HRT pre-newbie

[fjr02]

I go in for the start of my HRT tomorrow.
Two weeks ago, I went in for a consult with an HRT Doc with symptoms and a 2 week old BW from my annual physical.
From that BW, my Total T was 291 and the nurse told me over the phone that my free T was 49. I'm not sure the free T value makes sense.

My normal MD told me that 291 was fine, and I didn't want to begin HRT. He said it was called "getting old" I am 49, lift, and am in shape.

Anyway, on my consult with the HRT doc two weeks ago, he said based on the paperwork I brought and my symptoms, he'd go ahead and give me a 300mg cyp jump start then told me to come back and see him in two weeks. At that visit he also took blood for a more complete hormonal BW. At that visit I had many questions for him (questions based on info I have read here). At that time, he told me my protocol cyp would once or twice per week. He lets me pin myself.

I go see him tomorrow , go over the new BW, and presumably begin treatment.

Here are a few comments he made on initial consult that raised an eyebrow.

(1) He told me that he felt that only Estradiol values above 50 were high and would prescribe an AI only over that number. Perhaps when the time comes, if I have symptoms, and a value below 50, he'll deal with it. But I hate to wait until there is a perceived problem. I stopped cycling in '86 and had my gyno surgically removed in '94. Back then, I never took an AI, and enjoyed deca. So I do have a history of gyno with no AI. Is 50 a bit high for a high range cut-off for normal?

(2) I said I was concerned with atrophy, He told me that since I already had kids, I didn't need HCG. Shall I bring up the HCG subject again?

(3) He said he was not concerned with DHT levels - I said "I WAS" - I have a full head of hair. ok I'm vain. Do the natural DHT control products work (zinc, saw palmetto, etc)? The script anti-hair loss products sound very scary.

I'll post tomorrow - with my starting BW and initial protocol

thanks!!

[flatscat]

Congrat's - take it one day at a time - it is only my opinion that for now, until any symptoms pop up, I agree with your doc on the E2, at least he is willing to run labs and has a threshold based on his experiences with his patients.

Sounds like you might be able to talk him into hcg if you so choose.

I gave up trying to stop the hair loss - again in my opinion it is like a lot of things - either you are prone to it at normal levels of t or you are not. Almost everything prescribed to prevent it will effect your hrt outcome in one way or another. RX Nizoral shampoo is about as strong as I go and it ain't stopping shiat.

When will your first follow up labs be?

Best of luck to you!

[JAMIE07652]

Good luck in your journey bro...

[Vettester]

Well, I'm not fully agreeing here with your doctor ...

He only administers AI when the E2 gets over 50? Not good IMO. Most males will find a good balance and well being somewhere between 20 and 40. It doesn't take much AI (sometimes none) to achieve this. Being that you had gyno issues when you were younger, you will obviously have the disposition for aromatization. I've been in the 40's before and started having libido issues. I think as a patient, you should get more say in this matter.

His position on HCG just throws me in a tail spin. This tells me that he is not overly experienced with administering effective HRT protocols. HCG isn't for the fertility thing. In fact, HCG mimics the LH analogue, but not the FSH analogue, which is the hormone mostly responsible for spermatogenesis. Anyways ... HCG, as you know, will simply provide testicular health benefits (when secondary), and it will keep atrophy from setting in.

Your concerns on DHT are also valid. Not sure how old you are, but if you have a full head of hair, there's also a good chance that you won't have any sides related to DHT. In my case, it's like I started growing more hair. So, I can't comment on what to do or take if hair loss becomes a problem, but again, as a patient, it should be your prerogative to review this and other panels. Your relation with your doctor needs to be a partnership, not a 1 way door that swings his way ... Just my .02

[flatscat]

fjr, your health, your body - do your research. You had gyno when you cycled in the eighties with no AI. No telling what your t levels were then - and prolactin especially if you were doing the deca thing. 50 is still in the normal range - but he said he would treat if symptoms arise below 50. Guess this is all mute until we see where your baseline E2 number is. Gyno at 50 is highly unlikely, but I think what vette is saying is if you may have a tendency to convert t to e. So you may ask your doc to prescribe an ai so you will have it on hand.

Your Doc is not as bad as many we see here - so I think if you go in and have your ducks in a row you could come out of there with an rx for the ai and hcg as well.

[fjr02]

Thanks guys.

I'm 49 and still have decent hair on my head.

Yes, it's my body for which I ultimately in control. I just don't want to be that demanding and pushy patient this early in the Dr.-Patient relationship. A sure-fire ticket to the exit door for me. I'll just tastefully feel him out on these few issues. He seems like a realist that should understand that these "good/bad" lines are not lines but really more like paint roller fat marks.

I went and had a preemptive consult with a dermatologist regarding acne related to the treatment today, just to discuss options and the up-to-date cleansing methods, etc. I got "cycle" acne in the 80's as well. But my T & e2 levels had to be on a "worlds o' fun" roller coaster ride. That coupled with a non-thorough skin cleansing program had to have made it worse that it will be here.

While I was there, I also asked him if he "did" hair also. He told me to begin rogain foam & biotin. He said the saw palmetto & Johns wart? stuff should be avoided.

There is no telling what my T & e2 levels back then. Our college lifting mantra was "If your liver doesn't quiver and your bladder doesn't splatter, up the dosage 'cause it really doesn't matter." It certainly was nice to be bullet-proof and invincible back then.

What do you guys think for follow-up labs? (4 or 6 weeks)?

[kelkel]

Agree with the above guys. It would be great to get a baseline DHT level though. And as stated, just because your DHT elevates it does not always mean your hair is going to fall out. If it does elevate a bit within the normal range and doesn't effect your hair, so be it. Most people are not aware that DHT is also a natural estrogen antagonist. Remember a lot of the Rogain type treatments come with a variety of side effects also. Google them.

[fjr02]

kelkel,

I just read the sides on rogaine. I think I will wait until I get settled into a TRT protocol before starting this. Too many new things at once could make it difficult to determine which sides are coming from what. But I don't want to wait until I have clumps falling out.

I'll add one product at a time as necessary - trying to keep this TRT to as few products as possible.
Most likely the goal of everyone here.

thanks.

[kelkel]

Good move. Keep us posted on THIS thread!

Good luck!

[doc w]

I would be hesitant to start dht blocker such as proscar or dutasteride( esp this one). I started it before my TRT thinking I had some prostate issues. I gained about ten pounds and started getting moobs as well as abdominal fat. It has a extremely long half life and takes months to leave your system. I also has gyno issues from one cycle of deca in the early 90's. I had surgery in 2005. I would be concerned about higher estrogen than anything. Newer studies point to estrogen as sensitizing the dht receptor to cause increased prostate volume as well as hair loss. If he won't give you AI maybe try zinc at 50 mg per day. Several good studies on medline show that it can prevent aromitization.

[fjr02]

Thanks Doc

My multi has 50mg of zing as well as some copper.

I'll carefully bring up the estrogen concern during my appt this afternoon. I am curious about my existing e2 levels. I'll find out in 5 hours. I don't want to be pushy with this new doc, so I'll just reiterate my general concern for estrogen given my gyno past. I'm not sure how I can nudge him from that 20-50 estradiol number being "ok" if need be.

From all I've read it sounds like 30 is a generic e2 target to keep in mind. Of course symptoms also play into the need or lack thereof for an AI. IF when the time comes I feel I need it and he won't budge, are there "no script required" places out there that are as safe as what I would get under a script at Walgreens?

DHT - On my consult, when I brought up DHT and hair loss. He said "I am not concerned with DHT". Does anyone have any comments to that?

As always - thanks in advance

[kelkel]

Yes. He does not understand DHT so he's dismissive of it. Your on the right track. Keep doing your research.

[ecdysone]

I'd be a little careful second-guessing a guy who's willing to front-load your test therapy. He sounds a bit aggressive so hopefully he understands the consequences of such an approach. I tend to be a bit more conservative than many of the guys around here, for example, I think 50 is fine for an upper (but not a drop more!) E2 range and whether HCG should be used depends on your individual reaction to TRT - might be you don't need it. Injecting multiple substances into your body is to be avoided whenever possible IMO.

[doc w]

Sometimes lower is also worse, I run around low 20's and tend to get a little achy with new workout routine( hit 40 so maybe I'm just getting older). Ur immune system does not function well with lower estrogen levels

[Vettester]

DHT - On my consult, when I brought up DHT and hair loss. He said "I am not concerned with DHT". Does anyone have any comments to that?

As always - thanks in advance

Yes, at the bottom paragraph of post #4, I made a comment.

[fjr02]

As I brought home a bunch of "stuff" today, I am no longer a Pre-newbie.
I am a newbie.

We reviewed my BW from two weeks ago (taken an 3pm)
Total T = 391
Free T = 40
Estrodiol = 17
SBHG = 40
Cholesterol = 147 ( I am on simvastation)
My BW from 4 weeks ago (taken at 10am after a fast) had me at 291/49. Wierd

I am 49, 5'-8", 170 lb

Fast forward to today.
The Doc said with a 391 I was a marginal candidate by some standards. For him I was still a candidate as based on his criteria. My free T was low, considering the SBHG & Total T values.

We talked about testicular atrophy. I played the dumb guy that just happened to ask all the right questions (thanks to this forum). He said, at your levels we can try a straight HCG (only) TRT and see how that works - he said I could get to a total T of 500 maybe a 550 tops with that. I asked him if I would get the mental clarity that I got from the 300mg cyp I got from him 2 weeks ago. The answer was most likely not. He said - we could do both.
I agreed. I have BW in 4 weeks to asses the result of the protocol he has set me up on.

The protocol
100mg cyp 2 times per week (200mg per week total) & 500units of HCG 3 times per week (mon/wed/fri).
I know that the cyp sounds aggressive. Does the HCG dose also seem high?

If I use this protocol, I'll assume my T will greatly increase and we'll adjust in 4 weeks. As I was refreshing myself on the procedures of a quad shot, and learning how to mix HCG, he stuck his head in the door and said "If you take more than I have prescribed, you are off the program". When he closed the door, I told the nurse - that will not be a problem, if anything I'll take less. And of course she said - No take what he told you to take.

I am going to cut my 40mg/day statin for cholesterol to 20mg/day and check it in one month. With a 147, I'd like to take as little of that as I can.

Oh yeah, and I gave myself a 300mg pin in the office under their supervision as the start.

Well, that's my update for you.

Let me know what you think about the protocol. I think we can assume that it will change if the BW indicates that it should.
I also have questions on the timing of the HCG injections as compared to the cyp injections.

[kelkel]

Yes. It does seem aggressive to start. But it seems more and more common to see 200mg per week which surprises me as with other meds they would never start high, always low and titrate up. With twice a week injections I would just stick to the m-w-f HCG protocol. Keep it simple. One injection it would be different. Stick with it and adjust with your BW. Have you considered a non-statin for cholesterol? Good Luck Fjr!

[fjr02]

Thanks kel
Will do.
Also keeping on his protocol will keep the Dr-patient relationship in on a positive track.
I can handle it for one month.

Statins - No I've never really looked into anything else.
I assume my normal anti-TRT doc gets a golf vacation out of the pharm company. He's an ok guy so I'm good with that.
A year ago I was at a 230. Then I began eating 1 cup of brown rice (with a can of chicken) for lunch each day.
I started that for some good carbs. I've made no other change and my cholesterol dropped to 147. geeez
I had no idea.

What else is there out there besides the statin family?

[Vettester]

IMO, if you CUT it in half, you would have a GREAT protocol. Bet you a protein shake that your total test will be 1,200 + when you do your follow up labs. Everyone metabolizes differently, so maybe it won't, just going off of reviewing hundreds of other members protocols over the past few years.

To boot, if you could get your SHBG down, you would have more free testosterone, which is really where you get your bang for the buck when looking at the big picture. 2% to 3% is a good place to be, and increasing that will mean that your total serum has to be overly high to achieve optimal well being.

Keep us posted, I'm looking forward to seeing how you progress.

[fjr02]

vette

I slept on what you said ("...cut it in half...")
Actually - Superpump 250 kept me up a bit from a late night workout.

I am seriously thinking of cutting by 40%.

I don't see the harm. Say I cut my dose down right now, the possible scenarios in 4 weeks will be:
(1) my BW looks good, and the Doc says "ok looks good, let's continue". Then I just bank cyp & HCG (if not mixed).
(2) The BW looks low, I say let's keep it where it is for another month and see what the numbers look like then", then I can slightly increase the dosage.
(3) The BW looks high, so he prescribes less, and I cut down from where I am now - so I potentially still have some to bank.

So I propose an adjustment downward to:
(1) cyp: from 100mg twice per week to 60mg twice per week
(2) HCG: from 500 units 3 times per week to 300 units 3 times per week.

A 40% reduction in dose.

I am due my first HCG dose tonight, so if I could hear back from you guys before late PM today that would be very helpful

I want to say thank you to everyone on this forum, the wealth of combined knowledge is invaluable. This forum has put me in a superior position to understand the ins & outs of TRT.
It's hard to believe that some guys are like the bummed out TV guy that has his happy shadow man behind him dancing the night away and are content to blindly do what they are told from their docs.

[kelkel]

Not a bad plan as long as your doc doesn't find out. I don't really know how he would for that matter. My doc writes me 200mg per week while he knows I only do 120. Gives me some wiggle room so I'm not micro-managed or at a pharmacies mercy, etc. It's a trust thing. Regarding HCG most seem to do 250 units per injection but it does vary. I do mine m-w-f also. You've educated yourself well and are on the right path. Be sure to stick around!

[fjr02]

Thanks!!,
Yes, I agree how would he know.

I think I've covered the different 4 week from now BW scenarios well. My Doc was concerned about "over-use".
If my T comes in low, I'll say I've had to work tons, very little sleep (pretty much read up on the stuff that naturally suppresses T.
Besides I think this early in the program, it's too early for him to make that kind of "under-use" assessment.

I'm sticking around - not going anywhere, to me TRT is big deal and a serious venture. The hormones are a balancing act and one needs to be informed and up to date.

Thanks again guys.

I do have some questions about traveling with HCG, but that'll be a different post.

[Vettester]

If anything, I'm pleased that the conversation here is allowing you to put some careful thought into what direction you go with this. I'm of the same mindset as Kelkel on this, that you will have that wiggle room to work with. IMO, you can't do harm with going lower, but the exact opposite can be said with going higher. If you cut it down by 40% as indicated, I would be very shocked if you don't come in around 600 - 800.

If if doesn't play out that way, then of course you have the extra room to buildup to the level that suits you. However, I think you will see some great benefits, you won't be getting hit with sides nearly as bad (depending on what sides you will have a disposition to), and you might have some extra on hand if it was ever needed. If you suddenly found out that your doctor closed up, it's good to know that you don't have to go into panic mode during the transition to find someone else that you feel can administer HRT to you as effectively. Could be other scenarios too ...

[fjr02]

Vette,
Regarding banking unused cyp for future unforeseen circumstances - that is exactly my goal.
Worst case: To have enough on hand to able to very slowly wean myself off, in case the supply went away for whatever reason (in the "other scenarios" category).
We are on the same page.
I assume that unopened depot cyp kept at room temp in the box has a pretty long shelf life.

[Vettester]

Just keep it in a dark place (cupboard, drawer, etc.) and it will be fine. I rotate mine as I get it, and have used cyp that is 1 year old, no problems.

Nothing wrong with a little surplus ... We do it with food, some with ammo, and I wish I had a silo filled with gasoline when it was $2.00 per gallon, as it would be great to have now. Unfortunately, if you ever have to "wean off" of it, you will just be weaning off to a state of complete suppression. Your 291 total serum will likely tank down into the 100's, if not lower, when and if you ever stop taking it. Hopefully, if a crisis hits, you will be able to have plenty of time to just get a new program lined up without worries of the clock ticking.

[fjr02]

I started my normal 60mg bi-weekly dose this morning along with 250IU of HCG (every three days).
Prior to that, for whatever reason the same doc hit me with 300mg of cyp two weeks ago, then another 300mg on Thursday (last week).
I already have breast tenderness (and a small lump). It is in the lower outer pec not directly on the nipple. I had gyno removed about 18 years ago from previous cycling.
As of two weeks ago (before the first shot) my E2 was around 17.
I'm really surprised it has hit me this fast. Now that I am on a lower regular dose, will this reduce in size or sensitivity?

I guess the question is:
Do I need to give this a month (under this lower dose) until my next BW and see if it "calms down"?
Do I need to go in for an appt now?

A bigger picture question - if I am already dealing with these sides...and decide to step out of TRT after one month of 120mg/week and 750IU of HCG per week how bad have I hosed my normal production levels.
I was right on the line for treatment. My free T was a little low when plotted on his SHBG, Free T, Total T chart.

IF I could be treated with HCG alone, would this be the smart long term play - or would I be opening myself up for a new and different set of sides?

[fjr02]

I deleted this post.....

[steroid.com 1]

I started my normal 60mg bi-weekly dose this morning along with 250IU of HCG (every three days).
Prior to that, for whatever reason the same doc hit me with 300mg of cyp two weeks ago, then another 300mg on Thursday (last week).
I already have breast tenderness (and a small lump). It is in the lower outer pec not directly on the nipple. I had gyno removed about 18 years ago from previous cycling.
As of two weeks ago (before the first shot) my E2 was around 17.
I'm really surprised it has hit me this fast. Now that I am on a lower regular dose, will this reduce in size or sensitivity?

I guess the question is:
Do I need to give this a month (under this lower dose) until my next BW and see if it "calms down"?
Do I need to go in for an appt now?

A bigger picture question - if I am already dealing with these sides...and decide to step out of TRT after one month of 120mg/week and 750IU of HCG per week how bad have I hosed my normal production levels.
I was right on the line for treatment. My free T was a little low when plotted on his SHBG, Free T, Total T chart.

IF I could be treated with HCG alone, would this be the smart long term play - or would I be opening myself up for a new and different set of sides?

I just read through this thread and it's one of the better across all fronts.

All time reading this I kept thinking of was elevated E2.

Now, on start-up protocols some Docs in the know will hold off on AI's til first round of BW (usually 6 weeks from start-up). This is not a bad thing...however, other Docs start out with an AI in some rational ratio to the Test and hCG dosages knowing that the likelyhood of elevated E2 is high.

You have history of gyno and you are seeing neg sides now as well.

You can get your own E2 tested to see where you are at or just call you Doc and provide details of your symptoms and how they are consistent with elevated E2. He may just go ahead and write you a script over the phone for you to pick up at the pharmacy.

In either case, nip this in the bud; remember, if you are aromatizing it's converting your Testosterone into E2 so you're getting less of what you really need and more of what you don't want.

Get BW done, it never lies!

[kelkel]

I just read through this thread and it's one of the better across all fronts.

All time reading this I kept thinking of was elevated E2.

Now, on start-up protocols some Docs in the know will hold off on AI's til first round of BW (usually 6 weeks from start-up). This is not a bad thing...however, other Docs start out with an AI in some rational ratio to the Test and hCG dosages knowing that the likelyhood of elevated E2 is high.

You have history of gyno and you are seeing neg sides now as well.

You can get your own E2 tested to see where you are at or just call you Doc and provide details of your symptoms and how they are consistent with elevated E2. He may just go ahead and write you a script over the phone for you to pick up at the pharmacy.

In either case, nip this in the bud; remember, if you are aromatizing it's converting your Testosterone into E2 so you're getting less of what you really need and more of what you don't want.

Get BW done, it never lies!

GD, humor. Nice!

[fjr02]

Nip it in the bud, apparently I am slow, yes that was well put.

Aromatizing symptoms with low e2

As a followup question, we've all agreed that my aromatization sides came from my two 300mg Dr given jump starts.
So to prevent you from having to read this entire post, here's the bottom line intro to the question...

(a) 1994, I have gyno removed from previous gear usage in the 1980's
(b) April 20, 2012 - I see the TRT Dr, he draws blood and based on symptoms, gives me a 300mg cyp poke
(c) March 01, 2012 - we go over BW, yes my T & free T are low, but not crazy low, my e2 is 17. As a lovely parting gift (game show jargon) I receive a script for cyp & HCG and get another 300mg injection in the office.
(d) March 03, 2012 - I notice a lump in my lower left pec, and both pecs are sore near the nipple area.
(e) March 04, 2012 - my normal TRT has begun 60mg cyp x 2 per week, 250IU hcg x 3 per week

Perhaps I've set a new TRT record. "Aromatazing sides present one day before TRT program begins"
I am going to call the Doc this morning.

My last BW showed e2 of 17, yet I have sides that would suggest requiring AI. And therein lies the catch 22.

So now the questions.
(1) Should I only request BW now and no AI as my last e2 value was already below normal? I would think AI now, even though the sides would suggest a requirement, would be premature given my previous value. Could my e2 have skyrocketed to the point that numerically on new BW, I would need an AI?
(2) Are the lump(s) here to stay? Or as my big 300mg 'gifts' have ceased, will the 60mg dose allow them to shrink?
(3) When I call what would you think the logical response for an experienced TRT Dr. be? It's always beneficial to know the reasonable and most correct answer before it is even asked.
(5) Should I pause my TRT until I get a handle on this?

thanks as always

[steroid.com 1]

I am confused by your time line?

You go from 1994 to April then to March?

You then say "Aromatazing sides present one day before TRT program begins"...well your TRT program began when your Doc blasted you twice with two 300 mg injections which can and will cause big spikes in serum levels and increased E2 levels as a result and thus your nipple issues.

I like your weekly protocol and that will help to smooth things out but you need to get E2 tested as some point.

So now the questions.
(1) Should I only request BW now and no AI as my last e2 value was already below normal? I would think AI now, even though the sides would suggest a requirement, would be premature given my previous value. Could my e2 have skyrocketed to the point that numerically on new BW, I would need an AI?
Wait 6 weeks and get tested. This will be enough time to see what your protocol is doing to you. Keep an eye for other elevated E2 symptoms in the mean time.

(2) Are the lump(s) here to stay? Or as my big 300mg 'gifts' have ceased, will the 60mg dose allow them to shrink?
The small lumps may go away over time but if they are E2 related they may be there for good.

(3) When I call what would you think the logical response for an experienced TRT Dr. be? It's always beneficial to know the reasonable and most correct answer before it is even asked.
What are you asking here?

(5) Should I pause my TRT until I get a handle on this?
No! Run your protocol for 6 weeks as prescribed and get tested!!!

[fjr02]

GD

Timeline
Yes I would be confused by my timeline as well.
The 1994 was listed the last related "chest event".
The April 2012 should be February 2012 - sorry about that.

Actions
I called the Doc, he wants to do BW today, no harm in that. We'll see what he says today if I see him (might just be the nurse).
Lump status - there for good, that's unfortunate - I guess time will tell, perhaps as the dosages have decreased and have become much more regular, they will not enlarge.
My intent regarding the question about the Doc's response was - what would be a responsible Dr. response to my situation. A mad dash for an AI or BW. The BW is today.
I'll stick to the protocol.

Thanks for the help and advice.
If the doc gives me any interesting info, I'll post.

[steroid.com 1]

If you received 300 mg of Test on March 1st your panles will not be where you live.

Half life of Test is about 7 days on average so you're going to present with elevated Test levels.

E2 will be effected as well.

Honestly, it's best to get tested in 6 weeks after you settle down and become more stable...just my $0.02.

[fjr02]

I spoke with the doc.

He said continue with the HCG, but skip this Thursday's cyp dose and do BW on Monday (12March).
That'll be 11 days after the 300mg, and 7 days after the 60mg dose.

I'll post after next Monday's BW comes back.

[steroid.com 1]

I spoke with the doc.

He said continue with the HCG, but skip this Thursday's cyp dose and do BW on Monday (12March).
That'll be 11 days after the 300mg, and 7 days after the 60mg dose.

I'll post after next Monday's BW comes back.

That's better but not ideal.

You'll be bottoming out so you're going to get a lower reading.

At this point, (considering both of the 300 mg blasts) it would have been better to just stick with your protocol and test 6 weeks later as that's where you're going to live any way.

Monday's BW is not where you live so what's the point?

Post your numbers with ranges when you get em!

[fjr02]

-gd-

I'm just keeping the Doc happy on this one.
I'll post any information that I get.

[fjr02]

Guys,

Gyno-like symptoms questions.

(1) Now that I have one lump in each pec from the two 300mg cyp blasts from my doc, are they a permanent souvenir (other than surgery)?
(2) Does 250IU HCG M/W/F contribute to e2 conversion and therefore perpetuate or exacerbate this potential on-going issue?
(3) If I get a script for AI from the Doc, will that remove the nipple area tenderness?
(4) Will an AI do anything to reduce what I have now, or only deal with the e2 conversion going forward.

thanks again