Clomid Journey Over; Starting TRT

[Esq]

After 10 months under treatment with Dr. Saya and Defy Medical, I'm making the jump from clomid to traditional TRT. I won't rehash my history again here, but for those interested, I had a thread running in the Clomid section with those details: https://www.excelmale.com/forum/showthread.php?9873-Clomid-(and-maybe-more)-with-Defy.
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I had my most recent consult with Dr. Saya yesterday, and we both agreed that I've exhausted most other potential causes of my symptoms (dangerous to say "all"). That, coupled with what seems to be a trending downward of natural testosterone levels over the past 18 months, now leads me to give TRT a try. The plan is to give treatment 6 to 12 months to see if I subjectively notice improvements. If I don't, Dr. Saya thinks there is a good chance I can do another clomid restart and get my natrual levels back at or close to current levels so long as I don't go much beyond 12 months.
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My starting protocol will be 64mg test C E3.5D (128mg/week), 400iu HCG E3.5D, and 0.125mg anastrozole EOD.
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Dr. Saya feels that with my high SHBG levels (52.5 before clomid peaking at 68 while on clomid), injections every 3.5 days is a good starting point. He also recommended low dose anastrozole at the outset because my sensitive e2 hit 70 while on clomid (and 0.25mg anastrazole EOD only brought it down to the mid-50s). We're hoping to keep my e2 from getting out of control as I start TRT with the understanding that the dose can be adjusted up or down (or I can stop the AI entirely) if e2 stays more in check than it did with clomid.
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My plan is to inject the testosterone shallow IM with a 27g 1/2" insulin syringe and inject the HCG SQ with a 30g 5/16" insulin syringe. I may consider injecting both at the same time town the road, but for now I will start with separate injections.
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Meds and syringes were ordered yesterday with overnight shipping, so accounting for Empower's compounding time, I'm hoping to start injections tomorrow or Thursday. Follow-up labs will be in 10 weeks with my next consult in approximately 12 weeks.
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Fingers crossed. . .

 

[Vince]

Esq, my fingers are crossed. I hope you see improvements in your well-being.

 

[CoastWatcher]

No one can suggest you were hasty with this decision. Time, money, and - to a certain extent - anxiety went into the past months. I'm sorry it didn't work as you'd hoped, but I wish you great success as you take this next step. Please keep us all updated.

 

[Esq]

Esq, my fingers are crossed. I hope you see improvements in your well-being.

No one can suggest you were hasty with this decision. Time, money, and - to a certain extent - anxiety went into the past months. I'm sorry it didn't work as you'd hoped, but I wish you great success as you take this next step. Please keep us all updated.

Thanks to both of you. I appreciate the words of encouragement.

 

[Esq]

I had my first injections this morning, and I feel like Superman! It's amazing!
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Joking, just joking. I don't feel anything just yet, but I am happy with how easy the process was. I've never injected myself before, and it was easy all around. It only took a minute, at most, to draw the test into the 27g insulin syringe. I injected in my delt, and felt nothing at all, and again, probbaly less than a minute to deposit all the test. The HCG was similarly painless SQ with a 30g in my abdomen, although I had a very minor burning sensation that started about 5 minutes after the HCG injection and continued for about half an hour. Nothing major, and it was gone quickly.
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I'm giving some thought to injecting the HCG 24 hours before my test shot, instead of same day, since I'm injecting separately anyway and every 3.5 days. Some seem to think that helps manage e2 a little better and keeps a more consistent test level coming into trough? I'm tryng not to overthink this process at the outset, but since it doesn't create any additional injections or anything like that, I may give it a go.

 

[FeelingLost]

This is exciting I look forward to reading about your new journey and progress. Congrats on mastering the injections so smoothly.

I am only injecting HCG right now and I've learned a little trick I'd like to share and ask you if you would not mind doing a small test for me with your T injection.
When I have my belly skin lightly pinched I will gently poke the needle around and I can find spots were there is no feeling. I can just push the needle in and there is ablolutely no needle sting. You feel nothing. To reduce any lumps of HCG I usually stop pinching the skin once the needle is in and inject slowly.

Now for my test/experiment. Would you try the lightly poke around your choosen injection site for no needle feeling and insert the needle there? My theory is there are spots on the skin between the nerves and if one can find them the needle insertion is prick/painless.

 

[Esq]

This is exciting I look forward to reading about your new journey and progress. Congrats on mastering the injections so smoothly.

I am only injecting HCG right now and I've learned a little trick I'd like to share and ask you if you would not mind doing a small test for me with your T injection.
When I have my belly skin lightly pinched I will gently poke the needle around and I can find spots were there is no feeling. I can just push the needle in and there is ablolutely no needle sting. You feel nothing. To reduce any lumps of HCG I usually stop pinching the skin once the needle is in and inject slowly.

Now for my test/experiment. Would you try the lightly poke around your choosen injection site for no needle feeling and insert the needle there? My theory is there are spots on the skin between the nerves and if one can find them the needle insertion is prick/painless.

Haha - you're asking a lot of a guy just getting used to sticking himself! But no, I don't mind giving it a try. I swab a pretty big area with the alcohol swab anyway.
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Funny story though - I decided to give blood yesterday and get on a regular donation schedule. I'd rather try to keep hematocrit down preemptively than be scrambling around to donate with high levels. I don't mind needles (and donating is a nice thing to do anyway) and so wasn't anticipating any issues. I do have very small veins, and this particular tech was having a hell of a time getting the needle placed correctly. Lots of moving the needle around, and LOTS of pain.
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Finally she got it set, but after about 5 minutes the blood was not flowing very quickly, so she tried adjusting the needle AGAIN and my body just shut down - I got lightheaded, nauseous, clammy, etc. They called the donation, and once the needle was out I was fine. Luckily, no significant bruising or pain after the fact, but I was really close to either throwing up or losing consciousness.
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So I arrive home, and find that my shipment from Empower has arrived. I unpack it, and just stare at the test and HCG wondering if I could get up the nerve to stick myself for the first time after the donation debacle a mere 30 minutes earlier. I finally worked up the courage, and luckily all went smoothly.

 

[FeelingLost]

Haha - you're asking a lot of a guy just getting used to sticking himself! But no, I don't mind giving it a try. I swab a pretty big area with the alcohol swab anyway.

No pressure my friend. Just if you feel up to it.
I believe you said you are doing HCG. See if my example/tip with that needle works for you. If it does that might help since you will know what to feel for.

 

[Esq]

I'm at the four week mark (first injection was on October 19), so I thought it a good time to update this thread.
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So, first, the good. I didn't feel much of anything the first week or so, but starting mid-week 2 and continuing to today I have noticed a subtle increase in energy and a small, but noticeable improvement in mood. Strength definitely is up despite eating at a small caloric deficit to cut a little fat, and overall body composition seems to be improving (past attempts to cut some fat have led to a seemingly equal loss in muscle and fat - since starting TRT, the muscle seems to be hanging around better and maybe even growing).
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All of these positives are extremely subtle, and I wouldn't call these first 4 weeks to be life-changing, but I'm certainly optimistic about the long term viability of this.
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Now, the (kind of) bad. I struggled with pretty severe acne as a teenager, including cystic acne, and went through several rounds of Accutane between ages 15 and 18, so my biggest concern with TRT was potential acne, which hasn't been a problem at all for me since I was in my very late teens. I noticed a few spots on my face and upper chest during the second week, but those resolved pretty quickly. My face continues to be a little more oily than normal, but so far no major outbreaks there. Over the past week, however, I've had quite a few spots develop all over my back and shoulders, some quite painful. I'm hoping all that is just temporary until my hormones settle into place.
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I've also noticed some mild water retention/bloating, similar to when my e2 began to spike on clomid. My fingers are crossed that its also temporary, because I'm really hoping not to have to go higher than the 0.125mg anastrozole EOD I'm on now (and I'd love to be able to go even lower or drop the AI entirely).
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Finally, despite my overall mood being subtly, but noticeably improved, I have had periodic bouts of pretty extreme irritability. That was another thing I felt with my e2 spiked with clomid, so again, REALLY hoping that's just temporary while things settle into place.
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Overall, I'm very pleased with how things are going. I realize I'm very early in the journey, but the positives are definitely outweighing the negatives so far. My next round of labs will be in about 6 weeks.

 

[FeelingLost]

Hi Esq thanks for the update. I have had all of the things you've described and they were temporary.
Oily skin and acne was the worse. However now in month 11 it is gone. Every time my doc raises my T lvl the oily skin returns for a few weeks.
Acne is a big issue with many that take there T lvl over the top.

I have found 20 minutes in a infrared sauna and 15 minutes in the steam room every other day really helped purge the skin of excess oil.

On the mood swings I've felt it was my harmones trying to balance out and sometime they overshoot. I do not adjust my protocol because of them.
I always wait it out and change when my blood test dictate a changes is needed.

 

[Esq]

Hi Esq thanks for the update. I have had all of the things you've described and they were temporary.
Oily skin and acne was the worse. However now in month 11 it is gone. Every time my doc raises my T lvl the oily skin returns for a few weeks.
Acne is a big issue with many that take there T lvl over the top.

I have found 20 minutes in a infrared sauna and 15 minutes in the steam room every other day really helped purge the skin of excess oil.

On the mood swings I've felt it was my harmones trying to balance out and sometime they overshoot. I do not adjust my protocol because of them.
I always wait it out and change when my blood test dictate a changes is needed.

Appreciate the encouragement. I'm definitely not going to make any changes until I get bloods and talk with Defy again. Plus, the positives are far outweighing the negatives so far.

 

[Verdilo]

@Esq i am on trt just for 3 weeks and got greasy hair so you are not alone. Also some acne but only little bit. I never got acne in my life so maybe its genetic.

Got a question for you. Did you actually felt a lot better when on clomid therapy? I was on clomid for 2 months and my numbers were ok (t level, lh, fsh, e2 and prolactin) but only numbers. I was feeling still very bad and nothing was improving for me except less pain in my joints and better sperm.

Thats why i decied to move on trt, didnt have another choice, unfortunetly.

 

[Esq]

Got a question for you. Did you actually felt a lot better when on clomid therapy? I was on clomid for 2 months and my numbers were ok (t level, lh, fsh, e2 and prolactin) but only numbers. I was feeling still very bad and nothing was improving for me except less pain in my joints and better sperm.

Thats why i decied to move on trt, didnt have another choice, unfortunetly.

I did not. I had about a 5-day run early on where I felt great, but otherwise felt nothing for the most part (other than feeling terrible for a few weeks when my e2 spiked). My numbers were crazy high (total T above 1500 ng/dL and free T at 36 pg/mL about 100 days in), but I didn't feel anything. That's exactly why I decided to give TRT a go.

 

[Verdilo]

Oh, i thought that maybe You are one of this magic unicorns which clomid helped.

Thats exectly what happened to me. First 5-6 days on clomid therapy i was feeling small improvements in mood and overall but then everything stoped, crushed and i started to have problems with my eyes too. I was cuting e2 levels to normal range but still it didnt give me anything.

 

[Esq]

My first labs since starting TRT came back last week, and are attached. As a reminder, I'm on 64mg test E3.5 (128mg/week), 0.125mg anastrozole EOD, and 400iu HCG E3.5. A few things jump out at me.
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* Total testosterone at 1278 ng/dL seems a little high for a trough value?
* Free test is above range at 37.9 pg/mL, but not crazy high.
* Pre-trt, I had relatively high SHBG in the mid-50's, and that's now down to 41.4 nmol/L.
* Sensitive e2 at 21.4 pg/mL is perhaps too low, especially with test levels that high. I have been having some joint pain and other very minor low e2 symptoms.
* DHEA-Sulfate is still high at 623.9 ug/dL, but is actually down a bit from pre-TRT levels of 640+.
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The CBC and metabolic panel numbers appear in good shape to me. I'm thinking I may need to lower both test and AI dosages a tad, but we'll see what Dr. Saya thinks when we talk in a few weeks.
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Other than the very minor low e2 symtpoms I've felt the past few weeks, I otherwise feel pretty good and significantly better than before TRT. Not necessarily 100%, but maybe 80-85% of the way there. The acne issues and oily skin from early on have pretty much cleared up entirely, libido, energy, and strength are up, body composition continues to improve, and my sleep has been very good (AHI numbers for my sleep apnea are at the lowest levels ever - could be from getting better adjusted to the CPAP but the numbers have been improving the longer I've been on TRT).
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Thoughts or suggestions based on my labs? My only complaint is that my HCG seemed less effective the longer I was on it. Possibly losing some potency after 60 days or so? Hopefully the fresh batch coming (hopefully) soon gets the boys plump again.

 

[Systemlord]

I've had sore joints since I began TRT back in may and my E2 was usually above range most of the time, so it doesn't necessarily mean your E2 is low. I've heard that anastrozole can mess with your cholesterol levels, so perhaps lower your test dosage which will allow you to reduce your AI dosage. Also Dr Crisler mentioned when a guys T levels are too high it can mess with your lipids. Some guys report HCG working in the beginning but starts to become less effective over time, either increase or decrease dosage or perhaps inject more often.

 

[Esq]

My 3 month consult with Dr. Saya took place this morning. As always, it was a pleasant and informative conversation. Overall, he's happy with how my labs look. He wants to keep on eye on the slightly elevated potassium. My lipid profile still look fine even with the slightly elevated LDL, but obviously we'll keep monitoring that. He wants to see total T come down a little from my last trough of 1278 to somewhere between 900 and 1200 and free T come down from almost 38 to somewhere between 25 and 35. He also wants to see sensitive e2 come up from 21 to somewhere in the high 20s or low 30s. So, a few protocol changes:
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* Moving from 64mg test every 3.5 days (128mg/week) to 36mg test M-W-F (108mg/week). I have noticed a fairly regular low in the 12-24 hours leading up to each injection, so he thinks going to M-W-F might help this. The lowered dose reflects the desire to bring the numbers down a bit and also the more frequent dosing. We discussed EOD as an option as well, but for now we'll give M-W-F a try.
* Moving from 0.125mg anastrazole EOD to 0.125 twice a week, taken with my HCG dose (which will remain the same at 400iu every 3.5 days).
* I started doing regular blood donation when I decided to begin TRT, but Dr. Saya suggested not donating any more (last donation was mid-December) until we see where HCT is after follow-up labs. He thinks I may not need to donate regularly, and perhaps not at all, based on current HCT.
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All in all, I'm pleased with my progress so far and hope that these minor adjustments get me closer to a dialed-in protocol. Dr. Saya wants me to get follow-up labs in 10 weeks and then we'll talk again in 12 weeks.
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Two quick c/s related applauds - first, Defy let me go ahead and schedule my 12-week follow up today, which was nice. Waiting until labs are ordered (or come back) can lead to delay sometimes, so I really appreciated that. Second, I noticed that the order confirmation email I received today was much more descriptive on the process from order to delivery, even listing realistic delivery timeframes (8-11 business days for standard, 5-7 business days for express, and 4-5 business days for expedited). I sincerely applaud Defy for making those changes to their email confirmations as it makes the entire process much more transparent to the patient. Hopefully that resolves future delivery-delay-related-complaints with patients (which we're not allowed to post here anymore anyway). Nice work!

 

[Vince]

Esq, I'm happy everything went so good with your consultation with Dr Saya. Sounds like you're making good adjustments to your protocol, hopefully you'll get closer to being dialed in.