Upper Limit on TRT Dose?

Pharma / TRT Testosterone Replacement
1

This is my first post and I’m looking for a bit of guidance.

In July of last year I had some labs drawn to get a baseline before starting a training program. I went through Direct Labs so I picked what I wanted tested. Much to my surprise my total testosterone was 249. I was starting training again after being sedentary for a long period of time. I was a discus thrower in college but had basically stopped training when my eligibility ran out.

I’m 36 now so it was a 13 year layoff. I figured I would start training, clean up my diet, and retest in a few months. I started 5/3/1 in August and have ran it for 6 consecutive cycles and haven’t missed more than 2 workouts. In November I was still feeling tired, lethargic, muscles hurt all the time, low libido, periodic ED even on Cialis so I figured it was time to look into TRT.

I found the nearest guy who was still over a 100 miles away. He did labs on my initial visit and my total testosterone was 287 and estradiol was 30. He started me on 250 mg weekly of testosterone cypionate as well as a whole cocktail of other things including Danazol 100 mg 3 times a week, Cytomel 5 mg daily, DHEA 25 mg daily, and Arimidex 1 mg daily. Based on my reading I thought the Arimidex was too high a dose so I only did this every other day.

When I started the testosterone I felt great initially. My drive and mood got better. I was horny all the time and either had sex or masturbated 10 days in a row with no problems. In the past frequency like that would have caused ED or inability to orgasm.

After about the first couple of weeks I didn’t feel as good and I had a lot of muscle and joint pain. I did my shots on Wednesday. There was a bit of a mixup about the dose as the doc told me 250 mg and the vial I received from the pharmacy said 200 mg (more on this later). I did 200 mg IM testosterone cypionate the first 2 weeks, and 250 mg the 3rd week. On the 4th week I had labs drawn before my weekly injection. So my repeat labs 3 weeks after the first injection were total testosterone of 282 (down from 287), estradiol of <15 (down from 30), and SHBG of 12 (down from 21).

It took forever for the doc to follow up on me with those labs and I finally talked to him today. In the mean time I’ve been injecting 250 mg each week and I cut my Arimidex down to 1 mg every 3rd day. I’m a doctor and the labs were drawn at my hospital so I’ve had the results long before I ever discussed them with the HRT doc. Since cutting back the Arimidex I have less aches and pains but still feel tired and lethargic.

I’m at a little bit of a loss to make sense of my testosterone going from 287 to 282 on 250 mg weekly. I’m not aromatizing it based on my estradiol of <15. The only thing I can figure is that my endogenous production dropped and dropped quickly. I am a very large individual and even before starting to lift again always carried a lot of muscle mass. I’m 6’ 4" and weigh about 420 right now. I had skin folds done at the first of the year and was at 26% bodyfat.

So I talked to the HRT doc today and he recognizes that I need a higher dose of testosterone but he claims he can’t write a higher dose than 200 mg per week or he runs afoul of Federal regulations. That was the reason the vial from the pharmacy only said to take 200 mg. He told me later to take 250 mg and he’d prescribe a higher quantity but the label could only say 200 mg.

Now he is pushing for me to do pellets as he claims he can do a higher dosage with those. I’m hesitant based on dosing issues I’ve read about the pellets.

At this point my main questions for the forum are:

  1. Why did my level drop further despite being on 250 mg per week of test cyp?
  2. Are those of you on TRT having troubles getting your docs to write for more than 200 mg weekly or am I just a special case for needing that much?
  3. I’m considering switching docs to someone who works more with guys with sports performance concerns. My guy just seems to want to sell me supplements. If it’s only a few times per year I’d be willing to go to Dr. Crisler or someone in Southern California (my wife would like the vacation). What are some big name docs I should know of if I decide to go that route?

Thanks for all your help in advance.

2

There are many on here who are more knowledgeable about trt than most Dr.'s and Endo’s. Read the stickies on the first page namely “Protocol for Injections” and “Advice for new guys” which were written by these experienced members. The standard starting dose is 100mg test/week and 1mg of Anastrozole in divided doses. You were taking 7 times the recommended dose for Anastrozole which will seriously screw up your protocol. An underlying theme that you will find on here is that more T is almost always not better.

3

I’m well aware of what the usual starting dosages are. I’m also well aware that my docs initial prescription for Arimidex was too high which is why I didn’t take the full amount. My question for the group is why would what appears to be a big doseage (250 mg/week) actually cause my total testosterone to drop from 287 to 282. I’m looking for a more insightful answer than “read the sticky, it says you should take 100 mg”.

4

I’m not an expert either, but I think your hypothesis of your endogenous production dropping could be the cause. Perhaps you need to just stay the course for a while and see if you begin responding to the injections.

There is a guy on here named KSman - he can probably help you. He seems to really know his stuff when it comes to TRT.

What I can tell you is that I take more than 200 mg weekly and my MD has not mentioned anything about fed regs.

Good luck

5

your blood work is going back 5 months on your test results… my dr did me on 100mg every five days for 6 months then tested second time… he didnt like the results adjusted to 100mg once a wk but try and over lap wks basically push my inject date back a day each week. so if was a sunday then next injection was saturday, and then next was a friday so on and so on. i am also on 1/2mg of Anastrozole every other day. 6 more months go by, draw labs and boom. consistant 1050-1080 across the board and never felt better.

im 30 but had three back surgeries and one foot surgery since 09 getting out of the marines and my levels were 221 when i finally got knowledge of maybe weight gain and all the medication i was on maybe the reason i felt like a 65 yr old man…

so maybe you just need to wait longer on your labs our pretty much not even waiting til the kick in rate. they say it takes 3 weeks to even “kick in”

6

I’ll discuss it with my doc but maybe he tested too early after starting TRT. I’m considering retesting again to see where I’m at especially considering I started 250 units of HCG the 2 days prior to injection since getting the last lab result. He also mentioned changing to more frequent injections. I’ve read that some have more success with every 3 day injections.

7

Please read these stickies:

  • advice for new guys
  • thyroid basics
  • protocol for injections

First, you need to be injecting divided doses more often. Twice a week might do, but suggest EOD dosing so we can feel how you feel and what your labs are like when your levels are steady.

We see a few, very few who are hyper metabolizers of T who need 300mg/week to get what others get on 100. But we need you to follow the above to judge this.

In the USA, you can get labs done on your own, in most states via lef.com, suggest the male panel that covers many issues.

Your T is low because your HPTA is shut down and your levels are dropping when you do the labs after a week.

Read the finding a TRT doc sticky. Doctors are really the only problem, most are clueless or unwilling. We also have willing+clueless.

Please list all labs with ranges. We also need total cholesterol, CBC, ALT/AST, T, FT, E2, TSH
Also would like to see TSH, fT3, fT4 [not T3, T4]

8

[quote]Discobolus wrote:
This is my first post and I’m looking for a bit of guidance.

In July of last year I had some labs drawn to get a baseline before starting a training program. I went through Direct Labs so I picked what I wanted tested. Much to my surprise my total testosterone was 249. I was starting training again after being sedentary for a long period of time. I was a discus thrower in college but had basically stopped training when my eligibility ran out.

I’m 36 now so it was a 13 year layoff. I figured I would start training, clean up my diet, and retest in a few months. I started 5/3/1 in August and have ran it for 6 consecutive cycles and haven’t missed more than 2 workouts. In November I was still feeling tired, lethargic, muscles hurt all the time, low libido, periodic ED even on Cialis so I figured it was time to look into TRT.

I found the nearest guy who was still over a 100 miles away. He did labs on my initial visit and my total testosterone was 287 and estradiol was 30. He started me on 250 mg weekly of testosterone cypionate as well as a whole cocktail of other things including Danazol 100 mg 3 times a week, Cytomel 5 mg daily, DHEA 25 mg daily, and Arimidex 1 mg daily. Based on my reading I thought the Arimidex was too high a dose so I only did this every other day.

When I started the testosterone I felt great initially. My drive and mood got better. I was horny all the time and either had sex or masturbated 10 days in a row with no problems. In the past frequency like that would have caused ED or inability to orgasm.

After about the first couple of weeks I didn’t feel as good and I had a lot of muscle and joint pain. I did my shots on Wednesday. There was a bit of a mixup about the dose as the doc told me 250 mg and the vial I received from the pharmacy said 200 mg (more on this later). I did 200 mg IM testosterone cypionate the first 2 weeks, and 250 mg the 3rd week. On the 4th week I had labs drawn before my weekly injection. So my repeat labs 3 weeks after the first injection were total testosterone of 282 (down from 287), estradiol of <15 (down from 30), and SHBG of 12 (down from 21).

It took forever for the doc to follow up on me with those labs and I finally talked to him today. In the mean time I’ve been injecting 250 mg each week and I cut my Arimidex down to 1 mg every 3rd day. I’m a doctor and the labs were drawn at my hospital so I’ve had the results long before I ever discussed them with the HRT doc. Since cutting back the Arimidex I have less aches and pains but still feel tired and lethargic.

I’m at a little bit of a loss to make sense of my testosterone going from 287 to 282 on 250 mg weekly. I’m not aromatizing it based on my estradiol of <15. The only thing I can figure is that my endogenous production dropped and dropped quickly. I am a very large individual and even before starting to lift again always carried a lot of muscle mass. I’m 6’ 4" and weigh about 420 right now. I had skin folds done at the first of the year and was at 26% bodyfat.

So I talked to the HRT doc today and he recognizes that I need a higher dose of testosterone but he claims he can’t write a higher dose than 200 mg per week or he runs afoul of Federal regulations. That was the reason the vial from the pharmacy only said to take 200 mg. He told me later to take 250 mg and he’d prescribe a higher quantity but the label could only say 200 mg.

Now he is pushing for me to do pellets as he claims he can do a higher dosage with those. I’m hesitant based on dosing issues I’ve read about the pellets.

At this point my main questions for the forum are:

  1. Why did my level drop further despite being on 250 mg per week of test cyp?
  2. Are those of you on TRT having troubles getting your docs to write for more than 200 mg weekly or am I just a special case for needing that much?
  3. I’m considering switching docs to someone who works more with guys with sports performance concerns. My guy just seems to want to sell me supplements. If it’s only a few times per year I’d be willing to go to Dr. Crisler or someone in Southern California (my wife would like the vacation). What are some big name docs I should know of if I decide to go that route?

Thanks for all your help in advance.

[/quote] 420 and 26% BF? Even if you are only 26% BF, your heart hates you for having such an inflated BMI. Sorry to be tangential but this weight just seems like a HUGE FUCKING issue to address before TRT and should not be justified by saying you have X body fat or stating your athletic background. Greg Kovacs comes to mind. Even steroid free Mark Henry who has denser than normal bones and low 20’s BF @400 is probably going to pass at an early age.

Anyway maybe try switching the needle sizes and injection sites to leanest body parts in the meantime before seeing a new doc.

9

0.5 mg arimidex EOD is still a very high dose, considering a typical TRT dose is about 1 mg per WEEK in divided doses.

The joint pains are typical of low E2. If I were you I would stop the arimidex for a while.

Your SHBG is now too low. High doses of exogenous testosterone will cause SHBG to drop (you can look it up under low SHBG causes in the medical literature), which seems to have happened in your case. Low SHBG in turn will cause less retention of T in the body.

For this reason, it may be counterproductive to increase your TRT dose, since it may cause an even further drop in SHBG and even less retention of T in the body. You may have to reduce your T dose to allow your SHBG level to recover.

10

I really am 420 pounds. I had my bodyfat tested with a 7 site skinfold at the first of the year and it was 26% according to that. I think my actual bodyfat is probably a bit higher, probably mid 30’s. The guy who did the skinfolds is a former state champion bodybuilder, former division I strength coach, and masters in exercise science.

He’s done thousands of these before so I don’t think it was user error just that at higher bodyfats the folds can be harder to grab. Fat loss is going to be a big priority for me right now. I actually gained 38 pounds in the last 24 weeks of running 5/3/1 for 6 cycles. I wasn’t doing this intentionally.

My waist went down 1/4" during that time period so essentially didn’t change. Family kept asking if I was losing weight and my wife said kept commenting on my muscles being more defined. I added 85 pounds to my bench press, 70 pounds to my military press, 80 pounds to my deadlift, and 70 pounds to my squat during that time period.

As far as the SHBG going down I think that was actually my doctors goal. He started me on Danazol at 100 mg MWF in order to bring down the SHBG in order to raise the free testosterone. I’ve read a lot on the subject but I’ve never heard of anyone using Danazol for this purpose before but it seemed to work.

As far as the Arimidex dose I knew from my reading that it was too high to begin with. He was prescribing 1 mg daily and I was only taking 1 mg EOD. When I got the result back of <15 I cut it back to E3D. I knew then that the joint pain was due to the low estrogen so cut back. I’m getting my estradiol checked again this Wednesday and will see where I’m at.

The problem with the Arimidex is that he doesn’t give me a script for the meds he orders them through a compounding pharmacy who sends me the meds in the mail. So the Arimidex I get is capsules and I can’t cut them in 1/2 or 1/4s.

Since my labs were asked for I’m including those now.

July 5, 2013. I was just checking a baseline on some things in order to see where I was at prior to starting a weight training program. I had no clue my testosterone would be low because I’m pretty horny, carry a lot of muscle mass, and have large testicles.

These labs were done by LabCorp (this was as a part of a larger panel but this is the pertinent stuff)

Total Testosterone: 249 ng/dl (348-1197)
Free Testosterone: 9.6 pg/ml (8.7-25.1)
Estradiol: 41.9 pg/ml (7.6-42.6)
25 Hydroxy Vitamin D: 39 ng/ml (30-100)
AST: 23 IU/L (0-40)
ALT: 51 IU/L (0-44)
Hemoglobin: 15.5 g/dl (12.6-17.7)
Hematocrit: 46.6% (37.5-51)
DHEA-S: 324.6 ug/dl (88.9-427)
Hemoglobin A1C: 5.6% (4.8-5.6)
TSH: 1.07 uIU/ml (0.45-4.5)
Total T4: 9.0 ug/dl (4.5-12)
Total Cholesterol: 162 mg/dl (100-199)
LDL: 81 mg/dl (0-99)
HDL: 45 mg/dl (>39)
Triglycerides: 181 mg/dl (0-149)

October 23, 2013. These were ordered by the HRT doc prior to starting TRT. These labs were done at Quest Labs

Total Cholesterol: 178 mg/dl (125-200)
HDL: 53 mg/dl (>40)
Triglycerides: 173 mg/dl (<150)
LDL: 90 mg/dl (<130)
Hemoglobin A1C: 5.4% (<5.7%)
25 Hydroxy Vitamin D: 49 ng/ml (30-100)
TSH: 0.83 mIU/L (0.4-4.5)
Free T4: 1.4 ng/dl (0.8-1.8)
Free T3: 360 pg/dl (240-420)
Reverse T3: 240 pg/ml (70-260), my doc thought my free T3 to reverse T3 level was too low so started me on Cytomel 5 mg daily
Hemoglobin: 15.5 g/dl (13.2-17.1)
Hematocrit: 47.2% (38.5-50)
DHEA-S: 283 mcg/dl (110-370), my doc thought this was too low and started me on DHEA-S 25 mg daily
Insulin: 5 uIU/ml (<23), my doc thought this was good and showed I didn’t have insulin resistance
Total Testosterone: 287 ng/dl (241-827)
Estradiol: 29 pg/ml (<39)
SHBG: 21 nmol/L (10-50)
Albumin: 4.5 g/dl (3.6-5.1)
Note: my doc didn’t order a free testosterone but this can be calculated using total testosterone, SHBG, and albumin
PSA: 0.4 ng/ml (<4)

October 23, 2013. I ordered some labs through Direct Labs the same day I got my blood drawn for the doc. He didn’t order a few key things and I was curious so I ordered these myself. These were done through LabCorp. These were done at a different lab in town and drawn within 20 minutes of the above labs.

LH: 3.5 mIU/ml (1.7-8.6)
FSH: 3.9 mIU/ml (1.5-12.4)
Prolactin: 17.4 ng/ml (4-15.2). I’m sure I had sex within 48 hours prior to this
Total Testosterone: 317 ng/dl (348-1197)
Free Testosterone: 8.1 pg/ml (8.7-25.1)

I started Testosterone Cypionate shots on 11/18 at the following doses

11/18: 200 mg
11/25: 200 mg
12/2: 100 mg (I was going to try to split my total dose into a twice weekly dose)
12/4: 150 mg (I met with my doctor that day and he said he wanted me on 250 mg weekly and not the 200 mg weekly that the vial said. So I gave myself an additional 150 mg to total 250 mg for that week. He then wanted me to get repeat labs done in a week prior to my next shot)

I started Arimidex 1 mg EOD on 11/18 and Danazol 100 mg MWF on 11/18.

December 4, 2013. Repeat labs ordered by my doctor. These were done by Quest Labs

Total Testosterone: 282 ng/dl (250-1100)
Estradiol: <15 pg/ml (<39)
SHBG: 12 nmol/L (10-50)

Since 12/4 I’ve been doing 250 mg testosterone cypionate each Wednesday and cut my Arimidex down to 1 mg E3D on 12/12.

I see my doctor again on Wednesday and will talk about increasing the frequency of the injections. Just for my own curiosity I ordered total testosterone and estradiol from Direct Labs to be done on Wednesday morning.

I also started HCG on my own (ordered from HCG123.net) and have been doing 250 units Monday and Tuesday with my testosterone on Wednesday. I started this on 12/30.

11

But your SHBG wasn’t high to begin with, so he had no business lowering it with danazol, and now it is much too low. No wonder your body cannot hold on to the testosterone. Low SHBG is bad - besides the hormonal problem you are encountering, it is also associated with various health conditions including metabolic syndrome. And prescribing 250 mg as a starting dose is irresponsible for TRT. He doesn’t sound like a very good doctor, and if you are concerned about your health long term you should probably look for a different one. OTOH if you are looking to use him for a legal steroid cycle, you should probably at least cut out the danazol.

For smaller arimidex doses, dissolve in water or alcohol.

12

6’4 420 26-30% you must be built like a brick shit house!

I’ve seen a lot of guys that are naturally that size, or close to it.
I’m 6’3" 235 45yo, big dude by most standards, but I have two brother in laws
that absolutely dwarf me. The older one is 6’5" 345, hands like cement blocks
and does not lift weights, he’s around 25-30% body fat and looks like he’s at
the gym 4-5x a week.

His little brother, 6’7 340, hulking dude and doesn’t lift weights…was the # 5 high School
/college prospect in the country in his day before he blew out his knee. As a HS
senior he was 295 with 10% BF tested hydrostatically. He still got a full ride
to a top school…then destroyed his other knee.

The point is, the OP has blessed genetics, and guys like this exist and are healthy
at their natural size.

Now, to your issue.
Get rid of the danazol, low SHBG isn’t a thing you want. I have it genetically and it’s a SOB
to work around in a TRT context.

In your case it’s ruining the benefits you should be getting from TRT.
Danazol, lowers SHBG, low SHBG means your body eliminates T too fast. You take bigger doses of T
to combat this, and the bigger dose of T lowers your SHBG and the T you injected gets eliminated even faster.

I was trapped by the recipe above for a cpl years before I realized that less is more.
Cut your T dose back to 100mg per week and inject frequently. The idea is to give your body smaller
doses of test, and let your SHBG come back to where you were pre trt/danazol.
Once your SHBG comes back to the 20’s, you can start upping your T dose depending on
your goals.

Living with low SHBG I find it best to inject daily. The smaller amounts aren’t enough to drive SHBG
lower, and leave a very small amount for my body to aromatize into e2. I inject my delts with
12mg T-Prop per day using 29g slin pins (I think Prop is superior to Cyp or Enth for guys
with low SHBG) but if all you can get is CYP, inject it daily. It’ll mimic your natural production
and your total and free will both rise.

Also, cut your Adex back to 1mg per week. just take .25 mg every other day.

13

PKNY, I was thinking the same re: test prop. I’m sorry though but 420lbs and 30% bf is not healthy. I don’t care if the OP has 8% BF, his heart is working too hard at that weight. Praising natural size is one thing, but 420 lbs. contributes to early death 99% of the time.

14

I was wrong on the Arimidex dose. I’ve actually been taking 0.5 mg capsules and not 1 mg. So my E3D dosing I’m currently doing is about correct.

15

I met with my HRT guy today. He pushed the pellets really hard but I wanted to try more frequent shots. He agreed to 250 mg every 5 days but said he thought every 3 days was not necessary. The amount he is prescribing will allow me to do 150 mg every 3 days which I’m planning on doing. I’m also going to start HCG EOD 250 units, discontinue the Danazol, and continue the Arimidex at 0.5 mg E3D. I should have labs back on Friday which I’ll post here.

16

No. Read PKNY’s post again, especially the part about cutting your dose (and the reasons for it). The dosing you are proposing will only make your problem worse.

17

My labs yesterday done 7 days out from my last injection showed total testosterone of 468 and estradiol of 41.1.

18

What is going on with your case Disco?

19

Yup …
have been following . please keep us posted !

20

I’m still doing 150 mg testosterone cypionate every 3 days, 0.5 mg Arimidex every 2 days, and 250 units HCG every 2 days.

On my last labs my estradiol was perfect at 22 and my total testosterone was 589.

The problem is the compounding in Florida won’t fill the testosterone in the amounts that my doctor is prescribing. So they are refusing to fill more than a 200 mg per week supply. So I’m taking it as prescribed and then missing several doses until they will ship it again. When my total testosterone was 589 it was 6 days out from my last shot because I had missed a dose.

So all concerns about my regimen aside, it’s working, but I’ve yet to get a satisfactory answer to my original question.

Are any of you having trouble getting the pharmacy to dispense testosterone cypionate at doses above 200 mg per week? I asked him why he couldn’t just give me a script I could take to Walgreens or Wal-Mart and he gave me some convoluted answer even though I know a lot if guys get their test that way. Part of it is probably that he makes money on the drugs themselves. I place an order at his office and pay him. The office then places an order with the pharmacy who ships it to me.

I’m getting fed up with the runaround and I’m thinking of just finding a good TRT doc who operates like a legit clinic and not a longevity clinic. I’ve considered making an appointment with Dr. Mills in Denver simply because he has good reviews on here and I enjoy visiting Denver.