After reading KSman's receommended basic TRT Protocol, I want to be sure I am crystal clear in my understanding. I am currently using a generic T Cypionate that is 200mg/ml. If I understand his recommendation correctly of 100mg / week total, then this would be at the 50 mark on a 1mil insulin syringe. If I then divide the weekly total to SC EOD, this should equate to approximately the 12.5 mark on the syringe, correct?
For some other background information: Here-to-fore,I have been taking 180mg T Cypionate / week total divided into two doses per week (each shot is at the .40 mark on a traditional 1cc 22ga x 1.5" syringe). I have also been taking 500 units of HCG twice a week, given the night before each T injection. Also, recently started Arimidex .25mg on same day as T injection. E2 was last shown at 30 after four weeks of starting Arimidex. Free testosterone was at 225.
Not sure if last post went through. Nevertheless, having fresh lab work done in The AM and will report back with accurate numbers. I have been on the 80mg twice week protocol ever since seeing Dr. Eugene Shippen in March 2010.
Yes, Shippen is an now an advocate of "Mini-Shots" as he calls them. He told me that at one point he favored pellets, although they were difficult to find, as well as, locate a doctor that could insert them correctly. He took me off of Androgel which was causing my hair to fall out. I have since had successful hair transplant surgery by a well respected surgeon, Dr. Jerry Cooley in Charlotte, NC. Dr. Cooley has advocated that I take only (1-2) .5mg capsules of Avodart per week. He told me the primary reason for the hair loss was due to the Androgel and it's higher conversion to excess DHT, relative to shots. Nevertheless, he still suggest very low dose of Avodart. I realize DHT has may positive benefits and like Estrogen, I simply want to try to control some of the negative effects of any excess, without eliminating it completely. As a result of the smaller doses of testosterone that you suggest and the reduced spike in DHT, I may decide to eliminate Avodart completely.
While on Androgel, I was taking the maximum dose (8 pumps) which still only put me at 575 on a scale of 300-1000. Shippen is the first doctor, I had seen that advocated HCG at 250 units twice a week. Prior to that my gonads ached and had atrophied. My local Endro suggested testicular implants and would not even consider HCG. This flippen response convinced me that many of these guys are clueless. I had read Shippen's book years ago and felt like he was the best resource that I was aware of up to that point. I have been on some form of TRT since 1996. My low T was most likely induced by recreational steroids in my earlier days. I believe if I could have had the proper advice back then, perhaps we could have coaxed my pituitary axis back into service. Unfortunately, the urologist that first diagnosed me prescribed the traditional 2-3cc shot every three weeks. It was terrible and I believe contributed to a failed marriage. Glad to be here now and with your help and others from this site I am hopefully on a safe and healthy path to the appropriate TRT protocol for the rest of my life.
Body & Facial Hair: Good wisker pattern. Average, not excessive on rest of body. Had head hair transpant procedure due to using Androgel for several years and being unaware of it's significant spike in DHT. Now on injections.
Fat: Carried in waist and hips, not excessive.
Heath Conditions: Generally good, although have low HDL (value under 40) and boderline hematrocrit (17.9), Plan to begin donating blood frequently. Other indicators good. Take 90mg Armour Thyroid / day.
OTC Drugs: In addition to T Cypiponate, HCG and Arimidex, also taking (2) .5mg Avodart per week per hair surgeon's advice.
Labs: See Attached
Diet: Generally good with flax, olive and organic coconut oil. (!) glass red wine most nights, limited alcohol otherwise.
Testes: Use to ache, until starting HCG in 2010.
Morning Erections: Yes on occasion, as I am experimenting with correct Testosterone, HCG, Arimidex dosage.
Background: Used Androgel from 2005 to 2010 with lackluster results. Saw Dr. Shippen in March 2010. Prescribed "Mini Shot" regiment. 120mg / week divided into (2) doses taken Mondays & Thursdays. Initially 250 units HCG on nights before T-shot next day. Never mentioned use of Arimidex or concern about elevated estradiol. Felt like I had lost adequate results in libido and general sense of well being. Therefore, increased injections to 180-200mg week. Also, upped HCG to 500units, twice per week. Not realizing role of excessive Estradiol that had evidently crept up. Now understand that I was only making maters worse.
Current protocol reflected in attached labs from 12-31-12 (Note: these lab readings were taken on a Monday morning with last T injection, HCG and Arimdex dosage taken previous Thursday). 180mg / week T injections (divided into (2) doses) 500 units HCG twice / wk. November 2012 started .25mg Arimidex twice / week on days of injections. Have had Estradiol tested twice since starting Arimidex. First reading of 30 was taken day after .25mg dosage. Most resent reading of 40 taken 4 days after last .25mg dosage. Starting taking 50mg Iodoral tablets after reading Thyroid sticky. Been loading for 1 week and observing body temps increasing. Morning 97.5, mid afternoon 98.2.
Based on what I have gathered on this site, I believe I need to decrease my injections to 100-120mg week. 250 units HCG EOD and perhaps .25mg E3D. Appreciate any feedback / opinions.
The attached graph is what Dr. Shippen used to arrive at the 'Treatment Range" he wanted me in. This was based on my SHBG level of 29 nmol/l shown on the far right vertical scale. He calculated a free testosterone treatment range from 100-250 pg/mL and told me that just prior to my next injection (3 days), I should be at approximately 160 pg/mL (shown on graph where the horizontal center line intersects with vertical center line, labeled "mid normal"). I suspect he used prior experience to arrived at the suggested 120mg per week protocol, split into two injections of .60mg each.
Recent Labs Notes:
My Monday morning 12-31-12 lab work put me at 187.6 pg/mL free testosterone when my last 80mg injection had been the previous Thursday 12-27-12.
Tried 50mg / split twice week (25mg per shot) Testesterone SQ with insulin syringe for several weeks with disappointing results. Went back to 170mg / wk (.35mg per shot) and feel much better. Also back using short 5/8" 25 gauge needle in upper hip muscle. Still on .25mg Arimidex EOD, as well as, 250 units HCG also EOD. I don't want to do more T then necessary, but just feel much better at this level. One other change, was taking (2) Avodart only one day a week per hair doc's recomendation. DHT was a 2 on a scale of 1-6. HRT doc took me off all Avodart 2 weeks ago, so perhaps this is helping also.
With E2=40 and target near E2=22, modify old dose of anastrozole by a factor of 40/22. Note that your anastrozole dose needs will vary by serum T levels and thus by T dose.
As you increase T levels or decrease E2, SHBG can be expected to decrease. Makes the use of that chart a bit silly as everything changes.
Injecting once a week, your levels are changing a lot. The lab report is a snap shot of a moving system and the lab results are very much a mater of lab timing. With frequent injections, hormone levels are quite steady and then lab results really do represent reality.
Large T peaks from larger infrequent doses promote more E2 than with divided dosing. Probably similar effects on SHBG.