1 year HRT and just started with injection - Troubleshooting

[new_man]

Hello all,

I am very thankful I could join this community and it is great to see how everybody helps each other!
About me:
I am 30 years old and got low testosterone since a few years. 1 y ago a special doc (who should know HRT very well) put me on Testosterone. That's when the bad ride started. It started all with 1 testogel per day. In the beginning I was in the morning awake and it felt better, but after 1 months this effect was gone and I felt almost the same. I guess my own production was shutting down, the good effect wasn't there. After 2 months the doc put me on HCG mono (twice per week 1500iu). In the beginning this was great but after 1-2 weeks this was too much for my body and everytime after the shot I was getting tired. My Testosterone levels didn't shoot more than 700 (range 300-1100), and all the other values were according to my doc in range. So the doc told me to take 2 testogel per day. I did that for 3 months and I felt really good and strong and things become every week better. My depression just vanished, lol. I was a different, better man and I started to handle girls so well, I felt like a man. Only problem was for me that I had the urge to pee in the morning and it felt a bit strange (prostata), but since the other effects were so great I just enjoyed the ride. I wanted to be sure to do nothing wrong so I went to the doc to test my values. Testosterone was over 1500, DHT was 4 times as high as the upper range and fT was very high too. All the other values are in range. So the doc told me I shouldn't take anything and wait till the values are down. 1-2 weeks later the values were all very down and I felt really really bad! Because of some more tests they wanted me to stay off. I felt so bad that life was every hour a pain. After 7 weeks without anything I started with 1 testogel again until for 14 days ago.

When I was off testosterone one thing that helped me a lot was 5 mg of pregnenolone and 5 mg of dhea - transdermal. It was just a small amount but I felt better. But still I felt not good.

14 days ago I started with my new doc testosterone injection. The plan was E5D Testosterone Enanthate 80 mg injection. Here is my experience:
Day before injection 1 => in the evening I took 1 testogel
Day 1 in the afternoon => 80 mg Injected. I felt good in the evening
Day 2-3 => I felt good
Day 4-6 (without the new Injection) => I felt not so good anymore.
Day 6 Injection in the afternoon. 80 mg
Day 7 => I felt moody
Day 8-10 => I felt very moody and felt not great, I felt even leaner (like metabolism is fast) and I didn't sleep that well but my head was more or less clear. But I was worrying about all kind of things and I had the feeling I couldn't manage things in my life. I was scared and worried about things I wouldn't usually. Coz I didn't sleep a lot and metabolism was fast I had the feeling that Testosterone was high. But since I worry so much and feel not great I could imagine that something else isn't right.
Day 11 => I woke up and was allright. Today injection 3. I felt so bad all day long and I had anxiety. My balls got bigger. Why this? I sweat, I have warm and could take of my tshirt quite often. And I am not hungry like I used to be. In the evening I took the third shot. Then thing improved and I could sleep preety good.
Day 12 => I woke up and I felt way better, I was happy that I didn't stop anything and that I continued. After 2:00 pm I was getting tired, was getting hot, sweaty and had no energy. I wasn't hungry at all.

Bytheway: E2 was all the time very stable and even when I took 2 testogel the E2 was in range.

Testing the values after 4-5 weeks after starting with injection 1. But I would like to adjust to feel better since I'm so moody. Any suggestions? What I plan with my doc is going from E5D to E4D, that I don't think that would solve the prob. I know, I should wait for the next test, but it doesn't feel good yet, so I wonder what could be wrong?

Thank you so much for your thoughts!

-- UPDATE --

HISTORY

Before HRT (Test August 15)
SHBG 30 nmol/l
T 7.8 nmol/l
fT 22 pmol/l
DHEAs 6.1 umol/l
DHT 0.8 nmol/l

After that I started with one Testogel per day. I felt a little better in the beginning, but the effect was gone after 2-3 weeks (i guess my own production stopped and levels droped a bit - that's my theory). I told this the doc and he changed the protocol to mono HCG.

On mono HCG (December 2015)
E2 145 pmol/l
T 23 nmol/l
fT 88 pmol/l
DHT 0.9 nmol/l
Prog 2 ng/ml
IGF-1 43 nmol/l
I told my doctor that this makes me really tired and I gain weight like crazy. In 6 weeks I gained like 6 pounds. I had no energy at all. Doc told me to take 2 Testogel per day.

2 Testogel per day (March 2016)

OMG. My sex drive was awesome and my confidence was brilliant. Sometimes I was just walking around feeling happy - something that I haven't felt since a long time. Everything was getting better. I did it 2 months and then I asked the doc to do some testing because I wanted to know what my magic numbers were. Here the result:
E2 135 pmol/l
SHBG 29 nmol/l
T > 52 nmol/l
fT > 340 pmol/l
DHEAs 6.4 umol/l
DHT 10 nmol/l (DANGEROUS)

Because of those high values, the doc let me crash big times.
Because of some other doctors I started with 5 mg of Pregnenolone and 5 mg DHEA transdermal. I felt in my head better and anxiety was better too. I could live with that but energy and so on was still very bad. After 2 months I started again with 1 Testogel...

1 Testogel (June 2016)
E2: 96 pmol/l
Progesterone 1.5 nmol/l
17-OH-Progesterone 1.1 nmol/l (whats the difference between those two progesterone - which is the right one?)
shbg: 27.2nmol/l
testosterone 10.4 nmol/l
ft 17.4 pmol/l
DHT: 558 pg/ml
DHEAs: 5.7 umol/l (special letter u)
Pregnenolonsulfat: 56 ug/l (special letter u)
I was tired, low energy, low libido, brain fog.. but better than nothing.

NOW

I take E5D 80 mg Enanthate - I just had yesterday the third shot. Besides that DHEA and Pregnenolone 5 mg each.

 

[new_man]

I would just love to hear from you what could be the problem. In my eyes it could be:
=>I switched from 1 gel to injection... the E5D 80mg Injection misses something that was in the gel. I didn't have anxiety with the gel (well, it was low T, mid DHT and E2: 96 pmol/l). So I could imagine that something is missing in the injection.
My speculations / some thought for the cause:
=> E2 is too high or too low
=> or DHT is too low (side effect of gel is higher DHT in some people)
=> or Testosterone is too low, because I maybe crashed a bit because I stopped the testogel 1 day before Injection (80 mg). So the testosterone of the Gel was missing and 80mg of Enanthate isn't a lot in the beginning when the half life is between 5.5 and 9 days. (half life from person to person is different)

By the way. I'm very lean, 1.8 m high and 145 pounds heavy.

 

[MAD King]

The only one who can find out what is wrong is your doctor.

 

[CoastWatcher]

Hello, new_man, welcome to Excelmale. We hope you'll be an active member. I would question your claim that your doctor understand and knows androgen replacement. I suggest that you haven't been well cared for. Your protocols have been poorly designed, you were taken off TRT - meaning your blood levels undoubtedly crashed, and now you're on 80mg of testosterone by injection every five days. Can you do us a favour? Will you list your pre-TRT blood test results and your most recent blood work? Just a simple list. Then, give us a list of everything you are taking (name, amount and frequency). Finally, will you let us know how you feel and where you live (different countries present with different treatment and lab options). Thank you!

 

[new_man]

Hello, new_man, welcome to Excelmale. We hope you'll be an active member. I would question your claim that your doctor understand and knows androgen replacement. I suggest that you haven't been well cared for. Your protocols have been poorly designed, you were taken off TRT - meaning your blood levels undoubtedly crashed, and now you're on 80mg of testosterone by injection every five days. Can you do us a favour? Will you list your pre-TRT blood test results and your most recent blood work? Just a simple list. Then, give us a list of everything you are taking (name, amount and frequency). Finally, will you let us know how you feel and where you live (different countries present with different treatment and lab options). Thank you!

CoastWatcher, thank you so much for your answer! My old doctor understands androgen replacement, but he has absolut no clue how to handle sensitive person like me. I changed the doc and I want to learn how to do it right because my old doc did some very bad things to me I would like to never ever experience again in my life. I know that some of the people here can relate to what I have just said. I wanna know how to do it right and I also know that everyone is different. There are also many doctors with many different opinions. Many of my doctors are old school medicin. I came to this community because I know some of you guys have more experience on how to troubleshoot and I also like when somebody takes the supplement by its own because of the experience. I dislike when somebody writes "go to the doctor". I wanna learn and I wanna know what others think about what piece could be missing in the puzzle or how to improve it.

It wasn't my dream to go cold turkey, I knew that the old doc was a bad influence but I couldn't do anythin against it because he was in charge. Blood tests are in the beginning of this thread (see UPDATE). How I'm feeling => also in the beginning (Day 11 and 12 are in bold because I have updated them). I'm from basel, switzerland. I think you should have now all the information. If not, please ask.

 

[CoastWatcher]

You are right, many of us, probably the majority, have had encounters with doctors that were unsatisfactory. A quick question: are you self-injecting? I ask because that would make it reasonably easy to adjust your protocol to address the issue of estradiol.

 

[new_man]

You are right, many of us, probably the majority, have had encounters with doctors that were unsatisfactory. A quick question: are you self-injecting? I ask because that would make it reasonably easy to adjust your protocol to address the issue of estradiol.

Yes. I'm very excited to read your next answer.

 

[CoastWatcher]

Yes. I'm very excited to read your next answer.

You are injecting 80mg every five days. Over the course of a month that is, essentially, 480mg a month. If you went to a schedule where you injected 60mg every 3.5 days, Monday morning/Thursday evening for example, you would be receiving the same amount of testosterone every month, but in somewhat smaller, more frequent doses. That might - "might"is the key word - eliminate peaks and valleys of both testosterone and estradiol. You are outside the US so the sensitive estradiol test is not available to you.

 

[new_man]

You are injecting 80mg every five days. Over the course of a month that is, essentially, 480mg a month. If you went to a schedule where you injected 60mg every 3.5 days, Monday morning/Thursday evening for example, you would be receiving the same amount of testosterone every month, but in somewhat smaller, more frequent doses. That might - "might"is the key word - eliminate peaks and valleys of both testosterone and estradiol. You are outside the US so the sensitive estradiol test is not available to you.

Thank you so much for the answer CoastWatcher. Hope others will contribute too to this thread too.
I could imagine that my T was too low in the beginning. Before I was used to Testogel once per day, but when I started with the shots, I wasn't taking anymore the Gels. So I started with 80 mg Enanthate. Since half life is somewhere between 5 and 9 days (as I know, it depends on the person), I could imagine that I just had about 35 mg of T in the first 5 days. So this was in my eyes too low and this could be the reason why I crashed big times. Since T was to low, the E2 and other few (or hunderts hormones we have no clue about them) hormones were too low too. Everything I just said is speculation and I like to hear some other speculations too.
Anyway. I have learnt in the last few days that most people make better experience with more frequent, but there are also some people who do better Injecting once per week. That's a though question why it is like that!? (Once per week will maybe shoot the E2 higher and they need the higher E2?) I think I'm gonna go for more stable values, thank you - so I'm gonna Inject every 3.5 days if this sounds good for my doc too. Here is my question: If I would Inject on Monday evening and on Friday morning (3.5 days between), isn't bad for the body since one Injection is in the morning and the others in the evening? Isn't better to Inject just on monday morning and thursday morning and then find out if 3 (from monday to thursday) or 4 days (from thursday to monday) is better? I guess when I do every 3, 3.5 or 4 days - then it doesn't matter if IM or SubQ? I guess I should try this also out because some people feel better with IM and some with subQ?

Lol, so the europeans can't handle E2 correct because they don't have the sensitive test? There must be atleast one lab in europe isn't there one?

Thank you CoastWatcher and thanks for other people who are hopefully sharing their thoughts.

 

[MAD King]

Lol, so the europeans can't handle E2 correct because they don't have the sensitive test? There must be atleast one lab in europe isn't there one?

This is not true. i do not know where you get this information. Every doctor and lab e.g. in Germany is able to to a sensitive E2 test. If your doc is telling you this, change your doc.

 

[CoastWatcher]

I think I'm gonna go for more stable values, thank you - so I'm gonna Inject every 3.5 days if this sounds good for my doc too. Here is my question: If I would Inject on Monday evening and on Friday morning (3.5 days between), isn't bad for the body since one Injection is in the morning and the others in the evening? Isn't better to Inject just on monday morning and thursday morning and then find out if 3 (from monday to thursday) or 4 days (from thursday to monday) is better? I guess when I do every 3, 3.5 or 4 days - then it doesn't matter if IM or SubQ? I guess I should try this also out because some people feel better with IM and some with subQ?

Lol, so the europeans can't handle E2 correct because they don't have the sensitive test? There must be atleast one lab in europe isn't there one?

Thank you CoastWatcher and thanks for other people who are hopefully sharing their thoughts.

Three and a half days is twice a week, it is not stressful for your body to adhere to that schedule, injecting once a week in the morning and once a week in the evening. Why do you believe it would be detrimental to adopt such a schedule? It is a standard, one could say the preferred, schedule for most men who are being treated by experienced androgen replacement physicians in North America. It means your body is receiving exogenous testosterone twice a week on a standard schedule. It is true, some men inject more frequently, every other day (I inject on a daily basis), but every 3.5 days is the template that one can use as a starting point. As for the estradiol test (LC, MS/MS) one may be able to find it outside the US, but as of yet no one has reported being able to.

A question: are you using HCG as part of your protocol?

 

[new_man]

Three and a half days is twice a week, it is not stressful for your body to adhere to that schedule, injecting once a week in the morning and once a week in the evening. Why do you believe it would be detrimental to adopt such a schedule? It is a standard, one could say the preferred, schedule for most men who are being treated by experienced androgen replacement physicians in North America. It means your body is receiving exogenous testosterone twice a week on a standard schedule. It is true, some men inject more frequently, every other day (I inject on a daily basis), but every 3.5 days is the template that one can use as a starting point. As for the estradiol test (LC, MS/MS) one may be able to find it outside the US, but as of yet no one has reported being able to.

A question: are you using HCG as part of your protocol?

I know that the recommondation of Testosterone Gel is to apply it every day on the same day (so that the body can get used to it/the time). So I thought it is maybe good to do it with injections too - so that there is always the same time. But since it is not daily and since it is enanthate I guess it doesn't matter so much.

Can I ask why you are doing it daily? Where can I see your protocol or what's your protocol?

I wanna introduce soon HCG with my doc... What's the best way to do that? I am now adjusting to the Injection. Anxiety is almost gone (just a little bit in the late afternoon) and it gets better every day I believe. The third injection made things really better. I believe that I had too many low hormones when I started with Injection. I thought I'm gonna get my body comfortable to the new Testosterone Enanthate and after 4-6 weeks I could introduce HCG 2-3 times a week with 200-300 iu. Or what's a good protocol? Is there also a good recommondation from a famous doctor? (I'm asking this because it would be a good basis to convince my doctor to follow his protocol). What effect on the hormon levels is the HCG gonna have? I guess it is individualistic, but I guess there are general things you can say about the effect.

 

[CoastWatcher]

...can I ask why you are injecting testosterone daily? Where can I see your protocol or what's your protocol?

I wanna introduce soon HCG with my doc... What's the best way to do that?

Regarding my protocol - 16mg of testosterone enanthate every morning, 250 of HCG twice a week. I adopted a daily injection schedule to minimize estradiol issues and maintain a blood level truly reflecting hormonal steady-state. It has worked for me, perfectly. It is, by no means, a protocol that everyone should adopt, but my doctor (always open to ideas) and I agreed it works for me.

As for HCG, this study may be of interest to you and your doctor.

https://www.excelmale.com/forum/sho...ents-two-case-studies&highlight=HCG+case+Saya

 

[new_man]

Regarding my protocol - 16mg of testosterone enanthate every morning, 250 of HCG twice a week. I adopted a daily injection schedule to minimize estradiol issues and maintain a blood level truly reflecting hormonal steady-state. It has worked for me, perfectly. It is, by no means, a protocol that everyone should adopt, but my doctor (always open to ideas) and I agreed it works for me.

As for HCG, this study may be of interest to you and your doctor.

https://www.excelmale.com/forum/sho...ents-two-case-studies&highlight=HCG+case+Saya

Wow, I'm quite impressed of your protocol. So your T level is very constant.

Let's say that the testosterone level is in the morning 1000. Then I think that in the afternoon that level will decrease around 30% normally and in average (please correct me when I'm wrong). Does this happen too with cypionate/enanthate in your blood? Isn't the level too constant to mimic this decrease? A similiar question is: what's when you sleep - is the testosterone level with cypionate/enanthate constant or does it change too and how is it normally? Another question: What happens if you win the world soccer championship with enanthate/cypionate in your body? Does the body release it in the blood so that the level rises when winning? I don't expect answers to those questions I just asked. I just wonder and I have never read about it.

Thank you so much for those studies!

 

[MAD King]

Cypionate and enanthate are the same.
Cypionate is more common in the USA and enanthate more in Europe.

 

[CoastWatcher]

Wow, I'm quite impressed of your protocol. So your T level is very constant.

Let's say that the testosterone level is in the morning 1000. Then I think that in the afternoon that level will decrease around 30% normally and in average (please correct me when I'm wrong). Does this happen too with cypionate/enanthate in your blood? Isn't the level too constant to mimic this decrease? A similiar question is: what's when you sleep - is the testosterone level with cypionate/enanthate constant or does it change too and how is it normally? Another question: What happens if you win the world soccer championship with enanthate/cypionate in your body? Does the body release it in the blood so that the level rises when winning? I don't expect answers to those questions I just asked. I just wonder and I have never read about it.

Thank you so much for those studies!

The following is from a post by Dr. Justin Saya, medical director at Defy Medical and the author of the HCG study that was linked to you earlier. It addresses the question of dosage frequency and the level of hormone in the blood.

A member posts his protocol and blood work and Dr. Saya responds to his questions.

I switched to daily SubQ injections at 140mg per week. I was previously injecting IM on MWF at 140mg per week. Here are the shocking results:

IM:
Testosterone,Free and Total 1151 ng/dL 348 - 1197

Free Testosterone(Direct) 20.4 pg/mL 7.2 - 24.0

SubQ:
Testosterone,Free and Total 1500 ng/dL 348 - 1197

Free Testosterone(Direct) 44.3 pg/mL 7.2 - 24.0

Various members went on to discuss and postulate why this may occur. It's important to note that for the MWF injection routine, the patient had labs on Mon (after last injection Friday- no injection Sat, Sun, or Mon prior to lab draw). The daily SC lab draw was on the day after a daily SC injection (prior to the next injection).

My response (again copy/paste so forgive if formatting acts funky):

This is very common with DAILY injections, regardless of if it's SC or IM. Most folks don't have the desire or wherewithal to stick to a daily injection routine in the LONG term without developing "injection fatigue" or becoming noncompliant. For those that can (and actually WANT to inject daily), they can often (with a few exceptions for unique cases) get away with lower cumulative weekly dosages than folks who do once weekly, twice weekly, or even three times weekly injections. Again, this happens with both SC and IM (I have seen both) and is really a factor of the frequency of injections more than the location/technique of injections.

The complicated reasoning is due to the pharmacological parameter of TERMINAL half life, accumulation, and steady-state. In simplest terms, T cyp does not reach a TRUE steady-state with once weekly, twice weekly, or three times weekly dosages (although twice weekly and three times weekly come close enough for our purposes, but there is STILL variation). On the other hand, daily injections, at least pharmacologically speaking, are capable of achieving a TRUE steady-state (even less fluctuation than BIW/TIW) and consequently can often use smaller dosages. Now this comes with the obvious trade off of poking yourself 365 times per year vs 156 (three times weekly) vs 104 (twice weekly)...in the real world and clinical practice, the subjective/symptomatic difference usually isn't large enough to outweigh the increased hassle (except for a select few). Hope this isn't too complex or technical, but hope it helps with understanding! Indeed an interesting phenomenon.

 

[MAD King]

That is a big difference with the same amount of test.

 

[new_man]

Thank you CoastWatcher so much!

IM:
Testosterone,Free and Total 1151 ng/dL 348 - 1197

Free Testosterone(Direct) 20.4 pg/mL 7.2 - 24.0

SubQ:
Testosterone,Free and Total 1500 ng/dL 348 - 1197

Free Testosterone(Direct) 44.3 pg/mL 7.2 - 24.0

This makes sense. So it is not possible to compare in this test (see quote) SubQ and IM because the test wasn't done right. I believe that it is hard to compare different tests when the injection frequency is different. One thing that could be measure would be the overall levels, but to to this somebody would need to do tests every few hours if you know what I mean. This is very abstract and I guess somebody could write a few books just about how to compare tests.

You inject daily because Testosterone Undecanoate is too expensive for you? Is this true? With Testosterone Undecanoate you would only need to inject every 4 days since it is almost the same like injecting cypionate every day. Always welcome to correct me.

Is it right that it doesn't matter IM or SubQ when injecting E3.5D?

What does BIW/TIW means? No, it wasn't too complex. I understand it. Thank you.

 

[CoastWatcher]

Thank you CoastWatcher so much!



This makes sense. So it is not possible to compare in this test (see quote) SubQ and IM because the test wasn't done right. I believe that it is hard to compare different tests when the injection frequency is different. One thing that could be measure would be the overall levels, but to to this somebody would need to do tests every few hours if you know what I mean. This is very abstract and I guess somebody could write a few books just about how to compare tests.

You inject daily because Testosterone Undecanoate is too expensive for you? Is this true? With Testosterone Undecanoate you would only need to inject every 4 days since it is almost the same like injecting cypionate every day. Always welcome to correct me.

Is it right that it doesn't matter IM or SubQ when injecting E3.5D?

What does BIW/TIW means? No, it wasn't too complex. I understand it. Thank you.

No, I inject daily so as to minimize testosterone and estradiol peaks and valleys. I was injecting every 3.5 days, an excellent protocol, the standard starting point, and due to low SHBG found I was clearing testosterone too quickly. In addition to which, my estradiol was creeping up. As Dr. Saya points out, I have achieved true steady-state levels - total and free testosterone along with estradiol. Very stable. That is only possible on a daily schedule. It isn't a protocol for everyone, but it works perfectly for me.

I have found no difference between IM/SubQ injections. Oh, BID: twice weekly, TID: three times weekly.

 

[new_man]

No, I inject daily so as to minimize testosterone and estradiol peaks and valleys. I was injecting every 3.5 days, an excellent protocol, the standard starting point, and due to low SHBG found I was clearing testosterone too quickly. In addition to which, my estradiol was creeping up. As Dr. Saya points out, I have achieved true steady-state levels - total and free testosterone along with estradiol. Very stable. That is only possible on a daily schedule. It isn't a protocol for everyone, but it works perfectly for me.

I have found no difference between IM/SubQ injections. Oh, BID: twice weekly, TID: three times weekly.

Thanks again!
It seems like that most people got problems with High E2. Arent's there people who have too low E2? I guess that the solution for that is to increase the testosterone - or use a little bit of HCG since I have heard that E2 goes higher with it. Correct me again when I'm wrong.

I guess you are injecting cypionate because the half life is way longer than propionate - so that you will get a constant level. But if you are interested in a really constant level, why not injecting Undecanoate? It has a way longer half life than cypionate. (As I know it is quite expensive and I'm not sure if you can get 10ml Undecanoate vials.)

I know or I believe that most people do really well with E2 in between 20-30. It also depends on the ratio E2-T. How is it with SHBG... I guess it is better to be in the low range? Is there a ratio too?