Looking for advice -- just started TRT

[chronological]

Tried to get advice on this on steroidology and healthboards but no replies worth mentioning on the latter, and the former has gone dead. Hoping you guys know more.

I started TRT six weeks ago. I'm self-injecting test. cypionate into my quad every two weeks. My only two prior measurements - i.e. from before starting TRT -- were a 380 and a 420 (roughly -- I forget the precise numbers). I'm told those are within normal range, but are "low normal". My primary symptoms are obesity, lack of energy, and a decided lack of mental focus. Thus far we've been trying to hit the latter using ADD stimulants, to little effect. TRT is a different approach to the same problem. I'm 47, 5'8" and 290lbs.

Here's what I've seen so far:

• Some time in 2010. (Pre-TRT). T level of around 380
• January 2012. (Pre-TRT). T level of around 420
• Thu Feb 16th: Dose 1 = 0.75cc (150mg) Testosterone cypionate
• Tue Feb 21st: Blood test for "peak" => 800+
• Sun Feb 26th: Dose 2 = 0.75cc
• Mon Feb 27th: Doc calls to discuss that peak level. Says that although it's good, he wants it higher than that because it's going to drop again. He's aiming for a peak of between 1000 and 1200. So he says to push up the dose from 0.75cc to 1.0cc.
• Sat Mar 10th: Blood test for "trough" => 170 (huh!?)
• Sun Mar 11th: Dose 3 = 1.0cc (200mg) (i.e. upped according to Doc's instruction on 27th)
• Tue Mar 13th: Doc calls to discuss the trough. Says not to worry about it for now, and instead we need to keep on working to get the peak up. I've to keep the dose at 1.0cc but to increase frequency from once every 14 days to once every 10 days. He says it may need to go as high as once every week.

So my next dose is now due in two days (i.e. 11 days after the most recent one). And then three days after that, we'll draw blood for another peak test.

Overall, as yet there are absolutely no subjective improvements in any of my symptoms. I don't feel any more (or less) focused/energetic/aggressive/mellow/horny And I can't deny I'm a tad concerned by that 170 trough level.

Anyone able to offer any input on this? Should I be seeing effects by now? Also, the doc has so far mentioned nothing about HCG or anything else. Is that a concern? He has mentioned nothing about estradiol either.

Thanks in advance.

 

[foreveryoung]

I don't even know where to start, other than to say that your body managed to naturally be within normal range testosterone even though you were very very obese, personally I would have stayed far far away from any trt and would have instead focused my goals as to improving my health by changing my habits and losing weight first.

 

[angrydad]

Hey Chronological,

Foreveryoung is right, I can understand you want to improve your lifestyle and increase drive, motivation etc. It's a fact you would be better served by staying away from TRT (at least for now) you are just muddying the waters with your health. Injecting testosterone is just going to shut down your own natural supply and bring about more things to worry about. Concentrate on losing the weight with exercise. Eat less, try and remove the stress from your life.

I tell you now, taking T when you don't necessarily need it is just crazy and over the top. Taking T is not usually a cure all fix. It's like going fishing using hand grenades.

I wish you well but fear you should address your exercise/weight and lifestyle issues first. E2 will definitely come into play when you start adding external T.

Not wanting to put you off or be negative, it is your call after all. Just giving you my thoughts.

Good luck

 

[chronological]

I don't even know where to start, other than to say that your body managed to naturally be within normal range testosterone even though you were very very obese, personally I would have stayed far far away from any trt and would have instead focused my goals as to improving my health by changing my habits and losing weight first.

Thanks foreveryoung (and angrydad). I appreciate it.

In fact it was my doc who suggested the TRT -- I didn't ask for it. And even he had considered and then dismissed it twice over the past couple of years as we've tackled my weight and attention issues. The reason he changed his mind is he has recently attended a series of lectures by a local endocrinologist who is arguing that just as our old ideas about what is healthy for blood pressure (used to be anything below 160 systolic was fine) and blood sugar (used to be 200 was no problem), so there is mounting evidence that what we call "low normal" for testosterone is medically significant and benefits from treatment.

That sounds plausible I suppose, but what do I know. I'm not a (medical) doctor.

On the obesity thing. One argument he made is that there is a vicious circle going on there. You get fat, your T levels fall, you get tired and less driven, so you exercise less, so you get fat, your T levels fall, ... In that case, I can see how -- modulo the possible negative impact on your natural T levels -- a short term (a year?) use of exogenous T could kick help someone out of that circle.

But I've always been wary of purely qualitative correlations. Yes, I'm very overweight, so yes it will be impacting my natural T. Does anyone have some figures to quantify that relationship? How many ng/dl improvement on average would losing 10lbs of fat produce?

Final point. No one who has experienced the level of obesity I have would see "changing habits" as being a solution to anything. That's not to say that it is not part of what has to happen, but it is no more a practical solution than is "stop consuming hydroxylated hydrocarbons in water" is to an alcoholic. The eating/lack-of-exercise habit I have is not the cause of my problem -- it *is* my problem.

 

[Michael Scally MD]

I don't even know where to start, other than to say that your body managed to naturally be within normal range testosterone even though you were very very obese, personally I would have stayed far far away from any trt and would have instead focused my goals as to improving my health by changing my habits and losing weight first.

Hey Chronological,

Foreveryoung is right, I can understand you want to improve your lifestyle and increase drive, motivation etc. It's a fact you would be better served by staying away from TRT (at least for now) you are just muddying the waters with your health. Injecting testosterone is just going to shut down your own natural supply and bring about more things to worry about. Concentrate on losing the weight with exercise. Eat less, try and remove the stress from your life.

I tell you now, taking T when you don't necessarily need it is just crazy and over the top. Taking T is not usually a cure all fix. It's like going fishing using hand grenades.

I wish you well but fear you should address your exercise/weight and lifestyle issues first. E2 will definitely come into play when you start adding external T.

Not wanting to put you off or be negative, it is your call after all. Just giving you my thoughts.

Good luck

Thanks foreveryoung (and angrydad). I appreciate it.

In fact it was my doc who suggested the TRT -- I didn't ask for it. And even he had considered and then dismissed it twice over the past couple of years as we've tackled my weight and attention issues. The reason he changed his mind is he has recently attended a series of lectures by a local endocrinologist who is arguing that just as our old ideas about what is healthy for blood pressure (used to be anything below 160 systolic was fine) and blood sugar (used to be 200 was no problem), so there is mounting evidence that what we call "low normal" for testosterone is medically significant and benefits from treatment.

That sounds plausible I suppose, but what do I know. I'm not a (medical) doctor.

Chronological:

Were you informed that TRT is for life? Were you told of the shutdown of your own production, which is normal? Were you told of infertility should that be an issue? Were you told that it might be very difficult, possible impossible, to bear the side effects if you decide to stop? What about a change in insurance, income, employment, etc. and the result upon treatment? Did the doctor speak about any means to restore the HPTA?

FYI: https://thinksteroids.com/community/threads/134309231

 

[Excallibro]

No one will argue that weight loss helps, because fat absorbs and stores free testosterone ... a lot.

However, having said this, here's the rub. If you're mentally unhealthy, BECAUSE you have low T., then you're very unlikely to get motivated enough to lose the weight, because of your mental health.

Many people are misdiagnosed for ADD, and even fewer told that they MUST avoid caffeine while taking other stimulants to combat ADD. So who knows what might have been there, before adding T., assuming you didn't avoid caffeine, and most don't.

My advice is that if you're taking T. to help your mental health, and you're low, it won't hurt you. I will help you enormously, but I wouldn't do it without HCG, or just going with HCG alone, to boost your free T. HCG is much more mood stabilizing, has been my experience.

It's a tough row to hoe if you're mind needs higher levels of T. and if you're like me, the weight loss didn't change that factor ... ONE BIT. My weight had nothing to do with the effect of low T. on my mind. I was lean for many years, and I still had low T. In fact, my weight didn't really change my total T.

Free T., there's no doubt, but I still was low, and no weight loss regiment was going to fix that.

In the future, many men will be treated with T./HCG injections for depression, instead of SRI's. In the future, many men will be treated with T./HCG injections for poor erections, instead of back door routes like Viagra.

This whole scare tactic here is bs, for older guys. Unless you're way over doing it, you're at very little risk of permanently affecting your feedback mechanism or permanently washing out your receptors. Other long term health factors ... we admittedly don't know fully yet, but they can't decide these for women either, and they're still treating them!

Regardless, when it comes to my mental health, I would rather have thirty minutes of wonderful than a lifetime of nothing special." ~Truvy in Steel Magnolias

I think I'll make this my new signature.

 

[chronological]

...Were you informed that TRT is for life? ...

Michael (et al), I do appreciate what is clearly concern for me on your part, but I don't think I'm imagining things in detecting a degree of disapproval of me being on TRT.

The crux of what I have told you guys is simply that I had readings of 380 and 420, yet you guys seem to take that as sufficient to conclude that me going on TRT is ill advised.

Since you appear to be basing that conclusion on only two T readings, the implication is that TRT is *never* justified with those readings. Is that the case?

If not -- if TRT *may be* justified if some extenuating circumstances are present -- then surely the sensible response would be at very least something like, "Strange, it's unusual to see TRT prescribed given those levels unless <extentuating circumstances> were present. Were <extentuating circumstances> present?"

Or, ideally, instead of second guessing me, someone could simply answer the question I asked (I asked about the numbers) instead of the one they may think I should be asking.

I know this -- especially the latter -- sounds harsh, but I'm not trying to be. And I've no doubt your concern is well intentioned.

 

[Millard]

Or, ideally, instead of second guessing me, someone could simply answer the question I asked (I asked about the numbers) instead of the one they may think I should be asking.

If you're asking about numbers, I'm curious about the sporadic dosing schedule. It's difficult to get meaning numbers if you are switching so many variables. You've switched frequency (from 10 days to 14 days and then 10 days again) and dosage (from 150mg to 200mg) within a couple weeks.

The trough you're concerned about can most likely be attributed to the dosing schedule. Most people on injections prefer at least weekly, if not 2x weekly, injections to keep T levels more stable and minimize the trough.

 

[Millard]

The crux of what I have told you guys is simply that I had readings of 380 and 420, yet you guys seem to take that as sufficient to conclude that me going on TRT is ill advised.

I think a big part of the concern is based on the perception that you think this is THE solution to your problem when it may not be the best, or even a necessary, approach.

So far you are reporting no positive benefits and only negative effects (HPTA suppression):

Overall, as yet there are absolutely no subjective improvements in any of my symptoms. I don't feel any more (or less) focused/energetic/aggressive/mellow/horny And I can't deny I'm a tad concerned by that 170 trough level.

 

[chronological]

If you're asking about numbers, I'm curious about the sporadic dosing schedule. It's difficult to get meaning numbers if you are switching so many variables. You've switched frequency (from 10 days to 14 days and then 10 days again) and dosage (from 150mg to 200mg) within a couple weeks.

Well we've just started and so we're titrating up to the best dose and frquency. He started lower/less-frequent than he reckoned would be needed, but we did the same when I was trying ADD meds. Now maybe my dates were wrong but it was supposed to start as 0.75cc (150mg) every 14 days, with an expected increase of dose to 1.0cc after the first few doses. That happened. But he also decided to increase frequency, to every 10 days. So it's all fairly consistently increasing, both dose and frequency.

The trough you're concerned about can most likely be attributed to the dosing schedule. Most people on injections prefer at least weekly, if not 2x weekly, injections to keep T levels more stable and minimize the trough.

OK, that was my worry. My lowest T level prior to TRT was 380, so to see it fall to 170 when *on* TRT was confusing. I assumed it was some kind of hypo rebound kind of thing. However, my doc insists we shouldn't be too concerned with that for now. He says his first priority is to get the dose right to establish an appropriate peak level. At that point, we'll look at frequency. I hope he'll also look at the need (or otherwise) for associated meds, such as HCG.

On the one hand, my doc seems cautious in that he didn't easily prescribe, and he's careful to titrate up gently. We're not looking for a quick fix. And he seems thoughtful, well read, and he listens well and explains stuff. On the other hand, he hasn't mentioned anything about all the other stuff people seem to take when on TRT. I don't want to go for a second opinion yet, but I'm keeping my eye on things.I ppreciate your advice here too.

 

[Millard]

OK, that was my worry. My lowest T level prior to TRT was 380, so to see it fall to 170 when *on* TRT was confusing. I assumed it was some kind of hypo rebound kind of thing.

This is just a sign that the exogenous testosterone injections are suppressing your own production.

A lot of people are under the impression that TRT "supplements" your existing test levels.

For example, they think if their levels prior to TRT are ~400, any testosterone they take will just add to that number.

But that's not how it works, TRT shuts down one's natural production significantly, and really does "replace" it and then some.

 

[chronological]

I think a big part of the concern is based on the perception that you think this is THE solution to your problem when it may not be the best, or even a necessary, approach.

Hmm. I don't know where anyone got that perception. It's true I'm not sticking a needle in my leg every two weeks with *no* expectation of benefit, but I certainly don't think of this as any kind of silver bullet. I'm still trying to control diet, making eyes at the gym, and deploying all the ADD coping strategies I know of, in addition to trying TRT.

So far you are reporting no positive benefits and only negative effects (HPTA suppression):

I don't think a single data point constitues enough evidence to conclude that the low level is being caused by the TRT. Ad hoc ergo propter hoc an' all that. That said, it's a weird coincidence if that's all it is. The lack of positive effects is not too out of line with the Saad paper. That said, I'm now in week 6 and there is still nothing going on, which is a bummer.

 

[Millard]

I don't think a single data point constitues enough evidence to conclude that the low level is being caused by the TRT. Ad hoc ergo propter hoc an' all that. That said, it's a weird coincidence if that's all it is.

No, suppression, to some degree, is the one thing you can be absolutely guaranteed will happen when you use anabolic steroids / testosterone.

 

[chronological]

This is just a sign that the exogenous testosterone injections are suppressing your own production.

Yes, but is the suppression normally that fast and that severe? That's well over 50% reduction in level after only two doses of Test. Cypionate.

Regardless, your point matches what my doc is saying. He said not to worry about it and that "we are trying to override your entire system".

 

[Millard]

Yes, but is the suppression normally that fast and that severe? That's well over 50% reduction in level after only two doses of Test. Cypionate.

It does seem pretty quick. Your point about a single data point is well taken with regards to how much suppression has been caused and how quickly. But it will happen to some degree. This is perfectly normal with TRT.

 

[chronological]

It does seem pretty quick. Your point about a single data point is well taken with regards to how much suppression has been caused and how quickly. But it will happen to some degree. This is perfectly normal with TRT.

So, I'm working under the assumption right now that I have time to decide if the bad effects can be ameliorated or at very least if any positives are a sufficient counter to the downsides. But that's based on another assumption, namely that it'll take some time for effects (good or bad) to manifest. I'm also assuming that it will take even longer to experience *irreversible* bad effects.

How long is "some time" I don't know. But I assumed that a period of up to six months wouldn't be excessive. The only data I have for that is that I know a few bodybuilders who have taken their ridiculously high levels of steroid intake for a few *years* and have suffered no long term effects. Of course they could be outliers. Or maybe I'm an outlier who is particularly sensitive to TRT.

Overall though, I, in contrast to the bodybuilders, am under a doc's supervision, on medically appropriate doses (granted there's controversy over that in general for "low normal" ranges, but my dose is no more than 100mg per week), titrating up slowly, with blood tests every other shot to see what's happening.

Am I wrong? Could things go bad fast? Is there genuine danger that overnight, on entering month three of treatment, I'll wake up with my balls having shrunk to the size of peanuts, needing a bra for my gyno, unable to come off the TRT because if I do I'll turn into a girl, but unable to stay on it because I will, 'roid enraged, rip the head off anyone who passes me in the street?

 

[Millard]

Overall though, I, in contrast to the bodybuilders, am under a doc's supervision, on medically appropriate doses (granted there's controversy over that in general for "low normal" ranges, but my dose is no more than 100mg per week), titrating up slowly, with blood tests every other shot to see what's happening.

Am I wrong? Could things go bad fast? Is there genuine danger that overnight, on entering month three of treatment, I'll wake up with my balls having shrunk to the size of peanuts, needing a bra for my gyno, unable to come off the TRT because if I do I'll turn into a girl, but unable to stay on it because I will, 'roid enraged, rip the head off anyone who passes me in the street?

Medical supervision, regular labs, and side effect management is key. My biggest concern would be restoring HPTA if you eventually decide to discontinue. But this can be done.

Michael Scally really did a great interview with Nelson Vergel about monitoring and managing side effects while on TRT. I highly recommend it:

• Dr. Michael Scally Talks About TRT and Steroid Side Effects, Part 1
• Dr. Michael Scally Talks About TRT and Steroid Side Effects, Part 2

 

[chronological]

Michael Scally really did a great interview with Nelson Vergel about monitoring and managing side effects while on TRT. I highly recommend it:

• Dr. Michael Scally Talks About TRT and Steroid Side Effects, Part 1
• Dr. Michael Scally Talks About TRT and Steroid Side Effects, Part 2

Thanks. Those were really interesting. However, links from those pages elsewhere do raise a question:

In which States, if any, is Scally currently licensed to practice medicine?

UPDATE: Forget I asked. I can see this is kind of a FAQ and the answer appears to be "none".

(For the record: whether or not the state chooses to "certify" someone is of decreasing interest to me these days, especially when it comes to medication, or consumption by a free adult of any substances for that matter. Lack of certification doesn't mean a person talks nonsense, any more than certification means they talk sense.)