1) Allowed myself to crash to around baseline T levels (after 2 years on TRT, this was probably below 200 ng/dl).
2) Frontload 50mg of Testosterone Cypionate, injected subcutaneously
3) Starting 24 hours later, inject 20mg of T-Cyp EVERY NIGHT before bed (rotate injection sites between obliques and upper glutes on either side)
4) Take 25mg of research-chemical Exemestane every night before bed
5) Take another 25mg of research-chemical Exemestane every morning before leaving for work about 12 hours later

This puts my total T in the 800-900 range and bioavailable T in a proportionately high-normal range.

Taking that much Exemestane seems like it should crash my E2 through the floor. I actually haven't gotten an E2 lab since starting this protocol, and I really don't care what that number is at this point. (I once got near the Holy Grail E2 reading of 22, and I still was not feeling great).

I feel good, my mood is stable, it's easy to lose bodyfat, workouts are good, sexual function is good...even morning/nocturnal wood is much more consistent and vigorous than it's been in many years. This has been the story for about 5-6 months now. No looking back, as far as I'm concerned.

The daily injections are a hassle, and yes, I'm sure I'm building up some considerable scar tissue. But that's a small price to pay, in my opinion.

I hope this helps someone. Life was pretty bad before getting the hormones stabilized. I'm glad I didn't quit.


#2

I am hoping you can explain the rationale for the bedtime injections vs upon awakening? I also take daily T Cyp,(70mg/wk) SQ, I am running TT at 700, FT 80-90% range, and no elevation in E2, so no AI’s. Also, no change in past year in testicle size, so haven’t thought about HCG. I started at 100mg, but TT was slightly over 1000 after a month, so dropped the dose to 10mg a day.


#3

davidRN, we see some guys whose testes do not shrink, magic genetics I guess. When TT is unexpectedly high, it can be exaggerated with higher levels of T+SHBG that is not bio-available. That can be from higher SHBG levels or reduced ability of the liver to clear T+SHBG. It really makes sense to be testing free testosterone [FT].

Any developments re thyroid levels, iodine, body temperatures?

When injecting ED or EOD, there are many active overlapping injections and levels are so steady, I doubt that AM VS PM effects would be noticeable.

jrNE, are you using #29 insulin syringes?


#4

KSMan, Thanks for the quick response, first I wanted to mention my use of syringes. I spent a decent amount of my career in med research, but about 12 years ago I retired from that end, and returned to clinical work, so I had a crap load of supplies,including syringes, just needed to buy some a few months ago. I started with 29g, 1/2", but I found my abds are much stronger, and it was feeling too much like an IM injection, so I tried, 31G/6mm (15/64") they draw fast enough, and I am only taking 0.05ml a day, I use 10ml/200mg, so need very little for 10mg a day.

"Any developments re thyroid levels, iodine, body temperatures? "
I don’t want to side track the OP, but since you asked:

I am currently taking T3 5mcg 3 x day, and T4 88mcg at bedtime, levels are great. I don’t wake up with high temps, but I am always at 98-99 in middle of day. I took 5% Lugols daily for more than a few months, worked up to 50mg /day, then weaned down to 25mg for a few months. Currently I apply 2% Lugols to the testicles a few days a week. My diet is better, I have found more success with my RA by going Gluten Free, rarely eat any processed GF products either, but occasionally treat myself to some bread or a desert. I drink Raw milk, and no one else at my dairy was interested , so I buy raw colostrum, I freeze it in ice cube trays, and put a cube or 2 in a daily smoothie.


#5

You say you’ve tried changing many variables, but did you change them independently, or together? IE: if you went from EOD dosing IM with no AI to every day dosing SC with Exemestane and saw an improvement, then you don’t know which one of those changes mattered, or if all 3 were required. It could be that it was just the AI that mattered, and the other two changes made no difference.

I’d be amazed if you really need every day dosing of test cyp, that morning vs. night would matter, and that you need 2x a day dosing of Exemestane. On the other hand if what you’re doing works for you and you don’t mind frequent dosing, then there’s no need to continue experimenting, might as well keep doing what you’re doing.


#6

So you tried anastrozole and that did not work well for you? That would be 1mg/week vs 700mg per week and increased costs.


#7

JrNE,

I have low SHBG and I am fighting with symptoms for more than two years by now. They only get worse, and now I am in the land of desperation. So few questions for you, if you do not mind:

  1. How low is your SHBG?
  2. Did you do any steps to raise SHBG, and if yes, did they result in success?
  3. Which protocols did you try which were unsuccessful?
  4. How long did you give each protocol before moving on to the next? (i.e. when do you know that your current protocol is not working and it’s time to change?)

Thank you!


#8

Sorry for delay, all. Let me answer those questions.

Davidm: Bedtime injections mainly for convenience; pinning every day, I don’t think time of day makes much difference.

KSMan:
-I am using the larger 25 syringes. I know, I should switch. Old habits…
-Anastrozole seemed to cause problems for me. Tried different doses, monitored E2, and regardless of the lab number, I usually felt like garbage, even when E2=22. Completely different story with Exemestane purchased from the same RC company.

DFW:
-I would change one variable at a time, kept a daily log of symptoms/progress or lack thereof.
-The daily pins and high Exemestane dose are unusual, but I believe I tried just about everything else.

Kwn:
-My last SHBG reading was 15.7 (ref 16.5-55.9). Just below range.

-I am doing a couple dietary things to bring it up (green tea, increased fiber). I’ve not re-checked SHBG level since implementing those. Admittedly, there’s less urgency to spend time and money on lab work when you’re feeling good.

-Previous protocols (starting from ground zero ignorance, with a helpful but minimally knowledgeable general practitioner):

1x/week injections (100mg T Cyp) with no AI
2x/week (50mg) with no AI
3x/week injections (various doses) with no AI

These all produced rollercoaster good then bad days, mostly bad. Then added Anastrozole at various doses – never felt particularly good, and sometimes felt absolutely horrible. (I can now sympathize much more with women with PMS.) Exemestane changed everything. After switching to daily T injections and a low dose of exemestane, everything was going well except no morning wood. Bit the bullet and jacked up the exemestane, and then that last missing piece got a lot better. Morning/nocturnal wood is still not completely consistent, but I can perform in the sack better at age 41 than I could at 35, which is the main goal.

I’ve never used HCG, mostly due to the cost. Everything I’m doing is out-of-pocket.

-I would usually try to run a protocol for at least a month to let things settle out, but I often felt so bad that I would be compelled to switch it up sooner than that.


#9

I read your initial post and thought to myself “right, he’s tried EVERYTHING” and this last post of yours confirms that in fact you hadn’t.

if you like injecting T everyday, by all means man, go for it. I’m sure you get something psychological from it, even if injecting that frequently isn’t necessary. I’m sure some would find it odd (though I’m betting there’s a higher % that wouldn’t), but I personally look forward to my T shots.

BUT- as you say above, you tried 1x, 2x, and 3x a week- ALL with no AI! You switched to everyday, and things were better for you, but it still didn’t all come together until you added the Exemestane. So…how can you be sure that the 1-3x a week + AI wouldn’t have worked?

EDIT: I re-read, and I’m still under the impression that you hadn’t added AI until after you switched to daily T, and at that point started low dose EXE- if I’m wrong and you tried the AI with the last protocol prior to everyday- the 3x/week, then I guess disregard my post.


#10

JrNE,

What were your symptoms during the miserable search years? You mention deadened libido, depression, ED. How bad were they? Also, was your current protocol just a stab in the dark (accidental find) or did you have some guidance/intuition behind it?

Also, did you use regular women estradiol or sensitive test?

My problem seems (at least right now) that I am clearing E2 too bad even with no AI. My sensitive measurements are no more than 20, and I just cannot keep it up.


#11

You are not the first to report doing better with Exemestane. Others should use anastrozole because of the much lower chemical load and costs. Don’t know how to present this alternative and context in the stickies.


#12

To clarify, I tried 2x/wk and 3x/wk injections and coupled both of these schemes with trials of different doses of Anastrozole. By this time, I had learned that no one injects once per week.


#13

[quote]Kwn wrote:
JrNE,

What were your symptoms during the miserable search years? You mention deadened libido, depression, ED. How bad were they? Also, was your current protocol just a stab in the dark (accidental find) or did you have some guidance/intuition behind it?

Also, did you use regular women estradiol or sensitive test?

My problem seems (at least right now) that I am clearing E2 too bad even with no AI. My sensitive measurements are no more than 20, and I just cannot keep it up.[/quote]

KWN, symptoms were quite severe: Libido was non-existent most days; ED was never total, but for years, I almost never achieved “full hardness.” Depression was the worst of it – lots of suicidal ideation toward the end of my Anastrazole use. Never had a “sense of well-being,” which is quite consistent at this point.

Rationale for eventually daily injections: Our bodies produce T steadily, not in a burst every 2 or 3 days. I wanted to get closer to the natural model, but wasn’t ready for a 24-hour IV drip…

I believe I consistently used the ultrasensitive E2 test.


#14

I have been doing daily T Cyp injections for the past 6 months,and daily has helped me, not need an AI or to donate blood from an increase in my H&H. However, this past week, I decided to try EOD for the next month to see if I notice a difference in Libido (that is my watermark).
I wonder for those of us who are daily, what if we (slightly) vary the dose? I was taking 10mg a day/ 70mg a week, but what if instead I alternated 6mg with 14mg, or 8mg with 12mg? We should still have a fairly stable TT level, but some variation, within a smaller window, might help mimic the small natural variation from day to day?
Any thoughts, or prior experiences from anyone?


#15

Sort of a bump, but an update. I have not noticed any issues with my change from daily T Cyp, to EOD. Had some labs drawn yesterday, (was with the wife, and its an hour drive,so had some done just because I was there) will see how my H&H changes, even though its less than 3 weeks. Mostly I am interested in my CRP, it was 1 on Enbrel, 2 months after stopping Enbrel and Methotrexate, it went up to 15, at that point I started low dose prednisone (under 10mg) to supplement my LDN until it kicks in in 4 to 5 months.

Was hoping to hear if anyone varied there daily or EOD T Cyp dosing slightly? But keeping the same weekly total?


#16

I think jrNE has analyzed his HRT very well. With excellent results I may add.
Please keeps informed about your progress.

dez6485 - seems you were intentionally slamming jrNE - he is sharing his research with us and your comments comes off snarky.
Not cool.

davidrn - EOD may work for you, everyones body chemistry is different. Would Clomid on off days be an option?

Getting old sucks, but as we have learned in life, when things turn South, we can either pick up the gauntlet or whimper.
I choose the former.


#17

Roger that, Borg Master. Appreciate the feedback.

Updated labs after about a year on this protocol:

Total T = 672 ng/dl (Ref. 348-1197)
Free T = 23.8 pg/ml (Ref. 6.8-21.5)
Estradiol = 19.1 pg/m. (Ref. 7.6-42.6)
DHEA-S = 259.6 ug/dl (Ref. 102.6-416.3)

One change I made a few months ago was cutting down from 50mg of Exexmestane per day to 42.5 per day (25 mg before bed + 12.5 mg in the morning). This was prompted by joint pain, which pretty quickly was resolved after adjusting.

Total T is not as high as expected, but Free T looks plenty high. I’m continuing with 20mg T Cyp every night. About once per month I bump up the injection to 30mg, theoretically to compensate for the little bit of Cypionate that often leaks out when I inject.