I am (fairly) new to this site. My first post, but I have lurked/read/researched for a while. I started TRT in September 2017 (so it's been about 12 weeks), and as I learn more and more about it, I am realizing the importance of getting everything squared away - getting the dosing protocol right, having the right conversations with my care provider(s), getting the right blood tests, etc.
My hope is that some of the more experience members here can guide me and help me make sure I'm taking the right approach.
I've tried to provide basic info, test results, medical history, current protocol, and concerns/questions. Of course, if anything is missing, I'm happy to provide more information/context. I know this is a long post, but I did want to be as thorough as possible.
Basic Stats
32 Years old
~225 lbs
Body fat ~20-22%
Test Results
[TD="align: center"]6/22/2017[/TD] | ||
Total Test. | [TD="align: center"]286[/TD] | |
Free Test. | [TD="align: center"]7.4[/TD] | |
Prolactin | [TD="align: center"]16.6[/TD] | |
SHBG | [TD="align: center"]25.7[/TD] | |
LH | [TD="align: center"]3.5[/TD] | |
FSH | [TD="align: center"]2.6[/TD] | |
Cortisol | [TD="align: center"]7.3[/TD] | |
PSA | [TD="align: center"]0.3[/TD] |
Timeline
*Late Summer/Early Fall 2016 - Symptoms started in earnest. Heavy fatigue. Lack of motivation, especially at work (I was in exactly the job I wanted to be in at the time, too), loss of sex drive, loss of "vigor", loss of assertiveness/competitiveness.
* Feb/Mar 2017 - Initial tests with my PCP, who suggested looking at Testosterone levels. At this point, I had thought it was possibly a sleep issue so I worked to perfect my sleep routine, both hygiene and scheduling. I also went ahead and was evaluated for apnea, which it turned out I do not have. I was snoring a bit, and got a mouthpiece, which helped.
* March 2017 - Saw a urologist, who was not helpful. Literally didn't even look at the test results and just told me I was too young to consider TRT, and told me to work on diet, sleep, and exercise, without asking what I was currently doing in those areas.
* June 2017 - First endocrinologist appointment; first and second more detailed blood panels. Since Prolactin was high, was referred for an MRI.
* July 2017 - Had MRI; came back negative for a tumor. Started cabergoline.
* August 2017 - Follow up appointments and blood draws; Testosterone levels still low, prescribed Testosterone Cypionate
Medical History
Current Medications are:
(1) Fluoxetine (I've struggled with depression since I was about 14 and just started taking something earlier this year)
(2) Advair
(3) Cabergoline
Former Medication - Finasteride. For ten years. I don't think it will surprise anyone to know I now regret this. Stopped in June at suggestions of endocrinologist. When I started taking it, I noticed a drop in assertiveness and sex drive, but neither concerned me at the time. In fact, the former I viewed as a plus, as I could be somewhat hot-headed in my younger days. I also wasn't sure if I had imagined the difference.
I have had two minor concussions, neither of which were symptomatic for more than a few hours.
I had moderate trauma to the testes earlier this year (early March), when I got in between dogs who were trying to fight, and was clawed between the legs. However, though I needed sutures, an ultrasound revealed no structural damage.
Endocrine issues run in my family. My mother had has issues with her thyroid and parathyroids, and my brother didn't produce HGH during puberty and had to inject for several years.
Protocol
Started with 200mg every other week for ~8-10 weeks, and felt like I felt some decline towards the end of the dosing period. Switching over to 50mg every 2.5 days, based on what I've read here and elsewhere.
Concerns
My endocrinologist is a great guy. He is significantly better than most care providers in that he listens well, takes him time with you, and address all your concerns (i.e. he is not dismissive or a know-it-all). He is also a TRT patient.
With that said, he did suggest the 200mg/14days dosing to start; then told me later it rarely actually works. He suggested going to 200mg/10 days, but I told him I was wary of upping the dosage without simply trying more frequent injections and suggested 100mg/7 days...but as I said, I'm now favoring 50mg/3.5 days. He didn't express concern that a 3.5 or seven day protocol wouldn't work, he just said that it was more than most guys could keep up with, in terms of being sure to dose when they were supposed to.
Additionally, he hasn't tested for E2, and doesn't seem too concerned about it. There was also no mention of HCG other than, "Well, if you decide you want kids, we'll put you on it, and everything will be sorted out."
I guess I am slightly torn about what to do in terms of care -- this guy has a lot of positives, the practice is covered by insurance, it's part of the broader network that my other doctors are in, but...I feel like he is not a hormone replacement expert.
Thanks for reading - guidance is appreciated!
