What should I do to get T levels to normal

[Gunner@1911]

I am 56 years old, 5'6" and about 150lbs. About 6 months ago I had a battery of blood tests done and everything looked really good except my T levels. They were very low in the 150 levels. My general doc put me on 200ml of ciponate injection every two weeks. I have not noticed much of any changes except my ED has gotten slightly better, about 50/50. Energy levels have not really gotten any better. Muscle fatigue has not really improved and regeneration has not improved. I had my T levels checked yesterday (1 week after injection) and it was a whopping 1133!

I am wondering if I should decrease my dose and extend intervals between injections? I spoke to doc this morning and she recommends 100ml once every 3 weeks to try to get my levels into the normal range.

I am not into body building but I am fairly active. Work on my feet all day and restore cars in my spare time. Im not trying to build bigger muscles, just trying to feel better and get my body working better across the board.

This is all new to me so please be patient with me. I dont know all of the lingo so any explanations or advice is greatly appreciated.

 

[Vince]

The ideal testosterone level would be the one you had at age 21 you probably don't know what level that was, like most men. I would start with 50 mg of testosterone every 3 and 1/2 days and adjust from there.

 

[Gunner@1911]

The ideal testosterone level would be the one you had at age 21 you probably don't know what level that was, like most men. I would start with 50 mg of testosterone every 3 and 1/2 days and adjust from there.

Vince,
Thank you for the reply.

Would you self administer 50mg by injection? Currently I am getting the 200ml every two weeks thru injection by the doc.

Im not sure about injecting myself. Not a big fan of needles.

Dave

 

[Vince]

Vince,
Thank you for the reply.

Would you self administer 50mg by injection? Currently I am getting the 200ml every two weeks thru injection by the doc.

Im not sure about injecting myself. Not a big fan of needles.

Dave

Yes, mostly everyone here self-inject. I use a 29 g 1/2" in syringe. Easy and pretty painless. I'll post a thread for you.

 

[BadassBlues]

Vince,
Thank you for the reply.

Would you self administer 50mg by injection? Currently I am getting the 200ml every two weeks thru injection by the doc.

Im not sure about injecting myself. Not a big fan of needles.

Dave

Hi Dave,

Injection intervals are just as important as dosage. When you inject testosterone cypionate (cypionate is the ester that binds the testosterone) you are creating a depot that is dissolved over a period of time, slowly releasing the testosterone into your system. Cypionate has a half life of about 8 days. Right after injection, you get what is known as a peak, the highest level of T from the injection. This then fades into the trough, the lowest level of T. There are other esters that have different half lives, but cypionate is the most common.

In your case, injecting at two week intervals creates a long span with a very low trough. Essentially, after 8-10 days, you have none of the active medication in your system and since your HPTA is now shut down from using exogenous (not your own) testosterone, your t levels plummet.

There are other esters that are designed for longer intervals, but most who have tried them don't report very good results. At least from what I have seen. Perhaps others on here can give a different perspective.

If you are going to stay with cypionate, you need to adjust your injection intervals to weekly, or bi weekly. Some guys do very well with a single IM (intramuscular) injection. Some do twice weekly, either IM or sub q (subcutaneous, just under the skin). Sub Q injections are quick and painless as you are using an insulin syringe.

There are newer oral forms of testosterone as well. I am not up to snuff on those, as I have not used them, or researched them. @madman would be a good source of info on that.

We are here to help, any questions, just ask.

 

[Vince]

How to Inject Testosterone Intramuscularly, Shallow IM or Subcutaneously ?

Click here to watch videos on how to inject testosterone intramuscularly or subcutaneously More information on subcutaneous testosterone injections: https://www.discountedlabs.com/blog/intramuscular-vs-subcutaneous-testosterone-injections-are-they-both-effective Subcutaneous Testosterone...

www.excelmale.com

 

[Gunner@1911]

Hi Dave,

Injection intervals are just as important as dosage. When you inject testosterone cypionate (cypionate is the ester that binds the testosterone) you are creating a depot that is dissolved over a period of time, slowly releasing the testosterone into your system. Cypionate has a half life of about 8 days. Right after injection, you get what is known as a peak, the highest level of T from the injection. This then fades into the trough, the lowest level of T. There are other esters that have different half lives, but cypionate is the most common.

In your case, injecting at two week intervals creates a long span with a very low trough. Essentially, after 8-10 days, you have none of the active medication in your system and since your HPTA is now shut down from using exogenous (not your own) testosterone, your t levels plummet.

There are other esters that are designed for longer intervals, but most who have tried them don't report very good results. At least from what I have seen. Perhaps others on here can give a different perspective.

If you are going to stay with cypionate, you need to adjust your injection intervals to weekly, or bi weekly. Some guys do very well with a single IM (intramuscular) injection. Some do twice weekly, either IM or sub q (subcutaneous, just under the skin). Sub Q injections are quick and painless as you are using an insulin syringe.

There are newer oral forms of testosterone as well. I am not up to snuff on those, as I have not used them, or researched them. @madman would be a good source of info on that.

We are here to help, any questions, just ask.

Badassblues,

With the subcutaneous injections are they still injecting cypionate? If so at what dose?

I am currently getting the deep muscle injection with 200ml every two weeks and my levels are high but I dont feel any better?

Everyone I talk to says they have had good results with TRT and as of right now Im not too sure for me if its worth it but I want to give it a fair shot.

Dave

 

[Systemlord]

My general doc put me on 200ml of ciponate injection every two weeks.

Your doctor is out to lunch! Many doctors, even the ones you think would be the experts in this area of medicine clearly are no better, few doctors truly understand how to manage male hormones.

Given the half-life of cypionate, 5-7 days, by day 10-14 your hormone levels are low, known as, "testosterone crash", and your levels are only ideal 50% of the time.

There's your 50% improvement.

Ridiculous!

Diagnosis and management of testosterone deficiency - PMC

Testosterone supplementation therapy (TST) use has dramatically increased over the past decade, due to the availability of newer agents, aggressive marketing, and an increasing incidence of testosterone deficiency (TD). Despite the increase in TST, ...

www.ncbi.nlm.nih.gov

Slightly longer but still relatively short-acting agents testosterone enanthate and testosterone cypionate require injections every 1–2 weeks due to half-lives of 5–7 days, respectively. All of the short-acting agents are plagued by a “roller coaster” effect by achieving supraphysiologic levels within 2–4 days after injection followed by sub-therapeutic levels by 10–14 days. A rapid decline in serum levels around 10–14 days has been called “testosterone crash” and is associated with sudden recurrence of TD symptoms. To minimize these effects, more frequent dosing from once to twice weekly has been suggested as is preferred by these authors.

 

[Systemlord]

I am currently getting the deep muscle injection

Wondering if my TRT prescription schedule makes sense at all

So I had low test for quite a few years that was first tested when I was about 29. I have been on methadone since age 19. Though I have been on opiates for a long time, I was always a “functional addict” as I was a an athlete and was drafted into the QMJHL back in 2005. I always stayed in shape...

www.excelmale.com

 

[BadassBlues]

Badassblues,

With the subcutaneous injections are they still injecting cypionate? If so at what dose?

I am currently getting the deep muscle injection with 200ml every two weeks and my levels are high but I dont feel any better?

Everyone I talk to says they have had good results with TRT and as of right now Im not too sure for me if its worth it but I want to give it a fair shot.

Dave

Cypionate is the main ester used for most guys, yes, sub q as well. I do a bi weekly sub q injection using 30mg of a 10ml vial @ 200mg per ml. That equates to 120 mg a week. This keeps my total T levels at between 800-900, which is perfect for me.

This is not a sprint, it's a marathon. You need to get on a sensible dose at a proper interval and give it 8 weeks. Don't try to analyze it before you have given your body a chance to adjust. After 8 weeks, test, analyze and make any logical adjustments.

Testing should include:

Total Testosterone
Free testosterone
Estradiol / E2 (Using sensitive assay)
DHT
CBC

Of course there are other tests, but those are the main markers of how your TRT is working. If any of them are out of balance, take the steps to correct it.

I will tell you this, and it is the gospel. If you aren't willing to do it right, don't do it.

 

[BadassBlues]

Something else to try, considering your age, is Selegeline (Deprynyl):

DepPro™ Tablets (Deprenyl) - The Antiaging Store

50x 5mg Tablets Deprenyl HCL - The Versatile Antiaging Smart Drug By protecting dopamine levels in the brain, Deprenyl is a cognitive enhancing smart drug that works to improve brain function, facilitate faster cognitive actions and improve concentration. HCL - Hydrochloride The last couple...

theantiaging.store

Selegeline is a selective MAO-B inhibitor that keeps dopamine levels higher be inhibiting degradation. It is very safe, and effective. It is especially helpful for those of us who are a bit more on the older side It works synergistically with TRT.

Try a 2.5 mg dose, once a day in the AM.

 

[Gunner@1911]

Something else to try, considering your age, is Selegeline (Deprynyl):

DepPro™ Tablets (Deprenyl) - The Antiaging Store

50x 5mg Tablets Deprenyl HCL - The Versatile Antiaging Smart Drug By protecting dopamine levels in the brain, Deprenyl is a cognitive enhancing smart drug that works to improve brain function, facilitate faster cognitive actions and improve concentration. HCL - Hydrochloride The last couple...

theantiaging.store

Selegeline is a selective MAO-B inhibitor that keeps dopamine levels higher be inhibiting degradation. It is very safe, and effective. It is especially helpful for those of us who are a bit more on the older side It works synergistically with TRT.

Try a 2.5 mg dose, once a day in the AM.

BadassBlues,

Thank you for the information.

Im still very much on the fence about continuing this therapy because of the lack of results.

Clearly my doc is out of her field in the diagnosis but she is willing to work with me. So I guess my questions are;

If I were to continue down the path of TRT should I take the info that has been recommended here to my doc to see if she understands?

Should I seek out a urologist in my area that specializes in TRT?

If I was to decide to abort TRT all together is there any protocol for stopping the therapy?

My main concern right now is doing harm trying to figure it out to an otherwise healthy body.

I really want to feel better and get my ED under control but I ask myself at what cost due to the possible side affects.

Thank you so much for the information and advice thus far. It really is appreciated!

Dave

 

[Vince]

Gunner, I'll show you my protocol. My age and SHBG is much different than yours.

Vince's Labs for October 2023

I haven't changed my protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg twice weekly and no AI. Pregnenolone 10 mg and 25 mg of DHEA. My last injection before labs, about 28 1/2 hrs. Labs are from LabCorp. Testosterone, Serum 1417 ng/dL range 264-916 Free Testosterone 47.8 ng/dL...

www.excelmale.com

 

[Guided_by_Voices]

BadassBlues,

Thank you for the information.

Im still very much on the fence about continuing this therapy because of the lack of results.

Clearly my doc is out of her field in the diagnosis but she is willing to work with me. So I guess my questions are;

If I were to continue down the path of TRT should I take the info that has been recommended here to my doc to see if she understands?

Should I seek out a urologist in my area that specializes in TRT?

If I was to decide to abort TRT all together is there any protocol for stopping the therapy?

My main concern right now is doing harm trying to figure it out to an otherwise healthy body.

I really want to feel better and get my ED under control but I ask myself at what cost due to the possible side affects.

Thank you so much for the information and advice thus far. It really is appreciated!

Dave

Before you started TRT you should have had a comprehensive evaluation from a good holistic doctor who could look for the root cause of your symptoms, so doing that now would be a good idea. While your T levels may ultimately still be too low and a sensible TRT program warranted, a lot of other things could be in play such as thyroid issues, nutrient deficiencies, chronic infection, and/or lots of other things that a mainstream doctor would not see on a "battery of blood tests". Poor sleep or under-eating for example can both cause low T and fatigue which may resolve if you fix those issues. You can stay on a lower T dose as suggested, but don't assume that is your only issue.

 

[Gunner@1911]

Before you started TRT you should have had a comprehensive evaluation from a good holistic doctor who could look for the root cause of your symptoms, so doing that now would be a good idea. While your T levels may ultimately still be too low and a sensible TRT program warranted, a lot of other things could be in play such as thyroid issues, nutrient deficiencies, chronic infection, and/or lots of other things that a mainstream doctor would not see on a "battery of blood tests". Poor sleep or under-eating for example can both cause low T and fatigue which may resolve if you fix those issues. You can stay on a lower T dose as suggested, but don't assume that is your only issue.

Guided_by_voices

Thank you for the reply,

While I would have liked to have been examined by a holistic doc they are few and far between in my area and the one that I tried to get into is booked clear into next year with no availability.
Since starting TRT my T levels seem very high to me(1133 as of this past Wed) with little to no changes in the way I feel.
I am seriously thinking about aborting the TRT right now until I can get something else figured out. I dont see the advantage of continuing the treatments without the benefits.
I am planning a Iridology exam as soon as I can get in. Never tried it but have a friend that had good results. I really wish there was a proven holistic treatment for TRT but I havent had any first hand experience with any. I would prefer that route if Im not hurting anything else.

Dave

 

[BadassBlues]

BadassBlues,

Thank you for the information.

Im still very much on the fence about continuing this therapy because of the lack of results.

Clearly my doc is out of her field in the diagnosis but she is willing to work with me. So I guess my questions are;

If I were to continue down the path of TRT should I take the info that has been recommended here to my doc to see if she understands?

Should I seek out a urologist in my area that specializes in TRT?

If I was to decide to abort TRT all together is there any protocol for stopping the therapy?

My main concern right now is doing harm trying to figure it out to an otherwise healthy body.

I really want to feel better and get my ED under control but I ask myself at what cost due to the possible side affects.

Thank you so much for the information and advice thus far. It really is appreciated!

Dave

I'll give you a more in depth answer later this afternoon when I get back in, but at your age, and with your levels being on the low end, I do believe that the right protocol would be very beneficial for you. It's not just the total T number you are looking for, it's the free T, DHT and E2 which all need to be in balance. That takes time to dial in.

 

[Gunner@1911]

I'll give you a more in depth answer later this afternoon when I get back in, but at your age, and with your levels being on the low end, I do believe that the right protocol would be very beneficial for you. It's not just the total T number you are looking for, it's the free T, DHT and E2 which all need to be in balance. That takes time to dial in.

BadassBlues,

Thank you again for the reply and I look forward to your more in depth answer.
One thing though, with me being so new to this I do not understand what all of the acronyms mean so please keep that in mind.

I appreciate all the help.

Dave

 

[Systemlord]

My main concern right now is doing harm trying to figure it out to an otherwise healthy body.

ED is a predictor of cardiovascular/heart disease and a decline in overall health. There’s more harm in the long run quitting therapy now.

TRT is relatively safe.

All you need is a better protocol to get you feeling better.

 

[FunkOdyssey]

My general doc put me on 200ml of ciponate injection every two weeks. ... I had my T levels checked yesterday (1 week after injection) and it was a whopping 1133!

I am wondering if I should decrease my dose and extend intervals between injections?

The 1133 ng/dl is total testosterone, which does not tell us much. You may have a high SHBG value which drives up total testosterone to that 1133 even with a reasonable free testosterone value. Free T is the far more important value which reflects the amount of active hormone and correlates most closely with your symptoms. You can calculate free T if you have your SHBG tested, or you can test for free T directly if you use an accurate form of that test like equilibrium dialysis.

The 150 ng/dl testosterone you started with means that TRT is not a question of just improving symptoms for you. At 150 ng/dl, you needed TRT for your health and longevity. Men that low are at greater risk for osteoporosis, diabetes, heart disease, and all-cause mortality. It will be worth it to stay the course and make adjustments as needed to find a protocol that works well for you.

You definitely want to increase your injection frequency and reduce the intervals between injections, not increase them! The minimum injection frequency that people tend to have success with is once weekly with cypionate. Twice weekly is one of the most popular protocols that works for many people.

If I were you, I would keep the dose at 100 mg weekly for now, increase your frequency to something more sensible that helps keep your levels stable (like twice weekly), and re-test properly so that you have at least your trough (right before injection) Free T and E2 values.

 

[BadassBlues]

BadassBlues,

Thank you again for the reply and I look forward to your more in depth answer.
One thing though, with me being so new to this I do not understand what all of the acronyms mean so please keep that in mind.

I appreciate all the help.

Dave

If you have come this far, you owe it to yourself to, at the very least, do a small course correction to see the real benefits of TRT.

As I said, at your age, low testosterone levels are detrimental to your longevity and your quality of life. I respect what Guided By Voices advised you regarding seeking an overall medical profile, and you should do that. However, age related decline is just a different situation. I am 66, I understand where you are in life my friend.

I have learned to give age related advice over the years. I would not tell a 20 year old the same things I would tell you. The reality is that at your current age, the chances of increasing testosterone levels naturally are not so good. Yes, there are some methods and supplements that you may employ to see a small increase, but it wouldn't be enough to make a difference. I can personally attest to you that there are indeed methods to greatly improve your lifespan and your healthspan. You should seriously take a good look at the Deprenyl / Selegeline link I gave you.

So, back to TRT (testosterone replacement therapy), I will give you explanations of the acronyms so you can familiarize yourself with them. So while we are on the subject, it is a better acronym to refer it to HRT (hormonal replacement therapy). Not only will this give you the knowledge, but it will give you the ability to express to any medical professional that you are someone to be respected. But be advised, most medical professionals are clueless on this subject.

The very first thing you need to do is find a doctor who will work with you. Many on this forum use Defy Medical. Defy specializes in HRT. You stated you are in an area of limited access to physicians. Defy does the majority of their work remotely. This is just a recommendation, you may have more options than you know. There are networks of doctors that we can access to see if there is anyone in your area with the expertise in HRT.

To keep things simple, testosterone cypionate is most likely what you will be prescribed. Your initial dose is something that will most likely be adjusted. 100 mg per week is the usual starting dosage (as was stated by the Funkmeister). That can be a single weekly IM dose, 2 bi weekly IM doses or subcutaneous, Sub Q (under the skin). We discussed the peak and trough above. By doing a weekly, or bi weekly injection you are keeping your testosterone levels from tanking. This is extremely important. You do not want a yo yo effect with your hormones.

Natural testosterone production is controlled by the HPTA (hypothalamic pituitary gonadal axis). Rather than go into all of that here, here is a link that will explain that function:

Hypothalamic–pituitary–gonadal axis - Wikipedia

en.wikipedia.org

It is essentially a feedback loop that regulates testosterone production. Again, there are multiple variables to what can affect this process, but we will stick to the age factor. Age just naturally slows this process down. This is where exogenous (not your own) testosterone becomes beneficial.

As was stated above by myself and others, total testosterone levels are only a small part of the equation. There is a hormone that binds to testosterone, SHBG (sex hormone binding globulin) that decreases the amount of free testosterone. "Free T" levels are what we are after. But... that's not all we are after. Men need estradiol (E2) just as much as women do, albeit at a much lower level. Testosterone converts to E2 via aromatase (an enzyme). Testosterone also converts to DHT (dihydrotestosterone). Both of these need to be in balance with your unique genetics. This is why testing, and time are critical to make this whole symphony come together.

It seems to be an overwhelming and complicated process, but taken logically, with the right testing, dosage and protocol, you can get yourself dialed in in a few months and at that point you would most likely not regret making the decision.