My Lab Results on 50mg of TRT e4d

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These are my labs, everything looks pretty normal? 652 total T and 24 free T seems decent for my age (23) but I still don’t feel great, lots of fatigue, not sleeping well, weak erections, and I just am not very motivated to do anything. My estrogen is high, but it’s only at 40, and if 35 is still in range, is 40 that bad? Is it enough to make me feel like crap most days? Or could my testosterone be higher, or is there anything else in the results that seems like it could cause these issues? I’m also classed as obese, I’m 230 pounds and 6’0, and not much muscle. I’m also very moody and irritable sometimes, small things piss me off a ridiculous amount, awful mood swings too.

How long have you been on this protocol? When were labs taken trough or peak? Your E2 is high when looking at the T to E ratio (estrogen dominant) could explain the symptoms you are experiencing. Also SHBG is LOW. You could also be metabolizing T quickly which would explain why 100mg every 4 days only gets you in the 600s… You might benefit from smaller more frequent injections given your higher E2 and lower SHBG. Basically a smaller more frequent injection will induce smaller T peaks which will result in smaller E2 peaks. Im sure @systemlord can touch more on this. Also have you had your thyroid checked (T4,T3, RT3, and such)? TSH of 2.5 is not optimal.

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Why every 4 days?

I actually meant 50mg every 4 days, sorry, and that test was taken in the afternoon on the day before my shot, so a trough. Also TSH was normal but I didn’t have other thyroid levels checked. Only been doing e4d for a few weeks, I was taking 100mg once a week before, and felt worse, so I do feel slightly better since then, but still not great.

I suspected my Estridol was high, and my PCP wouldn’t listen, and I was desperate and read that taking less more often can lower e2

The general consensus here is that any dosage or protocol change will result in a magnitude of symptoms as the body adjusts. Allow yourself at least 6 weeks at the current protocol to dial in and “settle”. Re-do bloods to see where you are at in 6 weeks time. I am currently going through this. Do not drive blind.

I see your problem, your SHBG is really low, the good news is this is 100% correctable. I have low SHBG and never felt great on one or twice weekly protocols which has to do with both low SHBG and the fact I’m extremely sensitive to hormonal functions.

I don’t know when in relation to your injections you’re drawing labs, how long you have been at this dosage, but you should be doing labs right before your injections, this is known as trough, your lowest point 6 weeks after dosage changes.

Your estrogen is high and what makes this worse for you because SHBG is low, SHBG binds and deactivates testosterone and estrogen, so you lose that natural buffer to bind up androgens. These large to moderate dosages can spike estrogen and cause problems and make it seem like TRT isn’t working and you may feel no better than pre-TRT.

The way to deal with this is inject smaller more frequent doses which minimize estrogen spikes and lowers estrogen. The optimal approach is to inject doses daily, using 27-29 gauge insulin syringes. An EOD protocol could also work, but estrogen may in fact be a little higher.

I suspect these labs were done prematurely because your LH is 1.8 and not suppressed yet.

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This is more common than you know, most doctors don’t know how to manage men on TRT. PCP’s don’t normally specialize in endocrine disorders, even those who do TRT is an area of medicine that escapes doctors. We are left to figure everything out on our own.

The only doctor that seems to have a clue are those in the private practices in anti-aging and sports medicine often they don’t take insurance.

I concur. Please give it 6 weeks at your current dosage/frequency and re-draw labs to see where you are at number wise and symptom wise. At that point you can dial in and adjust protocol if need be.

Okay it’s good to know, I feel like I haven’t even started TRT, and I’ve been on it for about 5 months, but my PCP was an idiot. I have a consultation with Defy on Saturday, I believe I have read that you use them, so I’m sure I’m in good hands, just trying to figure this out, I’m 23 and want to do so much but have no energy or drive. And I didn’t know low Shgb could have such an effect so I’m glad to hear that it could causing problems and that it’s correctable.

Dr. Saya is very knowledgeable, but I would refrain from using HCG right away, it can make the dailin in process long and difficult, plus you’ll have even bigger problems with estrogen. Im my opinion AI’s are a last resort, but it isn’t common for men to need an AI on daily dosing.

You’re in good hands, the intake staff at Defy can run circles around most so called hormone specialists.

I’m believed to have always been infertile, and I’m not worried about fertility, so I’ll let them know that. Will they recommend AIs, or will they try other ways of lowering estrogen first? And is that T level (free and total) seem okay for my age?

They might provide you with a very low dose .125 AI, but instruct you not to take it for the first couple of weeks because it will take this long before estrogen is elevated. Defy wouldn’t provide an AI unless they thought you would need it, for instance a high SHBG guy with low FT and low E2 will more than likely not be prescribed an AI.

A 23 year old should have FT levels at the top of the ranges, the ranges go all the the way up to 26.5 pg/mL. You could have levels higher and still benefit without problems, everyone is different.

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So in your opinion, do you think when my Estridol and Shgb are under control, I should feel better? I’m desperate for symptom relief and everything I read on here helps me through it, and I really appreciate your advice.

Once dialed in you will know it and you will begin to learn what dosages and frequency works best for you… SHBG is not something you can “control” necessarily however knowing your SHBG number allows you to design a protocol best suited for you. I hear you on wanting to feel better… I am in the same boat. Stick to your current protocol for a full 6 weeks and post labs. We will go from there. Stay strong and don’t give up.

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When you estrogen comes down in range (<35) or maybe closer to 25, you will feel better, but I wouldn’t worry about SHBG because you have no control over it. I will say the medium to large T dosage suppress my SHBG more than the daily protocol.

When my estrogen is high, it feels like I’m not even on TRT.

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I’m trying to get a better understanding of my labs. First off i’m 23 years old, i’m 6ft0, and 225ish pounds, not a whole lot of muscle. Currently taking 100mg of TC weekly, taking 50mg e4d. I have asked about my labs before, but I want to just get a better understanding overall, because this will be a life long treatment for me. (primary hypogonadism since birth)

My lab results:
Total T: 642
Free T: 22.4
E2: 40
LH: 1.8
SHBG: 16

I had more things than this tested, but the other things i understand pretty well, I had my thyroid checked it it looked okay. So this bloodwork was done at a trough, the day before my injection in the afternoon. Does that mean when I’m at a peak, my TT, FT, and E2 are all higher? I’ve been told that TT to E2 ratio is not good, and is probably the reason for why i feel like shit still. And when it comes to the LH, I was told its still pretty high, since TRT will shut down your production, so my LH should be lower. So what i’m wondering is, as my LH decreases and my natural production stops, will my Test levels drop, since my testes are no longer making the small amount of T that they we’re making? Also the lab I had done before these, like 3 months prior, my TT was 470, and my Free T was 12, at that point I had been on TRT for about 5 months. I don’t understand how without any protocol or dosage change, my levels raised so much in those 3 months, when I did nothing different. That test was also taken on a trough day. I have a consultation soon, and i’m worried about them lowering my dose or putting me on an AI, because my FT is pretty high for a trough day, and my E2 was high, so lowering my dose would lower my FT and my E2 correct? which FT is the important factor here, so the clinic probably wouldn’t be as worried about my TT getting lower in order to correct my FT and E2? am i understanding this correctly or am I off? I want my levels to be high as they can with as little side effect, I have low self esteem, Low confidence, fatigue, brain fog, weight gain, lack of sexual desire, weak erections (I still have decent sexual desire, and erections, but nowhere near what i belive it should be for my age). I do feel pretty good some days, but only in the mornings, and then it tapers off and i feel like shit. The only signs that TRT is working, is my muscles have gotten bigger and stronger, and i’m getting alot of facial and body hair, but thats about it. Not many mental benefits at this point.

E2 is in range, although I’d lose bodyfat through diet, which would naturally lower it more.

How long have you been on your current protocol?

Edit: If anyone knows low SHBG, it would be @systemlord. Not sure how long you stuck with your current protocol, but you’ll likely need EOD or ED injections since you are low SHBG as he explained.

Low SHBG men do not do well with estrogen on the higher end of the range, one needs to consider free estrogen. Men with low SHBG are better served injecting very frequently.

By injecting large doses once weekly you are spiking estrogen higher, by injecting smaller doses estrogen doesn’t spike as high and is lower and more controlled.

You could achieve similar testosterone levels and lower estrogen injecting your doses daily.

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