My Journey

Pharma / TRT Testosterone Replacement
1

Some of you on here may know me as a long time poster… I think I’ve kept my health situation quiet here but basically I’ve dealt with low test levels for at least the past few years. Twenty two years old currently and first got levels tested at age twenty, fighting tooth and nail to even let me do that with my doc at the time.

Results came back at 271(off memory) with a ref range of 262-1593. Was given no second thought and begged for an endo referral. Saw someone a few months later and retested at 293 or so, still no help. Two years go by and I have varying degrees of the usual symptoms all of you are familiar with, I was doing TRT research along the way.

I was going to embark on some prohormone use and had acquired the necessary PCT drugs ahead of time but it sort of dawned on me … “If my natural levels suck what am I recovering too?” so I decided to get my blood drawn again. That visit is a story for another day but it wasn’t pleasant and I will not be treated by that PA again that’s for sure. Results come back

Total test(the only thing they tested even though I INSISTED free/bio/shbg/e2/etc be in there)

104 ng/dl with the same 262-1593 ref range. Follow up two days later and I get a script for 200 mg of test cyp every other week. The doctor suggested I come back to the lab that day and they’d administer my first dosage, 200 every other week I knew was a setup for failure so I opted for at home treatment.

Secured my prescription(insurance wouldn’t cover it), a bunch of 25 gauge syringes, alcohol swabs etc and dialed up 1/2 ml and used my left quad for the inject. We have tentatively scheduled a follow up for blood work 4 weeks from now.

So here I am now, very new to this and optimistic for once about receiving proper treatment. Given my age and future desire to have a kid(s) I don’t believe that hCG will be too much of a hassle to acquire upon my follow up and I’d likely dose this at 250 ius 2x weekly. I don’t know what to expect in terms of testicular atrophy but if there is any at my TRT dosage I’ll be getting it, through her or otherwise if I have to.

AI to be determined on whether or not I need it based on the blood work. I have research chemical AI and SERMS but would obviously rather use prescription strength Aromasin over Adex someone likely made in their bath tub. I am refraining from the PH use till all things are stabilized at a normal/high normal level with the test that’s for sure.

So some questions for guys with experience here now that you’ve got decent background on where I’m coming from.

For those that get their TRT covered by insurance who were initially denied, what steps did you have to take to get that covered?

EDIT Got this taken care of, $10 copay instead of 118 dollars for a 10ml vial is quite a bit nicer.

To get my blood work to properly reflect what I want long term, how should I time it in relation to my dosing schedule? IE I injected Tuesday evening and will likely just stay with that, do I want to get my blood drawn Tuesday morning or later in the week?

Also follow up to that is do I tell her that I am doing 100 mg weekly vs the prescribed 200 every other? I expressed concern on this when the script was written but she noted that on her end her hands were tied and she was unable to write the script that way since it was “off label”.

She commended me on my knowledge and I told her I would be dosing it at home, I have a sneaking suspicion she already knows I’m going to do it how I want.

The goal here is to get my levels up as high as they will go without negative impact on estrogen or RBCs/blood pressure/lipids. Optimization I suppose in terms of lifestyle and of course physique benefits.

My baseline blood work reflected good HCT, HMG, blood pressure was under control. I will be doing cardio 4x weekly, weight train very intensely 3x weekly and follow a carb cycle diet put together by Shelby Starnes. Health supplements like a multi vita/mineral, fish oils, vitamin D3, additional fiber on top of several cups of veggies and a greens powder etc. Nothing on THAT front should be overlooked so if there is any negative sides it will easily attributed to the TRT.

Does anyone here keep a log in terms of their progress from the start of TRT onwards? It would be comforting to see some daily/semi regularly updated posts by someone in terms of how long it took for things to kick in, different methods that are being used to get the best results(ie IM vs SQ injections in the real world).

Guys that have been on for months and years will obviously have great insight into this, but I think I will be able to learn a good deal from those who have just recently walked the same path I’m about to.

I have a future concern in that once everything is normalized in terms of my TRT I will have a desire to pursue more “anabolic” supplementation… I’m talking legal PHs here and OTC products only. I have a feeling this is best asked in the other forum but if anyone has experience of doing so in addition to normal healthy TRT dosages I’d be interested on their appraoch.

Mainly in terms of if any of the SERMS are even necessary or offer benefit vs just going from a hypothetical 100 mg test cyp weekly with hCG/AI, 4-6 weeks on an oral PH(in addition to cyp and others), and just straight back to normal cyp/hCG/AI.

I would like to see what I can do for awhile with a full functioning hormonal system for at least a few months but the desire to push it further is there, just want to do things appropriately.

Any help from guys here is very much appreciated and I’d be glad to offer up any more information that is needed.

2

You will respond better injecting twice a week or EOD/E2D.

Your response will be better with E2 levels in the lower 20’s. You doc may never grasp that.

Will you be able to get E2 tested or you have to do that on your own and out of pocket.

Test 1/2 way between injections.

You are assuming that Aromasin work properly. You can take 1mg of adex or let your body put up with large amounts of aromasin. The weekly costs of Rx anastrozole might be cheaper, so investigate that.

AI’s in tablet form are often not good for dose refinement.

At your age you really need to find out why this has happened and not ignore the implications of a possible pituitary adinoma. Checking LH/FSH would determine if you have pituitary insufficiency or testicular insufficiency. There are other things that can repress HPTA function such as head injury or Rx drugs. Now that you are on TRT, you cannot test LH or FSH.

How had your testicles changed? Smaller, softer, aching, not hanging down? This might determine LH status.

Do not touch PH products! Did you take them before your hormones declined? Are you using drugs to combat hair loss? Other Rx and OTC drugs can cause problems.

Please provide height, how is your height different from father or brothers, weight, waist size, describe body and facial hair, any signs of gyno, where do you carry fat.

3

In my case, my doctor typically wants the blood drawn on the day prior to the next injection, so if you inject on Saturday once a week, you would go in Friday for bloodwork. Your doctor may have other ideas, but this should represent you baseline level (assuming you have been on T for more than a couple of months). It take a while for the levels to build up to the baseline. As for AI, you may or may not need it depending on how much you convert to E. You may want to try the “natural” methods of controlling E first, such as limiting alcohol cunsumption, reducing body fat (if that is an issue), and taking 50-100 mg of zinc daily. If these do not work, and you test high for E on your next blood draw, your doctor shaoul prescribe Adex. If not, find another doctor. HCG will also be necessary if you ever want to have kids.

As for other “anabolic” supplementation in the future, I would advise against it. It takes months, even years, to get the right treatment plan put together and get the hormones dialed in correctly. Why would you want to mess with that?

4

In my case, my doctor typically wants the blood drawn on the day prior to the next injection, so if you inject on Saturday once a week, you would go in Friday for bloodwork. Your doctor may have other ideas, but this should represent you baseline level (assuming you have been on T for more than a couple of months). It take a while for the levels to build up to the baseline. As for AI, you may or may not need it depending on how much you convert to E. You may want to try the “natural” methods of controlling E first, such as limiting alcohol cunsumption, reducing body fat (if that is an issue), and taking 50-100 mg of zinc daily. If these do not work, and you test high for E on your next blood draw, your doctor shaoul prescribe Adex. If not, find another doctor. HCG will also be necessary if you ever want to have kids.

As for other “anabolic” supplementation in the future, I would advise against it. It takes months, even years, to get the right treatment plan put together and get the hormones dialed in correctly. Why would you want to mess with that?

5

[quote]KSman wrote:

You are assuming that Aromasin work properly. You can take 1mg of adex or let your body put up with large amounts of aromasin. The weekly costs of Rx anastrozole might be cheaper, so investigate that.
[/quote]

I was just using that as an example, I’ve got no problem with adex…just would prefer legitimate adex that I know for sure is what I want as opposed to trusting somebody I don’t know. That’s going to be dosed/administered on an as needed basis though, but I am aware of keeping the estro sides in check.

No rx drug use, no head trauma, MRI revealed no tumors so the cause is unknown at this point. I’m happy to have gotten treatment but would like to eventually find the cause.

Nothing different yet, I literally started TRT two days ago.

[quote]
Do not touch PH products! Did you take them before your hormones declined? Are you using drugs to combat hair loss? Other Rx and OTC drugs can cause problems.

Please provide height, how is your height different from father or brothers, weight, waist size, describe body and facial hair, any signs of gyno, where do you carry fat.[/quote]

I have no previous PH usage but I’m just being up front with guys here on my longer term goals. The PH use is much delayed at this point, I imagine 6+ months until things are optimized on my TRT front. I’ll make it clear that there is no intent to use till things are on cruise control here on all fronts, but if we are being honest they will be used in the future in some fashion if required to reach physique goals.

Height: 5’7.5, Father I believe is 5’11 or 6’0, brother was 5’9/5’10.
Weight: fluctuates depending on a lot of factors but down to a pretty lean and depleted 165 or so now. I imagine once we switch gears towards size gains and I “fill out” I’ll be over 170 within a few days. This is down from a soft 185-190 after much down time from the gym.
Body and facial hair: full chest/stomach has hair, legs obviously, light on the forearms. I was very hairy early on(11-12 I’d say) but don’t require a shave as often as I used to. Full beard if I wanted but slow growth. Hair on my head is sadly receding a bit but I buzz it down to the scalp anyways.
Gyno: I used to think I had it but once I dieted down it doesn’t appear to be the case. Doctors have assured me I didn’t have it after I expressed concern years ago.
Body fat: typical male pattern of stomach and love handles. I am lean currently… good muscle separation(can see all triceps heads,biceps split, quads are pretty lean, back is separated) but abdominals are not prominent(possibly just genetically inferior). I would estimate I am a legit 10% bodyfat percentage and not “10-12 but actually fat” that people put out there.

6

Just bumping this for my own selfish purposes(so I can find it easier when I get lab work)

Shot #3 tomorrow evening.

I’ve noticed slightly oily skin on my face the past few days but nothing significant to report yet as expected. Libido is the only qualitative marker I’m really going to rely on as far as “has the test kicked in”… and it’s still the same.

7

T can kick in and boost libido, elevated E2 can then lower libido. Most do need anastrozole to get optimal libido.

8

Brief update.

Had my first follow up today just to see how things were, got some basic blood work* and a referral to an endo since my PCP said anything beyond what we were doing is beyond her expertise which I can respect. I’ll have at least my total T levels thus far on the current treatment for a ball park of how things are being handled by my body. More specialized blood work can be done by the endo. The endo appointment is set for August 4th so we will see how that goes with a new doctor, was at least pleased I only had to wait a few weeks as opposed to months like I feared.

My string of great workouts is showing a strong correlation towards the test having at least a minor impact on me physically. The oily skin is on/off but I also have noticed a slight increase in aggression and maybe a shorter “fuse” which isn’t all that bad as I’ve always been pretty passive. No outbursts or anything because I’m a calm guy but I think it’s a sign things are working. Sex drive still low but there are at least some promise thus far that things are headed in the right direction.

*nearly passed out while they drew blood today which has never happened. She started on the right arm and I noticed much more throbbing as she drew(I think she missed) and the nurse remarked that it was no longer pumping. She switched to the left and within seconds I felt something was amiss, light headed and like the blood left my face. When she asked how I was doing(it was probably apparent I wasn’t OK) I tried to say I was feeling light headed and got about 4 words out before I started slurring my speech. They had enough blood I guess and propped my feet up and basically did everything short of slapping my face to keep me awake. Kind of scary for a few moments and the effects were lingering for 20-30 minutes while I sat there recovering.

9

from what I have read, your reaction at the blood draw sound like classic adrenal fatigue. Your cortisol may be off which can cause that type of reaction. stopthethyroidmadness.com has some great information about adrenal fatigue and ways to test for it.

without a complete bloodwork up, you are just walking blindly through a minefield. with no idea what is going on in your body, what the root cause is, or if you are fixing the problem or just causing more damage.

If you can’t get a doctor to do the blood tests, there is always the lef.org male hormone panel you could pay for if financially able to. It may give you the ammunition you need to get the doctor to run the right tests.

10

I’m confident with the endo appointment I will be able to reveal more pieces to the puzzle with a more comprehensive blood panel.

Total T is the only thing they are concerned about really because they don’t specialize in this area, but I will get the full scoop as far as what’s going on with the TRT in the coming months.

11

I wish you the best of luck, but don’t expect your doctor to be on the same page. You need to know what tests you want and why, and have possible treatment plans you are looking for - doctor’s and even specialists know surprisingly little. Did you read the adrenal info I suggested?

The Endo I went to confirmed my low LH, but then just slapped on 7.5mg Androderm patch on me and sent me out the door. I felt better for two months, but then it was all downhill from there, and he did nothing on two follow up visits even though I had the exact same symptoms I came in with originally. He never looked at my E2, Vitamin D, Cortisol, ferritin, etc. which would have helped fix my problems.

Just read through the threads here about all of the bad doctors, misdiagnosis, bad treatment plan, harmful treatment plans, etc.

maybe your endo will the one rare one who thinks outside of the normal endo box, but I really wouldn’t count on it.

12

I’m not going to rely entirely on the doctor for my treatment, if that was the case I never would have got the blood work to confirm what I have suspected/tested for previously. I will always play an active role in my own treatment and if things are not improved I will of course look for other options/causes/treatments.

My thyroid has been tested several times and always came back in a normal functioning range thus far. The symptom list on that site includes just about anything that could be wrong with someone… sure I have exhibited some of those symptoms but not any large number of them. It’s something I will consider if the treatment isn’t causing improvement but as of now I’m concentrating on one thing at a time.