madman
Super Moderator
1st post from your thread.
I talked with the doctor at the clinic and he suggested proceeding with TRT (he had offered me this in March but I want to try weight loss first). Hope is my Free T will improve, SHBG will decrease, and adding muscle mass will help with the A1c. I understand what he is saying is accurate. I am concerned about whether or not I should keep searching for other causes for the high SHBG before I commit to something that could be lifelong
My starting regimen would be, 100 mg test cyp Monday and Thursday (200 a week), HCG 500 iu Monday and Thursday (1000/week). AI 0.125 only for symptoms. I have everything, just haven't started taking it yet.
Find a new doctor these idiots are setting you up for failure!
Cookie cutter protocol.
Way too high a starting dose let alone throwing in an AI off the hop.
As I have stated numerous times on the forum all these years most men on TRT are injecting 100-200 mg T/week whether once weekly or split into more frequent injections such as twice-weekly, M/W/F, EOD, or daily.
The majority can easily achieve a healthy/high or in some cases, very high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.
Yes, there are some outliers who may need the high-end dose of 200mg T/week but it is far from common.
As we always say on here best to start low and go slow on a T-only protocol as we want to see how your body reacts to testosterone.
Lots of time to increase the dose down the road or add in ancillaries (hCG, AI) if need be.
Would try and avoid the use of an AI.
Most relying on such are overmedicated and running way too high a trough FT level.
Post #3
I will say, the improvement I have seen with what I done so far has been great. If TRT helps that further along (like the joint pain, build muscle, not be as tired), great. I was advised to only take the AI for symptoms and he did tell me that we could lower the dose, I will avoid it.
Again they are overmedicating you off the hop.
200 mg T/week let alone split 100mg T every 3.5 days off the hop is ridiculous.
Such a dose will have most men's trough FT level very high/absurdly high!
No need to even consider the use of an AI if you were started on a sensible dose.
post #21
The doctor didn't think I would, but gave me the AI with a (don't use it unless things get bad, and he did let me know we could change the testosterone dose). It would be good to have it a little higher though.
I am questioning the need for HCG. I'm not having anymore kids and it would add another factor to figuring out what's helping/not helping. The testosterone dose of 200 mg/week (divided in two), he explained was to overcome the relatively high total levels I have. I do wonder if it is too much with what I have learned here.
Wrong way to go about it.
Even if your SHBG never budged driving up your TT will bring up the FT.
If your TT was in the gutter pre-trt this does not mean you need a very high dose of T to achieve a healthy let alone high trough FT.
If you have highish/high SHBG it does not mean you need a very high dose of T to achieve a healthy let alone high trough FT.
Even when using exogenous T (therapeutic doses) it is not a given that everyone will notice a big drop in SHBG.
Some may notice a big drop whereas others may only see a small decrease and in others, there may be no change.
My pre-trt SHBG was 34 nmol/L.
I run a higher-end trough FT and my SHBG sits at 32 nmol/L.
I have at one time even had my trough FT absurdly high and my SHBG never budged lower than 30 nmol/L.
Again the best piece of advice is to start low and go slow on a T-only protocol.
Patience is key.
Lots of time to increase your dose down the road if need be.
Much easier going up than having to come down trust me on this one.
The common starting dose is 100mg T/week and you would most likely fare better splitting up the weekly dose to 50mg T (every 3.5 days).
If you are eager you could try 120 mg T/week split (60 mg T every 3.5 days).
Blood work will be done 6 weeks in so we can see where such protocol (dose of T/injection frequency) has your trough TT, FT and estradiol let alone other critical blood markers (RBCs, hemoglobin, and hematocrit).
Keep in mind when first starting TRT or tweaking a protocol (dose of T/injection frequency) hormones will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common to experience ups/downs during the transition as the body is trying to adjust.
Even then once blood levels have stabilized (4-6 weeks) it will still take time (a few months) for the body to adapt to the new setpoint and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-t symptoms and overall well-being.
This is where the rubber meets the road.
Every protocol needs to be given a fighting chance (12 weeks) to claim whether it was truly a success or failure.
Again patience is key.
Too many make the mistake of increasing their T dose 6 weeks because they do not feel great.
Unless your trough FT was too low (highly doubtful) in most cases then you need to ride it out well past the 6-week mark.
Otherwise, you will be left in a constant state of confusion chasing your tail endlessly.
My reply from previous threads.
Too many are still caught up in jumping the gun off the hop!
*As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months.
*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.
Canadian Urology Guideline on Testosterone Replacement
Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021) Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan...
www.excelmale.com
26. What is a reasonable timeline to begin to observe improvements in the signs and symptoms of testosterone deficiency?
*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.76,77 As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months. 77 In addition, patients should be counseled that diet and exercise in combination with testosterone therapy are recommended for body composition changes.
*Appreciating this pattern of response to testosterone therapy is fundamental when determining the impact of treatment and the appropriate timing of follow-up evaluations while on therapy. For example, if patients undergo a symptom review and measurement of testosterone levels too early (< 3 months), it may lead both physicians and patients to conclude that the treatment has not been impactful (i.e. normal levels of testosterone without symptomatic/structural/metabolic benefit). However, if the same assessment was scheduled 3-6 months after the initiation of therapy, the clinical response tends to be more reflective of normalized levels of serum testosterone.
