Starting TRT, what do you think of this protocol?

[sanipialo]

Background
I am 32, low body fat, fit but having some problems related to slow testosterone. My level is 299 ng/dl and in The Netherlands the doctors would not treat me, so I went to a specialist in Belgium. My appointment was planned for January, but someone cancelled and I got their spot.

Treatment
He found my testosterone to be within the norm but too low for my age. He can only prescribe Sustanon 250 and Nebido.

He gave me 2 options.

1. Came back in a few months and wait and see what my body does and do a blood test after 2 or 3 months. This is based on my last two blood tests. First one being 299 ng/dl and 4 weeks later it was 322 ng/dl. This could be my body recovering. Because my FSH and LH are fine, it could be that my levels where temporarily low. If it has not recovered he will start treatment. The official protocol is not to treat patients that have no problems with FSH and LH and have level higher than 260 ng/dl.

2. Start with a pilot of Sustanon 250 every 4 weeks for 12 weeks .Because he wants to run a pilot for f 12 weeks Nebido is not a great option as it is too slow for the 12 weeks pilot.

I can pin myself and I asked him about splitting the Sustanon 250 in once a week, but he is against that as they only option are 1ml ampules. Splitting in once a week doses is not practical and is not protocol.

If the pilot is successful he would put me off the Sustanon 250 and on Nebido once every 8 to 12 weeks depending on the blood results.

Based on academic research and nearly every experience I can find on different forums, injecting Sustanon 250 every 4 weeks is going to be an unpleasant ride as the half-life of the esters used in Sustanon are too short for 4 weeks.



I can do TRT using an alternative route.

Alternative 1
He cannot prescribe testosterone enanthate, but I am able to get it myself in 10ml vials of 250mg/ml. The alternative is to self-medicate with 65mg enanthate every week for the period of 12 weeks. While the doc thinks I am taking Sustanon 250. This is a very low dosage, but matches his prescription of 250mg Sustanon every 4 weeks.

Alternative 2
Just go for it myself and do the following to boost my levels:
Week 1 start with 100mg of enanthate every week from week 2 to 12. Do a blood work in week 7 and 14 and after 14 start PCT for 2 weeks, wait 2 weeks and do another bloodwork. If my levels are lower than they are now, go back to the doctor.

Dilemma
My dilemma is what to do. Waiting a few months for my nature to do its work might be a better option in the long term, but it does mean a few more months of fatigue, low libido, brain fog, losing muscle and other problems.

Sustanon 250 every 4 weeks for 12 weeks is not going to be pleasant.

Replacing Sustanon 250 with "black market" 65mg of enanthate (alternative 1) seems like a low dosage.

Doing things myself (alternative 2) seems more in line with most TRT protocols, but I really don’t want to f*ck my body.

What would you recommend and why?

 

[Megatron28]

Given those bad choices I would take the first of waiting three months and getting on Nebido. Just make sure your TT comes in low when you go back to retest. There are ways of "tanking" your natty T.

 

[sanipialo]

Given those bad choices I would take the first of waiting three months and getting on Nebido. Just make sure your TT comes in low when you go back to retest. There are ways of "tanking" your natty T.

I wish that that was the case. Option 1 is a delayed version of option 2. If my natural levels rise to above 345 in a few months. That is it. If it stays between 260 and 345 (9 an 12), then the next step is to do a pilot of 12 weeks with Sustanon 250 once every 4 weeks.

 

[Chiefy]

Yikes, none of those options sound particularly good.

Did your doctor give you any more details about the "pilot" of Sustanon? What's the long term goal? TRT is not something that you just try out and then stop if the desired results aren't achieved. If I were in your shoes I'd be concerned that if you do this "pilot" and things don't go well (they won't), your doctor may want to stop treatment or something weird.

 

[IMT staff]

Yikes, none of those options sound particularly good.

Agree. Sounds like its a protocol from the 80's

 

[sanipialo]

Yikes, none of those options sound particularly good.

Did your doctor give you any more details about the "pilot" of Sustanon? What's the long term goal? TRT is not something that you just try out and then stop if the desired results aren't achieved. If I were in your shoes I'd be concerned that if you do this "pilot" and things don't go well (they won't), your doctor may want to stop treatment or something weird.

The goal of the pilot is to see if my symptoms will disappear if I am on TRT. The doctor basically believes that my levels are too high for a permanent TRT solution. And thinks that I am in a loop. My symptoms (low energy, fatigue, brain fog) are causing me to be less active, not go to the gym, get sicker easier, which all results in a lower testosterone. This then increases my symptoms resulting in a loop.

With a pilot he would be giving me above average testosterone, resulting in a breaking of the loop. He would then restart (no details of the restart yet) and see if my body can maintain it. He believed it can based on his experience.

Looking at my bloodwork (such as FSH, LH and Prolactin) he cannot see any reason to believe that my body would have lower testosterone. His patients for TRT are people with things like Kallmann syndrome, Klinefelter syndrome and other similar problems. He said he also has some ex bodybuilders and some cancer survivors. So compared to them my level is high and my FSH and LH is great.

 

[sanipialo]

Agree. Sounds like its a protocol from the 80's

Sustanon is a medicine from the 1970s so the 1980s is probally too advanced for the doctors I deal with. I joke about it, but it is very sad

 

[Chiefy]

The goal of the pilot is to see if my symptoms will disappear if I am on TRT. The doctor basically believes that my levels are too high for a permanent TRT solution. And thinks that I am in a loop. My symptoms (low energy, fatigue, brain fog) are causing me to be less active, not go to the gym, get sicker easier, which all results in a lower testosterone. This then increases my symptoms resulting in a loop.

With a pilot he would be giving me above average testosterone, resulting in a breaking of the loop. He would then restart (no details of the restart yet) and see if my body can maintain it. He believed it can based on his experience.

Looking at my bloodwork (such as FSH, LH and Prolactin) he cannot see any reason to believe that my body would have lower testosterone. His patients for TRT are people with things like Kallmann syndrome, Klinefelter syndrome and other similar problems. He said he also has some ex bodybuilders and some cancer survivors. So compared to them my level is high and my FSH and LH is great.

I wouldn't be comfortable with that at all. If you're going to start TRT, go into it with the mind set that you'll be on it for the rest of your life. That's typically how TRT works.

If he wants to try a restart, why not just try that first? What's the point in taking a drug that suppresses your own testosterone production first? Testosterone doesn't do anyhing to restart your HPTA, it does the opposite.

This doctor is no good. Low/high LH and FSH are not the only things that can cause low testosterone.

 

[Megatron28]

You need to find a new doc that will help you do a restart attempt

 

[IMT staff]

yes I understand what sustanon is

 

[sanipialo]

@Chiefy,
The pilot is not to restart me. Basically the doctor is not 100% sure that low testosterone is the core of my problem, but rather a result of something else that is causing my testosterone to go down due because of the fatigue, low energy and so on. Based on the blood tests and other tests the other 2 doctors have already done, they cannot find any core problem. By doing the pilot he can see how my body will react. Based on the 12 week pilot, it could be that I have to do it for life and in that case Sustanon might be replaced by Nebido after the pilot. Or it could be that I won***8217;t be needing TRT for life and in that case he will stop after the pilot with the proper PCT (he does not call it PCT, but just says further steps).

@Megatron28
He is the end of the line. My GP has forwarded me to 2 internists already. And this doctor from a private clinic is the only internist that has experience with TRT within a 250 mile radius. Within my means I cannot see another doctor that knows what TRT is.

The only other option is to self-medicate with the typical US TRT treatment of 100mg testosterone enanthate (cypionate) every week or every 5 days.

 

[Megatron28]

@Chiefy,
The pilot is not to restart me. Basically the doctor is not 100% sure that low testosterone is the core of my problem, but rather a result of something else that is causing my testosterone to go down due because of the fatigue, low energy and so on. Based on the blood tests and other tests the other 2 doctors have already done, they cannot find any core problem. By doing the pilot he can see how my body will react. Based on the 12 week pilot, it could be that I have to do it for life and in that case Sustanon might be replaced by Nebido after the pilot. Or it could be that I won***8217;t be needing TRT for life and in that case he will stop after the pilot with the proper PCT (he does not call it PCT, but just says further steps).

@Megatron28
He is the end of the line. My GP has forwarded me to 2 internists already. And this doctor from a private clinic is the only internist that has experience with TRT within a 250 mile radius. Within my means I cannot see another doctor that knows what TRT is.

The only other option is to self-medicate with the typical US TRT treatment of 100mg testosterone enanthate (cypionate) every week or every 5 days.

Have you seen an endocrinologist or urologist?

 

[sanipialo]

Have you seen an endocrinologist or urologist?

I have seen both and more.

Dr 1. General practitioner
Dr 2. Internist
Dr 3. Urologist
Dr 4. Endocrinologist

 

[3J]

sustanon is a back dated treatment for hrt... it was made so you only need one injection a month (short to very long estered) bu takes your hormones for a roller coaster ride along the way..

you always have to follow the rule of running your injection frequency based on the shortest ester to get the most stable levels.. with sust its prop.. horrible for hrt..


ideal hrt is injected twice a week to give the best levels

 

[Baldur2630]

I had a similar problem. I'm 73. I was three years without a libido and no erections at all. My idiot doctor took blood and only did a 'standard' blood test here in Belgium. My Free T was 484 and I was told that it was very good for my age and why would I want an erection anyway!

I go to the gym 4 times per week weight training and I was getting weaker and weaker and putting on FAT even weighing everything I ate and eating a calorie DEFICT of 1500 cals per day.

Eventually after making enquiries on various Forums, I went to a different doctor. I had to put up a fight to get a proper blood test, but eventually I won. When the results came back, my Total T was was 434 but my Free T was almost non-existent. My Estradiol was way down and my SHBG was very high.

They sent me to a specialist endocrinologist. He told me I needed Testosterone injections but he couldn't prescribe them because my age put me into a 'grey area'. After I crapped him out, he told me that he would give me a prescription for Sustanon, that I should inject once per month, but I would have to pay for it myself.

I knew from my research that this was a really bad idea, so I decided to do it on my own. Getting GOOD stuff here is not easy, because Customs will confiscate everything even rehydration salts if they come from outside the EU. A lot more research found me suppliers of REAL stuff posted out from inside the EU, so it doesn't go through Customs.

I've played around with the dose and I'm using Testosterone Cypionate. It's 200 mg/ml, so I've got it to 0.25 ml twice per week in the glutes. My wife injects me. It is NOT painful. I've been on it since mid October. Very quickly, I started to feel a lot better, my weight that I can push went back up, I lost body fat and gained muscle. I feel a hell of a lot better. I started to get a bit of libido back and a half- hearted erection, quit soft and only lasting a few minutes. No matter what I do with the dose, that's IT.

My wife (she trains with me), decided to take HGH, She found Somatropin at a VERY good price. It's been tested by guys on another forum and it's good. She lost all interest in sex (just as well for me) after menopause, but after three weeks on HGH, WOW! I started it as well just one IU per day. The difference it has made is incredible after only two and a half weeks. I can actually enjoy sex again!

If you PM me, I can help you.

I wish you all the best, after all we are neighbors!