I’ve gotten in a bad habit of changing my protocol much too frequently recently. I’ve always been a “paralysis by analysis” guy with everything where I overload myself with information and end up spinning my wheels.
The last month I literally did not inject the same dose twice because I kept overthinking the protocol I was about to try which is absolutely stupid. I don’t have any major issues like low shbg or anything out of range on my labs, except for low vitamin d which I started supplementing. My main issues on trt have been low libido and ed.
I think it’s time for me to do a hard reset and stick to a protocol regardless of any perceived sides for a while and reestablish a baseline.
Based on what you know now, if you were starting from scratch, how would you approach it? Doses, frequency, target levels, ancillaries etc.
We will get arguments but Frankly, I would start out on gels. It works for most men for TRT. Thats TRT…not Cycles. Not blast and cruise. Not getting ripped.
You simply strt out on 2 pumps/day. Test for levels. Then go to three. Test for levels. Etc until you achieve the desired levels (where you feel best). Most closely resembles natural rythms. Dont need any “ancillaries” or anything else. Best levels IMO are 550 - 750 for TRT. No gyno. No Estragen issues. No lipid problems. No injection problems. No erection problems.
I’ve had vitamin D deficiency while on TRT and it can cause ED and low libido. It wouldn’t hurt to check ferritin levels, because sometimes TRT can drag it down from the creation of hemoglobin.
Thanks - this is the first time my vitamin d has been officially below range (20) but it has been borderline bottom of the range for quite some time (~30). I started supplementing 5000iu a couple of weeks ago after seeing the lab results. It seems to make me groggy but I’m hoping that’s just an adjustment period that levels out. Fwiw I still had these issues years ago when d3 was at 55, but I was also on a piss poor protocol then that had me on clomid in conjunction with low doses of t and large doses of preg/dhea.
Vitamin D to become biologically active requires magnesium, therefore magnesium can be depleted taking large doses of vitamin D. Vitamin D also increases calcium absorption and vitamin K keeps calcium from accumulating in the bloodstream and organs, vitamin K is like a traffic cop, it directs the calcium where it needs to go.
You can’t supplement that much vitamin D without also taking vitamin K or you risk calcification.
You typically require 100-200 mcg vitamin K with 5000-10000 IU D3.
I have an extreme sensitivity to vitamin D, I can’t handle anymore than 600 IU, or I get nauseated, weakness and fatigue.
I’ll start low and go up. Part of me wants to just inject once a week to minimize the time I’m stressing about my protocol during the week. I think I get in my own head the more I think about it/have to inject.
Never understood the advice to start at 150 and then go up or down. How the hell are you supposed to know if it’s too much or too little.
Always wondered if some of us could have titrated up to a dose very slowly overtime we could have been happy with but never made it work by introducing it too soon.
Agree and disagree. Agree with starting low and working up. Agree with a starting dose of 70 mg (of T-cyp). Generally, most guys do not need to go over 120 mg/week, but that’s where labs come in.
Agree/disagree with the 4 week recommendation. Six weeks is a minimum. As Readalot pointed out, it takes that long just to stabilize T levels, but other downstream hormones and neurotransmitters may take much longer to stabilize for the “feel” aspect. I recommend a minimum of 8 weeks but 12 would be better.
Disagree with the “feel best” method of determining optimum dose. The way we feel is influenced by way too many other factors such as competing medications, length of day, stress, natural body rhythms, and the list goes on and on. Instead, I believe that labs should drive decision making. I aim for getting Total and Free/bioavailable T into the 90-100th percentile of my age group. In reality, I want to be in the upper 33% of a 20-30 year old for free T but labs seldom give you ranges outside of your own age group and you can’t compare one lab’s results to another even if you can find them on the web.
I would add that more frequent than once weekly for a dosing protocol is better. I like E2D or E3D protocols (I go back and forth between the two). More frequent dosing gives you more stable hormone levels (a smoother ride) with fewer side effects because you avoid the way out of range peeks in hormone levels which drive faster conversion to E2 and DHT. An added benefit is that you can drop down on needle size. You don’t need a harpoon to inject 0.15 to 0.2 mL of T-cyp. I currently use a 28G 1/2 inch needle insulin syringe for my dosing.
I would not mess around with aromatase blockers (other than possibly DIM and/or Chrysin supplements) until after you get to a stable protocol and have labs to show that you are out of range for E2. I will get disagreement with this next recommendation, but I also suggest the LS/MS method for measuring E2. We’ve covered that in a recent thread and don’t want to get this one side-tracked.
On final recommendation, and this one might get a LOT of argument, is that if I were doing it all over again, I would add topical finasteride (not oral) to my protocol from day one. I experienced a lot of hair loss early on in my 11+ years of TRT and I would love to go back in time to prevent it. Topical finasteride gets more of the drug to the site where you need it the most. Studies (and my personal experience) show that only about 20% of the scalp applied finasteride make it into the blood stream. So, my 5 mg daily finasteride dose results in about 1 mg systemically. What’s most important is that you couple this with lab tests to guide you in your dosing. For me, 5 mg topically will keep my DHT levels in about the 60th percentile of ‘normal’ for my age group. This is why I do not have ED or libido problems that many of the finasteride opponents point to. Smart use of the drug guided by labs is key to success.
I can see the merit in waiting longer, and titrating from 80 to say 160mg a week maybe best to take time if you really want to make 160mg a week work when it didn’t work if you just introduced it off the bat.
With that said though unless we are speaking of small incremental changes such as that I am not a believer of this waiting game. As if something magical will happen between week 5-8.
Like say you did 100mg a week and just jumped to 150mg a week. Honestly by week 3-4 you should already know if you are headed in the right or wrong direction. And I don’t mean it’s bad if you just feel a little “off” with slight anger at 3pm daily. I mean if you are dead tired, lost libido, ED, brain fog all day I will fight tooth and nail to call bullshit that all of a sudden things will turn around by some magical number assigned to a week.
Edit: just read about that super frequency, don’t agree with that either. The majority are fine on once a week. The majority of the minority that aren’t fine on once a week are fine with twice a week. All this “stability” nonsense is just that, nonsense. We have plenty of people on prop, on once a week dosing, on cream/gel. If this super stability was a thing we would see more pellets or undeconate.
I appreciate the details in your reply. Can I ask why you switch between e2d and e3d? Do you notice any sort of differences or is it more a matter of injection fatigue? Would daily technically then even be an improvement from e2d or e3d?
I think I remember you having the same trt provider I used to who had us both on 40mg e3d to start. That put me at roughly 650 trough and didn’t have much relief, although that was probably 5 or 6 years ago now.
I’m fairly new to TRT and started at 100 unit injections 2x weekly, moved up to 200 then switched to pellets.
I prefer pellets but at ~$700 and a light surgery causing a week plus of no gym time every three months, shots make more sense as insurance covers cypionate for like $8 per month and no down time. I’m switching back to injections but will experiment with daily micro-dosing.
I do experience polycythemia so I donate blood 1x per quarter, I have anastrozol on hand but only use 1/4 of a tab if I feel waterlogged or my nipples itch or something. It dries me right out for weeks.
Pretty simple if you ask me. I feel “dialed in” at 200 units per week, use a quarter of a pill should sides show up and aside from a need for blood donation, no further issues. And I like donating blood anyway. Save a life and keep my own blood fresh. Lots of studies show reduced health risks in donors.
15-45 estradiol depending on how close to labs I feel like I need the quarter tab.
I usually donate blood after labs to keep values accurate so hemotocrit and hemoglobin tend the be right on the high end, maybe negligibly over. I’ll donate right after, so the donation’s effect does last the full three months, for me, like clockwork.
This is based on 2x weekly injections.
Pellets have been in the same range but there is a downward trend in feeling, strength and energy as they absorb and wear out. We moved from 5 month insertions to 4 and discussed every three months to stay level most recently, at which point the convenience is gone and it’s more than I can justify spending considering health insurance covered injections.
I should start daily injections in the next couple of weeks, and if I remember I’ll report back in a few months.
I did once weekly for about the first 6 months and always had problems at the end of the weekly injection cycle. Started at 100 mg/week and worked p to 140 and still had end of cycle problems. Also, my nadir TT vales were only in about the 60th percentile of the normal range.
I switched providers going to a well respected name in TRT and he put me on an E3D protocol with about 93 mg/week (40mg E3D). My nadir labs shot up well over the 100th percentile (values varying between 1000-1600 ng/dL). Basically, the peaks are smaller and the nadirs are higher when you go on a more frequent dosing protocol. A big benefit that I discussed previously is that I am able to drop way down on needle size, which I like a lot.
Regarding daily injections, Yeah one could do that but one needs to decide how far one wants/needs to go for the sake of stable hormone levels. I find E2D or E3D to be a balanced approach.
Regarding your experience with 40mg E3D, it again comes down to the labs to drive decision making. You may (probably) have lower SHBG levels than I do (mine are very high) and that could mean you metabolize T faster.