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  1. #1
    fire232 is offline Junior Member
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    Need some advice please

    Hello,

    First thank you to anyone who responds. I've got a few questions. I've been TRT for almost a year since that time I've been checked 3 times. My test levels started at 498 then went to 289 after 3 months. I just got my levels checked again and they are 146. I've started taking 200 mg once a month and then by my second check up the doctor started me at every 2 weeks. Now I'm going to be taking shots every week. I'm curious why my levels are getting so low? Should I be taking HCG as well. All other blood work tests are normal. I'd really like to figure this out so I can try a cycle and then my levels not be so low after I finish. For example if I did a cycle of test should I run a PCT?

    Thanks for the help

  2. #2
    scardinals8 is offline New Member
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    Quote Originally Posted by fire232 View Post
    Hello,

    First thank you to anyone who responds. I've got a few questions. I've been TRT for almost a year since that time I've been checked 3 times. My test levels started at 498 then went to 289 after 3 months. I just got my levels checked again and they are 146. I've started taking 200 mg once a month and then by my second check up the doctor started me at every 2 weeks. Now I'm going to be taking shots every week. I'm curious why my levels are getting so low? Should I be taking HCG as well. All other blood work tests are normal. I'd really like to figure this out so I can try a cycle and then my levels not be so low after I finish. For example if I did a cycle of test should I run a PCT?

    Thanks for the help
    What was the reason to start TRT nearly a year ago? Obviously, it was low T, so perhaps a better question is: Why did the doctor decide exogenous testosterone was the solution? If you have low T, exogeneous testosterone should be really the last treatment option. The reason: When you take exogenous test, it shuts down the hypothalamic-pituitary-gonadal feedback loop. If low T is due to steroid use , it is most likely that the problem falls along HPG hierarchy, at one of several structures: hypothalamus, pituitary gland, or testes. A normal HPG feedback loop would go like this - simplified: hypothalamus --> gonadotropin releasing hormone --> pituitary gland --> gondaotropins = LH and FSH --> testes --> effect: LH stimulates leydig cells to produce test and FSH stimulates sperm production. During the synthesis of test, a byproduct is estrogen - so when test levels rise, so do estrogen levels. Estrogen will bind to receptors in the hypothalamus - and even the pituitary gland - which basically tells those structures, "Hey, we are good on test right now." That signals the hypothalamus to release an inhibiting hormone that shuts down the whole process.

    Taking exogeneous testosterone has a similar effect: it tricks your hypothalamus and pituitary gland into thinking test levels are high and the leydig cells are doing their job. The reality is, though, your leydig cells are being shut down, and aren't producing any test, since you're getting test exogeneously. If these structures are inhibited long enough, one of the effects and manifestations is: low T.

    What your doctor needs to do is first determine which structure is causing the low T. In other words, which structure is shut down? If I were the doctor, I would start by targeting the pituitary gland. Remember, the PG secretes gonadotropins - which are LH and FSH - in response to gonadotropin releasing hormone produced by the hypothalamus. Your doctor can prescribe you something like Clomid, which stimulates the PG to secrete LH and FSH, which both act on the testes - LH = testosterone, FSH = sperm production. If you see a rise in your test levels, the issue is likely at the pituitary level. If you see no improvement, then you look at the testes, specifically the leydig cells.

    I would recommend asking your doctor about clomid. It really does work. I know from experience; I had low T due to a genetic mutation in one of the alleles in my pituitary gland that resulted in very little LH and FSH release, and therefore low T. I''ve been on it for two and a half years. My levels went from low 200s to high 600s. I have to take it for the rest of my life, because mine is genetic. But it is possible - and has been successfully done and documented - to basically "restart" the natural production cycle in your body. The longer you stay on TRT, the more likely youll become dependent on it.

    Sorry for being long winded, I wanted to give you all the information and without knowing your background, I wasn't sure of your level of understanding or working knowledge on the stuff.

    I would do some research on other alternatives to TRT, like taking Clomid, and discussing them with your doctor, which should be an endocrinologist, if possible.

    Good luck. I hope you get some answers and some results.

  3. #3
    hammerheart's Avatar
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    Quote Originally Posted by fire232 View Post
    Hello,

    First thank you to anyone who responds. I've got a few questions. I've been TRT for almost a year since that time I've been checked 3 times. My test levels started at 498 then went to 289 after 3 months. I just got my levels checked again and they are 146. I've started taking 200 mg once a month and then by my second check up the doctor started me at every 2 weeks. Now I'm going to be taking shots every week. I'm curious why my levels are getting so low? Should I be taking HCG as well. All other blood work tests are normal. I'd really like to figure this out so I can try a cycle and then my levels not be so low after I finish. For example if I did a cycle of test should I run a PCT?

    Thanks for the help
    200mg Test cypionate once a month is retarded, after two weeks only residual activity is left. Weekly injections are the gold standard.


    Quote Originally Posted by scardinals8 View Post
    I had low T due to a genetic mutation in one of the alleles in my pituitary gland that resulted in very little LH and FSH release, and therefore low T.

    You were really lucky to find someone whom would check for mutations... if I could ask you some questions, what were your symptoms? Age of diagnosis? Did you have a normal puberty? Thanks.

  4. #4
    Simon1972's Avatar
    Simon1972 is offline Knowledgeable Member
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    put simply- your dr has failed you.

    The purpose of trt is testosterone replacement therapy- not testosterone depletion.

    id have to go so far as saying the gold standard , to coin bizzarros phrase, is now bi weekly injections.

    The minimum is as follows- and is what i follow.

    TUES EVENING, 50mg injection into the abdomen fat
    SAT MORNING , 50 mg injection into the abdomen fat.

    You should also check sensitive essay estrogen in your next blood work. You may need an Aromatase inhibitor such as anastrozole if your E is too high.

    I take 0.5 mg (half a tablet) alongside my injections, that is twice a week.

    I would seriously not consider doing a steroid cycle until after you have your TRT testosterone levels sorted out. After you get dialled in, you can blast away, you will not need PCT, simple return back to your twice a week injection protocol.
    This could take a year.

    Buy the book by dr John Crisler , this has valuable info and you can show your Dr where he is failing you.

    Dr Crisler is considered an expert in male hormones alongside Dr Shippen.

  5. #5
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    hammerheart is offline Knowledgeable Member
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    Imho, it is usually best to start things simple, then eventually work up to more refined protocols. Most guys do just fine on per-once weekly.

    Also, subQ injections won't do well on everyone. Some reports lower DHT readings or either higher/lower E2 compared to IM. Check out the following study - (DOI: 10.1002/sm2.80, can't post links).

    Scroll down to table 2 (in the pic). For 200mg IM and 100mg SubQ, readings at day 7 for DHT/E2 are 117/50 and 51.9/48.3, respectively. That's almost the same E2 value for half the dosage!
    Attached Thumbnails Attached Thumbnails Need some advice please-im_vs_subq.png  

  6. #6
    Simon1972's Avatar
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    Quote Originally Posted by bizzarro View Post
    Imho, it is usually best to start things simple, then eventually work up to more refined protocols. Most guys do just fine on per-once weekly.

    i tried once weekly and found the highs and lows where alot easily manageable dosing twice weekly - i felt average by weeks end- also having higher starting Test levels lends itself to higher aromatization conversion, with a higher dosage of an AI.
    Also, subQ injections won't do well on everyone. Some reports lower DHT readings or either higher/lower E2 compared to IM. Check out the following study - (DOI: 10.1002/sm2.80, can't post links).

    True, some are higher and some are lower-so averaged out it really ends up being a non issue and more of what the patient prefers - no need to aspirate when going SubQ /less build up of iintramuscular scar tissue and serums levels seem to also be alot more stable going down the SubQ route.
    Scroll down to table 2 (in the pic). For 200mg IM and 100mg SubQ, readings at day 7 for DHT/E2 are 117/50 and 51.9/48.3, respectively. That's almost the same E2 value for half the dosage!

    do you have a table based on twice weekly injections?

    Not disagreeing with you - i think we are both on the right track- but considering the fluctuations occur naturally daily for men, it would be safe to assume a more frequent protocol would typically result in more stable results.

  7. #7
    Youthful55guy is offline Senior Member
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    Quote Originally Posted by Simon1972 View Post
    put simply- your dr has failed you.

    The purpose of trt is testosterone replacement therapy- not testosterone depletion.

    id have to go so far as saying the gold standard , to coin bizzarros phrase, is now bi weekly injections.

    The minimum is as follows- and is what i follow.

    TUES EVENING, 50mg injection into the abdomen fat
    SAT MORNING , 50 mg injection into the abdomen fat.

    You should also check sensitive essay estrogen in your next blood work. You may need an Aromatase inhibitor such as anastrozole if your E is too high.

    I take 0.5 mg (half a tablet) alongside my injections, that is twice a week.

    I would seriously not consider doing a steroid cycle until after you have your TRT testosterone levels sorted out. After you get dialled in, you can blast away, you will not need PCT, simple return back to your twice a week injection protocol.
    This could take a year.

    Buy the book by dr John Crisler , this has valuable info and you can show your Dr where he is failing you.

    Dr Crisler is considered an expert in male hormones alongside Dr Shippen.
    The above post is probably the best free advice is a single, short, easy to read forum post you'll ever get!

    1) The concept of weekly (or less frequent) is old school. I could never get weekly to work for me. ALWAYS had a hormone crash by day 5 or 6. Even adding a bunch of HCG to the end of the cycle. Humans (men) did not evolve to have huge spikes of T early in the week and have it wane to sub-optimal levels after 7 days. The idea is ludicrous. I'm a huge advocate of twice (or more frequent) dosing of much smaller amounts. Several benefits: More stable T levels, smaller peaks, less E2 and DHT conversion, smaller volumes = insulin syringe, you can get by with an overall lower average weekly (I was ably to cut my weekly average by about 25% going from weekly to every 3 days).

    2) Have your E2 checked, and by all means, insist on the sensitive (LC/MS/MS) assay. If your doc won't order the correct test (or doesn't know how to), get it done yourself. it's not that expensive. I use Discountlabs.com and I can order just about any male hormone panel I want. Best advice I can give is first get on a stable T program first, because E2 will fluctuate with T levels. Big swings in T = big swings in E2, so getting tested for E2 after a 2 week hormonal roller coaster ride is not going to be very informative.

    3) Get your Free (or bioavailable) T and SHBG tested too. The purpose of SHBG is to bind sex hormones and protect them from liver metabolism, but too much (or too little) is not good. You can have normal to high T levels and still be deficient in T if the majority of it is bound to SHBG. High SHBG will also drive up total T and give you false information. Note it also will drive up E2, but it is less tightly bound and more bioavailable than bound T, which makes it a double whammy.

    4) You can go with either IM or SQ. it doesn't make a difference. I prefer IM with a 28G 1/2 inch insulin needle. It will not cause scar tissue at that size.

    5) Nail down your T dosing first, then get your E2 levels checked, and then consider whether an aromatase inhibitor is needed and base the dosing and adjustments on testing. Don't just jump on the aromatase bandwagon without stable levels and testing information. Guy need E2 too for normal eraction (one of God's little jokes). If you crash E2 it will bring on a bad case of ED.

    6) There was discussion of a steroid cycle. I didn't read through all the posts to figure out where that came from, but the advice is sound. If you are relying on TRT for stable lifetime hormone levels, then there is no need for a PCT. However, be aware that part of coming off of a steroid cycle is allowing hemoglobin level to come back down. If you are always on, you are going to have dangerously high hemoglobin levels that will be difficult to control even with regular blood donations (you can only donate so much).

    7) There was advice about buying Dr. C's book. I agree. I think he could have used a better editor, but there's a lot of good information in it.

    Hope this helps!

  8. #8
    fire232 is offline Junior Member
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    Sorry I didn't give much information about myself. I'm 39, I've never been on any steroids however after being tired and never feeling recovered from workouts my dr did blood work. After that is when I got put on shots. I really appreciate all the help!! I just want to get everything back to normal.

  9. #9
    Proximal is offline Banned
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    Quote Originally Posted by Simon1972 View Post

    The minimum is as follows- and is what i follow.

    TUES EVENING, 50mg injection into the abdomen fat
    SAT MORNING , 50 mg injection into the abdomen fat.

    You should also check sensitive essay estrogen in your next blood work. You may need an Aromatase inhibitor such as anastrozole if your E is too high.

    I take 0.5 mg (half a tablet) alongside my injections, that is twice a week.
    Simon, are you doing .5 or .25mg. (half of a half) of Arimidex ? For me personally, .5 mg.2x/wk. dropped my E2 below range pretty quickly & I 'm injecting .75mg. of test c 2x/wk.

    Sorry for the intrusion.

  10. #10
    scardinals8 is offline New Member
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    Quote Originally Posted by bizzarro View Post
    200mg Test cypionate once a month is retarded, after two weeks only residual activity is left. Weekly injections are the gold standard.





    You were really lucky to find someone whom would check for mutations... if I could ask you some questions, what were your symptoms? Age of diagnosis? Did you have a normal puberty? Thanks.

    I was diagnosed, I believe, at 22...I had trouble putting on muscle - and retaining it, I felt I could never recover between workouts, I was constantly lethargic, had muscle weakness, and chest pain. I brought this to my family doctor's attention in high school, but he just said I hadn't hit my growth spurt. From, I'd say, the age of 16-21, I didn't gain more than a couple pounds of muscle (I was basically 160lbs during that time). And I was lifting year around, with personal trainers and the strength and conditioning guys for the University in my town. I just couldn't add muscle...As far as puberty, it was "normal." But at that time, no diagnosis was made, so my test levels, and sperm count weren't measured.

    But, I am grateful for this endocrinologist I have. He's like a guru when it comes this stuff; my test levels, free test, sperm count, etc., are all normal for my age - well, actually they're slightly higher for my age, since the clomid basically tricks my body into thinking my test levels are low, while at the same time, stimulating my pituitary gland to constantly secrete LH, which stimulates test production.

  11. #11
    username101 is offline New Member
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    From my personal experience my Doctor has prescribed me with 200mg of Testosterone Enanthate every 9-14 days. 200mg/ml once every 9-14 days keeps my levels pretty stable. My levels are tested every 3 months. If my levels drop below the average range my dosage is increased. If my levels raise above the high range my dosage is lowered.

    If you can time it right you can easily cycle 600mg for 6-8 weeks without being detected as a high level.

    Talk to your Doctor.

  12. #12
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    Quote Originally Posted by Proximal View Post
    Simon, are you doing .5 or .25mg. (half of a half) of Arimidex ? For me personally, .5 mg.2x/wk. dropped my E2 below range pretty quickly & I 'm injecting .75mg. of test c 2x/wk.

    Sorry for the intrusion.
    0.5 mg each time I inject, that is 1mg a week. But my dosage is 75mg test each time I inject, not 50mg.

    50mg is the recommend starting dose for the op

  13. #13
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    Quote Originally Posted by scardinals8 View Post
    I was diagnosed, I believe, at 22...I had trouble putting on muscle - and retaining it, I felt I could never recover between workouts, I was constantly lethargic, had muscle weakness, and chest pain. I brought this to my family doctor's attention in high school, but he just said I hadn't hit my growth spurt. From, I'd say, the age of 16-21, I didn't gain more than a couple pounds of muscle (I was basically 160lbs during that time). And I was lifting year around, with personal trainers and the strength and conditioning guys for the University in my town. I just couldn't add muscle...As far as puberty, it was "normal." But at that time, no diagnosis was made, so my test levels, and sperm count weren't measured.

    But, I am grateful for this endocrinologist I have. He's like a guru when it comes this stuff; my test levels, free test, sperm count, etc., are all normal for my age - well, actually they're slightly higher for my age, since the clomid basically tricks my body into thinking my test levels are low, while at the same time, stimulating my pituitary gland to constantly secrete LH, which stimulates test production.
    Very interesting, thanks. We share a similar pattern of signs&symptoms development.. I was diagnosed at age 24 with hypogodatropic hypogonadism. Had persistent symptoms of weakness and lethargy since teenage. Started lifting a lot and managed to drop about 60 lbs of fat. Strength and energy were indeed up but hard to maintain, and eventually returned like before.

    Obviously I have no way to know whether symptoms were related to low t or other conditions (I'm also affected with autommune thyroiditis). My (ex) endo actually is a professor and a researcher, but offered no help other than a regular regimen of TRT, and has absolutely no interest inquiring further.

    Perhaps weight loss caused low t, which happens to some. If it is the case, I guess I'll never know. LH secretion is also regulated by hormones such as Leptin secreted by fat tissue. Leptin antagonizes ghrelin (hunger hormone, secreted by parietal cells of the stomach) in the hypothalmus. Relevant weight loss can mess with the Leptin-Ghrelin system, and restoring weight seems to have no effect in affected individuals. According to a study performed on rats, Leptin infusion are actually able to restore normal LH release from the pituitary.


    What I did meant for "normal puberty" was actual development of secondary sex characteristics... as for me, no major issues, other than underdeveloped facial hair and rather wide hips for my gender.

  14. #14
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    Quote Originally Posted by scardinals8 View Post
    What your doctor needs to do is first determine which structure is causing the low T.

    Unfortunately this is where most doc's seem to fail. The don't search for the causative factor and simply band aid the problem. Baffles me as it's not really that hard.
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    Quote Originally Posted by bizzarro View Post
    Did you have a normal puberty?

    I've used that line on Friday nights after a few drinks......!
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