Does Hormone Replacement Therapy (HRT) benefit from use in cycles instead of constant?

[WasHousebound]

Does HRT benefit from use in cycles instead of constant?

The purpose of this thread is to ask this question, before my doctor's appointment in a week:
Is there a benefit to my "cycling" testosterone cypionate, rather than staying on a stable dose (probably for life)?

The answer obviously depends on my demographics, so put plainly:
permanently disabled for ~13 years, now age 45, endocrine system out of whack, auto-immune problems, CFIDS, Lyme-positive (some doctors say post-Lyme, others say B.S. to that), in short doctors don't know what to do for me, so they just follow their little recipes. If I want something done I have to present them with the data and recommendations myself. Shutting down my own production of hormones forever is of no great consequence since the same is already true of my thyroid. Always been at a good weight for my stature, Mesomorph, was lifeguard, runner, racing bike rider, weight lifter (high reps of moderate weight, never went for bulk), naturally powerful (relative to populace, not you guys), etc. 6'1.5", 190lbs, no desire to bulk up over 200lbs, that would tax other parts of my health. Being completely cut would probably lower strain on my other systems and make desired activities easy (climbing, swimming, even just walking in every day life). Liver and kidney function are great, and tested often.

Last few years previous to hormone therapy: needed a cane, could pass out on standing, groin pain, back pain & difficult urination due to BPH - all resolved completely. Now I can even hang upside down from a bar, doing so before might have killed me! (that's called Orthostatic Intolerance)

Once I started using testosterone cream [November?] everything resolved, and I even started working out at a gym with huge improvements. Eventually ability to work out diminished.
Started injections [end of December?] of testosterone cypionate at 100mg/week equivalent (split into two injections), power returned, continued to make fast gains at the gym, this too diminished. Physically crashed, quit going to gym end of February, stopped the month-to-month gym membership. Can start again, or change activities (climbing gym, swimming) when hormones allow.
Side effects began: Bitch tits began, bad body zits, flushed skin.
Started anastrazole at 1mg/week (.5mg x 2 / week) just after blood work "Ultra Sensitive Estradiol - Quest Diagnostics" showed 82 (ref<29 for men)
I concur with the "morning wood" test, that improved and eventually diminished. All side-effects are now gone.
New blood work (same test) showed <2, no Estradiol detected. Obviously I'm cutting the anastrazole dose in half.
First test showed testosterone, total, free, and bioavailable at high end of normal; second test showed them as just mid-range on same dose of testosterone. Been consistent with 100mg/week testosterone cypionate (besides a couple weeks where I tried 150mg/week) since December. I infer this means my own production is shutting down completely - which may not be a bad thing, for other reasons.

If I merely do as my doctors would have me, I'll continue testosterone cypionate at ~100mg/week forever to maintain normal/high testosterone, and the amount of anastrazole to keep my estradiol just under 30.

As their experience is just out of books, and steroid users have real experience, I figure you have a better grasp of the specifics. What recommendations do you forum members have, and any references to back it up (to bring with me to the doctor) if possible, to maximize my benefits from testosterone treatment?

Perhaps PCT (hopefully minimizing the suffering of low testosterone using some drugs) for a particular period of time, and then back onto a steroid cycle, where I plan my activities accordingly, to get the most gain. (I gained weight and lost fat (maybe added 20lbs of muscle and lost 10lbs of fat) such that I'm nearly in ideal shape (10-15% BMI estimate) though I don't have much energy - and may never have much energy as there are other factors.

 

[SolomonGrundy]

you had side effect at 100 mg a week split into two 50 mg shot ? wow.. that's odd for my experience but everyone different. i would have though that to be a perfectly acceptable dose for your body and well accepted and natural stability would have occurred
Glad you have access to the Aromatase inhibitor (AI) meds, now just dial in a standard dosing, be conscience of blood pressure as infrequent higher doses may mask the levels but symptoms can continue in between, i like low daily doses

when im on my normal testosterone replacement therapy (TRT) dose i use no Aromatase inhibitor (AI), but thats me

 

[halfwit]

If you're on testosterone replacement therapy (TRT) you have NO natural production to speak of. Cycling on and off your testosterone replacement therapy (TRT) dose will only make things worse for you. I think you're on the right path with the Aromatase inhibitor (AI) and your 50mg/biwkly injects to be honest. Just keep an eye on your levels and go from there. Remember, some guys function better at different levels of Estradiol, so you may feel better at the upper range (30-40) where others find their "sweet spot" at 20-30.

My .02c

 

[WasHousebound]

[edit] Actually, no side effects from the testosterone, but it caused (or exacerbated) gynomastia - excess estrogen.

Low daily dose of anastrazole (or another AI?) sounds great, using what feels best (20-30 or 30-40) as my target. My "morning wood" optimized about half way through the month going from 82 to <2, so that may be a very simple way of determining optimum dose.

Where do I get really low dose Aromatase inhibitor (AI), and in what form? (I have a legitimate prescription) The anastrazole comes in 1mg tablets which I have to break up to quarters (and is covered by insurance). My doctor can write an appropriate prescription for low daily doses if a source can be suggested. I could ask for 3 months at a time if I must pay cash and it costs very much, I'll order it legitimately from Canada, where anastrazole costs <$**** per mg tablet. A local compounding pharmacy can make the Aromatase inhibitor (AI), but charge about $** per capsule no matter how low the dose and takes no insurance.

Just read up on Liquidex, sold by *** "for research purposes only." I guess that is an option, but since I have a prescription is there an FDA-approved product since I have a prescription?

So no benefit from cycling, where I'd work out heavily for short periods, and only maintain the rest of the time?
And what about cut instead of bulk? I can afford to be skinny, as it takes strain off my organs.

 

[WasHousebound]

Update for those in similar position:
I am not comfortable buying unregulated anastrazole liquid, but found a few sources at roughly $***NO PRICE DISCUSSION ALLOWED*** for 30ml at 1mg/ml. I then called a few compounding pharmacies. regulated, quality controlled product compounded locally, at what you might say is a premium price - seems like pretty cheap insurance for getting guaranteed quality. The bottle came with a high precision oral syringe that fits into a matched inner cap, so I can adjust my dose precisely. Being half strength, my starting dose is 0.2ml daily to equal 0.7mg per week, and I can easily see to adjust it in 0.01ml (0.005mg) increments.

Having just received it, I cannot yet report any change of effect vs cut tablets, but administration is easy - just squirt into mouth. First day I felt a bit off with it absorbing through my tongue so I hold a bit of liquid (coffee) in my mouth, then squirt it. I suppose one could add it to a food or drink, but I think sub-lingual absorbs too fast. The tablets are in a buffer, so they absorb slowly in the stomach, so it makes sense this liquid should be done the same.

I'll report any problem here as soon as it occurs, otherwise assume it works fine. I may report back in a month or two after I'm certain of effect and have more blood work done.

As to cycling for someone such as myself: every source (including two types of doctors, and this forum) say no. It seems I'll be injecting testosterone cypionate for the rest of my life twice a week, at a dose that puts me in the high end of normal range (total, free, bioavailable), and estradiol ~30 (higher or lower as clinically indicated - no gyno & max erections)

BTW: my resting vitals at the clinic at age 45, disabled for years: 120/70 with pulse of 66, 193lbs (max I've been in years, having had problem with wasting away), and low body fat ~10%. Without working out, I'm maintaining an optimal muscle mass (for normal life)

 

[halfwit]

Sounds like you found a great alternative to using pills that don't offer a great deal of flexibility. You're very fortunate in having a doctor that is willing to prescribe an Aromatase inhibitor (AI) and forward it to a compounding pharmacy. Those vitals look FANTASTIC, I'm sure testosterone replacement therapy (TRT) will only continue to help you stay healthy and live a happy life. Thanks for the update!

 

[WasHousebound]

Update for anyone following this...
By the numbers, I am now in absolutely prime condition - but I feel like s**t and have no energy, but that is likely for other reasons. Blood work by another doctor came from the same day I had <2 estradiol, showed low serotonin, low dopamine, high epinephrine, high norepinephrine, really low thyroid even on 300mg Armour. Those were all normal on a previous test before starting anastrazole. So excess anastrazole may have blocked all these other chemicals or there must be some other endocrine factor involved, and I've had to increase my nightly diazepam to 30mg from 20mg (that's a lot). Something is messing me up, though it may be the severe antibiotic/anti-protozoal regimen for Lyme. No doubt all that is out of the scope of this forum, besides the possibility that fluctuating estrodiol has effects that continue for weeks after adjustment. Here are my numbers as of 4/16/13, after a week of locally compounded anastrazole in almond oil ( I now hold a bit of juice or yogurt in my mouth, squirt it in, none gets wasted in container or absorbed through my tongue):
0.25ml x 2 per week injected Testosterone Cypionate 200mg/ml intramuscular in thigh muscles (equals 100mg per week)
0.2ml per day oral anastrazole 0.5mg/ml (equals 0.7mg anastrazole per week)
360mg Armour Thyroid per day (this completely shuts off my thyroid! This is only okay because I have Hashimoto's. For anyone else, this would cause great harm!)
'weak pot of coffee' per morning, sometimes two, as I don't handle stimulant pills (caffeine is gentler than every prescription I've tried, Ritalin is next-best tolerated)
(massive antibiotic/antiprotozoal regimen - not relevant here, but has massive side-effects possible but no known interactions)
Results: (age 45)
Testosterone, Total: 1095 (ref: 250-1100)
Testosterone, Free: 166.2 (ref: 46.0-224.0)
Testosterone, Bio: 378.0 (ref: 110.0-575.0)
SHBG: 34 (ref: 10-50)
Albumin: 5.0 (ref: 3.6-5.1)
Estradiol, ultra sensitive test: 19 (ref: <= 29) [will therefore reduce anastrazole after gynomastia resolves completely]
Blood pressure and pulse: textbook perfect
BMI: not tested, but 'middle of normal' (not ripped or wasting, not fat)
Sexuality: healthy and normal
Gynomastia: grape sized mass is gone - nipples still soft and reactive but that seems to be going away as well

I should be feeling perfect with great energy. The compounded protocol described seems to be ideal without complication. Unfortunately my health has many other factors. I can say with certainty that I'm doing much better than before testosterone replacement therapy, and guess (or hope) that I'll be feeling a continuous improvement now that my hormone protocol seems dialed in.

Needles/Syringes: it was like pulling teeth to get through my doctor and two pharmacies, but finally have what seems to be the ideal needle combination for me, so am sharing this information (caveat emptor, so print this and get your doctor's opinion, opinions may differ):
BD 309659 - 1ml syringe "Tuberculin Slip Tip" (much easier to see a tiny dose than the usual 3ml syringes, but better than one piece because you don't dull the needle drawing from the vial)
BD 305196 - 18G 1.5" needle to draw from vial [G means gauge]
BD 305136 - 27G 1.25" needle to slowly inject into large muscles (thighs are easy) - requires a very steady hand, you certainly don't want it moving around or breaking off.
I no longer have any pain, b***sing, or that charliehorse feeling that sometimes occurred a while after injecting with 25G, but someone without a steady hand or patience ought to use something like I started out with four months ago (BD 305122 25G 5/8" instead of 305136). It's a whole lot easier to inject into my outer thighs than into my glutes. These are all available without prescription from online stores, but getting my doctor to approve changes in my kit was annoying, as was doing my own research. I put this out there in case someone needs this information. Keep in mind that just because the needle is 1.25" long doesn't mean you need to inject at that full depth.

Cost:
*******NO PRICE DISCUSSION ALLOWED******

Logistics:
My doctor first tried to prescribe the compounded ******** for me from a couple sources, and it didn't work out, so I contacted compounding pharmacies with my dosage information and price-shopped, worked out the formula and options (which oil, which strength, which needles), and then took the appropriate information in with me to my next doctor's appointment and he prescribed them - with the pharmacies already knowing what to expect. The doctor decides the dose (amount of which medication), I decided the rest. I only change my dose with my doctor's permission. In fact, I have a second doctor that I run things by to make sure everything is on track. I don't "doctor shop." My doctor decided what I was to do, I decided the source, formula, strength, and in the case of anastrazole - administration type. I even gave him the address to this forum, and my moniker!

 

[IMT staff]

Your E is a little low. You may feel a heck of a lot better up around 40.

The best needles IMO are the BD Integra retractable syringes.

 

[IMT staff]

These are the ones I can only suggest that you get them through your doctor. In my state I buy them at walmart for 67 cents a piece by the box.

 

[WasHousebound]

Ones I mentioned waste the volume between 1ml plunger and 27G needle, then the volume of the 27G needle, maybe a drop. Ones you mentioned waste the volume of a 25G needle, but apparently not an area between needle and 3ml plunger. I guess there's a difference, but my preference is to use a 1ml syringe for my tiny dose, and 27G needle for less muscle trauma since my compounded testosterone cypionate in sesame oil manages to flow through 27G. If "Integra retracting" 1ml syringes and 27G needles existed, I'd use them. We are talking about a very small difference.

Here's a big savings that I started after a while: after removing the needle from the vial with the accurate dose, I tip the needle up and pull enough air to empty the fill needle completely, switch to the injecting needle, expel most air, tap the [edit: syringe - not touching the needle] to remove any air bubbles, and press the plunger until a couple drops come out. After injecting, I draw some air needle-down and squirt the waste onto my thigh which amount to some droplets (one regular water drop total?). Please tell me if there's anything unhealthy about doing that.

 

[Megatron28]

Ones I mentioned waste the volume between 1ml plunger and 27G needle, then the volume of the 27G needle, maybe a drop. Ones you mentioned waste the volume of a 25G needle, but apparently not an area between needle and 3ml plunger. I guess there's a difference, but my preference is to use a 1ml syringe for my tiny dose, and 27G needle for less muscle trauma since my compounded testosterone cypionate in sesame oil manages to flow through 27G. If "Integra retracting" 1ml syringes and 27G needles existed, I'd use them. We are talking about a very small difference.

Here's a big savings that I started after a while: after removing the needle from the vial with the accurate dose, I tip the needle up and pull enough air to empty the fill needle completely, switch to the injecting needle, expel most air, tap the needle to remove any air bubbles, and press the plunger until a couple drops come out. After injecting, I draw some air needle-down and squirt the waste onto my thigh which amount to some droplets (one regular water drop total?). Please tell me if there's anything unhealthy about doing that.

All that to get perhaps half a mg (or less) additional drop of test cyp? The stuff isn't that expensive. Why bother with all that?

 

[WasHousebound]

All that to get perhaps half a mg (or less) additional drop of test cyp? The stuff isn't that expensive. Why bother with all that?

Very little reason, though total waste given all variables might be 0.025ml (10%) per injection or more. I was responding in detail to "IMT staff" that my wastage is pretty miniscule, and I prefer the 1ml syringe and 27G needle vs the potential benefit of the Integra retracting set, because it uses 3ml syringes and 25G needles.

But when I was dumping the "18G fill needle" full each time, and squirting a little out each time like in the movies, my first bottle lasted at least 10% less time than it was supposed to. That has one potentially big problem: the doctor might think I'm cheating. Losing my doctor's trust can lose my legitimate prescription, and therefore my routine blood tests and follow up assistance which are covered by insurance and would be very expensive.

Besides that, the stuff is cheap - but the same conservation methods could be used for something more expensive.

 

[Megatron28]

You aren't supposed to squirt it out like in the movies. That was your problem. Just "prime the pump".

 

[WasHousebound]

Following up to say - all is well.

100mg/wk (divided into two injections)
& custom compounded anastrazole (equivalent of 0.1mg per day) from local pharmacy

quite a while now. Swings are gone, strength is reasonably up, gynomastia gone, effect of low estrogren (crashed thyroid and affected other systems) gone.
I'm not working out, nor intend to. I am level - with testosterone around 1200 and estradiol somewhere around 30.

end of thread, I guess, just following up to state that everything worked out - custom anastrazole from highly reputed pharmacy was key (I didn't want to buy 'research purposes only' stuff):
30ml of "Anastrozole in almond oil with lemon flavor 0.5mg/ml, take 0.2ml (0.1mg) daily by mouth" will last me six months for $****no price discussion allowed read the board rule***.
Warning: squirting right on tongue caused swings - easily resolved by holding a tiny bit of liquid (water, milk, yogurt, juice) in mouth and squiring into that, then chasing with more liquid.

BTW: the subject of needles was a tangent, but for what it is worth, the needles I use (described earlier) work out beautifully - no b***sing, no pain, little wastage.
What was counter-intuitive is that I found I can just gently press the needle to the skin, and let it sink extremely slowly through to muscle causes no pain- but if the spot I choose hurts a lot on contact (right on a nerve?), I just move the needle over a tiny bit (maybe swapping needles). Fast can cramp, "slow" hurts like hell, "extremely slow using almost no pressure" does not hurt. I have no experience with needles, this is just my observation. They can be mail ordered cheaper than the handling fees (here in California), so it just makes sense to buy the full "minimum quantity" and have it last over a year instead of hassling to go through the pharmacy for needles every month.

That's it from me, assume no problems if I never write again. Thanks all!

 

[1693]

Great news, thanks!

 

[WasHousebound]

Been a year, figured anyone who reads this thread ought to have some follow up:
Due to my health conditions (several, not relevant here) and many hard-core medications, keeping hormones dialed in requires blood tests almost once a month. Steroids are a legitimate crutch for me that allow me to function regardless of many other health problems. Not only was there adequate justification directly, but it helps me indirectly (managing to get outside and do stuff helps other parts of life). My condition varies.
Target:
Testosterone, total: 800-1000, free and bioavailable in normal range
Estrodiol, ultra sensitive (estrogen): 25-35 feels best (Quest lab test reference says "<29" which is wrong)

Dose (after a year and a half):
40mg-100mg per week: testosterone cypionate in Sesame Oil from Strohecker's Pharmacy (legit: you must have a prescription) [split to two injections per week, Lyme Disease seems to require extreme consistency]
due to other factors, my body does not process things right so blood tests and frequent changes in dose are necessary
(tiny doses do well with 1ML syringe, 20g needle to draw, smallest needle possible to inject for less trauma - Strohecker's fits through 27g needles - described in earlier post)
with the draw needle still on, with cap back on, running needle under hot water to get near body temperature makes it much more comfortable - obviously avoid contamination
compounded anastrazole only when my estrogen went high (not in a long time) - microdose daily (0.1mg/day)
now trying progesterone cream in low dose - no opinion yet

Working out in a gym was only a short term effect as I haven't been able to do any such thing in many years. It did wear off after a few months; someone similar reading this may achieve balance faster and maintain that effect for much longer. (maybe use less than I did to start? maybe add some progesterone cream?)

Relative to before steroids at all, my health (ability to do anything) is far better; I no longer use a cane! However it has been a roller-coaster ride getting doses dialed in, as my body and unrelated medications keep changing so frequent blood tests help dial in hormones. I dropped the anastrazole after several months; it did its job and my body adjusted. Gynomastia (lump on left, up to the size of a grape; other minor problems) disappeared and never returned.

Now experimenting with progesterone, but there's a lot of contradictory information out there. I have no opinion yet, but it might have avoided gynomastia in the first place.
(I'll make a separate post on the contradictory references to progesterone in a few minutes)

 

[WasHousebound]

Thought I'd bring this up to date, if anyone is interested. Had a head on car crash a few months after my last post, could no longer walk with cane (one hand and opposite shoulder were seriously damaged) so my Urologist increased me to 160mg/wk which brought me back up to my feet. Big help, let me return to reasonable activity. That doctor left my medical system, I got stuck with an idiot endocrinologist, kept on same dose even after my need increased.
Red blood cells went crazy, needed phlebotomy but they wouldn't do it, so went ~8 months in severe pain and underdosed on T as insult on top of injury. As T keeps symptoms at bay that are not even diagnosed, this was a nightmare; I could not walk or leave home again. In May 2017, after several months of phlebotomy normalizing red blood cells, idiot would only increase me to 170mg/wk. Hematologist told him he could increase me more, but he wouldn't. Several months earlier I figured out a nice little method of increasing without buying extra:
Prescriptions have a percent of wastage built in. Learn to use every drop (using a bubble, described elsewhere) and pick up your prescription as often as if you waste what they think you do, and you end up with more than you need (save it, don't just use it). They switched me from 10ml viles to 1ml viles which I thought was pretty stupid - but it ends up giving me even more expected wasted T to work with. By trial and error, I have absolutely zero wastage, and months of T on hand. Not relevant if you have your own source, but for Rx'ed T, this is a big deal. In terrible shape and idiot wouldn't increase it, I increased from 170mg/wk to 200mg/wk on my own. I planned out the 'cycle' and a workout schedule (involving a shovel and wheelbarrow a few hours a day, when I couldn't even walk - but I had to start an exercise to make use of the extra T), and saw my Hematologist over a month later and spoke off record. He said to keep cheating, and he'll keep my blood right. That's been a few months, and I'm even back to the gym a little bit, and feeling great (as opposed to painfully walking with a cane short distances). Can't believe 'idiot' would leave me in that state and call it good. So for anyone in similar situation on HRT, consider getting your own private blood work done and a second doctor who will monitor your health. I'll taper off for a week or so before I must get my T tested for the record, and then go back up; though ordering my own bloodwork on full dose would be better. If I get surprised with a random blood test, I'll tell them I just dosed. If my hematologist finds my blood to lose balance (I'm truly seriously ill, not a cheating athlete) at that point I'll need to taper off the cycle. So far, no need. I get a CBC done every two weeks due to condition (but skip my T tests) and that tells my Hematologist all he needs to know. I had never recovered from the car crash because of needing more T but not getting it, now a few months on 200mg (a few years after crash) and my injuries are fairly healed. As for gym, I'm carefully building tendons and hands and cardiovascular system, adding zero bulk using very little weight. Must work the connective tissues before adding muscle, and may not bother adding bulk. Some 'Beefcake' guys have looked oddly at my doing 3x30 of HIIRT low weight, keeping my heart rate over 120 the entire time and peaking at 160bpm, while they are still sitting at the same machine or free-weight through my whole workout. They are quietly laughing at me, I'm quietly laughing at them! Health is what matters.
I will have to cycle off when my system crashes again, and I do need to figure out how to maintain my gains at that time, using other drugs as mentioned on these forums. E has stayed solid since the switch to two shots per week. 'idiot' isn't testing E when he tests my hormone panel. I should be able to pay cash to get a full complement of tests, but haven't yet had the need.
Learned another alternative I'm not using (yet): Get under the care of a ***** hormone doctor, and s/he'll send you your hormones by mail order. I accidentally found that out when I contacted one when considering moving to ***** in order to get healthcare! Apparently, moving to **** is not necessary; they'll send it. Same goes for another type. Be prepared to spend a lot more money, but only about the same as a cash hormone doctor in the USA but without the US restrictions on dose. There may be quality issues, and flying there to get subcutaneous pellets is an option.
That's just a basic update. Left to my idiot endocrinologist, I'd be walking with a cane right now and taking several days to bring in the groceries. By having zero waste and a second doctor keeping track of my health, I'm working out in the gym and you can't really tell I'm ill.
I will have to ask, though, what to do to cycle off when I come to a crash as will happen at some point. I'm pretty sure that as the thread title says, I do better with some cycling. I'll ask here when that happens.
- WAS housebound. (and will be again, but not for a while)

 

[Nicky_eye_lids]

what a horrible ordeal to go through when you know you need more Test in your system to get your levels higher and the Hematologist wont do what he has to do.