On TRT for a year now. I feel like its time for a change......

[Srh1968]

Hi, Guys,...... So here is my story.

I am 47, 5'5", 140lbs, small build frame. I dont really have alot of muscle tone, unless I workout (which currently I do not) I do have the middle age gut. I stay active on the farm, and at work. My diet, is sub par I would say, I dont drink or smoke. My job has me on the road constantly, so its restaurants all of the time.

A year ago in February, I had a vasectomy, and at the encouragement of my wife I had my Testosterone level checked. I really didn't think I had any issues, I mostly chalked it up to our relationship with each other (of course she thought I was the problem, and maybe I was..... I was miserable with her). We were sexually active, just not that often. I could perform with no problems, I just didn't chase her around the bed like she thought I should.

I will say that I didn't feel bad, sexually I could function (maybe not like It was when I was 20), I stay active working and was motivated to do most anything.

So, my urologist that did my procedure that checked my testosterone verified that my Total T was at 257. And so TRT began........ I started an injection every 2 weeks of 200mg 1cc. After 4 months i was re-tested and my Total T came back as 1021. I will say that the only changes I could feel was that my erections were harder than before and my testicles did feel like they were lifting up into my body more usual. I didnt feel any better, worse, my mood was the same.

I have always believed that if your going to do something make the most of it, so I found this site and started reading. I discovered that HCG would help with my testicles, and I thought I read that would have some other benefits also.

I mentioned this to my Urologist and he told me that he was going to refer me to another doctor, that he was doing all for me that he could. He refereed me to an Endocrinologist. I went to see her, and told her my history. She questioned if I even needed to be on TRT. I told her that I would like to remain on it because I did like the extra benefit of my erections. This was just after my last lab and she went with those results at that time (Total T 1021). I asked about HCG, she refused to offer it because it was not approved for why I was asking. I was told to come back in December to test my levels.

I returned in December and my Total T was at 363. She told me to bump mt injections from 1cc to 1.25 cc every two weeks. I went back 2 weeks ago for another lab test, and my Total T was at 404 and she told me everything is good and don't change anything.

So, I am curious about HCG. I think I would like to go down that road, but I do think it would be a challenge because I am traveling all the time (storing, refrigerating......).

 

[Vince Carter]

HCG really isn't something that you need to use constantly. If you had some breaks while traveling it wouldn't be detrimental though we often say that success lies in a steady and consistent program.

 

[PAUL-E]

IMHO 2 week apart injections are crazy and trough of 404 would have me feeling bad... defy seems highly recommended and they have loads of experience with TRT witch given your protocol your DR's don't seem to have.

 

[CoastWatcher]

An every two week injection schedule is outdated and will not bring you the benefits you want. The half-life of the drug is such that at the end of the 14th day you are likely to have dropped to a miserable level. Weekly or, even better, twice/three times a week injections of smaller amounts of testosterone are what the leading TRT practitioners are prescribing. Essentially, every member here at Excelmale who has achieved success on TRT has done so (I confidently believe) through a protocol that calls for no less than weekly injections. You deserve better care.

 

[ERO]

Yes, you need a doctor than understands modern TRT, not the decade out of date protocol you are on now. Nobody would feel well on that program.

 

[John O'Connor]

Too many details missing here for anyone to give you advice. Do you have primary or secondary hypogonadism? Did you have FSH & LH checked prior to starting T.

You are providing Total T levels, but not telling us how many days after shot these levels are occuring? Note Cypionate peaks between 48-72 hours. So day 3 blood draw would show highest levels. But preferably you are getting checked on day 8 exactly 1 week after your injection. This would be your baseline trough level - if you were taking weekly shots. Checking any point after that is not telling you much about your typical levels as cypionates half-life = 8 days.

So picure a graph where T peaks on day 3 at 100% absorption, and dips to 50% by day 8 when only half of T is active. Now imagine what day 10, 11, 12 look like. Totally worthless.

Get full blood work done: It may be advisable to stop everything & get baseline numbers again so you can compare them as you move forward.
http://www.excelmale.com/showthread....t=blood+nelson

And please - at a minimum move to weekly injections. But preferably every 3.5 days (E3.5D) as so many recommend. Schedule would be Sunday morning/Wednesday evening as an example.

Note if you start HCG - it peaks at 48 hours and is pretty much gone by day 4. Most people on E3.5D take both cypionate & HCG on same schedule.

Check out this post by Dr. Justin Saya, MD:
https://www.excelmale.com/forum/sho...dose-of-HCG-Dr-Saya-presents-two-case-studies

 

[Srh1968]

Sorry John,

I guess I did leave out some details. My urologist only checked my testosterone level and nothing else. Only after I moved on to the Endocrinologist did she check other things than just the test. I asked her if she would be checking my Estradiol level, but she told me there was no need to.

All of my lab test are taken 2 days before my next shot, I take my shot on Monday nights, and get my labs the Saturday before. I have been using what they started me out with, 1.25cc with a 20ga in the gluteal muscle, alternating sides each time.

From now on, After hearing how the absorption rate breaks it down. I will change how often I take my shots to twice a week. So, going forth, what is the recommend syringe and needle to use and locations? I seem to recall reading others doing it differently than what I was instructed to do.

Also, I will reach out to Defy and talk to someone that specializes in TRT.

 

[ERO]

instead of 200 mg every 2 weeks, do 50 mg every 3.5 days (like Monday AM and Thursday PM). You can use insulin syringes for that as well, no need for the 20 gauge needles. Stay on that for 4-6 weeks and then re-test.

 

[John O'Connor]

Srh1968 - no need to apologize - we are all learning here. I would just encourage you to read every thread posted for a couple weeks. Most topics are covered daily here, so doing that will give you great insight into the proper protocal and possible pitfalls to look out for, such has high estradiol, high or low SHBG, low vitamin D, thyroid issues, etc.

Also - the clinical guidelines the doctors and endocronologists follow are terrible. This is not the doctors fault. Try to educate your doctor. Print things out or even better ask if you can email them links so you can show them examples of why specific tests are needed, etc. That is exactly what I'm doing with my doctor (a 2nd year Family Medicine Resident). I'm his 1st TRT patient, and we are learning together. Lucky for me he is open to learning.

Note, I started TRT in November, but never had Estradiol - sensitive, Free T, SHBG, DHEA-S, etc. So I've actually gone off TRT for the last 4 weeks to recheck everything. I'm getting full baseline numbers now so can fully understand what is going on in the future. I'm also switching from weekly to E3.5D schedule, and may add HCG too. Living & learning...

Be sure to share the 2 links above: Nelson's list of recommended bloodwork, both pre & during TRT. + Dr. Saya's HCG Case Study. Good luck!

 

[Srh1968]

Thanks John,

My current Dr., I really don't thing she'll buy into me bring her data from the internet to try to convince her of changing what college has taught her,...... I'm thinking it may be time to change Dr's... again..

That's Awesome your Dr. is open minded to help with things he doesn't already know.

How long would I need to be off of TRT to wash out to get a clean base line?

One thing I have noticed recently is that my ejaculation volume seems be less than it used to be, could my testosterone being as it is effect my volume?

 

[Vettester Chris]

All GREAT talking points above, good job guys!

OP, not sure why you would want to go "baseline"? You could present your current program and results to a place like Defy, and they would just help get something new in place for you. However, for what it's worth, I can see baseline somewhere between Day 18 and Day 21 after the last injection. Active life of the medication is around 14-15 days.

 

[CoastWatcher]

I don't understand why you think a washout is necessary. As long as you can summarize your TRT efforts to date, a good doctor (and you're going to be working with a very good doctor) shouldn't have any difficulty understanding where you stand, how you got there, and what needs to be done for you to get where you need to be. My own doctor, speaking on the same topic, once said she saw no reason to reduce a person to a baseline, hypogonadal state because she has to fix another doctor's errors.

 

[John O'Connor]

Chris & CoastWatcher have much more experience than me, so take their advice regarding baseline. My decision to get baseline again was related to going on a new medicine, and just wanting to see how my numbers change. Many people have low or high SHBG, or Estradiol-sensitive, but the analysis seems to make more sense when they know what their original baseline numbers started at. Just my preference, but probably overkill on my part. And to their point - I did feel like crap around day 14-18 off of TRT, but feel better now that my natural production seems to have kicked back in. Still looking forward to restarting TRT next week after blood draw.

As for reduced ejaculation volume - did you have PSA checked? Any post urination leakage issues? I'm just guessing here.

As for the doctor - I'd push the info down their throat and force them to learn it - and/or force them to refer me to a doctor that is willing to learn. Every doctor should be humble in admitting they are not an expert in everything. Also - they should respect another doctor's case study. The source matters. Dr. Saya's case study is not the result of some random google search.

 

[Srh1968]

Thanks guys! I placed my order for a blood test at Defy last night. So Ill explain my situations to them and go from there.

John, no I did not have PSA checked that I know of. My last labs had a lot of items checked, what would I look for , ....PSA? As of now, I don't have any post urination leakage. It may be as simple as my diet or getting older, I dunno. I was just wondering if it possibly be related to low T.

 

[John O'Connor]

Enlarged prostate, BPH would be the concern. PSA (prostate specific antigen) is something every guy on TRT should be checking to make sure they don't have prostate cancer. Its a pretty standard test at age 47, like you and me. Defy will definitely check it.

 

[Srh1968]

Oh, my bad.

I didn't look at my previous lab results, which she did check my PSA, it was .683 at the time. The range listed for it was 0.0-4.0 ng/ml

One other thing I noticed on that lab report was my Prolactin was high. It clocked in at 33, the range listed was 3.7-17.9 ng/ml.

She must not have too concerned with either of them, she didn't check them on my last lab test.

 

[CoastWatcher]

Oh, my bad.

I didn't look at my previous lab results, which she did check my PSA, it was .683 at the time. The range listed for it was 0.0-4.0 ng/ml

One other thing I noticed on that lab report was my Prolactin was high. It clocked in at 33, the range listed was 3.7-17.9 ng/ml.

She must not have too concerned with either of them, she didn't check them on my last lab test.

The PSA is just fine. Elevated prolactin is something you need to be sure Defy notices. It can cause erectile dysfunction, depressed libido, and(occasionally) infertility. Not a good trio.

 

[Srh1968]

Thats good to know, Coastal. I'll be sure to make Defy aware.

I purchased a blood test from them last night, will they email me my paperwork or send it to me in the mail. I'm hoping for email, I'm out of town for the next week and half, would liked to got my labs this week or first of next instead of waiting for 2 more weeks til I get back home........

 

[ERO]

They email it to you so you should be good to go.

 

[Jackie Treehorn]

Thanks guys! I placed my order for a blood test at Defy last night. So Ill explain my situations to them and go from there.

Smartest move you've made so far. You need to run, not walk away from your current Endo. She is completely clueless with regard to modern TRT protocols, and the level of care you're receiving is horrendous.

And seriously, stop harpooning yourself with a 20ga needle...that's just ridiculous, and painful, no doubt. A 1/2"/27 or 29ga insulin pin will do the job just fine. It will take a while to draw into the syringe, but you won't even feel the needle. Remember to inject slowly.

Once you talk to Dr. Saya or Dr. Crisler, you'll never go back to that clown...excuse me, Endo again.