Back on trt. What’s changed?

[Lowtuk]

Hey everyone,

Been on and off trt for 5/6 years now, came off for a year in 2020 to get pregnant for my son and came off at the end of last year to get pregnant again. We are half way through the pregnancy now so I am jumping back on.

My dose had always been a vial of sust 250 once per week injected into the thigh or glute.

Since I’ve been off and out of the trt circle for a while, I had a few questions.

Is this still a sound protocol that I’ve been prescribed?
Is there a better injection frequency/style? I’m still using the long needles and going deep into the muscle?
I’m 10 days in so 2 injections and feel a bit bloated, this may be diet/sickness but could it be from the trt or is that too early?

My blood work was:

Total test 2.85 ng/ml ref range 2.79-8.16
Free test 52.1pg/ml (1.83%) ref range upto 2-3%
Sensitive Estradiol <20 pg/ml ref range <20-47

Any advice or pointing in the right direction of new articles/studies would be much appreciated.

My goals from the trt are two fold. Firstly quality of life/libido/mood/energy and secondly to lose fat as im starting to participate in triathlons

 

[madman]

Hey everyone,

Been on and off trt for 5/6 years now, came off for a year in 2020 to get pregnant for my son and came off at the end of last year to get pregnant again. We are half way through the pregnancy now so I am jumping back on.

My dose had always been a vial of sust 250 once per week injected into the thigh or glute.

Since I’ve been off and out of the trt circle for a while, I had a few questions.

Is this still a sound protocol that I’ve been prescribed?
Is there a better injection frequency/style? I’m still using the long needles and going deep into the muscle?
I’m 10 days in so 2 injections and feel a bit bloated, this may be diet/sickness but could it be from the trt or is that too early?

My blood work was:

Total test 2.85 ng/ml ref range 2.79-8.16
Free test 52.1pg/ml (1.83%) ref range upto 2-3%
Sensitive Estradiol <20 pg/ml ref range <20-47

Any advice or pointing in the right direction of new articles/studies would be much appreciated.

My goals from the trt are two fold. Firstly quality of life/libido/mood/energy and secondly to lose fat as im starting to participate in triathlons

Is this still a sound protocol that I’ve been prescribed?

No, and it never was.

This is overkill.

The majority of men would never even need what would be considered the high-end TRT dose of 200 mg/week to achieve a healthy let alone high trough FT level.

Most can easily achieve such by injecting 100-150mg T/week especially when split into more frequent injections.




Is there a better injection frequency/style? I’m still using the long needles and going deep into the muscle?

Nothing wrong with starting out injecting once weekly but the downfall is that there will be a significant difference in the peak--->trough and blood levels will not be as stable throughout the week which can have a negative impact on mood, energy, libido/erectile function and recovery.

Regardless some men will do well injecting once weekly.

More common to split your weekly dose and inject twice weekly (every 3.5 days) as this will clip the peak--->trough and blood levels will be more stable throughout the week.

Some may even go with injecting lower doses more frequently as in M/W/F, EOD, or even daily.

Most men are injecting strictly IM (shallow/deep) or subcutaneously.

Need to find what suits you best.

The majority of men on TRT are using 27-31G (various needle lengths) LDS insulin syringes (fixed needle) to draw and inject the oily solution.

No need to use 22-25G needles let alone switch out needles to draw/inject.

One of the main advantages of using an LDS insulin syringe for trt is that there will be minimal waste of medication due to low-dead space let alone you draw/inject using the same needle (fixed).

Numerous benefits of using an LDS insulin syringe (fixed needle) as injections are virtually pain-free, minimal trauma to the tissue, minimizing any waste of medication, easier for many to measure accurate doses when injecting lower volumes, and you can draw/inject using the same needle to boot.

“Fixed insulin type syringes have no void space at the point where the needle joins the syringe, and so are known as Low Dead Space Syringes, which is sometimes abbreviated in the literature to LDSS. They are made like this so that the full accurate dose is delivered, and there is no waste”








I’m 10 days in so 2 injections and feel a bit bloated, this may be diet/sickness but could it be from the trt or is that too early?

Bloat/water weight is expected and there is a good chance you are going to hold a lot on the absurd dose of T you are starting out on!

Although excess e2 can play a role in water retention (bloat/puffiness) it is not solely to blame.

Androgens increase the retention of electrolytes.

The use of exogenous androgens will result in the retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates.

Bloating/edema can be common in some and to what degree depends on many factors.

Most of the initial increases in weight gain on trt are water-related whether extra-cellular/intra-cellular.

Many men on trt can gain 5-15 lbs of water weight within the first month.

The majority of gains when first starting trt are due to extra-cellular water (between the muscle and skin) which shows up as bloat/puffiness and intra-cellular water (inside the muscle cell) which will make the muscle look fuller and harder due to increased glycogen stores.




My blood work was:

Total test 2.85 ng/ml ref range 2.79-8.16
Free test 52.1pg/ml (1.83%) ref range upto 2-3%
Sensitive Estradiol <20 pg/ml ref range <20-47

You are missing important blood markers such as SHBG and CBC which include critical markers RBCs, hemoglobin, and hematocrit).

Again need to tread lightly on that absurd dose of T you are starting out on as not only will it put your TT, FT, and estradiol through the roof but more importantly it is going to drive up your hematocrit.




Any advice or pointing in the right direction of new articles/studies would be much appreciated.

Use the search function.

The forum is littered with such!

So who is happy with TRT? Who wish they never started?

lol 60mg EOD is not microdose... folks START at that a week ...210mg a week is actually very high and more of a "fitness" dosing than optimization. I would expect something else going on and MACRO dose of 280mg a week is what makes u feel "ok". ie over a gram of test a week is VERY high and...

www.excelmale.com

Principles of Testosterone and hCG Injection Technique

Selecting the Devices There are many different syringes and needles, suiting many different procedures. It is important to choose the needles and syringes carefully according to the type of injection to be administered. For example, the length and gauge of the needle and type of syringe must...

www.excelmale.com

 

[madman]

Hey everyone,

Been on and off trt for 5/6 years now, came off for a year in 2020 to get pregnant for my son and came off at the end of last year to get pregnant again. We are half way through the pregnancy now so I am jumping back on.

My dose had always been a vial of sust 250 once per week injected into the thigh or glute.

Since I’ve been off and out of the trt circle for a while, I had a few questions.

Is this still a sound protocol that I’ve been prescribed?
Is there a better injection frequency/style? I’m still using the long needles and going deep into the muscle?
I’m 10 days in so 2 injections and feel a bit bloated, this may be diet/sickness but could it be from the trt or is that too early?

My blood work was:

Total test 2.85 ng/ml ref range 2.79-8.16
Free test 52.1pg/ml (1.83%) ref range upto 2-3%
Sensitive Estradiol <20 pg/ml ref range <20-47

Any advice or pointing in the right direction of new articles/studies would be much appreciated.

My goals from the trt are two fold. Firstly quality of life/libido/mood/energy and secondly to lose fat as im starting to participate in triathlons

This sums it up for anyone starting TRT!


My reply from a previous thread:


The common starting dose is 100 mg T/week injected once weekly or split into twice-weekly injections.

Yes, there are some men who choose to inject more frequently.

Always best to start on a T-only protocol as we want to see how the body reacts and where such a dose will have your trough TT, FT, estradiol, and other important blood markers such as RBCs, hemoglobin, and hematocrit.

The use of ancillaries such as hCG or AI can eventually be added if need be but even then I would try to avoid the use of an AI!

Keep in mind that when first starting TRT or tweaking a protocol (dose T/injection frequency) hormones will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks when using TC/TE) and it is common for one to experience ups/downs during this transition as the body is trying to adjust.

Even then once blood levels have stabilized (4-6 weeks) it will still take the body time (a few months) to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.

Every protocol needs to be given 12 weeks in order to claim whether it was truly a success or failure.

Blood work is always done once steady-state is reached which is 6 weeks after starting a new protocol (TC/TE).

Labs should be done a the true trough (lowest point) over the week just before your next injection.

Critical to use the most accurate assays TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration) when getting blood work done.

Always use the same lab and the same assay (most accurate).

If you are injecting once weekly then the true trough would be 7 days post-injection, and if you are splitting your weekly dose by injecting twice-weekly then the true trough would be 3.5 days (84 hrs) post-injection.

The dose of T you start on should only be increased at the 6-week mark if labs show that your trough FT level is too low which is highly unlikely in the majority and if anything many end up with too high a trough FT level as they are started on that high-end dosed T protocol of 200mg/week pushed by those knumbskulls (dime a dozen run of the mill T-clinics, BROforums, or those so-called internet GURUS) polluting the f**KING internet with that more T is better mentality!

Trust me when I tell you it's always best to start low and go slow.

There is lots of time to increase your dose down the road if need be.

Patience is key.

 

[Lowtuk]

Thanks for the advice guys, very glad I came on here to post. Very detailed and really appreciate the time taken to help me out. I'm based in the middle east and the knowledge/accessibility to experienced Endo doctors here is very limited.

So I am deffo on too high a dose, I've taken two injections 7 days apart on 15th and 22nd of the full Sust 250 vial. Shall I wait two weeks for the levels to subside and then dose just under half the vial to get to 100? Is that how it works?

Going to research 27-31G (various needle lengths) LDS insulin syringes and how to inject this afternoon.

 

[madman]

Thanks for the advice guys, very glad I came on here to post. Very detailed and really appreciate the time taken to help me out. I'm based in the middle east and the knowledge/accessibility to experienced Endo doctors here is very limited.

So I am deffo on too high a dose, I've taken two injections 7 days apart on 15th and 22nd of the full Sust 250 vial. Shall I wait two weeks for the levels to subside and then dose just under half the vial to get to 100? Is that how it works?

Going to research 27-31G (various needle lengths) LDS insulin syringes and how to inject this afternoon.

250 mg/mL strength:


U-100 insulin syringe

1 ml = 100 units

0.01 mL = 1 unit = 2.5 mg esterified T-blend (Sustanon)

Same for the 0.5 mL (50 units) or 0.3 mL (30 units) insulin syringes.




If you are going to inject 100 mg T/week then it would be 0.4 mL (40 units).

If you want to start out a little higher 125 mg T/week then it would be 0.5 mL (50 units).

Forget waiting the 2 weeks just start your new dose on Nov.29 th which would be 7 days since you last injected that absurd dose of 250 mg.

Keep in mind that you will need to start over and give it enough time to reach a steady state
before getting blood work done otherwise, your labs will be skewed and you will have no idea where your true trough TT/FT level truly sits.

Always make sure to test at the true trough (lowest point) before your next injection.

You would most likely be far better off splitting your weekly dose (100 or 125 mg T/week) and injecting twice weekly (every 3.5 days).

If you prefer sticking with once weekly for the time being then do what you feel is best for you.

 

[XBiker]

I agree, I think you're taking to much. IMO, you're cycling, not using HRT / TRT, but I don't want you to feel that I (or we?) are bashing on you.

250 / week of Sustanon would put most men well over the normal range after the long-ester test has had a while to build up.

In addition, you're spiking you levels, even though Sustanon is a mix of short > long chain esters. IMO, it's always best to inject on a 3.5 day schedule to keep from getting a peak and valley effect from the test administration.

Madman posted a lot of good info, and I concur with him. You should really take a look at your goals, your protocol and your overall health to maximize your HRT / TRT.

 

[Lowtuk]

Hey everyone,

Thank you all for your comments.

Just by way of an update, I have split my Sustanon 250 vial into 4 syringes that I am taking every 3.5 days so If my match is correct, I am now dropped down to 125 of test per week.

This has only been the protocol for a couple of weeks so shall I give it 4 more weeks and then go for blood tests to see how my levels are, I normally just get Total Test, Free Test and Estradiol tested, can you recommend if I need other tests requested?

 

[Lowtuk]

Hi All,

Update after around 8 weeks on the new protocol, had my blood work last week and below are the results.

Would appreciate any feedback please as the advice really helps me.

Estradiol is high and doctor is saying to use nolvadex at 20mg a day? is this right? I'm seeing people recommend Arimidex as a better solution? If AI then what dosage please as I am taking 70mg test every 3.5 days.

Tests were done 3.5 days after last injection.

Testosterone 5.45mg/ml Ref range 1.75 - 7.81
Free Test 99.8pg/ml (1.83%) Ref range upto 2-3%
HBA1C 5.07 % ref range 4-5.6%
RBC 4.82 x106/ul Ref range 4.5-5.5
Haemoglobin 15.20 g/dl ref range 13-17
Aldosterone 12.5 ng/dl ref range 1.17 -35.3
Estradiol 87 pg/ml Ref range 20-47

Thank you for any advice

Just to give an update on lifestyle etc...

Since Oct I stopped drinking, started training for an ironman so 10-14 hours a week of swimming/cycling/running and eating clean. lost some weight then started back on TRT and my weight has stayed the same for 3 months now and I'm suffering from stubbon fat around stomach and chest and feeling bloated.

 

[Systemlord]

I would check your thyroid levels, TSH, Free T4 and Free T3.

 

[FunkOdyssey]

Hi All,

Update after around 8 weeks on the new protocol, had my blood work last week and below are the results.

Would appreciate any feedback please as the advice really helps me.

Estradiol is high and doctor is saying to use nolvadex at 20mg a day? is this right? I'm seeing people recommend Arimidex as a better solution? If AI then what dosage please as I am taking 70mg test every 3.5 days.

Tests were done 3.5 days after last injection.

Testosterone 5.45mg/ml Ref range 1.75 - 7.81
Free Test 99.8pg/ml (1.83%) Ref range upto 2-3%
HBA1C 5.07 % ref range 4-5.6%
RBC 4.82 x106/ul Ref range 4.5-5.5
Haemoglobin 15.20 g/dl ref range 13-17
Aldosterone 12.5 ng/dl ref range 1.17 -35.3
Estradiol 87 pg/ml Ref range 20-47

Thank you for any advice

Just to give an update on lifestyle etc...

Since Oct I stopped drinking, started training for an ironman so 10-14 hours a week of swimming/cycling/running and eating clean. lost some weight then started back on TRT and my weight has stayed the same for 3 months now and I'm suffering from stubbon fat around stomach and chest and feeling bloated.

What symptoms are you looking for improvement with here? It sounds like you mostly want to treat the E2 number because it's high? That isn't really advisable. In any case, that should come down as you get leaner.

 

[Lowtuk]

What symptoms are you looking for improvement with here? It sounds like you mostly want to treat the E2 number because it's high? That isn't really advisable. In any case, that should come down as you get leaner.

Thats the issue I’m trying to treat. I’m not getting leaner, I’m in a calorie deficit. I’m burning between 3500-4500 calories dependent on the training day and yet I’m stuck at the same weight for last 2 months and am just basically soft and watery so I’m wanting to reduce the E2 to reduce the water weight and bloating

 

[Lowtuk]

Hey everyone,

Just wanted to give an update.

Stuck with the 100mg test a week split into 2 injections.

Diet has been great, still no alcohol, lots of protein. Been training hard and completed an ironman end of feb and fo the last 6 weeks been cycling around 400/500km a week.

However even with the high trining, clean diet and lower dosage of test, I still haven't lost any weight and I still have a lot of fat around my stomach that sticks out.

Really starting to get disappointed with this now as I see lots of people changing their body composition from being on trt and it just isnt working for me and I feel if I hadn't started trt then I'd be seeing lots of weight loss from the diet and workout regime.

Please any advice would be greatly appreciated.

I have an appointment with my endo this afternoon to discuss

 

[Lowtuk]

@Systemlord I got an email saying you posted referencing my T number of 5.45mg/ml in a ref range of 1.75 - 7.81 saying "you need a high TRT dosage"

But I can't find the post here?

Could you let me know more details please as in why I need a higher dose and what dose you would suggest?

Also for everyone, my Endo said he couldn't work out why I was still storing stomach fat.

He has ordered the below tests and is saying he may prescribe me DHEA along side my test? Does anyone know much about that protocol and will it help my issue?

Tests Ordered for Fri as my last injection was yesterday.

Blood Count complete automated HGB HCT RBC WBC and Platelet Count and automated differantial WBC Count
Dehydropepiandrosterone-sulfate DHEA-S
Estradiol Total
Test Total
Test Free

Please let me know any further tests that should be requested and I will send them to him.

 

[Systemlord]

@Systemlord I got an email saying you posted referencing my T number of 5.45mg/ml in a ref range of 1.75 - 7.81 saying "you need a high TRT dosage"

But I can't find the post here?

I don't know what happened to that post.

Estradiol Total

Clarify, is this Total Estrogens? If so this is not normally the best lab test because it includes other types of weak estrogens E1 and E3.

You should only concern yourself with estrogen or E2.

Also for everyone, my Endo said he couldn't work out why I was still storing stomach fat.

The main benefit of TRT is estrogen (E2) which redistributes body fat and help decrease fat mass, especially in the belly area. If you took an AI and crashed your estrogen, I would excerpt lots of belly fat to accumulate within a week or two.

I experienced this myself after taking an AI.

Estradiol is high and doctor is saying to use nolvadex at 20mg a day? is this right?

No, that's not right. Nolvadex also known as tamoxifen, is used for blocking estrogen at the breast receptors only, it doesn't lower estrogen.

Nolvadex is the go to drug for gynecomastia.

The only way to prevent testosterone from excessively converting to estrogen is the usage of an aromatase inhibitor or AI.

Your doctor is an idiot!

The majority of endos are out to lunch!

It is for this reason sick care, insurance based care isn't a good place to seek treatment for TRT! I have the same problem, none of my endo's know what the f*** they're talking about, they talk a good talk, but are more or less clueless!!

 

[Lowtuk]

Thanks for coming back to me @Systemlord

I've sent a message on these points and waiting now, unfortunately in Dubai we are very limited with TRT places and most are just Endo's prescribing and it's difficult to get dialled in.

I haven't taken the nolvadex or the AI, just played about with the dosage and am on 100mg a week now, do you feel like that is too low as per your previous post? would this lead to low E2 and the accumulation of belly fat? This has been a constant problem since I've been on TRT Or does high E2 cause the same effect?

Thinking about last night other symptoms have been loss of libido, weak ejaculation, lots of fatigue (but I put this down to the training) sleeping in.

How long after my last injection should I take the blood tests?

Going to try and research a new doctor

 

[Systemlord]

would this lead to low E2 and the accumulation of belly fat?

A small minority of men will have very low estrogen on TRT because they lack aromatase enzymes within the body, which convert testosterone to estrogen. In these cases, hCG is needed, which helps your testicles make some estrogen in addition to estrogen from aromatase.

This has been a constant problem since I've been on TRT Or does high E2 cause the same effect?

Testosterone affects other hormones that tell the kidneys to reabsorb more sodium, and sodium carries water. If this is the case, sometimes injecting smaller more frequent doses can help.

Thinking about last night other symptoms have been loss of libido, weak ejaculation, lots of fatigue (but I put this down to the training) sleeping in.

This fluid retention caused by testosterone action on the kidneys, can create fluid imbalances, which can cause all of these symptoms.

Once we see your labs, we will be able to pinpoint what your problem may be.

 

[Lowtuk]

Thank you.

When should I take the blood tests? My last injection was Friday

 

[Systemlord]

When should I take the blood tests?

Right before your next injection, or trough.

 

[Lowtuk]

Hey everyone,

Got the first bunch of my blood tests back and below are the tests that came back outside of the reference range. Will get my T levels on Monday.

Any advice on the below? Does the low Iron contribute to my feelings of fatigue, low energy, libido and storing belly fat?

Creatinine 1.26mg/dl Ref range 0.64-1.25
Iron 9.7 umol/l Ref Range 12.5 - 32.2
Triglycerides 241.5mg.dl 0-149 desirable, 150-199 Borderline high, 200-499 high
LDL Cholesterol 115.2mg.dl optimal <100 near optimal/above optimal 100-129
Chol-HDL Ratio 3.7 Ratio desirable 3.5 average risk 3.5-5
RBC 4.36 x19*6/ul Ref Range 4.5-5.5
Haemoglobin 14.18 g/dl Ref Range 13-17
HCT/PCV 39.5 % Ref Range 40-50
MCH 32.5 pg Ref Range 27-32
MCHC 35.9 g/dl Ref Range 31.5 - 34.5

 

[Systemlord]

Does the low Iron contribute to my feelings of fatigue, low energy, libido and storing belly fat?

Low iron will actually make TRT much less effective because low iron causes all sorts of metabolic abnormalities preventing TRT for working.

If your body doesn't have enough oxygen, it can't function normally and metabolic processes slow to a claw.

Too much iron can do the same thing and I personally been at both ends of the spectrum.