I have been on TRT for 10 months. I was diagnosed secondary hypogonadism. I started at 100mg e7d. Doc Raised me to 150mg e7d. Then doc raised me to 100mg e3.5d. Both of those times the increase was due to my complaint of the weekly roller coaster. I was on the 2x weekly dose for 10 weeks then had a follow up appt. By now the roller coaster is gone but what I do have in a constant feeling of below average “meh” all day everyday.
I have included a list of labs below. I started out with my GP. He referred me to an endo after I got my E2 tested and it was high. The endo appt was a major flop. He started the appt accusing me of being a bodybuilder and looking for a dose increase. I asked about adding hcg and an AI and he again called me a bodybuilder asking for the “holy trinity”, I’ve never heard of this. He later told me I’m too young to need trt, I have too much hair, he doesn’t want me to become addicted, and he doesn’t want to be the doc prescribing me T when I “stroke out.” He suggested I taper down to 100mg e7d and then eventually go to 0mg because I don’t need it.
I am now back at my GP. He knows about hcg and AI’s but he’s not comfortable learning using them on me. He has agreed to do labs for me and keep prescribing T while I work with Defy.
I have the weird mid point lab test because regular estradiol was tested. I had my doctor add the sensitive test to the lab work and the results came back as a failed specimen. I took re new test before leaving on vacation so I would have new results in time for my Defy appointment.
Current meds: 90mg SQ e3.5d
height: 5’ 11"
weight: 185lb
BF: ~25-28% The E has made me raging hungry
age: 34
I go to the gym 5 days a week
| labs |
range |
pre TRT |
100mg e7d IM |
150mg e7d IM |
100mg e3.5d IM |
100mg e3.5d SQ |
90mg e3.5d SQ |
90mg e3.5d SQ |
| lab timing |
|
|
trough |
trough |
trough |
trough |
trough |
42hrs after injection. mid cycle. |
| total test |
262-1070 ng/dl |
215 |
242 |
648 |
987 |
854 |
627 |
1483 |
| free test (calculated) |
47-244 pg/ml |
35 |
|
|
|
|
130 |
|
| estradiol enhanced (LC/MS) |
10-40 pg/ml |
|
|
|
69 |
|
|
68 |
| estradiol (regular test) |
26-61 pg/ml |
|
|
|
|
|
26 |
|
| Hct |
42-52 % |
44 |
47 |
47 |
47 |
|
47 |
|
| fasting glucose |
70-105 mg/dl |
106 |
98 |
112 |
114 |
|
110 |
|
| A1c |
4-6 % |
5.3 |
|
|
|
|
5.1 |
|
| TSH |
0.3-4.0 miU/ml |
2.6 |
|
|
|
|
1.75 |
|
| T3Free |
2.3-4.2 pg/ml |
3.7 |
|
|
|
|
3.44 |
|
| T4Free |
0.79-1.77 ng/dl |
1.3 |
|
|
|
|
1.19 |
|
| T3Reverse |
9-27 |
|
|
|
|
|
16.7 |
|
| Iron |
50-212 ng/dl |
103 |
|
|
|
|
47 |
|
| Iron Satn |
|
27 |
|
|
|
|
12 |
|
| Iron + TIBC |
250-450 |
376 |
|
|
|
|
386 |
|
| Ferritin |
23.9-336.2 ng/ml |
61 |
|
|
|
18 |
34 |
|
| Vitamin D |
30-100 ng/ml |
|
|
|
51 |
|
|
|
| DHEA-S |
89-457 ug/dl |
|
|
|
|
|
152 |
|
| PSA |
0-4 ng/ml |
|
|
|
|
|
0.46 |
|
| IGF-1 (Z score) |
-2 to +2 SD |
|
|
|
|
|
1.04 |
|
Do you have any suggestions for me or questions I should have for Defy?
It’s unfortunate you’ve had to put up with that abusive behavior. It’s difficult to compare the IA and MS/LC/LC E2 tests because the testosterone levels were so divergent. However, if you are experiencing high E2 symptoms you’ll want to do something about it. Ask them about DHEA supplementation, too. Too bad they did not check free test on your last one.
That guy was a major dick. I even told him I was expecting a lower dose. I also told him I wont be back. One day I was thinking about the appt and it made me mad again then I got a survey request from the clinic about my visit. The next day my online information was deleted.
I was surprised that the standard E lab showed low value but sensitive shows high.
Too young for TRT, sure you are but that doesn’t mean you don’t need TRT. There’s so many false studies out there that has doctors scared shitless about prostate cancer, studies of 65+ year olds getting stokes on TRT who were previously diagnosed with heart problems as a result of having low testosterone for decades and TRT gave them energy they wouldn’t naturally have do to the heart problems.
Even after all studies have been debunked and it was agreed the studies finding were poorly done, the stigmata still remains because people latch onto negativity more than something that is positive. You are missing one of the most important tools hormone specialists use to determine dosing and injection frequency, SHBG scavenges sex hormones and prevents you from clearing out testosterone too quickly.
If SHBG is lower than you need more frequent smaller dosages, on the other side of the coin moderate dosing less frequently. Your dosage is likely too high, most men can’t handle anywhere near 200mg weekly unless they are a hyper metabolizer and or hyperexcreter, you’re nether.
Defy Medical was a good move, I’m with Defy and they are top notch.
The immunoassay E2 level is lower because your total test level is lower, therefore less aromatizing to E2. My IA and MS/LC/LC tests come back similar. Go with your symptoms.
Just because I can’t say it enough, that endo was major asshole. The too young argument was stupid. Looks like I left out my ago. I’m 34. What I am too young for is having to deal with a testosterone level of 250.
I had SHBG tested. It’s in the calculated free t. Unfortunately my results side of the labs doesn’t show me that result. Using a calculator for free t and backing into SHBG, its 35.
I guess the weird part to me is that it is at the bottom of the lab range. I don’t think I have symptoms of low E.
Yeah, typically you would expect the IA to be relatively higher than the MS/LC/LC, but that is not always the case. I have seen the IA come back lower than the ultra sensitive myself.
Doctor doesn’t care because he’s not low T, so he’s not sympathetic to your situation. This endo probably knows you are suffering but is too afraid of all the false studies to risk his career on it.
At the end what really made me mad about the endo was him recommending 100mg e7d, then I said that’s how I started and it made me feel bad. He said that didn’t matter because those labs looked good.
Do you have ideas about my thyroid or possible iron deficiency?
Given fT3 of 3.44, and rT3 of 16.7, you’re fine. Any hypothyroid symptoms? You could check body temps. Need CBC indices to evaluate possible anemia.
Here is my CBC results. It seems like no anemia.
I had my appointment with Defy and it went really well. I have never talked to a doctor for 45 min before. I’m surprised how fast it seemed. I met with a PA Michael. He was very personable and answered all my questions.
The single topic we started with and spent the a lot of time on was the iron deficiency. He wanted me to get a occult stool sample test with my GP to check for blood before starting a supplement. This has came back negative, so I will start iron supplement. He said correcting with a supplement will likely take 6 months or more.
He wants my free testosterone to be higher to see if it makes me feel better. He recommended I change my testosterone dose from 90mg 2x weekly to 60mg 3x weekly. He suggested this wouldn’t directly impact raising the free t but is a good start to try to limit the e2 peaks. Also will provide a good starting point for a future adjustment.
I am also started on hcg 300iu 2x weekly. He believes due to my low pre-treatment LH of 1.4 miu/ml (range 1.24-8.62) that the hcg will increase my testosterone and possibly estradiol.
He also prescribed 0.125mg anastrozole to take 2-3x weekly if I feel the need. I’m worried about estradiol going out of control with the hcg. But I’m also concerned about crashing it with the anastrozole.
Does anybody have experience with iron deficiency?
@physioLojik I saw your recent post about not using an AI when you have 3x the dose of me, 6x the total t, but your e2 is 1/2 of mine. I haven’t been able to decide from your posts if you flat out are against using an AI for every single person no matter what? Do you think it would be better to find the dose of t that eliminates the symptoms of high e2, even though it results in a lower total t?
Most important question: How do you feel?
Are you having high e2 symptoms?
Arimidex is garbage. Lowering estrogen has caused nothing but pain for a lot of people.
I guess I left out that part. I have most of the high estradiol symptoms. Bloating, decreased libido, ed, mood swings, fat gain, tired, lack energy, night sweats.
I don’t have the goal of chasing a number. I am chasing the idea of feeling great.
Maybe some of this is the low iron. I have no idea. Its weird because I have never donated blood. I did have an occult stool sample that came back negative so I guess that rules out intestinal bleeding.
Here is my labs from my latest CMP. I dont think there are liver issues.
Overweight? Yeah slightly. 5’11" 185lb. Not crazy obese but could lose 10-15lb.
Lowering your dose is always preferable to taking an AI. But you can also try natural methods first. Warm Lemon water.
Calcium D Glucarate, Sam-E and DIM have all lowered my e2 before. Tanked actually, so be careful.
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You need to move to Denver and become
My assistant haha 
@anon10035199
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