Feeling pretty overwhelmed with this TRT protocol. Guidance please?

[mhswhite500]

Hey, all,

I’m about to go on a TRT protocol, and I’m a bit nervous as I feel like I’m going on a one way ticket here.

I’m 28, 5 10, 170lbs and around 10-12% bf.

I’ve used gear in the past, but I came off of it, several years ago, but I never seemed to fully “recover.”

I originally wanted to inquire about TRT because I couldn’t get morning wood, had next to zero sex drive, pre mature ejaculations and energy issues throughout the day, despite sleeping 8 hours and eating, what I consider, pretty damn healthy.

I got a blood test, to measure Test Serum, Free T (direct), LH, FSH and Estrodial

Test Serum - 537
Free T - 12
LH 1.9
FSH 2.7

Estrodial 25.4

I’m, obviously, not in internal meds here, but they seemed a bit low, relative to my age, and my symptoms aren’t exactly ideal.

I’m beyond looking to use “gear” for recreational purposes anymore; I just want to feel a bit better and more like a 28 year old.

This company that I’m going through approved me for TRT after the blood test. I spoke to a physician and he listed out the treatment plan.

I’m not doubting the fact that he’s a doctor, but I had a really bad vibe about the treatment plan as I felt that he described it as if he were prescribing a dose of Advil; so, I have some hesitation here because I don’t want to cause more harm than good.

My treatment plan, according to them goes as this:

200mg Test Cyp 1x per week

.5 Adex 1x per week (that seems odd, but I might be thinking in terms of an actual cycle here rather than TRT)

500iu HCG 2x per week

That’s the regiment. I’ve done cycles before; so, obviously, the lay out of a cycle is different from TRT, but after reading through the forms here about how TRT is widely misunderstood, I’m pretty concerned about my regiment. It’s all based off a hunch, but I’ve used this site, albeit a while ago, with much success, and I hope some experts, can help steer me in the right direction.

I’m happy to answer any more questions or post my full blood panel if needed.

Thanks, everyone

[Youthful55guy]

A couple of thoughts.

1) You need to always post normal ranges when posting labs. Normal numbers differ from lab to lab and they need to have a reference value.

2) Age 27 is very young to be going on a lifetime medication. Have you considered sterility issues. Yes, HCG can help prevent it, but TRT makes it more challenging.

3) This appears to be a on-size fits all Low T clinic protocol. It's old school. I suggest you read the "TRT Best Practices" sticky on the first page of the forum as a starting point.

4) I'd do more research before jumping on the TRT train. It's difficult to get off.

[HoldMyBeer]

Your total and e2 are right in the middle of the range. Idk what the other ranges are. Probably a mistake, but -notAdoctor

[kelkel]

Everything 55 said.

Read that sticky and challenge your doctor. Ask questions based on your research, but know the answer ahead of time. It will help you gauge the knowledge of this doctor. No one needs to start at 200 mgs per week and no one needs to start with an AI.

Edit and add ranges like 55 mentioned please. Also, do you have an shbg value?

[mhswhite500]

Thank you so much, Kel, for the reply, and to everyone, for that matter, I really appreciate the help.

I will research that sticky right after this post.

In the meantime, here is the full lab. And as for the shbg value, unless I’m illiterate, I don’t believe that it was tested for.

[Youthful55guy]

While your Total T and Free T numbers are not screaming low T (they are both in the "normal" range), they also are not supercharged. You have a difficult decision to make.

I suspect that the "doc" offering you TRT without much in the way of counseling of your medical condition does not have your best health interests in mind either. The protocol is very old school and I'm guessing it's a low T clinic. Been there, done that and it's not sustainable. Most of them make you come in for your weekly injections and don't prescribe T for home injection. They make money by charging your insurance for weekly office visits. They get you hooked by the balls and what happens when you want to take a 3-4 week vacation? Going through T withdrawal after your system is totally dependent on it really sucks. As you can tell, I have a very low opinion of Low T clinics.

Keep in mind that comparing how you feel now to how you felt while supercharged on whatever "gear" you used is not a good comparison. You'll never feel that way again. You can feel more "optimized" with a well structured TRT program, but it's not going to be like it was while on gear. But optimization with TRT comes with a price. it's a lifetime medication that you become physically and psychologically dependent on. It carries significant risk of sterility and if not administered properly (as the old school protocol you are being offered), has the risk of putting you on a hormonal roller-coaster. Controlling E2 is not as simple as popping a AI and then there's DHT conversion and control. At 200mg/week, your hemoglobin will more than likely be extremely difficult to control, even with regular blood donations (assuming you qualify and are willing).

Again, you have a difficult decision to make. I would consider your options carefully and be leery of Low T clinics offering quick solutions.

[mhswhite500]

You absolutely nailed it on all of this.

I completely agree. The “vibe” that I got with the “dr” felt like a sales pitch, and when I asked seemingly basic questions about doses and meds, I felt that he answered them in a totally half assed way. Again, not questioning if he’s a Dr. but I questioned his knowledge about what the regiment was going to be.

I feel this route is going to cause more harm than good.

I totally understand that I’m never going to feel supercharged again when I was running gear, and I couldn’t care less about that, but I was hoping there was a way I could get libido, energy and some other seemingly regular “functions” back again.

I’ve had BP and hemocrit issues before; so, I know that’s a concern here.

This all said, in your unbiased opinion, should I even be considering TRT or looking into to Lowtestoterone.com, or is this something where it’s completely subjective to where I need to make this 100% decision?

[Youthful55guy]

I’ve had BP and hemocrit issues before; so, I know that’s a concern here.

This all said, in your unbiased opinion, should I even be considering TRT or looking into to Lowtestoterone.com, or is this something where it’s completely subjective to where I need to make this 100% decision?

BP is not that big of a deal. Lots of guys are taking BP meds. Many new ones on the market with excellent side-effect profiles (particularly sexual side-effects). I personally like Losartan (generic for Cozaar). No sexual side-effects and works well for me. One of it's know side-effects is actually beneficial to guys on TRT. It has a very slight affect on lowering output of hemopoietin, thus helping (in a small way) to control hemoglobin production while on TRT.

The key to controlling hemoglobin production is to control DHT production. DHT drives hemoglobin production much more than T. My original high profile TRT doc told me that years ago, but it was only recently that I came across some excellent medical research supporting that theory of his. The best way to control T conversion to DHT (or E2 for that matter) is to use a small frequent dosing protocol. I highly recommend you start with 40mg T-cyp (0.2mL of a 200mg/mL solution) every 3 days. I discuss my rationale for dosing schedule in the "Best Practices" thread. As a secondary measure, you may wish to consider adding in small amounts of finasteride to your protocol. The difficulty there is that 1mg tablets are generally considered cosmetic (hair loss) by the insurance companies, so you have to get 5mg tablets. Cutting 5mg tablets into 1/2 is fairly easy, but anything smaller is difficult. My experience is that 1-2mg/day is an optimal dose using the eye dropper method. It's a powerful DHT inhibitor and it needs to be dosed carefully. You need some DHT for normal libido.

I have no experience with Lowtestoterone.com, but others here have mentioned it. I believe they advertise that everything is included for $199 per month. That's a bit pricy compared to a standard doctor prescribed protocol. T-cyp and HCG is not all that expensive and as I have said before, you shouldn't need an AI with proper dosing.

Here's what I pay. Except for the annual doctor visit and the labs, I pay out of pocket and don't even bother trying to get insurance coverage.

Testosterone Cypionate -Pizer branded Depo-Testosterone 200mg/mL - Local Pharmacy $63.36/10 mL. At prescribed dose of 0.2 mL E3D = 50 doses/vial = 150 days of treatment = $0.4224/day = $154.18/year

HCG - Merck branded Pregny - Local Pharmacy $127.01/10,000 IU = $0.012514/IU. At 1050 IU/week (current dose 2X more than prescribed) = $13.34/week = $693.47/year. Most guys use half that amount, so the cost for you would be closer to $350/year if you had a prescription.

Syringes (for testosterone) - 122 (28G 1/2 inch) 1 cc insulin syringes/year. Currently use Easy Touch brand from https://www.totaldiabetessupply.com/...g-1cc-1-2-inch. $14.45/100 = $0.14 each = 122 X $0.14 = $17.08 /year.

Syringes (for HCG) - 156 (31G 5/16 inch) 0.5 cc insulin syringes/year. Currently use Easy Touch brand from https://www.totaldiabetessupply.com/...-5cc-5-16-inch. $13.99/100 = $0.14 each 156 X $0.14 = $21.84 /year.

Doctor Visit (copay) = 1/year at $20 = $20.00 /year.

Labs = $0 (no copy with my insurance)

[mhswhite500]

Once again, you absolutely killed it here. Thank you for going into such depth here.

I saw your sticky about the frequent dose protocol, and everything makes sense there.

As for my labs, from what I’m understanding, from you and Kel, is that they’re, in your guys’ opinion, incomplete? Do I need to get the E2 tested as well? I’m sorry. I didn’t quite catch that.

I know there’s no sourcing here, but I was wondering how you went about getting such a sweet set up with your TRT regiment? Is there anything you can recommend on how I can go about it? This current “clinic” that I was about to go through is going to charge 200/month for the Cyp, HCG , pins and Adex.

Thanks again

[kelkel]

Great answers by 55, as expected.

Your labs are pretty complete with the exception of shbg. Which I suspect is probably a bit elevated based on your Total T level and FT level. Speaking of Total T yours is actually a good number, particularly considering your lower LH value.

If you're set on TRT and actually feel that you need it, why not find a doctor instead of a clinic. Maybe you addressed that in a earlier post, not sure.

[Youthful55guy]

Once again, you absolutely killed it here. Thank you for going into such depth here.

Do I need to get the E2 tested as well? I’m sorry. I didn’t quite catch that.

Thanks again

There's little need to test E2 pre-TRT, particularly if you are low on T. E2 is made from T, so E2 levels generally follow T levels. In your case, Your T levels are within the normal range and per the report you attached, so are your E2 levels (25.4 pg/mL, normal =7.6-42.6).

Monitoring E2 occasionally while on TRT is a good idea, but if you keep your T levels with in physiological ranges at all time (i.e., avoid the big spikes with big infrequent dosing), then your E2 should also stay within range. Most guys are overly paranoid of E2 and often crush it to undetectable levels with excessive use of an AI. I've seen this way too often in the forums. Guys need E2 too for normal erections and libido and AIs are very powerful drugs that are designed for treating female breast cancer. They are very difficult to dose for men.

Much of the paranoia comes from bodybuilding lore, where guys are using grossly excessive T dosing and then stacking it on top of other synthetic anabolic hormones (such as nandrolone ) that have progestin-like activity. The combination of excessively high E2 (from excessively high T levels) combined with hormone that mimics progesterone is a path to gynecomastia . Combine that with high prolactin levels and a guy can even begin to lactate. From a physiologic view, this hormonal combination is what takes place during the 3rd trimester of pregnancy and sets women up for nursing. Once breast tissue develops in men, they will be forever sensitive to E2 levels unless they have surgery to remove the mammary tissue. This is why a lot of former gear users are sensitive to E2 levels that most of us nonusers tolerate well. Their paranoia is based in reality, but it's not applicable unless you have a history of excessive gear abuse.

What are appropriate E2 levels for men? From my perspective and experience and not having a history of gear abuse, keeping E2 within the normal range is a good goal. In your case the lab's normal range is 7.6-42.6 pg/mL. My lab and lab method is slightly lower (8-35), but I use the more sensitive LC/MS/MS method. I personally set 45 pg/mL using the LC/MS/MS method as a cutoff point where I consider using an AI and/or dropping my T dose. I have played with low dose anastrozole using the eye dropper method when my E2 gets into the upper 30's, but I've found it too difficult to control. I often end up crushing my E2 and stopping the AI.

[Youthful55guy]

I know there’s no sourcing here, but I was wondering how you went about getting such a sweet set up with your TRT regiment? Is there anything you can recommend on how I can go about it? This current “clinic” that I was about to go through is going to charge 200/month for the Cyp, HCG , pins and Adex.

Thanks again

Glad you asked. I don't mind providing in-depth answers to questions in the open forum because I believe it is helpful for a lot of other guys groping in the dark, trying to find their way through a jungle of misinformation regarding TRT. Always keep in mind that I come from the perspective of an older individual (62 Y/O) who does not have a history of anabolic steroid abuse and have a less common form of low (free) T caused by excessive production of Sex Hormone Binding Globulin (SHBG). From what I've found in the medical literature, this affects about 15%-20% of the general population, but since only have of them are men and women are generally unaffected by high SHBG, it's medically relevant in only about 7%-10% of men. it's also genetically linked. On the flip side of the coin, the best available treatment is TRT using standard protocols with the goal of dosing T such that Free T remains within normal physiologic range.

I think the best way to answer your question is to take you through my TRT story. I'll try to be as brief as possible since it have many chapters to get from where I was 10 years ago to today.

CHAPTER 1: for about 4 years beginning about age 51 (2008 through 2012), I knew that something was off with my body but the dinosaur docs kept telling me that my T levels (between 400-600 ng/dL) were just fine and that it is most likely all in my head and that I should just get use to getting older. One even offered me an antidepressant! They only ran Total T labs and this is a meaningless lab for guys who do not have "normal" SHBG levels (either high or low SHBG). In my case, very high SHBG. However, none of them (nor I) knew enough to run SHBG labs and/or Free T (or Bioavailable T) labs. They just sent me on my way and said there was nothing wrong.

CHAPTER 2: The problem got progressively worse over the years. I had little energy and began to feel a buzzing in my head. I was having difficulty focusing at work and I have little to no interest in sex and a bad case of ED. In early January 2012, I decided to go down the Low T clinic route because I lost faith in the mainstream medical community and, quite frankly, was at the end of my rope. A new clinic just happened to open around that time about a 45 minute drive from my house. I made an appointment and they ran some basic tests, which included Free T. That is when the true medical problem first came to light. Even though my Total T was excellent (618 ng/dL), my free T was an abysmal 7.1 pg/mL (normal = 7-18). They offered me a one-size fits all protocol with weekly dosing of 100mg and a 1/4 AI table twice per week plus 150 IU HCG 3X per week. The upside was that the T was covered by my insurance and I did feel somewhat better. However, they did not offer T to go, so I had to make a 90 minute round trip once per week, every week, to get my fix. Also, we could never get the T dose to last more than 5 days before I'd crash, even going as high as 140mg.

CHAPTER 3: I stayed the Low T clinic course for about 4 months when I realized that I had a 3 week European vacation on the horizon and there was no way I could last more than a week, let along 3 weeks) without my weekly T fix. That's when I started cruising the forums and asking guys for advice in finding a TRT doc near me that would prescribe T for me to self-administer. I finally found one in another (now defuncted) forum. The doc was a 4 hour round trip from my house, but was/is a world renowned TRT doc that agreed to take me on as a client. He made it clear that he does not take insurance and that I had to pay upfront and his fees cost me an arm and a leg, but I was getting desperate (I had not yet discovered overseas sourcing of T or even considered self-administration). I was not disappointed with my initial consult. He spent over 2 hours with me. Went over EVERYTHING and gave me my first injection in the office. I also walked out with a script for both T and HCG. He was the doc that clued me in on small frequent doses of T being the ticket to managing side-effects and preventing the hormonal rollercoaster to hell, and he was right.

CHAPTER 4: I stayed with my TRT doc for about 3 years and he taught me most of what I know about TRT. That is when I finally convinced my (new) local PCP to take over administration of my protocol. I was upfront with her about what I was doing with the TRT doc and she monitored my protocol with additional labs. She eventually saw the benefit I was getting from TRT. I believe being up front with her and having her monitor the program was instrumental in bringing her up the learning curve (let's face it, most docs know nothing about TRT) and to gaining a level of comfort to take over administration of the protocol.

That's where I am today. As you can see, it was a contorted path to get where I way to where I am today. You need to be willing to do the research, educate yourself, and ask probing questions of docs to get you on the right path. TRT is lightyears ahead of where it was when I started, but is still mostly stuck in the stone age of medicine. Yes, it sucks, but if you are diligent and are willing to work the system, it can be done successfully.

[kelkel]

TRT is lightyears ahead of where it was when I started, but is still mostly stuck in the stone age of medicine. .

Agreed. Doctors are given minimal to zero training in hormones in med school. If you find a GP that knowledgeable it's due to his own diligence and personal interest.

Great story 55!

[mhswhite500]

Thanks for chiming in, Kel.

At this point, I guess, I’m just a bit unsure if I actually “need” it, or if it’s just going to make my current effects worsen.

That said, I’m definitely steering clear the clinic. Thank god for you guys. I was about to get roped into a 6 month contract, too.

About the finding the Dr. part, is this just something where I’m going to have to do some massive research (which I don’t mind doing), or is there a resource, such as another forum (or this one), where guys find their Doc. I’m just not too sure where to start looking aside from basic Google searches.

[mhswhite500]

Thanks for clarifying more about E2. I had a general sense about what it is, but this really cleared things up.

Luckily, I never messed with Deca , Tren , anadrol and those other kinds, and I never had any gyno (from what I know of) issues. I’m not sure if that’s irrelevant info here.

[mhswhite500]

Wow, like Kel said, great story, man.

You obviously, from the beginning, took things into your own hands to get a solution.

So, I’m I’m not misunderstanding, it sounds like you found your original doc though a forum, which, unfortunately, is shut down; however, is there another forum or resource where men discuss these issues and where to find a legit TRT doc, or is this just done purely though old fashioned googling?

Thank you again for sharing all of this. I really appreciate it.

[Youthful55guy]

You might start here: https://www.a4m.com/find-a-doctor.html.

This is a search function for doctors that are a member of the American Academy of Anti-Aging Medicine (A4M). Although this is not how I found my original TRT doc. He is listed in their directory and is a frequent lecturer at their events.

You might also simply post a new string and posting your general location and asking if anyone knows/recommends a knowledgeable TRT doc in your area. This is how I did it and got lucky.

[kelkel]

Do some searching locally on google as well. Then you can simply call some local doctors and ask one of the nurses if the doc will treat you with self-injections, HCG and an AI if needed. They can usually answer that for you to avoid a wasted appointment on both ends. Remember, it does not take a specialist (Uro / Endo) to treat you well regarding TRT. Just a doc that's knowledgeable. It ain't rocket science!

[Grappler13]

I run 200mgTest per week and 150IUHcg eod with no AI. Puts my Test at 1100ng/dL and my sensitive E2 at 40 which is perfect for me. Test is definitely higher than “normal” but I don’t want to be normal and other blood markers check out.

Ideally you should not be using an AI on TRT.


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[Youthful55guy]

I run 200mgTest per week and 150IUHcg eod with no AI. Puts my Test at 1100ng/dL and my sensitive E2 at 40 which is perfect for me. Test is definitely higher than “normal” but I don’t want to be normal and other blood markers check out.

Ideally you should not be using an AI on TRT.

While your dose may seem to be a bit high for the average guy, but you demonstrate a valid point. That is, TRT cannot be done cookbook style. There is no one-size-fits-all protocol. There are suggested starting points (i.e., 100mg/week in divided doses) and some general rules (e.g., your comment regarding AIs). However, as you point indicate, TRT needs to be done with appropriate labs before it is initiated and periodically after implementation of the protocol. Dosing decisions should be made on lab results (Free T in particular) and not be done by "feel". There are just too many compounding medical, social, and psychological factors that influence how we feel.

[Quester]

You may be alright with just Clomid and a multivitamin. Vitamin D deficiency is huge.