Update on my Testosterone Therapy

[killergoalie]

It was suggested that when I first posted that I had been diagnosed with low testosterone levels , and had the majority of the symptoms, and posted the results of the BW that I had gotten done, that I should post updates to what was happening.

I also asked if others who were on TRT had successfully had their Doctors increase the frequency of their testosterone injections.

So first off, I'll repost part of my original post, which includes the BW results, then the update.

Excerpt from original post to give some background story information:

I was diagnosed with severely low total testosterone (40.3 ng/dl from a range of 241 - 827 ng/dl), so my Dr. prescribed test -cyp injections .

I had my first injection of 150 mg on Feb 23rd, but am not scheduled to receive my next one until March 15th. At the time of my initial injection , I discussed the fact that most TRT recipients, seem to get the best results from weekly, or even 2x, or 3x per week injections to keep a more balanced, and sustained level of testosterone , instead of extreme peaks, and crashes.

My Doctor told me that because I'm using a depo-testosterone , it's a slow release type, so there is no need for a shorter injection criteria. But she did say we could discuss it more on my next visit.

I had follow up BW done a week after that initial injection , and my results were:

Total Testosterone : 11.5 pmol/L from a range of 8.4 - 28.7 pmol/L Which converts to 331.4 ng/dl from a range of 241 - 827 ng/dl. A bit higher than my initial reading, but still significantly low.

Estradiol: 178 pmol/L from a range of < 156 pmol/L OR converted... a result of 48.5 pg/ml from a range of <42 pg/ml.

The lab (B.C. BioMedical Labs) used the Roche - Electrochemiluminescence method of testing. I told them I wanted the sensitive assay for males Estradiol test , but they informed me that the Roche - Electro... was the only test they use.

PSA: 0.38 ug/L from a range of <4.01 ug/L.


So it's clear that my estradiol level is way too high, and I'm going to discuss an A.I. with my Dr. My test level has gone up, but still far too low for my liking. (I still feel like crap, no energy, no motivation, tired, depressed, no strength, etc), but at least my PSA level seems to be fine.

I am 52 years old, a type 2 diabetic, and yes, obese. But my blood sugars are well in control, and I am losing weight. (I've lost 21 lbs. since Jan 6th).

Update:

Well I had my second test-cyp injection on March 15th, but it didn't give me the same level of overall energy, and vigor that the original shot did.

I still wasn't able to convince my Dr., despite informing her on information from Dr. Crisler, to increase my injections to a minimum of once a week, preferably twice weekly, and possibly doing them sub-Q.

However I did manage to convince her to up the frequency at least from the previous 3 weeks between shots, to 2 weeks between injections.

I also asked about an A.I. since my estradiol level is so high, and mentioned the fact that since it is that high, a lot of the testosterone I am injecting, is being converted into estrogen, thus I'm not getting the full benefit of the testosterone, so until my estrogen levels go down, or at the least I can prevent the obvious abundance of aromatase enzyme that I have from converting testosterone to estrogen, and then having that estrogen bind itself to my androgen receptors, I'm basically just throwing whatever money I'm spending on the testosterone-cypionate out the window. But she wouldn't prescribe an A.I.

She did though make me an appointment with an endocrinologist, who happens to also be my diabetes Dr. She discussed the possibility of an A.I. with him, but he said because of my obesity, my E2 levels would go down if I lose weight. DUHHHH!!

But, it would more than likely take me 6 months to a year (if not longer) to lose enough bodyfat...esp around the abdomen, in order for my E2 levels to get down to "proper" levels, and I don't feel like waiting that long for it to do so!

Also, since my E2 levels are so high, and it's still causing me to have low testosterone levels, and still feel like crap, have no energy, no motivation, depression etc, I don't have the energy, or desire to exercise, or work out, which would help lose the weight.

However it's been well documented that when test levels go up, along with keeping E2 at a proper level, this will in fact usually help burn bodyfat.

But for some reason my Dr. can't seem to understand this, and won't help me get my E2 levels down A.S.A.P.

But I do have my first appointment with my Endo on Monday, so I'm going to try and convince him, and explain to him, what I just mentioned above. Why should I have to wait 6 - 12 months, if not longer in order for my bodyfat to get down low enough that it causes my E2 levels to lower, thus allowing me to reap the benefits of the testosterone I'm injecting, when a simple A.I. would more than likely get the job done MUCH FASTER, or at least would prevent the testosterone from being converted to estrogen and thus I would in all probability lose the bodyfat much quicker because I would actually feel like working out, and exercising!

To me it seems like a no brainer.

I'm also going to mention Dr. Crisler to him, and his suggestion of a minimum or weekly injections.

Hopefully at least something positive will come out of all of this.

I apologize for the lengthy post/update, but I wanted to give as much information that I possibly can.

[Vettester]

Thanks for the post, and the recap was helpful. Sorry, but that doctor you are dealing with is just a nitwit! She's just not up to speed on any of this stuff, and doesn't understand what you are going through. Again, active life of the injections is right there at 2 weeks, so it's just a roller coaster ride with that protocol.

Keep us updated with the endo appointed, and stay positive that he will have a better grip on this, and he will get you going on the right track!

[killergoalie]

Thanks, vetteman! I appreciate the support.

Yeah, I specifically made a point of emphasizing the "roller coaster effect" even going as far as directly quoting Dr. Crisler on that specific topic, and it still didn't sink in. She told me that her other TRT patients are happy with monthly injections (they probably don't even do any personal research on the subject, and just agree with whatever the Dr. is telling them) but she did say that she's never had anyone with as low a starting testosterone level as I had. So that's why she agreed to increase the frequency to every two weeks...which is still far too long between shots.

I also explained the half life situation, and that after my first injection, I immediately felt great, and felt good/better than I had prior to the injection, for about 4-5 days, but after about 7-8 days, I began to feel lousy again, then after about 10 days, I actually felt worse than I felt before the injection. But it didn't seem to register.

I also told/asked her about Sub-Q injections, and how injecting even twice a week (smaller doses of course) allows for a much steadier, and constant level so you don't get the extreme highs, and then sudden crash that you get when there is too long of a gap between injections, and even told her that probably the leading Dr. on TRT, Dr. John Crisler even recommends Sub-Q injections, but all she kept saying that test-cyp is for intra muscular injections. I also mentioned that Dr. Shippen, another "authority" on TRT also suggests Sub-Q injections.

But as you said, hopefully my Endo will have some better knowledge, and be more up to date on recent studies.

I was so looking forward to FINALLY feeling better again, once I started the test injections, but now I'm almost at the point of saying screw it! Why should I go through all the hassle, the worry, the research, the cost, the effort, when I still feel like crap, and my Dr. won't even do all she can to allow me to get the most benefit from it.

I'm even going to tell my endo this straight out!

But again, I'll see what my endo has to say.

[kelkel]

Killer it seems to me that you've done your homework and probably already know more than your Doc's regarding correct administration of TRT. Politely demand to be treated along the protocols you know are correct and back it up to your doc by handing him/her paperwork from Crisler explaining it. Be prepared to argue your points if they shut you down. If they are to aloof to take the time to learn then you need to start the process of finding another doctor. Don't accept poor treatment when you know what is right. Keep doing what your doing. Educate yourself. You will find the correct doctor. If all else fails in your immediate area. Make an appointment with Crisler in Michigan. Be worth the trip.

[steroid.com 1]

Kel and Vette make excellent points as usual.

She doesn't understand half-life and as a result you are getting big swings in serum levels promoting conversion.

She doesn't understand TRT protocols and is not willing to learn so stop wasting your time and putting your health in jeopardy with her.

And don't think your Endo is going to get it either...most don't. All you can hope for with your Endo is that he's willing to listen and learn with you.

If not...find a Doc who understands TRT protocols in men...it will be the game changer you are looking for and more importantly deserve.

gd

[killergoalie]

Thanks everyone for all your support, and excellent advice!

Trust me, I plan to get my points across, and inform my Dr., and the Endo if necessary on current facts, and figures, and information. Even if it means having to argue with him to do so.

Since getting an appointment with a specialist, such as an Endo has to be made through your family Dr. here in B.C. Canada (Unless one is willing to wait several months, and pay through the eyes...even then I'm not sure if it's possible) I'll have to examine that possibility if and when it would be necessary if the Endo I'm seeing on Monday still refuses to help me. But I'll cross that path if and when I get to it.

[freshmaker]

What nightmare. I was doing 1x week shots and the crash was unbearable 4 days later. I talked to my very sensible doc and I'm on every 3.5 days now. He had zero problem with it. How any doc could be against splitting doses is hard to understand.

I cannot imagine being on an every 2, 3 or 4 week schedule.

Thanks everyone for all your support, and excellent advice!

Trust me, I plan to get my points across, and inform my Dr., and the Endo if necessary on current facts, and figures, and information. Even if it means having to argue with him to do so.

Since getting an appointment with a specialist, such as an Endo has to be made through your family Dr. here in B.C. Canada (Unless one is willing to wait several months, and pay through the eyes...even then I'm not sure if it's possible) I'll have to examine that possibility if and when it would be necessary if the Endo I'm seeing on Monday still refuses to help me. But I'll cross that path if and when I get to it.

[killergoalie]

I know what you mean about the crash, freshmaker. It sounds as if you crashed exactly at the same time, that I was. Right around 4 days afterward sounds just about bang on! You're lucky to have a sensible, and likely knowledgeable Doctor.

How do you feel using the 3.5 day protocol? What dosages are you using? Are you on an A.I.? Just curious.

Thanks for the support!

I can only hope my Endo is at least reasonable, and willing to listen.

[keep fightin]

I'll jump in Killer,went a few months on 100mg 1xew and felt great! .5mg adex 2xew no HCG . the " I don't feel as good after four days" crept up on me. went to a 60 mg pin twice a week ,SQ 3xHCG and .5adex 2xew, felt great again for about two weeks then felt horrible! didn't do bw but cut my adex to .25 2xew and now feel great again [ took another two weeks] my current protocol resembles several other much more knowledgeable members

[killergoalie]

Thanks for the info, keep fightin! Much appreciated. Yeah I still haven't quite figured out what's going to work best for me. Hopefully my Endo will be able to get me on a good protocol...even if I have to tell him what I should be doing. Consistency seems to be a major factor. That's all I'm hoping for really...to consistently feel as good as I possibly can. No stupid fluctuations in moods or aggravating roller coaster effects! I've suffered long enough!

Glad to see that you're feeling great!

[keep fightin]

fight the good fight! your knowledge of trt is better than the Docs, as GD said a search for a new Doc might be in your future. awesome on the weight loss, you will get dialed in, keep us posted!

[killergoalie]

Update time again!

Well I saw the Endo today, (He's also my diabetes Dr. so we have a pretty good rapport). He agreed that the more frequent the intake of testosterone , regardless of how it is administered, gel, patch, injection...the more stable, the levels will be. He said that everyone's body adapts differently, and each person has to figure/find out what works best for them.

I told him I prefer the injections, and would like to try weekly (at the minimum), or even twice a week Sub-Q injections, and he just said if I want to try it, I'm free to do so. So since I received my 3rd injection today (100mg,) which was 11 days since my last injection of 150 mg, I'm going to try 50mg Sub-Q starting Next Monday, then another 50mg Sub-Q the following Thursday. (3.5 days later) To see how my body reacts, how I feel etc.

I asked about an A.I. he said I'm free to try one if that's my desire, but because it's not to prevent breast cancer, or some other serious degenerative disease, he can't legally prescribe one or else he could lose his license. But I may know of a place where I may be able to possibly get some.

I mentioned Dr. Crisler, and he is aware of him, but he told me that there are so many theories out there, and so much...perhaps even too much information, and the best thing to do is see what works best for me. Not only by the numbers, but also by how I feel.

So I feel quite a bit more at ease with things now, I'm getting BW done tomorrow morning, and also next Monday.

Not entirely the news I was hoping for, but as I said, I do feel quite a bit more at ease about things now.

[steroid.com 1]

EXCELENT! You are in great care with a Physician who gets it!

Very happy for you killer; you made my day

[killergoalie]

Thanks GD! All the advice, and support I've received from this board definitely paid off.

Since I have quite a bit of belly fat (Which is where I'll probably do the majority of my subQ injections), I was just trying to decide if I should go for the 31 gauge 5/16" insulin needles, or the 29 gauge 1/2" ones, and also since I do have TOO MUCH belly fat, I think I should still inject @ 90 degrees even though it's subQ. (I can pinch at least 2" (for now)).

I think I'm finally getting the show on the road!

I also asked about HcG , and he told me not to worry about it at this time. He just wants to make sure my test levels get up to a place where I feel very good, and comfortable on a consistent basis.

[doc w]

Sounds like a good doc. However the line about ai' is a misunderstanding or a fib. As physicians we are allowed to use any medication as " off label"he probably just has not done it before so he is not comfortable.

[kelkel]

^^^Exactly. How many people here have heard that about HCG ! Killer we are happy for you. You can wait a bit on the HCG. One change at a time is best so you know exactly what the response is. I also inject twice a week and rotate sites. You don't have to just do SQ.

[steroid.com 1]

^^^Exactly. How many people here have heard that about HCG! Killer we are happy for you. You can wait a bit on the HCG. One change at a time is best so you know exactly what the response is. I also inject twice a week and rotate sites. You don't have to just do SQ.

Doc - He lives in B.C. Canada so laws may be a bit different re off lable scrips...

[killergoalie]

Thanks kelkel. I realize I don't have to just do it sub Q, but I think I'd probably feel most comfortable doing it that way. Esp since I just bought a box of 100 BD Ultra-Fine 1cc 12.7mm (1/2" length needle) 29 gauge needle insulin syringes. (I was going to buy the 31 gauge 5/16" insulin syringes, but since my test-cyp is 100mg/ml it would require 2 injections to make up 50 mg since the syringe doesn't go that high, so I bought a little bigger syringe.)


I'm not sure if the rules are the same for Drs. in Canada, as they are in the U.S. as far as what they can write prescriptions for or not.

And yeah, that's exactly what he said...one change at a time is best so I know exactly what the response is.

[MickeyKnox]

Excellent thread!

I'm so glad things are moving in a positive direction for you KG. and hats off to you for being proactive in your health care. please continue to share your results and experiences.

thanks and good luck

Sub'd.

[killergoalie]

Thanks, Mickey! Glad to share my journey, and I appreciate all the help and support I've gotten.

As I've mentioned, I'm just starting out on this trip of a lifetime, but as the saying goes, the journey of a thousand miles begins with a single step, so that's what I'm doing...taking things one step at a time. I'm just glad that things seem to be going in the right direction finally.

I just can't wait until I have the energy to start working out again. Feeling tired, lethargic, run down etc all the time really sucks!!

[keep fightin]

Killer, all in all not bad! you can hear some real horror stories from other members concerning first contacts with Endos. One thing at a time was some of the first advice I received here. I'm using the 30 gauge till box is done, let us know how long the draw is with that 29. Glad you are getting started in the right direction!

[killergoalie]

Thanks, KF. I'll make sure to document the draw time of the 29 gauge syringe/needle. When I saw the size of the 31 gauge syringe/needle, and realized I'd need 2 doses per injection, I thought, screw that!! I'd rather go with a slightly larger gauge (smaller number) and get it done in one dose. LOL.

The thing that I was most encouraged about is when I first walked into his office, he said, "Jason, I understand that you have some questions, so let's sit down, and we'll go over them one at a time. He let me have my say, he had his, we discussed each topic, and he didn't have the attitude of "I'M THE DOCTOR, YOU'RE JUST THE STUPID NO NOTHING PATIENT, I KNOW EVERYTHING ABOUT EVERYTHING, SO WHAT I SAY GOES AND MY WORD IS FINAL!!" And as I mentioned, he's also my diabetes Dr. and has been for close to 10 years, so we have a very good rapport.

He knows I'm willing to work hard, and do whatever is necessary to get myself to optimum health (as optimum as I can get of course), and he seems as if he's willing to work with me.

I just finished my first weight training session in about a month, and I felt/feel great! Of course I didn't go too heavy, or too long, but I definitely feel better than I have for several weeks.

[kelkel]

Killer don't forget the nutrition forum here. Lots of help to be had there.....

[killergoalie]

Thanks for reminding me about that, kelkel. Will be sure to check it out.

Funny thing, after going nearly three straight months of eating as clean as possible, I sort of "rewarded" myself the last 3 days or so by enjoying some "not so good for you" items within reasonable portions of course...(Cap'n Crunch, Pizza, Kings Hawaiian rolls (hey nobody's perfect LOL)), and while I did enjoy the treats, when I got back on track today, I actually feel better eating "clean & healthy" than I did when I "cheated". I guess the bigger, overall picture is more important to me than the "excitement" of a "one night stand". LOL

[socalfun64]

Hey Killer, I also want to jump in and say thanks for the great thread. I'm in almost the same boat as you. I'm 47, Secondary HypoG, 6ft1in 275lbs. I'm just getting back into Weight Lifting now as well (starting slow). I figured I didn't want to waste the extra energy and Test just on the improved Sex life!! I'm in the process of battling with the Dr. to get what I want as well (script AI, HCG , etc). I have an appt. tomorrow with the VA Endo. I have been so busy learning about all the other stuff on here, I guess I missed the parts about people using Sub-Q now instead of IM. So I'm off to read up on the whole Sub=Q thing.
Thanks again everybody for contributing to a very educational thread.
Socal

[killergoalie]

Thanks for the support, Socal! Best of luck with your journey as well!

I think it's great to have a place where we can all share our experiences, and can learn, and help each other learn as well. I realize that everyone is different, but it's good to be able to at least have some guidelines to see what has worked, and what has not really worked for most of us.

It's also been a great help in allowing us to go see our Doctors with plenty of great information, and not just go into things blindly, and have little or no clue as to what's going on, and what are some of the steps we need to take, or that could help us along. Otherwise if one was to go into this completely clueless, and had no idea what was happening, what to expect, what some of the options are, and especially if their/our Dr. also had no idea whatsoever what he/she was doing, or talking about, it would basically be the blind leading the blind...a total recipe for disaster.

My Endo yesterday even made the comment on how I seemed to have tried to have gotten as much information that I could, and that he was glad to see me asking so many questions. Which is all thanks to the incredible support, and information I've received from everyone on this board! Plus a little common sense. If you don't ask, you'll never know!

Again, best of luck with your TRT journey.

[kelkel]

Glad this forum has helped you Killer. Stick around!

[killergoalie]

Oh I plan on sticking around, kelkel.

[killergoalie]

Latest BW results.

Got my limited BW results back. My Endo wanted to test for Total, and bioavailable testosterone , but our Provinical Government's medical plan will only cover the cost of the bioavailable test ONLY if the total testosterone is between 4 - 10 nmol/L (115.2 - 288.2 ng/dl) So I had to settle just for the total testosterone level.


My latest results thus are: Total Testosterone: 12.5 nmol/L from a range of 8.4 - 28.7 nmol/L. Converted:

Total Testosterone: 360.2 ng/dl from a range of 242 - 827 ng/dl

That was after a 100mg injection of testosterone-cypionate yesterday morning @ 9:30 A.M. I took the BW at 8:00 A.M. this morning.

My Endo wants me to get my BW tested again next Monday just before my next injection. I guess he wants to see how much difference there is in a week.

I asked about testing my estradiol levels again, but he said the Gov't doesn't allow/pay for too many E2 tests in such a short span of time. (I had one done a little over 3 weeks ago, and I can't afford to pay for one on my own.)

I'm glad to see that my T level has gone up somewhat, but I still wish it would be higher, esp considering it's the day right after my injection. Being that I'm going to begin self injecting Sub-Q next Monday, and will be doing so twice a week, I was thinking I might up the total dosage to 120mg per week @ 60mg per injection. Once every 3.5 days. i.e. Monday 9 a.m. Thursday 9 p.m. etc. Or maybe I'll just stick to 100 mg @ 2x 50 mg.

[kelkel]

You'd see a better peak in T if you waited around 48 hrs or so. I'm glad your endo wants the next test one day prior to next injection. You'll see your trough level. A lot of us here are proponents of twice a week injections. I highly recommend them if you have the time and are disciplined enough.

[killergoalie]

Thanks kelkel. I'll make a note of that 48 hr. timeline, and get my next "after" BW done around 48 hrs after an injection. I'm planning on doing the subQ injections twice a week @ 50mg per injection. Since the labs here are closed on Sundays, I'll get my next BW done next Monday, then do my first subQ self injection of 50mg on Tuesday @ 7:00 a.m., then the next 50mg sub Q injection on Friday @ 7:00 P.M. which is exactly 1/2 of the week.

The BW the following week will be slightly delayed since the labs will be closed due to the long weekend, (At least the "after" readings).

I have to make sure I'm disciplined enough to do twice a week injections. This IS for life, and it is MY life! No one is going to do it for me!

[steroid.com 1]

You really need to get:

E2 (Sensitive)
SHBG
Albumin

Your Total level seems low to me based on your dosage and the fact that you injected about 24 hours before the pull. Albeit you were not peaking but your serum level would have been cruising up for sure.

You need more and if you have to pay for it out of your pocket so be it...it's important.

Socialized medicine...see what we're in for fellows!

[killergoalie]

Oh I realize I need more tests, gd, but as I've mentioned, I literally can't afford to pay for it. Also, the labs here for some reason don't do the E2 sensitive assay test, unless there are labs that I've never heard of.

I'm not trying to be naive about it, or be a smart ass, I honestly just can't afford it right now. I'm on a fixed income, but I'll try my best to do what I can.

Didn't mean to disappoint.

[kelkel]

Not disappointing at all. You doing the best you can. Keep it up man!

[killergoalie]

Thanks kelkel! That's what I'm trying to do..."keep it up" LOL

[edmundo22]

My test was also given to me in ng/dl which is a pain in the ass, yours being severely low at 40.03, My endo told me my result of 21.2 ng/dl was actually quite good.

Best of luck with everything dude were in the same boat

[MickeyKnox]

to go from ng/dl to nmol/L, you divide by 28.43 (which is 10% of the molecular weight of testosterone - 284.3)

to go from nmol/L to ng/dl, you multiply by 28.43.


KG, do you mind me asking which province you're located in? the reason i ask is that it appears each province,and many time each lab, has a different scale for measuring testosterone. for example here in Ontario it seems to be 6 - 27 nmol/L is the scale that was used to measure my testosterone.

[edmundo22]

Crap I made a mistake it was nmol/L not ng/dl
In Ireland my endo told me 15-35 nmol/l is the normal range.

[MickeyKnox]

you just gave me an idea for a new thread..

[killergoalie]

to convert nmol/L to ng/dl you divide the nmol/L reading by 0.0347 to get the ng/dl reading. Thus the range of 15-35 nmol/L would equal a range of 432 - 1008 ng/dl.

To convert from ng/dl to nmol/L you multiply the ng/dl reading by 0.0347 to get the nmol/L reading.

This is according to this chart/scale: http://www.globalrph.com/conv_si.htm