After my last bloodwork on May 12th, I changed my protocol to the following:
50 mg Test Cyp EOD via SubQ
No anastrozole (overresponder, estradiol was at 11pg/mL)
No HCG (doctor wants me to cycle)
I have attached updated bloodwork pulled 48 hours after my EOD injection (6/21/16). I am happy with the results as my total T jumped to 1024 ng/dL and assuming my albumin hasn’t changed from my first set of labs free T should be 31.1 ng/dL (3.04%).
With the increase in T, I had a huge increase in estradiol to 61.3 pg/mL. I need to start taking anastrozole again and am trying to calculate my dose adjusted for the increase in weekly Test Cyp. Here is my thinking:
Old estriadiol of 11 pg/mL divided by goal of 22 pg/mL equals .5 multiplied by .5 mg equals an adjusted dose of .25 mg at 120 mg Test Cyp per week.
To account for the increase in weekly Test Cyp to 175 mg (average with EOD injections);
(.25 mg adjusted dose X 175 mg new Test Cyp dose)/(120 mg old Test Cyp dose) = .36 mg anastrozole per week.
.36 mg anastrozole per week comes out to about .1 mg EOD with injection of 50mg Test Cyp.
Do these calculations sound correct?
I will be bringing research provided from this website and others regarding continuous HCG at a low dose to see if my doctor will get on board with eliminating the cycling. I felt better with HCG and would prefer to keep my testes working.
How have you felt since starting TRT? You’ll have to take minimal doses for AI if you’re indeed an over responder. I, myself have been on for 5 weeks now but haven’t had a response apart from better morning wood.
It has been a bit of a roller coaster, I wasn’t one of the lucky guys who got everything right with the initial prescription. My initial dosage had my T way to low, my estradiol to low, I didn’t feel any better and was holding a lot of water.
After increasing my T dosage and stopping the anastrozole, I had a week or two where I felt amazing. Energy, libido, ED all improved enormously. My guess was that my T rose with the increased dosage, estrogen increased from stopping anastrozole, and I hit the sweet spot for a short period before my estrogen continued to rise and then was to high.
Now that I have my total T where it needs to be, I am hoping I can dial in my estrogen levels and stay in that sweet spot I experienced for a week.
I started the Anastrozole dosage mentioned above and am feeling 10 times better, so it sounds like I was right about swinging through the ideal E range. I ordered a sensitive estradiol test from discount labs and will get blood pulled tomorrow to see where my E is at after adjusting the Anatrozole.
I am so glad I finally seem to have everything working right. I feel great, loads of energy, libido through the roof, ED non existent, recovering in the gym quickly, and weight is finally coming off. Water weight is under control now as well, guessing it was related to high E. To anyone wondering if TRT is worth it and struggling with getting everything working correctly, I can tell you that in my opinion it absolutely is.
On another note, my doctor wants to cycle HCG even at a dose of 1000 iu a week. I found a few studies that speak to long term use of HCG, but nothing that definitively shows that low dose HCG does not cause LH desensitization. Does anyone know of a study on low dose HCG and desensitization or is everything anecdotal at this point?
That was addressed in a 2015 study of 250iu hCG SC EOD that was determined to be a replacement dose for LH in normal males repressed by T injections where intratesticular testosterone levels were sampled by fine needle aspiration. OUCH!
The paper suggested that this dose was creating roughly the same LH receptor stimulation as a naturally occurs with LH and that this dose would seem to have no risks of LH receptor overload or over stimulation; so they concluded that receptor desensitization was then not a likely concern.
The paper was titled “low dose” because many doctors and BB guys have [wrongfully] advocated insane doses.
Glad that anastrozole has turned your ship around. Now you too can be a estrogen control zealot!
I have at time suggested to those with heightened concerns for fertility that they could at times switch from hCG to Nolvadex 10mg ED to get some FSH in the mix. But to be honest, you still end up with stimulation of the LH receptors. If your doc is worried about constant LH receptor activation, then perhaps he would like to see all normal males have their LH turned off on cycles to protect from some imaginary risk of been normal.
Thanks KSman. That was one of the studies that I read but it unfortunately it is only for a 3 week duration. I agree with the conclusion that mimicking physiological levels of LH with hCG will likely not cause long term LH desensitization, but my doctor wants a study proving long term hCG use will not cause LH desensitization. I cannot find any long term studies on LH desensitization specificaly, but the following study seems to indicate that after 1 year of low dose hCG semen production had not decreased:
I am not by any means an expert on the HPTA system, but if after one year of low dose hCG semen production was still up, it is probably safe to assume that the body has not built a tolerance to hCG.
This study seems to indicate that after 1 year of hCG alone, semen production did decrease slightly indicating there may be some validity to low:
When do you take your anastrozole on an EOD injection schedule? I take it with my injection but if Test Cyp peaks at 72 hours from injection, I am wondering if there would be any benefit to taking the anastrozole between my injection days when total testosterone is peaking. My last two blood draws occurred 48 and 72 hours from my injection and total T was higher on at the 72 hour mark with the same T dosage.
Adex doesn’t work more or better or harder in the presence of more T. Adex is drug that attaches to the enzyme responsible for converting T to E2. When it’s attached, T can’t attach and be aromatized. You have a certain amount of this enzyme in your body. As long as you take the adex on a regular basis, you will always have some of the enzyme blocked. Think of the enzyme like parking spots at your favorite restaurant. Think of adex as the number of cars always parked in some of those spots. Think of the T as the cars that want to get into the vacant spots. When you are on TRT, you always have more cars than spots available. So it doesn’t matter if your T fluctuates a little. Your E2 will be good so long as you have enough on board on a regular basis.
Great analogy and thanks for the input. I didn’t realize that Adex response was not correlated to the amount of T in your blood. That’s good to know as if I ever increase my T dosage I do not necessarily need to increase Adex accordingly. Are you on EOD injections and when do you take your Adex?
I inject the T cyp on Sunday mornings and Wednesday afternoons. Currently I take the Adex at the time of the shots just for convenience. However, I’m thinking about taking the Adex Sundays, Wednesdays, and Fridays. I take 1.75mg now and am hoping to cut that to 1.5mg with the new protocol. I won’t know the effectiveness of this until I run labs in late October. Of course, if I develop symptoms, I’ll adjust sooner.
With EOD injections, T levels are very steady with multiple injection sites active. So timing of AI with steady T levels is not a problem and then taking AI when you inject is simply a easier routine to live with. A twice a week protocol is close to the same, useful for those who do not find injecting EOD desirable. Is that optimal? Perhaps not, but many have good results doing that. With hCG, EOD is a good idea and that can drive all of T+AI+hCG as a good routine.
@ddillon I am pretty much in the same boat as you. If you are still around on the forums it would be great if you could give us an update how things are going. Thanks!
Happy to follow up. Things are going very well 4 years in. Took a bit of testing to get my numbers where i wanted them, so i used some blood testing services outside my doctor to see results more frequently. After about a year of treatment, everything improved significantly; weight loss, sex drive, energy, focus, etc. It wasnt until I felt better that i realized how much low t was affecting me. The symptoms creep up on you slowly and you believe to begin it’s the norm.
I did have a low sperm count over a year ago even after using HCG the entire time. Added FSH and within 6 months my sperm count was above normal, wife just delivered our son last week. FSH isn’t cheap, but it worked for me.
Routine is still EOD for t shots and adex in vodka.
Can’t speak to clomid for fertility. I’ve heard it works, but have no first hand experience. I didn’t want to deal with potential side effects or get off t replacement. FSH was $500 a month via a compounding pharmacy and i was able to stay on test. Will use again if we go for a second kid.
To be clear i used HCG from day one of t replacement and i still had a low sperm count. I may have had a low count before starting trt that hcg couldn’t bring up. I’ve read hcg works better at maintaining levels that are already within range.
FSH is what brought my levels up. I did a sperm test 6 months after starting FSH and was well within range. Wife didn’t get pregnant until a year in due to some complications on her end.
I don’t know your age, but we got a late start on kids and wanted to get pregnant asap. I wish i would have pushed harder for my doctor’s to check my wife and i earlier to identify any potential hangups. The issue my wife was having was remedied within a week and she was pregnant the next month.
I’m in a similar boat age wise, 36, no kids, so trying to get things moving. I’m about to start HCG and we’ll go from there I guess
Did you do fsh and HCG or just fsh once you saw hcg wasn’t working?
I’ve been on TRT for probably 6-8 months now without HCG so I’m sure I’m low now. I’m starting to think I might need fsh to get things back up enough but I guess we’re going to see. Don’t want to spend the $500 a month on fsh if I don’t have to
