1. #1

    Started TRT .... Looking forward

    Hey all , Just wanted to say what’s up and that I’ve finally took the dive and began the TRT journey. ( I started Monday the 11th actually , sorry I’m a little late on the thread)


    I’ll give some background first. Or you can just scroll past the background, straight to the protocol if you’d like ;].


    Well I’m 29 and about to be 30 this year. Almost 3 years ago I began experiencing some really weird and unexplainable health issues. I began feeling very tired and out of it, started getting anxiety (which I’ve never had before), developed depersonalization and derealization, extreme fatigue, brain fog , lack of motivation, and really low libido. This all caused depression and increased anxiety which in turn basically made every symptom even worse, creating a vicious cycle.


    After hardly any help from my PCP and every test and lab work coming back fine, I thought maybe I needed to try the natural way and see a naturopath.. I started seeing a naturopath , who did a bunch of lab work and noticed my testosterone was very low at 281 ng/dL. He said it was the lowest he’d seen personally in a guy my age. He immediately wanted to treat me with some hormones but I’m a research first kind of guy. And thankfully my research led me to here.


    After joining here and listening to recommendations from members and mods, I began with Dr. Saya at Defy. We got me on a clomid protocol , along with some DHEA and NatureThroid. My T numbers did go up, but unfortunately I wasn’t getting any symptom reduction. I eventually tapered off the clomid and the rest of my meds and then just sat for a few months , medication free, to see how my body would act. And weirdly, I felt the exact same and maybe even a tiny bit better after stopping everything.


    About a couple months ago I finally got fed up with all my symptoms , again , and just said eff it , I’m going to get in touch with Defy. I called, order labs and set up an appt. I did my labs in the afternoon as this is when I usually feel worse and TT came back @ 152 , Range 250-1100 and FT came back @ 29.4 , Range 35.0-155.0 pg/mL. After discussing everything with Dr. Saya, we decided to go the TRT route. I know , finally right!! Well , I have my fingers crossed and pray everything goes well.




    My protocol:



    • 60mg Test Cyp every 3.5 days
    • HCG 500iu every 3.5 days
    • 0.25 mg Anastrozole every 3.5 days



    Taking meds Monday mornings and Thursday nights.


    Just an FYI:


    SHBG was tested last year and came back @ 13 , Range 10-50 nmol/L

    E2 came back @ 24 , Range <or=29 pg/mL

    Also I keep my PCP in the loop on things and he had me do another set of testosterone labs 2 weeks ago but in the AM. Those numbers were:


    8:30 AM
    TT = 398 , Range 250-1100 ng/dL
    FT = 97 , Range 35-155 pg/mL




    So far , Week 1:


    Right after first injection I started feeling some anxiety and just a little off the rest of the day, which I kinda expected is normal being it was my first time self injecting anything into my body.


    I haven’t noticed anything different as far as reduction in symptoms. I do however feel a little more tired this week and feel like today I’ve been a little more impatient / short tempered than in the recent weeks prior.. Could just be me overthinking about it though. Idk.


    Other than that I can’t wait for what the upcoming weeks have in store. I will update weekly and look forward to all of your guys feedback.


















    Last edited by AntCon; 06-16-2018 at 06:23 PM.

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  3. #2
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    Man with a FT = 97 , Range 35-155 pg/mL
    I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.

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    Quote Originally Posted by FeelingLost View Post
    Man with a FT = 97 , Range 35-155 pg/mL
    I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.
    Hey , yea I’m pretty new to all this so still learning a lot ... When I did the afternoon labs though (basically when I start to feeling my worse) my FT was at 29 which is below the range. From your knowledge do you think this is way too far of a drop?

  5. #4
    Quote Originally Posted by FeelingLost View Post
    Man with a FT = 97 , Range 35-155 pg/mL
    I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.
    Lol no this is false.

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    Quote Originally Posted by equel View Post
    Lol no this is false.
    How about elaborating equel. Which part of my statement is false? Does the body use or need all the T that is boundup?
    Last edited by FeelingLost; 06-16-2018 at 07:23 PM.

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    Quote Originally Posted by AntCon View Post
    Hey , yea I’m pretty new to all this so still learning a lot ... When I did the afternoon labs though (basically when I start to feeling my worse) my FT was at 29 which is below the range. From your knowledge do you think this is way too far of a drop?
    I'm no doctor I can't say. Naddy T does move around a lot during the day. Did you workout have sex a bad nights sleep it all effects your natural T lvl.

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    Quote Originally Posted by FeelingLost View Post
    I'm no doctor I can't say. Naddy T does move around a lot during the day. Did you workout have sex a bad nights sleep it all effects your natural T lvl.
    Yea , no none of that. It was just a normal day for me, where I begin feeling drained in the afternoon so I decided to see what my labs looked like then.

  9. #8
    Junior Member FOX1's Avatar
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    It must have been a very difficult decision for you at 29 years old, very young to be on TRT, I hope your doctors gave you sound advice

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    Quote Originally Posted by FeelingLost View Post
    Man with a FT = 97 , Range 35-155 pg/mL
    I am very surprised you wanted to go down the TRT path. TT doesn't mean crap its a useless number. FT is what you feel.
    Both TT and FT are important, you could argue FT is perhaps "more" important, but TT is not a useless measurement by any means.

  11. #10
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    Quote Originally Posted by AntCon View Post
    Yea , no none of that. It was just a normal day for me, where I begin feeling drained in the afternoon so I decided to see what my labs looked like then.



    As you may know a healthy young males endogenous testosterone level peaks in the early am and than gradually declines in the late afternoon/early evening due to the 24hr circadian rhythm.

    Labs for testosterone should be done fasted and in the early morning between (7-10am) as you want to test during the peak.

    Levels will fluctuate throughout the day and testosterone levels can be up to 25-30% lower in the afternoon.

    Your other labs were done at the wrong time and any doctor should know that blood work for testosterone is done in the early am.

    Sure you may have wanted to look at your levels later in the day but it has no bearing to your peak levels.

  12. #11
    Quote Originally Posted by madman View Post
    As you may know a healthy young males endogenous testosterone level peaks in the early am and than gradually declines in the late afternoon/early evening due to the 24hr circadian rhythm.

    Labs for testosterone should be done fasted and in the early morning between (7-10am) as you want to test during the peak.

    Levels will fluctuate throughout the day and testosterone levels can be up to 25-30% lower in the afternoon.

    Your other labs were done at the wrong time and any doctor should know that blood work for testosterone is done in the early am.

    Sure you may have wanted to look at your levels later in the day but it has no bearing to your peak levels.
    Tangent,

    I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.

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    Quote Originally Posted by Vitamin_C View Post
    Both TT and FT are important, you could argue FT is perhaps "more" important, but TT is not a useless measurement by any means.
    Thanks Vitamin C, I could have worded my post better.

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    Quote Originally Posted by Blackhawk View Post
    Tangent,

    I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.
    Here's a conspiracy theory for you BlackHawk.

    I think the whole trough thing was started so guys could get away with taking more.
    I recently did a peak T blood test since Nelson has the TT/FT test on sale for 30 bucks.

    I believe when you have HCT issues FT peak plays a big roll. You can't let your FT peak go above range.

    I have my E2 under control and that is the only reason I can think of for TT/FT trough numbers since E follows T.
    So your T trough is you E2 peak.

    I plan to ask Defy if I can do peak TT/FT on future blood test the trough has no value to me.

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    Quote Originally Posted by FOX1 View Post
    It must have been a very difficult decision for you at 29 years old, very young to be on TRT, I hope your doctors gave you sound advice
    I know :/ .... It took me a while to finally make the decision to start. It was a hard but I’ve tried many different things to get my health in order with no luck. And Yea, I am very confident in my doctor and his advice.


    Quote Originally Posted by madman View Post
    As you may know a healthy young males endogenous testosterone level peaks in the early am and than gradually declines in the late afternoon/early evening due to the 24hr circadian rhythm.

    Labs for testosterone should be done fasted and in the early morning between (7-10am) as you want to test during the peak.

    Levels will fluctuate throughout the day and testosterone levels can be up to 25-30% lower in the afternoon.

    Your other labs were done at the wrong time and any doctor should know that blood work for testosterone is done in the early am.

    Sure you may have wanted to look at your levels later in the day but it has no bearing to your peak levels.
    First, thanks for the reply. .Yes, my doctor understood that they weren’t done in the AM. We’ve already done labs in the past at early AM fasting times , so he has those too. Plus he said that even if you take in the fact that my testosterone was higher in the AM that lab day, it still would be considerably low (for a guy my age) with the added percentage

  16. #15
    Low SHBG men usually need to inject more frequently, preferably EOD or for some everyday. I realize everyone is different and this is only a starting point, however is symptoms don't improve you may need to inject more frequency. I only respond well to TRT when injecting EOD even with higher SHBG levels (16-18), twice weekly my results are underwhelming.

  17. #16
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    Quote Originally Posted by Blackhawk View Post
    Tangent,

    I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.

    Endogenous testosterone production: diurnal rhythm (24hr)-episodic fluctuation in circulating testosterone levels over shorter periods (minutes to hours) carried along by pulsatile lh secretion.

    Diurnal patterns of morning peak testosterone levels and nadir levels in the mid afternoon are evident in YOUNGER and healthy OLDER men hence it is conventional practice to STANDARDIZE testosterone measurements to morning blood samples on at least 2 different days.

    Regarding exogenous t patches and trandermal (gel/cream) would be a close as one could get to mimicking the natural diurnal rhythm as oppose to injectables which in no way mimic the natural diurnal rhythm even when injecting daily.

    When one uses transdermal and reaches steady state blood work for testosterone levels is done within 2hrs after application (peak).


    Exogenous testosterone: steady state (depot testosterone injections maintain steady state delivery pattern depending on dose/injection frequency/ester used/ones shbg levels)

    Regarding peak/trough ones dose, injection frequency, ester used and of course ones shbg levels are all contributing factors.

    When one is injecting once weekly (higher doses) there is a big difference between peak/trough and stability of testosterone levels as oppose to injecting more frequently using lower doses.

    Injecting every 3.5 days or M/W/F would result in a lesser peak/trough and more stable blood levels and when injecting EOD or daily peaks/troughs would be greatly minimized and steadier blood levels would be achieve.

    Are we comparing natural endogenous testosterone (24hr diurnal rhythm) to exogenous testosterone injections resulting in steady state as in levels elevated over a period of days?

  18. #17
    Quote Originally Posted by madman View Post
    Endogenous testosterone production: diurnal rhythm (24hr)-episodic fluctuation in circulating testosterone levels over shorter periods (minutes to hours) carried along by pulsatile lh secretion.

    Diurnal patterns of morning peak testosterone levels and nadir levels in the mid afternoon are evident in YOUNGER and healthy OLDER men hence it is conventional practice to STANDARDIZE testosterone measurements to morning blood samples on at least 2 different days.

    Regarding exogenous t patches and trandermal (gel/cream) would be a close as one could get to mimicking the natural diurnal rhythm as oppose to injectables which in no way mimic the natural diurnal rhythm even when injecting daily.

    When one uses transdermal and reaches steady state blood work for testosterone levels is done within 2hrs after application (peak).


    Exogenous testosterone: steady state (depot testosterone injections maintain steady state delivery pattern depending on dose/injection frequency/ester used/ones shbg levels)

    Regarding peak/trough ones dose, injection frequency, ester used and of course ones shbg levels are all contributing factors.

    When one is injecting once weekly (higher doses) there is a big difference between peak/trough and stability of testosterone levels as oppose to injecting more frequently using lower doses.

    Injecting every 3.5 days or M/W/F would result in a lesser peak/trough and more stable blood levels and when injecting EOD or daily peaks/troughs would be greatly minimized and steadier blood levels would be achieve.

    Are we comparing natural endogenous testosterone (24hr diurnal rhythm) to exogenous testosterone injections resulting in steady state as in levels elevated over a period of days?

    Yes, that is the point, to compare endogenous with exogenous in relationship to timing of lab draws.

    Yes of course, peak/trough fluctuations on exogenous do not mimic the diurnal timing.

    So what can we gain from studying the peak-trough aspect of differing injection frequency for exogenous use, and of what value is knowing peak measurement as well as trough? It seems very pertinent to me but I have seen no such studied information presented.

  19. #18
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    Quote Originally Posted by Blackhawk View Post
    Tangent,

    I find it a bit ironic that theoretically we are looking for the peak lab level on endogenous, but trough with exogenous.

    When screening for hypogonadism testing fasted in the early am during peak helps give a more accurate picture of ones levels especially in younger men.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681273/

  20. #19
    Member madman's Avatar
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    Another reason why testing in the am in a fasted state may help when screening for low t.

    https://serval.unil.ch/resource/serv...D303D.P001/REF

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    Madman, I always look forward to your posts. Rarely do I not learn something.
    Thank you for being a part of this community. Your detailed posts to help others does not go unappreciated.


    Quote Originally Posted by madman View Post
    Endogenous testosterone production: diurnal rhythm (24hr)-episodic fluctuation in circulating testosterone levels over shorter periods (minutes to hours) carried along by pulsatile lh secretion.

    Diurnal patterns of morning peak testosterone levels and nadir levels in the mid afternoon are evident in YOUNGER and healthy OLDER men hence it is conventional practice to STANDARDIZE testosterone measurements to morning blood samples on at least 2 different days.

    Regarding exogenous t patches and trandermal (gel/cream) would be a close as one could get to mimicking the natural diurnal rhythm as oppose to injectables which in no way mimic the natural diurnal rhythm even when injecting daily.

    When one uses transdermal and reaches steady state blood work for testosterone levels is done within 2hrs after application (peak).


    Exogenous testosterone: steady state (depot testosterone injections maintain steady state delivery pattern depending on dose/injection frequency/ester used/ones shbg levels)

    Regarding peak/trough ones dose, injection frequency, ester used and of course ones shbg levels are all contributing factors.

    When one is injecting once weekly (higher doses) there is a big difference between peak/trough and stability of testosterone levels as oppose to injecting more frequently using lower doses.

    Injecting every 3.5 days or M/W/F would result in a lesser peak/trough and more stable blood levels and when injecting EOD or daily peaks/troughs would be greatly minimized and steadier blood levels would be achieve.

    Are we comparing natural endogenous testosterone (24hr diurnal rhythm) to exogenous testosterone injections resulting in steady state as in levels elevated over a period of days?

  22. #21
    Agreed. Very smart, analytical and detailed dude. Much appreciated for sure.

  23. #22
    But ya with a SHBG that low you definitely need to go EOD or ED injections. You can do E3.5 days but it’s not going to be optimal for you. So why not just try and optimal protocol from the start to save time. ED would be ideal with your SHBG, but if that’s too many injections, definitely go EOD.

    Also, I would wait to start the AI. If you took it along with your first injection, that could absolutely be the reason why you feel more tired. I personally would drop it completely during this first run and see where your E2 falls after your first blood work. Your E2 was surprisingly higher than I thought it would be considering your low total T. So there’s a chance it could elevate quite a bit on this protocol, but I would see how you feel without it first. If you are going to use it, I would at least wait a couple weeks before implementing it. Also I think you might of had the regular E2 test done. The sensitive E2 test is what you want. The regular E2 test usually always come back higher than the sensitive, so if this was the regular test, then ur sensitive E2 is most likely lower than 24.

    So definitely up the frequency of injections. If not, what’s going to happen is you’re going to get your testosterone at trough checked and it’s gonna come back lower than you’d probably like because you’re excreting it too quickly. And you’re going to think a dose increase is needed which will elevate everything else like E2 and possibly prolactin. Which is gonna require you to use more AI. When in reality all you need to do is increase the frequency, and even with the same dosage your testosterone levels might come back just where you want them. And this way you might not even need an AI. And if you can avoid using an AI, trust me, it’s 100% the way to go
    Last edited by Gman86; 06-17-2018 at 09:26 PM.

  24. #23
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    Quote Originally Posted by Gman86 View Post
    But ya with a SHBG that low you definitely need to go EOD or ED injections. You can do E3.5 days but it’s not going to be optimal for you. So why not just try and optimal protocol from the start to save time. ED would be ideal with your SHBG, but if that’s too many injections, definitely go EOD.

    Also, I would wait to start the AI. If you took it along with your first injection, that could absolutely be the reason why you feel more tired. I personally would drop it completely during this first run and see where your E2 falls after your first blood work. Your E2 was surprisingly higher than I thought it would be considering your low total T. So there’s a chance it could elevate quite a bit on this protocol, but I would see how you feel without it first. If you are going to use it, I would at least wait a couple weeks before implementing it. Also I think you might of had the regular E2 test done. The sensitive E2 test is what you want. The regular E2 test usually always come back higher than the sensitive, so if this was the regular test, then ur sensitive E2 is most likely lower than 24.

    So definitely up the frequency of injections. If not, what’s going to happen is you’re going to get your testosterone at trough checked and it’s gonna come back lower than you’d probably like because you’re excreting it too quickly. And you’re going to think a dose increase is needed which will elevate everything else like E2 and possibly prolactin. Which is gonna require you to use more AI. When in reality all you need to do is increase the frequency, and even with the same dosage your testosterone levels might come back just where you want them. And this way you might not even need an AI. And if you can avoid using an AI, trust me, it’s 100% the way to go
    Thanks for the reply. Yes , in regards to the low SHBG, it was in the back of my head about EOD injections. While talking with Dr. Saya though, we decided on me trying every 3.5 days first and seeing how it works out for me. Which I have no problem with, especially since ideally, the less frequent I have to inject the better.

    As far as my E2 , it was the ultrasensitive test. My E2 was actually even higher in a set of labs I had done last year @ 31.. So when I was on Clomid, I actually was on an AI with that too. This came into play , when deciding if I should be on an AI along with TRT. I’m going to consider getting labs done anyhow at the 3 .5 week mark since my insurance covers it, just to get an idea where everything is sitting at. What are your opinions on that? I’ll still stick out the protocol until my follow up with the doc though, unless there’s anything alarming I notice.

    Would increasing frequency of injection eliminate the need for an AI ? Or is that just dependent on the person ? I’d be curioious to know if there is anyone in this forum that has EOD or even Everyday injections and still has to use an AI.

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    Yesterday I felt really on edge and easily annoyed / agitated. Today is better but would you guys say this common in the beginning stages of TRT ?

  26. #25
    Quote Originally Posted by AntCon View Post
    Yesterday I felt really on edge and easily annoyed / agitated. Today is better but would you guys say this common in the beginning stages of TRT ?
    You will have good days and bad days, it's guaranteed. The same thing can be said on a protocol change even long after you've been on TRT for awhile. I always have a worse time by week 3, it's always bad for me. This is when I start doubting everything in life and remind myself I'm BS'ing myself and snap out of it. Week 4 is magic, this is when my erections say hello.

    The thing I hate is if you make the slightest dosage change it resets the 6 weeks until you reach a stable state, so don't. A lot of new guys make that mistake and wonder why they never feel good.

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    Quote Originally Posted by Systemlord View Post
    You will have good days and bad days, it's guaranteed. The same thing can be said on a protocol change even long after you've been on TRT for awhile. I always have a worse time by week 3, it's always bad for me. This is when I start doubting everything in life and remind myself I'm BS'ing myself and snap out of it. Week 4 is magic, this is when my erections say hello.

    The thing I hate is if you make the slightest dosage change it resets the 6 weeks until you reach a stable state, so don't. A lot of new guys make that mistake and wonder why they never feel good.
    Yea that’s what I figuring. I know times are gonna be hard during this but I definitely won’t change anything , unless recommended by the doc at follow up.. Im just gonna have to have my wife slap me up a couple times to snap me out of it lol. I’m looking forward to that week 4 magic though haha. Just hope I feel it by then , as I’ve read for some it’s sooner and others later.

  28. #27
    Ya I think labs at the 3.5 week mark would be a great idea. The testosterone cypionate will still be increasing and raising your total T after this point for another 2-3 weeks or so, but your HCG and anastrozole will have both reached a steady state, so it will give you a decent peak into where things are and where things will probably end up. Most importantly it will let you know what the anastrozole is doing to your E2.

    Increasing frequency will pretty much decrease E2 in everyone. I've personally only heard of that not being the case with maybe 1-2 guys out of hundreds, possibly thousands of posts at this point. With you having such a low SHBG, you're not going to need a high amount of total testosterone to get a good free T, so if you were to increase the frequency of your injections, and use the minimum dose needed to get your free T into a good range, I'd say the chances of you not needing an AI are very high.

    An AI is usually needed more for high SHBG guys that require a higher total T to get a good level of free T, but with you having a higher E2 to begin with, you might possibly be the exception to that. I'm very curious to find out, as are you I'm sure.

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    Alright , yea , I think will get those labs then for sure. When looking at lab work how can you tell what the HCG is doing for you? Is there anything specific to look for that correlates to taking HCG?

    Thanks Gman , I really appreciate all the info and advice. I’ll definitely be keeping all this in mind as things go forward.

  30. #29
    Anytime man, thatís what this forum is here for. To help eachother out.

    With the HCG I donít think thereís any blood test that specifically will tell you about the HCG in your system. I think the only things you can really go by are testicular size and a semen test to see how much sperm you are producing and the quality of them. Other than those two things idk how else you would be able to tell if the HCG is working, and to what degree. Does anyone else know of any tests?

  31. #30
    Quote Originally Posted by Gman86 View Post
    Anytime man, thatís what this forum is here for. To help eachother out.

    With the HCG I donít think thereís any blood test that specifically will tell you about the HCG in your system. I think the only things you can really go by are testicular size and a semen test to see how much sperm you are producing and the quality of them. Other than those two things idk how else you would be able to tell if the HCG is working, and to what degree. Does anyone else know of any tests?
    Debatable, but potentially 17-OH progesterone as an upstream marker.

    Serum quantitative beta hCG level can be checked to show actual serum levels, but as you stated testicular size and, if fertility is considered, semen analysis are the common measuring sticks.
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