4th week on TRT, what to expect

[JonSnow]

Hi all.
This is my second thread, here is an old one with just a couple of posts:

Just started Trt, having second thoughts

Hi all. Forgive me please if my post is long and incoherent, I am typing as I go, trying to summarize everything with a single question. I think I always had low/ish T. My right testicle was in my abdomen when I was little, never really trully developed, is about 2,5 cm long only, still...

www.excelmale.com

Long story short, I am 40 yo, one year ago I gave up on TRT before I even started, so to speak, and started 5mg daily cialis instead. Some Lab work data is included in the first thread, my whole history and symptoms.

I found a new doctor/andrologist, and a great one at that, which I thought was a mission impossible in the area where I live in Germany. My hypodonadism is primary. Started TRT 4 weeks ago, 110 mg test e/week(2 55mg injections s.c.), also mo/we/fr 250 IUs Hcg each injection(advice here was 50% start hcg straight away, 50% wait a while, maybe you don't even need it, but I wanna try to remain fertile and avoid atrophy). Continued 5 mg daily tadalafil. Now, I have been reading about TRT for years, I wanna try and make the story/question short. And you'd please excuse me at the end if the question is stupid ☺.

Week 4 and I feel absolutely fantastic. I have probably the worst job in the world at this very moment, ICU anästhesiologist in Corona time. For years I have been tired even when I didn't work. Starting last week, feel like a supermen, never even once felt I needed a nap or similar. Libido is through the roof. Erections are not rock hard, they are diamond hard. Morning wood turned into "almost all night wood ". Never felt like this, even as a teenager as far as I can remember. Brain fog, bad sleep etc., all gone. No side effects whatsoever except a few zits.

Now I will give it 2 months before doing the complete lab work again. Not overly concerned about anything except hematocrit and cholesterol. I have read all the "what to expect after staring trt" and the timelines on the web. Some things happened way sooner than expected/described. Now here is the dumb question. Keep finding the expression "honeymoon period". I don't want how I feel now to ever go away. Should I keep my hopes up that I will be one of the lucky ones, meaning I got it right from the start, I mean lab work here too; or should I expect that everything slowly worsens and I would need tuning up. From what I read, cases like me are practically exceptions.

Thank you.

 

[Cataceous]

Unfortunately the honeymoon effect is real and you're in it. The hope should be that you don't experience much backsliding in the coming months. Your dose may end up being a little on the high side—it would put the average young man at 1,000 ng/dL (24/7). Furthermore, with twice-weekly injections you could have peak serum testosterone about 50% higher than trough values. This kind of variation over several days may contribute to side effects in some men.

Did you confirm primary hypogonadism with further testing? Did you measure LH, FSH, SHBG? What's interesting about treating primary hypogonadism with TRT is that it may be possible to tune the dose to achieve normal levels of LH and FSH, retaining their benefits and avoiding HPTA shutdown.

 

[JonSnow]

Thanks, Cataceous.

Yup, primary confirmed. Complete hormone panel, even MRI of the cranium, 2 times varicocoele surgery und untreated undescented testis on the opposite side, all together leading to a multifactorial "testicular injury" as a cause of primary hypogonadism.

It is a weird thing to say, because of other people who started TRT and who describe feeling terrible in the early weeks(seem to be a LOT of people), but it comforts me that I don't only not feel terrible, that I don't only feel great, but that I feel better every single day and have the feeling it is just the beginning. Like I said, no side effects till now whatsoever, the only thing I notice that is a little different is how my ejaculate/sperm looks like. Lighter/not so white, "thinner", more in form of lots of smaller "drops" instead of several "beams" like before TRT. Volume is definitely down. But orgasms are so strong, feel like I wanna scream every single time. No testicular atrophy.

I understand I probably took a risk with starting HCG along from the get go, also that 110mg a week sc together with hcg may sort of "equal" to about 150 mg/week, but I will continue it for now and hope the honeymoon stays a permanent thing. Hoping it doesn't put me at ~1500 ng/dL and that that is why I feel great. Lipids worry me, HCT too(but a little less, I can do my own phlebotomies if needed), and I am also very interested in what my free/bioavailable T would be when I do the next lab, among other things.

Hoping for the best, for as little tweaking as possible along the road, but if it turns out to be must, well, I am not the only one. I would do everything to always feel like I feel now. I just feel so good, I feel like I lost the last 20 years of my life.

 

[madman]

Thanks, Cataceous.

Yup, primary confirmed. Complete hormone panel, even MRI of the cranium, 2 times varicocoele surgery und untreated undescented testis on the opposite side, all together leading to a multifactorial "testicular injury" as a cause of primary hypogonadism.

It is a weird thing to say, because of other people who started TRT and who describe feeling terrible in the early weeks(seem to be a LOT of people), but it comforts me that I don't only not feel terrible, that I don't only feel great, but that I feel better every single day and have the feeling it is just the beginning. Like I said, no side effects till now whatsoever, the only thing I notice that is a little different is how my ejaculate/sperm looks like. Lighter/not so white, "thinner", more in form of lots of smaller "drops" instead of several "beams" like before TRT. Volume is definitely down. But orgasms are so strong, feel like I wanna scream every single time. No testicular atrophy.

I understand I probably took a risk with starting HCG along from the get go, also that 110mg a week sc together with hcg may sort of "equal" to about 150 mg/week, but I will continue it for now and hope the honeymoon stays a permanent thing. Hoping it doesn't put me at ~1500 ng/dL and that that is why I feel great. Lipids worry me, HCT too(but a little less, I can do my own phlebotomies if needed), and I am also very interested in what my free/bioavailable T would be when I do the next lab, among other things.

Hoping for the best, for as little tweaking as possible along the road, but if it turns out to be must, well, I am not the only one. I would do everything to always feel like I feel now. I just feel so good, I feel like I lost the last 20 years of my life.

Glad to hear you feel great so far as it is common for many when starting trt or tweaking a protocol (increasing T dose) to experience what we call the honeymoon period.

Some may not be so lucky and may have a bumpy ride.

Unfortunately, you are only 4 weeks in and this means nothing when looking at the bigger picture.

Need to understand that you have just driven up your T levels from <300 to most likely well over 1000 ng/dL and during the weeks leading up until blood levels have stabilized (4-6 weeks) your hormones are in FLUX.

Things will level off once the body adjusts and the critical time period will be the next 2-3 months and this is when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

Even then depending on how one feels/blood work a protocol may need to be tweaked.

*The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low-t symptoms while at the same time minimizing/avoiding any potential side effects (cosmetic/overall health) while keeping blood markers healthy long-term.

Blood work is critical!




post #2

week 4 on TRT - lots of ups / downs

just started; baseline; Total T: 226 ng/dl Free: 7.62 ng/dl Estradiol: 16.1 pg/ml doc gave me 100mg/2weeks ( i know this is too low, and he seemed to be willing to go up to 100mg/week once my next bloodwork comes back at 4 weeks) - i switched to 1x week - 50mg as of now. initially I went...

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