New member from Hawaii

Hi,

I've been doing a bunch of research and it led to this site which I've found very helpful and I'd like to introduce myself. I'm 42 yrs old. I have been athletic my entire life however over the last few years I've seen a drastic decrease in motivation and drive, and increase in body fat, decreased libido....all the signs of low T. I was recently tested and my total T was 195, my free testosterone was 3.7.

My primary care physician is extremely hesitant to do anything about it so I moved on. I found a clinic that specializes in TRT and they recommend starting out with 200mg of Test Cypionate once per week in conjunction with HcG and Anastrozole. I haven't started yet but that seems about right based on what I've seen around the web. Any thoughts?

As an alternative to the injections, I was offered a compounded 20% testosterone cream. I'm leaning towards the injections but value any input.

Thanks!
Tony

200mg of T is a high starting does, most inject every 3 1/2 days. I wouldn't starting an AI (Anastrozole) unless you have high E2.

So maybe something like 100mg every 3 1/2 days rather than 200mg every week would be better?

You need complete set of labs. I inject 100mg of T and 500iu of HCG every 3 1/2 days and no AI.

Here's a copy of my labs. https://www.excelmale.com/forum/showthread.php?8533-My-New-LabCorp-Labs

Thanks, that's very helpful. I'm awaiting the results of more comprehensive labs that my new doctor ordered. The old doctor just ordered testosterone and a CBC. He actually made me do it twice because he was supposed that my levels were below range.

welcome, I do not blame you for finding another doc, just before starting my tt was 360 and ft 4.0, and I absolutely had no drive or motivation, so I can imagine how you feel, I would do like Vince said, and not take an AI unless you really need it.

TM1897 said:

Hi,

I've been doing a bunch of research and it led to this site which I've found very helpful and I'd like to introduce myself. I'm 42 yrs old. I have been athletic my entire life however over the last few years I've seen a drastic decrease in motivation and drive, and increase in body fat, decreased libido....all the signs of low T. I was recently tested and my total T was 195, my free testosterone was 3.7.

My primary care physician is extremely hesitant to do anything about it so I moved on. I found a clinic that specializes in TRT and they recommend starting out with 200mg of Test Cypionate once per week in conjunction with HcG and Anastrozole. I haven't started yet but that seems about right based on what I've seen around the web. Any thoughts?

As an alternative to the injections, I was offered a compounded 20% testosterone cream. I'm leaning towards the injections but value any input.

Thanks!
Tony

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Welcome to Excelmale, Tony. All the fellows who've contributed so far have been on point. Let me add that one of the keys to success, seen consistently here at EM, is smaller, more frequent injections. They result in two things - smoother, more consistent testosterone levels and lower estradiol values. I would not start injecting 200 mg of testosterone once a week. You are likely to see a strong spike in your testosterone followed by a corresponding rise in estradiol. Yes, this clinic prescribed Anastrozole, but why start out pushing the envelope? You don't know your SHBG value, which is a key factor in how quickly you'll clear your testosterone dose...too many questions are unanswered. Frankly, it sounds like this clinic gave you a cookie-cutter protocol: a big dose of testosterone and a whack of anastrozole. You deserve better.

If you have any other labs, please post them.

Thanks for the info. I'll post the rest of the labs as they should be in today or tomorrow. I agree that the protocol seems cookie-cutter but it was in line with what I found during my preliminary research. As I dig deeper, TRT seems much more complicated with many different opinions and protocols. My doctors rationale was that he wanted to get my test levels up right away and prevent the onset of any E2 issues before they occurred then draw labs again at 6 weeks and adjust protocol from there. After doing more research here, that seems a bit aggressive. Are there any drawbacks to taking an AI as a preventative measure? My doctor felt that it was easier to prevent E2 side effects such as gynecomastia than reverse them.

Many anti-aging or men's health clinics prescribe anastrozole, a blocker of estradiol production, to men who start testosterone replacement (TRT). Higher estradiol blood levels not only can cause breast tissue growth (gynecomastia) but also water retention (edema). Some people speculate that high estradiol can also lead to erectile dysfunction but no scientific papers have been published on this subject. Since higher testosterone blood levels can originate higher estradiol levels, the belief is that using anastrozole will prevent breast tissue growth and erectile dysfunction by lowering any potential increase in estradiol. However, we have no data on how high is too high when it comes to this hormone in men. Some even speculate that low testosterone-to-estradiol ratios may be more closely correlated to gynecomastia and erectile problems than estradiol alone.

The truth about these speculations is starting to emerge but we still do not have enough data to say what the upper value of the optimal range of estradiol really is. We have a lot of evidence about the lower side of the optimal range since it has been found that estradiol blood levels below 10-20 pg/ml can increase bone loss in men. A recently published study also nicely demonstrated that low estradiol can be associated with higher fat mass and lower sexual function in men. So, be very careful when a clinic wants to put you on this drug without first justifying its use.

Another concerning fact is that many clinics may be using the wrong estradiol test that may be over-estimating the levels of this hormone in men. An ultrasensitive estradiol test more accurately measures estradiol in men instead of the regular test that costs less.

Fortunately, most men on TRT do not develop gynecomastia even without using anastrozole (gynecomastia is common in bodybuilders who may use high doses of testosterone, however). Those that have gynecomastia at TRT doses (100-200 mg of injectable testosterone or 5-10 grams of testosterone gel per day) may be genetically predisposed to having more aromatase activity or have liver dysfunction. Treating all men who start TRT with anastrozole from the start may be counterproductive since this may lower estradiol to very low levels. Some physicians monitor estradiol blood levels after 6-8 weeks of having a man start TRT alone using the ultrasensitive estradiol test to determine if anastrozole use is warranted. Doses range from 0.25 mg per week to some clinics using excessive doses of 1 mg three times per week. After 4-6 weeks on anastrozole its dose can be adjusted to ensure than estradiol is not under 20 pg/ml. Fortunately, many men on TRT do not need anastrozole at all.

So we await for more studies that will clarify the role and optimal ranges of estradiol. Here are a few studies that we already have available based on the role investigated.
read more.......https://www.excelmale.com/forum/showthread.php?2309-Role-of-Estradiol-in-Men-and-Its-Management

Welcome to EM! Glad you joined ... Great advise above!!

I received the rest of my labs today. Besides the low testosterone, the estradiol was high. Other than that, everything looked ok. So my doctor started me off with the 200 mg injection of test cyp once per week, followed by 250 iu of hcg every 3 days, and .5 mg of anastrozole every 3 days. I brought up some concerns mention above and he was receptive to it but thought it best we try this protocol out for 6 weeks and tune it up based on next set of labs.

Testosterone 196 ng/dL (348-1197)
Testosterone Free 3.7 pg/mL (6.8-21.5)
Thyrotropin 1.377 mcIU/mL (.358-3.74)
Lututropin 4.4 mIU/mL
Follitropin 4.5 mIU/mL
CBC all in range
CMP all in range
PSA 0.8 (0-2.5 ng/mL)
Estradiol 53 (0-47 pg/mL)

TM1897 said:

I received the rest of my labs today. Besides the low testosterone, the estradiol was high. Other than that, everything looked ok. So my doctor started me off with the 200 mg injection of test cyp once per week, followed by 250 iu of hcg every 3 days, and .5 mg of anastrozole every 3 days. I brought up some concerns mention above and he was receptive to it but thought it best we try this protocol out for 6 weeks and tune it up based on next set of labs.

Testosterone 196 ng/dL (348-1197)
Testosterone Free 3.7 pg/mL (6.8-21.5)
Thyrotropin 1.377 mcIU/mL (.358-3.74)
Lututropin 4.4 mIU/mL
Follitropin 4.5 mIU/mL
CBC all in range
CMP all in range
PSA 0.8 (0-2.5 ng/mL)
Estradiol 53 (0-47 pg/mL)

Click to expand...

Wrong estradiol test. Based on the range the standard, rather than the sensitive, LC, MS/MS, test was run. It's of no value to men as it overestimates the estradiol level. You may/may not need the AI that was prescribed. So...you are taking a large, a very large, weekly dose of testosterone, a significant amount of Anastrozole, that you may not need, and your doctor ordered the incorrect E2 test. This doesn't speak well of the care you are receiving.

CoastWatcher said:

Wrong estradiol test. Based on the range the standard, rather than the sensitive, LC, MS/MS, test was run. It's of no value to men as it overestimates the estradiol level. You may/may not need the AI that was prescribed. So...you are taking a large, a very large, weekly dose of testosterone, a significant amount of Anastrozole, that you may not need, and your doctor ordered the incorrect E2 test. This doesn't speak well of the care you are receiving.

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The next doctor I could find in Hawaii can't see me until late January - which I have booked an appointment. Until then, my choice is run with this doctor or remain in a desperate state of life that I'm currently in. I'll have the current doc order the sensitive estradiol test in the meantime.

Or you could use Defy Medical and their tele-medicine model and get treated right away. I am a patient of theirs but not otherwise affiliated so my recommendation is only based upon how good they are and how easy and thorough myself and many others find them to be.

ERO said:

Or you could use Defy Medical and their tele-medicine model and get treated right away. I am a patient of theirs but not otherwise affiliated so my recommendation is only based upon how good they are and how easy and thorough myself and many others find them to be.

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I tried Defy but they only use Labcorp and Labcorp isn't in Hawaii and you are by law prohibited from ordering your own labs. I was stuck at an impasse with Defy.

TM1897 said:

I tried Defy but they only use Labcorp and Labcorp isn't in Hawaii and you are by law prohibited from ordering your own labs. I was stuck at an impasse with Defy.

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I am not a Defy patient, but it is my understanding that members here at EM use Quest and LabCorp for their Defy-ordered bloodwork. Hawaii is not the only state where LabCorp doesn't operate; Defy advised you that you had to use LabCorp? I would think they'd do all they could to provide a work-around for you.

CoastWatcher said:

I am not a Defy patient, but it is my understanding that members here at EM use Quest and LabCorp for their Defy-ordered bloodwork. Hawaii is not the only state where LabCorp doesn't operate; Defy advised you that you had to use LabCorp? I would think they'd do all they could to provide a work-around for you.

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I have patients in Hawaii. We can supply lab RX for use at ANY lab facility of patient's choosing, however patient will need to determine if their insurance pays or if they pay the lab directly. Seems there may have been a miscommunication TM1897. You can contact the office again and ask for Adam or Chelsea for more info.

That's good news. The gentleman I spoke with, I think it was Adam (Chelsea was on vacation) said Defy only worked with Labcorp so I would have to get my own labs. Good to know we can work around as Defy was one of my top choices.