Just started TRT. Sceptical about protocol; help me optimize please :)

[krm]

Hi guys

alright... after months of going back and forth, I was finally put on TRT. (This was quite a bit of "work" despite my labs showing that there's something off.).

I'm highly skeptical about my doc's protocol, so any advice would be highly appreciated so I can be more educated next time I see him (6 weeks)

So, I was diagnosed with primary hypogonadism (labs below).

Initially, doc wanted to start me on gel, which I declined (I have 3 little kids at home, some of which still sleep in our bed either permanently or at least sometimes - didn't want to risk any transfer issues, plus I hate smearing stuff on my body).

So we agreed on testosterone enanthate injections.

His initial suggestion was one vial (250mg/ml) every 4 weeks.
I said that I believe this would give me too much fluctuation after reading a lot of information on the subject, and I'd rather do weekly injections.

He wasn't happy with that due to the "risks involved with weekly self-injections" and that I might get fed up with injecting myself weekly. So we decided to do every 14 days as a starter.

He injected me with 0.5ml (125mg) and gave me 2 more vials (glass/break-off) to inject in 14 and 28 days, respectively; at the end of week 6 (so low point after injection) he would draw blood to check my levels and see me again to discuss dosage.

125ml EOW seems very little to me; what do you think?

Thanks for any suggestions.

----

LABS:

Short summary after the break, for those interested in reading the whole story, here are my two initial posts:

*************
Initial Post:
https://www.excelmale.com/forum/thr...o-zero-low-test-low-cortisol-what-next.15896/

Question specific to my low estradiol:
https://www.excelmale.com/forum/thr...ious-bottom-range-tt-ft-interpretation.16013/

**************

Short version:

Over past 2 years, was feeling increasingly exhausted and fatigued, "out of mojo", lack of energy. Just couldn't get things done. No ED/sexual issues.

GP and endo involved, LOTS of other tests showed no other issues (no depression / no cortisol issues / no adrenal / thyroid / etc. issues (though some suggested here thyroid was evaluated too "old-school).

last bloodworks were:

Oh, symptoms - mainly really bad lack of energy, irritability, problems to focus. No thyroid, adrenal, glucose or other issues. Not taking any medication atm.

Thanks a ton guys.

*******

Latest bloodwork, 8am fasted:

Total Test (ref 8.64 - 29.0 nmol/l) - 12.9
Free Test (ref 198.0 - 619.0 pmol/l) - 227.7
Free Test (ref 1.53 - 2.88 %) - 1.77
Bioavailable Test (ref 4.36 - 14.3 nmol/l) - 5.6
Bioavailable Test (ref 35.0 - 66.3 %) - 43.1

SHBG (ref 14.5 - 48.4 nmol/l) - 39.6
FSH (ref 1.5-12.4 U/l) - 5.8
LH (ref 1.7-8.6 U/l) - 5.1
Prolaktin (ref 4.0-15.3 μg/l) - 12.4
ACTH ACTH (ref 1.3 - 13.9 pmol/l) - 2.5
DHEAS DHEAS (ref 1.2 - 8.98 μmol/l) - 8.2
ALB Albumin (ref 35.0 - 52.0 g/l) - 45.0

Oh, symptoms - mainly really bad lack of energy, irritability, problems to focus. No thyroid, adrenal, glucose or other issues. Not taking any medication atm.

Thanks a ton guys.

*******

Latest bloodwork, 8am fasted:

Total Test (ref 8.64 - 29.0 nmol/l) - 12.9
Free Test (ref 198.0 - 619.0 pmol/l) - 227.7
Free Test (ref 1.53 - 2.88 %) - 1.77
Bioavailable Test (ref 4.36 - 14.3 nmol/l) - 5.6
Bioavailable Test (ref 35.0 - 66.3 %) - 43.1

SHBG (ref 14.5 - 48.4 nmol/l) - 39.6
FSH (ref 1.5-12.4 U/l) - 5.8
LH (ref 1.7-8.6 U/l) - 5.1
Prolaktin (ref 4.0-15.3 μg/l) - 12.4
ACTH ACTH (ref 1.3 - 13.9 pmol/l) - 2.5
DHEAS DHEAS (ref 1.2 - 8.98 μmol/l) - 8.2
ALB Albumin (ref 35.0 - 52.0 g/l) - 45.0

Estradiol was tested separately and came in at
31 pmol/l, of a range of 41.4 - 159 pmol/l
("normal" test, we don't seem to have the sensitive array here in Switzerland)

He then decided to do an LHRH stimulation test with me.

results of today:
LH response seems fine, FSH should be more active. (LH: t0/t30/t60min - 21.3/23.8/5.9 U/l, range 1.7-8.6; FSH 5.2/7.6/8.3 U/l, range 1.5-12.4)

BUT:
Estradiol, this time, was below the measurement threshold (<18 pmol/l) for all 3 measurements. (range 41.4-159).

total test, this time, was 11.0/12.3/14.6 nmol/l (range 8.64-29.0)

FREE test measured, however, showed 33.6/28.8 pmol/l (range 49.2-112.3)

free test, calculated, showed 173.9 pmol/l (range 198-619
free test, calculated, 1.58% (range 1.53-2.88)
bioavailable testosterone was 4.2 nmol/l (range 4

 

[Nashtide]

This^^^

 

[krm]

Will definitely push this through next time I see him (6 weeks).
Was just happy today to walk away with my first injection and something to start with.

What do you guys think about the dosage? Isn't 125 biweekly (or roughly 65 weekly if I split it myself) way too little?

Or is this okay as a starting point?

 

[Jiu Jitsu Dude]

My doc started me bi weekly at 200mg. It was terrible. Switched on my own to 100mg weekly and it made a big positive difference. I'm new at this too but your dose seems a little low. Maybe start at 80mg a week.... But again I'm a newbie too

 

[Nashtide]

It's unlikely you will have a positive experience with this doctor.

 

[mooseman109]

I am ok with low dose, I do 70 mg/ week and it works fine. That said I am one of the rare low dose guys on here and I am still tweaking, but still low.
My dr started me on 200 mg every 2 weeks. It worked, but my hct went thru the roof.

 

[krm]

I’ve sent my doc an email and asked for the reasoning behind this low dose. He answered that he wants to prevent tachyphylaxis and is thus starting low.

I’ve never heard of tachyphylaxis with regards to test...does this even make sense?

 

[Vince]

I’ve sent my doc an email and asked for the reasoning behind this low dose. He answered that he wants to prevent tachyphylaxis and is thus starting low.

I’ve never heard of tachyphylaxis with regards to test...does this even make sense?

That's funny. My fear would be after 2 weeks your testosterone levels will be so low you'll feel worse then you did before you started trt.

 

[MarkM]

I’ve sent my doc an email and asked for the reasoning behind this low dose. He answered that he wants to prevent tachyphylaxis and is thus starting low.

I’ve never heard of tachyphylaxis with regards to test...does this even make sense?

I thought tachyphylaxis was related to women and hormone replacement therapy. I've never heard it in regard to TRT in men, but I'm no physician.

This is about all i could find on tachyphylaxis ..........

Testosterone Therapy in Men. The Hype! Who Needs It? And How to Increase Your Own Testosterone Production – An Interview with Gary Huber, DO

"In men the use of supra-physiologic doses of topical testosterone cream is many times administered at 50, 100 or 150 mg per day (the male only produces 5-12 mg of testosterone per day). These doses will create a “tachyphylaxis” or attenuation of the hormone’s ability to activate the hormone receptor sight due to supra-physiologic doses of topical testosterone in the attempt to raise serum levels. More and more testosterone is used with less and less benefit while serum levels rise slowly and moderately (sometimes not at all) over time."

http://www.stayinghealthytoday.com/testosterone-testing-lifestyle-clomid-gary-huber/
The article also states.........................

"Dr. Huber has found that by using physiologic doses of testosterone in the 5-10 mg range, endogenous testosterone production is not suppressed as much or at all......

For one, your not utilizing a topical cream and you surely are not going to achieve or have to worry about supra-physiological testosterone levels on your prescribed dose.

 

[krm]

Thanks, I've found that article as well... I think that dude has no clue, to be honest.

The fact that that guy talks about "supra-physiological" doses of 50, 100 or 150mg for creams and does NOT take into consideration that only about 10% of that is absorbed (which would actually be very well in his suggested "natural range" of 5-12mg natural production a day), PLUS that he seems to take TT as a guideline and not FT or BAT - well, those things tell you something about him...

 

[MarkM]

Thanks, I've found that article as well... I think that dude has no clue, to be honest.

The fact that that guy talks about "supra-physiological" doses of 50, 100 or 150mg for creams and does NOT take into consideration that only about 10% of that is absorbed (which would actually be very well in his suggested "natural range" of 5-12mg natural production a day), PLUS that he seems to take TT as a guideline and not FT or BAT - well, those things tell you something about him...

Your right, absorption is right at 10% for Androgel per their own literature so in a wweek of applying 100 mg a day you end up with a total of 70 mg.

Might want to find a new doctor early verse end up dealing with this doctor for years to come.

 

[Systemlord]

I believe the reason why doctors suggest such long injection protocols is because naturally our levels fluctuate wildly throughout the day so in their mind fluctuations are of no consequence. We have to remember we are taking control of our HPTA and the rules are different.

These fluctuation men experience on TRT are happening at a much slower pace and I believe it's this slow pace that our body notices rather than the natural super fast pace our bodies are used to.

Go to fig 1 graph B in link below and see what happens after day 6, levels drop below optimal, on 200mg I felt this dip after day 4-5 do to lower SHBG. The 3rd week I was right back in low T land, after a while this drives up hematocrit to the point where your doctor has to stop your treatment. It's cruel and unusual punishment.

Any doctor that still doing these 200mg every 2-3-4 weeks is choosing to be ignorant, it's a choice to not learn.

--> https://www.jstage.jst.go.jp/article/endocrj/53/3/53_3_305/_pdf