Long time lurker turned patient

[mewmewmew]

Last year fell into a whirlwind of low test like symptoms and consistently tested in the 350s total as a healthy and active 34 year old. In November and December I tested at 257 total / 35 free and 186total with 32 free. I was diagnosed with hypogonadism this month due to an issue found in MRI on my pituitary and my endo OKd me for hormone replacement.

Now I am prescribed 80mg cyp every 10 days to start — I’ve been lurking and researching long enough to know this is an extremely low and probably overly conservative dose. He wants labs at the 35 day mark (5 days after my last 80mg) and re-evaluate from there.

I am doing daily subQ of the 80mg over the 10 days instead to hopefully help get more consistent levels and manage e2 and hematocrit (was 52% and I just donated blood this weekend to help)


realistically what can I expect at this dose in terms of benefits and really a timeline where I could expect to notice anything?

I plan on adding hcg probably next month (compounded) to help maintain fertility but didn’t want to start right away so I can get the true baseline on the docs protocol

Thanks!

 

[Nelson Vergel]

Welcome to the other side of the lurking, my friend. The fact that you've done your homework and already made smart adjustments to your protocol tells me you're going to navigate this well.

First, let me acknowledge something important: you got a real, structural diagnosis. A pituitary finding on MRI changes the picture significantly compared to the typical "your T is low, here's a script" situation. That's actually useful information, and it means your secondary hypogonadism has a known cause. Make sure you're following up on whatever that finding was with your endo, because the nature and size of a pituitary lesion matters for your long-term care and fertility planning.

Now to your protocol. You're right that 80mg every 10 days is conservative, and the labs at day 35 (5 days post-injection) are going to show a mid-to-low trough that will likely underrepresent your peak levels. But here's the thing: your instinct to convert that to daily subQ microdosing is genuinely smart. You're essentially giving yourself 8mg per day, which is on the lower end of what most men need, but it's a reasonable and physiologically sensible starting point. Daily subQ keeps your levels more stable, reduces the conversion spikes that drive up estradiol, and is much easier on hematocrit than big bolus IM injections. That hematocrit of 52% is worth watching closely given you've already donated, so this approach is the right one for your situation.

At 8mg/day of testosterone cypionate, you're probably looking at total testosterone levels somewhere in the 400-550 ng/dL range once you stabilize, though individual response varies quite a bit. That may or may not be enough to move the needle meaningfully for you. At a true therapeutic dose of 100-150mg per week, many men land in the 600-900 range, which is where most guys feel the real benefits. So be prepared for the possibility that this starting dose gets you partway there but not to where you want to be, and advocate for an upward adjustment at your 35-day labs if your symptoms haven't improved.

As for timeline: most men start noticing something within the first 3-4 weeks, usually improved mood and energy come first. Libido often follows at 6-8 weeks. Body composition changes take longer, 3-6 months. And full optimization, where everything clicks into place, sometimes takes 6 months of dialing in dose and frequency. Be patient but not passive. If nothing is shifting by week 6, push for a dose increase.

Your plan to add HCG next month after establishing your baseline is textbook smart thinking. For fertility preservation on TRT, HCG at 500-1000 IU every other day or three times a week is the standard approach. Since you have a pituitary issue causing secondary hypogonadism, HCG may actually work particularly well for you because your testes are likely still responsive. If you're seriously thinking about fatherhood in the next few years, keep this a priority conversation with your endo and don't let it get pushed aside.

For labs at your 35-day mark, push to get total testosterone, free testosterone, estradiol (sensitive assay, not the standard one), SHBG, CBC with hematocrit. And keep donating blood or doing therapeutic phlebotomy no more frequent than every 2.5 months if that hematocrit climbs back toward 52%.

You're off to a smart start. Keep trusting your instincts, keep tracking how you feel week by week, and don't be afraid to advocate for yourself with your endo using the data you're collecting. That's exactly how this process is supposed to work.