Be Your Own Doctor and Do It Well or Roll the Dice

Pharma TRT
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This is a bit of a ramble but hopefully will be of interest to some as it is an amalgamation of various recent topics.

Testosterone is a relatively new discovery in medicine and even scientists still don’t fully understand the mechanism of hormones. With that being said, it is my belief that ones body carries out processes that we don’t even know about yet and as such have no way of replacing exogenously.

TRT is a blessing to those truly hypogonadal but can be a risky venture to many on this site who seek life improvements. The fact is that there are many things that can make someone feel sub optimal. I feel TRT is being pushed to men as the solution and a cute for all. A good example of this could easily be guys with very good bloodwork numbers but poor sexual function. Additionally, there is not always a clear differentiation between ED and lack of libido. If guys have unresolved psychological issues then TRT won’t solve their sexual function problems no matter how good the doctor is.

IMO I’m afraid there’s only one way to guarantee that you get the most from TRT and that’s to use your own self-learned knowledge to effectively manage your own protocol and bloodwork.

There’s a financial incentive for clinics to entice you onto their books promising this and that. The reality is that they often don’t have the resources and often even the knowledge to provide adequate monitoring and care.

If your hormones are initially way out of range then TRT will probably be an improvement even with a poorly managed protocol.

If your hormones are low normal i.e you are able to function but seek improvement, things are a bit more risky IMO for some key reasons I will outline below.

  1. Due to the time and financial costs of blood work it is only typically practical to monitor your hormones a few times a year. In between those times your hormone levels are in an unknown state. Your low normal natural state is constantly managed by a complex feedback loop that maintains levels in your body that allow you to function as a man. This all happens in the background. Even the most comprehensive bloodwork and protocol change is incomparable to your bodies ability to simultaneously check and adjust all of your hormones on the fly.

  2. Unless pinning daily your hormones will have higher peaks and troughs than naturally which leads to supraphyiosolgically high levels of some hormones which can have negative sides that you otherwise wouldn’t have encountered with your low normal natural levels.

  3. SHBG is often touted as burden making precious testosterone unavailable to your body. TRT drives down SHBG in many. It is now coming to light however that SHBG carries hormones to other receptors and is very necessary. Low SHBG seems to be a common problem.

  4. There is reduction in hormones upstream from testosterone such as DHEA and pregnenalone which can have implications.

  5. Thick blood is not good. More viscous fluids requires more force to pump through a system this is why you could blow air through a a garden hose but probably not treacle. Your heart is working harder when you’re blood is thick.

Now, I’m not writing this to burst anyone’s bubble but instead trying to encourage people to ask themselves an important question-

Can you do a better job than your own body currently can with the knowledge and resources available to you? If your are clinically hypogonadal then this is an easy question to answer.

If you are low normal and currently functioning, then you better have the knowledge and resources to do a good job of replacing your testosterone or you might just end up spending a lot of money, feel like shit and damage your health.

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What Happens to Natural Production
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I hope so too although it may be uncomfortable reading for some who seem to have a one dimensional, rose tinted view of the cause and effect mechanisms of manually altering hormones.

The reality is that our bodily functions are infinitely complex systems comprising of psychological and physiological elements that are functions of each other and the environment we live in. Trying to emulate part of this system without adequate awareness of what is required to do it well and what the possible complications are can very easily make a person worse then their “sub-optimal” natural state. I’ve not really seen this point of view discussed much. I don’t believe it’s a given that you will feel better with high normal T levels than low normal T levels. You improve those specific numbers but alter countless other parameters in the body that could affect wellness.

I often wonder if people not “designed” to have high T levels have the other auxiliary parts required to function at that level. Variable receptor sensitivity between people?

It might be analogous to putting a 500bhp engine in a basic Honda Civic. The car has the engine but not the chassis and drivetrain to operate it at full capacity……

TRT is an effective medicine for those who are deficient first and foremost. It’s now being cashed in and marketed more and more as a ethical everyday household PED.

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You make many excellent points (most of which I have made myself on this forum). And yet you have managed to draw the absolute wrong conclusion from them, IMO. It is not the men who receive TRT under a doctor’s care who are ‘rolling the dice,’ it is those acting as their own doctor. The notion that “there’s only one way to guarantee that you get the most from TRT and that’s to use your own self-learned knowledge to effectively manage your own protocol and bloodwork” is absolute folly. Someone seeking reliable self-education cannot get it from the forum:

Nor can they get it from the literature:

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Absolutely agree. The level of anti-doctor rhetoric in many threads is absurd. That and the de-emphasis of basic training/nutrition are two of my biggest disappointments with the T Replacement forum.

Fixed.

Dunning-Kruger is dangerous when it comes to any medical condition, including TRT.

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I can now see how this title could be misleading. A more appropriate title might have been “Manage Your Own Care and Do It Well or Roll the Dice”.

I fully stand by the intended message though, which is essentially think before you act. This seems straight forward but there is quite a bit of thinking to be done in the “think” part.

The motivation for this post was in part due to a spate of recent posts from men in the their early 20s essentially looking for the green light to jump on TRT. The other part comes from the consistent stream of guys with libido issues, high/low e2 and general lack of wellness.

This post is in no way an attack on doctors. It is an attack on the business of some TRT clinics that do not manage cases properly as they attempt to cash in on the surging TRT market.

Doctors are often employees to these clinics not the owners. They will follow the processes and procedures as they are required to do. There is an obvious issue with many of these processes and procedures which stems from a lack of standardisation in what is after all quite a new field. There are clear inconsistencies between care providers that seem to require structure and regulation by an appropriate body whoever that may be.

The level of inconsistency drives people to forums like this for information. Forums where completely unqualified largely anonymous individuals can give medical advice. This in itself can cause issues not only because of the the total lack of accountability but the various biases that are present skewing perception on this or any other board.

Why do you need to have adequate base knowledge to ensure you get the most from your TRT? Here’s a couple a couple of reasons why-

  1. There are a minority of bad doctors out there, doctors who are not specialized or diligent enough to provide adequate contemporary protocols tailored to the individual.

  2. Bypassing your HPTA and manually providing your body with the required amounts of hormones and chemicals to maintain “optimal levels” is a highly iterative process for a significant proportion of men. Typically once the honeymoon period is over a patient may need many protocol changes through testing and adjustments to find the spot where he feels well.

Some of these variable might be-

Amount of T per week 80mg, 100, 120….180mg/week?
Cypionate, Propionate, a blend?
Cream, injection?
HCG or no HCG.
AI or no AI.

From this, these are many combinations and it might take time, effort, money and a lot of testing to get and keep yourself in a good place. This cannot be assumed static either. For example weight change might affect e2 over the evolution of weight gain/loss. Meaning you might have to repeat the process.

Does your doctor have the time for this? Do you have the funds for the required iterations? What is the standard process for “dialling in” that ensures everyone is provided for??

Well there’s not one.

Typically it goes like this, take your shots, have bloodwork drawn to get a few numbers 6 weeks later and if all is well then you should feel well. The only thing is, many don’t feel good even with good numbers. The numbers that were tested were good but what about the ones that weren’t? For example, high prolactin symptoms are rife on this board but its usually e2 that gets the blame for ED.

So back to the original statement of “Be Your Own Doctor and Do It Well Or Roll the Dice”.

Is there any other way to be sure that the care you are getting is adequate? There’s not.

There is a rather large caveat in this argument though. Is it possible to learn enough so that you can adequately manage your own protocol and spot mistakes of the many average, non-specialised doctors under pressure from overly subscribed pop-up TRT clinics enticing in men who are hoping to improve their lives? I think the answer is - maybe some can and maybe some can’t. The ones that can’t have to roll the dice.

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I hope to have confirmed my view on this in my reply to @EyeDentist. There are certain cases written in some posts where it does seem like clinical negligence but this is surely the exception and not the rule.

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Thank you for clarifying. I agree with the vast majority of what you have said here. But if an individual is concerned they’re receiving suboptimal or ‘cookie-cutter’ healthcare, the proper (meaning ‘in one’s best interest from a health standpoint’) response isn’t to try and bootstrap oneself into amateur-endocrinologist status, rather, it’s to seek out better healthcare. Put another way: If you think you have a bad doctor, find a new one.

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This is a fair statement. Don’t be the Endo but at least know what they should be providing you with.

Guys embarking on their first cycle over in pharma get a hard time for not doing their prior due diligence and research. No such hard time is dealt in the T replacement section. Given the lack of regulation in the field, I don’t think one can leave the treatment management solely to the facilitator just yet.

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I am in agreement with all here. Not only is self-medication unwise and potentially unhealthy, as I’ve said for years, TRT is not as complicated as a Mars mission, is not a hobby, and is not meant for performance enhancement. Taken in appropriate doses, it’s medicine, and that’s it.

My “protocol” was two packs of Androgel or Testim daily for years, and for years has been 100 mg T cyp per week. No AI, no daily injecting. I never felt a lick of a difference between 100 mg once per week versus 50 twice per week. I’ve tested at 500 to 900-plus. I’ve never felt any difference in well-being and function across this range. The only time I felt off was when I tested at 1500 ng/dl and that is not a good, normal value with Androgel, and I have no idea how that happened.

The anti-doctor sentiment is overdone. I’ve been with the same doc for 20 years and with his help I have two kids.

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Excellent point. There is a lot of anti-Doc talk on this forum. Ive bashed the bad ones. There are many Docs out there that do care, some have come around and understand TRT.

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What if you ARE an endocrinologist!

Rare scenario

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You need 0.3271 mg injected IM every 32.54 minutes. Without this protocal, you will NEVER feel optimised.

Where did you apply the androgel? Absorption rate may differ by site of application. Esp if you stray from the recommendations on the packaging. Is it possible you accidentally doubled up? This has happened to me twice, not that it bothers me. Not nearly as problematic relative to when I forget a shot and wonder why I’m feeling so bad 13-14 days post 100mg shot.

I didn’t like androgel, it wasn’t nearly as effective relative to 100mg IM/wk and I didn’t like not being able to shower, swim or exercise until 4-6 hours post application

That and, in Australia a script for androgel (private or subsidised) on 10g/day is at the very best 2.5x more expensive relative to the shots. Why would I CHOOSE to spend more money when the cheaper alternative is more convenient?

If you HAD to… What would you choose? Having to constantly feel like you’ve got a TT of 1500, or a TT of 150-200? To note, in this circumstance you won’t actually have these testosterone levels, but you’ll always feel one way or the other. I choose the latter. I have experience at both ends of the spectrum. While I’m not certainly a fan of higher dose testosterone, I’d still take the feeling elicited with it over the feeling associated with being hypogonadal any day of the week.

125mg T/wk is my favourite dose.

Depends on the doctor, I’ve had doctors tell me they know little to nothing about testosterone replacement therapy. The anti endocrinologist, anti urologist, anti andrologist sentiment is off-putting. You’ll always encounter a bad endocrinologist or two, I’ve been exposed to one personally. But for that one terrible endocrinologist there will be a plethora of fantastic endocrinologists. You don’t go to med school for four years, then do res/internships coupled with years of specialisation only to come out knowing nothing.

Doctors need to be educated and brushed up on SO many variables, relatively uncommon conditions typically treated by those who take up niche specialties tend to slip under the radar at times. Testosterone replacement is indicative of this. A relatively uncommon, highly politicised, polarised and demonized treatment. With all the other information doctors are required to store in their head, I can’t blame many for not being experts on testosterone replacement.

The average internet expert might know a fair bit about trt, but put them in a room with a doctor to discuss the process of coronary calcification, metabolic abnormalities and systemic low grade inflammation (two are somewhat interlinked) associated with being overweight or obese, the different types of ankle fractures etc. The average trt expert will be schooled.

From what I recall you see a urologist. Of course your urologist knows about TRT, his profession requires one to have a very detailed level of knowledge pertaining to male anatomy, particularly the region wherein testosterone is endogenously produced.

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Spot on. Treatment success will be higher for those who truly need it to function because they are hypogonadal. Those who had a decent level of function before and are “optimising” are more likely to notice complain about various side effects of TRT.

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Unless all they want is gains.

Going from a TT of 500 to 2000+ is going to give you some nice shoulders, traps, a neck like you’ve never had before

Some nice acne, bacne. Cystic acne on the back can also be a lot of fun. Have you ever looked at a pepperoni pizza with a LOT of pepperoni on it. Imagine that. And the shape of your back will also reflect an upside down slice of Pepperoni pizza.

The water retention can also be on fleek (gen Z language), you’ll have the facial aesthetics of an obese person.

I’d mention stretch marks, but my atrocious, graphic stretch marks around my shoulders, back and chest came from low dose trt alone (at the time like 1x 250mg shot every 3 weeks). At the time I was sedentary and even that small boost had quite an impact on my mood and vigour, albeit the crash towards the middle and end was absolutely awful. I find below 450ng/DL and I start feeling subpar, below 350 and it’s obvious something is wrong, below 250-300 and it’s absolutely awful, below 180-200 and it’s hell…

In like six weeks I put on 15-20 lbs, I went from a measly 135 to right around 155. Such weight gain in such a short period of time, esp for someone with my connective tissue profile led to the development of horrible, horrible stretch marks. I’m around 173-174 now.

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Knowledge on trt is def lacking among many drs. I know I had to visit a few Drs before I found one that knew enough about trt.

I have read many guys end up in a trt run of the mill clinic because a Dr refuses to treat symptoms and require absurdly low t levels to start trt. And then when they do start it’s an every 2 week protocol.

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In Australia, unless you go private and/or find a good endocrinologist you need to be below 174ng/dl three times, all tests at least three months apart

Exceptions can be made for younger people of whom age related and/or those wishing to seek out a private script. Unfortunately most references ranges in Australia actually go down to around 130-150ng/DL at the bottom, and most cut off below 750ng/dl. I’ve actually seen ref ranges that specify below 100ng/dl is normal, I saw one that cut off below 600ng/dl. This means most doctors won’t even think about dispensing TRT unless you have a TT below 130-150. This is insane, apparently Australia is the hardest place within the secular, developed world to acquire a testosterone prescription. There was a HUGE crackdown on trt here around ten years ago, one that wasn’t warranted to begin with.

There are a few clinics/specialist doctors that will help people out. But the former example exists for performance enhancement, the latter is legitimate and both are very expensive. Want 250mg/wk, go to one of these clinics that primarily operate through word of mouth. Want legitimate trt, go to the latter.

Or… Be like me and luck out by finding an amazing andrologist. I was VERY close to going down the self prescribed route, and I’m glad I didn’t. I did experiment, and I have no regrets over that despite it not necessarily being in my best interest. But all in all I’ve found 100-125mg/wk to be my bread and butter. Quality of life, overall energy levels are SO much better with it. Granted there are benefits in my particular set of circumstances of which I reap from higher dosages, but there are also many disadvantages. I won’t get into that conversation though.

I used to be prescribed more than 100mg/wk, but requested to cut back due to acne and a little bit of water retention at the expense of a slight drop in libido. Neither dose I was prescribed had me at consistently supraphysiological levels. I believe the higher dosage (closer to 140mg/wk) had me pushing the limits at peak.

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There’s nothing wrong with wanting those sweet gains😆

Very true but it’s a crying shame when one can attract the ladies with those elevated levels of test, pronounced traps and shoulders but cant perform in the sack because they don’t have a fucking clue how to keep the rest of their hormones in check……. Next up, not just the e2/prolactin dick but now a nice dose of psychological ED and self esteem issues. Yay how fun!

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I think this is a common misconception. There is a niche of women who like the “big, bulky” look, and that niche tend to be REALLY into it. There’s also the water retention associated with testosterone use in high dosages. Women are more inclined to go for a guy who isn’t holding an extra 15lbs of water. Certain non aromatising androgens can elicit a "cut’’ fake natty look, I say this as to look like Frank Zane provided you don’t have amazing genetics you actually need to take quite a lot of gear. Not only testosterone, there is a cosmetic look that can’t be replicated as a natty 24/7 without enhancements. If you’re natural/almost natural, you can set up a peak day/week months in advance, but otherwise you can’t sustain a full, vascular, ripped appearance year round

Can’t say I’ve ever had libido problems from higher dosed test, though it’s been a while since I’ve taken higher dosed T (almost two years I think) Some of the meds I take decrease my libido substantially in which case it doesn’t matter what I’m on, I’ll always have trouble performing (sad face). The time I tried masteron (aaaaaAAAAAAAAAA cardiomyopathy! Dyslipidemia, focal segmental glomerulosclerosis, insulin resistance, systemic inflammation, oxidative stress, autonomic dysfunction!!! DEATH!!! Prison!!!) Was about the only time I had an outrageous libido that broke through antidepressant use. So when I say “I’ve never had problems” what I mean is “I’ve always had problems, high dose T didn’t make them any worse”. Though hypogonadism will crush the already low level at baseline into non existent realms.

But for most, huge neck, traps and whatnot isn’t considered a nice look. Girls like muscles, but not Michelin man, Phil Heath type muscles. The physique @brickhead had when he competed is probably the most extreme most women will like. Actually… What did women think of it when you were in your bodybuilding stage? You were extremely lean, dipping into “essential bodyfat” reserves. It’s not healthy to be that lean, and while I think it looks sick (slang for awesome), are women generally okay with that? Or do they find it gross?

You’re also friendly with professional bodybuilders. Do NORMAL women like that look? Or is it the gym centric women, female bodybuilders and such who are into it?

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I’m on the fence about this.

For the most part, I question “why” someone feels the need to become that big. It typically stems from deep seeded insecurity, an omnipresent sense of inferiority, feeling as if one isn’t masculine enough (very easy to feel this way today).

Sometimes therapy can help one to cope, sometimes people grow out of this mentality. However sometimes there is no fix, and for whatever reason “get big or die trying” is seared in and serves as the only way to deal with or overcome this insecurity.

Unfortunately, these insecurities tend to float when you try to drown them and thus steps in body dysmorphia. Perhaps you’ve done 3 proper, high dose cycles and even when off/on trt you’re 200lbs lean at 5’8 yet you still perceive yourself as being small. It’s a slippery slope

But provided you don’t have a significant other who is unaware of your hobby, a family to take care of and/or your kids are adults I don’t have an issue with a mentally competent individual above the age of eighteen here or 21 in America using anabolic steroids in their own time. There are worse things you could be doing, though consistent in moderate dosages provided you never stop will likely take around twenty years off your life, equitable to smoking very heavily.

I use the arbitrary ages of 18/21 as this is when people are considered “adults” in both societies mentioned. You can drink, smoke tobacco, smoke cannabis (in some states), vote, own a gun, enlist in the army, buy a house and more at these ages. So… If you can do that, you can take steroids regardless of whether or not it is a good idea to do so. Nicotine has a tremendously deleterious impact on reward pathways when used at the age of 18… But you CAN buy cigarettes at 18 in Aus and interestingly enough there is no smoking age here. Police can’t confiscate cigarettes from a 13y/old like they can in the US.

I don’t think taking steroids makes you a bad person at all… But I’d never recommend them to anyone, they’re psychologically addictive and regular use is destructive.

Some of the harsher AAS like testosterone (in higher dosages), progestogenic AAS like nandrolone and trenbolone, various orals like oxymetholone and fluoxymesterone can screw with your head. All can induce a degree of neurological dysregulation predisposing one to psychiatric aberrations, but for the most part this is somewhat overplayed as stereotypical “I’m going to murder you” type roid rage is rare.

All in all, while I can understand the desire to use (both literally and theoretically), though I don’t think it is a good idea to use

At the same time, i’m all for decriminalization and/or tightly regulating the intake in pharmacies wherein one could come in and order a cycle provided they meet various criteria. I think sending one to jail over the use of testosterone, nandrolone etc is beyond stupid.

I’d rather mandate therapy as opposed to jail, a permenant criminal record that will forever neuter employment prospects.

Since going in TRT and getting seriously involved with training I’ve gone from 135 (or 130) to 173lbs (today actually clocked in at 174) and my bf% is arguably lower relative to when I started. That’s forty pounds, it has had no impact on my rate of success with women. I’m a guy who tends to keep to himself, I’m autistic and I have a VERY odd sense of humour, so I’m not a ladies man. When women do flirt with me (actually happens quite a bit) I’m typically unable to detect what is going on at the time. I also sometimes turn down sex if offered depending on the situation. At college I once had an inebriated woken offer to go back to my room with me, the woman liked me. I turned her down because she was drunk and had feelings for me but I didn’t. The fact I’m somehow not a virgin is a miracle within itself. But I haven’t had sex in a long time (over a year) at this point.

Another I was at a bar, an attractive woman from the dormitory across from me walked up to me and poked my face. I had no idea what to do in that situation. Can anyone give me pointers for future reference?

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Typically woman like a decent build I’d say including traps and shoulders that are above average.

Steroids are a turn off for a lot of woman. Various stigmas.

The built athletic look of ~ 12% body fat is probably optimal but you will get outliers on either side.

Some woman might associate an impressively chiseled physique with obsessiveness and “making up for other deficits” but these are probably just responses to them feeling inferior like they will have too much competition….?

You can’t win them all but can’t go wrong with the athletic ~12% BF look with noticeably developed muscle. IMO