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TRT Clinic Management questions...

J

judgmentalist

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Get Shredded!
OK. So I'm about to start my TRT and I'm already considering how to manage it properly. The doctor signed off on 200 mg a week and I want to keep it that way. I'd like to keep my testosterone pegged as high as they will let me. They told me they're going to pull labs at 13 weeks to see where we're at.

I would like to do my own labs as soon as it's appropriate to see what my testosterone stabilizes at and to check my hematocrit. They told me I might have to give blood on a regular basis but I want to how I react first. Also want to check my E levels and see whether I need all the anastrozole they prescribed.

When should I get my labs done to replicate what they will likely see at 13 weeks? If my testosterone comes in high do you think I should reduce the amount I'm using to avoid them lowering my prescription?

Any other things I should think about? Any advice?
 
just wondering if its true trt why are you managing it? that's what dr is supposed to be doing
 
Because I'm distrustful of authority. I don't want some goober head doctor bumping me down from 200 mg to 100 because he thinks 1206 ng/dl is a lot and then I end up going back to 700.

i'm perfectly content to stay on the very high side of normal and see where that gets me. I mostly just want to b maximum legal.


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Look bro...I use to play that game with my doc years ago but I challenged myself to be more knowledgeable than him and developed my own protocol. If you like your Test levels at a certain range and he or she doesn't agree then you need to take your health into your own hands and manage it properly. This means you need to be an expert on bloodwork and everything else pertaining to this protocol.



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ldog said:
Look bro...I use to play that game with my doc years ago but I challenged myself to be more knowledgeable than him and developed my own protocol. If you like your Test levels at a certain range and he or she doesn't agree then you need to take your health into your own hands and manage it properly. This means you need to be an expert on bloodwork and everything else pertaining to this protocol.



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Click to expand...

Working on it :)


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My issue was not being able to find a doc that would do 1 or more of the following, and I've been to several.


1. Not prescribe an AI
2. Won't let me self administer injections
3. Prescribe me 150mg of Cyp or less every TWO weeks.


Due to those reasons I self administer and get my own blood work.






Anyway, yeah you could ease up on the dose. But do you really want to have to do that weeks before every blood draw? You're never really going to know what the results will be which could lead to other issues with your Doc. I know I need to seek out a Doc soon though.
 
Last edited:
Intense said:
My issue was not being able to find a doc that would do 1 or more of the following, and I've been to several.


1. Not prescribe an AI
2. Won't let me self administer injections
3. Prescribe me 150mg of Cyp or less every TWO weeks.


Due to those reasons I self administer and get my own blood work.






Anyway, yeah you could ease up on the dose. But do you really want to have to do that weeks before every blood draw? You're never really going to know what the results will be which could lead to other issues with your Doc.
Click to expand...

Good point. And no, I don't. I guess my hope is that I can get through the initial rush of tests and settle into "if it ain't broke don't fix it" mode while staying legal - at least for the time being.

I can't imagine why a doc wouldn't be willing to prescribe an AI. That's annoying.


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judgmentalist said:
OK. So I'm about to start my TRT and I'm already considering how to manage it properly. The doctor signed off on 200 mg a week and I want to keep it that way. I'd like to keep my testosterone pegged as high as they will let me. They told me they're going to pull labs at 13 weeks to see where we're at.

I would like to do my own labs as soon as it's appropriate to see what my testosterone stabilizes at and to check my hematocrit. They told me I might have to give blood on a regular basis but I want to how I react first. Also want to check my E levels and see whether I need all the anastrozole they prescribed.

When should I get my labs done to replicate what they will likely see at 13 weeks? If my testosterone comes in high do you think I should reduce the amount I'm using to avoid them lowering my prescription?

Any other things I should think about? Any advice?
Click to expand...
It's all a big game especially with insurance... You need to do some serious research as LDog said. So many factors come into play when you get tested. How long do they wait to test after last inject is a huge one. All of us break down the Ester at different rates. Did you have sex the night before. Did you go to the gym that day. What did you eat. And on and on.... Your test numbers can fluctuate 200 points up or down at any given moment. Most GP's don't know shit. Even Endos barely have a grasp. Hopefully your Doc will go by how you feel and not your number. Some guys feel great at 500 some 1000. We are all different so just research the hell out of it and know more than your Doc does. Then if your test comes back at 800 and he or she tries lowering your dose you can have some knowledgeable input. You do not want to play the up and down game. Then what's the point. You just feel like shit all the time. Good luck!!!

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judgmentalist said:
Because I'm distrustful of authority. I don't want some goober head doctor bumping me down from 200 mg to 100 because he thinks 1206 ng/dl is a lot and then I end up going back to 700.

i'm perfectly content to stay on the very high side of normal and see where that gets me. I mostly just want to b maximum legal.


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Click to expand...

then yes you need to not take a 200 mg shot for say at least 10 days before you test. that should put you in the safe zone .
if you come in over 900 total he is going to drop you down
 
IML Gear Cream!
AI's are additions and have risks, sides and add expense. Think anout this like any other prescription: if a doctor told you he was prescribing you one drug for your cholesterol and 2 more to manage the side effects of the the cholesterol medication would you call him a great doctor? Realistically no. So for doctors looking at trt as medicine, it makes sense that they wouldn't want to prescribe more test than you need to correct the deficiency to the point that you need drugs just to manage the sides. After 5 years of trt I have come full circle on many points back to where my original conservative doctor had things. Like split dosing, and sometimes lower doses. If I'm cut up and lean I aromatize less so 200mg once a week and no ai works, but higher body fat and less muscle I aromatize more. Splitting the dose and dropping it to ~150 does away with the need for an ai. Also arimidex is easier to be consistent with than asin which I managed to get prescribed from the doctor. I still get 30 asin a month, but I don't use them. It's much easier to adjust the test to not need an ai and ultimately I feel better. Now blasting and cruising is obviously different and the higher doses mean actively managing e2, but at the higher doses of a cruise (3-400) asin again becomes easier than adex.

My point is we really should give doctors a bit more credit. Not all of them, and not all the time, but the ones that know where field can teach us a lot.
 
I think you're in a great position. Healthy 200mg/wk dose, an AI, and 13 wks till the first test? That's crazy good... a micromanaging doc might have you back in every week or two.

I want a doc that good! Gotta go digging for one soon... :/

I'd get blood work *twice* in say week #3 -- two days after pin and again at five days after. This'll give a safe amount of time for your endogenous production to zero out and tell you how you metabolize the ester. Is it enanthate or cypionate? Probably doesn't matter... my bet is you'll get 5.5-ish days for the calculated half-life in either case. Post results here and keep track of precise times of blood draws so you have the number of hours elapsed between them. Did you get HCG? If so, you'll have to hold off on that entirely if you want to run this experiment.

After that, get bloods again in week #5 a full 7 days after pin, just as they'll do in week #13 I assume. It's a trough measurement for a weekly pin schedule. By the fifth week your blood levels have stabilized into the sawtooth pattern you'll have indefinitely.

If the reading is too high, you can easily adjust by pinning only say 100mg at the beginning of week 13. If you skip the pin altogether you'll get more than another half life of decay before the doc draws bloods and levels will be so low they'll know something's wrong.

The labs you want are the $73 LabsMD female hormone panel with lc/ms/ms (mass spec) for T. Privatemdlabs has a similar panel but it's not the standard cheap one everyone gets, but the $86 version (before coupon).
 
Just realized you could save one of those three lab sessions by combining them, if you're patient enough to wait. In week #5 get bloods on day 2 or 3 and then again on day 7.
 
Thank you for this information. If I understand correctly you are suggesting that I hold off on using the HCG until I pull labs twice in week three, and then start up with the HCG?


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judgmentalist said:
Thank you for this information. If I understand correctly you are suggesting that I hold off on using the HCG until I pull labs twice in week three, and then start up with the HCG?
Click to expand...

Yep, assuming you want to measure your ester metabolism. Which you should. :winkfinger: Then we'll be in a club of two of the members here who actually know it. <highfive>

HCG mimics LH which triggers Leydig Cell testosterone production, i.e. your endogenous supply. That'll screw up any T assays where you're trying to judge the gear potency or half-lives, etc. After 3 wks (and maybe as early as 7 days, but let's be certain) of exogenous T you'll be completely shut down -- LH & FSH essentially zero -- and we won't have this problem.
 
chocolatemalt said:
Yep, assuming you want to measure your ester metabolism. Which you should. :winkfinger: Then we'll be in a club of two of the members here who actually know it. <highfive>

HCG mimics LH which triggers Leydig Cell testosterone production, i.e. your endogenous supply. That'll screw up any T assays where you're trying to judge the gear potency or half-lives, etc. After 3 wks (and maybe as early as 7 days, but let's be certain) of exogenous T you'll be completely shut down -- LH & FSH essentially zero -- and we won't have this problem.
Click to expand...

Cool. I will follow this lab protocol and post the results here. I didn't ask which ester was prescribed, but I'll post a pic when I get my first shipment. Thanks.


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JRotten said:
AI's are additions and have risks, sides and add expense. Think anout this like any other prescription: if a doctor told you he was prescribing you one drug for your cholesterol and 2 more to manage the side effects of the the cholesterol medication would you call him a great doctor? Realistically no. So for doctors looking at trt as medicine, it makes sense that they wouldn't want to prescribe more test than you need to correct the deficiency to the point that you need drugs just to manage the sides. After 5 years of trt I have come full circle on many points back to where my original conservative doctor had things. Like split dosing, and sometimes lower doses. If I'm cut up and lean I aromatize less so 200mg once a week and no ai works, but higher body fat and less muscle I aromatize more. Splitting the dose and dropping it to ~150 does away with the need for an ai. Also arimidex is easier to be consistent with than asin which I managed to get prescribed from the doctor. I still get 30 asin a month, but I don't use them. It's much easier to adjust the test to not need an ai and ultimately I feel better. Now blasting and cruising is obviously different and the higher doses mean actively managing e2, but at the higher doses of a cruise (3-400) asin again becomes easier than adex.

My point is we really should give doctors a bit more credit. Not all of them, and not all the time, but the ones that know where field can teach us a lot.
Click to expand...

This is an annoyingly good point even though I don't want to hear it. I realize I should probably be trying to figure out a minimum effective dose for safety sake rather than pushing it to the limit, having said that... yeah that doesn't sound like me :)


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judgmentalist said:
This is an annoyingly good point even though I don't want to hear it. I realize I should probably be trying to figure out a minimum effective dose for safety sake rather than pushing it to the limit, having said that... yeah that doesn't sound like me :)


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Click to expand...
I totally get it. But after 5 years on trt laziness becomes operative. Least pinning and shit to remember and keeping everything working right is my trt goal now. Blasting and cruising is blasting and cruising and trt is something different. I'm not saying don't game the doc. I have 200/wk and I get 30 asin a month because the pharmacy fucked I'm the filling orders and I don't say a damn thing to anyone. I pocket script AI and test and have for years. I'm just saying it's come in handy to know what puts you where for the simple and then from there do what you need to do. My only real point is we should be nicer to our doctors since they have all the good drugs lol.
 
JRotten said:
I totally get it. But after 5 years on trt laziness becomes operative. Least pinning and shit to remember and keeping everything working right is my trt goal now. Blasting and cruising is blasting and cruising and trt is something different. I'm not saying don't game the doc. I have 200/wk and I get 30 asin a month because the pharmacy fucked I'm the filling orders and I don't say a damn thing to anyone. I pocket script AI and test and have for years. I'm just saying it's come in handy to know what puts you where for the simple and then from there do what you need to do. My only real point is we should be nicer to our doctors since they have all the good drugs lol.
Click to expand...

Got it :) thanks boss. Hypothetically speaking, if one were to find oneself with an excess of testosterone and or AIs, what should that person do with the excess material?


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I got this in an email as part of my TRT intro package. What do you guys think?
aa56048cc35edfe03924d95052a669af.jpg



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Get Shredded!
I couldn't find a lot of information regarding anastrozole delivered by injection.

A patent for testosterone/anastrozole IM solution:

https://www.google.com/patents/US20140371186

The bioavailability of oral anastrozole is rated at 83-85%. Delivering this by IM should raise the availability to 100%. This should make 1mg as effective as about 1.2mg oral. Seems kinda like a high dose to start off with to me.
 
Phil6502 said:
I couldn't find a lot of information regarding anastrozole delivered by injection.

A patent for testosterone/anastrozole IM solution:

https://www.google.com/patents/US20140371186

The bioavailability of oral anastrozole is rated at 83-85%. Delivering this by IM should raise the availability to 100%. This should make 1mg as effective as about 1.2mg oral. Seems kinda like a high dose to start off with to me.
Click to expand...

Thanks. In gonna do some labs in a couple weeks to see where I'm at and then I'll see about fighting with the doc. Alternatively, I've been considering banking a legit vial here and there and swapping out with something that doesn't have the Anastrazole added in. What do you think?


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judgmentalist said:
Because I'm distrustful of authority. I don't want some goober head doctor bumping me down from 200 mg to 100 because he thinks 1206 ng/dl is a lot and then I end up going back to 700.

i'm perfectly content to stay on the very high side of normal and see where that gets me. I mostly just want to b maximum legal.


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Click to expand...

I don't follow... you are going through a great deal to be in the "High side of Normal"? What are you trying to achieve?

You are not gonna notice much difference in muscularity, energy or anything for that matter between 800 -1200 that justifies your intent. There a reason why people cycle and that's to get 3-4 times higher that range you desire...that's when the difference is "noticeable". What's 1200 gonna do that 800 isn't? In short nothing.

What will happen is that you will be putting more stress on ur organs constantly by being consistently at that higher range. Worst yet you won't be reaping the rewards that some one in 800 isn't. Again there's a reason why people cycle because your body can't tolerate the effects of a higher range of test.

So say you walk into you doctors office and you are above the 1200ng you will most likely get taken off TRT Completely. You likely then be tested in another 3 months to see where your levels are then and he will decide whether or to resume treatment. I've seen it happen before.

My advice don't risk going to your doctor unless you know where your levels are at and 2) again you are going through to much trouble to be in the " high side of normal".

Not trying to be dick and hope I didn't offend... just my 2 cents.


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Nofreak said:
I don't follow... you are going through a great deal to be in the "High side of Normal"? What are you trying to achieve?

You are not gonna notice much difference in muscularity, energy or anything for that matter between 800 -1200 that justifies your intent. There a reason why people cycle and that's to get 3-4 times higher that range you desire...that's when the difference is "noticeable". What's 1200 gonna do that 800 isn't? In short nothing.

What will happen is that you will be putting more stress on ur organs constantly by being consistently at that higher range. Worst yet you won't be reaping the rewards that some one in 800 isn't. Again there's a reason why people cycle because your body can't tolerate the effects of a higher range of test.
Click to expand...

Those are some strong statements there. Have any studies to back it up?
 
Sorry I lost track of this thread. I would not want my AI in my test. AI dosing is not just highly individualized, but it can and does change for the individual. For me 200mg of test needs .25mg of adex split twice a week IF I INJECT ONCE A WEEK at around 18% bodyfat. If I am lifting that bf comes down and once I'm 195@13% I don't need the AI. I have a friend that has this compounded mix you have and he seems ok I guess. I would have low e2 symptoms which suck while at he same time I have naturally low SHBG which causes me to be high out of range on FT at 900 TT, which will cause a doctor to lower doses, if you have no input.

My personal recommendation is this: have a really good PCP you can talk to, get on trt however you can with a clinic if necessary, let them do the initial testing and dose adjusting, see how the adjustments affect you and how you feel, don't interfere by manipulating dosing or taking other aas, be open with your PCP about the trt and any issues you have with that doctor, this way I was able to get my doctor to take over my PCP scripting, don't bother the doctor every time you see them to increase the dose, now you can start to manipulate dosing so that your scores come back lower (by now you should know how to successfully manipulate your levels for upcoming bloodwork), keep all your other markers clean and now you can ask to up the dose.

I actually use much less than I prescribed when I am not blasting or cruising. What do I do with the horded test and exemestane? I save that shit. I use the pharmacy test for cruising and I save the pharmacy AI for blasting and since I have awesome insurance that pays 100% I haven't bought an AI or wondered if it was legit in years. Go price real US pharmacy grade exemestane and you'll see what a great deal that is. It damn near equals my monthly insurance premium since I finally got off the self insured bullshit. That's awesome.
 
JRotten said:
Sorry I lost track of this thread. I would not want my AI in my test. AI dosing is not just highly individualized, but it can and does change for the individual. For me 200mg of test needs .25mg of adex split twice a week IF I INJECT ONCE A WEEK at around 18% bodyfat. If I am lifting that bf comes down and once I'm 195@13% I don't need the AI. I have a friend that has this compounded mix you have and he seems ok I guess. I would have low e2 symptoms which suck while at he same time I have naturally low SHBG which causes me to be high out of range on FT at 900 TT, which will cause a doctor to lower doses, if you have no input.

My personal recommendation is this: have a really good PCP you can talk to, get on trt however you can with a clinic if necessary, let them do the initial testing and dose adjusting, see how the adjustments affect you and how you feel, don't interfere by manipulating dosing or taking other aas, be open with your PCP about the trt and any issues you have with that doctor, this way I was able to get my doctor to take over my PCP scripting, don't bother the doctor every time you see them to increase the dose, now you can start to manipulate dosing so that your scores come back lower (by now you should know how to successfully manipulate your levels for upcoming bloodwork), keep all your other markers clean and now you can ask to up the dose.

I actually use much less than I prescribed when I am not blasting or cruising. What do I do with the horded test and exemestane? I save that shit. I use the pharmacy test for cruising and I save the pharmacy AI for blasting and since I have awesome insurance that pays 100% I haven't bought an AI or wondered if it was legit in years. Go price real US pharmacy grade exemestane and you'll see what a great deal that is. It damn near equals my monthly insurance premium since I finally got off the self insured bullshit. That's awesome.
Click to expand...

I don't care for the AI being incorporated into the Testosterone either. For one thing, since I get two months worth of T at a time, it will take up to ten weeks to make adjustments to my AI levels if it becomes necessary.

I got on the TRT initially with a clinic, not an ends or PCP. Your advice about discussing the TRT protocol with my PCP seems sound. I would prefer to transfer to a straight prescription(s) rather than being locked into this clinic if possible. My insurance doesn't cover hormone therapy so that isn't my concern.

I'm going to continue with the dosage I was initially prescribed until week 5 and then pull two sets of labs to determine my ester metabolism per ChocolateMalt's advice earlier in this thread and that will give me some useful information as to how to proceed. As of this moment, I actually have no way of knowing how by body is responding to the 200mg T-CYP and .5mg Anastrazole I am currently on.

I'm particularly concerned about making sure my E2, Hemoglobin and Hematocrit are in range first of all. My initial E2 was normal despite T being in the toilet, so I want to make sure I'm not some kind of super-aromatizer or something.


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