Hi from Thailand. 33yo - 4 weeks into TRT. 250mg Test E every 2 weeks - Very Low E2 levels?

[TransitPoloce]

Hi There,

I've recently started TRT at 33 years of age after noticing low Test levels from a general health checkup of 267 ng/dl.

I went to a GP for a second blood test and my free testosterone came back with 4.92 ng/dl and 217 ng/dl Total test - so she was open to treat it with TRT. My doc is open minded and seems fairly progressive, but is def not a TRT specialist.

I had alot of the common symptoms such as fatigue, mental fog, slight depression, low energy, low lebido, ED. I live fairly healthy , workout reguarly, Eat well and rarely drink, I'm 5'11, 175lbs.

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It's just Testoviron Depot 250mg ampules or Nebido available for TRT here - so I began on Test E 250mg every 2 weeks administered by my doctor.

I have asked to switch to 125mg weekly, however my doctor wanted to check my Test levels after a month on current dose, which she wants to do midway between doses - a week after/before injections.

I do have the option to self administer and change the schedule (Test E is OTC here), but I wanted to make sure I had a Doctor happy to work with me and to monitor everything before I did that.

I didn't get my E2 levels checked before starting TRT, but checked a week after the first injection and they were extremely low at 6.3 pg/ml, Ref 25.8 - 60.7 pg/ml - my Dr suggested a retest as this was extremely low, but wasn't too concerned that they were low.

I'm not sure the type of test it was, it just says Estradiol (E2)

I had a comprehensive blood test done and other outliers were low RBC and Hemoglobin, LDL was High at 172 and a low HDL.

Other relevant blood work:
LH: 1.78 mIU/ml Ref 1.7 - 8.6 mIU/ml
FSH: 2.7 mIU/ml Ref 1.5 - 12.4 mIU/ml
HCT: 36.8 L Ref 43.5 - 53.7
LDL 172 mg/dl Ref <130
HDL 39 mg/dl Ref >40
TSH: 0.779: uIU/ml Ref 0.27 - 4.2uIU/ml
Fasting Glucose: 75 mg/dl

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How soon should I recheck my blood work / test levels after beginning TRT?

I haven't had any negative side effects so far - some testical shrinkage in the first week, but they seem to have gone back to normal.

Libido / ED seemed to improve almost immediately after starting.

Any other advice on changing my dosing schedule or ancillaries I should look into?

Thanks for your help guys.

 

[Vince Carter]

Once you're on T there's no need to waste money testing LH or FSH, those should be ~0 due to the negative feedback loop and shutdown, but yours are not...interesting.
Id' pull your SHBG next time, that'll give you a better clue to how often to inject, you're on the right track with weekly but the prevalent protocol here in the states has become twice per week. We typically test 4-6 weeks, with the blood drawn just prior to the next injection.

 

[CoastWatcher]

Welcome to Excelmale. Your doctor may be open-minded, but she is hardly progressive. Injections of testosterone every two weeks are a ticket to failure. Success is found, typically, through smaller, frequent injections - 50 to 60 milligrams every 3.5 days is a sound starting protocol.

You will not have access to the sensitive estradiol test outside the US, so symptom management/recognition is going to be very important. You and your doctor should be very concerned if your estradiol is too low (you indicated your low results didn't trouble you). Low E2 is as concerning as elevated, but yours should rise as your therapy progresses.

Test four to six weeks after therapy begins. Any change in your protocol means another period of four to six weeks has to be maintained before you test again.

Was HCG discussed to maintain your fertility? Was a psa run for baseline purpose So?

 

[TransitPoloce]

@Vince Carter - sorry for the confusion - those labs were all pre TRT - just the E2 was done after I had began. How does SHGB levels influence how often one should inject?


@Coastwatcher - Didn't discuss HCG with doctor, although I had done some reading beforehand on my own. I guess progressive isn't the right word. I'm from Australia where TRT is about 10 years behind the USA and currently living in Northern Thailand, so was happy to find a doc at least willing to treat it.

The hospital that did my initial bloodwork said they treat TRT with one 250mg T injection a month or a Nebido injection Every 14 weeks.. so it's all relative

Forgot to add:

SHGB: 20.72 nmol/L Ref 18.3 - 54.1
PSA: 0.522 ng/ml Ref 0.00 - 4.00

These were both baseline, pre TRT.

 

[CoastWatcher]

@Vince Carter - sorry for the confusion - those labs were all pre TRT - just the E2 was done after I had began. How does SHGB levels influence how often one should inject?


@Coastwatcher - Didn't discuss HCG with doctor, although I had done some reading beforehand on my own. I guess progressive isn't the right word. I'm from Australia where TRT is about 10 years behind the USA and currently living in Northern Thailand, so was happy to find a doc at least willing to treat it.

The hospital that did my initial bloodwork said they treat TRT with one 250mg T injection a month or a Nebido injection Every 14 weeks.. so it's all relative

Forgot to add:

SHGB: 20.72 nmol/L Ref 18.3 - 54.1
PSA: 0.522 ng/ml Ref 0.00 - 4.00

These were both baseline, pre TRT.

You asked about SHBG and injection schedule. If one has lower SHBG, yours is on the low end, though certainly not as low as some members here deal with, you will clear testosterone quickly and be depleted far more quickly. Lower SHBG typically requires smaller, frequent injections in order to avoid testosterone spikes/troughs and estradiol challenges. It's a necessary element that needs to be factored into protocol design.

 

[TransitPoloce]

@CoastWatcher

Thanks - great to know, I hadn't heard that before.

Are there any books/resources on TRT besides this forum you recommend reading?

 

[CoastWatcher]

"Testosterone, A Man's Guide," Nelson Vergel.
"Testosterone Replacement Therapy, A Recipe For Success," John Crisler.
"The Definitive Testosterone Replacement Manual," Jay Campbell.

These will ground you. Dr. Crisler's would be a good introduction in terms of length.

 

[TransitPoloce]

Thanks for the reccomendations Coastwatcher, have gotten all three.

It seems Nelson reccomends a very different injecting protocal now on the forums than when that book was written?
23 gauge in glutes once a week vs 27-29 gauge twice a week.

 

[CoastWatcher]

Thanks for the reccomendations Coastwatcher, have gotten all three.

It seems Nelson reccomends a very different injecting protocal now on the forums than when that book was written?
23 gauge in glutes once a week vs 27-29 gauge twice a week.

I have edited out all references to your bloodwork in this thread so as not to confuse the issue. All comments will appear in one place. I have responded to your labs in the appropriate thread (as I'm sure others will).

Nelson's is the oldest of the titles I suggested. He has modified his technical approach to the injection process over time. He also makes scant, if any mention of the sensitive estradiol test as its efficacy had yet been made clear. However, on the biology and physiology of TRT, that book stands the test of time.

 

[at15]

Im in thailand too, just do your own thing man forget the docs. TRT is ass backwards in USA and AUS let alone Thailand. 250mg once a month what a joke that would make you feel worse than before. Any doc that mentioned that I would be walking out of the office immediately. These docs spend like 1 hour on this stuff in medical school thats it. This forum will provide all the knowledge you need. Stick to 125 mg once a week, load 2 syringes 0.5 ml each then save one for next week. Assess your blood with that. 99% chance you dont need any ancillaries. Forget hcg unless your trying to get a girl pregnant. I actually break that bayer testoviron open and transfer 10 amps into an empty vial, a lot more freedom with your dosing. There are plenty of walk in labs in Thailand to assess blood work, and you can check off anything you want, usually about 400 baht (~$11 usd) each item.

 

[TransitPoloce]

Im in thailand too, just do your own thing man forget the docs. TRT is ass backwards in USA and AUS let alone Thailand. 250mg once a month what a joke that would make you feel worse than before. Any doc that mentioned that I would be walking out of the office immediately. These docs spend like 1 hour on this stuff in medical school thats it. This forum will provide all the knowledge you need. Stick to 125 mg once a week, load 2 syringes 0.5 ml each then save one for next week. Assess your blood with that. 99% chance you dont need any ancillaries. Forget hcg unless your trying to get a girl pregnant. I actually break that bayer testoviron open and transfer 10 amps into an empty vial, a lot more freedom with your dosing. There are plenty of walk in labs in Thailand to assess blood work, and you can check off anything you want, usually about 400 baht (~$11 usd) each item.

Hey @at15

I ended up switching to a TRT clinic in Bangkok for a few reasons. Main one being I want legit scripts for HCG/Ai's as needed and I need my medical history for TRT documented if I move back to Aus so I don't have a hard time getting proper TRT prescribed there.

This place was actually quite knowledgable, Doc had a similar approach to what is suggested around here.

Protocol was changed to 75mg twice a week, 6.25mg aromasin with injections (I had high Estradiol, and am prone to gyno since puberty, so Dr suggested going on an AI until levels are normal)

HCG I haven't started, but am considering it and will discuss it next month.

I get all my meds sent up north once a month, so it suits me fine. I use BRIA labs for bloodwork, you can walk in and get any test for cheap, they're in CM now as well as BKK. Most tests are 100-400bt, except for DHT / Free test are a bit pricy.

You could probably do diy TRT for <$10usd/month in thailand lol - but I'm happy to pay a bit more for a legit script and for the reasons I listed above.

Also travel is an issue, I've had to fly with syringes/test in carry on in Thailand and needed the Dr's letter to take it on the plane.