2nd Time Around - Need Recommendations

[Pharmer7]

Hey guys, I'm new to this forum so please bear with me. I'm in need of some experientially informed guidance, and I hope I've come to the right place! I'm considering going on TRT for a second time, and I need some advice. I apologize for the length of this post but I want to cover all my bases so that you guys can (hopefully) best help me out.

Basics: 21 y/o male, 5'9.5, 167 lbs, very fit/lean. No drinking, no drugs, healthy diet and ample exercise (resistance and cardiovascular).

Background: About this time last year (beginning of spring), I was dealing with crippling exhaustion (both physical and psychological, excessive sweating/hot-flashes, moderate depression, an absent libido etc. However, I had little trouble putting on muscle mass - my only issue is maintaining it. Anyway, I had a hunch that my testosterone was low so I asked my doctor to check it. I don't have all the labs in front of me so I can't provide every figure, but my total testosterone was 215. None of the other figures were out of the normal range, however the free testosterone number was quite near the low end of the range. My doctor put me on Androgel 1.0%, 6 pumps daily (6.25mg if I remember correctly?)

I noticed instant improvements, both psychologically and physically. Within a few weeks, my hot-flashes had largely subsided and I had returned to more normal energy levels. My body composition changed to some extent, which was a bonus. I was currently enrolled in a PT course with ROTC at my university, so that definitely compounded my results. Anyway, after about a month or two I started to experience some ups and downs in terms of my energy levels (and thus, most likely, my testosterone levels as well). I expected this because it's near impossible to match the release 'schedule' of endogenous testoerone. Either way, I was feeling much much better than I was before, and I was willing to put up with a few down days here and there; the results were worth it to me. The only thing which really persisted was my depression, but surely for other reasons as well.

The catch: Androgel is god-awfully expensive. I was (and am currently) without health insurance, and it was costing me 300-400 dollars a month. This was entirely unsustainable for me, so I asked my doctor about other alternative methods for TRT. He suggested shots, gave me one that day, and tested my levels again (it had been ~3 months since I began treatment). He called me back saying that my levels had returned to a healthy, normal range ~700, and that this meant that I didn't need treatment anymore. He discontinued my treatment and recommended I see a therapist for my depression. He discharged me as a patient and that was that. Absurd, right?

Anyway, I took measures to try to manage these symptoms which (unsurprisingly) began to come back after a while (though less severely). I looked into the actual causes of low testosterone, and made the decision to start supplementing with Zinc. I already had most of the other bases covered: I don't drink, I don't smoke, I don't stress, I sleep well, I do resistance training, I get lots of sun and supplement with vitamin D, I take fish oil, I eat very healthily (including lots of fats). The zinc helped pretty considerably, and seemed to offset the peskier side effects of low T that I had been experiencing, whether or not it actually helped to raise it (via natural aromatase inhibition). Most of all, it combated my exhaustion.

Fast forward to now, and I decided to have my levels out of curiosity rechecked by an old physician of mine (not the asshole mentioned above) at my university's health center. I pursued retesting because I had since thinned out a good deal, and my libido had returned to nill. My results were unsurprising:
SHBG 29.1 (normal 11-80),
total testosterone 287 (normal 300-1080),
free testosterone, 2.1% (normal 1.6-2.9)
albumin 4.3 (normal 3.5-5.0)
estradiol E2 24 (not given range, I don't have this lab in front of me) - but within normal range (not elevated significantly).

This physician has agreed that it would be reasonable to resume TRT and she's willing to do so. I came to this forum to ask your guys' recommendations about the various forms of TRT and which you think might be best suited for me. In my experience, the shots were more prominently effective than the Androgel, but the brand-name gel was out of my price range. The only shot I had, however, made my my nuts atrophy to pre-teen size within 2 weeks.

So,

• should I do shots?
• should I get a cream/gel compounded?
• should I try troches (sublingual form)? I'm especially curious about these.
• are there any other options you guys think I might want to try?
• will I need to 'cycle'?
• what might a cycle look like for someone on TRT for legitimate hypogonadism (i.e., not for bodybuilding purposes)?
• can I/will I need to account for testicular atrophy (HCG)?

Naturally, these are questions I'll be asking my doctor when I see her next week, but I'd also value the input of those more subjectively experienced herein. I really appreciate any feedback from you guys. From what I've read, you guys are a supportive community and I feel that I've come to the right place. Please let me know if you guys have any questions for me, and I'd be happy to provide any and all information I can. I'm a biology student too, so please discuss this as scientifically as you wish

Cheers,
Lucas

 

[ws2006]

Most on this forum will recommend shots - typically split into two injections for a more even ride. It will help nullify the roller coaster effect by keeping you out of the supra physiological range and the extreme lows of an empty trough.

HCG is best if you ever plan to have children or the cosmetics of your nuts is important to you. Probably want to think about an aromatase inhibitor as well just in case you are sensitive to estrogen conversion - everyone seems to react differently.

I would advise against "just doing a cycle" as that will hurt your natty production and levels even more - especially without a proper post cycle therapy (pct). Cycle does not equal TRT. Most will run 100-200 mg test cyp per week, 250-500 iu Human Chorionic Gonadotropin (HCG) per week.

Some issues with the gel - many just don't see results, it can be transferred to women and children, skin irritation - shots are the way to go. I have never tried the troches but I think I remember reading they are fast acting with a short lifespan so need to be taken frequently. Others with more experience may have more information on them.

Hope this helps - good luck whichever way you decide to go!

 

[Sedg1]

Not sure what other treatments cost, but cyp injections at my docs office - 200mg every 10 days - costs $35. That is pretty much what a cup of DD coffee and a bagel costs per day, and a lot more satisfying. I suspect that a script for the same dose for self-injections would be peanuts.
The idea that a doc would initiate testosterone replacement therapy and discontinue the treatments once at therapeutic levels were achieved would encourage me to find another doc as well. He seems to be confusing treatment with cycling. Good that you came to the same conclusion and found another doc who supports the care.
At least you know it works. And the cost of injections will not bleed you dry.
You may also want to talk to your new doc about a referral to an endocrinologist to see if there is a physiological explanation for your low levels. At 21 yo. you should be a testosterone factory.
Best of luck, bud.

 

[Daniel_IMT_Staff]

At your age, I hope you had comprehensive labs done to establish an epidemiology of your low t. Have you received a diagnosis? Primary/secondary?

 

[Pharmer7]

Thanks for the responses guys,

ws2006 - when you mention having the shots split up, do you mean splitting what would otherwise (perhaps) be a 2 week dose into one half of that dose every week instead of every other week?
do you have a specific recommendation as to which ester may prove most useful in my case?
is arimidex available generic? is it costly either way?
is this kind of treatment (TRT) going to be something that I'll likely be on all year round, or is it something you go off and on with? (I'm basically asking how cycling works with respect to testosterone replacement therapy (TRT) and not bodybuilding purposes).

sedg1 and Daniel_IMT_Staff - I have had pretty comprehensive labs done with nothing conclusion showing up. I suspect that I may have a very very small benign pituitary adenoma, but I cannot afford to have this checked with medical imaging, much less operated on. There are a few in my close family.

Thanks again for your help guys, I appreciate it!!

 

[totalburnout]

Pharmer - your LH & FSH being tested as long with your prolactic levels being tested will help give some insight into potential causes for the problem.

You don't 'cycle' TRT. You're on it for life or until your body can recover and begin its own production (thats with a hCG type protocol which would be recommended for someone who is young like you).

Yes Arimidex does have a generic. The drug is actually Anastrozole.

A 10-20 week supply will likely cost about 100 for Test Cyp and Anastrozole - even without insurance. Needles were $7 @ Rite Aid with their wellness card.

Test gels will be significantly more. Testim1 does have a card that the first 12 months the costs are drastically less. (Only $10/month with insurance).

 

[ws2006]

Thanks for the responses guys,

ws2006 - when you mention having the shots split up, do you mean splitting what would otherwise (perhaps) be a 2 week dose into one half of that dose every week instead of every other week?
do you have a specific recommendation as to which ester may prove most useful in my case?
is arimidex available generic? is it costly either way?
is this kind of treatment (TRT) going to be something that I'll likely be on all year round, or is it something you go off and on with? (I'm basically asking how cycling works with respect to TRT and not bodybuilding purposes).

sedg1 and Daniel_IMT_Staff - I have had pretty comprehensive labs done with nothing conclusion showing up. I suspect that I may have a very very small benign pituitary adenoma, but I cannot afford to have this checked with medical imaging, much less operated on. There are a few in my close family.

Thanks again for your help guys, I appreciate it!!

Typical esters for TRT are cypionate or enthanate - depends on where you live. Cypionate is popular in the US and the two have a similar half life. Splitting doses is generally done on a weekly basis about 3 1/2 days apart - some do fine with weekly injections but most prefer two per week since they start to feel like ass the day or two before their injection when running a week at a time. There is no cycling with TRT - you are on for life - people do blast while on TRT though and run higher levels similar to cycling but then go back to their standard dose - nice thing is that there is no post cycle therapy (pct) needed if you are on TRT.