Ready for a Real Protocol at 56

Pharma TRT
1

First off, wow, thank you to those of you who have taken the time to collect and post so much useful info. Wish I had taken the time to find this board before embarking on my journey.

Quick Summary:

8 months ago (Jan '14):
Me to PCP: Lethargic, depressed, nothing sudden, just feeling old
226lb, 6ft 1in height, 38in waist
PCP: Let’s test your T: (TT=316ng/dL (250-1100), FT=61.1pg/mL (35-155)
PCP: Bzzzt, you don’t qualify, suck it up, old dude! Dang…
Continued workouts of weights (3 d/w), hiking (3 d/w) and yoga (2 d/w),
but no lifting gains or improvement in hiking speed - stalled.
Other tests at this time:
PSA: 2.59ng/mL
Vit D: 37/ng/mL
T Chol: 184 mg/dL
Trigly: 81 mg/dL
HDL: 57 mg/dL
LDL: 111 mg/dL
Fast Gluc: 80 mg/dL
BP: 126/78
Supplements (ED):
Costco “Mature” Multi-vit (includes 125mcg iodine)
Tri-something Glucosamine, MSM
DHEA 100mg

6 months ago (Mar '14):
Me to PCP: Hey, I take DHEA - maybe that jinxed the test!
PCP: OK, stop the DHEA for 6 weeks and we’ll test again…

4 months ago (May '14):
Test results: (TT=227ng/dL, FT=31.1pg/mL)
PCP: Result says your T is low…
here, get these 25mg gel packs and rub on alternating shoulders ED

First few weeks, wow, great! No more depression, started getting
things done again, went from 226lb to 212lb, increased lifts, started
running (slowly, still an old fat guy, but still better than just hiking)

Then, a few weeks in, my nuts were shrinking, and so was my energy, and the
depression came back, and my weight started going back up…

2 months ago (July '14):
PCP: OK, lets see where your T is: (TT=67ng/dL, FT=10.9) Yiikes!
PCP: You must not be applying the gel properly & consistently
Me: I don’t feel like an idiot, but fine, let’s give it a bit more time

1 month ago (Aug '14):
Me: My nuts are gone and my weight is back to 220lb…
and my BP is 135/88…this isn’t right
PCP: Your T levels should be back up to stable, let’s test
Results: TT=86ng/dL, FT=17pg/mL - still, like, Yiikes!
PCP: You must not be applying the gel properly & consistently
Me: Nah, you just don’t know what to do…I’m on my own here…
quick, Robin, to the Internet!

2 weeks ago (late Aug '14):
Me to PCP: So, a real TRT protocol is something like 100mg T, 750iu HCG,
and 1mg anastrazole per week; any chance we can do that?
PCP: I won’t prescribe HCG or adex, but I’ll give you a referral to
an endocrinologist
Me: We could have been here 6 months ago…but, OK
Current Supplements:
Costco Mature Multi
Tri Glucosamine/MSM
100mg DHEA
50mg DHEA-S
50mg Pregnenolone
BP: 148/92 before running, 126/78 after
that seems high - is it maybe the gel packs, or the supplements?
Seems like it is time for BP meds, at any rate.

Tomorrow (8-Sep):
Appt to see endo, am thinking to ask the following:
Let’s test these things:
TT, FT, E2, PSA
Let’s start on a real protocol, like:
40mg Test Cyp SC E2D (that yields 140mg/week)
250iu HCG SC E2D
0.25mg anastrazole E2D
Let’s test again once per month until we get things right

QUESTIONS:

  1. Is that I am seeking from the endo reasonable?
  2. If he wants to start over, or test first, should I just punt & go to
    one of those TRT “clinics”?
    One I have found seems reasonably priced, a bit more expensive than
    the endo (with insurance), but my plan won’t cover the HCG anyway,
    so by the time I pay for compounding, going with a clinic that
    provides the medicine is maybe $100/mo more.
  3. If he wants to run tests, anything in addition to those above I should
    get at this point?
  4. Anything else I should be looking at, like body temperature?

Cheers,

PD

2

You can read the thread I started, but basically, this is what prompted me to just go ahead on my own. The endless Dr. (Dis)Appointments and screwing around is just not worth it. I’d like to have more regular blood tests, but that’s the main down side. I suppose the slight possibility of getting arrested for drug trafficking is a possibility, but there have to be bigger fish to fry than me.

It’s a shame that making a man feel like a man is such a taboo in this country. What I’m doing is so minimal that the results have blown me out of the water. I’m sure that I’d feel great by adding a little T-cyp or T-en, but right now I just don’t see it as necessary and I like to keep things as minimal as possible. While I’m not following his protocol per say, the things that KSman has put here is really helpful. Thanks.

3

Proton decay is a vastly rare event. Thanks for the amusing post.

You did not test LH/FSH, so we do not know if primary or secondary. But less of a concern with men of your age.

Transient inability or total inability to absorb transdermal T is a symptom of hypothyroidism. If you had read the advice for new guys sticky you would know that.

Please also read the thyroid basics sticky and eval your long term intake of iodized salt or from vitamins. Used those vitamins with 150 micrograms for years or recent.

Also do these labsTSH, fT3, fT4. [and check body temps]

Don’t go nut with DHEA. Take 25mg/day then do DHEA-S labs later and see where you need to go. Some have problems with DHEA–>E2.

Endo’s can be useless. Read the finding a TRT doc sticky.

Supplements - goals:

  • EFA’s: fish oil, nuts, flax seed meal/oil
  • olive oil and other healthy fats
  • keep taking the multi
  • CoQ10 in ubiquinol form
  • keep E2 levels down near 22pg/ml [better for arteries and prostate]
  • more iodine [maybe]

You need to be monitoring PSA and hematocrit with TRT.

140mg T/week makes sense based on your body weight, but perhaps not based on lean body weight. We see guys that do not get stabilized when starting on higher doses.

4

Thanks KSman. Really appreciate your insight and will post again once I get the additional tests and other bits tightened up.

Endo says he is likely to recommend Clomid HPTA restart, but wants to see LH and Thyroid panel first. Will post those.

I am concerned, based on reading other threads on Clomid HPTA restart that I will be left with higher T numbers (over the minimum threshold), but no real improvement in symptoms (energy, virility, etc.).

I will do a bit more reading to see if one of the threads discusses the potential for HPTA restart with a T + HCG + AI protocol.

5

I corrected above to state:
Transient inability or total inability to absorb transdermal T is a symptom of hypothyroidism.

You have age related hypogonadism. A HPTA does not make sense. Endo has lost his perspective and your age.

Would have been good to have LH/FSH, but you are on transdermals now? Can’t check LH/FSH while on TRT.

Follow up on thyroid issues as I suggested.

Check your body temperatures!!!

Please also read the thyroid basics sticky and eval your long term intake of iodized salt or from vitamins. Used those vitamins with 150 micrograms for years or recent.

Please re-read my post above.

6

Thanks KSman - a bit of new info:

Temperatures (three days worth, anyway):
06:00: 97.1, 97.6, 97.1
15:00: 97.8, 98.3, 97.6
Action: Lugol’s 5% on order, plan to ramp from 6.25 mg to 25 mg/day, stay on until 750mg reached or mid-day temps approach 98.6, whichever comes first.

Additonal tests ordered by endo:
LH <0.1 (1.5-9.3) - guess that goes with Androgel sending the boys up north
Prolactin 9.3 (2.1-17.7) - not sure this means anything
TSH 1.45 (0.34-4.82) - close enough to 1?
TT 184 (241-827) - ah, Androgel, what hast thou done?
E2 48 (0-39.8) - oh, so that’s where the test is going (and maybe the DHEA)

Yes, yes, I know - asked for the other tests, and he “said” he was adding them, but then they didn’t get done (so much for integrity; at least we can proceed apace).

So, sent endo a note saying - “Let’s get the boys back where they belong, and then discuss Clomid”. He prescribed 100mg Test-C/wk (100mg/mL), 1000iu HCG/wk (10,000 iu Pregnyl), and 1mg Adex/wk, and some syringes the size of knitting needles (21 & 22 g, 1 1/2"), along with instructions to schedule an appt with his nurse to learn how to inject properly (he really, really wanted me to come in every two-three weeks for the injections, only reluctantly agreed to allowing me to self-inject weekly, and completely objected to SubC when I brought it up - I think the large needles and 100mg/mL instead of 200mg/mL are his way of trying to make the injections so painful I will gladly opt for Clomid in a couple of months). Luckily, the pharmacist couldn’t afford the shipping on such large hunks of stainless, so suggested a 25g 1" swap-out, to which I readily agreed. And, I think I have some 29g 1/2" insulin syringes around here somewhere that need to get used up. I might forget to make that nurse appt - if endo chases me on it I will send him the many links on SubQ I have gathered - better to piss him off early and move to a new doc than end up with scarred up butt-muscles over time.

Got the Adex that night and started with 0.5mg (dissolved in Herradura Double Barrel - waste of fine Tequila, but I never have liked Vodka, and it would be immoral to waste good Scotch putting meds into solution; BTW - Adex does not dissolve all that well - should have crushed first). Another 0.25mg tonight (40 hours). Already feeling better (libido, virility), so I believe it is doing its job.

Question: Given my pre-TRT output of 217 ng/mL TT and 100mg/wk of T-Cyp, is 0.25mg Adex EOD a reasonable dosage? Will test again in 30 days, but would still like to approximate the correct dosage upfront, if possible. Maybe less? But still EOD, right, given the decay rate of Adex?

It turns out that T-Cyp and HCG are harder to come by around here than I thought they would be; 3 days for vendor makeup and another 2 for delivery, so estimated arrival is still out a couple of days.

Further research into Clomid HPTA restart agrees with yours - I am an unlikely candidate for success - so am guessing the Endo-endgame is long term pill-popping. Not wild about the long term prospect of high T, low libido, low virility, and eventual liver failure - seems like few rays of sunshine on that stage. And since, as far as I know, the super-tight knots that sadistic urologist put into my vas deferens after severing them a few years back are still holding, I am unlikely to see (nor do I need) an increased sperm count.

Still, on the theory that having as much of the pipeline operational as possible is better than starting halfway along with fake LH, I will probably suck up the anticipated Clomid symptoms for at least a couple of months to see how things go. Well, see, that is, if there aren’t too many medically induced floaters in my eyes. And, if that happens at least I won’t have to sit and cry through as many love-story movies, which in turn will give me time to attend those court-mandated anger-management classes. There, did I miss any symptoms?

Always look on the bright side of life.

Next post once I have something more useful to post.

7

What does this mean? “eventual liver failure”

  • TRT will not do that.

Get Nolvadex instead of Clomid!

LH/FSH prior to TRT would have been good.

Prolactin is not a cause of your problems.

Your poor absorption of transdermal T points to thyroid issues as well as your low body temps and moderately elevated TSH.

100mg/wk of T-Cyp, is 0.25mg Adex EOD a reasonable dosage?
-yes

8

Thanks KSman.

Better half has vetoed the Clomid/Nolvadex for now based on experiences with women we know who used Clomid for fertility treatments - as pretty spouse observed, “It is a wonder none of them did serious time.” I’ll do a bit more research, but this does not look like a promising protocol for me.

The Adex started on Tues PM is increasingly having the desired effect - energy level continuing to pick up, mood improved. Fingers crossed the other drugs do their part.

I’ll be back in a month with the next set of labs, experiential observations.

Happy Trails…

9

“Better half has vetoed the Clomid/Nolvadex for now …”
Guys taking 10-12mg per day to get LH/FSH into normal levels do not have the problems that your wife imagines. Some guys react badly to clomid from the estrogen effect it has for some guys. Perhaps some females have issues with clomid as well. SERM’s are given to post menopausal women and to non-menopausal women who are getting fertility treatments. In the later case, the doses may be extreme and hormone can greatly disturbed.

10

Howdy Folks, quick update on results/experience since modifying my TRT regimen in mid-September 2014:

  1. Prior to end-September was on 25mg of Androgel ED - E2 was high, mood/libido low. Weight was 226lbs. Morning temps low. BP 115-140/70-80.

  2. Changed to 100mg Test-Cyp EW, 0.15mg Anastrozole ED, 250iu HCG EOD. Also started on 12.5mg Lugol’s Iodine, 18.75mg Zinc Acetate, and 400mg of Magnesium Citrate ED. Immediate improvement in mood, libido, energy level, lifting gains, endurance - felt like firing on all cylinders for the first time in years. Weight increased over 4 weeks to 230, but body composition felt better, so I got some of those calipers - yielding 16.3-19% bodyfat based on two different measuring protocols (single site, three site). Body temp went up to 99.4 upon waking, so cut back the Lugol’s to 12.5mg a 2xEW.

  3. After a few weeks I experienced lower libido/mood, unabated tendonitis in my elbows and right shoulder, lower energy level/endurance, but still improving on lifting ability, so I went in for an E2/TT test. E2 was <6.0 pg/mL, below the lower limit of the test, TT was 992 ng/dL (241-827 scale). Reduced Adex to 0.10mg EOD, Test-Cyp to 90mg EW, and HCG to 150iu EOD. Body temp holding right around 98.7 upon waking to 99.0 in the PM. BP increased to 120-140/70-85 mm/Hg.

  4. On the revised dosages my mood/libido and energy level improved, but I still have the tendonitis. Tests from 30-Nov indicate E2 at 24 and TT at 546 (241-827 scale). Endo wants to keep things there (and he did not bring up switching to Clomid, so neither did I). Body temp unchanged (98.6-99.1). Bodyfat is now 14.7-17.0% based on same measurement protocols, but weight is at 234lbs. Higher weight isn’t a goal, but I’ll take the improved composition. BP has continued up, now 135-155/70-90 mm/Hg - Endo isn’t too concerned, says it should come down if I lose a bit of the weight.

5a) So, on to BP and tendonitis. Spoke to big guy at gym (won Mr. California many years back) and he said to start supplementing with gelatin - one packet every day - and I should see results within a couple of weeks. He also advised to let my E2 climb a bit - up to 30 - says even a few points can make a difference in joint comfort. Thoughts?

5b) He also thinks getting weight down should help the BP, but says that’s a common side effect to using Adex/HCG and I may need medication if losing a bit of weight doesn’t help. Thoughts on that?

  1. Finally, looking into peptides a bit, both GHRP/GHRH and TB500, to improve my tendonitis - are those acceptable topics for this forum, or should I take that conversation elsewhere?

Anyway, things are generally much better now than in August/September, so I have to recommend TRT to any other middle-aged pudgy guys looking for alternatives.

11

Where is HTC? - if elevated can contribute to higher BP.

You should not be injecting only once per week. Your levels are changing a lot and your steady anastrozole levels do not match T levels.

12

Im curious why people allow there insurance company to run there health? I pay cash and they got me on a real protocal at age 35. I was started at .2cc EOD Test Cyp. Insurance is in the game to pay as little into your well being as possible. PCP providers hands are tied by the insurance you bring to them. I wouldnt trust my endocrine health and well being to my insurance company.

13

You never seemed to pick up on the earlier thyroid/iodine issues.

14

Hi KSman - not sure what you mean by HTC - are you able to clarify?

Not sure what I missed re the Iodine. Morning temps were low prior to supplementation with Lugol’s, but now come in right around 98.7 and stay in the range of 98.7-99.1 over the course of the day. Do you see an issue there?

I have ordered up a thyroid panel and will reply again once I have the results.

15

So IR worked! -great

HTC is hematocrit, a measure of the “solids” in your blood, which can get too high on TRT, so you get that in your labs, probably as part of CBC.