Please Help: Testosterone Protocol Advice Needed (Low Libido)

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KenLowT

Active Member
Hello everybody,
I'm hoping for some serious advice from people suffering from low T. I have had low T for years, never getting out of the 300's even though I was in my 20's, 30s, and now 40's. Of course I had doctors tell me that I was still in the normal range so they didn't want to treat me. Fortunately, I have a new endocrinologist who is working with me. My symptoms are low libido, sometimes erectile dysfunction, low energy, and some anxiety. The anxiety from my low libido has led me to binge eating which has brought up my weight significantly over the years. I'm 5'7 and 264 lbs. My doctor started me off on HCG Monotherapy since I still wanted to have kids (I have one already, but have been unable to get enough of a libido to work on another one throughout my 30's). I was injecting 1000 iu's three times per week. I was on that protocol for a few months with the below results:

HCG.jpg
estrogen.jpg

My total T went from 396 in January to even less with HCG monotherapy. She decided to up the dose to 2000 iu's three times per week, but the insurance will only cover 6 HCG orders lifetime so now I've been forced to stop. After my sudden stop this June I experienced absolute loss of what already was a very low libido, Erectile dysfunction, lack of energy, and overall suckiness. I then told my doctor to start me on TRT even if it meant making me sterile because I couldn't take being in the low 300's again. So for the past three weeks I have taken 175 mg of testosterone cypionate per week even though the doc wanted it every other week which I read was not the right way to do injections. So far my libido still has not returned, my ED has somewhat improved, and my overall fitness has been great. I'm able to train at the gym 6 days a week and my strength has improved. My mood is a lot better, but inconsistent. Some days are really good, some okay, some low. I am not depressed or bipolar or anything. My main reason for starting TRT was to have a sex life again. I literally will go weeks to months without wanting sex and that's where I am today. I take a DIM supplement to control my estrogen so it's not high like it used to be. My question is, due to my weight and height is 175 mg weekly of test cyp a good starting dose? I usually feel nothing libido wise until days 5 & 6 libido wise, but it's minimal at best. Should I break up my 175 mg into two injections per week? I'm assuming she started this high because of my weight and how desperate I am to get a functioning libido. My first blood test while on test will be next week on trough day. I'm just disappointed my libido hasn't spiked and hoping that I can adjust something to make this work. Thanks for your help guys! By the way the T injections have given me a great boost which has helped me to lose weight. I was originally 270 lbs when I started the T a few weeks ago. I cleaned up my diet, work out consistently, and my sugar cravings are gone. This has been a good effect from the T replacement. I just wish it did something for my libido too.
 
Defy Medical TRT clinic doctor
Given your SHBG you should be injecting 50mg twice weekly, this will get most men to midrange to high normal ranges. You current doctor is indicating he/she has very poor knowledge as it pertains to TRT, you deserve better care and should seek out a hormone specialists that likely doesn't exists within your insurance network. Your current protocol will fail you, 175mg weekly is a big starting dosage.

I've got to ask, is that estrogen test the LC/MS/MS method? In all seriousness I doubt it.

Most of us are forced to seek care privately, insurance is all but useless do to the medical community ignoring hormone therapy for decades. Doctors are still playing catch up and guys like you and me are suffering.
 
Thanks for the advice. Why do you say that I should lower the dose because fo the SHBG. The SHBG level looks normal on my test, doesn't it? I'm afraid if I go down in dosage that my already gone libido will never come back. I certainly wouldn't mind injecting twice a week. I got used the three times per week injections on the HCG. I'm just wondering if my high dosage is because of my weight.
 
Thanks for the advice. I used to get 100,000 Iu from the speciality pharmacy for $40 a month. Then insurance capped it and now it cost $900. I might have to go with Empower. Will HCG after I started testosterone injections still bring up my sperm count? At my last appointment with my endo she did not want to use testosterone cypionate and HCG at the same time since she was using HCG monotherapy to boost up my testosterone levels. I doubt she will give me the okay. I would go see another endo, but that could take weeks and I don't want to lose the T treatment.

Do you really believe 100 mg of T cypionate per week is enough considering my height/weight and total lack of libido? It's just weird that a trained endo would give me such a different dosage.
 
SHBG is a tool to determine dosage and injection frequency, SHBG tells us how well you hold onto your testosterone. Height/weight doesn't mean anything in relation to dosage, your libido will come back once you've had a stable testosterone levels for several weeks to months. If you're injecting infrequently libido will be weak or non- existent.

The majority of endo's have no clue what their doing and have no training at all, they are simply following instructions written in the guidelines which is limited. Another endo is likely going to be as clueless as the next, TRT is a grey area for them and is typically outside of what they normally do, which is thyroid and diabetes.

Low thyroid function can have the same symptoms of low testosterone.

I have good insurance but choose not to use it because doctors clearly have no idea what their doing and I'm tired of every endo being as clueless as the next. I would rather pay out of pocket for TRT than suffer.
 
100 mg of testosterone cypionate or enanthate is usually the starting dose, especially is adding HCG to it. I would try splitting up your dose in two and adding 500 IU of HCG also twice per week. It would be nice to see what this panel looks like (plus a sperm test) after 8 weeks. Your doctor may be able to have your insurance pay for them but, if not, here is a panel that includes DHT and other hormones that affect not only erections but also libido.

How are you sleeping? Any stress in your life that may be wearing you down for the lust for sex?


https://www.discountedlabs.com/ed-panel
 
Finally, someone that feels my pain. So how in the world do you get testosterone and/or HCG prescribed without a doctor? I know if I go back to my endo that 1. She won't agree to using HCG/test cypionate together 2. It will take me forever to find me a doctor that will do both. So what is the next step?
 
That is interesting. I will definitely look into getting that panel done. I do have some results I would like to share that were done in January BEFORE I had started the HCG monotherapy. Please see below:
prolactic.jpg
T4.jpg
T3.jpg
TSH.jpg
Testsosterone.jpg
FSH.jpg
estrogen2.jpg

I will plan on doing the panel you mentioned once I return from vacation. In the meantime I will lean on reducing my injections to two 50mg twice per week. Forgive me for being worried, I have always thought more was better when it came to testosterone. Hopefully reducing will not affect me in the gym because the Test Cypionate has already helped me to lose weight and my body is starting to take shape after years of being fluffy. If I can get "a libido", I will be on cloud 9.
 
Pre-treatment labs are showing LH is near to top of the range so testosterone should be higher and it's not, usually this indicates primary hypogonadism, a failure of the testicles.

Next step you ask, private care is sometimes the only option if you want to work with the best hormone specialists. Defy Medical is an option that does telemedicine and ships you your medicine, you're guaranteed to be working with the knowledgeable hormone specialists. TRT together with HCG is a common prescribed protocol, they do thyroid treatment as well.
 
Sorry, I forgot to respond to the quesiton about stress and sleep. I sleep just fine. Typically 7 to 8 hours a night. My only stress is, which basically controls my every fiber, is not having a libido. I'm 42 years old, was married at 29 and have never had a normal libido. Sex every 5 weeks if I'm lucky. That's my main stressor and it's a nightmare that continues on decade after decade. Even though my wife is 37 going on 38, she would still like to have another child as do I. However, my lack of libido and occasional ED really has made it almost impossible.
 
Defy Medical, that would be great! My only concern is the cost. I work in public education (definitely middle class), so money will be a factor here. I would love to learn more about them. I'll hit the banner up top.

No, I am not taking any medications, only the test cyp. My daily supplements are multivitamin, fish oil, DIM (to keep estrogen balanced), and 500 mg niacin (because I was worried about the ED).

Pre-treatment labs are showing LH is near to top of the range so testosterone should be higher and it's not, usually this indicates primary hypogonadism, a failure of the testicles.

Next step you ask, private care is sometimes the only option if you want to work with the best hormone specialists. Defy Medical is an option that does telemedicine and ships you your medicine, you're guaranteed to be working with the knowledgeable hormone specialists. TRT together with HCG is a common prescribed protocol, they do thyroid treatment as well.
 
I next see my endocrinologist on July 18th. I'm hoping that she will prescribe the HCG again while I'm taking the Test Cypionate. She thought it was overkill the last time I brought it up. If she says no, are there other avenues I can use other than Defy? I do not want to do TRT without HCG as my wife and I are still trying to have a child.

100 mg of testosterone cypionate or enanthate is usually the starting dose, especially is adding HCG to it. I would try splitting up your dose in two and adding 500 IU of HCG also twice per week. It would be nice to see what this panel looks like (plus a sperm test) after 8 weeks. Your doctor may be able to have your insurance pay for them but, if not, here is a panel that includes DHT and other hormones that affect not only erections but also libido.

How are you sleeping? Any stress in your life that may be wearing you down for the lust for sex?


https://www.discountedlabs.com/ed-panel
 
I next see my endocrinologist on July 18th. I'm hoping that she will prescribe the HCG again while I'm taking the Test Cypionate. She thought it was overkill the last time I brought it up. If she says no, are there other avenues I can use other than Defy? I do not want to do TRT without HCG as my wife and I are still trying to have a child.
What do you mean, "other avenues?" In an earlier post you asked about obtaining testosterone without a prescription. That is a bad idea, unless you want to spend time in a federal prison; testosterone is a controlled substance in the US. If you're looking for other physicians, you can contact Prime Body, another site sponsor, a network of physicians.

None of us know your financial situation, and we understand that cost is an important consideration...in every aspect of life. But how important is your health and your car? We all dig down and fork over the cash to keep our automobiles running. When it comes to our health, our body, we become nickel-and-dime specialists.
 
That is interesting. I will definitely look into getting that panel done. I do have some results I would like to share that were done in January BEFORE I had started the HCG monotherapy. Please see below:
View attachment 5248
View attachment 5249
View attachment 5250
View attachment 5251
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View attachment 5253
View attachment 5254

I will plan on doing the panel you mentioned once I return from vacation. In the meantime I will lean on reducing my injections to two 50mg twice per week. Forgive me for being worried, I have always thought more was better when it came to testosterone. Hopefully reducing will not affect me in the gym because the Test Cypionate has already helped me to lose weight and my body is starting to take shape after years of being fluffy. If I can get "a libido", I will be on cloud 9.
More is not ALWAYS better when it comes to testosterone (though large doses may be necessary). I inject 16mg of enanthate every morning - because of low SHBG - and my levels top 1000, free testosterone solidly near the upper end of the reference range.

There red are so many myths about testosterone replacement...many of those are held by physicians who should know better.
 
Coastwatcher,
I did not mean "other avenues" meaning illegally. I meant other than my PCP, my endo, or a TRT clinic where they make you come in every week. I was looking more for the Defy's of the world, hormone replacement places where they are serious about treating you rather than making money off of you every week. Thanks for the suggestions. if my endo won't prescribe Testosterone with HCG then I'm going to be forced to go the Defy route. My only concern is that I am currently on testosterone which means more than likely they are going to want me to get off for a few weeks so they can get an accurate read on me. Then I will sit there for a few weeks in utter misery feeling much worse than I feel now. At least now I have energy and motivation to work out, it's just my libido that sucks. If I get off the T I'm going to get tired, weak, and all my gains will be gone.
What do you mean, "other avenues?" In an earlier post you asked about obtaining testosterone without a prescription. That is a bad idea, unless you want to spend time in a federal prison; testosterone is a controlled substance in the US. If you're looking for other physicians, you can contact Prime Body, another site sponsor, a network of physicians.

None of us know your financial situation, and we understand that cost is an important consideration...in every aspect of life. But how important is your health and your car? We all dig down and fork over the cash to keep our automobiles running. When it comes to our health, our body, we become nickel-and-dime specialists.
 
Nelson, would you suggest I go split my current 175 mg of testosterone cypionate into half of the dose 2x weekly? Or do you think I should drop down to 100 mg of testosterone cypionate and split it into 50 mg 2x weekly? I've only had three injections, but I'm unsure if I should stick with current dosage or go down like you had mentioned earlier.

It's so strange, I only feel somewhat of a libido 2 out of 7 days. Out of a scale from 1-10, most days are a 1 and on those two days while on testosterone I would rate it as a 4.

100 mg of testosterone cypionate or enanthate is usually the starting dose, especially is adding HCG to it. I would try splitting up your dose in two and adding 500 IU of HCG also twice per week. It would be nice to see what this panel looks like (plus a sperm test) after 8 weeks. Your doctor may be able to have your insurance pay for them but, if not, here is a panel that includes DHT and other hormones that affect not only erections but also libido.

How are you sleeping? Any stress in your life that may be wearing you down for the lust for sex?


https://www.discountedlabs.com/ed-panel
 
I doubt Defy will want you to stop taking T. They will have you pull labs and based on what they see, will advice adjustments to your current protocol to be more effective for your particular symptoms.

I understand the money aspect. I am self employed. No insurance. And have many irons in the fire. That being said...priorities. Do you drink alcohol, coffee drinks, eat out often, have $100+ a month cell phone plans, etc? If yes...drop or change those things and you can afford TRT treatment from Defy.
 
Coastwatcher,
I did not mean "other avenues" meaning illegally. I meant other than my PCP, my endo, or a TRT clinic where they make you come in every week. I was looking more for the Defy's of the world, hormone replacement places where they are serious about treating you rather than making money off of you every week. Thanks for the suggestions. if my endo won't prescribe Testosterone with HCG then I'm going to be forced to go the Defy route. My only concern is that I am currently on testosterone which means more than likely they are going to want me to get off for a few weeks so they can get an accurate read on me. Then I will sit there for a few weeks in utter misery feeling much worse than I feel now. At least now I have energy and motivation to work out, it's just my libido that sucks. If I get off the T I'm going to get tired, weak, and all my gains will be gone.
It will not be necessary for you to abandon TRT if you seek treatment from Defy, or Prime Body. No capable doctor wants or needs to reduce a patient to a state where the symptoms associated with hypogonadism are experienced again in order to prove there is a genuine medical need for testosterone. You have pre-treatment labs, you will supplement those with any that were not run, and a more appropriate protocol will be prescribed. Dr. Saya and Dr. Crisler have both commented here that it is pointless, and cruel, to put a patient through a "washout" procedure.
 
Nelson, would you suggest I go split my current 175 mg of testosterone cypionate into half of the dose 2x weekly? Or do you think I should drop down to 100 mg of testosterone cypionate and split it into 50 mg 2x weekly? I've only had three injections, but I'm unsure if I should stick with current dosage or go down like you had mentioned earlier.

It's so strange, I only feel somewhat of a libido 2 out of 7 days. Out of a scale from 1-10, most days are a 1 and on those two days while on testosterone I would rate it as a 4.
I'm not speaking for Nelson, but I suggest you keep Dr. John Crisler's mantra in mind: Start Low and Go Slow. It's always easier to increase the doses associated with a TRT protocol, easier than pulling them back. If I were you, I'd start at 100mg, 50mg every 3.5 days.
 
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