4 Months on TRT, Help with Labs

Pharma / TRT Testosterone Replacement
1

Hey everyone,

I am having a few issues I am seeking advice on, hoping I can get it here from ya’ll. Im 28, Im 5’7 and I was about 142 pounds in December with a BMI of 23.2 and a PBF of 15.9. I had my initial blood work done and the results were as follows;

E2 was low, under 15
my total test was 304
my CFT was 6.66
SHBG was 26.15
Vit. D was almost low at 31.8
Hematocrit 46.1

My sex drive and erection frequency/quality were great, but my issues were my mental fog, energy level, muscle weakness and inability to put or keep weight on. I started the Test cyp. at 140 MG a week, and I felt pretty good. My energy level came up, my sex drive was still the same, and I felt really clear mentally. I also started taking vitamin D because I was almost deficient. 6 weeks went by, and I had my second labs done as follows;

Total test came up to 513
CFT came up to 14.3
SHBG went down to 18.7
my Estrogen came up to 35

Everything was still going good at this point, they increased my dose to 180 MG a week. At this point I also was starting to see some weight gain and strength increases. I also started to notice I was getting some acne on my back and my balls were kinda achy and drawing up. At this time I was put on DIM plus at 2 pills a day, plus DHT blocker and I started HCG bi weekly injections of 500 units on days 3 and 5. People started asking me if I was sunburnt, I was starting to look red in the face and flushed. My 18 weeks came around and I got my third labs done and these were as follows;

Estrogen came up to 46.8
SHBG came up to 34.6
Total Test came up to 765
CFT came up to 16
Vita D came up to 60
Hematocrit came up to 50.3

At this point I continued to have strength and size gains, I was up got 157 around this time. They told me my hematocrit was too high, so I donated blood. They also increased my DIM PLUS to 3 pills or 600MG daily. I continued to have acne on my back, but my balls firmed up again after the HCG and no longer ached. They increased my weekly test dose to 210mg. At this point I started to notice that my nipples were itchy, I was a little more emotional than normal, I jumped in weight up to 165 after holding at 157 for weeks. I started having night sweats, hot flashes and I feel like the frequency and quality of erections has decreased as well as my sex drive. I was put on 0.5 MG of Anastrozole once a week 48 hours following my injection. I continue to have the same symptoms, minus the nipple itching. The night sweats and hot flashes seem to be getting worse. I continued on this with the anastrozole for a few weeks, then I had my labs drawn again as follows;

hematocrit is 47.1
total test is 746
CFT is 17.2
SHBG is 32.3
Estrogen is 46.6

They increased my dose again, and I am currently staying on the recommended path of 240 MG of Test Cyp once a week, following by 0.5 MG of anastrozole 48 hours after the injection, as well as my 500 units of HCG on days 3 and 5 plus I continue to take my DIM plus at 600MG a week and my DHT blocker and vitamin D. I continue to have issues with my hot flashes, night sweats, decreased sex drive, decreased erection quality/morning wood frequency. I continue to have acne on my back, my energy level fluctuates, but I would say overall its lower than when I started the first few months, I am back to wanting to take my afternoon naps. My joints are hurting, but I continue to see jumps in strength gains, setting new PRs. I was thinking that, for me, despite what my lab values say, my symptoms indicate that my E2 is still too high for me, but my doc wants to actually lower the dose of my anastrozole. What say you? Thanks!

2

The only dose that you made a point to state that you felt good at was the lowest dose. The pattern in your post is the higher the dose and the more drugs added the worse you feel. If I were a betting man I’d put my money on lowering the dose and cutting the other shit out and see how you feel then adjust in small increments.

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I agree. Your E2 is too high for you, and your dose is probably too high as well. Less is more.

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You overshot your test dosage by a pretty good bit. The high HCT, back acne, and elevated E2 should have clued your Dr in to that. You need to drop back to around 150-180mg, drop the HCG and AI, and get a FULL thyroid panel run.

TSH
T3
T4
Rev T3

And while you’re at it, get a blood test that shows Free T. A Dr trying to design a TRT protocol based on Total T is going in half cocked brother.

Edit… I apologize I just saw that you included calculated Free T in the labs.

With that info…it looks like you metabolize test like a madman!! You should still drop the HCG. That’s just going to compound your E2 issues because AI won’t touch E2 produced in the testes. I also still believe that you should start looking at thyroid.

Your test dose should be backed down until you hit that sweet spot again. You should have stopped increasing when you were feeling good, instead of chasing the numbers. That’s a bad way to fly.

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Original tsh was 1.009 uIU/ML, range 0.450-5.330

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Do you know that you have high DHT? If not i think it is stupid to block something blindly. DHT is a good thing not bad.

It would help with your high e2 sides from manifesting having DHT

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The plan is when I go in next week to ask them about splitting the dose to every third day, backing down to 180 again, reducing the DIM and dropping the AI. I think that’s a good start In the right direction. I’ll probably have to find a primary care and ultimately end up switching away from the clinic. I never found out why I have low t to begin with, so maybe I should drop it all together and reevaluate?

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It is generally good to know the cause before pursuing the treatment, but you may be able to determine that without stopping

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What do you mean I metabolize like a madman? Also, I think if I drop back down to 140-180, my total test should go back to 500, free t around 13 and estrogen around 35 without the Anastrozole and I can cruise there while I figure the rest out

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What I mean is that you have very modest levels for that high of a test dose. Most guys would be at damn near supra-physiological levels on that high of a dose.

You seem to metabolize the test and excrete it out of your system, which is why your serum concentration hasn’t built up to higher levels than where you are now.

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So is that a good thing or a bad thing? If they keep pushing my test dose up to increase my free t lab values, it’s going to continue to increase my E2 and they’re gunna wanna keep me on the AI. So even if I drop my test dose back to 140 and my lab values are say less than modest… that’s still fine though right? I don’t need off the chart test lab values to see results

12

DHT blocker, can you be more precise?

13

The numbers are a good guide for diagnosis, but every person is unique. There’s a certain “sweet spot” hormonally speaking where you’re going to feel your best. Below that level and above you’ll start to feel off and then the further out you go, the worse you’ll feel. It sounded to me like you were way below that level for you and then they kept upping your dose. You hit the spot on the way up because you said you felt way better, but then they increased you again and then the way you felt started going the other way again.

Your body had its own balance that it’s looking for. Not too high. Not too low.

Anytime you make a change, your body is going to raise or lower other hormone levels to try to reach its own balance. This process usually takes about 6-8 weeks per change. That change can be in dosage amount, application method, or the frequency of injections. The time period is usually dependent on the ester of the test you’re injecting, but for Test E and Test C the time line I stated is accurate. During the transitioning period, you can’t really go by how you feel because levels are fluctuating wildly. After you settle, then you assess how you feel and what your numbers are.

If you feel pretty good, then that’s what you’re going for right? “Optimal” for you may very well fall in the middle of established lab ranges, and not so much at the top of the scale.

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Why dont you break up your dosing frequency and see if you can get you t up and e down that way? Do you self inject?

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I’ll ask when I go in next week, I can probably split it if I come in twice a week but I don’t think they will let me take it home

16

Find a new Dr. Im on methadone and i walk out with 27 doses. 2 weeks worth. One of my doses could kill my wife and 3 children if they all split it up. Test will kill no one. Your Dr wont let you leave with testosterone that should tell you something. Call defy. Probably much cheaper too. Your Dr is taking you for a ride

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Well I went in again today this week after my post and I talked to them. I voiced my concerns and asked about lowering my dose, dropping the anastrozole and splitting the injection. They won’t split the injection, and they won’t let me take it home with me, it’s only a “controlled protocol” at once a week and I have to go in to the clinic it. He didn’t want to drop me from 240 to 180, he said I would crash and feel like crap. They kept me at 240, he told me to skip the anastrozole and wait tell I do labs next week and see what happens. I went and saw my primary care, they kinda laughed at everything and referred me to an urologist, I should be able to get in and see them within the month. However, this last week has been better. My sex drive has come up and I’m not having the night sweats anymore but I do feel more tired and weaker in the gym.

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Let them give you more doses and save it for a rainy day.

Go back to your original dose and stay there. Remove the DiMM and make sure you are doing eod or daily injections to keep estrogen at bay.

You need a new doc. Stop fudging with these amateurs who don’t ask how you feel and keep raising T.

My god if they would jsut report on FREE T they would realize low shbg converts to FREE T and estrogen easily. This means you will have estrogen issues with higher doses.

Find a new doc. You jsut toon your Ferrari to a motorcycle mechanic.

Stop playing games with your health.

19

His clinic is doing the injections so he has no choice to take what they give. At least as long as he keeps going to them.

20

What is the reason behind the DHT blocker and what exactly are they giving you to block it?