Is there a standard testosterone replacement therapy (TRT) starting point protocol?

[bigben66]

Is there a standard TRT starting point protocol?

Hi,

I've booked in to see an endo in a week's time with regards to my libido and ED issues... My natural Test levels have dipped alarmingly and my want for sex and everything that goes with it are non-existent...

I've tried Testogel sachets to no effect last year and I'm hoping that I can convince the endo to start me on a testosterone replacement therapy (TRT) protocol and hopefully get them to prescribe some Cialis too.

I have a strong feeling (I live in quite a remote and dated village) that I would be better going to see them forearmed with an idea of what I think I'd like to try, and then use my powers of persuasion...

I was wondering if there is considered a starting point protocol for TRT?
I know it's usually Test Cyp with an Aromatase inhibitor (AI) - but is there a standard dosing for these which can be tinkered with after commencing?

I'd like to go to them and say 'Please try me on this and see how I go' rather than just walk into the clinic looking like a blank canvas...

Your thoughts would be greatly appreciated fellas...

BTW: I'm 42, 5ft 9", 205lbs and about 9-10% BF (see avatar)

Thanks in advance

BigBen66

 

[lxm]

I started testosterone replacement therapy (TRT) through the NHS about 7 months ago and have had laid out to me the NHS testosterone replacement therapy (TRT) protocol....

A warning, the NHS give you only enough testosterone to take you to the lower/mid of the 'normal' and nothing more, with the aim of freeing you of symptoms to function normally and give you a sex drive.

Since you have tried the gels, I shall miss them out, the options for you are Nebido or Sustanon250, these are the only two injectables that are offered. (BTW THE DOSAGE SCHEDUELS ARE HORRIBLE AND CAN MAKE YOU FEEL WORSE WHEN THE CRASH COMES AND THE SYNTEHTIC T AS LEFT YOUR SYSTEM)

Sustanon250

You will be started off at 250mg (1ml) injected one time every 4 weeks. (62.5mg per week) Depending on how you feel and bloods, this will be lowered to 250mg (1ml) injected one time every 3 weeks (83.3mg per week)

This is usually where the dosage frequency stops with sustanon250 on the NHS. The guidance and the literature in the british medicines prescribing book states dosage @ 1ml E3W. Even if your trough bloods show poor numbers at E3W and you are symptomatic, most endos wont agree to 1ml every 2 weeks (125mg per week)

There are some endos who have the experience and confidence to prescribe the sustanon250 at every 2 weeks, but they are far and few between because most endos In the UK are diabetes specialists, and don't have a clue.


Nebido

1000mg (4ml) of Nebido injected one time every 12 weeks, there will be a loading phase at week 6, then maintenance injections at 12 weekly. Some endos will adjust this to 10 or 11 weekly.


That's your options mate, I think you have read too much about the American side of things like I did, and you will be sorely disappointed with what we have. There is no 100-150mg injections every week with Aromatase inhibitor (AI) or HCG... its all based around how the testosterone is stored in single use amps, so that amp will be prescribed and injected once to cover a lengthened period until its depleted in your system.

I personally had a nightmare. Was started on 250mg sustanon every 4 weeks... After the first 2 weeks of my first injection I crashed hard and was really unwell, the way I felt made me pretty much dysfunctional... until of course my next injection... I crashed hard again after 2 weeks and the endo kept me on this schedule for a further 4 months (How can a doctor have a patients quality of life suffer needlessly?)

I switched over to 3 weekly injections without the Endos instruction and finally at my next appointment he ordered blood trough at 4 weeks and agreed to switch me to E3W. Still at this frequency I was crashing hard, I have since switched over to E2W injections without my Endos instruction but through my GP and have had a trough blood level drawn for this frequency. I know at my next review the endo will take me off the sustanon250 E2W and move me over to Nebido....

Most NHS patients have to visit the GP or Nurse for the injection, although many ask for self inject, this of course would give you the option to change things about yourself, but the above info is the base you have to work from!

I hope this helps!

 

[DreDay187]

The absorption rates of transdermal systems is something around 10% and can affect anyone you come in physical contact with so mention that to get injections. Usually it would be a small dose of test cyp or maybe enanthate even under 250mg/wk or so. Make sure there's a full blood panel being done to see if it could be something else affecting you besides just low test. Good luck BigBen, hope you sort this issue out ASAP brother.

 

[lxm]

A short version of my above post

-NHS only prescribes Sustanon250 or Nebido. You will initially be started with the longer frequency. Injections are not split weekly, the single use ampule dictates that the dosage will be injected one time and left over the frequency period.

Sustanon250
-Guidance to doctors is 1ml at E4W then E3W (62.5mg then 83.3mg per week) - Some experienced endos will change to E2W (125mg per week) but you will have to go through the latter first with trough tests (takes months)

Nebido
-Guidance to doctors is 4ml at E14W, with a 6 week loading phase. then E12W. - Some experienced endos will change to E10W or E11W but you will have to go through the latter first with trough tests (with nebido will take up to a year)


Pretty much the maximum amount of test given in the UK on the NHS is 125mg (sustanon) and that is if your lucky enough to find an Endo to agree! otherwise its 83.3mg (sustanon) or 100mg (nebido)

 

[Megatron28]

A typical testosterone replacement therapy (TRT) protcol is 100-200mg of test per week via injection. Sometimes an Aromatase inhibitor (AI) is needed at that dose. You need to check your E2 regularly to determine if an Aromatase inhibitor (AI) is needed.

What is your Total Test currently at?

 

[bigben66]

Thanks guys, and big thanks to lxm for the UK perspective... albeit quite daunting

I should have results back from latest testing over the next couple of days so will post them here for your thoughts asap.

I had a feeling the UK guidelines would be far and away from what I've read from US posters on here... I guess I'm facing a challenging few months!

 

[DreDay187]

Thanks guys, and big thanks to lxm for the UK perspective... albeit quite daunting

I should have results back from latest testing over the next couple of days so will post them here for your thoughts asap.

I had a feeling the UK guidelines would be far and away from what I've read from US posters on here... I guess I'm facing a challenging few months!

Good luck BigBen!!

 

[lxm]

No problem.

I'm 22 and would rather not have to go through all of this! NHS really is backwards.. The peaks & troughs of the NHS schedules are horrendous and Oestrogen is not taken into account at all - although they test for it and have 'reference ranges'

My last E2 reading was 222pmol at a trough(0-150 range) and I was having complete Erectile dysfunction for the first 1.5 weeks after injection, I only got errections back for the last 3 days before my next injection...

I asked the Endo what he was going to do with my E2 levels and highlighted my ED issues. He said that E2 plays no important role in men and that my E2 is high because of my bodyfat level and that I need to loose weight. I asked him why they test for E2 and have ranges for the hormone and 'ermm haaahmmm' was the response. If your Testosterone is out of range they treat it, if your E2 is out of range they don't.

Good luck....

 

[bigben66]

lxm....

I do have private healthcare.... it might be an option to try and have a consultation using this first?

Your thoughts?

 

[lxm]

lxm....

I do have private healthcare.... it might be an option to try and have a consultation using this first?

Your thoughts?

I am covered under BUPA through my mum, we looked down that route and the reality is that its the same protocol anywhere in the UK, they use the same guidelines and knowledge private or not! (unless you are visiting an independent private male sex hormone Endocrinologist specialist in London's Harvey street) Just because you are paying private wont get you more testosterone prescribed unfortunately, or an Aromatase inhibitor (AI) or HCG, and it turns out its the same doctors...

 

[bigben66]

I am covered under BUPA through my mum, we looked down that route and the reality is that its the same protocol anywhere in the UK, they use the same guidelines and knowledge private or not! (unless you are visiting an independent private male sex hormone Endocrinologist specialist in London's Harvey street) Just because you are paying private wont get you more testosterone prescribed unfortunately, or an Aromatase inhibitor (AI) or HCG, and it turns out its the same doctors...

OK, cool, well I guess I'll suss out the endo next week and see how my persuasive powers work... I really appreciate you taking your time to explain your protocol and the problems you have had so far - it'll stand me in good stead for my battle.

Thanks again guys... be healthy!

 

[DreDay187]

Don't know if they operate in the UK but we have a board sponsor IncreaseMyT that is more forgiving when it comes to these matters. Maybe there's similar programs in the UK so you can get by those doctors that are closed minded. Another option would be to self-medicating testosterone replacement therapy (TRT) once you get a diagnosis from the Endo?

 

[lxm]

@bigben66

Its no problem! Honestly I usually struggle with the testosterone replacement therapy (TRT) sites, not really anyone to talk with or relate to via NHS care... or if there is its a 2 week wait for a reply to a post.... I had to figure it out myself by going through it all.

I live in Scotland and it turns out that there isn't any 'male hormone/androgen' specialists here at all! All endos are pretty much Diabetes registrars & consultants...Turns out my GP's son is on testosterone replacement therapy (TRT) and she had already searched the NHS's endos up here with no result, so had to settle with a well seasoned Diabetes consultant who was willing to research and dig about....


Another option for you once you get a diagnosis and a repeat prescription and are only on 6 or 12 monthly reviews is to go it alone. Source yourself Pharm testosterone and run it on a decent schedule whilst still collecting your scripted gel, sustanon or nebido. You can then once collected enough of your scripted stuff to run it in batches at your preferred dosage.. i.e. your own bought stuff, then your NHS stuff. I have thought about this.

@DreDay187

There is no physical or 'online' "anti aging" clinics such as IncreasemyT within the UK who work in partnership with private doctors and pretty much write and hand out protocols and scripts generously, everything is pretty well regulated and has to initially go through the NHS General Practitioner.

 

[DreDay187]

@bigben66

Its no problem! Honestly I usually struggle with the testosterone replacement therapy (TRT) sites, not really anyone to talk with or relate to via NHS care... or if there is its a 2 week wait for a reply to a post.... I had to figure it out myself by going through it all.

I live in Scotland and it turns out that there isn't any 'male hormone/androgen' specialists here at all! All endos are pretty much Diabetes registrars & consultants...Turns out my GP's son is on testosterone replacement therapy (TRT) and she had already searched the NHS's endos up here with no result, so had to settle with a well seasoned Diabetes consultant who was willing to research and dig about....


Another option for you once you get a diagnosis and a repeat prescription and are only on 6 or 12 monthly reviews is to go it alone. Source yourself Pharm testosterone and run it on a decent schedule whilst still collecting your scripted gel, sustanon or nebido. You can then once collected enough of your scripted stuff to run it in batches at your preferred dosage.. i.e. your own bought stuff, then your NHS stuff. I have thought about this.

@DreDay187

There is no physical or 'online' "anti aging" clinics such as IncreasemyT within the UK who work in partnership with private doctors and pretty much write and hand out protocols and scripts generously, everything is pretty well regulated and has to initially go through the NHS General Practitioner.

Gotcha brother. Didn't know how it operated over there. Only time I've been to the UK was on a layover to the Middle East. Been meaning to go back though but apparently not for testosterone replacement therapy (TRT) hahahaha. That's good info to have though for the future in case anyone asks. Thanks