How has everything been going with the Baylor doc? I am on Dr. Lipshultz’s waitlist as well. Currently on HCG monotherapy myself (same does Dr. Khera wanted to start you on).
- UPDATE Feb 3, 2015:
So I decided to go for T hCG and eventually IA. Decided to join lowtestosterone.com, which I found had some good reviews in this forum. hCG monotherapy at about 500-600 IU EOD had failed to push my TT beyond 400. Still waiting for previous doc to make a decision regarding hCG mono’s effectiveness – if he decides to change it to T and hCG, I might consider going back to him and rescind contract with lowtestosterone.com if it is better cost wise.
New doctor said to start with 150 mg T (cyp) weekly and 500 IU hCG EOD. Knowing this forum’s recommendations, I decided to lower both doses to 100 mg T separated in 2-3 shots throughout the week, and 250/300 IU hCG EOD. Started one week ago.
Doctor said no need of IA for now, but to wait for 6 weeks to see where my levels are by then.
QUESTIONS:
- With my background (and TT = 196 as a baseline before any treatment) is it enough to inject 100 mg T per week in divided doses, or should I go instead for the full 150 mg T prescribed?
- Is it OK to wait for IA for now? I don’t want to wait till my E2 is through the roof to go for it.
Wait a bit and see how you feel before making adjustments. How you feel is more important than test results.
Many feel great on the suggested protocol. So take it for a spin.
- UPDATE Mar. 7, 2015:
I’ve been on the following protocol for 6 weeks:
- 100 mg test cyp per week, split in doses of 40 mg, 30 mg, 30 mg, taken EOD subcutaneously (belly fat); and
- 300 IU of hCG taken EOD subcutaneously.
These are the labs that came today:
T = 536 [348-1197]
E2 = 39.8 [7.6-42.6]
FSH = less than 0.2 [1.5-12.4]
LH = 0.1 [1.7-8.6]
So I’m concerned about several things:
-
My T levels are still halfway to upper level ranges (I’m 28 y.o. male). I’ve been feeling great, though, with increased sex drive, better and more frequent erections, and great gains in strength at the gym. Should I still attempt to get higher by increasing the T dose? Or do I stick to this protocol for more time?
-
My E2 levels seem high. From my experience with previous protocols (Clomid mono, hCG mono), I am quite estrogen dominant. Should I consider adding an AI? Or should I wait more time on this protocol?
-
FSH and LH are really low, right? Would that be enough to maintain my testicular function? Should I consider increasing hCG? Waiting?
FSH and LH are always → zero on TRT. Only exception is that FSH will not go to zero when there are FSH secreting testicular or [rare] pituitary cancers. And testes will react to that. That is why you take hCG. hCG does not show up on LH/FSH labs.
Try the 1.0 mg anastrozole per week in divided doses.
Your E2 on TRT is sort of what is expected.
You would do just as well on 250iu hCG EOD, might save some $$.
Your T, 40, 30, 30 is not EOD as there are 3.5 EOD doses per week.
You do need more T. Best to do labs half way between injections and don’t change that. But we really don’t have the complete picture without FT lab work.
What T exactly are you injecting? Brand? cypionate?ethanate 200mg/ml? Wondering if the T is the cause of the lower lab result.
Odd that doc suggested 150mg from the start.
Symptoms are the most important. If you have been feeling really good, you are doing much better than most guys on TRT who write on forums - I wouldn’t chase higher T values just because someone calculated an average. The idea that you should have T in the 700s at your age is nonsense anyway. I have seen papers where they tested elite athletes in their 20s and found average T levels in the 400s. Everyone responds differently to given T levels.
HCG may not fully preserve fertility, though. It mimics LH mainly, not so much FSH. FSH is required for spermatogenesis but is suppressed by HCG. Clomid is better for preserving fertility. I am actually not sure why the doctor would have changed you over from Clomid if you felt good on it and had very decent T values on it.
[quote]KSman wrote:
. . .
You do need more T. Best to do labs half way between injections and don’t change that. But we really don’t have the complete picture without FT lab work.
What T exactly are you injecting? Brand? cypionate?ethanate 200mg/ml? Wondering if the T is the cause of the lower lab result.
Odd that doc suggested 150mg from the start.
[/quote]
Will have the FT labs these days; will post then.
I’m using 200mg/ml test cypionate by Empower Pharmacy (the one working with lowtestosterone.com).
Should I try 150 mg/week?
[quote]seekonk wrote:
. . .
HCG may not fully preserve fertility, though. It mimics LH mainly, not so much FSH. FSH is required for spermatogenesis but is suppressed by HCG. Clomid is better for preserving fertility. I am actually not sure why the doctor would have changed you over from Clomid if you felt good on it and had very decent T values on it.
[/quote]
Stopped Clomid monotherapy because my T levels were still around 400. Should I try T with Clomid instead of hCG?
How can you tell or assess if hCG is preserving testicular function? Sperm analysis? I’ve noticed that my testicles are less swollen than normally, but not near the atrophy that was going on in the month I was on 300mg/week with no hCG.
hCG will preserve physical attributes. The LH stimulation from hCG can be less that from the Clomid if Clomid cause high LH levels. You Clomid dose was way too high in any case.
When on TRT, you are not taking hCG to produce a much T. Injections do that. If sperm count is low, you can take a SERM when you need to make babies or take in place of hCG a few time per year as a tune up. And then dose should be sane, 10mg ED would do. As always, some will not feel well on Clomid and Nolvadex avoids that.
I am suspicious of that compounding pharmacy and your doctor. Your doc sends you to that pharmacy and your dose-response seems off by 50% and your doc recommended 150mg instead of 100mg from the get go. Ask doc what he thinks of your dose-response.
Is the T compounded with something else? I expect so, given the FDA restrictions on things that are otherwise commercially available.
Your T injections are .2 ml, .15 ml and .15 ml?
[quote]KSman wrote:
I am suspicious of that compounding pharmacy and your doctor. Your doc sends you to that pharmacy and your dose-response seems off by 50% and your doc recommended 150mg instead of 100mg from the get go. Ask doc what he thinks of your dose-response.[/quote]
I will ask this week my doc for his opinion.
[quote]KSman wrote:
Is the T compounded with something else? I expect so, given the FDA restrictions on things that are otherwise commercially available. [/quote]
Can’t tell if T is compounded with something else. Label says nothing other than it has been “specifically compounded”. Here is the info they have on their webpage: http://www.empowerrxpharmacy.com/drugs/testosterone-cypionate-injection.html
[quote]KSman wrote:
Your T injections are .2 ml, .15 ml and .15 ml?[/quote]
Correct.
Are you suspecting that 100 mg of this T may indeed be lower in effect than actual 100 mg?
That link was to a bunch of meaningless junk. Not a good sign.
The way that you respond and doc starting at 150 makes me suspect that.
Most are in 800’s at 100mg T cyp per week.
[quote]santiagom wrote:
Stopped Clomid monotherapy because my T levels were still around 400. [/quote]
Your levels were almost 500 on Clomid, but anyway it doesn’t matter as long as you feel good. Bad health outcomes are only associated with T less than 350 or so, so there is no good health-related reason for increasing T levels above the high 400s if you feel well at that level.
Anyway, you can try and see if you feel any better with higher T levels than that. I am almost certain that you won’t, but you should try it for yourself.
UPDATE
I received the FT levels from last day’s test, and they are greater than 50 [9.3-26.5].
What does this mean? Doc said there was probably a lab error, considering also that TT levels were mid-range.
What were you doing for that lab work?
I had my blood drawn by noon on March 6th. Had taken my T shot (40 mg) and hCG shot on the morning of the previous day (March 5th).
Doc said that the treatment was fine because, even though my TT was mid-range, FT was high-range due to low SHBG. Suggested to make no changes. I’ve been feeling pretty well in terms of mood, sex drive/erections, and strength.
Any opinions?
I guess that would make sense, but you did not do SHBG lab work. If you are doing well, that is the bottom line.
- UPDATE June 20, 2015:
I’ve been on the suggested protocol for 5 months. These are the labs that came today:
TT = 6.77 ng/ml [2.62-15.93]
Bioavailable T = 441 ng/dl [190-295]
E2 = 37
E2=37 is too high. You were using anastrozole? If so, increase dose by a factor of 37/22