I could really use some advice. I’m 37 and have been on TRT for a year now. Throughout that year, I have read posts on this forum up and down as well as several other forums to educate myself and to have more informed conversations with my urologist. I think I’m pretty fortunate that he is actually aware of a lot of the topics on these TRT forums and has been open and receptive to my suggestions and info based on them. That said, I think we’re getting to a point where he doesn’t know where to turn and neither do I.
I have primary hypogonadism – my thyroid/FSH/LH, prolactin, cortisol etc. are normal. My comprehensive metabolic panels, lipid profiles, and CBC’s are all normal. I’ve lost 22 pounds over the past year (6’0 and 194 now) and can see quite a lot of lean muscle definition which I’ve never had before in my life. But I currently have high E2 (42.7pg/ml) and it’s just the worst thing ever.
So a little history:
In March 2015, I was started on T Cyp 200mg every 2 weeks which of course sucked. Then 100mg every week by last summer which didn’t seem any better. My T was up to 800, but would drop rather quickly to 125 by the 7th day. That seemed to me to be a pretty fast drop for something that has a half-life of 8 days, but maybe it’s normal. E2 was at 32. By the end of summer, I was telling the doc about what I was reading and how smaller, more frequent injections were supposedly superior. I told him I wanted to try that so he said let’s try 50mg E3D, and I could adjust a little up or down if I wanted. My T went up to 925, but I didn’t feel any better. I eventually went up to 60mg E3D by last fall and man that made all the difference. Throughout November and December, I can say that I felt better than I ever have in my life. And I should have, because my T was 1059.
Then things started to go downhill in January. I now have horrible acne on my back and shoulders and it’s starting to go down my arms. I physically cannot have sex. I’ve tried daily 5mg Cialis, I’ve tried taking 4 of those at once (doc’s suggestion) to get a “normal dose”, and I’ve tried 100mg Viagra. They all literally do nothing now whereas last summer, they worked great. I sometimes get morning wood, but it’s only like 50% I would say.
So to me it’s obvious that the high T has caused E2 to climb so much that it’s now more than I can handle. I’ve tried taking DIM Plus for several weeks in Feb and March, but it just didn’t seem to be strong enough. I pretty much demanded that I wanted an E2 test in mid-March based on my symptoms, and my doc was hesitant, but I got one. That’s how I know it’s 42.7pg/ml. And it’s actually likely higher than that, because that test was done while I was taking the DIM. So my doc finally acknowledges the E2 problem after seeing the rest results. but didn’t want to prescribe and AI even though he has mentioned that it is used in the past. He kept saying that well, it’s an off-label use and there isn’t a prescribed dosage for men. Sort of seemed like he was chickening out when it came down to it. I know all of that and suggested that I try a quarter tablet with each injection to see if it helps. But first he just wanted to lower the injections to 40mg E3D because the other docs that he consulted said my T should be 500-600 and not almost 1100. I just want to feel good and don’t care what number it’s at, but aside from the high E2, I have had no other side-effects from it being that high and all of my bloodwork is well within the normal ranges, so I didn’t see what the problem was. Don’t mess with what is working, and just fix the single E2 problem was my logic.
I’ll get another T and E2 test in about a week. Maybe E2 will be a little but lower, but obviously something is still wrong because I still have the exact same symptoms. If anything, I don’t have as much energy now. Not sure if that’s because of E2 or the lower T Cyp dose.
There isn’t much of a choice around here for switching doctors. It’s a rural area and there just aren’t many urologists. At least this guy has been somewhat open to my suggestions in the past, so I feel as though I’m better off than a lot of other guys based on stories I’ve read. Where can I go from here? Is there somewhere that I can point him to an AI dosage? Is an AI appropriate?
I’ve also read about HCG, and how that helps ED and low libido in some guys for what seems like an unknown reason. It sounds like it is mostly prescribed to keep a guy’s sperm count up, but I had a vasectomy 7 years ago so that’s no concern. And I’ve thought about my testicles shrinking – they have somewhat, but I don’t feel like that bothers me at all.