Many guys crash their e2 with just .5 on normal trt dose.
Many don’t even need any AI with 100 mg a week. That with HCG. Now you can see a big jump on e2 from HCG. Everyone is different.
E2 and levels take at least a month to stabilize.
Guys see high e2 symptoms early on in treatment. Take ai - then crash- then stop ai- then e2 back up because not stable yet- and it goes on and on.
It is usually best to lower t dose and HCG to get an acceptable e2 with little to no sides. The AI is extremely difficult to dose on a trt long term treatment.
New lab results doing 50mg Cyp 2x a week, 50mg clomid ED, .25mg AI EOD for about 2 months now.
Total Testosterone: 1,238 (300-1,080)
Estradiol: <17 (<50)
SHBG: 47 (15.5-55.9)
Free test and bioavailable test were supposed to be on there… thinking they just haven’t posted yet. LH and FSH numbers weren’t on the test but i’m curious where those are at. I understand 50mg clomid every day is high, but i was taking 75mg EOD and my balls had shrunk considerably so i upped it to 50mg ED and they have gone back to normal size. I really think switching to injecting 2x a week really helped. This represents the highest levels my testosterone has ever been since beginning treatment. I wish I could say that all of my symptoms are the best since treatment. I do feel 100% better overall, but some symptoms seem to have gotten worse since starting testosterone which i didn’t think would happen. My energy and motivation has seemed lower… my brain fog has gotten worse, especially at work it’s hard to focus on work, weight loss/muscle gain hasn’t been spectacular, but my diet and exercise routine has been completely wack up until a few weeks ago when some normalcy has come back. In other areas things are really good… I used to require 200mg of sildnafel in order to maintain an erection, but recently i’ve been able to drop to 150. I am getting morning wood pretty consistently (only a couple months ago I was getting 0 erections), also random erections throughout the day, and very high libido. Curious on everyone’s thoughts on this update, however, I will say I’m planning on staying this same regimen for at least 6 months so that my body can normalize and get used to the new therapy.
Update on symptoms… no updated labs as of yet other than what is listed above. Due for more labs in the next month or so.
Current protocol (consistent for the past 4 weeks or so): 60mg test cyp 2x a week, 500iu 2x a week. .25mg AI 1x a week after injection.
Libido has come back down from sky high where it was. Still higher than before starting TRT.
Erections are non existent… back to having to use 200mg viagra to maintain erections… morning woods are completely gone, no random erections throughout the day (maybe one a week if i’m lucky). Testicles have also shrunk REALLY bad. The 500iu HCG isn’t cutting it. Talked to the office and the urologist prescribed me 1,000iu HCG 3x a week which sounds very high. I’m going to start with 750iu 3x a week and work my way up. I also understand that higher doses of HCG cause E2 to spike so i’m going to keep an eye on that as well.
Taking the AI once weekly could be a problem, I would expect after the AI wears off that estrogen would be higher at the end of the week and lower in the beginning. The anastrozole half life is 30-50 hours, so estrogen will change dramatically. Erections need steady estrogen levels.
Thanks for the response @systemlord as always. I’m breaking my 1mg AI tabs into quarters and can’t get them much smaller (already feel like they aren’t exactly .25mg (try to get it as close to the middle as possible with my pill cutter). I’ve heard of diluting it with alcohol. Any tips or videos on how to do that with pill form?
In regard to the HCG, so maybe 500iu EOD? Still equates to close to 2000iu weekly.
Compounding pharmacies go as low as .125 and even 0.050 anastrozole. I have no problems cutting up aromasin into 1/20ths, it’s probably better to grind it into powder form and wet the end of a Q-tip or im my case toothpick and whatever sticks consume.
You’re going to have to get creative.
Give it a try, if you don’t respond to that, perhaps you never will.
Yeah I do understand this may be an issue. When I started TRT at 50mg of test 2x a week, I was doing .5mg of AI EOD. I was on this protocol when the above labs were done. Once I got the labs back I dropped the AI for 4 weeks and then started to feel like crap so I added a small dose .25mg per week.
Updated labs… there was a lab error and for some reason my testosterone levels were not recorded. Just had testosterone only drawn today hopefully will have those results soon.
However, even without testosterone i’m interested in thoughts on some other levels… Hematocrit and RBC are pretty high, do you think I should donate blood to help with that? Also noticed that SHBG is higher… i’ve been taking boron, zinc, and magnesium to try and combat the high SHBG. Would more frequent injections help? I’m doing 2x a week. I’ve also completely dropped the AI and it has seemed to go to a normal level which is good to see.
I went to see a new Endocrinologist for another opinion. She really seems to care and understand which I haven’t typically found with female doctors in relation to these kind of issues. Our first appointment was about 1.25 hours and we went over my pretty complicated medical issues I had when I was born and also the unique upbringing I had being raised a very strict/conservative home. She gave me a pretty involved physical exam and thinks that there may be something going on with my pituitary affecting all of this as well as possibly some sleep disorder possibly. I got the MRI done yesterday and am waiting to hear results. She also ordered labwork, some of which I’ve never had drawn before such as IGF-1 and ATCH.
ACTH 22.7 NORMAL
Reference Range: 7.2-63.3 PG/ML
IGF-I 192 NORMAL
Reference Range: 103-341 NG/ML
I noticed quite a few of the labs came back with high or low markers (attached). Any input appreciated.
A sleep disorder (sleep apnea) would see high hematocrit levels do to a lack of oxygen during sleep which the body would then increase hematocrit to compensate.
Ferritin is on the lower end, it may indicate your body’s iron stores are low and you have iron deficiency. I’m not seeing adequate thyroid testing, no Free T3 or Reverse T3.
MRI of Pituitary update: all came back normal. Honestly, beyond frustrating to me… I was really hoping for answers. Endo is still push the sleep study, but I really don’t think I have any sleep disorders, however, it could explain why I’m tired all the time? I do snore.
Diet could definitely be better on the weekends, but during the week it’s pretty solid. Have never taken any iron supplements of any kind.
Labs from my March 5th post include:
Free T3: 3.6 (2.2-4.2)
Free T4: 1.66(.8-1.9)
TSH: 1.27
Honestly… I’m at the point where i’ve been on TRT for close to a year now and the ONLY difference I’ve noticed is increased libido and some increased muscle mass. Maybe slight improvement to mood. However, i’m still experiencing severe ED which hasn’t improved, no energy, anxiety, no focus/brain fog, always tired even if I get 8-10 hours of sleep. I’m frustrated to the point where I’m debating quitting all of TRT if i’m not really seeing results with it. I’ve only heard people getting no results from TRT if they have thyroid issues but my throid levels don’t look bad. I’m thinking of getting some T3 and trying a low dose for 6 weeks to see if it helps at all (maybe 25mcg ED). A doctor friend recommended possibly going down the path of looking into seeing an infectious disease specialist to check for other options such as ILADS, chronic mono, CMV, and EBV.
Sorry I didn’t notice it before, but your calculated Free T is low, if accurate would explain why erections are difficult to maintain and are tired all the time. Recently I scored a Free T above midrange (16) and had some symptoms of low testosterone, feeling tired all the time, brain fog, no energy (sound familiar?) and doctor increase my dosage and already feel better.
Energy is increasing, stronger, brain fog disappearing, you get the picture.
You’re not even at mid range on your Free T levels, I’m surprised you want to quit so easily when your Free T levels aren’t even close to optimal. You just need more fine tuning to dial-in is all. The problem with endo’s is once your levels are normal and inrange, they pretty much call it a success without truly optimizing your levels and is why I recommend not to seek out an endo for TRT.
That’s the sick care mentality, if you ask me you need to seek someone who specializes in TRT, endo’s are usually no help at all because they are operating on little to no knowledge and do not know how to help and often prolong suffering for years to where you end up wanting to quit TRT.
You may need higher levels in order to increase Free T to the optimal ranges which your endo may not be able to accommodate you. Most men need Free T at the top of the range to feel good, frankly you sound as if you are suffering from low testosterone (feeling tired all the time) even though you are on TRT.
Thank you for your informative response! I do have some extra vials of T, so i’m going to try and bump up dosage and see what happens. Have been on 60mg 2x a week of T Cyp. Do you think bumping to 100mg 2x a week is too much? Should I add AI? I currently am not taking AI. Would you recommend adding an iron supplement? If so, what kind? The doctor’s office said that the endo wanted to talk to me about my prolactin levels. Is there any concern around my levels from my last lab results?
I would go to 160mg, if you want to lower estrogen, increase injection frequencies. Injecting smaller doses lowers estrogen. I prefer changing to foods rich in iron and an iron supplement allow my body to get what it need naturally as well, this helps with gut health because you are breaking down this important minerals the natural way.
Prolactin levels are fine, you doctor is just following his training of chasing reference ranges, doctor sees levels .8 points above range and freaks out. The fact that your doctor is even concerned or wants to waste time talking about it is troubling.
We’re not robots, we are all biochemical unique, it’s not even a whole point over the range.
