Questions about TRT
Find answers to commonly asked questions about TRT, administration, and benefits.
How about stacking TRT with peptide therapy. Are Sermorelin, Tesamorelin, or CJC w/ Ipamorelin actually safe to use with TRT? What are the real benef...
These are perfectly reasonable options. Currently we and other TRT providers can dispense Sermorelin, though not long ago it was permissible to work t...
Does HCG make sex better? Not necessarily having issues currently with my TRT dose but anecdotally heard it increases sensitivity and makes sex better...
There has been anecdotal reports of this by some men, though we tend to think this is more about finding the right hormone levels rather than the addi...
Is there an alternative to HCG in respect to keeping the testes from shrinking? Ive also read anecdotal reports from some that HCG has helped them ke...
There are not good alternative for teste size, or at least none as good as HCG with as few negatives as it has other than price.
Is going over 300+ for a lady similar to staying above 1500 for a gent? Noe my wife is 0.5 nmol, which means she's at an abysmally low level of 15 ng...
The risks are a bit more for women with too much testosterone than men with too much.
I started on testosterone pellet therapy in late October (100 mg) and it took about 4 weeks for me to notice a response. When I did, my sex drive was...
First, we never recommend starting with pellets. Because absorption rates are variable, you may be under or overdosed, and you are stuck with that for...
I’m only doing 6mg a week right now of test cyp. And I’m also injecting estrogen. I’m splitting the test cyp dose (so 3mg twice a week) and I have to ...
That is a very robust response to that dose. You likely would do better with splitting the injections into 3x/wk. It would at least be worth giving it...
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Once a week vs twice a week for women? Lower doses/more frequent decrease aromatization? And if you’re injecting small doses like 2-6mg is there a lar...
Twice a week is recommended to prevent T levels dropping into the symptomatic range at the end of the week. More stable levels typically mean less sid...
1. Do you have a standard protocol that you start most women off with when they sign up with you? For example, my trt clinic seems to have their star...
A lot of providers are recommending hormonal BCP as the entry HRT for perimenopausal women. At the same time many of them are also low T and benefitti...
Yes, numbers matter much less than how you feel.
What would ‘closer monitoring of labs’ look like? How often would you check? Particularly when just starting out. I started 6 weeks ago; 10mg/week tes...
We typically test after 6 weeks, and again at 12 weeks. If no adjustments are made to the dose or regimen, then we typically check once more 6 months ...
What if it feels like all the weight gain is in the lower belly/FUPA area? Will DIM help and if so how much?
Perhaps. Higher estrogen levels contribute to fat deposition in the FUPA area. DIM supplementation has been shown to increase the breakdown and excret...
Wife 46 years old. Been on TRT for 3 months now. Takes small dose twice. Week. Works out 3-4 times a week. Feels better but gains around 5lbs of water...
Edema from exogenous testosterone is typically from estradiol or progesterone, not testosterone.
I’m not exactly on just TRT doses right now, would be concern with putting that much oil subq at the moment, but maybe worth a shot
In general if you're injecting more than 0.5ml per injection you should be looking to break up your dose more or go with a higher concentration. Subq ...
In percentages how much lower are you seeing estrogen levels when people go from im to subq?
We wouldn't be able to say. We generally start about 85-90% of our clients on subq right from the start since it tends to be easier to learn, so we do...
Do you have any references for subQ injections? I am only 5 weeks into TRT injection 2x IM per week. Wondering if subQ would be better for me. Is swit...
This is a good reference video:
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...
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 f...
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 itchi...
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 yo...
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 af...
Understood, then still the same advice as our other post. Low & slow to start, increase after 7-8 weeks & 10mg at a time.
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 tot...
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 effec...
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 & pred...
Any merit to adding testosterone cream to existing testosterone injections and is this something you guys do for increasing DHT/libido? Also do you h...
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 a...
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...
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...
Taking hCG concurrently while on TRT can maintain sperm production.
I don’t know anything about TRT 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 pred...
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...
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 numb...
Does SHBG decline when TRT is started?
Yes & no.
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 gu...
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...
What would the symptoms of the initial aromatization (if that’s a word?
Being overly emotional, fluid retention/bloating, acne, and nipple sensitivity/breast swelling. Other symptoms can include low libido and weak erectio...
I experienced injection site hives when using Hikma brand testosterone cypionate, other brands were fine for me
Being that it's a commercial brand & since I can't tell by doing a simple search, it's very likely that they have cottonseed oil as their carrier oil ...
Does your clinic ever use AI's with clomid, and have you noticed any benefits? Disclaimer: obviously not asking for medical advice. Just discussing.
For the patients that we have on Clomid, most of them require the use of an AI. The benefit of adding the AI helps reduce high E2 symptoms which inclu...
Are you guys happy to have people running 200-250mg per week if their trough is around 500 TT on that dosage?
If that's the case from an existing TRT regimen & you know it works best for you, yes we are happy to work with you for whatever your body needs.
What course would you recommend if Total T is at 282 but prolactin is in the 1150 range?
That prolactin level is more than just a little high. Low T in the setting of high prolactin raises concern for a prolactinoma (a usually benign neopl...
The doctors plan is 160mg a week the last I spoke with him. He said he wanted to give me a 500mg “boost”, then start the normal dose after 2 week. Hi...
Once a week injections always carry the risk of your T levels dropping to levels where your symptoms may return later in the week.
650 TT and 85 free T. I have brain fog, fatigued all of the time, low energy, etc. All of this gets worse as the day goes on. The doctor I visited thi...
It's a good sign that doctor is onboard already. With good TRT, the symptoms really do matter more so I wouldn't let the numbers hold you back.
I've been having low T symptoms so I had my level checked. Came back 542 ng/dL. I then learned about Free T and bioavailability so I had my level chec...
Free T is the only “active” T. That means it is the only T available to attach to androgen receptors. Bioavailable T is a combination of free T and T ...
I've been on 120ml/ week test c for about a year. Once I got through initial phase, all has been well except my hematocrit has been very high. The las...
Options to control hematocrit elevations/erythrocytosis on TRT are relatively limited. Lower TRT doses do sometimes help lower the red blood cell coun...
Why on trt, 2x60mg a weeks I have problem with memory I can’t remember a thing?
n general with TRT, getting your hormones back in balance improves brain fog & memory rather than worsens it. Did this start only after starting TRT &...
I’m really glad you all are doing this! Thank you for supporting this community! I just started TRT three months ago and got my first bloodwork back ...
Given those numbers & while still being a bit unsure of the measurement type, it doesn't sound like numerically your Estrogen is off base, however you...
Does pregnyl lose potency after 60 days?
Technically yes, but realistically no.
Started T 8 mos ago, iron level is slightly high at 208 with a saturation of 82%. Ferritin is normal at 82. Does iron stop increasing after a while of...
Iron stores do typically stabilize after awhile of being on TRT. Though at 8 months in, we would expect that you are at steady state. Donating blood w...
If your working FIFO two months on one off, what would be best type of test to use if can’t inject when onsite?
Depends on what country you are currently in, as some of the longest lasting esters are only available in some countries, but pellets are probably the...
I am a 52 year old woman. I am taking testosterone because my energy and motivation to get out of my chair were both really low. I also didn't have an...
Transdermal treatment, with both gels and creams, have been proven to have a higher conversion rate to DHT. The skin has a higher amount of the 5a-red...
Why do TRT clinics just throw 200mg out to start
They really shouldn't, but because many take the approach of uniform care over individual planning, they pick a dose that will *certainly* give result...
Im 32 can I do hcg alone or trt with hcg and still gain permanent penis size gains? Did anyone do this before? Or with a dht cream with hcg ?
The only study that showed gains with penis size on hCG was done in fully grown men with micropenis. It does not cause penis growth outside of that su...
Are nicotine pouches safe while on TRT? I.e. 4mg of nicotine once to twice a day?
Yes. They are safe on TRT. There does not appear to be any additional risks to nicotine supplementation while on TRT.
I have a total test of 300 and free t of 10. I’m 30 years old and started TRT through a local clinic 3 weeks ago. I live a healthy and active lifestyl...
60mg/wk is a bit lower than average (standard starting dose is 100-120mg/wk). The average conversion rate for most men is ~6-7 ng/dL of total T for ev...
Do you test to confirm primary or secondary hypogonadism before determining treatment strategy? Does the strategy change depending on the diagnosis? I...
We work with a two stage consultation system unless you're already on TRT or have existing lab results, though I would say a lot of online TRT clinics...
How long does using trt, or using full cycles take to from a blockage or, worsen a blockage of the heart?
TRT does not increase risk of heart attack at all. In fact, it seems to
My primary physician says it’s a bad idea to start TRT and she says she gets patients all the time who have long-term complications directly related t...
I have certainly seen men have long term complications from anabolic steroid abuse. These men use testosterone at levels far higher than TRT doses. Th...
I’m starting TRT when my kit arrives. What are some things I should expect? Will I experience hair loss?
Hair loss is a possibility in anyone on TRT, though it only occurs in those who have a genetic predisposition.
What are most common symptoms of high estrogen for men? Does everyone need an aromatase inhibitor? Would a SERM help with symptoms vs and AI? Thanks i...
High E2 symptoms: tender/swollen nipples, fluid retention/edema, emotionality, pimples, loss of libido
If you get mild lip swelling and facial swelling and mild breathlessness on test e does that mean you're allergic to the carrier oil and need to switc...
These are worrisome symptoms, and consistent with an allergic reaction. Any airway compromise (lip/tongue swelling, trouble breathing) means you shoul...
Does the amount one takesTest correlate to the amount they should take with HCG? Lets say you take only 40mg a week should you take the same amount of...
HCG dose is independent of what TRT dose you are on. Basically, when on TRT, the LH receptors are just hanging out, doing nothing. They are just waiti...
What have you found to be best for fertility with your patients, clomid or something like hcg+fsh? Obviously people react differently on different med...
With our patients, we have had more success with hCG. This may have to do with the fact that more of our patients prefer hCG to clomid. Every patient ...
I'm battling water retention/edema on Sustanon 1x week. I am basically staying away from salt to battle this, which seems to help, but low salt is at...
Water retention/bloating tends to be related to elevated estradiol. Options to lower your estradiol without an AI are lower the dose, increase the inj...
How much does oxandrolone cost from you guys? And what can it be prescribed for? I’ve heard about people getting it prescribed for body recomp, but no...
For Oxandrolone/Anavar it is an ancillary medication which means it would be handled by a single payment for typically a 90 day supply at a time. It w...
Is there anything anyone could do or say that would make you turn them down for a cookie-cutter dose of TRT? Let me guess. 200 mg per week and anastr...
I don't really understand why the general hate for TRT clinics people have automatically gets applied to us without reading our threads. If anything w...
Should I consider increasing/optimizing SHBG? Some mild symptoms of low SHBG but feel great for the most part. Before TRT: Testosterone: 371 Free T: ...
Once you have started TRT, SHBG loses a lot of its meaning because you can always adjust your regimen to overcome any problems you have with it.
I got a shot Thursday and still quite sore in the buttocks. The more shots you get does the soreness decrease ?
Yes, generally. Virgin muscles get more used to injections over time.
180 being a bit high for a start would you recommend lower dosing? Without looking at my labs, are you saying it’s more common to start off around 150...
Without getting too specific, or try to guide your treatment, I will just say that the majority of men on TRT in the US average between 100-140mg/wk. ...
I just started TRT and was put on 180 mg test cypionate and anastrozole. Reddit hates AI but my physician put me on it. The huge amount of people sayi...
Never let the people on the internet get between you and a physician you trust. That being said, here are some general thoughts…
You replied to my previous post with: “That prolactin level is more than just a little high. Low T in the setting of high prolactin raises concern fo...
I’m glad you were able to get properly diagnosed.
So I’ve been on TRT for over a year now. Hypothetically, what if my doctor happens to move, or his office shuts down, etc. would finding a new doctor...
Most doctors would likely be comfortable following an established protocol if it had been working for a patient. Switching insurance companies is usua...
34, been consistent in the gym for 14 years with a good diet. Had very low energy, low libido and poor recovery after my workouts. Currently on 180 M...
It's very likely that 180mg from that starting T level may be more than you need, especially if you're feeling so good. Dropping down to 160mg (or 17...
Best remedy for facial acne that occurs during TRT?
If it's during the first 8 weeks of hormone adjustments & fluctuations, just some lifestyle improvements will help. Eating less fatty foods, less bad ...
Let‘s say someone would want to switch from Testosterone Enanthate injecting 2x/week (already on it and saturated) to Testosterone Undeconate: 1. How ...
Typically when switching to a long acting Esther, you would keep the same dose, but just increase the time between injections. For undecanoate, you ty...
How many mg of pregnenonlone and she’s should a man take per day. Also what are these two for? And are they 100 percent should be taken orally or at a...
Doses for pregnenolone for men on TRT vary between 100-300mg/day. The neurosteroids help with focus and attention primarily. They also assist with mem...
Is hcg necessary for the nuerochemical cascade that you wouldn’t get if you just took trt?
Necessary? Not really considering the neurosteroids that are affected by TRT can actually be taken orally. Pregnenolone (and its derivative allopregna...
My urologist is starting me off with 2000 unit of HCG a week.. my levels are in the 200s. Canadian. Any chance I notice any difference? Is it safe fo...
If you have secondary hypogonadism (pituitary function poor, normal testicular function), then hCG may double your total testosterone. If you have pri...
At what levels of Total Testosterone and Free Testosterone in your opinion would someone benefit from starting TRT?
The level at which they are feeling low Testosterone symptoms. I know that's kind of a non-answer, but it's also the best answer. The cornerstone of g...
Can you explain the relationship between trt and arterial fibrillation? Is it really a concern? Thank you
There was a study that suggested that there may be some correlation between TRT use and atrial fibrillation.The studies that said there may be an incr...
I’ve been on the cream 4.5mg dose daily for exactly 3 weeks now, but don’t feel any different. Should I keep going for a total of 6 to 8 weeks before...
If it's okay, I am going to share our TRT timeline expectations that we send to folks, because it seems appropriate here:
How concerned do people actually need to be about hematocrit levels? I was at 55 on my last bloodwork but based on where I’ve had tests pre trt with ...
It's one of those things that providers are always going to want to be wary of. Since you can have issues with high hematocrit they'll always err on t...
I’m not taking an AI, but supplement with calcium d glucarate. It’s not alcohol/drinking related, but yes travel is definitely a stressor for me. My l...
I think you have some room to come down on your TRT dose. You might try taking a day off, dropping your total from 210 to 180/wk and see how you feel.
Hi, I’m on TRT (30mg/day subc -210/week) and HCG (200 iu 3x/week). I feel great at this dose most of the time but sometimes I get very hormonal, espec...
From a TRT/medication standpoint, probably not. What you describe would be having extra Estrogen at those times, which you could control with an AI or...
I am 42 and have been unable to lose weight or build muscle for years now even working with trainers and nutritionists. Semagultide makes me horribly ...
We've treated men at 700 before. Relative hypogonadism is far more rare than normal than traditional low Testosterone, but if you're suffering then yo...
What are your recommended levels based on total T and free T to prescribe/administer TRT to a patient? What if they exceed those what else could be pr...
There actually are no specific thresholds for treatment with TRT based on the
What is the youngest age you have treated someone?
I believe the very youngest we have worked with was 20 or 21 & it was for a secondary hypogonadism patient who had suffered gonad injuries. However if...
Is Trt safe for an overweight individual who needs a CPAP to sleep?
Yes, it is safe. One thing to bear in mind is that you need to tell your TRT provider this. Because you can expect some muscle response on TRT, TRT ca...
What about the gel? Or is the cream better?
They will both provide the same intended benefit for this, the main difference is that gels are stronger than creams & so the dosing will be different...
I quit trt in February cause my hematocrits would get to about 50 and I would donate every 8 weeks and I was tired on donating, my dose was only 100mg...
Since you have started CPAP and are now on naringen, I think it would be fair to give TRT another try. You may consider trying the creams next time, a...
My T is at 443 ng/dl and my free test is at 8.9 pg/ml. Have some symptoms of Low T. Is this a range where you would prescribe TRT? If so how much and ...
That level is a bit higher than what would be considered textbook primary or secondary low total Testosterone, however good TRT follows the symptoms. ...
Are there any mental health conditions that you wouldn't prescribe trt to?
We wouldn't say that, no. Typically anxiety, depression, self confidence issues, and body dysmorphia or body image issues can be a results of having l...
How do you feel about oral trt that some competitors have begun to offer?
It is intriguing. Oral testosterone is likely the future of TRT, though there are not many studies yet on the true efficacy of them.
Regarding Enclomiphine while on TRT to maintain testicular function, do you see many issues with IGF-1 with many of your patients?
Yes. We have seen many, many patients who come to us after being treated with enclomiphene. Nearly all of them complain that they lose strength and mu...
My insurance is good and I was able to get a 6 month supply of 50mg and 75mg Xyosted (Testosterone Enthanate). My protocol right now is 75mg every 3.5...
T enthanate has a shorter half-life (6-7) days than cypionate (7-8).
Been on Test Cyp for 2-1/2 years now. Currently pinning 3 times a week of 50mg (150mg total a week) puts my test around 800 on my labs. I am having an...
That seems like a good dose & a really nice level to come out of it for the Testosterone, and it does sound like the Estrogen could be the culprit her...
I take 100mgs every Friday night. Should I switch to 50mgs every 4 days?
Once weekly injections are still “standard of care” in that is what medical textbooks suggest as far as injection frequency. However, with the half-li...
What would cause your testosterone and E2 levels to decrease, but the patient has been taking the same dose? (Testosterone cypionate 200mg weekly) No...
This could be a number of things.
Can TRT contribute to kidney issues. High protein levels in urine or cause excessive damage.
Just the opposite. Testosterone increased protein uptake in the muscles, thereby decreasing the protein found in urine. Several studies have shown TRT...
Do urologists use different criteria from primary care physicians when evaluating patients for TRT?
Yes & no.
What AI do you prefer? Why? What's the average dose, frequency?
Anastrozole is preferred primarily because it can be taken less frequently than others, and it is also the most widely used and widely studied, meanin...
Is there any way to reduce HCT without donating blood constantly? I had high numbers from the beginning and it seems to keep climbing. We have reduce ...
Sadly dose reduction is one of the main raise to help lower this if you don't want to deal with blood donations. There may be some OTC options as well...
I have been on TRT for over 4 years and I won’t be able to continue my normal TRT protocol using Test Cypianate. I won’t be able to inject at my norma...
We'd honestly be happy to if we could source it for you. I took the time to review the most up to date formularies we have for the biggest compounding...
Regarding TRT, what are the most important blood tests that you check for?
For initial diagnosis that would be total testosterone, free testosterone, and LH.
My hematocrit and RBC seem to always creep up, leading to BP spikes that don't go away. Is donating blood the only way to remedy this? The other week...
You could look to lower your dose as well, or if your dose is not effective at a lower level then you can look to manage your BP as a separate concern...
Are there any benefits to taking metformin while on trt?
No more or less than taking metformin while not on TRT.
Maintaining testicular size and strength are important to me should I start TRT, and I hear HCG is the way to do that. Are there any alternatives if H...
Adding hCG to TRT essentially “keeps the factory working”. It counteracts the most of the testicular shutdown that occurs on TRT, and at sufficient do...
If I have too low E2 while I am on TRT would HCG a good option to slightly increase it? I tend to have low E2 with sometimes under 10 even though my ...
Yes, hCG does result in a higher aromatization rate than exogenous testosterone. This is because when you are already on TRT, your body recognizes tha...
I'm 64 and started on gel, e pump daily on May 1st. My TT was okay but my FT was on the low side. So far I'm doing well on that dose. I feel much more...
Most of the time that BP elevations occur with the initiation of TRT, it resolves on its own in a few months. The body essentially accommodates the ne...
Why do some people here say to only use AI like Anastrozole if symptoms appear but some TRT clinics just put men on it proactively regardless of havin...
To be blunt a lot of online clinics will just put you on a far higher Testosterone level than you need, then assume you'll have side effects like high...
I’m convinced that HCG ruined my TRT experience. Unfortunately my clinic started me on both at the same time. Experienced sides immediately that last...
Many men have side effects from hCG. This is why we never advocate for starting hCG and TRT at the same time. Dial in the TRT first and find your opti...
Would it benefit to add Dim to the protocol then and does DHEA have any effect at all on the combo? Should not even be included?
I would definitely try both DIM and the CD2 together. Adding DHEA can have some benefits on cognition, but usually will result in higher E2 levels thr...
My question is have you heard of Calcium D-glucarate being substituted instead of an AI? And reducing E levels? My Endo seems to know nothing about AI...
Calcium D-glucarate has been shown to increase the metabolism of estrogen, meaning your body will eliminate it from your system faster. It does nothin...
I have been on Test CYP for 6 months and now want to come off. I have 4 5000iu bottles of HCG. What is the typical dOSE per week people are taking to ...
Reading this post has me confused on something I thought I was clear on. Hope my sophomoric question doesn’t rile anyone up.
Can HCG be used alongside Clomid for fertility proposes? For example 1500iu EOD and 25mg Clomid ED until conception.
There are some providers who recommend that, though bear in mind HCG and the LH produced from Clomid use compete for the same receptor.
I am 25 years old with a total T of 256, prolactin 26.6, free t of 38.6. Working out 5-6 days per week and a decent diet. 6’2” roughly 170 lbs maybe <...
For someone who works out that much & who is looking at body metrics, alongside those symptoms, switching to TRT would provide you more benefits most ...
What is a common dosage of HCG for someone who is taking 200mg of Testostorone Cypinate weekly? On forums I have seen as little as 100mg HCG 2x a wee...
HCG dosing is determined independent from Testosterone levels or Testosterone dosing, and is generally based on desired use case. If your goals are co...
When suspecting there may issues with hormones for men, what hormones are there to look into and what blood tests should be run to see if all hormones...
The gold standard for TRT should be looking at a patient's overall symptoms & onset durations first, these are the most important as individual hormon...
Do hematocrits ever level out without donating blood? I was on 100 mg once a week , my levels the day before injection was always about 580 that being...
They can, yes. There is no exact answer for hematocrit to dosing ratio to look at, because this one is totally dependent on the individual. Some men c...
Is HCG better than Enclomipine?
To be very general, yes. There's many aspects to consider but the biggest one for us is that IGF-1 can be suppressed heavily on Enclomiphene & it isn'...
I see many people say that HCG can raise estrogen in a disproportionate amount when compared to just testosterone alone. However, I’ve never seen any ...
There are no studies on this. It is primarily something noticed clinically. For example, I saw a patient last week who was on 150mg/wk of TRT. His E2 ...
My total T was 293 when I started TRT at 28 years old. Been in 120mg weekly. Injecting twice week with no side effects other than body acne do too ge...
If you wanted to come off of TRT then you'd want to work with your TRT provider. You could likely come off with HCG dosing and potentially a short sti...
Is it ok to discontinue HCG until ready to plan for children? If children aren’t in the immediate future is HCG just unnecessary and costly
Yes. hCG can be used as needed based on your family planning timeline. Allow for 3-4 months for it to take effect and for the sperm to reach maturatio...
What would be the minimum amount/ frequency to actually avoid testicular atrophy on the mid/Kong run? I heard 5000iu every 6 months should do but idk
Do you mean a single 5000IU dose every 6 months?
Hi! I’m doing HCG mono 3500 UI / week. 3 mg Anastro / week and 50mg clomi 3x / week. My T is at 1050 and E2 at 39. Without anastro I was with 90 E2 f...
That is indeed a very high dose of anastrozole.
I’m on HCG monotheraphy medication called Ovitrelle which contains choriogonadotropin alpha 6500 IU (3x/week). I see that it’s potency is way higher i...
Ovitrelle is slightly different than other forms of rHCG, but is similarly dosed. That is a higher dose than usual for hCG monotherapy.
I’m taking 500iu 2x week, so far I’ve not really felt anything but I’ve probably read too much about it and have some anxiety about side effects or th...
The symptoms of high estrogen can include:
Just out of curiosity, why is some of the Hcg prescribed for intramuscular injections by regular docs? My understanding is that it works better subcu...
hCG can be either SQ or IM. Most men will see better absorption and synthesis by the body via SQ. SQ also won't ruin arm or leg day or cause you to ha...
I am 37 years old and I consistently have low DHT levels but normal (500) testosterone levels. I do feel tired and am experiencing decreased libido. W...
Generally yes. You may be riding the line between low Testosterone & relative hypogonadism but we have had patients with you same situation before see...
I also noticed with my E2 on the low, and I wake up in the middle of the night, having to pee twice, feel dehydrated in a lot of weight gain in the mi...
This may or may not be related to E2 then, based on the ranges in your other post. If you're fairly new to TRT we may expect this, but 7 years in you ...
I do IM injections im going to try going to twice a week injections. I feel better with my estrogen in between 30-35 also Weird I went to labcorp & q...
That is very odd to get such wildly difference results on the Testosterone. For the Estrogen values, it may make sense for a bit more variation since ...
Hi there I’m on 150 mg test cyp a week split MWF don’t take a AI any reason why my E2 won’t budge over 14 been on this seven weeks been on try for 3 y...
Are you looking to raise your Estrogen intentionally? Aromatase reactions are less of a proportionate to dosing event, and more about a reaction to yo...
Is bcp157 only removed from compound pharmacy's?
From all pharmacies that are for human consumption, though it is still available from locations for not human consumption.
i've been on TRT for about a year, I have already had children, so I don't need my fertility. I'm not taking HCG and from my understanding because I d...
In your case, we wouldn't recommend HCG for you. Mostly because you don't want the fertility & because it sounds like you have the benefits you need f...
I (49M) have ED and estradiol at 41 pg/mL. 450 total testosterone. 2.0 LH mlU/ml. Free test is 73 pg/mL. Low libido. Not on trt. Does this sound more ...
It could be a bit of both because those are pretty middle of the road. Levels behave differently for each man & 41 for you may be too high or it may b...
I am empty sella syndrome and my natural test level is just below the bottom of the range, free test just above because SHBG relatively low. Been on T...
That would still be productive compared to no traditional TRT treatment, and you will likely still feel benefits.
Can you give an example of where HCG monotherapy would be suitable and the dosing strength and frequency?
The most important aspect of choosing whether hCG monotherapy is appropriate is first determining if you have primary or secondary hypogonadism. Prima...
What is the ideal injection frequency for someone in the middle of the reference range for free t but, very high shgb? Is there any benefit to propion...
So, SHBG is released by the liver whenever it notices a bolus of sex hormones. The larger the bolus, the more it creates in an effort to buffer it (lo...
Is there any long term risk associated with hcg use?
Generally HCG is fairly safe to work with long term, and many men enjoy low doses of it alongside their traditional TRT.
How does HCG affect total t, free t, and estrogen on top of current trt dose? If there is a large difference, would it be beneficial in some cases to...
HCG can effect this in some very specific cases. Usually it is if the HCG dose is moderate to high & the patient in question had a higher baseline Tes...
I'm on a 2000 IU, 3x a week (6k...) dosage of hcg after having done trt for 2 years. The hcg does totally make me feel better, but my dosage feels a b...
That is a relatively high dose of HCG, though if you are trying for active conception, that could be fine until it occurs. After that, it may be wise ...
My labs are dialed in on TRT but I still feel like I have room for improvement. Whats a good starting dose of HCG to help improve libido further and h...
Typical low end dosing for hCG is 500IU/wk. “Start low and go slow” is what they teach in med school, and I would suggest that with the addition of an...
I started TRT early January because of low libido, weight gains, low energy. The clinic I worked with started me at 200 mg per week of test cyp, dail...
You do not need to go to 300mg a week. They're not addressing your Estrogen in this scenario at all despite it likely being related to your water rete...
My Dr has only prescribed HCG after I'm done with my vial of Testosterone, is that normal? To only take it between my vials of testosterone? My proto...
No, that would not be very normal. It is much more common to be on a consistent safe dosing of Testosterone constantly & a lower dose of HCG semi-cons...
How much HCG is it good for me to start with being on 250ml of test? Plz conservative doses only I don’t want to over do it
If you're looking for basic maintenance doses of HCG, 500 units weekly is a very standard approach for baseline fertility & testicle size. At 250mg T ...
What are your thoughts on an hCG starting dose? And how long before I would notice a difference for my trial? And since I’m asking questions… I know ...
Starting dose for hCG is typically 500-750IU/wk, often divided into 2 or 3 shots per week.
I’d like to try adding HCG to my t dose. I’ve been on t for about 3 years, 49m, had a vasectomy, not looking at having any other kids. My dose is 45mg...
There are some benefits beyond fertility. Adding HCG essentially restarts the sex hormone cascade. This means the neurosteroids such as pregnenolone, ...
'm currently on TRT (cypionate 110ml/week) for really low T that presented itself after a chronic Rocky Mountain Spotted Fever and Anaplasmosis infect...
It is interesting that is has that effect for you, and we may suggest experimenting with the dosing & frequency further to see if it can provide that ...
Does TRT help venous leak and erectile dysfunction in general?
In general, yes. It increases corpus collosum blood flow. It helps by bringing in more blood flow, though to a lesser extent slowing venous outflow. B...
Why do primary care DRs have such a skewed scale for low t. Some Dr won’t consider 300 to low even if the patient is feeling terrible symptoms of low ...
A lot of that has to do with comfort levels. Generally speaking, primary care is not as comfortable doing TRT or even evaluating the labs because they...
Do you have experience with patients taking progesterone for anxiety and relaxation?
We do have some men who add it in to help with hormone balancing but not directly for anxiety concerns. That could be a potential benefit, but it woul...
How do you treat someone who’s on trt and an ssri like Lexapro experiencing genital numbness? Does a high dose testosterone mitigate those side effect...
TRT will not override the numbness and delayed orgasm that can be associated with SSRIs. I would certainly prioritize my mental health especially with...
What should be the normal dosage of HCG while on my cycle, here's what I'm dosing 2cc per week (800mg) need to know right dosing nuts are shrinking wa...
For HCG dosing, it is done by units. If you are on 800 units weekly, that should be fine for a moderate dose to maintain things as they are. If you're...
If experiencing symptoms of high E when HCG is introduced (I’ve done just Test 200/weekly no sensitive nipples) but when HCG is introduced I got them…...
You can lower the dose. Spreading the dose out won’t change much considering the half-life is 3.5 days, so doing it more frequently won’t change much.
If children aren’t in the immediate future is it ok to discontinue HCG use until ready to conceive? Or metaphorically speaking .. is it smarter to ke...
Due to the price of HCG & how it tends to work, many men elect to go through TRT without it until the time comes for conception. We generally ask for ...
What are your thoughts on enclomiphene without TRT and do you see it gaining FDA approval anytime soon?
This is very similar to another question so I will copy/paste that answer.
How would you go about handling a situation with someone who produced too many RBC on a TRT dose. Therapeutic phlebotomies?
That is certainly the easiest way to do it. And blood donation is good for the community. Other than that, we have seen some men have success suppleme...
I had six stents installed in my heart 10 yrs ago, why won't any trt clinics help me? I'm 65m battling low testosterone for 30yrs.
The main reason is liability & the kind of country we are with medicine. A small amount of people produce too many RBC on Testosterone therapy or expe...
In TRT, What do you consider to be an effective low dose?
250 weekly at the lowest usually, but 500 weekly preferred for maintenance. 750-1000 weekly for conception focuses.
At what estrogen level, or estrogen to test ratio, do you recommend using an AI if there are mild symptoms? And how long do you wait after putting a c...
Mostly the levels are considered to confirm the symptoms. So, if you hare having symptoms, and the labs show elevated estrogen, starting an AI low dos...
What are your thoughts on HCG mono-therapy? What dosage would you recommend?
In general it is fairly safe, and if you are suffering from low Testosterone & don't want your TRT to be in the form of Testosterone injections, it i...
How would you treat someone with very low SHBG and high estrogen symptoms? Assume patient is taking a large amount of AI already.
Generally adjust their dosing frequency to be more frequent to reduce overall spikes which may cause aromatization, switch from IM to subq because it ...
I’ve read that subq tends to aromatize more due to conversion in fat. Is that true?
No, it is not truly. In almost all cases it causes overall less aromatization to occur because that action is in response to when your body detects T ...
I've been in TRT for near 10 years. No HCG as wife said no kids. Now she wants a child. Can I stay on my trt and add HCG? Or best to come off? I don...
It depends on your timeline. If there is any rush, the fastest route to fertility is quitting TRT. However, it only takes the majority of men 90-120 d...
Is it possible to order just the HCG from you, if I receive my TRT from a different clinic?
This would be possible, though the pricing for this would be different than the traditional TRT costs. (Higher, since HCG costs more than Testosterone...
I take 250 units every other day, so about 750 per week, because I heard that a lower dose wouldn't be as effective in maintaining testicular size. Do...
750IU/wk = ~ 93% of baseline testicular function while on TRT.
What if my baseline was around 250-280, would dropping the HCG disrupt my current levels with the HCG by a lot you think?
Not likely by that much. While hCG does add to the total testosterone level while on TRT, the TRT is still suppressive to a degree that is rarely over...
If possible. How common are blood clots with HCG? And does HCG directly increase hypercoagulability by itself or indirectly via increased Testosteron...
They are not a common side effect of the medication at all, nor is it considered common to Testosterone either. If it were to impact it, it would be v...
When we're talking H&H, where does you cutoff fall for discontinuation of therapy? There is a lot of debate around secondary vs primary causes of eryt...
There shouldn't be a cut off if you are requiring therapeutic phlebotomy and doing so. If you're not doing it and you're getting into the mid and high...
I’m already splitting HCG & test doses into 3x/week injections, IM test and SubQ HCG. Which one were you referring to when you suggest switching to Su...
Your Testosterone specifically for Subq. Testosterone is absorbed slower via subq than IM, resulting in an overall more even level & lower Testosteron...
HCG benefits more than just fertility. It also benefits mood and sensitivity, but too much can cause someone to crash. I'm guessing it causes E to sp...
Awesome to hear that, those are great outcomes. Yes, it can cause E spikes as well at any level depending on the person. That more has to do with how ...
I have two questions. I’m on 160mg a week test C. The also gave my enclomiphene. I really don’t care about fertility since I’ve had a vasectomy. Would...
You can search here on Reddit about many men who were placed on a similar protocol as you using a SERM along with TRT. As you will discover, many men ...
Do you have any patients where trt has made erection quality worse? I’ve been on trt for 4 months with all bloods in range but feel like my erection q...
So, hormones are only a small part of erection quality, though an important part. As a general rule of thumb, if you get morning wood, but have ED dur...
What are some common side effects you guys see with AIs?
Some reported side effects of AIs include headache, joint pains, fatigue, and hair loss
How far in advance should one start HCG before trying to conceive?
Generally 3-6 month's heads up is what we suggest, 3 months is the minimum time it takes for a sperm to reach maturity.
Why is hCG being restricted? It has personally been extremely helpful for me and I dread a day where I can get it… I just paid 250 for 2x 6000iu vials...
The "why" aspect of it comes down to likely overregulation but really some of these small changes can have some pretty large impact on the whole proce...
So what are some risks of trt dose for rest of life besides not being able to have kids really just trying to understand ? Thanks in advance
Risk factors for traditional managed TRT are quite low, it is one of the lowest cost malpractice medical fields to put it into perspective. Since you ...
Is there anything you can take to remove/reduce gyno or is surgery the only option? Have gyno from steriods when younger and now on TRT
Tamoxifen can been used to reduce or resolve gynecomastia. How effective it is depends on the severity and the duration (it is most effective on mild-...
I have brain fog after starting TRT about 2 months ago. What can be causing this?
This would normally be after your levels are stable. It could potentially be higher HCT or higher Estrogen, though hard to say without doing a panel t...
Do you believe Tamoxifen is necessary? I see people always saying there's not point taking 2 SERMs at once, but even well informed people like Vigorou...
This has been studied, and there is no benefit in being on two SERMs at the same time. SERMs are partial antagonists that have differing estrogenic an...
What are the perfect number?! Let's say I would like my total T to be around 1000....
The perfect number has to do with your individual goals of therapy.
If I have been living in Thailand for a few years and have been on TRT the whole time with supervision from doctor, will I be able to get my meds in t...
We are happy to work with men transferring from other TRT clinics or UGLs to managed care. We will generally take your initial pre-TRT bloodwork if yo...
Why would my dose response drop so dramatically? 6 moths from start treatment: 133 mg/week. EOD frequency. Test on the morning before evening injecti...
The fact that your SHBG is dropping along with your TT and FT suggests you may have a problem with your liver’s metabolism. The liver performs over 50...
I have a brand new vial of HCG I need to reconstitute. Would you recommend that I drop the progesterone or continue it while I reintroduce HCG? (Regar...
While we recommend you speak to your doctor regarding your protocol, our recommendation would be to take only hCG or progesterone; not both. Taking bo...
At 1000 iu weekly, are there any long term side effects of the body no longer responding and producing LH?
As answered in another question today, long term use of hCG does carry the risk of downregulation of the LH receptor. So we always recommend a "drug h...
What would TRT cost with the addition of hcg? How many months of prescription do you send out at once and is it delivered to my door or do I go to a ...
Generally HCG is $300 at the time of order/reorder and we send out 10,000 units at a time. Typical dosing is 500-1000 units weekly depending on goals,...
What is your opinion about high hematocrit, including high RBC and high hemoglobin? There seems to be some debate about whether high values on TRT a...
There certainly is debate regarding how relevant high hematocrit from TRT is as a risk factor. So far, there is no evidence to suggest it is as concer...
I’m currently with a local provider; considering switching. I feel like I haven’t gotten a lot of the benefits that are commonly associated with TRT....
Is the concentration of your medication 200mg/mL, or 100mg/mL? Are you taking ancillary medications like Enclomiphene? If you're not taking that medic...
Can oxandrolone can heart problems/chest pains? I had it but was also anxious at the time of taking, and it seemed to cause chest pains. UNLESS that ...
It has no known cardiac effects, but is known to trigger anxiety in some people.
Are you aware of any long term studies conducted on TRT? With TRT bringing testosterone under 1,000.00
There are plenty of long term studies on TRT. If I’m understanding your question correctly, you are asking if those studies kept TT levels under 1000?...
Good day. Thank you for taking the time to answer questions and share your knowledge and experience to us. 33M, I’ve been on testosterone Cyp. 140mg ...
If you're taking HCG for cosmetic effect (compared to targeted fertility for the short term) then 500 units weekly or so is fairly normal. Although ad...
When the HCG gets here should I do em both? I've seen them used together with a mixed bag of opinions. It's just 1 vile I will not be getting anymore ...
Once the hCG arrives, you should discontinue the gonadorelin.
So I've been on TRT for 6 months, my clinic doubled my dose when I was at 615 with normal E2 levels then 3 months later. I'm only at like 718 and my E...
You already paid for it, there is no harm in trying it. It’s true, gonadorelin is a poor substitute for hCG, and has little benefit for this purpose, ...
Thoughts on eth/cyp vs sus? In EU I'm on sus as its half the price of the other two
Sustanon is kinda weird stuff. It was formulated decades ago on the incorrect assumption that long esters don’t release immediately, so shorter esters...
Would you recommend someone who is 65 years old start TRT?
If you have low Testosterone symptoms & would like them resolved, absolutely. We have plenty of men at this age range start TRT & have great results.
What labs should I get with total test at 314, free test 6.1 and estradiol at >5. What should I check for?
If you're feeling well overall with no side effects, you could just add a CBC or HCT & a PSA. Those are always good values to have on hand to compare ...
What's the indication for Subcutaneous vs IM administration? Personal preference? Skill?
In general Subq is better for TRT when given both options because the absorption is slower & leads to a more even level overall, so there are less spi...
Been on trt for a few weeks and blood pressure has going up again. I have increased my usual telmisartan 20mg to 80mg and still on 135/75 any suggesti...
There is typically an 8 week phase when starting TRT that is going to be a lot of chaos, and around which you shouldn't be changing doses and medicati...
In instances where E2 is high and patients don’t respond well to AI, have you had success with other alternatives such as DIM, CDG, and/or Zinc? And ...
With those options, DIM does work. It is much less robust than prescription AIs, but you may be able to further lower your E2 a bit by adding 300mg/da...
What percentage of your patients are on AI? And what dosing protocol do you typically recommend?
Dosing should be based on initial levels which respect where you're starting, we tend to see men who need between 120mg-180mg weekly most often, with ...
What injection frequency do you typically see the most success with your patients? 1x weekly, 2x weekly, EOD, ED, etc.
In our practice, ~90% of men get best results with twice weekly injections. The remaining ~10% have different injection frequencies ranging from once/...
At what range for Total, Free, and E2 do you typically see the most success for your patients (peak and trough)? (Minimal sides and no need for A
This varies enough that I would hesitate to make a general statement, because it varies based on age, androgen and estrogen receptor sensitivity, and ...
Using test prop (35mg) every other day, avg about 120mg a week, as I'm used to needles with suffering crohns disease for years. I find it keeps my le...
If it ain’t broke, don’t fix it. Test prop works better for a select few. It sounds like you have found a regimen that works for your particular physi...
Thoughts on oral test like Kyzatrex?
We have not seen great results from it. Since the bioavailability of all oral forms is low, even maximum doses do not seem to have a very robust effec...
Is there anything you can take to remove/reduce gyno or is surgery the only option? Have gyno from steriods when younger and now on TRT
Tamoxifen can been used to reduce or resolve gynecomastia. How effective it is depends on the severity and the duration (it is most effective on mild-...
I have brain fog after starting TRT about 2 months ago. What can be causing this?
This would normally be after your levels are stable. It could potentially be higher HCT or higher Estrogen, though hard to say without doing a panel t...
This is two years of 6 month interval tests including FSH and LH Here’s a summary of my Total Testosterone and Free Testosterone numbers over time: ...
Your LH levels are lower than expected for your T levels for true isolated primary hypogonadism. You may have some mixed hypogonadism (both testicular...
What about someone with low t, low free with no real symptoms except insulin sensitivity, stubborn body fat, strong but hard to put on visible muscle...
It sounds like you have all your lifestyle factors dialed in and yet still have low T. The only way to know if it will work is to try it. HCG monother...
What results do you see people experience doing HCG monotherapy and what side effects?
In general HCG monotherapy's effectiveness it based on someone's baseline production ability, much like Enclomiphene. If someone is having low Testost...
If I have been living in Thailand for a few years and have been on TRT the whole time with supervision from doctor, will I be able to get my meds in ...
We are happy to work with men transferring from other TRT clinics or UGLs to managed care. We will generally take your initial pre-TRT bloodwork if yo...
Why would my dose response drop so dramatically? 6 moths from start treatment: 133 mg/week. EOD frequency. Test on the morning before evening injecti...
The fact that your SHBG is dropping along with your TT and FT suggests you may have a problem with your liver’s metabolism. The liver performs over 50...
I’ve got some questions about your clinic as well. What sort of numbers do you look for in your clients? What all do you check for in your labs? What...
Our general approach to patient care is one that is focused on patient goals. We also treat the patient, not the number. So if you have goals that are...
My e2 was a little elevated and the doc suggested doing .25 after every injection (EOD, so it’s a little less than 1mg/wk) to knock it down a bit but ...
We live in a world where there are still very few good long term studies on men’s health. In the case of AI’s there are exactly zero studies on AI us...
While fully understanding that everyone is different AND you treat symptoms mostly rather than chase numbers, are there treatment tricks and methods ...
Yes, this does occur. Some men have much higher SHBG, which acts like a sponge and soaks up the total T, leaving a low amount of free T.
I’m a little confused by my blood test numbers and reference ranges. Is 555 ng/dl total testosterone and 11.7 pg/ml free testosterone low. The free te...
We would say that depends on your age, but if you are below 50 years old, then yes, your free T would be considered low. Also, T levels drop by 30% th...
Why would my provider not allow me to use deca with anavar?
Without knowing more about your specific situation, or reason for needing all these medications, all I can say is that more is not always better and t...
What is your opinion on using short esters vs long esters for TRT? Do you see particular situations where one would work better than the other?
There may be cases where one works better than another, but generally the most accepted form of Testosterone (Testosterone Cypionate) tends to do best...
Any correlation to low thyroid and low t, and thoughts on the importance of adding thyroid medication to trt if thyroid output is low?
While there are some small studies that suggest that there may be some link between thyroid and testicular function, there currently is no consensus o...
What are your thoughts on long term, low dose nandrolone as part of TRT treatment. A safe addition to testosterone full time, or should it be cycled ...
We do this with certain patients, though we normally request some additional check-ins and lab work. Many times it is prescribed due to it's beneficia...
I've just started TRT. My SHBG is 55 nmol/l (normal range: 18 to 40 nmol/l). Will injecting cypinate M/W/F, subq, at 132mg a week, lower my SHBG? And ...
Each person's response to TRT is entirely different. This is why there is typically some trial and error involved in the dosing, injection schedule, a...
Interesting that you say that because I found that my 3-4 years of elevated blood pressure have gone away ever since introducing one pump of progester...
While we recommend you speak to your doctor regarding your protocol, our recommendation would be to take only hCG or progesterone; not both. Taking bo...
At 1000 iu weekly, are there any long term side effects of the body no longer responding and producing LH?
As answered in another question today, long term use of hCG does carry the risk of downregulation of the LH receptor. So we always recommend a "drug h...
What would it cost with the addition of hcg? How many months of prescription do you send out at once and is it delivered to my door or do I go to a ...
Generally HCG is $300 at the time of order/reorder and we send out 10,000 units at a time. Typical dosing is 500-1000 units weekly depending on goals,...
I've been on TRT for 1.5 years and have not been able to figure out why it has caused ED. Estrogen is where it should be. I'm not on excess T. Not on ...
The melanocortin receptor pathway is a relatively newly discovered mechanism for both erectile function and libido. It is entirely separate from tradi...
My problem is that my low shbg is causing me to have a low libido and erectile dysfunction. Do you have a solution when this happens? I’m already micr...
SHBG can be tricky, but traditionally high boluses of a sex hormone like testosterone will trigger the liver to make more SHBG. Doing daily "microdose...
Is it safe to use Tamoxifen to increase shbg when it’s in the single digits? I’m otherwise healthy, not obese, no insulin resistance, thyroid is good ...
Tamoxifen has more side-effects than most SERMs, and for this reason should be used at the lowest therapeutic dose, and for as short a period as possi...
DHT is inactivated in muscle tissue so explain how it is more anabolic?
It does get inactivated in muscle, though not immediately. Before it is inactivated, it causes anabolism through the mTORC1 pathway.
When I take a weekly bolus dose of T instead of twice a week a feel more anabolic, my labs are identical either way. is there a reason behind this mo...
On once weekly injections your peak will be higher, leading to a greater "overflow effect". Like an overflowing cup, the higher your peak, the more yo...
What’s the cost of trt + tirzepatide?
Our normal TRT program is $129 a month, and our normal Tirzepatide program is $386 a month. (Though if you wanted to use Semaglutide as your GLP-1, th...
Do you offer peptides and if so can you talk a little bit about which ones you offer and the possible benefits?
We do, though they are more tightly focused than a full on peptide provider. This is because we can only work with peptides that are available from ph...
Does Deca Durabolin cause extreme anxiety and jealousy at therapeutic dosages of 100-200 mg./wk.?
No. It does not & should not. We routinely work with men at the 100mg/wk mark and this is not a common concern at all. When getting near 200mg/wk you'...
I’ve been thinking about how to have the conversation with my primary care doctor. I had a testicular torsion during my teenage years and would bet th...
It is true that TRT would not have any interaction with your current medications.
My question is regarding high hemoglobin and hematocrit. I’m currently on 90mg per week; injecting twice a week. Going higher will increase my values ...
Some methods to reduce erythrocytosis on TRT include:
TRT Providers should work on making the following available: Anastrozole, exemestane in dosing specifically for men like 0.1 and 5 mg. A way to get...
Yes, these would be nice to have available.
What are your thoughts on using Deca and/or Anavar alongside TRT?
Perfectly normal & we do support this. Those are both legal medications to prescribe, though they cannot be prescribed en masse for all patients witho...
Could switching to testosterone propionate help with lowering hematocrit, because of the short ester?
Potentially.
You prescribe Oxandrolone? Just curious is this common or is there a specific individual that is eligible for or benefits from this treatment?
We do, as needed. I hope you don't mind me copying another answer I just made which talks about Oxandrolone/Nandrolone. Those are both legal medicatio...
Do you recommend taking dhea with test? I have sides of high estrogen because of my weight. Do you service California? What is your average dosage for...
Taking DHEA with TRT is perfectly fine, and can help balance hormones slightly. Though in cases like what you describe, it's generally better to add a...
is there a big difference in injecting ,same weekly dose, once a week vs twice a week vs three times a week vs EOD vs ED. I have tried all and don't...
Generally we don't have enough data to compare between the two, as you'd really need a man who has done both & testing multiple times with both at th...
if someone if having high E2 symptoms, poor sex drive, ED issues, water retention, High BP, high emotions, would you recommend lowering the dose or a...
It depends. So long as they still have relief of their low T symptoms on a lower T dose, then typically lowering the dose is the correct first step to...
If your LH levels are low as well as your testosterone levels, would you be a good candidate for hcg as opposed to trt? And do your levels stay elevat...
For those with low LH (secondary hypogonadism), hCG monotherapy can work well to raise testosterone. Once you stop treatment, levels will return back ...
Does the monthly price include bloodwork as needed throughout the treatment?
We have a partnership for discounted labs through LabCorp and Quest, and we write order requisitions so that you can get your labs covered by your hea...
If the goal is to prevent permanent testicular atrophy with no immediate plans to have a kid, would the advice be to go on HCG every 3 months for a 3-...
For many men the easy solution is to do 3 months on & 3 months off, or just stay on a low dose long term. A simple 500 units weekly tends to be a soli...
1. Disregarding systemic effects, are there any downsides for your hair specifically to taking oral dutasteride? I'm fortunate to have zero signs of h...
I’ve been on TRT for about 5 months. Currently at 140mg per week and my PSA jumped from 1 to 1.6. Any cause for concern?
PSA is expected to raise by 0.3 to 0.7 after starting TRT. The threshold for concern is any elevation in PSA >0.75ng/mL above baseline.
So. According to you. Taking AI essentially means your body will work harder to produce E2. Taking SERM mono essentially means your body will stop p...
Improving lifestyle habits have been proven to raise testosterone levels, but only by an average of ~15%. But if you need to use a medicine of any kin...
I know someone who is on 200 mg a week. Went from 290 to 1000 at trough, but they don't feel any different. Test is from a clinic in USA. Thoughts?
It sounds like they may either be on too much for what they need & much is aromatizing to Estrogen, or they preemptively gave them an AI that was too ...
Does chrysin calcium d glucarate zinc actually work in lowering estrogen levels?
Maybe.
Hello! I’m about 6 months into TRT. A few days ago, I noticed that I was shedding hair. To clarify, if I gently tug on my hair with a closed fist, I’...
Based on what you describe, that does not sound like an atypical amount of hair loss. The Hair Pull test is a common test done in healthcare which hel...
Hi I’m curious to know the price of standard 10 week vial test cost from this clinic?
We do not sell individual medications, though medications are part of being a member. Our cost is $129 a month & covers most dosing, though can be red...
Currently on trt last few months. 120 mg. HCT fine, estrogen fine, rbc, fine. All bloods perfect. I get weird hypersensitivity feelings, almost like p...
The “prickly sunburned skin” sounds like paresthesia. This is typically due to inflammation, irritation, or compression of peripheral nerves. That is ...
If someone starts TRT and requires additional meds down the line (anastrozole, finasteride, etc), are there additional charges, or does your monthly f...
Generally most medication is included, and we're pushing to reduce costs this coming year as well. For things like an AI, this is already a part of th...
what are your thoughts on running very low dose Primobolan on TRT?
At first glance Primobolan seems like it would be a great option to boost the effects of TRT while also helping control estrogen. However, its use can...
I had good libido before TRT, periods of good to great libido during the first 2 years of TRT, then it disappeared for no reason and I've never been a...
Understood. Have you experienced any other life changes or stressors during this time period?If all of those values are normal, then you may want to t...
In your experience, what are the usual reasons that men lose their libido after some time (2+ years) on TRT despite their numbers looking good, and no...
This is a great question, and I hope you don't mind, but I'd like to copy/paste an answer we just gave because it's a good summary of this ebb & flow.
What doses and ratios (testosterone:nandrolone) do you normally use for TRT regiments? And how often do you forgo testosterone completely in favor of ...
A normal testosterone:nandrolone protocol is dosed at a 2:1 ratio.
Is it possible for DIM to not work at all? Never got an effect (afaik) from DIM..though only going by feel
Most patients do underdose DIM, so they often claim it does not work for them. But, even at higher doses, the effect is much less robust than other me...
I’ve seen a lot of threads on here with people starting TRT, getting no libido improvements and after weeks or months switching to Propionate and sudd...
This suggests that their testosterone cypionate dose was too high. Considering the half life is 8 days, testosterone levels exceed normal levels, trig...
In regards to "Why do I get resolution of my sexual dysfunction and low libido when taking testosterone gel (2clicks) together with 100 mg split in 2 ...
Yes, we do have some patients on the hybrid protocol using topical and injectable testosterone. This is used primarily for men looking for the sexual ...
Currently on 130mg testC per week divided by 3x week injections. recent labs showing low shbg 11 (29 6 months ago). test 1100 (1400), free T 38 (31),...
Thanks for clarifying.
So 6 months ago my ratio was ideal? any harm in further reducing shbg < 10 with more frequent injections? might go back to previous dose if this is t...
A conservative proviron dose is actually 25mg every other day, then increasing to daily if needed.
When you say there isn't much point increasing test but lowering igf-1 in a low testosterone male, is that from a physical or mental point of view as ...
IGF-1 has no mental benefit. It does have a very outsized benefit in regard to strength and muscle gain. Even more so than testosterone in fact. So th...
47 y male started subq 2x week 120 mg total . Total T 240 shbg 67 freeT 27 ! Is this a good starting point,no sexdrive can’t build much muscle 💪 5’10...
It’s hard to say, considering everyone responds so differently to TRT. But we can say that 120mg/wk is a common, though conservative starting dose. Si...
No libido increase after starting TRT, probably even slight drop due to balls shrinking and no longer needing regular emptying. Of course I'm going to...
Most instances of low libido are not hormonal. Most low libido is emotional/paychological, stress induced, due to sleep apnea, or relationship Issues.
I have lowish SHBG (11-17) on TRT 120mg injecting 6 days per week. Can I raise it by decreasing injection frequency? Do you treat your patients with...
Yes. Decreasing injection frequency typically results in higher SHBG. Higher doses induces your liver to start producing larger amounts of SHBG in an ...
What if a male with history of ferritin started trt and noticed a further drop in ferritin and an increase in hematocrit and rbc. How would your staff...
Ferritin is a building block necessary to create the hemoglobin in red blood cells. If you begin producing RBC’s at a rate that exceeds your ability t...
Is 496 too low at 20? Am i in a disadvantage?
When looking at a textbook definition of Testosterone levels, you would not be considered low. However, you would still be within an acceptable range ...
Cold turkey to quit testosterone?
We would generally advise against this, as it is fairly easy to work with either HCG, Clomid, or Enclomiphene to make the transition off of TRT easier...
As someone who just restarted TRT after 6 months off trying to see if my body would restart, I wish I’d reached out to you guys as well. What is the p...
The only thing we require is labs that are less than 12 months old. We can easily transfer you over after a brief consultation. You can visit the webs...
Your 'expert' Finasteride video: https://www.youtube.com/watch?v=mKum5L64cPk @ 2:07 Your 'expert' dudebro says serum DHT concentrations were 100 time...
He did misspeak, thank you for pointing that out.
What is the likelihood of a shortage of test?
Of available injectable Testosterone on the market? Very low. It has been around for a long time and many pharmacies produce it both domestically and ...
So what would you recommend as the best therapy for a secondary hypogonadism patient? I have tried enclomiphene and nasal testosterone gel, but neithe...
Honestly this is a hard question to answer for us as a company, as there's so many potential causes, but one that we would feel comfortable working wi...
What is your opinion on exemestane monotherapy to restore testosterone levels of someone with secondary hypogonadism?
Exemestane can increase testosterone levels by reducing circulating estrogen. Estrogen has a negative feedback loop on the pituitary's production of F...
With continued estrogenification of our environment in societal wide decreases in testosterone and sperm count, not everyone is going to necessarily f...
The question really comes down to do you have primary or secondary hypogonadism. If you have primary hypogonadism, you could take all the enclomiphene...
What are your thoughts on theoretical long term effects on enclomiphene or were the studies not designed or powered to look for adverse events? Clomid...
For the long term use of Enclomiphene I'll let one of my partners hop in on that tomorrow who is more knowledgeable on that aspect.
How can you promote Finasteride considering the PFS problems?
We'd prefer topical Finasteride to oral for exactly that reason. In that video it explains really well why it's not an issue in that form.
Why does enclomiphene raise testosterone levels, but the testosterone doesn’t seem to be absorbed by the body, thus not relieving any symptoms of low ...
So, this may be a bit of a two part answer. A bit candid if you're okay with that.
I'm with a different provider, but am considering jumping the fence. I've heard that there can be a delay though for transfer patients to get their mo...
Sure!
hello , im currently an existing client from anouther clinic and im looking out for different options and comparing the knowledge ,pricings etc. -- ...
absolutely.
What happens to the test carrier / ester oil in your body when you inject into the muscle. How is it metabolised/ where does the oil go?
Testosterone in its true form, like most drugs, comes in a powder. Most drugs are hydrophilic, so if they need to be injected, they are mixed with sal...
If my labs come back with let’s say tt of 750 and I have no side effects but still no libido and feeling OK, but still like I was befor trt maybe a l...
Let's take a look at that TT first. First, what age are you (or age range)? Second, what was your TT before you started therapy?
Where does testosterone come from? Is it made in the USA? How is it typically made?
From a USA based domestic company, we use an USA based compounding pharmacy that produces their Testosterone here.
How often do doctors prescribe something like oxandrolone or nandrolone in addition to a regular testosterone protocol for TRT? Some people claim that...
I feel like Oxandrolone & Nandrolone in TRT need their own videos to talk about them, so we'll do that this week, then share it here when done.There's...
This is not answering the question of what happens when I add RAD140 to my TRT protocol
'm sorry, that's what I was talking about when I mentioned "We'll follow-up on the concept of stacking in one of our videos, question added to the lis...
SARMS with TRT: They indeed have sides and I have seen them crash natural production. There is no free ride but if it cannot crash it because you don'...
The side effects of suppressing natural Testosterone when on any Steroid (including T itself) is usually overshadowed by the amount or effect gained o...
I have wondered the effects of SARMS with TRT. Is it worth it? I have seen people use them with incredible results but these people were not taking an...
I do need to be perfectly clear that SARMs are not FDA regulated & we cannot advise anyone to use them one way or another, so I can't speak to it bein...
BP, on some TRT patients it increases on others it decreases. What are your findings with patients on that matter ?
Our findings at AlphaMD seem to correlate with the general consensus on the matter that TRT lowers BP in nearly all men who were previously hypogonad...
I have high triglycerides: 3.5 vs <1.5 reference. I think a part of that is certainly genetic as father has been on statins since early 30's. I was ...
Triglycerides are not affected by statins to any significant degree. Statins help with cholesterol, most specifically LDL. The primary way to treat tr...
I have no problem donating blood, I'm 9 weeks into TRT and my last blood test show HCT at 0.53 (0.5 max range). I read a paper (which I can't find now...
Higher hematocrit levels can sometimes be thought of as a potential risk factor for heart attack or stroke. This is felt to be the case because the hi...
What are your thoughts on high HCT? I've seen a paper where it didn't increase risk of death. Mine was on the high end before starting TRT and it is ...
We've encountered a few people who've had a hard time donating blood due to things like iron level or high HCT. Is there a reason you'd be adverse to ...
How closely do you help monitor blood tests with the patient?
In general, we take blood tests for all new patients or accept recent lab work in place of that. If they're an established TRT patient & can provide p...
I have seen that SHBG contains 60-80% of total testosterone i have been told by a few people that my only problem is high SHBG but im wondering if tha...
I would say this: Men often like to think of values at absolute rules and facts in medicine. However, this is not true, as all men are wildly differen...
Could you give me some advice? im 23, 5'10, 62kg (136.687Lbs) high protein high fat diet, very active sleep 9-10 hours a night, total testosterone 600...
It sounds like a lot of your symptoms could be addressed by TRT, though given your history of Gyno, you'd want to be careful and mention that to your ...
I felt great on aas. Physically and mentally. I never felt bad or lacked ambition anyway, but it made me more confident. Broke plateaus in the gym. Ma...
Great explanation. You felt better when your T was higher, it was good for your life, though the AAS were potentially illegal or bad for your organs. ...
Hi im questioning if i could benefit from trt. I'm 34m. 6' tall, 191lbs. in my late 20's i decided to try aas. since coming off my life has been a ro...
So the main questions here, did you feel good on AAS? How long ago was that? Typically with any steroid (Testosterone included, though we tend to not ...
Are any of these TRT specialists online? If I continue with my GP, since he is checking my levels, couldn’t I just increase or decrease accordingly b...
Well, essentially in medicine you have a provider who oversees your care. If you're overseeing yourself you assume all risk related to self treatment ...
Ok. I’m being treated by my GP but he’s obviously clueless. My sister in law is a pharmacist so I can also seek her help when needed. I will continue ...
I would encourage you to seek a TRT provider if you're able. If you're unable, then consider not going that low either.You were having a large injecti...
Does low T cause hair loss as well?
Typically no, at least not the kind that we're talking about on the head. However low T does lead to lack of the hair you do want as a man (most men)....
Hi, do you know if hair thinning is less likely with a more natural dose of test cypionate every 3 days vs a large dose once a month or every 2 weeks?...
So, the easiest way to answer this is that the higher the dose, the more conversion that occurs, like an overflowing cup of water.What I mean by that...
Hey, maybe slightly unrelated (and I don't have bloodwork yet,have a appointment on the 4th of May to get my 6 weeks bloodwork). I had borderline low ...
You are right in considering that E2 may be a bit off, even if you don't have the other side effects. Some men are more sensitive to levels that are ...
Out of curiosity how does one usually decide between the types of trt to run? As in what ester to use and route of delivery like IM or Sub Q injection...
Of course!
I’m very interested in trt and my main concerns for giving it a go some of the possible side effects. I struggled for years with acne and have very oi...
At a therapeutic dose, this tends to not be an issue for most people as adults even if they previously had issues. This is due to (honestly) eating be...
Is any symptom considered more relevant for TRT than others? I.e. low libido versus ED versus muscular issues
Some symptoms are more directly treated by TRT than others, and that makes them more relevant to diagnose it. Low energy, low libido, difficulty losin...
What levels do you consider low enough that the person will see a benefit from TRT?
In general, it's a lot more about how someone feels than about the numbers themselves. The range for "acceptable" Testosterone in men can go from 250-...
Age 62, athletic, nutrition freak (usa). Started TRT 15 months ago when testosterone at 298. Six months later it was 498 and I was doing great. Level ...
I'll share some conjecture here without knowing more.
Who are your pharmacy’s? How do you choose them?
In digital TRT, it's usually best to work with a compounding pharmacy or a pharmacy designed to work with businesses. Local pharmacies like Walgreens...
Do you guys prescribe other anabolics other then Testosterone?
Where it's appropriate, yes.
Not about your company specifically, but why can’t Doctors in the US prescribe primobolan? It’s commonly prescribed in Europe, has some of the collag...
Primobolan (Metenolone) is an interesting medicine that has many health benefits. However, like you say, it cannot be prescribed in the US.
What’s your opinion on more frequent inflections, same weekly dose? I think there was a pretty big study in the ik about levels being more stable with...
We are definitely fans of more frequent injections. It makes for less of a difference between the highs and lows, which generally means fewer side-eff...
My current level has rebounded to 550. In December, it was 400 and I'm assuming at the end of the marathon season it was 200 or less. I might just lo...
For Testosterone, injections are much better than creams and gels. They are more consistent, potent, accurate, take less time investment, and generall...
Does anyone "time" TRT use according to their endurance schedule? That is, I *know* roughly when I'm going to bottom out -- during the two hardest mon...
From personal experience, I have raised my Testosterone consumption during periods I know it was dropping due to reasons like the above. However, I am...
What do you recommend for someone that experiences low T as a result of endurance activities? Specifically, I was training for my first marathon last...
Someone else from our team may hop on and expand on this, but in my personal opinion:
Any comments about DIM for estrogen management? And is a low SHBG good or bad for a 45 yr old?
Typically it's somewhat to be expected. SHBG decreases with age for all men, which isn't really a bad thing. When having your total Testosterone teste...
What kind of protocol you would suggest with Sustanon?
The half-life of Sustanon is 15 days. For this reason, it is typically injected once every 3 weeks for TRT. While some protocols recommend injecting i...
Have you ever turned down someone for treatment, or do you prescribe cookie cutter programs to literally everyone who signs up regardless of labs, pot...
I understand haha, that's what it feels like sometimes with many online TRT clinics.
Do you require bloodwork? What test levels are you shooting for? My current clinic shoots for 1100.
We do require bloodwork, most TRT companies will since Testosterone is a controlled substance & it's good to have this info on file even if someone is...
What can you do for someone high estrogen and can't take ai ?
What would be the reasons that you can't take AIs?
Been on TRT since November. My wife and I would like to eventually have kids but we won’t be ready to start trying for 2-3 years. I know some doctors ...
That is generally how we approach this subject as well.
You offer enclomiphene therapy?
Yes, we do.
• 2y ago Is there a way to estimate peak testosterone by dosage and 7 day trough numbers ? Do levels linearly decline from the peak after the shot u...
For the average man, 1mg of testosterone cypionate translates to approximately 5-6 ng/dL of total testosterone. This means that 100mg/wk should get mo...
How do you handle libido problems? If testosterone and estradiol are both in range, where do you look next? DHT? Prolactin? I am currently dealing wi...
Libido issues can unfortunately be difficult to pin down sometimes because there are many factors, both intrinsic and extrinsic, that affect it.
How do you look at "dialing in" doses and other aspects of a protocol for somebody who is generally responding to TRT well? The only clear restriction...
In medical school, they often say "Treat the patient, not the numbers." In my experience, in no other field of medicine is this more true than in trea...
What are some important things to include on a blood test to diagnose low T?
Labs can be expensive, so I will list the most essential ones for diagnosis and treatment. I will also point out that there are different types of as...
What do you recommend for PE. I can't stand it. I am using desensitization but still not much help. Also takes aot of preplanning to be effective. The...
For premature ejaculation, medically speaking you have a couple options. But it is important to know, the FDA has not approved any medications for PE,...
Would you advise a 49 y/o man with documented low T but also a long (>10yr) history of extensive PVCs (every 3rd to 5th beat) to avoid TRT? My PVCs h...
PVCs are typically ideopathic, which basically is medical speak for "I dunno what is causing them". It sounds like your cardiologist has said the same...
Hypoxia only effects erythropoietin levels to raise hematocrit. Testosterone raises hematocrit through multiple mechanisms. Since DHT was on your lis...
I have not personally seen any patients have a drop in hematocrit while using a 5-alpha reductase inhibitor, nor have I seen any studies on the matte...
Men living at high altitudes often have raised hematocrit levels and this is deemed normal/safe/ok. Men on TRT who get above 50% PCV are usually giv...
This is an excellent question, which requires a pretty complex answer. But the basics lie in the differences between chronic hypoxia induced erythrocy...
Looking at your website I am unclear what you folks mean by “We are able to offer the prices we do because we do not work with insurance companies. Y...
This is an incredibly complex topic, so I am going to list some articles in an effort for you to get the basics of the health insurance industry in th...
Do you prescribe nandrolone as a trt add on for joint pain?
Nandrolone is a legal medication, and assuming appropriate representation for treatment (like joint recovery concerns due to injury or intense physica...
Where is the list for pricing from your peptide partner?
Their practice philosophy is to meet with patients to understand their needs and teach them about peptides, then build a plan to reach their goals.
Should trt be given when total testosterone is normal but free testosterone is low? can this legitimately cause symptoms? Also If shbg is not the caus...
Good question. The short answer is yes. Normal total testosterone with a low free T will cause symptoms. In fact, the ONLY test needed to diagnose hy...
I’m not sure how honest you’ll be since you identified your clinic but how common is it for these fee for service clinics to approve someone just for ...
would say it is something that happens with some of our competitors. We get many men who transfer to us only to have us take them off of excess medica...
I see alot of conflicting info on the validity of injecting subcutaneously. I'm actually microdosing my trt sub q daily at 200mg a week. It's like .14...
Great topics.
I’m a prepper. Being on a treatment that is pretty critical to my daily functioning kinda scares me. I have seen global supply chains go to shit quick...
This is somewhat related to a question that guys sometimes ask: Is this for life?
As an online clinic, how are you able to collect regular blood samples?
We primarily partner with testing companies who sent kits to patient's houses.
From a business model standpoint why do some brick and mortar trt clinics offer prefilled syringes instead of offering vials? I've read of clinics not...
Brick and mortar clinics have higher overhead than online clinics due to paying for rent, utilities, and staff. For this reason, they often use other ...
Is it possible for enclomiphene to “kickstart”Testosterone production? Example, 46yo male, 5’10 167lbs works out, eats good, sleep is pretty good, low...
In 16 years of practicing medicine, I have never seen anything “kickstart” testosterone production.
What’s your opinion or experience with Kisspeptin 10? My NP wants to run a 5 week cycle to see if it will kickstart or promote Testosterone production...
I'm starting up on TRT again after being off for about a year. My Dr was not familiar with the dose I should be taking of Anastrozole.. I was prescrib...
In general, it's best to adjust up as needed, first seeing if you are prone to high Estrogen or conversion like you say then add from there.
I have been seeing more advice on replacing HCG with 2x/week enclomid (5-12.5mg). What are the pros/cons if this scheme?
Pros:
What are your thoughts on HCG along with TRT? 41 yo started trt about 6 months ago, and considering HGC. What are some advantages, and disadvantages? ...
Pros:
Two questions. First, I find my testosterone significantly tanks when I've been extra busy, especially physically. When I first tanked (270 total or ...
For your first question, this can impact your Testosterone levels if you're not resting properly. I'll barrow from one of our earlier replies:
Do you provide us with an actual prescription for testosterone? In case I travel, I want to have the script to show that my meds are prescribed to me ...
Yes sir, any Testosterone given out in the USA requires a prescription. For us, we have your medication listed on our website, the script with the med...
I tried TRT, I wanted my libido back, no luck. Been on it 10 months, bloodwork is normal. My test now ranges from 900-1100.
Without knowing more, like what your free T is or what your E2 level is, we can’t give any specific advice. However, most men who struggle with libido...
Why is it that Clomid, despite raising T levels, isn't really that effective? I've seen countless people on here say that their Free and Total T leve...
People have this question often. And the answer is Clomid is a medicine, testosterone is not.What I mean by that is Clomid (clomiphene) is a foreign s...
I’m on week 8 of 140mg / week and the original prescription included hcg. Trt clinic wants to wait until post 8 week labs to then introduce hcg, not f...
So our opinion on HCG is that it's really expensive to produce in the USA & thus they're probably charging and arm & a leg for it. If you're not takin...
Can I bring my labs over from my current TRT clinic?
For our TRT practice, yes. It doesn't make any sense to have someone take a test while already on Testosterone if they're at a normal therapeutic dose...
When (or what circumstances) would you recommend clomid over testosterone?
The most common case is when a patient insists on it because they've read about the medication and really want to take a pill instead of do an inject...
What can you tell me about my last labs? 160mg a week at 80mg twice a week. No AI. I do take boron, zinc twice a weekly. I'm concerned about E2 and SH...
SHBG is produced by your liver anytime it notices that you have too much of a sex hormone (estradiol, testosterone, DHT) floating around.
How can you make definitive inferences about T level changes based on two tests taken one year apart? (Knowing that there is notable methodological an...
Really the goal with treatment is to improve someone's condition, the goal is not to adjust someone's number (which is variable like you say).
If all labs come back in the normal range, I’m curious how you arrive at the decision to prescribe or not. Does it become all about symptoms? Or is th...
I didn’t like HCG so my dr switched me to enclomiphene, which I tolerate better. I recently purchased some clomiphene citrate, is that ok to take for ...
Are you on TRT as well or are you doing SERM mono therapy?
Just started 200 mg split in 2 doses a week. Felt great first few week with high sex drive, full erections, morning wood, and strength in the gym. Wee...
There is a very common phenomenon around the 6 week mark of TRT, where some of the benefits seem to diminish. No one knows why that is, though we beli...
What is the best way to prevent aromatizing too much? Does it have to be meds or are there legitimate supplements, diet etc
Aromatase is primarily found in adipose (fat) tissue. So weight loss is the most important way to naturally reduce aromatization.
How do you infer from those association analyses that it is indeed E2 and not too high testosterone that caused the anxiety?
If you read the studies, you will see that they tested men with high T and high E, high T and normal E, normal T and high E, normal T and normal E, lo...
I know a lot of guys get anxiety symptoms when on TRT. What do you find causes that? And what do you do about it?
Low testosterone is a known cause for anxiety. For many men, TRT improves their anxiety significantly, or resolves it completely. In fact, the science...
For someone who is on TRT and is looking to start trying for kids, What is the recommended dosage and frequency protocol for adding hcg? I understan...
350-500 IU 2x/wk is the typical dosage to prevent testicular atrophy while on TRT
While TRT is great for testosterone levels, what are the wider impacts for health considering it suppresses other HPTA aspects? Examples: Pregnenolon...
Welcome to endocrinology, the most complex area of healthcare.
Do you think that most mental health issues are contra indications for starting TRT? Such as depression and bipolar for example? Or have you seen peop...
For us, we have had a significant number of patients join us with slight anxiety or depression start TRT and find that those mental health issues impr...
Is breast sensitivity a pretty good sign you should add AI or should you always wait and check blood work and only add if you are too high? (Asking si...
If your current TRT provider has suggested to wait until reviewing bloodwork, we would follow their directions.
When should you add AI to TRT? So many of low vs high estrogen symptoms are the same.
t’s true, many of the symptoms are the same with the exception of nipple/breast sensitivity.
Can working night shift long term be a cause for low T? Asking because I saw another comment stating night shift cause their low in their 20’s which i...
It depends on how this effects your sleep, but the answer is if it does, then yes.
32 years old, not done having kids. T level at 294 with no energy, depressive tendencies and up and down libido. Doctor has prescribed me Clomid. I'v...
Many men still produce enough sperm while on TRT and hCG to get a woman pregnant.
Who is eligible for TRT ? What’s the criteria ?
Anyone who is suffering from hypogonadal symptoms is eligible for TRT. These can be caused by environmental factors (everyone in the USA has 30% less ...
I’m 28 years old and got a major testosterone deficiency while working the night shift for 5 years. Was able to get levels up to 500 after going back...
Hey there! There's a few things to keep in mind but by and large it's totally fine.As the one reply to you right now & as someone on TRT, I started in...
Why is it that Clomid, despite raising T levels, isn't really that effective? I've seen countless people on here say that their Free and Total T level...
Although we replied in the other thread, just going to post it here incase it helps someone:
Can you have one of your providers look at my most recent thread (which includes bloodwork) See if they can give correct diagnosis. Would be a chance ...
Please refer to our disclaimer that we are not your doctor, and this advice is general and not meant to constitute a treatment plan.
I was reading hcg alone wasn’t a viable option according to the gurus of Reddit. But then again it’s the internet. Any comment on that ? Also there wa...
It's certainly more of a short term option as a stand alone, the addition of Testosterone will always be better, but trying to provide a benefit while...
I still want to have kids and want to avoid anything that could possibly shut me down all together. Which treatment is best for me ?
It depends on when you want to have children. If your intent is to conceive in the next 12 months, you should choose hCG alone or a SERM like enclomip...
I’m 44. I did a T test only. Came in at 385ng, I don’t know my free T. Although I’ve gained some muscle and lost weight, I’m finding it difficult to ...
The recommended cutoff for low testosterone is now 400 based on
If I have small areas of adult acne, will it likely become worse while on TRT? Is there anything that can be done to avoid acne flareup?
TRT has been known to worsen acne. This is due to the increased DHT that comes with it. You can use a 5-a reductase inhibitor to prevent this DHT conv...
What your thoughts are on men with Crohn's disease taking testosterone I know my levels are low from years of severe malnutrition and Prednisone use i...
Testosterone is actually an approved treatment for Crohn's Disease
How do I go about getting my testosterone levels tested do I just got thru my main Dr and if they come back low do I have to go thru my Dr or could I ...
The typical first step is to schedule an appointment with your doctor to have blood work. Mention your symptoms and that you would like your testoster...
And can you write scripts that can be use for insurance? Like thryroid meds and hcg?
We do sometimes work with local pharmacies instead of compounding pharmacies when patients ask for it. It's just important to note that your insurance...
I’m on 200 mg of test cyp and 200 mg nandrolone with defy. How much would you charge?
For something like that it would be ~$129 base + $12 for higher T dose + ~$33 per month while on the Nandrolone. That's assuming we can source the Nan...
Is it too late to ask a question in this thread? I’d love to hear your opinion on low dose cialis (5 mg ED) as an addition to TRT. Obviously most gu...
We are advocates for cialis. It certainly has the known benefits of improved sexual function, but it also helps regulate blood pressure. It is also kn...
Why does testosterone increase my anxiety ?
Most men who use testosterone actually report a decrease in anxiety.
Been fighting with doctors and ins co for 30 years, chemo wiped out my ability to make test at the age of 18. I'm 52 now and I just take care of my me...
The fact that you have been fighting insurance tells me you are in the US. With that in mind, the main thing you need to be careful with self medicat...
Scenario 1: i am on TRT and raise my TT level to 1,000 Scenario 2: i take enclomiphene and raise my TT to 1,000 What's the difference?
Its late and we have answered this question a few times today, so forgive me for copying and pasting this answer from another question:
What are your opinions on Maxum King’s and Hims treatment and the clomid tabs? Is clomid a beginners route to see if supplements are the right path? ...
We're not the biggest fan of clomid itself. It does raise Testosterone levels but lowers IFG-1 levels, which is one of the larger benefits of having ...
Anything to try other than cabe ror P5P to lower prolactin? Since starting TRT I've had a really difficult time reaching orgasm. Erections are no prob...
Pramipexole works well to control prolactin. It has been proven to help both achieve orgasm as well as with the refractory period after orgasms.
Thoughts on people under 30 seeking TRT? Seeing as this is a lifetime commitment?
It sucks if a man has to start TRT before 30. It also sucks that it is unlikely that a man who gets low T in his 30s is able to naturally increase his...
Best way to decrease water retention on TRT, assuming one is already on a daily dose regimen subcutaneous of .12 ml of 200mg/1ml test?
Decrease salt intake. Decrease carbohydrate intake. Manage estradiol levels (bloating and water retention can become an issue in levels above 30 pg/mL...
Thoughts on Pregnenolone and DHEA supplementation, when it would be justified to take, dosage recommendations for the average person, symptoms of a d...
Pregnenolone should be supplemented any time someone is noticing mental fog or anxiety while on TRT.
I’m at 120mg per week spaced m/w/f and currently past the two month mark. It seems like some of the early improvements or honeymoon phase wore off an...
That sounds like a solid plan. Review the lab results and see where you landed, adjust from there with your TRT provider to dial it in.
I am a a 33/m work out 5 days a week. Heavy lifting. But I have been feeling lethargic for as long as I remember. Low libido. Sex drive. Always tired....
Based on what you've shared here & those test results, we'd consider you a candidate for TRT. We have members who have had similar levels to yours yet...
Tell me how you justify prescribing someone TRT at a level at of 400 ng/dl?
That's a pretty easy answer, since you're not providing any other context for an imaginary patient, which is significantly important. If their age, sy...
How bad is blacking out from booze… chronically. I haven’t found much in the way of research on this. There are studies on chronic alcoholism and the ...
I’m not sure they have any studies on frequent drinking to the point of blacking out. That would be nearly impossible to do ethically, and I don’t kno...
Im 19 my testosterone is normal 712 total but my free testosterone is on the lower side but still in normal range i eat healthy and do everything i ca...
Pls elaborate on Efficacy of puberty gyno management with Raloxifene? If someone is know aromatizer - what is most intensive AI protocol?
Use of raloxifene or tamoxifen for gynecomastia. It works in every case I have seen, but to varying degrees. Obviously, the more pronounced the gyno,...
My provider won’t continue my TRT without yearly face-to-face visit which they say is law. Are you similar or does it vary by state?
That's not the law yet, per the DEA's temporary rule.
What’s your opinion on HCG monotheraphy for treatment of secondary hypogonadism?
We see hCG mono therapy as a viable alternative to TRT, though there are a few limitations.
Just an idea, I'd suggest that there should be a version of exemestane and anastrozole especially for TRT in 5/2.5 mg respectively 0.1 mg. I think tha...
Related: Some pharmacies do offer alternative doses of Anastrozole, one of ours is pretty good about it. However they typically price per tablet rathe...
I am finding myself very exhausted and fatigued some days. I am on test c 105mg split 3x a week m/w/f. I have been on trt for five weeks. Should I in...
We'd have our patients ride it out. What might not have been covered with your provider is that *somehow* although injected Testosterone & Testosteron...
Why did someone who’s RDW was fine before taking TRT change in a month to a below value? Eat red meat, they’ve been increasing their cardio to 20 minu...
RDW stands for red cell distribution width. It is essentially the variance between the different sizes of red cells (biggest to smallest). RDW outside...
Is there any possible way that meds can be shipped to US territories, such as Guam or the CNMI? USPS delivers to US territories just like anywhere el...
There is no regulations regarding shipping medications from mainland US. The main issue is licensing. A doctor has to be licensed to practice there in...
Is HCG recommended even if fertility is not a concern?
The very short answer: No. It does not provide much benefit that normal Testosterone wouldn't as well, and is current very expensive. That said, if so...
Would a person that has low test and takes trt build more or less muscle than an average person that doesn’t take anything?
They would generally build the same amount of muscle, assuming that "average person" was not also a low Testosterone individual. This is because the p...
I have low SHBG of 11. Was never on TrT or any steroids for that matter. On second test it was 13. My endo has no answer for me. What could be the rea...
The main causes for low SHBG in the absence of using exogenous hormones are: Hypothyroidism Cushing’s syndrome Type 2 diabetes High prolactin levels C...
Beyond burn victims and people with diseases related to muscle wasting how does someone qualify for ND or Anavar? Also how much information do you pr...
As someone who also works in nursing homes, I have prescribed Anavar for chronic wounds and general reconditioning and wasting syndromes. These patien...
Do you think can you mostly tell when guys are runnin some TRT+ and adding alittle deca, winny etc?
In general yes, because they tell us. We prescribe legal substances associated with TRT & sometimes Nandrolone or Oxandrolone in more specific or extr...
I am taking .2 ml a day of 200 mg/ml sub q. Would there be a benefit of doubling that and taking every other day? Would that allow some fluctuations o...
Most men do just fine with twice weekly injections and don’t notice the fluctuations. If you feel good now, then the “if it ain’t broke don’t fix it” ...
I struggle with high estrogen on TRT. Even with a 200mg/1mg test cyp/anastrozole compound injection done sub-q. EOD .2ml injections and total test ar...
So based on your dose you would be receiving about 0.6mg of anastrozole each week. While that dose is typically adequate for most, there are some men ...
Currently on trt cream, no hcg. Talking about starting family with my wife, wondering what the best way to boost fertility without coming off would be...
Without coming off of TRT, then hCG would be the typical recommendation. This will raise intratesticular testosterone levels and restart sperm product...
I realize you need to answer in a generalization, but I’m searching for answers on nipple sensitivity and puffiness around the nipple. Currently no lu...
hCG aromatizes more that testosterone does. Your likely having elevated estradiol from that. You should speak with your doctor, but your options are t...
Take someone like me, for example...I am using my PCP for TRT. He is clueless. He wrote 200mg once every two weeks. He would only test for total t pr...
This ends up happening to a lot of men who transition to TRT specialists. I don't know about all clinics, but for us we take on patients who are alrea...
Just did an allergy test with my doctor. He came back and said that i wasn't allergic, but sensitive to all of them and perhaps combining foods would...
I would argue that you do have hypogonadism with symptoms of fatigue, depression, anxiety and a total testosterone level below 300 ng/dL. Especially a...
I took a full blood test because i was feeling low motivation, really low libido and drastic weight loss. However, my endocrinologist said everything ...
It never hurts to get a second opinion. If they're not interested in pursuing the source of those symptoms then it doesn't seem like they have the sam...
Is low 500’s considered normal and healthy for a 28 year old male?
Purely by number's sake compared by age? That sounds just fine, but the question is how you feel. Do you feel normal, healthy, happy, and motivated? T...
I have 2 questions. Which route is better ? IM or subcutaneous? Best syringe gauge and length?
Great question, and the answer is: It depends.
What are your thoughts on phthalates affecting the endocrine system? And on a personal level, has what you've learned about them caused you to try to ...
Phthalates are just one of many, many chemicals assaulting our endocrine systems in this modern world.
Can the patient opt to include Enclomiphene?
We're happy to work with Enclomiphene if it's what the patient truly wants.
I'm interested in TRT, buy I'm on the fence if it's something I should be taking or not. I'm a fit mid thirty man, always been physically fit and act...
Even more conservative protocols now utilize 350 ug/dL as the cut off to begin TRT. It already sounds like you are experiencing symptoms. HGH will wor...
Is TRT safe to implement with kidney disease?
TRT has been shown to actually
Do you test for free T, shbg, etc… I feel like my current provider just run basic test and doesn’t get the whole picture. I have been on for a year no...
When we start out with someone we also tend to go with a simple test as well, though that's decided on during the initial consultation. If someone ha...
7 years ago, at 41 years old, I started TRT for the first time. My total T was 199 (forgot what my free T was but it was low as well). That was all my...
Regarding the prostate enlargement, that would be secondary to elevation in DHT, which is a downstream byproduct of testosterone. T is converted to DH...
How dangerous is high hematorcrit?
There are some studies that show it can increase cardiovascular issues, though you'd tend to notice some of the symptoms if it was induced from starti...
What are the benefits of DHEA with Testosterone?
As of now, no DHEA receptor has been identified in the human body. That means that DHEA is solely a precursor to other sex hormones. Any DHEA you take...
If I get on TRT, besides energy and mood, are there other effects I will see? I am naturally not a hairy person, I don’t have an overly deep voice….et...
You should expect increased libido, better erection quality, improved sleep, reduced anxiety/depression, better confidence.
36 y/o morbidly obese male total testosterone is 107 and free is 26.1. Should I lose weight first or should I combine my new lifestyle (losing weight...
You will lose weight much faster with TRT than without. You will have more energy and motivation to do workouts, recover quicker with less muscle sore...
Have you ever had patients get migraine from TRT? What would you say could be the reason that TRT would do that? Just curious if you guys have inform...
So testosterone does not have migraine as a side effect listed on the package insert. But your doctor isn’t lying, in that there certainly do seem to ...
50 yr old insulin dependent diabetic here. Most recent lab results show Total T 614, Free T 55. The blood panel did not include SBHG. I just started T...
Being insulin dependent, I can say for sure your SHBG is high. The easiest way to lower SHBG is to split your T dose into several smaller doses. Also,...
Is TRT for life or not?
All men considering TRT should be prepared for the fact that it is a lifelong treatment.
Psa and trt- what are your thoughts?
We follow the recommendations regarding this and have all men age 55 and older have a PSA before starting TRT.
Thanks to glp1's, I have lost 28% bodyweight in 11 months. Taken my BMI from over 50 to 39. I am 6'3 and 54 years old. 30 years ago I was a hyper resp...
I would say it would be wise to check your T levels. There is no harm in knowing, and this conversation may be moot if your T levels are normal.
Do you find people require a different dose when switching between subcutaneous and intramuscular injections? I've seen comments from people that the ...
I would say that needing a different dose when switching from IM to SQ is not typical, though we have seen it a few times. Everyone is different and a...
What is the optimal time to take AI? For me it’s not a question of if I need to take it, but when to take it. I see most people on here say to take it...
Anastrozole levels peak at 3 hours and the half life is 50 hours. For greatest effect you would want to take it on the day of your injection.
How does minoxidil affect testosterone levels?
Minoxidil is a blood pressure medication that is used for hair loss. It is believed to help with hair loss by increasing blood flow to the scalp. It d...
For patients on finasteride for hair loss, do you aim for a higher total T level? Generally in those not on TRT, starting finasteride will increase t...
Typically it is best to evaluate therapy based on symptoms and how you are feeling after starting. There is no ideal T level, and T levels are very su...
Would you recommend enclomiphene or clomiphene citrate before starting TRT?
In some cases.
Do you optimize T even if that puts it above the current reference range, or do you merely get it in range?
The values are far less important than the symptoms and goals of the patient, they are a great guidepost as where to start and to review if there's so...
Could you give some ballpark numbers for what is considered high or low for LH and FSH? Also if LH and FSH are out of alignment, is one a more importa...
FSH between 2-4 IU/L or below is considered low, 10-12 IU/L or above is considered high. Normal is between 4-10.
What levels of LH/FSH suggest primary vs secondary hypogonadism?
Primary hypogonadism (testicular failure): high FSH/LH, low T Secondary hypogonadism (pituitary failure): low FSH/LH, low T Mixed hypogonadism: normal...
In what states can you prescribe T?
The vast majority of them, though there are a few in the south that give us problems sometimes because they're harder to hire for due to their restric...
Do you also recommend that location for Androgel for your patients? It says to only use your shoulders, but have also heard that is because that is al...
We actually recommend application of gels and creams to the scrotum. This is because the skin there is thinner and more vascular, so you get better ab...
I am: 42 yo male, 5'11" 280 lbs with a BMI of 40 and 42% body fat. Pre trt blood work: TESTOSTERONE, TOTAL, MS 242 L TESTOSTERONE, FREE 35.7 I star...
In most cases we would want a patient to wait at least past the 6-7 week mark before adjusting dosages because that's around the point that your body ...
What blood tests should I have to rule out things? I did have cancer a couple years ago and my levels are still low. I'm on top of screening so we ca...
I would definitely follow up on the thyroid and have additional tests like T3 and T4.
I have very low SHBG (below reference range). What do you recommend clients with low SHBG? And is it an indicator of poor health?
Low SHBG itself is not a bad thing. But, low SHBG is an indicator for some medical conditions that can be bad. Cancer lowers SHBG. It’s the cancer tha...
Recently had a massive drop in quality of life over the last 10 months, after being fit all my life and a natural bodybuilder for the last 8 years. ...
So there is this strange rumor that somehow developed that hCG can “kickstart” normal testicular function. I’m not sure where it started other than i...
What about issues with ferritin donating this frequently?
Donations every few months should not negatively effect ferritin levels to any significant degree.
I have been on the same protocol (200mg/week; inject EOD) for two years now. I was told I am a “hyper-responder” as my total testosterone levels are c...
If you're happy with where you're at I'd say: If your RBC values are still high when donating every 4 months, the very first step before adjusting dos...
Is there research on recovery if anyone wants to stop or has to stop due to medical reasons? Can they actually recover their natural production? Does ...
You can read the research
I recently started Testosterone gel. I'm so nervous about transfering it to my partner or my kid. I apply it to my shoulder/upper arm and wait 5 mi...
The actual testosterone should be fully absorbed within a few hours tops, though it is possible that a tiny amount remains on the skin for longer. Som...
I’m 31, 6’2”, and 345lbs. I had back surgery last year and I was about 260 and athletic before I got injured 10 years ago. I’m fairly strong (I do som...
Well, you have low total and free T. Technically, your FSH and LH should be higher in an effort to get your testicles to work harder. But FSH and LH a...
I’ve been struggling with a lot of depression and anxiety for 10 years on various medications. Believing that my hormones could have been unbalanced ...
Anxiety and depression are known symptoms of hypogonadism. However, they are rarely the only symptoms. While it’s true your level of 377 is on the low...
What added benefits does HGH (not peptides) bring to a TRT routine?
HGH Carrie’s the benefits of improving nitrogen retention beyond that of testosterone. It increases IGF-1 levels to a greater extent than testosterone...
Hello, will any amount of exogenous testosterone shut down HP axis ? Example - someone is on exogenous testosterone 2 mg daily (hypothetically) will ...
Any exogenous testosterone will lower natural production. An amount as low as 2mg daily will not shut down the HPTA axis completely, but it will certa...
Can you get hcg mixed into TRT cream? Or does hcg need to be injected?
hCG does cannot be absorbed through the skin. It also cannot survive first pass metabolism, so it cannot be taken orally either.
Regarding androgen receptors; will there come to a point where my receptors are “getting used to” my dose and need more?
No. Doses do not need to increase over time as androgen receptor numbers stay the same over time.
So someone who is using 200mg vs someone who is using 100mg and both of their labs show ~1000 test levels irregardless of weight/fat that just means i...
In our experience, it tends to just be very individual. Like your example, we have some men on 90mg/wk who have total Ty’s around 1000, and some men w...
How does body weight and/or fat % come into play when determining dosage. I’ve noticed they don’t ask weight or body fat when considering treatment. I...
There are some drugs that are doses based on weight, some on body surface area, and others on renal function. Testosterone is not one of them. Androge...
My Endo has me on the standard 100mg/week Test C dosing and while I’ve definitely noticed some difference in strength mood etc, my T is still only ~50...
With us? Yes, and we do take TRT transfer patients.
Mid 50s with no health issues, excellent lipids/BP/hba1c, etc. most labs within range except for RBC which came in at 6 mill/uL and estradiol at 45 pg...
If you want to confirm your total T in about 6 more weeks from now for your own knowledge, even if you're feeling good, that would be just fine.
What's the most appropriate schedule for labs, and what labs do you suggest getting every single time?
This will vary a bit based on health, age, and dosage.
How many mg a week do you start patients at?
In general, men who have hypogonadal symptoms with low total T values & have not been on TRT before, are good to be started between 140mg-175mg per we...
Is there anything you recommend to have tested to rule out other bad actors besides hypogonadism? Or how about tests that could conclude it? I was off...
First let me say that I am sorry for your experience, we hate when we hear about men being treated like that.
Does it make sense to not take HCG currently if your plan to have kids is in, let's say, 5 years? Instead, you start taking HCG after those 5 years to...
Yes, that makes sense. Every study on the subject has shown that hCG causes a return of fertility. In fact, 75% of men on TRT become fertile while als...
In terms of injecting, how many times in a week or month would patients typically inject HCG?
Typically you'd do injections twice weekly if you're going to be on TRT anyways, as you inject Testosterone twice weekly most of the time anyways. Giv...
Does HCG effectively mean I would still produce my own T as well as gain T naturally as I take TRT? Say for example, im on TRT and HCG, I’m going to t...
Not quite. A good way to think about it is that the main purpose & effect of HCG is to "prime" the testes for production, which will do a good job of ...
I was on 150mg a week and 1 mg of AI. My provider bumped me up to 200mg and 2mg of AI based off of updated labs and not being in the "optimal range". ...
Wow man, my advice is to get a new doctor.
Does it matter what time of day I inject? I’ve always been doing it at night when I’m not in a rush.
Time of day doesn’t matter. Whenever is most convenient for your schedule is all that matters.
I’m doing sub q injections of 60 mg on Monday and Thursday. What day should I have my lab work done? I was at 213 ng/dl before starting treatment and...
You want to draw blood when your testosterone levels would be at their lowest. In your case that would be expected to be on either Sunday or Wednesday...
What is more important? An absolute range of estradiol, or in proper ratio with total testosterone? And what is best course of action to manage estrog...
This is very subjective and there are no studies to say one way or the other which is more important, T/E ratio or total E.
42yrs old. I took Boron and DHEA for about 7-8 years and T levels were in the mid 400's and felt good. Recently it stopped working as well so I stopp...
It would depend on your test results, but things like Clomid increase your Testosterone by an amount of your base ability to do so. You won't notice a...
34 years old in gym regularly for Two months all my other levels came back normal except 0.03 below the 1.00 normal level just wondering if this test ...
It does look like it's at a high range, but "too high" might not apply in this case, especially if you were being treated for relative hypogonadism fr...
Just wondering your take on injection size? Do you ever use a 27 gauge 1/2 inch or do you mostly use bigger size needles?
If we're dealing with IM injections then we start in the 21g draw & 25g 1" injection needle range. This is typically the sweet spot for being able to ...
Currently on TRT for about 8 years, doctor does not want to put me on HCG long tearm. I am only 37 and want to recover testicular function. Any studie...
There are not really long term studies on HCG that you could present, no, as that is still considered off-label technically. However, anecdotally, man...
Currently taking 150 weekly on test. I’ve noticed my scalp gets extremely itchy when I start to sweat. Is this a normal side effect.
We wouldn't call this a normal side effect, but it can occur. We would recommend using selenium sulfide shampoo, also called selsun blue. It helps by ...
What do you think about combining enclomiphene with a peptide to increase IFG1 to counteract enclomiphenes side effect of lowering IFG1?
Logically that makes sense and we get it, however there are not long term studies on this exactly. If you're cool with that you could be the test subj...
What you are doing is awesome guys! I would highly appreciate your input on my case. I have been working out in the gym/calisthenics/swimming/jogging...
To answer your questions in order:
What do you think of combining enclomiphene citrate with HCG as a way to boost test?
We would think that it would boost your Testosterone, but to keep in mind that these things improve your natural production. They are more effective t...
My biggest question is regarded around not just libido but controlling my ability to orgasm. Not in the sense most men are concerned, no. Im not worr...
Are you currently suffering from either one of those issues, or is this pre-emptive? Do you currently take any Finasteride orally?
I'm in a bind right now with my situation. I've been on trt for 11 months, 150mg a week split into 3 shots. I also take hcg with every injection, 50...
While not knowing everything exactly and not wanting to step on anyone's toes, we'd suggest consulting with a fertility specialist rather than just a ...
1. Have you noticed any difference clinically in daily subcutaneous dosing compared to weekly or twice weekly IM dosing, assuming the weekly dose is e...
Do you treat women? And would admitting I've been taking small amounts [10-20mgs/week IM] of my bf's Test (and getting great results) be a barrier to...
We currently have female patients on similar low doses to optimize their hormones. They typically need a bit of Estrogen to keep everything in balance...
What do you think about rotating subQ and IM?
I personally do it often, mainly because I want to give my muscles a break. There is no reason you can’t do it.
While on a standard trt protocol (200 weekly) + hcg, at what testosterone level can one maintain fertility?
We do not necessarily agree with 200mg weekly being a "standard" dose. It is actually the highest use case dose that the DEA considers normal treatmen...
How prevalent is “moon face” in the guys you treat? And what can be done about it?
We've had nearly zero men report this as an issue on standard therapeutic doses of TRT. This is more prevalent at higher doses, say something a bodybu...
I travel internationally quite often for work, and just recently started TRT. Do you guys provide an actual prescription that I can include in my lug...
Yes sir. Your prescription should be right on the vial or the container that the vial comes in from our compounding pharmacies. You can also show anyo...
Currently on TRT. Estradiol is 43.4 and DHEA 493.7. Are those levels concerning? I take 110 mg per week testosterone cypionate. No aromatase inhibitor...
Those numbers don’t raise any red flags. Many men will start to experience symptoms of E2 at levels 40 and above, though plenty of men don’t. If you f...
I have vitiligo and subclinical hypothyroidism and a skinny fat at29, can TRT severe those conditions if I am not taking any medications for the other...
TRT has no effect on either vitiligo or hypothyroidism, regardless of if you are on other medications or not.
My question is about gyno. Currently I am on my 4th bottle of test. My gyno (I think it’s gyno) started on my second bottle of test, 100mg a week, inj...
Your description of your symptoms is typical for gynecomastia. This is from an excess of estradiol. An AI would certainly be recommended in your case.
Question about the “honeymoon phase”. So I started 6 weeks ago on my protocol and felt great the first 4… energetic and kicking ass in the gym and on ...
Yes, it is very common. And your theory as to why it happens is the same as ours, though there is no way of knowing exactly why it happens.
Been having shbg at the end of the high range since at least 2 years. Training a lot, eating clean, body fat under 15 percent. Boron did nothing for m...
If on TRT, SHBG will decrease with more frequent injections. Aside from that increasing fiber and protein in your diet, taking magnesium and zinc, and...
Do you think people abusing (abusing may in most cases be a strong word) TRT for aesthetic purposes may hinder hypogonal men’s access to TRT?
Yes. People are predictable and judgmental. Just like people assume all people with chronic pain and need narcotics are just addicts, people using AAS...
What’s are potential causes in getting brain fog / dizzy during TRT (Androgel because of where I live)?
I’m not sure we can blame the androgel without more info, but if it is from the androgel, what would make the most sense is higher aromatization. T ge...
What is the best protocol for someone prone to acne?
Acne is typically blamed not on T, but on E2 and/or DHT. Preventing conversion of T to these substances is key to preventing acne in those that are pr...
I'm 37. I went to a clinic with my complaints and a hormonal test was done: Fsh 2.69mIU/mL Lh 7.28mIU/mL Prolactin 3.95ng/mL Testosterone 18.0nmol...
Your doctors didn’t lie in saying your labs don’t show anything abnormal. But they won’t always because what is “normal” is based on population avera...
I just started with this provider so they wanted to start on the lower side and titrate up in a few months. It’s an out of pocket expense so switching...
Understandable. There are TRT companies out there who will take over your care without forcing you off Testosterone and new testing though, do keep th...
If I supplement with my own sourced testosterone, could I discontinue X amount of time prior to labs without my provider knowing? I’m not looking for ...
We cannot suggest that you use any form of an UGL.
Started at 370-440 natural T levels (fluctuations between labs), Dr rx’d 80mg cyp weekly (40mg every 3 days) to start for 2.5 months. Will those dose...
As a general rule of thumb, most men convert 1mg of injected testosterone into 5-6 ug/dL of total testosterone. That is just the average though, some ...
Can you treat a New York based patient? How would you do the blood work and how often? How much would that cost?
We are happy to work with New York patients!
Why does institutional endocrinology insist on horribly outdated treatment protocols, when modern evidence says they're wrong? eg: I asked my nearly ...
Have you ever seen low Testosterone cause other weird abnormalities in blood work? Like high b12 or something along those lines?
Not typically, no. On the other hand low B12 can cause lower levels of Testosterone in some cases. The one thing we'd keep on eye on for abnormalities...
Have been zeroing on some health issues and I recently got a Testosterone test of 301 ng/dl. As a very healthy male ( train 6x a week, track every cal...
You would be considered a patient for TRT based on your symptoms. We would want to talk with you to dive a bit deeper into them, but at a glance, yes....
Can I get my wife prego (on purpose) while on 200MG/ML every 2 weeks of testosterone cyp. from the VA for serious low T. The VA has had me all over th...
Some men still have enough spermatic function to do so while on TRT. However if you're actively trying & want to be on TRT then adding HCG for the dur...
1. Any reason or will ever we see a better prescription option for a longer ester say like Test U? 2. For long term patients, do you typically see sh...
Test U's half life is really nice for people who want to do less frequent injections, but you'd still want to do it once a week to have overlapping do...
If you could rank all the different forms how would it go?
Some of our providers have come from working with pellets in the past, so even here we may have some slightly different opinions amongst us.
What do you think of gels, creams, pellets, patches, natesto and other methods of testosterone administration other than injection? Seems to be mixed...
In general, they are less effective than injections. The reason for the mixed opinions is generally because for some people, just a small change is en...
If I were to switch to pinning daily, what is the best time of the day to pin?
The best time is generally the one at which you can be most consistent with the least chance of skipping your dose for the day. There will not be an o...
My last test @ 8 weeks showed 953 test with 50 estrogen at my trough. I inject 3x times per week 50mg per injection totaling 150mg test c per week. U...
Again, we are not able to diagnose anything via Reddit, but just a few thoughts.
Hi. I am 46 and about normal weight for my height. I have all the low T symptoms except for ED for past few years. However My test is 750, my free T i...
Unfortunately, there is an almost certainty that your
What's the likelihood of someone with very low shbg getting good results on TRT?
Very high. SHBG is just one factor to consider, but can be easily managed with an individualized treatment plan.
How many patients have vision problems with clomid?
Between 1.5-3% of patients will experience vision problems with clomiphene. The higher the dose, the higher the likelihood. Most cases are reversible,...
What do you recommend for estrogen control? I am in this dilemma where I don’t get adequate symptom relief at under 150mg/week, but no matter what dos...
In this case we might opt for coming at the issue from another angle. If you're injecting twice weekly we would try three times weekly. If you're doin...
I am wanting to switch my from clinic they absolutely refuse to stop infusing my TRT with anastrozole , what do you guys usually include in a protocol...
I'm guessing that the pharmacy that they use only sells their Testosterone Cypionate with that mixed in, or that they don't care to take things on a c...
I am Male 31 year old . Attached are my reports with hormone . I am hovering on the low borderline of testosterone. What are my treatment options if ...
Let your symptoms be your guide. That much free T isn’t a bad thing, though like you say you have noticed a recent decline in your well-being. Maybe t...
How do you handle someone that’s already on TRT? I’m pretty much dialed in (been on TRT for 4-5 years now) so of course I’m not going to have low test...
Yes, we accept transfer of patients. We do not require repeat lab testing with proof of your current regimen (showing us you are currently on TRT).
I’ve got a pile (sorry) since I’m debating switching providers. Since you are telemedicine how do you handle the yearly physical? Is it a requirement...
Why is HCG impossible to get in certain states. We can’t get it in Arkansas. They don’t or won’t compound the medicine. Do y’all prescribe HCG or what...
The rules regarding
What is the goal level of free/testosterone to achieve on trt? What’s the aim range?
It may not be the answer you're looking for, but it is very much it depends. Men are so wildly different in both their bodies and how they respond to ...
Is lowering IGF1 a bad thing?
In a vacuum it is not harmful to you. However often when people are looking at treating low Testosterone or hypogonadal symptoms then lowering IGF-1 i...
How much monthly for enclo therapy?
In general Enclomiphene is more expensive than Testosterone. We would add a surcharge of ~$20 a month to cover this difference in cost.
I’m currently going through a local clinic that frankly charges too much and expects labs too frequently, what’s the process like to switch to your cl...
We have a large number of TRT transfer patients. All we ask is that we get a copy of your current regimen and that we can meet with you to see how you...
Is 129/69 for BP on 200mg of Test every 4 days an okay blood pressure or should I try to lower it? If so how can I do that
BP of 129/69 is pre hypertensive.
Do you have to come off completely through out the year or is it fine to stay on a cruise dose the whole year ?
TRT should always be considered a life long treatment. The main reason anyone would come off is for fertility purposes (25% of men fail TRT and hCG fo...
I have been on TRT for three years and just had labs done, if I were to change to you, would I need to pay this initial consultation as I wouldn't nee...
Yes, generally - we set you up with a provider to meet with you instead of a normal initial consultant. That way they can verify everything with you d...
One thing I can't find on your site is how do you handle labs and how often you require them. Are they part of the $129 a month, or do you require the...
Our initial consultation price pays for a Testosterone testing kit to be shipped to you. It's fairly cheap considering it's paying for both that & the...
Any TRT providers that take insurance? Would be a lot cheaper for me.
The only providers that accept insurance are local clinics. Getting credentialed with an insurance company is a pay to play system. It costs $300 per ...
Why can’t you stay on HCG long term?
It is generally more of a concern about cost more than anything for the average American. When taking HCG with Testosterone, it is not adding much in ...
Do you foresee patients currently dependent on TRT to sort of be “screwed” at any point due to increased regulations that make it so they can no longe...
I don’t have a crystal ball, but I don’t see that being a problem. Treatment is becoming more prevalent because we are better at recognizing the sympt...
I use a compounded cream 15% and am happy with it but would like to use micro needling to increase the concentration of T going in. Do you know of any...
You would be the first I have heard of trying this. I can see the logic of your thought process though. You should report back with before and after l...
Are muscle pains (e.g. calf pain) directly related to DVT or are there other possible causes? My bloodwork has been very consistent (never a concern)...
We cant safely diagnose you via Reddit, so we would suggest you go to see your local doctor.
Are there any studies about TRT affecting sperm quality? I know about motility and sperm count. I mean specifically like denaturing of the sperm quali...
Testosterone does not cause birth defects. Remember what you are injecting is the same substance that has been coursing through your body every single...
I was just wondering if TRT ruins sperm quality? Not just like making you infertile, but what effect if any does TRT have on sperm quality and functio...
While on TRT, total sperm count and motility decrease. These changes are reversible once you stop TRT. Adding hCG can mitigate this effect while on TR...
I have heard that adding anavar helps with joint pain, I am on 200 test every 4 days as my protocol from the doctor and with lifting heavier weights m...
Any AAS can improve joint recovery, however, one of most common side effect is joint pain. It has been proven to help with osteoporosis associated bon...
Hi there, I have chronically low T , but not quite low enough that my doctors will prescribe it for me (hovers around 225-290 ng/dl) . I’m also trying...
For fertility purposes, clomiphene and enclomiphene are your best bets. They are the first line treatment used by fertility doctors to increase sperm ...
M 19 my total testosterone was 712 free testosterone 11.3(direct) shbg 27nmol. Why is my free test on the low end of normal even though i have normal ...
So there are two things that bind to testosterone, SHBG and albumin. If your SHBG is normal, then the albumin in your blood would be binding to the re...
I'm on cyp 80mg twice a week, subq. For some reason unknown to me, my E2 won't go above 15. My total test last draw was 1157 SBGH 89. Taking boron to ...
Add a DHEA supplement and recheck again in a month. On TRT, DHEA almost exclusively converts to estrogen.
How much would 150mg of testosterone cypionate, 1000iu’s of HCG weekly be?
150mg of Testosterone Cypionate would be within our standard ranges and covered by our basic $129. For the HCG it would come down to the intended leng...
Do you guys prescribe HCG and can you telemed in Nevada? And what pharmacy do you guys use for compounding?
Yes, we can prescribe HCG & we are able to do telemedicine in Nevada. We use a handful of compounding pharmacies which have better prices on different...
My SHBG is very low (just under reference range). My fasting sugar is middle of reference range (meaning not pre-diabetic?), I don't have cancer (in ...
Add a DHEA supplement and recheck again in a month. On TRT, DHEA almost exclusively converts to estrogen.
So it's very easy to find the half life of testosterone eaters... but what is the half life of oestrogen?
The blood half life of estrone and estradiol, once released from either albumin or SHBG is between 10-70 minutes.
I have a couple of questions... Are there any symptoms in the beginning(I'm 7 weeks in)that would be similar to gyno? My nipples stay hard, and I fee...
Are you experiencing nipple tenderness, or general area tenderness on the days of injection or the day after? Tenderness or swelling is generally what...
I'm curious about the effect on prostate. Could you take finasteride with TRT to keep prostate size in check?
Both the short and longer answers are yes!
If one has low SHBG, but is insulin sensitive , works out , eats clean , tracks all macros and lifts (just to say I’m not overestimating cals out and ...
By insulin sensitive I’m assuming you mean you are not diabetic or pre-diabetic (in medicine this term is often used for type 1 diabetics who have rob...
What recommendations do you have for keeping hemoglobin and hematocrit in check, assuming both rise while using any effective dose (100mg+/wk)?
We would recommend looking out for the side effects & if you're concerned due to family history of this being high or previous labs you've had done, w...
If I am taking ferrous sulfate to keep ferritin up, will that raise hemoglobin?
Think of ferritin as a stack of bricks used to build a building. In this analogy, the building is your hematocrit.
Any suggestions on how to keep ferritin up when needing to donate blood rather consistently. Currently on 100mg a week and treating sleep apnea via C...
Iron supplements typically do the trick. Ferrous sulfate 325mg every other day should do the trick
I'm thinking about getting on TRT to boost my energy, libido, and mental performance. I would like to maintain my fertility too. What do you think abo...
Hey there, we had a few people review this since you were pretty clear.
What would you consider a good low dose to start with for help with libido?
100mg every other day is enough for most men to feel libido changes as a trial, then can increase from there after 6 weeks to 100mg daily if still not...
I'm on week 10 of injections. First 7 weeks no issues, now I'm getting hard spots and bruising. I switch legs and injection spots every time. How can ...
It does come down to personal preference, but there are many things you can do to reduce PIP. Rotating injection sites is a good start, let me share ...
Have you ever heard of TRT causing any kind of testicular cysts or bumps? I was about 1.5 weeks in, balls felt uncomfortable so had a check and found ...
TRT is not known to cause testicular cysts. The most common type of testicular cyst is what is known as a spermatocele. They are benign and nothing to...
I started trt few months back and been prescribed Enclomiphene 25mg twice weekly. I was wondering if I added HCG to that protocol to help keep fertili...
Are you saying that you're on Testosterone injections & Enclomiphene at the same time? Either way, we would suggest that if you're trying to have a ch...
Have you noticed some men need large fluctuation in levels to get a libido increase on trt? SHBG aside, keeping levels consistent with pinning daily ...
We have had a few men where that is the case, though I would definitely not say it is the rule. The primary driver of libido in men is DHT, and more D...
How do I deal with 0 estrogen conversion? I take 200mg no ai weekly and my levels are ideal. but I get hot flashes and horrible low estrogen symptoms....
If you have low natural aromatase levels, and aren't looking to take more injections, you can do essentially the opposite of what we would normally su...
Why are my numbers free test and testosterone dropping? I take 160 once a week. I get blood work done day before injection. I inject every 7 days. Wen...
You will want to do more extensive labs to include SHBG, albumin, and free T. You should also check liver function, as it is possible you are having m...
The pharmacy recently messed up my script. I was supposed to get a 10ml vile of 200mg cypionate, and it was supposed to be for .50ml (100mg a week). T...
The manufacturing of single use vials and multi-use vials is the same. Each puncture of a vial does increase the risk of contamination, so all vials r...
How do you determine a patients starting dose? Is there a protocol you follow? Is BMI a factor? Also, what are your thoughts on IM vs SQ? Which do y’...
There is no set protocol as far as a starting dose other than we need a dose to overcome the patient's symptoms. Without being too specific, most of o...
Why is standard protocol 200mg a week over two shots and .5mg dex 2x a week? Isn't this already an archaic model?
Yes. It is.
What are your thoughts on AI and are there certain situations where you recommend them?
In general we opt for a "lowest medication needed" approach, as most things in TRT have less benefits and higher side effects the higher you go in dos...
Estrogen reducers are quite expensive. Would Arimistane ( Androst-3,5-diene-7,17-dione )be a suitable alternative? And if so at what approximate dosag...
Arimistane should not be considered an aromatase inhibitor in the traditional sense. Unlike medications like anastrozole or letrozole, which block aro...
Why is HCG impossible to get in certain states. We can’t get it in Arkansas. They don’t or won’t compound the medicine. Do y’all prescribe HCG or what...
Our compounding pharmacies are large continental US based rather than smaller and locally based. The reason your local ones probably aren't is because...
I'm 40 years of age about to see a clinic about trt. I have a tumour in my head, namely an acoustic neuroma . Can you tell me if testosterone effects ...
No sir, this will have no effect on those types of tumors.
Can you discuss the phenomena of veterans experiencing low T from PTSD? Is this a legitimate thing?
So, PTSD in and of itself does not cause low testosterone. However, veterans are at risk of hypogonadism for many reasons that often coincide with PTS...
Do you guys work with people that want to go into the enhanced body building realm, and that are already on TRT?
We work with many people who transfer from other TRT services or who have been on UGLs and wish to be with a medical service now, we have no issue wit...
If someone were to experience a drastic reduction in free testosterone levels (over 40%) with mild increase in SHBG and E2 on 3x weekly injections at...
Would this be out of nowhere or just a few weeks into treatment/dose adjustment? If we're counting AIs as ancillaries in this then the 3x weekly is al...
Am 8 weeks in on Test Enanthate, was diagnosed with Primary hypo I started low at 125mg and last 2 weeks bumped it up to 150mg. I want to add in HCG...
Your protocol sounds good to us as is. Something to keep in mind is that you should be adjusting things based on your symptoms and how your doses make...
Do you independently test your prescribed meds? or do you just write a rx that's then filled at a local pharmacy? I'm interested in switching provider...
We work with compounding pharmacies rather than local pharmacies. That is because they tend to have products available cheaper as they are the manufac...
How do you address patients that started with low libido and continue to have low libido/worse libido since starting TRT?
Libido is one of the hardest hypogonadal symptoms to dial in correctly. Part of this is because libido is not entirely hormonal and is confounded by e...
Do you guys provide nandrolone for joint relief? If so, what would 10ml of 200mg/ml add to your monthly costs?
For that reason & being able to talk with a patient about it to determine the severity, yes. Though we would typically want to see if normal TRT can i...
If someone was at 2000ng/dl and one person required 200mg/week and the other 400/week, would the person on twice the dose incur twice the amount of he...
Replying to this as a hypothetical scenario, as we do not treat individuals to these levels: Yes we would expect more health issues for the patient ta...
Hi there. Was wondering since some people have different levels of response to testosterone, if one person for example has to take twice as much to ac...
The short answer is closer to the second question's implication.
Im on a pretty reasonable TRT dose - 125mg/week test E subQ - but seem to keep having high e issues. Im around around 20-23%BF and dont understand why...
That sounds like a reasonable dose for Testosterone, even a bit on the low side to expect Estrogen issues with. You're doing subq as well which would ...
What are the earliest signs that you might need to use an AI? What’s the lowest effective dose of arimadex/anastrazole?
Sensitive nipples is the number one easy to spot symptom for a man. There's other things like noticing you cry when watching movies that you typically...
I’m in California. I’m already on with Royal. If I switched to you guys what would the cost be? Could you also get me on HCG and T?
There's no extra cost from switching TRT providers, we do accept current treatment plans but would still want to talk about how you're feeling on it.
Can you donate plasma while on TRT?
Yes. You can donate plasma while on prescribed TRT.
How often do you check labs and how soon after a protocol change do you re check them?
We always want to start by getting lab work done before treating a patient. This helps to Dx hypogonadal symptoms if they're far below what we would ...
What would you say is the most common reason TRT users sometimes see drops in libido?
Libido is one of the harder aspects of TRT & we're lucky that often times low Testosterone is the cause of it (and the associated other hormones) so t...
Free T vs total. Do you focus on one over the other? I have mid teens shbg and run my total test around 1000-1100. This puts my free test 2-3x the m...
Yes and no. Total Testosterone is a great way to decide if someone strictly has low Testosterone by the value being below normal & can easily point to...
Do you find some guys feel like crap (low libido, low energy, poor sleep, fatigue etc.) at high T levels even if using AI to control E2? Wondering if...
Hey there - We finished up this weekend event but I came back to let people know about the military discount we have.
38 yr male, no libido, have lost a lot of weight/muscle in the past year, general depression and lack of motivation. I'm going to start pinning in tw...
Based on your labs, starting TRT will make you feel 20 years younger. You should expect more energy, more muscle, higher libido, better mood, better e...
I’m on 100mg TRT and am trying to get more dialed in on my proper dose amount and frequency and am suddenly getting ads for enclomiphene and was conce...
We'd say that you'd get a bit more out of going up a few more mgs for T, but like you mentioned the E is a concern. You could potentially try switchin...
Thoughts on use of enclomiphene as opposed to TRT?
The best case & results we've seen for it's use has been for men who have higher base Testosterone levels, aka relative hypogonadism TRT candidates. S...
If someone were to experience a drastic reduction in free testosterone levels (over 40%) with mild increase in SHBG and E2 on 3x weekly injections at ...
I think this was posted in our other thread too, so I'll copy the reply here for others -
I'm on 100mg test E per week split into 2 doses. Started about 8 weeks ago or so. Last blood test was a month ago and E2 was well within range. Was su...
In general no & there could be a few reasons for this with a few of them related to slightly higher Estrogen. However if your E was normal 4 weeks ago...
26 Year old male, 5ft 7 @ 80KG Multiple symptoms of low T & recently started 100mg test c per week Pre TRT: TT: 10.6 nmol/L, SHGB: 11 nmol/L, DHEAS...
That is an adequate yet conservative starting dose for TRT. At that dose the average man should expect to be mid-range total T, with no side effects. ...
You are saying that less frequent injections will force the liver to produce more SHBG because of high peaks. So for people like me with naturally low...
We try to keep answers general in order to make sure we are not upsetting the mods, so sorry if it was rambling.
How bad is it to have naturally low SHBG when it comes to TRT treatment, is it more difficult to dial in and manage when you have low or high SHBG, a...
SHBG irreversibly binds to sex hormones (estrogen, DHT, androstenedione, and testosterone). On any given dose of TRT, the higher your SHBG, the less y...
Presuming I will be in this fight for a year or two… and I want to really really feel the libido and mood benefits of TRT… I can accept that I will ha...
You will definitely have a much easier time dialing things in by following free T than following total T. Yes, you will want to get within the upper r...
My SHBG is currently 12.0 nmol/L I am on 100mg/wk of test cyp - daily injections 1500iu hCG/wk Before TRT it was ~ 14 So bottom of the range. I r...
Your insights regarding why you have low SHBG seem accurate. First, being pre-diabetic, your body has been overproducing insulin for awhile. It often ...
Estradiol 20.4 T 175.8 FSH 3.9 LH 1.0 Prolactin 5.8 Thsr 1.59 Xt wbc 5.3 35m 170lb 16 % bf decent sleep , clean eating no alcohol Fatigue sex drive ha...
Your LH is low and your FSH is on the lower end as well. This suggests you may have secondary hypogonadism.
I’m on top of macros and lifting heavy. History of losing body fat and keeping it off. Disciplined. Etc. I have rocked pretty large deficits for mo...
Yes. While on TRT, you are more likely to preserve muscle while in a caloric deficit. In fact, it is still potentially possible to gain some muscle in...
I am currently self administering TRT 125mg PW Sustanon to be precise (35yo Male, no known medical conditions or physical health issues besides MH & L...
There is very little issue adding HCG full time to a TRT regimen, though you want to be reasonable and only use 500-1000 units a week. Closer to 1500 ...
I'm on 100mg test E per week split into 2 doses. Started about 8 weeks ago or so. Last blood test was a month ago and E2 was well within range. Was su...
In general no & there could be a few reasons for this with a few of them related to slightly higher Estrogen. However if your E was normal 4 weeks ago...
26 Year old male, 5ft 7 @ 80KG Multiple symptoms of low T & recently started 100mg test c per week Pre TRT: TT: 10.6 nmol/L, SHGB: 11 nmol/L, DHEA...
That is an adequate yet conservative starting dose for TRT. At that dose the average man should expect to be mid-range total T, with no side effects. ...
So you are saying that less frequent injections will force the liver to produce more SHBG because of high peaks. So for people like me with naturally...
If you want to raise your SHBG, then fewer injections will accomplish that.
How bad is it to have naturally low SHBG when it comes to TRT treatment, is it more difficult to dial in and manage when you have low or high SHBG, an...
SHBG irreversibly binds to sex hormones (estrogen, DHT, androstenedione, and testosterone). On any given dose of TRT, the higher your SHBG, the less y...
Presuming I will be in this fight for a year or two… and I want to really really feel the libido and mood benefits of TRT… I can accept that I will ha...
You will definitely have a much easier time dialing things in by following free T than following total T. Yes, you will want to get within the upper r...
My SHBG is currently 12.0 nmol/L I am on 100mg/wk of test cyp - daily injections 1500iu hCG/wk Before TRT it was ~ 14 So bottom of the range. I r...
Your insights regarding why you have low SHBG seem accurate. First, being pre-diabetic, your body has been overproducing insulin for awhile. It often ...
Estradiol 20.4 T 175.8 FSH 3.9 LH 1.0 Prolactin 5.8 Thsr 1.59 Xt wbc 5.3 35m 170lb 16 % bf decent sleep , clean eating no alcohol Fatigue sex drive ha...
Your LH is low and your FSH is on the lower end as well. This suggests you may have secondary hypogonadism.
Can vouch for them. Smooth transition from my in person local clinic to using alphaMD. Meds arrived this week and no issues. Switched from once a week...
Happy to hear it & thank you very much for the shoutout sir!
I’m on top of macros and lifting heavy. History of losing body fat and keeping it off. Disciplined. Etc. I have rocked pretty large deficits for mo...
Yes. While on TRT, you are more likely to preserve muscle while in a caloric deficit. In fact, it is still potentially possible to gain some muscle in...
If I were interested in becoming a patient of your clinic, could I forward you my current lab work or would we need new labs? My current lab work is ...
We are happy to take current lab work from a patient new to TRT or past lab work/prescription from a current TRT patient transferring over. No need to...
Hello I’m a 32 year old male with a history of anabolic steroid use at age 27. I’ve been having all the hallmark signs of hypogonadism Just had some r...
For you the answer would probably: Both are just fine. It more depends on your goals & what Sx you're feeling.
Generally speaking does 2x or 3x per week help with acne symptoms too? Most on here say so, I'm going to start my regimen in a couple weeks and will ...
Absolutely, you should see an improvement with twice a week over once a week by a large amount, as the spike you would have had would be huge. You sho...
My PCP thankfully scripts my TRT but I'm curious about your take on injection regimens. Are ED injections, in lieu of EOD injections, more efficaciou...
Short answer: Yes this approach is typically better to manage Estrogen issues.
What's the deal with TRT and lipid profile? Does TRT actually cause plaque build up and, if so, does the use of a statin in combination with TRT negat...
How does testosterone and TRT relate to the lipid profile? To answer that you need a little background.
Do you prescribe anavar for Trt or alongside Trt? If so how would that effect the monthly subscription?
There are appropriate use cases for Anavar & some of our members have used it short term. In general it depends on the dose & available costs at the t...
I have some questions about your business as I am shopping around. I am currently prescribed test through my primary doctor which is pretty inexpensiv...
We are available in most states, with a few exceptions. If we can't help, we can offer advice. What state are you moving to?
Some questions about how SHBG works: A lot of guys here and elsewhere talk about taking either supplements or medication specifically to lower SHBG,...
Overall, your analogy is correct. SHBG is like a buffer for "overflow". It is there to keep levels of the sex hormones from going too high or too low....
I recently had my first blood test for Testosterone after seeing my GP about low mood, energy and Libido.(30 rs old, fit, well muscled, but suffer fro...
We can't say for sure what your doctor will recommend for you, but try not to freak out. There are options other than injections (creams, pellets, etc...
My LH is zero. Will HCG fix that?
Other than fertility issues, are there any other concerns that a 26 year old man should have before starting trt? (Before starting I have taken 2 test...
In general, *current* fertility & hair loss are our main concerns for otherwise healthy young men.
44 year old male, 6’2” 218lbs 16% body fat, very active in terms of weightlifting and working out in general. Took a finger prick test from Everlywell...
If those feelings have been ongoing for 6 to a few years but weren't there before and you have no other health issues, it sounds like it could be low ...
Can I find a trt script with managed and recovered heart failure and stage 3 kidney disease. I’m on a unground trt dose now. Just want to be legal an...
I see no reason we can't work with you, the main reasons we wouldn't be able to would be if someone has active prostate cancer. Do you have recent lab...
I am currently on a protocol that is HCG based "monotherapy" it has been working great it seems, especially on bloodwork, but I wonder if I'm feeling ...
Clomid & HCG are fine together, they come at the problem from different avenues to try and accomplish the same thing.
I'm on 100mg Test E a week. Split into 2 injections. My estradiol is 50 which is slightly over reference. I feel a little emotional at times and have...
If you're having high Estrogen symptoms at 100mg a week then you're probably sensitive to Estrogen. You may need an AI if you increase in dose because...
What is the maximum dose/week that is legally available to prescribe? I've heard 400/week?
There really isn't one. You can write for whatever you want, but the DEA states that 200mg and below is normal for use. They don't bat an eye at it. W...
Would you say most clinicians are wrong for aiming for a total test level rather than regular high free testosterone levels? I had a clinic keep tryi...
They're not 100% wrong but they're not right. The main reason some places harp on the numbers is because it's good for marketing. Men love numbers & b...
What all tests would you recommend to someone before starting TRT in their late 20s? No doctors in my country prescribe TRT, so I'd have to manage eve...
All that follows is opinion and non advice:
I have been on TRT for a couple years. Unfortunately I’ve been going the UGL route. I don’t want to quit just to validate my blood panel but I really ...
Find a clinic that doesn't care where you came from. We help many men on UGLs go legit. It's better that someone moves to managed care than to put up ...
Hi. 54 YO man. T was 170. Been on .75 Xyosted for 2 months. Now T is 420 and feeling good. But, the Testicular atrophy is killing me. Right Testicle k...
Xyosted
I’ve been on 150 for like 2 years. I just got back in the gym so I figured I would turn it up a little to give me a little boost to get back where I w...
It's very likely at 300mg you're oversaturated anyways, not fully able to use all of that Testosterone & more is just around to aromatase into Estroge...
Hi im having an issue with my aggression, irritatabilty and agitation. Everything pisses me off I hate everyone. Including my family. I’ve always had ...
If you are noticing aggression at those higher levels, then your decision to lower your dose back to 150mg/wk makes sense.
Makes sense. Apomorphine sounds promising on account of not requiring an injection, so I'll probably inquire about that first when I visit a doctor. H...
Apomorphine effects typically kick in 20min after the sublingual dose. Its effects typically last several hours..hCG should typically be dosed no less...
If a person would take HCGs the preserve fertility, how many injections can he expect to do weekly on a combo of TRT and HCGs Also, regarding libido,...
Someone looking to maintain fertility by using hCG while on TRT would typically dose at a minimum of 500 IUs/wk, with improving sperm levels with incr...
Thank you for taking time address our questions regarding TRT. I’ve been researching the topic for some time now, so it’s wonderful to have experts of...
No, this question is not too specific. Just remember that we are doctors, just not your doctor. As per our disclaimer, our advice online should not be...
Do you guys provide over 200mg per week? I felt so could on 300mg a week. I didn’t realize that was on higher dose at the time. Maybe I won’t need abo...
We do not have a maximum level for treatment. Some patients require a higher dosage for symptom relief, and there is no toxic or unsafe threshold of t...
What is the list of everything checked with your blood test’s? Thanks
We personalize our lab orders to each individual patient based on their needs during the initial consult, and we also accept outside lab results. But ...
Let’s say a 45yo guy has all the symptoms of low testosterone but 2 tests 2 months apart show total t at 930ng/dl and free t at 16ng/dl naturally. SHB...
Yes, you could absolutely have symptoms just from the drop in testosterone, despite being within the upper range of normal. If what is normal for you ...
Most people on TRT are doing the injections, I can’t seem to find the answer of what gel/cream dose is required to match at 150 or 200mg injection dos...
The reason it's hard to figure out is because you can get so many combinations from compounding pharmacies on demand. You'd look at the concentration ...
I don't have hair loss genetics but my hair is thinning. Can low testosterone be the cause for that?
In some cases yes. It is more common that extremely high Testosterone converting into DHT causes hair loss, but the goal therapeutic doses should put ...
I'm afraid I have low T levels. Is there a way to test for T levels without drawing blood?
There are some tests out there that don't involve blood at all, but a good middle ground would be a finger prick test. It's not a needle in your arm, ...
What about telemedicine? Do you have to travel to your office or totally virtual?
Missed that one!
Do you cut off your treatment and prescription refills at a certain hemoglobin and hematocrit? How much is it monthly with your company? Do you do t...
What’s relative hypogonadism?
Relative hypogonadism is a term for men who have symptoms of hypogonadism, despite having lab tests that fall within the normal range based on lab va...
I am having more blood work done on Thursday. I guess what I'm wondering is, if I came to your clinic, would you look at my situation and think that I...
If you have low T symptoms and aren't showing any other reason for having them, then you are a candidate for TRT. The labs help us show what kind of d...
I recently went to a clinic and had blood work done because I had been feeling low on motivation, anxious, depressed, low sex drive, and had some exce...
So, obviously all men respond differently to testosterone. However, as a general rule of thumb, the average man will convert 1mg of exogenous T into 5...
How do you manage bph while on TRT? I’ve considered finasteride but hear very conflicting information about its usage.
The longer you are on TRT, the harder it is to bounce back from, should you decide to go off, correct?
Yes and no. If you were to only take it for a few months, then recovery would be expected to be rapid, typically within a few months. The longest it h...
I'm all over the second, non medical advice. I have labs to test my ferritin & iron levels next week. If they look good I'm going to a different bloo...
Good planning with the lab tests, most donation companies don't talk to one another at all.I would be annoyed as well. It's really interesting the spe...
I've been cruising on 100mg EOD for a year, last set of labs they looked good, cholesterol was a bit high but I don't think it was terrible. I need to...
What's your protocol for high hematocrit?
I'm on prescription TRT through my general doctor and have been for over a year now. Everything is good feeling wise except back acne. What are you ...
You may have already tried some of these things, but our first steps would be:
What do you think of e2 being more in a ratio of 3-5% of total t instead of in a range of 20-40? Just curious. In my experience, I have not had any ...
The debate of "is it the number or the ratio" continues!
I continue to have issues with what appears to be estrogen. Pre TRT my estradiol was 88 nmol/l. Shortly after starting, I had very spicy nipples and ...
It sounds like you're sensitive to Estrogen transference & have a high Estrogen baseline.
I was wondering if I could ask about my labs. Current 46 years old. Started feeling symptoms that could be associated with low t. I was also overweigh...
First, awesome job losing the weight and making lifestyle changes.
4 weeks into trt. Bi-weekly injections. Bi-weekly enclomiphene. Daily Armour thyroid. 39 yrs old. 260 lbs. 6' 1". Seems like libido increased initial...
So, the drop off is pretty normal, let me share something we give to our new patients:
I’ve kept my dose flat at 133mg/week (EOD injections) for the past 2 years. Over that time, I’ve probably lost 30 pounds of fat and put on 10 pounds ...
Yes & no.
How do you guys handle increased blood pressure on trt? Normal bp off, but high when on trt.
In general, we look to make sure the doses make sense & are not overly high to create unnecessary side effects to BP. If the dosage is right & you sti...
I started TRT about 3 and a half weeks ago (37 and very active) and am curious about dosing and was hoping you could clarify. My initial T levels prio...
No worries about the long post, happy to help.
Do you need a large barrel needle to reconstitute peptides, or would poking drawing and adding BAC water to the peptide vial over and over be ok?
Either should be just fine, though doing it multiple times still needs you to follow sterile procedures each time. Use plenty of needle swaps & alcoho...
Do you also supply growth hormone with TRT? Why or why not?
No, we do not. Reason: Because the DEA could get pissed off and send us to jail.
I have read that some patients are using a Deca+Test protocol and some have a deca solo protocol. Have you seen this? Benefits? I have read it helps w...
We typically do use Nandrolone for those who are having joint issues or very physically demanding lifestyles that are hard on them. It is rare to have...
On daily cypionate and HCG but estrogen is high. Tried examestane and anastrazole which brings down to normal levels but I feel hollow sometimes and a...
It sounds like the goal is to maintain treatment and remove the need for AIs. With that in mind, you could consider reducing your HCG dose unless you'...
Considering starting for a TT of 440. I have sleeping issues and workout recovery is affected. 34yo. I have test prop. I’m fine with EOD or so dosing....
We don't use that in TRT often anymore due to the short half life, so we don't have active patients with it to speak from experience on.
Been on T for a few months now, 200mg/week, and my sleep is not as good as it was pre-T. Any thoughts on that? I was very active before (lifting 3x/...
We would think it odd, TRT usually improves sleep rather than worsens it.
What are the best supplements to add to TRT to increase libido?
Horny Goat Weed is cheap, OTC, generally well tolerated, and works good for most men. I personally use it daily and can notice a solid drive differenc...
I only dose 1x per week currently because that’s what is convenient for me. I have tried 2x weekly and didn’t notice much of a difference, but that wa...
We would say definitely don't do once weekly with Enanthate, and before switching try twice weekly again. Although you may not have "felt" a differenc...
In what situations would you recommend a person switch from Cypionate to Enanthate or a different ester? I’ve only taken Cypionate and I’m considering...
So, this is a bit of a subjective area. Some men will swear by one over the other & feel very validated in their reasoning. The biggest change is just...
Regarding hair loss, the good news for me is that I’m already bald. lol. Interesting comment about hemorrhoids. What is it about nand that would cause...
Its anecdotal, but it might be due to a transient increase in hematocrit (blood volume) which nandrolone is known for.
I’m 55yrs old and on 200mg test cyp/wk. Workout 5-6 days/week and am in good shape. BP is good and bloods are too. My joints, especially my knees, ar...
We would say that you're right on the money about it being 100mg more Nandrolone than you need. At 200mg you're probably going to feel great from a fi...
Are options for compounded medication given to patients? Say, if someone was currently receiving medication from one pharmacy (I.e. empower) but want...
If you have a known issue from a pharmacy we're happy to use another one, just let us know. In general we decide which pharmacy to use based on the me...
I struggle with getting enough testosterone for my prescription. I was recently prescribed 64 days of test (2000mg). My prescription is 120mg/4 days....
In general, online companies like our use compounding pharmacies & have access to much better prices on Testosterone than you will find locally, plus ...
Any experience of managing trt that is also supplemented by the individual with 4 Androstenediol. I use 2 squirts of Testogel daily but feel it doesn...
2 weeks in TRT why do I feel like crap about two days after injection? Is this normal until injected levels elevate and blood levels get steady? And h...
At this point, you may just need time to adjust to the changes. You could reasonable be experiencing suppression effects with not-yet-optimal improvem...
Would it make sense to be on 25mg of enclomiphene twice a week while on 140mg a week of test cyp to help preserve fertility? I was prescribed this and...
While you can, we would suggest to not if you're interested in the fitness aspects of TRT (which most men are).
I'm currently taking 60mgs test cyp, 500iu HCG and 25mcg anastozole twice a week. I'm new to HCG and strictly taking it for the neurological benefits ...
In general yes, though HCG is relatively safe for long term personal health (though a bit harmful to long term monetary costs depending how you get it...
What are the general health benefits of TRT with someone with RRMS, besides the obvious benefits from extra muscle mass ?
Interestingly, low testosterone appears to actually be a risk factor for developing MS. In fact, men with hypogonadism have a
You mentioned TRT is proven to be good for blood pressure , but why does it feel like my heart beat is much much stronger on TRT? Especially when lyin...
Testosterone therapy has been proven to do a few things, it reduces afterload (systemic vascular resistance), stimulates repolarization of cardiac myo...
I’m at 150g / week at the moment and feel happy enough at this level I’m already showering a lot, morning noon and night some days but will invest i...
That sounds like a good level.
Ive been on Test cyp for over 6 months now, I use hcg as well through a UK clinic. What can I do to combat the acne I have all over my chest and back?...
I seemed to have lost libido after being on test cyp and hcg for 10 years it started happening this past year, I get the following labs done which are...
Libido is one of the hardest things about TRT to dial in, since it has so many factors by physiologically & psychologically. It sounds like you're doi...
How to lower hematocrit on top of blood donation ?
Taking 500mg of naringen has been proven to stabilize hematocrit levels. By stabilize it means it lower hematocrit if it is too high, and raise it if ...
I’m wanting to switch clinics. The quality of care and communication has gone downhill. I am currently being treated and would love to switch to you ...
We’re sorry to hear about your experience with your current provider.
Hey! I have elevated e2 of 70, total test of 400 maximum, lh 1.9, fsh 3.2 I feel testicle ache, shrinkage, and low T symptoms going on 2 years. Any ...
HCG monotherapy will still increase Estrogen compared to normal. You would probably be primary or secondary, yes. It may be work taking an AI, the onl...
is 928 total considered dangerously high? ......it was 1000 was concerned the high end but my last labs they were saying anything after 850. I don't k...
No, it is not. Many men sit above 1000 & it feels right to them, especially men who suffer from relative hypogonadism. The awesome thing about what ma...
Do you offer oxandralone?
My original TT was under 600, free t was very low. I had a lot of low T symptoms including sex drive, libido, energy, mood, etc.. Before TRT my estrog...
The only long term side effects of supraphysiologic testosterone levels that have been identified are increased risk of high blood pressure and low HD...
what is the shortest and smallest needle you'd recommend for IM cypionate ?
We tailor each plan individually, which includes supplies for injection. For that reason, there is no right or wrong choice for needle size. If a man ...
What is your approach for men with low SHGB (eg mine is 10 or 11). I am finding that lower levels of cypionate every day appears to be working better...
Essentially, those with less SHBG will need less exogenous T to reach a therapeutic range. So if you have low SHBG, you should be able to use doses be...
What can cause severe anxiety and palpitations (especially at night) on trt and Hcg?
Well, TRT is not typically known to cause anxiety, though elevated estradiol levels can, so you should look into that. hCG is more likely to aromatiz...
With my 1344ng/dl trough on 120mg, what dose would you drop to if you were me?
Simple math would say you convert 1mg of exogenous testosterone into 11.2ng/dL of total testosterone (average is 6-7).
How do you recommend coming off TRT if you have been on for many years?
A combination of Clomid/Enclomiphene & HCG is usually ideal. It would be fine to start those up while still on TRT for a few weeks if it's all planned...
What's the average dose for hyper responders in your clinic? My total testosterone is at 1344ng/dl trough on 120mg a week. I'm considering dropping t...
We have a few hyper responders, which we would probably loosely define as anyone who needs less than 100mg/wk.I would guess that about 5% of our curre...
What are options for AI if allergic to arimidex?
If allergic to that (Anastrozole) then daily Exemestane can be an alternative. There are others as well, though some have more side effects. I would a...
A lot of people on here say taking AI is bad and you may crash your E2, can you speak to that?
Yes, this is common, and it's due to poor TRT clinic practices.
I continue to have issues with what appears to be estrogen. Pre TRT my estradiol was 88 nmol/l. Shortly after starting, I had very spicy nipples and g...
I'm going to let you in on a little secret in mens health. Its an easy one to remember:Average estradiol levels for men age 18-25 (when we are at our ...
My current provider prescribed me 200mg a week. I did my research and I started lower than that. I started at 120mg 2x week, I was at 330 TT at 35! Ty...
You can take your weekly dose & do some napkin math at x4-5 to see the expected rise in TT. At 120 we'd expect a rise of 480-600. Keep in mind each ma...
I was on testosterone but quit a couple weeks back and now take HCG and Enclomiphene to try to get fertility back. Do you offer anything else that wou...
HCG & Clomid/Enclomiphene would be the same course of action that we would take for someone trying to cycle off of Testosterone to have a child. Thoug...
I am in Australia, where my provider isn't able to provide Test C anymore. They have given me Test E now, and I feel like I have gone back to my pre t...
The testosterone molecule is exactly chemically the same, whether it comes attached to cypionate, propionate, enanthate, undecanoate, isocaproate, hex...
Why do I get such an amazing result with Test C? As compared to either Test P or Test C? Isn't Test C technically weaker than the other ethanates?
It is likely that by following the appropriate injection routine with Test C that you are going to maintain a better overall Testosterone level consta...
If you’re diagnosed with hypoganadism obesity and are put on trt. Then you drop a bunch of weight. Is it possible to stop trt and have healthy T leve...
Your Testosterone may improve with weight loss & your Estrogen certainly will with loss of fat. However Testosterone baseline production over *ever* g...
If a guy has normal TT but high SHBG (thus low FT) is TRT the best option?
Hypogonadism can be diagnosed with a low total testosterone and/or a low free testosterone. Technically, either scenario qualifies someone for TRT.
Have you ever had patients who have developed breathing issues on TRT?
No, we have not. I have heard of something similar with hard steroids but not with Testosterone.
Follow-up to the question about hematocrit: in the setting of completely normal RBC and platelets (middle of reference range), along with no discernib...
From a personal perspective based on my own experiences, not necessarily as some people have been happy & fine there.
I have chronically low SHBG and TRT hasn't changed this. All other blood markers are okay. Have you seen this before or have any information on it?
There are many things that can effect SHBG levels. Body fat percentage, alcohol intake, vitamin D levels, problems with insulin levels or the thyroid,...
Hearing more about demesterol levels and enclomiphene as being a long term cardiovascular risk factor. Have u looked into that at all?
Desmesterol is the pre-cursor to cholesterol. Enclomiphene blocks the conversion of desmesterol into cholesterol by inhibiting the enzyme 24-dehydroch...
Do u also offer compound cream for those that cannot do injections?
Yes. Creams are available & may cost slightly more per month (maybe $8-20) just because they are more expensive to produce & ship. In cases like this ...
Do you offer online consultations and blood work through the mail? Or do we have to come into your clinic? Currently I'm going through defy and blood ...
We just talked about this in a post and you were saying yall don’t give more than 160mg a MONTH without “significant paperwork”.. now you admitting th...
We do have a few hyper-responders, who only need 60-70mg/wk, but we have never seen a patient who only needs 160mg in a month either.
Is it possible to be on low dose trt (I'm on 54mg a week, 3 shots of 18mg mon, we'd, Fri) for life and not have any sides? My only issues is a little ...
Yes, it is. You don't need to necessarily be on a super low dose, either. The goal of TRT should be to put you back at to where you used to be or what...
How do you know if the gnarly bumps all over someone’s back is acne or a rash?
Extreme back acne isn't common at therapeutic doses of Testosterone use. The higher your dose outside of therapeutic ranges (200mg weekly+) the higher...
My next question if you don’t mind, is fat loss on TRT. Are there certain types of TRT that are better for aiding fat loss? I’ve been lifting heavy fo...
Typically finding that ideal range of high benefits to low side effects will be the best course of action when using TRT for fat loss. There isn't too...
I see people post on various threads on steroids and how they age substantially in a few years. Does TRT have similar effects or is that more hardcore...
For traditional TRT, aka non-bodybuilding levels of Testosterone, this is almost what we would consider the opposite. Testosterone in men helps to mai...
If guys in places like Colorado have higher hematocrit levels from being at higher altitudes, why do guys on TRT have to donate blood when their hemat...
Mostly because of what it does to you & how each person is different. Their bodies may be doing that based on the strain of their environment & then u...
Higher bp! Just go on bp meds? High rcb, high hematokritt. Do blood donation, but they rebound faster every time and tanking my ferretin. I raise ferr...
Typically if you're at a therapeutic range for Testosterone, it shouldn't be a reason for higher BP. If it turns out to be so for you, then traditiona...
Sorry, but there's no such thing as a great dose. Take me, for example. Off 120mg my trough is 1344ng/dl. At 175mg, I was off the charts. My point is ...
I agree that everyone is different and that there will always be outliers, good stuff to share.
I’ve been on TRT for 6 months (160 mg weekly). Added HCG (1,500 weekly) 3 months ago. Balls though got firmer but still have not recovered to the pre-...
160mg a week is a great dose for Testosterone. For HCG 1500 units a week is what we would use for someone trying to actively conceive a child.A good ...
Is the 129 a month is that a monthly premium and plus we have to pay for blood wk and medicine?
Any tips for guys with low estrogen, normal-ish testosterone and high SHBG levels? I have yet to take any Testosterone. My stats are 37 years old, Ma...
You should consider consultation with your physician and labs regardless, because you state you are not feeling great.
TLDR: high output / high stress life. Physically and mentally. Last 2 years feeling sluggish, burned out, and find doing challenging things extremely...
We very often here "I have been feeling like shit for 6 months for 2 years, I have symptoms of low T" for all patients seeking if TRT is right for the...
Don’t think I've got super low T but never felt like ive got good range of T either. Question is, can i do one cyxle and come off and see effects if i...
We would advocate to go through a traditional TRT practice so they can help guide the needs:dose and talk about it based on your symptoms. That said, ...
How does one start taking HCG with TRT? I want to try testosterone only initially and see how my body responds to it, then when I think I'm maintainin...
You would not need to adjust your Testosterone dose when adding HCG generally. HCG/Clomid increase your natural production. On Testosterone your natur...
Is there any real difference between SubQ and IM injections? Starting TRT in a few weeks and have a pretty strong phobia of needles
For overall average testosterone throughout the week there is not much change. However subq is better at managing Estrogen symptoms because it absorbs...
If low T is symptom driven, then what is the purpose of having a “range”?
Testosterone ranges were created using population studies, using thousands of men. They just randomly tested men, whether they had any symptoms or not...
With T fluctuations being so drastic from any given hour, day, week, how can you really know if someone has a hormonal imbalance?
That is why symptoms are king, and numbers should be used as a guide post for what treatment is appropriate and how responsive someone is. Your 500 an...
How does one know they are allergic to a certain carrier oil?
Itchiness after injections, especially around the injection site, rashes near it, swelling. It happens after each injection, then passes after a day. ...
Looking into stopping TRT for a while and starting enclomiphene (for fertility). I've read that clomiphene can get your test numbers into the referenc...
The reason it doesn't feel as good as normal TRT is that Clomid/Enclomiphene suppress IGF-1, which is what builds/maintains muscle & provides many of ...
Going to have blood done early Jan to check on E levels etc. have been doing IM injection on delts. Might take the suggestion and go subq. Have a bunc...
Those would work fine. Anywhere that it's easy to grip your body fat. For most men sitting down and using the stomach works great. You'd want to use v...
36 M - 4 weeks into treatment. 60MG test cyp injection Tuesdays and Fridays. Started w T level around 280 - all typical symptoms. Low energy, moodines...
Check out this timeline we give to our patients:
Does trt improve or reduce sperm count?
Exogenous testosterone will always have a detrimental effect on sperm count.
I’m hoping to start TRT next month. Been dealing with terrible symptoms the last five years, got blood work done that showed low free and total T. I...
Yes sir, many men do. You could probably start on a mild dose of 500-1000 units weekly until you're actively trying and then kick it up to 1500 units ...
Why is it so hard to get your dose increased from 100 when you felt better at the beginning as you still had natural production?
That would definitely need to be a conversation to have with your medical provider. But all I can say is that it is not uncommon to need to make a few...
Do you sell testosterone?
We consult with our patients and prescribe testosterone when needed. We send the prescription to the pharmacy who then ships it to our patients.
I'm a 36-year-old male, I've been on TRT for hypogonadism for about 10 years now. The TRT specialist/internist I was getting treatment with, emigrate...
We hear a story like yours all the time. GP’s have a lot of things they have to keep up on. New treatments for diabetes, new diagnostics for rheumati...
Am I good candidate for TRT? M29 W: 240 built. Very consistent in the gym, but was curious about TRT due to muscle recovery, mental health, libido, an...
When it comes to low T & being a candidate for TRT, your symptoms matter a fair bit. The testing is really good to tell us if your primary/secondary h...
Just recently raised dose from 100>120mg (sub q daily 17mg) Have noticed a bit of acne breakout on back and shoulders. Previously on 100mg it was very...
It really is up to the person with little way to predict it. Many men can jump their dose up 50mg and see no acne change at all. If you're already doi...
Do I have to pay $49 for a consultation for peptide therapy? Can I Use my FSA for that as well?
Any consultation does require a payment to talk with a provider, though you can use "
How to increase IGF levels if I’m taking enclomiphene as my TRT?
Enclomiphene has the distinct feature of decreasing IGF-1 production.
Where can I see the price plans for the peptide therapy? I would like to see what to do.
We primarily work with Testosterone and ancillaries related to it, we can work with peptides but those are based on an as-needed case.
Do you take FSA?
We take both FSA & HSA, as long as the card they give you works with the payment processor, which it often does. If it cannot run, we can provide rece...
Can you comment on the distinction between TRT cream and injections? Do you find cream has better dht conversion? Does this mitigate some of the libid...
In general we find that libido & erectile function are improved through either method for any man suffering from hypogonadism. There are a few cases w...
I have been on trt for one year. Finally found a good dose of 100mg of cypionate a week. I feel pretty good except for daily anxious feeling. Last blo...
Anxiety is not a listed side effect of TRT, though we certainly have heard of a few patients express concern that anxiety could come from their TRT. I...
I'm pushing 47 years old now and was in TRT in the past. I didn't like that big freaking needle, and my BP increased but maintained at 140 while on th...
It’s hard to say, because everyone responds differently, but most men do well on the creams, and creams are known to have less of an impact on blood l...
Without actually buying prescription medication for acne is there any soap of shampoo i can buy that will help my back acne? and I'm also lowering my ...
You can pick up Hibiclens (chlorhexidine) soap, which does help reduce acne severity. Selenium sulfide shampoo has been helpful to reduce acne in many...
I've been on test cyp 100mg/wk for three months. My total testosterone keeps coming back in the low 300's. My free testosterone has increased from 20 ...
It is somewhat hard to say for sure, but at the very least we'd say you may be a lower converter. For rough napkin math you generally take the weekly ...
i’ve been on compounded cream for 3 weeks. twice daily to scrotum. i am having difficulty sleeping but also started thyroid. is the thyroid medication...
In general Testosterone helps with sleep rather than hinders it, it's one of the big benefits that we talk about with patients looking to start TRT.
Any reasons why I should be looking into L-Carnitine for androgen reuptake? What sort of benefits could I gain? Any downsides? I have the same questio...
L-carnitine is natural and safe, and supplementing with it can absolutely help speed with muscle growth. It pairs well with TRT due to the increase in...
What are your thoughts on someone jumping from trt 100mg/week to trt plus, e.g. 300mg test and then stacking primo or Masterone to avoid aromatization...
We do work closely with many men who follow protocols like the one you mentioned. We do our best to help them do it safely with careful monitoring.
How normal is it for someone on TRT or even a blasting steroid cycle to have low hematocrite and smaller red blood cells? My last tests showed it whil...
Testosterone increases red blood cell production. Increased red blood cell production requires more iron, so iron stores can get exhausted if your red...
I've been noticing a lot of fatigue and brain fog the day before I take my Testosterone Cypionate. Is this just in my head since the half-life for Tes...
It is realistically closer to 4 days, and if you can tell a difference the day before your normal shot it would be perfectly fine to change to three t...
I know this isn’t TRT related but I’m a 20 year old male(344 ng/dl first test done at 8:30, and 311 ng/dl done at 9 am, 2 different dates) overall hea...
Clomid is a form of TRT the way we think of it, no worries.
I am 49. Feel all the effects of low test. Going to VA in a couple weeks to get tested. I believe my last test 2 years ago and was 395. Was told I am ...
In general the VA follows the same path that insurance companies/PCPs do by focusing on ranges more than symptoms.
How does testosterone cream compare to injections? Are side effects less likely with the cream? Can you reach the same test levels with the cream (eve...
Both forms have pros and cons, and both are excellent options.
Does TRT deplete folate?
Just like men who naturally produce higher levels of testosterone naturally are not at greater risk of low folate, exogenous testosterone holds no gre...
So my current trt provider has me on 20 units per day of 200mg, if I were to switch to you all, would this protocol stay the same with you all?
We are happy to continue regimens from other TRT providers if they are working for you.
10 weeks on trt. 120mg split 2x a week puts my trough at 750. RBC 5.83 HEMOGLOBIN 17.6 HEMATOCRIT 51.6. Pallets normal at 240. Should I worry and shou...
A hematocrit of 50+ or so in a man and we would suggest continued monitoring and donation of blood. This may come down with time as you say, but there...
Is your service available in Alabama?
Yes, for the most part. For some reason that we don't quite understand, none of our pharmacies can provide Semaglutide/Tirzepatide injections or subli...
Why can't I seem to find the gels on any ugl providers? Is it hard to make compared to injectables? I'm prescribed the gels but they will only give m...
In general, even in normal medicine, gels are more expensive to make. The volume & then later the shipping of said higher volume tend to add to the co...
Been on TRT 100mg week (everyday sub q pins) 16 weeks in. Did bloodwork (provider said can increase) am going up to 120mg week. When should I do blood...
I've been on trt for about a year and it started right away, started at 160 a week and it was so bad I wouldn't be able to sleep for two days, but I'm...
RHR increase on TRT - while this is not a common complaint, it is known to occur. While the phenomenon has not been evaluated extensively, a common th...
I started trt 6 months ago and I’ve noticed my blood pressure has gone up. Should I be concerned? 120 mgs a week split into 3 shots. I started with 11...
It would be likely not connected to TRT. There is little connection between increased Testosterone and raising your blood pressure, especially at that...
Is there any information about using hcg with trt that contains benefits outside of fertility and ball size? I’m old and done with kids and don’t care...
There can be some. Some men have reported having better Estrogen levels or having it help with libido while on TRT.
Do you think patients can return back to their pre TRT levels in the case they have to come off due to unforeseen side effects or complications?
Yes. We have seen this numerous times. Many of our patients come to us after having being off TRT for awhile for one reason or another. When we compar...
What exactly is included at your $129/month price point? I checked your website but didn’t find specifics. Thanks.
Provider consultations, lab test reviews, most doses of Testosterone (if the dose is high there may be a slight increase, as we have to buy or send mo...
Can you guys send me something to get labs done? I’m an existing patient
Absolutely. Would you head over to this location & select "Member Contact" and shoot us a message?
Thoughts on taking test just to get to the upper reference range? 41 almost and total test came back at 500. Obviously would like to feel 25 again but...
This is what we would call relative hypogonadism. Since all men lose Testosterone with age, you would have been much higher when you were younger.If y...
Thoughts on using HCG + Enclomiphene in lieu of TRT for younger men with low testosterone worried about fertility?
They are fine ways to improve your Testosterone level, though each has some drawbacks.
Is there one diet that’s best or optimal for TRT? I usually eat following the Mediterranean diet. Frankly I never even thought about this until I just...
Mediterranean diet.
How often do you test hormone levels? My current provider checks me every 3 months.
We adjust testing & re-testing based on the patient to better meet their needs or means.
Hi, I’m 25 years old. Test is 404. I work out 5 days per week, am pretty lean and fit and healthy I had previously considered TRT but ultimately turn...
A few things to note:
I'm 50-years-old, and my doctor recently prescribed TRT to address my symptoms of low testosterone. While I don't suffer from hypogonadism, my doctor ...
First, most providers go by mg per week, so for this we will just say your dose is 100mg per week. That is generally a lower dose, especially for some...
At how long on TRT are men normally put in the category of being sterile? And how would being on DHT-derivatives increase the chances?
TRT is essentially male birth control. All men on TRT will suppress sperm production while on treatment. But just like women on birth control, it is n...
What's the half life of oestrogens? Can't find it anywhere
The serum half-lifes of estrone (E1) and estradiol (E2) are about the same; 10-70 minutes.
When you change your dose, how long does it take to reverse the side effects?
Typically your E2 levels will stabilize around 2-3 weeks after any change in dose.
How long after starting TRT does it take for estrogen to spike, if it’s going to? And what is the first protocol to stop it? Lowering the dose or add...
Generally within the first 2 months you will notice an Estrogen issue or likely not have one. Everyone is a bit different.
How come RHR increases with TRT usage? My RHR used to be in low 50s and now is it is low 60 even with my cardio conditioning improving. Also, why does...
RHR increase on TRT - while this is not a common complaint, it is known to occur. While the phenomenon has not been evaluated extensively, a common th...
What are your thoughts on DIM or other supplements to manage estrogen?
We advocate for use of DIM. It’s cheap and natural. We certainly have seen it work for some, though we have also seen it not work in others.
At what point do you think that AI is necessary to handle E levels, assuming that the patient is generally asymptomatic.
There is no specific level of estradiol that triggers initiation of an AI. Typically, they are prescribed only in the presence of estradiol associated...
Have you had any success raising shbg in patients with single digit numbers? Do you make modifications to protocols based on shbg specifically?
We do not typically follow SHBG levels in our patients unless there is a specific reason to. Most often we would check would be in cases where someone...
I was diagnosed with hypogonadism and I was wondering, do you usually cycle TRT with that or do you just stand TRT for your entire life? Also, how lo...
You typically stay on TRT for as long as you want relief from low Testosterone symptoms, as it is a treatment & not a cure sadly.
What requirements do you require to get started with semaglutide, tirzepatiode or any of the following that you mentioned above ?
GLP-1s are less of a controlled medication that Testosterone & TRT is, which means the guidelines for use when not working with insurance justificatio...
Do you guys only require a at home test? What about other stuff like lipids ? I have a blood panel from last week. Could you take that for step 1?
Yes, we personally take at-home tests & send them out ourselves when needed.
For context, I'm a 35 year old male. I have had two blood test. The first of which stated: Finger prick blood test Total testosterone - 17.100 Free ...
Our opinion would be to rethink the goal & metrics a bit. For TRT & why you've been denied care, many institutions like insurance companies or very ol...
How frequent are the injections for TRT? Are they subq or IM?
At minimum injections should be twice weekly due to the half-life of the hormones (how long until half of the medication has left your body). It can b...
Is anastrazole typically prescribed at a starting dose of 1mg? Or specifically for me, .5mg 2x per week? Is this too high a dose to start out with? Wh...
We typically start with zero AI because we look at a man's TT & can usually use therapeutic doses of 120mg-160mg to provide an ideal range with high ...
38 with hormonal issues and it's attendant symptoms and effect since adolescence. Completely bald by 23, finger nails and pubic hair takes a very long...
Fatigue, confidence, libido, motivation, and erectile function are all things that improve on TRT. Head hair & likely nail growth speed is typically n...
Hello, I'm on 160 a week split into two dosages going into my 4th week. I'm feeling more energetic and my cognitive seems to be getting better. I have...
Morning wood is expected to return within the first 6 weeks or so once starting TRT.
What is the normal level of testosterone for healthy males? My doctor says it is 300.
The idea of normal ranges is not a good one. It is a very subjective level for each man. That said, 300 is the lower end of the insurance based "norma...
What works better in your experience, subcutaneous injections or intramuscular injections. Are there pros and cons to each that should be considered?
In practical terms subq takes longer but requires less knowledge/skill to perform & is typically less painful due to the size of the needle & location...
When do you recommend doing labs? I’m on 140 mg test-c split into two weekly injections. It’s been five weeks since I started. Planning to get labs do...
We'd agree with your plan. It's best not to test until week 7 or 8 if you're going to be testing. Labs are important if you're having side effects or ...
How soon does sleep apnea/upper airway growth reverse after stopping TRT? I have another drug induced sleep endoscopy coming up, my last test cyp pin...
Sleep apnea and TRT have an interesting relationship. There is a
Just started 90 MG / week divided into 2 shots of 45 each time. I’m 51 , and concerned about losing my hair. What’s the consensus on using Finasteride...
Hair loss on TRT is almost entirely dependent on your genetics. Therapeutic doses of TRT, especially as something as low as 90mg (I know that Canada h...
How are you guys feeling with using Enclomiphine as a means to preserve testicular function vs HCG while on testosterone? Have you tried combining the...
So, we are a bit more conservative in that we don't feel like the science has proven any benefit for use of a SERM and TRT concurrently.
Why do the testosterone reference ranges vary widely depending on practitioner / lab? Is there a study demonstrating a shift towards lower Total Test...
What is "average" and what is "normal" are not the same thing. The average person in most developed nations is obese, so does that mean obesity is "no...
Do you prescribe nandrolone, oxandrolone, or stanozolol? If so, what are some legitimate reasons you could and would prescribe each one of these to s...
Yes, yes, and yes. Some variability between states when it comes to availability, but most states have most of these. As long as you have good reason ...
I wanted to ask you guys based on my shbg 10 nmol/L, total testosterone 923 ng/dl, where should my free testosterone sit at to feel optimal regarding ...
In terms of your dose & free Testosterone, that's unfortunately going to be unique to you when talking about libido.
Is there an upper limit on total T to be eligible? My total is high, but free is in lower reference range due to high SHBG.
No, not truly.
My wife and I I look to try for our third child next year, first post TRT, I wanted to get your thoughts on what i should be researching, asking my pr...
So, to keep it simple, TRT is male birth control. While some men still can produce sperm while on TRT, you should never assume you are one of them. A...
When these neurosteroids bottom out, would that cause adhd medications to stop working? Would introducing HCG be a better option than supplementing wi...
Yes, when these neurosteroids are depleted, it would make focus and attention worse. This would typically mean that any treatments for attention would...
Aside from high/low E2, what else are the primary reasons a person on TRT would have poor mood and low energy?
Hormonally speaking, it could relate to the neurosteroids pregnenolone and DHEA-S. These act directly on the brain and are associated with mood and co...
I have a weird sunburn, sensitive skin, almost like pins and needles feeling over my arms, neck and back going on. Is this from the anastrozole that I...
That side effect you describe is more consistent with anastrozole. It’s not likely from the carrier oil without any associated hives.
I’m new to TRT. I’m 47 yrs old. Did bloodwork and was put on 200ml/week in Oct of 2023.l. felt great, sex drive was good, even had “morning wood” most...
Well, I think I have your answer. The average man produces 10-20mg of progesterone daily. If you are really taking 200mg daily, you are overdosing.
How do I make sure I hit the ventroglute? I either seem to go too far back or too far forward and yesterday went too far forward and have a big ass lu...
We have a self-administration video on this available, actually. Let us know if this helps:
My friend was in the hospital for CHF with mild ejection fraction and no clots. All good markers are good and Ejection fraction is now normal. Can be ...
The science is pretty clear on the fact that low testosterone is a greater risk factor for heart disease and CHF than TRT.
Can you get Trt if you suffer from the common symptoms but your levels are in normal range?
Hypogonadism is more than just a number. So yes, you may meet criteria for treatment with a "normal" testosterone level.
Hey guys, 25 YO. My test is 404, which is pretty low for my age, SHBG being 19.60 nmol/L I’ve previously looked into TRT and was perscribed, with Top...
Yes, that would account for the return in your symptoms slightly, but it is likely another very common occurrence too.
Is TRT only a viable long term strategy, or does the shutdown of other hormones (due to testes shutdown) cause issues after a while. Do you find most ...
Since low Testosterone is a life-long condition and there is no cure, which only gets worse with age, treatment is the only course to remain symptom f...
I’m with a clinic and they’ve told me HCT levels up to 57% are acceptable and my SHBG being low at 12 nmol/l they said it’s fine. What are your guide...
For HC anything around 51% and we would advise to donate blood somewhat regularly to make sure it stays under control, especially because it is free t...
My current TRT protocol is 60mg/week 200mg test cyp. The day after injection I feel great and then I am back to feeling “normal” which normal for me i...
60mg/wk is considerably lower than most men take for TRT. It sounds like you are also doing one injection weekly, which is also no longer considered s...
Any downside to micro dosing HCG? I take 60 units per week, 17 units EOD. I have heard it is not as effective at low doses. True? Would I be better of...
I wouldn't say there's a downside to micro dosing vs more spread out injections on paper. The trouble is that when you're working with those very very...
I was recommended by a clinic to take Anastrozole starting week 2. I started week 3 and have taken it for 4 weeks. It could have been the initial boos...
During weeks 1-4 most men find increasing benefits week over week.
Is there any correlation to an imbalance of hormones and an increase in WBC count particularly when estrogen is spiked when there is no infection insi...
Not necessarily, but the latter may be related to something else.
I see many people on this sub post with bloodwork confirming that while on TRT (test only, no HCG) all health markers look great/within range and they...
Is an AI provided for free in your TRT protocol if blood work or reported side effects warrants it?
Thoughts on Enclomiphine Vs HCG alongside testosterone for the sole purpose of preventing testicular atrophy? I just started EOD 12.5mg Enclomiphine ...
There are no studies on using enclomiphene and TRT together, but it is becoming a more common practice. Logically, it keeps your FSH and LH production...
What do i do if i am fat(37 BMI) and and have low SHGB(11 nmol/l) low test(1-2 ng/ml over several measurements). I do go to the gym 4 times a week, ha...
Additional Testosterone is converted into Estrogen because the body sees it as "maintaining the balance" and isn't directly related to body fat conten...
Is having really high test results like 1,000+ Free and Total an indication you are a "good responder" or a "bad responder"?
Super short answer: Probably a good responder.
Is arimadex safe to take long term for estrogen management? I’ve seen a few comments on here hinting they are bad for you.
It does depend on the context.
do you notice a difference in benefits of DHT from using topical fin vs oral? mainly for test thanks! I’ll check it out I get test and bloods from ...
We'll do a follow-up video in the next week or so about oral vs topical Finasteride & IM vs SQ Testosterone injections for you.
What’s your favorite hair protective method for someone who is prone to baldness? Also subq vs IM? The age old question. I started with HCG mono and ...
When it comes to TRT, Testosterone at a therapeutic dose (getting you to where you should be) typically doesn't cause additional* hair loss. However i...
What can I do for the water retention and moon face effect?
Moon face is typically due to water retention. This can be multifactorial, either from too much estrogen, progesterone, or aldosterone, or cortisol; o...
Hey there, thanks for doing this. I have been on for about 18 months with minimal side effects then suddenly over new years I developed pancreatitis ...
There are many potential causes for pancreatitis. The most common being excess alcohol use, and the second most common being due to gallstones. There ...
Can a small dose of trt (50 to 80 ml) weekly and small dose of enclomiphene (not clomid) be used? The reason for the enclomiphene is to keep a small n...
A dose of 50-80 mg (I'm assuming you meant that as opposed to mL) weekly is a dose that likely would typically get most men only to a level in the low...
I know this is late, hoping you guys see this. I'm interested in working with you guys. However, why doea your business .org and not .com? Also, can y...
We chose the .org vs .com primarily because we are a healthcare organization, and preferred that designation over a commercial designation.
Theoretically, if someone had bloodwork and started TRT without a prescription, but wanted to start with an actual clinic soon, would they have to ce...
Nope, that's a cruel thing to ask a patient to do, not with us at least. If you have bloodwork from before TRT & can speak to your symptoms, it's not ...
Is HCG the recommended product to return testicular size when on a TRT regimen?
Generally yes. There are a few other things that can help, but HCG is going to be the most direct & effective.
Can increasing trt dosage lower sex drive? Went from 220 to 240 per week, and I feel like sex drive went down. I take a blocker three days after my sh...
Libido is one of the most fragile aspects of TRT. There is definitely a "sweet spot" as far as levels are concerned where men notice improved libido. ...
I have heard that some providers may begin to offer primobolan is that true?
Methenolone (Primobolan) is DEA Schedule III and remains FDA approved in the USA. So technically it remains legal to prescribe. However, it stopped be...
40 year old M, 6' 225 lbs. Regarding an impact on liver function, how will TRT go into it? I have depression/anxiety, and low dose Lexapro has helped...
TRT has no detrimental effect whatsoever on the liver. In all but its oral formulations, it has no hepatotoxicity. Alcohol use with TRT is not a conce...
I’m 67 years old. Basically my entire life I’ve tried to keep physically fit running and powerlifting. In powerlifting I hit my personal bests in my ...
Yes, you sound like you meet criteria for hypogonadism. A level below 350ng/dL is considered low testosterone. Combined with your symptoms, you will l...
What are your thoughts on taking finasteride with trt? Major side effects? Any contraindications with suboxone (I’m on a slow taper to get off, curren...
Finasteride has some significant potential side effects. If you choose to use finasteride, you should use the topical formulation as opposed to the or...
What would you suggest for very high Hb and HCT levels in labs while on T?
Very high hemoglobin and hematocrit should be addressed, and not ignored. The quickest way to address it would be phlebotomy/blood donation. If it is ...
Question Here I’ve been on TRT for a couple of years . My initial level was at 132 . When I got tested again full panel it only improved to like 250 m...
That really depends on the situation, but if you were unresponsive to doses & your symptoms didn't improve we would increase your dose & test you as n...
Should I be worried if my psa levels increased from 1.5 to 2.2 in 6 months? I’m getting blood drawn again in about a month. My clinic told me that I w...
Typically any raise in PSA less than double is considered benign and non-concerning. However, repeat testing with any elevation is recommended.
Have you guys treated men with high levels of shbg who have symptoms of low t (even after lifestyle changes ) and low end free t but normal total test...
We have before. The biggest take away is that "normal" Testosterone isn't a very good term, as every man's normal will be different. So what might be ...
I am considering trt to improve my gym performance and physique. I'm wondering if I decide to stop trt one day, how long will it take for my own body ...
Many more recent studies show that 6 months to 1 year for production levels to return to normal completely unassisted.
TESTO GEL VS TEST C /E ? What about doing TRT and prostate cancer ( heritage from Father )?
Gel pros: No needle, ease of use, less risk of high hematocrit
If I tested hypogonadal and started self treating, would I be able to be a candidate without coming off testosterone in between?
For us at least, yes. We deal with a lot of guys who have started on UGLs & want to go to a legit source. We'd really prefer if you had some pre-trt t...
Any idea why I would be constantly buzzed/wired on a low dose of 80/wk every day subq? What percentage of your guys are subq vs IM?
I am currently working am with a local clinic. During this process we have found that I actually function correctly with a test level around 1000-1200...
We do, and we're happy to do so for patients who can show a history or reason for this. Though we wouldn't just start someone where out of the blue, a...
I’m currently on 120mg split 2x weekly and gives me a trough of 750. Is this a good trough for that amount? Also I want to add oxandrolone to my proto...
For 120mg weekly to give you 750, that sounds great. If you're feeling good at that level and how you want to be without side effect, I wouldn't bothe...
What is the common range most patients find symptom relief? 120-150?
We find that 140mg-160mg is the range that works best for men who need TRT. Some men start at 120mg a week and other go closer to 200mg a week, but th...
I’m currently on enclo and got my first set of labs back this week (7 weeks in). Total T went up from 465 to 732 and E2 from 25 to 44. My Free T perce...
That can sadly be common along with the IGF-1 issue, as you say, with Enclomiphene. I can see the logic of you being on the line between primary/secon...
I have low shbg, low T and high estrogen. How would I go about managing these when taking testosterone?
Starting Testosterone will improve your low T & likely raise your SHBG a bit, but you would want to see by how much after starting, as everyone is uni...
Can you speak to pinning frequency/time of day and what bearing it has on sleep, if any. Thank you!
Most men notice increased quality of sleep on TRT. Some however do note having a harder time sleeping, which can sometimes be the case if they're less...
Started TRT 5 days ago. Compounded locally 20% cream, 2ml once daily rubbed in thighs. I take Valsartan 80mg and Amlodipine Besylate 2.5mg at bed for ...
In general TRT has little effect on BP. Some men's BP is affected by their Testosterone & may adjust once their Testosterone is in a proper range, but...
Any thoughts on being on GlP-1 agonists in conjunction w/ trt?
Perfectly fine, and honestly encouraged if you have a lot of weight to lose.
Can 25 mg Clomid twice a week, be enough to help prevent shrinkage with 0.5 mL of 200 mg Delatestryl once a week?
Classic low T symptoms (38/m). Had total T come back at 281 and estradiol come back at 13.X. Thyroid tests all came back pretty good. No other hormon...
No, that is more than enough to begin treatment.
Why is hCG so expensive?
A good few years ago they changed the regulations regarding its manufacture, making it a much harder process on the production side of things. This c...
What’s your recommended dose for hcg weekly to maintain fertility and testicular size? And it hcg increases e2 too much is it fine to take an AI long ...
Anywhere from 250-1000 units weekly will have a good effect for cosmetic size & can be considered a maintenance dose. Many men opt for 500 units weekl...
Can I just order TRT online and have it shipped to me via USPS? I am living in Japan and started TRT here. Ive had extensive bloodwork done I’ve been ...
Are you a US citizen living on a military installation? The answer would be: Sometimes.
How is traveling overseas with TRT? Especially in strict countries like the Arab countries. Do you provide a note? Any tips?
You hit the nail on the head with that second part.
I know everyone's different in how they react to trt. I've been doing pretty well for about 2 months. At what dosages and frequency do you see side e...
Two months in is a great time to evaluate how you're feeling on your dose. Most fluctuations are settled down at this point & you can more confidently...
Dr told me to stay away from trt because my grandfather had prostrate cancer. Will trt increase my chances of it or is it the same with taking clomid ...
While old thinking was that TRT could increase the risk of prostate cancer, more recent and better studies have demonstrated just the opposite. Not on...
What additional anabolics would pair perfectly for a trt regiment regarding strength and adding on muscle mass?? Also, if a patient is taking Adderal...
As a legal men's health company, we can only speak to the "additional anabolics" that are legal for prescription in the US. Typically these would be n...
Regarding Libido Increase: I started TRT about 4 months ago after several years of low total and eventually a high LH. I was getting 200mg/mL IM inje...
Libido is one of the more delicate things to deal with when it comes to TRT. If often doesnt take much to over or undershoot the "sweet spot". But the...
What could I expect cost wise to start on TRT and include HCG for fertility purposes? Considering it and no clue what to expect for cost. I know there...
Almost all clinics are going to cost around an average of $130-150 a month, despite whatever they say, for baseline TRT (no HCG). There are some like ...
32 year old male. I’ve tried every antidepressant there is to no avail. Energy and mood are always in the dumps. I’m 5’10” 250pounds(down from 267) 40...
We see a great many men respond to having low Testosterone return to appropriate levels with an marked increase to their mental health and mood.
My doctor is only testing free testosterone for medically prescribed TRT at my appointments. What other levels and things should I ask him to check? ...
Truthfully if you're only on a moderate dose of TRT, it is providing the benefits you're looking for, and you have no side effects - Basic Testosteron...
What is your opinion on test decanoate and undecanoate? I had posted a few links by some well known fitness influencers/coach who claimed that the lon...
To be honest, we don't have much experience with decanoate or undecanoate in the US, as these esters are still on patent, so are very expensive. This ...
At which time would you recommend doing blood work after injection when the frequency is each 5 days 75mg? On injection day t0, or in between on t3?
Typically the idea is to check the trough, so you know what your lowest T level is. Since there is no such thing as testosterone toxicity, we don't ne...
Why did I get brain fog from TRT (Androgel)? Could not think anymore. Any ideas why that could be?
The thought regarding this is that use of exogenous TRT shuts down all upstream steps in the
I’ve heard and seen conflicting ideas for trt, with regards to obese people. I want to do it, and have had weight/hormone problems for ages… Is there...
There is no weight you have to be at to begin TRT. We see underweight, normal weight, overweight, and obese men who are hypogonadal, and need TRT.
Have you experienced any clients with severe arthritis (Ankylosing Spondilitis, Rhumatoïd arthritis) have seen massive benefits from TRT? I know some ...
Yes, we have seen patients with rheumatic conditions improve with TRT. Hypogonadism is a state that increases inflammatory proteins in the blood, and ...
Does ALCAR have any effect on LH and FSH for men? I'm currently on 160mg Cypionate, 0.5mg semaglutide, and 500mg daily of ALCAR.
No. Acetyl L-Carnitine has no effect on LH or FSH. However, it is an excellent addition to anyone who wants to get the most out of their TRT.
Currently on 140mg split twice weekly. 950 - TT 20 - E2 Free T - 27 All other values are normal to include progesterone and prolactin. I have very l...
Did this start with TRT or has it been present before starting? How long have you been on TRT?
I have had a "sensitivity" to testosterone. I'm on 160mg weekly (SubQ once with 0.5mg Anastrozole). My trough Total T is 1400ng/dL and Free T is 46ng...
You certainly would expect enhanced muscle growth and improved metabolism at that level. Supraphysiologic levels can often translate to higher libido ...
I am completely confused about TRT. I see people here talking about HCG, AI, different gauge needles, amounts, different types of Testosterone. Can y...
Yeah! No worries. A lot of men are in the same boat. Happy to clear up what I can here too.
I started TRT a few months ago due to primary Hypogonadism, starting from 125, 150 to 175mg test E a week. I recently added HCG at 500iu a week split...
If you have the option, switching to Test Cyp could help. They have similar half-lives on paper but C leans longer & E leans shorter. At the same dose...
I've been reading a lot about trt. I’m about to turn 36, had a general testosterone blood test done within the last year that came back normal. Iv swi...
If you've been having low Testosterone symptoms enough to research it, the likelihood is that you're probably a candidate. Do you remember what your T...
Im dealing with : Shortness of breath, severe cognitive issues (memory, verbal fluency, cant remember simple words during conversation) Water retentio...
Well, the shortness of breath is an indication that your symptoms may not be related to your hormones. You have described symptoms that could be relat...
What dose of hcg would you recommend when starting TRT?
The dose would depend on the purpose & a bit on financial reach.
I’m currently in my first three months of starting 200 mg/wk testosterone cypionate (35 m) and the benefits have been amazing. Mental clarity, focus, ...
That's a tough spot to be in, I'm sorry to hear about the lab being slow.
Currently I have been with a TRT provider ( tele health - i'm in NYC, they are in Fla. ) for 1.5 years. I'm not satisfied w/ many things and would lik...
Switching clinics: This happens all the time & we encourage patients to find clinics that work the best for them. It's generally good practice to let ...
I want to start with a telemedicine clinic but I’m worried about what I’ve read on the rules changing in November with the dea requiring A in doctor v...
I'm going to copy another recent reply we made to this comment, if you don't mind, and expand on it.
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 ...
Its now widely recognized that low testosterone is a risk for metabolic disorders, obesity, and heart disease.
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 produc...
Exactly as you say. Low Testosterone caused by primary, secondary, or relative hypogonadism without any other outside conditions is a life-long situat...
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 lo...
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 regula...
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 bo...
What percentage of your patients are on an AI like anastrazole would you say?
Probably ~25%.
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 recom...
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. Th...
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 pa...
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, thyroi...
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, k...
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 wou...
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)...
Happy to help.
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 TR...
Yes & no.
What are your thoughts on using Primobolan as an AI instead of Arimidex or Aromasin? I have been told that there have been recent studies which shows ...
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...
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...
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.
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.
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...
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.
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 li...
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
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 ...
While starting TRT would certainly increase your IGF-1, which would increase muscle mass over time, starting TRT is not always the answer.
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 wit...
No & yes.
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 Testos...
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 ...
Yes & no.
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 significan...
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, miti...
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 cas...
Can you pair low-dose enclomiphene with testosterone for hypogonadism treatment? Would it overall help increase testosterone levels? I recently switc...
This may not be the answer you like, but it may be best not to combine them.
Is there a substantial difference between sub-q injections and IM?
Yes and no.
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 malp...
This is true about the challenging nature of getting a PCP to sign off on TRT, but not for those reasons.
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 incr...
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 ev...
I 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 t...
Ideally you're looking to find a ideal spot where you consistently take your AI at the right dose, the same times each week.
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...
neurosteroid deficiency
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 t...
Very rarely.
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.
Just stared taking testosterone cypionate via prescription for hypogonadism. 260-280 range. I’ve been taking tongkat and fadogia for a couple months....
Generally speaking, and supplements meant to increase natural testosterone production will no longer have that effect once you start TRT. Once you sta...
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 excep...
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 lis...
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 re...
It depends on the concentration of medication typically. The higher the concentration the more like syrup a substance acts as & the lower the more lik...
Do you offer hcg?
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 ...
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 no...
Great question, and yes.
When giving blood to control high hematocrit and hemoglobin my ferritin drops to like 15? Is that a problem?
Ferritin is one of the building blocks of hemoglobin, which is part of red blood cells. When you donate a unit of blood, on average your hematocrit wi...
What is the ideal testosterone level while on trt?
That would be depending on the starting Total Testosterone of the patient for initial dosing & then finding the sweet spot for the most benefits for t...
How to lower high cortisol?
Increasing your calcium, vitamin D, and vitamin B1 intake can help control cortisol, but beyond that, most treatment for high cortisol is through life...
55 year old male. 170 lbs, decent shape. Have been experiencing some anxiety/low mood and low energy for last year for first time. Been checked medica...
From your lab results alone with no other information or context, we'd say you look to be not immediately primary or secondary hypogonadal.
I was mistakenly taking Sawpalmetto for a year between 2008 and 2009. Had my T to the floor and recuperated from that over years to the lower end of t...
One of my colleagues may jump in & add to this regarding that interaction, but I'll share some experiences we have.
If still answering, curious about hear rate when on TRT. Before starting, I had a consistent RHR of 55-59. After being on trt for about 7 months, my R...
HR increase on TRT - while this is not a common complaint, it is known to occur. While the phenomenon has not been evaluated extensively, a common the...
I’m having a hard time controlling my blood pressure. Since starting T my diet is clean and I’m in better shape. Is there anything you recommend?
Most men do not have problems with blood pressure while on TRT, though in a few cases, they can. Overall, it has been proven with
My doctor put me on 25mg every other week for three months then off for six weeks. I know it’s pretty low test wise. His reasoning is he doesn’t want ...
Any exogenous testosterone will completely shut down your natural production. Even if he gave you 5mg it would completely shut down your natural produ...
What’s your take on ED issues with guys on TRT? What’s the most common cause? High Estradiol? Low T? Where’s the sweet spot for E levels? 20-30 is wha...
ED is often more complicated than just hormones. But when it comes to sex hormones, low T, high/low E2, and high prolactin are common culprits.
Is it unhealthy to have an estrogen level of 3 after a decade of TRT? (No AI used, I just dont aromatize like I did in the past; test is about 950.) ...
Testosterone itself increases bone density. Estrogen help prevent bone resorption. While having low estrogen will mean bone resorption rate will be hi...
Is there any point in taking hcg and clomid at the same time? Would hcg cancel clomid's effect out? Like clomid trying to kick pituitary to function w...
There are no studies on this practice of using both at the same time, but logically speaking, using them together doesn’t really make sense. HCG attac...
What are your thoughts on Grapefruit/Naringin to lower hemoglobin on TRT?
We have been recommending it to our patients for awhile, and have seen significant results. It is extremely cheap and easy to take, and lowers hematoc...
How do you increase low SHBG ? On TRT
Less frequent injections and higher doses both increase SHBG while on TRT
If on bloodwork, clomiphene citrate works for an individual to raise your total T to similar amounts, what is the argument for or against it, compared...
The arguments against long term use of Clomid:
Getting ready to schedule the initial consult and trying to figure out how to apply the military discount, am I just blind and missing the military di...
We apply it after the consult. Make sure to have your military ID handy during the consult for confirmation.
I self inject in the glute area. I have trouble turning to my left side so I only inject my right glute. I recently have noticed almost like a knot in...
Carrier oil is absorbed fairly rapidly, but it will leave deposits of crystallized testosterone in the area. Your body will slowly absorb this, but if...
Are compounding pharmacy’s that provide testosterone generally the same as the regular pharmacy’s? Also, what differences from Subq vs IM when startin...
They're similar it terms of oversight, standards, & quality but compounding pharmacies must always change a commercially available product ever so sl...
I (26) got my Testosterone tested twice. The first result was 169 the second days later at 222. My PCP says that’s low, my endocrinologist says “it’s...
Can you prescribe to local pharmacy or do we have to use your compound, Pharmacy?
We can send your scripts in locally if you feel like your insurance might cover them, though the cost of our medication is already included in your mo...
Do you guys fill prescription for T only? Can I get Anavar or Winstrol?
We work with many forms of Testosterone. For Anavar it depends on the state, but yes. Stanozolol/Winstrol doesn't really have availability.
I want to split my prescribed 100 mg/ week dose into two 50 mg/week doses. Does 100 mg Tcyp come in multiple use vials ? Is there 50 mg/ml dosage ?
You should be able to split it just fine. Although "single use" vials are not as durable as multi-use vials, we have plenty of men who have used them ...
Should new patient to TRT start with AI preventively or wait and only start if having symptoms? Is topical finasteride good enough to prevent worseni...
In our book, unless you're doing high levels of bodybuilding Testosterone where you're near guaranteed to have side effects, you should start normal T...
Im currently on test cyp in MCT oil. I inject 80mgs 1x a week. Ive tried various protocols and used different carrier oils. Typically, the day after i...
In the absence of labs, it’s hard to say for certain. But based on what you describe, this sounds like an inflammatory reaction. Either way, this cert...
i don’t like needles even though i inject twice a week, i haven’t donated blood in 6 months. How high of a risk is me neglecting reducing high RBC?
The reality is that risk associated with high RBC due to TRT has never been directly studied. All the risks believed to be associated with high RBC ar...
Do different pharmacies TRT (same dose) affect people differently? I recently switched pharmacies and have actually felt a difference from the same do...
I’m going to use an analogy here which I think will answer this question:30-40 years ago, different gas stations had different additives in their gaso...
With estradiol above 90 pg/ml at only 150mg test cyp split into MWF (test at 850). Is a long term AI generally safe on the body?
Speaking generally, the fewer medications you can be on, the better. So adjusting the dose and/or frequency of testosterone should always be your firs...
Do you treat women with low t? If so what is a common starting dosage and frequency?
Yes, we do. We plan on making an update on our home page soon to better show this because we've had so much interest lately. We normally offer $10 off...
Have you heard anything regarding Covid and its effects on testosterone. Since catching Covid the first time in 2021 my energy levels fell and never c...
Yes, COVID lowers testosterone in 86% of men who catch it.
Hello! So are there any side effects new cypionate users might experience during the first month or so as the body gets introduced and acclimated to n...
For those who are new to TRT, the primary thing to watch out for is elevated estradiol symptoms. Because it takes several weeks for what remains of yo...
Does testosterone ever lose its efficacy…. If you’re on 200mg/ week for 1.5-2 years then come off for a year.. then go back on same dose… is it less ...
Some medicines can develop what is known as tachyphylaxis, which is fancy medical speak for becoming less potent over time. Interestingly, testosteron...
Any chance there will be AI's in dosages for TRT? All the AI dosages are made for women and men just need a fraction of that. Would be pretty nice if...
Yes. With us, we often lean on trying to avoid AI use via other Estrogen control methods first. If you do need an AI we tend to start pretty conservat...
I had a doctors appointment the day after an injection and the doctor ended up doing blood tests. My testosterone and Estradiol were both quite high t...
Yes, they do decrease between injections. Typically TRT uses Testosterone Cypionate as it's Testosterone mainstay. That has a "half-life" of 8 days, w...
My question is have you heard of Calcium D-glucarate being substituted instead of an AI? And reducing E levels? My Endo seems to know nothing about AI...
Calcium D-glucarate has been shown to increase the metabolism of estrogen, meaning your body will eliminate it from your system faster. It does nothin...
Does timing matter for HCG injections? Husband is adding hCG (3x/week MWF) to usual TRT (2x/week Sun/Thurs) to regain fertility, and didn’t know if AM...
Generally no. With hCG it is less direct than with TRT, as it's not the medication itself causing a level to change but the downstream effects which p...
Hello, I had low T but normal LH and FSH levels last year. Sperm count and quality was also good. I started HCG monotherapy (1500 IU twice a week) aro...
So, primary hypogonadism is typically diagnosed when LH levels are normal are high, and testosterone level is low. Basically, LH is the gas pedal tel...
I need to take hCG because, simply put, my testicular pain disappears. So, I undergo treatment just to maintain testicular health and size. In this c...
If it is simply for this reason and nothing else, then it would make sense that the lowest possible dose while still providing the benefit you are loo...
What benefits do you typically see from monotherapy with HCG?
The removal of low Testosterone symptoms would be number one on the list. Essentially, effectiveness goes somewhat in this order: Injection T > Topica...
If you are someone who has no fertility concerns (family planning is done) is there any benefit to taking hCG alongside TRT. My clinic has me on test...
It would mostly be used for testicle size & fertility.
I’ve read you should take hcg for 20 days then stop for a while and others say take it as long as you want. What’s a good protocol. I’ve been taking m...
The reasoning is that you do become a bit desensitized to it over time, which can require a higher dose. However outside of that there's not many othe...
I switched from my primary doctor to a TRT clinic a month ago in order to get HCG along with my test, and 2 weeks after my first hCG dose I am told I ...
Yes, we do!
What are your thoughts on clinics that refuse to prescribe an AI or take on a patient that wants to continue an AI? Earlier this year I joined a telem...
We personally take a stance that you shouldn't add an AI unless clear symptoms show up, as it's only ~25% of men who need it at our typical therapeuti...
Currently my provider has paired TRT with DHEA. What is the benefit/risk of DHEA?
Adding DHEA benefits:
Would hCG increase sperm motility in an asthenozoospermia situation.?
hCG has been shown to help with sperm motility, though only slightly. hCG is far better for sperm count than for motility. FSH is more important for ...
Thoughts on Kisspeptin and how it compares to hCG?
Kisspeptin works in a different pathway. Kisspeptin is produced in the hypothalamus and acts upon KISS1 and GPR54 receptors to stimulate the release o...
Does my health insurance provider cover my TRT?
Most TRT companies do not work with insurance companies because insurance likes to deny most care for TRT. So many follow the same path as us & simply...
Would you say that TRT with hCG is a much better option for someone that wants to maintain fertility as opposed to Enclomiphene mono therapy? I was co...
We would say that, yes. In general although Enclomiphene appears to have less side effects than Clomid, it has not been around as long as these other ...
Are there any viable alternatives to hCG when trying to maintain fertility on testosterone? If not, are there any being studied or developed? I've be...
There are some, like Enclomiphene or Clomid, but they are not as safe & effective as hCG is for the same purpose. That said, for many men like yoursel...
For someone who is new to this topic, yet interested in TRT if needed, would a pill or topical form be a reliable method of TRT? I have no experienc...
In general oral medications tend to be the least successful with the most amount of side effects. Topical or injectable medications are more direct a...
Question regarding HCG and HTN: I had a weird experience on 200units of HCG. I was prescribed 500 units three times a week but did a test dose of 200u...
First of all this sounds very scary and I am glad to hear that you have no long-term affect from this incident. I'm also glad to hear that you were cl...
Is there cream or gel for hCG plus TRT?
No sadly, for hCG you would need to use an injectable given what is available on the market right now.
What happens if my provider gives me hCG for 6 months with the same vial when it says one month is the max on the bottle ? Is it still good ?
For hCG & the listed 60 days (or 30 days depending on the state that you are in); The discard date (sometimes labeled as expiration date) is not the s...
I used to have cumshots that would make a pornstar jealous. I know hCG is mainly for fertility, will it also help me with the cumshot?
Yes & no. Only a small portion of ejaculation comes from the testicles, which is why it's not a major concern/complaint when someone has a vasectomy....
I've been wondering about something about hCG in regards to RBC, hematocrit, and hemoglobin. It's well-known that exogenous testosterone use will rais...
TRT and hCG can/will cause some elevation of hematocrit and/or hemaglobin. Changing doses doesn't usually get H&H into better ranges. The best method ...
What’s your view on different esters? I’ve seen a number of posts and YouTube videos claiming libido and erections returning and better energy when s...
Different Esters can have impact on the actual average dosing you experience. That is why even if you take Test C & Test E at the same amount per wee...
I started HCG 1200 IU weekly at the same time as 100 mg test, with no AI. If my bloods come back normal but with high e2, would the first course of a...
It would depend on a few things. First, how you're feeling on the two medications & what your Testosterone comes back as. If you are feeling great wit...
If I accidentally left reconstituted hCG out of the fridge. How long is too long and I should be worried if at all?
Generally this is fine depending on how long you plan to use it for. Some men don't even refrigerate their hCG because their dose is high enough that ...
Do you believe it’s likely to have kids while onTRT if using hCG regularly? I’ve been in TRT for a 4+ years but have only been using hCG for the last...
HCG can keep your sperm count high enough for conception. You can get a sperm count done, but generally you should have high enough to conceive.
Is there a benefit to adding DHEA to TRT?
I would first consider your current DHEA levels. There can be benefit as it can support test production/levels and in a different pathway. This can im...
35 M, Just got tested last week. My levels were 136 total test and 3.6 Free test. Doc who isn’t a specialist obviously wanted me to jump on a T script...
While we have seen some somewhat "miracle" situations with men who have more than doubled their baseline Testosterone on their own, these are almost a...
Is there any disadvantage to HCG monotherapy as opposed to TRT?
So I recently had a horrible experience with a TRT clinic. They had very affordable prices, but charged a $170 annual physician fee. They charged this...
I'm sorry for your experience with them.
Assuming cost isn’t an issue, what’s the best dose of HCG as a supplement to TRT? I’ve seen as low as 500iu weekly and as high as a few thousand. What...
"Best" dose is always individual, but here is a quote from a frequently cited study that will help explain things:
If I have managed high blood pressure, my cholesterol is 89, and I had a stroke like event a few years ago, should I even consider adding deca to my ...
This is not a discussion we can even begin to consider as there is so much more information that would be needed. There is also serious consideration ...
I’m on test 100 mg per week pinned twice a week. I recently added 500iu hcg split twice weekly. Almost immediately I got acne on my chest back and arm...
It sounds like you were right at your sweet spot for Testosterone levels where your body didn't see it as an issue & aromatase into extra estrogen. Ad...
I was just prescribed HcG from my endocrinologist. I’ve been on Clomid for a year and it has made me feel awful. I’m a different person on it. What ca...
In general there are a lot of side effects with Clomid compared to HCG, especially if we're talking monotherapy without additional Testosterone. Assum...
I'm currently taking half a ML a week of pregnyl on top of half a ML of test cypionate, with that dosage a bottle would last me 20 weeks. The shelf li...
So, the "shelf-life" is how long an FDA medication can "gurantee" sterility after puncture. The actual medication in the vial remains viable for up to...
Many people are talking about using hcg instead of clomid, but hgc is simply an analogue of LH. when it comes to fertility explicitly you need both go...
You are right in that Clomid provides better fertility than hCG because it also increases FSH, which we now know matters less for sperm count, and mor...
A diabetic friend recently showed me their little auto-clicker injector things for insulin and Ozempic. Their needles are only 1/4" long. Why does th...
Availability, cost, volume, & different users.
Does TRT benefit erection quality?
Yes, generally the three main reasons people start TRT are: Energy/motivation, fat loss issues/muscle loss, and libido/erectile function.
How do people know they need an AI with TRT? My pcp didnt prescribe one, I guess that is ok??
Like any medicine, ideally you should be able to take TRT without any side effects. However, some men have a higher amount of aromatase than others, a...
Endo has me on clomid and trt. Would they switch me to hcg instead? Is it better to use than clomid?
The SERM (clomiphene or enclomiphene) and TRT combo is still experimental and not proven science. The hCG plus TRT is proven and the gold standard for...
Why has it been so hard to find a pharmacy that can fill compounded hCG?
Due to new FDA regulations, access to compounded hCG is now extremely restricted and may at some point stop altogether. This means an already low supp...
Is there a shortage of hCG in the US?
Yes. There has been less hCG available in general terms for all pharmacy distributors across the board.
I’ve been on trt for 8 weeks now. My libido is no existent and I feel no different then before. I take 150mg weekly split into a eod dose. What would ...
Is there any reason to use Testosterone Cypionate and Enclomiphene concurrently?
There are two negative feedback loops on LH release, estrogen and testosterone.
How important is it to start HCG with TRT if conceiving isn't in the plans for several years down the line? Once on TRT, how soon should hcg be starte...
All studies on concurrent use of hCG on TRT were done as a recovery study, not a preservation study. What that means is, all the data we have about hC...
What would be the safest peptides/hormones to take for injury recovery? Would something like deca have some healing properties beyond cushioning join...
As far as FDA approved medications legally obtained with prescription in the USA, nandrolone (deca) is the greatest “bang for your buck” when it comes...
Im just curious what is the most common dose for TRT? I know everyone is different but is 200mg a week very uncommon?
The most common dosing in TRT for low Testosterone patients is 120-160mg in the majority of cases, with outliers. Many online clinics will start a pat...
How effective is tadalafil paired with TRT? Does it helps to reduce e2, and if so, do you recommend? And what daily dose to see synergy?Does it helps...
It is common to combine the two when the initial symptoms of low Testosterone include low libido or ED. We tend to hold off on adding it right away to...
I have 2 questions id like to hear from you guys on. What do you think about adding in deca/npp for joint support? And how do you feel about deca/NPP ...
We are advocates for nandrolone. We have seen it work wonders in regards to helping heal tendon injuries and help patients break through strength plat...
I had low test levels around 280 and have been on 160mg trt for the last year which puts my levels around 800-900. Beside the expected acne i knew I ...
Testosterone has been proven to increase tendon strength and repair, though at a rate much slower than gains muscular strength and size. This means th...
When you get ED/low libido due to high e2 would you recommend decreasing dosage or using an AI?
It depends on whether or not the symptoms of low T have resolved or not on that particular dose. But typically lowering the dose is typically the firs...
I am just getting ready to start trt through an online clinic. Waiting on my order. I was SHOCKED as to how expensive this is going to be and not sure...
That is far more expensive than it should be. You would be wise to spend some more time researching the pricing of other clinics.
Besides total and free testosterone, what else in the blood test are you looking at when you start as a new patient to decide if TRT is appropriate t...
Additional initial testing typically would also include LH/FSH, estradiol, prolactin, and a PSA at a minimum.
How do you decrease e2 value without using an AI?
You can lower the dose, increase dose frequency, reduce adiposity (body fat), add an OTC like DIM, or any combination of these.
With TRT, are you aiming for specific testosterone range and/or e2 ratio? how do you know if someone should increase or decrease the dosage?
Our goal is to relieve the symptoms of low testosterone. Whatever number that ends up being is our target, whether it is 500 or 1000. TRT is a very su...
Does TRT increase prostate (BPH) issues?
Raising testosterone to normal levels using TRT means you will have the same risk of BPH and prostate cancer as any other man who has normal testoster...
Can a TRT clinic prescribe cabergoline? I feel my t levels are low due to elevated prolactin My prolactin seems to be elevated based on the past 2 ye...
It depends, but most TRT clinics should be able to prescribe cabergoline (AlphaMD does).If the cause of your low T is because of high prolactin, then ...
For your patients on TRT therapy do you also recommend and/or assist in the monitoring of other hormone levels, such as pregnenolone and DHEA, that m...
We don’t routinely test for neurosteroids unless a patient on TRT complains of cognitive issues. The prevailing wisdom is that all upstream hormones ...
Dermatologist wants me to discontinue TRT due scalp inflammation 37m on TRT for 18 months. Started at 200mg and then dropped to 150mg a year ago and ...
We have had some patients who note an increase in sebum production once they start TRT. On the scalp there are two types of sweat glands. Sebaceous (o...
Are there any benefits of using different testosterone like propionate rather than cypionate? Upvote 2 Downvote Reply reply Share Share
Generally no. Cypionate is fairly standard as the easiest to work with for a 2-3x weekly injection routine & as a result the pharmacy market caters to...
Why do I get resolution of my sexual dysfunction and low libido when taking testosterone gel (2clicks) together with 100 mg split in 2 injections? I’v...
It's likely related to under dosing on your Testosterone at 100mg weekly & needing the topical to put you into the ideal range for DHT/Testosterone, o...
Every time I inject testosterone, my legs get really heavy and I got back aches. These symptom usually come on the day after injection and persist for...
This is not a common side effect of TRT. However, there is some evidence that some men do experience muscle tightness with TRT. It is believed that th...
I have been in enclomiphene for a year, but my test has been going down, and I just haven't been feeling as great as I did overall after starting the ...
Based on how you've responded, and how adding that has gone - We'd suggest swapping to injectable TRT & HCG for fertility instead. The main issue with...
Is true you cannot take finasteride and nandrolone decanoate at the same time?
Testosterone is converted to dihydrotestosterone (DHT) by the enzyme 5a-reductase. DHT is the most androgenic hormone out there, and is the number one...
At what time would you check levels after starting TRT? I have heard 4-6 weeks.
We would generally not want to check levels before at least week 5, but more ideally around week 7-8. Although some men may stabilize around week 4-5,...
Do you have any theories as to why some people experience a honeymoon phase for a few weeks then lose the benefits of TRT?
The most common reason for this in men tends to be a need for a simple dose adjustment. There's a general 8 week uptake period where injected levels ...
Fitness question: Many men think about starting TRT with their natural T levels in the 200-400 range. How much improvement in the gym would such patie...
In general, men who have levels in those ranges & who are experiencing low Testosterone symptoms will already have difficulty putting on muscle mass, ...
What are the best peptides to pair with TRT for getting lean?
In terms of what we can recommend via current official pharmacy offerings, Sermorelin would be a good boost. We could also anecdotally suggest that Ip...
Can guys at 18% bodyfat benefit from adding the anorectic peptides like semaglutide, trizep, etc for a weight loss phase? Or is it only feasible for ...
Anyone will lose weight by adding a GLP-1RA like semaglutide or tirzepatide. They are the most popular drugs on the market and work well, regardless o...
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