Hi all - just started on TRT....

[Ubermensch33]

32 year old male, 5'9 150lbs. Eat well, sleep well, drink a bit, lift weights, and surf. Sedentary desk job.

Last few years I have exhibited what are now known to me as classic test deficiency symptoms - with the exception that I hadn't yet experienced any loss of libido or inability to get erections. But, mild depression, bad anxiety, lethargy, fatigue, no drive, etc...

So I was curious more than anything. Got some blood work done about 2 months ago-not optimal tests, but here they are:

TESTS	RESULT	UNITS	INTERVAL
Testosterone, Serum	306	ng/dL	264 - 916
Free Test (Direct)	10.3	pg/mL	8.7 - 25.1
Prolactin	10.7	ng/mL	4.0 - 15.2
Estradiol	20.5	pg/mL	7.6 - 42.6
SHBG, Serum	41.1	nmol/L	16.5 - 55.9

I was a bit shocked to see my test/free test so low at the age of 32 (33 in 2 weeks). So I started cramming. I read everything I could here, Jay Campbell's newest book, and Nelson's book. I listened to Jay's podcasts. I took the plunge and went to a men's clinic here in Los Angeles (an appt. with a known TRT friendly urologist would have been a month out - I'm thinking I will keep the appointment, though, as perhaps insurance may cover me there).

I got my first two injections on Thursday - 150mg of test cyp (is that high?), once per week, and Hcg (I forget the dosage and have an e-mail out to them on this). Labs will be done again in ~3 weeks, indefinitely. Then twice/year after that. The clinic director seemed very knowledgeable, and was able to answer all the questions I could come up with from my cramming sessions.

Anyway - I was and am a bit nervous about all this (it is my personality), but I do already feel different. It's difficult to come to terms with the fact that this is a lifelong therapy, but my numbers are there in black and white, I suppose, and so is my mood. I'm sure acceptance will come with time! Nice to meet everyone! Please let me know if you have any concerns about my story! Thanks for all you guys do.

 

[OMI100]

Well you read the first 2 books on my list of "Books to read"!
Looks like you are doing your "Home work".
**************************
ExcelMale.comGuide to Testosterone Replacement
https://www.excelmale.com/forum/showthread.php?5823-ExcelMale-com-Guide-to-Testosterone-Replacement
************************
Might download DR. Johns papers that will add to your knowledge base here:
http://www.allthingsmale.com/publications.html
and download:
TRT: Recipe For Success
Print out.
and
HCG Update.
andthe TRT Power Point presentation.

Dr. Crisler is one of the "TRT Cutting Edge DR's" here in the states....
Also go here:
http://www.drjohncrisler.com/the-cri...part-deux.html
and also print out the article.

 

[MarkM]

Welcome to the forum! Self-education is a fantastic thing and you will be better off for doing it. 150 mg of test cyp is a huge first dose and once weekly is not a very good protocol for most. The large once a week injections like you have been put on when give you a rollercoaster ride with your hormones and emotions. Your SHBG isn't high enough in my mind to warrant such a high dose once weekly. You would probably be much better off with two injections a week (every 3.5 days - example of Monday morning and Thursday evening).


Having labs done again in three weeks is a little early and should probably not be done again until at least 6 weeks, 8 weeks being even better. It will take the test cypionate 40 days to reach a steady state. If you take labs after three weeks they will not give you an accurate depiction of where you are going to end up on your starting dosage. If it were me I would probably knock that doseage down to 100 mg a week total and split that into two injections of 50 mg each.

Best advise is to take it nice and slow. It is much easier to increase your dosage than to bring the dosage down.

Once again welcome to the forum.

 

[FeelingLost]

I got my first two injections on Thursday - 150mg of test cyp (is that high?), once per week, and Hcg (I forget the dosage and have an e-mail out to them on this). Labs will be done again in ~3 weeks, indefinitely. Then twice/year after that. The clinic director seemed very knowledgeable, and was able to answer all the questions I could come up with from my cramming sessions.

Will they let you give your own shots? It takes T cyp 40 days to reach a steady state in your blood so the T is building everyday. Your body is going to have a few issues along the way. One thing is forsure T is not a party drug its a hormone so don't expect much at first. 150mg/wk is a big dose for TRT however you will have E2 problems and later HCT issues on that dose. One good thing about the big 150mg shot is it will bring your SHBG down and that is a good thing. It will take less T to get you to your sweet spot. Most TRT guys try to get to the top of the Free T range and keep their E2 and HCT in check.

HTH and welcome to the forums.

 

[Ubermensch33]

Welcome to the forum! Self-education is a fantastic thing and you will be better off for doing it. 150 mg of test cyp is a huge first dose and once weekly is not a very good protocol for most. The large once a week injections like you have been put on when give you a rollercoaster ride with your hormones and emotions. Your SHBG isn't high enough in my mind to warrant such a high dose once weekly. You would probably be much better off with two injections a week (every 3.5 days - example of Monday morning and Thursday evening).


Having labs done again in three weeks is a little early and should probably not be done again until at least 6 weeks, 8 weeks being even better. It will take the test cypionate 40 days to reach a steady state. If you take labs after three weeks they will not give you an accurate depiction of where you are going to end up on your starting dosage. If it were me I would probably knock that doseage down to 100 mg a week total and split that into two injections of 50 mg each.

Best advise is to take it nice and slow. It is much easier to increase your dosage than to bring the dosage down.

Once again welcome to the forum.

Thanks for your thoughts! More than once a week makes logical sense to me, too (and echoes everything I've read), but I looked at some of the studies and it doesn't seem like 1x/week is THAT bad (certainly not as bad as 1 injection/2 weeks). Honestly, my guess is that the clinic does it for convenience, but I will certainly ask again.

The good news is that with the exception of the first injections, I believe I can pick up my shots and administer them at home. So I could break up the dosage that way (I believe, unless there's something I don't know about the needles/syringes - that's one area in which I'm completely ignorant).

 

[Systemlord]

Your protocol is far from a modern TRT protocol, no HCG, no AI which is strange considering your large dosage. These clinics often aren't capable of diagnosing complex medical conditions which automatically makes them less qualified to treat you. Getting your injections at the clinic is convenient for them, not you.

If they refuse to allow you to inject at home it's because they want you tied to the clinic for life for financial gain.

I'm not at all impressed with this clinics TRT protocols.

 

[Ubermensch33]

Your protocol is far from a modern TRT protocol, no HCG, no AI which is strange considering your large dosage. These clinics often aren't capable of diagnosing complex medical conditions which automatically makes them less qualified to treat you. Getting your injections at the clinic is convenient for them, not you.

If they refuse to allow you to inject at home it's because they want you tied to the clinic for life for financial gain.

I'm not at all impressed with this clinics TRT protocols.

Thanks for your reply, System. I did mention in the OP that they put me on HCG as well as the 150mg dose of test cyp. once per week. Do you agree with others that dosage is high just starting out?

Agreed on the self injection. They said they will let me do it at home. Now, that doesn't mean they will write me a prescription. I will still have to go pick up the dose from their office.

I thought paying out of pocket at these types of men's clinics was typically a better route (if one can afford it) than an endo/urologist. Do you disagree? Obviously, it would be great to find a completely knowledgeable urologist, but my impression is that they are few and far between, and most are reluctant to even prescribe testosterone, much less know how to manage on an ongoing basis.

Thanks again for your input.

 

[CoastWatcher]

Thanks for your reply, System. I did mention in the OP that they put me on HCG as well as the 150mg dose of test cyp. once per week. Do you agree with others that dosage is high just starting out?

Agreed on the self injection. They said they will let me do it at home. Now, that doesn't mean they will write me a prescription. I will still have to go pick up the dose from their office.

I thought paying out of pocket at these types of men's clinics was typically a better route (if one can afford it) than an endo/urologist. Do you disagree? Obviously, it would be great to find a completely knowledgeable urologist, but my impression is that they are few and far between, and most are reluctant to even prescribe testosterone, much less know how to manage on an ongoing basis.

Thanks again for your input.

Your perception that doctors, regardless of specialty, are wary and ignorant of managing the care of hypogonadal men is accurate. The amount of time devoted to the question during the years of medical school/internship/residency is astonishingly small. Are there capable doctors in the United States accepting insurance who do know how to play this game? Of course there are, but experience suggests they are few and far between. The silly, time consuming practice of making you go to your current doctor's office to "pick up" your weekly injection is an example of childish anxiety on their part; are you charged for that weekly trip? So, yes, a specialty clinic - NOT a T-mill - would be a rational response to what you have encountered.

Your dose is likely to be excessive, risking estradiol spikes. By the way, you were tested with the incorrect estradiol test (reference range is a dead giveaway). Men should only be evaluated with the sensitive (also known as ultrasensitive) estradiol test - LC, MS/MS. Bear that in mind for future tests.

 

[Ubermensch33]

Your perception that doctors, regardless of specialty, are wary and ignorant of managing the care of hypogonadal men is accurate. The amount of time devoted to the question during the years of medical school/internship/residency is astonishingly small. Are there capable doctors in the United States accepting insurance who do know how to play this game? Of course there are, but experience suggests they are few and far between. The silly, time consuming practice of making you go to your current doctor's office to "pick up" your weekly injection is an example of childish anxiety on their part; are you charged for that weekly trip? So, yes, a specialty clinic - NOT a T-mill - would be a rational response to what you have encountered.

Your dose is likely to be excessive, risking estradiol spikes. By the way, you were tested with the incorrect estradiol test (reference range is a dead giveaway). Men should only be evaluated with the sensitive (also known as ultrasensitive) estradiol test - LC, MS/MS. Bear that in mind for future tests.

Thanks, Coast. Read a lot of your posts recently.

The Estradiol test I listed was ordered by myself, very early on in my education.

I'm a little confused as to where to go from here. I do consider the clinic I'm going to somewhere between a specialty clinic and a T-mill: they were very quick to label me a candidate for therapy. However, the director does seem somewhat knowledgeable (what I imagine to be well above average when compared to endos/urologists in my area). Is there anything you'd recommend for next steps? I'm in west Los Angeles, FWIW.