T Nation

What's Better, the Implant or the SubQ Injections?


#1

I was just diagnosed with hypogonadism. I’ve had low testosterone read for the last 4 years but I’m only 28. I have tried to get it to normal by exercise but had no luck. My endocrinologist pretty much said I’m going to have to rely on TRT. He ordered an MRI and is recommending me to an urologist. Any advice on the journey I’m about to take? I am kind of nervous about the outcome. I don’t know whether to do the pellet implants or rely on the shots.


#2

Neither, but definitely not an implant.

You need to figure out if you are primary or secondary hypogonadism. If you are secondary, treatment with SERMs (clomid / nolva) can be an easy and effective course of action.

Post your labs with ranges.


#3

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones - anything here applies to you?
  • protocol for injections?
  • finding a TRT doc

Do not start TRT before:
LH/FSH lab work
Discussion with doc re shrinking testicles and real risk of infertility.

TRT causes LH/FSH–>zero. To prevent damage to the testes, you need to inject 250iu hCG SC OED. Terminology explained in the advice for new guys sticky.

E2 needs to be managed near E2=22pg/ml for optimal mood, libido and fat loss. This is done with ~ 1.0mg anastrozole per week [oral]. Anastrozole is a competitive with T, thus needing steady T levels for anastrozole to work against. Pellets create highs and lows over a period of a few months making E2 management impossible to get right. Optimal is self injected T twice a week.

You need to understand these things because very few doctors do.

You need to diagnose the cause of your low-T which at your age is symptom and not the disease. Almost all doctors get that wrong. You need to seek the cause and address the cause(s) if possible.

We need labs with ranges and the info suggested in the advice for be guys sticky.

Your diagnostic and treatment options vary by where you are located. Please indicate where you are.

Was your prolactin high? Taking Dostinex for that?

Endos are deservedly known as the worse for TRT intelligence and urologists are a bad option as well as they never have your overall wellbeing in mind.

Labs with ranges:
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
fasting cholesterol - could be too low
fasting glucose
AST/ALT

Please reread this post a few times as we typically see guys only picking up on a few points.

Also, thyroid function seems to affect T levels as secondary hypogonadism. In this case, thyroid labs do appear normal because the “normal” ranges are deeply flawed.

  • have you always used iodized salt to support thyroid hormone production
  • go you get cold easily
  • are outer eyebrows sparse

#4

I just left the appointment today. He decided to put me on clomid for two months to see if there is any change.
My last lab had
Testosterone total 117. The range is 249-836ng
Sex hormone bind glob 10. The range is 10-57
Ferritin 97 range 22-322
Free testosterone 32.93 range 30-150
Lh 7.1 range 1.7-8.6miu
Fsh 3.1 range 1.5-12.4miu
Prolactin 21.6 range 4-15.2


#5

Prolactin is getting high. Can be up from, no lie, cuddling puppies, babies, kittens or a recent orgasm.

Please list all medications, Rx and OTC.

What was on the MRI?

Have you read the stickies?

What dose of clomid?

When on Clomid, do these labs to see what going on:
TT
FT
E2 - can get high from clomid
LH/FSH - the whole point of clomid is to increase these.

If E2 gets elevated on Clomid, you can take anastrozole to manage that. But that cannot manage T–>E2 inside the testes which can result from dose of Clomid that is too high. Doctors often over-dose Clomid because of habit and lack of understanding basics.


#6

No prescription. Just got put on 50mg clomid. Ive never been on any prescriptions. The mri came back normal so that’s a good thing.


#7

50mg clomid may be good if you are post menopausal woman with estrogen positive breast cancer.

That dose is too much.

  • expect LH to get too high
  • possible LH receptor desensitization
  • high T–>E2 inside tests increases serum E2 and anastrozole cannot control that
  • liver sees high E2 and creates more SHBG, lowering relative FT

You need to read the HPTA restart sticky to see what the game plan should be.
If you do 50mg clomid and stop that suddenly, expect to be worse off than now.

If clomid makes you feel horrible, like it does for a lot of guys, switch to Nolvadex that does not have those estrogenic side effects. Some feel really bad on a single dose.