Doc Wont Prescribe hCG/Arimidex

Hello everyone,

this is my first post here.

Quick background: I’m a 25 yo male. I have been feeling fatiqued/low energy and lethargic for a long while (years). I work out in the gym with a lot of dedication and I have a good clean diet and sleep and supplement well. However, I have not been getting the results I wanted… progress is slow and I seem to quickly lose the mass I gain (also unable to maintain mass while cutting).

So, I decided to get my T and other hormones checked a few months ago. Total T was low normal, nothing problematic but still quite low for my age. However, free T was even lower in comparison probably due to fairly high SHGB levels. Early morning measurement:

TT: 5,2 ng/ml (2.5 - 8.4)
FT: 88.9 pg/ml (57.00 - 178)
SHGB: 48.10 nmol/l (14.5 - 48.40)

Note: At around 11 am my TT was only about 3.8 ng/ml but I assume this is still semi-normal; Free T would have been drastically low at this point. I also had a bunch of other stuff/hormones checked, everything else seemed fairly normal.

I finally found an endo willing to prescribe TRT in the form of sustanon (no cyp/enth available here). He told me to inject once every three weeks, 250mg. However, I intend to inject about 80 mg’s every week to maintain stable blood levels.

Now to the point: the problem is that he was unwilling to prescribe me hCG and Arimidex. He feels that hCG is not necessary for therapeutic doses and will only subscribe Arimidex once my E2 goes out of range.

I read the TRT protocol sticky and I assume it is best that I use small doses of Arimidex from the start? Same goes for hCG?
If he is unwilling to prescribe then I will probably have to buy Arimidex and hCG online without a prescription. However, how can I be sure that I buy from reliable sources? Can anyone give some advice regarding this issue?

Thanks

Do not take an AI unless you have a demonstrated need for it!!! I agree with your doctor in that regard.

The rest of your protocol is awful.

[quote]VTBalla34 wrote:
Do not take an AI unless you have a demonstrated need for it!!! I agree with your doctor in that regard.

The rest of your protocol is awful.[/quote]
Hello,

thanks for your quick reply.
Can you tell me what exactly is so awful about it? You don’t like the sustanon, the dosing, the frequency? I would appreciate some input on a better protocol if you don’t mind.

Thanks!

Hi again,

I would like some additional feedback; Is there some kind of problem with weekly Sustanon 250 injections? What about the dosage? The endo didn’t really know what he was doing, he suggested me to find the right dosage myself while doing some followup blood tests. What would be the best initial weekly starting dosage? I was thinking 80mg (a third of the vial) every week… or should it be more?

As for the hCG. Is it necessary to use this or not? I would probably need to visit another endo in order to get it (or find a good source online…) because the current doc won’t prescribe it for some reason.

Thanks

Sustanon has short and long esters. The short esters (prop) should be injected everyday or every other day. I would dose sustanon no less than twice per week. But that is somewhat irrelevant, since I would never use sustanon in the first place. It is by far the most overhyped product out there, with no benefit over Cyp/Enth. If you can’t get Cyp or Enth, then I guess it will have to do.

Also 80 mg is a rather low dose per week. You MIGHT feel ok on that, I dunno, but it will barely get you into the ranges.

His assessment of HCG not being required for therapeutic dosages is most likely wrong. Not all men need it, but many do. To completely discredit its use is not a good position to have, in my opinion. Add it in if necessary.

Your labs are consistent with elevated E2 levels. Get E2 tested. If E2 is a problem now, it will be a must for TRT.

You doctor is an idiot who can’t see past the very old and stupid testosterone injectable literature.

80mg sustanon can be expected to not be enough. The testosterone yield from the longer esters will be lower than for cyp or eth.

Endo’s are as a group quite useless for TRT.

Hello,

Thanks for the reply guys.

Some other relevant information - 11am blood tests (not fasted):
TT: 379 (280-800)
FSH: 2.5 (1.5 - 12.4)
LH: 4.7 (1.7 - 8.6)
SHGB: 48.4 (14.5 - 48.4)

DHEA-S: 573 (90 - 525)
Prolactine: 10.4 (4.0 - 15.2)
IGF-1: 238 (170 - 418)
Oestradiol: 33 (7.6 - 42.6)

Free T4: 1.59 (0.93 - 1.70)
TSH: 1.42 (0.27 - 4.20)

Note: I also had a fasted blood test a few months before. My Oestradiol levels were much lower back then.
Oestradiol: 18.6 (7.63 - 42.59)

I will not start the TRT treatment before I can obtain hCG and have some arimidex available if problems should occur. However, it’s a long wait until the next appointment and I’m not sure the other endo will prescribe the hCG/adex. Can I get some input on reliable sources to buy these products online myself?

Another question: Are my IGF-1 levels problematic? I read that optimal levels should be between 350-400 for my age (25). I also read that the TRT might increase IGF-1 levels; Is this correct? Does it also increase natural HGH output?

Thanks!

IGF-1 is not bad and the bottom line is that you will not start injecting GH, so you can put set that concern aside for now and see where that goes later.

When you inject, as with T, you suppress your own production. When someone with low GH injects, part of the dose goes to supporting IGF-1 to where they were and then the rest of the dose increases IGF-1. In your case, a lot of the cost of the GH to take you to where you are is lost money and the increase above that is less cost effective than than the benefits for someone with much lower IGF-1. My IGH-1 was almost 1/3rd of where you are now and I feel a lot better now, still lower than where you are now. To improve on were you are now, you would probably need 2iu per day, that would cost $20 per day, probably more, if you use Rx.

You will be able to find a liquid anastrozole product if you are not able to get a medical solution. hCG is difficult as you would be importing from overseas and that has major risks. In some states, hCG has been criminalized by classification with anabolic steroids. Not a federal crime in terms of that classification, but still not legal and subject to seizure.

Thyroid looks odd. fT4 seems to look good, but TSH is unexpectedly high. May not be a problem, but does catch ones attention.

Have you reviewed the thyroid concerns in the ‘advice for new guys sticky’: iodine, body temperature, sea salt, iodized salt?

Hello,

Sorry for the late reply; Thanks for answering my questions.

I’ve looked around for some online pharmacies in the meantime and there are a few that seem to deliver Arimidex and hCG without prescription.
For Arimidex the brandname is called “Altraz”. For hCG there is a choice between “Corion” and “Fertigyn”. The Corion is cheaper but the name of the manufacturer is not available, so I have no idea if the source is reliable. The manufacturers for Altraz and the Fertigyn both seem to be located in India.

I assume I also have to buy a seperate mixing kit (with antibacterial water to mix + syringes)? These kits seem to be sold on hCG dieting websites, but they cost more than the actual hCG.
(I also found another doctor that thinks the use of hCG is necessary while doing TRT, but he can’t prescribe it since he’s not an endo. I will try to get the necessary mixing material through him first before bying the kit online.)

I’m actually not from the USA myself but the hCG is indeed subjectible to seizure… I guess I’ll have to take that risk; Thanks for the warning.

For the thyroid issue: A value of 1.42 TSH doesn’t seem very high to me? According to online sources only 3+ values could potentially be problematic?

Thanks!

Just check your temperatures and see. I pointed out what the concern was, read it again. Will it really be bother to state what your iodine intake is?

Yes, doctors will not see a problem with your thyroid labs. But they look for situations that are bad enough to warrant thyroid meds for life. Here, we are more interested in optimals not pathologies.

For T4 that high, it seems odd that TSH is not closer to 1.0. If rT3 was blocking your [unknown] fT3, then even if fT3 looked optimal, rT3 could be blocking fT3 and your perfect labs would not tell you if you had a functional case of hypothyroidism. Just check your temperature and see. If temps are fine, then you do not have anything to worry about. If low, you could have iodine deficiency and or elevated rT3.

Hello,

thanks for the reply.

My current temperature is about 36.4C (97.5F) so I assume that’s pretty normal; I always had a relatively low baseline temperature. My diet is pretty good: I eat chicken, lean steak, salmon, tuna, eggs, steamed veggies and multiple sources of complex carbs every day. I assume the fish, eggs and veggies deliver more than enough iodine in my diet?

It might also be interesting to note that my cholesterol is extremely low (according to me… doctor again said it was normal and even “very good”). I tried pushing my LDL higher by increasing the saturated fats in my diet, since all my meat/fish is cooked in oils or calorie free baking sprays. I’ve been eating 6 full eggs per day the last few months and I also started eating extra nuts for mono’s. Both my HDL and LDL went up a few points but LDL is still pretty low. Latest lab (not fasted 11am):

Total cholesterol - 113 (<190)
HDL-Cholesterol - 55 (>40)
LDL-Cholesterol - 46 (<115)
Triglycerids - 60 (<150)

I also seem to have some kind of genetic risk factor for cardiovascular decease.
Lipoproteine (a) (lp(a)): 556 (<300)

From what I read online the Lp(a) acts like LDL somehow so it might actually be a positive thing to have my real LDL at low levels. The doctor says I shouldn’t be concerned with the lp(a)…

My diet:
3360kcal at 29/50/21 ratio
protein: 243 grams
Carbs: 420 grams
Fat: 78 grams

Some other stuff:
Prolactine - 10.4 (4.0 - 15.2)
Cortisol - 18.4 (morning should be 6.2 - 19.4)

→ my real fasted morning cortisol was 21 the last time with the same reference range. This is probably training related… I try to keep this in check by having 2 rest days per week to avoid overtraining. I also train each muscle group only once a week. My work is seated/non-moving so it shouldn’t be too much of a problem I assume.

Thyroid extra:
Microsomiale (TPO) As - 15.9 (<34.0)
Thyreoglobuline As - 10.6 (<115)

I also got the sustanon at the pharmacy last week. It came with a 20 gauge 1.5 inch needle, seems pretty thick and long the me. I read the sticky and looked online and I assume I should get some thinner and maybe less long needles? 22 or 23g 1 inch needles should work for injecting 80 or maybe 125mg sustanon per week?

Thanks!

Read the protocol for injections sticky. There is no need for large needles. #23 works well for 1.5" and would flow better for 1". #20 is insane

So you have body temps that are a bit low, your thyroid profile is a bit odd and you assume that food has enough iodine. That last assumption is dead wrong and if that was true, anyone who eats food could not get goitre. I am glad that you have that figured out.

https://www.google.com/search?q=goiter+pictures&hl=en&client=firefox-a&hs=yhq&rls=org.mozilla:en-US:official&prmd=imvns&tbm=isch&tbo=u&source=univ&sa=X&ei=RTeYUM7mM5D82gX1zoCwAg&ved=0CB8QsAQ&biw=1594&bih=1000&sei=TzeYUIX8M6Xg2QXox4C4Ag

If you cannot get to 98.6 with repeated measurements, try iodine replenishment and see if your temperature gets closer to normal. Yes, the sea food is helpful.

Your cholesterol is horrible and certainly isn’t helping your T levels. My doctor likes to see cholesterol over 180. Maybe you should mix in some pork and fatter cuts of beef. I’m no dietician but your fat intake looks way low. You could probably trade some carbs for fat in your macros.

Hello,

Ok, I’ll try to get some 23g 1" needles then.
I’ll look into some iodine supplementation and I’ll start monitoring my temperature… thanks for the tip.

Ptownmike,
80 grams (720kcal) of fat in a diet is certainly not that low, it’s kind of average actually. I could indeed try to up it again to about 100 grams by adding some more satured fat and see what happens to my LDL levels. I doubt that it will have a severe influence on my T levels though. However, I’m not going to wait a half more year to find out before going on the TRT… :slight_smile:

I also read some things about correlation between TRT and hair loss, because of the DHT conversion. Can this be an issue for me, at a young age? My dad is balding but the father of my mother had a full head of hair at old age. Some of my uncles at fathers side have hair, others are balding. I don’t have any hair loss issues myself at this point but I would hate for this to start once I start the TRT… Are DHT blockers commonly used while on TRT?

Another issue:
it seems that the online pharmacy where I wanted to buy the hCG/Arimidex doesn’t ship to my country. Can anyone provide me some reliable online sources to buy this online? (Or, can I send a PM to someone for this?)

Thanks!

Cholesterol is the building block for steroid hormones so your low T can be heavily influenced by your low cholesterol… Again I’m not a dietician but I doubt trading some carbs for fat is going to hurt anything.

Stay away from DHT blockers and deal with the baldness if it comes. A lot of people have permanent sexual dysfunction from using hair loss products/DHT blockers. DHT is essential for sexual function. I’d rather be bald with a working Johnson than have a nice head of hair with a permanently limp noodle.

Hello,

Ok, thanks for the tips guys.

I have an appointment with a nurse that will show me how to inject the sustanon on saturday. However, I still have no AI or hCG on hand and I would really like to have it in the house just in case something goes wrong. I have to wait two months for the next appointment with another endo who will (probably) prescribe both meds. Can someone provide a good source to buy hCG/Adex online?

Another question: Is it a good plan to start almost immediately with the 2x250iu hCG if I want to keep my own production/fertility in check? Or, should I wait for a few weeks/months until my body actually starts shutting down its natural T production?

Thanks!

Yes,it’s very difficult just to get a dr. to Rx-testosterone. The aromataze inhibitor at such a low-dose may not be required. Remember aromataze inhibitor’s are for people who use 5-10 times thwe biological level of natural testosterone.

The body of a 35year old man produces according to some studie’s between 7-10mg’s per day.So between 70-100mg’s per week,hence.hrt/trt Not getting testosterone enanthate,cypionate is unusual,as those are the drug’s of choice for injectable’s,and injectables are the more bio-active way to go.

Why not look into an anti-aging clinic,as they are quite $4expensive,but will be more knowledgeable in regard’s to testosterone and the Ancillarie drug’s. all the best john

[quote]JustMeOnTRT wrote:
Hello,

Ok, thanks for the tips guys.

I have an appointment with a nurse that will show me how to inject the sustanon on saturday. However, I still have no AI or hCG on hand and I would really like to have it in the house just in case something goes wrong. I have to wait two months for the next appointment with another endo who will (probably) prescribe both meds. Can someone provide a good source to buy hCG/Adex online?

Another question: Is it a good plan to start almost immediately with the 2x250iu hCG if I want to keep my own production/fertility in check? Or, should I wait for a few weeks/months until my body actually starts shutting down its natural T production?

Thanks![/quote]

Please don’t get all nervous.In Arnold’s day there was no arimedex and hcg and no one got in trouble.I was a competitive bodybuilder in the 1978 jr.Mr.Canada.I came 3rd and i used 500-2000mg’s in a cycle,and i never GOT GYNO!!!,or my ball’s didn’t get shrunk like raisin’s.Your on a VERy LOW dose?

Hello,

thanks for the tips Johny.
The next endo that I’m visiting works in a wellness-care type hospital. They are indeed more inclined to look at optimal values instead of just the reference ranges (and hopefully have some more knowledge about hCG and AI’s).

I am planning on taking 125mg of sustanon each week and will evaluate blood tests after a month or two. However, I just had my first injection done today. There was a miscommunication with the nurse and he actually injected the whole vial (250mg); I assume it’s not too much of a problem? I will start injecting myself next week.

Question: Do I have to throw half of the ampule away if I only use half of it? Or, can I load up a second syringe and keep the other half in the refrigarator for the next week?

Another thing: I just received back some stool analysis results. Digestion itself seems to be OK (no muscle fiber, starches etc in stool), but my gut flora seems to be very problematic:

Escherichia coli 10^5 (10^6-10^7) → yellow indicator on “sliding red, orange, yellow, green colorchart”
Enterococcus sp. 10^3 (10^6-10^7) → fully red indicator
Bifidobacterium sp 10^7 (10^9) → fully red indicator
bacteroides sp 10^7 (10^9) → fully red indicator
lactobacillus sp. 10^4 (10^5-10^7) → yellow to green indicator
ph value: 7.5 (5.6-6.8) → fully red indicator

Transient flora, candida, fungus etc were all OK (fully green indicators), no problems there.

Dysbiosis factor: 3 (<1) → yellow to orange indicator

I still have to see a doc about this, but I already started taking probiotics capsules.
Some other people in my family, including my sister, have or had very severe gut problems so this might be a genetic issue. My diet is relatively clean, as stated above… maybe I should lower my proteins/meat consumption a little bit?

I assume that these intestinal issues can also be a source of my fatique and low energy levels?

Thanks.

It is not uncommon for a family to share similar gut flora profiles, good or bad. Most get flora from vaginal delivery. There are concerns that C-section delivery disconnects one from millions of years of bacterial heritage. Many/most probiotics are useless. The product should have many different kinds of bacteria and should be sold from refrigeration in the store.

I use this product, which has a confusing number of alternatives. http://www.renewlife.com/probiotic-supplements.html