Recently diagnosed with low T, just started TRT and looking for advice

[jpritchard11]

Hey Guys,

I was recently in for a visit with my primary physician to do some bloodwork and everything came back good/great except for my T levels. Based on the results of the bloodwork my Testosterone was measured at 108 ng/dL and my Free Testosterone was measured at 5.4 pg/ml. According to my doctor both levels are very low for my age. I am 33 years old, 6ft tall, and weigh approximately 175-180. I follow a pretty strict diet and work out 5-6 days per week regularly and would consider myself to be very healthly and in good shape. Unfortunately I've had a feeling that there was something "wrong" with me for a while but I couldn't quite put my finger on it. My energy levels have been pretty low, sex drive non-existent, and I have felt "off" for the about the last 1.5 years. I was pretty relieved to get this diagnosis as I feel that the TRT will really help to get me back on track.

My doctor prescribed the following regiment:

8 weekly shots of 200mg testosterone cyp with 2 daily doses of 50mg of zinc. 10 days after the last shot I will then start taking HCG along with either tamozifen or clomid for 5-10 days and then redraw blood to see what my levels are at.

I did my first shot on Monday and am noticing some minor differences such as a slight increase in energy levels, concentration, and also morning erections. I have absolutely zero experience with TRT and am hoping for any advice/insight that the more seasoned members on this board can give me. I have the results of the full panel of blood work that was done and would be happy to answer any questions that I can to clear anything up. Thanks in advance for the help!

 

[Megatron28]

Were you diagnose with Secondary Hypogonadism? I am guess yes since your doc wants to put you on hCG.

What is your docs rationale for using test injections for 8 weeks and then trying hCG? This will only further suppress your HPTA and make it harder to get yours working again. Has your doctor ever successfully helped a patient restart their HPTA? Did you discuss using clomid?

Sounds like you have a bad doctor. I would encourage you to read the following thread to learn more about TRT. Sounds like you are going to have to advocate better for your own health

http://www.steroidology.com/forum/testosterone-replacement-therapy/662394-basic-trt-overview.html

 

[jpritchard11]

I'm not sure about the secondary hypogonadism, it was not something that he brought up.

My understanding of doing the injections for 8 weeks was to get my test levels back to a normal range and then transition to HCG to trigger my body to start producing test on its own. We discussed using either tomaxifen or clomid along with HCG to help keep estrogen levels down.

He did tell me that he's been able to get some of his other patients with similar test levels back to normal/natural testosterone production with a similar type of regiment.

 

[Megatron28]

I'm not sure about the secondary hypogonadism, it was not something that he brought up.

My understanding of doing the injections for 8 weeks was to get my test levels back to a normal range and then transition to HCG to trigger my body to start producing test on its own. We discussed using either tomaxifen or clomid along with HCG to help keep estrogen levels down.

He did tell me that he's been able to get some of his other patients with similar test levels back to normal/natural testosterone production with a similar type of regiment.

Your HPTA doesn't work that way. Running Test before trying a restart is counterproductive. It will actually make the probability of a successful restart lower.

What was your LH and FSH? This will help determine if your have Primary or Secondary Hypogonadism. A restart will only have a chance of working if you are Secondary.

Your doctor is mistaken. Tamoxifen and Clomid do not lower estrogen levels in the body. They actually just "trick" the pituitary into not recognizing the estrogen in your body. When your pituitary thinks estrogen is low it sends out more LH which tells your testicles to produce more testosterone. That is why Tamox and/or Clomid are used in HPTA restarts.

I hope it is that you are not fully grasping everything your doctor is telling you. Because if your doctor is telling you this stuff, I hope you see that he is way off base and you need to run away as fast as you can. His proposed treatment is most likely going to make you worse off and guarantee that you will need to be on TRT for life.

 

[jpritchard11]

I double checked the report for my blood work and did not see results for LH or FSH.

Everything that I've posted is based off of my recollection of a 30 minute conversation that I had my with physician about a week ago. There's a pretty good chance that any inaccuracies are based on my lack of knowledge on the subject/information overload from our conversation.

 

[Megatron28]

So what if you have Primary Hypogonadism? The restart would be pointless. You would be taking medications that have potential negative side effects and absolutely no upside if you are Primary. Are you certain your doc didn't check your LH and FSH? That is Hypogonadism 101.

Have you read the thread that I gave you a link to yet? Is any of this beginning to make sense?

 

[Megatron28]

How "strict" is your diet? 175 pounds for 6' tall is on the light side. Are you restricting calories? Have you lost a lot of weight recently? That can lower your endogenous testosterone.

 

[PrinceDianabol]

So what if you have Primary Hypogonadism? The restart would be pointless. You would be taking medications that have potential negative side effects and absolutely no upside if you are Primary. Are you certain your doc didn't check your LH and FSH? That is Hypogonadism 101.

Have you read the thread that I gave you a link to yet? Is any of this beginning to make sense?

Since I've started hanging out in the TRT forum I swear I've become an angrier person! (Or maybe it's just the tren ) I knew incompetent doctors were everywhere but honestly... This is the second time this week I've seen a doc tell a patient to jump on testosterone before attempting a restart... where do they come up with this crap??

OP you should listen to Mega and do as much research and reading into Hypogonadism as you can. Unfortunately for us there is so much misinformation (or ignorance?) in the medical field in regards to TRT. Many of us look after our own protocols simply because it's healthier and we know better. For a doctor to prescribe testosterone and not even check LH/FSH is ludicrous.

He may well have had some patients recover to better levels but that's because of the restart AFTER the suppression. In reality, all of those patients would have recovered to better levels had they not been on testosterone first. And the ones that failed, and are now stuck on TRT for the rest of their lives may have had a chance.

/rant over

 

[TRTnooby]

Since I've started hanging out in the TRT forum I swear I've become an angrier person! (Or maybe it's just the tren ) I knew incompetent doctors were everywhere but honestly... This is the second time this week I've seen a doc tell a patient to jump on testosterone before attempting a restart... where do they come up with this crap??

OP you should listen to Mega and do as much research and reading into Hypogonadism as you can. Unfortunately for us there is so much misinformation (or ignorance?) in the medical field in regards to TRT. Many of us look after our own protocols simply because it's healthier and we know better. For a doctor to prescribe testosterone and not even check LH/FSH is ludicrous.

He may well have had some patients recover to better levels but that's because of the restart AFTER the suppression. In reality, all of those patients would have recovered to better levels had they not been on testosterone first. And the ones that failed, and are now stuck on TRT for the rest of their lives may have had a chance.

/rant over

I feel the same way. Doctors like this make me so angry. I don't understand how someone could go to school for so many years and still be so clueless about simple things.

 

[jpritchard11]

So what if you have Primary Hypogonadism? The restart would be pointless. You would be taking medications that have potential negative side effects and absolutely no upside if you are Primary. Are you certain your doc didn't check your LH and FSH? That is Hypogonadism 101.

Have you read the thread that I gave you a link to yet? Is any of this beginning to make sense?

I understand what you are saying re: primary vs secondary hypogonadism, like I said I don't remember discussing that with my doctor during our visit but I will talk to him about it asap. I read the TRT Overview thread prior to posting anything and have gone back and reviewed it, again this is all very new information but it is starting to sink in.

As far as testing for LH and FSH....am I certain that he did not test for it? No, I'm not....I read through the paperwork I was given multiple times to see if there were results for LH and FSH and did not see anything. I would be happy to post a screenshot of my lab work if that would help.

I recently leaned out for a vacation that I took a few weeks ago and came down from 188-190 to approximately 175-176 at my leanest. I was slowly/progressively restricting calories during this time and my macros were about 30/40/30, my cut lasted approximately 12-13 weeks.

 

[Megatron28]

Posting your blood work would be very helpful.

That dieting is probably not enough to tank your T to the degree we are seeing. Sounds like it was not a severe caloric restriction nor an extremely long time.

 

[henry5h5]

feedback

I am not a healthcare professional, do not feel comfortable critiquing your physician. But I'll say something about my experience with TRT.

Receive TRT as a middle age man with low testosterone, low energy.

Receive 250mg testosterone cypionate 3X month, 2 months on, one month off. Approximate cost: $67 1 vial of T; $25 per injection.

I do not take zinc or HCG, have never heard of that.

From time-to-time have blood tests. About once a year a full lab work up. Approximate cost: $85 blood test; $200 full lab.

Results: increase energy, increase muscle mass, 15 lbs increased weight - mostly lean muscle. Only adverse side effect is increased red blood cell counts, which are countered with the one month breaks.

Further result, not often credited/discussed: when you're on TRT you're obviously seeing your family physician regularly, and developing a good, close working relationship with that physician. With the blood tests and lab work, your physician is closely monitoring your overall health, which may reveal other, hidden health concerns. Example: my lab work showed dangerously high cholesterol counts (as risk factor for heart attack and stroke), which are now inexpensively controlled by statin medication. Would never have discovered that issue without the TRT.

 

[Megatron28]

I am not a healthcare professional, do not feel comfortable critiquing your physician. But I'll say something about my experience with TRT.

Receive TRT as a middle age man with low testosterone, low energy.

Receive 250mg testosterone cypionate 3X month, 2 months on, one month off. Approximate cost: $67 1 vial of T; $25 per injection.

I do not take zinc or HCG, have never heard of that.

From time-to-time have blood tests. About once a year a full lab work up. Approximate cost: $85 blood test; $200 full lab.

Results: increase energy, increase muscle mass, 15 lbs increased weight - mostly lean muscle. Only adverse side effect is increased red blood cell counts, which are countered with the one month breaks.

Further result, not often credited/discussed: when you're on TRT you're obviously seeing your family physician regularly, and developing a good, close working relationship with that physician. With the blood tests and lab work, your physician is closely monitoring your overall health, which may reveal other, hidden health concerns. Example: my lab work showed dangerously high cholesterol counts (as risk factor for heart attack and stroke), which are now inexpensively controlled by statin medication. Would never have discovered that issue without the TRT.

Do you go off TRT for a whole month because you can't afford to stay on all the time? How do you handle the hypogonadal symptoms when the return while you are off? I have never seen anyone do a TRT protocol like this. If it is for financial reasons have you considered lowering your dosage so you can spread your supply over three months instead of two?

How is your estradiol on 250mg injections without an AI?

 

[henry5h5]

Cost is not an issue.

It's 2 months on, 1 month off because after 2 months my red blood cell counts are above normal and my physician wants me to take a break. After a 30 day break my red blood cell counts return to normal. And then we restart.

Not sure what hypogonadal symptoms and estradiol are. Apart from the 1 issue mentioned, I do not have any adverse affects from TRT, at all.

Perhaps you are correct that my particular TRT protocol is unusual, not sure. It may be that different men react differently to TRT, require a higher/lower dose, and different amounts of time on/off, etc.

But I've been taking TRT for 4 years now, have tried various dosages, times on/off, etc, working very closely with my physician. At this point in time, one 250mg about every 10 days for two months, then one month off is what works best for me.

 

[Megatron28]

Cost is not an issue.

It's 2 months on, 1 month off because after 2 months my red blood cell counts are above normal and my physician wants me to take a break. After a 30 day break my red blood cell counts return to normal. And then we restart.

Not sure what hypogonadal symptoms and estradiol are. Apart from the 1 issue mentioned, I do not have any adverse affects from TRT, at all.

Perhaps you are correct that my particular TRT protocol is unusual, not sure. It may be that different men react differently to TRT, require a higher/lower dose, and different amounts of time on/off, etc.

But I've been taking TRT for 4 years now, have tried various dosages, times on/off, etc, working very closely with my physician. At this point in time, one 250mg about every 10 days for two months, then one month off is what works best for me.

Hypogonadal = Low Testosterone. It is the reason you went on TRT presumably. So once every three months you are returning to your old hypogonadal condition.

I hope you realize that you can simply donate a pint of blood once every 56 days to lower your hematocrit (red blood cells). Then you wouldn't have to stop your treatment. That is what most guys on TRT do. I am shocked your doctor never suggested this to you. And by the way, you would be helping other people who need blood.

You really need to learn about estradiol. It is a potent form of estrogen. Testosterone is converted into estrogen by the Aromatase Enzyme. When your testosterone levels are high, lots of it is aromatized into estrogen. High estrogen levels in men causes a whole bunch of problems such as: gynecomastia, acne, prostate problems, edema, high blood pressure, moodiness, etc. Again, I am amazed that you are not checking your estradiol regularly to make sure it is in the normal range and discussing it with your doctor.

Injecting once every 10 days doesn't work well for most men either. The half life of Testosterone Cypionate is only about 5 days. If you are unfamiliar with half lives you should research the topic

I am sure your doctor is a nice guy and means well, but he doesn't seem to know very much about TRT. And you have misguidedly put all your trust in him. I really want to encourage you to be more proactive about understanding the HPTA, TRT and advocate for your health. There are a lot of great threads in the TRT section that you can start reading. The Sticky threads are a good place to start.

 

[hiram1st]

Educate yourself you have to be pro active in this game:

http://www.steroidology.com/forum/testosterone-replacement-therapy/662394-basic-trt-overview.html

 

[henry5h5]

I hope you realize that you can simply donate a pint of blood once every 56 days to lower your hematocrit (red blood cells). Then you wouldn't have to stop your treatment. That is what most guys on TRT do. I am shocked your doctor never suggested this to you. And by the way, you would be helping other people who need blood.

Thank you for the information about donating blood to lower red blood cell counts, did not know that, will definitely inquire and discuss with my physician.

Note: I am a gay man. I believe that they used to screen out gay men from donating blood. But my understanding is that ban is no longer in place.

The T gives me more physical energy. It does raise my T levels, but at best to low normal, sometimes not even to that. For me the main benefit, an important one, is increased physical energy.

I do not have estrogen issues with TRT, none, ever. I have blood and full lab every year.

RE injection frequency, would like more frequent injections. And a higher dosage. But have worked with 3 physicians on this, all very hesitant to prescribe more than 200/mg 2X month. Really had to work with my current physician to get her to approve 250/mg 3X month.

 

[Megatron28]

Thank you for the information about donating blood to lower red blood cell counts, did not know that, will definitely inquire and discuss with my physician.

Note: I am a gay man. I believe that they used to screen out gay men from donating blood. But my understanding is that ban is no longer in place.

The T gives me more physical energy. It does raise my T levels, but at best to low normal, sometimes not even to that. For me the main benefit, an important one, is increased physical energy.

I do not have estrogen issues with TRT, none, ever. I have blood and full lab every year.

RE injection frequency, would like more frequent injections. And a higher dosage. But have worked with 3 physicians on this, all very hesitant to prescribe more than 200/mg 2X month. Really had to work with my current physician to get her to approve 250/mg 3X month.

Really? My primary doc prescribes 200mg/week of test cyp. Lots of guys here are on that much. That puts me in the upper quartile of the normal range for TT.

You can now be gay and donate blood. But only if you have not had sex with another man in the last 12 months. Don't get mad at me. I am not the one making up these retarded rules. If I were you I would either lie about sex with other men or ask your doctor to prescribe what is known as a Therapeutic Phlebotoby.

What is you estradiol coming in at a couple of days after you inject?

Why don't you just choose to inject more frequently? Or are you going I to a clinic to receive injections?