So in April switched over to a local urologist for my TRT so that I could get this paid for by my insurance.
I had been on 5g Androgel daily, hcg 200iu every other day. Feeling decent in the head but still not much libido or energy.
He does a big blood test panel. Apparently he has his own "RIA" (radio immuno assay) equipment in his clinic. Insulin was a bit high, homocysteine was really good, and other things to him indicated that the 5g Androgel daily was not enough. He commented that he usually starts men out at 10g Androgel per day.
Based on those results and how I was feeling, he recommended going to weekly IM Test Cyp shots, starting at 200mg per week. I told him that seemed high. He said after 6 weeks we'd see, and that I could continue the QOD hCG if I wanted to. He said Total T is not as important as Free T, which he likes to see around 300. His philosophy is that instead of aromatase inhibition, you need to add so much T that it always "out races" the estrogen at the receptors. Hmm.
Six weeks later, he tested only 4 things. Here are the results:
Total T: 1502 (his range goes up to 1700 or so)
Free T: 532 (way over 300 I'd say)
Estradiol: 48 (0-58)
SHBG: 13 (bottom of his scale)
I asked him if he thought my estradiol should be lower, he said as long as it's below 58, it's fine.
During the first couple weeks of 200mg per week, I felt like the horny teen I never was, but after that, I was back to how I started, great mental clarity, but not much libido or energy.
At our most recent discussion, he told me to go up to 240mg per week and come back in 3 months. He also told me that if for any reason I felt it was too high, I could lower it at my discretion.
I also found out he's a sex-change doctor, and that's where he gets a lot of his clinical experience with the effects of T. Oh my. He also told me he's been on TRT for 3 years and he still hasn't figured out the perfect dosage for himself.
His solution to the roller coaster is to push up the whole curve, so to speak.
I really don't like my estrogen number, but he would not prescribe Arimidex.
So, is he crazy? Back when I was on 100mg T per week I was told my Total T was a bit high and to lower it. Quite frankly, I feel I would prefer a lower does and some Arimidex right about now.
I know that my body is very estrogeno-philic (did I just make that up?). I am not happy being at 48 on a scale of 0-58, but that's based on reading that middle or slightly below middle of the range seems preferable to others.
I've got plenty of night wood and morning wood. I do think about sex more often, but my body doesn't exactly "keep up". Also sometimes my prostate feels a little "bigger" than normal, including it being a little more difficult to urinate. Not difficult as in painful, but I can't "push it out to make it go faster", if you know what I mean.
Since he said I could lower the dose at my discretion, I'm leaning towards doing just that. He also said I could split my doses, but doing so could mean needing a lower dose over all. Finally he said it could take 9 months to a year to really stabilize and for testosterone and estrogen related metabolic issues to get sorted out once stable.
Any professional or non-professional opinions?