Just Started HRT...many questions please help!

[willnorthwest]

Hello everyone. 33 year old male, feeling tired all the time, anxiety, depression, low libido. i have felt this way for many years and decided to get tested for low test. Test levels came back at 218ng. Doctor initially prescribed 200mg Depo-Testosterone Cypionate once a month. Got my first shot of 200mg on 3/1/2013. I did some research and found that 200mg once a month was a horrible idea, so I went back to him and convinced him to give me 100mg every week. Got my first 100mg shot 3/15/2013.
Questions:
What is Human Chorionic Gonadotropin (HCG) and do I need to have some on hand?
What is Aromatase inhibitor (AI) and should I have that on hand as well?
Shouldnt my doctor already know the answers to these questions? He told me to call him if I have any side-effects!

Im very new to this Hormone Replacement Therapy (HRT) stuff, and need to know exactly what else I need to be taking in addition to the Cypionate that Im supposed to be injecting once a week
Also, I want to start a family pretty soon, am I okay taking testosterone and trying to have kids?

Please help, Thanks!!

 

[Daniel_IMT_Staff]

Willnorthwest

Sorry to hear that and yes you are correct, you should be able to ask your doctor these questions and he should know the answers.

HCG is a medication which mimics luteinizing hormone (LH.) LH is the hormone that your brain(more specifically pituitary) sends to your testicles to stimulate testosterone. Adding hCG to your therapy will prevent testicular atrophy and maintain intra-testicular testosterone levels. It is an amazing medication and should be a staple to TRT.

AI or aromatase inhibitor is a class of drugs which interfere with the conversion of testosterone -> estrogen. Most commonly, anastrozole is used. Testosterone converts to estrogen at a certain rate, this is very individual and the use of an Aromatase inhibitor (AI) is to control estrogen levels from running rampant. Most TRT patients discontinue their TRT because their doctor prescribes testosterone only and they get all these side effects from estrogen such as bloat, enlargement of the breast tissue(gynecomastia), mood swings including crying for no obvious reason, elevated blood pressure and the list goes on.

About 50% of TRT patients can start a family without a problem. We have programs to increase your fertility which make it a lot easier. This is very individual depending on your diagnosis.

Anytime I see a TRT patient on the boards asking questions about their therapy indicates two things. Either their doctor doesn't have the knowledge-base required to help the patient balance his hormones or the patient doesn't trust his doctor.

It's very easy to switch over your treatment to IMT.

 

[HammerT1]

My recomendation is get with a testosterone replacement therapy (TRT) Speaclist. It's a long road and better to do it right with the experts.

Sadly I know it all to well. I am still doing it the hard way. It has been a crappy ride with it is not being done properly or correct dosages. You definately don't just want to be taking thes test without the other meds when there is so much going on with what test can do.
Good luck.

 

[willnorthwest]

Okay guys, thanks for the help so far! At this point Im gonna call my primary physician and ask him to refer me to the best testosterone replacement therapy (TRT) specialist in town. I live in Johnson City, TN, which has a huge medical community....ie ETSU medical school, Mountain Health State Alliance, etc... So im sure that there are many qualified experts in my town.
Few more questions:
What would be a good maintenance dose of Human Chorionic Gonadotropin (HCG) and Aromatase inhibitor (AI) to compliment my weekly 100mg Cypionate injections? I would like to be able to discuss this issue with my testosterone replacement therapy (TRT) specialist and semi seem like I know what Im talking about, as well as to make sure that he in fact does know!

 

[300winmag]

maint Human Chorionic Gonadotropin (HCG) probably between 500IUS to 1000IUS weekly, dosing schedule can be debated. But you may not need the stuff. personally it does nothing for me. Only reason i am on it is so I can have kids, because testosterone replacement therapy (TRT) killed my swimmer count. Aromatase inhibitor (AI) maybe .25 ot .5mg 2-3 times a week depending. again you may not need it. get blood work first. I firmly beleive there is no reason to throw meds at something until the blood work and how you feel confirms it.

But if you are wanting to start a family, you may hold off all till you start and at least get one kid going. If you decide the testosterone replacement therapy (TRT) route you NEED to get sperm analysis first, that was my mistake. Then probably get another one 4-6 months in.

Good luck

 

[willnorthwest]

300winmag...
Although I am wanting to have children, my first priority is my health. If my testosterone replacement therapy (TRT) prevents me from physically having kids, but makes me feel like a strong, healthy man again, then I have absolutely no problem. I don't have a problem adopting, as there are many kids that need a home.

So is hCG an injectable or an oral?

 

[IMT staff]

maint Human Chorionic Gonadotropin (HCG) probably between 500IUS to 1000IUS weekly, dosing schedule can be debated. But you may not need the stuff. personally it does nothing for me. Only reason i am on it is so I can have kids, because testosterone replacement therapy (TRT) killed my swimmer count. Aromatase inhibitor (AI) maybe .25 ot .5mg 2-3 times a week depending. again you may not need it. get blood work first. I firmly beleive there is no reason to throw meds at something until the blood work and how you feel confirms it.

But if you are wanting to start a family, you may hold off all till you start and at least get one kid going. If you decide the testosterone replacement therapy (TRT) route you NEED to get sperm analysis first, that was my mistake. Then probably get another one 4-6 months in.

Good luck

We will have to agree to disagree here, in the following study out of 1100 men, testosterone implementation made the Asian men infertile, 99% of them. Upon cessation of the testosterone all but 2 of them regained fertility..................... it is my guess these 2 men had problems before they started the T.

There is no reason to hold off testosterone replacement therapy (TRT) because of infertility issues, there is 0 evidence to back up the sterility claims. I see you tell guys that a lot, but it is on a whim at best.

There was no evidence of major side effects, and all but two of the men in the study returned to normal fertility after stopping the injections. The average time it took for the men to return to normal fertility was around six and a half months.

Testosterone Tested as Male Contraceptive

PS : in caucasian men testosterone was only about 72% effective as a contraceptive, about the same as a ripped condom

Test makes you infertile: Rumor

It took 6 months to regain fertility, without Human Chorionic Gonadotropin (HCG), with it I am sure it would happen, and have seen it happen, 3 times as fast.

So until someone provides some evidence suggesting T can make you infertile, I would suggest not telling people that.

 

[willnorthwest]

I don't give a shit about my fertility, like I said, I'll adopt.

Since I got my first shot of test cyp I have felt better. I have more energy, my libido is finally good, and I have no anxiety, depression, or sleep issues. This has all happened in 18 days, as my first shot was on 3/1/13. I do know that in a few months, however, that my testicles will probably shrink. I would like to avoid this. Recommendations would be encouraged on how to prevent this.

I also know that testosterone replacement therapy (TRT) can also elevate Estrogen levels. I would also like to prevent this. Again, recommendations as to proceed would be encouraged

 

[IMT staff]

HCG will keep form and function.

 

[willnorthwest]

what is the best Aromatase inhibitor (AI) to take? I believe there are a few...Arimidex, Nolvadex, Clomid.......which is the best to use for testosterone replacement therapy (TRT), and at what dosage and frequency?

 

[IMT staff]

I am sorry man I want to help you but I can not recommend anything on behalf of IMT unless you are a client of ours. This is one of the main reasons clients use us, because of our comprehensive knowledge in the field of TRT.

 

[willnorthwest]

first of all, im not asking IMT to give me recommendations. I thought this forum was for individuals, by individuals, trying to help and give their own personal recommendations based on prior experiences. That is all I am asking......

Re-stated
Based on your own personal experiences, what is the best anti-estrogen medication to take? Also, I have only been on testosterone replacement therapy (TRT) for 3 weeks, so Im hopeful that I wont need any AI's for awhile. But, at what point do most people start taking AI's during testosterone replacement therapy (TRT)? Do they immediately begin Aromatase inhibitor (AI) medication while beginning testosterone replacement therapy (TRT)? Or can Aromatase inhibitor (AI) introduction take place a few months after starting TRT?

 

[IMT staff]

It would most likely be a good idea to start with the weakest. Exemestane is not approved by the FDA so that just leaves 2 that would most commonly be used.

Obviously speak with your physician before changing anything.

The difference between anastrozole and fermara is their ability to penetrate dense lipid cells.

 

[Megatron28]

Just my two cents here... Instead of focusing on what drugs you may need, you should key in on what lab tests you will need to run and when. Knowing how to interpret your blood work is the key to managing your testosterone replacement therapy (TRT) protocol and being able to engage with your doctor. It is probably less useful to debate whether arimidex or aromasin is a better aromatase inhibitor. They are both good. It is like asking what is the best NSAID -- ibuprofen or naproxen?

 

[willnorthwest]

megatron....
okay im listening.
heres my situation. i started trt on 3/1/13 after blood work results indicated t level at 218ng. my free test was in range. the major problem i have is that i don't think they tested my estradiol level! so basically i have no idea what my estradiol level was before trt began! now, another problem im having is that when I asked my doctor if i should be taking hCG or Aromatase inhibitor (AI), he said "nah, just call the office if you have any side effects"! Well, I can tell you this....I am definitely feeling better since I started therapy 18 days ago, and I don't want this overall healthy and strong feeling to slowly/rapidly fade away due to elevated estrogen levels. I might need to switch docs as he is just a general practitioner....I have quality insurance and need to find a quality trt expert in my hometown. Im not really interested in online clinics. I guess an endocrinologist is the way to go

 

[Spudstr]

I am sorry man I want to help you but I can not recommend anything on behalf of IMT unless you are a client of ours. This is one of the main reasons clients use us, because of our comprehensive knowledge in the field of TRT.

that sounds more like, "FU pay me" , and yet your on a forum where people come in a common place for answers and all you want is money before saying anything helpful.

 

[THE-DET-OAK]

Well they are in the business................. that would be like you fixing people's car for free. Not to mention it is against the law for them to conflict any advice given from the patient's physician without their written consent.

This is a free forum, IMT never said others couldn't help them. They just can't. If you don't understand that you are not very bright.

Looks to me like Todd added quite a bit to the thread, with scientific evidence to back it up no less

 

[Megatron28]

megatron....
okay im listening.
heres my situation. i started trt on 3/1/13 after blood work results indicated t level at 218ng. my free test was in range. the major problem i have is that i don't think they tested my estradiol level! so basically i have no idea what my estradiol level was before trt began! now, another problem im having is that when I asked my doctor if i should be taking hCG or Aromatase inhibitor (AI), he said "nah, just call the office if you have any side effects"! Well, I can tell you this....I am definitely feeling better since I started therapy 18 days ago, and I don't want this overall healthy and strong feeling to slowly/rapidly fade away due to elevated estrogen levels. I might need to switch docs as he is just a general practitioner....I have quality insurance and need to find a quality trt expert in my hometown. Im not really interested in online clinics. I guess an endocrinologist is the way to go

I am guessing that your estrogen probably wasn't a problem before you startewd TRT. What matters now is monitoring it while you are on TRT. Get your estradiol checked. If it gets elevated ask for an Aromatase inhibitor (AI). Read the TRT stickies for how to use Private MD - Buy Lab Tests Online.

 

[willnorthwest]

megatron...
okay i think i might just do that! where i live there is a Any Lab Test Now store. They can do the Estradiol test for only $49 and the results will be back in only 8 days. Even though i have already started my testosterone replacement therapy (TRT), I still think it would be good to get a baseline Estradiol measurement. However, do you think that I should start Aromatase inhibitor (AI) regardless of the results? I mean, wouldnt it be easier to take an Aromatase inhibitor (AI) as a form of preventative measure rather than waiting to see if and when my Estrogen level does increase?

 

[Megatron28]

The one I told you about is cheaper for a full panel and you get your results in 24 hours. Check it out.

Don't take Aromatase inhibitor (AI) unless you need it. That would be dumb. Lot's of guys on a TRT dose don't need Aromatase inhibitor (AI). Having low E2 is just as bad or worse than having it too high.