1 Year Trt Questions from Australia

Pharma / TRT Testosterone Replacement
1

Hey guys, been lurking a while, first time posting.

Brief history and info (not sure what info is relevant to my question at this point as it’s not the typical “do I need TRT question”)
Current stats;
24 Years old
176cm in height
10% bf from 7 point test.
68kg

I have been on TRT for just over a year in Australia Due to damage to my pituitary from an awesome combo of glandular fever and meningitis in 09.
In December 2012 I started TRT with Reandron 1000 (Testosterone Undecanoate)
Every 10 weeks.

I am quite happy with my endocrinologist and he tested almost everything in the stickies before I started and then was happy to get the ones he didn’t do test when I mentioned them. Sadly I cant find the massive pile of papers right now , but I can get anything needed re printed tomorrow when I see my GP.

Anyway my main question is about E2 levels.

E2 is at 33 pg/ml (10-40) (5 weeks after shot)
With my T testosterone at 24 nmol/L (10-33) (5 weeks after shot)

At these levels I have occasional itching, tingling and pain from nipple area.
I also have a few lumps next to my left nipple starting from the outer edge and traveling up toward my arm pit for about 2 inches. There are 4 in total evenly spaced, partly mobile and quite painful towards the end of my shot. At the moment they are small, I estimate 3-5mm in diameter and have only slightly increased in size over the last year (not visible…Yet)

Sadly this is where the doctor differed from the recommendations here and stated that 34 is boarder-line, but not at a point he is happy to treat with an AI and suggested lengthening the time between shots as the gyno was very very minor.

The fact that most of my symptoms occur at the end of the 10 weeks lead me to believe my issues stem from poor testosterone E2 ratio in the last few weeks as by week 10 my testosterone has dropped significantly.
15 nmol/L (10-33) (week 10)
with my E2 level staying almost the same at 32 pg/ml (10-40) (I thought this was odd)

I feel I need an AI and that lengthening the time between shots would not be in my best interest but I would like some more opinions.

If you need more info please let me know, Hope this post was not too nooby for you all!

Thanks for any help guys!

2

Bump

3

Smaller amounts more often might be better. What does your doctor say about that?

4

Hey man, I’ve no experience with TRT so I’ll refer to what others on the forum have said. Not meant as hard advice but some things you could look into:

E2 at 34 is somewhat high (the target advocated here is 22). Granted, it’s still in range but keep in mind those labs were taken 5 weeks after the shot, which brings me to another point. E2 levels follow T levels because T is the substrate for aromatization so the more you have, the more E2 you’ll have, so your E2 levels were probably higher than that from weeks 1 to 5.

Along these lines, your E2 should drop as time goes by and your T levels fall and it is odd that your E2 levels at week 10 were almost identical to your E2 levels at week five. This could be because you’re not clearing it efficiently. The liver clears E2 so liver function labs may be in order to assure it’s functioning isn’t impaired and causing E2 pooling. Are you experiencing any other E2 related side effects?

It seems to be universally accepted that more frequent shots are better because they yield steadier levels of T. Lengthening the time between shots would only do the opposite so it’s a very odd way to approach the problem.

I think most people here would recommend a new TRT protocol where another T ester with a shorter half life (like enanthate or cypionate) is injected 2-3 times per week and the use of an AI like Arimidex or Aromasin. This would provide a steadier and better T/E ratio and hopefully take care of developing gyno. You could talk to your doc about it.

In my opinion (the opinion of some unexperienced dude behind a keyboard, mind you), your E2 is indeed a problem regardless of it being in range at the time the test was taken. The fact that you have symptoms is indicative enough so I think it’s in your best interest to treat it and not wait until the condition worsens,

Best of luck and hopefully everything will get sorted out.

5

We have seen effects from infrequent high doses of T cypionate or ethanate that are similar to your issues. If you had steadier levels of T, E2 would be lower and FT should on average be higher as SHBG should decrease to some extent.

Please read these stickies:

  • advice for new guys
  • protocol for injections

When I had high TT and FT with E2=37pg/ml, I felt horrible. I would never say that E2=34pg/ml was OK.

6

[quote]seekonk wrote:
Smaller amounts more often might be better. What does your doctor say about that?[/quote]

Reandron is a single use snap off vial thing so I cant really get say half injected. Also doc wont let me self inject.
I could switch to another compound (testosterone enanthate) but the minimum injection period he uses is 2 weeks, still a huge roller coaster. Is that any better that what I am doing now?

The doctors here in Australia don’t seem to want to do anything recommended by pretty much everywhere else!

7

[quote]KSman wrote:
We have seen effects from infrequent high doses of T cypionate or ethanate that are similar to your issues. If you had steadier levels of T, E2 would be lower and FT should on average be higher as SHBG should decrease to some extent.

Please read these stickies:

  • advice for new guys
  • protocol for injections

When I had high TT and FT with E2=37pg/ml, I felt horrible. I would never say that E2=34pg/ml was OK.[/quote]

Wow guys thanks for all the replies.

KSman I have just gone and read those particular stickies.
I find myself thinking… I think my Endocrinologist is an idiot…
Lots of info and I will try to absorb as much as I can tonight and I am seeing my GP tomorrow. I am getting some blood tests back from him and I think I will be asking for a few more!

Glad to know I’m not crazy for thinking 34pg/ml is too high.

I will do a big post up tomorrow with the full stats suggested in the sticky and blood results.

Don’t suppose anyone knows a TRT savvy doc in Brisbane Australia?
Might have to just call and email them all!

8

[quote]KSman wrote:

I would never say that E2=34pg/ml was OK.[/quote]

It’s really not necessarily high.

This study found a mean E2 = 30 pg/mL (ranging between 23-36) in healthy young men (I converted from pmol/L) with mean SHBG of 24 nmol/L. Interestingly, it also found that young men had about 50% HIGHER bioavailable E2 than older men (due to lower SHBG in young men), suggesting that problems such as bone loss in older men is from too little bio E2, not too much. Also, suggesting that if your SHBG is more than 24 nmol/L, you probably need E2 of more than 30 pg/mL to compensate.

http://press.endocrine.org/doi/full/10.1210/jcem.86.8.7736?view=long&pmid=11502778

Another study I saw the other day found a mean E2 of 33 pg/mL for young males, which is close to the above. Can’t seem to regoogle it though and didn’t save the reference. MIght try to find it if I have time later.

Since the OP feels good during the initial few weeks and less good during the final weeks, this suggests the problem is not high E2 but rather falling T levels.

9

TRT guys often feel better with lower E2 levels. That is a fact. What is found in the population does not really matter when a guy feels better with lower E2. To flip the coin, take guys with E2 in the lower 20’s, increase to 30 or whatever and see if they feel better or worse.

When T levels are high, T–>E2 is also occurring in tissues for local consumption. That happens in the brain. Thus serum E2 levels do not fully determine the effective levels of E2 in the brain. Ditto for bone.

We see guys with bone loss with low T and estrogen dominance.

E2 also creates risks for heart disease, insulin resistance and prostate enlargement.

Low T leads to a catabolic state characterized by loss of collagen. This results in thin skin and sagging facial features. But, out of site, the collagen matrix that forms the bones also becomes degraded. The integrity of the mineralization of the bones is then compromised. As bone turned over, it is torn down and rebuilt. The resultant state of the collagen matrix is thus degraded.

10

The problem with using AIs to reduce E2, though, is that we don’t know if the AI might be interfering too much with the T->E2 conversion you mention in some tissues, say brain, bone, or skin, or just enough to make your brain feel good but at the same time too much in the blood vessel linings, for example. We would not be able to see whether this is the case from serum E2 levels.

So if we are going to “do better” by ignoring the example of the healthy young population, we need a damn good reason to be sure we are not doing harm. Lots of things that make us feel particularly euphoric are not good for us in the long term.

In any case, we are not really talking about lots of men on TRT but about the OP. The OP said he feels good in the first weeks after the injection, at an E2 level of around 34, which really suggests that E2 is not the culprit here.

11

Honeymoon effect: The way that one feels is all in the brain. We see guys feeling great on T only at first, but by 6 weeks they have problems. The level of E2 that did that was probably achieved within one week. It takes time for E2 to make the changes in brain function that make guys feel wrong and also decrease libido. So when someone says that they feel good in the first few weeks, I file that under transient conditions. Elevated E2 changes brain function and brain patterns, that takes time. Conversely, when one’s brain has been exposed to higher E2 levels for a few months, getting normalized after E2 levels are “corrected” takes time as the brain patterns take time to adjust.

It all really adds up to how one feels. If one feels better at E2=22, what else is there to worry about? Many young virile men have E2 levels that low. If you feel good, E2 levels in brain tissue cannot be pathological.

The arterial endothelial cells are one cell layer thick. I see no reason to think that the E2 levels in those cells is not represented by serum E2.

The big problem is high hCG doses or high SERM induced LH where anastrozole cannot reduce high T–>E2 in the testes. If one used high AI doses to try to control this situation, peripheral T–>E2 would then be pushed very low. But in that case, serum E2 levels are still elevated and that will tend to have some effect off-setting the effects of the AI. There really is no info about this, only the interferences. Again, how one feels and their libido all the real indicators that matter.

We have many reports of guys feeling very down with E2 in the mid thirties and above and feeling great with an AI. That is real data. In any case, if someone feels to the contrary, they can adjust or stop the AI. A few feel better on aromasin than with anastrozole, you can only go with what works.

When guys feel bad with E2 in the thirties on TRT with high TT/FT, there might be this going on: The brain gets exposed to serum E2. But the brain also is exposed to T–>E2 inside the brain. So there may be problems from both of these combined factors. Serum E2 is then only a partial measure of brain E2 levels. In that case, lowering serum E2 and in-brain E2 production with an AI makes sense if the result is felt to be good. If we take how we feel and libido as our guide then the suggested serum E2 levels achieved with an AI while on TRT might be accepted as optimal for the brain. So E2=22pg/ml may be optimal if one feels optimal.

We see some guys with E2=22pg/ml who have low T. Do they feel optimal? No. They are estrogen dominant. When a guy has high TT/FT on TRT+AI and E2=22pg/ml, brain E2 levels will be higher than the guys who has low E2, but they are then not estrogen dominant. With natural guys, the HPTA does not allow high T and high E2 at the same time. But when we do TRT and get high T and high[er] E2 levels at the same time, the E2 effects in the brain can be high and un-natural. I am not attempting to make a crystal clear picture of what is going on, but trying to show that there are complex interactions and implications.

Some are very much more sensitive to E2 than others. When I started AI at 37 I felt a lot better and landed near 22pg/ml. But over time my E2 crept up to 28, reasons unknown. I increased anastrozole dose and I felt better getting back to 22pg/ml; using the dose adjustment math described by me elsewhere. I had been feeling off, then felt better. For me, my general sense of well-being and libido are in lock step. While one can be uncertain about their mood etc, libido is very much easier to self-quantify.

Calling wolf and stating that AI is a problem seems like bad advice. We know that AI makes most feel better when E2 is elevated. They can tune the dose and E2 levels and do what works best for them. We also know the elevated E2 is a risk factor for arterial disease, prostate problems, libido and mood problems. Does AI work flawlessly for every guy? No. But we have to work with the tools that we have. Again, for those who do not do well on anastrozole, there is aromasin. If nothing there works, they can do without AI and again, they are just doing what feels optimal for them.

12

[quote]KSman wrote:
Honeymoon effect: The way that one feels is all in the brain. We see guys feeling great on T only at first, but by 6 weeks they have problems. The level of E2 that did that was probably achieved within one week. It takes time for E2 to make the changes in brain function that make guys feel wrong and also decrease libido. So when someone says that they feel good in the first few weeks, I file that under transient conditions. Elevated E2 changes brain function and brain patterns, that takes time. Conversely, when one’s brain has been exposed to higher E2 levels for a few months, getting normalized after E2 levels are “corrected” takes time as the brain patterns take time to adjust.

It all really adds up to how one feels. If one feels better at E2=22, what else is there to worry about? Many young virile men have E2 levels that low. If you feel good, E2 levels in brain tissue cannot be pathological.

The arterial endothelial cells are one cell layer thick. I see no reason to think that the E2 levels in those cells is not represented by serum E2.

The big problem is high hCG doses or high SERM induced LH where anastrozole cannot reduce high T–>E2 in the testes. If one used high AI doses to try to control this situation, peripheral T–>E2 would then be pushed very low. But in that case, serum E2 levels are still elevated and that will tend to have some effect off-setting the effects of the AI. There really is no info about this, only the interferences. Again, how one feels and their libido all the real indicators that matter.

We have many reports of guys feeling very down with E2 in the mid thirties and above and feeling great with an AI. That is real data. In any case, if someone feels to the contrary, they can adjust or stop the AI. A few feel better on aromasin than with anastrozole, you can only go with what works.

When guys feel bad with E2 in the thirties on TRT with high TT/FT, there might be this going on: The brain gets exposed to serum E2. But the brain also is exposed to T–>E2 inside the brain. So there may be problems from both of these combined factors. Serum E2 is then only a partial measure of brain E2 levels. In that case, lowering serum E2 and in-brain E2 production with an AI makes sense if the result is felt to be good. If we take how we feel and libido as our guide then the suggested serum E2 levels achieved with an AI while on TRT might be accepted as optimal for the brain. So E2=22pg/ml may be optimal if one feels optimal.

We see some guys with E2=22pg/ml who have low T. Do they feel optimal? No. They are estrogen dominant. When a guy has high TT/FT on TRT+AI and E2=22pg/ml, brain E2 levels will be higher than the guys who has low E2, but they are then not estrogen dominant. With natural guys, the HPTA does not allow high T and high E2 at the same time. But when we do TRT and get high T and high[er] E2 levels at the same time, the E2 effects in the brain can be high and un-natural. I am not attempting to make a crystal clear picture of what is going on, but trying to show that there are complex interactions and implications.

Some are very much more sensitive to E2 than others. When I started AI at 37 I felt a lot better and landed near 22pg/ml. But over time my E2 crept up to 28, reasons unknown. I increased anastrozole dose and I felt better getting back to 22pg/ml; using the dose adjustment math described by me elsewhere. I had been feeling off, then felt better. For me, my general sense of well-being and libido are in lock step. While one can be uncertain about their mood etc, libido is very much easier to self-quantify.

Calling wolf and stating that AI is a problem seems like bad advice. We know that AI makes most feel better when E2 is elevated. They can tune the dose and E2 levels and do what works best for them. We also know the elevated E2 is a risk factor for arterial disease, prostate problems, libido and mood problems. Does AI work flawlessly for every guy? No. But we have to work with the tools that we have. Again, for those who do not do well on anastrozole, there is aromasin. If nothing there works, they can do without AI and again, they are just doing what feels optimal for them.[/quote]

This is one of the most informative (if not the most informative) posts I’ve read on the subject.

13

Hey guys thanks for all the info.

I have a new doc who is willing to try more frequent shots to reduce estrogen.

I had a chest ultrasound to check my chest for gyno.
The report said “There is a prominent appearing fat lobule in this region (left pec) though no definite evidence of a discrete lipoma”
Couple of questions about this, could this fat lobule be from estrogen? Can a lobule be burned off by losing body fat?
This lump is concerning me as even if it isn’t gyno it really is starting to look like a boob!

14

Quick update, I switched to weekly shots, getting T and E2 tests done in a few weeks to see how much the shot frequency helps.

15

Coming up to my second weekly shot, all good so far, will keep updating here.

16

Quick question, when should I do blood tests after switching to weekly, my doc has my next one in 7 weeks right after a shot then another right before the next one, Is this too far away?

17

Hey mate, I’m a fellow Brisbane resident.
I am in the same position, chronically Ill and two shoulder reconstructions for which I was taking opiate painkillers for too long (halts production of test) have left my testosterone in shambles, which my doctor has confirmed, but know nothing about trt.
Could you do me a favour and give me the name of your Doc?
Thanks mate.

18

[quote]italstal86 wrote:
Hey mate, I’m a fellow Brisbane resident.
I am in the same position, chronically Ill and two shoulder reconstructions for which I was taking opiate painkillers for too long (halts production of test) have left my testosterone in shambles, which my doctor has confirmed, but know nothing about trt.
Could you do me a favour and give me the name of your Doc?
Thanks mate.[/quote]

Hi italstal86,

I live in Brisbane and I recently did what I saw suggested somewhere here and rang a few compounding pharmacies and asked them for doctors who provide TRT. Some of them even have lists on their website. I have only tried one so far and I have only seen him once. Seems ok so far but I would like to see him again before I pass judgement.

19

Hi Waggat,

Thanks for the reply.
How is the treatment going so far?

Thanks

20

[quote]italstal86 wrote:
Hey mate, I’m a fellow Brisbane resident.
I am in the same position, chronically Ill and two shoulder reconstructions for which I was taking opiate painkillers for too long (halts production of test) have left my testosterone in shambles, which my doctor has confirmed, but know nothing about trt.
Could you do me a favour and give me the name of your Doc?
Thanks mate.[/quote]

Hey guys it has been sooooo long since I posted an update.
Firstly italstal86 it can take a LONG time for test to recover from opiates I have seen recovery take over a year before normal test levels return!
If you are still around send me a PM with more info (opiate dosage and duration) and I will help you If I can.

On to my results from switching from 1000mg test undecanoate every 10 weeks to 100mg/ week. (same dosage, more frequent injections)
Long story short, I switched to weekly shots and after about a month was the man before I got meningitis. Everything changed. My endocrinologist had said there was no way changing my shot frequency would lower E2, he was so wrong. It put it a the bottom of the range! From the top all the way to the very bottom, no dosage change, just smaller more frequent injections.

He also said E2 would not have negative effects at my levels. Once my E2 dropped, my nipples basically became normal bit of skin with absolutely zero odd sensitivity! My dick became so hard when I got horny it kinda hurt and throbbed, a sensation I had not experience in half a decade, my girlfriend loved this change!

So on to my workouts. I no longer lose strength for 3 weeks before my shot. So my gains in the gym are insane. I have gained some serious mass and dropped body-fat. I have proper shoulder striations show for the first time ever!
I have added 3-5 pound per week to my deadlift, its slowing down now but over 100 pound increase! AMAZING!

I am waiting to hit a plateau in my training and then I was thinking about doing a small test only cycle.
I wanted to have my levels stable for 6 months and know how use my diet effectively before even considering doing a cycle. Now I am getting close to this point I would also like to be slightly more flexible through the legs and shoulders before I put that much pressure on the body.

Now what would you guys suggest in terms of when to cycle when already on trt.
I am in no rush at all and would like to do it properly!
Do you guys suggest similar strength and weight goals for me as a non trt persons first cycle?
I am a long way off 200 pounds still personally I thought 175 while lean would be a great base to start from (still some work to go to even get there lean).
How many people suggest no cycling at all? Or perhaps should I be on a stable dose for a full year or two before I start to fiddle? I would of course have bloods taken frequently to check for sides that I cant see or feel.

Now finally. A HUGE thank you to everyone here who has helped me get to this point!
your knowledge has been the single biggest impact upon my health and well being for the last 9 months or so and this can’t be understated.

THANK YOU ALL!