New to TRT: Wondering if it's working or not...

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lcvl

Member
Hi everybody,

Despite having read plenty of threads about TRT all over this excellent website (thanks Nelson!), I'm still trying to understand how TRT is working for me (if at all).

A little background:
Almost 43 y/o. Active lifestyle and healthy diet (I work in fitness/training), very lean (8-10% bf), never been very muscular, probably suffered from low T most of my life without knowing it.
Experienced sporadic ED episodes since my mid twenties. Not so great libido throughout my 30s. Starting two years ago overall energy levels and ED got way worse. PD5 inhibitors helped with ED at first, then less and less. A few months ago I started educating myself on the topic of hypogonadism/low T syndrome and finally decided to see an urologist.

First BW showed 6.6ng/mL Total T and 6.6 pg/mL Free T.

The doctor thought I was within normal range (!!!) but we decided to start TRT anyway and see if that could help with my ED.

Initial protocol was 100mg of Testex (test cyp) IM every 2 weeks. Didn't feel any difference at all. After 5 weeks (two injections) of treatment I had more tests done, although for a stupid misunderstanding I waited too long so my values were probably starting to go back to basal.

Anyway, second BW showed 5.7ng/mL Total T and 7.7 pg/mL Free T.

Doctor decided to move up to 250mg (Testex 250) every two weeks. I mentioned the option of increasing frequency of injection instead of dosage, but he wasn't familiar with such "undocumented protocols" (!!!).

After the first 250mg injection I had 5 days of feeling like a superhero. Never experienced anything like that in my whole life. Plenty of energy, mental clarity, incredible sex drive (spontaneous erections and morning woods. Hadn't had neither of them in probably 15 years!!!), great mood. >>Almost<< too much to deal with, but wow, what a feeling...
On the 6th day I crashed. Low energy, low libido, feeling very emotional and insecure.

Things leveled out a bit throughout the second week (kind of like pre TRT), and had a third BW done right before my 2nd 250mg shot.

Third BW showed 2.5ng/mL Total T and 5 pg/mL Free T (!!!)

I didn't feel any improvement at all after the second 250mg shot. Kept feeling lethargic (even worse than pre TRT), thick head feeling, maybe high pressure, no sex drive, low mood, aching joints.

After 8 days of hell, instead of waiting for the full 2 weeks, I decided on my own to try with injecting half a vial of Testex 250 (aprox 125mg) and find a proper doctor (this time an endo).

The week on 125mg wasn't too bad. Stable mood and energy levels. Mild libido. Nothing to write home about (nothing compared to that first 250mg boost) but overall a good feeling of well being.

The new doctor/endo suggested to keep the injections at 100mg a week and have some new/more complete BW in about 6 weeks. I mentioned the crash on 250mg, maybe related to high aromatase/E2 values (not measured with the previous blood tests), but she kind of dismissed the idea, saying that usually only happens to overweight people (???).

The day after the visit (6th day after that 125 mg injection) my energy levels dropped again.

On the 7th day (last Friday) I had a new 100mg injection hoping that could lift me up, but that didn't happen. Today is Monday and I still feel thick-headed, lethargic, low libido, mild erections even on 50-100mg sildenafil, very emotional and with a quite negative outlook on life in general.

Any idea on what could possibly going on here?

I'm very indecisive about how to proceed:
- Following the protocol to the letter (100mg every 7 days) and have more blood tests done in 6 weeks.
- Splitting the dose to 50mg twice a week, maybe even trying SC.
- Do some BW right away, to see where my E2 levels are at.

My actual symptoms: thick head, no energy, low mood, low libido, feeling very sensitive/emotional, maybe slightly more sensitive nipples (not sure about that though), maybe a bit of water retention (I gained about 3kgs since I started TRT 10 weeks ago), and I seem to wake up tired even after 8-9 hours of sleep.

Thanks in advance for any help you can offer.
 
Defy Medical TRT clinic doctor

ERO

Member
Your doctor does not understand TRT at all. You need to be doing shots twice weekly not every two weeks. Also, what are your E2 values? Does your doctor even check that? It's no surprise you don't feel any better on the protocol you have been on.

My 2 cents would be to do 50 mg twice a week SC and do your own blood work, and then find a doctor that specializes in TRT. Defy Medical is great and a ton of folks here use them with great results. (I am not affiliated with Defy in any way - just a satisfied customer)
 

CoastWatcher

Moderator
ERO is right. You have fallen into the care of a doctor who doesn't grasp the proper way to administer TRT. The only failure here is your doctor - it is time to find another, one you can rely on. Defy, with whom I am not affiliated, delivers services to many on this forum.
 

Gene Devine

Super Moderator
Totally agree with the guys on here; Your current Endo is still not properly trained in TRT for men.

Weekly injections at a minimum and better is twice weekly to smooth out those peaks and valleys.

You need Estrogen, Hematocrit and PSA monitored at a minimum.

Are you on HCG to keep your Testicles alive?

If I were you, I'd start a search for a TRT Doctor or simply call Jasen Bruce at Defy Medical and have them manage your TRT correctly. You can even ask for Dr. John Crisler to care for you.
 

lcvl

Member
Thank you guys for the responses.
The second doctor seems to know the subject A BIT better. She asked for a more complete blood panel in 6 weeks (including E2), and she put me on a 100mg weekly dose (I know, not ideal, but still better than every two weeks, like the first doctor suggested).
I live in Spain, so as far as TRT goes my options are a bit more limited.
I'm thinking of trying (on my own, without telling the doc) subcutaneous injections 2 x week, 50mg each, using an insulin syringe, and see if that makes any difference with the mood/energy swings.
 

CoastWatcher

Moderator
Some guys do well on 100mg per week. I thought I was one of them, then I was shifted to 60mg every 3.5 days. The change was dramatic.

have you started your new protocol yet?
 

CoastWatcher

Moderator
Libido was enhanced, energy level shot up and remained consistent (I had noticed improved energy while injecting once weekly, but it did start falling toward the end of the week as I approached my next injection), concentration was focused.

I felt good on 100mg weekly, but feel remarkable on 60mg twice a week. I am 57 years old, and it as if my life has been returned to me.
 

lcvl

Member
Novice question: Testex 100mg comes in a 2ml vial. With 2x50mg injections a week that would be 1ml subQ injection each time.

Wondering if that's too much fluid for such a shallow pin...

Thanks again!
 

ERO

Member
That should be no problem. I have done 1 ml injections of B-12 subQ for years without issue. Just press it in slow and you should be fine. If you are super lean - like 7-8% bodyfat, you may need to go subQ on an area with more fat like your glutes.
 

lcvl

Member
Quick update on my situation.

After a few weeks of pretty intense highs and lows (not sure if caused by the once a week dosage or just the body's adaptation to TRT), my energy levels seem pretty stable right now. This has been my first week of 2x weekly subQ injections (50mg at the time) and so far it seems it's working.
Libido is up (still no morning woods though), energy is up, great mood and spirit. No AI, no HCG for the time being. BW in about 4-5 weeks to check for TT, FT and E2.

I'll keep you guys posted.

Thanks!
 

lcvl

Member
I'm not 100% sure if it's the 2x week injection protocol that's making a difference, or just the fact that my body is getting used to the therapy and the new hormonal balance. At some point in the next months I might try going back to 100mg every 5/6 days and see if I notice any difference.

Only T, nothing else. It's just the beginning of my TRT. I'll see how my body reacts with new BW in a few weeks and decide from there if I need to add anything else.

Thanks!
 

abram134

New Member
yeah bro they say if doctors make you inject twice a week or every two weeks there not good trt docs most good docs that are experience inject weekly
 

lcvl

Member
Hi everybody,

I'm reviving this very, very old thread. Hope you guys don't mind.

When I first created it I was just at the beginning of my TRT journey here in Spain, and today it's exactly 8 years (to the day) since I wrote that original post.

Despite the initial doubts about the effectiveness of the treatment, once TRT settled in, the past 8 years have been quite a steady ride.

The endo ended up recommending a weekly dose of 125mg TESTEX PROLONGATUM and that kept me stable in the T upper range with no side effects for all this time.

Yes, just Test... Don't even try to ask for anything else. That's the way they do it here in Spain.

For a few months I tried splitting the dose in half (2 x weekly) but honestly I didn't feel any different to justify the hassle of an extra injection every week.

Anyway, back to the present.

Today the endo proposed to stop TRT cold turkey.
For no apparent reason. Just like that. She didn't even bother to do some more recent blood work.

"You've been on it for so long. Let's stop for 6-8 weeks and see if your body is able to restart on its own."

After 8 years of treatment. At 51 y/o.
No need to say I was speechless.

"It's normal medical procedure. Sometimes the body can restart its own T production. We have to give it a try."

I tried to explain how terrible I felt the couple of years before starting TRT but she insisted that was her advice.

"You can still look for a second opinion"

You bet I will... I'm already looking for different specialists in the area, but in the meantime I wanted to ask the more experienced members here on the forum...

Is that REALLY common medical practice?
Stopping TRT cold turkey, after so many years of treatment, with everything going and feeling well?
Is the body able to heal on its own the primary hypogonadism it was diagnosed with years ago?

Back in 2015-2016 I did a pretty good amount off research on the subject and I don't remember having ever read anything similar.

Maybe you guys here can offer some help and insights.

Thank you in advance.
L
 

Systemlord

Member
It's normal medical procedure.
It’s not normal, that would be no different than someone diagnosed with primary hypothyroidism to stop treatment years later. Doctors would never do that, but because it’s testosterone, a steroid, all bets are off.

It’s the stigma of steroids that’s to blame for your doctors ignorance.
Is that REALLY common medical practice?
I never heard of it before.
 
Last edited:

Systemlord

Member
Is the body able to heal on its own the primary hypogonadism it was diagnosed with years ago?
No, to my knowledge, there’s no cure for primary hypogonadism. I fear her personal beliefs may be influencing her treatment decisions.

I would tell her you’re going to report her to a governing body or medical board, because she is practicing cowboy medicine.

This doctor of yours is dangerous ignorant!
 
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Guided_by_Voices

Well-Known Member
First, congratulations on having reached a successful steady state. That in itself is an accomplishment that not everyone is able to achieve. Here are a few thoughts beyond just finding a more sensible doctor and/or self-prescribing:
- The studies I can remember seeing suggest just the opposite of what your doctor is saying. They are based on long-term steroid users, however the basic conclusion is that many people cannot gain their prior T production after having been shut down for a long period.
- To give such an approach a fair shot, you would likely want to use some combination of clomid, Kisspeptin and/or HCG, and even that would be a rough ride.
- Compare risk and reward...reward is that best-case you are no different than you are now with no benefits other than cost. Downside is many months of being in a sub-optimal state with low chance of success (again, where is there any formal evidence that a large population has regained their production?)
- Worst of all, there is no assurance that you could get back to your present state if you re-started the T at a later time. The body likes consistency and if you start messing with a complex system and something goes wrong, it may not be possible to get back to where you are now. I have no formal data on that but there are plenty of people who report making major changes and then can't get back to where they were, especially since there are many non-T pathways involved such as dopamine, etc.
- I used to come off for 6 weeks once a year, and there is/was a clinic here in the US that recommended that, but that is by no means the norm and in retrospect, 6 weeks is nowhere near enough to fully return to natural production.
- In general, one of the more important principles of health is to not mess with things that are working well, and stopping T would certainly violate that principle.

Ok, good luck.
 

Jerajera

Active Member
Look into the private clinic Balance My Hormones in the UK, they ship Testosterone legally with a prescription directly to several European countries. I know someone in Europe using them who's happy with their services. Not sure about Spain but it's worth checking.

Your endo is criminally clueless, goes to show again that regardless of the field the vast majority of people are completely useless and oftentimes dangerous. A degree just means you were good enough at memorizing information to pass the right tests, that's about it.

Whichever way you go, don't use a woman again for your HRT care and ideally find a male doctor who is himself on HRT. It's one thing to have a coach who doesn't play anymore, it's another thing entirely to have a coach who's never played the game.
 
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