TRT Basics

Hey all.

I have recently noticed a huge amount of interest and questions around Testosterone Replacement Therapy on this board and most others. Please understand I don't claim to be an expert, but I have been on TRT for around three years and have picked up information, research, firsthand and anecdotal experience over that time. I would like to write up a general TRT overview for people new to it or those wondering what they should be doing. I would also welcome other TRT guys on the site posting their comments and advice. It may even be worth another Forum subject dedicated to TRT (@admin :whistle: ). This post is only going to be an overview with basic information. TRT is a complicated subject that should be talked about in depth and this is already going to be a long post. I know I'm opening myself up to disagreement, just remember, this post is really to help new guys understand and navigate the basics of TRT, opinions differ and any constructive comments that will assist them are welcome.

Caveat: I am not a doctor of any sort, none of the information below is medical advice. It is simply my observations and research. If you believe you need TRT, consult a doctor first!
On that point, TRT is a treatment for a medical condition. It is not a "cruise" and not an opportunity to get onto long term, legal, low-dose prescription testosterone. If you need it, your endocrine system is compromised and requires supplementation probably for life, if you don't need it and you do it, you could damage your endocrine system irreversibly and then you will need it, for life.

Blood Tests. When you describe your symptoms to your doctor he should send you for blood tests. They should include Total Test - TT, Free Test - FT, SHBG - Sex Hormone Binding Globulin, Estradiol (E2 sensitive assay), LH - Leutinising Hormone and FSH - Follicle Stimulating Hormone, plus PSA - Prostate Specific Antigen as a minimum. Ideally you should also have Vitamin D, DHEA, Thyroid Panel and Cholesterol Panel. There are a host of others such as prolactin, cortisol, DHT etc that could be added in depending on your pocket, however these would be respectively, the minimum and next best to have.
Results: Remember that a lot of doctors will decline to treat you if you are in the "normal" ranges. My TT was 288ng/dl (range 200-1100ng) and my FT was 180pmol/l (range 170-660). My initial doctor told me I was fine, just getting older! Actually my level was equivalent to that of a 75 year old man. These "ranges" are taking from a cross section of the male population between 21 and 80 years old or so, thin, fat, healthy, ill, muscular etc. Ideally you should look at your level vs your age range. Needless to say I found a new Dr.

Total Test is a good indicator of your general T status, however it has to be read with SHBG and Free T.
It is entirely possible to have good TT numbers and low T, one cause of which could be high SHBG. Generally TT is not a good number to look at if FT is low.

SHBG - does what it says and binds to sex hormones, making them unavailable for use. Even though Testosterone has a much higher affinity for binding with SHBG, estrogen is also bound by SHBG. Too low levels can have negative effects on lipids, too high reduces the bio-available sex hormones, be aware of this when using other products offering SHBG lowering effects such as Proviron.

Estrogen is critical and too low or too high can have nasty effects. By far the most difficult aspect to control in TRT management, in my opinion.

LH is the hormone that directs your Leydig cells to produce testosterone. LH and FSH are key indicators, high LH can indicate that you are primary hypogonadal meaning the problem is in your testes, or if low, secondary hypogonadal, which indicates the problem lies in the pituitary or hypothalamus and not the testes. Once on TRT these readings will be consistently low and not necessarily tested. As an aside, Low FT with normal LH can indicate a reversible low T problem such as obesity or high alcohol use among others. In other words this may require other interventions and not TRT.

PSA is a blood test to give an indication of your prostate condition. If is it elevated, further testing will be requested. It's not absolute but enough to indicate further investigation.

Your bloods come back and show you are hypogonadal and have a case for TRT. The new rage seems to be Dr's prescribing 200mg Test Cyp (Depot) per week, plus HCG plus an AI such as arimidex. I don't necessarily think this is the best protocol as a start. To break that down.

Testosterone - Start at 100 mg/week. This is a good base dose. Get tested again after 6 weeks to 3 months and see where your levels are. In fact test yourself every 3-6 months even if your Dr doesn't want to. Lancet offers the option to request blood tests without a Dr's instruction. You want to be at the high normal range of your labs but more importantly you want to feel better overall. This may be mid-range or above the upper level, everybody is different. Make sure your doctor is treating you and not lab numbers. You might go up to as much as 200mg/week, but increase your dosage in 50mg batches. Bear in mind, this is exogenous medicine you are introducing to your body. The less you use, the less possible side effects should arise.

HCG - I am not a fan. It shoots my estradiol levels up and makes me irritable within a few weeks. Some men say they feel better on HCG and this may be due to the higher testosterone in their system or some other effect. Besides how it may make you feel, the real benefits of HCG are if you are concerned with infertility and possibly aesthetic in that your testicles can shrink a little on TRT and HCG prevents this. Bear in mind that HCG is an LH mimic, causing natural testosterone production, as well as your exogenous production. Higher T levels can cause higher aromatisation. If you have low estradiol levels then TRT with HCG could be an option, however if your Doc prescribes this automatically, do some further research for yourself. In my experience, the higher end of TRT dosing with HCG becomes problematic form an aromatization perspective.

AI - People use AI's such as Arimidex to reduce estrogen aromatisation. Most people, myself included, don't want to hear this, but, in a normal case, the most efficient way to reduce estrogen is to reduce your testosterone dose to the point where your estrogen levels are manageable and you do not feel symptoms of low T. AI's can be necessary and if you need them, so be it, however they have a host of potential issues such as negative impact on lipids, possible liver toxicity and reducing your estrogen level too low. This happened to me and it was the most miserable time on TRT I've had yet. Once again, you may need an AI, just check first, don't blindly accept what your doctor is saying.

Proviron, low dose masteron etc etc. None of these have a place in TRT. Your goal should be to get your levels to a point that you are feeling rejuvenated with as low a dose of testosterone only, or with as few other products as possible. Don't get me wrong, I'm not being holier than thou! I have run masteron, NPP, proviron, MHR and others while on TRT. All I'm saying is consider that blasting. And if you choose to run other low dose products, or cruising and blasting, that's your decision. My point is, none are absolutely necessary for successful TRT in the majority of "normal" cases.

Injections. If your doctor prescribes anything other than weekly Test Cyp injections as a minimum, you need to query him. Half life is around 8 days. By day 14 you will have around a 1/4 of your initial dose and feel like crap. Note that your body produces testosterone daily, not once every 14 days, or even every 7 days. For me, injections every 3.5 days works. Others do well once weekly, try it and see. It makes sense to me that a peak of testosterone leads to a peak of aromatisation, it stands to reason that more frequent injections of lesser quantities of T would lead to less aromatisation. Just note the half life of the product you are being prescribed as there are different Test esters out there with different actions and half lives.

Another new trend is subcutaneous testosterone injections. I use intra muscular and Subq. I honestly cannot say which is better. There is talk around subq showing lower aromatisation however I can't confirm this besides anecdotally. I alternate between glute IM for 3 months and sub q in my stomach for similar time. When injecting sub q I find if I inject very slowly about 1.5" away from and in a straight line to the right or left of my navel, I don't get bumps or bruising. If I inject in the same area but below my naval line, I often get lumps which take forever to go away. I draw the Test with a 20g needle and inject, IM - 23/24g needle, Subq - 27g needle.

The first 6 months of TRT is the honeymoon period. Generally once it is running you will feel great but that starts to become the new "normal". I have found myself chasing that honeymoon feeling again, playing with quantity of Test, other products, scheduling and dosing. Bear in mind, you should feel normal, not super human, unfortunately. The more you add or play around, once you have reached normal, the more chance you have of throwing something off and spending months trying to recover.

Hopefully that helps answer some basic questions around TRT. I'm sure the other guys will update with their experiences soon. Good luck.

Thanks for taking the time to write this guide. I think it's worthy of becoming a forum "sticky".

This was such a well written post. I love that you mention E2 as this is the biggest thing I find that many Dr prescribing TRT do not check for or know how to manage it. There is personally no better AI for TRT other than Arimidex, Letro and Aromasin are difficult to dose and get accurate figures.

HCG should only be used if you are interested in still having children, or else it doesn't really have a place in TRT.

I love that you mention doses, I have a friend on 100mg a week with free test over 1000, so like you said this is TRT for a medical purpose and not a way to legally cruise. Like you said you need to get away with the lowest possible dose or you risk serious side effects. New research is coming out that donating while on TRT might not prevent polycythemia and I don't think this is something that should be taken lightly.

I would say it's also extremely important to do a kidney profile as GFR and creatinine does change while on TRT and knowing what you where on prior to staring is important. Testosterone also alters iron metabolism so testing Ferritin is my opinion is also important.


Once again, great post.

Great post. You really nailed all the important stuff that guys new to TRT need answers to. Thanks for the contribution. This could help a lot of people.

Befok. Thx. Hierdie sal nog baie mense help

This is a great article, thanks Mfezdro - I've also seen a lot of questions on the board around this topic and am glad this is now something the guys can reference.

The only additions I'd make is about life after TRT. I think you hit the nail on the head about the first 6 months being the honeymoon phase - the changes in mental and physical wellbeing are significant and somewhat overwhelming, especially if you have suffered from clinical hypogonadism for a while, muscles grow, fat dimishes, confidence swells and the sex drive makes you stupid! After this period I noticed how I felt became the "new normal" and the temptation to add an extra 0.1ml at every injection was something I had to resist... Simply because I was chasing that improvement feeling.

Life after trt isn't quite smooth sailing, needing a stash of needles, syringes, alcohol swabs on hand isn't the hard part, the continuous monitoring of blood levels is. I self medicate, it was a decision I made based on the expertise levels of local doctors, the closest doc I could find was a 2 hour drive away and because my medical aid doesn't consider male HRT a "thing" they have exclusions for any steroidal interventions - so medicines and consultations are private. But there is a wealth of quality information available online, Jay Campbell's TOT bible being one, Nelson Vergel's excelmale website another. So, in my opinion, with a bit of homework and knowledge this is quite possible to run solo on, with possibly annual checkups with an experienced doctor to make sure you are doing things right.

As part of this self medication i was forced to use UGL products, pharmacy grade test cypionate is expensive and 2k a month for test just isn't worth it, UGL products cost a quarter of that for a 3 month supply. But this is entirely a personal decision on risk-reward.

Dealing with E2 hasn't been an issue for me at all, I don't have a genetic predisposition to gynocastomea and other than a little nipple sensitivity at the beginning have had no issues on pure TRT dosages. Where I think all us TRT folk find the greatest risk is with rbc and hematocrit levels. The bottom line is, if you are on TRT, you will have elevated levels, practically guaranteed. I skipped a blood donation in January, and when I donated this week my level was 17, they refuse blood at 18 - and watching the blood flow into the packet, it was thick - my heart must have been having a rough time sending that syrup around. So regular donations are a must. I knew it was high because I was sweating easily and just not feeling good.

As far as administration goes, I only do subQ, I found the stomach area gets a bit overloaded and I discovered the fatty pads on the upper, outer area of the glute are a lovely spot - more often than not I don't feel the pin going in or out and the injection is absolutely painless. I've done shoulder shallow IM before, but those hurt, and I've never tried the legs.

TRT delivery is another point that I have been looking into.
There have been a few studies trying to confirm a link to TRT and cardio vascular events, this is a horse that Dr's unfamiliar with TRT like to flog, along with the prostate cancer stick. There has been no causal link established between TRT and CVE, when using TRT correctly to treat a medical condition. Study overview here
www.ncbi.nlm.nih.gov/pmc/articles/PMC4709429/

But what was found when analysing another set of studies was that the method of delivery did have an impact, not only on CVE risk but also DHT.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4245724/

Basically transdermal and intra muscular shots (no reference to sub q) were found to have no significant impact on CVE risk, but oral TRT, being T undecanoate (andriol) tablets were found to have an increased risk, so if your Dr is prescribing this, please ask them to reference the studies and make sure they feel comfortable there is no risk to that method.

Another interesting point is that DHT levels remained stable with injections but were elevated dramatically with transdermals. I have read somewhere that there are more DHT receptors in the skin but this may be internet science. This is probably why guys on transdermal patch or cream TRT seem to have strong libido consistently, due to the higher DHT? Also be aware if you're on transdermals that any additional DHT substances like Anavar or Proviron are probably going to really skyrocket those levels.

I've never used the creams but most of what I have read online and guys I have spoken to seems to indicate some guys do really well on creams and some just don't get that "bang for their buck" they get on injections. I am considering giving it a bash though.

So if you're given the choice of IM or cream, make sure you are familiar with the different impacts on your hormone levels and what that may mean for you. Also suggest trying the two systems to see which is better over a period of 6 months each and run blood tests to check your DHT and test levels. Personally I would stay away from oral TRT.
Lastly, "papier is geduldig" as they say. Studies can be read any number of ways and for every positive one there are negatives. Research everything until you are satisfied you are informed enough to discuss intelligently, to make a suggestion to, or question your Dr on your health.

Just an update regarding my journey and TRT, I personally find with me that I need to donate. Yesterday prior to blood letting my blood pressure was 148 over 84, I could feel it was high and I was around 3 weeks overdue, today during my routine testing it has dropped to 111 over 62, it's now to low, but that is fine it will increase over the next few days. So just a shout out to remind all guys on TRT how important donating is, high red blood cells is not fun for long periods of times, it makes the blood thick like sludge.

Thanx for taking the time to write this bro! +1

Thanks for this info, it has answered a number of my questions regarding TRT.

I'm 182cm tall, 47 years old and weigh 100Kg's

I have been on TRT for around 6 weeks now. I have a very knowledgeable Dr, but unfortunately he is charging ridiculous rates. He assured me that Medical Aid would pick up 75% of the bill, but they have barely covered 10%. In short he "fiddles" the invoices so HCG and DHEA etc. appear, but not the Test Cyp.

So I have paid almost 8k in six weeks for the bloods and all the gear etc....ridiculous I know.

I would like to continue using his expertise, but only for bloods and checkups every 8 weeks or so.

He currently has me on 150 mg per week Test Cyp, Keifi Progona 5000 1 x 50 on insulin syringe. Not exactly sure what that equates to in iu or mg. He also has me on DHEA tabs EOD and CoQ with Milk thistle. He tells me there is an AI in the test CYP already?

After a lot of research and reading through the forums here, I am considering going on self medicating.

My Main questions are:

1. At 150 mg per week Test Cyp, would it be better/advisable to split that into 2. As in 1 shot every 3.5 days?

2. A lot of research says subcutaneous is fine, in fact some Dr's recommend it. I'm not opposed to IM, but if pining more often I'd like to go subcutaneous. What needle/syringe combo should I use for this? I have read that the standard insulin syringe is not ideal.

3. Should I continue with the HCG? At that dosage? Should I also split that into 2 shots? 1 every 3.5 days?

4. What AI should I look at because I do not know what he is using in the Test Cyp mixture at the moment? Aromisan or Arimadex? Is it even necessary at less than 200mg per week and given the fact that I am splitting my shots into two a week?

I used various AAS in the past like more than 15 years ago. I've never been really susceptible to side effects. However I want to play it as safe as possible.

For the record I feel amazing at the moment and am very glad I discovered TRT as it has made a tremendous difference in my life other than just the physical aspects, which was not the reason I went down this rabbit hole in the first place. In short I feel like I got my mojo back.

steady wrote:
He tells me there is an AI in the test CYP already?

Really :lol: :lol:

Thanks Oupa, pardon my ignorance, but your response would indicate that he is talking bull. There is no inject-able type AI? He assures me the Test is his own blend with not just Cyp, but a little Sust etc too. I can see the HD Labs bottles on his desk????? Depo for sure....

Looks like time to drop the doc then.



thanks

steady wrote:
My Main questions are:

1. At 150 mg per week Test Cyp, would it be better/advisable to split that into 2. As in 1 shot every 3.5 days? Half life is 8 days.

2. A lot of research says subcutaneous is fine, in fact some Dr's recommend it. I'm not opposed to IM, but if pining more often I'd like to go subcutaneous. What needle/syringe combo should I use for this? I have read that the standard insulin syringe is not ideal. I cant pin oil subq, i get serious lumps. IM is my only option.

3. Should I continue with the HCG? At that dosage? Should I also split that into 2 shots? 1 every 3.5 days?
You have to do some research on this forum. Use the search function and brows the articles.

4. What AI should I look at because I do not know what he is using in the Test Cyp mixture at the moment? Aromisan or Arimadex? Is it even necessary at less than 200mg per week and given the fact that I am splitting my shots into two a week? I wont use an AI unless i start having side effects. Get Arimidex.

I used various AAS in the past like more than 15 years ago. I've never been really susceptible to side effects. However I want to play it as safe as possible.

For the record I feel amazing at the moment and am very glad I discovered TRT as it has made a tremendous difference in my life other than just the physical aspects, which was not the reason I went down this rabbit hole in the first place. In short I feel like I got my mojo back.

steady wrote: Thanks Oupa, pardon my ignorance, but your response would indicate that he is talking bull. There is no inject-able type AI? He assures me the Test is his own blend with not just Cyp, but a little Sust etc too. I can see the HD Labs bottles on his desk????? Depo for sure....

Looks like time to drop the doc then.



thanks

Ek dink hy fok rond as jy my vra. HD Labs op n dokter se tafel? nee man :lol:

Oupa wrote: Ek dink hy fok rond as jy my vra. HD Labs op n dokter se tafel? nee man :lol:

This is the second time in two weeks I'm hearing reports of a Dr using HD labs to treat his patients and absolutely screwing them on the costs... wonder it it might be the same doc, but the other one I know about is from a small town in NW so what is the chances of it being the same one...

Fact, he might be knowledgeable, but he's definitely taking a chance.

So I take it you're not a fan of HD? Are LP, UPA and PGW ok?

Ek wardeer jou tyd.

dankie

Thanks Admin. No this Dr is based in Jhb.

Which brands do you prefer over HD?

thanks

Why would you accept underground gear from a doctor? Keifei is not pharmaceutical grade? Surely that goes against the fundamental premise of being a medical professional... Weird shit, asking for a prescription seems smart.

Thanks MPhilosopher, I had no idea what is or is not UG until very recently. Haven't seen any AAS's in almost 20 years. So when the Dr gives you something you would assume it's legit right? You are correct though I will go the prescription route. If he refuses, I'll have to get my TRT the old fashioned way. That's not an issue.

Thanks again

Absolutely bro I am a beginner in these things I just thought to point that out from a doctor ethical point of view. Unfortunately we can't trust doctors blindly. Honestly pretty disgusting that guy is allowed to operate. tbh if you haven't paid him yet.... don't.

steady wrote: Thanks Admin. No this Dr is based in Jhb.

Which brands do you prefer over HD?

thanks

What MPhilosopher said. It's not a brand issue but rather an ethical one since a medical professional should only be using pharmaceutical grade drugs to treat patients. Get a new doctor, this one is a quack and he is not very knowledgeable if he tells you that there's already an AI in the Cyp vial... he's just a good con artist.

Fair comment, thank you

admin wrote:

steady wrote: Thanks Admin. No this Dr is based in Jhb.

Which brands do you prefer over HD?

thanks

What MPhilosopher said. It's not a brand issue but rather an ethical one since a medical professional should only be using pharmaceutical grade drugs to treat patients. Get a new doctor, this one is a quack and he is not very knowledgeable if he tells you that there's already an AI in the Cyp vial... he's just a good con artist.

I went to the same doc, he mixes in the test cyp vial (4 week stock) some HD mastaject, I saw the one time when he prepped the vial for me and called it an AI

Does TRT affect the immune system in a negative way; specifically from a covid-19 perspective?

No, not if using it for medical reasons and pharma, hence running a Dr prescribed dose. What that dodged Dr does is a different story. Mayne the test was contaminated and you get sick and then pickup a virus ontop of that.