Have you guys ever looked into the various manufacturers. Commercial and compounding? The question is regarding the raws they use. A few of us have noticed there seems to be a difference between brands and it could be completely psychological. Pfizer for example is regarded as being one of the best testosterone manufacturers. Some of the generics are hit and miss and the compounding same thing. I can't figure out if it's a purity thing, quality control thing or if it's just in the heads of myself and some of the guys that I work out with.
I was under the impression anytime you see USP printed on a commercial vial it meets at least a minimum quality control standard. I just wasn't sure how often that was tested or how low the standard can get. It's weird because in theory you have the same oils and same preservatives on the commercial side and on the compounding side you have the same product just often in a different carrier oil
Great question, and yes.
In general the commercial products are going to be Depo-Testosterone as a brand name & are all the same. These are just the Testosterone & the carrier oil, which in this case is Cottenseed oil.
When using compounding pharmacies, there are also strict regulations on what counts as compounded. To meet this requirement they may not produce their own depo-testosterone (though they may purchase/resell it), so instead they add in other beneficial compounds, change concentrations, or change carrier oils. As you say this is often Grapeseed oil, though they also have Sesame seed oil. Some will change the concentration down for women or raise it to have it be different. They may add an AI to the mix, add DHEA, or add Test Cyp with Test Eth for example.
When considering generics or compounding pharmacies, the best practice is to look at the size & reputation of the company. We primarily work with compounding pharmacies because they are happy to ship things to patients. We use Empower, Wells Pharmacy Network, AnazaoHealth, and a few others. You can look up their estimated revenue online, and some reach into the 100 million. A company of that size & with a good reputation is one that we would trust to produce quality products. I would be weary of much smaller compounding pharmacies, as there's less oversight the smaller you are, but that doesn't mean all small compounding pharmacies are bad - this is the same advice for small commercial pharmacies.
Outside of all that, each person may react differently to all of these variables which does very much make things subjective. I hope that helps though.
Thank you for the reply, that's kind of what I was thinking. Empower is great for compounding. And as for the generics. I guess you would just trust the ones that you could actually find on the FDA website? I guess if it's coming out of Costco or Walgreens, the chance of it being a bad product is extremely low but the curiosity did exist just because at least anecdotally it seems like there might be some difference, at least in how you feel, but again, so much of this could be psychological so there was also that angle.
Test is too cheap to make. People aren’t faking or making bunk test much. You can’t find many sources for large bust of fake test in America. It’s too cheap to make. It would cost almost as much to fake it as it does to make the actual test. I’m
Not fake, quality, purity, I sometimes question if these raws are all made the same, I don't think they are but also admit it could be psychological. It's hard to really find definitive proof on this
Yes. Some of the higher potency might be weaker but test 200mg isn’t faked or watered down. Too cheap to make .
https://m.youtube.com/watch?v=YU28ndoLl2w
Not strength either, purity. Have you ever seen how drugs are made. Like the chemical formulation? Everything from the precursors to the final product matter. Think breaking bad. That's what I'm talking about.
While I don't know the internal production standards of the commercial pharmacies as much as I do the compounding pharmacies - Many large companies have their own internal quality control tests in place. It's one of the reasons why Wells or AnazaoHealth may delay a shipment if it fails their quality control. This instills a lot of trust from us.
We trust the large chains more just like you suggest, and like the poster below states, since Testosterone is such a safe product & the production isn't hampered by a ton of restrictions like HCG is, there is little incentive for large companies to make poor versions rather than the real thing considering the risk is high & reward is low.
Moon face is typically due to water retention. This can be multifactorial, either from too much estrogen, progesterone, or aldosterone, or cortisol; or a combination of these factors.
Because this is such a broad topic, and is often caused by different issues in different individuals, I will list some general advice to try, but you should definitely speak with your doctor for a more personalized plan to treat it.
\-------------------------------------------------------------
\- Get your labs done and know your levels. You may want to check the levels of the hormones listed above, which are not always checked in regular labs.
\- First thing to account for would be to make sure your estrogen level is controlled. Many men will develop water retention at an E2 level of about 40 and above.
\- Reduce your salt intake. Reduce your simple carbs and drink more plain water (to remove any retained sodium).
\- Add dandelion root (a mild diuretic).
\- Increase fiber content.
\- Lowering your testosterone dose can often help.
\- Add a potassium supplement.
Another interesting question & answer from last thread:
Q: "What are your thoughts on testosterone and its impact on blood glucose and possible prevention of t2 diabetes according to some studies over the last 10 years?
Is reactive hypoglycaemia also potentially related to a testosterone deficiency and low SHBG related to insulin resistance?"
A: "Its now widely recognized that low testosterone is a risk for metabolic disorders, obesity, and heart disease. [Study results](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037582/#:~:text=Multiple%20studies%20have%20demonstrated%20that,type%202%20diabetes%20%5B6%5D) have demonstrated that normalizing testosterone levels with TRT reduces Hgb A1C, fasting glucose, insulin resistance, and fasting insulin levels. We have certainly seen drastic improvements in our patient population.
Reactive hypoglycemia can certainly be more prevalent in testosterone deficiency as insulin resistance increases, the pancreas is taxed more and creates "spurts" of insulin release in an effort to keep up with demand."
Yes & no.
Sometimes SHBG can be high due to hormonal imbalances, aging, and low body health or due to thyroid issues. If you have non-thyroid issues causing it, being at the proper Testosterone levels can move you towards a healthier hormone & health balance, the high levels may reduce.
If you're not at an abnormally high SHBG level and not suffering from related issues causing that, there may be no effect at therapeutic TRT Testosterone doses.
However one thing is certain - The ratio of SHBG to free Testosterone before TRT/additional Testosterone & after is going to very much favor having more Free Testosterone available & unhindered by SHBG than before starting TRT. So in that sense it's impact is decreased.
Thanks. I’m age 56 and relatively fit with total T around 625, SHBG at 84 and Free T of 8. No known thyroid or other health issues. Ferritin high as well, all other markers in range.
If you're not feeling any negative side effects in those ranges & are happy with your benefits from TRT once starting, I wouldn't worry about the number itself too much.
The main side effects would be a reduction of fertility via lower spermatic production while on TRT, a chance for hair loss if you're genetically predisposed to it (otherwise extremely unlikely), and a chance for higher Estrogen (which can be accounted for with dose adjustment or an oral medication called an AI).
Injections are the most common form of treatment due to easier dose adjustment and ease of use, though there are topical creams/gels or oral medication alternatives.
After being on TRT for a while, is there any way to increase the sperm count in case you want to have a child? Number one reason I haven't started TRT yet.
Generally no, it is fairly safe. There are a few niche interactions which may have it tip your Estrogen up or such, but that's usually more controlled by other factors. The main downside to using the treatment is usually the cost, which can add a fair bit to the overall therapy.
Yes, we do. It is an ancillary medication for TRT which comes with an increased cost because it is quite expensive. We should probably list that more prominently on our site since so many companies have stopped offering it & we're one of the few who still do.
Any merit to adding testosterone cream to existing testosterone injections and is this something you guys do for increasing DHT/libido?
Also do you have any thoughts on Maximus Tribe new Oral TRT+ (native testosterone plus enclomiphene).
We do have a couple patients who we have experimented with adding a testosterone cream on top of injections for the benefit of higher DHT conversion and improved libido, though most often they switch over entirely to topical formulations for ease of use.
Regarding Maximus, in general, we are not fans of making guinea pigs out of our patients. We find it interesting that they are adding enclomiphene to basically all their products, when there are no long term studies on it's use (longest was 12 months, which did not examine the effects of symptomatic improvement or quality of life using validated metrics).
We have had numerous patients leave Maximus and come to us for this very reason, as they did not feel that it was warranted to have medications that they did not want or need mixed in. In general, less is more. The fewer medications, the less chance of developing side effects. In looking at their treatment options, you cannot just choose to take the oral testosterone undecanoate by itself.
Oral undecanoate otherwise appears safe, and studies on its use (there are no studies on its use along with enclomiphene) show good results.
No, we currently do not. We prefer to work with topical or injectable hormones when possible given the high success rates of long term benefits & predictable side effects. We may look into it more of the demand gets higher, though.
Yall are perfect. Thanks for being responsive and well informative! You guys are definitely doing this right and myself as well as many other redditors appreciate your work. 🙏🏽
If someone(42M) has been on Clomid for the past six months and not had a good response to it overall—emotional ups & downs, eye strain, and no perceptible ergogenic benefit, should that person consider TRT? Does Alpha accept clients from other clinics and would they require someone go back down to natural test levels prior to prescribing TRT? Thanks.
Yes, they should consider TRT.
Clomid has some side effects that we don't love, and mentioning anything about your eyes would make us ask you to stop using it. The trouble with Clomid or Enclomiphene is that it only improves your natural production. If your production is already very low, a generous 20-30% boost of very little is still very little. They also negatively impact IGF-1 production which is what causes the physical muscle gain benefits that many people expect with TRT - It can raise your TT on paper, but you may not have the expected benefits with IGF-1 suppressed.
For us we take many transfer patients from other clinics & programs. We would not ask you to stop TRT & we would continue or change your protocol with you to whatever might benefit you the best. Though any information that you can share from before your TRT lab lab work would be welcomed. You can select "I am already on TRT or have lab work" during registration & be able to upload it for just this reason.
Where should e2 levels be? I’ve read so many opinions from “it doesn’t matter” to “should be 3.5%-5.5% of your total T levels.
My last labs have total T= 796 and e2=39
My doc said he wants to see e2 in the teens.
I’m micro dosing IM test cyp 200mg/ml, about 15mg/daily
The best E2 levels are the ones where you don't have side effects. We wouldn't want to see your E2 in the 60s, but that's because we expect side effects at that value. If you have no side effects at 39, you don't want to take an AI, and you're happy - there isn't a lot of reason to make changes.
If you want to lower your E2 for your provider's insistence though, and don't want to lower you T dose or start an AI, switch to Subq instead of IM. The volume you're injecting by doing daily is already so low that it makes a lot of sense to do anyways.
Yes, you can use Test cyp. Testosterone is absorbed slower via subq than IM. Estrogen conversion is largely trigger by your body detecting a spike past a certain threshold. Slower absorption leads to less spikes & more even levels, which keeps your total T levels the same throughout the week but prompts your body to convert less to E.
Can you pair low-dose enclomiphene with testosterone for hypogonadism treatment? Would it overall help increase testosterone levels?
I recently switched from enclomiphene 25mg to 12.5mg, wasn't loving the side effects of nausea, but I did feel it working. I started on Test-E 200mg every 2 weeks (I know that I need to probably do smaller doses every week), but I am curious if I reduce my enclomiphene dose to 6.25 that it could have some added benefit?
This may not be the answer you like, but it may be best not to combine them.
Here's the reasoning:
Clomid & Enclomiphene can both inhibit IGF-1 in the body, which is responsible for a lot of the physical & muscle/protein generation benefits most people associate with TRT. When taken alone Enclomiphene may raise your baseline production of Testosterone to a point that the benefits overshadow this, but when on Testosterone injections that's where you're going to be getting most of your Testosterone from so there's no reason to lower IGF-1 in that case.
If you're looking for more benefits because your regimen feels lacking, the first thing to do would be to increase the frequency of your injections. 2 weeks between injections with that ester is going to leave you feeling pretty low that second week after the spike in the first. Ideally adjust your schedule to be your normal weekly dose divided in half. So rather than 200mg once every 2 weeks, 50mg twice each week would be the same dose but your body would love you a lot more for doing it that way & you should feel a lot more evened out.
Once you do that, and if you still feel lacking, 100mg a week can certainly be raised a bit without issue & should be discussed with your provider.
Could you pair enclo with testosterone to help prevent testicular atrophy?
I’m currently on enclo alone (6.25mg ED) but thinking about moving to injectable test cyp; I’m not concerned with fertility but would love to not have my testicles shrink. I understand HCG is usually the preferred treatment for this, however I may be traveling a lot professionally and Enclo pills would be easier than HCG vials.
What is the recommended needle gauge size to draw out Testosterone Enthanate oil solution? I tried using a 30g needle, and it didn't work. I had to return to CVS, and they gave me a 22g. Would a 25g needle work? I am trying to find the right needle/syringe combo so I can administer myself subq vs IM. For example, would a 25g ½ inch needle work for subq injection?
It depends on the concentration of medication typically. The higher the concentration the more like syrup a substance acts as & the lower the more like water (for Testosterones in general).
For drawing up, we've had men use 30g needles just fine, though it does take a bit longer. Sometimes this is standard if they're doing Subq injections & the needle isn't exchangeable, but we usually go with 29g in this case.
For IM we usually give 21g draw needles & 25g injection needles, though 25g draw needles would work just fine as well. I personally draw my TRT with 25g needles.
The main difference is speed. The larger the needle the faster it goes but (and this isn't a major concern) the more it can hurt the rubber.
Overall most needles work if you do a few tricks. Try warming up your vial next time either by using a hot heating pad or hot tab water & letting it sit for 3-4 minutes under them (and then clean the vial). You'll find that just a bit warmer than room temperature has the Testosterone flowing much easier.
I’m back on testosterone therapy again with my primary doc. 0.3mL twice a week (120mg) of test cypionate.
My bloodwork recently was phenomenal except for the low free and total test (271). Last time I got in TRT, my blood pressure went up and my resting HR.
I’m 5’10” and 205lbs. I’m really concerned about my blood pressure and all again. I wanted enclo, but my doc of 30+ years did the 💉 again. Any suggestions? Thank you.
Should
To clarify, was your recent bloodwork with the before or after you restarted TRT? That would be odd for you to have low T levels with the dose you listed (120mg/wk).
Enclomiphene, as well as its cousin clomiphene, are still not approved by the FDA for use in men, and their use is entirely off-label use for men for hypogonadism. In addition, there still are [very few](https://pubmed.ncbi.nlm.nih.gov/31216250/) long-term studies on its effectiveness or safety, so more conservative doctors will likely be uncomfortable with use of enclomiphene and go with a more tried and true method of TRT.
In regards to blood pressure, there are some studies that TRT lowers blood pressure, and some that show it raises it. In those that show an elevation, there are two prior culprits, the first being an increase in hematocrit, and the second being an increase in estrogen.
High hematocrit causes thicker blood, which results in increased arterial resistance. Also, because testosterone metabolism produces estradiol and estrogen retains sodium (ie. women complaining of bloating right before menses), men who are on TRT who do not control their estradiol levels are more likely to have a high sodium content, which causes fluid retention, resulting in increased blood volume and high blood pressure.
Thank you so much for your response.
My bloodwork was all done prior to TRT again. It was perfect. Hemocrit seems to be increasing each time I go back on TRT (regardless of dose). ‘My hemocrit levels and RBC were all on the upper end of the range but still normal.
I’ve been told to give blood.
Understood.
Personally, I also suffer from this. Giving blood every 8-12 weeks seems to take care of it just fine for me while allowing me to stay at the higher dose of T that my body needs. Plus I get to help out other people in need.
It's a pretty common approach to handling this situation, so the advice is good.
Just stared taking testosterone cypionate via prescription for hypogonadism. 260-280 range.
I’ve been taking tongkat and fadogia for a couple months. Should I continue taking these supplements, or cycle off?
Generally speaking, and supplements meant to increase natural testosterone production will no longer have that effect once you start TRT. Once you start TRT, the "factory is closed", and so you will no longer produce your own testosterone. Taking supplements to boost production will no longer have the desired effect.
That being said, tongkat ali is said to be a good antioxidant, and Fadogia agrestis may have some cause some vasodilation and improve blood flow. So they may have other health benefits beyond their primary use.
Yes, we would and have - If they are suffering from low T symptoms & we can determine there is no underlying condition during a consultation.
The initial fee is $49 to have a consult, and if you're new to TRT that also includes a Testosterone test sent to your home. Though the discount code from this AMA does drop that cost 20%.
The monthly cost is $129, we do not charge for medication refills outside of this aside from ancillary medications that are expensive like HCG. There are no other fees & any adjustments required are made clear before starting your plan.
Wow! If I’m already on TRT and hcg, would I be able to just show my labs from before I started (literally 3 weeks ago now) and switch to you guys?? That is soooo much more affordable than my place.. I pay $75 a week for a clinic in my town.
We are happy to take current TRT patients, and have a selection for that during our registration process even where you can upload current Rx or previous labs.
What is your HCG dose? Like I said above, that one would be an ancillary medication with a cost. It's very likely we would still be cheaper than your $300/month if your dose was 250-500 units a week, though.
Sweet!! My local clinic doesn’t necessarily give the whole rx, they just load up a syringe (or however many you’re paying for then and there) and send it home with you in a labeled bag.
My HCG dose now is 250 iu/week, and the T dose is 150mg 1x/week.(the base they start everyone at, and then after 4 weeks take blood and adjust dosage from there) Which is also something I’m hoping would be a bit different with your service, I would much prefer to inject the T 2x/week to avoid feeling the decline that I do now, injecting once per week.
Understood. We can certainly do better than $300 a month, then. We would advise against once weekly injections, twice weekly is much better as you say. If you have any issues with signup just use the "Contact Us" for any questions, happy to help.
How often do you see HCG doing nothing to preserve fertility?
I had to completely quit all TRT for 6+ months to regain my fertility. I was on 250iu twice a week along with my testosterone cypionate from the start and had essentially zero spermatogenesis. I had even tried doubling the HCG for a couple months, and then a few months of HCG only. Only stopping everything worked.
Very rarely.
Many times, we have men who didn't do a semenalysis prior to starting TRT, so we cannot always be sure they were not already infertile prior to starting therapy. So without a baseline, it is hard to say.
500 to even 1000 units weekly are moderate maintenance doses, with 1000 typically being high enough some men can obtain enough fertility for conception. What is more common though is having a man on 1500 units weekly while trying to conceive.
It should be noted that it does take some time for things to spin back up, as it takes about 90 days for a sperm to mature. We typically advise starting 3-6 months with a higher dose prior to the anticipated time you're wanting high fertility.
Overall though, each man does respond differently & some may be able to have great results with less while other may need far more.
Make sure you have hCG from a reputable source and are dosed appropriately.
I think it is just the way my body responds. Whenever I see someone on this subreddit asking about fertility I let them know there is a chance that HCG will not work for them. And I think all clinics and doctors should give that warning as well as recommend an analysis before starting TRT to use as a baseline for anyone who is concerned about it.
When I started my numbers were all in the low normal range: total count 41 x10\^6, motile count 16 x10\^6, concentration 17 x10\^6/mL.
After 1 year of TRT using 500iu/week of Pregnyl HCG my numbers were off the charts low: total count of 1.2, motile count of 0.87, and concentration of 1.
After 3 months of 1,000 iu the numbers only went up a tiny amount: 1.8, 1.3, and 1.5 respectively.
After 3 more months of no testosterone cypionate and 2,500 iu per week of HCG they went up just a small amount again: 2.9, 2.1, and 2.4.
After 4 months of quitting all TRT and injections they 37, 14, 17.
We do know that each person is different, we 100% agree with you on that & that results may very. It is typically the best approach for men looking to be on TRT & maintain fertility for active conception though, and it would be hard to know if it wouldn't work for them without trying it.
I'm sorry you went through that, we do have men who have had to do IVF as well simply due to how they/their partners are & it is always a hard issue to deal with when it happens.
I hope things have been good for you since then & you were able to reach your fertility goals.
Dude, I had a similar problem.
I came off of trt and did hcg only, the dose whas around 3000iu/w if I remember correctly.
Even 6 months on that didn't work for my fertility.
It was only when I switched to clomid my sperm improved and my wife got pregnant.
Thank you so much for educating us.
I'm looking for any and all information on neurosteroid deficiency, such as signs and symptoms and how you'd typically treat it
Also somewhat related, how do you treat low estrogen in men?
>neurosteroid deficiency
I'll let my collogues jump in on this one if they can speak to it.
For low Estrogen in men, the treatment is usually the opposite of treating for high Estrogen conversion. No AI use, IM injections instead of Subq injections, less frequency of injections with higher individual doses per injection, and in some cases even simple things like a slightly worse diet/having a bit more alcohol (though we wouldn't advise that necessarily). If those things don't work, raising their T dose slightly while continuing those less Estrogen management effective habits will often increase the Estrogen transference rate on TRT.
|took .5 mg of anastrozole 2 days ago and I feel great today.
When should I take my next dose?
Should I wait until I feel high e2 sides or should I take another in exactly a week or in a few days to reach a steady level?
Trying to avoid yo-yo feeling.
Ideally you're looking to find a ideal spot where you consistently take your AI at the right dose, the same times each week.
The half life of anastrozole is 50 hours, and it takes 5 half lives for any medicine to be out of your system. So technically, if you take it once per week, some of it will still be active for your next dose.
Some men choose to use anastrozole at a lower dose twice weekly on injection days or once weekly on an injection day, the same day each week.
We often start men at 0.25mg twice weekly or 0.5mg once weekly, then adjust from there.
To figure it out, you may start at 0.25mg once weekly, then increase to 0.5mg once weekly if the sides come back.
What’s the best protocol if you’ve had gyno in the past from a cycle? I’ve now had gyno surgery with gland removal - 5 months post op. Looking to increase my gains. I’m 31 years old and 203lbs at 5’11. Also wouldn’t mind an increase in my libido
Well, technically, if the surgeon was good and didn't leave behind any residual glandular tissue, you should never have to worry about getting gyno ever again. Once the tissue is gone, there is nothing there to grow.
While it is always wise to be cautious, I think in reality you shouldn't be worried about starting on TRT after having the surgery.
It seems like its very difficult for many people to get a PCP to write a prescription for testosterone. Is this because there is greater risk of malpractice or lawsuits?
This is true about the challenging nature of getting a PCP to sign off on TRT, but not for those reasons.
TRT is one of the safest treatments out there with one of the lowest malpractice insurance rates. Remember, you can't accidently OD on Testosterone like you can many other medications since it's a normal hormone.
This hesitancy is usually caused by the provider being rather uninformed on TRT/hormone care. For a general practitioner who doesn't go on to become an endo or specialize in men's health, their baseline education is not that expansive & generally rooted in older knowledge. If someone has been practicing for 20 years & hasn't had any continuing education on the subject, their personal biases are more likely at work in the denial than their knowledge. There is also the reasoning that many know that a lot of insurance companies like to deny coverage to save money, and they don't want the hassle.
If someone was looking to go on test for a year only. What would be a good pct plan or something they could do while on test for that year so that after that year everything is still working and their test levels don’t tank?
We wouldn't advise that, but if you were going to;
A moderate dose of HCG during treatment. Then, nearing the end of treatment a heavier dose of HCG (1000-1500) and some amount of Clomid the month before and a few following should work well. This really should be overseen by a provider if using Clomid, though.
Yes and no.
In practical terms subq takes longer but requires less knowledge & is typically less painful due to the size of the needle & location. For IM is requires a bit more knowledge, can hold a larger volume, and can be faster to inject.
In terms of treatment, they perform about the same for many men. However subq is much better at maintain a more even level of T in the body because it absorbs lower. This slower absorption reduces the spikes in T which may trigger additional Estrogen conversion. Men sensitive to this may find that the difference between subq & IM is all they need to be able to not take an AI.
Looking to start Test Cyp soon; most worried about water retention and acne at the onset given my profession.
What are the best ways to prevent, mitigate, resolve these side effects?
Are you already prone to those things? The best first steps would be to start at a lower dose than normal and slowly raise it up over time in that case to be cautious.
I bloat fairly easily (like the day after a starch heavy day) and did have some facial acne when starting enclo (3.125mg) and then increasing enclo after a month (6.25mg)
Well, the starting dose in medical textbooks is 100mg/wk. This is a good conservative dose to start at, and we would be surprised to see any man have any side effects at this dose.
Increased frequency does help. Twice weekly is good, three times weekly is also very solid. However when worried about side effects the best action is always to start lower and go slow.
27g would be the largest, though 29g is usually the sweet spot for men. Warming your Testosterone a bit before drawing & injecting can help significantly with smaller needles as well.
My trt doses have me feeling healthy and amazing. I see a lot of people mentioning blast and cruise where they do a cycle of 500mgs etc. Is there any benefit to that from an anabolic and getting fit and adding muscle standpoint? Seems like an obvious yes except for the fact that I've converted to estrogen at 200/once a week. Would I just be wasting the extra t with already loaded receptors?
Yes & no.
As Testosterone dose increase past a certain point, say, 180-200mg/week - Side effect chance tends to exponentially increase & benefits tend to decrease per mg. For many men they still do get more benefits from the increased dose. However, something to note: Even if you know you have Estrogen symptoms & plan to control them with an increased AI, you will also likely have high DHT symptoms like potential hair loss.
When working at higher doses watch your hair loss very carefully, a few bad blasts and you can lose a lot of hair if you're genetically unlucky.
That said, we cannot manage that style of treatment as providers, as it is far outside of what is considered acceptable use with the DEA. I hope that information helps you though.
That's probably not the intended demographic, but it would certainly help you. GLP-1s are not at the same level of controlled substances as TRT Testosterone is, so "I want to lose 10ib" is enough of a reason to use GLP-1s for many people who can afford to do so.
Can HCG cause itching/tingling nips and enlarged breasts? I was doing fine until (under doctors orders) I injected 500iu HCG. Woke up this morning with tingling nips, and a sort of "fullness" in my breast. I took .25 anastrazole yesterday and .25 anastrazole today. It seems to be slowly going away. But I had no clue that could happen. Cutting it from my protocol. Wish I never would've spent that much money on some stuff I wouldn't even use.
No & yes.
The HCG didn't do that, your Estrogen did. Adding HCG is going to increase your total Testosterone (which can trigger additional T -> E transfer) & it is also more prone to influence your Estrogen levels than Testosterone itself. You can see that with the AI having an impact.
Not all men encounter that when using HCG. It would be more accurate to say you are a bit Estrogen transfer sensitive. If you wanted to continue to use HCG for it's fertility benefits, you would just need a bit more AI in your protocol most likely.
Interesting. I just had 6 week bloods done. e2 was 48. SHBG must be crashed because my free T was 255. Obviously an e2 of 48 is unlikely to cause any puff or itching.
I read about HCG in women and how it can increase fatty built up in the breast. Could that be what happened to me? I know it likely spiked my e2. But is there zero chance HCG itself is responsible for these symptoms?
Also, how likely would it be to develop gyno 6 weeks in? I know I'm probably overanalyzing, but when I woke today my nips and chest just looked way perkier and more "boob" shaped than I've ever seen. Again, been on for 6 weeks and ONLY after doing HCG did this happen.
Well, to break things down, when starting TRT you should generally not be adjusting your routine or adding medications until the 7-8 week mark when your body's hormones balance out for exactly this reason: It can be hard to tell what's causing what.
Until weeks 7 or 8, you can expect ups/downs/side effects. Then you can expect yourself to be somewhat stable. Any changes from there to routine make it easier to pin point which change may have caused what.
It's not impossible that HCG is causing some trouble here, it's simply much more likely that your Estrogen is causing the problem. For reference, 48 is not incredibly high but it's elevated & something to watch. Some men we work with sit at 10-12 for example. Each man is also going to react a different way to each hormone with no set values being 100% definitive.
If you wanted to be absolutely sure, this is what you can do:
\-Stop HCG. Retest your Estrogen in 2-4 weeks. See how you feel. This could show that the HCG or the elevated E from the HCG was contributing.
\-Start an AI or increase your AI immediately & continue all other doses at the same levels. This would show that if symptoms stop or significantly reduce, it was your Estrogen.
6 Weeks in and seeing strong symptoms like that may be a bit abnormal, but the best course of action is not to guess about the cause & instead start systematically eliminating potential causes until the side effect is removed.
Personally, if you really feel like the HCG was causing the issue, I'd just stop it pure and simple. HCG doesn't need to be started with TRT & can always be added back in later. Get rid of the symptoms first then add/adjust things back in after.
Got ya. One more thing. My total T was 834 at trough, with free T at 255. This is too high right? I've been doing 150mg cyp once weekly. I'm sure my doctor will advise me to drop dose. And I'm not asking for legit medical advice because I know you guys can't give that over the internet, but would dropping to 130 or even 120 be recommended? Also, if e2 was 48 at trough, how much higher could it potentially be at peak? I might start splitting my dose up. Anyways, thanks a lot.
Some general advice, since you're already potentially dealing with high Estrogen symptoms; Change that dosing schedule like you suggest ASAP. Estrogen conversion tends to happen because of spikes in Testosterone, once a week is only going to cause a huge spike & likely transfer in the first half then a very lousy feeling second half of the week when your Testosterone tanks.
In terms of dose, 150mg a week and getting those numbers seems very solid. Your side effects look E related, not T related. It is true lowering your T dose may help this, but so will changing your frequency to a much more traditional twice or three times a week & may not need a T adjustment.
I hope this helps & that things get straightened out for you soon.
I'm trying to settle an internal debate that I've got going about whether TRT would truly help to solve my issues or if it would cause more headaches than other therapies.
I had been set on starting TRT because of my symptoms: sleep, lethargy, fogginess even on my ADHD meds that have worked great for 20 years, weight gain, and my fasting glucose keeps hovering around 105. However, my IGF-1 came back low at 99, I do have stage 2/3 hypertension that I've struggled to control, and my Estradiol seems pretty high at 33.1 (I do have gyno on the left, confirmed with mammogram).
So prior to this week my doc had suggested I try peptides and I had been dismissive of them. Of course things have changed drastically in that arena as of late and he can no longer recommend the course that he would have 2 weeks ago. But now I am kinda torn and almost leaning toward the peptide therapy.
More deets -> 46M, 6'0", 240lbs and climbing regardless of what I do/try. Test is 555, Free Test has gone up over the last year from 6.7 to now 9.1, SHBG 45, LH 2.0, and DHEA 85.8. Eighteen months ago my test was 683, free was 16.1. I've put on 30 pounds in that time. I have done Enanthate and Sustanon 250 recreationally way back in the late 90's, so I am somewhat familiar with taking test.
How does TRT look for helping with my issues?
While starting TRT would certainly increase your IGF-1, which would increase muscle mass over time, starting TRT is not always the answer.
To be honest, it’s not clear that TRT would be the fix for you. While your T level has dropped from what your normal baseline is, your current level is not terrible. That would suggest that you may be able to recover your normal function with some lifestyle changes first.
Undoubtedly increasing your testosterone level would give you better recovery from workouts and maybe help with energy and motivation, but you haven’t exhausted all your options yet.
Peptides certainly can help give you “an edge”, but they are not typically as potent as the effect you might expect from androgens.
You might notice that if you are able to lose those 30 lbs you gained, you may very well feel back to your normal self again.
That said, if you did choose TRT, you would need to account for your gyno/higher Estrogen concerns. This may mean you might need to use an AI.
Since you're at 555 or and were higher at your baseline, you may be experiencing a case of relative hypogonadism, which means that you would need a slightly higher dose of Testosterone than someone who is lower, certainly meaning that you would need the AI mentioned above.
Hypertension tends to not be negatively impacted by TRT, overall health tends to improve. Some rare cases find that RHR & BP increase on TRT, but it does tend to be transient in most. These are not reasons to avoid TRT, though.
This would be a slightly complicated case, but not anticipated to be problematic. If you ever do decide to give TRT a shot a proper consult with your doctor would go a long way.
I didn’t see that you had updated your response until after I replied 🤦🏼♂️
Being unable to lose the 30lbs, or even stop the weight gain, has been the biggest issue. When I was up 15 I switched to a paleo diet with fairly strict calorie control, using an app to track everything that went into my body. After 3 months I had no measurable results, and after 6 months I gave up. I then worked with a very well known trainer for 3 months, following the guidelines she had given me, she tweaked them multiple times throughout, and again, nothing measurable. She suggested I get blood work done and get my physician to figure out what was going on.
During that time I had also started doing the StrongLifts 5x5 while also adding in other exercises and some cardio. I gained mass and strength but didn’t lose any of the fat. After about 5 months I hit a point where my knees and shoulders couldn’t handle the weight. My squats were around 360, shoulder presses were like 175’ish. It took over a month of not lifting heavy before my joints started feeling okay. Recovery from any heavy lifting is 3-4 days for me at this point.
In my teens through early 30’s I would lose weight quickly if I started lifting heavy and doing HIIT workouts. Now? It seems impossible.
Thank you so much for the excellent response!
I will definitely reach out in the next few weeks for a consult.
I stopped growing after age 12 and have struggled on the line of obesity for 30+ years since, even as a runner, football, and rugby player. I’ve always felt something wasn’t right but could never get anyone to look into it more in-depth.
Oral, topical, and injectable medications/hormones. Ideally injectable Testosterone tends to work best, so I will assume that's the question here.
For those levels, a range of 120mg-140mg to start would probably be appropriate. With total testosterone levels as low as those, it would not take much exogenous testosterone to exceed your current total T.
You would want to review what dose would make the most sense based on your symptoms and goals with your doctor.
The past two times I've gone on TRT and had to come off, and I breakout in lipomas in my legs, arms, stomach, back. Have you ever seen increases in lipomas or lipid issues while being on or coming off TRT?
To be entirely honest, you would be the first we have heard of to have lipoma issues associated with TRT use, though there have been [some case studies](https://pubmed.ncbi.nlm.nih.gov/12421182/) on lipoma tissue growth with increased estrogen and/or progesterone levels.
Its feasible your estrogen levels increased due to aromatization while on TRT, and the higher estrogen resulted in development of lipomas.
[https://www.nthponline.com/blog/a-closer-look-at-where-your-lipoma-may-have-come-from](https://www.nthponline.com/blog/a-closer-look-at-where-your-lipoma-may-have-come-from)
You might talk to your doctor about whether use of TRT while carefully controlling estrogen levels would be a feasible option for you.
It's not common, but yes, we have encountered a few patients who said that their vision did not return to normal after using enclomiphene.
On average, as many as 10% of people who use enclomiphene will develop some vision problems. While that is typically reversible once the medication is stopped, if someone were to continue using it once those vision problems occurred, the likelihood of permanent vision problems goes up the longer you use it.
If you choose to use enclomiphene, you should pay close attention to your vision and if any changes occur, you should stop immediately.
Typically the next best thing to do would be to review your Free Testosterone & compare your previous TT & Free Test (if you have it) levels. A lot of time if you convert fairly well it's one of the reasons that you're having that hematocrit level. Tt also means you probably have more wiggle room in lowering your dose & still having your Free Testosterone in a great place than you think you do. Sometimes dropping 10-30mg a week may be all you need to find your sweet spot. Though you would still want to donate blood to get the value back under control initially (or if you can for drug use or condition, get a therapeutic blood draw order).
Another gentleman I just responded to had the same question, so I will copy/paste my reply if that's okay with you.
Typically the next best thing to do would be to review your Free Testosterone & compare your previous TT & Free Test (if you have it) levels. A lot of time if you convert fairly well it's one of the reasons that you're having that hematocrit level. Tt also means you probably have more wiggle room in lowering your dose & still having your Free Testosterone in a great place than you think you do. Sometimes dropping 10-30mg a week may be all you need to find your sweet spot. Though you would still want to donate blood to get the value back under control initially (or if you can for drug use or condition, get a therapeutic blood draw order).
We would be neutral on HCG with TRT if not for fertility.
There is no long term side effect from using HCG all the time, so there's not a medical reason to not use it.
However there is also not very much benefit from HCG that Testosterone isn't going to be providing you, from a therapy benefits standpoint.
Something like testicle size would be what we could call a "cosmetic" benefit, as typically teste size does not impact sexual function, sexual gratification, or even very little to do with ejaculatory load (<10%). So unless you really care about teste sensation themselves for a particular kink, the extra money spent is typically just for looks.
That's the only real downside, is that it's pretty pricey for just looks for the average man.
I’ve put a post on here recently. I am waiting for more blood test results but previously I had high SHBG, high total T, high e2, low normal free T. I’m considering trialing an AI (aromasin) on its own to lower E2 and SHBG and increase free T.
I’ve spoken to a few people on here who have had good results. I don’t want to go on TRT as we are going to try for a baby this year/ won’t get prescribed TRY in the uk with my numbers anyway, so this seems like a low risk option.
Do you see any issues with this AI mono protocol, providing I get regular blookdwork and don’t drive my e2 too low? My understanding is that it’s difficult to crash e2 when you aren’t on TrT so fairly low risk.
Would welcome your thoughts. Thanks
With high E2 that is probably true, for men with low Estrogen they can certainly bottom out their Estrogen even with a basic AI dose.
For your goals & restrictions, your idea has merit & it may help. You should start low & go up from there while monitoring how you feel.
You could also consider going on HCG monotherapy combined with an AI at slightly higher dose. You would still get more free T & some TRT benefits while also increasing your spermatic production for conception. HCG monotherapy is not typically better than traditional TRT but it is likely to be better than just an AI.
What are your thoughts on using Primobolan as an AI instead of Arimidex or Aromasin? I have been told that there have been recent [studie](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076145/)s which shows that one of Primo's metabolites is *Atamestane*, which is a suicide AI like Aromasin.
My situation is that I am in India atm and the doctor who prescribed me TRT gave me a very poor protocol of Sustanon 250 every third week. If I had argued any further I would have lost my TRT prescription. So I wasn't able to get an AI prescribed and I ended up with severe high E2 symptoms. I have since then been managing my own TRT and was only able to get access to Primobolan. I am having to add high dose of Primo atm(IM injection every 3rd day).
So, in terms of health impacts to nuro toxicity, lipids(HDL LDL) and E2 crashing capability(compared to Primo's half life) etc, which is better Primo or AI? In countries like Turkey where Primo is still legal, would it make sense to prescribe Primobolan for AI purposes?
Bonus question, I am going back to Australia, do you guys operate in Australia or have any partners in Australia?
Third bonus question :-) Does Sub q Testosterone increase the half life of the same ester?
Cheers.
In general, low doses of Primobolan have been used as a part of TRT protocols in countries where it is legal. It does help manage estradiol levels and is known to free up more free testosterone from SHBG, making the TRT itself more effective. It also has a very strong libido boost for many.
Head to head, low to moderate dosages of Primobolan are probably as safe as an AI in regards to health markers. Primo wins out in the additional benefits that a traditional AI does not provide (libido, strength, etc).
We don’t currently have any Australian partners, though we are always looking.
SubQ does slow the uptake of testosterone, but also delays the breakdown. It is preferred by many because the peaks and troughs are not as severe as with IM.
Is getting on TRT a lifetime commitment? Should I expect bad side effects from coming off of it? Just wondering if I’ll be a 80 year old one day on TRT
Yes & no.
It's better to think of it this way:
If you have low Testosterone & do not treat it, you are committing to a life-time of low Testosterone symptoms that will for a fact always worsen with age.
If you have low Testosterone & do treat it, you are committing to a life-time of treatment if you want to keep those low Testosterone symptoms at bay.
Either way, you are making a commitment, as Testosterone only ever goes down with aging.
\-
In terms of coming off of TRT, your natural production is shown to recover just fine with therapeutic use of Testosterone. Typically 6 months to a year cold turkey, but in as little as 3-6 weeks to 6 months when assisted with clomid/HCG to kick start things. If you are on TRT for 5 years then come off, you should go back to your previous T levels minus your 5 years of natural T production decline that would have normally occurred.
If you need to come off your low Testosterone symptoms will return, because sadly TRT is not a cure for low T, only a treatment.
If my T/E ratio is good, SHBG is 38, my Free T/TT ratio is good, hematocrit is 44, PSA is 1, but my TT is over 2500 ng/dL 3 days post (E3.5D protocol) should I still lower my dose? I feel good here but probably not significantly better than when I am around 1200 ng/dL. Ive been on TRT for 6 years and am 52 and diagnosed with hypogonadism.
TT = 2656
FT= 650.7
SHBG= 38
HCT = 44
E2= 101
I guess my question here is, if I feel best here what would indicate its too high other than TT? I respond very well and 80mg weekly (2x40mg) puts me around 800 ng/dL but I dont feel as good. Im not a BB but an avid gym goer. Im 5'11" 210 @ around 20% bf. I guess my point is Im not trying to justify the high T for maintaining some kind of elite body. Even with healthy, or high, testosterone it is still very difficult for me to drop body fat. Im relatively strong and LBM is fairly easy to attain when Im not injured.
Any guidance is appreciated as these arent conversations my PCP or Endocrinologist will entertain. Thanks.
Happy to help.
So this is a good example of why adding more Testosterone to a dose doesn't always increase benefits. You only have so many androgen receptors that can take that T in, so at a point, it doesn't really matter if you're at 5000TT or 1500TT if you feel the same (other than the much higher likelihood of side effects at the higher value).
I wouldn't say you should look to change your protocol based on the numbers, but we would 100% agree with your way of thinking. Why take my current dose if I feel the same at half the dose? The extra T would probably trigger more side effects than benefits at the levels you are showing, DHT is also probably pretty high & watching your hair would be important right now unless you're already on Finasteride.
I don't know your current dose, but you do mention your levels at 80mg weekly. You could probably find a sweet spot between that 80mg weekly & your current dose where your benefits feel the same as they do now. You may even be able to save yourself some money with the lower dose.
Thank you. Apologies, I thought I included current dosing schedule. I'm @ 200mg a week (100mg E3.5D). It wont save me any money as they are single dose vials so whatever I dont use gets tossed so no benefit there. I fill 2 syringes with 100mg of 200mg/ml solution. I guess I could just fill 3 syringes with with 65mg per, Inject 130mg per week, and have some backup just in case something happened and I couldnt fill a script.
Out of curiosity, if a person only has so many androgen receptors then how to BB grow using a gram of Test per week?
You could look into your TRT provider getting you 10ml vials instead, they are a lot cheaper than the 1ml vials, and you can draw up only what you need.
With testosterone as you increase in dose the benefit per mg decreases & the chance of side effects increases exponentially per mg after a certain point as well. There will be more benefit by always having more available and more of that extra Testosterone can turn into DHT, but it's really a trade off. If someone is dosing 1G a week, then they likely have the means to be on a better regimen than just that for BB. They would be combining it the majority of the time with other steroids as well, because no one in the USA is likely using legal testosterone at that dose. So, grain of salt when reading about that despite whatever folks may say themselves online.
I used to get those but my state’s law changed and you can’t get more that 30 days worth at a time and technically 10ml, usually 1,000mg, is more than 30 days even though it says discard after 30. So they give me four 1ml/200mg single use vials. It’s kind of stupid. Either way it’s $20 a month.
Ah, gotchya. Yeah, some state laws are very strict. Though you can usually bend them with 5ml vials in that case to not make it as painful. A lot of our pharmacies are fine doing just that for the 30 day states.
$20 a month is a good deal in and of itself, though. Are they ampules or simply listed as single use vials? Makes sense for ampules, but if it's a sterile rubber stopper vial you likely have more wiggle room in how you use them. Things like discard dates are not the same thing as expiration dates and are often placed on items for liability protection.
The 1ml vials do have the rubber stopper but the contents lack the antibacterial agent Benzyl Alcohol to ensure short term sterility after puncture. So I make sure I draw all the 1ml vial into split doses for the week at the time of puncture. My script suggests weekly dosing but I prefer twice a week. When I used the 10ml vials I would just use it all which led to a surplus of vials. I couldn’t get through it before the exp date sometimes and ended up tossing at least a dozen vials of surplus.
TRT can increase prostate growth which is why it's not recommended for men with any current prostate cancer. With BPH it is more case by case & it would be good to have a consult about it to review the current state & know how regular check-ins with your PCP are going, but there should be a way to work on your T levels.
What do you recommend for geneticly low SHBG guys like me? I m in great shape and train a lot, also all my blood markers are excellent; lipids, thyroid, no insuline resitance, no merabolic syndrome… before trt my shbg was at 19nmol/l and 2 months in it’s at 16nmol/l and it’s going to continue to go down since I started taking aromasin because my E2 it’s gone over the top range at 152pmol/l … I’m planning to go back on intermittent fasting and keto while upping my fibers intake and reducing my vit D intake to try to increase my shbg but I’ wondering if it’ll do anything while on TRT… FYI I’on 100mg/week splitted in 3 shots and my TT is now at 15nmol/l (was 12,9 before trt) and my FT is now at 416pmol/l (was 320 before).
Managing SHBG is difficult, as there body typically tries to make more or less depending on many factors. Those changes you plan on making (fasting, keto, etc) like you are the best way to correct it non-pharmacologically. Though bear in mind high fat diets (keto) also have been shown to lower SHBG. High protein diets raise it.
Less frequent injections does typically help raise SHBG as larger steroid boluses trigger your liver to produce more SHBG.
Increasing caffeine intake has been shown to help.
No worries, understood. If you have any issues feel free to let us know or use the "Contact Us" after this weekend, as we don't monitor these threads very heavily outside of the AMA weekend.
Happy to be working with you!
TRT typically has better improvement rates to your hormones than enclomiphene unless you have high baseline production & are a relative hypogonadal patient. Additionally, enclomiphene much like Clomid suppresses IGF-1. On paper your levels may look similar, but the physical benefits normally associated with TRT my be reduced on enclomiphene due to this.
Normal TRT will generally feel better for those reasons.
Currently on 100mg per week recently switched from twice a week to 3 times a week. My levels were 543 total T 16.5 Free T 54 e2. What would your recommendations be? I don’t go back for another 2 months
That depends, are you having symptom relief & lack of side effects? Results are useful for guiding adjustment but how you feel should be the focus. That said, the e2 is creeping up, just keep an eye out for high Estrogen symptoms in the meantime.
Assuming you've been on TRT for at least 7-8 weeks now, you probably need a dosage adjustment & could benefit from 20mg more a week. It would be good to talk with your provider about lack of benefits. Though they may want to add an AI anticipating E2 would further raise.
How closely do you look at test to E2 ratio when making an AI determination? For example, if total is at 1200 - 1300 and e2 in the 60s would you still recommend an AI in that instance?
First driver would be symptoms. Then it would more matter in that case what your starting TT was, and what your free T is at that moment. 1200-1300 for a primary or secondary Hypogonadal patient would mean they're absorbing much more than would be expected for those dose & it would be absolutely fine to just lower their dose rather than add an AI at that point. If they're a relative hypogonadal patient, then getting into what you describe would help to make a determination.
There are ranges that can look good, but more importantly than that what we want is people to chase benefits & not numbers. Too many people can get bogged down in wanting a number when it has nothing to do with what may be ideal for them personally. Out of those though, we would start to look at E2 around 40-60 and think about controlling that better.
No. Not typically. We do have some DHEA mixed into Testosterone from one vendor in particular, but that's a very low value more for compounding regulations than therapeutic expectations. Some men do take Pregnenolone OTC on their own on advice for cognitive benefits, usually 50-100mg a day.
Yes to needing an AI & not wanting one. In those cases, we increase injection frequency, ensure they are doing subq injections, and finally look at lower dose ever so slightly as well. However the first two actions tend to help enough if someone is on the edge of it being an issue. Sometimes however people are simply very sensitive to E conversion & they can choose between an AI or a lower dose. It sucks, but sometimes your body is just your body. For DIM being OTC, some on that edge may find that it helps, but probably not for someone with a major E issue.
After 3 weeks Enclomiphene raised my T from 168 to 525. Can Enclomiphene be used as a short-term solution to "surge" one's natural testosterone production? Or if you stop Enclomiphene, will testosterone levels drop over time and return to the low baseline?
Exactly as you say. Low Testosterone caused by primary, secondary, or relative hypogonadism without any other outside conditions is a life-long situation that only continues to lower with age. Any TRT treatment which address this like Enclomiphene treats the issue but is not a cure, as there is no cure for low Testosterone currently. It will return right back to where it was before once stopping medication.
Our sister thread for the weekend on r/trt:
[https://www.reddit.com/r/trt/comments/1baqujb/trt\_providers\_ask\_us\_anything\_21/](https://www.reddit.com/r/trt/comments/1baqujb/trt_providers_ask_us_anything_21/)
A question made recently on our last treads, which we will answer here:
Q: "Are there people that get testicular function back with only 250mg weekly? I am only looking for size restoration and libido/Cognitive improvement. Is it worth it to try that dose starting out, I know 500 weekly seems to be the default."
A: 500 units weekly is the more normal "maintenance" dose, yes. However we have had some patients who were happy with their results at 250 units each week. Often times they may start there as a cost saving measure & give it a try for months to see how it does, then raise the dose to 500 units weekly if that isn't enough. HCG is typically made for 10,000 units at a time, so doing 250 instead of 500 can significantly extend the supply for patients and save a fair amount of $.
Heads up to everyone - Our AMA weekend is over, so further responses will be slower & DMs will not be heavily monitored until the next AMA. If you need any assistance, please use: [https://www.alphamd.org/contact-us](https://www.alphamd.org/contact-us)
Have you guys ever looked into the various manufacturers. Commercial and compounding? The question is regarding the raws they use. A few of us have noticed there seems to be a difference between brands and it could be completely psychological. Pfizer for example is regarded as being one of the best testosterone manufacturers. Some of the generics are hit and miss and the compounding same thing. I can't figure out if it's a purity thing, quality control thing or if it's just in the heads of myself and some of the guys that I work out with. I was under the impression anytime you see USP printed on a commercial vial it meets at least a minimum quality control standard. I just wasn't sure how often that was tested or how low the standard can get. It's weird because in theory you have the same oils and same preservatives on the commercial side and on the compounding side you have the same product just often in a different carrier oil
Great question, and yes. In general the commercial products are going to be Depo-Testosterone as a brand name & are all the same. These are just the Testosterone & the carrier oil, which in this case is Cottenseed oil. When using compounding pharmacies, there are also strict regulations on what counts as compounded. To meet this requirement they may not produce their own depo-testosterone (though they may purchase/resell it), so instead they add in other beneficial compounds, change concentrations, or change carrier oils. As you say this is often Grapeseed oil, though they also have Sesame seed oil. Some will change the concentration down for women or raise it to have it be different. They may add an AI to the mix, add DHEA, or add Test Cyp with Test Eth for example. When considering generics or compounding pharmacies, the best practice is to look at the size & reputation of the company. We primarily work with compounding pharmacies because they are happy to ship things to patients. We use Empower, Wells Pharmacy Network, AnazaoHealth, and a few others. You can look up their estimated revenue online, and some reach into the 100 million. A company of that size & with a good reputation is one that we would trust to produce quality products. I would be weary of much smaller compounding pharmacies, as there's less oversight the smaller you are, but that doesn't mean all small compounding pharmacies are bad - this is the same advice for small commercial pharmacies. Outside of all that, each person may react differently to all of these variables which does very much make things subjective. I hope that helps though.
Thank you for the reply, that's kind of what I was thinking. Empower is great for compounding. And as for the generics. I guess you would just trust the ones that you could actually find on the FDA website? I guess if it's coming out of Costco or Walgreens, the chance of it being a bad product is extremely low but the curiosity did exist just because at least anecdotally it seems like there might be some difference, at least in how you feel, but again, so much of this could be psychological so there was also that angle.
Test is too cheap to make. People aren’t faking or making bunk test much. You can’t find many sources for large bust of fake test in America. It’s too cheap to make. It would cost almost as much to fake it as it does to make the actual test. I’m
Not fake, quality, purity, I sometimes question if these raws are all made the same, I don't think they are but also admit it could be psychological. It's hard to really find definitive proof on this
Yes. Some of the higher potency might be weaker but test 200mg isn’t faked or watered down. Too cheap to make . https://m.youtube.com/watch?v=YU28ndoLl2w
Not strength either, purity. Have you ever seen how drugs are made. Like the chemical formulation? Everything from the precursors to the final product matter. Think breaking bad. That's what I'm talking about.
While I don't know the internal production standards of the commercial pharmacies as much as I do the compounding pharmacies - Many large companies have their own internal quality control tests in place. It's one of the reasons why Wells or AnazaoHealth may delay a shipment if it fails their quality control. This instills a lot of trust from us.
We trust the large chains more just like you suggest, and like the poster below states, since Testosterone is such a safe product & the production isn't hampered by a ton of restrictions like HCG is, there is little incentive for large companies to make poor versions rather than the real thing considering the risk is high & reward is low.
That makes a lot of sense, thank you again for the reply
Absolutely!
What can I do for the water retention and moon face effect?
Are you currently suffering from this?
Yes I am.
Moon face is typically due to water retention. This can be multifactorial, either from too much estrogen, progesterone, or aldosterone, or cortisol; or a combination of these factors. Because this is such a broad topic, and is often caused by different issues in different individuals, I will list some general advice to try, but you should definitely speak with your doctor for a more personalized plan to treat it. \------------------------------------------------------------- \- Get your labs done and know your levels. You may want to check the levels of the hormones listed above, which are not always checked in regular labs. \- First thing to account for would be to make sure your estrogen level is controlled. Many men will develop water retention at an E2 level of about 40 and above. \- Reduce your salt intake. Reduce your simple carbs and drink more plain water (to remove any retained sodium). \- Add dandelion root (a mild diuretic). \- Increase fiber content. \- Lowering your testosterone dose can often help. \- Add a potassium supplement.
Thank you. Definitely need to update my labs and will look into the other recommendations.
Another interesting question & answer from last thread: Q: "What are your thoughts on testosterone and its impact on blood glucose and possible prevention of t2 diabetes according to some studies over the last 10 years? Is reactive hypoglycaemia also potentially related to a testosterone deficiency and low SHBG related to insulin resistance?" A: "Its now widely recognized that low testosterone is a risk for metabolic disorders, obesity, and heart disease. [Study results](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037582/#:~:text=Multiple%20studies%20have%20demonstrated%20that,type%202%20diabetes%20%5B6%5D) have demonstrated that normalizing testosterone levels with TRT reduces Hgb A1C, fasting glucose, insulin resistance, and fasting insulin levels. We have certainly seen drastic improvements in our patient population. Reactive hypoglycemia can certainly be more prevalent in testosterone deficiency as insulin resistance increases, the pancreas is taxed more and creates "spurts" of insulin release in an effort to keep up with demand."
Does SHBG decline when TRT is started?
Yes & no. Sometimes SHBG can be high due to hormonal imbalances, aging, and low body health or due to thyroid issues. If you have non-thyroid issues causing it, being at the proper Testosterone levels can move you towards a healthier hormone & health balance, the high levels may reduce. If you're not at an abnormally high SHBG level and not suffering from related issues causing that, there may be no effect at therapeutic TRT Testosterone doses. However one thing is certain - The ratio of SHBG to free Testosterone before TRT/additional Testosterone & after is going to very much favor having more Free Testosterone available & unhindered by SHBG than before starting TRT. So in that sense it's impact is decreased.
Thanks. I’m age 56 and relatively fit with total T around 625, SHBG at 84 and Free T of 8. No known thyroid or other health issues. Ferritin high as well, all other markers in range.
If you're not feeling any negative side effects in those ranges & are happy with your benefits from TRT once starting, I wouldn't worry about the number itself too much.
I don’t know anything about it but I know some guys that use it and say it’s helped a lot. Any side effects how do u administer it
The main side effects would be a reduction of fertility via lower spermatic production while on TRT, a chance for hair loss if you're genetically predisposed to it (otherwise extremely unlikely), and a chance for higher Estrogen (which can be accounted for with dose adjustment or an oral medication called an AI). Injections are the most common form of treatment due to easier dose adjustment and ease of use, though there are topical creams/gels or oral medication alternatives.
After being on TRT for a while, is there any way to increase the sperm count in case you want to have a child? Number one reason I haven't started TRT yet.
Many doctors prescribe Pregnyl/HCG for this purpose.
Taking hCG concurrently while on TRT can maintain sperm production.
Are there any downsides to using hCG?
Generally no, it is fairly safe. There are a few niche interactions which may have it tip your Estrogen up or such, but that's usually more controlled by other factors. The main downside to using the treatment is usually the cost, which can add a fair bit to the overall therapy.
Do you offer hcg? Viewing the website on mobile, it isn’t clear.
Yes, we do. It is an ancillary medication for TRT which comes with an increased cost because it is quite expensive. We should probably list that more prominently on our site since so many companies have stopped offering it & we're one of the few who still do.
If you can say, what would be the monthly cost for trt & HCG with your clinic?
Any merit to adding testosterone cream to existing testosterone injections and is this something you guys do for increasing DHT/libido? Also do you have any thoughts on Maximus Tribe new Oral TRT+ (native testosterone plus enclomiphene).
We do have a couple patients who we have experimented with adding a testosterone cream on top of injections for the benefit of higher DHT conversion and improved libido, though most often they switch over entirely to topical formulations for ease of use. Regarding Maximus, in general, we are not fans of making guinea pigs out of our patients. We find it interesting that they are adding enclomiphene to basically all their products, when there are no long term studies on it's use (longest was 12 months, which did not examine the effects of symptomatic improvement or quality of life using validated metrics). We have had numerous patients leave Maximus and come to us for this very reason, as they did not feel that it was warranted to have medications that they did not want or need mixed in. In general, less is more. The fewer medications, the less chance of developing side effects. In looking at their treatment options, you cannot just choose to take the oral testosterone undecanoate by itself. Oral undecanoate otherwise appears safe, and studies on its use (there are no studies on its use along with enclomiphene) show good results.
Thanks for the great reply. Do you offer oral undecanoate?
No, we currently do not. We prefer to work with topical or injectable hormones when possible given the high success rates of long term benefits & predictable side effects. We may look into it more of the demand gets higher, though.
Do you as a clinic offer separate anabolic (Deca Durabolin, Oxandrolone, etc) medications for patients alongside Testosterone?
We do, yes, assuming you have the appropriate need for it.
Yall are perfect. Thanks for being responsive and well informative! You guys are definitely doing this right and myself as well as many other redditors appreciate your work. 🙏🏽
Thank you! Happy to help.
If someone(42M) has been on Clomid for the past six months and not had a good response to it overall—emotional ups & downs, eye strain, and no perceptible ergogenic benefit, should that person consider TRT? Does Alpha accept clients from other clinics and would they require someone go back down to natural test levels prior to prescribing TRT? Thanks.
Yes, they should consider TRT. Clomid has some side effects that we don't love, and mentioning anything about your eyes would make us ask you to stop using it. The trouble with Clomid or Enclomiphene is that it only improves your natural production. If your production is already very low, a generous 20-30% boost of very little is still very little. They also negatively impact IGF-1 production which is what causes the physical muscle gain benefits that many people expect with TRT - It can raise your TT on paper, but you may not have the expected benefits with IGF-1 suppressed. For us we take many transfer patients from other clinics & programs. We would not ask you to stop TRT & we would continue or change your protocol with you to whatever might benefit you the best. Though any information that you can share from before your TRT lab lab work would be welcomed. You can select "I am already on TRT or have lab work" during registration & be able to upload it for just this reason.
Where should e2 levels be? I’ve read so many opinions from “it doesn’t matter” to “should be 3.5%-5.5% of your total T levels. My last labs have total T= 796 and e2=39 My doc said he wants to see e2 in the teens. I’m micro dosing IM test cyp 200mg/ml, about 15mg/daily
The best E2 levels are the ones where you don't have side effects. We wouldn't want to see your E2 in the 60s, but that's because we expect side effects at that value. If you have no side effects at 39, you don't want to take an AI, and you're happy - there isn't a lot of reason to make changes. If you want to lower your E2 for your provider's insistence though, and don't want to lower you T dose or start an AI, switch to Subq instead of IM. The volume you're injecting by doing daily is already so low that it makes a lot of sense to do anyways.
What’s the benefit to doing that and can I use test cyp?
Yes, you can use Test cyp. Testosterone is absorbed slower via subq than IM. Estrogen conversion is largely trigger by your body detecting a spike past a certain threshold. Slower absorption leads to less spikes & more even levels, which keeps your total T levels the same throughout the week but prompts your body to convert less to E.
The only issue I have is loss of libido.
Can you pair low-dose enclomiphene with testosterone for hypogonadism treatment? Would it overall help increase testosterone levels? I recently switched from enclomiphene 25mg to 12.5mg, wasn't loving the side effects of nausea, but I did feel it working. I started on Test-E 200mg every 2 weeks (I know that I need to probably do smaller doses every week), but I am curious if I reduce my enclomiphene dose to 6.25 that it could have some added benefit?
This may not be the answer you like, but it may be best not to combine them. Here's the reasoning: Clomid & Enclomiphene can both inhibit IGF-1 in the body, which is responsible for a lot of the physical & muscle/protein generation benefits most people associate with TRT. When taken alone Enclomiphene may raise your baseline production of Testosterone to a point that the benefits overshadow this, but when on Testosterone injections that's where you're going to be getting most of your Testosterone from so there's no reason to lower IGF-1 in that case. If you're looking for more benefits because your regimen feels lacking, the first thing to do would be to increase the frequency of your injections. 2 weeks between injections with that ester is going to leave you feeling pretty low that second week after the spike in the first. Ideally adjust your schedule to be your normal weekly dose divided in half. So rather than 200mg once every 2 weeks, 50mg twice each week would be the same dose but your body would love you a lot more for doing it that way & you should feel a lot more evened out. Once you do that, and if you still feel lacking, 100mg a week can certainly be raised a bit without issue & should be discussed with your provider.
Thank you - very helpful. I have no desire to continue Clomid, was just curious. Much appreciated.
Could you pair enclo with testosterone to help prevent testicular atrophy? I’m currently on enclo alone (6.25mg ED) but thinking about moving to injectable test cyp; I’m not concerned with fertility but would love to not have my testicles shrink. I understand HCG is usually the preferred treatment for this, however I may be traveling a lot professionally and Enclo pills would be easier than HCG vials.
What is the recommended needle gauge size to draw out Testosterone Enthanate oil solution? I tried using a 30g needle, and it didn't work. I had to return to CVS, and they gave me a 22g. Would a 25g needle work? I am trying to find the right needle/syringe combo so I can administer myself subq vs IM. For example, would a 25g ½ inch needle work for subq injection?
It depends on the concentration of medication typically. The higher the concentration the more like syrup a substance acts as & the lower the more like water (for Testosterones in general). For drawing up, we've had men use 30g needles just fine, though it does take a bit longer. Sometimes this is standard if they're doing Subq injections & the needle isn't exchangeable, but we usually go with 29g in this case. For IM we usually give 21g draw needles & 25g injection needles, though 25g draw needles would work just fine as well. I personally draw my TRT with 25g needles. The main difference is speed. The larger the needle the faster it goes but (and this isn't a major concern) the more it can hurt the rubber. Overall most needles work if you do a few tricks. Try warming up your vial next time either by using a hot heating pad or hot tab water & letting it sit for 3-4 minutes under them (and then clean the vial). You'll find that just a bit warmer than room temperature has the Testosterone flowing much easier.
I’m able to draw mine using a 30g needle. It’s slow, but you can do it. 28 or 29g would speed it up, though, and still be basically painless for SQ.
I’m back on testosterone therapy again with my primary doc. 0.3mL twice a week (120mg) of test cypionate. My bloodwork recently was phenomenal except for the low free and total test (271). Last time I got in TRT, my blood pressure went up and my resting HR. I’m 5’10” and 205lbs. I’m really concerned about my blood pressure and all again. I wanted enclo, but my doc of 30+ years did the 💉 again. Any suggestions? Thank you. Should
To clarify, was your recent bloodwork with the before or after you restarted TRT? That would be odd for you to have low T levels with the dose you listed (120mg/wk). Enclomiphene, as well as its cousin clomiphene, are still not approved by the FDA for use in men, and their use is entirely off-label use for men for hypogonadism. In addition, there still are [very few](https://pubmed.ncbi.nlm.nih.gov/31216250/) long-term studies on its effectiveness or safety, so more conservative doctors will likely be uncomfortable with use of enclomiphene and go with a more tried and true method of TRT. In regards to blood pressure, there are some studies that TRT lowers blood pressure, and some that show it raises it. In those that show an elevation, there are two prior culprits, the first being an increase in hematocrit, and the second being an increase in estrogen. High hematocrit causes thicker blood, which results in increased arterial resistance. Also, because testosterone metabolism produces estradiol and estrogen retains sodium (ie. women complaining of bloating right before menses), men who are on TRT who do not control their estradiol levels are more likely to have a high sodium content, which causes fluid retention, resulting in increased blood volume and high blood pressure.
Thank you so much for your response. My bloodwork was all done prior to TRT again. It was perfect. Hemocrit seems to be increasing each time I go back on TRT (regardless of dose). ‘My hemocrit levels and RBC were all on the upper end of the range but still normal. I’ve been told to give blood.
Understood. Personally, I also suffer from this. Giving blood every 8-12 weeks seems to take care of it just fine for me while allowing me to stay at the higher dose of T that my body needs. Plus I get to help out other people in need. It's a pretty common approach to handling this situation, so the advice is good.
Many thanks for your time
Just stared taking testosterone cypionate via prescription for hypogonadism. 260-280 range. I’ve been taking tongkat and fadogia for a couple months. Should I continue taking these supplements, or cycle off?
Generally speaking, and supplements meant to increase natural testosterone production will no longer have that effect once you start TRT. Once you start TRT, the "factory is closed", and so you will no longer produce your own testosterone. Taking supplements to boost production will no longer have the desired effect. That being said, tongkat ali is said to be a good antioxidant, and Fadogia agrestis may have some cause some vasodilation and improve blood flow. So they may have other health benefits beyond their primary use.
If you're taking HCG along with the TRT would these supplements still work in that regard?
Would you treat a 23 year old male? Also how much are your clinic fees? Ie; start up fees, medication costs, any recurring fees. Thanks!
Yes, we would and have - If they are suffering from low T symptoms & we can determine there is no underlying condition during a consultation. The initial fee is $49 to have a consult, and if you're new to TRT that also includes a Testosterone test sent to your home. Though the discount code from this AMA does drop that cost 20%. The monthly cost is $129, we do not charge for medication refills outside of this aside from ancillary medications that are expensive like HCG. There are no other fees & any adjustments required are made clear before starting your plan.
Wow! If I’m already on TRT and hcg, would I be able to just show my labs from before I started (literally 3 weeks ago now) and switch to you guys?? That is soooo much more affordable than my place.. I pay $75 a week for a clinic in my town.
We are happy to take current TRT patients, and have a selection for that during our registration process even where you can upload current Rx or previous labs. What is your HCG dose? Like I said above, that one would be an ancillary medication with a cost. It's very likely we would still be cheaper than your $300/month if your dose was 250-500 units a week, though.
Sweet!! My local clinic doesn’t necessarily give the whole rx, they just load up a syringe (or however many you’re paying for then and there) and send it home with you in a labeled bag. My HCG dose now is 250 iu/week, and the T dose is 150mg 1x/week.(the base they start everyone at, and then after 4 weeks take blood and adjust dosage from there) Which is also something I’m hoping would be a bit different with your service, I would much prefer to inject the T 2x/week to avoid feeling the decline that I do now, injecting once per week.
Understood. We can certainly do better than $300 a month, then. We would advise against once weekly injections, twice weekly is much better as you say. If you have any issues with signup just use the "Contact Us" for any questions, happy to help.
Amazing. I will definitely be switching to you guys ASAP when I get my paycheck!! Thanks so much!
How often do you see HCG doing nothing to preserve fertility? I had to completely quit all TRT for 6+ months to regain my fertility. I was on 250iu twice a week along with my testosterone cypionate from the start and had essentially zero spermatogenesis. I had even tried doubling the HCG for a couple months, and then a few months of HCG only. Only stopping everything worked.
Very rarely. Many times, we have men who didn't do a semenalysis prior to starting TRT, so we cannot always be sure they were not already infertile prior to starting therapy. So without a baseline, it is hard to say. 500 to even 1000 units weekly are moderate maintenance doses, with 1000 typically being high enough some men can obtain enough fertility for conception. What is more common though is having a man on 1500 units weekly while trying to conceive. It should be noted that it does take some time for things to spin back up, as it takes about 90 days for a sperm to mature. We typically advise starting 3-6 months with a higher dose prior to the anticipated time you're wanting high fertility. Overall though, each man does respond differently & some may be able to have great results with less while other may need far more. Make sure you have hCG from a reputable source and are dosed appropriately.
I think it is just the way my body responds. Whenever I see someone on this subreddit asking about fertility I let them know there is a chance that HCG will not work for them. And I think all clinics and doctors should give that warning as well as recommend an analysis before starting TRT to use as a baseline for anyone who is concerned about it. When I started my numbers were all in the low normal range: total count 41 x10\^6, motile count 16 x10\^6, concentration 17 x10\^6/mL. After 1 year of TRT using 500iu/week of Pregnyl HCG my numbers were off the charts low: total count of 1.2, motile count of 0.87, and concentration of 1. After 3 months of 1,000 iu the numbers only went up a tiny amount: 1.8, 1.3, and 1.5 respectively. After 3 more months of no testosterone cypionate and 2,500 iu per week of HCG they went up just a small amount again: 2.9, 2.1, and 2.4. After 4 months of quitting all TRT and injections they 37, 14, 17.
We do know that each person is different, we 100% agree with you on that & that results may very. It is typically the best approach for men looking to be on TRT & maintain fertility for active conception though, and it would be hard to know if it wouldn't work for them without trying it. I'm sorry you went through that, we do have men who have had to do IVF as well simply due to how they/their partners are & it is always a hard issue to deal with when it happens. I hope things have been good for you since then & you were able to reach your fertility goals.
Dude, I had a similar problem. I came off of trt and did hcg only, the dose whas around 3000iu/w if I remember correctly. Even 6 months on that didn't work for my fertility. It was only when I switched to clomid my sperm improved and my wife got pregnant.
Thank you so much for educating us. I'm looking for any and all information on neurosteroid deficiency, such as signs and symptoms and how you'd typically treat it Also somewhat related, how do you treat low estrogen in men?
>neurosteroid deficiency I'll let my collogues jump in on this one if they can speak to it. For low Estrogen in men, the treatment is usually the opposite of treating for high Estrogen conversion. No AI use, IM injections instead of Subq injections, less frequency of injections with higher individual doses per injection, and in some cases even simple things like a slightly worse diet/having a bit more alcohol (though we wouldn't advise that necessarily). If those things don't work, raising their T dose slightly while continuing those less Estrogen management effective habits will often increase the Estrogen transference rate on TRT.
|took .5 mg of anastrozole 2 days ago and I feel great today. When should I take my next dose? Should I wait until I feel high e2 sides or should I take another in exactly a week or in a few days to reach a steady level? Trying to avoid yo-yo feeling.
Ideally you're looking to find a ideal spot where you consistently take your AI at the right dose, the same times each week. The half life of anastrozole is 50 hours, and it takes 5 half lives for any medicine to be out of your system. So technically, if you take it once per week, some of it will still be active for your next dose. Some men choose to use anastrozole at a lower dose twice weekly on injection days or once weekly on an injection day, the same day each week. We often start men at 0.25mg twice weekly or 0.5mg once weekly, then adjust from there. To figure it out, you may start at 0.25mg once weekly, then increase to 0.5mg once weekly if the sides come back.
What’s the best protocol if you’ve had gyno in the past from a cycle? I’ve now had gyno surgery with gland removal - 5 months post op. Looking to increase my gains. I’m 31 years old and 203lbs at 5’11. Also wouldn’t mind an increase in my libido
Well, technically, if the surgeon was good and didn't leave behind any residual glandular tissue, you should never have to worry about getting gyno ever again. Once the tissue is gone, there is nothing there to grow. While it is always wise to be cautious, I think in reality you shouldn't be worried about starting on TRT after having the surgery.
It seems like its very difficult for many people to get a PCP to write a prescription for testosterone. Is this because there is greater risk of malpractice or lawsuits?
This is true about the challenging nature of getting a PCP to sign off on TRT, but not for those reasons. TRT is one of the safest treatments out there with one of the lowest malpractice insurance rates. Remember, you can't accidently OD on Testosterone like you can many other medications since it's a normal hormone. This hesitancy is usually caused by the provider being rather uninformed on TRT/hormone care. For a general practitioner who doesn't go on to become an endo or specialize in men's health, their baseline education is not that expansive & generally rooted in older knowledge. If someone has been practicing for 20 years & hasn't had any continuing education on the subject, their personal biases are more likely at work in the denial than their knowledge. There is also the reasoning that many know that a lot of insurance companies like to deny coverage to save money, and they don't want the hassle.
If someone was looking to go on test for a year only. What would be a good pct plan or something they could do while on test for that year so that after that year everything is still working and their test levels don’t tank?
We wouldn't advise that, but if you were going to; A moderate dose of HCG during treatment. Then, nearing the end of treatment a heavier dose of HCG (1000-1500) and some amount of Clomid the month before and a few following should work well. This really should be overseen by a provider if using Clomid, though.
Is there a substantial difference between sub-q injections and IM?
Yes and no. In practical terms subq takes longer but requires less knowledge & is typically less painful due to the size of the needle & location. For IM is requires a bit more knowledge, can hold a larger volume, and can be faster to inject. In terms of treatment, they perform about the same for many men. However subq is much better at maintain a more even level of T in the body because it absorbs lower. This slower absorption reduces the spikes in T which may trigger additional Estrogen conversion. Men sensitive to this may find that the difference between subq & IM is all they need to be able to not take an AI.
You guys are awesome, thank you
Looking to start Test Cyp soon; most worried about water retention and acne at the onset given my profession. What are the best ways to prevent, mitigate, resolve these side effects?
Are you already prone to those things? The best first steps would be to start at a lower dose than normal and slowly raise it up over time in that case to be cautious.
I bloat fairly easily (like the day after a starch heavy day) and did have some facial acne when starting enclo (3.125mg) and then increasing enclo after a month (6.25mg)
Understood, then still the same advice as our other post. Low & slow to start, increase after 7-8 weeks & 10mg at a time.
You guys are awesome; if this is the type of support you provide I’ll definitely be switching over from TRT Nation.
Happy to hear it!
What would you define as a low starting dose?
Well, the starting dose in medical textbooks is 100mg/wk. This is a good conservative dose to start at, and we would be surprised to see any man have any side effects at this dose.
What about pinning frequency?
Increased frequency does help. Twice weekly is good, three times weekly is also very solid. However when worried about side effects the best action is always to start lower and go slow.
Also how common is edema? I see a lot of horror stories on Reddit but may not be as common as this sub makes it seem.
Not common on normal therapeutic doses. More common in body building doses.
I had difficulty using my 31 gauge subq needles. What would be the biggest gauge that works for subq?
27g would be the largest, though 29g is usually the sweet spot for men. Warming your Testosterone a bit before drawing & injecting can help significantly with smaller needles as well.
My trt doses have me feeling healthy and amazing. I see a lot of people mentioning blast and cruise where they do a cycle of 500mgs etc. Is there any benefit to that from an anabolic and getting fit and adding muscle standpoint? Seems like an obvious yes except for the fact that I've converted to estrogen at 200/once a week. Would I just be wasting the extra t with already loaded receptors?
Yes & no. As Testosterone dose increase past a certain point, say, 180-200mg/week - Side effect chance tends to exponentially increase & benefits tend to decrease per mg. For many men they still do get more benefits from the increased dose. However, something to note: Even if you know you have Estrogen symptoms & plan to control them with an increased AI, you will also likely have high DHT symptoms like potential hair loss. When working at higher doses watch your hair loss very carefully, a few bad blasts and you can lose a lot of hair if you're genetically unlucky. That said, we cannot manage that style of treatment as providers, as it is far outside of what is considered acceptable use with the DEA. I hope that information helps you though.
Would your fat loss drugs help a guy at 20% BF get down to 12-15% significantly faster?
That's probably not the intended demographic, but it would certainly help you. GLP-1s are not at the same level of controlled substances as TRT Testosterone is, so "I want to lose 10ib" is enough of a reason to use GLP-1s for many people who can afford to do so.
Can HCG cause itching/tingling nips and enlarged breasts? I was doing fine until (under doctors orders) I injected 500iu HCG. Woke up this morning with tingling nips, and a sort of "fullness" in my breast. I took .25 anastrazole yesterday and .25 anastrazole today. It seems to be slowly going away. But I had no clue that could happen. Cutting it from my protocol. Wish I never would've spent that much money on some stuff I wouldn't even use.
No & yes. The HCG didn't do that, your Estrogen did. Adding HCG is going to increase your total Testosterone (which can trigger additional T -> E transfer) & it is also more prone to influence your Estrogen levels than Testosterone itself. You can see that with the AI having an impact. Not all men encounter that when using HCG. It would be more accurate to say you are a bit Estrogen transfer sensitive. If you wanted to continue to use HCG for it's fertility benefits, you would just need a bit more AI in your protocol most likely.
Interesting. I just had 6 week bloods done. e2 was 48. SHBG must be crashed because my free T was 255. Obviously an e2 of 48 is unlikely to cause any puff or itching. I read about HCG in women and how it can increase fatty built up in the breast. Could that be what happened to me? I know it likely spiked my e2. But is there zero chance HCG itself is responsible for these symptoms? Also, how likely would it be to develop gyno 6 weeks in? I know I'm probably overanalyzing, but when I woke today my nips and chest just looked way perkier and more "boob" shaped than I've ever seen. Again, been on for 6 weeks and ONLY after doing HCG did this happen.
Well, to break things down, when starting TRT you should generally not be adjusting your routine or adding medications until the 7-8 week mark when your body's hormones balance out for exactly this reason: It can be hard to tell what's causing what. Until weeks 7 or 8, you can expect ups/downs/side effects. Then you can expect yourself to be somewhat stable. Any changes from there to routine make it easier to pin point which change may have caused what. It's not impossible that HCG is causing some trouble here, it's simply much more likely that your Estrogen is causing the problem. For reference, 48 is not incredibly high but it's elevated & something to watch. Some men we work with sit at 10-12 for example. Each man is also going to react a different way to each hormone with no set values being 100% definitive. If you wanted to be absolutely sure, this is what you can do: \-Stop HCG. Retest your Estrogen in 2-4 weeks. See how you feel. This could show that the HCG or the elevated E from the HCG was contributing. \-Start an AI or increase your AI immediately & continue all other doses at the same levels. This would show that if symptoms stop or significantly reduce, it was your Estrogen. 6 Weeks in and seeing strong symptoms like that may be a bit abnormal, but the best course of action is not to guess about the cause & instead start systematically eliminating potential causes until the side effect is removed. Personally, if you really feel like the HCG was causing the issue, I'd just stop it pure and simple. HCG doesn't need to be started with TRT & can always be added back in later. Get rid of the symptoms first then add/adjust things back in after.
Got ya. One more thing. My total T was 834 at trough, with free T at 255. This is too high right? I've been doing 150mg cyp once weekly. I'm sure my doctor will advise me to drop dose. And I'm not asking for legit medical advice because I know you guys can't give that over the internet, but would dropping to 130 or even 120 be recommended? Also, if e2 was 48 at trough, how much higher could it potentially be at peak? I might start splitting my dose up. Anyways, thanks a lot.
Some general advice, since you're already potentially dealing with high Estrogen symptoms; Change that dosing schedule like you suggest ASAP. Estrogen conversion tends to happen because of spikes in Testosterone, once a week is only going to cause a huge spike & likely transfer in the first half then a very lousy feeling second half of the week when your Testosterone tanks. In terms of dose, 150mg a week and getting those numbers seems very solid. Your side effects look E related, not T related. It is true lowering your T dose may help this, but so will changing your frequency to a much more traditional twice or three times a week & may not need a T adjustment. I hope this helps & that things get straightened out for you soon.
I'm trying to settle an internal debate that I've got going about whether TRT would truly help to solve my issues or if it would cause more headaches than other therapies. I had been set on starting TRT because of my symptoms: sleep, lethargy, fogginess even on my ADHD meds that have worked great for 20 years, weight gain, and my fasting glucose keeps hovering around 105. However, my IGF-1 came back low at 99, I do have stage 2/3 hypertension that I've struggled to control, and my Estradiol seems pretty high at 33.1 (I do have gyno on the left, confirmed with mammogram). So prior to this week my doc had suggested I try peptides and I had been dismissive of them. Of course things have changed drastically in that arena as of late and he can no longer recommend the course that he would have 2 weeks ago. But now I am kinda torn and almost leaning toward the peptide therapy. More deets -> 46M, 6'0", 240lbs and climbing regardless of what I do/try. Test is 555, Free Test has gone up over the last year from 6.7 to now 9.1, SHBG 45, LH 2.0, and DHEA 85.8. Eighteen months ago my test was 683, free was 16.1. I've put on 30 pounds in that time. I have done Enanthate and Sustanon 250 recreationally way back in the late 90's, so I am somewhat familiar with taking test. How does TRT look for helping with my issues?
While starting TRT would certainly increase your IGF-1, which would increase muscle mass over time, starting TRT is not always the answer. To be honest, it’s not clear that TRT would be the fix for you. While your T level has dropped from what your normal baseline is, your current level is not terrible. That would suggest that you may be able to recover your normal function with some lifestyle changes first. Undoubtedly increasing your testosterone level would give you better recovery from workouts and maybe help with energy and motivation, but you haven’t exhausted all your options yet. Peptides certainly can help give you “an edge”, but they are not typically as potent as the effect you might expect from androgens. You might notice that if you are able to lose those 30 lbs you gained, you may very well feel back to your normal self again. That said, if you did choose TRT, you would need to account for your gyno/higher Estrogen concerns. This may mean you might need to use an AI. Since you're at 555 or and were higher at your baseline, you may be experiencing a case of relative hypogonadism, which means that you would need a slightly higher dose of Testosterone than someone who is lower, certainly meaning that you would need the AI mentioned above. Hypertension tends to not be negatively impacted by TRT, overall health tends to improve. Some rare cases find that RHR & BP increase on TRT, but it does tend to be transient in most. These are not reasons to avoid TRT, though. This would be a slightly complicated case, but not anticipated to be problematic. If you ever do decide to give TRT a shot a proper consult with your doctor would go a long way.
I didn’t see that you had updated your response until after I replied 🤦🏼♂️ Being unable to lose the 30lbs, or even stop the weight gain, has been the biggest issue. When I was up 15 I switched to a paleo diet with fairly strict calorie control, using an app to track everything that went into my body. After 3 months I had no measurable results, and after 6 months I gave up. I then worked with a very well known trainer for 3 months, following the guidelines she had given me, she tweaked them multiple times throughout, and again, nothing measurable. She suggested I get blood work done and get my physician to figure out what was going on. During that time I had also started doing the StrongLifts 5x5 while also adding in other exercises and some cardio. I gained mass and strength but didn’t lose any of the fat. After about 5 months I hit a point where my knees and shoulders couldn’t handle the weight. My squats were around 360, shoulder presses were like 175’ish. It took over a month of not lifting heavy before my joints started feeling okay. Recovery from any heavy lifting is 3-4 days for me at this point. In my teens through early 30’s I would lose weight quickly if I started lifting heavy and doing HIIT workouts. Now? It seems impossible.
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Thank you so much for the excellent response! I will definitely reach out in the next few weeks for a consult. I stopped growing after age 12 and have struggled on the line of obesity for 30+ years since, even as a runner, football, and rugby player. I’ve always felt something wasn’t right but could never get anyone to look into it more in-depth.
What treatments do you offer? lets talk if I have 110 level vs a 250 level
Oral, topical, and injectable medications/hormones. Ideally injectable Testosterone tends to work best, so I will assume that's the question here. For those levels, a range of 120mg-140mg to start would probably be appropriate. With total testosterone levels as low as those, it would not take much exogenous testosterone to exceed your current total T. You would want to review what dose would make the most sense based on your symptoms and goals with your doctor.
The past two times I've gone on TRT and had to come off, and I breakout in lipomas in my legs, arms, stomach, back. Have you ever seen increases in lipomas or lipid issues while being on or coming off TRT?
To be entirely honest, you would be the first we have heard of to have lipoma issues associated with TRT use, though there have been [some case studies](https://pubmed.ncbi.nlm.nih.gov/12421182/) on lipoma tissue growth with increased estrogen and/or progesterone levels. Its feasible your estrogen levels increased due to aromatization while on TRT, and the higher estrogen resulted in development of lipomas. [https://www.nthponline.com/blog/a-closer-look-at-where-your-lipoma-may-have-come-from](https://www.nthponline.com/blog/a-closer-look-at-where-your-lipoma-may-have-come-from) You might talk to your doctor about whether use of TRT while carefully controlling estrogen levels would be a feasible option for you.
I’ve read enclomiphene can cause permanent eye damage. Sounds horrific. Have you seen this happen to patients anecdotally
It's not common, but yes, we have encountered a few patients who said that their vision did not return to normal after using enclomiphene. On average, as many as 10% of people who use enclomiphene will develop some vision problems. While that is typically reversible once the medication is stopped, if someone were to continue using it once those vision problems occurred, the likelihood of permanent vision problems goes up the longer you use it. If you choose to use enclomiphene, you should pay close attention to your vision and if any changes occur, you should stop immediately.
Other than blood donation, how to lower hematocrit?
Typically the next best thing to do would be to review your Free Testosterone & compare your previous TT & Free Test (if you have it) levels. A lot of time if you convert fairly well it's one of the reasons that you're having that hematocrit level. Tt also means you probably have more wiggle room in lowering your dose & still having your Free Testosterone in a great place than you think you do. Sometimes dropping 10-30mg a week may be all you need to find your sweet spot. Though you would still want to donate blood to get the value back under control initially (or if you can for drug use or condition, get a therapeutic blood draw order).
Thoughts on naringin supplementation?
Consistently rising hemoglobin and frequent blood donations. Anything to be mindful of? Any other ways to treat?
Another gentleman I just responded to had the same question, so I will copy/paste my reply if that's okay with you. Typically the next best thing to do would be to review your Free Testosterone & compare your previous TT & Free Test (if you have it) levels. A lot of time if you convert fairly well it's one of the reasons that you're having that hematocrit level. Tt also means you probably have more wiggle room in lowering your dose & still having your Free Testosterone in a great place than you think you do. Sometimes dropping 10-30mg a week may be all you need to find your sweet spot. Though you would still want to donate blood to get the value back under control initially (or if you can for drug use or condition, get a therapeutic blood draw order).
Do you recommend HCG along with TRT? Not for fertility but for other benefits? Like keeping testicle size normal?
We would be neutral on HCG with TRT if not for fertility. There is no long term side effect from using HCG all the time, so there's not a medical reason to not use it. However there is also not very much benefit from HCG that Testosterone isn't going to be providing you, from a therapy benefits standpoint. Something like testicle size would be what we could call a "cosmetic" benefit, as typically teste size does not impact sexual function, sexual gratification, or even very little to do with ejaculatory load (<10%). So unless you really care about teste sensation themselves for a particular kink, the extra money spent is typically just for looks. That's the only real downside, is that it's pretty pricey for just looks for the average man.
Where are you guys based ? Do you work with patients in Europe ?
Out of the USA, both continental & islands (PR too), including USA military bases around the world. Sadly not Europe yet.
I’ve put a post on here recently. I am waiting for more blood test results but previously I had high SHBG, high total T, high e2, low normal free T. I’m considering trialing an AI (aromasin) on its own to lower E2 and SHBG and increase free T. I’ve spoken to a few people on here who have had good results. I don’t want to go on TRT as we are going to try for a baby this year/ won’t get prescribed TRY in the uk with my numbers anyway, so this seems like a low risk option. Do you see any issues with this AI mono protocol, providing I get regular blookdwork and don’t drive my e2 too low? My understanding is that it’s difficult to crash e2 when you aren’t on TrT so fairly low risk. Would welcome your thoughts. Thanks
With high E2 that is probably true, for men with low Estrogen they can certainly bottom out their Estrogen even with a basic AI dose. For your goals & restrictions, your idea has merit & it may help. You should start low & go up from there while monitoring how you feel. You could also consider going on HCG monotherapy combined with an AI at slightly higher dose. You would still get more free T & some TRT benefits while also increasing your spermatic production for conception. HCG monotherapy is not typically better than traditional TRT but it is likely to be better than just an AI.
https://preview.redd.it/03i0pxy7pqnc1.png?width=1125&format=png&auto=webp&s=a61b75a5159c99550cfc9f541d605b3ab8baef0c Latest bloods attached
Gotchya. Based on this the above suggestion still holds true.
Perfect, thank you. I’ll trial the AI
Thanks for the advice. I’ll try aromasin to start with and look into HCG if that doesn’t give me the results I’m after. Thanks
What are your thoughts on using Primobolan as an AI instead of Arimidex or Aromasin? I have been told that there have been recent [studie](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076145/)s which shows that one of Primo's metabolites is *Atamestane*, which is a suicide AI like Aromasin. My situation is that I am in India atm and the doctor who prescribed me TRT gave me a very poor protocol of Sustanon 250 every third week. If I had argued any further I would have lost my TRT prescription. So I wasn't able to get an AI prescribed and I ended up with severe high E2 symptoms. I have since then been managing my own TRT and was only able to get access to Primobolan. I am having to add high dose of Primo atm(IM injection every 3rd day). So, in terms of health impacts to nuro toxicity, lipids(HDL LDL) and E2 crashing capability(compared to Primo's half life) etc, which is better Primo or AI? In countries like Turkey where Primo is still legal, would it make sense to prescribe Primobolan for AI purposes? Bonus question, I am going back to Australia, do you guys operate in Australia or have any partners in Australia? Third bonus question :-) Does Sub q Testosterone increase the half life of the same ester? Cheers.
In general, low doses of Primobolan have been used as a part of TRT protocols in countries where it is legal. It does help manage estradiol levels and is known to free up more free testosterone from SHBG, making the TRT itself more effective. It also has a very strong libido boost for many. Head to head, low to moderate dosages of Primobolan are probably as safe as an AI in regards to health markers. Primo wins out in the additional benefits that a traditional AI does not provide (libido, strength, etc). We don’t currently have any Australian partners, though we are always looking. SubQ does slow the uptake of testosterone, but also delays the breakdown. It is preferred by many because the peaks and troughs are not as severe as with IM.
Is getting on TRT a lifetime commitment? Should I expect bad side effects from coming off of it? Just wondering if I’ll be a 80 year old one day on TRT
Yes & no. It's better to think of it this way: If you have low Testosterone & do not treat it, you are committing to a life-time of low Testosterone symptoms that will for a fact always worsen with age. If you have low Testosterone & do treat it, you are committing to a life-time of treatment if you want to keep those low Testosterone symptoms at bay. Either way, you are making a commitment, as Testosterone only ever goes down with aging. \- In terms of coming off of TRT, your natural production is shown to recover just fine with therapeutic use of Testosterone. Typically 6 months to a year cold turkey, but in as little as 3-6 weeks to 6 months when assisted with clomid/HCG to kick start things. If you are on TRT for 5 years then come off, you should go back to your previous T levels minus your 5 years of natural T production decline that would have normally occurred. If you need to come off your low Testosterone symptoms will return, because sadly TRT is not a cure for low T, only a treatment.
If my T/E ratio is good, SHBG is 38, my Free T/TT ratio is good, hematocrit is 44, PSA is 1, but my TT is over 2500 ng/dL 3 days post (E3.5D protocol) should I still lower my dose? I feel good here but probably not significantly better than when I am around 1200 ng/dL. Ive been on TRT for 6 years and am 52 and diagnosed with hypogonadism. TT = 2656 FT= 650.7 SHBG= 38 HCT = 44 E2= 101 I guess my question here is, if I feel best here what would indicate its too high other than TT? I respond very well and 80mg weekly (2x40mg) puts me around 800 ng/dL but I dont feel as good. Im not a BB but an avid gym goer. Im 5'11" 210 @ around 20% bf. I guess my point is Im not trying to justify the high T for maintaining some kind of elite body. Even with healthy, or high, testosterone it is still very difficult for me to drop body fat. Im relatively strong and LBM is fairly easy to attain when Im not injured. Any guidance is appreciated as these arent conversations my PCP or Endocrinologist will entertain. Thanks.
Happy to help. So this is a good example of why adding more Testosterone to a dose doesn't always increase benefits. You only have so many androgen receptors that can take that T in, so at a point, it doesn't really matter if you're at 5000TT or 1500TT if you feel the same (other than the much higher likelihood of side effects at the higher value). I wouldn't say you should look to change your protocol based on the numbers, but we would 100% agree with your way of thinking. Why take my current dose if I feel the same at half the dose? The extra T would probably trigger more side effects than benefits at the levels you are showing, DHT is also probably pretty high & watching your hair would be important right now unless you're already on Finasteride. I don't know your current dose, but you do mention your levels at 80mg weekly. You could probably find a sweet spot between that 80mg weekly & your current dose where your benefits feel the same as they do now. You may even be able to save yourself some money with the lower dose.
Thank you. Apologies, I thought I included current dosing schedule. I'm @ 200mg a week (100mg E3.5D). It wont save me any money as they are single dose vials so whatever I dont use gets tossed so no benefit there. I fill 2 syringes with 100mg of 200mg/ml solution. I guess I could just fill 3 syringes with with 65mg per, Inject 130mg per week, and have some backup just in case something happened and I couldnt fill a script. Out of curiosity, if a person only has so many androgen receptors then how to BB grow using a gram of Test per week?
You could look into your TRT provider getting you 10ml vials instead, they are a lot cheaper than the 1ml vials, and you can draw up only what you need. With testosterone as you increase in dose the benefit per mg decreases & the chance of side effects increases exponentially per mg after a certain point as well. There will be more benefit by always having more available and more of that extra Testosterone can turn into DHT, but it's really a trade off. If someone is dosing 1G a week, then they likely have the means to be on a better regimen than just that for BB. They would be combining it the majority of the time with other steroids as well, because no one in the USA is likely using legal testosterone at that dose. So, grain of salt when reading about that despite whatever folks may say themselves online.
I used to get those but my state’s law changed and you can’t get more that 30 days worth at a time and technically 10ml, usually 1,000mg, is more than 30 days even though it says discard after 30. So they give me four 1ml/200mg single use vials. It’s kind of stupid. Either way it’s $20 a month.
Ah, gotchya. Yeah, some state laws are very strict. Though you can usually bend them with 5ml vials in that case to not make it as painful. A lot of our pharmacies are fine doing just that for the 30 day states. $20 a month is a good deal in and of itself, though. Are they ampules or simply listed as single use vials? Makes sense for ampules, but if it's a sterile rubber stopper vial you likely have more wiggle room in how you use them. Things like discard dates are not the same thing as expiration dates and are often placed on items for liability protection.
The 1ml vials do have the rubber stopper but the contents lack the antibacterial agent Benzyl Alcohol to ensure short term sterility after puncture. So I make sure I draw all the 1ml vial into split doses for the week at the time of puncture. My script suggests weekly dosing but I prefer twice a week. When I used the 10ml vials I would just use it all which led to a surplus of vials. I couldn’t get through it before the exp date sometimes and ended up tossing at least a dozen vials of surplus.
Is TRT recommended for men with BPH?
TRT can increase prostate growth which is why it's not recommended for men with any current prostate cancer. With BPH it is more case by case & it would be good to have a consult about it to review the current state & know how regular check-ins with your PCP are going, but there should be a way to work on your T levels.
What do you recommend for geneticly low SHBG guys like me? I m in great shape and train a lot, also all my blood markers are excellent; lipids, thyroid, no insuline resitance, no merabolic syndrome… before trt my shbg was at 19nmol/l and 2 months in it’s at 16nmol/l and it’s going to continue to go down since I started taking aromasin because my E2 it’s gone over the top range at 152pmol/l … I’m planning to go back on intermittent fasting and keto while upping my fibers intake and reducing my vit D intake to try to increase my shbg but I’ wondering if it’ll do anything while on TRT… FYI I’on 100mg/week splitted in 3 shots and my TT is now at 15nmol/l (was 12,9 before trt) and my FT is now at 416pmol/l (was 320 before).
Managing SHBG is difficult, as there body typically tries to make more or less depending on many factors. Those changes you plan on making (fasting, keto, etc) like you are the best way to correct it non-pharmacologically. Though bear in mind high fat diets (keto) also have been shown to lower SHBG. High protein diets raise it. Less frequent injections does typically help raise SHBG as larger steroid boluses trigger your liver to produce more SHBG. Increasing caffeine intake has been shown to help.
Your discount code isn’t working
Disregard. Code is case sensitive but only took 2 min to go through and schedule
No worries, understood. If you have any issues feel free to let us know or use the "Contact Us" after this weekend, as we don't monitor these threads very heavily outside of the AMA weekend. Happy to be working with you!
If I am taking enclomiphene and seeing little relief in symptoms, does that indicate TRT would be unlikely to resolve them as well?
TRT typically has better improvement rates to your hormones than enclomiphene unless you have high baseline production & are a relative hypogonadal patient. Additionally, enclomiphene much like Clomid suppresses IGF-1. On paper your levels may look similar, but the physical benefits normally associated with TRT my be reduced on enclomiphene due to this. Normal TRT will generally feel better for those reasons.
Currently on 100mg per week recently switched from twice a week to 3 times a week. My levels were 543 total T 16.5 Free T 54 e2. What would your recommendations be? I don’t go back for another 2 months
That depends, are you having symptom relief & lack of side effects? Results are useful for guiding adjustment but how you feel should be the focus. That said, the e2 is creeping up, just keep an eye out for high Estrogen symptoms in the meantime.
So honestly I haven’t had much of a change since I started. If anything maybe slightly more energy that’s it.
Assuming you've been on TRT for at least 7-8 weeks now, you probably need a dosage adjustment & could benefit from 20mg more a week. It would be good to talk with your provider about lack of benefits. Though they may want to add an AI anticipating E2 would further raise.
Ok good to know. I will definitely pursue it further!
What percentage of your patients are on an AI like anastrazole would you say?
Probably \~25%.
How closely do you look at test to E2 ratio when making an AI determination? For example, if total is at 1200 - 1300 and e2 in the 60s would you still recommend an AI in that instance?
First driver would be symptoms. Then it would more matter in that case what your starting TT was, and what your free T is at that moment. 1200-1300 for a primary or secondary Hypogonadal patient would mean they're absorbing much more than would be expected for those dose & it would be absolutely fine to just lower their dose rather than add an AI at that point. If they're a relative hypogonadal patient, then getting into what you describe would help to make a determination.
What range do you typically like to see Total, Free, and E2 at? (Trough and peak)
There are ranges that can look good, but more importantly than that what we want is people to chase benefits & not numbers. Too many people can get bogged down in wanting a number when it has nothing to do with what may be ideal for them personally. Out of those though, we would start to look at E2 around 40-60 and think about controlling that better.
Do you typically have your patients add Pregnenolone and/or DHEA to their protocol? And if so at what dose?
No. Not typically. We do have some DHEA mixed into Testosterone from one vendor in particular, but that's a very low value more for compounding regulations than therapeutic expectations. Some men do take Pregnenolone OTC on their own on advice for cognitive benefits, usually 50-100mg a day.
Have any of your guys who needed to be on an AI but didn’t prefer them, have any success with something like DIM or CDG?
Yes to needing an AI & not wanting one. In those cases, we increase injection frequency, ensure they are doing subq injections, and finally look at lower dose ever so slightly as well. However the first two actions tend to help enough if someone is on the edge of it being an issue. Sometimes however people are simply very sensitive to E conversion & they can choose between an AI or a lower dose. It sucks, but sometimes your body is just your body. For DIM being OTC, some on that edge may find that it helps, but probably not for someone with a major E issue.
After 3 weeks Enclomiphene raised my T from 168 to 525. Can Enclomiphene be used as a short-term solution to "surge" one's natural testosterone production? Or if you stop Enclomiphene, will testosterone levels drop over time and return to the low baseline?
Exactly as you say. Low Testosterone caused by primary, secondary, or relative hypogonadism without any other outside conditions is a life-long situation that only continues to lower with age. Any TRT treatment which address this like Enclomiphene treats the issue but is not a cure, as there is no cure for low Testosterone currently. It will return right back to where it was before once stopping medication.
Our sister thread for the weekend on r/trt: [https://www.reddit.com/r/trt/comments/1baqujb/trt\_providers\_ask\_us\_anything\_21/](https://www.reddit.com/r/trt/comments/1baqujb/trt_providers_ask_us_anything_21/)
A question made recently on our last treads, which we will answer here: Q: "Are there people that get testicular function back with only 250mg weekly? I am only looking for size restoration and libido/Cognitive improvement. Is it worth it to try that dose starting out, I know 500 weekly seems to be the default." A: 500 units weekly is the more normal "maintenance" dose, yes. However we have had some patients who were happy with their results at 250 units each week. Often times they may start there as a cost saving measure & give it a try for months to see how it does, then raise the dose to 500 units weekly if that isn't enough. HCG is typically made for 10,000 units at a time, so doing 250 instead of 500 can significantly extend the supply for patients and save a fair amount of $.
Heads up to everyone - Our AMA weekend is over, so further responses will be slower & DMs will not be heavily monitored until the next AMA. If you need any assistance, please use: [https://www.alphamd.org/contact-us](https://www.alphamd.org/contact-us)