I get a few requests for more details about my protocol, so I’m putting them here for easy reference. This protocol represents an attempt to fix some of the problems created by regular TRT, those which stem from the suppression of other important hormones. The protocol is not a casual undertaking. It is demanding and may take several months to yield consistent results. At this point there’s too little data to say if those results are likely to be as good for others as they have been for me.
• Testosterone. This is a blend of testosterone propionate and a longer ester, such as enanthate or cypionate. It is injected daily—upon waking—to give realistic levels and diurnal variation. Ideally the ester ratio is tuned to provide the appropriate variation, with trough testosterone about 40% below the peak. For me, getting half the testosterone from each ester gives the appropriate result. In the case of cypionate the ester ratio is 0.837 / 0.70 = 1.2 parts cypionate to 1 part propionate by weight. For example, 120 mg of cypionate and 100 mg of propionate would be mixed in a separate vial. The dose size is adjusted to yield appropriate peak free testosterone. If better information is unavailable then "appropriate" is assumed to be what's average for young men. This corresponds to about 15 ng/dL for the
Vermeulen calculation and 23 ng/dL for
Tru-T. With normal SHBG, at around 30 nMol/L, total peak testosterone ends up around 600-800 ng/dL. Troughs are around 400-500. My current daily dose contains 3.2 mg enanthate and 2.4 mg propionate.
• Progesterone. This often ends up low under TRT and should be supplemented if that's the case. In the absence of better information I target mid-range serum levels for morning tests after nighttime dosing. Progesterone can be injected or applied topically. I currently inject 0.6 mg each day at bedtime.
• GnRH/LH/FSH. GnRH is injected in the form of gonadorelin to stimulate the pituitary to produce LH and FSH. Men naturally generate a pulse of GnRH every two hours or so. Without an infusion pump we can't easily mimic this dosing. The alternative is to inject a number of times each day. I don't know what the minimum number of daily doses is for this to work. There is some evidence that single larger doses may still stimulate LH and FSH. But this is less natural and may or may not provide acceptable subjective results. In any case, I chose six daily injections because that's the maximum I thought I could reasonably tolerate. I found that a larger bedtime dose interferes with sleep. Therefore I inject 20 mcg five times during the day, and 5 mcg at bedtime. Pulsed doses in the literature range from 5-30 mcg. It's been mentioned that some guys may be able to obtain gonadorelin as a nasal spray. With an appropriate dose size this delivery method could make it more practical to take multiple daily doses.
• Enclomiphene. Estrogens are suppressive at the pituitary. Under TRT estradiol is high enough to mute the pituitary's response to GnRH, reducing LH and FSH output. To avoid this a SERM is used. Initially I used 12.5 mg enclomiphene daily. I also tried using 12.5 mg every other day for a period, but have since gone back to daily. I still have reservations about using this drug long-term, as its effects are not fully understood. It's possible that in some men it actually causes imbalances in estrogenic activity, potentially explaining the mixed subjective results seen in monotherapy.
• Kisspeptin. Unfortunately, kisspeptin may not be prescribed in the U.S. and a pharmaceutical grade product is not available. Any use thereof is purely experimental and at one's own risk. The research on kisspeptin lags that on GnRH, so dosing is pure guesswork. Let's say that a plausible dose is 5-10 mcg taken with each 20 mcg dose of GnRH. Note that in theory this could yield pulses of both endogenous and exogenous GnRH. It's a good idea to delay introduction of kisspeptin relative to GnRH so that its independent effects can be discerned.
• Selegiline. I hadn't considered this drug as part of the "official" protocol, but I think it must be mentioned as a potentially useful tool for the aging male. Loss of dopaminergic activity harms us in various ways—including reducing libido—and selegiline can counteract this. Objectively I know it lowers my prolactin. Subjectively I believe it contributes to better mood and libido. My preferred dose is 2.5 mg daily. I'd advise younger guys to steer clear of it unless prolactin is a problem.
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