35 yo male 6’2” 235 lbs. I’ve been on trt for 12 years and have never been able to find a protocol that works for me. The closest I’ve come to feeling well was when I was taking 150 mg test per week with 250 iu hcg eod. Labs looked decent but libido was non existent. Shbg was 9. But I didn’t take any anastrozole. Currently I’m prescribed 200 mg test once a week injections but it drives my blood pressure through the roof and although it makes me feel much better on occasion, I feel like anastrozole drives my rbc and hct up forcing me to donate blood leaving my ferritin in the teens. I have hcg still but I’m not currently taking it bc it is expensive and I don’t really feel any great benefits from it. I’ve tried daily injections of up to 14 mg a day but I still needed anastrozole to cope and that drove rbc and hct astronomically high where the dr demanded I donate blood. Does anyone have any suggestions on a protocol?
I have low SHBG too. Common advice is to do more frequent injections. EOD or MWF work fine for me, E3.5D does not.
HCG is only needed if fertility is a concern; I recommend not to bother with it unless you’re trying to conceive. Maybe a 2-3 month run of it yearly would be a good call to help with atrophy (bro science), but otherwise no need.
Maybe try 200mg/wk split EOD, no HCG.
Some men are sensitive to the large spikes in hormones from injecting large doses of Test. It seems some doctors mistakenly prescribe anastrozole for side effects, instead of lowering the dosage and or increasing the injection frequency.
I had low SHBG (@11) at the start of TRT and only felt good on 7mg daily injections. Now I’m on Jatenzo, a new oral testosterone capsule @237 mg twice daily and getting excellent results!
Now my SHBG is 24 and frequent dosing still produces the best results.
14mg daily may have still been too much Test for someone sensitive to androgens, which is why you still needed the anastrozole.
I recommend 7 mg daily injections, nothing else.
I don’t see any other important info, that is critical to get the maximum benefits of TRT like working out, eating, cooking healthy whole food.
I appreciate the input. Several years ago, I tried exactly what you suggested and it caused terrible brain fog, high blood pressure and a swollen prostate. I want to find a protocol where I can ditch anastrozole because I only have high rbc and hct when I take it. I’ve donated so much blood as a result of anastrozole that my ferritin is in the teens. And I just recently discovered that low ferritin can cause sleep issues which is something I was dealing with during the labs I posted.
Systemlord- I will look into jatenzo! Thank you. Can you share T, free T, and E2 levels?
I have experience with low ferritin, TRT causes iron deficiency, and have to take a mega dose of iron supplements and for a while my doctor forced monthly phlebotomies.
TRT doesn’t work very well when ferritin is low and can actually make you worse off.
There’s Jatenzo, Orlando, and Kyzatrex, the latter option is cash only on average $160-200 per month.
There’s also little chance at getting erythrocytosis or high RBC’s on oral testosterone due to the nature of the PK profiles.
A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men
Jatenzo @237 mg twice daily, 988 ng/dL peak (Free T= 28 ng/dL) within 2 hours, 552 ng/dL @5 hours and 289 ng/dL at 12 hours.
I feel the same 24/7, stable across the entire day.
What about E2? That seems to be the biggest problem I try to navigate.
On injections anywhere between 28 on daly injections, to 70-90 on moderate doses less often.
I never bothered to test for E2 on Jatenzo, because most of the side effects on TRT aren’t from estrogen, it is from your poor state of health that lead to low-T.
TRT can cause your kidneys to adsorb more sodium/water which increases blood pressure and has nothing to do with estrogen.
Once again…thanks for the input. For the last several months my hands have been ice cold consistently. Any experience? Could it be from E2 , low ferritin, or something I’m missing?
Bro you’re suggesting OP run 49mg test a week??
Jesus
a) my SHBG is 11 throughout
b) i switched protocols to Tprop daily, feel best in ranged of 25-30mg/daily
c) i use zyHCG from reliablerx (india), with good results, 22usd/10k IU. no kids needed, but helps with libido (has some downsides)
d) AI is worthless, adjust dosage like mentioned.
That’s iron, ferritin related.
If he is sensitive to androgens, then absolutely. He stated 14 mg daily, he still needed anastrozole, indicating his dosage is still too high.
We men naturally produce 5-7 mg daily.
Typically when someone is sensitive to androgens, the first thing that happens is elevated RBC’s, hematocrit.
I think a lot of his symptoms could be coming from repeated blood donation/low ferritin that is the result of being overdosed.
I believed this was in combination with HCG, no?
OP please clarify
That is correct. I was using 100 iu and 14 mg test daily. This led to anastrozole being necessary and rbc of 6.68 and hct of 59.
Were you doing therapeutic bloodletting to help with this?
Libido doesn’t appear until E2 levels are in the single digits for me. Which I know isn’t healthy, but my wife is a dime and I prefer to be chasing her around the house.
I did as soon as I got labs back and changed protocols again bc it scared the crap out of me.
Have you run 14mg daily with no HCG and no AI?
I would try this before going as low as 7mg daily. Personally, I do not even believe this to be a replacement dose.
I haven’t tried that. I wanted to but the whole rbc and hct going super high made me turn away from daily all together. BUT my testosterone during that visit was only 355. My drs office is really weird about testing free testosterone and nearly refuses to do it.