TRT Troubleshoot

I'm a little stumped on where to go from here and my GP isn't very up to speed on TRT. Rewinding a few months, I got a recommendation from Vetteman (thanks again!) for a Anti-Aging clinic. At the same time, my GP was open to the idea of TRT but his proposed protocol of monthly shots and very short duration concerned me. Due to the initial buy-in cost at the AAC, I decided to keep it as a backup and try to work things with my GP. Who knows, I could be helping some other guy down the line who uses the same GP.

For the past few months I have been on Test C injections through the GP. The initial injection of 200mg was on 7/23/10.

Initial labs (6/28/10):
Testosterone 347.2 ng/dL (175.0-781.0)
LH 2.88 mIU/mL (1.24-8.62)
FSH 2.74 mIU/mL (1.27-19.26)
PSA 1.240 ng/mL (0-4.0)
Estradiol 22 pg/mL (20-75)

I had follow-up labs done after the first two weeks. My GP was mainly concerned about an increase in PSA.

2 weeks after first 200mg Test C injection (8/6/10):
Testosterone 277 ng/dL (241-827)
LH 1.4 mIU/mL (1.14-8.75)
FSH 1.20 mIU/mL (1.37-13.58)
PSA 1.1 ng/mL (0-4.0)
Estradiol 15 pg/mL (11-44)

Seeing that all my levels dropped, my GP was fine with continuing treatment. We stayed with 200mg Test C EOW and I asked for labs again 8 weeks later.

10 weeks in (10/1/10):
Testosterone 267 ng/dL (241-827)
LH <0.07 mIU/mL (1.14-8.75)
FSH <0.05 mIU/mL (1.37-13.58)
PSA 0.9 ng/mL (0-4.0)
Estradiol 22 pg/mL (11-44)

Now from reading around I know that these results are to be expected from the HTPA axis getting shut down due to the exogenous test. My symptoms have somewhat improved, but not fully. I have also read on here that it takes time to undo the damage from having low test levels for however long they've been that way. I was thinking that perhaps the EOW was causing too much of a dip, even though I didn't feel any noticeable negative effects, so I asked to go to weekly 100mg injections. We started that protocol on 10/15/10 and have been doing so for the last 3 weeks.

I was thinking about getting labs pulled again to see where I'm at and if E2 level is rising, but I wanted to get some advice and see if I might be going in the right direction. I did try to broach the subject of self-injecting, since driving to his office in LA traffic every week is a pain. He offered the gel and was not comfortable prescribing self-injections. While that denial was disappointing, he has pretty much given me free reign as far as my dosage. He proposed going to 250mg EOW before I asked for 100mg weekly, but I figured that would induce too much of a spike and subsequent low. Any thoughts/opinions would be greatly appreciated. Thanks!

I think 100mg/week will be a much better protocol for you. I'd redo your bloodwork in another 3 weeks or so to see where you stand. When you got your second bloodwork done, how long after your injection was it? If you want to accurately track your levels, you need to do your bloodwork on the same day every time, relative to your last injection. I'd go for a happy medium somewhere between injections so you're not at the peak or valley of your testosterone levels.

i was wondering the same as frawnz and probably know the answer- that you were doing bloodwork just before the shot so your levels would be at the lowest which isnt bad but i would want a peak level and maybe even a median to look at if i could...but most importantly you say that you feel better and thats the most important...

i do think 100 is the best protocol quacky has had you on thus far when u get your next labs from doing 100 could you do them around day 4 or 5 and post em.....if your not upper range maybe you can get him to bump to 125 or 150...

your estradiol is staying nice and non bitchy which is good to see...

thanks for coming back with an update and hope you continue to get better

Quote:

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Originally Posted by jpkman

i was wondering the same as frawnz and probably know the answer- that you were doing bloodwork just before the shot so your levels would be at the lowest which isnt bad but i would want a peak level and maybe even a median to look at if i could

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Yep, that's exactly right. I was doing just prior to the shot, fasted, first thing in the AM (just in case). Unfortunately with this doc, he's also very paranoid about levels getting too high and I don't know what his threshold is.

Quote:

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Originally Posted by jpkman

when u get your next labs from doing 100 could you do them around day 4 or 5 and post em.....if your not upper range maybe you can get him to bump to 125 or 150...

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Cool, I will try that hopefully next week, which will be five weeks into the 100 regimen.

Thanks guys for the help!

Wish I could understand the reluctance of these doctors to let you self-inject. Their diabetic patients do so with great frequency. If you have a demonstrated need for exogenous testosterone, IM injections really seem like the way to go...especially in terms of costs to the "system". My last gel refill for three months supply was shown as $1300 charged to my health insuror. That is a staggering amount of money for something that should be relatively cheap.

Anybody have an idea of what a rough equivilant amount of test.cyp. would be?

sirp

Quote:

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Originally Posted by sirupate

Wish I could understand the reluctance of these doctors to let you self-inject. Their diabetic patients do so with great frequency. If you have a demonstrated need for exogenous testosterone, IM injections really seem like the way to go...especially in terms of costs to the "system". My last gel refill for three months supply was shown as $1300 charged to my health insuror. That is a staggering amount of money for something that should be relatively cheap.

Anybody have an idea of what a rough equivilant amount of test.cyp. would be?

sirp

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$100!


OP-
I believe that most docs are reluctant due to the fact that it's easy to abuse and let's face it, it's gotten tons of bad press over the years. Only now do they seem to be warming up to the idea. It's also intramuscular which is a *little* more tricky to inject, but tons of us here do it. Myself included. I sometimes get the feeling with these docs that you need to "prove" yourself to them that you can be responsible. I'd say keep going the route you are on. Do the 100mg weekly for at least a month until you can get some test results to show that it's the way to go, then spring the self injection question again. Tell him how great you feel on the 100mg but this is going to be a life long commitment and there's no way you can see going to his office forever every week. Eventually he'll agree if he's already working with you this much.

Good luck and keep us informed.

also dont be afraid to get on the phone and get another doctor lined up

Thanks again guys for the advice. I went and got measured on the 5th day after injection (shot Friday, tested next Wednesday) and had the following results:

Testosterone 880 ng/dL (241-827)
Estradiol 35 pg/mL (11-44)

Due to some scheduling issues, I had my shot about 30min prior to them drawing blood. I know that isn't preferred, but how likely is that to affect things? Unless that messed things up, numbers look pretty much on target. I'm thinking it may just require patience and time to reverse the accumulated effects of low T.

Quote:

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Originally Posted by wczs

Thanks again guys for the advice. I went and got measured on the 5th day after injection (shot Friday, tested next Wednesday) and had the following results:

Testosterone 880 ng/dL (241-827)
Estradiol 35 pg/mL (11-44)

Due to some scheduling issues, I had my shot about 30min prior to them drawing blood. I know that isn't preferred, but how likely is that to affect things? Unless that messed things up, numbers look pretty much on target. I'm thinking it may just require patience and time to reverse the accumulated effects of low T.

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u made this totally confusing..

did u have a shot of testosterone 30 minutes before giving the blood for the numbers you listed in this post???????? if so, wtf would u do that?????? if that was the case why would u even wait 5 days???? that would mean u tested 30 minutes in your dose...
please confirm....yes numbers DO look good..how r u feeling?

Ya, I don't know why you would do your injection 30 min before blood draw, but you may have to discard these blood results because I'm really not sure how much your T levels rise immediately after injection. Try to remember that good blood work is a result of removing as many variables as possible. Doing something that could drastically alter the results makes the end product unusable because you don't know how much that action has affected the results.