Hello! - My TRT Journey

[trtnoobie]

By the way, what was said about HCG as an effort to keep fertility (and other things) in the picture? How much HCG is being prescribed?

Ah, sorry, I neglected to answer (and I really appreciate your help!).

No HCG is prescribed currently. When we talked about fertility, the doctor said (I'm paraphrasing): "95% of guys your age will still be able to conceive on TRT. There was one study that is often cited claiming it can go up to 99% if you use HCG, and it can help offset the shrinkage if you're concerned with that cosmetic factor, but it may not be worth the side effects and more frequent injection if you don't mind the smaller testicles and don't experience testicular pain."

This is something on my list of things to bring up again with the doctor as we dial in my protocol, but I'm trying very hard to adhere to the mentality of trying something simple and sticking with it for ~6 weeks (and blood work) before tweaking. This is part of the reason why my first post here was at 6 shots

Now that I KNOW that higher T is fixing my libido issues, I am focusing more on what I can do to achieve high T whilst maintaining fertility. It sounds like if I can accept injections for life (ie. not a restart protocol), it's worth further exploring injections + HCG as an alternative to a clomid restart.

 

[CoastWatcher]

Ah, sorry, I neglected to answer (and I really appreciate your help!).

No HCG is prescribed currently. When we talked about fertility, the doctor said (I'm paraphrasing): "95% of guys your age will still be able to conceive on TRT. There was one study that is often cited claiming it can go up to 99% if you use HCG, and it can help offset the shrinkage if you're concerned with that cosmetic factor, but it may not be worth the side effects and more frequent injection if you don't mind the smaller testicles and don't experience testicular pain."

This is something on my list of things to bring up again with the doctor as we dial in my protocol, but I'm trying very hard to adhere to the mentality of trying something simple and sticking with it for ~6 weeks (and blood work) before tweaking. This is part of the reason why my first post here was at 6 shots

Now that I KNOW that higher T is fixing my libido issues, I am focusing more on what I can do to achieve high T whilst maintaining fertility. It sounds like if I can accept injections for life (ie. not a restart protocol), it's worth further exploring injections + HCG as an alternative to a clomid restart.

Yes, TRT and HCG is a sound way to proceed. Behind fertility support, HCG should be part of everyone's TRT protocol for lots of good, upstream hormonal issues. I write that as one who has never, not once, realized any subjective benefit from HCG. No libido improvement (thankfully not needed) or anything else. But I respect the reasons good doctors prescribe it and make it part of my protocol.

 

[trtnoobie]

I'm very strongly considering your recommendation to find a new doctor. As I'm sure you know, that will take some time. Thankfully, my current doctor said that I should always feel free to ask about stuff or present papers I find that might help us come up with a better plan for me. He does seem willing to work with me if I can present a logical backing for what I want to try.

I'm going to work on finding more papers backing HCG. Maybe even lie a little and say my balls ache when I come if the papers aren't enough.

 

[CoastWatcher]

https://www.excelmale.com/forum/sho...e-Testicular-Shrinkage-and-Preserve-Fertility

It would be worth your time to read these posts and supporting material on HCG.

 

[trtnoobie]

Thanks, CW. I'll definitely check out the HCG info.

In the meantime, I'm emailing with my doctor to ask what he thinks about exogenous T shutting down the pituitary such that clomid won't work. Very curious to hear what he says and I'll reply back here when he does.

I picked up my T-cyp yesterday (2 1ml vials). They gave me 3cc syringes with 25g needles. I think the needles are okay but I'm going to need to find some smaller syringes if I'm to accurately dose my 0.5ml shots. I've read that I can go to www.getpinz.com to buy syringes. Does anyone know if this is legal to do in the US (shipping to NY, if that matters) without a prescription to go along with them?

 

[CoastWatcher]

Thanks, CW. I'll definitely check out the HCG info.

In the meantime, I'm emailing with my doctor to ask what he thinks about exogenous T shutting down the pituitary such that clomid won't work. Very curious to hear what he says and I'll reply back here when he does.

I picked up my T-cyp yesterday (2 1ml vials). They gave me 3cc syringes with 25g needles. I think the needles are okay but I'm going to need to find some smaller syringes if I'm to accurately dose my 0.5ml shots. I've read that I can go to www.getpinz.com to buy syringes. Does anyone know if this is legal to do in the US (shipping to NY, if that matters) without a prescription to go along with them?

Many of us buy our syringes online. That should be no problem for you. To be clear, exogenous testosterone will shut down your axis - which is already impeded, not working as it should. Clomid may, or may not, restart it when exogenous testosterone is withdrawn. It makes more sense, if Clomid is being considered, to initiate therapy prior to the initiation of TRT.

 

[Vince]

Thanks, CW. I'll definitely check out the HCG info.

In the meantime, I'm emailing with my doctor to ask what he thinks about exogenous T shutting down the pituitary such that clomid won't work. Very curious to hear what he says and I'll reply back here when he does.

I picked up my T-cyp yesterday (2 1ml vials). They gave me 3cc syringes with 25g needles. I think the needles are okay but I'm going to need to find some smaller syringes if I'm to accurately dose my 0.5ml shots. I've read that I can go to www.getpinz.com to buy syringes. Does anyone know if this is legal to do in the US (shipping to NY, if that matters) without a prescription to go along with them?

Nelson just posted a thread on that.

https://www.excelmale.com/forum/sho...Testosterone-and-HCG-Prescribing-Requirements

 

[trtnoobie]

Nelson just posted a thread on that.

https://www.excelmale.com/forum/sho...Testosterone-and-HCG-Prescribing-Requirements

Ah, this seems like an argument for an out-of-NY doctor when I search for a replacement, as they'd be able to prescribe more at a time and/or with refills. Thank you!

 

[trtnoobie]

Reply from Dr about T + Clomid:

"If the level of testosterone is sig elevated, then yes, LH/FSH suppression will happen and it is unlikely that the clomiphene level would be high enough to counteract. But as the testosterone levels drop, then that would not be the case. The question is at what level of exogenous testosterone does that happen, and unfortunately I do not know. So at the beginning, taking the clomiphene will serve no purpose. But at some point it should counteract the suppression from testosterone. Likely at a low dose of testosterone."

 

[CoastWatcher]

Reply from Dr about T + Clomid:

"If the level of testosterone is sig elevated, then yes, LH/FSH suppression will happen and it is unlikely that the clomiphene level would be high enough to counteract. But as the testosterone levels drop, then that would not be the case. The question is at what level of exogenous testosterone does that happen, and unfortunately I do not know. So at the beginning, taking the clomiphene will serve no purpose. But at some point it should counteract the suppression from testosterone. Likely at a low dose of testosterone."

"The question is a what level of exogenous testosterone does that happen, and unfortunately I do not know." It takes very little testosterone to shut down the axis. It's your call, but if Clomid is a possibility, I'd focus on it now and not later.

 

[trtnoobie]

Last week I saw another urologist (found via this board) to get a second opinion. After talking with him, I've decided to forego the clomid option. Basically, since there's no real reason for my low T (no trauma or history of AAS use), a restart isn't an option. And if I'm choosing between clomid for life or injections for life, I prefer the injections. I may end up switching to this urologist, but haven't decided yet. Yesterday was my weekly visit to the first urologist and I wanted to address two things:

First, the improvements from T injections on Wednesday are gone by Monday afternoon. I had him do a blood draw before my injection so I could see what my real trough is, and then he agreed to up the dosage from 100mg once per week to 60mg twice per week (Wednesday morning and Sunday morning). I've asked him to make sure this blood work uses the sensitive test for estradiol as well.

Second, if I'm sticking with injections I want HCG to preserve fertility (at least for the next ~5 years). He agreed to prescribe HCG but said that since there is no real dosing consensus I would need to play around with the schedule and dosage to find what makes me feel best. His only guidance was that I should stick to less than 1000 IU per week, probably break it into multiple injections, and that we'll do blood work again in 2 months to be sure things look okay. Based on what I've read on this board and elsewhere, I think I'll go for 250-500 IU twice per week (the day before my T shots). I'm thinking I'll start with 250IU and see how I feel, ramping up if necessary. Does this dosing seem good? How will I know I need to increase?

 

[Melvin]

have you thought about losing weight and reducing stress instead? your fairly young. There was a study out that showed testosterone is the same between 30's and 70's once they accounted for illnesses, and weight gain. which seems shocking to me.

 

[trtnoobie]

have you thought about losing weight and reducing stress instead? your fairly young. There was a study out that showed testosterone is the same between 30's and 70's once they accounted for illnesses, and weight gain. which seems shocking to me.

Yep. I actually did that first, for about 9 months, before I got frustrated with my lack of results and went to get blood work done for the first time.

 

[trtnoobie]

Got blood work back. First number is pre-TRT (in March), second number is peak TRT (Wed morning shot, Fri afternoon test), and third number is trough TRT (Wed morning pre-shot):

E2: <20, 42, 9
SHBG: 34, 19, 21
Total T: 314, 720, 375
Free T: 6.7, 14.7, 5.25

This was on 100mg/wk in one go (Wed morning). Since then, I've switched to 60mg on Wed morning and again on Sat night. I've noticed my libido sucks again, where before it was good ~Friday/Saturday at least. I'm guessing I need to up my dose? Talking to the doctor about the results today I hope.

EDIT: In the last update I mentioned we are adding HCG to the protocol. It's still clearing my insurance process, so I haven't added yet. Once I do, I'm planning 250 IU on Tue morning and Fri night (24 hours before each T shot).

 

[CoastWatcher]

Got blood work back. First number is pre-TRT (in March), second number is peak TRT (Wed morning shot, Fri afternoon test), and third number is trough TRT (Wed morning pre-shot):

E2: <20, 42, 9
SHBG: 34, 19, 21
Total T: 314, 720, 375
Free T: 6.7, 14.7, 5.25

This was on 100mg/wk in one go (Wed morning). Since then, I've switched to 60mg on Wed morning and again on Sat night. I've noticed my libido sucks again, where before it was good ~Friday/Saturday at least. I'm guessing I need to up my dose? Talking to the doctor about the results today I hope.

EDIT: In the last update I mentioned we are adding HCG to the protocol. It's still clearing my insurance process, so I haven't added yet. Once I do, I'm planning 250 IU on Tue morning and Fri night (24 hours before each T shot).

How long have you been on your current protocol, when was the last change - of any sort - made?

 

[trtnoobie]

Edit: blood draws were in March (pre-TRT), then on 2017-06-02 and 2017-06-21

[TD="align: right"]2017-05-03[/TD]	Wed	[TD="align: right"]2:00 PM[/TD]	T-Cyp	150mg	IM (L Glute)
[TD="align: right"]2017-05-10[/TD]	Wed	[TD="align: right"]2:00 PM[/TD]	T-Cyp	150mg	IM (R Glute)
[TD="align: right"]2017-05-17[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (L Glute)
[TD="align: right"]2017-05-24[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (R Glute)
[TD="align: right"]2017-05-31[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (R Delt)
[TD="align: right"]2017-06-06[/TD]	Tue	[TD="align: right"]4:45 PM[/TD]	T-Cyp	100mg	IM (L Delt)
[TD="align: right"]2017-06-14[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (R Delt)
[TD="align: right"]2017-06-21[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	60mg	IM (L Delt)
[TD="align: right"]2017-06-24[/TD]	Sat	[TD="align: right"]8:00 PM[/TD]	T-Cyp	60mg	IM (R Delt)
[TD="align: right"]2017-06-28[/TD]	Wed	[TD="align: right"]7:30 AM[/TD]	T-Cyp	60mg	IM (R Glute)

 

[CoastWatcher]

[TD="align: right"]2017-05-03[/TD]	Wed	[TD="align: right"]2:00 PM[/TD]	T-Cyp	150mg	IM (L Glute)
[TD="align: right"]2017-05-10[/TD]	Wed	[TD="align: right"]2:00 PM[/TD]	T-Cyp	150mg	IM (R Glute)
[TD="align: right"]2017-05-17[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (L Glute)
[TD="align: right"]2017-05-24[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (R Glute)
[TD="align: right"]2017-05-31[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (R Delt)
[TD="align: right"]2017-06-06[/TD]	Tue	[TD="align: right"]4:45 PM[/TD]	T-Cyp	100mg	IM (L Delt)
[TD="align: right"]2017-06-14[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	100mg	IM (R Delt)
[TD="align: right"]2017-06-21[/TD]	Wed	[TD="align: right"]10:30 AM[/TD]	T-Cyp	60mg	IM (L Delt)
[TD="align: right"]2017-06-24[/TD]	Sat	[TD="align: right"]8:00 PM[/TD]	T-Cyp	60mg	IM (R Delt)
[TD="align: right"]2017-06-28[/TD]	Wed	[TD="align: right"]7:30 AM[/TD]	T-Cyp	60mg	IM (R Glute)

You've only had three injections at 60mg every 3.5 days. That is too little time to draw any conclusions as to the efficacy of this protocol. At a minimum, one must wait four weeks, six is preferable, before determining where you stand. That's a good, solid rule of androgen management good doctors impress on their patients.

You will feel a range of symptoms and reactions as serum levels become stable. When I went from a protocol similar to yours, 60mg twice weekly to 16mg every day, it was a bit of a roller-coaster. Be patient before making another sudden jump.

 

[trtnoobie]

Roller-coaster for sure. I feel like I'd do anything right now to get back to the Friday/Saturday feeling I had 2 weeks ago. But I know you're right, I should be more patient. Thanks, I needed to hear this.

 

[CoastWatcher]

Roller-coaster for sure. I feel like I'd do anything right now to get back to the Friday/Saturday feeling I had 2 weeks ago. But I know you're right, I should be more patient. Thanks, I needed to hear this.

Another move now and you're wandering in the woods.

Will this protocol work for you? I can't say, but you have every reason to expect good results...in time.

Is another change now, an increased dose, say, a good idea? Certainly not. Too many moving pieces in play.

Stay the course.