New Guy Getting Up to Speed

Pharma TRT
21

KSMan, had a hiccup with the nurse this morning when I took my test cyp to her to be shown how to inject. I printed out the injection protocol and highlighted the part about using #29 needles and injecting SC rather than IM and she said she could only show me how to inject IM. I said that was fine and that I’d experiment at home with SC injections. She gave me a blank look to which I responded by pointing out the highlighted portion that mentioned the Canadian research that showed SC injections producing steadier testosterone levels. Another blank look and she said she would need to talk to the doctor. She returned and stated I’d need to schedule another appointment with the doctor. I’m seeing him on the 24th.

It’s just as well, as I wanted to follow up on my email to him about your advice concerning getting off T4 and on to T3 and monitoring my dosage according to body temp.

Here are my questions, varied as they might be:

Besides the Canadian research and what I presume to be a sizeable number of TRT patients finding they do better with SC injections over IM, what ammo can I empty on the doctor to get him to come around on at-home SC injections? I assume that the doctor writes the script for needles and that without it I’m screwed, or can I just be a good boy and have the nurse show me how to inject IM and get my own #29 needles and do my own SC thing at home? Or is it even something to fight over?

From the injection sticky you state: “My recommendation is to start anastrozole at 1.0mg per week (in divided doses) starting the day of the first injection. Then let the first follow up E2 lab drive any needed anastrozole dose adjustments. It is not a good idea to wait and see how high E2 levels go before taking action. Dose anastrozole EOD if possible.”

The conversation with my doctor had it that we would add an AI “as needed” after the follow up E2 lab. He and I have not discussed the E2=22 target yet and since I am at E2=15 pre-TRT what is your sense about the doctor’s willingness to start me off on day one with an AI? Do I have another fight on my hands?

Finally, at 52 I’m not looking to father children but in my first visit to the doctor I spelled out that I’m inclined to want to take hCG to preserve teste size. I think he mumbled something about hCG being expensive and I got the impression he would be a hard sell to prescribe it. I now read in the injection sticky that hCG can help with the 24/7 ache that some feel in the testes. Also, hCG prevents pregnenolone deficiency, and, as you stated, hCG helps to improve mood. I’m seeing more good reasons to be on hCG than I first understood, yet I’m bracing for a fight with him over this, too. Maybe I should backtrack and say I want to father children? Or maybe I should report achey testes? I’m not comfortable misrepresenting myself, but I feel I’m not ‘gaming’ the system so much as the system is ‘gaming’ the patient.

So, should I press hard for hCG? If so, how best to do this?

As always, thank you very much for your time, attention and excellent advice!

Rick

22

You can buy your own needles and syringes online. I would love to link but it’s not allowed on here. It’s easily found by google search. As far as HCG goes, I would press the doc for it with some legitimate research info. It will all depend on how flexible he/she is. It may convince him/her or it may simply piss them off. Goodluck.

23

Get the T-cyp and inject as you please. You can get insulin scripts without an Rx in most jurisdictions.

As for SC: There are pellets under the skin, now an FDA approved SC injection device, transdermal preparations etc. If its in the body, it gets absorbed. You will figure out the injections, they are the same as for insulin. Docs and nurses will think that the T will not load and flow, it just takes time and thats not in their mind-set. The advantages are in the stickies. The most important is avoiding a life-time of muscle damage.

Cost of hCG is your problem. Most insurance will not pay. Don’t have it presented with the words “fertility” as that is an dangerous works as most plans to not pay for fertility treatment.

24

What does a month supply of hCG run?

As I’ve mentioned earlier, my initial understanding of the benefits of hCG had it that it will keep your testes from shrinking and that it will allow you to father children. Now I understand that hCG can help with pregnenolone/mood, and I’m thinking that’s the best reason of all to be on hCG. I’m bracing for the doc either to not be willing to prescribe it and/or it is prohibitively expensive to pay for it out of pocket. I don’t relish the thought that going without hCG is going to come with a diminished mood. Maybe I’m worrying too much…

25

Find compounding pharmacies and see what they charge. Will be hCG+B12

26

KSMan, you’d asked for a ‘Cortisol, AM’ test and I had reported the saliva test that measured cortisol. I just noticed on a second page a result for ‘Cortisol, AM’ and I thought I should mention it. I guess I don’t understand the difference between the two tests, but nevertheless here it is:

Cortisol, AM Result: 19.0 ug/dL Range: 4.3 - 22.4

Also, I posted in the ‘Injection Protocol’ sticky a question or two about SC injections.

I greatly appreciate your time.

Rick

27

Cortisol, AM Result: 19.0 ug/dL Range: 4.3 - 22.4 is a good result. Better that 10!

28

So, I performed my fourth self-injection yesterday of test cyp on an E3D dosing schedule which means I started on 3/24/15. I also am transitioning from a T4 (Levothyroxine) treatment for my hypothyroidism to a T3 (Liothyronine) treatment. This requires me to systematically increase the dose over time and monitor my body temp and pulse. I initiated the transition on 3/25/15.

My question is this: Ten days into these two new treatments it seems to me that I feel my energy level and mood is dragging. I realize that hormone therapies take some time to get dialed in, but is it too early to implicate these new treatments as driving my diminished energy and mood?

At my last doctor’s appointment I presented him with documentation in support of subcutaneous self-injections of T as well as KSMan’s advice to not wait to get on hCG and AI. My doctor relented on the SC injections but was unwilling to prescribe hCG and AI before we performed the 6-week blood labs. Would it behoove me to ring up my doc and report my diminished energy and mood and ask for hCG and AI?

Thanks,

Rick

29

I have some blood lab numbers now that I’ve been on test cyp starting six weeks ago. I was under the impression we would be getting an E2 number but obviously the doctor didn’t order it. And I don’t know why we didn’t get an FT number because I believe it was ordered along with TT. We did get an IGF-1 number which KSMan suggested. I got the impression the FT number would be available later in the week (I did blood on 5/1/15 and, of course, today is Cinco de Mayo). That seems fishy but today was not my finest day and I didn’t press him on anything. I thought we would be getting thyroid numbers too, but the doc says we’ll measure that at 3 months, so another 6 weeks out.

My mind has been preoccupied since 4/12 when it appears I suffered a torn medial meniscus in my right knee. This was sustained on the job and it took 18 days to get in to see my orthopedist. We did x-rays (Grade 2 osteoarthritis which lands me on a track for an artificial knee in time, I’m told) and we await authorization for an MRI. I mention the injury not merely to account for my passivity in the doctor’s office today but to highlight an interesting blood lab number.

Total Testosterone: 554 — reference range of 291 - 739 ng/dL
IGF-1: 321.3 ----- reference range of 68 - 245 ng/mL

As you can see, the IGF-1 number is way high. The doc asked me if I took anything over-the-counter, which I don’t. He is wondering if my knee injury is seeing the body respond in ways to spike IGF-1.

As KSMan will recall, concurrent with going on test cyp we switched over from a T4 (levothyroxine) therapy to a T3 (Liothyronine) therapy. As mentioned, blood labs for thyroid in 6 weeks. For now, I’ve noted body temps rising about half a degree and getting me into the 97s and pulse increasing about 10 points and getting me into the mid 70s. I’ve not felt my heart race or any feeling of being hyperthyroid.

Additionally, I’ve reported to the doctor that any abatement in my symptoms would be considered subtle. My biggest complaint is low energy and I suppose I’ve felt a minor improvement. Same goes for libodo and erectile function.

Given this, the doctor is prepared to prescribe hCG. Conversely, he is prepared to increase the test cyp, but not if we add hCG. What is your thought, KSMan?

As we have no baseline for IGF-1, it is hard to find a context for the high number. The doc kicked around the possibility of a pituitary tumor but the knee injury might have elevated it.

Lastly, my doctor seems to be fixated on estrone over estradiol. For the ‘clinical requisition’ for the next blood labs in 6 weeks he checked the box next to “ESTF (Fractionated Estrogens)”. I presume that includes E2. He also wants to check Prolactin, which I assume is related to any concern about a pituitary tumor.