Help with HRT Protocol from Clinic...

[rammanftw]

Finally managed to find a place listening to concerns over testicular atrophy, ache, health etc. Unfortunately it was a clinic and felt a bit like a candy store... Was hoping you guys could shed some light on their protocol and see if it needs some more tweaking to be closer to the norm or if i should follow as directed...

Most recent lab work: Pre-t shows blood work done the day I started HRT before Tx with Test-Cyp 200mg IM E14D/2 weeks and Nadir which shows my Nadir point taken 4weeks after starting Test on my last day before my third shot which subsequently caused my urologist to increase my dose to Test-Cyp 200mg IM E10D. After the change in does I began taking 120mg every 6 days since that works conveniently with my work schedule and split the does into two smaller does...

Pret initial labs: 4/24/12

Total Test: 326 (250-1100) ng/dL
Free Test: 70.7 (35.0-155.0) pg/mL
LH: 3.2 (1.5-9.3) mIU/mL
FSH: 4.3 (1.4-18.1) mIU/mL
Estradiol: 18 (11.0-44.0) pg/mL
Progesterone: 0.65 (range missing) ng/mL
Prolactin: 4.6 (2.1-17.7) ng/mL

Nadir Labs: 5/23/12

Total Test: 322 (348-1197) ng/dL
Free Test: 9.2 (8.7-25.1) pg/mL
LH: 0.1 (1.7-8.6) mIU/mL
Estradiol: 24 (3-70) pg/mL
Progesterone: 0.7 (0.2-1.4) ng/mL

After seeing this labwork as well as some other older lab work regarding thryroid hormones and trending they prescribed me with:

300 mg test cyp every friday

250 IU HCG every wed and thurs

0.5 mg anastrazole saturday and wednesday

Progesterone 100mg nightly for sleep due to low progesterone

and changed my hypothyroid medication from 75mcg synthroid every day to Amour thyroid 60mg BID.

On the surface seems great, they prescribed everything I could hope for and dug through old lab work and addressed my thyroid issue which I had wanted to change as well as progesterone which I wasn't even aware of. That being said am I wrong in feeling that 300 mg a week is way too high?

Dr. mentioned increasing my dose from their standard 200mg weekly to 300mg since my nadir point was so low after test therapy started and I was on too low of a dose for therapeutic benefits.

Any help would be greatly appreciated as well as possible suggestions for working this regimen out on an more shift friendly schedule. I work 24 on and 48 off and injecting on shift days are something i'd like to avoid if possible.

Would this schedule sound more feasible?

Day 1: 100mg Test Cyp
Day 2: 0.5 mg AI
Day 3: 125 iu HCG

repeat...

Thanks in advance!

[HRTstudent]

I agree, 300mg is far beyond physiologic TRT. That's what you get with some clinics.

Blood work will show you what dose is best for you, but most exprts in the field cut off TRT at 200mg per week. After that, its no longer a T problem.

[rammanftw]

I agree, 300mg is far beyond physiologic TRT. That's what you get with some clinics.

Blood work will show you what dose is best for you, but most exprts in the field cut off TRT at 200mg per week. After that, its no longer a T problem.

That was my thinking.. Was planning on reducing it to 200, but I'm beginning to question if that's even too high to start. Same thing with HCG dose.. I guess the only thing I can do is start somewhere and let the blood work do the rest...

[HRTstudent]

I know of no legit docs who start at the highest dose and titrate down.

I believe Dr Crisler now starts at 80mg per week.

I feel 100mg is a good starting point though. Once or split into twice a week.

[kelkel]

These labs below. Am I correct in reading that they were taken about two weeks after injecting 200mg or am I confused. If that is the case then no wonder they are low as it's a half-life issue of T.

Nadir Labs: 5/23/12

Total Test: 322 (348-1197) ng/dL
Free Test: 9.2 (8.7-25.1) pg/mL
LH: 0.1 (1.7-8.6) mIU/mL
Estradiol: 24 (3-70) pg/mL
Progesterone: 0.7 (0.2-1.4) ng/mL

Remember, the more a clinic sells the more money they make....If my assumption is wrong then I concur with HRT.

And welcome to the forum!

[rammanftw]

I know of no legit docs who start at the highest dose and titrate down.

I believe Dr Crisler now starts at 80mg per week.

I feel 100mg is a good starting point though. Once or split into twice a week.

There in lies the rub. I figured and had hear 100 mg a week was a good place to start as well. Before visiting this clinic i was doing 120 E6D because I got tired of listening to the idiot urologist who wanted me doing 200 E10D. Based on how I feel that does was fine, blood work is the key to knowing where I'm at level wise though I suppose...

[rammanftw]

These labs below. Am I correct in reading that they were taken about two weeks after injecting 200mg or am I confused. If that is the case then no wonder they are low as it's a half-life issue of T.

Nadir Labs: 5/23/12

Total Test: 322 (348-1197) ng/dL
Free Test: 9.2 (8.7-25.1) pg/mL
LH: 0.1 (1.7-8.6) mIU/mL
Estradiol: 24 (3-70) pg/mL
Progesterone: 0.7 (0.2-1.4) ng/mL

Remember, the more a clinic sells the more money they make....If my assumption is wrong then I concur with HRT.

And welcome to the forum!

You are correct which was why I was so confused as to why they placed any standing whatsoever in the Nadir point blood work of a chemical who's half life is way under the 13 day span from injection to BW. But what do I know right? I don't have a white coat..

Thanks for the welcome, I appreciate it and all the advice! Trying to navigate through this while educating providers is a less than desirable way to approach health care, but every bit of support and advice helps! I am obviously not going for the 300mg a week route and paying for all those extra rounds of golf haha!

[kelkel]

Good luck ramman. Let us know how it works out for you!

[HRTstudent]

You'd be suprised how little most white coats actually know about male TRT. That's why I stress so much on finding the right doctor.

[rammanftw]

You'd be suprised how little most white coats actually know about male TRT. That's why I stress so much on finding the right doctor.

The more i research the less I'm surprised at all. How sad is that haha?