My Journal

The final frontier. Deciding when, if and how.

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Re: My Journal

Postby merrix » Fri Feb 14, 2020 1:22 am

With some hesitation, yes, I will post this.
I guess first of all, this is a bit off-topic. This is the implant forum, not a TRT-forum.
Secondly, this is pure medical stuff, and I don't like in general when laymen give medical advice.
On the other hand, I did get some PM asking what my protocol is, and it saves me time replying here instead of in several PM.
Also, this whole forum, about implants, is full of laymen giving what could be labelled medical advice, so why not in this post as well.
Furthermore, a lot of guys here with implants in this forum are obviously, from their signatures, on TRT. Which perhaps tells us something. Maybe that low T does cause the dreaded VL. Or at least contributes to it developing.
Moreover, this should not be referred to as medical advice. I will merely, as I have done in relation to my implant, state what I do, what I have learned from reading and talking to doctors, and what I have learned through experience, mistakes and trial and error. Be very well aware of the fact that there is of course a chance that things I write are incorrect. I am not a doctor. I might have misunderstood stuff I read/heard and drawn the wrong concusions.
Finally, which is pehaps the main reason for my hesitation to write this, I don't want to make anybody start TRT for the wrong reasons just because they read this. Going on hormone therapy is serious shit and it will fuck up your HPTA axis, i.e. your own production of hormones, mainly Testosterone. The longer you are on it, the more certain. The time will come when there is practically no way back. You are doomed to take Testosterone for life, because your own production is fucked forever.

So here goes, and this will be one of my longest post ever...

I started off With Nebido, which is simply injectable testosterone in a very slow releasing oil base. I don’t think it is FDA approved yet in US, but it is very popular in Europe. It is supposed to be injected every 10-12 weeks, but in reality I think many need to inject more often. The idea is you inject when your levels are down at around 400 and your peak will be around 800-1000. Already there we have the problem. Even though the dip from peak to trough happens gradually over 10 weeks, the peak is still around double the trough. Which will for sure make you feel different at the peak than you do at the trough, and it will also cause your Estradiol to be much higher at the peak than at the trough, meaning if you do get E issues, then that will be hard to control. Basically you would need to taper down you Aromatase inhibitors during the 10 weeks, which would be a hassle to get perfected. The huge advantage though is the infrequency of the injections. Once every 10-12 weeks (8 weeks in my case, otherwise my trough was down to 250), no self injection, and no transfer risk as with the gel. You don’t get reminded of it. No need to bring gel or syringes when you travel. Just go to the doc once every two months and get a shot in your ass and that’s it. Great.
And it was great from the beginning. Felt better than ever in my life. But I was always on some sort of roller coaster. Feeling like shit at the end of the 8 weeks. Low T symptoms. Moody, irritable. Then getting high E symptoms the first days after the injection. Red-faced, sweating like crazy when exercising (and having sex), impossible to orgasm when having sex, the implant equivalence of impotence, i.e. a soft glans instead of a hard glans. Then having a few weeks in the middle of the 8 weeks where things were great.

So I started to think that maybe gel would be better. More stable T and E levels. Not the peaks and the troughs. What happened was it felt amazing from the beginning. Horny like crazy (which is because gels convert more than injections to DHT, which is a derivative of T which has a much bigger impact on sex drive than T itself. It also speeds up hair loss, and according to some research enlarges your prostate).
No E-problems, hence no need for aromatase inhibitors.
However, I hated the daily application of gel. Sort of like I hated the pills before implant. Just reminds you that you are a sick bastard who needs gel/pills or whatever to function like a man. Also a hassle to remember to bring it every time I travel. Which I do all the F time. But I could live with that of course if it worked.
The biggest downside though was the transfer risk and the sweating. I live in SE Asia, in tropic climate. It is always humid and 30+ degrees Celsius. I swim in the pool every day I am home, often in the mornings. I rarely ever wear a T.shirt when I am home, since we spend a lot of time out on the terrace and in and around the pool. I just wear my swim shorts all day basically. I also play a lot with my daughter in the pool.
So if I apply gel in the morning, I will either sweat it away, wash it away in the pool, or transfer it to my daughter when we play in the pool. I don’t want either. So I gave it up. Caused too much hassle. Plus, on a sidenote which I don¨t really give much of a F about, it is bloody expensive as well. And the standard dose of 5 per day wasn’t enough for me, I needed 7.5 to even reach average T levels for my age (500-600).

Back to Nebido again. Same shit after a while. Roller coaster. Another problem I had with the Nebido, both the first and second time, was hematocrit. Basically too much red blood cells. This increases risk of heart attack, high blood pressure, and overall you look sick. Red-faced, red-chested. The solution? Phlebotomy. I.e. give blood. Doable, but another pain in the ass. The gel didn’t give me this problem even though the average T level was the same on Nebido as on gel. My conclusion, supported by medical sites, is that it is the T peaks that cause the hematocrit rather than the average level over time. Also, someone wrote that injections cause it more so than gels.

Then tried Andriol, oral T. Again, felt like the F-ing king from the beginning. Horny all the time, alert and just feeling great. For a while. Then I started to feel tired and my joints hurt. Why? For some weird reason, my E just absolutely crashed. I was on 120-160 mg per day of Andriol, and my E was net even detectable in a test. <5. My T was ok, but still with a 24 hour roller coaster. Peaks of 800-1000 an hour after the morning dose. 300 in the morning before the first dose. Which sucks. Hematocrit was fine, no problem. But Andriol, or any orals, suck in my opinion. The huge daily T-level swings, the crash of E, which you can’t really fix – no doc will give you E as a man, and the fact that you must take them with food, preferably fatty food. And because of the ridiculously short half life, they must be taken at least 2 times per day, preferably more often. Which means you must bring them with you if you go out for lunch, dinner etc. And if you forget, well you are going to tank your T. And again, it is that feeling of not being free. Did I bring my balls with me? You have to ask that question every time you leave the house/office. Sort of like the Viagra etc. Never free.

Then I read about HcG. HcG “fools” your testicles to produce testosterone. The hormone mainly responsible for signaling to your testes to produce T is LH, produced by the pituitary. So for people with secondary hypogonadism (like myself) it is not really the testicles that is the problem, it is just so that nobody tells them to produce T, so they don’t. So when taking HcG, the testicles “believe” this is LH, and so they start to produce T. For guys with primary hypogonadism, this is pointless, since their balls can’t produce (enough) T anyway.
Then, if you’re secondary, why not go HcG only then, and skip the exogenous (i.e. the gels, shots, etc) T? Because some docs say that by experience, people don’t feel as well on HcG vs exogenous T even if the Total T blood level is the same. Nobody seems to know why though. And because at the same Total T blood levels, you will normally aromatize more and get higher E levels. Which is bad. Either you feel like shit because of the high E, or you must mess with aromatase inhibitors, such as Anaztrozole (Arimidex). Which is not easy to dial in and which will impact your cholesterol levels negatively. If you take too much Arimidex, you will crash your E which will also make you feel like shit. You will lose sex drive/performance, your bones/skeletal won’t like it.

Anyway, then I read about doctors promoting HcG in parallel with exogenous T. I also read a couple of scientific studies on the subject. Reasoning? Well, the best of both worlds. You reap the benefits of the TRT (more so than when on HcG mono therapy). You also keep your balls functioning (if they did in the first place of course), meaning they won’t shut down, they will continue to produce some T even though you add exogenous T. They will continue to produce sperm, which is pretty good if you want to stay fertile. And – since they are forced to go to work every day, they don’t shrink down to some rotten peas and park themselves high up on the shaft of your dick. But rather do they stay large and low.

So how would I put this together? Which form of exogenous T? Nebido, Gel, shorter acting T-injections?
I never did the weekly/biweekly T-injections of Testosterone Cypionate, Enanthate, Propionate. Just didn’t want to go that often to the doc’s office and wasn’t keen on giving myself IM (intramuscualar) injections. Sounded too hardcore, like some steroid abuser (and I never ever in my whole life tried anabolic steroids by the way. Well except for the testosterone in the TRT protocol of course, but never steroids at high doses to build muscles)..

I read two great pieces. One from a “guru” in the TRT field whose first choice for his patients was Gel + HcG. Daily gel and HcG as frequent as the patients could handle. But absolutely not less than every third day.

Then there was this published paper which had studied, and recommended, daily (yes daily) injections of T-cyp and twice weekly injections of HcG.

Both reported great results. The first source, preferring gel, recommended those who for some reason wanted to do injections to go at least twice per week to avoid the peaks and troughs.

The half life of T-Cyp is 8 days. By taking weekly injections you will basically have almost 100% difference from the trough to the peak. Bad. Those morons recommending their patients to do it biweekly will give their patients a nice roller coaster ride where the peak is 240% higher than the trough. So if you want your trough to be at 400, then your peak will be at 1350, which is supraphysiological values. No post pubertal man has those levels. Basically. If you want your peak to be 1000, then your trough will be 300, which is basically deficiency, which you wanted to avoid in the first place. Now you will have it 26 times per year for a few days.

Anyway, since the gel was out of question for me, I was going for the Testosterone injections. How? Sub-q. Meaning injecting to the fat layer under the skin, not in the muscle. Many people, even some doctors I think, will say this is BS. Test should be injected to the muscle, IM. Period. That’s what we did 40 years ago and that is how it should be done in the future forever as well.
Problem with that is that there are multiple studies proving that wrong. On the contrary, there seems to be advantages with sub-q. Less aromatization to E. And more effective utilization of the T. I.e. lower dose for same blood levels. And – most importantly maybe – anybody can do sub-q injections by themselves.

Both the sources which made the most impact on my decision were advocating, and using, sub-q injections of T-cyp.
So I started this protocol. Every bloody day, I take two injections. One with T-cyp and one with HcG. A bit of a hassle, yes, but what this does is:

• Gives you the absolutely most stable T-levels you can get. Even more stable than daily gel, since half life of T-cyp is much longer than half life of Gel. The difference between peak (a few hours after gel application for gel and 24 hours after injection with T-cyp) and trough will be higher for gel than the T-cyp. On daily T-cyp, you will have around 10% difference between your peak and your trough. Probably less of a peak-trough difference than a young man.
• Preserves your balls. Whether you just want low hanging, normally sized balls instead of two peas on the shaft of your dick, or whether you want to have the chance to be a father one day, I like the idea of having my balls intact.
• The HcG, will according to papers I’ve read, also provide more benefits. LH is not only needed in the body for knocking on the door of the testicles bungalow and tell them to go to work, it has several other functions as well. And when you add exogenous T, the LH production will inevitably shut down, which means those other functions suffer as well.

Downsides? Well, two injections per day is… two injections per day. Takes me 5 minutes every morning. But also means I poke 2 holes in myself every day. 700 holes per year. Maybe another 40,000 before I give in. Is it a problem? I don’t know. Diabetics do it. So far, no issues.

Plenty of “TRT gurus” on the internet advocate two more additions to any great TRT protocol. DHEA and pregnenolone.
I never tried either before. But I tried. I started them when I started my daily injection protocol. And it has been great. What is that makes me feel great, I don’t know. Maybe the DHEA and/or the pregnenolone is useless, but I am not going to exclude anything as long as I feel fine and my blood work is good.

So what doses am I taking?

I started off with a low dose. As always, I want to take the conservative approach to drugs. So:

• 10 mg of T-Cyp per day (i.e. 70 per week, which is a very low dose. Normally, a minimum weekly dose is 100 mg)
• 80 IU of HcG per day, (560 IU/week) which is also low. Sometimes you see people do thousands of IU per week.
• 25 mg DHEA per day, divided in two doses
• 30 mg pregnenolone per day, divided in two doses.

T levels where first right where I wanted them. 643ng/dL. E was 33 pg/mL, which is just outside the sweetspot of 20-30, but still fine. I normally get issues when it hits 40.
All was good.

Then a lot of things happened, not necessarily in this order. But I was up at 50 mg DHEA per day, and realized it made me tired during the day.
My T levels dropped at the same T and HcG dose.
So I reduced the DHEA and increased the T and HcG.
Waited… E went up. Added Arimidex. Crashed my E.
Reduced the T and HcG again. And so on. Tuning this is not easy.

But now I have been at a protocol for months where everything is just stable and nice.

• 12 mg of T-cyp per day
• 100 IU of HcG per day
• 20 mg of DHEA per day, divided in 2 doses
• 10 mg of Pregnenolone per day
• Arimidex when needed. The above dose makes my E hoovering just at or above my threshold for what is ok. As soon as I feel any sign of high E (sweating when having sex (!) and less sensitivity and hence harder to orgasm), I start on an extremely low dose of Arimidex. 2*0.125 mg per week. That is 1/8 of a tablet on Monday and 1/8 of a tablet on Thursday. Doable, but you need a sharp, thin bladed knife…

My T-levels on this protocol is around 600-650. E is 30-40, which again is borderlilne high, but I also know that I feel the best when it is exactly that – borderline high. It is like playing Black Jack. You want to go as high as possible, but not go bust. I feel the best at the same level as where I get the issues. So I want to keep it right there. At the borderline. When I take it down, my libido decreases and my joints start to feel my age.

As for my balls, it sure took some time to see the results. I think they had shrunken a fair but during 6 years of TRT. You don’t really notice it, it just sneaks up on you. Not only were they smaller, but my whole scrotum was smaller. Balls sitting high, scrotum always tight and “high”. Like a pre-pubertal boy sort of. At least that’s how I remember myself as a nine-year old.

After a few months of the low-dose daily HcG, I didn’t really notice any difference. But I stuck with it. And then – wow. It has really made a huge difference. I would say they are now back at the size not only before I started TRT, but as big as they ever were. I suppose they are still growing, we will see where it ends.

So – my advice:

• Nebido, the long-lasting injections suck. They are great because you just go to the doc’s office 6 times per year and get your injection, and that’s it. That’s freedom. No need for pills, gels, self-injections… But they still suck. Because it will be difficult to control the E. If they work for you, you don’t need any aromatase inhibitors, you don’t feel any low-T dip just before the injections, then they are great. But I doubt that will happen.
• Forget biweekly, or even weekly, T-injections. Why? If you have the capability of giving yourself sub-q injections, then do it. And do it as often as possible. At least twice per week. I never gave anybody an injection my whole life, but a sub-q injection with an insulin syringe is really, really easy. Anybody can do it. Really. Because of the relatively long half-life of T-cyp (8 days), it is really not a big deal if you would miss one dose either. Just take it in the afternoon or the evening. Or just do double the dose next day. If it happens a few times per month, it won’t make any difference.
• Gel is fine if you like it. But be aware of the transfer risk to women and kids. You don’t want to risk a loved one’s health. And be aware of the impact sweating, swimming, etc will have on the absorption. In my case, I like to go to the gym in the morning before work. So I can’t apply it before my workout, then I’ll sweat and shower it away. So I will have to wait till after the gym. But if you are like me, and you are still leaving the locker room sweating, then you have to wait till you are in the office, stopped sweating. Which can be 10 am. And you have to take the hassle of finding a WC, strip your shirt off, rub the gel, and then wait 5 minutes to let it dry in before you put on your shirt. A bit unconvenient, but of course doable.
• Use HcG. It will preserve, or even grow back your testicles size. However, the sources I refer to and trust, all say you should never, ever inject more than 200 or maximum 250 IU at one time. This destroys your receptors and makes you less sensitive to the HcG in the future. Keep it at a level which triggers your testes to the same degree as your LH production would have. So options for HcG is basically either 100 per day, 150-200 every 2 days, or 200-250 2 times per week. But the more frequent and the smaller the dose the better.
• Keep aromatase inhibitors to a minimum. They are sons of bitches which can mess you up badly. Crashing your E is a really bad thing. It will make you impotent (well, in this forum, it will reduce whatever natural blood flow you still have), it will make your bones weak and susceptible, it will make your joints hurt, it will make you fat. And these meds are very easy to overdose. The window you have in terms of dosing to achieve the right E suppression is very small. Not easy to dial in. So if possible, just reduce your T dosage instead of adding Arimidex etc. And lose weight. T converts to E in fat cells. Get lean and your E will go down.
• Use Pregnenolone. I am not able to explain why it works. But in my case it seems to do. Pregnenolone is proven to fight memory loss, just make you sharper. It is also the “mother” of all hormones. In the chain where Testosterone is produced, Pregnenolone is the first hormone in the chain.
• My DHEA was non-existing when I tested it during my TRT, before starting to supplement. My belief is that hormones, whatever they are, should be kept in normal range if possible. DHEA is a sex hormone as well, and why would I want it below the normal range. Now it is up just below average, and I feel good. One thing I notice with DHEA is that I actually sleep better. I read a very complicated article where a doctor presented a theory on why a lack of DHEA when on TRT makes you sleep like shit. In my case, my sleep definitely improved when I started taking it. However, too much of it made me sleepy through the day as well.
• Read, read, read. For sure, since there are so many different approaches by doctors out there on TRT, you can either be a passenger who just takes the hormone ride in the backseat and take what you get. Or you can study your ass off and be active in getting the best results you can. If he denies medical proven facts, scientifically proven and published in respected journals, replace him. If you don’t feel well, require another protocol. If he won’t, or he doesn’t have one, replace him.
• Don’t go overboard. Sure, it might be tempting to up dosage to reap some potential benefits. More muscle, less fat, more sex drive. But my experience is that it isn’t that easy. You can’t just add and get more. Everything comes at a price. Higher T – higher E. Higher E – more Arimidex. Too much Arimidex – too low E. Too high T – Too high hematocrit. High hematocrit – high blood pressure, red face, need to do phlebotomy. Too high T – too high DHT. High DHT – lose your hair and potentially grow your prostate. Fix the hair loss and the prostate growth with another pill and lose your libido. Yada, yada, yada. In the end you’re just stuck in a vicious circle where you are fixing one side effect with something that will give you another side effect. Just keep it moderate. Aim for mid- or slightly higher than mid range. Aim for feeling good. Aim for health benefits, not superficial benefits that comes at the price of risking your health. A good rule is, if you need an aromatase inhibitor, you are taking too much T. Back off.
43 yo, ED forever from VL
Fit and active
Implanted 151215
Titan XL 24 cm, no RTEs
Dr. Eid
Activated day 13
Sex after 3 weeks
Gained length and girth
So far It works perfectly
Only one advice: Find a world class surgeon

Posts: 381
Joined: Mon Nov 06, 2017 12:43 pm

Re: My Journal

Postby FreddyFree » Fri Feb 14, 2020 8:18 am

Great post Merrix !

You are spot on with how hormones interact with each other. The best analogy I’ve heard is Teeter-Totters. (The playground structure where a kid sits on one end of a board another kid on the other side of the board with a fulcrum in the middle and when one kid goes up the other comes down.)

Hormones that check the other react the same way. Too much of one may leave the other suspended.

You have done a lot of research and I thank you for that. I am in the process of beginning with my doctor a protocol for managing my T. I like going in to appointments with as much information as possible. Your post helps greatly.
AMS 700 CX 18cm. x 12mm. With 3cm. RTEs. 10/10/18

Posts: 92
Joined: Sun Feb 01, 2015 12:40 pm
Location: Canada

Re: My Journal

Postby Echegollen » Fri Feb 14, 2020 1:43 pm

The wealth of knowledge in this thread is amazing. Merrix, you really are a generous man. It is amazing that you are still around sharing your experience with the rest of us years after you had your operation. It is just too common to see people disappear shortly after their operation never sharing anything again. Like it's been written before, you can do all the research you want, nothing beats reading the experience of someone else who went through the operation himself.

Thanks for sharing your TRT protocol. It seems very tricky. There doesn't seem to be a consensus on how to do it and like you said, very few doctors are knowledgeable on the subject.

I am now 36 years old and my testosterone level was in the low range (460 ng/dL) for my age. I was able to get a prescription for HCG and I did 1000IU twice per week. People might think I am crazy to have done those levels but that's what a ''guru'' had recommended. At first I felt very good and my T level was in the high range (1000 ng/dL). After 3 months of doing it though, I started to feel a little lump forming in my right nipple, commonly referred to as ''bitch tits''. That is usually a good sign of high estrogen level. I got some blood work done and surprisingly, my estrogen level was only at 26 pg/ml which is not high at all. I stopped using HCG completely and started taking 1/4 of a 2.5mg pill of Letrozole (0.625) which is a much stronger aromatase inhibitor than Arimidex. I did it for 1 month. Some people might think that I completely crashed my estrogen level and that I felt like crap, but that was not the case. The lump went away, my estrogen level dropped to a reasonable 17 pg/ml, and my T level was at 914 ng/dl.

One doctor recommended the following protocol to me:
-Crush a 2.5mg pill of Letrozole and dissolve it in a 10 ml seringue with water ;
-Take 1 ml of the dissolved Letrozole everyday which comes back to 0.25mg everyday ;
-See how it feels and adjust accordingly by taking more or less ;
-Don't take anything else (no HCG).

That being said, your protocol of 100IU of HCG everyday seems safer though. I will probably give it a try.

By the way, I still didn't get the implant yet. I'm still using Caverject which I don't really like but it is the only medication that allows me to penetrate a woman. At 40 years old though, I'm getting the operation no matter what.
I'm 33 years old. Never was able to maintain my erections for more than 1 minute. Pills don't work. Had sclerotherapy by Dr. Kuehhas in Austria in 2016. Didn't work. Injections (Caverject) are the only things that gave me good results.

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