My 6 weeks TRT Labs: advise welcome

[aneuman]

Hello guys,

Many of you are aware of my journey, but for those who don't know, I started with HCG 2000 IU a week, felt like a greek God for two weeks, then back to basics, Enclomiphene, Great labs but no symptom relief, then Enclomiphene + HCG, some improvements, then TRT.

I was prescribed 100 mg Testosterone Cypionate. I started with 90mg a week (3 x 30mg M-W-F). I notice an increase in morning wood the first two weeks, but after that, not much other than increased anxiety and heavy breathing. I also have BPH, I have not noticed any deterioration of LUTS.

Here are my first 6 weeks labs (July 17)

• Estradiol, Ultrasensitive, LC/MS [<= 29 pg/ml] = 34 pg/ml (HIGH)
• Testosterone Total, MS [250 - 1100 ng/dL] = 1044 ng/dL
• Testosterone, Free [35-155 pg/mL] = 195.2 ng/dl (HIGH)
• Sex Hormone Binding Globuline: [22 - 77 nmol/L)=- 36 nmol/L
• Vermuelen calculated FreeT: 22.9 ng/dL
• TrueT calculated Free T: 23.1 ng/dL
• 
  
• Red Blood Count: 5.54
• Hemoglobin: 16.9
• Hematocrit: 49.6. (previous 47, June 2)
• Platelet Count: 221
• 
  
• PSA: 3.14. (previous was 2.6, June 2)

For the first time ever, in any protocol, Free testosterone has been above 13 ng/dL, and even that only happened once, on enclomiphene and a total T of 1183 ng/dL. Typically my Free T averages the low 70s, most recently in the 40s.

Advise request:

As I mentioned, at the time of the labs (true trough, Monday, before injection, on a M-W-F schedule) the only thing I've noticed is increased anxiety.

What do you think in regards to:

• Timeframe: Does it take much longer than 6 weeks under these conditions for main effects (morning wood, erection, sleep, etc) to return? Keep in mind I'm a 60 year old, so I don't expect miracles, or should I?
• Dosage: Should I increase decrease the dosage? I know for some in this forum "more is better", but maybe lower will be better? or not?
• Frequency: Should I go back to M-W-F, stay on M-F, or maybe change to once a week, as prescribed.

Statistically, based on prior experience, what would be the recommendation for a 60 year old white male, no other comorbidities other than BPH, currently on Cialis 5mg a day, no other medication. No family history of prostate cancer. My BP is around 120/7x.

On Monday I changed to 2 x 50 mg (M-F) thinking that maybe maintaining levels too constant would not be desired.

Before you answer "Only you should know, everyone is different", let it be known that I know that, and if we applied that logic to everything, there wouldn't be a need for a forum, as no-one could provide advise to anyone, since "everybody is different"

Feel free to speculate but if you can, please state your thoughts and logic. I understand that this is not medical advice and I will not hold anybody liable for any consequences. I even asked chatgpt to write a disclaimer for me :-D

Disclaimer:

The opinions and advice provided in response to my online inquiry are solely the views of individual users and do not represent professional or expert opinions. I acknowledge that I am seeking advice at my own discretion and will not hold any person, entity, or platform responsible or liable for any consequences arising from following or implementing the advice provided.

I understand that the information shared online is for general informational purposes only and should not be considered a substitute for professional advice or consultation. Any decisions I make based on the responses received are entirely my responsibility.

Furthermore, I recognize that online communities may consist of individuals from diverse backgrounds and varying levels of expertise, and their advice may not always be accurate, complete, or applicable to my specific situation. Therefore, I will exercise my own judgment and consider seeking guidance from qualified professionals if necessary.

By posting my inquiry and receiving responses, I agree hold harmless all participants, moderators, and platform owners from any claims, damages, or losses that may occur as a result of acting upon the advice provided.

I am fully aware that the internet is a public domain, and any information shared may be accessible to others. Hence, I will avoid sharing sensitive or confidential information while seeking advice online.

In summary, I acknowledge the risks involved in seeking advice online and agree to release all parties from any liability related to the guidance provided. Ultimately, I am responsible for my decisions and actions based on the information received.

 

[aneuman]

I was thinking, and maybe I'm wrong, but TT 1044ng/dL on a trough is a bit high, so maybe I should hit for a more humble 700 - 800 ng/dL?

True, I was on an almost EOD schedule, so troughs would be higher and peaks lower, but still that would put my peak at probably above 1500, don't you think?

@Cataceous, your a reasonable man, what do you think?

 

[Vince]

I thought I'd give you a quick response or my two cents. Personally, I like your levels. I'm one who does better with higher levels. I do think it's better to start low and see how you feel. You may want to drop down your testosterone injection amount. It may help with your anxiety.

Did you do your labs on Monday morning before you injected?

 

[madman]

Hello guys,

Many of you are aware of my journey, but for those who don't know, I started with HCG 2000 IU a week, felt like a greek God for two weeks, then back to basics, Enclomiphene, Great labs but no symptom relief, then Enclomiphene + HCG, some improvements, then TRT.

I was prescribed 100 mg Testosterone Cypionate. I started with 90mg a week (3 x 30mg M-W-F). I notice an increase in morning wood the first two weeks, but after that, not much other than increased anxiety and heavy breathing. I also have BPH, I have not noticed any deterioration of LUTS.

Here are my first 6 weeks labs (July 17)

• Estradiol, Ultrasensitive, LC/MS [<= 29 pg/ml] = 34 pg/ml (HIGH)
• Testosterone Total, MS [250 - 1100 ng/dL] = 1044 ng/dL
• Testosterone, Free [35-155 pg/mL] = 195.2 ng/dl (HIGH)
• Sex Hormone Binding Globuline: [22 - 77 nmol/L)=- 36 nmol/L
• Vermuelen calculated FreeT: 22.9 ng/dL
• TrueT calculated Free T: 23.1 ng/dL
• 
  
• Red Blood Count: 5.54
• Hemoglobin: 16.9
• Hematocrit: 49.6. (previous 47, June 2)
• Platelet Count: 221
• 
  
• PSA: 3.14. (previous was 2.6, June 2)

For the first time ever, in any protocol, Free testosterone has been above 13 ng/dL, and even that only happened once, on enclomiphene and a total T of 1183 ng/dL. Typically my Free T averages the low 70s, most recently in the 40s.

Advise request:

As I mentioned, at the time of the labs (true trough, Monday, before injection, on a M-W-F schedule) the only thing I've noticed is increased anxiety.

What do you think in regards to:

• Timeframe: Does it take much longer than 6 weeks under these conditions for main effects (morning wood, erection, sleep, etc) to return? Keep in mind I'm a 60 year old, so I don't expect miracles, or should I?
• Dosage: Should I increase decrease the dosage? I know for some in this forum "more is better", but maybe lower will be better? or not?
• Frequency: Should I go back to M-W-F, stay on M-F, or maybe change to once a week, as prescribed.

Statistically, based on prior experience, what would be the recommendation for a 60 year old white male, no other comorbidities other than BPH, currently on Cialis 5mg a day, no other medication. No family history of prostate cancer. My BP is around 120/7x.

On Monday I changed to 2 x 50 mg (M-F) thinking that maybe maintaining levels too constant would not be desired.

Before you answer "Only you should know, everyone is different", let it be known that I know that, and if we applied that logic to everything, there wouldn't be a need for a forum, as no-one could provide advise to anyone, since "everybody is different"

Feel free to speculate but if you can, please state your thoughts and logic. I understand that this is not medical advice and I will not hold anybody liable for any consequences. I even asked chatgpt to write a disclaimer for me :-D

Disclaimer:

The opinions and advice provided in response to my online inquiry are solely the views of individual users and do not represent professional or expert opinions. I acknowledge that I am seeking advice at my own discretion and will not hold any person, entity, or platform responsible or liable for any consequences arising from following or implementing the advice provided.

I understand that the information shared online is for general informational purposes only and should not be considered a substitute for professional advice or consultation. Any decisions I make based on the responses received are entirely my responsibility.

Furthermore, I recognize that online communities may consist of individuals from diverse backgrounds and varying levels of expertise, and their advice may not always be accurate, complete, or applicable to my specific situation. Therefore, I will exercise my own judgment and consider seeking guidance from qualified professionals if necessary.

By posting my inquiry and receiving responses, I agree hold harmless all participants, moderators, and platform owners from any claims, damages, or losses that may occur as a result of acting upon the advice provided.

I am fully aware that the internet is a public domain, and any information shared may be accessible to others. Hence, I will avoid sharing sensitive or confidential information while seeking advice online.

In summary, I acknowledge the risks involved in seeking advice online and agree to release all parties from any liability related to the guidance provided. Ultimately, I am responsible for my decisions and actions based on the information received.

As I have stated numerous times over the years 6 weeks means nothing when looking at the bigger picture.

Unless your trough FT level was absurdly low (far from common) or on the other extreme high/absurdly high and you were struggling with sides it would be a big mistake tweaking your protocol.

Every protocol should be given 12 weeks to gauge whether it is a success or failure.

When using TC/TE steady state is achieved (4-6 weeks).

Once a steady state is achieved it will take time for your body to adapt to your new set-point.

As you can clearly see on < 90 mg T/week ( 30 mg split M/W/F) you are hitting a very high trough TT 1000+ ng/dL and more importantly a high trough FT as your SHBG 36 nmol/L is normal (not high/low).

Top it off that this is your true trough Monday morning ( 72 hrs post-injection) on the M/W/F protocol which means that your peak TT, FT, and estradiol will be much higher!

• Dosage: Should I increase decrease the dosage? I know for some in this forum "more is better", but maybe lower will be better? or not?

More in the majority of cases is never better when your trough FT is already high.

Even then your RBCs, hemoglobin, and hematocrit are sitting at the top-end.

Although this should not be a big deal seeing as you mention no symptoms keep in mind that you are only 6 weeks in on such protocol and it will take anywhere from 6-9 months or in some cases up to a year to reach peak levels.

So where your RBCs, hemoglobin, and hematocrit sit now is not where they are going to be 6-12 months down the road.

Increasing your T dose which would bring up your peak/trough TT/FT will only drive up those blood markers further!

If anything you need to give the protocol more time to truly gauge how you feel overall.

Again big mistake tweaking your dose/injection frequency 6 weeks in.

Glad to see you are finally hitting FT levels you can brag about LOL.

Keep us posted on where this goes.

Sleep question

I started TRT (.4ml or 80MG per week) on 09/07/2022 and approximately 10 days after starting TRT my sleep was amazing for a few days (back to normal) and then dropped off after a few days. Prior to TRT my sleep was fragmented and I had been waking up like every hour. I had a long stint before...

www.excelmale.com

 

[madman]

Hello guys,

Many of you are aware of my journey, but for those who don't know, I started with HCG 2000 IU a week, felt like a greek God for two weeks, then back to basics, Enclomiphene, Great labs but no symptom relief, then Enclomiphene + HCG, some improvements, then TRT.

I was prescribed 100 mg Testosterone Cypionate. I started with 90mg a week (3 x 30mg M-W-F). I notice an increase in morning wood the first two weeks, but after that, not much other than increased anxiety and heavy breathing. I also have BPH, I have not noticed any deterioration of LUTS.

Here are my first 6 weeks labs (July 17)

• Estradiol, Ultrasensitive, LC/MS [<= 29 pg/ml] = 34 pg/ml (HIGH)
• Testosterone Total, MS [250 - 1100 ng/dL] = 1044 ng/dL
• Testosterone, Free [35-155 pg/mL] = 195.2 ng/dl (HIGH)
• Sex Hormone Binding Globuline: [22 - 77 nmol/L)=- 36 nmol/L
• Vermuelen calculated FreeT: 22.9 ng/dL
• TrueT calculated Free T: 23.1 ng/dL
• 
  
• Red Blood Count: 5.54
• Hemoglobin: 16.9
• Hematocrit: 49.6. (previous 47, June 2)
• Platelet Count: 221
• 
  
• PSA: 3.14. (previous was 2.6, June 2)

For the first time ever, in any protocol, Free testosterone has been above 13 ng/dL, and even that only happened once, on enclomiphene and a total T of 1183 ng/dL. Typically my Free T averages the low 70s, most recently in the 40s.

Advise request:

As I mentioned, at the time of the labs (true trough, Monday, before injection, on a M-W-F schedule) the only thing I've noticed is increased anxiety.

What do you think in regards to:

• Timeframe: Does it take much longer than 6 weeks under these conditions for main effects (morning wood, erection, sleep, etc) to return? Keep in mind I'm a 60 year old, so I don't expect miracles, or should I?
• Dosage: Should I increase decrease the dosage? I know for some in this forum "more is better", but maybe lower will be better? or not?
• Frequency: Should I go back to M-W-F, stay on M-F, or maybe change to once a week, as prescribed.

Statistically, based on prior experience, what would be the recommendation for a 60 year old white male, no other comorbidities other than BPH, currently on Cialis 5mg a day, no other medication. No family history of prostate cancer. My BP is around 120/7x.

On Monday I changed to 2 x 50 mg (M-F) thinking that maybe maintaining levels too constant would not be desired.

Before you answer "Only you should know, everyone is different", let it be known that I know that, and if we applied that logic to everything, there wouldn't be a need for a forum, as no-one could provide advise to anyone, since "everybody is different"

Feel free to speculate but if you can, please state your thoughts and logic. I understand that this is not medical advice and I will not hold anybody liable for any consequences. I even asked chatgpt to write a disclaimer for me :-D

Disclaimer:

The opinions and advice provided in response to my online inquiry are solely the views of individual users and do not represent professional or expert opinions. I acknowledge that I am seeking advice at my own discretion and will not hold any person, entity, or platform responsible or liable for any consequences arising from following or implementing the advice provided.

I understand that the information shared online is for general informational purposes only and should not be considered a substitute for professional advice or consultation. Any decisions I make based on the responses received are entirely my responsibility.

Furthermore, I recognize that online communities may consist of individuals from diverse backgrounds and varying levels of expertise, and their advice may not always be accurate, complete, or applicable to my specific situation. Therefore, I will exercise my own judgment and consider seeking guidance from qualified professionals if necessary.

By posting my inquiry and receiving responses, I agree hold harmless all participants, moderators, and platform owners from any claims, damages, or losses that may occur as a result of acting upon the advice provided.

I am fully aware that the internet is a public domain, and any information shared may be accessible to others. Hence, I will avoid sharing sensitive or confidential information while seeking advice online.

In summary, I acknowledge the risks involved in seeking advice online and agree to release all parties from any liability related to the guidance provided. Ultimately, I am responsible for my decisions and actions based on the information received.

On Monday I changed to 2 x 50 mg (M-F) thinking that maybe maintaining levels too constant would not be desired

Need to rethink that one!

Hope you understand that you would need to start all over again and wait for blood levels to stabilize (4-6 weeks).

Trust me when I tell you that you will end up chasing your tail indefinitely tweaking your protocol every 6 weeks.

Recipe for disaster!

 

[aneuman]

I thought I'd give you a quick response or my two cents. Personally, I like your levels. I'm one who does better with higher levels. I do think it's better to start low and see how you feel.

Thank you Vince! I really appreciate your two cents!

You may want to drop down your testosterone injection amount. It may help with your anxiety.

That's what I was thinking. The only problem is that I tend to overthink everything, and I'm afraid of dropping the dose, then changing frequency, then see FreeT too low, then too high, HCT up, etc.

What I'm really, really interested is in the timeframe. I say I have not seen improvements other than anxiety, but maybe they are happening, under the surface, in a way that's not really noticeable and it will take a bit longer. If I "knew" that, I could maintain the discipline of dosage/schedule.

so the real questions is:

• does everybody see brutal changes quickly, such as becoming superman 2 hours after injection with permanent rock hard erection and bloody eyes and achieve 7% body fat and Arnold-like musculature in a week?
• Or are there any poor humans like me in which effects come very slowly and it takes longer than 6 weeks or ever 12 weeks to see minor improvements, but the journey is still worth it?

Based on this understandably failure-biased forum, I see people changing protocols almost very two weeks, which leads me to believe that there're certain expectations that "change" or "improvement" should occur quickly. And according to this, some changes may be expected quickly.

Results: Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond. Changes in erections/ejaculations may require up to 6 months. Effects on quality of life manifest within 3–4 weeks, but maximum benefits take longer. Effects on depressive mood become detectable after 3–6 weeks with a maximum after 18–30 weeks. Effects on erythropoiesis are evident at 3 months, peaking at 9–12 months. Prostate-specific antigen and volume rise, marginally, plateauing at 12 months; further increase should be related to aging rather than therapy. Effects on lipids appear after 4 weeks, maximal after 6–12 months. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3–12 months. Changes in fat mass, lean body mass, and muscle strength occur within 12–16 weeks, stabilize at 6–12 months, but can marginally continue over years. Effects on inflammation occur within 3–12 weeks. Effects on bone are detectable already after 6 months while continuing at least for 3 years.

I have labs again in 6 weeks (these are the "official" doctor ordered, these interim ones were "mine" on DiscountedLabs). I'd like to make adjustments, if any, and keep them for at least the 5 weeks I have remaining. I see a few options at the moment and would like your take (and others) on it.

1. Go back to M-W-F schedule at a lower dosage (let's say 3 x 25mg, i.e. 75 mg/week). Logic: keeping a more frequent schedule would keep HCT in range and lower E2, while a lower dosage could help with the anxiety
2. Continue on M-F at a lower dosage (e.g. 2 x 40mg, i.e 80 mg/week) Logic: more distant shots would allow lower throughs, which some have indicated could be beneficial, while a lower dosage would help with anxiety.
3. Go back to Sub-Q. I was originally 3 weeks SQ, same dosage/schedule. I didn't see any anxiety, but was feeling a very minor pain at the site of injection, (nothing major and totally tolerable, but decided to switch to shallow IM) in this case I have the same two options:
   1. Go back to M-W-F schedule at a lower dosage (let's say 3 x 25mg, i.e. 75 mg/week). Logic: keeping a more frequent schedule would keep HCT in range and lower E2, while a lower dosage could help with the anxiety
   2. Continue on M-F at a lower dosage (e.g. 2 x 40mg, i.e 80 mg/week) Logic: more distant shots would allow lower throughs, which some have indicated could be beneficial, while a lower dosage would help with anxiety.

Unfortunately I have a very analytical mind that takes everything and slices and dices every detail, consequences, etc. Sometimes I think ignorance is bliss. 30 years ago I would have gone to the doctor, he would have prescribed 200mg every two weeks and I'd probably be happy. Unfortunately, those days are gone. I'm woke!

Did you do your labs on Monday morning before you injected?

Yes, I was on M-W-F schedule and had the labs on Monday 8:30 am after completing 6 weeks before the injection, so yes, true trough.

Thanks a lot for taking the time a patience to read my long post. I have an uncontrollable urge to explain everything as clearly as possible and I know not everyone welcomes that, especially in this day and age.

 

[madman]

post #3

Canadian Urology Guideline on Testosterone Replacement

Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021) Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan...

www.excelmale.com

This is gold!

26.What is a reasonable timeline to begin to observe improvements in the signs and symptoms of testosterone deficiency?

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.76,77 As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months. 77 In addition, patients should be counseled that diet and exercise in combination with testosterone therapy are recommended for body composition changes.

*Appreciating this pattern of response to testosterone therapy is fundamental when determining the impact of treatment and the appropriate timing of follow-up evaluations while on therapy. For example, if patients undergo a symptom review and measurement of testosterone levels too early (< 3 months), it may lead both physicians and patients to conclude that the treatment has not been impactful (i.e. normal levels of testosterone without symptomatic/structural/metabolic benefit). However, if the same assessment was scheduled 3-6 months after the initiation of therapy, the clinical response tends to be more reflective of normalized levels of serum testosterone.

 

[Cataceous]

Because most of us have no idea what our healthy, youthful testosterone levels were — as you have also noted — I favor targeting average levels, at least initially. For Vermeulen FT this is around 15 ng/dL, based on data from healthy young men two or three decades ago. This preempts some complaints about the normalization of falling levels. So yes, I do think it's preferable to start lower and give it at least a couple months before experimenting with higher doses.

I appreciate your frustration in having seen in your honeymoon period that the equipment is ok, but you don't know how to maintain anything close to that. The first step of course is to normalize testosterone and give it plenty of time to work. You've been at this a while now, but arguably hCG and enclomiphene don't count due to their problematic aspects. Even so, expect limited effects from modest variations in your TRT protocol. If nothing changes then at some point I would add back a little hCG to the TRT, maybe only 250 IU a couple times a week. I'd also measure progesterone and supplement if low. Beyond this it's a question of your tolerance and patience for further experimentation. There are various supplements to enhance neurotransmitters. I like selegiline in particular due to its other possible benefits. Being about your age I appreciate anything that can push back against the clock a little. You can also look into restoring some of the other hormones suppressed by TRT, such as GnRH and kisspeptin. Oxytocin is something else to try. I've wondered about microdoing PT-141, but haven't tried this yet. There's always the danger of ending up like me, reliant on a very complex protocol. However, I contrast how I feel now with the problems I had before to remind myself that it's worth it.

 

[madman]

For any newbie starting TRT!

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.76,77

 

[aneuman]

Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months.

Thanks madman. Damn! I think these would probably be the longest 3 months of my life.

*Appreciating this pattern of response to testosterone therapy is fundamental when determining the impact of treatment and the appropriate timing of follow-up evaluations while on therapy. For example, if patients undergo a symptom review and measurement of testosterone levels too early (< 3 months), it may lead both physicians and patients to conclude that the treatment has not been impactful (i.e. normal levels of testosterone without symptomatic/structural/metabolic benefit). However, if the same assessment was scheduled 3-6 months after the initiation of therapy, the clinical response tends to be more reflective of normalized levels of serum testosterone.

I guess it makes sense. There's only one solution: wait.

Thanks for taking the time to read and post a good answer.

 

[aneuman]

First off @Cataceous, thanks for taking the time to read and respond. I really appreciate it, because your one of the people I trust on this forum, given that you have always offered reasonable advise and can backup your claims.

Because most of us have no idea what our healthy, youthful testosterone levels were — as you have also noted — I favor targeting average levels, at least initially.

Agree. Walking back with increments between 0.8%- 1% a year since my last natty results, in my 30s I should have been around 600 - 650 ng/dL given that at 57 I was at 492ng/dL, yet at that level I was not feeling well already and had all the symptoms. So to your point, I do not know at what levels I felt good.

I appreciate your frustration in having seen in your honeymoon period that the equipment is ok, but you don't know how to maintain anything close to that.

I know you do and I appreciate that too. Having been to the mountain top for 2-3 weeks and then fall back hard to the bottom is very frustrating to say the least.

The first step of course is to normalize testosterone and give it plenty of time to work. You've been at this a while now, but arguably hCG and enclomiphene don't count due to their problematic aspects.

That's the hypothesis I'm operating under as well, my average total T for the past two years has been 767ng/dL, but there have been a lot of protocol changes, first hCG compounding was banned, then EC disappeared, then appeared again, poor guidance from doctors, etc, so a lot of up-and-downs. So I'm assuming that there was not time for stabilization and normalization like you say. I'm also weary of the unknown side effects of HCG and EC, particularly the latter.

Even so, expect limited effects from modest variations in your TRT protocol.

I'm equally concerned about symptom resolution as I am with elevated HCT and E2. I do not want to solve one thing at the expense of the other. There are certain risks I'm willing to take (as @tareload always says, pay to play) but I'm not willing to put it all down just for the fun of 20Kg/dL of free T.

If nothing changes then at some point I would add back a little hCG to the TRT, maybe only 250 IU a couple times a week.

I'm tempted to do that, but I'm holding until the 3 month mark at least. Don't want to touch too many variables.

I'd also measure progesterone and supplement if low.

I did purchase the progesterone cream you mentioned in anchor thread (I assume, the coconut oil base) and did use it twice with some weird results: at about 3 am, I was hot as hell (hot as in temperature) by temp was 98.6 (97.5 before going to bed), but after that passed (30-45 min), I had a very solid sleep and woke up refreshed. Happened twice, haven't done it again. I have never measured it though.

Beyond this it's a question of your tolerance and patience for further experimentation.

Ah! There's the rub.

Tolerance: moderate. I can do things that most people I know won't (TRT is one of them). I'm ver concerned about the sources and purity of the substance. I've seen a lot.

Patience: almost zero, and that's my biggest liability. Since I was a child, I always told my mom that I wanted things "this very minute, this very second" (I was not aware of milliseconds at age 6)

Oxytocin is something else to try.

Tried Oxytocin once (Empower's) and did not notice anything al all. vey expensive. Needs refrigeration.

I've wondered about microdoing PT-141, but haven't tried this yet.

Me too. I've been very close to "Buy now" but I'm trying to cultivate patience.

There's always the danger of ending up like me, reliant on a very complex protocol. However, I contrast how I feel now with the problems I had before to remind myself that it's worth it.

I know brother. I do not want to overcomplicate my life. At some point, I guess, it's not worth it.

Just a final question if I can abuse your friendliness:

You saw the labs above. What would you hypothetically do:

• Keep things the same (currently 2 x 50 mg per week)
• Lower to 2 x 40 mg /week
• switch to Sub-Q again and,
  • Keep things the same (currently 2 x 50 mg per week)
  • Lower to 2 x 40 mg /week

As always, I appreciate your insight and time spent reading and replying. Very valuable advise.
Thanks.

 

[aneuman]

As I have stated numerous times over the years 6 weeks means nothing when looking at the bigger picture.

Hey @madman, I know it should be frustrating having to repeat the same thing over and over, and yet, I know that and could not ask. It's the anxiety of "maybe it's not working, should I do something?" that's killing me. I have been very impatient since I was a child.

Unless your trough FT level was absurdly low (far from common) or on the other extreme high/absurdly high and you were struggling with sides it would be a big mistake tweaking your protocol.

Every protocol should be given 12 weeks to gauge whether it is a success or failure.

When using TC/TE steady state is achieved (4-6 weeks).

Once a steady state is achieved it will take time for your body to adapt to your new set-point.

As you can clearly see on < 90 mg T/week ( 30 mg split M/W/F) you are hitting a very high trough TT 1000+ ng/dL and more importantly a high trough FT as your SHBG 36 nmol/L is normal (not high/low).

That's one of my concerns, I think it's a high trough, I was expecting maybe 700. So what do you think. Should I lower the dosage, maybe to 80mg/week for the next 6 weeks and retest?

Top it off that this is your true trough Monday morning ( 72 hrs post-injection) on the M/W/F protocol which means that your peak TT, FT, and estradiol will be much higher!

Agree, ergo my question. Should I decrease the dosage now? or wait another 6 weeks and readjust based on that? My thinking is that at that point, HCT might be too high, and may require additional intervention, which I'd prefer to avoid.

• Dosage: Should I increase decrease the dosage? I know for some in this forum "more is better", but maybe lower will be better? or not?

More in the majority of cases is never better when your trough FT is already high.

Totally agree

Even then your RBCs, hemoglobin, and hematocrit are sitting at the top-end.

Yes, but keep in mind that my Ttal T has been high as well during all this time due to Enclomiphene/HCG. In my previous Lab (June 1st) my HCT was 47. My assumption was that TRT could dramatically increase HCT in low testosterone individuals, but perhaps, as it happens frequently, I was wrong.

Although this should not be a big deal seeing as you mention no symptoms keep in mind that you are only 6 weeks in on such protocol and it will take anywhere from 6-9 months or in some cases up to a year to reach peak levels.

Yes, that's the hard reality I guess. If I could just increase my mass enough to make the time fly faster ;-)

So where your RBCs, hemoglobin, and hematocrit sit now is not where they are going to be 6-12 months down the road.

I know, and I'm trying to avoid it. That's why I'm asking about lowering dose or increasing frequency again.

Increasing your T dose which would bring up your peak/trough TT/FT will only drive up those blood markers further!

I guess my tongue-in-cheek question came out wrong. I was never ever thinking of an increase. I was trying (and obviously failed) to may fun of those in the "more is better" camp. I should not incur into comedy and stick with engineering.

If anything you need to give the protocol more time to truly gauge how you feel overall.

good advise. will do.

Glad to see you are finally hitting FT levels you can brag about LOL.

ha! You made me laugh! I'm going to tattoo it on my forehead. I'm surrounded by a bunch of 50 year olds at work, so I guess I should brag!

Keep us posted on where this goes.

Will sure do.

Thanks @madman for your valuable advice. The truth is hard. I just have to wait.

 

[aneuman]

On Monday I changed to 2 x 50 mg (M-F) thinking that maybe maintaining levels too constant would not be desired

Need to rethink that one!

Hope you understand that you would need to start all over again and wait for blood levels to stabilize (4-6 weeks).

Trust me when I tell you that you will end up chasing your tail indefinitely tweaking your protocol every 6 weeks.

Recipe for disaster!

Will revert to previous schedule on Monday. 3 x 30mg M-W-F. This week was just a singularity. Cannot be explained. Function is undefined.

Thanks @madman.

 

[Cataceous]

...
You saw the labs above. What would you hypothetically do:

• Keep things the same (currently 2 x 50 mg per week)
• Lower to 2 x 40 mg /week
• switch to Sub-Q again and,
  • Keep things the same (currently 2 x 50 mg per week)
  • Lower to 2 x 40 mg /week

...

Let's guess that your average Vermeulen FT is around 25 ng/dL. A 20% dose reduction is going to put that at about 20 ng/dL. With twice–weekly injections you'll nominally see peaks at 50% over troughs, with FT varying in the range of 17-23 ng/dL. I think that's a little high for initial dosing. Going with 30 mg TC twice a week should put the average closer to 15 ng/dL. This would be the low-and-slow approach, though the 6 mg T/day is pretty close to youthful average production, so not really that low except relative to the (over)dosing of most guys on injections. I'm on the equivalent of 44 mg TC/week.

 

[aneuman]

Let's guess that your average Vermeulen FT is around 25 ng/dL. A 20% dose reduction is going to put that at about 20 ng/dL. With twice–weekly injections you'll nominally see peaks at 50% over troughs, with FT varying in the range of 17-23 ng/dL. I think that's a little high for initial dosing.

Makes sense. I'm listening...

Going with 30 mg TC twice a week should put the average closer to 15 ng/dL. This would be the low-and-slow approach, though the 6 mg T/day is pretty close to youthful average production, so not really that low except relative to the (over)dosing of most guys on injections. I'm on the equivalent of 44 mg TC/week.

Understood. Now trying to minimize E2/HCT peaks on peaks (if that makes sense), would it make more sense twice a week (30 + 30) instead of 3 times (20 + 20 + 20) assuming pinning is not a problem (at the moment at least...)

If twice a week produce a peak about 50% above nadir, would it be fair to say that 3 times a week produces a peak about 30% higher? If that were the case, my peaks are possibly 1352 ng/dL, something I'd prefer to avoid. Assuming symptoms are resolved, I'd very much prefer to swing within the accepted "normal" range.

Is there really that much difference between twice a week and 3 times week o warrant the extra pinning? Does it really makes any practical difference to try and keep the levels as stable as possible vs. making them rise and fall? Neither case is close to physiological circadian rhythm anyway.

Again, appreciate sharing your thoughts.

 

[aneuman]

@Cataceous

I'm sure you'd probably have an excel worksheet somewhere ... is there any way to estimate, based on injection amount/frequency (for T.Cyp specifically) what the troughs/peaks would be. Even if this is based on "young healthy adults". If it also estimates E2, DHT, HCT that would be heaven, but I doubt there's something like this.

 

[Vince]

This thread has become long quickly. I do agree with your 25 mg of testosterone three times weekly. Hopefully you're HCT will stay within a good range. If not, just donate blood. TRT has been very easy for me. I've never had any issues. I do like to mix it up once in a while but that's just my personality. Every protocol I've been on I felt great. Right from day one.

For the first two years of TRT, I donated blood every 8 weeks and still felt good. When I went to daily injections, my HCT has stayed in a good range for over 6 years now. Boy am I lucky.

 

[Cataceous]

... Now trying to minimize E2/HCT peaks on peaks (if that makes sense), would it make more sense twice a week (30 + 30) instead of 3 times (20 + 20 + 20) assuming pinning is not a problem (at the moment at least...)
...

While both estradiol and hematocrit respond to serum testosterone, they respond on different time scales. This may or may not matter. If you're looking to minimize estradiol peaks at a given dose then more frequent injections of a long testosterone ester should yield the "best" result. As a side note, there are quite a few anecdotal reports of less estrogenic activity with daily use of testosterone propionate. If this is real then it suggests greater complexity. At the least we should ask whether a given effect is driven by peak, average, or trough hormone levels—or some combination—along with duration of exposure.

...
If twice a week produce a peak about 50% above nadir, would it be fair to say that 3 times a week produces a peak about 30% higher? If that were the case, my peaks are possibly 1352 ng/dL, something I'd prefer to avoid. Assuming symptoms are resolved, I'd very much prefer to swing within the accepted "normal" range.
...

With 3x/week injections spaced at 2/2/3 days the three cycles are unique in their peak/trough variations. Without jumping into the math I'm going to guess that the three-day cycle could still see a peak that's as much as 40% over the trough. However, I can also mention that on EOD injections of a longer ester I could not discern any variation; pre-injection and day-after injection measurements seemed to be about the same. If you want more certainty then you have to measure your levels.

If symptoms do not resolve with levels in the normal range then one's efforts should be directed towards understanding why. In my opinion throwing more testosterone at the problem is not a good approach.

...
Is there really that much difference between twice a week and 3 times week o warrant the extra pinning? Does it really makes any practical difference to try and keep the levels as stable as possible vs. making them rise and fall? Neither case is close to physiological circadian rhythm anyway.
...

You will find plenty of guys saying they find one way or the other to be better. It's not clear if these would be sustained if blinded testing were possible. Of course the same skepticism should be directed at my preferred protocol—daily injections of a propionate/enanthate blend designed to create a diurnal rhythm in serum testosterone. While I am pretty confident that my sleep is better compared to when I had stable levels, other benefits are too subtle to be sure about.

@Cataceous

I'm sure you'd probably have an excel worksheet somewhere ... is there any way to estimate, based on injection amount/frequency (for T.Cyp specifically) what the troughs/peaks would be. Even if this is based on "young healthy adults". If it also estimates E2, DHT, HCT that would be heaven, but I doubt there's something like this.

Here are formulas for estimating total estradiol and DHT based on total testosterone. Maybe @tareload can point to a more general pharmacokinetic calculator for testosterone cypionate? Alternatively, or in addition, I've found it's possible to generate some pretty decent predictions with crude calculations based on one's own lab work. The first step is to estimate a constant of proportionality k such that free testosterone is the product of k and the dose rate. This is best accomplished with relatively frequent dosing with a long ester. As I mentioned, for me EOD dosing with cypionate or enanthate yielded consistent results. I have found that with the constant k and a trough testosterone measurement you can calculate a reasonable estimate of the peak.

 

[aneuman]

As always @Cataceous , much appreciated. The educational value you add to this forum (or at least to me) is unparalleled.

 

[tareload]

. is there any way to estimate, based on injection amount/frequency (for T.Cyp specifically) what the troughs/peaks would be

Some labs out of range -- would you change anything?

Tool to Assess your TT Dose Response -- Percentile Curves

Summary: Tools to estimate your individual dose response for injectable testosterone ester in comparison to a normal distribution (95 percentile confidence estimate) of adult males (Ref). Plot below shows a summary of data from (1) clinical trials gathered from the literature + (2)...

forums.t-nation.com

Btw...been banned at TNation so I can't access or edit my stuff over there any more. At some point may port over here and share a calculator which would be improved version of that online roidcalc web page (whatever it called now) to show predicted temporal serum levels based on some minimal lab data inputs. In the mean time the table shared above in link will get you in the ballpark for different dosing frequencies.

And sorry guys for some reason the "mention" feature doesn't work for my new user name. Serves me right for messing around haha. I did not see Cataceous mention of me above until I scrolled through thread. Love the thread man. Beat wishes on your journey.