HRT problems for years!

Glad I found this site! I'm fifty years old, but have been on HRT since I was thirty eight. I started on Androgel and after six months my levels dropped. It worked great during that time, but I have battled with the right protocol ever since. I believe I was having issues with absorption and also believe estradiol was a problem. Your exactly right with most doctors......I seen endo's, urologists, etc. None would even discuss the conversion to estradiol. I was in the military, so I moved around a lot and every place was the same. I started injections, but I still didn't feel right. Again estriol may have been the problem. I paid a fortune thinking the pellets may be the answer.....was I ever wrong! Their answer was just to increase the dosage each time......I discovered my levels were through the roof and I felt like crap! I traveled once to seek help with Dr. ******* (was suppose to be the TRT expert). That was a waste of time and money! I came to him with some lab work.....my SHGB was nearly Zero. He had never seen that and didn't have any idea why? This was several years ago and now I've found several articles about it....doesn't sound good though. Any thoughts about this? I will get it checked next lab work. A few months ago I was doing 100mg per week and my labs are as follows- Estriadiol--63 (range should be less than 39), total testosterone--789, free testosterone--218.2 (range 35-155)
After these results I decided to try 50 mg every three days with .25mg arimidex at the same time. I haven't had labs done yet with this protocol. Do you think I should be taking more arimidex? Do you think HCG would be beneficial with my situation? I don't know why my free is so high and I feel so bad? I'm desperately wanting to get on the right plan. I appreciate any help in seeking guidance for my problem. Thanks

There's a term known as "Transdermal Fatigue" that's probably what you experienced with the Androgel. It works well and after awhile your body adapts. Now the Androgel dose has to increase and you have to continue increasing it often to keep it working. Before you know it you need a bathtub full of it to get anything out of it. This is not an uncommon situation at all. I believe I've mentioned this before, even the Androgel brand admits to a 20% fail rate in its literature, meaning the product won't work in 20% of all men from the start. But I do not believe it mentions the issue of Transdermal Fatigue, which holds true with every form of transdermal testosterone.

The protocol you're on now may be OK but it's impossible to say for use with out a blood work examination. The best way to determine how you're doing is how you feel, that's always the primary factor but as far as your numbers go, the same protocol will result in different numbers for every man. There's no one single protocol that produces the same numbers in all men.

If you'd like a good, sound protocol I'd encourage you to consider injectable testosterone. It's the easiest to control and manipulate until you find the right dosing plan for you. It also doesn't have a fail rate in normal men.

I'm sorry, but my last paragraph should have said I was injecting 50mg of cypionate every 3 days. I think this might help with Estriadiol levels going too high? I am still taking arimidex .25 every injection day. I may have to go up depending on my next labs. I have some good days, but I don't think I've found the right mix yet. Do you think HCG would do anything for me? If so, what amount.......I see a lot of people do 250ml all the way to 500ml. Any info about SHGB bottomed out? Thank you

Taking the anastrozole the day after your injection might help you quite a bit. There's more aromatase activity to block at that point in time.

HCG will help stimulate natural testosterone production while taking testosterone and is a good way to help keep testosterone levels balanced between injections. However, It doesn't always work as well in men who are 50+ as they're often primary, not secondary. This isn't always the case, but it commonly is.

Primary Hypogonadism: The testicles are not producing testosterone. The pituitary releases LH, the signal that tells the testicles to make testosterone but very little production occurs.

Secondary Hypogonadism: The testicles work fine but the LH signal is weak.

HCG mimics LH. If a man is primary and already has a very strong LH signal, essentially dumping more LH into the body won't help. It's not going to kill you but it won't help. It should also be noted that HCG can increase your estradiol levels. Also, HCG is usually measured out in iu not ml. Just a clarification point for future reference.

Lower SHBG, sugary foods can lower SHBG. Some have said Vitamin D can also lower it. Regardless, you want lower SHGB far more so than higher. The higher your SHBG is the lower your Free Testosterone levels will be. It's also been said that low levels of SHBG can be a result of diabetes and obesity. However, I'm not sure how conclusive this is as typically the men who come through our program that have diabetes or are obese have very low levels of Free Testosterone and not necessarily low levels of SHBG. Your thyroid can also affect your SHBG as well as many areas of the body. A simple TSH w/Thyroid test can tell you what's going on there.

Another issue I'm experiencing is low ejaculate. I had never had any problems with this until the last couple of years. Also I use to have plenty of force too.....not so much anymore. I do take 40mg of Micardis HCT for blood pressure. Any idea of what is causing this? Thanks for any advice.

When your testosterone to estradiol gets out of line this can cause ejaculate issues. Get that balanced and it will help a lot. You may also consider HCG as this often helps too.

What do you recommend on the dosage of arimidex?

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Originally Posted by martyjack

What do you recommend on the dosage of arimidex?

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As little as possible. A common big mistake is taking too much, which bottoms your estradiol out, makes you feel like garbage and often makes a man give up on TRT, which again makes him feel like garbage. It normally doesn't take much. Common doses for the purpose of TRT range from 0.25mg per week to 0.5mg two times per week. Some men need more, 1mg twice a week isn't unheard of but that's the high dose. Very few men need more than that, but it does happen. Bottom line, most men feel their best when their estradiol is in the 20-30 range, although some men will still feel pretty good in the low 30's. Much higher than that can cause symptoms, much lower than 20, especially below 15 will make you feel terrible.

I seem to be having trouble with HRT again? I was doing 100 mg weekly, but discovered my levels were bottomed out at the end of the week....prior to next injection. I was advised to go up to 140 mg weekly and have been doing this for about 3 weeks. I never feel any better.....seems like my libido has bottomed too? My Estriadiol levels were below 30... I take about a half mg Arimidex weekly. Any ideas what may help or something else I need to Check? Also seem depressed a lot....not sure what's going on? Help!

Are you splitting your testosterone dose into two shots per week or one shot?

Estradiol - is this a standard or sensitive E2 test? What's the lab and unit of measurement?

Do you take HCG?

I'm not splitting the dose anymore.... inject every 7 days. My Estriadiol was 22.... I'm sure this was probably a standard test. The high end on the reference range was 39. I don't take HCG....tried to discuss it with doctor.....basically because of my age, there was serious doubt that it would do any good. Any advice would be appreciated.

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Originally Posted by martyjack

I'm not splitting the dose anymore.... inject every 7 days. My Estriadiol was 22.... I'm sure this was probably a standard test. The high end on the reference range was 39. I don't take HCG....tried to discuss it with doctor.....basically because of my age, there was serious doubt that it would do any good. Any advice would be appreciated.

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If you're bottoming out at the end of the week on 100mg you'll more than likely still bottom out at the end of the week on 140mg. You're metabolizing the testosterone quickly and probably need to go back to a split dose. If you're at 140mg/wk, then 70mg twice per week, such as Monday & Thursday.

Curious on what age you are that makes the doctor think HCG won't work. It is true, if you are completely primary then HCG won't do much for you. However, even then it doesn't hurt to give it a try - it certainly can't hurt you. It's definitely worth looking into.

I would request a Estradiol Sensitive panel. The problem with a standard panel is it is very hit or miss when it comes to accuracy. In fact, it's very common (extremely) for the reading on a standard test to be 10+ points higher than a sensitive. If that happens to be the case with you, then that means your E2 is lower than you might think, which would explain in part the libido issues.

Solutions:

1. Split testosterone dose into two injections per week.
2. Consider HCG - 250-500iu 2x/wk is the common dosing range.
3. Get sensitive estradiol test to determine true E2 reading. Without a proper balance between E2 and testosterone therapy cannot work.
4. If your doctor will not work with you on these things, find a new doctor. One of the most common arguments I hear in this regard is "well, this doctor is covered by my insurance." That's all well and fine but pretty worthless, in my opinion, if the treatment isn't good.
5. If your E2 and testosterone numbers are good and you're having any type of ED issue, consider some type of PED5 Inhibitor, maybe low dose daily Cialis. A lot of men get upset when their TRT is good but they are still having ED issues - you can have both Low T and blood flow issues in the downstairs area.
6. If you're looking for an even larger energy boost, consider Injectable B12, specifically Methylcobalamin. You do not want the other forms of B12. Also you might (if you're not already) consider supplementing with 5000iu of Vitamin D3.

Thanks Justin. I have some HCG in the cabinet, got from a protocol I was on a year ago. Do I use the HCG the day before each testosterone injections? If I split the testosterone into biweekly, I think I will get me some 27 gage needles and try your subcutaneous injections. Most family practice places have never heard of this, sounds great to me though. I will cut back on the arimidex also.
I also wanted to see if I can work out something with you to get the HCG. I have recent labs, they indicated low testosterone prior to my next injection. That's why I'm doing 140mg now. I'm retired military, so I use Tricare standard for insurance. I would love to get my labs worked through you. I have a good doctor here, but like many they are just not up on latest hormone therapy. He did understand the arimidex after I explained it to him.....my Estriadiol was elevated at the time. I have a good prescriptions n for the testosterone and arimidex......just would feel better with you checking my appropriate blood levels. Think we could work something out?

We do not sell any medications. Our program is a flat rate fee of $199 per month. Yes, you could use that for an HCG prescription only but that wouldn't make a lot of sense, as I'm sure you'd agree. The program covers doctors visits, blood work and all medications needed (HCG, testosterone & anastrozole), I don't have a way to split it up.

Justin,
I went to a pharmacy here and the pharmacists tells me no way can you inject testosterone subcutaneous with a 27 gage needle......says it's too thick? Is your testosterone the same as all others? I've never seen anything but oil based. He mentioned maybe you compounded it differently? I definitely want to try this method and will show him your web site. Thanks

Most all pharmacist will say this. We have a large number of individuals in our program that inject SubQ and do so obtaining the testosterone from various different pharmacies. We work with a few different pharmacies, not just one in particular. All the testosterone from all the pharmacies is oil based in either cottonseed or sesame seed oil, as I'm sure the pharmacy you're dealing with is, or grape seed oil, almost forgot that one.

For whatever it's worth, I've injected testosterone with a 30g insulin needle on more than one occasion. I never do this on purpose, have just run out of regular size needles at times and that's all I had. It takes a good 10min to draw the dose out with an insulin needle but if you're sitting there watching TV or something like that it's not like you don't have the time. As for pushing it through, it takes a little extra pressure but it's not like trying to push a rock through or something like that. It's still just liquid.

Yea my bad.....I went and bought me some 28gage insulin syringes. I just filled the insulin syringe with the needle I had been using for the IM injections. Injection was painless! One more question....If I'm prescribed 140 mg weekly and I'm now doing bi-weekly injections......do you think it would benefit me to do 3 smaller injections EOD? Also when should I use the hcg......the day before injections? If I do 3 injections?..when?
Thanks

Based on the active half-life of the testosterone, you shouldn't need to inject it three times per week. I do know of guys who do split their's up into three shots, I have even heard of guys injecting minuscule amounts daily and they swear it makes a difference but that seems very unlikely are far more likely a placebo effect. A twice a week split should be fine.

As for the HCG, if you're injecting that twice per week and the testosterone twice per week, the easiest thing to do is to do it on the same day as your testosterone. Some prefer doing the HCG the day before or after testosterone injections, but the only issue with this is you potentially create more possible estrogen spikes throughout the week. Is that guaranteed? No, and even if it happens it could be minimal, but doing both the same day is the easiest and should work well. Now if you're splitting your HCG dose into three shots per week (Not necessary but possibly more beneficial than 3 testosterone shots per week) I would simply take two of the HCG shots with my testosterone and one in-between, something like this:

Mon: Testosterone & HCG
Wed: HCG
Fri: Testosterone & HCG

Hi…new forum member and a first time post. This thread has been a very informative…both, the detailed questions and thorough responses. I recently had my labs drawn through a local "Low T Center" in the Woodlands, TX, but have not started their protocol…my total testosterone levels were at 112 ng/dl at 10AM (yes, extremely low for a 39 y/o male).

I'm thinking of checking out the LowTestosterone.com's clinic in Houston…The nurse staff at the "Low T Center" are terrific, but Justin has been more informative than their PA. Main concern is to be able to use my TRICARE insurance coverage (retired Marine).

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Originally Posted by freefldive

Hi…new forum member and a first time post. This thread has been a very informative…both, the detailed questions and thorough responses. I recently had my labs drawn through a local "Low T Center" in the Woodlands, TX, but have not started their protocol…my total testosterone levels were at 112 ng/dl at 10AM (yes, extremely low for a 39 y/o male).

I'm thinking of checking out the LowTestosterone.com's clinic in Houston…The nurse staff at the "Low T Center" are terrific, but Justin has been more informative than their PA. Main concern is to be able to use my TRICARE insurance coverage (retired Marine).

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Welcome to the forum. With the lowtestosterone.com program you wouldn't have to go to the doctor every week for your treatment. All administration is done by you in the privacy of your own home. Some clinics and programs make a big deal about this and act like you could never do such a thing, but anyone that tells you that isn't telling you the truth. A five year old baby could probably figure out how to inject testosterone - not that it should, I'm simply saying it's that easy. As for insurance, lowtestosterone.com does not accept any form of insurance. Sorry, it's cash pay only, meaning debit or credit card.

if you split up your doses into more separate times, that may help.