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43 Year-old Male's TRT Journey
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<blockquote data-quote="DJXS" data-source="post: 209720" data-attributes="member: 43123"><p>I'm a 43 year-old, diagnosed with hypogonadism nearly two years ago. My T level was tested several times, ranging from 60-250ng/dl, before the diagnosis was made. I was started out on 40.5mg gel, then increased to 81mg, but even at 81mg my T levels didn't exceed 250ng/dl. My endocrinologist refused to increase dose or switch to injections, so I changed to a different endocrinologist in May '21, who agreed that I should move to IM injections, and started me on 150mg/2weeks testosterone cypionate. Doctor had labs done two days before 4th injection, and level was 68ng/dl. But turns out doctor wanted labs done exactly one week after injection, so on day 7 following 4th injection had labs again and T was 319ng/dl. With this result, doctor increased dose to 200mg/2 weeks; doctor is reluctant to, but not completely against, increased frequency. Doctor wants me to get labs again exactly one week after 2nd injection at this new dose, aiming for 500+ng/dl midway between injections. I'm concerned that with 500-600ng/dl midway, my levels will be low again for 3-6 days before injections, resulting in rollercoaster levels between peaks and troughs. From the labs we have thus far, it seems that 175-200mg/week would keep me above 500ng/dl at trough and help maintain more stable levels; guessing between 1200ng/dl at peak and 500+ng/dl at trough, rather than 1200ng/dl at peak and about 250ng/dl at trough with injections every 2 weeks. If my PSA and Hematocrit remain normal with 175-200mg/week, I don't understand why doctor is against this, yet doctor says if the 200mg/2 weeks doesn't work, that we can try 100mg/week, but says that won't increase above that regardless of numbers. Doctor doesn't want to check FT or estradiol, but says we can maybe look at those later on. I'm guessing that my T levels are testing so low is related to my low SHBG (see below); that my body burns through the T rapidly. What are your thoughts on my doctor's approach, protocol, and resistance to prescribing anything in excess of endocrine society's "gold standard" TRT recommendations? Thanks in advance for your feedback!</p><p></p><p>*I'm 6'0, 235lb., and in otherwise good health according to blood, psa, metabolic, and lipid panels, other than somewhat elevated cholesterol levels (and HDL +/-50). SHBG is low though: was +/-14 before TRT, dropped to +/-10 on gel, and a very low 2-4 on injections.</p></blockquote><p></p>
[QUOTE="DJXS, post: 209720, member: 43123"] I'm a 43 year-old, diagnosed with hypogonadism nearly two years ago. My T level was tested several times, ranging from 60-250ng/dl, before the diagnosis was made. I was started out on 40.5mg gel, then increased to 81mg, but even at 81mg my T levels didn't exceed 250ng/dl. My endocrinologist refused to increase dose or switch to injections, so I changed to a different endocrinologist in May '21, who agreed that I should move to IM injections, and started me on 150mg/2weeks testosterone cypionate. Doctor had labs done two days before 4th injection, and level was 68ng/dl. But turns out doctor wanted labs done exactly one week after injection, so on day 7 following 4th injection had labs again and T was 319ng/dl. With this result, doctor increased dose to 200mg/2 weeks; doctor is reluctant to, but not completely against, increased frequency. Doctor wants me to get labs again exactly one week after 2nd injection at this new dose, aiming for 500+ng/dl midway between injections. I'm concerned that with 500-600ng/dl midway, my levels will be low again for 3-6 days before injections, resulting in rollercoaster levels between peaks and troughs. From the labs we have thus far, it seems that 175-200mg/week would keep me above 500ng/dl at trough and help maintain more stable levels; guessing between 1200ng/dl at peak and 500+ng/dl at trough, rather than 1200ng/dl at peak and about 250ng/dl at trough with injections every 2 weeks. If my PSA and Hematocrit remain normal with 175-200mg/week, I don't understand why doctor is against this, yet doctor says if the 200mg/2 weeks doesn't work, that we can try 100mg/week, but says that won't increase above that regardless of numbers. Doctor doesn't want to check FT or estradiol, but says we can maybe look at those later on. I'm guessing that my T levels are testing so low is related to my low SHBG (see below); that my body burns through the T rapidly. What are your thoughts on my doctor's approach, protocol, and resistance to prescribing anything in excess of endocrine society's "gold standard" TRT recommendations? Thanks in advance for your feedback! *I'm 6'0, 235lb., and in otherwise good health according to blood, psa, metabolic, and lipid panels, other than somewhat elevated cholesterol levels (and HDL +/-50). SHBG is low though: was +/-14 before TRT, dropped to +/-10 on gel, and a very low 2-4 on injections. [/QUOTE]
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