New HRT Patient

[juggs]

Hi guys, just posted over in the new guy forum if you want to read about me. I've been a member over at ********* as Juggs for a couple years now, ever since I became interested in AAS. Before that I had been a member since 2004 under a more personally identifiable name. I wanted to start a thread here to track my progress. Any of your wisdom or recommendations 100% welcome.

Bottom line - I'm 30yrs old and have been dealing with low T symptoms for some years now after a botched vasectomy. I finally got tested and my total T came back at 302. I'm weaker and fatter than I used to be, have trouble sleeping, general lack of well being, energy, and motivation. If it weren't for my career, school, and family life going so well I'd probably deep in depression right now, but most days I find it's hard to fake the funk, and it's only getting harder. So thankfully I'm starting HRT probably early next week or whenever my supplies arrive. My doc prescribed 210mg test-cyp per week, 1mg of adex per week and 1000iu of hCG twice per week as a starting point.

Latest labs below...

TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB
CBC With Differential/Platelet
WBC 6.1 x10E3/uL 3.4 - 10.8 01
RBC 4.80 x10E6/uL 4.14 - 5.80 01
Hemoglobin 15.2 g/dL 12.6 - 17.7 01
Hematocrit 44.3 % 37.5 - 51.0 01
MCV 92 fL 79 - 97 01
MCH 31.7 pg 26.6 - 33.0 01
MCHC 34.3 g/dL 31.5 - 35.7 01
RDW 12.8 % 12.3 - 15.4 01
Platelets 289 x10E3/uL 150 - 379 01
Neutrophils 45 % 01
Lymphs 44 % 01
Monocytes 8 % 01
Eos 2 % 01
Basos 1 % 01
Neutrophils (Absolute) 2.7 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 2.7 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.5 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Comp. Metabolic Panel (14)
Glucose, Serum 86 mg/dL 65 - 99 01
BUN 9 mg/dL 6 - 20 01
Creatinine, Serum 1.00 mg/dL 0.76 - 1.27 01
eGFR If NonAfricn Am 101 mL/min/1.73 >59
eGFR If Africn Am 116 mL/min/1.73 >59
BUN/Creatinine Ratio 9 8 - 19
Sodium, Serum 139 mmol/L 134 - 144 01
Potassium, Serum 4.4 mmol/L 3.5 - 5.2 01
Chloride, Serum 98 mmol/L 97 - 108 01
Carbon Dioxide, Total 24 mmol/L 18 - 29 01
Calcium, Serum 9.5 mg/dL 8.7 - 10.2 01
Protein, Total, Serum 7.3 g/dL 6.0 - 8.5 01
Albumin, Serum 4.6 g/dL 3.5 - 5.5 01
Globulin, Total 2.7 g/dL 1.5 - 4.5
A/G Ratio 1.7 1.1 - 2.5
Bilirubin, Total 0.5 mg/dL 0.0 - 1.2 01
Alkaline Phosphatase, S 55 IU/L 39 - 117 01
AST (SGOT) 34 IU/L 0 - 40 01
ALT (SGPT) 60 High IU/L 0 - 44 01
Lipid Panel With LDL/HDL Ratio
Cholesterol, Total 175 mg/dL 100 - 199 01
Triglycerides 73 mg/dL 0 - 149 01
HDL Cholesterol 55 mg/dL >39 01
Comment 01
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 15 mg/dL 5 - 40
LDL Cholesterol Calc 105 High mg/dL 0 - 99
LDL/HDL Ratio 1.9 ratio units 0.0 - 3.6
Please Note: 01
LDL/HDL Ratio
Men Women
1/2 Avg.Risk 1.0 1.5
Avg.Risk 3.6 3.2
2X Avg.Risk 6.2 5.0
3X Avg.Risk 8.0 6.1
Thyroid Panel With TSH
TSH 1.010 uIU/mL 0.450 - 4.500 01
Thyroxine (T4) 9.4 ug/dL 4.5 - 12.0 01
T3 Uptake 30 % 24 - 39 01
Free Thyroxine Index 2.8 1.2 - 4.9
Testosterone,Free and Total
Testosterone, Serum 302 Low ng/dL 348 - 1197 01
Comment:
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) 12.5 pg/mL 8.7 - 25.1 01
Estradiol 19.6 pg/mL 7.6 - 42.6 01
Roche ECLIA methodology

[kelkel]

Hi Juggs, very curious about you relating your vasectomy to the low testosterone and if you can expand on it. Do you have your T levels before the procedure by chance?

The protocol you mentioned sounds like it's coming from a clinic. Yes - No? Regardless, know that the amount of T prescribed is high end TRT and very few guys need that amount. The goal is to restore healthy T levels without the need for ancillaries (adex) if at all possible. The only way to effectively achieve that is to start low (er) and titrate up based on blood work. A normal starting dose would be around 100 mgs per week, pull blood in 6 weeks and evaluate. Many also will split that dose into 50 mgs and inject twice per week to achieve more stable T levels and to have a lesser impact on estrogen levels.

Speaking of estrogen. What you had tested is Estradiol which is geared for women and usually reads higher in men. Sometimes much higher. Men need a Sensitive Estrogen Assay. Many doc's / clinics either don't understand this or stick to estradiol as it costs less, much less. When it comes to HCG why such a huge dose? If it's a clinic I've already answered this question! To large a dose over time can desensitize you. The normal HCG dosing in this arena would be 250 iu's either 2 or 3 times per week.

[juggs]

Hi kelkel, thanks for the response. In regards to my vasectomy being a potential cause, that was my doc's speculation based on the fact that I had an artery nicked leaving me black and blue from knees to nipples and with a sack the size of a honeydew. He thinks it may have damaged my testes due to lack of blood flow. No idea what my test levels were prior to this, but I do know that I was a horny MFer sometimes having sex 3-4 times per day, with much less BF, more muscle, and just generally felt better.

Yes it's a men's wellness clinic, per say. Seems to be their standard dosing. I definitely don't mind being on the very high end of normal, as that is how I think I was before, complete speculation of course based on reasons mentioned above. With that said, I would definitely like to minimize side effects and avoid being stuck taking an AI if at all possible. I'm open to lowering the dose based on how I feel and how blood work comes back.

Thanks for the heads up on the sensitive estrogen assay. I will bring that up at my next followup.

I wasn't aware that the hCG dose was so large. I've seen much larger in the AAS context, but I suppose for TRT it can be much lower?

[Simon1972]

if they prescribe such a high amount i would seriously consider storing it for a future cycle.

im on 150mg a week of TEST E and i have just been told my results are way too high- i will most likely drop down to 100 and re-evaluate.

i came back in at outside reference range 300-1100.

if you are carrying excess body weight, aromatase activity could also be high.

i take 1 mg of anastozole a week split half/half with my twice weekly injections and for me, it works at that dose.
I could be a high estrogen converter though- my guess is being on such high a test dose im ïnviting aromatase activity" . For that reason alone id be backing your dose way down to 100mg a week /splt. keep an eye on that and you might be able to drop your AI to follow suit.

listen to kel and welcome to our board.

[juggs]

Thanks Simon, I'll definitely keep that in mind. I don't want to come back real high and have them decrease my prescription, for reasons you already mentioned.

I am carrying excess bodyfat at the moment, but I've lost about 7lbs recently and have about 20 more to go before I'm fairly lean. I'm taking it slowly because I just had a major shoulder surgery and don't want to be undernourished. I will also be on semi-weekly doses, on Mondays and Thursdays.

Thanks again Simon.

[kelkel]

I wasn't aware that the hCG dose was so large. I've seen much larger in the AAS context, but I suppose for TRT it can be much lower?

The only time I can imagine seeing a larger dose would be during a very aggressive pct, such as the Scally Power PCT which involves short term, higher dosing of HCG. Key is short term. Long term it's not necessary and puts you at risk. Clinics can get away with higher doses as the clients normally do not understand hormones.

When it comes to testosterone I fully agree, high end of normal is great, but this should be based on your free testosterone level not your total testosterone. Free T is what works for you, not total. It should also be based on how you feel along with your blood work. A higher dose is fine as long as you don't constantly have to mitigate it with ancillaries. Remember, as T rises estrogen will follow and so usually will hemoglobin and hematocrit. All this needs to be in balance which is why we say "less is more" in TRT. It's about long term health.


Read this excerpt from a study on HCG and it's effectiveness and remember your source, the more they put you on the more profit they make:

Human chorionic gonadotropin therapy
A known critical element in the development of healthy spermatogenesis is high intratesticular testosterone.13 In men using exogenous testosterone, these levels can be greatly diminished. Intramuscular human chorionic gonadotropin (hCG) therapy is an option shown to protect against, or at least to diminish, the impact that exogenous testosterone has on intratesticular testosterone levels. In a randomized, controlled trial of 29 healthy men randomly assigned to four groups, testosterone enanthate was given 200 mg per week plus either intramuscular saline, 125, 250, or 500 IU hCG every other day. Sperm, intratesticular testosterone levels, and gonadotropins were measured at day 0 and day 21. Intratesticular testosterone levels were suppressed by 94% in the placebo group, 25% in the 125 IU hCG treatment group, and 7% in the 250 IU hCG treatment group, and they were increased 26% from baseline in the 500 IU hCG treatment group.13 Thus, even with supraphysiologic doses of testosterone replacement, healthy levels of intratesticular testosterone were maintained by low-dose hCG therapy.

[juggs]

Excellent information, thank you. So if I'm interpreting those numbers correctly, it sounds like 275-300iu EOD of hCG would be the proper level to maintain intratesticular levels at baseline. So just about 1000iu per week. One question for you though - is twice weekly administration often enough, because that is my current plan.

This is something I will discuss with my doc today, and I highly doubt he would keep me on such a high dose if at my 8 week followup my levels are through the roof. I certainly don't mind having some extra test lying around, but no need to pay for double the hCG as well.

[kelkel]

The over-whelming majority use about 250 iu's either 2 or 3 times per week. Some like daily low dose administration. I'm sure you'd be just fine at 500 iu's x 2 per week. Just know that to much hcg can lead to excess intra-testicular estrogen which is not controlled via AI's. There's a learning curve to all this. Stick around, read and contribute. Also, start to maintain your own copies of your blood work as well. You'll find it will help you immensely.

[juggs]

Spoke with my doc today, and he assured me he's been using hCG to assist with weight loss for years, and that this is not a high dose. However, we are gong to followup at 8 weeks with more blood work and take it from there.

A couple things I notice here, and please don't take this as being argumentative. I appreciate all the info you can give. Based on the study you posted above, it seems that even on a dose of 250IU every other day still resulted in a slight suppression - 7% to be exact. Wouldn't it make sense to dose such that there is as close to zero suppression as possible? Taking that into account it sounds like 250IU 2-3 times per week is a low dose. Granted that doesn't take into account the experiences of peolpe who have been doing this for a while, just crunching numbers here.

There also seems to be a lot of conflicting information out there. This study on sperm production refers to 500IU EOD as "low dose." Of course I realize that the dosage is not what's in question in this particular study, but just surprised that they would call that amount a low dose given what you posted above.

Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy.
Hsieh TC1, Pastuszak AW, Hwang K, Lipshultz LI.

PURPOSE:
Testosterone replacement therapy results in decreased serum gonadotropins and intratesticular testosterone, and impairs spermatogenesis, leading to azoospermia in 40% of patients. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy.
MATERIALS AND METHODS:
We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin. Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every other day. Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.
RESULTS:
A total of 26 men with a mean age of 35.9 years were included in the study. Mean followup was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p <0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.
CONCLUSIONS:
Low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.

[juggs]

Just got my own labs done after taking prescribed dose for the the last few weeks. My TT/FT was 2645/37 and E2 was at 17.5. So my T levels are astronomical as expected. Gonna lower my dose by half, and hopefully be able to avoid having to use the anastrozole at all, and bank the extra for a future cycle hopefully. Definitely don't want to go back in for labs with my doc and have him cut my prescription.

[kelkel]

Was the scale on your E2 8-35?

Not argumentative at all! You're looking to keep them functioning and it does not have to be perfect. The top doc's in the industry (Crisler, Shippen, Morganthaler, etc) all prescribe in the dose range I mentioned based on years of treating patients, labwork and in-person feedback. Remember, some are even now recommending smaller, daily dosing at around 100 per say.

Try and recheck levels about a month after titrations if you can. Let us know how you do! Still intrigues me how your doc came up with 210 mgs per week. Not 200, but 210. Very odd to me. Unless that extra 10 mgs required you to purchase an additional bottle more frequently...

[juggs]

Was the scale on your E2 8-35?

It was 7.6-42.6 pg/nl.

The top doc's in the industry (Crisler, Shippen, Morganthaler, etc) all prescribe in the dose range I mentioned based on years of treating patients, labwork and in-person feedback.

I don't discount their training and experience, but it is also not lost on me that many docs, or any profession for that matter, often do things a certain way simply because that's how they've been doing it for years or that's the only way they've ever tried, and have a "If it's not broke, don't fix it" mentality. Not saying that is the case here but it's definitely something I think about because I've come across it in my own dealings with doctors.

Try and recheck levels about a month after titrations if you can. Let us know how you do! Still intrigues me how your doc came up with 210 mgs per week. Not 200, but 210. Very odd to me. Unless that extra 10 mgs required you to purchase an additional bottle more frequently...

Their standard recommended dose is 200mg, but for some reason after meeting with me and seeing my blood work they prescribed 210. It was specially compounded for me at 210mg/ml, so no need for extra bottles. I'll recheck in 4 weeks. I'll be due for followup blood work by that time anyway. Thanks Kel!

[kelkel]

It was 7.6-42.6 pg/nl.

Sounds like standard estradiol to me, not a sensitive assay?


I don't discount their training and experience, but it is also not lost on me that many docs, or any profession for that matter, often do things a certain way simply because that's how they've been doing it for years or that's the only way they've ever tried, and have a "If it's not broke, don't fix it" mentality. Not saying that is the case here but it's definitely something I think about because I've come across it in my own dealings with doctors.

Couldn't agree more, but the guys mentioned "are" the innovators in this field. Main thing is to stick to what works for you.

Their standard recommended dose is 200mg, but for some reason after meeting with me and seeing my blood work they prescribed 210. It was specially compounded for me at 210mg/ml, so no need for extra bottles. I'll recheck in 4 weeks. I'll be due for followup blood work by that time anyway. Thanks Kel!

Well, that's typical of a clinic to start high. Never made sense to me to start high and then have to mitigate the problems that arise insteead of starting lower and titrating up as needed.

[dreadnok89]

Hi kelkel, thanks for the response. In regards to my vasectomy being a potential cause, that was my doc's speculation based on the fact that I had an artery nicked leaving me black and blue from knees to nipples and with a sack the size of a honeydew. He thinks it may have damaged my testes due to lack of blood flow. No idea what my test levels were prior to this, but I do know that I was a horny MFer sometimes having sex 3-4 times per day, with much less BF, more muscle, and just generally felt better.

Yes it's a men's wellness clinic, per say. Seems to be their standard dosing. I definitely don't mind being on the very high end of normal, as that is how I think I was before, complete speculation of course based on reasons mentioned above. With that said, I would definitely like to minimize side effects and avoid being stuck taking an AI if at all possible. I'm open to lowering the dose based on how I feel and how blood work comes back.

Thanks for the heads up on the sensitive estrogen assay. I will bring that up at my next followup.

I wasn't aware that the hCG dose was so large. I've seen much larger in the AAS context, but I suppose for TRT it can be much lower?

Damn man sorry to hear that. I have no clue why any guy would go thru this. It's crazy

[juggs]

It was standard and not sensitive. Only reason I did that is because that is what my first lab was - same lab and same test, and wanted to compare apples to apples with the first one. Will be doing sensitive assay henceforth.

Yeah the dose is high, but I'm not complaining. At least that way, when I want to take a higher dose I can do so without buying stuff illegally.

[juggs]

It's cool man, you live and learn I guess. It was a terrible three months after my vasectomy, but from what I've read my issues are incredibly rare. I just didn't want any more kids, and I took a calculated chance I guess.

^^^ On that note, I don't know if it's the hCG or what, but my testicle pain is almost nonexistent since starting TRT. It's been a life-changer already.

[ryobi1]

my question is, is it important to keep sperm production up after a vasectomy,
as it has no way of being released and I assume it dies off or is consumed by
body regulation. Hcg therefore would have more of a role in LH and FSH
maintanence?....new to HRT or at least still trying to grasp it. any clarification
would be interesting to know

[kelkel]

Sperm remains in your testicals until dissolved or absorbed into your blood so you're on target when you say "consumed by body regulation."
Yes, HCG mimics LH production at the testicular level.

[juggs]

my question is, is it important to keep sperm production up after a vasectomy,
as it has no way of being released and I assume it dies off or is consumed by
body regulation. Hcg therefore would have more of a role in LH and FSH
maintanence?....new to HRT or at least still trying to grasp it. any clarification
would be interesting to know

Without delving into specifics that I know very little about, keeping the testicles active with hCG and simulating the body's natural release of LH also plays a role in healthy downstream hormones other than testosterone, so even if you don't need the sperm like me, it's still necessary. Also preventing testicle atrophy is something many are concerned with.

[juggs]

Hey guys, not much to update on right now, but I have procured a prescription for deca. So there's that...

[kelkel]

You need to get dialed in with your TRT before you delve into other anabolics, imho.

[juggs]

You need to get dialed in with your TRT before you delve into other anabolics, imho.

Kel, I completely agree with you in the general case, and while my blood work isn't completely dialed in yet, I do feel a hell of a lot better already, and I'm doing this with a prescription of low-dose pharm grade deca (100mg/wk) under the supervision of my doctor. The reason I decided to go this route is because of my shoulder surgery, which was the final straw that made me get my test levels fixed to begin with, because I didn't want to deal with yet another poorly tolerated, partial recovery. I start formal physical therapy on Monday, and will be on the deca for 10 weeks. After which I will definitely spend some time getting my TRT dialed in before using any other anabolics.