MONSTER 2.0 — The Needle

Daily testosterone approved. Anastrozole reversed. NAD+ discontinued. Growth hormone added. The full V3 protocol: eight compounds, 30.5 injections a week, every unit and reconstitution, my independent audit of their supply math, and every date through December.

MONSTER 2.0 — The Needle
0:00
/1:20
The plan. Netflix, cats, Sofi, kids. A completely reasonable Sunday.

The plan for Sunday was Netflix and chill. Sofi, the cats, the kids, nothing on the calendar. That is the video above and I stand by it as a plan.

It lasted until about two in the afternoon.

0:00
/1:00
Leg day. Sunday. Nobody asked for this.

Leg day. On a Sunday. In the middle of a rest week, because the productive-biohacking-family problem is that it genuinely cannot help itself.

0:00
/0:41
Meanwhile: Sofi and the kids, running fruit experiments and cashing in the last day before the plan starts.

Meanwhile Sofi and the kids were doing the other half of the job — first live experiments with fruit for Maxi, and a certain amount of officially sanctioned cheating, because their nutrition plan starts tomorrow morning and today was the last day of the old regime. Miranda negotiated for both of them. She usually does.

And then, in the evening, the thing I had been waiting three days for landed.

🇨🇴
The email that made this article

Adriana Martinez — Co-Founder and Executive Client Services at TRT Colombia — sent through the complete physician response on a Sunday night. Three documents: a Clinical Dossier V3 that supersedes the 13 August version, a Medical Prescription V3 that replaces the April one in full, and the quotation for the 5 September order. Then every one of my four questions answered individually, three changes to my plan I had not asked for, two supply questions resolved, and four items she flagged as still open — including one she pushed back on me about, correctly.

I have dealt with a lot of clinics. This is not the level of attention you normally get. Questions come back answered, not deflected; when the physician reverses himself she says so and explains why; when she disagrees with me she says that too. Thank you Adriana, and thank you TRT Colombia. This protocol is better than the one I proposed, and that is entirely because of how seriously it got taken.

So this is the whole thing, in one place. Every document, every number, every date, what I checked independently and what I found, what the pharmacology actually says, and exactly what goes into a syringe on which day. If you read this end to end you have the complete picture.


The 60-second version

What
APPROVEDDaily testosterone. 25 mg every morning, 175 mg/week — the weekly total does not move. This is what I started on 17 August, now prescribed rather than running ahead of the physician
APPROVEDHCG 250 IU every other day, exactly as I proposed. Low dose specifically because I am already on testosterone
REVERSEDAnastrozole: do not start. Not deferred on dose — deferred entirely, pending the estradiol re-check at one month. It is off the order
REVERSEDNAD+ discontinued. Not run down to empty — stopped. Two unused vials stay in the fridge unless it is re-authorised
REVERSEDCJC-1295 and ipamorelin continue, 200 mcg each, five nights a week, explicitly alongside somatropin. This undoes my own washout proposal
REVISEDBPC-157 to five days a week, not daily. Which means 20 mg covers the entire eight-week course and there is no reorder
NEWSomatropin 0.6 IU nightly. Growth hormone enters the protocol for the first time
THE NUMBERIGF-1 above 300 → cut somatropin 20%. Physician ceiling 350. Current value 214.70

Eight active compounds. 30.5 subcutaneous administrations a week at steady state. One deferred, one discontinued. Total for the September order: $7,875,500 COP, which is roughly two and a half million pesos a month cheaper than July — because taking NAD+ out removed a line that cost more than the growth hormone, the HCG and the testosterone combined.


1 · Where this started — fifteen weeks of evidence

None of this is a fresh start. It is the second phase of something that has been running since late April, and the reason the physician approved an escalation at all is that the first phase produced numbers. Nineteen of twenty-two requested markers have returned, plus a current ECG.

MarkerBaseline · 21 AprCurrentChangeRead
HbA1c5.7 %5.4 %−5%Out of the prediabetic band entirely
Fasting insulin8.7 µU/mL4.5 µU/mL−48%Halved
HOMA-IR1.780.90−49%Insulin sensitivity roughly doubled
Triglycerides148 mg/dL87 mg/dL−41%Substantial
hs-CRP0.28 mg/dL0.10 mg/dL−64%Inflammation at the floor
Total testosterone455.52 ng/dL712.60 ng/dL+56%And that is a trough draw
SHBG19.20 nmol/L29.63 nmol/L+54%Healthier binding capacity
Prolactin16.07 ng/mL9.22 ng/mL−43%Normalised to mid-range
IGF-1251.30 ng/mL214.70 ng/mL−15%Back inside the lab range — and the headroom that matters below
Body weight~110 kg105 kg−5%While training load went up, not down
Estradiol13.93 pg/mL43.84 pg/mL+215%99.6% of the assay ceiling. The number this whole phase turns on
Haemoglobin15.7 g/dL17.0 g/dL+8%Higher on treatment. This is what constrains the dose
Ferritin129.05 ng/mL78.38 ng/mL−39%Falling while haemoglobin rises. Under surveillance
HDL40 mg/dL39 mg/dL−2%The one lipid that did not move — and the reason anastrozole is deferred
📐
The three numbers that condition everything below

Estradiol 43.84 pg/mL — 99.6% of the upper limit of the CMIA reference interval (11–44). Chemiluminescent immunoassays carry known bias and limited specificity at male estradiol concentrations, so that figure is approximate. A sensitive method (LC-MS/MS) is preferred for confirmation.

Haematocrit 47.5% with haemoglobin 17.0 g/dL — this, not testosterone concentration, is what governs how far the dose can go. Reticulocytes 0.9%, within range, read alongside ferritin and transferrin saturation.

HDL 39 mg/dL — the single marker that did not respond to fifteen weeks. ApoB at 81.28 and hs-CRP at 0.10 put overall atherogenic risk considerably better than HDL alone suggests, but HDL is precisely why you do not suppress estrogen casually.

The rest of the panel, for completeness: free testosterone 12.27 pg/mL · LH <0.09 · FSH 0.07 · TSH 1.825 · free T4 1.10 · free T3 2.52 · DHEA-S 233.30 · morning cortisol 11.20 · PSA 0.89 · creatinine 1.24 with eGFR 74 and cystatin C 0.68 · ALT 21 · AST 28 · albumin 5.22 · total cholesterol 158 · LDL 102 · VLDL 17 · ApoB 81.28 · Castelli index 4.1 · glucose 81 · vitamin D 44 · homocysteine 10.25 · platelets 211 · RDW 14.2 · transferrin saturation 20.87% · serum iron 67.2 · TIBC 322. ECG on 3 August: normal, sinus rhythm, PR 152 ms, QRS 104 ms, QTc 379 ms.

Still pending: Lipoprotein(a), due 13 August, and soluble transferrin receptor, due the 20th. Neither changes the current protocol. Lp(a) affects how aggressively ApoB gets pursued later; sTfR feeds the iron picture, which is the one genuinely open question in the panel.


2 · What changed, and why — the V2 to V3 reversals

I submitted MONSTER 2.0 as a proposal. The physician reviewed it and issued a first set of decisions on 13 August. Then he reviewed it again on 16 August and reversed four of his own decisions. That second pass is the reason this protocol is better than either my proposal or his first answer.

TherapyI proposedV2 · 13 AugV3 · 16 Aug — ACTIVEWhy it moved
Testosterone250 mg/wk175 mg once weekly175 mg/wk as 25 mg DAILYHe moved three times: twice weekly at 87.5 mg, then every other day, then daily. Rationale is bioavailability and peak attenuation — a flatter curve limits peak aromatisation and gynecomastia risk. Conditional on the weekly total staying at 175 mg
AnastrozoleReserve, symptom-based1 mg every other dayDO NOT INITIATEReversed. Estradiol gets re-controlled in the laboratory before any aromatase inhibitor starts. I am asymptomatic and HDL is already below range
HCG250 IU every other dayDo not restart250 IU every other dayReinstated at exactly what I asked for. He chose a low dose precisely because I am already on testosterone
Retatrutide2 mg/week2 mg weekly2 mg weeklyConfirmed both rounds. Endpoints are body composition, fat loss and waist-to-height, read against glucose, HbA1c, insulin and lipids
BPC-157500 mcg daily500 mcg daily × 8 wks500 mcg, 5 days/weekRevised down in frequency. Same 8-week course, and 20 mg now covers all of it with no reorder
TB-500Restart 2 mg 2×/wk then taper2 mg twice weekly2 mg twice weeklyThe April regimen retained without modification
SomatropinOption B — HGH0.6 IU daily0.6 IU daily, eveningConfirmed, with an explicit reduction criterion and a defined ceiling for age
CJC-1295Washout, then resumeNot in protocol200 mcg, 5 nights/weekReinstated. He confirmed separately there is no impediment to running it alongside somatropin
IpamorelinWashout, then resumeNot in protocol200 mcg, 5 nights/weekAs above, same evening timing, with CJC-1295
NAD+ContinueDiscontinueDISCONTINUEConfirmed twice. Removed to cut injection burden and protocol complexity
SequencingAll at onceImplement togetherImplement togetherConcurrent, subject to active clinical and laboratory monitoring
🧠
The one where I was right about the pharmacology and still got overruled — correctly

My point 4 argued for washing out CJC-1295 and ipamorelin before starting somatropin. The reasoning was sound: exogenous growth hormone raises IGF-1, IGF-1 feeds back through hypothalamic somatostatin, and that suppresses exactly the pulsatile release the secretagogues exist to stimulate. Running all three is partly self-cancelling.

The physician kept all three anyway. Adriana's email says so plainly: "Your pharmacology was right: exogenous GH does suppress the pulsatile release that the secretagogues stimulate, but he made a different call."

Being right about a mechanism is not the same as being right about a decision. The secretagogues act on pathways somatropin does not — GHRH-receptor and ghrelin-receptor signalling, with effects on sleep architecture and appetite that are not purely IGF-1-mediated. Sub-additive is not zero. What it does mean is that the monitoring has to be tighter than the schedule currently is, which is the single most important finding in this entire article and gets its own section below.

3 · The protocol

Eight active agents, all subcutaneous. This is the complete physician-directed protocol as it runs from 6 September.

AgentDoseFrequencyTiming and siteWeekly total
Testosterone cypionate25 mgDailyMorning · lower abdominal SC tissue or outer thigh, rotating175 mg
HCG250 IUEvery other dayConsistent time of day · abdominal SC tissue~875 IU
Retatrutide2 mgOnce weeklySame day each week · abdomen, thigh or upper arm2 mg
Somatropin0.6 IUDailyEvening, approximately the same time nightly4.2 IU
CJC-1295200 mcg5 nights/weekBefore bedtime1 mg
Ipamorelin200 mcg5 nights/weekBefore bedtime, with CJC-12951 mg
BPC-157500 mcg5 days/week × 8 weeksNear the affected shoulder where appropriate2.5 mg
TB-5002 mgTwice weeklyAbdominal SC tissue, cycled with BPC-1574 mg

Deferred: anastrozole — not to be initiated, not to be purchased, not to be self-started. Discontinued: NAD+ — existing stock not to be used unless re-authorised, no reorder scheduled.

The safety thresholds — the numbers that stop things

TriggerRequired actionWhat it protects
Haematocrit ≥ 54% or haemoglobin ≥ 18.5 g/dLSuspend testosterone and reassessHaematologic safety. Either threshold alone is sufficient — they are not cumulative
Blood pressure > 140/90 sustainedReassess treatment exposure and clinical statusCardiovascular safety
Estradiol > 80 pg/mL with symptomsReassess testosterone and hormonal managementManages symptomatic excess without unnecessary suppression. Note the with symptoms — a number alone does not trigger it
Ferritin < 30 ng/mL or transferrin saturation < 15%No blood donation; investigate iron status before supplementingIron availability. Currently 78.38 and 20.87%
IGF-1 > 300 ng/mLReduce somatropin by 20% → 0.48 IU/dayGrowth-hormone axis. Physician ceiling 350 ng/mL

Those last two figures — 300 and 350 — are treatment thresholds chosen by the physician for me, not laboratory values. The lab's printed IGF-1 reference interval is 76–230 ng/mL and stays unchanged on every report. He does not apply the 230 ceiling at my age; the one he works to is 350. Two different kinds of number that look identical on a page, and confusing them is how people panic at a lab report.


4 · The injection plan — reconstitution, volumes, units

This is the section I actually use. Every compound, what goes in the vial, what concentration that produces, and what number to pull the plunger to on a 1 mL U-100 insulin syringe. Get the reconstitution volume wrong and every dose after it is wrong by the same factor.

CompoundVialAddConcentrationDoseVolumeUNITS · U-100
Testosterone cypionate1 mL ampoule = 250 mgNothing — oil, ready to inject250 mg/mL25 mg0.10 mL10u
HCG5,000 IU powder2 mL — its own solvent ampoule from the box, not your bacteriostatic water2,500 IU/mL250 IU0.10 mL10u
Retatrutide6 mg powder2 mL bacteriostatic water3 mg/mL2 mg0.67 mL67u
Somatropin36 IU / 12 mg cartridgePer manufacturer — see the warning below~36 IU/mL0.6 IU~0.017 mL~1.7u ⚠
CJC-12955 mg powder2 mL bacteriostatic water2.5 mg/mL200 mcg0.08 mL8u
Ipamorelin5 mg powder2 mL bacteriostatic water2.5 mg/mL200 mcg0.08 mL8u
BPC-15710 mg powder3 mL bacteriostatic water3.33 mg/mL500 mcg0.15 mL15u
TB-50010 mg powder4 mL bacteriostatic water2.5 mg/mL2 mg0.80 mL80u
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Three things on that table that matter more than the rest

BPC-157 doubles. It was 250 mcg = 7.5 units. It is now 500 mcg = 15 units, five days a week. Same vial, same 3 mL reconstitution, twice the plunger. Anyone running the old number is now half-dosing.

HCG changes completely. It was 2,500 IU = 100 units, a full barrel, once a week. It is now 250 IU = 10 units, every other day. Same vial, same 2 mL — one tenth of the draw, four times the frequency. This is the single easiest number in the whole protocol to get catastrophically wrong from memory.

CJC-1295 and ipamorelin go into one syringe. 8 units of each, drawn into the same barrel, 16 units total, one injection. This is standard, and it is also the assumption the clinic's own supply calculation depends on — more on that in the audit.
⚠️
The somatropin number is not usable yet — this is a real question for the clinic

The cartridge is 36 IU in roughly 1 mL, so 0.6 IU is about 1.7 units on a U-100 syringe. That is below the point where an insulin syringe measures reliably — the graduations are 1 unit apart and you are asking for one and two-thirds of one. A 10% error on 1.7 units is invisible to the eye and real in the blood.

There are two clean fixes and both need the physician, not me. Either dilute the reconstituted cartridge further into a sterile vial — take it to 12 IU/mL and 0.6 IU becomes 5 units, or to 9 IU/mL and it becomes 6.7 units — or use a smaller presentation. I do not inject the first dose until I have that number in writing.

The testosterone transfer — why there is a filter needle in the box

Testosterone comes as single-use glass ampoules, and the regimen is daily, so one ampoule cannot be opened and used ten times. The answer is a transfer kit: ten sterile vials and ten 5-micron filter needles, one of each per ampoule, included at no charge.

The filter needle is not optional and it is not a formality. Snapping a glass ampoule produces microscopic glass particles that fall into the solution. A 5-micron filter needle retains them; a standard needle draws them straight into the syringe and then into you. Use the filter needle to draw from the ampoule, swap to a clean needle to inject.

Procedure: transfer one ampoule at a time, as each is needed. At 25 mg a day a 250 mg vial is exactly ten days, which keeps punctures per vial low and leaves the rest of the box sealed in its original glass. Refrigerate after transfer and write the date on the label.


5 · The week — what actually happens on which day

Two compounds are daily and never move: testosterone in the morning, somatropin at night. Everything else hangs off that spine.

DayMorningEveningInjections
MondayTestosterone 10u · Retatrutide 67uBPC-157 15u · CJC+Ipa 16u (one syringe) · TB-500 80u · Somatropin6
TuesdayTestosterone 10uBPC-157 15u · CJC+Ipa 16u · Somatropin4
WednesdayTestosterone 10uBPC-157 15u · CJC+Ipa 16u · Somatropin4
ThursdayTestosterone 10uBPC-157 15u · CJC+Ipa 16u · TB-500 80u · Somatropin5
FridayTestosterone 10uBPC-157 15u · CJC+Ipa 16u · Somatropin4
SaturdayTestosterone 10uSomatropin2
SundayTestosterone 10uSomatropin2
Plus, every other dayHCG 10u — at a consistent time3 or 4

That totals 30.5 administrations a week — 27 fixed plus 3.5 for HCG, which alternates between three and four depending on where the every-other-day pattern falls. The figure matches the dossier's own count exactly, and it only works because CJC-1295 and ipamorelin share a syringe. Injected separately it is 35.5 a week, and that difference turns out to matter.


6 · The audit — I checked their math, line by line

Not because I distrust them. Because a supply calculation that is off by four days is invisible until the morning there is nothing in the fridge, and because verifying arithmetic is free. I rebuilt every coverage figure independently from the prescription.

What checks out

LineSuppliedWeekly useDays coveredVerdict
Testosterone cypionate2,500 mg (10 ampoules)175 mg100 daysCorrect — and it will not appear on the October or November order
HCG5,000 IU875 IU40 daysCorrect
Retatrutide12 mg (2 vials)2 mg42 daysCorrect
Somatropin36 IU4.2 IU60 days nominalCorrect on paper — see the waste problem below
CJC-12955 mg1 mg35 daysCorrect
Ipamorelin5 mg1 mg35 daysCorrect
BPC-15720 mg (2 vials)2.5 mg56 daysExact — 20 mg is precisely the 8-week course, to the milligram
TB-50020 mg (2 vials)4 mg35 daysCorrect

Every line covers thirty days or more. The cost arithmetic is also clean: the eight lines sum to $8,290,000, the 5% courtesy discount is $414,500, the total is $7,875,500, and the payment-method surcharges at +7% and +15% come to $8,426,785 and $9,056,825. All exact. No rounding drift, nothing padded.

What I found — four things worth raising

1️⃣
Somatropin: 53% of the cartridge gets thrown away

36 IU at 0.6 IU/day is 60 days of product. Reconstituted somatropin keeps roughly 28 days refrigerated. So 16.8 IU gets used and 19.2 IU gets discarded — I am paying $640,000 for about $300,000 of delivered drug.

Adriana raised this herself, unprompted, and asked me to put it to the physician. Here is the arithmetic that answers her question: at 0.6 IU a day, a 5.3 mg / 16 IU cartridge lasts 26.7 days — which lands almost exactly on the 28-day reconstituted shelf life. One cartridge, one month, near-zero waste. That is the presentation to ask for.
2️⃣
150 syringes is enough — but only just, and only one way

The quotation says 150 syringes covers "approximately 131 administrations plus draws." I could not reproduce 131 until I found the assumption buried in section 8.1 of the dossier: CJC-1295 and ipamorelin drawn into a single syringe. With that, 30.5/week × 4.3 weeks = 130.7. Exact match.

Injected separately it is 35.5/week = 152 a month — and 150 supplied is two short before a single reconstitution draw. Combined, there are 19 spare, which drops to about 12 after the seven monthly reconstitutions. So: co-administer them, which is standard practice anyway and one fewer needle a night. Not an error in the quotation — an assumption in it worth knowing you are relying on.
3️⃣
The testosterone bridge has literally zero margin

I have 500 mg in stock. At 25 mg a day that is exactly 20 days — 17 August through 5 September. Ordering on the 5th for delivery on the 6th meant zero margin: one day of slippage and I miss a dose on a daily protocol.

Fixed, and cheaply. I moved the order to ~1 September. Delivery around the 2nd turns zero margin into about three days of buffer, and shrinks the CJC-1295 and ipamorelin gap from six days to three. Nothing else about the protocol changes — this is purely a calendar decision and it cost nothing to make.

TRT Colombia had already flagged it in their own quotation before I raised it: "The testosterone line has no margin against current stock. Should any part of the order be delayed, that line is dispatched first." That is the correct mitigation and I am satisfied with it. Worth stating out loud that this is the one line where the schedule has no slack in it at all.
4️⃣
Two lines outlast their reconstituted shelf life

A vial's supply and a vial's stability are different clocks and the shorter one wins.

HCG: 5,000 IU at 250 IU every other day is 20 doses = 40 days, against a typical 30-day reconstituted window. The last handful of doses sit past it.
CJC-1295 and ipamorelin: 25 doses at five a week = 35 days each, against ~30. Marginal, but real.

Everything else is fine, and some of it is elegant: BPC-157 is two vials at 28 days each, TB-500 is 2.5 weeks a vial, retatrutide is three weeks a vial. All comfortably inside. Practical fix for the two that aren't: reconstitute the second half later rather than mixing everything on arrival, and keep the label date on the vial.

7 · The pharmacology — what the numbers actually predict

Why daily testosterone beats twice-weekly

Cypionate has a half-life of about eight days. At steady state the peak-to-trough ratio for any schedule is 2 raised to the power of the interval over eight. That is the whole calculation, and it settles the argument:

Schedule at 175 mg/weekPer injectionIntervalPeak : troughPeak vs meanTrough vs mean
Once weekly175 mg7 days1.831.33×0.73×
Twice weekly87.5 mg3.5 days1.351.16×0.86×
Daily — prescribed25 mg1 day1.091.04×0.96×

Daily dosing takes the weekly peak excursion from 33% above the mean down to about 4%. The physician's stated rationale — better bioavailability, attenuated peak, less peak aromatisation, less gynecomastia risk — is correct.

🎯
The caveat nobody should skip

Flattening the curve does not reduce mean exposure. The weekly dose is going from 100 mg to 175 mg — a 75% escalation — and estradiol production and erythropoietic drive both track average exposure, not peak.

A lower estradiol peak is plausible. A lower mean estradiol is not. Same for haematocrit: erythropoietic signalling integrates over weeks, so the average matters more than any single day's peak, and there is no strong trial evidence that daily subcutaneous dosing prevents erythrocytosis at an equal weekly dose.

Daily dosing is the right call. It is a smoothing measure, not a licence. The thing that actually protects me here is the one-month blood draw, not the injection schedule.

Three inputs on one axis — the real issue

Somatropin supplies growth hormone directly. CJC-1295 drives pituitary release through the GHRH receptor. Ipamorelin drives it through the ghrelin receptor. All three raise IGF-1, and IGF-1 feeds back through hypothalamic somatostatin to suppress the very pulses the secretagogues stimulate. The combination is sub-additive, not additive — but sub-additive is not zero.

Scale first. 1 mg of somatropin is about 3 IU, so 0.6 IU/day is 0.20 mg/day — 1.90 mcg/kg at 105 kg. For an adult with documented deficiency that is a replacement-level starting dose. In a man whose untreated IGF-1 is already 214.70, it is augmentation, not replacement. Whether the exposure ends up supraphysiologic is decided by the achieved IGF-1, not the nominal dose.

InputPlausible IGF-1 incrementLands atFrom 214.70
Somatropin 0.6 IU/day alone+25 to +65240 – 280
below threshold
CJC-1295 alone, short-acting0 to +15215 – 230
negligible
CJC-1295 alone, confirmed DAC+10 to +40225 – 255
modest
Ipamorelin alone0 to +15215 – 230
negligible
All three, allowing for feedback+30 to +90245 – 305
touches the threshold
High-response / DAC tail+90 to +130305 – 345
above 300, below the ceiling

Working probability of crossing 300 before the scheduled three-month check: roughly 35%, plausibly 20–55%. If the CJC-1295 is a short-acting modified GRF analogue, call it 20–35%. If it is confirmed long-acting DAC, 40–60%. Probability of exceeding the 350 ceiling is likely under 10%, but not zero. Which formulation it is materially changes the risk, and that is worth asking.

🔬
The most important finding in this article: the fastest-moving axis is scheduled last

IGF-1 is stabilised by binding proteins and has an effective half-life of 12–15 hours. A new daily-GH response is largely established within 7 to 14 days. Standard clinical titration reassesses IGF-1 about four weeks after starting or changing a dose.

The scheduled check is at three months. If IGF-1 crosses 300, it will do so in the first two to four weeks — not suddenly at week twelve. Waiting the full schedule could leave it above the physician's own reduction threshold for roughly eight extra weeks, with the reduction trigger sitting unread the whole time.

The dossier already proposes an earlier IGF-1 draw, recorded as a proposal for the physician to consider rather than an instruction. I am asking for it. And it costs nothing: there is already a comprehensive draw scheduled at two months. Adding one analyte to a needle that is going in anyway is the cheapest risk reduction available in this entire protocol.

Estradiol — why deferring is right

43.84 pg/mL, asymptomatic, on an immunoassay that reads high in men. Direct CMIA methods pick up cross-reacting steroid metabolites and assay background, which become material when true estradiol is only 20–50 pg/mL. There is no valid universal conversion to LC-MS/MS, but the scale is worth seeing:

If CMIA reads high byTrue value would beOverstatement
+5 pg/mL38.84 pg/mL13%
+10 pg/mL33.84 pg/mL30%
+15 pg/mL28.84 pg/mL52%

A 5–15 pg/mL positive difference is entirely plausible at male concentrations. So the number that looks like it is scraping the ceiling may be comfortably mid-range. Four reasons deferring is correct: the result is 0.16 pg/mL below the lab ceiling, not above it; there are no estrogen-related symptoms — no gynecomastia, no tenderness, no oedema; the assay can overstate materially at this concentration; and HDL is already 39, where unnecessary estrogen suppression offers no lipid upside and can push it lower.

A floor matters as much as a ceiling. Sustained estradiol below about 15 pg/mL by LC-MS/MS warrants concern for bone, sexual function and body composition. Below about 10, the evidence for increased bone resorption, fat gain, reduced desire and vasomotor symptoms gets substantially stronger — the controlled gonadal-steroid work that separated testosterone effects from estrogen effects found real consequences as estradiol approached the lower male range. I asked for a defined floor before any aromatase inhibitor starts. Adriana recorded the request in the dossier so it does not get lost between now and the one-month result. That is exactly the right handling of a question that cannot be answered yet.

HCG 250 IU every other day — the dose is well chosen

Under full suppression — LH below 0.09, FSH at 0.07 — HCG substitutes for the LH signal at the Leydig cell. The dose-ranging evidence in men on 200 mg/week of testosterone enanthate is unusually clean:

HCG doseIntratesticular testosterone vs baselineRead
None — testosterone alone≈ 94% below baselineNear-total collapse of intratesticular androgen
125 IU every other day≈ 25% below baselinePartial
250 IU every other day — prescribed≈ 7% below baselineEssentially maintained. This is the sweet spot
500 IU every other day≈ 26% above baselineSupraphysiologic, more aromatisation, no added benefit here

So 250 IU every other day is supported for maintaining near-baseline intratesticular testosterone — which is precisely the stated objective: testicular function and volume, not fertility. Two consequences worth holding: it adds endogenous testicular testosterone on top of the nominal 175 mg/week, so total androgen exposure exceeds the injected number; and it stimulates testicular aromatisation, which feeds straight back into the estradiol question. Even a 5 pg/mL rise moves 43.84 to 48.84. That is one more reason the one-month estradiol needs to be a good assay.

What it does not do: HCG replaces LH signalling, not FSH. Testicular volume should hold; seminiferous-tubule function and spermatogenesis can still decline with FSH fully suppressed. Testicular size and serum testosterone do not answer that question — only a semen analysis does.

Haematocrit and iron — the constraint that will bind first

Haemoglobin 17.0 and climbing, ferritin down 39% from 129 to 78.38, transferrin saturation 20.87% — 0.87 points above the usual iron-restriction boundary. With hs-CRP at 0.10, inflammation is not masking anything. The mechanism is textbook androgen-driven erythropoiesis:

StepWhat happens
1Testosterone increases renal erythropoietin signalling and resets the haemoglobin–EPO set point
2Testosterone suppresses hepatic hepcidin
3Lower hepcidin increases intestinal iron absorption and mobilises stored iron
4Marrow consumes that iron — haemoglobin rises, ferritin and transferrin saturation fall

Reticulocytes at 0.9% do not contradict this. They rise during an acute production change and settle back into range once the larger red-cell mass reaches a new steady state.

🩸
Haemoglobin, not haematocrit, is the number that will stop this

Margins: haemoglobin 17.0 → 18.5 is 1.5 g/dL, or 8.8%. Haematocrit 47.5% → 54% is 6.5 points, or 13.7%.

At my current haemoglobin-to-haematocrit relationship, haemoglobin would hit 18.5 at a haematocrit of about 51.7% — comfortably below the 54% line. So the haemoglobin ceiling binds first, and either threshold alone suspends testosterone. Both numbers can keep rising for three to six months after an escalation, which means a clean one-month CBC does not establish safety at month three.

At ferritin 78.38 there is no case for iron supplementation. If transferrin saturation drops below 20% or ferritin approaches 30, the answer is to investigate deficiency and blood loss — not to reflexively add iron or start donating blood.

Retatrutide against growth hormone — opposite directions on the same dial

Growth hormone reduces insulin sensitivity: more lipolysis, more free fatty acid delivery, more hepatic glucose output, less peripheral uptake. Retatrutide pushes the other way through GLP-1 and GIP signalling, reduced intake and weight loss — though its glucagon component can raise hepatic glucose output acutely. There is no trial of this combination. What there is, is arithmetic:

ScenarioGlucoseInsulinHOMA-IRvs today
Today814.50.90
GH wins — early weeks906.01.33+48%
Retatrutide wins — by month 2803.50.69−23%

Low-dose growth hormone tends to worsen insulin sensitivity in the first two to four weeks, while the metabolic benefit of weight loss accumulates after that. At a sustained 5% reduction, retatrutide probably wins on net by month two — but HOMA-IR at 0.90 leaves very little room to improve and plenty to lose. Metabolic preservation is the red line of this whole protocol, and month two is when it gets read.

⚖️
The 5% target has an ambiguity worth resolving

The clinical target is a 5% weight reduction by the three-month control. Five percent of my current 105 kg is 5.25 kg → target 99.75 kg. But five percent of the 110 kg I started at is 5.5 kg → target 104.5 kg — and I have already lost 5 kg, which is 4.55% of the original. On that reading the target is 0.5 kg away and essentially already met.

Those are very different instructions. I am working to 99.75 kg, the harder of the two, and I will confirm which one he means at the one-month control.

One more thing on scale weight: in incretin-based weight loss, roughly 20–40% of what comes off can be lean mass unless actively defended. On 5.25 kg that is 1–2 kg of lean tissue at risk. Testosterone and GH improve nitrogen retention and should blunt it, but no evidence says this combination eliminates it. And GH expands extracellular water — a litre reads as a kilo of "lean mass" on a body-composition scan without being a kilo of muscle. Which is why the two-month assessment reads body composition alongside waist measurement and strength performance, not instead of them.

8 · Two start dates — the bridge, then the real thing

The protocol does not switch on in one move, because two of the changes did not need anything delivered and the rest do. So there is a bridge.

PhaseWindowWhat runsWhy
BRIDGEMon 17 Aug → Fri 5 SepTestosterone 25 mg = 10u daily · Retatrutide 2 mg = 67u Mondays · CJC-1295 8u + ipamorelin 8u five nights, until stock runs out ~30 AugThese are the two changes that need no new product — I already had testosterone and retatrutide in the fridge. Starting them early means the one-month hormonal draw has a full month of the new regimen behind it
STOPPEDFrom 16 AugNAD+ — immediatelyDiscontinued by prescription. Not run down to empty. Two unused vials stay sealed
GAP~31 Aug → 5 SepCJC-1295 and ipamorelin, ~6 daysStock ends before delivery. Accepted rather than shipping ahead — six days off a secretagogue is pharmacologically unremarkable
GAP11 Aug → 6 SepHCG, 26 daysZero stock since 11 August. Under testosterone this is weeks-to-months territory, not days — but it is past the three-week point where it starts to count, and it is the reason HCG is in this order at all
FULL PROTOCOLSun 6 Sep onwardAll eight agentsDelivery day. Everything above plus HCG, somatropin, BPC-157 and TB-500

Nothing is being taken early that has not been prescribed, and nothing is being started before it arrives. The bridge exists because the calendar and the pharmacy do not run on the same clock.


9 · The calendar — every date I cannot forget

This is the section I will come back to. Orders on the 5th of the month, draws pinned to the prescription date of 16 August.

DateDayWhatType
17 AugMondayBridge starts. Daily testosterone 10u, retatrutide 67u on MondaysPROTOCOL
~30 AugSundayCJC-1295 and ipamorelin run outGAP
5 SepSaturdayLast day covered by current testosterone. Order moved earlier — see belowORDER
6 SepSundayOriginal delivery date. Now expected ~2 SeptemberPROTOCOL
~16 SepWednesdayONE-MONTH DRAW. Total + free testosterone, estradiol (ask for LC-MS/MS), SHBG, complete blood count. This decides anastrozoleBLOOD
5 OctMondayOctober order. No testosterone line — roughly $5,985,000ORDER
~16 OctFridayTWO-MONTH CONTROL. Full panel, metabolic, lipids, iron, transaminases, renal, body composition, waist-to-height, shoulder strength and mobility. Add IGF-1 hereBLOOD
1 NovSundayBPC-157 eight-week course ends. No reorderPROTOCOL
5 NovThursdayNovember orderORDER
~16 Nov or ~6 DecMonday / SundayTHREE-MONTH IGF-1. Which date depends on which clock — see belowBLOOD
~15 DecTuesdayTestosterone box runs out — 100 days from deliverySUPPLY
📅
There are two different clocks running and the documents use both

The prescription says estradiol is re-controlled "approximately one month from the date of this prescription" — 16 August, so ~16 September. The dossier says "approximately one month after initiation of the updated phase" — 17 August, so ~17 September. Same week. That question is settled: mid-September, not October.

But the growth-hormone axis does not start until 6 September. At a 16 September draw, somatropin has been running ten days. And section 10.3 of the dossier says IGF-1 at three months "from initiation of somatropin" — which is 6 December, not the 16 November you get from the prescription date.

The clean answer avoids the whole argument: put IGF-1 on the two-month draw around 16 October. By then somatropin, CJC-1295 and ipamorelin have run 40 days — well past the 7–14 days IGF-1 needs to equilibrate — and the needle is going in regardless. One extra analyte, no extra appointment, and the reduction trigger gets read while it can still act on something.

Every date after the order is provisional until the box is in my hands. The prescription clock and the growth-hormone clock run at different speeds. The hormonal draw is anchored to the prescription date of 16 August, so ~16 September does not move no matter when delivery lands — but every IGF-1 date is anchored to the first somatropin injection, which is delivery day. I will recompute the whole calendar from the real delivery date and update this section then.

The standing rhythm: order at the start of every month, delivery the next day, and check what is actually missing before each one rather than reordering the same box out of habit. October drops the testosterone line entirely because one box covers a hundred days.


10 · What I expect to happen, and when

Not hopes. Predictions with timeframes, so that in three months I can check which ones were wrong.

WhenWhat should show upWhat I am watching for instead
Week 1–2Steadier day-to-day energy and mood as the peak-trough swing collapses from 1.83 to 1.09. Sleep depth from the evening secretagogues. Injection-site tolerance to a daily rhythmWater retention and any breast tenderness — the early estradiol signal. Insulin sensitivity dipping as GH comes online
Week 2–4IGF-1 finding its new level — this is when it moves, not at month three. Appetite suppression from retatrutide at the doubled 2 mg. Testicular volume recovering on HCGIGF-1 crossing 300. Roughly a one-in-three chance, and the scheduled check would not catch it
Month 1 · ~16 SepTotal testosterone well up from 712.60 at trough. The anastrozole decision made on real data rather than an immunoassay guessHaemoglobin heading toward 18.5. That is the ceiling that binds first, at a haematocrit around 51.7%
Month 2 · ~16 OctFat down, waist-to-height down, lean mass held. Shoulder strength and mobility improving on the eight-week BPC-157 and TB-500 courseHOMA-IR. It is 0.90 today — almost nowhere to improve and plenty to lose if GH wins the tug of war
Month 35% weight reduction — 99.75 kg on the current-weight reading. Body composition confirming the loss was fat, not muscleLean mass on the scan. GH expands extracellular water, so a kilo of "lean" may be a litre of fluid. Waist and strength are the honest checks
ThroughoutMetabolic gains preserved — HbA1c 5.4, insulin 4.5, triglycerides 87, hs-CRP 0.10This is the red line. Everything else is negotiable; the metabolic numbers going backwards means the protocol is wrong regardless of what the mirror says

11 · Still open

The semen analysis — where Adriana pushed back on me

I said skip it. She made the case for doing it anyway, and it is a good case, so it belongs here in full rather than quietly dropped.

Her argument: the baseline is already gone — that would have been April, before fifteen weeks of suppression, and with LH under 0.09 and FSH at 0.07 a sample today cannot tell me what I had before I started. What it does capture is the pre-HCG reference, and that window closes the day the first dose goes in. HCG is going in specifically to preserve testicular function; if I want to know in six months whether it worked, I need a number from before it started.

It would not change the protocol. The HCG is approved and the result does not move the dose. It is information, not a decision. Her actual reason for pushing is simpler and harder to argue with: if it comes back azoospermic, that is worth knowing now rather than in two years — recovery after prolonged testosterone therapy runs six to twenty-four months when it happens at all, and knowing early leaves options that knowing late does not. She notes, fairly, that I have been consistent that fertility is not the objective, and takes that at face value.

My answer is still to skip it, and I want to be honest that this is a preference and not a refutation. She is right that the information is cheap and the window is closing. Fertility is not an objective for me, the result does not change a dose, and I would rather not add a test whose only function is to tell me something I am not going to act on. If that turns out to be a mistake it will be an informed one. Protocol, for the record: 2–5 days abstinence, and an abnormal result gets repeated at 2–3 weeks before anything is concluded, because a single sample varies enormously.

The other three

ItemStatus
Estradiol assay methodThe physician set the recheck at one month but did not specify the method. At 43.84 sitting at 99.6% of the CMIA ceiling, the method is the whole result. Adriana is confirming with the laboratory whether LC-MS/MS is available and will book it that way if it is. Correct instinct, unprompted
SchedulingNothing booked yet. The one-month draw and the two-month body-composition measurement both need home-service appointments. My answer: the draw around 16 September, body composition around 16 October
Pending resultsLp(a) was due 13 August, sTfR on the 20th. Both being chased. Neither changes the current protocol — Lp(a) affects how hard ApoB gets pursued later, sTfR completes the iron picture, which is the one part of the panel genuinely unresolved
Prescription signatureThe prescription is transcribed from the physician's own written instructions but is not valid until he signs it. Adriana sends the signed copy when it is back. Everything above is what it says; the signature is what makes it a prescription

12 · What it costs

#MedicationPresentationQtyUnitAmount
1Testosterone cypionate 250 mg/mLBox of 10 ampoules · 2,500 mg · 100 days1$390,000$390,000
2HCG5,000 IU vial1$400,000$400,000
3Retatrutide6 mg vial2$1,200,000$2,400,000
4Somatropin (Pfizer)36 IU / 12 mg cartridge1$640,000$640,000
5CJC-12955 mg vial1$560,000$560,000
6Ipamorelin5 mg vial1$600,000$600,000
7BPC-15710 mg vial · full 8-week course2$800,000$1,600,000
8TB-50010 mg vial2$850,000$1,700,000
Subtotal$8,290,000
Courtesy discount 5%−$414,500
TOTALBank transfer · no surcharge$7,875,500 COP

Included free: 10 sterile transfer vials, 10 five-micron filter needles, 150 U-100 insulin syringes, 2 × 30 mL bacteriostatic water (seven reconstitutions), 200 alcohol swabs, printed medication labels with dose and reconstitution date, a preparation and administration guide, cold-chain packaging, and local delivery in Medellín. Payment by transfer carries no surcharge; a payment link adds 7% ($8,426,785) and PayPal 15% ($9,056,825).

The direction of travel is down. Taking NAD+ out removed a line running at roughly $3,440,000 a month on its own — more than the growth hormone, the HCG and the testosterone combined. The protocol got broader and cheaper in the same revision, which is not the usual shape of these things. And because the testosterone box covers a hundred days, October and November do not carry that line at all.


What I actually think of this

I proposed 250 mg of testosterone a week. I got 175, fractionated daily, with a condition attached that the weekly total does not move. That is the right answer and it is not the answer I asked for.

I proposed washing out the secretagogues. I got told to keep them, with an acknowledgement that my pharmacology was correct and the decision went the other way anyway. Also probably right, and it is the reason the monitoring gap is now the thing I care about most.

I asked whether anastrozole could run at a lower dose. I got told not to start it at all until there is a real estradiol number, measured properly. That is the single best decision in the document — I was arguing about the size of an intervention that should not happen yet.

And the thing I was most attached to, NAD+, got removed entirely. Injection burden down, cost down by more than three million pesos a month, and nothing in the evidence base to defend keeping it.

Four of my positions revised, and the protocol is stronger for all four. That is what paying for expertise is supposed to look like and it is rarer than it should be. A clinic that tells you what you want to hear is not a clinic, it is a shop.

Eight compounds, thirty and a half injections a week, a hundred and twenty days of calendar, and one genuine open risk — three inputs on a single axis with the first measurement scheduled twelve weeks out. I know exactly where that risk is, it costs one extra line on a blood order to close it, and I have asked for it. Everything else is arithmetic and discipline.

First injection of the full protocol: Sunday 6 September. The next real data point is mid-September. I will publish both.

📖
Related Reading

MONSTER 2.0 — The Response — the first round of physician decisions, the 13 August dossier this one supersedes.

MONSTER 2.0 — The Kitchen — the solver-checked meal plan underneath all of this. 2,455 calories, 225 g of protein, 25 recipes.

Seven Foods and a Signed Deal — the same discipline pointed at an 11-year-old and a 9-year-old, which is a much harder problem than pointing it at myself.