I don’t think that you will find research when it is so obviously a stupid thing to do. HRT is about restoring hormones to youthful levels, not a roller-coaster to depression.
Tell her what you want to do. If she says no, tell her that 200mg a month in her office is not acceptable and inconvenient.
[quote]IKIMURA wrote:
I am on the same boat as you are BB. I just started 200mg a month. 1 shot. After three months she wants me to take another blood test 4 weeks after my last shot. I imagine my numbers will be real low after the shutdown and 4 weeks of halflifes whittling down to nothing. My Doctor also took another blood test and said the second test (before I started TRT) my numbers were all in the normal range. She said if she knew that I was in the normal range she would never had started me on test. Her action is to know go more on how I feel and try to get my numbers into the normal range. I too would like 400mg a month/ 100mg a week. Why the hell are these doctors so stingy with this?[/quote]
My doc, although not fully knowledgable, is keeping an open mind on some things. I gave him a few articles to read which he was willing to do. I think initially he did not trust me as he asked me twice on seperate occasions if I used steriods before because “I looked fairly muscular” I have never done steroids. After following his guidelines and being honest with my symptoms for the 1st month he allowed a higher and more frequent dose. When I told him how the emotions and energy levels changed week by by week in that month he agreed to change the dose and frequency. His idea is to get my Test levels up and using how I feel to figure out a dosage as we don’t have a record of what my Test levels were when I was younger. Depending on how things go with E2 and HPTA shutdown I may not feel any different. As I questioned him more and more on E2 and as well HPTA shutdown he admitted he does not know all the answers and keeps an open mind somewhat. I will keep discussing with him on the issues. However, the process towards an AI and HCG will be a slow one based on his current knowledge, or what I think his current knowledge is. I am considering alternatives until then.
Update: On Thursday July 16 I went to the doc who is filling in for my original doc who is away on holidays. I expressed my concern over testicular shrinkage since increasing my dose and frequency of TEST E a few weeks ago. Initially he was reluctant to prescribe anything. I showed him the TRT Injection Protocol from KSman and he read it. I was due for another blood test so I asked him to change the bloodwork request to include estradiol, LH and FSH. I could then start HCG the next day and when the bloodwork came in if there was anything out of whack we could readjust the dosages and then retest in a month. He agreed. So currently I am doing 100mg TEST E/week in divided doses, 1mg of liqiudex/week in divided doses the same time as the TEST E (5 weeks now), and, now just started on hCG at 250iu SC EOD. When the blood work comes back I can see possibly adjusting the liquidex dose a bit based on the insulin resistant comments above and possible influence of estogen dominance. We will wait and see what it says.
KSman the TRT Injection Protocol post you created was very helpful in informing what to look and ask for as well as passing information to my particualr doctor. He was a younger doctor and said the visit was ver educational.
I will update as things develop.
“”“we don’t have a record of what my Test levels were when I was younger”“”
-sounds like an interesting and obvious thing, but quite useless for older guys. T receptors are down regulated and the cells do not respond as well as they used to to T docked T receptors. And with age, SHBG keeps increasing so your youthful TT, whatever that was would be quite SHBG bound and FT very much lower than you had with your youthful TT when young. Older guys need higher TT levels to obtain decent FT levels. SHBG increases TT levels while bio-T is down. SHBG bound T is garbage waiting for an older liver to remove it.
I have converted my doc to the above thinking and he is comfortable with TT not being “the goal”. It will be hard for many to accept that some guys will need TT levels higher than youthful maximum ranges. This is implicit in the practice of some docs who do not check TT levels, only FT or bio-T.
“”“EOD. When the blood work comes back I can see possibly adjusting the liquidex dose a bit based on the insulin resistant comments above and possible influence of estogen dominance.”“”
-Insulin resistance comes with the partnership of low T and elevated E. Some anastrozole will make that concern vanish. Your target should be serum E2=22pg/ml [0-54]. This will also optimize libido and fat loss. If libido is not quite right, then you can look at some other factors.
[quote]KSman wrote:
“”“we don’t have a record of what my Test levels were when I was younger”“”
-sounds like an interesting and obvious thing, but quite useless for older guys. T receptors are down regulated and the cells do not respond as well as they used to to T docked T receptors. And with age, SHBG keeps increasing so your youthful TT, whatever that was would be quite SHBG bound and FT very much lower than you had with your youthful TT when young. Older guys need higher TT levels to obtain decent FT levels. SHBG increases TT levels while bio-T is down. SHBG bound T is garbage waiting for an older liver to remove it.
I have converted my doc to the above thinking and he is comfortable with TT not being “the goal”. It will be hard for many to accept that some guys will need TT levels higher than youthful maximum ranges. This is implicit in the practice of some docs who do not check TT levels, only FT or bio-T.
“”“EOD. When the blood work comes back I can see possibly adjusting the liquidex dose a bit based on the insulin resistant comments above and possible influence of estogen dominance.”“”
-Insulin resistance comes with the partnership of low T and elevated E. Some anastrozole will make that concern vanish. Your target should be serum E2=22pg/ml [0-54]. This will also optimize libido and fat loss. If libido is not quite right, then you can look at some other factors.[/quote]
I had a some poor choice of words there. I should have stated that I could see adjusting the liquidex dose a bit to bring E2 down to recommended levels (E2=22pg/ml) that would hopefully address the insulin resistance. But all your points make sense and helps me understand things more and more with each post. So much to learn, so little time and I just turned 49 on Sunday.
I do 100mg/week and do fine. Tried the twice a week and didn’t seem any different.
On July 17 the day prior to starting the HCG injections I had some blood work done and just got the results back. These results are in Canada so some of the measures and ranges may be different and I wonder how they relate to USA measures. If anyone can help, I would appreciate it. As follows:
Sex Horm Bind Glob 20.0 nmol/L range 13.0-71.0 (26.0 previous blood test)
Testosterone 28.20 nmol/L range 5.80-28.00 (11.6 previously)
Free Androgen Index 143.1 range 14.8-94.8 (43.9 previously). Free testosterone is no longer available and has been replaced with Free Androgen Index, which is a better measure of the bioavailability of testosterone. Reading posts on this site how does this compare to free T and bioavailable T?
FSH 0.3 U/L range 1.4-18.1 for males 13-70 years
LH 0.1 U/L range 1.5-9.3 for males 20-70 years. This was obvious testes shutdown and why my testes were aching and shrunken and why HCG is required.
Estradiol <37 pmol/L range 40-161 for males. There was nothing measured regarding e2 levels. Is this high and require adjustment to Ldex? If so how do I calculate how much more than the 1mg divided weekly dose dose?
I scheduled full bloodwork for the end of Aug to see what impact HCG has had on some these numbers. I suspect T will increase again. Since the HCG injections mood, energy, libido, and others have all improved.
Any comments suggestions or observations would be greatly appreciated.
I found some conversion numbers in google to my post above. If my Test levels are 28.20 nmol/L divided by .0347 as the test conversion factor = 812.7 ng/dL of Testosterone. Assuming this is Total Test and this is pre HCG.
For the Estradiol 37 pmol/L divided by 3.671 (E conversion factor) = 10.07 pg/mL. This was also pre HCG. I would have 2.5 weeks of liquidex before this blood test. My blood tests said <37. So perhaps I am over responding to the liquidex.
Since this is before the hcg injections will the estradiol number increase with the use of HCG and the estradiol will come closer to the suggested 22 pg/mL?
Any comments?
What is your anastrozole dose per week how often do you take it?
hCG will tend to increase E2 to some extent.
Testing LH and FSH at this point is a measure of stupidity.
If your E2 result is “<37” that suggests that the testing method does not report at or below 37. So you could really have E2=10 pmolo/L if that is the case. In that case your conversion factor is meaningless too. You may need to have a different E2 test requested that resolves lower E2 levels as found in children and post menopausal women.
With the serum E2 labs done here with a range of 0-54 pg/ml and a target level of E2=22pg/ml, the target is 40% of the top of the range. Converting your upper range of 161pmol/L we get 44pg/ml. So the upper ranges do not match. Converting 22pg/ml we get 81 pmol/L. Perhaps that should be your target. We know that your E2 level is around 47% of the target and perhaps much less.
It seems valid to assume that you are an anastrozole over responder… if you are taking 1mg/week.
What changes to diet have you made? Still having that serving of rice or pasta?
I am taking the liquidex(1mg/ml) at 1ml/week divided into 2 doses of .5 ml usually taken on Tues and Sat. In terms of diet I have not made any change as I didn’t want too many changes at once. I am trying to discipline myself to go back to a more low carb diet, but haven’t done anything yet. Will the diet influence things much?
If over responding, should I discontinue liquidex for a week or 2 and then resume with a smaller dose such as .25 to .5 mg/week or just continue but with a smaller dose?
Any other suggestions or comments? I really appreciate your feedback very interesting.
Tweaking E2 is tricky. You can blow right past the sweet spot in a very short amount of time and also we’re all different. My E2 is now 38 and that’s using .25mg of Adex every three days. It took me a long time to figure out that my E2 was to low at 28 but again we’re all different. Stop the Adex and wait for your libido to pick up.
[quote]brentf13 wrote:
Tweaking E2 is tricky. You can blow right past the sweet spot in a very short amount of time and also we’re all different. My E2 is now 38 and that’s using .25mg of Adex every three days. It took me a long time to figure out that my E2 was to low at 28 but again we’re all different. Stop the Adex and wait for your libido to pick up. [/quote]
Thanks for your comments. I haven’t had many symptoms of being too high or too low with E2 as libido has been very good the last few weeks. Some joints are a little twinge but I changed my workout to higher intensity which I feel is the major cause. But as you stated I’ll need to eventually find my level but I would like to work to the suggested level and work from there. I’ll likely stop the ldex for a bit. Thanks again
Over responders need to wash out for 6-7 days, then resume dosing at 0.25mg per week and evaluate after that. Once you get a lab results that registers, calculating the dose up or down from there is very easy. Try 2 drops EOD.
[quote]KSman wrote:
Over responders need to wash out for 6-7 days, then resume dosing at 0.25mg per week and evaluate after that. Once you get a lab results that registers, calculating the dose up or down from there is very easy. Try 2 drops EOD.[/quote]
Thanks KSman, I’ll try that and see where it goes. I have more bloodwork scheduled for the end of Aug/beginning of Sept. I’ll update then. I appreciate the advice
Another bloodwork update. I had this blood drawn the 28th of Aug. which would be about a month after starting .25 ml HCG SC EOD injection. Full blood work done as follows. Keep in mind this is Canada so some numbers need to be converted or are different measures. The blood was drawn 24 hrs before my next shot of Test E, l-dex and HCG.
Sex Horm Bind Glob 27 nmol/L range 13.0 to 71.0
Testosterone 35 nmol/ml range 5.8 to 28.00 converted is 879 ng/dl. Doctor feels it may be a bit too high.
Free Androgen Index(Free Test no longer available) 113.4 Range 14.8 to 94.8 was 43.9 1st blood test
Estradiol 227pmol/L Range 40 to 161. Converted is 61.9 pg/ml A few posts above from KSMAN we estimated to shoot for 81pmol/L. I had reduced down l-dex to .13 ml x 2/week after a 6 day dry spell around the beginning of Aug but a week before the blood test I had actually double dosed so skipped a dose and then had the blood test.
PSA didn’t test.
Hematocrit 0.455 L/L range .405 to .540
Total Cholesterol 4.69 mmol/L range 4.20 to 5.20
Triglycerides .67 mmol/L range .6 to 2.3
HDL Cholesterol 0.96 mmol/L range 0.90 to 1.80
LDL Cholesterol 3.43 mmol/L range 2.20 to 3.40 This was flagged as high
Chol. ratio(T/HDL/C) 4.9
Glucose Fasting 5.3 mmol/L range 3.6 to 6.0 down from 6.1 from the 1st blood test. Dropped the supper carbs. This was a concern (First blood test) for me as my father was the only one out of 8 kids that did not have diabetes.
If anyone has any questions or comments I would be interested in them. The estradiol number is a strange one for me. Am I that l-dex sensitive? Almost all numbers have increased since the first blood test.
Thanks
You need to remind the doc that the goal is to restore T levels to youthful levels, not age adjusted ranges.
Is the free androgen index range age adjusted as well? The following suggests that it can naturally be as high as 150.
E2 is scary. You need to have steady dosing so your labs are more useful. Are your T numbers valid or were you moving that around too?
HDL sucks: You need a lot of B vitamins, vit-D and fish oil.
How often do you inject T? How much? If 100mg/week, you should be using 1.0mg adex per week.
[quote]KSman wrote:
You need to remind the doc that the goal is to restore T levels to youthful levels, not age adjusted ranges.
Is the free androgen index range age adjusted as well? The following suggests that it can naturally be as high as 150.
E2 is scary. You need to have steady dosing so your labs are more useful. Are your T numbers valid or were you moving that around too?
HDL sucks: You need a lot of B vitamins, vit-D and fish oil.
How often do you inject T? How much? If 100mg/week, you should be using 1.0mg adex per week.
[/quote]
I am still on the 100 mg Test E /week by 50mg on Tues and again Sat and have been doing that since June and haven’t missed any shots or changed the amount, so the T values should be accurate. I won’t let the Doc try to lower my T dose if I can help it. A few posts back about a second blood test my estradiol had tested low, very low and we had assumed I over responded, so stopped for those few days and then resumed at .25 mg/wk. I was really pissed off at myself for over doing the L-dex the days before the blood test. Maybe a dose somewhere in between the 1mg and .25 is required, or maybe the estradiol testing method is screwed. I aassumed the same about the Vit D and fish oil when I seen the cholesterol numbers. Current protocol is:
50mg Test E on Tues and again Sat
.125 mg L-Dex orally on Tues and again Sat. Reduced from .5mg twice/week (1mg/week)
.25 ml of HCG SC EOD
Once more thanks for your comments and interested in any other thoughts from anyone.
[quote]KSman wrote:
Your doctor is yet another idiot. You need 100mg/week and that should be as two injections per week. You need E2 management and 250iu hCG SC EOD.
T+AI+hCG
What are your cholesterol, PSA and serum Glucose numbers?
Where are you located?.. lab units are not typical for USA.[/quote]
Could not of said it any better my self
Please also check adrenals, thyroid and then sex hormones. To many idiot dr’s start people on TRT with out checking other factors and after 3-4 weeks they crash then end up on anti depressants or viagra because other levels where not properly evaluated.