Hello, 57 year old about to start TRT and have questions

[Cali965]

Hello all, a little background.......I have been in a bad marriage for 37 years and have been through at least 5 traumatic family events & losses, so I assume I have been depressed for a while now but never dealt with it. I am now seperated and on depression, anxiety & insomnia meds started 2.5 weeks ago.
Even before I started the meds I felt less irritable, frustrated etc after my wife left and surprisingly do not miss her, even though I still care about her. My head is still foggy and I have fatigued, lack of motivation and concentration etc.
I also found out my total testosterone is low at 197 ng/dL and free is at 34.5 pg/mL and my Dr is starting me off with 100mg Cypionate intramuscularly in the inner thigh every 2 weeks starting this coming Monday and will do a T level check a week after the 2nd shot. Starting off with this and then adjusting has worked for her in the past.
I asked her about daily subcutaneos shots and to her knowledge that method is only used for transgender T therapy, so no go for now.

1. Is her starting dosing and method a good start and if not why?
2. Is injecting the Cypionate in the inner thigh a good idea?

Let me know if I should be asking any other questions or just fire away.
Thank you in advance for any responses, I appreciate it.

Cali

 

[Systemlord]

Dr is starting me off with 100mg Cypionate intramuscularly in the inner thigh every 2 weeks

Okay, you need to find a doctor that knows how to treat you, this protocol is setting you up for misery. Your doctor doesn’t know what she’s doing, probably has no experience with TRT.

The endocrine guidelines state 75-100 mg weekly or 200 mg every two weeks, so 100mg every two weeks makes no sense. That’s 50 mg per week!

These every two week protocols are known as hormonal roller-coasters. Your testosterone and estrogen levels the first week will be sky high, potentially causing issues and the second week much lower causing symptoms long before your next dosage.

This is no way to treat a patient.

There isn’t going to be one member here that will tell you this protocol is even remotely ideal. It’s that bad!

A lack of medical training in medical school for sex hormones, poorly written labels provided by the pharmaceutical companies sets most men up for treatment failure. Body builders figured it out decades ago and actually have taught some doctors how to prescribe it.

Ideally at a minimum you need a once weekly injection, some men need twice weekly shots while others need more to alleviate side effects, high estrogen, water retention and moodiness etc.

 

[Systemlord]

starting this coming Monday and will do a T level check a week after the 2nd shot.

Apparently, your doctor doesn’t understand pharmacodynamics which she should’ve learned in medical school, testosterone cypionate reaches steady states in 42 days injecting once weekly or around 5 doses, so checking levels this early in treatment makes no sense.

Your doctor should be checking your hormone levels no sooner than 4-6 weeks after starting TRT because by then your natural T production will almost be fully suppressed.

Your doctor has NO CLUE what she’s doing! Run, don’t walk away from this doctor!

 

[Cali965]

Okay, you need to find a doctor that knows how to treat you, this protocol is setting you up for misery. Your doctor doesn’t know what she’s doing, probably has no experience with TRT.

The endocrine guidelines state 75-100 mg weekly or 200 mg every two weeks, so 100mg every two weeks makes no sense. That’s 50 mg per week!

These every two week protocols are known as hormonal roller coaster. Your testosterone and estrogen levels the first week will be sky high, the second week much lower. This is no way to treat a patient.

There isn’t going to be one member here that will tell you this protocol is even remotely ideal. It’s that bad!

A lack of medical training in medical school for sex hormones, poorly written labels provided by the pharmaceutical companies sets most men up for treatment failure. Body builders figured it out decades ago and actually have taught some doctors how to prescribe it.

Ideally at a minimum you need a once weekly injection, some men need twice weekly shots while others need more to alleviate side effects.

So, if I can talk her into weekly 100mg Cypionate that would be a good start?
At the moment she is wanting to test at week 4.......should I ask her for week 5 or 6?

 

[Systemlord]

So, if I can talk her into weekly 100mg Cypionate that would be a good start?

Why would you start a treatment with a doctor that is completely unaware how to direct your treatment?

Please explain to me why this is a good idea?

 

[Cali965]

Why would you start a treatment with a doctor that is completely unaware how to direct your treatment?

Please explain to me why this is a good idea?

With my current plan I would need her to refer me to a Urologist or Endinocrologist which would require Authorization from plan provider first after which I could schedule an appt. With the holidays I am not likely to get an appt until Jan at the earliest or even Feb. By that time she should have already seen the results and made adjustments, then I can switch Dr if need be.
I don't see her until Monday so I have until then to decide the best route for me.

 

[tareload]

Welcome Sir. No go on the inner thigh. You have lots of options on injection site...most obvious is DG.

See here for overview of starting protocol and whole thread plus links therein is decent primer as I tried to give the OP a decent overview...

Starting TRT Over Soon

70-80 mg of TC/TE per week (weekly or twice weekly injections) 27 or 29 g insulin pin with DG injection. Swallow IM / Deep SQ (depends on how fat you are). I also add 400 IU hCG twice weekly. Something to consider longer term. Blood work at 6 and 12 weeks and adjust from there.

forums.t-nation.com

Starting TRT Over Soon

Sounds like a good plan. Everybody thinks they need to inject every 12 minutes cause that’s what they read on the internet and watch on Youtube I guess. I have done weekly or twice weekly injections. Felt no difference. Elimination half life of TC is 4.5-7 days with IM and a little longer...

forums.t-nation.com

And more here...

What is TRT and What is NOT TRT

What is TRT For the curious minds or folks seeking a better understanding, TRT stands for Testosterone Replacement Therapy. The R stands for replacement, not enhancement, or elevation. Sometimes there seems to be some confusion between the TRT and pharma section. Note, after discussion with...

forums.t-nation.com

TRT: Most Probable Weekly Dose Range for Treating Male Hypogonadism

Unburied this from another thread in case guys were curious about TRT dosing in the world of hypogonadism. Google xyosted, a vastly overpriced** testosterone enanthate (TE) sub-Q delivery system designed for mass in-network medical provider use to treat hypogonadism. Then look at the three...

forums.t-nation.com

By Monday you should have a decent overview after you get through these.

Happy reading.

And where all those weekly dose recommendations shake out....

Tool to Assess your TT Dose Response -- Percentile Curves

Summary: Tools to estimate your individual dose response for injectable testosterone ester in comparison to a normal distribution (95 percentile confidence estimate) of adult males (Ref). Plot below shows a summary of data from (1) clinical trials gathered from the literature + (2)...

forums.t-nation.com

50 mg/week may be too low and
200 mg/week almost assured to be too high if TRT is your goal.

 

[Cali965]

Welcome Sir. No go on the inner thigh. You have lots of options on injection site...most obvious is DG.

See here for overview of starting protocol and whole thread plus links therein is decent primer as I tried to give the OP a decent overview...

Starting TRT Over Soon

70-80 mg of TC/TE per week (weekly or twice weekly injections) 27 or 29 g insulin pin with DG injection. Swallow IM / Deep SQ (depends on how fat you are). I also add 400 IU hCG twice weekly. Something to consider longer term. Blood work at 6 and 12 weeks and adjust from there.

forums.t-nation.com

Starting TRT Over Soon

Sounds like a good plan. Everybody thinks they need to inject every 12 minutes cause that’s what they read on the internet and watch on Youtube I guess. I have done weekly or twice weekly injections. Felt no difference. Elimination half life of TC is 4.5-7 days with IM and a little longer...

forums.t-nation.com

And more here...

What is TRT and What is NOT TRT

What is TRT For the curious minds or folks seeking a better understanding, TRT stands for Testosterone Replacement Therapy. The R stands for replacement, not enhancement, or elevation. Sometimes there seems to be some confusion between the TRT and pharma section. Note, after discussion with...

forums.t-nation.com

TRT: Most Probable Weekly Dose Range for Treating Male Hypogonadism

Unburied this from another thread in case guys were curious about TRT dosing in the world of hypogonadism. Google xyosted, a vastly overpriced** testosterone enanthate (TE) sub-Q delivery system designed for mass in-network medical provider use to treat hypogonadism. Then look at the three...

forums.t-nation.com

By Monday you should have a decent overview after you get through these.

Happy reading.

And where all those weekly dose recommendations shake out....

Tool to Assess your TT Dose Response -- Percentile Curves

Summary: Tools to estimate your individual dose response for injectable testosterone ester in comparison to a normal distribution (95 percentile confidence estimate) of adult males (Ref). Plot below shows a summary of data from (1) clinical trials gathered from the literature + (2)...

forums.t-nation.com

50 mg/week may be too low and
200 mg/week almost assured to be too high if TRT is your goal.

Thank you I will do the reading.
How do you inject in the DG by yourself.... especially when you don't like needles in the first place?

 

[tareload]

pharmacodynamics

Pharmacokinetics.

 

[Systemlord]

With my current plan I would need her to refer me to a Urologist or Endinocrologist

Don’t be fooled into thinking either of these type of doctors are any more knowledgeable than your GP, TRT is new field of medicine and many doctors are untrained and have little experience prescribing TRT.

Finding a good TRT doctor is like playing the lottery, sometimes you hit a number, a few and more often you completely miss the mark.

My advice, do not start that 100 mg every 2 week protocol, because you think you feel bad now…..

 

[tareload]

Thank you I will do the reading.
How do you inject in the DG by yourself.... especially when you don't like needles in the first place?

Practice with the Doc and work on the thoracic mobility / stretching. VG also fine just stay away from nerves in buttocks as the videos/pics show. I prefer DG over shoulders. I stay away from quads (lots of nerves down there).

And no need to let the Doc harpoon you with 18/23/25 g needle. Very easy to fill 0.2 to 0.3 ml of test cyp in under a min or two with 29g insulin pin. Save the wear and tear on your tissue.

 

[Systemlord]

Pharmacokinetics.

I was using my talk->text feature, definitely needs some work over by the programmers.

 

[Guided_by_Voices]

This is a huge topic but a few quick thoughts...First, congratulations on taking steps to get yourself on a course to happiness, that in itself is major progress. Second, you would be well-served to use a specialized firm like Defy for the first year or so of your TRT to get yourself to a steady-state dialed-in good place. Then you can port your protocol over to an insurance plan knowing what you need at that time. Self-managing your hormones is fraught with peril and is absolutely an area of health where a specialist organization is essential. There are many threads on here about the various protocols people have found to work for them and what they went through via trial and error to find what worked, but I have never heard of the two-week approach being optimal and it is generally just the opposite.

 

[Systemlord]

I asked her about daily subcutaneos shots and to her knowledge that method is only used for transgender T therapy, so no go for now.

The clear lack of knowledge displayed by your doctor is disturbing, I worry should you encounter any side effects, she could potentially abruptly stop therapy since she is in over her head, leaving you with zero treatment all while your natural production is shutdown.

It’s something to think about. Also, if you start that ancient, outdated all be it low dose every 2 week protocol, mark my words, you will be sorry!

 

[Keepfit1]

Hello all, a little background.......I have been in a bad marriage for 37 years and have been through at least 5 traumatic family events & losses, so I assume I have been depressed for a while now but never dealt with it. I am now seperated and on depression, anxiety & insomnia meds started 2.5 weeks ago.
Even before I started the meds I felt less irritable, frustrated etc after my wife left and surprisingly do not miss her, even though I still care about her. My head is still foggy and I have fatigued, lack of motivation and concentration etc.
I also found out my total testosterone is low at 197 ng/dL and free is at 34.5 pg/mL and my Dr is starting me off with 100mg Cypionate intramuscularly in the inner thigh every 2 weeks starting this coming Monday and will do a T level check a week after the 2nd shot. Starting off with this and then adjusting has worked for her in the past.
I asked her about daily subcutaneos shots and to her knowledge that method is only used for transgender T therapy, so no go for now.

1. Is her starting dosing and method a good start and if not why?
2. Is injecting the Cypionate in the inner thigh a good idea?

Let me know if I should be asking any other questions or just fire away.
Thank you in advance for any responses, I appreciate it.

Cali

You have some pretty good answers already, you have had a few problems in life so you dont want any more from a doc who is getting it wrong from day 1. Run is good advice but if you cant run at least try to talk her into 100mg a week ie weekly shot , better 50mg twice a week or daily Subc 12-4 mg. As for saying its only Trans gender that use daily subc is nuts, personally I think the theory of microdosing is excellent and worth a try first, it didnt do it for me but does for most. The alternative is cream or Gel, anything is better than 100mg a fortnight. Some doc.

 

[Keepfit1]

You have some pretty good answers already, you have had a few problems in life so you dont want any more from a doc who is getting it wrong from day 1. Run is good advice but if you cant run at least try to talk her into 100mg a week ie weekly shot , better 50mg twice a week or daily Subc 12-4 mg. As for saying its only Trans gender that use daily subc is nuts, personally I think the theory of microdosing is excellent and worth a try first, it didnt do it for me but does for most. The alternative is cream or Gel, anything is better than 100mg a fortnight. Some doc.

oops typo, when referring to Sub it should have read 12-14mg on fourth line down as opposed to 12-4mg

 

[Cali965]

Thank you for all the responses and very helpful information and advice, I appreciate it.

1. I am going to ask her to put me on 100mg weekly, if she doesn't then I will look elsewhere.
2. If she's ok with 100mg weekly then should I decide on my own to do biweekly or is weekly ok? I am not looking forward at all to injecting myself.
3. Do I need to ask about HCG now? Def don't want nuts the size of raisins LoL.
4. Any other meds or vitamins etc I should start the same time as TRT?

Cali

 

[Systemlord]

If she's ok with 100mg weekly then should I decide on my own to do biweekly or is weekly ok?

Best to not push it, if you give her cause for concern, you may burn your bridges. Get the 100 mg weekly allowance and inject 1-2x per week.

If you ask me, asking your current doctor anything related to TRT isn’t worthwhile. She is only good for getting the script/refills at this point, guiding treatment is a no go.

 

[Cali965]

Best to not push it, if you give her cause for concern, you may burn your bridges. Get the 100 mg weekly allowance and inject 1-2x per week.

If you ask me, asking your current doctor anything related to TRT isn’t worthwhile. She is only good for getting the script/refills at this point.

I agree but if she agrees then maybe she'll learn something from the info I get in this forum over time.
I figured if I get the ok for 100mg then after then week 2 I can inject 50mg every 3.5 days and not tell her.
I just don't have time to try out different doctors etc at the moment so i'm going to have to research and have her for scripts and tests etc.

 

[Systemlord]

The alternative is cream or Gel, anything is better than 100mg a fortnight. Some doc.

Also, even though it’s expensive, if insurance covers it, Jatenzo at 237 mg twice daily, oral TRT is also an option.

The topical and oral TRT route make the dialing in process quick and easy since the frequency of dosing is already decided for you, it only becomes about the dosage.