About to start TRT soon would like some guidance

[Xinfamousxi]

Hi Everyone,

I'm glad I found this site and have read a bunch. I have symptoms of low T and visited a male clinic that wants me to get on on 140mg of test once a week along with an AI and Clomid. After what I read here I'm going to push back on the Clomid and AI and only accept the test. I'm also going to ask for twice a week injections. My questions are as follows

1. Do you see anything on my pre treatment labs I should look into before starting TRT?

2. When I asked about HCG they said they can provide me info of where to get it. Not sure what that means, but not worried about it now as I will not be having more kids.

A little about me. I'm a 5'9 36 year old male that weighted about 218 at the start of this year currently 183lbs . I started lifting 3 times a week. 10k + steps a day and eating mainly whole foods. I cut out all the sugary drinks and only drink water at least a gallon a day. The thought of injections is scaring me, but I hope to get use to it and then just start injecting myself along with the HCG.

Symptoms:
Low Libido
Sleeping issues (cant sleep through the night)
ED
Starting to stale and can gain muscle

Dr recently prescribes Cialis and it has helped tremendously the ED which I think naturally improved the libido. I also do use a CPAP for the last 4 years. Just had a sleep study and they lowered the pressure from 14 to 7 due to the weight loss.

F	GLUCOSE	95	65-99 (mg/dL)	KS
	-
	- Fasting reference interval
	-
F	UREA NITROGEN (BUN)	18	7-25 (mg/dL)	KS
F	CREATININE	1.04	0.60-1.26 (mg/dL)	KS
F	EGFR	95	> OR = 60 (mL/min/1.73m2)	KS
	- The eGFR is based on the CKD-EPI 2021 equation. To calculate
	- the new eGFR from a previous Creatinine or Cystatin C
	- result, go to Kidney Professionals
	- kdoqi/gfr%5Fcalculator
F	BUN/CREATININE RATIO	NOT APPLICABLE	6-22 ((calc))	KS
F	SODIUM	139	135-146 (mmol/L)	KS
F	POTASSIUM	4.7	3.5-5.3 (mmol/L)	KS
F	CHLORIDE	103	98-110 (mmol/L)	KS
F	CARBON DIOXIDE	29	20-32 (mmol/L)	KS
F	CALCIUM	9.7	8.6-10.3 (mg/dL)	KS
F	PROTEIN, TOTAL	7.3	6.1-8.1 (g/dL)	KS
F	ALBUMIN	4.9	3.6-5.1 (g/dL)	KS
F	GLOBULIN	2.4	1.9-3.7 (g/dL (calc))	KS
F	ALBUMIN/GLOBULIN RATIO	2.0	1.0-2.5 ((calc))	KS
F	BILIRUBIN, TOTAL	1.0	0.2-1.2 (mg/dL)	KS
F	ALKALINE PHOSPHATASE	77	36-130 (U/L)	KS
F	AST	20	10-40 (U/L)	KS
F	ALT	19	9-46 (U/L)	KS
F	WHITE BLOOD CELL COUNT	4.6	3.8-10.8 (Thousand/uL)	KS
F	RED BLOOD CELL COUNT	5.41	4.20-5.80 (Million/uL)	KS
F	HEMOGLOBIN	16.2	13.2-17.1 (g/dL)	KS
F	HEMATOCRIT	47.8	38.5-50.0 (%)	KS
F	MCV	88.4	80.0-100.0 (fL)	KS
F	MCH	29.9	27.0-33.0 (pg)	KS
F	MCHC	33.9	32.0-36.0 (g/dL)	KS
F	RDW	13.3	11.0-15.0 (%)	KS
F	PLATELET COUNT	220	140-400 (Thousand/uL)	KS
F	MPV	9.9	7.5-12.5 (fL)	KS
F	ABSOLUTE NEUTROPHILS	2479	1500-7800 (cells/uL)	KS
F	ABSOLUTE LYMPHOCYTES	1628	850-3900 (cells/uL)	KS
F	ABSOLUTE MONOCYTES	313	200-950 (cells/uL)	KS
F	ABSOLUTE EOSINOPHILS	161	15-500 (cells/uL)	KS
F	ABSOLUTE BASOPHILS	18	0-200 (cells/uL)	KS
F	NEUTROPHILS	53.9	(%)	KS
F	LYMPHOCYTES	35.4	(%)	KS
F	MONOCYTES	6.8	(%)	KS
F	EOSINOPHILS	3.5	(%)	KS
F	BASOPHILS	0.4	(%)	KS
F	DHEA SULFATE	363	93-415 (mcg/dL)	KS
F	FSH	2.1	1.6-8.0 (mIU/mL)	KS
F	LH	3.3	1.5-9.3 (mIU/mL)	KS
F	T4, FREE	1.3	0.8-1.8 (ng/dL)	KS
F	TESTOSTERONE, TOTAL, MALES (ADULT), IA	325	250-827 (ng/dL)	KS
F	TSH	2.41	0.40-4.50 (mIU/L)	KS
F	ESTRADIOL	21	< OR = 39 (pg/mL)	KS
	- Reference range established on post-pubertal patient
	- population. No pre-pubertal reference range
	- established using this assay. For any patients for
	- whom low Estradiol levels are anticipated (e.g. males,
	- pre-pubertal children and hypogonadal/post-menopausal
	- females), the Quest Diagnostics Nichols Institute
	- Estradiol, Ultrasensitive, LCMSMS assay is recommended
	- (order code 30289).
	-
	- Please note: patients being treated with the drug
	- fulvestrant (Faslodex(R)) have demonstrated significant
	- interference in immunoassay methods for estradiol
	- measurement. The cross reactivity could lead to falsely
	- elevated estradiol test results leading to an
	- inappropriate clinical assessment of estrogen status.
	- Quest Diagnostics order code 30289-Estradiol,
	- Ultrasensitive LC/MS/MS demonstrates negligible cross
	- reactivity with fulvestrant.
F	PSA, TOTAL	0.42	< OR = 4.00 (ng/mL)	KS
	- The total PSA value from this assay system is
	- standardized against the WHO standard. The test
	- result will be approximately 20% lower when compared
	- to the equimolar-standardized total PSA (Beckman
	- Coulter). Comparison of serial PSA results should be
	- interpreted with this fact in mind.
	-
	- This test was performed using the Siemens
	- chemiluminescent method. Values obtained from
	- different assay methods cannot be used
	- interchangeably. PSA levels, regardless of
	- value, should not be interpreted as absolute
	- evidence of the presence or absence of disease.
F	SEX HORMONE BINDING GLOBULIN	24	10-50 (nmol/L)	KS
F	T3, FREE	3.4	2.3-4.2 (pg/mL)	KS

 

[Systemlord]

I have symptoms of low T and visited a male clinic that wants me to get on on 140mg of test once a week along with an AI and Clomid.

Yet another cookie cutter protocol! The AI is most likely unnecessary once you optimize your dosage and injection frequency. The clomid while on TRT is just plain stupid, it benefits the clinic more than it benefits you.

I would argue that starting out at 140 mg per is a bit much, considering we don’t know how you’ll respond to androgens. It’s prudent to start at 100 mg per week and increase if needed.

You can inject 50 mg twice weekly to smother out the peaks and valleys.

The thought of injections is scaring me

It can be as scary as you want it to be, my doctor started me out using 18 gauge syringes that are more like nails and then I found 29 gauge insulin syringes not so scary.

 

[Systemlord]

1. Do you see anything on my pre treatment labs I should look into before starting TRT?

You have enough information to make an informed decision. I do think it should be mandatory to check ferritin levels prior to and six months after starting TRT. TRT, higher testosterone does use up more iron stores in the creation of more hemoglobin.

 

[madman]

Hi Everyone,

I'm glad I found this site and have read a bunch. I have symptoms of low T and visited a male clinic that wants me to get on on 140mg of test once a week along with an AI and Clomid. After what I read here I'm going to push back on the Clomid and AI and only accept the test. I'm also going to ask for twice a week injections. My questions are as follows

1. Do you see anything on my pre treatment labs I should look into before starting TRT?

2. When I asked about HCG they said they can provide me info of where to get it. Not sure what that means, but not worried about it now as I will not be having more kids.

A little about me. I'm a 5'9 36 year old male that weighted about 218 at the start of this year. I started lifting 3 times a week. 10k + steps a day and eating mainly whole foods. I cut out all the sugary drinks and only drink water at least a gallon a day. The thought of injections is scaring me, but I hope to get use to it and then just start injecting myself along with the HCG.

Symptoms:
Low Libido
Sleeping issues (cant sleep through the night)
ED
Starting to stale and can gain muscle

Dr recently prescribes Cialis and it has helped tremendously the ED which I think naturally improved the libido. I also do use a CPAP for the last 4 years. Just had a sleep study and they lowered the pressure from 14 to 7 due to the weight loss.

F	GLUCOSE	95	65-99 (mg/dL)	KS
	-
	- Fasting reference interval
	-
F	UREA NITROGEN (BUN)	18	7-25 (mg/dL)	KS
F	CREATININE	1.04	0.60-1.26 (mg/dL)	KS
F	EGFR	95	> OR = 60 (mL/min/1.73m2)	KS
	- The eGFR is based on the CKD-EPI 2021 equation. To calculate
	- the new eGFR from a previous Creatinine or Cystatin C
	- result, go to Kidney Professionals
	- kdoqi/gfr%5Fcalculator
F	BUN/CREATININE RATIO	NOT APPLICABLE	6-22 ((calc))	KS
F	SODIUM	139	135-146 (mmol/L)	KS
F	POTASSIUM	4.7	3.5-5.3 (mmol/L)	KS
F	CHLORIDE	103	98-110 (mmol/L)	KS
F	CARBON DIOXIDE	29	20-32 (mmol/L)	KS
F	CALCIUM	9.7	8.6-10.3 (mg/dL)	KS
F	PROTEIN, TOTAL	7.3	6.1-8.1 (g/dL)	KS
F	ALBUMIN	4.9	3.6-5.1 (g/dL)	KS
F	GLOBULIN	2.4	1.9-3.7 (g/dL (calc))	KS
F	ALBUMIN/GLOBULIN RATIO	2.0	1.0-2.5 ((calc))	KS
F	BILIRUBIN, TOTAL	1.0	0.2-1.2 (mg/dL)	KS
F	ALKALINE PHOSPHATASE	77	36-130 (U/L)	KS
F	AST	20	10-40 (U/L)	KS
F	ALT	19	9-46 (U/L)	KS
F	WHITE BLOOD CELL COUNT	4.6	3.8-10.8 (Thousand/uL)	KS
F	RED BLOOD CELL COUNT	5.41	4.20-5.80 (Million/uL)	KS
F	HEMOGLOBIN	16.2	13.2-17.1 (g/dL)	KS
F	HEMATOCRIT	47.8	38.5-50.0 (%)	KS
F	MCV	88.4	80.0-100.0 (fL)	KS
F	MCH	29.9	27.0-33.0 (pg)	KS
F	MCHC	33.9	32.0-36.0 (g/dL)	KS
F	RDW	13.3	11.0-15.0 (%)	KS
F	PLATELET COUNT	220	140-400 (Thousand/uL)	KS
F	MPV	9.9	7.5-12.5 (fL)	KS
F	ABSOLUTE NEUTROPHILS	2479	1500-7800 (cells/uL)	KS
F	ABSOLUTE LYMPHOCYTES	1628	850-3900 (cells/uL)	KS
F	ABSOLUTE MONOCYTES	313	200-950 (cells/uL)	KS
F	ABSOLUTE EOSINOPHILS	161	15-500 (cells/uL)	KS
F	ABSOLUTE BASOPHILS	18	0-200 (cells/uL)	KS
F	NEUTROPHILS	53.9	(%)	KS
F	LYMPHOCYTES	35.4	(%)	KS
F	MONOCYTES	6.8	(%)	KS
F	EOSINOPHILS	3.5	(%)	KS
F	BASOPHILS	0.4	(%)	KS
F	DHEA SULFATE	363	93-415 (mcg/dL)	KS
F	FSH	2.1	1.6-8.0 (mIU/mL)	KS
F	LH	3.3	1.5-9.3 (mIU/mL)	KS
F	T4, FREE	1.3	0.8-1.8 (ng/dL)	KS
F	TESTOSTERONE, TOTAL, MALES (ADULT), IA	325	250-827 (ng/dL)	KS
F	TSH	2.41	0.40-4.50 (mIU/L)	KS
F	ESTRADIOL	21	< OR = 39 (pg/mL)	KS
	- Reference range established on post-pubertal patient
	- population. No pre-pubertal reference range
	- established using this assay. For any patients for
	- whom low Estradiol levels are anticipated (e.g. males,
	- pre-pubertal children and hypogonadal/post-menopausal
	- females), the Quest Diagnostics Nichols Institute
	- Estradiol, Ultrasensitive, LCMSMS assay is recommended
	- (order code 30289).
	-
	- Please note: patients being treated with the drug
	- fulvestrant (Faslodex(R)) have demonstrated significant
	- interference in immunoassay methods for estradiol
	- measurement. The cross reactivity could lead to falsely
	- elevated estradiol test results leading to an
	- inappropriate clinical assessment of estrogen status.
	- Quest Diagnostics order code 30289-Estradiol,
	- Ultrasensitive LC/MS/MS demonstrates negligible cross
	- reactivity with fulvestrant.
F	PSA, TOTAL	0.42	< OR = 4.00 (ng/mL)	KS
	- The total PSA value from this assay system is
	- standardized against the WHO standard. The test
	- result will be approximately 20% lower when compared
	- to the equimolar-standardized total PSA (Beckman
	- Coulter). Comparison of serial PSA results should be
	- interpreted with this fact in mind.
	-
	- This test was performed using the Siemens
	- chemiluminescent method. Values obtained from
	- different assay methods cannot be used
	- interchangeably. PSA levels, regardless of
	- value, should not be interpreted as absolute
	- evidence of the presence or absence of disease.
F	SEX HORMONE BINDING GLOBULIN	24	10-50 (nmol/L)	KS
F	T3, FREE	3.4	2.3-4.2 (pg/mL)	KS

Welcome.

Congratulations on the weight loss and taking the steps to clean up your diet and start exercising.

Getting your T levels healthy will improve your overall health.

The clinic you are dealing with is out to lunch!

Starting T dose is too high and there is no need to throw in hCG let alone an AI off the hop.

Gets even more ridiculous throwing in the clomid.

I would tread lightly when it comes to the use of AI!

You are missing one of the most critical blood markers on your lab's FT.

Even then with a shitty TT 325 ng/dL and SHBG 24 nmol/L, your FT would be dismal.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Always best to start on a T-only protocol as we want to see how your body reacts to testosterone and where said protocol (dose T/injection frequency) will have your trough TT, FT, estradiol, SHBG, and other important blood markers such as RBCs, hemoglobin and hematocrit.

The hCG can be added in once you get settled in.

The main advantage of adding in the hCG is to help maintain fertility and minimize/prevent testicular atrophy.

When it comes to your T dose it is more sensible to start low and go slow.

100mg T/week split into twice-weekly injections (every 3.5 days).

You need to tread lightly here as you have sleep apnea and although you are treating it through the use of a CPAP your RBCs, hemoglobin, and hematocrit are still on the higher end and it is given that increasing your TT/FT level will drive up such markers further.

No need to fear injections.

Using an LDS insulin syringe (fixed needle) to inject shallow IM or strictly sub-q is virtually pain-free.

Most are using 27-31G various needle lengths and you can draw/inject with the same needle to boot!

Principles of Testosterone and hCG Injection Technique

Selecting the Devices There are many different syringes and needles, suiting many different procedures. It is important to choose the needles and syringes carefully according to the type of injection to be administered. For example, the length and gauge of the needle and type of syringe must...

www.excelmale.com

How to Inject Testosterone Intramuscularly, Shallow IM or Subcutaneously ?

True. That blue and gray diagram is not good.

www.excelmale.com

 

[Xinfamousxi]

Welcome.

Congratulations on the weight loss and taking the steps to clean up your diet and start exercising.

Getting your T levels healthy will improve your overall health.

The clinic you are dealing with is out to lunch!

Starting T dose is too high and there is no need to throw in hCG let alone an AI off the hop.

Gets even more ridiculous throwing in the clomid.

I would tread lightly when it comes to the use of AI!

You are missing one of the most critical blood markers on your lab's FT.

Even then with a shitty TT 325 ng/dL and SHBG 24 nmol/L, your FT would be dismal.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Always best to start on a T-only protocol as we want to see how your body reacts to testosterone and where said protocol (dose T/injection frequency) will have your trough TT, FT, estradiol, SHBG, and other important blood markers such as RBCs, hemoglobin and hematocrit.

The hCG can be added in once you get settled in.

The main advantage of adding in the hCG is to help maintain fertility and minimize/prevent testicular atrophy.

When it comes to your T dose it is more sensible to start low and go slow.

100mg T/week split into twice-weekly injections (every 3.5 days).

You need to tread lightly here as you have sleep apnea and although you are treating it through the use of a CPAP your RBCs, hemoglobin, and hematocrit are still on the higher end and it is given that increasing your TT/FT level will drive up such markers further.

No need to fear injections.

Using an LDS insulin syringe (fixed needle) to inject shallow IM or strictly sub-q is virtually pain-free.

Most are using 27-31G various needle lengths and you can draw/inject with the same needle to boot!

Principles of Testosterone and hCG Injection Technique

Selecting the Devices There are many different syringes and needles, suiting many different procedures. It is important to choose the needles and syringes carefully according to the type of injection to be administered. For example, the length and gauge of the needle and type of syringe must...

www.excelmale.com

How to Inject Testosterone Intramuscularly, Shallow IM or Subcutaneously ?

True. That blue and gray diagram is not good.

www.excelmale.com

Thanks for the reply, I will push back on the Clomid and AI and hopefully they don't give me crap about it. I will also ask to start at 100mg in regards to the RBCs, hemoglobin, and hematocrit what would you suggest regarding "tread lightly" do you think starting lower dose is treading lightly?

 

[madman]

Thanks for the reply, I will push back on the Clomid and AI and hopefully they don't give me crap about it. I will also ask to start at 100mg in regards to the RBCs, hemoglobin, and hematocrit what would you suggest regarding "tread lightly" do you think starting lower dose is treading lightly?

Do not jump in on 140 mg T/week!

 

[Xinfamousxi]

Do not jump in on 140 mg T/week!

Ill make sure to start at 100mg! I was hoping now that I’m at 183lbs it would have helped with my T. Whats weird is my first Testosterone test was 227 in December at 218lbs then it came in at 237 in march 325 in May and 440 end of May. Those seem like huge shifts in a short time span

 

[Systemlord]

Whats weird is my first Testosterone test was 227 in December at 218lbs then it came in at 237 in march 325 in May and 440 end of May. Those seem like huge shifts in a short time span

Your testosterone levels change every day, it’s called a natural daily fluctuation.

 

[Belekas]

When did you start working out and eating a healthy diet? A lot of folks never need TRT in the first place but they are too lazy to give it time and effort to tick all the required boxes before engaging in treatment. TRT helps to kick-start the process but in reallity I prefer to start from the other way around, get as healthy as possible, stay there, run more blood tests and only then make a well thought out and calculated decision if you need TRT in the first place. Hope that doesn't go over your head. Wish you best of luck either way and I'm sure you are in the good hands asking for help in this forum as we have a lot of experienced and well-researched/data driven guys.

Best regards,
Bel

 

[Xinfamousxi]

I know its lame but January 1st lol. However, I feel like I can stick with this. All the changes I made I can see myself doing for the rest of my life.


I don’t want to prematurely jump on the TRT. I have been sleeping 6-7 hours a night so I plan on trying to increase that to 8-9. I’m thinking the muscle stall is due to not eating enough so once I get to 175 I want to try bulking up currently 183.

The one area that has been a problem though for years is my libido and errections. Not sure if this is normal because my doctor made it sound like it was but the only time I get erections is when I’m intimate with my wife and there is some type of touch, but outside of that I never get erections no morning wood nothing. Which wasn't a problem before because I would still have good libido but over the last year I started having ED issues even when I was with her. Then over the last 6 months libido has completely dissapeared.

The doctor recently got me on 5mg of Cialis which I take every other day. It has helped get me stronger erections when Im with her, and some of the libido has come back.

 

[Systemlord]

The doctor recently got me on 5mg of Cialis which I take every other day.

I recently started 5 mg Cialis and it has hugely impacted my progress on TRT. I recently ran out because my doctor refuses daily regimen, so I’ve taken steps to get it through Defy Medical.

Cialis catapults my energy levels well beyond what I thought possible. My energy went from great to what I would consider unnatural, and perhaps I’m over-responding to Cialis just like over medicines, because if I go full throttle for several hours and don’t eat enough food, I crash so unbelievably hard, I’ll start shaking and almost fall to the floor until I eat something and recover.

So the Cialis may be compensating for the lower than optimal T at times.

 

[Xinfamousxi]

If I jump on TRT and my hematocrit jumps up am I able to just jump off the TRT and things will go back to normal or is the damage done and have to figure it out

 

[Systemlord]

If I jump on TRT and my hematocrit jumps up am I able to just jump off the TRT and things will go back to normal or is the damage done and have to figure it out

I don’t think I’ve even heard of someone not returning to baseline levels, it’s rare. Hematocrit is one of the benefits of TRT, it’s not the devil. As with anything else, genetics plays a role at what level you can handle without side effects.

My hematocrit used to be 55% and a hematologist wasn’t concerned because I didn’t have any symptoms, blood pressure was on the lower end. Now I’m at 51% and recently asking for a T dosage increase.

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador.

Living at higher elevation with higher hematocrit may decrease cardiovascular risk! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525493/...

www.excelmale.com

Conclusion: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has a stronger effect between 2,000 and 3,500 m.