M's Testosterone Replacement Therapy Log

Pharma / TRT Testosterone Replacement
1

Hi all.

I’ve been battling with a range of symptoms over the past 12 months - Lack of energy, brain fog, widespread tendon injuries, iron deficiency & low libido being the most prominent.

After a myriad of tests and investigation, I was diagnosed with Primary Hypogonadism.

Here’s my rundown:

I’m a 27 y.o male living in Australia

Height = 179cm (5’10")

Waist = 85cm (33")

Weight = 71kg (156lbs)

Body Hair is normal although minimal on chest; good facial hair coverage.

Minimal body fat, small amount around love handles which has crept up over the past 12 months.

Medication: 7.5mg Mirtazipine prescribed for sleeping issues which turned out to be due to obstructive sleep apnea (now controlled with a CPAP machine)
I used Minoxidil for about 6 months in 2014 but it gave me anxiety so I stopped.

Never had any aches associated with testes.

Disciplined with healthy diet (minimal sugar, low carb, no alcohol) and I have been doing the 16:8 intermittent fasting method for 18 months.
Train moderate intensity 6 days a week, mixture of weights and running/swimming. However the last 6 months I’ve barely been able to train due to my ongoing tendon injuries

Pre TRT Bloods:

Testosterone: 7.2 nmol/L (6.0 - 28)

SHBG 16 nmol/L (15-50)

Free Testosterone 196 pmol/L (200-600)

Estradiol 60 pmol/L (<150)

FSH 14 IU/L (1-8)

LH 4 IU/L(2-8)

Prolactin 136 mIU/L (45 - 375)

TSH 1.46 mIU/L (0.50 - 5.00)

PSA 0.44 (<2.51)

I was started on Androgel and after 6 weeks, although I began to see slight improvements in my symptoms my testosterone levels hadn’t changed significantly so I was prescribed Testosterone Enanthate 250mg to initially be administered every 2 weeks.

Bloods taken 14 days after first injection of 250mg:

Testosterone: 4.5 nmol/L (6.0 - 28)

SHBG 16 nmol/L (15-50)

Free Testosterone 119 pmol/L (200-600)

Estrodial: 74 pmol/L (<150)

I felt much better for the first 10 or so days after my injection, but as you can see my levels were even lower than when I started at the 14 day post-injection mark.

I’m after some advice going forward about the best dosage frequency based on my SHBG. My Urologist who prescribed the T is pretty happy to work with me but doesn’t seem to be fully abreast on the most suitable protocols.

Based on my research and hovering around this forum, I was thinking it would be best to inject 125mg/ week and then see how I’m feeling after a while and then perhaps transition to twice weekly injections.

This is only the beginning of what I expect to be a life-long commitment and so I’m willing to be patient to see how my body responds and tweaking the treatment for the best results.

Thanks very much for your advice and assistance.

2

There you go. No one will do well with every two week injections. Most with SHBG in the teens do better with twice weekly injections. It will be interesting to see where your levels are day 7post injection.

3

Where the hell are people getting the idea that injection frequency should be based on SHBG? Injection frequency should be based on how an individual metabolises and eliminates a drug, how long it takes for them to notice symptoms again, individual sensitivity to hormonal fluctuations etc. SHBG DOESN’T CAUSE YOU to piss out testosterone, anyone who disagrees with me, I invite you to prove me wrong, post medical literature on why SHBG should be the gold standard for injection frequency. It’s a transport protein dammit, explain how that has anything to do with injection frequency?

For people being treated with corticosteroids, is it important for the injection interval to be based off serum levels of corticosteroid binding globulin? NO it isn’t… If a doctor doesn’t know about administering more frequent shots due to SHBG, it isn’t because they’re behind or TRT ignorant, it’s because there is no literature saying it’s the right thing to be doing, maybe it is, however currently there’s NO evidence to suggest it makes a difference. You can give me the whole “BUT more E2 from higher peaks”, but E2 to testosterone should still be within ratio.

4

We see these 200mg every 2 week protocols handed out often to men and they just don’t work out well for the majority of men, levels peak in 24-48 hours and begin to decrease over the next couple of days and if these fluctuations are big, it prevents the body from reaching balance. You want to feel good on TRT, you have got to keep levels elevated throughout the entire week and not just the first couple of days.

My SHBG is lower (22) and I didn’t respond well to TRT injecting twice weekly, it wasn’t until I started injecting smaller doses EOD that I started responding to TRT. Low SHBG men can struggle to control estrogen while on TRT, the reason is because SHBG binds to sex hormones and when low the majority if free and bioavailable.

Twice weekly can work, but lower SHBG men typically do better on multiple injections (M/W/F) EOD or everyday if SHBG is super low. Typically when men start TRT we see SHBG levels decrease a little bit and sometimes we see it increase if insulin resistance was suppressing SHBG which is seen in Type 2 diabetes and those with fatty livers which is common in low SHBG men.

My SHBG before I started TRT was 22 and after 4 weeks of starting TRT, it dropped to 18 and then after 6 months 16, then I started an EOD protocol and SHBG increase back to (22) pre-TRT levels.

5

I never disagreed with this, the half life of testosterone enanthate is roughly seven days, therefore every two weeks isn’t acceptable for the reason you pointed out, levels need to be in therapaeutic range ALL the time, not occasionally. By the end of two weeks (with 200mg e2w) levels are typically below 10nmol (and there’s literature to back this up). In order to maintain therpaeutic levels with 2 week shots, one would have to shoot a fairly large amount at the start of week 1 (say 350-400mg), the supraphysiologic peaks can cause side effects to those sensitive to hormonal fluctuations and for those very sensitive to the side effects of elevated testosterone having supraphysiologic testosterone concentrations can create quite the slew of side effects, with 200mg E2W the majority will feel shit later on because their levels fall BELOW therapeutic ranges. I actually as an experiment might try 400mg E2W as an experiment just to see how I feel because I’m curious as to whether I’d feel alright, I hypothesize I’d feel amazing for the first 6-7 days or so and then normal for the rest of the duration before the next shot.

I’m very aware of how sex hormone binding globulin works, however if you have high free testosterone, you should have high free estrogen, which when within ratio people shouldn’t have trouble controlling E2, especially on a replacement dose. The reason you may have not responded to TRT with less frequent injections could be due to a myriad of reasons, such as

  • Individual metabolism and elimination of the drug
  • hypersensitivity to hormonal fluctuations
  • Problems with excess aromatase (people who are obese, have liver disease, aromatase excess syndrome (very rare), interestingly androgen replacement therapy with dihydrotestosterone is indicated for these people.

However it has nothing to do with you’re SHBG, it could be related to WHY the person has lower concentrations of SHBG, as non-alcoholic fatty liver disease (which could interfere with hormonal excretion), and obesity (issues with the amount of aromatase found in adipose tissue). Hence it would be nothing to do with the level of SHBG itself, but the reason as to WHY the person has low SHBG. I shoot every 7 days, I’ve used doses up to 250mg/wk (not replacement) and I’ve never had to deal with E2 related side effects, as a matter of fact, the thing that did the most damage to me was OTC herbal dietary supplements (was taking a ton of them and they made my heart beat very fast, scary shit. I stopped taking them and everything went back to normal).

SHBG fluctuates, while androgen administration probably has something to do with it, unless you have like forty labs showing you’re SHBG has consistently been 22 I don’t think it has anything to do with EOD or ED administration. Keep in mind I’ve had my SHBG test at 13, I do have insulin resistance/ impaired glucose tolerance, it appears I’ve always had it, dating back to when I was 13 (as can be seen by labs that I don’t post due to privacy concerns)

As to you’re comment about a pissing contest, @systemlord I can still see them lol, there’s no need to edit it out, I can handle insults (even when they aren’t nessecary), I HAVE been cranky lately due to sleep deprivation, however that has nothing to do with my original post (which wasn’t directed at you either, so there was no need to get upset about it, it was directed at ANYONE giving out advice on injection frequency correlating to low SHBG)

EDIT: In women, elevated or normal free testosterone without the presence of estrogen results is a phat decrease in libido, while we aren’t women, it goes to show estrogen is very important for sexual function and drive, free estrogen in my opinion needs to be within an appropriate ratio to free testosterone in order to feel optimal)

6

Thanks for the insight.

I’m going to try more injections and if I don’t notice a big resurgence in symptoms, I’ll continue for 6-8 weeks before checking my levels again.

7

How do you determine this? Do a peak and trough test and see how quickly it declines?

I’m high SHBG but thinking I might do better on twice weekly rather than weekly

8

Exactly, also if you have any issues with hypermetabolising certain drugs (that are hepatically metabolized) you are probably more likely to chew through testosterone at a faster rate, that’s an opinion based off no valid literature I’ve read but it’s an opinion I posess regardless (not being sarcastic, I actually think this, as the liver is responsible for excretion of certain hormones)

9

In thinking low SHBG guys do better with more frequent injections, it seems you think there is an association, not causation, with low SHBG?

In comparing notes with guys who are into TRT, there does seem to be a trend.

10

@unreal24278 I was thinking about this recently testosterone cypionate has 1/2 life 7 days. It actually makes no sense to inject more than 1x a week. Thinking back I felt the same when I was injecting 1x a week. Now an doing 2.

I do think because of its long half life that my test labs higher with less of a dosage on 2x a week.

When I drink coffee caffeine affects for me lasts for 10-12 hours or more. Do you think this means I metabolize slower? I actually rarely drink coffee because I can’t sleep. I would have to drink very early in the am so maybe it will not affect sleep.

It also doesn’t make sense that they’re are plenty of success stories of low shbg Injecting 1x a week. So you are on to something. I also believe I read physio state something similar to what you said.

In also think that some guys come in here with so many other complicated issues and May draw wrong conclusion on why something worked or didn’t work.

Btw i love reading your posts.

I mean if people want to inject more frequently they should really use a different Ester. Cypionate is a slowwwww release ester not meant for frequent administration.

11

yeet, exactly I think the low SHBG is not a cause for issues with aromatase, injection frequency etc. It’s more the issues someone may have that is associated with having low SHBG, as low serum SHBG is directly correlated with issues such as NAFLD which would interfere with the excretion of hormones and obesity can cause issues with aromatase and whatnot, therefore it would make sense for there to be a trend, however the trend itself probably isn’t a direct link to SHBG.

12

Well that depends, because while I think a 7 day injection protocal is really good, you’ll get those sensitive to hormonal fluctuation who do need to inject like 2 times/wk because remember once a half life is up, 50% of the medication is out, therefore someone could be very sensitive to a 50 percent dip, even if it’s a dip from 1500ng/dl to 750ng/dl (whether they feel bad at the top level or bottom level is inconsequential, I’m just listing an example), then there’s the issue with the fact that differing metabolism between people will affect the half life of the drug, for some test c might only have a HL or four days, these people probably should be injecting 2x/wk

You’re labs will test higher because you don’t experience the same nadir, however if you were to graph the daily levels from day 1-7 and 1-3.5 the median testosterone level would be very similar, if not exactly identical.

caffine gives me diarroheah , I don’t drink coffee either

Yeet, he is great, he has formed many of my opinions (although I do just agree with many of his opinions in the first place), if you view my posts from when I started posting on here, I was always against (myself) using aromatase inhibitors, however I used to not care what others did with them, now I generally reccomend against them. I was unsure about the SHBG injection frequency thing, always very skeptical, however I did think that there was a correlation between dose used and SHBG concentration, I don’t believe that to be the case anymore.

I never believed in shooting test C more than 2x/wk though as given the half life I thought it was absurd, however I do believe there is exceptions, and systemlord is probably one of those exceptions who legitimately does benefit from very frequent injections (not being sarcastic here, I’m serious)

Exactly, when you’ve got seven zillion health issues it’s hard to pinpoint exactly what’s causing what. Currently I only have one physical health issue, that is joint/muscle pain, however I’ll likely have that for the rest of my life

You can inject test C frequently (even though it’s not meant for frequent administration like you said) but why would you? The build up of scar tissue from all those frequent shots in the long term would likely be far greater, and have you seen what frequent sub Q shots do to you’re stomach? Try a sub-Q shot and be amazed by the gross to the touch blob of injection site irritation it causes to form over you’re abdominals, if that forms scar tissue over time then aesthetics are ruined forever haha.

13

@unreal24278 can you eye my thyroid numbers and tell me what you think?
Thanks.

14

Do you have symptoms of hypothyroidism or just numbers? My Free T4 is literally RIGHT at the bottom of the range, as in 0.1 point lower and it’s clinically low, however I have no symptoms of hypothyroidism therefore I don’t worry about it.

Do you use anabolic steroids or just TRT. Androgens (even TRT) can have a mild, subclinical affect on thyroid status that is usually evident by a mild to modest reduction in serum total T4 and T3 without impacting free T3 and T4, granted the impact from TRT should be veeeeeery minimal. You’re thyroid numbers don’t look awful, however they aren’t great either, at this point whether you should seek out treatment boils down to whether you have symptoms or not.

As a disclaimer, I am not a medical professional, physiolojik is.

15

Ik this may not be in my case but in read hypothyroidism cause slightly elevated prolactin and igf 1. Which is what I show in my labs. Also suppose to affect triglycerides which mine are high but that’s the case most of my life.

I do have fluctuating temperature during the day but who knows if that’s from thyroid. My dad is hypo but he didn’t start taking medication until about 55-60. Am 41.

Drs don’t want to treat my thyroid. But if I think it will help I have a Dr who I think may try it.

I do think a little t4 may help but not sure on my case if starting medication for life if it’s worth the risks /side affects of it. If synthroid has no potential harming sides, then it’s a no brainer.

Am just on trt. They way I see it now my thyroid is keeping up but struggling a bit. But i see a trend where the TSH will steadily increase.

Us being on trt we are on top of labs. So that is a good thing. We are on top of our health and well being. I speak to older people they know nothing about their labs.

16

For those who inject EOD, do you still do it intramuscularly? I was just wondering if it’s bad for your glutes to have needles so often.

17

I go eod and like it. Seems to give me less anxiety and maybe a tad bit of a sex drive.

I use 30 gauge 1/2inch needles, rotating shoulders and quads. Such a small needle so no issues.

I used to do subq but my stomach always was sore at injection site.

1 Like
18

Hi guys, bit of an update…

I’ve been doing 75mg Test E IM every 3.5days for about the last 5 weeks.

Overall i’ve felt great, no dips or return to old symptoms that I experienced on the 2-weekly protocol the doc had started me on.

However the last week or so I’ve noticed the tissue behind one of my nipples becoming hard and tender which of course has me concerned about the possibility of gyno and having my estrogen pushed too high.

I’ve went and got bloods done today and I’ll post them as soon as I know the results, but I am wondering what to do going forward. Because I’ve been feeling great otherwise, I’m reluctant to completely change the protocol but i’m after some advice about whether I should perhaps lower the dosage to 50mg every 3.5, or extend the frequency to 4 or 5 days and see if anything changes. I would like to explore all my options before discussing an AI.

The other question I have is, is it possible that the tenderness is an ‘adjustment’ of sorts and it may settle down without intervention or a change in the protocol?

Thanks for your help.

19

Levels are still in flux and therefore not stable yet, you have one more week before levels become stable.

This sunday will be 6 weeks for me, I’ve had nipple sensitively on and off for 5 weeks. I have a tiny mass under my left nipple and wonder if it’s always been there and I never noticed it because I wasn’t on TRT my whole life and didn’t have a need to play with my nipples.

20

Thanks for the response.

I think you’re right; there’s certainly an element of me being more aware of it because it’s on my mind with TRT, but there has been a definite ‘thickening’ of the tissue that I know wasn’t there before…
I suppose I should wait for the bloods and go from there.