New to TRT + HCG need real help

[Valhalla]

Today is the start of my 5th week on Test Cyp. I was diagnosed with Low T based on blood work and the side effects I've lived with since I was a teenager.

Total Testosterone = 151 ng/dL
Free Test = 29.8 pg/mL
Estradiol = 18 pg/mL

I have had no luck in finding a doctor that would help me in my small town so I went to a mens health clinic in town. I am glad that the nurse practitioner is helping me but I am concerned about his knowledge of TRT. So far everything has been amazing aside from a few side effects such has irritability, pounding headaches, anxiety and one night of ED which I had never had before (after reading I think he had me on arimidex when I didnt need to be taking it.

The protocol he has me on is 210mg T Cyp once per week, and 1/2 a tab of arimidex twice per week. I quit taking the arimidex the third week based on a recommendation from a bodybuilder friend and I have felt better since then.

The next concerning thing that just came up today is his prescription of HCG. I got it today and he told me to take 500IU every day for the first ten days and then drop down to twice per week. The HCG came in preloaded insulin syringes in a cooler pack. I have never heard of this protocol before so I was hoping someone could give me some sort of advice as mens health clinic isnt offering much reasoning behind their prescriptions.

 

[CoastWatcher]

Welcome to Excelmale. Your instincts, or your previous study, served you well. Your doctor doesn't know how this game is played. You walked into a T-Mill. You were given a cookie-cutter protocol. One that, almost certainly, caused your testosterone to skyrocket, your estradiol to spike, and misery to follow. You boarded the train for hormone hell. He would argue, I'm sure, that the anastrozole he prescribed would take of any e2 problems. But that dose is excessive and may have already crashed your estradiol levels if it was taken for more than a week. Too much..of everything. Not a doctor that inspires confidence.

Where did your SHBG sit when it was tested prior to the start of TRT? How old are you? Where did LH and FSH values come in? Is your thyroid function healthy? Was your estradiol level checked via the sensitive/ultrasensitive (LC, MS/MS) lab test? It's the only one appropriate for men.

T-Mills throw excessive testosterone and whopping levels of anastrozole at - essentially - every patient who walks in the door. But in this race, a marathon and not a sprint, victory comes to those who start low and go slow (the words of Dr. John Crisler). Your SHBG is an essential guide to how much and how often you should inject. Start sharing some of your additional lab work and the conversation will open up.

We're glad you joined.

 

[Valhalla]

Thanks for the response! I don't think he checked my SHBG, if I knew then what I know now I would have requested it. I just trusted that the guy knew what he was doing because he certainly acted like it.

As far as the arimidex goes I took it for a week and a half at the dose he suggested then cut it in half the next week and by the third - fourth week I quit taking it all together and am just now starting to feel better.

I will be 29 years old in august.

I dont know what these things are but he did test me for these:

IGF-1 = 119 ng/mL
Prolactin Lvl = 7.3 ng/mL
FSH = 1.58 m|U/mL
LH = 3.20 m|U/mL

My Estradiol level was checked LC,MS/MS

My thyroid test:
TSH = 1.602 u|U/mL
T4 Free = 1.02 ng/dL
T3 Free = 3.1 pg/mL
(these seem to be in range to me but he still prescribed me NP Thyroid for "weight loss". I didnt take them after some research I did at home.)

I can't really stress enough how little I know about all of this. I know I want to continue treatment and I want to remain fertile and feeling healthy mentally and physically.

 

[CoastWatcher]

Thanks for the response! I don't think he checked my SHBG, if I knew then what I know now I would have requested it. I just trusted that the guy knew what he was doing because he certainly acted like it.

As far as the arimidex goes I took it for a week and a half at the dose he suggested then cut it in half the next week and by the third - fourth week I quit taking it all together and am just now starting to feel better.

I will be 29 years old in august.

I dont know what these things are but he did test me for these:

IGF-1 = 119 ng/mL
Prolactin Lvl = 7.3 ng/mL
FSH = 1.58 m|U/mL
LH = 3.20 m|U/mL

My Estradiol level was checked LC,MS/MS

My thyroid test:
TSH = 1.602 u|U/mL
T4 Free = 1.02 ng/dL
T3 Free = 3.1 pg/mL
(these seem to be in range to me but he still prescribed me NP Thyroid for "weight loss". I didnt take them after some research I did at home.)

I can't really stress enough how little I know about all of this. I know I want to continue treatment and I want to remain fertile and feeling healthy mentally and physically.

Don't feel apologetic for not knowing much about hormone replacement, but be aware that you are now taking the first steps in becoming your own health advocate - an essential step in dealing with hypogonadism (or any other health issue).

You need a SHBG test. If your doctor won't order one, www.discountedlabs.com can offer you a self-testing option through LabCorp. Many of us turn to them regularly as we engage in self-monitoring. I see no mention of a PSA being run; was one ordered? It's another essential baseline that has to be noted at the start of therapy, and then followed regularly. It, too, can be obtained from www.discountedlabs.com if your doctor wasn't aware of the necessity of ordering it. When did you last have a CBC and a CMP pulled?

The importance of the SHBG level can not be overstated. If low(er), a whopping dose of testosterone such as you're injecting is counterproductive. To achieve success you'll need to inject smaller, more frequent doses over the course of the week. If high(er), a large dose MAY be necessary. Protocol design is a guess without knowing the SHBG number. That one was not ordered is a dead giveaway that this doctor is out of his league.

You're young. Was a discussion about fertility engaged in? Any idea as to what may be behind your hypogonadism? Primary or secondary in origin? How is your sleep, might you have apnea (sleep disorders hammer hormones)? Head injury or testicluar trauma?

 

[MarkM]

Welcome to the forum Suede117. I was going to offer some assistance but with CoastWatcher already involved there just isn't any more I could begin to offer you. You are in good hands! Good luck.

 

[Valhalla]

My PSA was ran and it .26 ng/mL

My CBC was ordered by him before treatment and he said everything looks good.

It sounds like I need to request a CMP and SHBG test ASAP!

He did ask me if my wife and I wanted to have children and I told him that yes we will eventually want kids. He told me that when I'm ready to have kids to let him know and he will put me on HCG (that seemed odd to me that it could be just that easy). Anyways I asked him about HCG today because my wife and I both noticed that my testicles were smaller and it hasnt even been 5 weeks yet since I started treatment.

He didnt offer me any information on what the cause could be even after I asked. He kind of made it seem like there isnt a way to find out. Its hard for me to guess as well because ive had lots of groin injuries from soccer and karate as well as head injuries from football and karate. As far as my sleep goes it has gotten better since I started taking vitamin D and since I started TRT. It was hard for me to sleep for a couple of years.

 

[Valhalla]

Also just to add, I am 5'8" 220 Lbs. My brothers are both 5'8" as well but they are both under 140 Lbs. I dont know if this is relevant or not but I have always been stronger than my peers. I can bench press 290, squat and deadlift over 400 lbs. I know that's not impressive but I just started lifting in January. That being said im also probably around 30% body fat or higher with gynocamastia (I cant tell if its just fat or actual breast tissue).

 

[CoastWatcher]

My PSA was ran and it .26 ng/mL

It sounds like I need to request a CMP and SHBG test ASAP!

He did ask me if my wife and I wanted to have children and I told him that yes we will eventually want kids. He told me that when I'm ready to have kids to let him know and he will put me on HCG (that seemed odd to me that it could be just that easy). Anyways I asked him about HCG today because my wife and I both noticed that my testicles were smaller and it hasnt even been 5 weeks yet since I started treatment.

He didnt offer me any information on what the cause could be even after I asked. He kind of made it seem like there isnt a way to find out. Its hard for me to guess as well because ive had lots of groin injuries from soccer and karate as well as head injuries from football and karate. As far as my sleep goes it has gotten better since I started taking vitamin D and since I started TRT. Its.

No reason, at all, for you to delay HCG; it would be foolish to do so in light of your wanting children. Ask yourself, since TRT will shutdown your natural production of testosterone, just as night follows day, why would you let weeks, months, possibly years go by with potential loss of testicular vitality?

Which leads me to a question that is asked all too often here, by necessity: are you willing to seek treatment elsewhere? You noted your own town offered no capable physicians, and you went to a men's clinic in another town. That means, I assume, you are outside your insurance network. There are highly competent doctors, working independently of the insurance industry, that we can refer you to. By the way, as a Canadian, I have no vested interest in this, other than seeing our members achieve success in their pursuit of health.

 

[Valhalla]

I really appreciate the help and I would love to get in touch with someone qualified to treat me and that is taking my health into consideration. I would get help somewhere else immediately, especially if they worked with my insurance.

 

[OMI100]

Self education is a must.
My MANTRA...
Also down load Dr. Johns TRT and HCG papers and power point. Link below.
Thyroid may not be an issue but good to get some info on it anyway...
********************************
First step is education....
********************************
Cannot tell how much research you have done on TRT.
If not a lot, I recommend you get a few books.
Get a few good books and educate yourself now:
1. Get Nelsons book "Testosterone: A Man's Guide".
2. Get Lee Myer's book "Natural Versus Testosterone Therapy".
3. Get “Testosterone for life - Dr. Abraham Morgentaller “.
4. Get “The Definitive Testosterone Replacement Therapy MANual: How to OptimizeYour Testosterone For Lifelong Health And Happiness” by Jay Campbell.
These books will give you a much better understanding of TRT....
********************************
ExcelMale.comGuide to Testosterone Replacement
https://www.excelmale.com/forum/showthread.php?5823-ExcelMale-com-Guide-to-Testosterone-Replacement
**********************************
One other forumthat has great info that might be useful to you is:
http://www.peaktestosterone.com/
GREAT article onE2 – A MUST READ
http://www.peaktestosterone.com/Hdr_Estrogen.aspx
********************************
Dr Saya's Videos on Testosterone Therapy and Side Effect Management
https://www.excelmale.com/forum/showthread.php?15207-Dr-Saya-s-Videos-on-Testosterone-Therapy-and-Side-Effect-Management
**********************************
Second step might be to have a look at your thyroid and see if any issues there.
********************************
Do some research.
I do like Tiredthyroid as a starting point.
Easy to read sections.
References at the bottom of each section (and NOT from people wearing "tinfoil" hats)
See below:
Basic sources to research Thyroid issues and testing:
******************************************
https://stopthethyroidmadness.com/
Spend time here and get the 2 books, “STTM: The Revised Book” and “STTMII:Authored by Doctors”.
*******************************************
http://www.tiredthyroid.com/
Great simple to understand articles.
Get her book.... “Tired Thyroid: From Hyper to Hypo to Healing—Breaking the TSHRule”, https://read.amazon.com/kp/embed?asi...Channel=system
A lot of clear researched information that is easy toread and understand.
***************************
https://hypothyroidmom.com/
Good info here. Look around.
*************************
https://www.restartmed.com/?s=thyroid
A LOT of good articles and a youtube page.
Spend time here looking around and reading after getting labs back.
************************************
Do you have Hypothyroidism?
The CompleteHypothyroidism User Guide for Patients (2018 Edition)
https://www.restartmed.com/hypothyroidism/
*********************************
Need information on thyroid testing....
Read here:
http://www.tiredthyroid.com/what-labs.html
And here:
http://www.tiredthyroid.com/optimal-labs.html
and here:
https://stopthethyroidmadness.com/recommended-labwork/
and here:
https://www.restartmed.com/thyroid-tests/
and here:
https://www.restartmed.com/hormone-testing/
And here:
https://www.restartmed.com/normal-thyroid-levels/
**************************************
Some additional links to read before you receive the books you have already ordered
Go here:
http://www.allthingsmale.com/publications.html
and download:
TRT: Recipe For Success
Print out.
and
HCG Update.
and the TRT Power Point presentation.

Dr. Crisler is one of the "TRT Cutting Edge DR's" here in the states....
Also go here:
http://www.drjohncrisler.com/the-cri...part-deux.html
and also print out the article.
***************************
ALSO look at the videos that are posted on this site. A LOT of great info to take in....
******************************
Now you will have a great reference library and knowledge base to go forward on!

 

[CoastWatcher]

I really appreciate the help and I would love to get in touch with someone qualified to treat me and that is taking my health into consideration. I would get help somewhere else immediately, especially if they worked with my insurance.

Where do you live? There are, as has been noted here, far fewer doctors who know how to help a patient manage hypogonadism than there should be. Perhaps a member of the forum who lives in your area may be able to direct you to a doctor who accepts insurance and delivers quality care. However, if you are willing to work with a physician on a fee-for-service basis, Defy Medical and Prime Body are site sponsors that treat men across the country.

I am a patient of neither practice, I'm a Canadian, and we face our own set of challenges in lining up quality care, but if I lived in the States I would certainly consult one of these national practices. They treat many, many of our members. Click on the banner ads and contact both. Ask them as many hard questions as you want to. You will get straight answers. As for cost, the total may be far less than you expect.

 

[Valhalla]

Thank you so much for the advice! I live in Joplin, Missouri.

 

[Valhalla]

I took my first shot of HCG of 500IU. Should I take it twice a week like I see everyone else doing or should I do as the clinic prescribed it? He told me to take it everyday for the first ten days then take it twice a week after that.

 

[Gman86]

Twice a week should be fine. I do EOD and that’s worked very well for me. I think EOD is more ideal than twice a week, but if EOD is too inconvenient for you, twice a week should be ok. Dr. Crisler recommends ED injections for HCG, which is a little too often for me. So I personally settled on EOD. The increased frequency minimizes the peaks and valleys, and keeps E2 a little lower. HCG has a short half life, so I think EOD or ED is probably best.

 

[Valhalla]

If i to take it every day or EOD I imagine 500IU would be too much right?

 

[Gman86]

Ya definitely. Most guys on HCG use between 800iu and 1000iu per week. Not many use more than that, and some use less, like around 500-600iu’s. I would just use 800-1000iu’s per week and break it up into ED or EOD injections, whichever u end up settling on

Some do well on 500-600iu’s, but me personally, need around 800iu’s to keep my testicles the size I like them. On less HCG they just were too small. I might bump it up to 1000iu’s per week after my next set of labs, depending on what my E2 comes back at

 

[CoastWatcher]

Ya definitely. Most guys on HCG use between 800iu and 1000iu per week. Not many use more than that, and some use less, like around 500-600iu's. I would just use 800-1000iu's per week and break it up into ED or EOD injections, whichever u end up settling on

Some do well on 500-600iu's, but me personally, need around 800iu's to keep my testicles the size I like them. On less HCG they just were too small. I might bump it up to 1000iu's per week after my next set of labs, depending on what my E2 comes back at

This pretty well captures the HCG situation - it's something of a crap-shoot or moving target. Far less of a consensus than on other elements of the typical protocol.

 

[OMI100]

FYI
DR. Saya's HCG study....
https://www.excelmale.com/forum/showthread.php?6133&p=32234#post32234