Doctor changed my protocol

About six weeks ago, my doctor changed my protocol, and I'm not agreeing with it. He had me on 260 mg of Testosterone Propionate every week and about 6 weeks ago changed it to 260 mg of Testosterone Enanthate every 2 weeks.

As a result, I find that I have been much more irritable around the ten-day mark and my energy levels have been fluctuating badly. I inquired about self-injecting and he told me that under no circumstances would he prescribe self-injections and I'd have to continue office visits for injections. I'm about to change jobs and that will prove problematic in and of itself since I will be out of state most of the time. I brought up the job change issue, and he stood firm on his self-injection stance in that he doesn't allow it.

I almost contacted Defy for a second opinion because I don't like my current treatment protocol. I'm thinking I will do that soon, regardless. Besides, a second opinion can't hurt, right?

You are on the right track with Defy. Don't waste anymore of your time dealing with your MD because he clearly doesn't know or understand the basics of TRT. I tried to educate my endocrinologist and all that happened is I wasted 3 years hoping he'd come around and it never happened. I finally found a TRT expert and for the most part I'm in much better shape because of it. The sooner you switch the better your health will be and life is too short to drag it out.

bad trt protocol could be as bad as low t. Im curious how often did you get the propionate injections? as your doc doesn't allow you to self inject I am assuming you were not injecting it every day or every other day?

lowe2sucks said:

bad trt protocol could be as bad as low t. Im curious how often did you get the propionate injections? as your doc doesn't allow you to self inject I am assuming you were not injecting it every day or every other day?

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Once per week, done at the office. I thought it was cypionate, and the nurse told me otherwise when they switched me 6 weeks ago. From my research, propionate is a fast acting ester and strangely enough, the labs had me all over the place while on it once a week. For example, one set had me in the 800s on that protocol after 7 days, another had me in the 1400s, and my last set had me just over 1000 when they switched me to every other week. I found it odd that they always drew blood after the testosterone injection.

damn man thats terrible protocol.. folks inject propionate every day or every other day because it has short half life and needs to be injected that often.. you should find better care thats horrible

No self injection, how are you expected to live your own life or even go on vacations when you're tied up like that? Your doctor must love to charge you or your insurance for the weekly office visits, he clearly doesn't know what in the hell he's doing giving you propionate every week, then gives you an even more outdated protocol of every 2 weeks! This stubborn doctor will never learn and clearly doesn't have much TRT traffic coming into his office on a regular basis. My first endo was like, "you can't inject more often", "your levels will get too high".

He sounds like an idiot!

Systemlord said:

No self injection, how are you expected to live your own life or even go on vacations when you're tied up like that? Your doctor must love to charge you or your insurance for the weekly office visits, he clearly doesn't know what in the hell he's doing giving you propionate every week, then gives you an even more outdated protocol of every 2 weeks! This stubborn doctor will never learn and clearly doesn't have much TRT traffic coming into his office on a regular basis. My first endo was like, "you can't inject more often", "your levels will get too high".

He sounds like an idiot!

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My wife is mad at me because I won't speak to my current doctor about his change in protocol. I told her why should I pay for an office visit and injection every single week when this is something that I can do myself? Besides, I want a second opinion now because I really don't like this every other week protocol at all. I swear I am almost worse off than before I started.

I really want to get back to a traveling type of job, and since my current doctor won't prescribe anything other than what happens in his office, it is time to look for other options.

Going further, from my research, I'd rather inject twice a week with the right ester just to keep my levels more constant.

You need to find out what your SHBG level is, because twice a week was barely enough for me with my low SHBG. I'm on 25mg EOD now which has made the biggest difference so far.

Systemlord said:

You need to find out what your SHBG level is, because twice a week was barely enough for me with my low SHBG. I'm on 25mg EOD now which has made the biggest difference so far.

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The lab before my last set had SHBG at 39.4 NMOL/L. The last set hadn't changed much, so I didn't bother asking for a copy. Tomorrow, I think I will. I'm also going to complain that this every other week protocol is not so good. I'll keep my mouth shut about a second opinion though.

Twice weekly will do nicely then.

I've attached a copy of the standard study showing the foolishness of prescribing a protocol calling for injections every two weeks. It's irrefutable and has all the trappings (published in a peer-reviewed journal) doctors love. Some of the "editorializing" (it's a Japanese study and it was run prior to the introduction of big-pharma topicals in that market) can be ignored. It shows your protocol will fail.

Thank you for the information.

Now, you are going to love this. The nurse I spoke to today stated that my initial, once per week injections, were their own proprietary custom compound designed for weekly injections. The protocol that I am on now contains 100 mg of that compound and 160 mg of enanthate. I love how I ask two different individuals the same question and receive a different answer. Actually, the former auditor in me HATES it, haha.

As for my mood, she says the doctor will probably increase my Anastrozole dosage but naturally, he and the nurse practitioner weren't there this morning. I can't switch doctors soon enough!

bouquetCPA said:

Thank you for the information.

Now, you are going to love this. The nurse I spoke to today stated that my initial, once per week injections, were their own proprietary custom compound designed for weekly injections. The protocol that I am on now contains 100 mg of that compound and 160 mg of enanthate. I love how I ask two different individuals the same question and receive a different answer. Actually, the former auditor in me HATES it, haha.

As for my mood, she says the doctor will probably increase my Anastrozole dosage but naturally, he and the nurse practitioner weren't there this morning. I can't switch doctors soon enough!

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What is your current estradiol level? Was it captured via the sensitive (LC, MS/MS) test?

CoastWatcher said:

What is your current estradiol level? Was it captured via the sensitive (LC, MS/MS) test?

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My last level was 36.2 PG/ML, but I am not certain of the test method AND this was prior to the one injection every two weeks protocol. I'm having new labs drawn on the 21st for my second opinion consultation, so I'll post more about it later.

Call me crazy, but I like the idea of multiple smaller injections every few days versus one huge injection every two weeks. It's rather unfortunate that my current doctor shot that idea down AND I ended up suffering more negative side effects over the past six weeks. Furthermore, the next time he will meet with me is the Wednesday before Thanksgiving.

Finally, I am glad this forum exists because it is a wealth of information. My only hope is that other medical practitioners learn from this and that treatment becomes better and more available in the future.

bouquetCPA said:

My last level was 36.2 PG/ML, but I am not certain of the test method AND this was prior to the one injection every two weeks protocol. I'm having new labs drawn on the 21st for my second opinion consultation, so I'll post more about it later.

Call me crazy, but I like the idea of multiple smaller injections every few days versus one huge injection every two weeks. It's rather unfortunate that my current doctor shot that idea down AND I ended up suffering more negative side effects over the past six weeks. Furthermore, the next time he will meet with me is the Wednesday before Thanksgiving.

Finally, I am glad this forum exists because it is a wealth of information. My only hope is that other medical practitioners learn from this and that treatment becomes better and more available in the future.

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There is nothing crazy about preferring more frequent, smaller injections (as is supported by the journal article I sent earlier). For over two years I have injected 16mg every morning - it is a first-class protocol. Not everyone (by any means) has to opt for a daily schedule, but most will benefit dramatically by breaking their weekly dose into at least two shots.

We here at Telthera would be happy to help you get on the right track, feel free to send me a private message, I'd like see your labs.

Regardless, I agree with most of what is said here. You should get away from this practitioner and go with someone more amenable to your changing needs be it us here at Telthera, Defy, or any of the other systems men here use to manage their care.

Thanks,
Scott
Telthera

bouquetCPA said:

My wife is mad at me because I won't speak to my current doctor about his change in protocol. I told her why should I pay for an office visit and injection every single week when this is something that I can do myself? Besides, I want a second opinion now because I really don't like this every other week protocol at all. I swear I am almost worse off than before I started.

I really want to get back to a traveling type of job, and since my current doctor won't prescribe anything other than what happens in his office, it is time to look for other options.

Going further, from my research, I'd rather inject twice a week with the right ester just to keep my levels more constant.

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Defy is a good choice and Dr Saya is very knowledgeable.

I figured I would update my thread to let everyone know what is going on. My testosterone level at 11 days was 634 and my Estradiol was 6.8 on the Sensitive method.

Could that explain my irritability due to the change in protocol?

Regardless, I questioned going from 260 mg per week to 260 mg every other week and was given the "I've been doing this for over 20 years and I know what I am doing" spill by the doctor.

My appointment with the Defy doctor is tomorrow.

On another note, my DHEA was also low at 79.1. I have not idea what that could cause.

EDIT: My SHBG was still good at 51.6. I figured I would throw that number in there since it was asked earlier.

bouquetCPA said:

I figured I would update my thread to let everyone know what is going on. My testosterone level at 11 days was 634 and my Estradiol was 6.8 on the Sensitive method.

Could that explain my irritability due to the change in protocol?

Regardless, I questioned going from 260 mg per week to 260 mg every other week and was given the "I've been doing this for over 20 years and I know what I am doing" spill by the doctor.

My appointment with the Defy doctor is tomorrow.

On another note, my DHEA was also low at 79.1. I have not idea what that could cause.

EDIT: My SHBG was still good at 51.6. I figured I would throw that number in there since it was asked earlier.

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You're almost out of the woods...your Defy consultation is on the horizon. Your present doctor may have been doing this for 20 years...but doing it well...that's another story.

bouquetCPA said:

my Estradiol was 6.8 on the Sensitive method.

Could that explain my irritability due to the change in protocol?

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Isn't 6.8 under range? if it is yes it could easily explain your irritability.