Hey guys, long time lurker first time poster. I looked on Google for info on this and came up empty so I’m hoping I can get some experiences and advice from you all.
My husband for the past 18 or so months has completely lost his libido, sweating a lot, gaining weight, etc etc etc. We assumed it was side effects from his SSRI but He FINALLY said something to the doctor about his symptoms and we got blood work ordered. Come to find out he doesn’t just have low-T, as seen in photo, he has VERY low-T.
(14ngml total 1.2L free 2.4L bioavailable)
I’m posting because I don’t know what to expect with his treatment, like 3 months ago I had ordered some grey market test-e on a hunch and gave him weekly shots for a month but idk if it actually got into the muscle or even was real shit. We didn’t see any effects other than he had morning wood like once.
Dr initially prescribed AndroGel 1.6% 2 pumps a day but his insurance sucks so we ended up with Test-C 200mgml and he got his first (real) dose yesterday. We signed up to get the gel paid for so we’ll see about that eventually. In the mean time the script says only one shot a month. That doesnt seem like enough. Id also appreciate a time estimate as to how long until his dick works again lol
Once monthly let alone one injection every 2 weeks doesn’t work for 99 percent of men (study linked below).
Most men absorb T-gels poorly, injectable testosterone is 100 percent absorbed and requires the most skill from your doctor. Men with lower SHBG more than likely will require frequent injections as any moderate fluctuations in testosterone and estrogen will prevent the body from reaching balance.
My SHBG is 22 and even injecting twice weekly, my levels fluctuate too much and I respond poorly to TRT, it wasn’t until I started injecting smaller doses (20mg) every other day that I started growing muscles, erections will not happen unless estrogen is managed and the majority of doctors refuse to even test for estrogen do to ignorance.
Many of us are forced to go private to seek competent care that just is almost impossible to find inside insurance networks, sex hormones therapies have been apart of anti-aging and sports medicine for decades, an area of medicine shunned by mainstream medicine which is why all the doctors are untrained.
Defy Medical is a telemedicine clinic that has experience TRT doctors who have been doing TRT for decades, all medicines are mailed to my front door, blood draws are done normally and consults are over the phone. I’m a patient since none of my doctors knew how to help even though I have great insurance.
Skip to figure 1 graph B and see levels drop below therapeutic levels after only 6 days after an injections at 200mg every 2 weeks. The body cannot achieve balance with levels fluctuating too much.
Before starting T he switched to a low dose of a SNRI that doesn’t list libido loss as a common side effect. Has been on it for 2 months. Today will be day 3 after his first shot. His mood yesterday was horrible.
His SHBG is 50. Is that a good thing? Are you suggesting injecting more frequently than his script says? We have a 10ml bottle and should have the gel in a week or so.
How do we bring these concerns up with his PDoc?
Why won’t the gel work? It makes sense that 60mg topically every day would create more stable levels than 200mg IM biweekly. I think?
What should we look out for as far as estrogen?
Is there any supplements he should be taking to help this process?
The P doc is really cool middle aged guy and receptive to help, we don’t want to have to spend a fuck ton of money on anti-aging revitalization docs unless we absolutely have to.
Thanks for the answers I just don’t want to be wasting any more time, I just want him to feel well as soon as possible.
SNRI and SSRI’s increase SHBG and lower free testosterone and damage hormone production, these medicines can also cause ED and lowered libido.
A protocol for someone with SHBG near the top of the reference ranges would be 50-60mg twice weekly as a good starting point, this will create super stable levels throughout the week. I would rather have an SHBG of 50 versus 22, TRT may lower SHBG a little which is also good as closer to 30 is perfect.
Everytime you adjust the TRT dosage, it takes 6 weeks to reach stable plasma levels of testosterone, after 6 weeks you would want to check Total T, Free T, SHBG and estrogen sensitive assay.
If estrogen is low or high erections will be challenging and libido may be lowered or dead, but do to the higher SHBG I doubt your husband with have problems with estrogen that adjusting the dosage wouldn’t easily resolve.
I would also recommend using 29 gauge insulin syringes which are painless compared to the nails these old school doctors provide. I inject 29 gauge 1/2 syringes in my shoulders and outer quads rotating injection sites.
You didn’t mention his age, regardless, this is terrible. With SHBG at 50, he will likely be fine with once weekly injections. I would start there. My SHBG runs in the mid 20s and I take 200mg test cypionate once a week. Last labs had me at 902 total and 220 free. Also, given how low he is, I would take 200mg. Get follow-up labs on the day of his injection, prior to the injection. Get E2 checked as well.
Some do fine with the gels, but most do not. Absorption is an issue and they tend to increase estrogen. Injections are the cheapest (unless insurance covers everything) and most effective mode of delivery.
Sounds as though your PCP may be willing to work with you. Make sure you stay on top of follow-up labs until you get this figured out. Good luck. Speaking from experience, a supportive wife is awesome.
Thank you all for the advice. He’s one of those people who is super into following doctors orders so the once a month thing is what he wants to do and he doesn’t believe me that it probably won’t work well if we do it that way. I think I’ve convinced him to do it every other week but everything I read on here seems to indicate that he should be taking every week. We just started and I like I said I really don’t wanna waste time. When should we start seeing results as far as his energy level? He’s also been taking a supplement that contains boron as its main ingredient.Does anyone have experience with that supplement?
Also the doctor has him going back at the end of January seems like a long time without labs given he just started?
Boron is thought to increase muscle and testosterone, used by some bodybuilders, but the evidence is anecdotal. Cannot say I noticed anything with boron.
As for when you should see results, I do not know. Typically, most report significant improvement in two to four weeks. I felt better is two weeks, weekly dosing however. I’m not sure what to expect with this schedule. Pay close attention to how he feels the first week following the injection compared to the second week. A significant drop in energy, etc., in the second week may convince him that a weekly injection is better. If he does great with twice monthly, great.
I see the consensus here widely is advocating for injections (not androgel) and at least weekly.
If i am able to convince him to do the weekly injections would it be 100mg each week rather than 200mg biweekly?
We may have to decide to do that if we find that the Androgel 1.62 manufacturer denies our “our insurance sucks and we’re not rich” application to get it for free. He would really prefer to use the gel because of an irrational anxiety around needles.
What is a good OTC or supplemental/food estrogen blocker? We’d like to try something like that for now as we won’t see doc again until early next year.
It’s difficult to get a clueless doctor with no experience to deviate from standard of care, if something were to happen to you as a result of a doctor going outside what’s recommended he/she could get in trouble and what’s recommended is insane and doesn’t workout well for almost everyone.
Whoever wrote these guidelines do so out of extreme ignorance and do not understand how things change after shutting down the HPTA. I believe androgel is pushed on patients to make things easier for doctors as they don’t have to spend much time with you to figure out your case.
Time is money.
Doctors have been living under a rock as far as TRT is concerned, a study (linked here) was published 12 year ago that show men injected with testosterone every 2 weeks and after 6 days testosterone dropped below therapeutic levels and men started having symptoms of low testosterone at this point.
Pay special attention to figure 1, graph B which shows after 6 days levels are low. Fluctuations in testosterone from injecting infrequently can feel as it TRT isn’t working and symptoms remain as a result.
DIM can help balance estrogen to a point, if estrogen is ungodly high it may make a smaller difference or none at all.