Finally starting TRT

[HHNJD]

Hi everyone. Excited to join the forums and be a part of this community. After years of feeling many of the typical symptoms of low T (the cognitive symptoms and low libido in particular), I have finally taken the step of doing something about it. I'm 46 and over the last several years I've watched my T levels go from the mid-200s to 168 on my latest labs. I've always been in good shape and have eaten pretty healthy, but with a big family and pretty demanding job I have struggled to manage stress and have not slept as well as I should. I'm working on those areas and hopeful that along with TRT I will see a significant improvement in overall quality of life. An improved physique to go along with it would be great as well.

Fortunately, I've found a local PCP willing to work with me on this. He's been very open to structuring and adjusting protocol based on my goals, preferences, and physiological response.

He's suggested started with 80mg Test Enanthate injected subQ weekly and work from there. No AI until we see labs or if I start showing signs of high E2. He also recommended holding off on HCG since I have no plans for more children but is willing to add it at any time if we feel necessary. Dosage seems a little low, but I'm willing to start small and work up from there.

My one question around this is whether I'd be better going to every 3.5 days but will probably see how weekly works first. Doc didn't feel it was necessary since I was doing subQ.

Anyway, as I said, very excited to be on this journey and look forward to being a part of the forums.

 

[Systemlord]

No AI until we see labs or if I start showing signs of high E2.

A little advice, treat symptoms not lab values when it comes to estrogen. Often symptoms can be resolved by adjusting dosage and/or injection frequency.

Once weekly dosing is old school in opinion and produces big differences between peak and trough which can produce symptoms.

Your trough levels are expected to be higher on a twice-weekly protocol when compared with a once-weekly protocol.

 

[HHNJD]

Thanks for the advice. Will probably go ahead and switch to every 3.5 days. No real reason not to other than my PCP didn't think it would be necessary.

 

[Vince]

If it was my protocol. I would inject 50 mg of testosterone cypionate twice a week, along with 500 IU of HCG. Have labs in 12 weeks and adjust from there. Keep it simple.

I would also use a 29g 1/2" easy touch syringe. Do shallow IM and subq injections.

 

[madman]

Hi everyone. Excited to join the forums and be a part of this community. After years of feeling many of the typical symptoms of low T (the cognitive symptoms and low libido in particular), I have finally taken the step of doing something about it. I'm 46 and over the last several years I've watched my T levels go from the mid-200s to 168 on my latest labs. I've always been in good shape and have eaten pretty healthy, but with a big family and pretty demanding job I have struggled to manage stress and have not slept as well as I should. I'm working on those areas and hopeful that along with TRT I will see a significant improvement in overall quality of life. An improved physique to go along with it would be great as well.

Fortunately, I've found a local PCP willing to work with me on this. He's been very open to structuring and adjusting protocol based on my goals, preferences, and physiological response.

He's suggested started with 80mg Test Enanthate injected subQ weekly and work from there. No AI until we see labs or if I start showing signs of high E2. He also recommended holding off on HCG since I have no plans for more children but is willing to add it at any time if we feel necessary. Dosage seems a little low, but I'm willing to start small and work up from there.

My one question around this is whether I'd be better going to every 3.5 days but will probably see how weekly works first. Doc didn't feel it was necessary since I was doing subQ.

Anyway, as I said, very excited to be on this journey and look forward to being a part of the forums.

He's suggested started with 80mg Test Enanthate injected subQ weekly and work from there. No AI until we see labs or if I start showing signs of high E2. He also recommended holding off on HCG since I have no plans for more children but is willing to add it at any time if we feel necessary. Dosage seems a little low, but I'm willing to start small and work up from there.

Welcome!

The best piece of advice is to start low and go slow.

100 mg/week would be a good starting point especially when jumping on once-weekly injections.

Smart move starting on a T only protocol let alone avoiding the use of an AI as we want to see how your body reacts to testosterone and where said protocol (dose T/injection frequency) has your TT, FT, estradiol, DHT levels let alone other blood health markers such as CBC which includes RBCs/hemoglobin/hematocrit.

Keep in mind that testosterone metabolites estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterones beneficial effects.

Having healthy estradiol levels is needed as it will have a positive impact on mood, energy, libido, erectile function, cardiovascular/brain/bone/immune system health, body composition.

Even if your estradiol ends up being high which is a given if you drive up your T levels you may very well feel great.

Some men do need to use an AI (micro-doses) to control e2 but it comes down to the individual and is not a given.

The addition of hCG can be added eventually if you want to prevent/minimize testicular atrophy let alone maintain fertility while using exogenous T.




My one question around this is whether I'd be better going to every 3.5 days but will probably see how weekly works first. Doc didn't feel it was necessary since I was doing subQ.

Although some men will do well injecting once weekly many men on trt tend to inject more frequently as in twice weekly (every 3.5 days), M/W/F/, EOD, or even daily.

Keep in mind that when injecting once weekly that there will be a significant difference in peak--->trough especially when injecting strictly IM let alone blood levels will not be as stable throughout the week which can result in having a negative impact on one's mood, energy, libido, erectile function, recovery throughout the week.

If you plan on once-weekly injections strictly sub-q than peak--->trough may not be as extreme let alone blood levels may be more stable throughout the week.

Even then I would be more concerned with where your SHBG sits as not only will it have a significant impact on free testosterone but can also dictate what injection frequency may suit you best.

If your SHBG is high/highish then you may fair well using once-weekly injections especially if you inject strictly sub-q.

In cases of low/lowish SHBG, a more frequent injection protocol (EOD/daily) may be needed.

Comes down to the individual and what works best.



once-weekly injections (IM)

Variance in Peak and Trough T Levels in Men Using Intramuscular T Injections

MP85-14 VARIANCE IN PEAK AND TROUGH TESTOSTERONE LEVELS IN MEN USING INTRAMUSCULAR TESTOSTERONE Bruno Nascimento*, Helen L Bernie, Elizabeth Schofield, John P. Mulhall, New York, NY INTRODUCTION AND OBJECTIVES In men using intramuscular testosterone (IM T), clinical experience shows us that...

www.excelmale.com

CONCLUSIONS: In our population of patients on stable IM T dose, there was a wide mean variation in both Tp (23%) and Tt (17.5%). In addition to that, 25% of patients had a maximum Tp change greater than 50% and a maximum Tt change greater than 35%. Clinicians should be aware of this high variability in levels when deciding on dose adjustment.




once-weekly injections (sub-q)

Pharmacokinetic Profile of Subcutaneous Testosterone Enanthate Delivered via a Novel, Prefilled Single-Use Autoinjector: A Phase II Study (2015)

Figure 3 Mean total testosterone concentration vs. time. Mean total testosterone (TT) concentration across weeks 1, 5, and 6 for subcutaneous (SC) testosterone enanthate (TE) treatment arms. (A) 50 mg SC TE (open shapes). (B) 100 mg SC TE (closed shapes). SD = standard deviation




Safety of a New Subcutaneous Testosterone Enanthate Auto-Injector: Results of a 26-Week Study (2019)

Figure 3. Panel A is the weekly pharmacokinetic profile of TT concentrations at weeks 1, 6, and 12 for patients in the PK substudy.

 

[madman]

A little advice, treat symptoms not lab values when it comes to estrogen. Often symptoms can be resolved by adjusting dosage and/or injection frequency.

Once weekly dosing is old school in opinion and produces big differences between peak and trough which can produce symptoms.

Your trough levels are expected to be higher on a twice-weekly protocol when compared with a once-weekly protocol.

When injecting strictly IM.....sure!




once-weekly injections (sub-q) XYOSYTED® (Testosterone Enanthate)

STEADY LEVELS WEEK AFTER WEEK

STEADY-STATE IN 6 WEEKS...THEN MAINTAINED

NO PATIENT HAD CMAX >1500 ng/dL AT WEEK 12

NARROW PEAK-TO-TROUGH RATIO OF 1.8

 

[HHNJD]

Thanks madman. That's a ton of great info and one of the reasons I'm so excited to be part of this community. Estradiol was off the charts low on my labs and SHBG in the low 20s, so certainly something I'll keep an eye on. I'm going to check with my provider on Monday to see if there's any concerns with bumping up to 100mg weekly as that seems to be the consensus starting point.