How to discuss TRT dosage adjustments with doctor?

[mobear]

Hey folks,

I’ve been on 100mg/wk Test-Cyp TRT for 6 weeks now. No side effects thus far, other than one mild case of acne breakout and skin greasiness (probably more to do with it being time to wash pillowcases and sheets). Today I’ve got an appointment with my TRT doctor to check in, get bloodwork, and refill my prescription. How do I discuss adjusting my dosage?

I’ve been experiencing a “yo-yo” effect with this dosage and schedule, and the effect got much worse about 4 weeks in. The first 2-3 days after my shot, I feel solid - confident, normal libido, good lifts in the gym, better sleep. The next 3-4 days, I start feeling more and more depressed, less energetic, and by the 7th day, I feel like complete crap - just as bad or worse than before I started TRT and Wellbutrin. I’ve been logging these swings in mood/energy in a journal on my phone.

How do I express these concerns to my doctor in a way that doesn’t come off as demanding? I genuinely feel that I’d feel much better taking this same dose of testosterone at every 3.5 days instead of every 7 days. It’s like I’m running out of fuel before I get to the next dose.

 

[S1W]

I would just tell him exactly what you said in your second paragraph. He shouldn't resist, in fact, he will probably appreciate you keeping track of your progress and communicating honestly with him.

You have a solid, well-documented reason for why you want to make the change. He will let you switch to E3.5D. E3.5D has more or less become sort of a standard for guys starting out, not once per week.

If he does not let you switch, then allow yourself to "switch" to a new doc ASAP. If for some reason that is not an option and he refuses to give you permission, then just switch to E3.5D anyway - he won't know.

 

[Vince]

I agree with S1W, just tell him what you posted. I also agree with injecting every 3 1/2 days.

 

[mobear]

I mentioned the energy dip around 3 days to my doctor, and he prescribed a vial of Test-Cypionate and said I can step my dosage up slowly to 100mg E3.5D as long as I don’t experience any negative side effects.
He also said he’ll be monitoring my estrogen levels to see if I need to be put on an estrogen blocker. I assume an estrogen blocker would be aromasin or arimidex?

 

[madman]

Hey folks,

I’ve been on 100mg/wk Test-Cyp TRT for 6 weeks now. No side effects thus far, other than one mild case of acne breakout and skin greasiness (probably more to do with it being time to wash pillowcases and sheets). Today I’ve got an appointment with my TRT doctor to check in, get bloodwork, and refill my prescription. How do I discuss adjusting my dosage?

I’ve been experiencing a “yo-yo” effect with this dosage and schedule, and the effect got much worse about 4 weeks in. The first 2-3 days after my shot, I feel solid - confident, normal libido, good lifts in the gym, better sleep. The next 3-4 days, I start feeling more and more depressed, less energetic, and by the 7th day, I feel like complete crap - just as bad or worse than before I started TRT and Wellbutrin. I’ve been logging these swings in mood/energy in a journal on my phone.

How do I express these concerns to my doctor in a way that doesn’t come off as demanding? I genuinely feel that I’d feel much better taking this same dose of testosterone at every 3.5 days instead of every 7 days. It’s like I’m running out of fuel before I get to the next dose.

Before jumping to any conclusions you need blood work to see where such protocol (dose of T/injection frequency) has your TT/FT levels at true TROUGH.

Let alone e2 and blood markers such as RBCs/hemoglobin/hematocrit which will be increased when using exogenous T.

What is critical right now is that when starting trt it is common for one to experience ups and downs because not only is your hpta shutting down but more importantly your hormones will be in FLUX during the weeks leading up until levels stabilize at 6 weeks as you are using injectable esterified T.

Many will experience bumps (ups/downs) along the way until blood levels stabilize and even then once levels have stabilized it can take 2-3 months for the body to adapt as this is the most critical period when you should truly gauge how you feel overall on such protocol regarding relief/improvement of low-t symptoms and overall well-being.

Now I will say when injecting larger doses of T once weekly there will be a drastic difference between the peak--->trough TT/FT levels let alone levels will not be stable throughout the week.

T levels peak 8-12 hr post-injection and will be much lower by the end of the week and for many, they could very well experience ups/downs in how they feel overall.

Also, keep in mind that seeing as you are injecting 100 mg T once weekly your true TROUGH levels (7 days post-injection) may very well be too low but the only way you are going to know is through blood work.

Most men would do much better splitting up the weekly dose and injecting twice weakly as not only will you be minimizing the peak--->trough but your blood levels will be more stable throughout the week which will result in overall beneficial effects.

Once you get your blood work back post it here.

You will most likely be better off splitting your dose 100 mg/week into 50 mg twice weekly (every 3.5 days) before looking into increasing your dose.

 

[madman]

I mentioned the energy dip around 3 days to my doctor, and he prescribed a vial of Test-Cypionate and said I can step my dosage up slowly to 100mg E3.5D as long as I don’t experience any negative side effects.
He also said he’ll be monitoring my estrogen levels to see if I need to be put on an estrogen blocker. I assume an estrogen blocker would be aromasin or arimidex?

This is horrible advice as first off you have only been on trt for 6 weeks let alone have no idea where your TT/FT levels sit and if anything switching from 100 mg once weekly to 50 mg twice weekly (every 3.5 days) would be the smarter move before increasing your dose.

Let alone going from 100 mg T once weekly--->200 mg/week T (100 mg every 3.5 days) is ridiculous, to say the least as that is a whopping dose of T.

Most men on trt are injecting 100-150 mg/week using various injection protocols (once weekly, twice weekly, M/W/F, EOD or daily, and such doses of T would have most men's TT/FT levels well into a healthy range.

Sure some are injecting higher weekly doses 150-200 mg/week but even than most would never need what would be considered the highest-end dose (200 mg/week) of T to achieve healthy TT/FT levels let alone experience the beneficial effects of trt.

Some of those clinics we would refer to as T-mills and some of the numbskulls on the numerous forums/youtube are pushing the more T is better mentality.

The best piece of advice that I will stand by is to start low and go slow.

If you eventually do need to increase your T dose to bring your TT/FT levels up in order to achieve a healthy FT level than going from 100 mg/week (50 mg every 3.5 days) to 120 mg/week (60 mg every 3.5 days) would be the smarter move.

Trust me when I tell you that increasing your T dose by 20 mg/week will have a big impact on driving up your TT/FT/e2 levels let alone RBCs/hemoglobin/hematocrit!

The more T is better mentality needs to die.

 

[mobear]

Thanks @madman, that seems like prudent advice. I did get bloodwork on Friday (at trough) and will be getting results back on Tuesday, so I should have more information about my testosterone/E2/hematocrit levels then.

Since I have the flexibility to dose at my own schedule, would an EOD or even ED schedule be better for hormone stability?