I Need a Little Help - Defective Male

Pharma / TRT Testosterone Replacement
1

I’m trying to find the correct TRT-dose for me, without compromising my general health too much.

After undergoing surgery on my testicles. Long story short - I was born with non-obstructive-azoospermia with elevated FSH (approx 21 - 28 nmol/L) - and had pretty much terrible hormone levels throughout the age of 16 - 28. I’ve been suffering from depression, fatique, memory loss and physical limitations my whole life. I couldn’t do shit about it, because I wanted the chance to get a child.
Thankfully I am about to have my one and only biological child. (9 single sperms out of two cut-open testicles, btw)

They refused to help me with my hormonal situation, as my free testosterone was the highest it has ever been throughout 10 years. 0,300 nmol/L.
I was having so many problems post-surgery, that I was about to literally kill myself from sadness. So I grabbed my balls and went on HRT.

I’m approximately 10 weeks in, and I feel fucking amazing. No mental issues, no libido issues, fatique gone, sleep incredible. Pretty much happy overall. I literally feel alive.
These are the numbers from my blood draw taken 3 days after my pin (trough, I think it’s called?).

I’m on
250 mg Test e (pin mon/thurs 125mg each).
0,75 g adex (I wanna drop this down eventually).
25 mg proviron (I dropped this out 2 days prior. Only feel slight libido increase. The test feels big enough of a boost).

Blood levels pre surgery:
SHBG: 18,9 nmol/L
Free test: 0,193 nmol/L
Total test: 7,41 nmol/L
Estrogen: 0,09 nmol/L
LH: 9,4 nmol/L
FSH: 19 nmol/L
HDL: 0,9 nmol/L
LDL: 2,2 nmol/L

Blood levels post surgery:
SHBG: 15,7 nmol/L
Free test: 0,300 nmol/L
Total test: 10,8 nmol/L
Estrogen: 0,11 nmol/L
LH: 11 nmol/L
FSH: 24 nmol/L
HDL: 0,9 nmol/L
LDL: 2,2 nmol/L

Blood levels after TRT:
SHBG: 11,8 nmol/L
Free test: 0,951 nmol/L
Total test: 29,9 nmol/L
Estrogen: 0,10 nmol/L
HDL: 0,8 nmol/L
LDL: 2,2 nmol/L

From the latest blood draw I can conclude, that my free test is in the upper-range, but still rather low compared to the dose of 250mg test e. I’ve consulted my doctor who explains it might be because of my low SHBG. But they wont help me more than that.

My plan is to slowly go down in dose 250 → 200 → 150, etc. Wait 6 weeks after changing dose and get a new blood sample.

I’m just confused if this is the correct way of doing it. Because I actually feel really good - and I don’t feel any side-effects whatsoever. Generally, I feel like this dose is perfect for me and I wouldn’t be sure if going down would help. I’m also unsure if the 0,75 g adex a week is gonna be healthy in the long run, together with 250 mg test e…

tldr:
I have low SHBG, which might(?) result in low free test on trough. I need guidance on whether to drop down from 250mg test e/ 0,75 g adex, or stay put. I feel really great atm with no sides.

2

You want to change all that because? Not sure you want to mess with this if it is not broken, I would not know what to say without knowing your reasons for changing anything. You’ll likely get many different suggestions and ideas here. What is your doctor saying?

It may be reasonable to question starting with an aromatase inhibitor prior to knowing if you actually need it.

3

Using steroids of any kind lowers SHBG. The only way for your doctor to help you with would be to take you off the testosterone. Not a great idea, right?

Things are going great, so I guess I would ask you to explain in detail why in the world you would want to mess with your protocol. You found a good dose and you feel great. Enjoy it rather than fucking with it.

Based on your numbers the appropriate dose would be 0mg/w for the next ~1,700 weeks. Your e2 is lower now than it was before getting on trt. That’s not necessary at all for the vast majority of men. If you can stop using it then that would be the best path forward.

4

Because I’m not sure if the trough numbers are good for me healthwise in the long run, compared to a 200 mg test e dose for example. My free test is in the supra-range, is it not?(The numbers above are 3 days past my pin).

I felt a slight of an itch around the nipple after 2 weeks of no ai. Started out with a 0,125mg dose - upping to eventually 0,75mg. Then the itching subsided completely. But I’m gonna try and dose down 0,75 → 0,50 → 0,25 incrementally by 2 weeks apart.

She understands why I’m doing it privately, but she has no thorough understanding on hormones, which is why she wants an endocrinologist on the sideline to guide me. But they would obviously rather want me to stop, which isn’t gonna happen.

I really enjoy it. But I also respect it - and therefore would want the ‘good feeling’ under the right conditions. 250 mg test e doesn’t seem like a trt dose compared to many others. That’s why I’m a bit confused.

So it shouldn’t matter that my e2 (likely) will be elevated into the upper range, if not above, when I dose AI down?
I know that e2 naturally rises with test. I just don’t know what range it should be in now, from a numerical standpoint.

I appreciate the advice guys.

5

I see, your doctor is not the doctor managing your TRT?

Lowering your testosterone dose should decrease estradiol and you may maintain the benefit of testosterone.

Probably would not matter.

6

Nope - I’m doing this by myself, which I wish wasn’t the case. But in my country, I have no choice as of right now. Hopefully in the future they will be more open about it.
But I am lucky enough to have a healthcare system, that allows me all the blood draws I want.

So I should try and lower the dose and see how I feel?

7

It should be in whatever range helps you feel normal without causing side effects. Numbers are little more than a generic guideline. Don’t go by numbers, go by your body’s reaction.

8

Sounds good as long as you are measuring for and have sufficient resolution to detect side effects. Early stages of some side effects won’t be picked up on blood work although BP and RHR are useful indicators.

That is why the reference ranges are useful. Minimizes the chances for known unknowns and unknown knowns.

9

your T dose might be too high. I’d go down to 150 for 8 weeks or so and see how you do
I’ve been in the higher better boat for some time. I feel better on 120-150 range then on 180-200
took me 6 months to figure that out

10

Seems pretty easy to detect high e2 by simple observation. Granted some people are indeed so stupid that they won’t notice that they’ve grown breasts or that they’re crying on the bathroom floor blasting Ryan Adams Love is Hell. But most people can probably keep track of things without multiple PhDs.

11

In the context of this and “TRT”, the discussion regarding side effects should be more broad than just high E2, especially in the long term.

12

Gonna do blood draws every 3 months for the next year - to make sure the numbers aren’t going in the wrong direction.

BP mean was 118/61 roughly 2 weeks ago.

I already have gyno from young age because of my testosterone deficiency, which was concluded by the doctors at that time. This is also why I know when the itch is a bad one. But nothing is tender/itchy at this point.

Which is exactly why I’m asking for help. When I compare the numbers with other men on the same dose, then MOST men would be way over the free-T reference on a 250mg dose.

I’m not complaining in any way at all. 0,900 nmol/L is definitely on the upper side, but yet inside the reference. From what I can understand is, that low SHBG fucks my free-T up if it is not dosed more frequently. So, from a number’s perspective I should be good-to-go, right? Or am I missing something in the larger spectrum?

Again, I’m very grateful for you guys putting the time and advice in for me. From what I can gather so far, is that the right approach would be to lower the AI dose. Preferably to 0 mg. If that doesn’t work, I should lower the test e dose to 200 mg and see how my e2 reacts.

I’m still 28. This is also the reason why I want a good mixture of ‘feel good’ and safe dosage long term.

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13

I’d encourage you to go by average TT and FT rather than trough. It is what I do, and I think it helps me wrap my head around overall risk. Lots of guys out there inject once a week, then measure at trough, are barely in range, and ask for an increase in dose. They are fooling themselves. Their average levels are well above natural levels.

@readalot has a nice table for converting trough levels to average levels based on injection frequency.

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14

Your TT is lower than typical for your dosing because your SHBG is lower end. Your free T is proportional to dose and not dependent on SHBG. Low SHBG does not f up or suck up free T (and doesn’t free more T either). Your free T level on exogenous testosterone is a function of your metabolism (liver clearance, lymphatic activity, etc etc). Some of these factors appear associated with SHBG, but SHBG does not drive your free T level on a particular dose. Yes I would agree your trough/peak?? value on upper end of free T range. When did you pull blood work in relation to injection?

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For those who work in the other set of typical units…

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As you can see above your TT/SHBG/fT relationship is pretty spot on using calculation by Vermuelen method. Free & Bioavailable Testosterone calculator

How were these measured (what assay for free T)?

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15

This is drawn from my 2nd pin day(thursday) before I pinned ofc. So, trough?
I usually do monday morning, thursday evening.

HPLC / Mass spectrometry

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16

That would be an assay for Total T. Gold standard for free testosterone (although still not harmonized among labs) would be LC/MS-MS combined with equilibrium dialysis (or ultrafiltration).

17

Yes. Gotcha.

This table from this thread may be useful to you to estimate mean TT/fT from your trough…
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Hence your mean free T may be about 20-25% higher than your trough reading (based on reasonable pharmacokinetic inputs for TC/TE). Your peak may be ~40% higher.

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18

TRT is not a set and forget therapy, your levels will still fluctuate. Three weeks ago I got a Total T at 1052 ng/dL and days ago 772 ng/dL and the dosage remained unchanged.

So no need to micromanage your TRT if you feel optimal.

19

Unpopular opinion: unless one’s numbers are above range, nobody should be hugely concerned about TT and FT if the following conditions are met:
-all other blood work is normal
-no side effects are popping up
-they feel good

I’ve seen guys obsess about getting their trough from 450 to 600 because somehow that is the thing holding them back. Meanwhile you find out their diet is fast food and they drink 10 sodas a week, sleep poorly, binge drink on the weekends, and have no idea what their macro split is. Loooooots of guys majoring in the minors within the trt world.

20

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Good 10 minute read for those who want a basic understanding on free testosterone situation as we wait for results of CDC Host work.