Help with HRT Protocol from Clinic...

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    Help with HRT Protocol from Clinic...


    Finally managed to find a place listening to concerns over testicular atrophy, ache, health etc. Unfortunately it was a clinic and felt a bit like a candy store... Was hoping you guys could shed some light on their protocol and see if it needs some more tweaking to be closer to the norm or if i should follow as directed...

    Most recent lab work: Pre-t shows blood work done the day I started HRT before Tx with Test-Cyp 200mg IM E14D/2 weeks and Nadir which shows my Nadir point taken 4weeks after starting Test on my last day before my third shot which subsequently caused my urologist to increase my dose to Test-Cyp 200mg IM E10D. After the change in does I began taking 120mg every 6 days since that works conveniently with my work schedule and split the does into two smaller does...

    Pret initial labs: 4/24/12

    Total Test: 326 (250-1100) ng/dL
    Free Test: 70.7 (35.0-155.0) pg/mL
    LH: 3.2 (1.5-9.3) mIU/mL
    FSH: 4.3 (1.4-18.1) mIU/mL
    Estradiol: 18 (11.0-44.0) pg/mL
    Progesterone: 0.65 (range missing) ng/mL
    Prolactin: 4.6 (2.1-17.7) ng/mL

    Nadir Labs: 5/23/12

    Total Test: 322 (348-1197) ng/dL
    Free Test: 9.2 (8.7-25.1) pg/mL
    LH: 0.1 (1.7-8.6) mIU/mL
    Estradiol: 24 (3-70) pg/mL
    Progesterone: 0.7 (0.2-1.4) ng/mL

    After seeing this labwork as well as some other older lab work regarding thryroid hormones and trending they prescribed me with:

    300 mg test cyp every friday

    250 IU HCG every wed and thurs

    0.5 mg anastrazole saturday and wednesday

    Progesterone 100mg nightly for sleep due to low progesterone

    and changed my hypothyroid medication from 75mcg synthroid every day to Amour thyroid 60mg BID.

    On the surface seems great, they prescribed everything I could hope for and dug through old lab work and addressed my thyroid issue which I had wanted to change as well as progesterone which I wasn't even aware of. That being said am I wrong in feeling that 300 mg a week is way too high?

    Dr. mentioned increasing my dose from their standard 200mg weekly to 300mg since my nadir point was so low after test therapy started and I was on too low of a dose for therapeutic benefits. Nadir point was done on day 13 after completely being in trough though.

    Any help would be greatly appreciated as well as possible suggestions for working this regimen out on an more shift friendly schedule. I work 24 on and 48 off and injecting on shift days are something i'd like to avoid if possible.

    Would this schedule sound more feasible?

    Day 1: 100mg Test Cyp
    Day 2: 0.5 mg AI
    Day 3: 125 iu HCG

    repeat...

    I've heard cutting the HCG dose would be beneficial or should i stick to the standard 250iu E3D/ 500 a week? I've heard from a few people the goal with HCG is smallest dose possible to restore testicular size as a proper indication of testicular function. Any thoughts on that? Thank again for everything... Thanks in advance!

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    Quote Originally Posted by rammanftw
    Finally managed to find a place listening to concerns over testicular atrophy, ache, health etc. Unfortunately it was a clinic and felt a bit like a candy store... Was hoping you guys could shed some light on their protocol and see if it needs some more tweaking to be closer to the norm or if i should follow as directed...

    Most recent lab work: Pre-t shows blood work done the day I started HRT before Tx with Test-Cyp 200mg IM E14D/2 weeks and Nadir which shows my Nadir point taken 4weeks after starting Test on my last day before my third shot which subsequently caused my urologist to increase my dose to Test-Cyp 200mg IM E10D. After the change in does I began taking 120mg every 6 days since that works conveniently with my work schedule and split the does into two smaller does...

    Pret initial labs: 4/24/12

    Total Test: 326 (250-1100) ng/dL
    Free Test: 70.7 (35.0-155.0) pg/mL
    LH: 3.2 (1.5-9.3) mIU/mL
    FSH: 4.3 (1.4-18.1) mIU/mL
    Estradiol: 18 (11.0-44.0) pg/mL
    Progesterone: 0.65 (range missing) ng/mL
    Prolactin: 4.6 (2.1-17.7) ng/mL

    Nadir Labs: 5/23/12

    Total Test: 322 (348-1197) ng/dL
    Free Test: 9.2 (8.7-25.1) pg/mL
    LH: 0.1 (1.7-8.6) mIU/mL
    Estradiol: 24 (3-70) pg/mL
    Progesterone: 0.7 (0.2-1.4) ng/mL

    After seeing this labwork as well as some other older lab work regarding thryroid hormones and trending they prescribed me with:

    300 mg test cyp every friday

    250 IU HCG every wed and thurs

    0.5 mg anastrazole saturday and wednesday

    Progesterone 100mg nightly for sleep due to low progesterone

    and changed my hypothyroid medication from 75mcg synthroid every day to Amour thyroid 60mg BID.

    On the surface seems great, they prescribed everything I could hope for and dug through old lab work and addressed my thyroid issue which I had wanted to change as well as progesterone which I wasn't even aware of. That being said am I wrong in feeling that 300 mg a week is way too high?

    Dr. mentioned increasing my dose from their standard 200mg weekly to 300mg since my nadir point was so low after test therapy started and I was on too low of a dose for therapeutic benefits. Nadir point was done on day 13 after completely being in trough though.

    Any help would be greatly appreciated as well as possible suggestions for working this regimen out on an more shift friendly schedule. I work 24 on and 48 off and injecting on shift days are something i'd like to avoid if possible.

    Would this schedule sound more feasible?

    Day 1: 100mg Test Cyp
    Day 2: 0.5 mg AI
    Day 3: 125 iu HCG

    repeat...

    I've heard cutting the HCG dose would be beneficial or should i stick to the standard 250iu E3D/ 500 a week? I've heard from a few people the goal with HCG is smallest dose possible to restore testicular size as a proper indication of testicular function. Any thoughts on that? Thank again for everything... Thanks in advance!

    This is good trt protocol but a chop chop cookie cuter operation. Any dr makes all those changes at one time should have their head examined. The potential for.you to do major damage is significantly increased by changing to.many.things at.one.time. You be making.some one very rich..
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by The Matrix View Post
    This is good trt protocol but a chop chop cookie cuter operation. Any dr makes all those changes at one time should have their head examined. The potential for.you to do major damage is significantly increased by changing to.many.things at.one.time. You be making.some one very rich..
    I agree 100% and was hoping you would respond. I am focusing on making the right decision for the trt protocol now. Any input or advice would be greatly appreciated. After running it for 4to6 weeks or so gauging feeling and tweaks I will get blood work before even thinking of the progesterone or changing my thyroid meds. There's no way I can tell what is making me feel better or worse if I do everything at once as you said.

    Took 100 mg test cyp yesterday, 0.5 mg AI today, and will pin HCG for first time tomorrow after about 6 weeks of atrophy and ache from ridiculous uro test only protocol... Any input on dose? Does the 3 day cycle sound feasible dropping the amount of test from 300 to 200? Thanks for the help...
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    Quote Originally Posted by rammanftw
    Finally managed to find a place listening to concerns over testicular atrophy, ache, health etc. Unfortunately it was a clinic and felt a bit like a candy store... Was hoping you guys could shed some light on their protocol and see if it needs some more tweaking to be closer to the norm or if i should follow as directed...

    Most recent lab work: Pre-t shows blood work done the day I started HRT before Tx with Test-Cyp 200mg IM E14D/2 weeks and Nadir which shows my Nadir point taken 4weeks after starting Test on my last day before my third shot which subsequently caused my urologist to increase my dose to Test-Cyp 200mg IM E10D. After the change in does I began taking 120mg every 6 days since that works conveniently with my work schedule and split the does into two smaller does...

    Pret initial labs: 4/24/12

    Total Test: 326 (250-1100) ng/dL
    Free Test: 70.7 (35.0-155.0) pg/mL
    LH: 3.2 (1.5-9.3) mIU/mL
    FSH: 4.3 (1.4-18.1) mIU/mL
    Estradiol: 18 (11.0-44.0) pg/mL
    Progesterone: 0.65 (range missing) ng/mL
    Prolactin: 4.6 (2.1-17.7) ng/mL

    Nadir Labs: 5/23/12

    Total Test: 322 (348-1197) ng/dL
    Free Test: 9.2 (8.7-25.1) pg/mL
    LH: 0.1 (1.7-8.6) mIU/mL
    Estradiol: 24 (3-70) pg/mL
    Progesterone: 0.7 (0.2-1.4) ng/mL

    After seeing this labwork as well as some other older lab work regarding thryroid hormones and trending they prescribed me with:

    300 mg test cyp every friday

    250 IU HCG every wed and thurs

    0.5 mg anastrazole saturday and wednesday

    Progesterone 100mg nightly for sleep due to low progesterone

    and changed my hypothyroid medication from 75mcg synthroid every day to Amour thyroid 60mg BID.

    On the surface seems great, they prescribed everything I could hope for and dug through old lab work and addressed my thyroid issue which I had wanted to change as well as progesterone which I wasn't even aware of. That being said am I wrong in feeling that 300 mg a week is way too high?

    Dr. mentioned increasing my dose from their standard 200mg weekly to 300mg since my nadir point was so low after test therapy started and I was on too low of a dose for therapeutic benefits. Nadir point was done on day 13 after completely being in trough though.

    Any help would be greatly appreciated as well as possible suggestions for working this regimen out on an more shift friendly schedule. I work 24 on and 48 off and injecting on shift days are something i'd like to avoid if possible.

    Would this schedule sound more feasible?

    Day 1: 100mg Test Cyp
    Day 2: 0.5 mg AI
    Day 3: 125 iu HCG

    repeat...

    I've heard cutting the HCG dose would be beneficial or should i stick to the standard 250iu E3D/ 500 a week? I've heard from a few people the goal with HCG is smallest dose possible to restore testicular size as a proper indication of testicular function. Any thoughts on that? Thank again for everything... Thanks in advance!
    Where are you located?
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    Quote Originally Posted by rammanftw View Post
    I agree 100% and was hoping you would respond. I am focusing on making the right decision for the trt protocol now. Any input or advice would be greatly appreciated. After running it for 4to6 weeks or so gauging feeling and tweaks I will get blood work before even thinking of the progesterone or changing my thyroid meds. There's no way I can tell what is making me feel better or worse if I do everything at once as you said.

    Took 100 mg test cyp yesterday, 0.5 mg AI today, and will pin HCG for first time tomorrow after about 6 weeks of atrophy and ache from ridiculous uro test only protocol... Any input on dose? Does the 3 day cycle sound feasible dropping the amount of test from 300 to 200? Thanks for the help...
    Would have started out at 40-50 mgs 2 times a week. It may have reduce the need for an AI. HCG could be added in later when T and e2 are stablized.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by The Matrix View Post
    Would have started out at 40-50 mgs 2 times a week. It may have reduce the need for an AI. HCG could be added in later when T and e2 are stablized.
    Am scheduled to pin again tomorrow. Can reduce dose if you recommend. Was doing 120 e6d before and could drop to 60. Have been on test cyp since April. Testicular atrophy and full shutdown of lh and sperm are in effect. Aches etc. Definitely feel the need to start HCG now. What does would be appropriate as I have heard the lower dose that restores testicular function the better.
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    Quote Originally Posted by rammanftw View Post
    Am scheduled to pin again tomorrow. Can reduce dose if you recommend. Was doing 120 e6d before and could drop to 60. Have been on test cyp since April. Testicular atrophy and full shutdown of lh and sperm are in effect. Aches etc. Definitely feel the need to start HCG now. What does would be appropriate as I have heard the lower dose that restores testicular function the better.
    You need to do things in layers not a crap shot. PRotocols I use with Dr are pretty much same, but there are alot of other issues which are being addressed and evaluate then most medical professionals. TRT protocol for more part 80-100 mgs T for 5 week no AI then remeasure. If e2 is high then add AI then retest in 3 weeks. When e2 stable for 6 weeks then add in HCG 100 ius 2-3 times a week to start then remeasure e2. If e2 goes up really high. Dump the HCG to 50 -100 2-3 times a week just to keep LH receptors alive.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by The Matrix View Post
    You need to do things in layers not a crap shot. PRotocols I use with Dr are pretty much same, but there are alot of other issues which are being addressed and evaluate then most medical professionals. TRT protocol for more part 80-100 mgs T for 5 week no AI then remeasure. If e2 is high then add AI then retest in 3 weeks. When e2 stable for 6 weeks then add in HCG 100 ius 2-3 times a week to start then remeasure e2. If e2 goes up really high. Dump the HCG to 50 -100 2-3 times a week just to keep LH receptors alive.
    Sounds like the right way to do things and unfortunately I am unable of finding adequate professional supervision down here capable of doing them that way. Are there any professionals you know of in central Florida/Tampa area that follow that methodical of an approach? I have found a means of obtaining chemicals in excess to self treat, but obviously there are many aspects of this I simply haven't been able to fully understand and could use the supervision of an actual professional. That or will be trying to find a place to get a lot of labs done on my own.
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    Quote Originally Posted by rammanftw

    Sounds like the right way to do things and unfortunately I am unable of finding adequate professional supervision down here capable of doing them that way. Are there any professionals you know of in central Florida/Tampa area that follow that methodical of an approach? I have found a means of obtaining chemicals in excess to self treat, but obviously there are many aspects of this I simply haven't been able to fully understand and could use the supervision of an actual professional. That or will be trying to find a place to get a lot of labs done on my own.
    Its easier then you Think, but you.need to have other issues ruled out before commencing other words you.may get benefits at first the later down the road things come.back.to.hunt you if.not.taken care of at the beginning. its alot of work but worth it in the end to.get.it right from the start. I may have a contact. I am working with a lead.now.in.Florida area. Will.let you.know
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by The Matrix View Post
    Its easier then you Think, but you.need to have other issues ruled out before commencing other words you.may get benefits at first the later down the road things come.back.to.hunt you if.not.taken care of at the beginning. its alot of work but worth it in the end to.get.it right from the start. I may have a contact. I am working with a lead.now.in.Florida area. Will.let you.know
    Any help would be greatly appreciated at this point. I'm afraid after a year of being frustrated with a lazy primary care doctor I jumped head first into it with an uneducated urologist. I do know for a fact that even on the ridiculous 200mg e14d i felt exponentially better than I did before hand until day 10 or so when i crashed. That being said I am incredibly reluctant to simply stop TRT until I can track down someone capable of providing excellent care so self treating is where I'm at...

    Do you think it would be more advisable to simply stay on a Test-cyp injections twice weekly without AI or HCG until I can find adequate care? I am extremely worried about testicular atrophy, pain, and being infertile and wanted to start running HCG asap... Let me know your thoughts, they are greatly appreciated.
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    Quote Originally Posted by rammanftw View Post
    Any help would be greatly appreciated at this point. I'm afraid after a year of being frustrated with a lazy primary care doctor I jumped head first into it with an uneducated urologist. I do know for a fact that even on the ridiculous 200mg e14d i felt exponentially better than I did before hand until day 10 or so when i crashed. That being said I am incredibly reluctant to simply stop TRT until I can track down someone capable of providing excellent care so self treating is where I'm at...

    Do you think it would be more advisable to simply stay on a Test-cyp injections twice weekly without AI or HCG until I can find adequate care? I am extremely worried about testicular atrophy, pain, and being infertile and wanted to start running HCG asap... Let me know your thoughts, they are greatly appreciated.
    If you find an open minded DR I be glad to work with him in helping fine tuning things. I have a few Dr's who I am mentoring showing them all the tricks I have learned in the past 10 years. The response has been over whelming from Drs as well as their patients are seeing results. Got to keep the customer happy
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by rammanftw

    Any help would be greatly appreciated at this point. I'm afraid after a year of being frustrated with a lazy primary care doctor I jumped head first into it with an uneducated urologist. I do know for a fact that even on the ridiculous 200mg e14d i felt exponentially better than I did before hand until day 10 or so when i crashed. That being said I am incredibly reluctant to simply stop TRT until I can track down someone capable of providing excellent care so self treating is where I'm at...

    Do you think it would be more advisable to simply stay on a Test-cyp injections twice weekly without AI or HCG until I can find adequate care? I am extremely worried about testicular atrophy, pain, and being infertile and wanted to start running HCG asap... Let me know your thoughts, they are greatly appreciated.
    If fertility is of major concern, have you thought of just using Clomid as a form of HRT? If you're doin this solo it may be the easiest way to go??
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    Quote Originally Posted by lboston View Post
    If fertility is of major concern, have you thought of just using Clomid as a form of HRT? If you're doin this solo it may be the easiest way to go??
    considering what I am reading..He does not have the knowledge to do that and may end up making matters worse if other issues are not ruled out FIRST !!
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by The Matrix

    considering what I am reading..He does not have the knowledge to do that and may end up making matters worse if other issues are not ruled out FIRST !!
    Well said
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    Quote Originally Posted by The Matrix View Post
    If you find an open minded DR I be glad to work with him in helping fine tuning things. I have a few Dr's who I am mentoring showing them all the tricks I have learned in the past 10 years. The response has been over whelming from Drs as well as their patients are seeing results. Got to keep the customer happy
    That is what's becoming increasingly more frustrating is tracking down one of those, once I do I know who to get him in touch with that's for sure! Until then I'm on my own or at least my own with the help of the internet...
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    Quote Originally Posted by The Matrix View Post
    considering what I am reading..He does not have the knowledge to do that and may end up making matters worse if other issues are not ruled out FIRST !!
    Fertility is not the issue at the moment. Preserving capability of being fertile through not self inducing testicular atrophy by testosterone based HRT alone is the issue. Everything I've read about SERMs and clomid only TRT isn't sounding great and not what I'd like to do unless it was the only option available at the time I am ready to conceive.
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    Quote Originally Posted by rammanftw View Post
    Fertility is not the issue at the moment. Preserving capability of being fertile through not self inducing testicular atrophy by testosterone based HRT alone is the issue. Everything I've read about SERMs and clomid only TRT isn't sounding great and not what I'd like to do unless it was the only option available at the time I am ready to conceive.
    Just try to keep the treatment simple. In all honesty to keep taking someting daily is not practical at all. What happens when you go in vacation...a shot here a pill there then another shot...looks good on paper but reality bites..lol
    Start with either 50mg or 75mg administered 2x a week or 100-150mg a week if you choose. THat keep blood serum constant. Throw in some arimidex or aromasin and you good. Dont over think it. To revitilize your nuts occasionaly add some HCG. Then go back to your normal TRT.
    If you do 150mg a week you prob need arimidex or aromasin. If you can tolerate 2 shots a week then that's ideal. Less ups and downs.
    Been doing this TRT for over 10 years in the long run the simpler the better.
  

  
 

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