Unsure about starting at 50mg/week TRT

Pharma
1

Alright, first time posting here so I’ll try to be as thorough as possible. TLDR; My main question is if I should really go with this protocol through an inexperienced PCP. Now, here’s the full story: (you can skip the ——— separated paragraphs which include the bloodwork and labs)

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29M 5’9” 150lb 16% Bodyfat (DEXA)

I started seeking TRT because at the age of 29 I’ve suddenly developed some strange health problems. The big one being osteopenia and joint issues. I was doing great this year getting stronger, getting leaner, and living an overall healthier lifestyle, until the beginning of October when I hit a wall of sudden fatigue. I took two weeks off from the gym and a week off work, and went to go get some blood work done. My PCP thought surely nothing was wrong because I’m “29, lean, and exercise often”. The only odd thing that came back from the CBC was prediabetes (very odd actually), and slightly high LDL and glucose levels.

Next I went to an endocrinologist to rule out thyroid issues as the fatigue would not let up. I was always tired no matter how much sleep I got. My job was starting to get affected.

We ran a full panel and all hormones checked out in the appropriate ranges, but my T and Free T were on the borderline low range, but still “within range”. Endo insisted it wasn’t hormone related and referred me to a Rheumatologist.

Some relevant results were:
10/7/23 11am, not fasted, 9 hours sleep
Total T: 310ng/dl (240 - 870)
Free T: 5.4 ng/dl (3.2 - 19)
SHBG: 40.8 nmol/L (14-113)
TSH: 2 uIU/ml (0.35 - 4.94)
Free: T4: 0.95ng/dl (0.7 - 1.48
FSH: 4.27 mIU/ml (1.27 - 19.26)
LH: 1.95 mIU/ml (1.5 - 9.3)
Ferritin: 46.43 ng/ml (21 - 275)
Prolactin: 4.76 ng/ml (2.6 -13)
Hemoglobin: 14.5
HCT: 44.6
A1C: 5.9%

I went and saw a urologist, who suggested clomid but was adamantly against TRT.

Saw a sleep doctor and a rheumatologist and am currently awaiting results from them. Hopefully it isn’t something as serious as autoimmune.

After advocating for a second set of labs from my PCP which I pulled from DeFy’s initial lab requirements, I got back these results:

10/14/23
Blood drawn at 8am, fasted, 9 hours of sleep.
Total T: 399ng/dl (240 - 1080)
Free T: 6.1 ng/dl (5.0 - 19.8)
E2 Sensitive: 10 pg/ml (11 - 44)
SHBG: 42 nmol/L (11 - 78)
DHEA: 259 ug/dl (49 - 592)
LH: 2.4 mIU/ml (0.6 - 12.1)
IGF-1: 155 ng/ml (84 - 259)
PSA: 0.48 ng/ml

The PCP finally agreed to prescribe me TRT to address the low E2, which may likely be related to the osteopenia and onset of the joint stiffness.

I then waited 3.5 weeks get the prescription approved and filled.
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My PCP prescribed me with 1000mg/10ml vial of test cyp. I went to go pick it up and the dosing said “Inject 0.5ml once monthly”. This set off some alarms as I’m sure my insurance probably won’t cover another vial if they’re expecting me to make this vial last TWENTY MONTHS…

I visited my doc today to get some clarification, as I thought we agreed upon 100mg/wk.

The doctor said that it’s difficult to get insurance to cover it when you aren’t outside the reference ranges for low T. He said for me to follow the dosing schedule so we can start low and “build a case”. I said no way would I inject once a month, I’m wasting time I feel like shit still. He said he understands but this stuff can take time to get insurance to cover it. He doesn’t want me to have to pay out of pocket through a clinic and he doesn’t want to get in trouble for writing a script for a schedule III substance. He said I can and should split it weekly but only 50mg a month.

After some back and forth he thought what was sent over was a 100mg/1ml vial, because he said the vial should last 2 months. So that was the miscommunication.

So now he wants to take advantage of the error and to take 50mg/wk and get retested in a month, and if my symptoms remain he plans to use that to “build a case” to the insurance that I need more. And we can double the dosage to 100mg/wk in a couple months.

My PCP clearly doesn’t know what he’s doing and is afraid of getting in trouble, but not if we do it the slow way. However I explained that I’m not concerned about the numbers as much as I am the symptoms, so when we get blood work if my T is higher but symptoms not relieved then I want to up the T. He said we can do that OR it could be unrelated to low T. That OR concerns me.

Another concern is 50mg being too little that once my T production slows or shuts down I’ll feel even worse, with no guarantee of my doctor or insurance upping the dosage to my liking.

My question is this: should I even bother with this doctor for the benefit of ease with insurance? Should I find someone else before starting? Should I just say screw it and go through a clinic like DeFy and get dialed in and THEN find a doctor?

2

Was your osteopenia diagnosed by a bone density test?

Can you describe the specifics of your joint issues?

3

First suspicion of osteopenia was two recreational DEXA scans on 7/9/23 and 9/30/23 that showed negative T scores. Of -1.4 and -2 respectively. I brought this up to the endocrinologist who ordered another DXA scan from a hospital and they diagnosed me as osteopenic and that vitamin deficiency, weight training, and hormone therapy could be used as treatment.

Since I ruled out vitamin deficiency like calcium or vitamin D, and I already do strength training, I figured hormone therapy might be the next step.

My joint issues are mostly just being very stiff. I also tend to get soreness in my tendons more often particularly in my elbows and knees. Sometimes my left knee will slightly lock up, and then release. It’s mostly painless but I’d say sometimes it’s a 3-4 on the pain scale. Enough to make me limp a bit. I can’t seem to run anymore without a flare up and without fail I can get my shoulders, elbows, hips, and knees to crack on rotation.

It’s these symptoms plus being unable to recover from workouts as quickly, which got worse quickly throughout this year, that prompted me to check T and E2 levels. Not to mention zero sexual interests, which I first attributed to cutting and losing weight in the first half of the year. I was about 11% bodyfat according to the 7/9/23 dexa scan. But now I’m 16% according to the 9/30/23 dexa scan and no improvements in libido.

Furthermore the rheumatologist had me do some rudimentary movements and was very dissatisfied with what I was unable to do with mobility, and also just based on other symptoms took a bunch of x rays and blood work to rule out autoimmune disorders. I’ll hear back from them in 2 weeks. The rheumatologist was definitely the best doctor I’ve seen so far, but she admittedly said she couldn’t help me with the hormones as that’s not her area of expertise. I appreciate when I doctor admits they don’t know something.

4

I wonder if this might be the source of the problem.

Just out of curiosity do you use creatine?

I’d fear that 50mg/wk is just enough to turn your natural testosterone feedback system off, yet low enough that your Total Testosterone will be less than 300ng/dL tested in the trough. I am far from an expert, but I would resist taking much less than 100mg/wk. plus pinning no more than 5 days apart. That’s just my thoughts. Many on T-Nation have much more experience varying their doses. I have been taking 100mg every five days for about 2 decades.

Also, a Total Testosterone of 399ng/dL doesn’t seem low enough to be the cause of your very significant problems.

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5

Do you know if she tested for CK (creatine kinase)?

6

I do not use creatine. And I hope it’s not the source of my problems. I feel I’d rather mess with my hormones than find out I’ve got something like rheumatoid arthritis or lupus. Those aren’t curable. Of course neither is hypogonadism, so it’s catch 22.

I’m wondering if it may be related to the lesser problems however. And furthermore I wonder if the majority of my problems comes with the low E2. After all, it’s a ratio of 40:1, where many people seem to aim for something like a 15/20:1 T to E2 ratio. I’ve also read research on TRT reversing osteopenia and also prediabetes as testosterone is a factor in how quick the body utilizes glucose and insulin resistance.

Regardless I don’t plan to start any exogenous T until December 1st when I hear back from the rheumatologist.

I’ve yet to find out anything from the rheumatologist or what they’re testing for.

7

Having been the victim of an autoimmune disease, I hope you not in the throes of one yourself.

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