Advice for New TRT Patient? Lab Results Included

Pharma / TRT Testosterone Replacement
1

Hello,

I’ve been a longtime reader, first-time poster. I have been considering TRT for about two years, and I’ve done a fair amount of research. But I am still a bit uncertain on the best course for me. Given the knowledge in this forum, I was hoping I could describe my situation, with lab results, and get your opinions:

– I’m 39. About two years ago, I began experiencing intermittent ED with my wife. This ED was strange; some nights no problem, other nights, total limp fish, no matter how much stimulation. That said, erection quality overall on good nights seemed a bit diminished. I also generally found myself less sharp and energetic than I recall being in the past, a little foggy, and not recovering from or getting the gains I’d expect from 3-4x/week at CrossFit. My weight has pretty much remained steady; clothes fit the same. These symptoms started primarily after having vasectomy, which may be a contributing factor in some way but is not what I suspect is the cause.

– In late October 2016, I had my hormones tested by Quest, from a blood draw at 1:42 p.m… Results: 549 Total T (250-1100 scale); 91.1 Free T (35-155 scale); Prolactin 5.3 (2-18 scale). At that time, I decided not to pursue TRT. I felt my numbers were still OK, and I was not a fan of the TRT clinic I visited then.

– In July 2018, I had my hormones tested again, this time via LabCorp. The blood draw was at 8:30 a.m. Results: 500 Total T (scale 264-916); 12.6 Free T (scale 8.7-25.1); 33 Dihydrotesterosterone (scale 30-85); 280.8 DHEA (scale 102.6-416.3); 4.4 LH (scale 1.7-8.6); 16.4 Estradiol Sensitive (scale 8.0-35.0); 34.2 Sex Horm Binding (scale 16.5-55.9); 8.5 Prolactin (scale 4.0-15.2)

As you can see, my Total T and Free T are down from 2016. While my current Total T is not bad at 500, my Free T, Dihydrotesterosterone and Estradiol Sensitive are all low. TRT doc suspects that these were likely reasons for my symptoms.

Suggested treatment:

  1. Conservative: 400iu 3x/week HGC monotherapy w/ AI when symptoms occur.
  2. Recommended: 200 mg T Cyp, 400iu HCG 2/week, adding AI when symptoms occur.
  • Plus DHEA with both 1 and 2.

I am debating whether to try HCG monotherapy to begin with, to see if this might resolve my symptoms. Since my LH is 4.4, TRT doc thought it’s possible I could produce more testosterone on my own with the HCG added in.

I have a vasectomy, so fertility is not a concern. I am just feeling like I should be cautious, since TRT is a life-long decision and I am not yet 40. But I also wonder if HCG monotherapy is a situation where I’m choosing a kind half-pregnant option that won’t really benefit me – and I should just bite the bullet and pursue a full TRT-HCG regimen.

I would love to hear any opinions from those of you with experience. I’d very much like some “If I you, here’s what I’d do” feedback.

Thanks.

2

I recently had my Total T 376, Free T 15.1 and E2 29.6 and weak to no erections most of the time. In range doesn’t meaning anything, some need Free T high normal to function properly. Your protocol is a mistake, not many men can tolerate 200mg, you need to inject 50mg twice weekly to keep stable levels and proceed with HCG and hold off taking the AI until labs and symptoms are present.

Large infrequent injections will cause a hormone roller coaster and cause E2 to spike increasing the need for large AI doses. If you proceed with that huge dosage control E2 will be problematic.

3

Would you recommend trying HCG monotherapy first, or just go ahead with the TRT-HCG together?

After reading your email, I realized that i think I misread/misreported here my regime. Here it is:

BEGIN TESTOSTERONE Cyp 200 mg/ml – 0.35 ml IM/SQ TWICE A WEEK
BEGIN HCG 400 iu SQ TWICE A WEEK to reverse/prevent testicular atrophy
BEGIN Anastrozole 0.125 mg TWICE A WEEK as needed per E2 symptoms (reviewed with Pt.) patient will hold until high E2 symptoms occur
BEGIN DHEA 25 mg one PO EVERY NIGHT

It’s .35 ml on a scale of 200 mg/ml. So I guess that’d be 70 twice weekly. Would that be OK, or 50 better for this?

4

That’s much better, big difference. Seems like you’re working with a TRT specialists worthy of the title. Time will tell if 70 twice weekly is too much, you will be tweaking things for several months to come. Rarely does anyone hit their sweat spot on the first try.