new to trt

[studog]

hello everyone I'm 54 have been on trt for about 4 months now. Before I started my test was at 666 told doctor I felt like I had all the symptoms of low t so he put me on it. Now I'm at 1382 , my hair is falling out like I'm on radiation therapy , kind of wish I never started this.

 

[CoastWatcher]

We're glad you joined Excelmale, and certainly sorry that you're dealing with issues. Perhaps if you could be a bit more specific- why are you and your doctor not adjusting your protocol to lower your total testosterone level? What is your protocol? What, other than total testosterone, do you have in the way of labwork that you can post? What other medications are you taking? How long have you been on TRT?

 

[studog]

Sorry for lack of info. I just got test results back and contacted doctor . I started out at one ml per week , I split that and did .5 twice a week. my first blood work my estrogen was low so he said skip the .5 anastrozole pill for now. I also take HCG twice a week day before I inject test cyp. resent labs prolactin was15.1 estradiol was 40.4 and free test was 27. was told to cut back test to .9 , I think probably lower on that maybe. Ive been on this for about 4 months .

 

[CoastWatcher]

Your protocol is aggressive. You're injecting 1ml of testosterone, at 200mg/ml, 200mg weekly? Why that much? A good, typical starting dose for a man of TRT is 50-6mg of testosterone injected every 3.5 days. Was your estradiol measured with the sensitive, LC, MS/MS, lab test? That is the only e2 test that men can rely on - the standard test is unreliable when used by men. If you're not sure, post the reference ranges for that test; the reference ranges are a sure giveaway as to which test was administered. What is your SHBG? Finally, your initial presenting testosterone level wasn't what we typically find new members presenting with. What sort of workup did you have?

 

[studog]

Sorry my bad again , I'm doing one ML a week split into two injections of .5 ML. so its not that much for my numbers to be sky high. id be fine if all my hair wasn't falling out, but I cant have that. so I was at 666 and I'm shutting down my own test for a couple hundred to get me to high normal. I don't know what I was thinking when I got on . my lab work says estradiol sensitive 40.4

 

[CoastWatcher]

Sorry my bad again , I'm doing one ML a week split into two injections of .5 ML. so its not that much for my numbers to be sky high. id be fine if all my hair wasn't falling out, but I cant have that. so I was at 666 and I'm shutting down my own test for a couple hundred to get me to high normal. I don't know what I was thinking when I got on . my lab work says estradiol sensitive 40.4

You're still injecting 200mg of testosterone weekly. Divided doses are a great first-step toward evening out the peaks and valleys (both of testosterone and estradiol), but why 200mg? Why not 60mg every 3.5 days? That will lower your total testosterone and *could* bring your estradiol in line. Many, perhaps most, men can achieve success with a protocol in that neighbourhood. I inject 16mg daily and post a total value at 1000, I feel great. Where does your SHBG sit? As for hair, what about your DHT?

 

[studog]

I don't know then , I have been doing .5 cc/ml twice a week so I thought that would be 1 ml a week maybe I'm doing it wrong. SHBG is 46.6 I cant find DHT on my test results but obviously it's go to be high.

 

[CoastWatcher]

I don't know then , I have been doing .5 cc/ml twice a week so I thought that would be 1 ml a week maybe I'm doing it wrong. SHBG is 46.6 I cant find DHT on my test results but obviously it's go to be high.

If you are injecting 1ml of testosterone a week, and the standard vial typically provides 200mg of testosterone per ml, that's a lot of testosterone, divided dose or not. It's also best to confirm with your doctor or pharmacist how much you are injecting in milligrams. Doses are always expressed in milligrams, not cc or ml. The latter two are a volume of oil - only milligrams provides you with accurate information.

You present with a high SHBG. Did your doctor prescribe the a large single dose because of the elevated SHBG level? One of the great sayings in the world of TRT, attributed to Dr. John Crisler, is, "Start low and go slow." It is always easier to adjust a dose up...much harder to adjust down. You're seeing that. What was the discussion surrounding SHBG and protocol design?

 

[studog]

Well you just turned on the light bulb for me . I just looked at the test cyp vial , its 200 per ml. so you are right for 4 months I have been taking 200 mg . I cant believe how stupid I am . my doctor is one of the online drs so I don't do office visits with him. Now that I know, will it take long for my numbers to come back down with the proper dose?

 

[Vince]

hello everyone I'm 54 have been on trt for about 4 months now. Before I started my test was at 666 told doctor I felt like I had all the symptoms of low t so he put me on it. Now I'm at 1382 , my hair is falling out like I'm on radiation therapy , kind of wish I never started this.

With T levels of 666 you probably should have never started TRT. Have you considered stopping TRT all together?

 

[studog]

With T levels of 666 you probably should have never started TRT. Have you considered stopping TRT all together?

Yes Id like to stop but I'm not sure how to do it now. ive only been on for 4 months so ill do some research and try to get off.

 

[strum]

With T levels of 666 you probably should have never started TRT. Have you considered stopping TRT all together?

Strum: what I find in my medical practice involving men that are either getting ADT (androgen deprivation therapy) or TRT (testosterone replacement therapy) is that most physicians do not obtain baseline lab results, do not monitor changes over time, often forget a major dictum (Above all do no harm), and rarely keep records where they can observe trends. The functional part of testosterone is the free testosterone. And all lab measurements are subject to being affected by the nature of the methodology used in the lab. LC/MS/MS is one of the most accurate methods used so make sure your test report indicates the nature of the assay as well as the range of normals.

Also, realize the major potholes involved in any therapy. For TRT, measure free testosterone but also keep an eye on estradiol (E2) and if high normal or elevated that use an aromatase inhibitor (AI). Often it only takes a 1/2 tab of anastrozole (Arimidex) 2 or 3 times a week to be effective. So titrate the dose of meds and "helper" meds.

Note that TRT will send a negative feedback message to the hypothalamic-pituitary tract to shut down LH. This often causes testicular shrinkage and I would be also concerned re penile shrinkage. This brings into play other drugs to stimulate "end-organs or tissues" like HCG.

Many men harbor occult prostate cancer (PC) so monitor the PSA over time and look for a serial increase that should alert you to a probably occult prostate cancer situation. The TRT does not cause PC but it will stimulate already present PC to grow and to start synthesizing PSA. If this occurs it is a red light to stop TRT and of course alert your MD.

There are many people on this forum that have a wealth of knowledge that should be shared. I am sure I can learn a lot from periodically looking at posts.

 

[Bevaklp]

Hey there. I am new too. Nice to meet you all.

 

[callebs]

Were you having symptoms with your level at 666? I'm 55 and after experiencing symptoms I recently found out my total T is in the 130-140 range. My goal with treatment would be to get in the range you are naturally.