Advice with TRT (Newly Prescribed)

So glad I stumbled across this site. Looking for thoughts or direction.

Here is my story:
41 y.o. turning 42 this week 5’7" 211# currently
recent recovery from Achilles rupture in April 2013
gained 20# during recovery and no I wasn’t eating cheetos and playing video games the whole time.
started working out again in January. Lifting 5-6 days/wk, running 10-15 miles per week, eating fairly clean. Noticed I was not dropping weight or very little and muscle memory/strength not bouncing back. Mood was “off” for me, and libido dropped somewhat. I work steady nights so always tired or trying to adjust my schedule.

I began getting discouraged and thought my testosterone was low. Went to an endocrinologist. Below were my initial levels with test normal ranges.
FSH 3.1 (1 - 10)
LH 8.6 High (Normal 7.0)
Testosterone 321 (220 - 1000 ng/dL)
Testosterone Free % 2.4 (0.5 - 3.2 % )
Testosterone Free 78.0 (40 - 240)
Prolactin 11.3 (2.0 - 14.0)
Vitamin D 25 Hydroxy 14.1 (31.0 - 80.0 ng/mL)
Hemoglobin 15.5 (13.0 - 17.0 g/dL)
Hematocrit 45.9 (39.0 - 51.0 %)

My iron, insulin assay, and thyroid were normal. He did not run E2 or SHBG levels. Based on above results and symptoms he prescribed test cyp 100mg/wk IM.
No AI. No HCG (I am fixed and fertilization is not a concern).

The vials are 200mg/ml. I have been taking the full 200mg in two divided doses/week. I am on week 3 when I came across this forum. Why did I take 200mg instead of 100 mg per week you ask? Figured 200 was a small dose and my doc was just being conservative plus I figured it would drop the weight and bring back the size of my youth. No prior use of AAS in past.

So here are my questions/concerns:

  1. Symptoms aside, would my numbers indicate that I truly need to be on TRT?
  2. I am feeling good with no side effects as of yet on the 200mg, should I stay on this or immediately drop to the 100mg?
  3. If I stay on the 200mg when I get retested the week of 5/26 will I be off the charts with my TT or FT? Should I taper to the 100 starting at beginning of May? Or 2-3 weeks from my tests?
  4. Should I strongly suggest to my endo using Arimdex and HCG? I did email him asking about E2 and and AI. He said not unless I was showing signs of gyno or soreness. He said HCG was not needed as fertility wasnt a concern.

Any help is appreciated. After reading the stickies I am not sure if I want to even be on TRT and just settle for I’m in my 40’s and the muscle and metabolism and drive I once had are a thing of the past.
5. Should I just do this 12 week script of 200mg and cut my losses, do a PCT, then let my natural T be what it is production wise? Or even stop cold at the end of week 3?

[quote]believingbody wrote:
So glad I stumbled across this site. Looking for thoughts or direction.

Here is my story:
41 y.o. turning 42 this week 5’7" 211# currently
recent recovery from Achilles rupture in April 2013
gained 20# during recovery and no I wasn’t eating cheetos and playing video games the whole time.
started working out again in January. Lifting 5-6 days/wk, running 10-15 miles per week, eating fairly clean. Noticed I was not dropping weight or very little and muscle memory/strength not bouncing back. Mood was “off” for me, and libido dropped somewhat. I work steady nights so always tired or trying to adjust my schedule.

I began getting discouraged and thought my testosterone was low. Went to an endocrinologist. Below were my initial levels with test normal ranges.
FSH 3.1 (1 - 10)
LH 8.6 High (Normal 7.0)
Testosterone 321 (220 - 1000 ng/dL)
Testosterone Free % 2.4 (0.5 - 3.2 % )
Testosterone Free 78.0 (40 - 240)
Prolactin 11.3 (2.0 - 14.0)
Vitamin D 25 Hydroxy 14.1 (31.0 - 80.0 ng/mL)
Hemoglobin 15.5 (13.0 - 17.0 g/dL)
Hematocrit 45.9 (39.0 - 51.0 %)

My iron, insulin assay, and thyroid were normal. He did not run E2 or SHBG levels. Based on above results and symptoms he prescribed test cyp 100mg/wk IM.
No AI. No HCG (I am fixed and fertilization is not a concern).

The vials are 200mg/ml. I have been taking the full 200mg in two divided doses/week. I am on week 3 when I came across this forum. Why did I take 200mg instead of 100 mg per week you ask? Figured 200 was a small dose and my doc was just being conservative plus I figured it would drop the weight and bring back the size of my youth. No prior use of AAS in past.

So here are my questions/concerns:

  1. Symptoms aside, would my numbers indicate that I truly need to be on TRT?
  2. I am feeling good with no side effects as of yet on the 200mg, should I stay on this or immediately drop to the 100mg?
  3. If I stay on the 200mg when I get retested the week of 5/26 will I be off the charts with my TT or FT? Should I taper to the 100 starting at beginning of May? Or 2-3 weeks from my tests?
  4. Should I strongly suggest to my endo using Arimdex and HCG? I did email him asking about E2 and and AI. He said not unless I was showing signs of gyno or soreness. He said HCG was not needed as fertility wasnt a concern.

Any help is appreciated. After reading the stickies I am not sure if I want to even be on TRT and just settle for I’m in my 40’s and the muscle and metabolism and drive I once had are a thing of the past.
5. Should I just do this 12 week script of 200mg and cut my losses, do a PCT, then let my natural T be what it is production wise? Or even stop cold at the end of week 3?

[/quote]

Get your actual TSH value, don’t let the doc tell you you’re in range
Supplement with 5000IU daily, retest in 3 months.
Cut your dosage back to 100mg/week. You justification for doubling the recommended dose is weak. What will you tell your doc when you need a refill in half the time?
Ask for E2 to be tested at your May checkup.
HCG is important to aesthetic reasons (prevents testicular atrophy) and allows the testicles to continue to produce pregnenolone.

[quote]Dr. Pangloss wrote:

[/quote]

Get your actual TSH value, don’t let the doc tell you you’re in range
Supplement with 5000IU daily, retest in 3 months.
Cut your dosage back to 100mg/week. You justification for doubling the recommended dose is weak. What will you tell your doc when you need a refill in half the time?
Ask for E2 to be tested at your May checkup.
HCG is important to aesthetic reasons (prevents testicular atrophy) and allows the testicles to continue to produce pregnenolone.[/quote]

Dr. P,

Thanks for the reply.
My TSH was actually 4.1 (0.4-5.5)
The Test C comes in 200mg vials so my refill will last if I am reading my prescription right. I am assuming he wants me to discard the other 100mg. (4bottles/800mg total says it will last 4 weeks per my script on the bag.)
I did ask about testing E2 and he said he will add it to my labs in may. I guess I will have to wait to see about my E2 level but I would rather dial in sooner than later if I should be on an AI.
Would there be any benefit staying on the 200mg for 8 weeks then tapering next 4 to my 100 mg/week? My thoughts are that progress has been fast and effective on the 200mg divided 2 doses every 3-4 days. ie. Libido is up, muscles full and mass coming back, fat levels decreasing, or am I basically screwing myself or wasting the extra T due to the fact that as T increases so does E. Especially given the fact that I am not taking an AI to inhibit the production of it. I know extra body fat will also effect E levels. I am not morbidly obese (in 34-36 pant) but I do have love handles so I will try dialing in my diet.

If I am being honest, the 200mg/week is more of an aesthetic/psychological thing. If I can get back my lean mass and fat down would do wonders for my perception and frustration of my whole Achilles deal and being back to square one.

also Dr. P,

what are you suggesting I supplement with 5000IU daily of? Vitamin D? My doc did put me on a weekly dose of Vitamin D 1.25 mg (50,000 units).

My suggestion was to supplement Vit D. I’m glad to see your doc addressed that.

TSH of 4.1 is too high, imho. Mine was 4.6 and I felt awful: no libido, weak erections, overwhelming fatigue. I think this is an avenue worth pursuing, but it may take some persuasive skills. The Qwest range is .5 - 5.0 and docs see anything within range as “normal”. You can read the thyroid sticky at the top of the page for more details. FWIW, getting my TSH down did much, much more for me than getting on TRT. N=1, of course.

I’m confused about your test script. In your original post, you said your doc prescribed 100mg/week. In your second post, you state, “4bottles/800mg total says it will last 4 weeks per my script on the bag”. This is unclear to me. It sounds as if he prescribed 200mg/week, but I don’t know of any bottles that are simply 200mg.

Would you humor me and let me know how many mL you bottles are? For example, my bottles are 10mL at a dosage of 200mg per mL. Therefore, each bottle holds 2000mgs. My script is for 100mg/week, hence a bottle lasts me 20 weeks. Maybe I need to up my levothyroxine dose, but I’m not following your dosing.

Hey Dr. P,

Sorry about the confusion. I will try and clear it up. The pharmacy supplied me with perrigo brand test cyp it comes in a small 1ml bottle. Each ml is 200mg so total bottle is 200mg. The pharmacy gave me 4 individual bottles. Now if I am reading the pharmacy dosing correct it says to inject 0.5 ml or 100 mg weekly. It then goes on to say these 4 bottles will give me a 28 day supply. So it appears as though each bottle will have 0.5 cc left over I am to discard. Instead of discarding the extra 100mg I’ve just been taking the additional 100 mg 3-4 days later.

Looks like the pharmacy did their math wrong. Injecting 100mg a week would give you an 8 week supply, not a 28 day supply. However, if your doc prescribed 100mg/week and the pharmacy dosing says 100mg week, then I would ignore their math mistake.

If you take 200mg/week, the pharmacy will need to call your doc for a refill. At that point, the doc may discover you’ve been taking 2x the dose he prescribed contrary to his instructions. I don’t know how your doc will react. He may merely correct you or he may treat you like a drug abuser and take away your script.

Lastly, imagine if the doc thinks you’re taking 100mg/week and your labs come in way high. Let’s say he cuts you back to 50mg/week and discovers the pharmacies math mistake so you don’t have a reserve. Now you’ve been hoisted by your own petard.

Your call, but don’t discard any extra you might have. Every time someone throws away perfectly good testosterone, Branch Warren kills a kitten.

bump