Starting Over on TRT

[jtm87]

Hello everyone, looking forward to this community and getting some help, this seems like the best and most reasonable forum around for the discussion of TRT. If you want to skip my long history, the questions are at the bottom.

History:
Tested for low total T (279, 303) at 24 (I'm 32 now). My local doctor said he wouldn't consider prescribing T until I was 55 and that he would only use androgel. I pulled the trigger on a Testosterone cycle and felt amazing once I figured out estrogen control. Continued running cycles of different steroids for the next couple of years and cruised inbetween. Found my sexual health (libido, erections) quickly deteriorating and decided to try coming off.
I did not recover higher than 300 total T and felt awful, so I went on self prescribed TRT with pharmaceutical enanthate using 50mg twice a week. I felt ok, I had energy, libido was good, but my erections were not usually full strength. I got a blood test and my total T at trough was a little bit above 700. I got the wrong estrogen test and got total estrogen instead of e2, and that led me down a path of using aromasin at 12.5mg twice per week even though my estrogen probably wasn't high. I felt good initially and despite quickly feeling awful, I continued this program for a year with no additional testing.
I then decided to come off again. I used the Power PCT protocol in William Llewellyn's book. 2500iu HCG EOD for 16 days, Clomid 50mg twice ED for 30 days, and Nolvadex 20mg per day for 45 days, as well as arimidex. This damaged my health greatly. I developed a lot of ocular pressure and moderate to severe eye floaters from the clomid. I had severe digestive issues which I can only assume are related somehow, skin problems, and extreme depression, and was unable to fully complete the protocol. I made it about 21 days.
I felt like I had to get back on so I started using the old Crisler protocol. 100mg test on a monday, with 250iu hcg saturday and sunday, no AI. I never felt good here, the only days I felt ok were Tuesday and actually pretty good on a Sunday, and I felt awful the rest of the week. I was never able to have sex, my dick was numb and would go soft. At trough, my levels were 300-500, E2 was single digits. I decided I needed a doctors help and signed up with Defy.
Defy recommended 70mg cypionate 2x per week, 400iu HCG 2x per week, and .125mg anastrozole 2x per week. I experienced low E2 symptoms very quickly and couldn't stick with the protocol. I decided to simplify and do 40mg cyp e3d. My total T was 650-700, E2 was 21, SHBG 35. Not much better than 100mg once a week, but slightly. However, no sensitivity in the penis at all. It seems like HCG added some sensitivity for the few days a week I was using it in the past.
After that I cycled through a few protocols but did not consistently stick with them. Ranging from 100-140 per week with random bouts of HCG thrown in. Never found something that consistently worked. I realize my mistake and that you need to give protocols time to work, and will not make that mistake again, I will be consistent.
Right now I am still struggling with libido and energy. I find myself sleeping a lot and have some soft nighttime or morning erections some days. If its relevant, I noticed that I don't gain erections quickly, even if I use porn, it takes a while and its usually not at full mast until I'm near orgasm. Also I'm starting to experience much more noticeable testicular atrophy.

Questions:
- I want to stick with a basic protocol. Would 50mg 2x per week of cypionate with 500iu HCG twice per week at the same time be a good starting point? (Monday morning, Thursday night). 50mg twice per week last time put me around 700 and e2 was probably low 20s, so I didn't know if I should target higher at first.
- Is there any reason to inject more frequently to start? I see that frequent injections are becoming the norm, I'd like to inject as infrequently as possible without losing any benefits. My SHBG was 34.5 on my last blood test.
- I'd like to avoid an AI if possible, I see that there are some issues with them, but I also don't tolerate anastrozole well. I feel "crashed" energy and get acne even from a single dose of .125mg. Is it possible that I would need it for some reason?

Thanks for all the help.

 

[Vince]

I like your protocol. 50 mg of testosterone cypionate twice a week, should put your levels in a good range. Especially with shbg of 34. Some men can't handle 500 IU of HCG twice a week, because it raises there estrogen too much.

5 years ago when I started trt, I use 500 IU of HCG twice a week and I never looked back. It's not the same for everyone though, I would probably start with 100 IU twice a week and if you're not having any bad reactions. I would then increase from there.

 

[S1W]

1. Yes that seems like a good starting point, although personally I'd start out without the HCG.

2. No, I'd try the 2x/week schedule first - if you can avoid having to inject more frequently, that'd be ideal and the only way to know is to try.

3. It is unlikely that you should need an AI at that dosage, especially if you choose not to use HCG.

 

[jtm87]

Thanks guys. I know that at one point I was using about 700iu of HCG per week and it didn't raise my estrogen very much. Defy recommended 500 twice. They also wanted 140 a week again but I don't want to start high on both HCG and test

 

[slicktop]

Not to thread-jack (I think there's relevance here) but these HCG discussions are really helping me, so thank you all for that. Defy has me on 500iu 3x a week so I'm actively researching the minimum effective dosage and found this for those that are interested: Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression My quick TLDR: "All three hCG groups in this study (125, 250, and 500 IU, given every other day) maintained ITT at levels statistically indistinguishable from baseline....Clearly, low-dose hCG can restore ITT to normal levels in men with gonadotropin suppression from exogenous T administration.... Lower doses of hCG may be as effective in treating male infertility due to hypogonadotropism as the higher doses used historically." I'm dropping my dose.

Back to the OP: you mentioned testicular atrophy. There's only two ways to look at that, neutral or bad, right? It certainly isn't good. With HCG, you should bring them back online, and unless you have an E2 spike from the HCG, it's hard to imagine that being a bad thing IMHO.

 

[jtm87]

250iu eod which is 17 percent below baseline from that study is still like 875 per week though right?
The atrophy isn't good, but also I feel a difference in how I feel without it. I'm not sure if that's a good or a bad thing, but I feel very flat and emotionless without it.

 

[Systemlord]

I'd like to avoid an AI if possible, I see that there are some issues with them, but I also don't tolerate anastrozole well.

I cannot tolerate anastrozole either, more frequent dosing fix that little problem.

 

[slicktop]

Questions:
- I want to stick with a basic protocol. Would 50mg 2x per week of cypionate with 500iu HCG twice per week at the same time be a good starting point? (Monday morning, Thursday night). 50mg twice per week last time put me around 700 and e2 was probably low 20s, so I didn't know if I should target higher at first.
Any reason for not going back to Defy's suggested protocol of test and HCG for a start, and maintaining it for 8-12 weeks? And just take the AI if you get E2 symptoms?
- Is there any reason to inject more frequently to start? For you? Probably not. I see that frequent injections are becoming the norm, I'd like to inject as infrequently as possible without losing any benefits. My SHBG was 34.5 on my last blood test. Us "daily" guys tend to have a common denominator: we tolerate AI fine, but we need a ton of it to keep our E2 down. This doesn't appear to be you.
- I'd like to avoid an AI if possible, I see that there are some issues with them, but I also don't tolerate anastrozole well. I feel "crashed" energy and get acne even from a single dose of .125mg. Is it possible that I would need it for some reason?
Yes, it's possible you may need it. You may need it later in your protocol as your body adjusts, especially if you stay on HCG. I wouldn't take it "just because", I'd take it if and when you develop E2 symptoms. You can also look into other less aggressive, natural E2 medications; DIM, zinc, ginseng, and others have helped some men. DIM is great for me.

Also, consider getting just the ultra-sensitive estradiol and total & free t tests done more frequently since you're having a hard time getting dialed in. They're not too expensive if you do just those three.

Genuinely sorry you're riding the roller coaster, man. Keep your hands inside the car at all times and don't get up until the ride has come to a complete stop.

 

[jtm87]

Questions:
- I want to stick with a basic protocol. Would 50mg 2x per week of cypionate with 500iu HCG twice per week at the same time be a good starting point? (Monday morning, Thursday night). 50mg twice per week last time put me around 700 and e2 was probably low 20s, so I didn't know if I should target higher at first.
Any reason for not going back to Defy's suggested protocol of test and HCG for a start, and maintaining it for 8-12 weeks? And just take the AI if you get E2 symptoms?
- Is there any reason to inject more frequently to start? For you? Probably not. I see that frequent injections are becoming the norm, I'd like to inject as infrequently as possible without losing any benefits. My SHBG was 34.5 on my last blood test. Us "daily" guys tend to have a common denominator: we tolerate AI fine, but we need a ton of it to keep our E2 down. This doesn't appear to be you.
- I'd like to avoid an AI if possible, I see that there are some issues with them, but I also don't tolerate anastrozole well. I feel "crashed" energy and get acne even from a single dose of .125mg. Is it possible that I would need it for some reason?
Yes, it's possible you may need it. You may need it later in your protocol as your body adjusts, especially if you stay on HCG. I wouldn't take it "just because", I'd take it if and when you develop E2 symptoms. You can also look into other less aggressive, natural E2 medications; DIM, zinc, ginseng, and others have helped some men. DIM is great for me.

Also, consider getting just the ultra-sensitive estradiol and total & free t tests done more frequently since you're having a hard time getting dialed in. They're not too expensive if you do just those three.

Genuinely sorry you're riding the roller coaster, man. Keep your hands inside the car at all times and don't get up until the ride has come to a complete stop.

I can do defys original protocol of 70mg and 400iu if you think that's better than 50mg and 500iu twice a week? I was just not sure if that would be too much and I'd like to avoid an AI if possible but I'm not completely opposed to them like some are.
I'll definitely do a lot more testing this time around.
Thanks for all the good info.

 

[slicktop]

I can do defys original protocol of 70mg and 400iu if you think that's better than 50mg and 500iu twice a week?

I don't necessarily think it's better, it's more like... you paid to get the opinion of a highly regarded expert in the field, then did something different than what they recommended and are having less than stellar results. Did you call or email them to tell them you were having complications? They'll talk to you any time for no charge in between your full consultations for any questions or concerns you have. But it sounds like you had low E2 symptoms and made other changes to your protocol on your own instead of targeting only the medicine that lowers your E2. So... I am NOT attacking you or trying to sound rude, but I guess what I'm saying is try sticking with Defy and check with them before you do anything different, at least for a few months.

 

[jtm87]

I can do defys original protocol of 70mg and 400iu if you think that's better than 50mg and 500iu twice a week?

I don't necessarily think it's better, it's more like... you paid to get the opinion of a highly regarded expert in the field, then did something different than what they recommended and are having less than stellar results. Did you call or email them to tell them you were having complications? They'll talk to you any time for no charge in between your full consultations for any questions or concerns you have. But it sounds like you had low E2 symptoms and made other changes to your protocol on your own instead of targeting only the medicine that lowers your E2. So... I am NOT attacking you or trying to sound rude, but I guess what I'm saying is try sticking with Defy and check with them before you do anything different, at least for a few months.

Youre not rude or attacking at all. You bring up good points. The only thing about defy is every time I call they tell me to raise my dose and add in all kinds of drugs like AIs, dopamine agonists even though my prolactin is fine, gh releasing peptides even though my igf1 is great, and I want to keep thing simple, and I'm hesitant of adding in all of these things and making it complicated. But I should be taking their professional opinion into account, you are correct. Thanks.

 

[slicktop]

Youre not rude or attacking at all. You bring up good points. The only thing about defy is every time I call they tell me to raise my dose and add in all kinds of drugs like AIs, dopamine agonists even though my prolactin is fine, gh releasing peptides even though my igf1 is great, and I want to keep thing simple, and I'm hesitant of adding in all of these things and making it complicated.

Ah, I see. Yes, they are in the business of selling medication as well. Their Lipo-C is a good example (not that it can't be helpful to some people, but... ya know... c'mon...). I'd try keeping your test up a little on the high side, which your prescribed protocol should allow.

I felt like I had to get back on so I started using the old Crisler protocol. 100mg test on a monday, with 250iu hcg saturday and sunday, no AI. I never felt good here, the only days I felt ok were Tuesday and actually pretty good on a Sunday, and I felt awful the rest of the week.

Based on that, it sounds like you felt the best when your test (and coincidentally, E2) was the highest. Building on that, I'd use your current protocol of 140mg a week and check the "basic three" every 4 weeks, if you aren't feeling great. Who does your consults with Defy? And I know I said to not make major adjustments, but I'm going to make a minor course correction and suggest you consider consulting with Defy about more frequent dosing since above you said you felt the best the day after your injections. Same weekly dose, split into more shots.

 

[jtm87]

Ah, I see. Yes, they are in the business of selling medication as well. Their Lipo-C is a good example (not that it can't be helpful to some people, but... ya know... c'mon...). I'd try keeping your test up a little on the high side, which your prescribed protocol should allow.

I felt like I had to get back on so I started using the old Crisler protocol. 100mg test on a monday, with 250iu hcg saturday and sunday, no AI. I never felt good here, the only days I felt ok were Tuesday and actually pretty good on a Sunday, and I felt awful the rest of the week.

Based on that, it sounds like you felt the best when your test (and coincidentally, E2) was the highest. Building on that, I'd use your current protocol of 140mg a week and check the "basic three" every 4 weeks, if you aren't feeling great. Who does your consults with Defy? And I know I said to not make major adjustments, but I'm going to make a minor course correction and suggest you consider consulting with Defy about more frequent dosing since above you said you felt the best the day after your injections. Same weekly dose, split into more shots.

To be honest the best I remember feeling was 50mg twice a week despite the slightly weak erections. The 100mg a week had my e2 in the single digits but I don't feel any improvement from having high E2 either. I suppose I can dose more frequently but would starting in the 100mg per week range make more sense than going too high?
Also I'm not sure if this makes much of a difference, but when I used big pharma e or c, I always felt better than the empower cyp, but I'm not sure if that was just due to protocol changes as well.

 

[Gman86]

To be honest the best I remember feeling was 50mg twice a week despite the slightly weak erections. The 100mg a week had my e2 in the single digits but I don't feel any improvement from having high E2 either. I suppose I can dose more frequently but would starting in the 100mg per week range make more sense than going too high?
Also I'm not sure if this makes much of a difference, but when I used big pharma e or c, I always felt better than the empower cyp, but I'm not sure if that was just due to protocol changes as well.

What big pharma brands of test E and Test C have you used? Any difference when using test E vs test C?

 

[jtm87]

What big pharma brands of test E and Test C have you used? Any difference when using test E vs test C?

I used Bayer for the E and Pfizer for the C. The Bayer felt a little stronger than the Pfizer but again this is totally anecdotal. Both have more of a feeling of energy than the empower.

 

[Gman86]

I used Bayer for the E and Pfizer for the C. The Bayer felt a little stronger than the Pfizer but again this is totally anecdotal. Both have more of a feeling of energy than the empower.

Thanks for reporting your experience. I just got switched to empowers enanthate. I plan on running it for around 6 weeks, get labs, and then switch to a brand name, run for 6 weeks, and get labs. All on the same dose. The experimenter in me just wants to see if there’s much of a difference in subjective effects/ labs, and if there is a difference in labs, I’m curious to see if it’s drastically different or not.

Last question, what’s your current protocol, if you don’t mind me asking. And what brand and form of testosterone are you using? Thanks.

 

[jtm87]

Thanks for reporting your experience. I just got switched to empowers enanthate. I plan on running it for around 6 weeks, get labs, and then switch to a brand name, run for 6 weeks, and get labs. All on the same dose. The experimenter in me just wants to see if there’s much of a difference in subjective effects/ labs, and if there is a difference in labs, I’m curious to see if it’s drastically different or not.

Last question, what’s your current protocol, if you don’t mind me asking. And what brand and form of testosterone are you using? Thanks.

I actually don't have a protocol right now. I recently tried a propionate protocol which made me feel good but gave me the worst libido, ed, and sleep I've ever had in my trt experience. Based on this thread advice I may either do a lower starting dose with hcg or a higher more frequent dose of test. If defy offers Pfizer or an equivalent I will ask for that, otherwise I'll be using the empower cyp.
I'm really curious to see the comparison of your 2 labs

 

[Gman86]

I actually don't have a protocol right now. I recently tried a propionate protocol which made me feel good but gave me the worst libido, ed, and sleep I've ever had in my trt experience. Based on this thread advice I may either do a lower starting dose with hcg or a higher more frequent dose of test. If defy offers Pfizer or an equivalent I will ask for that, otherwise I'll be using the empower cyp.
I'm really curious to see the comparison of your 2 labs

I’ll definitely make a thread reporting my results, even if there’s no difference. Where were you getting the pharma brands of test E and C from?

Im with Defy, and they asked me if I wanted the test E from Empower or a brand name. They didn’t specify which brand, but now I’m curious. When do you think you’re going to ask them? I’m curious what brand they were referring to. You can also have them write a prescription to your local pharmacy and just pick up whatever brand name you can get via a goodrx coupon.

 

[fifty]

@jtm87 , clomid 50mg twice each day? That’s highly questionable.

@Gman86 Did you ever post your bloodwork on creams? I saw you mention it a week ago but must have missed your labs.

 

[jtm87]

@jtm87 , clomid 50mg twice each day? That’s highly questionable.

@Gman86 Did you ever post your bloodwork on creams? I saw you mention it a week ago but must have missed your labs.

Yeah, I realize now it was a terrible protocol. At the time was popular from the book and Dr scally who I see is also not highly regarded now.