37 y/o contemplating TRT, pls help him

[kelkel]

Well, if all potential causative factors are ruled out then replacement would be a viable option for you.
HCG does not replace LH, it mimics it. HCG Mono is actually a little used form of TRT which over time is suppressive to endogenous T production.
HCG "should" be a part of any replacement protocol. If your doc doesn't know this it may be time to find another one.
Starting with 40-50mgs cyp/enth X 2 pw would be great. Again, assuming you have a doc in the know who understands hormones, but they're few and far between.

Before you see this doc it may be prudent to call his office and ask one of his staff if he treats TRT patients how you desire to be treated. Such as self-injections, HCG, adex if needed, etc. His staff should be able to answer this so as not to waste your time or theirs with an uneccessary appointment. You also want to know that you'll be treated based on how you feel, not as a number on a chart.

Update this thread with how things go please! Welcome to the Forum.

[Ephemeral]

Well, if all potential causative factors are ruled out then replacement would be a viable option for you.
HCG does not replace LH, it mimics it. HCG Mono is actually a little used form of TRT which over time is suppressive to endogenous T production.
HCG "should" be a part of any replacement protocol. If your doc doesn't know this it may be time to find another one.
Starting with 40-50mgs cyp/enth X 2 pw would be great. Again, assuming you have a doc in the know who understands hormones, but they're few and far between.

Before you see this doc it may be prudent to call his office and ask one of his staff if he treats TRT patients how you desire to be treated. Such as self-injections, HCG, adex if needed, etc. His staff should be able to answer this so as not to waste your time or theirs with an uneccessary appointment. You also want to know that you'll be treated based on how you feel, not as a number on a chart.

Update this thread with how things go please! Welcome to the Forum.

Is HCG suppressive by lowering the natural LH over time, or by some other mechanism?
The doc seems to be decent, he knows about HCG, adex, clomid etc. TRT is one of his main things. Unfortunately I live in a small country where my choices both in docs and labs are quite limited. The only form of T that u can legally buy here is Nebido (which is cool but not when u're trying to dial things in), if u can believe that, everything else needs to be imported.

Thanks man!

[Youthful55guy]

Is HCG suppressive by lowering the natural LH over time, or by some other mechanism?
The doc seems to be decent, he knows about HCG, adex, clomid etc. TRT is one of his main things. Unfortunately I live in a small country where my choices both in docs and labs are quite limited. The only form of T that u can legally buy here is Nebido (which is cool but not when u're trying to dial things in), if u can believe that, everything else needs to be imported.

Thanks man!

HCG is suppressive because it stimulates T production, which then feeds back negatively on the hypothalamus for decreased GnRH, and thus decreased LH/FSH. Bottom line is that HCG monotherapy does not work because you have to take a boatload of it and that gets really expensive. Don't go there.

If your doc understands HCG, adex, clomid etc., I would suspect he pretty much knows what he's doing and will get you on a good protocol. If given the choice of Clomid monotherapy and TRT, I'd skip the clomid and go straight to TRT. Clomid monotherapy is another protocol that just does not work well. Clomid has too many side-effects that mimic Low T.

If Nebido is all you can legally obtain, then I guess the decision is made for you. Personally, I have no desire to switch to the long lasting ester. I think they are still learning how to administer it, but it's certainly better than some of the old school barbaric weekly or bi-weekly protocols with T-cyp I still see guys being prescribed. I'm a big supporter of E3D 40-50 mg T-cyp or T-eth. I like it better than 2X per week because the shots are spaced evenly, so it doesn't matter which shot you time your labs to. With the 2X protocol, you have to pick one time interval and stick with it to compare results.

Finally, at your age, I'd be wanting to get a better understanding of why your T is on the slide.

[Ephemeral]

HCG is suppressive because it stimulates T production, which then feeds back negatively on the hypothalamus for decreased GnRH, and thus decreased LH/FSH. Bottom line is that HCG monotherapy does not work because you have to take a boatload of it and that gets really expensive. Don't go there.

If your doc understands HCG, adex, clomid etc., I would suspect he pretty much knows what he's doing and will get you on a good protocol. If given the choice of Clomid monotherapy and TRT, I'd skip the clomid and go straight to TRT. Clomid monotherapy is another protocol that just does not work well. Clomid has too many side-effects that mimic Low T.

If Nebido is all you can legally obtain, then I guess the decision is made for you. Personally, I have no desire to switch to the long lasting ester. I think they are still learning how to administer it, but it's certainly better than some of the old school barbaric weekly or bi-weekly protocols with T-cyp I still see guys being prescribed. I'm a big supporter of E3D 40-50 mg T-cyp or T-eth. I like it better than 2X per week because the shots are spaced evenly, so it doesn't matter which shot you time your labs to. With the 2X protocol, you have to pick one time interval and stick with it to compare results.

Finally, at your age, I'd be wanting to get a better understanding of why your T is on the slide.

Thanks for your reply! Yeah the negative feedback thing makes sense. Hopefully I'll be able to import cyp, we'll see. I looked at graphs about T levels after taking Nebido, it gets somewhat smooth after like 6 months, but I was not convinced at all.
Any ideas about how I could understand the reason behind my low T? I'm sure the doc will have something to say about it, but the more ideas I hear the better. The lowish LH points to secondary hypogonadism to me, so maybe a GNRH injection test, or an MRI to rule out some things?

Also, what do u guys think about the effect lifestyle can have on T? Like sedentary guy with no sex life vs an active person? Is there any data on that?

[MuscleScience]

Thanks for your reply! Yeah the negative feedback thing makes sense. Hopefully I'll be able to import cyp, we'll see. I looked at graphs about T levels after taking Nebido, it gets somewhat smooth after like 6 months, but I was not convinced at all.
Any ideas about how I could understand the reason behind my low T? I'm sure the doc will have something to say about it, but the more ideas I hear the better. The lowish LH points to secondary hypogonadism to me, so maybe a GNRH injection test, or an MRI to rule out some things?

Also, what do u guys think about the effect lifestyle can have on T? Like sedentary guy with no sex life vs an active person? Is there any data on that?

I fought going on TRT for probdbly 12 years or so. I knew I had low T in my early 20’s but could function fine. Finally sides and now all the research that points to just how terrible low T is for a mans health is, drove me to finally give in. I only wish I would have started it much sooner, I’m your age and just started if this year. My total T was never more that 350 mg/dL even in my early 20’s. Finally it got to be so low I just couldn’t function. It’s made a world of difference now that I have it dailed in.

[Ephemeral]

I fought going on TRT for probdbly 12 years or so. I knew I had low T in my early 20’s but could function fine. Finally sides and now all the research that points to just how terrible low T is for a mans health is, drove me to finally give in. I only wish I would have started it much sooner, I’m your age and just started if this year. My total T was never more that 350 mg/dL even in my early 20’s. Finally it got to be so low I just couldn’t function. It’s made a world of difference now that I have it dailed in.

I'm glad u feel better man, hopefully it's gonna make a difference for me as well. My wellbeing is in the gutter (not just because of this) to the point that it endangers my ability to make a living, so I gotta try what I can.

[Youthful55guy]

Thanks for your reply! Yeah the negative feedback thing makes sense. Hopefully I'll be able to import cyp, we'll see. I looked at graphs about T levels after taking Nebido, it gets somewhat smooth after like 6 months, but I was not convinced at all.
Any ideas about how I could understand the reason behind my low T? I'm sure the doc will have something to say about it, but the more ideas I hear the better. The lowish LH points to secondary hypogonadism to me, so maybe a GNRH injection test, or an MRI to rule out some things?

Also, what do u guys think about the effect lifestyle can have on T? Like sedentary guy with no sex life vs an active person? Is there any data on that?

Your prolactin does not seem excessively high, and high prolactin is often a sign of a pituitary adenoma, so I don't really suspect that's the problem, but an MRI certainly wouldn't hurt. Talk to your doc about it.

Also, when posting labs, ALWAYS include the normal ranges and the units. They differ by lab and by country, so a particular number may mean different things, depending on what the normal range is for that lab. For example, your prolactin is Prolactin 3.24 ng/ml, but how do I know that is high or low without a range to compare it to. For my lab, the "normal" range is 4.0-15.2 pg/mL, so your number falls below the normal range. However, your lab may have a lower end of the range, depending on methodology.

A GnRH challenge test might prove useful to see if your pituitary is responsive to GnRH. One question I forgot to ask is whether or not you've had any head injuries in the timeframe that things started going bad with the T? Head injuries, particularly whiplash, can damage the delicate blood vessel plexus connecting the hypothalamus (part of the brain where GnRH is made) to the pituitary (where it stimulates the release of LH/FSH). A GnRH challenge test might help to narrow the problem organ down to either the hypothalamus or the pituitary.

[Ephemeral]

Your prolactin does not seem excessively high, and high prolactin is often a sign of a pituitary adenoma, so I don't really suspect that's the problem, but an MRI certainly wouldn't hurt. Talk to your doc about it.

Also, when posting labs, ALWAYS include the normal ranges and the units. They differ by lab and by country, so a particular number may mean different things, depending on what the normal range is for that lab. For example, your prolactin is Prolactin 3.24 ng/ml, but how do I know that is high or low without a range to compare it to. For my lab, the "normal" range is 4.0-15.2 pg/mL, so your number falls below the normal range. However, your lab may have a lower end of the range, depending on methodology.

A GnRH challenge test might prove useful to see if your pituitary is responsive to GnRH. One question I forgot to ask is whether or not you've had any head injuries in the timeframe that things started going bad with the T? Head injuries, particularly whiplash, can damage the delicate blood vessel plexus connecting the hypothalamus (part of the brain where GnRH is made) to the pituitary (where it stimulates the release of LH/FSH). A GnRH challenge test might help to narrow the problem organ down to either the hypothalamus or the pituitary.

I've edited my first post with the ranges, thanks for saying. I was under the impression that the ranges given by the labs don't mean much, because it doesn't tell us the sensitivity of the tests, it's just a recommended range to have for a given thing. For example, for E2 the range is 0 - 47 (0 rofl), but upon further inquiry they told me that the test doesn't go below 19.9, and it probably goes way higher than 47.

7.5 years ago I was in a car accident, I headbutted the airbag after a 25 mph - 0 full stop. I can't remember having neck pain or stiffness afterwards, but it's possible that I did have. T was at 650 1.5 years later though, and no other injuries since then.

[BuddyGlove1]

[QUOTE=kelkel;7352657]

Before you see this doc it may be prudent to call his office and ask one of his staff if he treats TRT patients how you desire to be treated. Such as self-injections, HCG, adex if needed, etc. His staff should be able to answer this so as not to waste your time or theirs with an uneccessary appointment. You also want to know that you'll be treated based on how you feel, not as a number on a chart. [QUOTE]

Awesome advice. I went to several doctors before I was pissed off and went to a clinic. Still looking for a better dr as they don't cover insurance.

[kelkel]

[QUOTE=BuddyGlove1;7353743]

Awesome advice. I went to several doctors before I was pissed off and went to a clinic. Still looking for a better dr as they don't cover insurance.

See if you can submit it yourself. You may get a partial reimbursement. Pain in the ass but may be worth it.