My trek through a new life in TRT

[bigboy67]

Hey guys, first time posting, though I lurked for a while for info. I am 29 y/o and was recently diagnosed with low T. For the last 4 years I have gotten progressively more sluggish, blah about life, not excited about anything really. So I finally went to the doc to find out what is going on, and got the following blood test results (I know now I should have gotten more tests for a baseline, but its too late now)

6/17/2011

Total test 216.78 ng/dL
FSH 2.5 mIU/mL
LH 2.7 iu/L
Prolactin Level i 12.8 ng/mL

(also had a full CBC done as well, but too much to post, basically everything was normal, except my LDL was a little high [total cholesterol was fine])

Doc put me on 200mg Test Cyp eow

I was feeling good for a week at a time, then the second week sucked. Started lurking around forums, reading some good info, and then asked for weekly shots instead of eow. Doc said lets get a follow up test done

7/21/2011

Total Testosterone 240.50 ng/dL

(only test done)

Doc then decided to move me to 200mg ew. I did this for about a month, then talked him into letting me do it myself at home, and I split my dose up and starting dosing 100mg Test on Saturday night and then another 100mg on Wednesday afternoon.

This helped me to feel a little less puffy.

[bigboy67]

Now I have started to focus on making sure I get every lined out so I have a nice even protocol. I requested the following labs and had blood drawn today:

DHEAS
Total T
Bioavailable T
Free T
Estradiol (specifically requested the 'sensitive' assay)
LH
FSH
CBC
Lipid profile
SHBG

[bigboy67]

My only real problem is when I brought up hcg to my doc, he kind of rolled his eyes and told me that it is mainly for body builders, lol. I told him I have done a bit of research and it is a pretty standard protocol. He said he will discuss with me after my tests come back. He also says he thinks my Test Cyp dose is too high, but we shall see. I didn't even breach the subject of an AI since I don't even know what my E2 levels are yet so I will wait until I get those results back

I tried my hardest to find a doc that has more experience with TRT, but I live in Portland Oregon, so everybody recommends me going to these fricken naturopathic physicians. I am just afraid they are gonna try to cure me by taking me off Test and making me eat tree roots and shit, honestly, I am not interested. I just wanna get dialed in so I can stop focusing so much of my time on this

[bigboy67]

anybody have any recs for a real doctor in Portland Oregon that is TRT friendly and NOT an anti-aging clinic? I have really great insurance (my Test script comes out to $1 per injection)

and what do you think of my situation? ANy better way to approach my doc about the hcg and Anti-e?

[Jredwine]

I dont understand why docs arent giving hcg for low test. it's probably a good first step befor jumping on TRT. If you could jumpstart your natty test levels with HCG, why wouldnt you want to? I think we both aling in the fact that we both want our t levels on the high side and the rest to be kept in check, but I'd rather do it naturally if possible first. hcg is pricey without insurance covering. About 135 from normal pharma. A compunding pharma can usually get it down to 60-80 bucks. Mine was $65 per vial.

I dont understand it though as hcg is FDA approved for raising low t. I got mine thru bodylogicMD. they definitely get it. Costs about 700 for the lab and first visit and then about 65 bucks every 40 days for hcg, 10 bucks per 10 cc vial of test, and they will give you AI's with no questions asked and more than likely will just give it to you because it's part of their recommended protocol.

Hate to say it, and this will probably change, but Anti Aging clinics seem to have this down much better.

[bigboy67]

Hate to say it, and this will probably change, but Anti Aging clinics seem to have this down much better.

Ya, I could go that route, but thats the whole reason I have like the best insurance in the world, it just doesn't seem to matter since all the docs have their brains stuck in the 50's.

There has got to be a good MD who is a known TRT guy in Portland, I just haven't found him yet. Driving me crazy. If I have to I will just get a legal online script for the hcg and AI until I can find a good TRT doc in Portland.

I refuse to let some old antiquated thought process to control how I feel the rest of my life, its ridiculous.

[sirupate]

Just FYI...you can get HCG and AI's from overseas pharmacy sources without a scrip. Price is generally much less expensive than if bought in the US. I'm sure the "authorities" frown upon this, but also don't make an effort to stop it either. You would be self-treating however. If you can not find a good doctor, this is one option.

edit to add that one of the site sponsors sell AI's too...very reliable vendor.

[bigboy67]

I dont have any moral issues with self treating, but there is another wrinkle in all of this. My employment may be changing in the next few years, and if so I will be shooting for some positions which would require me to testify on polygraph that I have not used any illegal substances in the past so many years (includes steroids and associated protocols), so I have to ensure I have a script and do everythign on the up and up so I can honestly answer the question in the future.

Seems silly, I know, but I would hate to exclude myself from these positions over an AI and hcg

[sirupate]

I dont have any moral issues with self treating, but there is another wrinkle in all of this. My employment may be changing in the next few years, and if so I will be shooting for some positions which would require me to testify on polygraph that I have not used any illegal substances in the past so many years (includes steroids and associated protocols), so I have to ensure I have a script and do everythign on the up and up so I can honestly answer the question in the future.

Seems silly, I know, but I would hate to exclude myself from these positions over an AI and hcg

Not silly at all. It is a shame that steroids were made CIII substances and villified by the media.

[GotNoBlueMilk]

Some people find HCG a good replacement for TRT, but it is not a slam dunk universally. If your leydig cells have lost their ability to produce Test (common cause for low Test levels), all the HCG in the world isn't going to help. HCG only raises Test if your pituitary is not producing enough LH but your leydig cells are functioning fine.

And when HCG does raise Test levels, it does it at a cost, because it also raises progesterone and estrogen in addition to estrogen conversion that occurs from the higher Test levels.

[bigboy67]

Some people find HCG a good replacement for TRT, but it is not a slam dunk universally. If your leydig cells have lost their ability to produce Test (common cause for low Test levels), all the HCG in the world isn't going to help. HCG only raises Test if your pituitary is not producing enough LH but your leydig cells are functioning fine.

And when HCG does raise Test levels, it does it at a cost, because it also raises progesterone and estrogen in addition to estrogen conversion that occurs from the higher Test levels.

Yeah, I definitely am staying on the Test shots, just wanted to add the AI and hcg in there to have a balanced protocol that I can live with long term.

BTW, please feel free to PM me a good MD in Portland that works with TRT so we can avoid anyone getting in trouble with the mods here

[GotNoBlueMilk]

Jredwine: we don't discuss sources. Prices are still up in the air, but seems we don't often get away with that either (depends on which moderator sees it).

[bigboy67]

Another quick question. I always here guys on these forums talking about getting more/less sleep affecting testosterone, getting blood tests at night cuz thats when test levels will be lowest, etc. but wouldnt all of that go away once you starting injecting exogenous test and you shut down the natural test production?

[funkymonk]

Yup. LH sort of "pulses" in the morning IIRC, leading to a peak of natty test. Of course, you're probably shut down by now so I don't see how it would matter. I still go for my bloods first thing in the morning. They're 12 hour fasted since they run liver/lipid panels with my followups.

[bigboy67]

Felt like a slug today in the gym. Basically, because I have been lazy and fat for like the last 4 years, I have been hitting the gym 5-6 days a week, taking a day off when I start to feel run down.

But today, I just felt like I had no energy or strength. My lifts were still good and weights up, but man it felt like a huge struggle for every rep today.

Getting my test results this week, will post as soon as I get the results. Hoping the E2 is in check and my levels are now good.

Really, I was hoping that going from having a TT of 216 to dosing 200mg of Test a week would mean that I would feel really good, but honestly I dont feel like I have gotten that big "boost" yet, and it has been about 3 months

[lvs]

How did you sleep and how much sleep did you get last night. How was/is your diet. Did you have any alcohol last night, many factors can play in to your energy/stamina levels.

[bigboy67]

I slept fine, probably 7 hours. I usually get 7-8.

I had two beers with dinner, but that never would affect me in the past. Is something different now that I am supplementing Test?

My diet is pretty clean now, bout 2400 cals, 45% protein, 35% carb, 20% fat, all clean sources (eggs, little dairy, wheat toast, protein powders/shakes, chicken, rice)

[lvs]

I slept fine, probably 7 hours. I usually get 7-8.

I had two beers with dinner, but that never would affect me in the past. Is something different now that I am supplementing Test?

My diet is pretty clean now, bout 2400 cals, 45% protein, 35% carb, 20% fat, all clean sources (eggs, little dairy, wheat toast, protein powders/shakes, chicken, rice)

Diet and sleep look pretty good to me. Are you on E2 inhibitor? I wonder if your E2 is off the wall?

[bigboy67]

Diet and sleep look pretty good to me. Are you on E2 inhibitor? I wonder if your E2 is off the wall?

I'm not on an E2 inhibitor as of yet, not a real one anyways, I am currently using SNS Inhibit-e (OTC) for whatever that is worth. Once I get my numbers back this week, I will know for sure

[bigboy67]

I found an anti-aging/bioidentical hormone clinic in my hometown that does SubQ Test implants for ~$320 (supposed to last about 3-4 months), interesting option maybe something I will look at if I get sick of the e3D injections. Called my doc today, blood tests not back yet, but they are goign to fax them to me as soon as they get in

[bigboy67]

Got some results back from my latest blood test

DHEA - 2.430 [1.33-7.78] ng/mL
E2 - 112 [<=52] pg/mL
FSH - 0.3 [1.3-19.3] mIU/mL
LH - 0.3 [1.2-8.6] IntUnit/L
Testosterone, Free - 334 [47-244] pg/mL
SHBG - 16 [11-80] nmol/L

Also had a CBC and CMP done as well, everythign was normal except:

HCT - 55.4 [43.5-53.7]

I think this means I need to start doing a monthly blood draw, what do you think?

How about my free test results?

I know my E2 is really high right now, so I am going to call the doc to get put on an AI. not sure why a Total Test number didnt come through on this round of blood tests, I am sure I ordered it.

I am feeling good about the free test numbers and SHBG. I think once my E2 is in order I will feel a whole hell of a lot better. I may even drop myself down to 150mg per week when I run the AI.

Also thinking of running a DHEA/selegiline cream to supplement DHEA.

[bigboy67]

oh, adn just to clarify my current protocol:

200mg Test ew, broken up into two doses of 100mg which I inject every 3.5 days
no AI
no hcg

no other supplements except protein, 5-htp, and milk thistle for my previously high liver numbers

[bigboy67]

Talked to my doc's assistant. Apparently they forgot to add the Total Testosterone test to everythign else, kinda lame since I don't know my total levels.

Doc is supposed to call adn I will find out if he will jsut prescribe me an AI, or if he is going to make me come in for another appt before he will prescribe it.

Think my free test numbers look good?

[bigboy67]

I definitely specified the male "sensitive" assay for my estradiol test, so I think this may explain why I haven't really been feeling that much better. At first I felt great, my I guess my body caught up, haha. With an E2 level of 112, no wonder I feel like shit.

[APIs]

I definitely specified the male "sensitive" assay for my estradiol test, so I think this may explain why I haven't really been feeling that much better. At first I felt great, my I guess my body caught up, haha. With an E2 level of 112, no wonder I feel like shit.

I'm on roughly the same Test dose @ 100 mgs E4D. E2 of 112 is def no good. I take .5mg Anastrazole M, W, F & it keeps my E2 below 20. I've recently gotten below 260 lbs though & I'm thinking my E2 is probably even lower now. No sides experienced yet, but will have to check on my next BW @ end of Oct...

[bigboy67]

I'm on roughly the same Test dose @ 100 mgs E4D. E2 of 112 is def no good. I take .5mg Anastrazole M, W, F & it keeps my E2 below 20. I've recently gotten below 260 lbs though & I'm thinking my E2 is probably even lower now. No sides experienced yet, but will have to check on my next BW @ end of Oct...

What is your Total Test and Free Test numbers on that dosage?

Ya, I am going to haunt my doctor today so I can get the prescription for an AI and start NOW on it before my tits hit my knees, hahaha.

For Arimidex, should I take a frontload sized dose of it first? like take 1 mg M/W/F the first week then back down to .25mg M/W/F after that?

[bigboy67]

I'm on roughly the same Test dose @ 100 mgs E4D. E2 of 112 is def no good. I take .5mg Anastrazole M, W, F & it keeps my E2 below 20. I've recently gotten below 260 lbs though & I'm thinking my E2 is probably even lower now. No sides experienced yet, but will have to check on my next BW @ end of Oct...

what are your Free and Total Test numbers on that dosage?

I am haunting my doc today until he gives me a script for the Adex. Should I frontload by dosing 1 mg M/W/F for the first week and then move down to .25mg M/W/F, just to knock my E2 down right away?

[bigboy67]

I'm on roughly the same Test dose @ 100 mgs E4D. E2 of 112 is def no good. I take .5mg Anastrazole M, W, F & it keeps my E2 below 20. I've recently gotten below 260 lbs though & I'm thinking my E2 is probably even lower now. No sides experienced yet, but will have to check on my next BW @ end of Oct...

what are ur free and total test numbers on that dosing? Should I 'frontload' my first few doses of the AI? Just to get my numbers down initially, then move to .25mg EOD?

[bigboy67]

Test test test, my posts are showing up for some reason, weird

Guess once they release the hold on my account a bunc of the same posts are gonna show up, lol, I can only edit this post for some reason

[bigboy67]

ok, just talked to my doc. he says, "hmmm, your E2 is really high, and your free test numbers are quite high as well. we should back your dose down to 150mg."

I say no prob, 105mg ew it is, now what are we gonna do about my E2 being 112? his answer? "nothing, wait two weeks and let the E2 drop along with your Test numbers. If you have to be put on an AI, then I will have to refer you to a specialist."

so, i am going to wait the aforementioned 2 weeks and get my E2 checked one more time. if he says he is sending me to some kook endo that is gonna give me the run around, I am taking my business to a fricken anti-aging clinic and paying out of pocket.

[bigboy67]

Just made an appt with an anti-aging clinic. have already emailed with this guy and is A4M board certified with full prescription capabilities. In the know, available, and he takes some insurance as well (but even the out of pocket on it isnt really that bad)

[lvs]

Keep us informed on how it goes.

[bigboy67]

xxxxxxxxxx double post xxxxxxxxxxxx

[bigboy67]

Here is the email I got from my new HRT doc, much more along the lines of what I am thinking. I don't necessarily agree with his thoughts on dosage on T yet, but will talk to him about it on Tuesday.

" Here are my thoughts on your situation.


1) 200mg of testosterone cypionate is supra-physiologic and the body will convert the excess testosterone to estrogen. The testicles of a healthy young male produce around 8mg of testosterone per day give or take. Testosterone cypionate is about 70% testosterone. So, a 200mg dose is around 140mg of Testosterone. Divided by seven is 20mg/day. Easily twice what a healthy male produces. Doctors not trained well in anti-aging/HRT medicine don't seem to realize this, and this does not serve their patients well. 100mg weekly of testosterone cypionate is the upper limit of what I use.
There are of course many other things that can raise estradiol. Taking too much DHEA will do it, for example.


2) Dividing the dose to twice weekly makes sense in some patients as the 1/2 life of testosterone cypionate is around 4 days. This helps level out the serum T throughout the week. The main drawback to injectable T is that you get a huge peak then a drop off towards the end of the week. Most guys end up on 30-50mg/twice weekly.


3) HCG. HCG is nice to use if you want to preserve the testicles. Most guys also feel an increased sense of well being while taking HCG. There is HCG done right and HCG done wrong. The body is unable to absorb more than 500 IU of HCG in one day. Any protocol suggesting more than that is not based on human physiology. The HCG protocol developed by Dr. John Crissler is among the more intelligent strategies. http://www.allthingsmale.com/index.html. If doing injectable T once per week, HCG is added as a sub-Q injection on days 5 and 6.


4) I would put you on a more physiologic dose of testosterone, use an AI short term to fix the high Estradiol, with the added HCG and retest your levels in one month. You would add zinc 50mg as a natural AI. Retest in one month. If estrogen is still high, but testo is normal, we would have a discussion about aromatase inhibitors (anastrazole, femara etc.) long term . All rx can be called into the pharmacy of your choice.


5) We will verify your insurance benefit for you. If you have good coverage, we will bill your insurance. Otherwise, we can provide you with the superbill and you can forward that to your insurance carrier. Worst case scenario, your first visit is $150, f/u visits are $80.00. We would need approximately four visits a year the first year and likely less on subsequent years.


6) Other TRT options. Pellets are good option, theoretically, as they mimic the physiology of the body. However they are expensive and require frequent surgical implantation 2-3 times per year. The cost is around $400 per implant which includes all the testosterone. I am not really recommending this to patients under 70 years old, as the cumulative number of surgical interventions falls out of the "do no harm" ethos.

"


By the way, found out my insurance covers consultation with him, just a $20 copay, awesome! And the fact that he mentions Dr. Crisler really gives me hope this time around.

[funkymonk]

Sounds like he knows exactly what he's doing. For what it's worth, 100mg a week (no AI) works wonders for me. Test is @ 800 4 days after injection, and 500 6.99 days after injection.

[bigboy67]

per my new doc's recommendation, I have begun taking Zinc. Supposed to take 50mg a day, but I went ahead with 100mg yesterday and 100mg today. probably just placebo effect since it couldn't have had enough time to get into my blood enough to drop my E2 down, but i felt super strong today, not sure why.

could just be my estrogen swinging around and today happened to be a good day, who knows.

[funkymonk]

Everything I've read about Zinc says that it's useless unless you're deficient. I'm interested to see if it affects you.

[bigboy67]

saw my new doc today, he was awesome. bottom line:

Over the next five weeks i am goign to back down my dose from 200mg ew to 80 mg ew, in addition to .25 mg of arimidex eod for five weeks as well. Then I am going in for a follow up and labs. at which point we will introduce 250iu hcg e3d, wait a month, and then retest all my levels again and see where i am. also putting me on some vitamins, yadda yadda, the norm

[funkymonk]

I would injure someone for a regimen that perfect.

[bigboy67]

I would injure someone for a regimen that perfect.

ya, and covered by insurance no less, which I thought was a myth nowadays.