New member - 33yo recently starting TRT

[jkp062814]

Hello everyone,

New member here and I'll make my "journey" as to how I ended up here as short as possible. Currently 5'11" 180lbs, 33yo. I was very athletic in high school & college, playing basketball, football & boxing. Began feeling symptoms at around 27yo and saw endocrinologist. T was low, endo gave me the "Clomid test" to determine if it was primary or secondary hypo. T rose drastically so determined it was secondary. Was put on Clomid to try and restart my natural production. Never did restart it but maintained mid-level T ranges. Endo's belief was that a sports injury may have caused the secondary hypo. Since my wife and I wanted to have kids, endo kept me on a very low dose of Clomid for several years to maintain sperm production.

Was (fortunately) able to easily conceive two sons, the youngest being born 3 months ago. We decided we wanted no more kids, so told the endo that I was open to TRT if my natural production would not be sufficient. Several labs after stopping Clomid showed T levels around 240 ng/dL (range 260-916) and Free T 19 pg/mL (range 52-280). Endo prescribed 25mg daily 1% Androgel, stating that she preferred the steadier release versus the roller coaster of injections. With having young kids, the cost and the mess the gel creates, I knew this wasn't going to be an option for long but went along with it to start out. Applied this daily for 2.5 months. Labs showed total T 324 ng/dL (range 260-916) and Free T 23 pg/mL (range 52-280). She didn't measure estradiol or SHBG which confused me, especially being an endo. I hadn't noticed any positive results for obvious reasons, but I will say that I'm holding much more weight in my belly/sides with no other changes to my diet or lifestyle and I'm still physically active exercising 4-5 days/wk. I've read that water weight and bloating can occur in the early stages as my body and hormones adjust and stabilize, so hoping that's what this is. She upped the dose to 50mg gel daily which I started one month ago. Just this week, I switched to a new family doctor within their network and had my first visit with him. He instantly told me that it would be much more effective to switch to weekly injections (duh), so prescribed 50mg/wk Test Cyp and put an end to the gel.

First shot was just today. I understand that this seems to be a very low dose based on where my research has led me, but I know it's better to start low than too high. My only concern is that they don't recommend labs to be done until the 4-6 month point, which seems a bit too long, so I'm hoping to find a way to make that sooner if I experience no positive changes in the next two months or so. Maybe the nurse was wrong and meant 4-6 weeks rather than months. I was encouraged that this new doctor says he treats based on how his patients feel rather than just trying to get within normal ranges, and he'll also measure estradiol, SHBG, etc. as his normal protocol. All in all, I'm hoping that I'll eventually get back to feeling like my normal, active self and will be sure to browse the forum as I become more familiar with it!

 

[Systemlord]

She didn't measure estradiol or SHBG which confused me, especially being an endo.

Sex hormones education is absent from medical schools and residency, therefore doctors aren't trained in TRT.

To make matters worse, TRT makes up a very tiny fraction of treatments doctors provide to patients, so there aren't many doctors delving into TRT because it doesn't make up the bulk of their business.

Your typical endocrinologist treats diabetes and thyroid disorders.

My only concern is that they don't recommend labs to be done until the 4-6 month point, which seems a bit too long, so I'm hoping to find a way to make that sooner

T-cypionate has an average half-life of 7-8 days, so 42 days to a steady state and can take a total of 12 weeks to start feeling good.

We already know your dosage is laughably low, so in 4-6 weeks when your levels test low, which is a guarantee, the dosage increase will set you back another 4-6 weeks until blood levels reach a steady state and more tweaking may be necessary.

So at this point you're looking at feeling better in 3-5 months if you're lucky.

Don't be that guy, shop for a new doctor NOW!

If your insurance will cover Jatenzo, an oral T capsule taken twice daily, you can reach a steady state in 7 days.

The recommended starting dosage for Jetanzo is 237mg twice daily.

 

[Cataceous]

One of the perils of coming to the forums for advice is that you will get a lot of different recommendations and information, sometimes quite contradictory.

The half-life of testosterone cypionate in standard formulations is actually closer to five days, and typically one waits at least four to five half-lives before trying to see what serum levels are doing. Overall effects certainly can take a lot longer:

Onset of effects of testosterone treatment and time span until maximum effects are achieved - PMC

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects ...

www.ncbi.nlm.nih.gov

A starting dose of 50 mg TC per week is low but not unreasonably so. It's an average of 5 mg of testosterone per day, which compares to the 6-7 mg averaged naturally by healthy young men. Personally I've averaged as little as 3.8 mg per day without feeling hypogonadal. The bigger problem is the injection frequency. With weekly injections there are often large variations in serum hormone levels, with peak levels two to three times trough levels. This is what makes a lower dose untenable; the last day or two of each injection cycle will most likely be spent at hypogonadal testosterone levels. The preferred solution is to inject more often. At larger doses you could get away with injecting twice weekly. But at 50 mg TC per week I think it's safest to inject at least every other day, e.g. 14-15 mg EOD.

If you're going to consider alternative methods for raising testosterone then in my opinion a testosterone nasal gel such as Natesto should be first on the list. It has the least impact on your other hormones. At a minimum conventional TRT may disrupt LH, FSH and GnRH. More than a dozen other hormones can also be affected. Some men will experience side effects from these changes.

 

[Strengthandlibido]

One of the perils of coming to the forums for advice is that you will get a lot of different recommendations and information, sometimes quite contradictory.

The half-life of testosterone cypionate in standard formulations is actually closer to five days, and typically one waits at least four to five half-lives before trying to see what serum levels are doing. Overall effects certainly can take a lot longer:

Onset of effects of testosterone treatment and time span until maximum effects are achieved - PMC

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects ...

www.ncbi.nlm.nih.gov

A starting dose of 50 mg TC per week is low but not unreasonably so. It's an average of 5 mg of testosterone per day, which compares to the 6-7 mg averaged naturally by healthy young men. Personally I've averaged as little as 3.8 mg per day without feeling hypogonadal. The bigger problem is the injection frequency. With weekly injections there are often large variations in serum hormone levels, with peak levels two to three times trough levels. This is what makes a lower dose untenable; the last day or two of each injection cycle will most likely be spent at hypogonadal testosterone levels. The preferred solution is to inject more often. At larger doses you could get away with injecting twice weekly. But at 50 mg TC per week I think it's safest to inject at least every other day, e.g. 14-15 mg EOD.

If you're going to consider alternative methods for raising testosterone then in my opinion a testosterone nasal gel such as Natesto should be first on the list. It has the least impact on your other hormones. At a minimum conventional TRT may disrupt LH, FSH and GnRH. More than a dozen other hormones can also be affected. Some men will experience side effects from these changes.

I was just told on another site, "The research also shows that endogenous T replacement is closer to 5mg daily than 7mg as has been the belief for many decades." They didn't link a study for this, but maybe it's worth consideration.

 

[jkp062814]

@Cataceous

Thank you for the response. I'm aware from my research, while minimal, that many sites will have various members saying things that are contradictory. That leads me to typically not be as assertive with my doctor/s as most might be, because I view them as the professionals and more experienced than myself for obvious reasons.

As I stated in my original post, I fully understand why he's starting me out at 50mg/weekly rather than jumping to a dosage that might be too high. However, I really believe I need to have my labs done much sooner than at the 4-6 month mark as the nurse suggested. Hoping that may have been a mistake, so I need to follow up on that. If or when I do get my dosage upped, I will be sure to ask him about more frequent injections, which makes sense to avoid the roller coaster.

I'm also hopeful that they will request a full hormone panel rather than the few main ones, as you said, because every hormone can cause unwanted side effects as they fluctuate. I have patience, but will say that the one thing I've noticed since starting T (25mg gel daily beginning August 20th, upped to 50mg gel daily beginning November 18th and then to strictly 50mg weekly injection starting December 17th) is that I'm holding a lot of weight, seemingly water weight, in my midsection. For the last 6-8 years, I've maintained a bodyweight of 175lbs, give or take a few pounds, with consistent body fat of around 10%, athletic build. I weighed in this morning at 183lbs, heaviest ever, and it seems to be that "spare tire" that many struggle with. As nothing else has changed in terms of diet, exercise or stress, I'm attributing this to my body adjusting to the T and trying to find balance. Also why I want to get several hormones tested at the first set of labs.

I see several mentions of initial water weight gain by other members on various forums, but at the same time see men who claim to drop several pounds of fat in just the first 30-45 days, so like you said, many conflicting experiences and it likely comes down to each person's body responding differently.

 

[Systemlord]

Those experiencing water weight on TRT, more frequent injections is usually the way forward.

I really believe I need to have my labs done much sooner than at the 4-6 month mark as the nurse suggested.

There's no escaping the half-life of the ester.

 

[Systemlord]

I fully understand why he's starting me out at 50mg/weekly rather than jumping to a dosage that might be too high.

Your doctor is not following established guidelines and is coming across as inexperienced.

 

[jkp062814]

Those experiencing water weight on TRT, more frequent injections is usually the way forward.


There's no escaping the half-life of the ester.

You had mentioned steady state may take 4-6 weeks, correct? Would that typically be an ideal time to first measure blood levels?

My doctor mentioned following my endo's dosage recommendations at first, so the primary reasoning for doing 50mg weekly injections was because the endo had me doing 50mg daily gel just a month prior. I can't say for certain what dose he would typically start a new patient with, but since my endo had the 5+ years of my health history and treatment up to that point, he simply wanted to switch me from the gel to injections but not up the dose just yet. He reiterated several times that while many doctors' goal is to just get a patient within normal limits, he adjusts based on how the patient feels which gave me a sense of relief. I'm confident that he's open to my suggestions based on my first appt and conversation (future more frequent injections, dosage, bloodwork, etc.), so I didn't want to step on any toes and give my own suggestions just yet. I was just glad to get a doctor to fully agree that injections were better than the gel. LOL

This is a "newbie" question - with injections, and if I do end up injection more frequently, is this written as part of a prescription and will my pharmacy always just provide me with the correct number of needles, or do you guys get needles elsewhere? My apologies if that's a dumb question. I'm already a bit anxious about giving myself an injection for the first time in a few days after the nurse did the initial one last week, but trying to think ahead!

 

[Systemlord]

so the primary reasoning for doing 50mg weekly injections was because the endo had me doing 50mg daily gel just a month prior.

Once the topicals are stopped it will only take 24-48 hours for levels to plummet do to the half-life.

The only thing that explains your doctors low starting dosage has already been discussed in my previous post.

This isn't my first rodeo, I've seen this go on for years on this forum while the patient tries to rationalize why the doctor is doing what he's doing and it always ends the same.

Eventually the forum member snaps out of it and realizes his doctor doesn't know what the hell he's doing and starts the process of shopping for a new doctor.

I went through the same process myself more than once.

 

[Systemlord]

When I was on injections I would get my needles online, 27-29 gauge insulin syringes which are painless and you don't have to worry about wasting medicine and running out early.

I always recommend Easy Touch brand insulin syringes.

 

[Systemlord]

You had mentioned steady state may take 4-6 weeks, correct?

If you were to test your labs before the 4-6 weeks, you would be testing too early and therefore levels will came back lower than if you test at 4-6 weeks.

 

[jkp062814]

If you were to test your labs before the 4-6 weeks, you would be testing too early and therefore levels will came back lower than if you test at 4-6 weeks.

Thanks for the syringe recommendation, I'll check it out!

I thought 4-6 weeks sounded reasonable, but if you look back up at my previous posts, the nurse had mentioned 4-6 MONTHS to me over the phone. I'm hoping that was a mistake and will strongly urge them to be done sooner if it wasn't. If he doesn't agree to the 4-6 week timeframe, it would be a good indicator that he truly doesn't have any experience with TRT and that I should look elsewhere.

 

[Strengthandlibido]

You had mentioned steady state may take 4-6 weeks, correct? Would that typically be an ideal time to first measure blood levels?

My doctor mentioned following my endo's dosage recommendations at first, so the primary reasoning for doing 50mg weekly injections was because the endo had me doing 50mg daily gel just a month prior. I can't say for certain what dose he would typically start a new patient with, but since my endo had the 5+ years of my health history and treatment up to that point, he simply wanted to switch me from the gel to injections but not up the dose just yet. He reiterated several times that while many doctors' goal is to just get a patient within normal limits, he adjusts based on how the patient feels which gave me a sense of relief. I'm confident that he's open to my suggestions based on my first appt and conversation (future more frequent injections, dosage, bloodwork, etc.), so I didn't want to step on any toes and give my own suggestions just yet. I was just glad to get a doctor to fully agree that injections were better than the gel. LOL

This is a "newbie" question - with injections, and if I do end up injection more frequently, is this written as part of a prescription and will my pharmacy always just provide me with the correct number of needles, or do you guys get needles elsewhere? My apologies if that's a dumb question. I'm already a bit anxious about giving myself an injection for the first time in a few days after the nurse did the initial one last week, but trying to think ahead!

You can buy insulin needles online without a prescription. If you're going to be dosing under 20 mg/day, then the 29-gauge 3/10cc 1/2" should do nicely. Just do a search for "insulin needles online" and comparison shop.

 

[jkp062814]

You can buy insulin needles online without a prescription. If you're going to be dosing under 20 mg/day, then the 29-gauge 3/10cc 1/2" should do nicely. Just do a search for "insulin needles online" and comparison shop.

Just an update, I found needles/syringes online so will be stocked up soon. Thanks again for your help there. I injected myself this past Friday for the first time with no pain other than a little soreness the following day. The most difficult for me was drawing the correct amount (.25mL is not much oil at all) and keeping air bubbles out. I have no idea how I'll be able to get every last drop out when it comes time for my final dose of the month next week.

Also, I messaged both doctors separately (endo and family dr) to ask if levels and symptoms are monitored closely, would there be any harm in upping the dosage to 100mg/wk split into at least two equal weekly doses to help avoid peaks & troughs. Hoping they're open to it. Understanding that I started at such a low dose, I've still spent the last 4.5 months using gels and now injections to feel like I've seen no improvement, where others who may have been put on 100mg+ weekly injections starting out would have seen some improvements in various aspects of their lives by now.