Low T Since Age 26 / Starting to Self-Dose

Greetings from Prague!

Been a long-time lurker here... and thrilled to have the chance to make my first post. Big kudos and thanks to all the folks sharing their wisdom.

Well, here's my story...

I travel a great deal for work (I'm American, but am working in Prague for May) and have a high stress job... but for years I'd been totally unable to function with less than 10 hours of sleep. Getting up in the morning was miserable and every day was a struggle to get through. Also, never was able to gain any muscle back when I was skinny... and as I got older, the fat was definitely easier to pack on. After a few years of trying different vitamins, workout regimens, etc... I went to the doctor for a blood panel (2013). Came back with Total Test of 237 ng/dl (attached here).

Was sent to an endo (during next long-term travel assignment)... Who said that my test was no good since it was done at 10AM... and that I had to have it done before 8:30AM. I don't have the results on me, but it came back at just over 300 ng/dl. She said that she didn't feel comfortable prescribing anything since the generally accepted "okay" range was between 275 and 1100 ng/dl... After practically begging her for some help to feel better, she prescribed Androgel (calling it "off label" since she really didn't think I should be taking it)... at one pump a day.

I felt mildly better... I could get through the day without feeling too terrible... but still needed 10+ hours of sleep. My blood tests came in with about 375 ng/dl on the Androgel. I was on it for about 2 years. Mild improvement, but I always thought being 26-28 my levels should be higher... at least in the 600s. Whatever they needed to be to not feel like sh*t anyway.

Over the last year... My endo moved and I kept traveling for work... Saw another GP and Urologist... Who both prescribed blood tests. Came back at around 275 nd/dl... And they said that my natural testosterone may just be low, so they won't prescribe the gel. So I weened myself off and have been off for over a year.

So now I'm overseas... And I've been doing a lot of research. I've made the decision to start pinning... and I've ordered test c and prop (starting with prop and switching to c over the first few weeks following dose protocols here)... as well as aromasin (just in case). I'm having blood work done on Monday (should be avail Tuesday... will include free and total test as well as thyroid and hct) to get a baseline. Will post those results and would love any feedback, but assuming my levels are in the >250 ng/dl range as they have been for years, would like to get to pinning a steady 70mg of test c every 3 days. The goal is to be able to A. improve by quality of life as a whole and B. finally work out without being suicidal and see positive body changes (with diet and carb cycling)... instead of just continuing to get fat.

A few questions:

1. Does anyone here have any experience getting Blood Work in Prague? I had to go to a doctor to get the order here... And she wouldn't let me get the estrogen tested. I'll be able to get back to the States at the end of December so I know I'll be able to get what I need there... I'm just mainly concerned about Spring of next year (as I'm finished here somewhere between April and May).

2. I've seen horror stories about high hemocrit... My options are limited here, again, since getting blood tests are a pain. Just wondering how common it is?

3. I'd like to blast once everything starts to get in balance. How long should I wait? 4 Weeks or so?

Oh, and in case it's necessary... Current States are 30 years old/6'3"/240/25% bf.

Thanks for any insight!

Welcome to the forum Voyager!

First, sorry your T is low but it doesn't sound like anyone ever really investigated as to why it's low? You really need full BW to include a full thyroid panel, LH/FSH, Cortisol and Prolactin. These are the main items that can suppress pituitary function. For example, if LH/FSH is high yet your T is low it can be indicative of primary hypogonadism (testicular failure.) If LH/FSH is low and T is low then it may be issues with your pituitary. I hate to see young guys band aid an issue without finding out exactly what the causative factor is as I find it hard to believe it's andropause.

Many things can cause low T. Hypothyroidism is a primary one. Fix it and T usually returns to adequate levels. Do some reading at www.stopthethyroidmadness.com. You'll find it interesting. Have you suffered any head or testicular trauma in your past?

The doc who prescribed you one pump of androgel did not do you any favors. Basically just replaced your endogenous production with the gel. Waste of time unfortunately.

If at all possible get the correct BW so you can evaluate things properly. It would stink to embark on TRT when you really did not have to. You also have to remember that most docs don't know hormones as they're not trained in them in med school. If you can't get proper BW then at the most I'd probably consider Clomid therapy. This won't shut down your HPTA and is a plus if concerned with fertility in the future. Then when back in the states simply stop the clomid and see how your levels maintain on their own. At this point find a knowledgeable doc and get straightened out.

kel

Hey, Kel -

Thanks so much for your thoughtful response... I’m a fan of yours and was hoping you’d reply! :)

I’ve always thought it was weird that no one looked into the root cause of my T problem... no trauma and my nuts are normal as far as I know. I know I’ve had the LH/FSH, Cortisol, and Prolactin tested before... I just need to try to dig up some of my old labs until I get back to the states. Either way I’ll have all of that done next month.

I’d considered the Clomid-only route, actually... but the bottom line is... I’m tired of feeling awful. I’m grateful to have moved into a place in my life where my staff knows I can’t come in before 11, but this job is a long haul and I need some salvation. Sheesh that sounds lame.

Would it affect corsitol/LH/FSH/prolactin results if I started a 140mg dose now, and if the results come in as fixable, then pct off the test when I’m done here in the Spring tomaddress those things? I know it’s not ideal, but well, I’d like to make a for-sure change as soon as can be done. (And fertility will never be an issue that I’m worried about.)

Well, LH/FSH (pituitary function) will be shut down with endogenous testosterone making BW showing their function useless. Personally if you choose to do this I'd start out at 50 mgs x 2 per week and then check labs in about 6 weeks. It's always better to start low and titrate up as opposed to starting higher and having to mitigate issues such as elevated estrogen and possibly hemoglobin / hematocrit. Hopefully you can avoid the need for an AI this way. Starting with HCG at 250 IU's x 2 per week would be great as well, regardless of fertility concerns it's simply healthy and smart.

Be sure to check all the usual stuff (cbc, cmp, etc) as well as total and free T, SHBG and sensitive E2 if possible. See how they look and how you feel and adjust if necessary. Remember total T doesn't really matter, free T is what works for us so use that as your marker.

When back in the states run your pct and see how it goes. Let me know how all this works out for you. Update this thread please.

With your advice... I called the doctor and left word that I wanted to add LH/FSH/Cortisol/Prolactin... Not sure if they're going to go with it, but trying anyway! Would like to, of course, see what the underlying problem is and if it can be addressed... And, well, I don't want you to think I'm rushing into it! Just tired of feeling like crap for so long.

I'll post the results when I get them on Tuesday!

Quote:

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Originally Posted by kelkel

Starting with HCG at 250 IU's x 2 per week would be great as well, regardless of fertility concerns it's simply healthy and smart.

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I also agree that HCG is a good idea. Downside - I don't think I'll be able to get access to it here... but I do have clomid. I know they're not the same .. and I've seen mixed research and feedback about folks that have run clomid instead of HCG. What do you think?

I totally understand. You do what you have to do when you feel like crap.
No, don't run clomid at the same time as exogenous testosterone. It won't do anything for you at all.

Quote:

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Originally Posted by kelkel

I totally understand. You do what you have to do when you feel like crap.
No, don't run clomid at the same time as exogenous testosterone. It won't do anything for you at all.

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Blah. I’ll see if I can track down the HCG without a script here... but no luck so far. I’ve read about all the positives so I’d like to have it.

Check some of the overseas pharmacies. Not that expensive.

Quote:

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Originally Posted by kelkel

Check some of the overseas pharmacies. Not that expensive.

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Totally. Not really worried about cost... just don’t want to get anything that turns out to be crap.

This may be of interest... got my first pre-Androgel blood work from the Endo. LH/FSH/SHBC is included. T was higher than the previous too, but she made me go early.

Ordered the HCG. Hope it makes a good addition to the team!

Continuing the saga... went for my bw today... nothing different than any other time... and was pleasantly surprised when the phlebotomist said she was only collecting two vials. Well... after looking for veins in both arms, and a little trouble getting the blood to flow in......... I got super hot, vomited, and almost passed out.

Nurses and a doctor came in, flipped the chair back feet up/head down (who knew they could do that?!)... they applied a cold rag and opened the windows. Sigh. If I was them, I would have been judging the hell out of the 6’3” 240lbs dude that couldn’t get the blood drawn. Even worse... they didn’t get enough blood to do the test.

It seems as if I was dehydrated, though I really didn’t know. Will definitely kick up my water intake. Embarrassing more than anything. Sigh.

Any chance anyone has had a chance to look at my blood work a few posts up that I added? And please feel free to judge. Thank you!

I did. But it's 4 years old. You pituitary function is lower thus low T. LH signals the testies to produce testosterone. If it's not getting much of a signal then odds are slim you'd have solid T levels. Whether this is early on-set andropause or there's something else holding you back is anyones guess without BW checking all the items we've discussed earlier in this thread.

Totally understood. Thanks for the time and patience.

Keep us in the loop with what you do Voyager. Update this thread please.

Results back from the first part of my blood work... basic blood count. Will have the real results tomorrow and will post.

WBC - leukocyty 7.4 | |*| | 4.0-10.0 10^9/l
RBC - erytrocyty 4.98 | |*| | 4.00-5.80 10^12/l
HB - hemoglobin 142 | |*| | 135-175 g/l
HCT - hematokrit 0.429 | |*| | 0.400-0.500 l/l
MCV-stř.obj.ery 86.2 | |*| | 82.0-98.0 fl
MCHC - st.bar.k. 331 | |*| | 320-360 g/l
MCH - bar.k.ery 28 | |*| | 28-34 pg
PLT - trombocyty 413 | | |+ | 150-400 10^9/l
RDW 13.4 | |*| | 10.0-15.2 %
Neutrofil. segmenty 41.3 | -| | | 45.0-70.0 %
Lymfocyty 47.4 | | |+ | 20.0-45.0 %
Monocyty 6.9 | |*| | 2.0-12.0 %
Eosinofily 3.3 | |*| | 0.0-5.0 %
Basofily 1.1 | |*| | 0.0-2.0 %

Okay... Blood work part 2.

Cholesterol 4.6 | |*| | 2.9-5.0 mmol/l
HDL cholesterol 0.90 | -| | | 1.00-2.10 mmol/l
non-HDL cholesterol 3.70 | |*| | 0-3.80 mmol/l
LDL cholesterol 3.29 | | |+ | 1.20-3.00 mmol/l
Triglyceridy 2.45 | | |+ | 0.45-1.70 mmol/l
Index Aterogenity 5.11 | | |+ | 0.00-4.20
Glukóza 4.9 | |*| | 3.9-5.6 mmol/l
FSH 1.6 | |*| | 1.5-12.4 IU/l
LH 5.1 | |*| | 1.7-8.6 IU/l
Prolaktin 18.0 | | |+ | 4.0-15.2 ng/ml
Testosteron 6.85 | -| | | 8.64-29.00 nmol/l
SHBG 8.9 | -| | | 18.3-54.1 nmol/l
Free testosteron 76.97 | |*| | 35.00-92.60 %
Kortizol 439.0 | |*| | 166.0-507.0 nmol/l
TSH 1.800 | |*| | 0.270-4.200 uIU/ml
fT4 14.25 | |*| | 12.00-22.00 pmol/l

Total test in ng/dl is 197... Yikes. And strange that prolactin levels are high, eh? I do take an SSRI, so that may have an impact.

TT is horribly low yet your FT is still above average due to having such a low shbg level. Will look over this more later.

Thanks, Kel! I noticed that too, strange. Looking forward to your thoughts... and thanks again for the time!

Apparently my gear is coming from HK, so still have another week or so to wait. :-/

Quote:

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Originally Posted by Voyager1

Okay... Blood work part 2.

Cholesterol 4.6 | |*| | 2.9-5.0 mmol/l
HDL cholesterol 0.90 | -| | | 1.00-2.10 mmol/l
non-HDL cholesterol 3.70 | |*| | 0-3.80 mmol/l
LDL cholesterol 3.29 | | |+ | 1.20-3.00 mmol/l
Triglyceridy 2.45 | | |+ | 0.45-1.70 mmol/l
Index Aterogenity 5.11 | | |+ | 0.00-4.20
Glukóza 4.9 | |*| | 3.9-5.6 mmol/l
FSH 1.6 | |*| | 1.5-12.4 IU/l
LH 5.1 | |*| | 1.7-8.6 IU/l
Prolaktin 18.0 | | |+ | 4.0-15.2 ng/ml
Testosteron 6.85 | -| | | 8.64-29.00 nmol/l
SHBG 8.9 | -| | | 18.3-54.1 nmol/l
Free testosteron 76.97 | |*| | 35.00-92.60 %
Kortizol 439.0 | |*| | 166.0-507.0 nmol/l
TSH 1.800 | |*| | 0.270-4.200 uIU/ml
fT4 14.25 | |*| | 12.00-22.00 pmol/l

Total test in ng/dl is 197... Yikes. And strange that prolactin levels are high, eh? I do take an SSRI, so that may have an impact.

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Interesting that your prolactin is slightly above range. Wonder if that was just an anomaly of the test. It does not appear to be affecting LH to any significant degree.

As Kel mentioned, SHBG is low, which is why Free T is good, given the low total T. Free T is the important number, so I'm wondering if the way you are feeling is independent of the low Total T. Something to consider.

Hey Y55G - thanks for the thoughts! I do like that FT is high... but here it’s expressed as a percentage... meaning a have a high percent of super low total test... Right? I don’t think they can be looked at independently (IE Total T is in the tank but FT is high so all should be swell), right?

The prolactin is weird. And makes me feel... womanly. :-/

Quote:

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Originally Posted by Voyager1

Hey Y55G - thanks for the thoughts! I do like that FT is high... but here it’s expressed as a percentage... meaning a have a high percent of super low total test... Right? I don’t think they can be looked at independently (IE Total T is in the tank but FT is high so all should be swell), right?

The prolactin is weird. And makes me feel... womanly. :-/

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Very good point. I'm used to working with Free T being reported in pg/mL (normal range 9.3-26.5 for someone your age). When I saw such a high number, I instantly went to "there's nothing wrong". However, as a percent of an abysmally low Total T, yeah, I can see why you feel lick $#!%.

I'm also used to dealing with Total T in ng/dL, so I needed to do the conversion, your 6.85 nmol/L equates to 197.6 ng/dL. I don't know exactly what the range is for young guys like you, but for old farts like me, the range is 348-1197 ng/dL. Yours would be a little higher. Bottom line is that your total T is about half of the lower end of the range for a 50-60 year old man.

Ehen I plug the 197.6 ng/dL and your 8.9 nmol/L SHBG into a Free T calculator, and assuming your albumin is a normal 4.3 (or close), your Free T is about 6.44 ng/dL and your bioavailable is about 151 ng/dL (76.4%). Normal ranged for 50-60 year old men are 2-13.5 (Free) and 48-317 (Bioavailable). Younger guys would be slightly higher. So, while not being completely out of range (for an old man), your Free T is within the lower end of the range.

I don't see E2 in the labs, but I'm willing to bet that it is low, as there's not much T to convert. I suspect that if you do initiate TRT that the E2 will climb (best to get a baseline value first) and that may help drive up the SHBG, which would then increase your Total T. On the upside, SHBG acts to shield Total T from liver metabolism, so it gives it a longer half life in the body. On the flip side SHBG binds T tightly and prevents it from crossing the blood-brain barrier.

Finally, the prolactin and SSRI issues. Yes, SSRI usage can drive T down. This is pretty well documented in the literature. I have not researched much myself (b/c I don't use them), but I seem to remember that it is via increased prolactin. Perhaps others here with more knowledge on that topic can chime in. Also, note that the prolactin is not all that far out of range. I just discovered this week that I have very similar prolactin values of 17.8 (range 4.0-15.2 pg/mL). It disturbs me a little that it's not been measured before by any of my docs and I just happened onto it because it was a freebe in a larger hormone panel that I bought myself. However, I have had great success with TRT over the past 6 years, so it doesn't seem to be affecting me, and I had a pituitary MRI done for unrelated reasons about 4 years ago, so it rules out a tumor.

The bottom line here is that both you and I need to watch our E2 carefully to make sure it does not go out of range with TRT. E2 of and by itself is only a minor contributor to gynecomastia (contrary to popular belief), it's the combination of high E2 + High progesterone + High prolactin that cause rapid mammary development. However, even without high progesterone, high E2 + high prolactin should throw up a large yellow flag to do something. Fortunately, I have kept a close eye on E2 and always keep it in range and I have never had a gynecomastia problem.

Thanks for the detailed post Y55G! And thanks for breaking out all the math. :)

Agreed that I’m lucky to have the low SHBG... and that the free T isn’t as bad as it could be. I’d love to get the E2 sensitive and totally will when I get back to the states... but it’s just not going to happen while I’m over here. :-/ But it’s super important and I will be getting bw for it every chance I get.

Saw the endo today (on a Saturday!) and she said that HRT was definitely warranted and prescribed. But apparently here the only type of test available is sustanon. :-/ I have done almost no research on that as I had no plan on using it... but, here we are. She prescribed 1ml of 250mg once per month. Within an hour of the appointment I had my first injection. Any thoughts about that dosage? I’d always planned to do the cyp twice a week.

My HCG arrives next week, and I definitely plan on using it.

Quote:

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Originally Posted by Voyager1

Thanks for the detailed post Y55G! And thanks for breaking out all the math. :)

Agreed that I’m lucky to have the low SHBG... and that the free T isn’t as bad as it could be. I’d love to get the E2 sensitive and totally will when I get back to the states... but it’s just not going to happen while I’m over here. :-/ But it’s super important and I will be getting bw for it every chance I get.

Saw the endo today (on a Saturday!) and she said that HRT was definitely warranted and prescribed. But apparently here the only type of test available is sustanon. :-/ I have done almost no research on that as I had no plan on using it... but, here we are. She prescribed 1ml of 250mg once per month. Within an hour of the appointment I had my first injection. Any thoughts about that dosage? I’d always planned to do the cyp twice a week.

My HCG arrives next week, and I definitely plan on using it.

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Couple things. Yes, you're lucky to have low shbg in this circumstance assuming you do not possess any attributes of metabolic syndrome. When it comes to your new Endo it apparent that she is clueless about HRT by virtue of the frequency of injections prescribed. Sustanon is a blend of 4 testosterone esters, both short and long. Half life is arguably about two weeks due to the deconoate ester, meaning it'll be out of your system. The rest of the test esters are shorter. This means for the optimum effect your injections should be closer together. Your doctor is injecting you on it's terminal life putting you on a hormonal roller coaster. Make sense?

Quote:

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Originally Posted by kelkel

Couple things. Yes, you're lucky to have low shbg in this circumstance assuming you do not possess any attributes of metabolic syndrome. When it comes to your new Endo it apparent that she is clueless about HRT by virtue of the frequency of injections prescribed. Sustanon is a blend of 4 testosterone esters, both short and long. Half life is arguably about two weeks due to the deconoate ester, meaning it'll be out of your system. The rest of the test esters are shorter. This means for the optimum effect your injections should be closer together. Your doctor is injecting you on it's terminal life putting you on a hormonal roller coaster. Make sense?

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Oh I think the cluelessness was a given. The doctors here were lovely, but I never expected them to have the same level of knowledge as an HRT specialist back home. Totally knew that 1 month was a recipe for disaster... so my plan is:
1. Use this visit to credit the legitimacy of my issue when I go home
2. Add the sust to my stock of gear
3. Switch to cyp twice weekly after a week or two

It was just nice to get some sort of something pharm grade going now to fight off the fatigue etc. Really starting to negatively affect my life. :-/

She prescribed an MRI (super cheap here - only 600 USD!) and I’m just confirming that my job’s travel insurance will cover... then I’ll do that, too.

Re: metabolic syndrome - I do have some of the symptoms, but my hope is that with an increase in my T levels and a general increase in quality of life that I can actively fight that off. :)

And FWIW... there’s nothing that gets me up more than a heavily accented older Czech lady refer to my boys as “Tess Tess.” -shudder-

Quote:

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Originally Posted by Voyager1

Thanks for the detailed post Y55G! And thanks for breaking out all the math. :)

Agreed that I’m lucky to have the low SHBG... and that the free T isn’t as bad as it could be. I’d love to get the E2 sensitive and totally will when I get back to the states... but it’s just not going to happen while I’m over here. :-/ But it’s super important and I will be getting bw for it every chance I get.

Saw the endo today (on a Saturday!) and she said that HRT was definitely warranted and prescribed. But apparently here the only type of test available is sustanon. :-/ I have done almost no research on that as I had no plan on using it... but, here we are. She prescribed 1ml of 250mg once per month. Within an hour of the appointment I had my first injection. Any thoughts about that dosage? I’d always planned to do the cyp twice a week.

My HCG arrives next week, and I definitely plan on using it.

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I wouldn't be so quick to ditch the Sustanon, it can still be used for TRT with the right dosing. You just have to understand what's in it and how it compares to T-cyp, which is pretty much the standard in the USA.

The problem with comparing ester doses is that they have variable amounts of molecular T due varying chain lengths and molecular weights of the ester component of the drug. Therefore, you need to calculate the total molecular T in the dose and then use that to guide dosing of the stuff you have. Most guys do well on 100 to 120 mg T-cyp divided into twice weekly or E3D dosing (my favorite). Since T-cyp is about 68% molecular T (32% ester), each mL of 200mg/mL T-cyp delivers about 136 mg molecular T which is slowly released over about a weeks time. The following are the calculations for the amount of molecular T in a mL of Sustannon. As you can see, it has a slightly higher percent molecular T per mL, but the release kinetics are different than T-cyp.

Sustanon 250 is a blend of four esterized testosterone compounds:
30 mg testosterone propionate: 30 X .80 = 24 mg molecular T
60 mg testosterone phenylpropionate: 60 X 0.66 = 39.6 mg molecular T
60 mg testosterone isocaproate; 60 X 0.72 = 43.2 mg molecular T
100 mg testosterone decanoate: 100 X 0.62 = 62.0 mg molecular T
TOTAL MOLECULAR T PER ML = 24 + 39.6 + 43.2 + 60 = 166.8 mg T/mL

The idea behind frequent dosing is that it takes the emphasis off of the half-life of the ester because you are continually supplementing the ester and after a certain point you will reach pretty much a steady state of T in you blood. So let's say you decide to proceed with twice weekly dosing of Sustanon, here's how I would approach dosing.

Since most guys do well at a starting dose of 50 mg T-cyp twice weekly, that equates to about 50 X 68% = 34 mg molecular T twice weekly.

1 mL of Sustanon delivers about 167 mg molecular T, so 34 mg /167 mg/mL = 0.2 mL to get the same dose of molecular T

Therefore, start out at 0.2 mL and see how you feel in about 4-6 weeks. My normal advice would be to repeat labs, but given you location you may need to do this by "feel". If you feel the need for more, you can probably take the dose up to about 0.25 mL twice weekly, which would be slightly more what most guys need for TRT, but the dose is not as outrageous as some doses I see guys on in this and other forums.

The tricky thing is that you want to make sure E2 does not go out of range, but without labs that's going to be difficult. I hesitate to recommend that you start right away on anastrozole because without labs, you can easily dive your E2 too low and that may cause other issues (major ED for one thing). I've seen posts from some guys that claim that they can dose their anastrozole by their ability to rub out an erection but I'm not totally convinced it's a reliable method. Personally, I have noticed that when my E2 is in range, I can easily get nipple erections with certain activities but that's just a very subjective observation. It also does not tell you if/when E2 goes too high, just too low.

Quote:

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Originally Posted by Youthful55guy

I wouldn't be so quick to ditch the Sustanon, it can still be used for TRT with the right dosing. You just have to understand what's in it and how it compares to T-cyp, which is pretty much the standard in the USA.

The problem with comparing ester doses is that they have variable amounts of molecular T due varying chain lengths and molecular weights of the ester component of the drug. Therefore, you need to calculate the total molecular T in the dose and then use that to guide dosing of the stuff you have. Most guys do well on 100 to 120 mg T-cyp divided into twice weekly or E3D dosing (my favorite). Since T-cyp is about 68% molecular T (32% ester), each mL of 200mg/mL T-cyp delivers about 136 mg molecular T which is slowly released over about a weeks time. The following are the calculations for the amount of molecular T in a mL of Sustannon. As you can see, it has a slightly higher percent molecular T per mL, but the release kinetics are different than T-cyp.

Sustanon 250 is a blend of four esterized testosterone compounds:
30 mg testosterone propionate: 30 X .80 = 24 mg molecular T
60 mg testosterone phenylpropionate: 60 X 0.66 = 39.6 mg molecular T
60 mg testosterone isocaproate; 60 X 0.72 = 43.2 mg molecular T
100 mg testosterone decanoate: 100 X 0.62 = 62.0 mg molecular T
TOTAL MOLECULAR T PER ML = 24 + 39.6 + 43.2 + 60 = 166.8 mg T/mL

The idea behind frequent dosing is that it takes the emphasis off of the half-life of the ester because you are continually supplementing the ester and after a certain point you will reach pretty much a steady state of T in you blood. So let's say you decide to proceed with twice weekly dosing of Sustanon, here's how I would approach dosing.

Since most guys do well at a starting dose of 50 mg T-cyp twice weekly, that equates to about 50 X 68% = 34 mg molecular T twice weekly.

1 mL of Sustanon delivers about 167 mg molecular T, so 34 mg /167 mg/mL = 0.2 mL to get the same dose of molecular T

Therefore, start out at 0.2 mL and see how you feel in about 4-6 weeks. My normal advice would be to repeat labs, but given you location you may need to do this by "feel". If you feel the need for more, you can probably take the dose up to about 0.25 mL twice weekly, which would be slightly more what most guys need for TRT, but the dose is not as outrageous as some doses I see guys on in this and other forums.

The tricky thing is that you want to make sure E2 does not go out of range, but without labs that's going to be difficult. I hesitate to recommend that you start right away on anastrozole because without labs, you can easily dive your E2 too low and that may cause other issues (major ED for one thing). I've seen posts from some guys that claim that they can dose their anastrozole by their ability to rub out an erection but I'm not totally convinced it's a reliable method. Personally, I have noticed that when my E2 is in range, I can easily get nipple erections with certain activities but that's just a very subjective observation. It also does not tell you if/when E2 goes too high, just too low.

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Whoa... Whoa whoa. This is gold. Thank you, Y55G! Truly amazing. A great way to keep using a prescription while keeping hormone levels in check. Incredibly complex breakdown... but again, super awesome!

Yes, I'm worried about E2 for sure. And because of my current stats (went from about 13% body fat to almost 30% in the past 3 years, some of which I credit to this... though not an excuse) it's something I need to stay on top of. I hear that Aromasin doesn't crash E2 as hard as something like Adex... Maybe I should take 12.5mg/day just in case until I can get labs done?

On the upside... I'm into day 2 after my first injection. Though I know things aren't even close to stabilized yet, I already can tell a very noticeable difference with my attention span, energy level, and ability to get out of bed in the morning. That in itself has been worth it!