Increase dose. Stop everything else. Give it 6-8 weeks.
Done.
I think it really will be that simple. Switch clinics if this one won’t do it. If you were at 700 peak then your trough has to be really low. Way too low.
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Hi guys. I recently made a post related to my recent 6 month TRT fail. To make it short the docs seemed to only vaguely know the science of TRT, BUT they were extremely humble and open to suggestion. They did however say some things that I thought were flat out wrong. For example they continuously stated that after a year on TRT my system should be accustomed to testosterone and thus produce it on its own…I know, but hear me out. They also constantly told me that the reason it may not be so effective for me is that I may have “a large quantity of androgen receptors that are drinking all the T down too fast,” as well as other statements like, “HCG will keep your peak levels longer,” and that “TRT is telling my adrenals to send a signal to my body to produce more T on its own.” I know it’s all silly, but they did recognize that I needed help and were willing to pretty much hear me out, so I didn’t try to argue with them every visit. They had never heard of twice weekly injections and they allowed me to try it to see if it worked. Well after 6 months they could never advise me how to become stable. It was like I hit my peak the first month at 1180 Total T and I felt great and reported to them that I felt normal for the first time in years and that I could sleep well and wake up on time and generally felt better from depression and anxiety. However, it didn’t last and for the next 5 months it was constantly up and down with extreme peaks and lows and after 6 months I gave up.
Now, after coming here and researching a bit as well as communicating with these same Doctors I really want to try again seeing as 2 months after quitting TRT all of the original symptoms have reemerged. Go figure. Now I know that TRT was in fact helping, but it definitely was not an optimal protocol.
The best I felt was month 1 with total T of 1180 with 120mg Test Cypionate. When that stopped working we switched to 60mg injections twice a week and this definitely was more steady but was also weak feeling with only a very slight but longer lasting improvement. After I complained about this at month 5 we did labs and my total T at peak levels were 750. I was not educated and neither were they and so I gave it up seeing it as futile.
I could definitely go see another clinic and doctors, but these people were open to change and were totally nice and accommodating, but we both lacked the required knowledge which is kind of sad, however I am deciding to go back to them in order to avoid all of the initial consultation and interview questionnaires and the like.
While not totally starting over because we have a history together I am trying to go in on Thursday with a solid plan to present before they go off on the deep end with some alternative treatment because I believe that T is the answer, but the administration wasn’t up to par. Do you guys have a solid script for me so I can clearly and politely explain to them what it is I want and why? I know I want to feel normal, but I’m not sure what that translates to in terms of TRT protocols and I don’t feel I can leave it to them either. I’d love some knowledge on how to handle this situation.
For example I know from the forum that x2 a week is better and that because of my side effects (heart palps, migraines, floaters, anxiety) from anastrozole that I need to request to not take it, but that’s about all I know. I’m hesitant to immediately request to up the dose seeing as I’m restarting therapy anyways.
Here is my original post for my 6 month trt fail
Thanks guys
We’ve already answered this. Higher dose, somewhat more frequenct injections.
Something like 80mg 2x a week would be a good place to start IMO. 60mg 3x a week would be awesome too.
Clearly, with the statements they’re making they have no clue how to do this. There’s so much wrong in their statements. Pretty much everything in fact.
People get stuck in the being loyal because they have history with a particular doc or practice way too often. If they won’t give you what you need then you’re wasting YOUR time.
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These statements pretty much tells you your doctors TRT knowledge is very poor. Once you stop injecting exogenous testosterone the effects wear off and you lose the benefits some time after stopping.
Your pituitary gland is responsible for testicles stimulation and therefore testosterone protuction.
At 1 month your levels are not stable, not until 6 weeks and if at anytime you change the dosage, levels will be in flux for another 6 weeks.
Here is your problem and while TRT failed, by injecting once weekly you were setup to fail because these large infrequent injections drive estrogen production. I don’t think twice weekly will be much different, your going to have to make bigger moves to see big improvements.
Also some men are sensitive to fluctuating hormone levels, my body ignores testosterone when injecting twice weekly if levels are declining for too long. I think this is another reason why TRT failed.
You need to monitor your FT and SHBG levels, you can’t start TRT without them and if you do so you will be in the dark and could possibly end up another TRT failure. I think you need to say goodbye to whoever is managing your TRT unless they are willing to work with you and learn or you’ll need locate a private doctor who prescribes TRT on a daily basis.
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Thanks systemlord. You bolded 20% bodyfat from my previous post. Can you please explain what the bodyfat percentage has to do with injection frequency. I’m sorry, but I cannot see the correlation between more or less frequent and body fat.
Basically more body fat means more Aromitization / estrogen. More frequenct injections typically helps to reduce e2.
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That makes sense. Thanks I will try to push them to 60mg x3 a week and see if they will go for it so I can avoid that. That would make sense at 20% BF that some of it would be lost in one large dose. I will try and tell them this.
The aromatase enzymes live in visceral body fat, FT converts to estrogen so by having a higher body fat percentage, you will convert more testosterone to estrogen and when estrogen is high, men will make comments like TRT isn’t working anymore because you are estrogen dominant because large injections cause big spikes in testosterone and estrogen.
Then there’s the individual who is sensitive to hormone fluctuations, my trough levels right before my next injection on a twice weekly protocol was 697 ng/dL, not low by any standards and yet it felt like I was at 250 ng/dL. If I don’t inject T at least every 2 days, my body ignores testosterone.
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SO the idea is to keep the T coming in at slow and steady levels so there isn’t an excessive amount to be shuttled into estrogen? Rather than a big boost with lots of waste?
So, my gut reaction looking at your case is that you are not a good TRT candidate. You may think that all your symptoms lead to a low T diagnosis. But you are 26yrs old potentially making a lifelong medical commitment. I’m a recovering alcoholic and have struggled with depression/anxiety/mania. I was convinced when I was 30 that all my problems were T related. I was high 400’s total T. But truthfully I wanted to be ‘above average’. And I didn’t want to address some of the more glaring problems in my life…alcohol and drug use, diet, stress, sleep etc. I would caution against making a jump back into TRT until have your physical and mental health dialed in. I used to think there was a magic T number that would give me amazing erections and energy and strength. It took me 10 years of mistakes to learn that the HPTA is a delicate system and the benefits we seek are from factors more nuanced than just a T or E or DHT or SHBG or… number. There is a successful path out there both on and off TRT. And maybe yours is on TRT. But REALLY research it and be honest with yourself about your motives.
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Correct for some steady levels means less estrogen conversion if they are sensitive to estrogen conversion, then these large and even moderate injections will cause problems. I have seen super lean men convert huge amounts of testosterone to estrogen, it just means they have high levels of aromatase enzymes within their body.
There really is nowhere for doctors to learn this in textbooks, most of what’s learned about TRT management is through trial and error and sick care doctors are unable to work like this because there are guidelines and procedure to follow, thinking outside the box can get doctors in trouble if something were to happen to the patient.
That’s what standard of care is all about, you follow standard of care and you cannot get in trouble and the lawyers have no teeth.
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Blizzardtest, thanks for your concern. Really. I am only 26 ,but I am totally healthy in my habits and lifestyle and do everything I can to stay regulated and clean. I am in bed for atleast 8 to 9 hours nightly trying to sleep with no screens nearby and totally dark room. I have a great varied lacto-vegetarian diet with plenty of nutrients and I excercise and maintain general good habits and associate with nice clean people. I havent drank alcohol since 2017 and have never done drugs. I don’t even consume caffiene. I havent been on any mental health medications since 2016 because of the horrible side effects of the plethora I was put on over a 4 year period. Im not perfect by any means, but I am trying to humbly indicate that I have been trying to exhaust all natural means before the intervention of medicine and I still have problems maintaining normal mood, regularity, strength, bodyfat, motivation, concentration and other things. My total T is currently in the low 400’s. How long am I suppossed to sluggishly carry on meticulously changing every variable in my life? Im not trying to prod you, but whats the limit to the search? No one can try ALL the different lifestyles and no one can research ALL the knowledge so when is the point of making the decision to commit to therapy? Is 435 total T and feeling crumby suppossed to be even average? I feel that I just want to be normal, but sure my ego does think, “Hey, maybe there’s extra benefit too,” like muscular size and strength, but it would be silly not to recognize those as benfits. I think everyone here probably thinks this way. Who doesn’t want to feel their best?
Could you possibly enumerate the ten years of mistakes you made that led you to your conclusion about the HPTA being so delicate? I know that it is, but what exactly happened?
systemlord, are you saying that the standard of care procedures are why the TRT process is so convoluted with standard modern medicine which makes it hard for personalized hormonal treatments?
That about sums it up in a nutshell, more people die of prescription drug side effects (200,000) every year. TRT will not “cause” strokes, blood clots or cardiovascular events. People need to be properly screened before TRT commences.
A lot of doctors still believe TRT causes prostate cancer and when they see a rise in PSA, they freak out and stop treatment. There is so much contradicting studies out there doctors want no part of TRT, a young guy suggest to his doctor maybe my testosterone is low and the doctor laughs at the absurdity that a young man could have low testosterone at a young age.
These doctors have ignored hormones as a whole their entire career and couldn’t possibly be of any help, often men are told their levels are normal when in fact they are not.
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Systemlord, what exactly is “normal” for age groups? I know the standard in modern medicine is 300 ng/dl or less to be eligible for treatment, but what is the real scoop on when it is becoming a condition that should be treated by age group and what are the chances of someone like me naturally rising my t up to say 800 from a personal normal of 400-587? Are there unsalvageable cases and if so what are those like?
No one can make the decision for you. It was pointed out above that your weight and BF is still high. If diet and exercise aren’t working then you have a lot to consider, TRT being one of the options. I’m not trying to make you feel guilty about TRT. I’ve got things dialed in to an amazing place. It works. But I’m 42 and I wish I didn’t have to do what I do on a daily basis. That being said, as others have mentioned before, less T can be more. Increase injection frequency. Familiarize yourself with where T sits on the chain starting from cholesterol. Research And ask a lot of questions.
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Blizzardtest, thanks for the coolheaded reply. I can easily see myself wondering the same thing in say 20 years like what the hell why do I have to inject this crap everyday? I see thats what you think also and I understand. Im just wondering how long do you think you should have waited or do you think you could have? Would you have needlessly suffered or did you jump on too quick in your opinion? One thing that definitely did bother me was that the docs didnt think it was a lifelong commitment. They think that you can get on then off with higher t than before which is obviously ridiculous. What do you think recovery rates are for people who have been on T day for multiple years and get off? Is there ever a normal for them without T typically?
I would try the recommended 80mg twice a week.
For me, pushing shots more close together (more frequently) increased my E2 unless the shot amount of test was really low… WHICH made it feel like I wasn’t taking anything.
It’s a balancing act with keeping the E2 in check and getting the FT up. I’m a bit of an outlier however.
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I tried twice to come off TRT during the past 10 years. Neither time was I able to get levels very far over 300. Mind you…there were a couple of years in my early 30’s when I was blasting and cruising. So there may be no coming back from that. Everyone is unique. It seems you have a strong focus on your health and diet that I certainly did not have at your age. However there is nothing in the science that leads me to believe that one can ‘get on TRT’ for a short period to right things with the plan to get off and be all good. It’s not impossible but going on with that mentality would be a mistake.
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Any idea whether you’re secondary or primary?