Starting TRT. Protocol?

Pharma / TRT Testosterone Replacement
1

Hey guys-

Many of you have given me great advice on this forum. I’ve decided to start the TRT journey, and wanted to get some insight on my protocol.

age - 28

height - 6’2”

waist - 32"

weight - 205 (used to walk around at a lean 220, lost down to 198, have gained some back)

describe body and facial hair - (pretty thick facial hair but grows slower/less thick these days? Gaps in beard now? Low body hair

describe where you carry fat and how changed - Pretty lean- when I do carry fat, it typically comes in the chest area first, then around the lower back/love handles

health conditions, symptoms [history]
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever — no hair loss or any other drugs. Used to really drink heavy- possible cause of high SHBG? Last fall I started dropping weight quickly after a trip to Colombia. Thought at first it could
Be a parasite. Libido dropped, gradually, and no morning wood. Still get erections easily- but not full. Sex not on the mind. People began asking (and stil do) if I was sick- that’s the kind of mass I I’ve been losing (I’m a decent sized guy with a solid build, have turned thin/frail). Finally put two and two together, saw docs, and found out my SHBG was astronomically high- eating up all my test. Main symptoms: brain fog, no focus, weight/mass loss, libido loss, no morning wood, no motivation in general.

-lab results with ranges –

TT: 767 (264-916)
FT: 10.4 (9.3-26.5)
LH: 5.7 (1.7-8.6)
FSH: 10.7 (1.5-2.4)
Estradiol: 18.2 (7.6-42.6)
SHBG 95.2 (15.6-55.9)
T4: 5.6 (4.5-12.0)
T3: 85 (71-180)
DHEA: 303.5 (138-475.2)
TSH: 1.35 (.450-4.5)
DHT: 80 (30-85)

-describe diet — Very clean. High protein, moderate carb, moderate-high fat. Lots of red meat, green veggies, healthy fats, rice and sweet potatoes for carbs. Don’t track anymore, but stay around 3500-4200 cals/day. At least 265g protein/day. At least 100g fat/day. Supplement with whey/casein, tyrosine, carntine, betaine, omega, multi, ZMA, BCAA, probiotic, vitamin d, boron, etc

-describe training - Weight train 5x a week 75min. Heavy strength days two days, hypertrophy two days, miscellaneous day or body weight day. Sprints once a week and walking lunges a couple times a week are only cardio.

-testes ache, ever, with a fever? No

-how have morning wood changed? Gradual change- but no morning wood anymore. When I first started taking Boron, I had a couple mornings where I did, but boron’s effects seem to diminish for me after a while. Have upped the dose and see a boost each time that halts.

Libido- Not gone but low- able to get erection fairly easily, but not full like it used to be. Low volume. Not thinking about sex at all.

I was initially prescribed anavar at 25mg/day to lower shbg. After a while I gave in and took it at 12.5mg…the 3rd day I woke up feeling like someone wiped the fog off the windshield. Energy in the morning, better workouts, slight improvement in erections. I know anavar isn’t a long term solution- but the difference I felt made me realize it’s time to take the TRT route. No longer taking var and looking to start TRT at the following protocol:

Monday: 200mg Test C
Tuesday: .5mg anastrozole
Wednesday: .5mg anastrozole
Thursday: 250iu hcg
Friday: 250iu hcg

My biggest question- do I need anastrozole at all with my E levels being what they are? My doc thinks 1mg/week won’t be too much, esp with the high dose of T. Other concern- is this the best way to lay out the protocol? I’ve seen many people on the forums inject hcg EOD, and take anastrozole EOD, also guys who do HCG on the day of T injection. Any help would be greatly appreciated. I travel often for work (typically mon-thurs , so an efficient protocol where I’m not dragging hcg through the airport every week would be great. I also have a 10 day international trip coming up, and am wondering if I would be ok missing a dose of hcg?

Thank you guys for any input you may have!

2

You protocol makes me cringe, the AI dosing is aggressive, most need only micro doses. I wouldn’t start out TRT on HCG, it will increase estrogen which you don’t need more of and the majority of men feel better without it.

HCG supports your adrenals, your adrenals don’t appear to need to help. If you want to control estrogen on TRT inject small doses.

Starting out TRT with a bunch of compounds is a ticket to hormonal hell. I also think your T dosage is high, it’s not like FT is below range.

3

From what I’ve learned so far, I thought the anastrozole dose was a bit much as well. Thought maybe .25mg twice/week might be better?

As far as hcg goes, I thought if fertility was a concern it was better to start TRT with it? Is that something I could add in later once I’m stable? Just don’t want to lose function down there and have to worry more about starting things back up if I have to down the road.

I’ll double check when i get the meds and written prescription tomorrow, but I’m almost positive he wanted to start me at 200mg/week. I know 150mg is more the standard though…

4

If you turn out to be an AI over-responder, AI dosing will be a moot point because you won’t be able to go near it. The more experienced doctors start you out on .125 1-2x weekly to see how you do. I over-respond to 0.050 anastrozole. If I tough AI’s and it ruins my joints.

Most men who have been on TRT for awhile revisit HCG when it’s time to have kids, even adding FSH injections which works better than with HCG by itself.

5

Injecting 200 mg test once per week will be a ticket to hell

6

Would I not experience some pretty serious atrophy/complete loss of function without hcg? I’m not looking to have kids for quite a while, so if hcg isn’t necccessary to keep things somewhat running maybe I could do without.

7

Switch to injecting at least 3x a week and drop the AI and HCG. Start simple. Do that for 6 weeks and see how you feel.

Your nuts wont shrivel to nothing in 6 weeks. Start as simple as possible and add from there if it makes things better for you.

T3 also looks low to me so that needs to be addressed too

8

The large 1x week dose protocol was to hammer my SHBG down (currently 95.2). Would you guys still start with 2-3x week?

Going to take the advice on hcg and anastrozole, I’m with you guys on not throwing too much in my body at once.

Might be a dumb ?, but how would low T3 be adressed typically?

9

Also I might have the dose wrong…I’m pretty sure he told me 200mg once/week, but it might be 150mg. Meds will be here today so I’ll keep you guys posted once i have a written prescription in front of me.

10

My SHBG is almost double yours…

Personally I started with the whole daily subcutaneous injection thing that everyone talks about and didn’t love it. Maybe I didn’t give it long enough, but personally, for me, I liked 50mg Mon/Wed/Fri, shallow IM injections. I wouldn’t do it once a week though, I’d suggest 2 or 3x a week only because I felt better on 3x a week than daily for whatever reason.

I had issues with my ankles swelling really bad when I tried HCG so I decided to hold off on that for a little bit then I’m going to try to add it back in maybe once a month or every other week or something like that to try to keep atrophy to a minimum. But for now I didn’t want to add the extra estrogen and complicate things further.

200mg is probably a better place to start with high SHBG though, do at least 150-160. It took me a good 6 weeks before I started feeling any better, probably a little longer than that actually.

11

You’ll be fine with a once a week dose and 150mg would be OK to start but I would guess you’ll want to go to 200mg. Most TRT guys inject once weekly and most take 150-200mg.

I would not take anastrozole or hCG to start. Your E2 is pretty low, I think you’ll feel better with a higher E2 level and your SHBG is binding that anyway. If it is later determined you are overly sensitive to estrogen, you can always make changes or add anastrozole.

Unless you are actively trying to have a child, or concerned with the possibility of testicular atrophy, there is no need for hCG.

12

We don’t know if you will experience testicle atrophy, you lose function in that no testosterone is produced, but that’s why you are going on TRT. HCG can have side effects and increases estrogen, which can lower libido and causing ED.

I didn’t have testicular atrophy on TRT.

13

How is possible not to have atrophy?

14

Some have a lot, some have not much, it seems to be more a case by case thing for each person

15

Gotcha. I meant more losing function as in the boys eventually disappearing into a tiny mass of nothing. Could this happen after a long period of time? Would less hcg present less side effect risk? I.e. if I only injected this dose 1x week vs 2x?

@highpull I kind of had the same thought on SHBG keeping my E down…going to for sure hold off on the AI until I get bloodwork that shows me I need it (or start feeling the nipple soreness/sensivity.

Just got the meds in, and I heard the doc right, prescription is for 200mg 1x week.

Thanks again guys!

16

Also just checked the prescription- he wants me injecting 500iu 2x weekly on the hcg…is that a bit much? A lot of the protocols I’ve seen are 250iu 2x weekly…

17

No one can answer this question, your biology is unique to you so there is no way for me to know how your body will respond to HCG.

TRT is all about trial and error, 250iu twice weekly is probably too low a dosage. Your SHBG is very high and your estrogen and Free T not as low as I expected to see with SHBG this high, this tells me your SHBG doesn’t bind androgens very strongly.

I expect estrogen troubles with once weekly dosing, adding HCG is going to add estrogen on top of the estrogen from TRT.

18

I was prescribed something similar as a starting TRT regimen which I only started on Monday. Currently prescribed 160/week as one injection. Decided that I wanted to start at 100mg/week with ED injections as that just seems to have the most upside.Plan to probably increase the weekly amount depending on how I feel and labs look after a while. Not taking the HCG or AI as the majority of issues seems to be related to injection frequency, HCG, and Ai’s. Though I have had a vasectomy and don’t care if my nuts shrink either.

1 Like
19

If it were you, would you start with 2x weekly dosing at 100mg?

20

I would and if estrogen becomes an issue, I would move over to an EOD protocol.