1. #1

    Am i heading in the right direction?

    Hello, I'm new to the site and not very familiar with all the forum etiquette so please bare with me.

    I'm 48 years old and started TRT 1 year ago after my T levels came back at 201. As you can imagine i felt like shit and decided to start treatment. A friend referred me to a local men's hormone replacement clinic. I thought man this is great.. everything included. meds, blood work the works for a reasonable monthly fee. What i didn't anticipate was the roller coaster i've been on for the past year. I was initially given 200mg of test cyp per week but the weird thing was that .5 mg of anastrozole was compounded into the testosterone and i was also given hcg 2 times per week. i felt terrible on this protocol and eventually gave up with them after 4 months due to the severe joint pain high anxiety and low libido. test was 1100 and sensitive e2 was 18. they didnt check much.

    I began to do my homework and found one of the most respected TRT doctors in West Palm Beach, Florida. I won't mention his name because I'm not that kind of person. I was excited knowing that i was dealing with one of the best according to many many people on different forums. Once i started, i was given every medication known to man well, not really but i was started off with 200 mg of test cyp 1xweek, .25mg of anastrozole day3 and 6 post injection, 500mg of metformin 2x per day and some thyroid medication called cytomel. With this protocol my anxiety was so bad it was disrupting my daily life and the joint pain is horrible. Little by little i would eliminate meds with doctors approval and eventually wound up at 140mg of test cyp 1xper week and .25mg anastrozole 2x per week. things got better but I think i honestly felt better Pre TRT. On this protocol my test is 550, free test 127, sensitive e2 is 25, shbg 14. After 6 months of changing this and changing that i stopped going to the second doctor.

    I'm going to give this one more try with my primary Doctor who is very open and willing to work with me and how i'm feeling. I just started 50mg of test cyp every 3.5 days. no anastrozole for now (that stuff is poison) im hoping i wont need it. I will test my e2 in 4-6 weeks to make sure e2 is in check.
    I'm thinking of incorporating hcg back in my protocol with the split dose but want to change things 1 thing at a time.
    Do you all think this is a good start? I havent had any gaps between doctors so ive still been on trt just changing the protocol one last time.

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  3. #2
    This protocol will likely fail you like the ones before it because of your low SHBG. My SHBG is only 2 points higher than yours and I was miserable at 50mg twice weekly. Low SHBG guys have a ton of free hormones, free t and unfortunately free estrogen.

    You will likely only do well injecting micro doses every day, 5-8mg. You might be able to get away with 15-20mg EOD. Anything else will likely fail you, I'm doing 16mg EOD and still have estrogen problems and require a low dose AI to help control estrogen.

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    so low SHBG is why i have the anxiety symptoms im experiencing? My free t isn't to high at 127 (35-155 pg/ml) is it possible to have low SHBG and not have free T issues? never been an issue for me unless 127 is considered high.
    Last edited by carkrazy; 07-13-2018 at 09:26 PM.

  5. #4
    Low SHBG men can tolerate almost no estrogen due to the majority of it being free, the lower the shbg more free estrogen. Excess estrogen causes hypertension, anxiety and it blocks the mechanism in the brain that controls blood pressure in the brain.

  6. #5
    Member Mountain Man's Avatar
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    My guess is that the testosterone dose was too high right from the jump. Also, why HCG, AI, and metformin? Until you know the response to the testosterone, how do you know those are even necessary? Now it’s going to take a long time to figure out what is the problem. Too many of these men’s clinics are baffling guys who don’t know better with BS. The 50mg every 3.5 is the first part of your protocol that makes sense. Too bad that wasn’t where you started. Good luck with everything.

    i swear, some of these men’s clinics must be getting kickbacks from the drug companies for all these crazy initial protocols.

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    Thanks Mountain Man. I started to listen to my body and started to question all the other drugs. I felt 200 mg 1x per week was a bit much but this protocol was coming from a TRT expert according to many people on the forums. he's written books that have gotten rave reviews on testosterone therapy so i was going with the program initially. i finally couldn't take it anymore and wound up here. I figured with the vast experience on here and a Doctor willing to work with me it was worth a try as i dont want to go back to pre trt state. i
    Quote Originally Posted by Mountain Man View Post
    My guess is that the testosterone dose was too high right from the jump. Also, why HCG, AI, and metformin? Until you know the response to the testosterone, how do you know those are even necessary? Now itís going to take a long time to figure out what is the problem. Too many of these menís clinics are baffling guys who donít know better with BS. The 50mg every 3.5 is the first part of your protocol that makes sense. Too bad that wasnít where you started. Good luck with everything.

    i swear, some of these menís clinics must be getting kickbacks from the drug companies for all these crazy initial protocols.

  8. #7
    Quote Originally Posted by carkrazy View Post
    Thanks Mountain Man. I started to listen to my body and started to question all the other drugs. I felt 200 mg 1x per week was a bit much but this protocol was coming from a TRT expert according to many people on the forums. he's written books that have gotten rave reviews on testosterone therapy so i was going with the program initially. i finally couldn't take it anymore and wound up here. I figured with the vast experience on here and a Doctor willing to work with me it was worth a try as i dont want to go back to pre trt state. i
    You have found that you have to be your own advocate - no matter who your doctor is...no matter the number of books written...no matter what the internet says. TRT hasn't been a failure, the physicians you've worked with have failed. It's a story many of us have experienced.

    All the best.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    Amen to that brother!
    Quote Originally Posted by CoastWatcher View Post
    You have found that you have to be your own advocate - no matter who your doctor is...no matter the number of books written...no matter what the internet says. TRT hasn't been a failure, the physicians you've worked with have failed. It's a story many of us have experienced.

    All the best.

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    so would checking my labs after 4-6 weeks on this protocol of 50mg every 3.5 days be ok?
    also, i was wondering what some of you guys think about incorporating HCG later on as my testicular atrophy is beginning to freak me out a bit.

  11. #10
    Quote Originally Posted by carkrazy View Post
    so would checking my labs after 4-6 weeks on this protocol of 50mg every 3.5 days be ok?
    also, i was wondering what some of you guys think about incorporating HCG later on as my testicular atrophy is beginning to freak me out a bit.
    Sounds like a plan.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    can anyone shed some light on what could be causing anxiety while on TRT as this is my main complaint since starting a year ago. E2 has been consistently between 18-29

  13. #12
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    Quote Originally Posted by carkrazy View Post
    can anyone shed some light on what could be causing anxiety while on TRT as this is my main complaint since starting a year ago. E2 has been consistently between 18-29
    Maybe your estrogen levels are too low, if you're not on an AI. There's ways you can increase your estrogen, I supplement with DHEA and use HCG.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

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    Thanks for your input Vince. My E2 has been consistent between 18-29 with .25 mg of anastrozole 2x per week and depending when i draw my blood. i cant stand the anastrozole so im hoping that the split dose at 50mg every 3.5 days will help control estrogen. i have to give it some time as i just started the new protocol wednesday and stopped taking anastrozole.
    Quote Originally Posted by Vince View Post
    Maybe your estrogen levels are too low, if you're not on an AI. There's ways you can increase your estrogen, I supplement with DHEA and use HCG.

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    Quote Originally Posted by carkrazy View Post
    Thanks for your input Vince. My E2 has been consistent between 18-29 with .25 mg of anastrozole 2x per week and depending when i draw my blood. i cant stand the anastrozole so im hoping that the split dose at 50mg every 3.5 days will help control estrogen. i have to give it some time as i just started the new protocol wednesday and stopped taking anastrozole.
    There are many men and doctors that believe you do not need to treat estradiol levels until it hits 60, unless of course you're having symptoms of high estrogen. Something personally I've never felt, for that matter I've never felt low or high estrogen symptoms.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  16. #15
    Setting the anastrozole aside is a good idea. I felt elevated estradiol when my numbers hit 55 (sensitive test). Now, with no AI but daily injections, I keep it in the mid-30s and feel just fine. I suspect that even if it climbed into the 40s I would be in good shape. We're all different, but e2 is NOT a waste product, men need it. I hope your plan lowers the anxiety.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    Thanks CoastWatcher, the anxiety issue for me is my biggest thing. I did suffer from anxiety prior to TRT but since starting TRT my anxiety is at another level. I was very clear with my Doctors about it and wish they would have started me slow but hey, at least i found a good forum and protocol to follow now. Felt like these Doctors were killing me slowly.
    Quote Originally Posted by CoastWatcher View Post
    Setting the anastrozole aside is a good idea. I felt elevated estradiol when my numbers hit 55 (sensitive test). Now, with no AI but daily injections, I keep it in the mid-30s and feel just fine. I suspect that even if it climbed into the 40s I would be in good shape. We're all different, but e2 is NOT a waste product, men need it. I hope your plan lowers the anxiety.

  18. #17
    Quote Originally Posted by carkrazy View Post
    Thanks CoastWatcher, the anxiety issue for me is my biggest thing. I did suffer from anxiety prior to TRT but since starting TRT my anxiety is at another level. I was very clear with my Doctors about it and wish they would have started me slow but hey, at least i found a good forum and protocol to follow now. Felt like these Doctors were killing me slowly.
    "Start low and go slow" is a phrase, attributed to Dr. Crisler, that you'll read a lot here. It makes sense. In this game things can be more easily raised that lowered (I know that's a generalization and you don't want to push it too far). Nonetheless, in the estradiol game one MUST go slow.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    Agreed! would you say that the 50mg every 3.5 days is a good starting point then?
    Quote Originally Posted by CoastWatcher View Post
    "Start low and go slow" is a phrase, attributed to Dr. Crisler, that you'll read a lot here. It makes sense. In this game things can be more easily raised that lowered (I know that's a generalization and you don't want to push it too far). Nonetheless, in the estradiol game one MUST go slow.

  20. #19
    Quote Originally Posted by carkrazy View Post
    Agreed! would you say that the 50mg every 3.5 days is a good starting point then?
    With low SHBG, as many have commented, you need multiple/smaller injections over the course of a week. You've chosen a very standard approach, that's a compliment, not a criticism.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    Thanks again CoastWatcher and everyone else who added to this this thread. I at least have a much better understanding and have a plan of action.
    Quote Originally Posted by CoastWatcher View Post
    With low SHBG, as many have commented, you need multiple/smaller injections over the course of a week. You've chosen a very standard approach, that's a compliment, not a criticism.

  22. #21
    Quote Originally Posted by carkrazy View Post
    Thanks again CoastWatcher and everyone else who added to this this thread. I at least have a much better understanding and have a plan of action.
    Try and resist the urge to test early. Give everything six weeks to settle (it takes that long for steady-state serum levels to be achieved).
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  23. #22
    Wow sounds like you've had a rollercoaster of a year. I too have had anxiety get worse since starting hormone treatment, but I'm on clomiphene not testosterone. Clomiphene has some particular side effects of anxiety / depression / enhanced estrogenic effects I think though so it's not directly comparable of a situation.

    Sucks though man, if you're like me, anxiety was one of the main reasons for starting treatment. But as others have said, you need to simplify things. The 50mg every 3.5 days seems to be a common simple conservative starting point.

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    Will definitely wait 6 weeks. Thanks!
    Quote Originally Posted by CoastWatcher View Post
    Try and resist the urge to test early. Give everything six weeks to settle (it takes that long for steady-state serum levels to be achieved).

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    I have suffered with anxiety for 19 years due to mild PTSD but it has always been manageable. Since starting TRT, it is 5 times worse. Anxiety is terrible and hard for people to understand but i feel your pain. Meditation, eating well and exercise helps get rid of that excess anxiety but yes!, it feels like shit man. hang in there brother.
    Quote Originally Posted by Kirk001 View Post
    Wow sounds like you've had a rollercoaster of a year. I too have had anxiety get worse since starting hormone treatment, but I'm on clomiphene not testosterone. Clomiphene has some particular side effects of anxiety / depression / enhanced estrogenic effects I think though so it's not directly comparable of a situation.

    Sucks though man, if you're like me, anxiety was one of the main reasons for starting treatment. But as others have said, you need to simplify things. The 50mg every 3.5 days seems to be a common simple conservative starting point.

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    @carkrazy, you really should consider what others have suggested and immediately switch to frequent injections. For you, an E2 reading of 20 will feel like 40 to others because your E2 is not getting bound. Also, your free T may be high, but because of the very short half-life, it will be gone very quickly.

    By dosing every day (or EOD), you will maintain steady saturation levels, reduce your E2, and have more free t for longer periods.

    You could also try a low carb diet (Keto) to increase SHBG.

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    30005Gator, your input is noted but i already started with injections every 3.5 days and no anastrozole which is a huge change from what i was doing previously. I want to stick with one thing at a time to see how i feel before changing protocols again. Also the thought of injecting EOD seems like a pain in the ass (no pun intended). If i did decide later on to inject EOD what dosage would be appropriate?
    Quote Originally Posted by 30005Gator View Post
    @carkrazy, you really should consider what others have suggested and immediately switch to frequent injections. For you, an E2 reading of 20 will feel like 40 to others because your E2 is not getting bound. Also, your free T may be high, but because of the very short half-life, it will be gone very quickly.

    By dosing every day (or EOD), you will maintain steady saturation levels, reduce your E2, and have more free t for longer periods.

    You could also try a low carb diet (Keto) to increase SHBG.

  28. #27
    I'd inject as often as you need to, and no more than that. I realize that's an ambiguous declaration, but it's offered in response to your question about an EOD protocol. I don't know, and nobody else really does. Twice weekly shots, as you're planning, may well be successful. If they're not, it will be necessary to check what total and free testosterone levels were achieved on your every 3.5 day schedule. You and your doctor will have to look at your estradiol - is it at a comfortable level, or must attention be paid? HCG - if it's on the agenda - has to be weighed.

    I inject 16mg of enanthate every morning; that's my third injection protocol. It works, spectacularly well. But we arrived here in a step-by-step manner. Many guys don't need to inject more frequently than twice a week. If it turns out you do, you'll have plenty of data to draw on.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    CoastWatcher, I'm with you. I chose a protocol and sticking to it. I'm taking it one step at a time. I'll check my levels in 6 weeks and make adjustments if needed. I was just was curious as to what an EOD protocol would look like is all.
    Quote Originally Posted by CoastWatcher View Post
    I'd inject as often as you need to, and no more than that. I realize that's an ambiguous declaration, but it's offered in response to your question about an EOD protocol. I don't know, and nobody else really does. Twice weekly shots, as you're planning, may well be successful. If they're not, it will be necessary to check what total and free testosterone levels were achieved on your every 3.5 day schedule. You and your doctor will have to look at your estradiol - is it at a comfortable level, or must attention be paid? HCG - if it's on the agenda - has to be weighed.

    I inject 16mg of enanthate every morning; that's my third injection protocol. It works, spectacularly well. But we arrived here in a step-by-step manner. Many guys don't need to inject more frequently than twice a week. If it turns out you do, you'll have plenty of data to draw on.

  30. #29
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    Quote Originally Posted by carkrazy View Post
    30005Gator, your input is noted but i already started with injections every 3.5 days and no anastrozole which is a huge change from what i was doing previously. I want to stick with one thing at a time to see how i feel before changing protocols again. Also the thought of injecting EOD seems like a pain in the ass (no pun intended). If i did decide later on to inject EOD what dosage would be appropriate?
    Ah, sorry. I missed that you have already made a change. I agree that you should wait six weeks before making another change (if necessary...hopefully not!).

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