Looking to make slight change to TRT/HCG protocol; need advice

[cigpk]

I am hoping this will be the last post I make about my current set of side effects. My last dr. appt basically gave me the option of increasing T, increasing HCG or just keeping things to the same. I would prefer to keep my general dosage the same and maybe just change when I take it so that I can get more steady levels. I am hoping I can go to less frequent T injections (SHBG: 53) and EOD HCG injections as I have found I can lessen e2 spikes with more frequent doses)


Current side effects:
Insomnia, up/down energy levels, inconsistent results all around, acne, muscle aches/cramps

Current protocol:
40 mg test-c every 3.5 days (Tues Night, Sat Morning)
360 iu hcg 3x per week (Tues, Thurs, Sat all in morning)
No AI
Results on this protocol on Sat morning before Test/HCG injection:

My plan (and tell me if you think this is illogical or not going to make a difference) was to go to Test-c every 4 days (i.e. Mon, Fri, Tues) and HCG EOD. So Monday: Test-c + HCG, Wed: HCG, Fri: Test-C + HCG

I am looking to keep my overall dosages about the same. I believe this would mean I go to 50mg Test every 4 days, but what dosage of HCG for EOD schedule? I am 28, looking to have children in a few years so that is why I keep my HCG dosage around 1100 mg per week. Dr's over at Defy agree this is a good level to keep it at.

So essentially, how do I switch from an every 3.5 test-c schedule to every 4 days and switch HCG from 3 days per week to EOD.

May be simple math but I'm an occupational therapist, not a math guy. My hope is that more consistency with my schedule will help with the inconsistent results I'm having and maybe a less frequent T injection will drive down SHBG.

 

[Cataceous]

Regarding the T cypionate, you're averaging 40 / 3.5 ~= 11.4 mg per day. So you're looking at about 46 mg every four days for the same average.

Doing the same for hCG: 3 x 360 / 7 * 2 ~= 154 IU per day, meaning about 309 IU every other day for equivalent dosing.

 

[Cataceous]

If you're looking for maximum consistency then I would do both injections EOD, alternating days. That is, take cypionate one day, hCG the next, then cypionate, etc. I have followed and liked this schedule. The T cypionate dose would be 23 mg to maintain your current average.

 

[cigpk]

If you're looking for maximum consistency then I would do both injections EOD, alternating days. That is, take cypionate one day, hCG the next, then cypionate, etc. I have followed and liked this schedule. The T cypionate dose would be 23 mg to maintain your current average.

Yeah my only concern was the SHBG. I guess thinking of the idea that less frequent injections lower shbg.

 

[madman]

I am hoping this will be the last post I make about my current set of side effects. My last dr. appt basically gave me the option of increasing T, increasing HCG or just keeping things to the same. I would prefer to keep my general dosage the same and maybe just change when I take it so that I can get more steady levels. I am hoping I can go to less frequent T injections (SHBG: 53) and EOD HCG injections as I have found I can lessen e2 spikes with more frequent doses)


Current side effects:
Insomnia, up/down energy levels, inconsistent results all around, acne, muscle aches/cramps

Current protocol:
40 mg test-c every 3.5 days (Tues Night, Sat Morning)
360 iu hcg 3x per week (Tues, Thurs, Sat all in morning)
No AI
Results on this protocol on Sat morning before Test/HCG injection:
View attachment 7857


My plan (and tell me if you think this is illogical or not going to make a difference) was to go to Test-c every 4 days (i.e. Mon, Fri, Tues) and HCG EOD. So Monday: Test-c + HCG, Wed: HCG, Fri: Test-C + HCG

I am looking to keep my overall dosages about the same. I believe this would mean I go to 50mg Test every 4 days, but what dosage of HCG for EOD schedule? I am 28, looking to have children in a few years so that is why I keep my HCG dosage around 1100 mg per week. Dr's over at Defy agree this is a good level to keep it at.

So essentially, how do I switch from an every 3.5 test-c schedule to every 4 days and switch HCG from 3 days per week to EOD.

May be simple math but I'm an occupational therapist, not a math guy. My hope is that more consistency with my schedule will help with the inconsistent results I'm having and maybe a less frequent T injection will drive down SHBG.

What is this obsession with driving down SHBG?

Sure your levels are on the higher end but are by no means very high and again due to the newer understanding regarding SHBG:T binding.....even with having a higher SHBG.....very high TT levels are not needed to achieve a healthy FT.

As we went through this before in your previous thread using the newer calculated Tru T method.....your FT levels are just above mid-range and I would put my money on it that most of your issues would be resolved by dropping the HCG and increasing your T dose slightly to bring your FT levels up.



TT 783 nmol/L, SHBG 53 nmol/L (by no means very high) and Albumin 4.3 g/dL (mean) than your FT is 25.05 ng/dL (just above the mean 23.5 ng/dL of the reference range 16-31 ng/dL).

Current side effects:
Insomnia, up/down energy levels, inconsistent results all around, acne, muscle aches/cramps


Dropping the HCG and increaing T dose may very well be all you need!

I understand you are still young and maintaining your fertility is critical but I would just try dropping the HCG for 3 months while increasing your T dose.....that way you will truly know if the HCG/average FT levels are the cause of your grief!

 

[madman]

Starting to get played out.....everyone complaining about high SHBG.....get back to me when you are running 100+ nmol/L!



Straight to the point:


[0387] Relation between Percent FT with Total Testosterone and SHBG. Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated. Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations. In contrast, the Vermeulen's equation suggests a negative relation between percent FT and total testosterone. Furthermore, as SHBG concentrations increase, percent FT calculated using our new model shows only a modest decline in contrast to the marked decline in percent FT calculated using Vermeulen's equation.




Take home points that need to be HAMMERED in the noggins of men who seem to think their SHBG is so high that extremely high TT levels are needed in order to achieve a healthy FT!

* Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated


*Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations


*Furthermore, as SHBG concentrations increase, percent FT calculated using our new model shows only a modest decline in contrast to the marked decline in percent FT calculated using Vermeulen's equation.

 

[Vince]

Yeah my only concern was the SHBG. I guess thinking of the idea that less frequent injections lower shbg.

Since I went to daily injections, my shbg has come down. Originally believed that the opposite would happen.

SHBG 39.7 range 19.3 - 76.4
SHBG 48.8 range 19.3 - 76.4

 

[cigpk]

Thanks to everyone.

I have definitely bought into the “high shbg needs to be driven down” idea. I am also aware that I definitely don’t know even a smidgen of what there is to know about trt which is why I was seeking out the advice of everyone here. Thanks for the valuable input.

I would like to drop hcg but I am way too paranoid of what it will do to my fertility. I already know that I have a good semen analysis on hcg so it’s doing it’s job there.

I’m going to check in with my doc and see what they say about trialing an EOD protocol, alternating test/HCG.

If that doesn’t help, maybe I will trial a lower dose of hcg or something there.

 

[fifty]

Take home points that need to be HAMMERED in the noggins of men who seem to think their SHBG is so high that extremely high TT levels are needed in order to achieve a healthy FT!

Agree 1000%.

Pre trt I had a lab of 767 total T with a direct free T of 8.0. 767!!! Yet I was convinced trt was the way to go.

Got on a trt protocol and ended up at >1500 on 160mg per week. After a year of dealing with minor issues I’m coming off trt. Vermeulen and direct free t tests are straight trash.

 

[Systemlord]

So essentially, how do I switch from an every 3.5 test-c schedule to every 4 days

I don't see the point of changing T cypionate from every 3.5 days to every 4 days, this would increase sides in my opinion. I mean you're moving to smaller HCG doses to decrease sides.

 

[cigpk]

I don't see the point of changing T cypionate from every 3.5 days to every 4 days, this would increase sides in my opinion. I mean you're moving to smaller HCG doses to decrease sides.

Yes I believe I’m taking the advice and moving to EOD protocol.

I just reached out to my doctor and am waiting for a response before I make the change.

The new protocol will likely be about 23 mg test EOD and 310-320 hcg on EOD.

 

[madman]

Fertility?

Acerus Announces Publication of Study Results Demonstrating Effectiveness of NATESTO® Regardless of Baseline Symptom Severity

 

[Gman86]

What brand of HCG are you using? Glad to see that your sperm analysis was favorable on the dose you’re taking. Nice to know around 1000iu’s can be enough to promote fertility while concurrently using testosterone.

 

[cigpk]

What brand of HCG are you using? Glad to see that your sperm analysis was favorable on the dose you’re taking. Nice to know around 1000iu’s can be enough to promote fertility while concurrently using testosterone.

I am now using empower pharmacy hcg. The sperm analysis was on a compounded hcg from Integrity pharmacy In Atlanta Ga. was even on a smaller dose

 

[Gman86]

I am now using empower pharmacy hcg. The sperm analysis was on a compounded hcg from Integrity pharmacy In Atlanta Ga. was even on a smaller dose

Are you planning to get another sperm analysis while on Empower’s HCG? Do you mind if I ask how much it costs to get the sperm analysis done?

 

[cigpk]

Are you planning to get another sperm analysis while on Empower’s HCG? Do you mind if I ask how much it costs to get the sperm analysis done?

I likely will in a year or so. Mine was done through insurance initially so I don’t know the out of pocket cost.

I do know you can have one done at labcorp, and purchase it through defy if you’re a patient there

 

[Gman86]

I likely will in a year or so. Mine was done through insurance initially so I don’t know the out of pocket cost.

I do know you can have one done at labcorp, and purchase it through defy if you’re a patient there

Oh insurance sometimes covers it? Good to know! Thanks