New Member - Looking to Hone Protocol and Monitoring

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DMG

New Member
Hello Everyone:

I am (fairly) new to this site. My first post, but I have lurked/read/researched for a while. I started TRT in September 2017 (so it's been about 12 weeks), and as I learn more and more about it, I am realizing the importance of getting everything squared away - getting the dosing protocol right, having the right conversations with my care provider(s), getting the right blood tests, etc.

My hope is that some of the more experience members here can guide me and help me make sure I'm taking the right approach.

I've tried to provide basic info, test results, medical history, current protocol, and concerns/questions. Of course, if anything is missing, I'm happy to provide more information/context. I know this is a long post, but I did want to be as thorough as possible.

Basic Stats
32 Years old
~225 lbs
Body fat ~20-22%

Test Results

 

[TD="align: center"]6/22/2017[/TD]
[TD="align: center"]6/28/2017[/TD]
[TD="align: center"]8/11/2017[/TD]
[TD="align: center"]8/28/2017[/TD]
[TD="align: center"]11/1/2017[/TD]

Total Test.
264 - 916 ng/dL

[TD="align: center"]286[/TD]
[TD="align: center"]257[/TD]
[TD="align: center"]269[/TD]
[TD="align: center"]271[/TD]
[TD="align: center"]650[/TD]

Free Test.
8.7 - 25.1 pg/mL

[TD="align: center"]7.4[/TD]
[TD="align: center"]5.9[/TD]
[TD="align: center"]5.1[/TD]
[TD="align: center"]5.4[/TD]
[TD="align: center"]14.7[/TD]

Prolactin
4.0 - 15.2 ng/mL

[TD="align: center"]16.6[/TD]
[TD="align: center"]19.2[/TD]
[TD="align: center"]0.3[/TD]
[TD="align: center"]0.2[/TD]
[TD="align: center"]2.8[/TD]

SHBG
16.5 - 55.9 nmol/L

[TD="align: center"]25.7[/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]

 

LH
1.7 - 8.6 mIU/mL

[TD="align: center"]3.5[/TD]
[TD="align: center"]4.1[/TD]
[TD="align: center"][/TD]
[TD="align: center"]3.2[/TD]
[TD="align: center"]<0.2[/TD]

FSH
1.5 - 12.4 mIU/mL

[TD="align: center"]2.6[/TD]
[TD="align: center"]2.7[/TD]
[TD="align: center"][/TD]
[TD="align: center"]2.4[/TD]
[TD="align: center"]<0.2[/TD]

Cortisol
6.2 - 19.4 ug/dL

[TD="align: center"]7.3[/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]

PSA
0.0 - 4.0 ng/mL

[TD="align: center"]0.3[/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]
[TD="align: center"][/TD]




Timeline
*Late Summer/Early Fall 2016 - Symptoms started in earnest. Heavy fatigue. Lack of motivation, especially at work (I was in exactly the job I wanted to be in at the time, too), loss of sex drive, loss of "vigor", loss of assertiveness/competitiveness.

* Feb/Mar 2017 - Initial tests with my PCP, who suggested looking at Testosterone levels. At this point, I had thought it was possibly a sleep issue so I worked to perfect my sleep routine, both hygiene and scheduling. I also went ahead and was evaluated for apnea, which it turned out I do not have. I was snoring a bit, and got a mouthpiece, which helped.

* March 2017 - Saw a urologist, who was not helpful. Literally didn't even look at the test results and just told me I was too young to consider TRT, and told me to work on diet, sleep, and exercise, without asking what I was currently doing in those areas.

* June 2017 - First endocrinologist appointment; first and second more detailed blood panels. Since Prolactin was high, was referred for an MRI.

* July 2017 - Had MRI; came back negative for a tumor. Started cabergoline.

* August 2017 - Follow up appointments and blood draws; Testosterone levels still low, prescribed Testosterone Cypionate

Medical History
Current Medications are:
(1) Fluoxetine (I've struggled with depression since I was about 14 and just started taking something earlier this year)
(2) Advair
(3) Cabergoline

Former Medication - Finasteride. For ten years. I don't think it will surprise anyone to know I now regret this. Stopped in June at suggestions of endocrinologist. When I started taking it, I noticed a drop in assertiveness and sex drive, but neither concerned me at the time. In fact, the former I viewed as a plus, as I could be somewhat hot-headed in my younger days. I also wasn't sure if I had imagined the difference.

I have had two minor concussions, neither of which were symptomatic for more than a few hours.

I had moderate trauma to the testes earlier this year (early March), when I got in between dogs who were trying to fight, and was clawed between the legs. However, though I needed sutures, an ultrasound revealed no structural damage.

Endocrine issues run in my family. My mother had has issues with her thyroid and parathyroids, and my brother didn't produce HGH during puberty and had to inject for several years.

Protocol
Started with 200mg every other week for ~8-10 weeks, and felt like I felt some decline towards the end of the dosing period. Switching over to 50mg every 2.5 days, based on what I've read here and elsewhere.

Concerns
My endocrinologist is a great guy. He is significantly better than most care providers in that he listens well, takes him time with you, and address all your concerns (i.e. he is not dismissive or a know-it-all). He is also a TRT patient.

With that said, he did suggest the 200mg/14days dosing to start; then told me later it rarely actually works. He suggested going to 200mg/10 days, but I told him I was wary of upping the dosage without simply trying more frequent injections and suggested 100mg/7 days...but as I said, I'm now favoring 50mg/3.5 days. He didn't express concern that a 3.5 or seven day protocol wouldn't work, he just said that it was more than most guys could keep up with, in terms of being sure to dose when they were supposed to.

Additionally, he hasn't tested for E2, and doesn't seem too concerned about it. There was also no mention of HCG other than, "Well, if you decide you want kids, we'll put you on it, and everything will be sorted out."

I guess I am slightly torn about what to do in terms of care -- this guy has a lot of positives, the practice is covered by insurance, it's part of the broader network that my other doctors are in, but...I feel like he is not a hormone replacement expert.

Thanks for reading - guidance is appreciated!
 
Defy Medical TRT clinic doctor

TheDude

Member
You absolutely need to test for Estradiol, Sensitive. You need to see how these different protocols work for you. Unfortunately, those that need to stick with their DR because it's covered by insurance are going to have to be as educated as possible. The good news is that he is willing to work with you. E3.5D is a good starting point and should help with the ups/downs you experience with the every 2 weeks protocol. If he is willing, I'd add HCG as well.
 

CoastWatcher

Moderator
Your physician may be a fine fellow, a great guy, but he's not serving you as well as you deserve. He was planning to prescribe a protocol that he knew wouldn't work!! If that isn't malpractice, in a strict legal sense, it's astonishingly shoddy practice. It was your effort that gave you the knowledge that at the very minimum you should be injecting weekly. It's that same effort - your effort - that leads you to conclude a twice-weekly protocol might serve you more effectively (it almost certainly will). He doesn't seem interested in monitoring your estradiol...blowing off the HCG issue...I do hope he requested a PSA prior to the start of therapy. In other words, you should take a breath and find a doctor who actually believes in the protocols he prescribes, will monitor the appropriate markers for TRT success...a doctor who seems to give a damn. How much Cabergoline are you taking, what was your prolactin and what is it since the introduction of Caber?
 

DMG

New Member
Thank you both.

CoastWatcher, you make some good points. It was so refreshing to have a provider willing to listen and have an honest back and forth, especially after the arrogant and dismissive urologist, that perhaps I overrated him and the care I was getting.

I did have a PSA test before starting: 0.3 on a 0.0-4.0 reference range.

For Cobergoline, prolactin was at 16.6 and 19.2 (reference range of 4.0 - 15.2), and went to 0.3 and 0.2 after treatment. I was prescribed 0.5mg/wk, broken into two 0.25mg doses.
 

Keepgoing

New Member
Agree with all the above, your doctor is in over their head. Your best bet is to get a real TRT doctor. It cost more but what price do you put on health. As a side note elevated BF% does not help your issue. TRT has its limitations on benefits, a cheap way to increase effectiveness of TRT is safely lowering your BF%. Endocrinologist have the tuffest rating for BF% of all doctors. This is do to the direct corilation they perceive in hormone levels and BF%. Look up the Endocrinologist Journel of Medicine, search for the studies on BF% and hormon production. Dropping some Lbs is cheap and has a host of benefits.
 

Vince

Super Moderator
Here's my two cents on a good starting protocol, 70mg of testosterone Cypionate and 500iu of HCG injected every 3 1/2 days, no AI. Do labs in 12 weeks and make adjustments to get dialed in.
 
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