Question about my TRT current protocol

[Normisbest09]

31 years old here. 5’8, 160, I work out 4-5 times per week, decent diet. I was diagnosed with hypogonadism last year (June 2021). Test was at 210 (very low for 30 year old).

Side effects were depression, anxiety, low energy, very low libedo, weak erections. So doc put me on 100MG injected into the muscle once every 10 days. Felt a lot better at first when I got on the protocol. Energy returned, sexual functions were better. However this only lasted about 3-4 weeks and started to feel sluggish again. Got tested in October 2021 and levels were in the 330 range. Still low. Doc changed me over the 100mg every 7 days and it had the same overall effect. Felt great for the first 3-4 weeks and benefits decreased a little. Still felt better though. Depression, anxiety was gone, energy levels better. However, libedo is still inconsistent and erections are good enough but weak often.

Blood levels indicated today I’m in the 475 range. Doc says I should stay on current protocol, but I’m thinking I should increase slightly to get more in the 600 range (maybe 125mg per week, or maybe even 60mg doses twice per week every 3.5 days). Still don’t feel too great and it’s not fun having lower than normal libedo and weak erections.

TT- 475
FT- 14
SHBG- 11 (low, range is 13-89)
Estradiol- 17
Blood levels normal otherwise.

What do you guys think I should do? I think increasing by a little bit would help (maybe 125mg). I also take basic daily vitamins, a vitamin D pill, zinc.

 

[FunkOdyssey]

I think you have the right idea -- your last dose increase had a positive impact but the magnitude of the effect was insufficient. Makes sense to keep going I think.

 

[Systemlord]

Felt great for the first 3-4 weeks and benefits decreased a little.

You just found your perfect injection frequency, so split your dosage every 3.5 days. You may even feel better on more frequent dosing such as EOD and daily and seem to be the norm for a lot of low SHBG men.

The good thing about this protocol is your trough levels will be higher the more frequent you inject. Also if you start injecting more frequently and are using syringes with a dead-space design, you will run out of Test before your next refill, and therefore you should be using 27-29 gauge insulin syringes (no dead-space design) to inject your Test.

Blood levels indicated today I’m in the 475 range. Doc says I should stay on current protocol, but I’m thinking I should increase slightly to get more in the 600 range

A lot of doctors aren't up to date on what are healthy Total T and Free T levels. A previous study published in JAMA in 2009 showed that men with a Total T levels below 550 ng/dL had significant increase in their risk of cardiovascular disease, while men with levels above 550 ng/dL reduced their risk by 30%.

Another issues with our healthcare system is it's into disease management, not optimization where normal is good enough even though it might be healthy.

I think increasing by a little bit would help (maybe 125mg). I also take basic daily vitamins, a vitamin D pill, zinc.

SHBG- 11 (low, range is 13-89)

If your vitamin D levels are low, this can cause ED.

Are you a type 2 diabetic?

Blood levels indicated today I’m in the 475 range.

It's really important to know when you're running labs in relation to your injection. You should be testing a trough, or right before your next injection. So if you're running labs mid-point, then your levels are dropping even lower <300.

I can tell you from what you're saying, that you doctor is clueless in how to manage male hormones and is very common.

 

[Systemlord]

Another thing, if you can get your doctor to prescribe Jatenzo, an oral T gel capsule, I highly recommend it. Recommended starting dosages is 237 mg twice daily.

A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men

Jatenzo: An Advancement in Oral TRT

https://reachmd.com/programs/medical-industry-feature/advancement-oral-testosterone-replacement-therapy/11577/?autoplay=video Join Dr. Jennifer Caudle as she welcomes Dr. Adrian Dobs and Dr. Faysal Yafi to discuss testosterone replacement therapy and an oral soft gel option for appropriate...

www.excelmale.com

 

[Normisbest09]

You just found your perfect injection frequency, so split your dosage every 3.5 days. You may even feel better on more frequent dosing such as EOD and daily and seem to be the norm for a lot of low SHBG men.

The good thing about this protocol is your trough levels will be higher the more frequent you inject. Also if you start injecting more frequently and are using syringes with a dead-space design, you will run out of Test before your next refill, and therefore you should be using 27-29 gauge insulin syringes (no dead-space design) to inject your Test.



A lot of doctors aren't up to date on what are healthy Total T and Free T levels. A previous study published in JAMA in 2009 showed that men with a Total T levels below 550 ng/dL had significant increase in their risk of cardiovascular disease, while men with levels above 550 ng/dL reduced their risk by 30%.

Another issues with our healthcare system is it's into disease management, not optimization where normal is good enough even though it might be healthy.




If your vitamin D levels are low, this can cause ED.

Are you a type 2 diabetic?


It's really important to know when you're running labs in relation to your injection. You should be testing a trough, or right before your next injection. So if you're running labs mid-point, then your levels are dropping even lower <300.

I can tell you from what you're saying, that you doctor is clueless in how to manage male hormones and is very common.

Thanks for the reply!

475 was the test 7 days out from last injection. So my range is likely 475-700ish right now. Would like to be in the 600-900 range and to do that I think I’m going to inject 60mg every 3.5 days (120mg total for the week). With my SHBG being low increasing the frequency may help and increasing the dose by 20mg per week should raise my levels slightly and put me in a better range while at the same time not overloading my system.

I’m taking vitamin D daily now. Just started 2 weeks ago. I hope this helps me more.

Should I consider Viagra or Ciallis for my mild ED issues? Maybe a low dose of viagra in the 20-40mg range?

 

[Systemlord]

With my SHBG being low increasing the frequency may help and increasing the dose by 20mg per week should raise my levels slightly and put me in a better range while at the same time not overloading my system.

For some, the smaller the T dosage, the lower the impact on SHBG. The larger dosages are best for high SHBG guys, because it hammers down the SHBG by means of excess androgens.

Should I consider Viagra or Ciallis for my mild ED issues?

Cialis had benefits beyond fixing ED. Viagra (shorter half-life) can work better than Cialis (longer half-life) and some even combine the two.

I’m taking vitamin D daily now. Just started 2 weeks ago. I hope this helps me more.

Most definitely contributing to ED. I restarted my vitamin D supplement a little more than a month ago and already am noticing erections are returning as well as the sensitivity and orgasm quality is getting better.

How much vitamin D are you taking?

 

[Gladiator]

Thanks for the reply!

475 was the test 7 days out from last injection. So my range is likely 475-700ish right now. Would like to be in the 600-900 range and to do that I think I’m going to inject 60mg every 3.5 days (120mg total for the week). With my SHBG being low increasing the frequency may help and increasing the dose by 20mg per week should raise my levels slightly and put me in a better range while at the same time not overloading my system.

I’m taking vitamin D daily now. Just started 2 weeks ago. I hope this helps me more.

Should I consider Viagra or Ciallis for my mild ED issues? Maybe a low dose of viagra in the 20-40mg range?

You need to try the same dose at 50mg every 3.5 days before going up. You need to work with your doctor or risk getting cut off.

 

[Fortunate]

I think a good approach is to use a dose and injection frequency that is in line with medical recommendations. Next, you can consider doing some bro science to see if your dose and schedule are in line with what the TRT community at large is doing (caveat, I recommend doing the bro science here, instead of body building forums, etc). Once your decide on a protocol (ideally with the blessing of your doc), then go with it and try to give it time. You will see many references around here to giving things a minimum of six weeks before you make judgments about your current protocol. That doesn't mean you have to live with misery if something is clearly abnormal. But, it does mean that long term benefits can take time to realize. I would also recommend following symptoms instead of numbers, as long as your numbers are not totally out of line.

Guilty as charged here when it comes to patience - I have long been a victim of my own impatience. But, I am now starting to recognize it and get better. I think there are two reasons why guys make premature changes in protocols: the protocol is either too much or too little. Personally, I think it's fine to make early changes in the former case. If your side effects suggest you are injecting too much (can be hard to define), then I think it's wise to drop the dose or change the interval. On the other hand, in the latter case, if you still feel hypogonadal, there is a decent argument to try to be patient. Over, time, levels can rise, your body can adjust and symptoms can improve. Knowing how much hypogonadism-related symptoms are reasonable to tolerate is a matter of judgment.

Having said all that, there are tons of opinions on injection dose and frequency. I am in the camp that believes you won't know what's best for your until you try it yourself and give it some time. That said, many these days are extolling the benefits of low dose, frequent injections (every day, every other day, etc). Some feel better on larger, less frequent injections. I suspect (but can't prove) that the number of guys still doing once a week injections is dramatically less than it used to be. I say this, but also love the success story @sh1973 shared with us. He's doing really well on a modest dose, injected once a week. You just don't know until you try. But, his success came with patience. He gave the protocol close to three months before realizing how good he felt.

Also, try not to chase the honeymoon feelings. If you are not sure what this is, poke around here and you'll see what I mean. It can help to define what symptoms you are trying to address and keep them in mind when you periodically judge how things are going. It can also help to prioritize which symptoms are most/least important to you, as you may or may not solve each one.

Summary: pick a reasonable protocol; err on the low side; be patient; adjust up after you've given things time.

 

[Normisbest09]

I do know my numbers are low and I don’t feel good with my sexual functions. Libido is low, erectile function isn’t great.

So would slightly raising my TRT intake (from 100mg to 125mg per week) help raise my TT, FT, and estradiol to where I generally feel better? My numbers that I posted above are just too low for a 31 year old and I don’t feel very good to be honest with you.

 

[Fortunate]

I do know my numbers are low and I don’t feel good with my sexual functions. Libido is low, erectile function isn’t great.

So would slightly raising my TRT intake (from 100mg to 125mg per week) help raise my TT, FT, and estradiol to where I generally feel better? My numbers that I posted above are just too low for a 31 year old and I don’t feel very good to be honest with you.

It may help to know what your peak looks like to have a more complete picture.

Splitting the dose up by increasing injection frequency is for sure worth trying.

Are you using any supplements at all? For example, a lot of guys on TRT use DHEA and later realize it made them feel bad (I was one of those guys).

You might consider hCG. Some love it. Others hate it. But, it makes sense for a young guy to be on it. If you go down that road, I'd recommend trying to avoid infrequent, large doses. You may be able to drop your testosterone dose with hCG.

Although it can be hard, try to change one variable at a time and give things time to equilibrate (most say up to six weeks).

 

[Systemlord]

So would slightly raising my TRT intake (from 100mg to 125mg per week) help raise my TT, FT, and estradiol to where I generally feel better?

I think you need to inject more frequently. If you spend enough time on these forums, you'll start to notice something, low SHBG men tend to respond better to very frequent dosing, not all but a large percentage of them.

 

[Cataceous]

More testosterone is the last thing you need. Even with trough total testosterone at 475 ng/dL your Vermeulen calculated free testosterone is above average for healthy young men, due to very low SHBG. Peak values are likely to be 2.5-3 times higher, such that peak total testosterone is around 1,200-1,500 ng/dL. Your current dose of 100 mg T cypionate per week is giving you an average of 10 mg testosterone per day. This is more testosterone than all but a tiny fraction of men make naturally. Taking even more is inviting side effects and is unlikely to help with your remaining problems.

Splitting and reducing the dose is the best you can do with this one variable. This may be enough, but libido and sexual function rely on a lot more than the level of testosterone.

 

[Normisbest09]

More testosterone is the last thing you need. Even with trough total testosterone at 475 ng/dL your Vermeulen calculated free testosterone is above average for healthy young men, due to very low SHBG. Peak values are likely to be 2.5-3 times higher, such that peak total testosterone is around 1,200-1,500 ng/dL. Your current dose of 100 mg T cypionate per week is giving you an average of 10 mg testosterone per day. This is more testosterone than all but a tiny fraction of men make naturally. Taking even more is inviting side effects and is unlikely to help with your remaining problems.

Splitting and reducing the dose is the best you can do with this one variable. This may be enough, but libido and sexual function rely on a lot more than the level of testosterone.

What’s the correlation between SHBG and FT? You got a link to that calculator? I think my TT, FT, and estradiol numbers are all low for a 31 year old. I think all of those being low justify a slight increase in TRT dose (from 100mg to 120-125mg). Would like to try to see how I feel. My libido and sexual functions just suck. Do you think staying at the same dose but injecting more frequently would help those issues?

Have you heard of the more plates more dates guy? He posted his blood results at 100mg per week and his TT damn near matched mine. His estradiol and FT were higher, but he even justified that could safely increase dosage to 125mg per week given his estradiol numbers weren’t at the high end of average number.

My Blood Work On 100 MG Testosterone Per Week (Accurate LC/MS-MS)

I recently lowered my TRT dosage to 100 mg Testosterone Propionate per week split into every day subcutaneous administrations. This is my blood test result.

moreplatesmoredates.com

 

[Cataceous]

What’s the correlation between SHBG and FT? You got a link to that calculator? I think my TT, FT, and estradiol numbers are all low for a 31 year old. I think all of those being low justify a slight increase in TRT dose (from 100mg to 120-125mg). Would like to try to see how I feel. My libido and sexual functions just suck. Do you think staying at the same dose but injecting more frequently would help those issues?

Have you heard of the more plates more dates guy? He posted his blood results at 100mg per week and his TT damn near matched mine. His estradiol and FT were higher, but he even justified that could safely increase dosage to 125mg per week given his estradiol numbers weren’t at the high end of average number.

My Blood Work On 100 MG Testosterone Per Week (Accurate LC/MS-MS)

I recently lowered my TRT dosage to 100 mg Testosterone Propionate per week split into every day subcutaneous administrations. This is my blood test result.

moreplatesmoredates.com

Here's a commonly used implementation of the Vermeulen free T calculation. You have four parameters: total testosterone, free testosterone, SHBG and albumin. Each can be estimated if the other three parameters are known. Typically free testosterone is treated as the unknown because it's the most difficult to measure accurately. Using default albumin, your—trough—calculated free testosterone is 15.6 ng/dL. The average for healthy young men is about 15. Unless your free testosterone was measured using equilibrium dialysis or ultrafiltration the value is inaccurate and should be disregarded. Your total hormones are low because your SHBG is very low. The total hormones have less bearing on your results than the free hormone levels. Total estradiol of 17 pg/mL is ok in your situation because free estradiol is estimated to be 0.5 pg/mL—in the normal range of about 0.3-1.2 pg/mL. Your peak value is probably much higher.

I think you should reduce the dose and inject more often. Your average free testosterone is probably 25-30 ng/dL. Top-of-range is about 22 ng/dL. I think you should get free T down closer to 15 ng/dL and see how that feels. Ideally you'd inject frequently enough to avoid substantial variation over multiple days. Some intraday variation is natural and maybe even desirable. If it were me I would try 20 mg of cypionate every other day.

The more-plates-more-dates guy is comparable in spite of the differences. We don't know his SHBG and thus have no idea about free hormones—he didn't measure free testosterone by an accurate method. He is injecting daily. He is injecting a different ester with a much shorter half-life. He's probably also measuring at trough. In terms of hormonal variation, his daily injections are similar to your weekly injections. At least for myself I estimate peak hormone levels with daily propionate to be about three times the trough levels. Therefore he is also disregarding very high hormone levels earlier in the injection cycle.

 

[Normisbest09]

Here's a commonly used implementation of the Vermeulen free T calculation. You have four parameters: total testosterone, free testosterone, SHBG and albumin. Each can be estimated if the other three parameters are known. Typically free testosterone is treated as the unknown because it's the most difficult to measure accurately. Using default albumin, your—trough—calculated free testosterone is 15.6 ng/dL. The average for healthy young men is about 15. Unless your free testosterone was measured using equilibrium dialysis or ultrafiltration the value is inaccurate and should be disregarded. Your total hormones are low because your SHBG is very low. The total hormones have less bearing on your results than the free hormone levels. Total estradiol of 17 pg/mL is ok in your situation because free estradiol is estimated to be 0.5 pg/mL—in the normal range of about 0.3-1.2 pg/mL. Your peak value is probably much higher.

I think you should reduce the dose and inject more often. Your average free testosterone is probably 25-30 ng/dL. Top-of-range is about 22 ng/dL. I think you should get free T down closer to 15 ng/dL and see how that feels. Ideally you'd inject frequently enough to avoid substantial variation over multiple days. Some intraday variation is natural and maybe even desirable. If it were me I would try 20 mg of cypionate every other day.

The more-plates-more-dates guy is comparable in spite of the differences. We don't know his SHBG and thus have no idea about free hormones—he didn't measure free testosterone by an accurate method. He is injecting daily. He is injecting a different ester with a much shorter half-life. He's probably also measuring at trough. In terms of hormonal variation, his daily injections are similar to your weekly injections. At least for myself I estimate peak hormone levels with daily propionate to be about three times the trough levels. Therefore he is also disregarding very high hormone levels earlier in the injection cycle.

So I you think doing 50mg every 3.5 days would be a good place to start and evaluate how I feel after 6 weeks?

I’ve been reading a lot about estradiol and the link between that and libido/erections. I really want to be more on the high end of average on that and see how I feel.

 

[Cataceous]

So [do] you think doing 50mg every 3.5 days would be a good place to start and evaluate how I feel after 6 weeks?
...

This would be an improvement. If your absorption rate is typical then peak serum testosterone would be more like 50% higher than trough values. However, trough levels are expected to rise, so 35-40 mg dosing might be better. Don't fall into the "more is better" trap.

...
I’ve been reading a lot about estradiol and the link between that and libido/erections. I really want to be more on the high end of average on that and see how I feel.

Chances are you already have "high end" estradiol at your peak levels, within a day of each injection. The estradiol/testosterone ratio may have independent importance, but won't change much with higher testosterone dosing. If you really want to experience higher estradiol then just buy some estradiol cream and apply it sparingly.

 

[Guided_by_Voices]

A few other things. Working out 4-5 time a week could mean a lot of things. You want to make absolutely sure you are not overtraining, at least until you get your symptoms resolved and have a baseline. I would not do any sets to failure, do some low intensity aerobic work and a few sprints without overdoing it. You can ramp back-up once your symptoms are sorted out. Get the book Perfect Health Diet and do what it says. Make sure you are eating enough safe starches and quality protein, especially beef. Eliminate non-paleo foods. Consider getting a work-up that could detect undiagnosed infections or mold/environmental toxicity. Check thyroid. Supplement with b12. IOW, don't over-focus on T and under-focus on the vast array of things that could impact your health and energy. Yes to the viagra/cialis; there is almost no risk and they seem to have numerous benefits beyond the obvious. If your sleep is less than great, that alone would cause problems.

 

[GreenMachineX]

A few other things. Working out 4-5 time a week could mean a lot of things. You want to make absolutely sure you are not overtraining, at least until you get your symptoms resolved and have a baseline. I would not do any sets to failure, do some low intensity aerobic work and a few sprints without overdoing it. You can ramp back-up once your symptoms are sorted out. Get the book Perfect Health Diet and do what it says. Make sure you are eating enough safe starches and quality protein, especially beef. Eliminate non-paleo foods. Consider getting a work-up that could detect undiagnosed infections or mold/environmental toxicity. Check thyroid. Supplement with b12. IOW, don't over-focus on T and under-focus on the vast array of things that could impact your health and energy. Yes to the viagra/cialis; there is almost no risk and they seem to have numerous benefits beyond the obvious. If your sleep is less than great, that alone would cause problems.

Where can we get the work up for mold and all that?

 

[Guided_by_Voices]

Where can we get the work up for mold and all that?

I think most integrative/holistic Doctors are familiar with it and some mold-exposure tests you may be able to order yourself. I have not had that done myself but Dr Will Cole is a well-known practitioner who tests for that sort of thing and who does telemedicine.