Need Advice on Starting TRT

Training Over 35 Lifter
21

[quote]gmankc wrote:
Having problems posting, so I’ll apologize up front for double posting. I’ve been researching for over a year and am about to start TRT next week.

I talked with my endo about my test results but won’t see him until next week. Would appreciate any feedback I can get. I am 42 and had every low T symptom on the list. My test results are as follows.

Total T 427
Free T 70
Thyroid 282
Estrogen 75

He is suggesting biweekly test cyp injections as well as biweekly hcg injections. Basically he wants to push my total testosterone level the the high end of the range up around 1200. He says estrogen level is way to high and he hopes to get it under 25.

Also mentioned something about a script for an anti estrogen medicine and another for the thryoid. He really pushed to know if I ever wanted another child, that we will discuss that next week before I start. Not sure what that’s about.

I would really appreciate anyones thoughts/comments.

Greg[/quote]

When you restore your testosterone levels, your thyroid status may improve to some degree.

Is “thyroid” TSH?

22

KSman, I believe the thyroid was T3. I will ask for a copy of my blood tests so I can post accurate information here.

23

My fiance and I have decided to try to have children. We just consulted with a urologist, and he would like treat my low libido and low free T with either Clomid or HCG (4,000units twice weekly). He feels T injections are too risky at this time.

Do you think either Clomid or HCG will help both libido and increase my free T? Also, I’m hoping to make some more gains in the gym.

Also, I’m concerned about testicular desensitization at that dose of HCG.

Thanks for any advice!

24

This isn’t a big deal. Go on the T+HCG+AI protocol and when you’re ready for kids have the urologist add in HMG. Problem solved. HCG alone will keep you up and running to some degree and when you’re ready HMG will do the trick.

Clomid isn’t a good long term solution. It makes you feel like crap and it will raise SHBG. It’s a libido killer for most guys or we’d all be on it. Androxal is coming down the road but that’s years away.

4000IU of HCG twice a week is flat out insane. Guys doing HCG mono-therapy do 1000IU to 1500IU every three days. Some guys become more sensitive to it over time and can drop back to a lower dose. At 4000IU you’re going to fry your nuts. At a reasonable dose it’s debatable whether you’ll desensitize.

It sounds like you’re going to have to educate your urologist. We’ve all been down that road.

25

[quote]mazzie666 wrote:
My fiance and I have decided to try to have children. We just consulted with a urologist, and he would like treat my low libido and low free T with either Clomid or HCG (4,000units twice weekly). He feels T injections are too risky at this time. All he understands is the sledge hammer.

Do you think either Clomid or HCG will help both libido and increase my free T? Also, I’m hoping to make some more gains in the gym.

Also, I’m concerned about testicular desensitization at that dose of HCG.

Thanks for any advice![/quote]

Why are T injections risky?
Why at this point in time?

PSA is perfect.

“Estradiol-6=17.0 pg/ml”

What is the ‘-6’

Get on 100mg T cyp self injected twice per week. Self inject 500iu hCG EOD. E2 should go up and you will need to take adex to keep it in the lower 20’s. Test E2 with Labcorp serum E2 test or Quest ultra high sensitivity E2 test.

Are your testes feeling smaller or softer now? hCG will prevent the testes from shutting down and may restore their physical structure. Then you can take lower amounts of nolvadex to get the pituitary to produce hCG AND FSH. You need the FSH to get the sperm count up. hCG and LH do have some crossover FSH action.

By getting TT and FT up and keeping E2 in the lower 20’s, your SHBG should go down, libido should go up. If prolactin is up, then that will not work, dopamine will be low and you may lack enjoyment in life or be depressed. Dostinex/cabergoline can help lower prolactin and increase dopamine and may act as an antidepressant in that respect. You can also try trazodone as a sleep aid to increase dopamine. If no effect, you did not need it and are out $4.00 for a months supply, otherwise, you feel better.

Your endo may not understand libido very well.

That is too much hCG. If your testes are normal, 875iu is a maintenance dose. Yes, 8000 units will stimulate your testes and there could be damage from that.

Your sperm count: You have labs showing low sperm counts?

So, 100mg test cyp per week in divided doses, 500iu hCG EOD, use arimidex to maintain E2 near 22pg/ml. After you get some virilization and feel that your testes are more robust, add Nolvadex to the mix. That has less sides than Clomid. After you are pregnant, you can taper off of the SERM.

Later on, you can probably cut hCG back to 250iu EOD.

If your doctor pushes back. Look him in the eye and tell him that you understand that this is not the way he has been doing things. Add that this cannot do any harm, so there is no harm in him learning how this works for you.

Tell him that 8000iu hCG is going to create a risk of LH receptor damage. Tell him that you are afraid of 8000iu hCG per week and that you do not feel that this is a safe think to do.

If you have primary hypogonadism, then your testes are not very LH/FSH/hCG responsive. I did not see any LH/FST lab results to indicate what is going on. If you are primary and LH/FSH are high now, adding hCG or using an SERM may be futile.

Do not overlook the prolactin and dopamine factors. If libido does not respond to other things, look into those things.

You and your docs need to read this:

http://dspace.hsl.washington.edu/dspace/bitstream/2012/52/1/JCEM_2005_Low_Dose_Human.pdf

“Lower doses of hCG may be as effective in treating male infertility due to hypogonadotropism as the higher doses used historically.”

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“Tell him that 8000iu hCG is going to create a risk of LH receptor damage. Tell him that you are afraid of 8000iu hCG per week and that you do not feel that this is a safe think to do.”

You better listen on this one …
Long term damage can/will result from this high a dose over time. Your Doc is clueless !

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Recheck lab work as of one week ago:

Male Estradiol <20 (20-75pg/ml)
Male FSH 3.8 (1.4-18.1 MIU/ml)
Male LH 4.25 (1.24-8.62 MIU/ml)
Total T 340.4 (175-781ng/dl)
Free T 6.68 (8.8-27pg/ml)

Two semen analysis with good results past two weeks.

The urologist is a bit of an idiot. I plan to consult with my original TRT doc anyway. The TRT doc feels HCG and Clomid may be a good approach for the meantime. I’m waiting to hear back from him to discuss a protocol that won’t damage my LH receptors. After the kid stuff is underway, I’ll consider Test injections (my TRT docs recommendation). I don’t think I can get away with Test at this time (e.g. my fiance would flip out).

Does anybody have experience with just Clomid and HCG (at an appropriate dose) in terms of libido, increases in T, and gym gains?

Thanks for all of your advice!

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i personally hate clomid, causes me serious depression and over emotional reaction to life events. some guys tolerate it well but many will have these symptoms. i would never use it. I would go with hcg only if you are set against the t injections for now.

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The amount of research and effort that you guys have put into this is amazing. I’ve learned more from this site in the last month than I had in the last two years. I started HRT two weeks ago. complete test results prior to starting…
total test 427
free test 70
bioavailable 156
SHBG 24
albumin 4.9
DHEA 328
LH 3.4
estrodial 75
PSA 1.0
T3 282

I have been injecting Test E at 50mg 2X week. HCG 500iu 2X week. Taking 60mg natural thyroid daily as well as .25mg Adex daily. From what I’ve been reading in the threads this sounds like a fairly normal setup. At 2 weeks I feel results, like the fog has lifted somewhat. Definately more energy, but not much in the libido department. Will be retesting in three weeks to see how things stand and adjust from there.

I’m wondering if/when I’ll notice improvements at the gym. My biggest problem is recovery time. Also gained 10lbs of water weight almost immediately. BP is still perfect 110/68 today, but seriously and noticably bloated. What gives? Any thoughts?

30

Clomid is a waste of time. Seriously look into HMG. I really don’t think being on T is a big deal even if you’re trying to have kids. Use HCG in the protocol to keep you’re nuts going and when it’s time have the Dr add in HMG. Guys have had great results with it. Clomid and HCG together are redundant. HCG alone will shut you down like T. Clomid alone will raise T but make you feel like crap. Used together they will raise T and keep LH/FSH going but you’ll probably have little benefit if any.

If you’re going to try HCG mono-therapy and you’re concerned your body is going to lose the capacity to secret LH, although I’ve never heard of this happening, just use HCG and every other month use clomid for a week.

If you were going to use HCG and clomid why not just use T and clomid? Using HCG or T has the same result. No LH or FSH secretion. The clomid is being used so you’ll secret FSH so using it with T or HCG is the same result. There are a few guys that use a low dose of clomid in their TRT but only because they’re on transdermal T and want to avoid shots period.

Bottom line is you’ll be fine and you’ll be able to have kids. I’m surprised a TRT Dr is more up to speed on this.