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12-16-2012, 10:00 PM #1Associate Member
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Testosterone Injections- Type, Additions, and Dosing
Hi all! For those of you whom have not read my previous posts, I will soon be starting testosterone replacement therapy. Assuming that, correcting my thyroid issues will not remedy hormone imbalances. If you are curious of my tests or situations please consult my other threads. I have made the decision of using injectable testosterone . I will be using them within the next month I hope. I would like to know what different people's testosterone substitutions are. What type are you using, what additions (if any) are being used, such as HCG ; and what doses? Also, any other information that is relevant. What kind of success is being seen with your protocol?
Thanks, and I look forward to your input.
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12-16-2012, 11:37 PM #2
the best results for most of us is as follows,
test, 50-60 mgs twice a week SQ
hCG , 350 iu one day before each test injection or M, W, F 250 iu
AI, 0.25 mgs AI after each test injection but this has to be based on BW, you may not need it.
Donate blood as often as you can, also based on BW, TRT elevate RBC, Hemoglobin and Hematocrit, but donating brings it down.
Vitamin D3, 10,000 iu ed
Micronized DHEA, 50 mgs ed, LEF.com is best place to get it
Clean diet and exercise
Fish oil (omega 3)
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12-17-2012, 09:58 AM #3Associate Member
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What testosterone level does this protocol bring you to? I don't know what levels can be expected from injections. Can you shed some light on this? I understand it must be subjective, but for instance, what would I expect from 200mg shots? Also, what does the DHEA do?
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12-17-2012, 12:22 PM #4Associate Member
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1000mg nebido every 8 weeks
....... thats it
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12-17-2012, 01:59 PM #5HRT
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Nate - Are you under a Doctor's care or your TRT protocol?
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12-19-2012, 11:18 PM #6Associate Member
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Hi gDevin: I am under doctor's supervision; however, I have not yet began TRT because I am in a peculiar situation. My lab work indicates both hypothyroidism and hypogonadism. I have seen two endocrinologists at this point and neither have been able to diagnose me. I seem to be somewhat of a medical mystery at this point. Thus, I have not wanted to begin any treatment for my symptoms other than 50mcgs of Synthroid , despite my current endocrinologist wanting me to. Actually, I would appreciate if you could take a look at my thread http://forums.steroid.com/showthread...ork&highlight= and share your thoughts. I have an issue with links lately, so the name of the thread is Help Interpreting Blood Work if you need to search. Kelkel and I have been working it out thus far. Thank you.
Last edited by Nate02; 12-19-2012 at 11:21 PM.
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12-20-2012, 01:00 AM #7HRT
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It's late and I'm just dropping in for a quick check on things...let me get to this in the morning.
Peace brothers...
gd
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12-20-2012, 01:03 AM #8Associate Member
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12-20-2012, 02:38 PM #9HRT
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Has anyone said anything about your very low FSH serum levels?
Low levels of FSH in men can be linked with pituitary and hypothalamic disorders and just because your MRI didn't show a tumor it doesn't mean that there's still a chance one is there just too small to be seen with a MRI.
Also, hypogonadism is common when FSH levels are low. Either the pituitary or the hypothalamus gland may be at fault. There may also be a tumor present in either the pituitary or hypothalamic gland which can be identified with a radiological examination.
This where you need to focus on.
Read this:
Kallmann Syndrome
Kallmann syndrome can be a reason for registering a low FSH level. This inherited disorder affects men more often than women. The condition includes a failure to go through puberty and may also result in a partial or complete loss of smell. Cigna Health Services states that Kallman syndrome is rare and due to a hormonal imbalance that is caused by hypothalamus failure in the brain.
Hyperprolactinemia
Hyperprolactinemia can be a reason for low FSH levels in men and may first be preceded by symptoms such as vision difficulties and headaches. Georgia Reproductive Specialists state patients should first undergo radiology tests to rule out a tumor in the pituitary gland. The condition indicates a lowered pituitary response due to too little testosterone production. Both lowered libido and impotence are associated with the condition.
Fertile Eunuch Syndrome
Fertile eunuch syndrome, or FES, can be a reason for low FSH in men. Men with FES also tend to have low levels of luteinizing hormone which is the hormone that signals sperm production in the testicles. Even though men with FES have a low testosterone level, they are still able to produce sperm. Testosterone therapy is used to treat this condition along with human chorionic gonadotropin , or HCG , therapy, with the aim of increasing testosterone.Last edited by steroid.com 1; 12-20-2012 at 02:41 PM.
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12-22-2012, 07:08 PM #10Associate Member
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I might be starting Androgel but I have a feeling injections are what I will end up taking. They seem to be more suiting for me. Whatever I plan to do I want to start out slowly and build my way up to desirable levels. What is considered a low dose for injections?
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12-23-2012, 01:43 AM #11HRT
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You've completely dismissed my observation about your FSH levels.
Did you read what I stated above???
You need to rule out disease or other pathologies FIRST!
Throwing testosterone at you now without a full understanding of what is causing your low FSH condition is malpractice IMO.
Something is wrong with you...
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12-23-2012, 03:25 AM #12
That was weird. I though he would be all over that. Great information BTW.
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12-23-2012, 09:53 AM #13Associate Member
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I apologize, I actually did post a reply but I do not think it went through; my internet isn't great. I definitely do take what you said into account. I realize I was searching for a more complicated cause and single fix that could resolve both my thyroid and hypogonadism; I don't think one exists now. It seemed like the two were relevant and perhaps an uncommon issue was the cause. However, two endocrinologists have diagnosed me with two separate issues without doubt in their mind. They think that I have a problem with my pituitary and thyroid functioning; and want me to take Synthroid and testosterone. My hypothyroidism is not causing my hypogonadism, because I have my thyroid treated and there is no raise in my testosterone. That seems like yet another determinant that the two are separate issues. Perhaps I am just unfortunate enough to suffer from both. How certain are you that there is a single disease or pathology responsible for this? If you truly believe that my tests support one of these causes, then I will research them and potentially visit a doctor. I believe can provide better treatment than doctors at this point, given certain circumstances of course. Also, will the diagnosis of any one of these issues affect my treatment? I should add, I live in a part of Maryland where I am fortunate enough to have very strong medical care. One endocrinologist I visit is recommended between the personal experience of my parents and their friend. The other I chose myself through extensive research on a good doctor. I appreciate your interest in this. Thank you.
Last edited by Nate02; 12-23-2012 at 10:06 AM.
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12-28-2012, 09:31 AM #14Associate Member
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Can anyone give advice on what a starter dosage of testosterone injections should be? I have the desire to move up slowly through the numbers and don't want a doctor to prescribe something that would send them through the roof.
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12-28-2012, 11:19 AM #15Associate Member
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I hear some doctors start as low as 60 to 80 mg per week now.People i know started at 100mg per week.
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12-28-2012, 11:29 AM #16Originally Posted by J DIESEL3
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12-28-2012, 11:39 AM #17Associate Member
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With both of your starting doses, what did your testosterone levels raise to?
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12-28-2012, 11:44 PM #18
I started at 100mg weekly. after a couple of months my total T rose about 80 points. Dose increased to 120mg weekly for another couple of months and total T rose another 80'ish points. At about 5 1/2 months dose increased to 130mg weekly and total T rose another 100 points (and estrogen finally started to rise) 7 month total T increase from approx 280 to 550.
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01-02-2013, 02:52 PM #19Associate Member
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Hey Bass: I can't take the Androgel headaches much longer. I want to let you know, I am seeing my doctor tomorrow to ask for this protocol. I appreciate the more constant injections to provide consistency.
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01-02-2013, 03:37 PM #20
Hi Nate,
I looked at your original post in the thread you linked above (I did not read all of your posts). Your blood work showed that your calcitonin was low and your vitamin d was low-normal. In response to that you need to have your parathyroid (intact parathyroid hormone) levels checked as well as your calcium and ionized calcium levels.
Regarding your thyroid, you didn't post thyroid function tests from before the synthroid . Those would be nice to see. As you don't have anti-thyroid antibodies (as the cause of your hypothyroidism) you need to have your TRH (thyroid releasing hormone) levels checked (off of synthroid and ideally before u started taking it) as there needs to be an explanation for your hypothyroidism. You may have a hypofunctioning hypothalamus or hypopituitarism.
Lastly, regarding your hypogonadism/low testosterone , it seems that it is secondary to your underperforming hypothalamus and/or pituitary. You need all these issues addressed and treated in concert with one another by an endocrinologist (in person of course) who specializes in problems of the pituitary and hypothalamus (I am not an endocrinologist nor am I a currently practicing physician). You may respond very well to Clomid to raise your testosterone levels and preserve your fertility (assuming you are fertile), in which case you would not need testosterone supplementation. There are many studies that demonstrate effective use of clomiphene in treating hypogonadism in young men wishing to preserve or maintain fertility and I think u should explore this option as you are only 20 years old (is that age correct?)
It sounds like you have some complex issues going on and I would be naive to think i could solve them from the limited info, lack of physical exam, and lack of a thorough patient history (in which I could ask questions as well). I'm just trying to give you some pieces of info to bring to the attn of your doctor in case they have not yet been addressed or evaluated. Good luck and please keep us posted.
Also, if you are not confident in the care you are receiving now, consider seeing an endocrinologist at a university hospital, where you may get more thorough treatment.Last edited by AnabolicDoc; 01-02-2013 at 03:48 PM.
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01-02-2013, 04:35 PM #21Associate Member
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Hi AnabolicDoc, thank you for your response.
Actually I did post tests before Synthroid. Sorry if I didn't distinguish them, though. Every test except the last one was without Synthroid.
I will keep in mind that Clomid could be useful. Although, I have not learned about it nor have either of my Endocrinologists mentioned it.
I will be visiting John Hopkins in March.
I should also mention that now I am on Androgel 1.62%. I have been for one week.
On a side note, do you think there is anything to be worried about my cortisol levels? I know that it is supposed to be high at 8 AM, but I just want to be sure.
Thanks again, and I will most certainly keep you posted.
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01-02-2013, 05:28 PM #22
Your thyroid function tests all look normal, so I must be missing something.
Regarding your cortisol, an elevated level is followed up by a repeat test, ACTH, CRH, aldosterone, and renin levels. If still elevated, a dexamethasone suppression test is performed (it's easier if you Google it). The normal range is only for 95 percent of ppl, so your slightly elevated level may be normal for you. It really depends if you have symptoms of Cushing's syndrome as to whether it not your level is abnormally elevated. Also, if your cortisol level is deemed high, it is often followed by imaging of the adrenal glands to look for a tumor (assuming your CRH and ACTH were normal). There are few medications for treating elevated cortisol levels, so surgery of the adrenal tumor is often preferred followed by lifelong corticosteroid replacement therapy. The meds that are available are ketoconazole, mityrapone, and recently mifepristone was approved.
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01-02-2013, 05:42 PM #23Associate Member
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Ah I see. Yes they are all considered "normal". People still experience symptoms at levels towards the high-end of the reference range. It is optimal for TSH to be about 1.5 or 2.
Neither of my endocrinologists did a thing you said above...
Would it be advisable to stop my TRT till everything is checked? I'd really rather not because I have felt bad for so long, but if it would help diagnose me I would. Its just both my endocrinologists said with confidence that I have a thyroid and pituitary issue. What do you think? I am going crazy here. Ask Kelkel
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01-02-2013, 05:50 PM #24
As far as I know the only time thyroid replacement is given to bring TSH close to 1, even though it's within the reference range, is for depression. I see that you're on prozac so that must be the case.
As far as stopping TRT, you have to way the risk/benefit yourself. I don't know how long you've been on it for (I didn't read all of your posts). At the very least you should go to PubMed and search for hypogonadism and clomiphene and print some of the articles for your doctor.
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01-02-2013, 05:57 PM #25Associate Member
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01-02-2013, 06:02 PM #26
The more I think about it, the more I realize that Clomid may not be a viable option in cases of a hypofunctioning hypothalamus and/or pituitary as Clomid works by stimulating the HPTA. But hCG is an option that will maintain your fertility and is FDA approved for monotherapy of hypogonadism and will therefore keep your testosterone levels normal assuming your testicles are functioning properly.
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01-02-2013, 06:04 PM #27
I think hcg without testosterone definitely deserves consideration by you and your doctors as your treatment option.
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01-02-2013, 07:14 PM #28Associate Member
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I will bring it up tomorrow. Thank you so much for your help Anabolic Doc . After seeing the doctor I will be sure to post and let you and everybody know what is happening. I hope you'll be around to read it.
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01-05-2013, 01:40 PM #29Associate Member
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Well here is what is going on.
My endocrinologist doesn't agree to continue Androgel . Or I should say, he might not. He wants me to cease use of it till he can test my Free Testosterone again. Since there was a noticeable different in my two free testosterone tests *Look at my previous results* he thinks that either that lab or his lab made a mistake. This is irrelevant though, with either my previous score or this score of a 53 (35-150) it is low enough to merit TRT. He is hesitant to prescribe it because he has his own reservations about prescribing testosterone to someone my age I believe. So I don't want to stop it because: (1) As I said before, a score of 53 (35-150) is low. I should be on testosterone for that, so what is the point in testing it again, mistake or not. (2) If I start Androgel again I have to put up with another week of bad headaches, which won't be for another few weeks of wasted time.
The Naturopathic doctor agrees with me on all this, and says the choice is up to me whether I would like to stop using it for a few weeks to be tested again or not. He says it might be a good idea to comply to keep him around because of course, an endocrinologist has a different viewpoint and different regulations than a Naturopathic doctor. But I don't want to waste another month into my semester.
What if I stop the Androgel for two weeks, take the test, and it is close to the score of 50 (35-180) and my the endocrinologist says, 'Oh, well you don't need TRT,' which has a good chance of happening. Then three weeks later I start my Androgel and go through a week of bad headaches to get back tot he point I am at now. All of this happening, may I add, during my semester when I need to be focusing on school. It doesn't seem like a good idea.
Anyone have any thoughts?
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01-05-2013, 01:55 PM #30HRT
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You're HPTA suppressed now so stopping will only show that and not what your normal androgen levels would have been if you were still producing...so stopping has no merit at this point.
If you stop you will need to do a PCT to get your production back; but what's the point as you already know it's very low.
When and if you do stop you are going to crash, feel really really bad and your blood work will be much lower than pre TRT blood work.
Also know, mono HCG therapies are rarely effective in elevating Testosterone serum levels to optimal levels; if it was an effective protocols many more of us would be on it and not Testosterone...think about it.
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01-05-2013, 02:08 PM #31Associate Member
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Thank you gdevine always the voice or reason.
How long would it take without a PCT to restore normal values?
Yes, aside from all this turmoil he could cause my body, you think he would know its pointless just from looking at the low test scores. Mistake or not they are both still low!
I would feel a crash even this early? Being on Androgel for only a week or two?
I'm aware that HCG mono therapies do not work. I know they work as an addition to TRT. I was inquiring it in my other thread to consider it with Androgel.
Why in the world would a doctor want to do this to me??? The risks it has on me are CLEARLY worse than the benefits.Last edited by Nate02; 01-05-2013 at 02:12 PM.
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01-05-2013, 02:59 PM #32HRT
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01-05-2013, 03:29 PM #33Associate Member
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Anytime. You've always been so helpful and direct with your answers. Have to be one of these most informative people I've talked with about any of this. If I could I would let you treat me. Well if you're 100% sure my testosterone levels would be suppressed until I began PCT, there is absolutely no point to this. No, he must not understand the suppression of the axis at all. I'm curious about that, how come it won't undergo restoration naturally, only with PCT?
If you stop on daily Androgel you will feel the symptoms of crashing within 5 to 10 days and it will continuously get worse till your serum levels completely tank...not a good situation I can tell you that.
I apologize if this is a dumb question, I'm still just learning. But does this statement ^^^ mean that my levels would keep decreasing even after stopping Androgel ??? That would be just...dumbfounding if my endocrinologist didn't know something like that...
And you say it seemingly out of experience. Have you experienced that?Last edited by Nate02; 01-05-2013 at 03:33 PM.
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01-05-2013, 05:14 PM #34
My advice to you would be to:
1) Find a new doctor bc you clearly don't trust this one and it doesn't seem like he deals with this stuff a lot. Find a pediatric endocrinologist, they more commonly deal with pituitary disorders.
2) Stop the androgel - it's been less than two weeks and you should bounce back quickly to your previous levels. Then get your semen checked and if you're fertile preserve some sperm.
3) You have a hypothalamic-pituitary disorder, so hcg will substitute your deficient LH and you can boost your testosterone levels while maintaining fertility.
4) If you're unwilling to stop TRT, then ask him to switch you to hcg (a one month prescription) while you find a new doctor
5) This is not really advice, but hcg is fda approved to treat hypogonaditropic hypogonadism. The approved dosage varies bw 500-4,000 units 2-3 times per week. The reason more ppl aren't on it as monotherapy is that it's been generic for a long time, whereas there are many brands of testosterone being promoted by drug companies (although generic injectable testosterone esters exist). Most of what non-endocrinologist physicians learn about hormone therapy is after med school and residency, so if they don't take courses or do their own substantial reading, all they know is what they learn from the drug reps (it's sad). There's no drug rep pushing hcg to boost testosterone levels of middle aged men. Also low testosterone in adulthood is generally presumed to be from defunct leydig cells in the testicles. The cause either being AAS/TRT (aka ASIH, which stands for Anabolic Steroid Induced Hypogonadism) or more commonly older age. So providing hcg in these situations would only have a modest, if any, effect as the cells producing testosterone are of limited capacity. Lastly, the wide range of hcg dosages and need to titrate the dose based on individual response makes testosterone therapy a lot more appealing both to the doctor and patient. It is for those reasons that more ppl aren't on it.
6) Most importantly, have all your hormone disorders evaluated and treated, not just the thyroid and testosterone. For instance, I didn't see a somatomedin C level to check for growth hormone deficiency.
You have a complicated situation, but don't jump the gun just bc a little testosterone made u feel better. It makes most anyone feel better, at least initially. Think about preserving your fertility if possible or at least going on hcg and then hmg (menotropins) to stimulate your sperm production, store it, and then do whatever you want regarding TRT if you don't want to remain fertile.
Good luck in whatever path you choose.Last edited by AnabolicDoc; 01-05-2013 at 05:17 PM.
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01-05-2013, 05:42 PM #35HRT
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01-05-2013, 06:28 PM #36
Individual responses vary. Some ppl take longer to shut down than others. But I agree that it is possible that's why I suggested he ask his current doc for an hcg prescription. But with only less than 2 wks of use, I think he may be ok after a few days but if he can get hcg that would be better.
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01-05-2013, 07:06 PM #37Associate Member
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It might be irrelevant because I don't think I can get a prescription for HCG from anyone anytime soon. My doctors don't believe in it. And I don't want to feel the crash while I look for someone that might, while getting possibly worse.
I really am at a crossroads. I don't know what to do.
I just looked it up because I wanted to be certain. Today was my tenth day of taking Androgel.Last edited by Nate02; 01-05-2013 at 07:33 PM.
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01-05-2013, 07:36 PM #38HRT
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Oh...two weeks and using a transdermal I agree he may not be totally shutdown...good point.
So many threads sometimes they blend LOL
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01-05-2013, 08:18 PM #39Associate Member
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GDEVINE -- THIS IS NOT THE TIME FOR BLENDING Hahaha
So maybe it is a good idea to get off so I can visit a sperm bank. Plus I have never had my sensitive estrogen and SHGB tested and would like to get that done to track during it all. And I can keep the endocrinologist that wanted me to get off, just in case I need him
Now for the big question: How long would it be safe to say that my levels are back to normal???
Oh I should add! On 7 of those days I believe it was, I was on one pump. The last few days I have been on two pumps. So not a lot.
Gdevine, AnabolicDoc Help!! hahaLast edited by Nate02; 01-05-2013 at 08:21 PM.
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01-05-2013, 09:26 PM #40HRT
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Two weeks and your levels will be back to either 1) normal if you are still producing or 2) tanked if you're shut down.
It's impossible for us to determine if you're 1 or 2...only blood work will determine that.
My experience tells me it doesn't take much exogenous testosterone to cause HPTA suppression; so for me personally it wouldn't surprise me if you weren't HPTA suppressed.
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