New here! 57 year old needing TRT

[USMC]

Hello all, glad to find this discussion board! Looking forward to an education..
Some info and labs:
I'm pretty sure I've been battling with Low T for at least 5 years. My long time doctor (now retired) would never listen to me, or test me, for Low T and always blamed my beta blockers for my symptoms. Even though every time I've looked up my symptoms, it kept pointing to Low T... He switched me around to other beta blockers / blood pressure meds and nothing helped. For years he would refuse to test my T and told me to find another DR, and wouldn't refer me (required for insurance). Well, a few months ago, he retired. My new DR tested me without delay due to my symptoms: ED, weight gain, exhaustion, poor sleep, moody, etc..
My Labs:
Testosterone 1st test - 271 ng/dl... 2nd test a week later - 241 ng/dl (both at 8am)
SHBG - 25 nmol/L
Albumin - 3.9 g/dl
Testosterone / free - 225 pmol/L
Testosterone / bioavailable - 138 ng/dl
LH - 3.6 miu/ML
FSH - 6.8 miu/ML

Based on the above labs, my DR referred me to a urologist which I see this Friday.

I'm wondering what's next?

If you've read this far, thank you!

 

[Systemlord]

I'm wondering what's next?

The standard of care for TRT is outdated, so if your urologist prescribes 200 mg every 2 weeks, kindly decline.

A good protocol is injecting 1-2 times or more weekly. A weekly dosage should look like 100-150 mg for a total weekly dosage.

Some can get by with less. Insulin syringes are prefered and will be needed if injecting more frequently than 2 times weekly due to wasting Test in the larger syringes that have a dead space between the needle and syringe body.

 

[Systemlord]

For years he would refuse to test my T and told me to find another DR

It seems like your previous doctor was scared to death of TRT and wanted nothing to do with it.

 

[USMC]

The standard of care for TRT is outdated, so if your urologist prescribes 200 mg every 2 weeks, kindly decline.

A good protocol is injecting 1-2 times or more weekly. A weekly dosage should look like 100-150 mg for a total weekly dosage.

Some can get by with less. Insulin syringes are prefered and will be needed if injecting more frequently than 2 times weekly due to wasting Test in the larger syringes that have a dead space between the needle and syringe body.

Great advice, thank you. I'll report back on how things go.. I'm sure more testing is in order probably for E2, prolactin, tumor, thyroid, ect.. Hopefully, they can start my therapy while I'm awaiting those appts.. Takes forever lately to get seen and I'm sick of feeling this way. Not to mention my poor wife

 

[Vince]

Great advice, thank you. I'll report back on how things go.. I'm sure more testing is in order probably for E2, prolactin, tumor, thyroid, ect.. Hopefully, they can start my therapy while I'm awaiting those appts.. Takes forever lately to get seen and I'm sick of feeling this way. Not to mention my poor wife

Because of your age 57. You have a good chance of doing good at TRT. Most men over age of 50 seems to do the best. A good starting protocol would be 50 mg of testosterone cypionate and 500-250 mg of HCG twice a week. Probably with a 27 g 1/2" insulin syringe injecting in the shoulders. The main issue will be high levels of HCT which means you need to donate blood. I had to donate blood every 8 weeks for 2 years until finally my HCT stabilized. I no longer have to donate blood.

 

[MIP1950]

Because of your age 57. You have a good chance of doing good at TRT. Most men over age of 50 seems to do the best. A good starting protocol would be 50 mg of testosterone cypionate and 500-250 mg of HCG twice a week. Probably with a 27 g 1/2" insulin syringe injecting in the shoulders. The main issue will be high levels of HCT which means you need to donate blood. I had to donate blood every 8 weeks for 2 years until finally my HCT stabilized. I no longer have to donate blood.

Never had issues with HCT. I've been on various doses and injection schedules. Also never was on HCG. Not concerned with fertility nor size of my testicles, but I read that Dr. Shippen would prescribe it as a mono therapy for men who didn't have overt hypogonadism.

 

[USMC]

Another question... I'm full of them .. Does age and/or symptoms have anything to do with the doctor ordering an MRI to rule out pituitary tumors? I've read somewhere that MRIs are more common in younger folks.. Just trying to manage my expectations for my upcoming appointment. Thanks all for your time...

 

[Nelson Vergel]

Does age and/or symptoms have anything to do with the doctor ordering an MRI to rule out pituitary tumors? I've read somewhere that MRIs are more common in younger folks.. Just trying to manage my expectations for my upcoming appointment. Thanks all for your time...

At your T level, I bet all my money that a MRI will find nothing. Usually, when T is under 150 ng/dL without any explanation (like exposure to anabolics, opiates, anticonvulsants, or head injury) makes doctors think you may have high prolactin caused by a pituitary (usually benign) tumor. I am not sure why he is sending you to a MRI without testing your prolactin first.

Pituitary imaging findings in male patients with hypogonadotrophic hypogonadism.

Pituitary imaging findings in male patients with hypogonadotrophic hypogonadism. Authors Hirsch D, et al. Pituitary. 2014 Sep 23. [Epub ahead of print] Abstract CONTEXT: Data on pituitary imaging in adult male patients presenting with hypogonadotrophic hypogonadism (HH) and no known...

www.excelmale.com

 

[Nelson Vergel]

I'm wondering what's next?

I would watch this video I made a few years ago.

 

[USMC]

I would watch this video I made a few years ago.

Great video, thank you.. very informative!

 

[Systemlord]

I am not sure why he is sending you to a MRI without testing your prolactin first.

That's what I call a red flag and most likely means this urologist doesn't get his feet wet much with regards to TRT.

Just trying to manage my expectations for my upcoming appointment.

TRT being a new field of medicine and all the controversies and conflicting data out there, and the fact sex hormones aren't taught in traditional medical schools, expectations should be realistic.

Plan for the worst and hope for the best.

 

[Systemlord]

Another question... I'm full of them

I think everyone about to start TRT should see this video below.

 

[USMC]

The standard of care for TRT is outdated, so if your urologist prescribes 200 mg every 2 weeks, kindly decline.

A good protocol is injecting 1-2 times or more weekly. A weekly dosage should look like 100-150 mg for a total weekly dosage.

Some can get by with less. Insulin syringes are prefered and will be needed if injecting more frequently than 2 times weekly due to wasting Test in the larger syringes that have a dead space between the needle and syringe body.

Do insulin syringes work with IM?

 

[USMC]

So my first Urology appt. is tomorrow... as @Systemlord stated: "Plan for the worst and hope for the best," if it goes bad, like they don't want to treat me, or they're clueless, what are the best clinic options in your opinions? I'm hoping to use insurance and that's why I'm starting where I did.. PCP to Urologist. I'm just hoping my urology appt goes well.. I just learned via my appt. confirmation that I will be seeing an NP - not sure if that's good or bad. Anyway, I'll report back after tomorrow's visit...

 

[MIP1950]

Do insulin syringes work with IM?

Yes. I use the Easy-Touch brand. 29g, 1/2 inch, 1 cc .

 

[Vince]

Yes. I use the Easy-Touch brand. 29g, 1/2 inch, 1 cc .

I agree. That's what I use, if someone is using a higher dose, maybe a 27G 1/2-in syringe would work better. I do daily injections so I've only injecting a small amount, per injection.

 

[USMC]

Just returned from my Urology appt. No MRI ordered. It was recommended, but not required to have an ultrasound of my testicles to rule out varicose veins? I was prescribed .5 of tadalafiL daily.. or more before sexual activity. I will start Testosterone 80 mgs a week divided into two doses 40 mg twice per week via a subcutaneous insulin syringe. I am required to take an instructional class before my prescription is filled. They are backed up that far and that is the reason for the delay. After 30 days on therapy, they will re-evaluate my levels. Does this sound like a reasonable start?

 

[Systemlord]

Subcutaneous injection is overrated, I would just start IM if I were you.

 

[USMC]

Subcutaneous injection is overrated, I would just start IM if I were you.

Is that something I should run by the NP, or can I just do it myself?

 

[Systemlord]

Is that something I should run by the NP, or can I just do it myself?

It's up to you, I doubt your doctor will care. The goal is still the same, that is getting your testosterone up.

SubQ vs IM (E2)

Anyone get higher e2 from subQ injections? Is it because of estrogen in fat?

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