TRT with or without HCG and Ai

[Dedrag]

I’m very confused. I have talked to 3 different clinics. One says they only prescribe testosterone and only give HCG and a Ai if you have sides. They say you don’t need those. The other 2 clinics o talked to gives Testosteronic, HCG, and the Ai. And they say you have to have all 3 so you don’t mess your body up. I’m so confused on which to do. Please help. Thanks

 

[fifty]

Hcg is needed for fertility and so your balls don’t turn to raisins. Otherwise many people are on test only.

 

[Vince Carter]

I would defer to the other two that offer all 3, a guy should be using HCG or making an informed choice not to based on his own health. Withholding HCG and/or an AI is irresponsible. Some guys need an AI.

 

[Dedrag]

Thank you.

 

[Nashtide]

I agree. I would choose a clinic that offers all three.

 

[sh1973]

Better to start of with t only to see where you're dosing should be then add ancillary medications when and if needed. HCG causes more problems than it remedies in a large number of guys. You should by no means start on an AI without symptoms verified by labs. Keep it simple until there's a need to do otherwise because if you start on all three, then its a crapshoot to figure out what to adjust.

 

[Mr S]

My urologist discussed HCg in case of testicular atrophy but he didn’t want to start my protocol right away including HCG. He wanted to see how I responded to T Cypionate alone first. He kept an eye on my estradiol levels. All was fine. Atrophy started to occur 3 months later. Now, I’m on HCG but he’s waiting to see if I will need an AI. So, the fact that he was open to prescribe the 3 as needed was a good sign for me. Whatever sides I develop (if any) all I need to do is give him a call. He also added Cialis Daily during my last visit (my PCP had me on cialis or viagra as needed).

 

[J71]

I would choose the clinic that only prescribes hcg and ai with sides. I am on test only protocol and don’t want anyone forcing me to take anything extra. I would run far away from a clinic that says that you have to start right away with an ai before your bloods show that it is necessary.

 

[James]

The mistake I made starting out 5 years ago was injecting too much cyp (160 mg once weekly), without an AI. For a low SHBG guy, that's a recipe for disaster in most cases. What is your SHBG? Adding a low dose AI into my protocol has made a great difference. AI's are strong though. A small dose can go a long way. You'll look at that tiny pill and question if something so small will help. I can tell you I've patiently adjusted and logged my results and labs for many years and personally would never inject T without a low dose AI. Bottom line, I'd go with the clinics that offers all 3.

 

[Dedrag]

The mistake I made starting out 5 years ago was injecting too much cyp (160 mg once weekly), without an AI. For a low SHBG guy, that's a recipe for disaster in most cases. What is your SHBG? Adding a low dose AI into my protocol has made a great difference. AI's are strong though. A small dose can go a long way. You'll look at that tiny pill and question if something so small will help. I can tell you I've patiently adjusted and logged my results and labs for many years and personally would never inject T without a low dose AI. Bottom line, I'd go with the clinics that offers all 3.

Thank you for the reply. I have not had my labs done yet I’m still trying to figure out what company to go with.

 

[Vince]

Check the clinics that advertise here, defy medical and prime body. They're telemedicine, they do everything over the phone or through the internet. This save you a lot of money, plus one of their doctors is a member of this site.

 

[Dedrag]

Check the clinics that advertise here, defy medical and prime body. They're telemedicine, they do everything over the phone or through the internet. This save you a lot of money, plus one of their doctors is a member of this site.

Thanks I have just contacted defy today.

 

[Deleted member 16042]

And they say you have to have all 3 so you don’t mess your body up. Thanks

If the one clinic will give HCG or anastrozole if needed but don;t want you to start on all three, that is good.

If the other two insist you must take all three, run away from these clinics. They don;t know what they are doing.

Also some things to consider...

-What amount of T do they want you to take.... big warning sign 200mg in a single dose

-Warning sign they do not assess SHBG and start you on one dose every 2 weeks or once a week. Your dosage frequency should be based on your SHBG. If it is high, you might get away with once a week. If it is low, you may need every other day or even daily dosing

-Did they asses estradiol with the correct test.. LC/MS/MS methodology. If not, again it's a warning sign they know what they are doing. Giving an AI (anastrozole) should be based on correct testing and your symptoms, not just given from the get go.

You'll be in good hands with Defy!

 

[Dedrag]

If the one clinic will give HCG or anastrozole if needed but don;t want you to start on all three, that is good.

If the other two insist you must take all three, run away from these clinics. They don;t know what they are doing.

Also some things to consider...

-What amount of T do they want you to take.... big warning sign 200mg in a single dose

-Warning sign they do not assess SHBG and start you on one dose every 2 weeks or once a week. Your dosage frequency should be based on your SHBG. If it is high, you might get away with once a week. If it is low, you may need every other day or even daily dosing

-Did they asses estradiol with the correct test.. LC/MS/MS methodology. If not, again it's a warning sign they know what they are doing. Giving an AI (anastrozole) should be based on correct testing and your symptoms, not just given from the get go.

You'll be in good hands with Defy!

Thanks yes I spoke with defy today and really liked what I heard from them and will be going forward with them. Thank you

 

[DDD]

If the one clinic will give HCG or anastrozole if needed but don;t want you to start on all three, that is good.

If the other two insist you must take all three, run away from these clinics. They don;t know what they are doing.

Also some things to consider...

-What amount of T do they want you to take.... big warning sign 200mg in a single dose

-Warning sign they do not assess SHBG and start you on one dose every 2 weeks or once a week. Your dosage frequency should be based on your SHBG. If it is high, you might get away with once a week. If it is low, you may need every other day or even daily dosing

-Did they asses estradiol with the correct test.. LC/MS/MS methodology. If not, again it's a warning sign they know what they are doing. Giving an AI (anastrozole) should be based on correct testing and your symptoms, not just given from the get go.

You'll be in good hands with Defy!

I read your reply. I have a question about the SHBG. Could you explain SHBG a little more and why that should affect your dosing frequency? What is considered a high and low SHBG? Thank you.

 

[Deleted member 16042]

I read your reply. I have a question about the SHBG. Could you explain SHBG a little more and why that should affect your dosing frequency? What is considered a high and low SHBG? Thank you.

Once T is cleaved from the ester it either becomes free T or is bound to SHBG or Albumin.

Free T is very short acting and is used up rapidly.

Guys with low SHBG have much more essentially released into the system as free T which is used up rapidly and also rapidly excreted in urine if there is excess not bound to SHBG. These guys essentially burn up the supply faster and levels subsequently crash much faster, so smaller more frequent doses are appropriate to help keep levels more stable rather than running out after 2-3 days and crashing before the next dose. In terms of numbers, some of the guys on this forum have very low SHBG in the teens.


T bound to SHBG remains in the body much longer.

More SHBG means you bind up more T and it is retained in the body over a longer time period. As such, guys who have high SHBG tend to need larger cumulative total dose injecting T to achieve good Free T levels since so much is bound by SHBG. They tend to have lower Free T in relation to total T. It is kind of like there is a better long term storage system in place with higher SHBG, and this man does not burn up the available free T as fast. However, some men with higher SHBG like me actually also do better on more frequent dosing as well. For me theoretically it helps reduce estrogen by taking smaller more frequent doses compared to larger less frequent doses. My SHBG is currently ~52 which is high but not radically so. It can reach quite a bit higher in some men.


The bottom line is larger every other week or weekly doses create a "roller coaster" effect where Free T trough level is too low to feel good. The half life of T is about 8 days which means you lose close to half the amount of T you inject in about a week. 50% lower level can cause ill effects. Low SHBG guys burn up the Free T even faster and some need every day dosing to feel OK.

 

[Cataceous]

...
Guys with low SHBG have much more essentially released into the system as free T which is used up rapidly and also rapidly excreted in urine if there is excess not bound to SHBG. These guys essentially burn up the supply faster and levels subsequently crash much faster, so smaller more frequent doses are appropriate to help keep levels more stable rather than running out after 2-3 days and crashing before the next dose. ...
...

I'd been hoping someone would make a statement like this so we could have a more detailed discussion. The problem is that low-SHBG guys cannot "burn up the supply faster" because the limiting factor is the rate of supply, not the rate of clearance. That is, I've seen no evidence that the rate of testosterone absorption from an injected depot is affected by one's SHBG. Yet this absorption rate is the primary driver of the apparent serum half-life of testosterone, as opposed to the consumption side, in which the effective metabolic clearance rate is directly influenced by SHBG.

Consider this analogy with two tubs of water, one draining into another: the upper tub of water represents an injected depot of a testosterone ester. The lower tub of water represents testosterone in the body. The lower tub has a decent-sized drain opening that represents the testosterone being metabolized and eliminated. The upper tub has a small drain leading to the lower tub. In each tub the rate of flow out of the drain is proportional to the height of water in the particular tub. SHBG represents the size of the lower tub's drain, larger for low SHBG, smaller for high SHBG. The point is that this does not affect the upper tub's slow draining, which is what sets the apparent serum half-life.

 

[sh1973]

Really the only factors that can change the release from the formed depot are activity, blood flow and blood viscosity.

 

[Deleted member 16042]

I'd been hoping someone would make a statement like this so we could have a more detailed discussion. The problem is that low-SHBG guys cannot "burn up the supply faster" because the limiting factor is the rate of supply, not the rate of clearance. That is, I've seen no evidence that the rate of testosterone absorption from an injected depot is affected by one's SHBG. Yet this absorption rate is the primary driver of the apparent serum half-life of testosterone, as opposed to the consumption side, in which the effective metabolic clearance rate is directly influenced by SHBG.

Consider this analogy with two tubs of water, one draining into another: the upper tub of water represents an injected depot of a testosterone ester. The lower tub of water represents testosterone in the body. The lower tub has a decent-sized drain opening that represents the testosterone being metabolized and eliminated. The upper tub has a small drain leading to the lower tub. In each tub the rate of flow out of the drain is proportional to the height of water in the particular tub. SHBG represents the size of the lower tub's drain, larger for low SHBG, smaller for high SHBG. The point is that this does not affect the upper tub's slow draining, which is what sets the apparent serum half-life.

I was not implying that there is faster release from the depot.

I was saying that clearance of Free T from the system is faster than bound, and proportionally more is "drained" faster with low SHBG. "burning up the supply" yes, the supply of Free T, I was not referring to the depot.


Seems your analogy of the larger drain hole, contradicts your statement "the limiting factor is the rate of supply, not the rate of clearance."

Even so, I think we are both saying the same thing. In your analogy, the free T drains/clears from the system faster through the larger SHBG drain... Agree.

 

[Cataceous]

I was not implying that there is faster release from the depot.

I was saying that clearance of Free T from the system is faster than bound, and proportionally more is "drained" faster with low SHBG.


Seems your analogy of the larger drain hole, contradicts your statement "the limiting factor is the rate of supply, not the rate of clearance."

Even so, I think we are both saying the same thing. In your analogy, the free T drains/clears from the system faster through the larger SHBG drain... Agree.

The problem is that testosterone cannot "drain faster" because the supply rate is the limiting factor. When you increase the lower drain size—decrease SHBG—all that happens is that the water level in the lower tub is forced to a proportionally lower level, but the rate of decrease is the same. For example, with a fixed testosterone injection: suppose SHBG is 50 nmol/L, initial peak T is 1,000 ng/dL, five days later it drops to 500 ng/dL; then change only SHBG to 10 nmol/L, now you find the initial peak T is 500 ng/dL, and five days later it drops to 250 ng/dL.