From Panel to Protocol
The bloodwork said go. Saturday's consult locked the framework — TRT, hCG, NAD+, GH peptides, retatrutide, recovery peptides. Eight compounds working in coordinated synergy across hormonal, cellular, metabolic, and tissue-repair layers.
In Panel Says Go. Time to Push, the bloodwork came back cleaner than two months of lifestyle drift implied: pristine liver, insulin sensitive, HPG axis functional, GH axis running hot. The decision wasn't whether to start a protocol — the panel said go. The decision was Path 2: animal mode, healthy ceiling. Test optimization, GLP-1, recovery peptides, lifestyle reset. Not bodybuilder. Not conservative. Smart aggressive.
Saturday April 25 was the consult to lock that in. This post is the full debrief: locked-in protocol, the doctor's adjustments, what I had to recalibrate after the lab's final result landed, the cost, the timing, the tier positioning, and what is still outstanding before Day Zero.
The pre-consult prep
I sent Dr. José Barrera (Endocrinólogo Pediatra, ACCEP) a 10-page Spanish prep PDF two days ahead of the consult. The doc covered clinical profile, ECG read, the two-month lifestyle drift contextualization, 26 of 27 clean panel markers, the 7 flagged markers, three paths evaluated, why Path 2, proposed protocol with doses, and 9 specific clinical questions for the doctor. The intent was to arrive with shared context — not a blank slate.
Cost was explicitly off the table as a constraint. Highest quality compounds, rigorous monitoring, deepest follow-up. That framing was on the cover of the document.
The consult
Dr. Barrera had read the PDF — he confirmed it twice. Twenty-five minutes, methodical, panel-by-panel. He walked through my numbers, re-read sections as we talked, recommended adjustments where his clinical judgment differed from my research. The standard 3-month TRT monitoring panel was named explicitly: total testosterone, hematocrit, estrogens, prostate (PSA), HbA1c, glucose, cholesterol, full metabolic. Standard care, comprehensive.
The protocol
Eight compounds organized by physiological layer — hormonal foundation (testosterone + hCG), cellular foundation (NAD+), GH axis amplification (CJC-1295 + Ipamorelin), fat-loss engine (retatrutide), tissue repair (BPC-157 + TB-500). NAD+ was added after a follow-up exchange with TRT Colombia confirming the mitochondrial support indications.
| Compound | Purpose | Dose | Frequency | Duration |
|---|---|---|---|---|
| Testosterone Cypionate | T optimization | 100 mg | Weekly subQ | 6 months |
| hCG | Testicular volume + intratesticular T + neurosteroids | 500 IU | 2x/week subQ | 6 months |
| NAD+ | Cellular energy + mitochondrial support + neurological repair | Per prescription | Per prescription | 6 months |
| CJC-1295 | GH axis stimulation | 200 mcg | 5 nights/week before bed | 3 months |
| Ipamorelin | Selective GHRP — clean GH pulse | 200 mcg | 5 nights/week before bed (combo CJC) | 3 months |
| Retatrutide | Aggressive fat loss + thermogenesis | 0.5 mg month 1 → 1 mg months 2-6 (re-evaluate at 6-month bloodwork for escalation) | Weekly subQ | 6 months |
| BPC-157 | Shoulder + joint repair | 250 mcg | 5 days/week subQ | 3 months |
| TB-500 | Systemic tissue repair | 2 mg | 2x/week subQ | 3 months |
Each layer chosen for a specific physiological lever. None redundant. None reckless. The combined effect is calibrated body recomposition with cellular and neurological restoration underpinning everything above.
How the cycle works
The protocol is not all eight compounds running continuously for six months — that is a common misread. It is a mixed-duration architecture: hormones build a stable 6-month platform while peptides cycle intensively for 3 months, then stop. Here is how the timing maps.
| Compound | Months 1-3 | Months 4-6 | Why this cadence |
|---|---|---|---|
| Testosterone | ▓▓▓▓▓▓ | ▓▓▓▓▓▓ | Continuous — TRT cannot cycle once started; body suppresses native production |
| hCG | ▓▓▓▓▓▓ | ▓▓▓▓▓▓ | Continuous — must run alongside TRT to preserve testicular axis |
| NAD+ | ▓▓▓▓▓▓ | ▓▓▓▓▓▓ | Continuous — cellular foundation, no cycling benefit |
| Retatrutide | ▓▓▓▓▓▓ | ▓▓▓▓▓▓ | Continuous + titrating — metabolic intervention, fat-loss trajectory builds over time |
| BPC-157 | ▓▓▓▓▓▓ | — off — | 3-month cycle — tissue repair accomplishes work in defined window; receptor rest |
| TB-500 | ▓▓▓▓▓▓ | — off — | 3-month cycle — same logic, paired with BPC-157 |
| CJC-1295 | ▓▓▓▓▓▓ | — off — | 3-month cycle — pituitary habituates to continuous stimulation, cycling restores effectiveness |
| Ipamorelin | ▓▓▓▓▓▓ | — off — | 3-month cycle — paired with CJC, same pituitary logic |
Phase by phase — what runs, what stops, what comes next
Two timing tracks operate in parallel. Track 1 (continuous hormones) runs flat across all six months. Track 2 (cycled peptides) runs intensively for the first three months, then stops at the 8-12 week bloodwork checkpoint to give receptors a rest. This is what the protocol looks like as a phased journey.
| Phase | What's running | What's happening physically |
|---|---|---|
| Phase 1 — Maximum stack Months 1-3 | All 8 compounds active simultaneously | Peptides accelerate everything: BPC + TB-500 protect joints during gym restart, CJC + Ipamorelin amplify GH during deepest cut, Retatrutide ramps appetite suppression, TRT + hCG build hormonal platform, NAD+ powers cellular machinery |
| Checkpoint — 8-12 weeks ~Month 3 | First bloodwork re-evaluation | Per prescription. Verify TRT serum levels, hematocrit, E2, PSA, HbA1c, glucose, lipids, full metabolic. Adjust if needed before peptide cycle ends. |
| Phase 2 — Hormone consolidation Months 4-6 | Just TRT + hCG + NAD+ + Retatrutide continuing. Peptides off. | Body operates on the optimized hormonal platform. Three months of accumulated peptide-driven recovery and GH amplification banked. Continued fat loss + muscle preservation. |
| Decision gate — Month 6 | Full SYNLAB panel repeat | Year-2 strategy decisions made on data. See decision table below. |
The logic behind the cadence
Two timing tracks operate in parallel for a reason. Track 1 (hormones) cannot cycle once started — TRT suppresses native testosterone production, so consistent serum levels must be maintained or the body crashes into a sub-baseline trough. hCG runs alongside to preserve the testicular axis (volume + intratesticular testosterone + neurosteroid pathway). NAD+ is the cellular foundation supporting everything above it, with no cycling benefit. Retatrutide is a continuous metabolic intervention — the fat-loss trajectory builds over weeks of stable signaling with the dose titrating gradually upward.
Track 2 (peptides) is the opposite. Receptors face desensitization under continuous exposure. BPC-157 and TB-500 accomplish their tissue-repair work in a defined window — three months of focused shoulder and joint regeneration is the right dose-response curve. CJC-1295 and Ipamorelin stimulate the pituitary to pulse natural growth hormone, and extended stimulation leads to habituation, where the pituitary becomes less responsive over time. Industry-standard biohacker protocols use 8-12 week cycles followed by 4+ week off-periods to restore effectiveness.
The structure is sharp. The peptides do their hardest work during months 1-3 — exactly when they are needed most. BPC-157 and TB-500 protect joints during the gym-return phase when stress on the shoulder is highest. CJC-1295 and Ipamorelin amplify growth hormone during the deepest cut, when retatrutide is ramping toward 1 mg and the calorie deficit is hitting hardest. By month 4, the hormones (now fully steady-state) carry the load. The body has three months of accumulated peptide-driven recovery and GH amplification banked. Months 4-6 are consolidation: continued fat loss and muscle preservation on the optimized hormonal platform.
Month 6 — the decision gate
At month 6, full SYNLAB panel repeat. Decisions made based on data: re-cycle peptides for another 3-month round if shoulder still needs work or recovery quality is dropping? Escalate retatrutide to 2 mg or higher if fat loss is on the lower end of expected? Continue hormones (yes — TRT and hCG become lifelong commitments once started, and NAD+ stays as longevity foundation)? Add a Tier 4 longevity stack (rapamycin, metformin, NAD+ IV monthly)? The protocol is designed as a 6-month foundation cycle. Successful execution unlocks the year-2 strategy.
| Question at Month 6 | If yes... | If no... |
|---|---|---|
| Hit fat-loss target? | Maintain retatrutide at 1 mg/wk | Escalate dose toward 2 mg+ per the doctor's verbal plan |
| Shoulder still needs work? | Re-cycle BPC-157 + TB-500 for another 3 months | Skip; the work is done |
| Recovery quality dropping? | Re-cycle CJC-1295 + Ipamorelin | Skip; the GH axis is in good shape |
| Continue TRT + hCG + NAD+? | Yes — TRT and hCG are lifelong commitments once started, NAD+ stays as longevity foundation | Not an option once committed |
| Add Tier 4 longevity stack? | Layer in rapamycin, metformin, NAD+ IV monthly, advanced longevity tests (CAC, DEXA, CGM) | Stay current Tier 3 capability |
Where the doctor adjusted the research
Tirzepatide → Retatrutide
I had researched and proposed Tirzepatide. The doctor recommended retatrutide. His rationale: newer generation, more weight loss, fewer side effects. Reading deeper, he's right.
Retatrutide is Eli Lilly's investigational triple agonist — GLP-1 + GIP + glucagon receptor. The glucagon component is what makes it more powerful than tirzepatide: it adds thermogenesis (basal metabolic rate increase) on top of appetite suppression and insulin sensitization. Phase 2 NEJM data (Jastreboff et al., 2023) showed 24.2% mean body weight reduction at 48 weeks at the 12mg dose, vs tirzepatide's 22.5% at 72 weeks. The retatrutide weight loss curve was still descending at trial end. MASH (metabolic dysfunction-associated steatohepatitis) resolution exceeded 80% in subgroups.
The trade-off is regulatory status. Retatrutide is in Phase 3 trials (TRIUMPH program), available via compounding pharmacy in Colombia.
Testosterone dose
Proposed: 120 mg/sem split 60+60 (Mon+Thu) subQ. Approved: 100 mg/sem, single weekly. The doctor's reasoning — Total T at 455 ng/dL doesn't justify higher; single weekly is logistically simpler. Slightly less aggressive than my proposal, defensible on both counts. Single weekly works for most guys at this dose.
Where I had to recalibrate
Free Testosterone result reframed the TRT case
The Free Testosterone result was the last piece of the panel to land — it came in days after the rest. Result: 8.19 pg/mL on a reference range of 5.7-30.7 pg/mL. That places it at 9.96% into the range — bottom decile.
This matters because Total T at 455 ng/dL (mid-range) gave the impression that testosterone was "fine." But Total T includes both bound (to SHBG and albumin) and free (bioavailable) fractions. The free fraction is what actually crosses cell membranes and acts on androgen receptors. With SHBG at 19.20 nmol/L (lower-third of range) sequestering more T than expected, my measured Free T came out functionally low despite the "normal" Total T number.
This is the kind of finding that gets missed when a panel only includes Total T. The full picture reveals the actual bioavailable hormone is constitutionally low. The doctor's 100 mg/wk Cypionate prescription now reads as well-calibrated medicine targeting a real deficit — not just aesthetic optimization. Predicted Free T trajectory at week 12: 17-22 pg/mL, mid-upper range. That is a 2-3x increase in bioavailable testosterone. The subjective effects (libido, mood, recovery, lean mass building) should be noticeably stronger than "Total T moving slightly up" would suggest.
Update: TRT Colombia has now forwarded the complete panel — including the Free T result — back to Dr. Barrera for clinical review. The 100 mg/wk Cypionate dose was prescribed before the Free T result was in hand, based only on Total T 455 mid-range. With the bioavailable hormone now visible at bottom decile, there is real clinical justification for the doctor to consider an upward dose adjustment. Either outcome is defensible: stay at 100 mg/wk and measure Free T response at the 8-12 week bloodwork checkpoint, or bump preemptively to 120-150 mg/wk to target upper-range Free T from the start. Awaiting his response.
IGF-1 251 + GH peptides — not a stop sign
My PDF flagged CJC-1295 + Ipamorelin as paused, pending IGF-1 retest. Reasoning: IGF-1 already 9% above adult reference ceiling, why stack a GH stimulator on top? The doctor's mechanistic distinction matters more than I gave it credit for.
Direct exogenous HGH bypasses the negative feedback loop and forces IGF-1 production regardless of body need. Peptide secretagogues work WITH the natural pituitary regulation — the body retains its capacity to down-regulate if IGF-1 climbs. Mechanistically different paths to similar endpoints. Plus: acromegaly clinically ruled out, IGF-1 only 9% above ceiling, pituitary axis intact, Animal Pak glandular content + dairy plausibly contributing to the elevation as transient confound. Real biohacker clinics run CJC/Ipa on patients with IGF-1 in the 200-300 range routinely. Starting as prescribed. Monitor at 12-week panel.
CV markers — the protocol IS the fix
The HDL 40 / Índice Aterogénico 4.6 / hs-CRP 2.8 cluster was framed in the PDF as the number-one real issue. Technically accurate but operationally misleading: those numbers are lifestyle drift residue. 22 kg over normal weight, two months of carbs, regular Cohibas. The protocol I'm starting (retatrutide-driven fat loss + TRT + hCG + NAD+ + return to gym + clean diet + sustained sobriety) IS the cardiovascular fix.
Predicted 12-week shift:
| Marker | Now (baseline) | After 12 weeks |
|---|---|---|
| Weight | 110 kg | 95-100 kg |
| Total Testosterone | 455 ng/dL (mid) | 800-1000 |
| Free Testosterone | 8.19 pg/mL (bottom decile) | 17-22 (mid-upper) |
| HDL cholesterol | 40 mg/dL (floor) | 50-55 |
| Índice Aterogénico | 4.6 (elevated) | 3.2-3.5 |
| hs-CRP | 2.8 mg/L | <1.0 |
| HbA1c | 5.7% (borderline) | 5.2-5.4 |
| Resting heart rate | mid-50s | low-50s |
If those land, the cardiovascular picture moves from moderate-risk territory to athlete-tier in three months without any direct cardiovascular intervention. The protocol does the work.
Pending
- Dr. Barrera's clinical response on Free Testosterone — possible TRT dose adjustment upward given bottom-decile bioavailable hormone (currently 100 mg/wk, may bump to 120-150 mg/wk)
- Dr. Barrera's NAD+ dose recommendation — form locked as weekly home subQ; awaiting specific weekly dose (likely 100-300 mg/wk range)
- Final hCG + NAD+ vial counts → exact total pricing (calculated once doctor confirms doses)
- Hands-on nurse training session for first-time self-injection — covering all subQ techniques (TRT, hCG, NAD+, peptides) + tooling guidance (auto-injector pen vs standard insulin syringe)
Stock confirmed for Monday April 27 — order processing, payment, and final logistics happen then. Compound delivery + nurse training session within 1-3 days after. First injection projected by end of week. The framework is set; the operational pipeline is rolling.
Monitoring
Three signal layers running in parallel: continuous Oura ring telemetry (HRV, resting HR, sleep architecture, recovery scores, daily tags for injections and side effects), 12-week SYNLAB blood panel for the locked monitoring set (TT, hematocrit, E2, PSA, HbA1c, glucose, lipids, full metabolic), and clinical examinations as needed. Daily blood pressure, weekly body composition photos, training PR tracking. Disciplined measurement, no improvisation.
The cost
Full transparency on the locked-in pricing for the 6-compound subset (hCG and NAD+ pending separate prescriptions). This is the consolidated quote received from TRT Colombia on April 25 in response to the cost-document request. Every line includes bacteriostatic water and syringe kits where applicable. Note the mixed-duration protocol: hormones (testosterone + retatrutide) run 6 months, peptides (BPC-157 + TB-500 + CJC-1295 + Ipamorelin) cycle for 3 months only and can be re-ordered if needed for months 4-6 based on the 8-12 week bloodwork checkpoint.
| Compound | Duration | Vials | Cost COP | Cost USD |
|---|---|---|---|---|
| Retatrutide | 6 months | 4 × 6 mg | 4,800,000 | $1,200 |
| Testosterone Cypionate | 6 months | 10 × 250 mg amp | 420,000 | $105 |
| BPC-157 | 3 months | 2 × 10 mg | 1,600,000 | $400 |
| TB-500 | 3 months | 5 × 10 mg | 4,250,000 | $1,062 |
| CJC-1295 | 3 months | 3 × 5 mg | 1,680,000 | $420 |
| Ipamorelin | 3 months | 3 × 6 mg | 1,800,000 | $450 |
| 6-compound subtotal | 14,550,000 | $3,637 | ||
| hCG (5000 IU/vial) | 6 months | ~5 vials (estimated) | ~2,000,000 | ~$500 |
| NAD+ (1000 mg/vial) | 6 months | TBD per Rx (range 3-29 vials) | 2.4M - 11.5M (range) | $600 - $2,875 (range) |
Estimated full-protocol upfront cost (6-compound subtotal + hCG + NAD+) lands in the range of $4,750-7,000 USD depending on the NAD+ dose Dr. Barrera prescribes. The hCG addition is roughly $500. NAD+ is the cost wildcard — vial pricing is locked at $400 per 1000 mg vial, but total cost varies dramatically based on whether the doctor prescribes monthly IV (cheap, ~$600-1,200) or daily subQ (more expensive, $3,600-7,200). After month 3 when peptide cycles end, ongoing maintenance is just TRT + hCG + NAD+ + retatrutide, running roughly $400-700 USD/month depending on NAD+ ongoing dose.
Cost across the protocol phases
Breaking it down by what you actually pay and when. Day Zero is the upfront locked price for the full prescribed protocol — three scenarios shown reflecting NAD+ dose uncertainty until the doctor finalizes the protocol. Decisions about extending peptides into months 4-6 happen at the 8-12 week checkpoint based on bloodwork and subjective response. Year 2 maintenance is just the continuous compounds plus monitoring — most likely landing zone is ~6.5M COP/month for the standard biohacker maintenance setup.
| Phase | What you pay | Cost USD | Cost COP |
|---|---|---|---|
| Day Zero — most likely | 6 compounds + hCG + NAD+ at IV monthly 500mg | ~$4,500 | ~18,000,000 |
| Day Zero — plan-for buffer | Above + NAD+ at daily subQ 50mg + delivery/training buffer | ~$6,250 | ~25,000,000 |
| Day Zero — worst case | If NAD+ goes aggressive daily subQ 100mg | ~$7,500 | ~30,000,000 |
| Months 4-6 add-on (optional) | If extending peptide cycles into months 4-6 (decided at month 3 checkpoint) | ~$2,300 | ~9,200,000 |
| Year 2 — bare minimum | TRT + hCG + Retatrutide only | ~$300/mo | ~1,200,000/mo |
| Year 2 — conservative | + IV NAD+ monthly + quarterly bloodwork | ~$625/mo | ~2,500,000/mo |
| Year 2 — standard biohacker (likely landing) | + daily subQ NAD+ + occasional peptide re-cycle | ~$1,625/mo | ~6,500,000/mo |
| Year 2 — full biohacker | Above + BPC/TB + CJC/Ipa cycles every 6 months | ~$2,000/mo | ~8,000,000/mo |
NAD+ — the dose wildcard
NAD+ vial pricing is locked at $400 per 1000 mg vial. Delivery method also locked: weekly home subQ self-administered (chose this over monthly clinic IV for lifestyle fit — autonomous, fits with the existing peptide injection schedule, travel-compatible). What still floats is the specific weekly dose, which Dr. Barrera will confirm Monday morning along with his Free Testosterone follow-up.
| Weekly subQ scenario | Dose protocol | 6-month cost USD |
|---|---|---|
| Conservative | 100 mg subQ once/week | ~$1,200 |
| Standard (most likely landing) | 250 mg subQ once/week | ~$2,400 |
| Aggressive | 500 mg subQ once/week | ~$4,800 |
| IV in clinic option | RULED OUT — 1.5h monthly clinic visits don't fit lifestyle | N/A |
Most likely landing zone (based on standard biohacker subQ protocols): 250 mg weekly subQ, putting NAD+ at ~$2,400 USD for the 6-month run. Worst-case (aggressive 500 mg/wk) tops out at $4,800. Either way, NAD+ is now the smallest remaining variable in the cost equation since the form is locked and the dose range is constrained.
This sits squarely in the upper Tier 3 elite biohacker capability range — the compounds and monitoring infrastructure are full Tier 3. But the actual locked dollar figure is at the lower end of that band thanks to Colombia local sourcing arbitrage. The same protocol in the US or EU would run $30-50k+ annually. Colombia pricing makes Tier 3 accessible to the serious biohacker without crossing into Bryan-Johnson-tier excess. Effectively: Tier 3 capability at upper Tier 2 cost.
Cost-per-kg of fat loss projected: at the conservative retatrutide dose, expecting 8-12 kg loss over 6 months, that is roughly $370-640 per kg of fat removed — competitive with cosmetic interventions, with the bonus that everything else (hormones, recovery, cellular health, longevity markers) is being optimized in parallel.
Where this sits
There's a rough hierarchy in the world of compound-based optimization. Worth knowing where this stack lands.
| Tier | Profile | Annual cost |
|---|---|---|
| Tier 1 — Standard TRT | Just testosterone, often without hCG. Most clinic patients globally. Annual lab check at most. | $1-3k |
| Tier 2 — Engaged patient | TRT + hCG + maybe one peptide (BPC for injury). Wearable data, 3-month labs. Reads forums. | $3-6k |
| Tier 3 — Elite biohacker ◀ this stack | Full hormonal optimization + cellular layer + GH peptides + advanced GLP-1 + tissue repair + integrated monitoring. Peter Attia / Mark Gordon / Huberman territory. | $11-25k |
| Tier 4 — VIP / ultra-wealthy | Tier 3 + direct HGH + stem cells + CGM + DEXA quarterly + longevity stack (rapamycin, metformin) + extensive IV protocols. Bryan Johnson territory. | $50-200k |
| Tier 5 — Pro-bodybuilder AAS | Trenbolone, Deca, Anadrol, EPO, supra-physiological test. Trades organs for short-term mass. | Variable |
This stack lands in upper Tier 3, edging into Tier 4 with NAD+ added. Above 95% of TRT clinic patients globally. Coordinated, integrated, monitored. Smart aggressive. Path 2 — animal max, healthy ceiling — exactly where the prep PDF aimed.
What this stack deliberately is not: Tier 5 territory. No trenbolone, no deca, no anadrol, no EPO, no supra-physiological test. The pro-bodybuilder path was evaluated in the prep document and rejected — the cost in cardiac hypertrophy, renal stress, hepatic toxicity, and lipid destruction wasn't worth the marginal extra mass. Optimization, not maximization. The discipline to stop at the optimization line is what separates Tier 3 from Tier 5 — anyone with money can stack compounds.
The stack
Eight compounds in coordinated synergy across four physiological layers. Testosterone restores hormonal architecture and sets the anabolic floor. hCG preserves the entire downstream steroidogenic pathway — testicular volume, intratesticular T, pregnenolone, neurosteroids. NAD+ rebuilds the cellular machinery beneath everything — mitochondrial ATP synthesis, sirtuin activation, DNA repair, neurological pathway restoration. CJC-1295 + Ipamorelin amplify natural growth hormone pulses for sleep depth, lean mass preservation during the cut, and faster recovery between training sessions. Retatrutide's triple-agonist mechanism drops 10-15 kg of fat in 12 weeks via simultaneous appetite suppression, insulin sensitization, and glucagon-mediated thermogenesis. BPC-157 + TB-500 close out the lingering shoulder reconstruction with directed tissue repair.
Each compound chosen for a specific physiological lever. None redundant. None reckless. The combined effect is calibrated transformation — fat off, lean mass on, hormones restored, mitochondria rebuilt, tissue repaired, endocrine architecture preserved, metabolic resilience built — over a 6-month execution window with full quantified monitoring throughout.
Panel said go. Doctor confirmed the framework. Awaiting the prescription. Day Zero dispatch when the first syringe lands.
