TRT and Thyroid journey - fatigue since TRT start. [Labs Included]

[Creatine]

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I did get my DHT tested and it is quite high. ...

I'd view this as another reason to prefer injections over transdermal testosterone.

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As for low SHBG vs 50mg dose: I'm confused here. I understood that because of low SHBG, a lot of testosterone remains "free" and hence gets flushed out by the liver. So, if I took 250mg dose (injection) once a week, there would be so much free or unbound T, that most of it will get flushed out in a day or two. So, I won't have any T remaining in my system after couple of days. So, it is important that I take another dosage of T to replenish the flushed out T.

So, if I took 150mg dosage a day of which only about 10% or 15mg gets absorbed as it is transdermal. Then in a week, I'm absorbing 105mg of T. And my level everyday will be more or less steady because I'd be replenishing whatever T was cleared out.

But if I were to take 105mg as a one-time injection per week, then it won't provide me with steady level. Because within a couple of days of taking injection, the unbound/Free T will be flushed out. And I'd have 5 days remaining before my next shot. So, my T levels will decline significantly over these 5 days.

So, I suppose 15mg (absorbed. Meaning 150mg, not 50mg, applied) is what makes sense?

Also, another related question:
I keep reading conflicting peices of information. I read that injected T is far superior. People report feeling better on injected T more often than on transdermal T even if the dosage (adjusted for absorption rate) is same. So, this really confuses me. T is T. How can it be different.

I understand that transdermal will convert to DHT slightly higher rate but still, T is T.

Is this just a myth or is this true?

The longest ester in Sustanon has a typical half life of over two weeks. Even with your low SHBG the half life for you is almost certainly on the order of days. But this may still be short enough to give substantial variation in hormones with weekly injections. Throw in the shorter esters present in Sustanon and you're likely to experience uncomfortable fluctuations. A combination of the absolute testosterone level and large swings can allow free estradiol to elevate, both in absolute terms and relative to free testosterone. This imbalance frequently leads to problems.

Ok. How about if I took just a long ester Testosterone like testosterone undecanoate? My thinking is that - because it is a long ester, it will dissolve slowly. So, if I took 100mg. Maybe only about 10mg of will become available to body everyday. Out of this 10mg, some will be bound to SHBG, some will get converted to Estrogen. And some will remain free.

Is my thinking flawed here? This way, I can avoid injecting multiple times a week.

[Mindscape]

...
I did get my DHT tested and it is quite high. ...

I'd view this as another reason to prefer injections over transdermal testosterone.

...
As for low SHBG vs 50mg dose: I'm confused here. I understood that because of low SHBG, a lot of testosterone remains "free" and hence gets flushed out by the liver. So, if I took 250mg dose (injection) once a week, there would be so much free or unbound T, that most of it will get flushed out in a day or two. So, I won't have any T remaining in my system after couple of days. So, it is important that I take another dosage of T to replenish the flushed out T.

So, if I took 150mg dosage a day of which only about 10% or 15mg gets absorbed as it is transdermal. Then in a week, I'm absorbing 105mg of T. And my level everyday will be more or less steady because I'd be replenishing whatever T was cleared out.

But if I were to take 105mg as a one-time injection per week, then it won't provide me with steady level. Because within a couple of days of taking injection, the unbound/Free T will be flushed out. And I'd have 5 days remaining before my next shot. So, my T levels will decline significantly over these 5 days.

So, I suppose 15mg (absorbed. Meaning 150mg, not 50mg, applied) is what makes sense?

Also, another related question:
I keep reading conflicting peices of information. I read that injected T is far superior. People report feeling better on injected T more often than on transdermal T even if the dosage (adjusted for absorption rate) is same. So, this really confuses me. T is T. How can it be different.

I understand that transdermal will convert to DHT slightly higher rate but still, T is T.

Is this just a myth or is this true?

The longest ester in Sustanon has a typical half life of over two weeks. Even with your low SHBG the half life for you is almost certainly on the order of days. But this may still be short enough to give substantial variation in hormones with weekly injections. Throw in the shorter esters present in Sustanon and you're likely to experience uncomfortable fluctuations. A combination of the absolute testosterone level and large swings can allow free estradiol to elevate, both in absolute terms and relative to free testosterone. This imbalance frequently leads to problems.

Ok. How about if I took just a long ester Testosterone like testosterone undecanoate? My thinking is that - because it is a long ester, it will dissolve slowly. So, if I took 100mg. Maybe only about 10mg of will become available to body everyday. Out of this 10mg, some will be bound to SHBG, some will get converted to Estrogen. And some will remain free.

Is my thinking flawed here? This way, I can avoid injecting multiple times a week.

What if you metabolize testosterone faster than undecanoate releases it into the blood stream? Guess you'll never know unless you try Sustanon or Ethanate. The latter can maintain more stable levels and you feel better as a result.

[Cataceous]

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Ok. How about if I took just a long ester Testosterone like testosterone undecanoate? My thinking is that - because it is a long ester, it will dissolve slowly. So, if I took 100mg. Maybe only about 10mg of will become available to body everyday. Out of this 10mg, some will be bound to SHBG, some will get converted to Estrogen. And some will remain free.

Is my thinking flawed here? This way, I can avoid injecting multiple times a week.

This is basically the right idea. The concern with undecanoate is the opposite--that you may end up with too long of a half life in spite of lowish SHBG. It takes four or five half lives to stabilize serum testosterone levels, so potentially you're looking at a long adjustment period between protocol changes. But undecanoate is appropriate if you really don't want frequent injections.

[Cataceous]

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What if you metabolize testosterone faster than undecanoate releases it into the blood stream? ...

I'm open to data suggesting otherwise, but my impression from fiddling around with some models is that this is not possible because there's typically a proportionality tying the rate of excretion and consumption to the amount present. This means that the lower the serum testosterone the lower the rate at which it can be used, which in turn means you can never run out, at least in theory--except you can come close if the half life of the ester is short compared to the period between injections.

[Creatine]

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Ok. How about if I took just a long ester Testosterone like testosterone undecanoate? My thinking is that - because it is a long ester, it will dissolve slowly. So, if I took 100mg. Maybe only about 10mg of will become available to body everyday. Out of this 10mg, some will be bound to SHBG, some will get converted to Estrogen. And some will remain free.

Is my thinking flawed here? This way, I can avoid injecting multiple times a week.

This is basically the right idea. The concern with undecanoate is the opposite--that you may end up with too long of a half life in spite of lowish SHBG. It takes four or five half lives to stabilize serum testosterone levels, so potentially you're looking at a long adjustment period between protocol changes. But undecanoate is appropriate if you really don't want frequent injections.

Thanks. I will speak to Dr. I've booked an appointment with Dr. Crisler so I'll update this thread after I hear from him. From the looks of it, it sounds like I've two reasonable potential protocols:

Protocol 1:
Transdermal 20%, 50-100mg ED (of which only about 5-10mg will be absorbed), morning after shower
+ HCG 500 IU - 1000 IU once a week, as this is only to prevent testicular atrophy and preserve fertility, I think once a week should be adequate
+ AI like Arimidex or Aromasin - dosage will depend on how my body responds. I'll probably start with .5mg twice a week of Arimidex or 25 MG Aromasin Twice a Week.

Protocol 2:
Test Cyp (say, 65 mg) twice a week - knowing myself, I don't think I can commit to more than twice a week of injections. Even twice is going to be hard.
+ HCG 250 IU on the same day/time as Test shot, so twice a week.
+ AI like Arimidex or Aromasin twice a week as well, on the day of the shots

With both protocols, continue taking Thyroxine (T4) 100mcg ED morning upon waking up, empty stomach

[Cataceous]

The half life of hCG is under two days, so a single weekly injection isn't ideal. It is possible to put both hCG and a testosterone ester in the same syringe in order to reduce the number of separate injections.

Also, consider starting with a lower AI dose when you're sure one is necessary.

[Creatine]

The half life of hCG is under two days, so a single weekly injection isn't ideal. It is possible to put both hCG and a testosterone ester in the same syringe in order to reduce the number of separate injections.

Also, consider starting with a lower AI dose when you're sure one is necessary.

Ah, if the half-life is 2 days. I suppose I could take 1000 IU dose? Day 2: 500 IU remains, Day 4 250 IU remains, Day 6 125 IU remains, Day 7: another 1000 IU shot.

Make sense?

I can certainly do 2 x injections of HCG combined with Testosterone injections but that is only if doctors advise me to take T via injection. If doctors agree with transdermal then I'd only be injecting for HCG and hopefully a single 1000 IU dose once a week would be adequate.

[Cataceous]

Ah, if the half-life is 2 days. I suppose I could take 1000 IU dose? Day 2: 500 IU remains, Day 4 250 IU remains, Day 6 125 IU remains, Day 7: another 1000 IU shot.

Make sense?
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No. The idea is to avoid the roller coaster and have stability. The half life is probably more like 1.5 days. You can see the exact hCG protocol you're proposing modeled in this paper. In figure 5, note the violent swings in testosterone when weekly dosing is used.

[Creatine]

Ah, if the half-life is 2 days. I suppose I could take 1000 IU dose? Day 2: 500 IU remains, Day 4 250 IU remains, Day 6 125 IU remains, Day 7: another 1000 IU shot.

Make sense?
...

No. The idea is to avoid the roller coaster and have stability. The half life is probably more like 1.5 days. You can see the exact hCG protocol you're proposing modeled in this paper. In figure 5, note the violent swings in testosterone when weekly dosing is used.

Wait, what I'm saying is DAILY Transdermal + weekly HCG. So, there shouldn't be any roller-coaster because I'd be applying same amount of T to my skin daily.

I understand the purpose of HCG is to preserve fertility and preserve testicular atrophy. So, as long as testes are being stimulated over the week, it should keep the machinery running, so to speak. We don't really care if any significant amount of T is produced or not because we'd be adding T via gel anyway.

[Cataceous]

The spike in testosterone and estradiol from a 1,000 IU injection may be significant, and more pronounced with low SHBG. You should try to give yourself the best chance of success.

[Mindscape]

Nobody does weekly HCG, not one of Half-Life is 24 to 36 hours.