Been on 100mg cypionate IM once weekly since 2016. “Ok” but never great. Always seemed lacking. Various irritations/complaints. Family doctor and later endocrinologist never tested or mentioned estradiol. Endocrinologist had recently switched me to 124mg cypionate SQ, divided into two weekly doses. I know, i know…weird protocol. Dont get me started…
NP who runs TRT clinic now taken over. Switched me to enanthate due to my perceived sensitivity to cypionate. Wanted to start me at 200mg SQ weekly (divided as two weekly injections). I told him i wasnt comfortable with that, and would rather start lower and have to titrate up than start higher and encounter probs. Told him i wanted a healthy response, not to be a body builder or feel 16 again. He was agreeable, went ahead and prescribed as he wanted but with verbal instructions to start at 120mg (divided as two weekly doses). Told to stay on that for at least 3 weeks, then could pop up to the 200mg if I perceived insufficiency. Also prescribed 1mg anastrazole once weekly, in between the two injections. Told him ok, but i wanted to reassess the anastrazole once i was stabilized on a dose…i really dont want to be taking extra meds if i dont have to. Im leery of prescription meds! He told me warning signs to look out for in case anastrazole crashed my estrogen. Said to call with problems, otherwise he will see me in 3 months for checkup and labs. He was making these decisions based on various complaints and observations i relayed on the previous cypionate dosing.
Prior to starting this new protocol/dosing, the NP ordered the following labs at the trough of the endocrinologist’s weird 124mg cypionate weekly protocol and had these results:
RBC (4.20-5.80): 6.25
Hemoglobin (13.2-17.1): 18.9
Hematocrit (38.5-50.0). 55.0
Estradiol (less than or equal to 39): 46
Total T (250-827): 565
He didnt order Free T, presumably because previous doctor tested it December 27. Total T at that time was 535. Free T was 99.2 (35.0-155.0)
Dont know why he didnt order SBHG? I know he didnt order LH and FSH because i told him that infertility was desirable for me.
He ordered a therapeutic blood draw (immediately had that done) and gave standing orders for that to be done every two weeks as long as hemoglobin was above 15.0
Going from 120->200 mg is a very big step! If you’re not getting good results, increase 20 mg at a time and retest in 6-8 weeks.
Do you realize repeated therapeutic phlebotomies can deplete your iron stores?
My ferritin is cut in half after only one donation, even while taking 140 mg elemental iron daily and I don’t recover what I lost for at least a month.
dosing: yes, i had a similar line of thought as you. I already intended to do this.
2). Blood draw: im glad you mentioned this. I recently (like, one day prior to my post) became of the ferritin issue from reading this forum. THe blood bank tests my hemoglobin prior to the draw, and if its within range (even if high) i think i would consider delaying it. There is another issue in play here, that being Ive had wicked poor sleep since early December due to some sleep 02 and quality issues. I think ive finally successfully addressed that, and im looking for my hemoglobin to come down now. It has never been an issue for me before. Regardless, your words of caution are well received.
3). The anastrazole makes me uneasy. I have no contextual understanding of whether 1mg once per week is a minimal dosing for a man on TRT. The NP said it was, but the only info i can find on reputable drug websites only comments on use in women.
Someone here recommended a TRT in Florida called DefyMedical. They seem to have a large practice, unlike my little one guy outfit. Id like to start on the 120 total weekly for several weeks, then pay them, their $250 fee for some comprehensive T labs and a one hour consult. Get their second opinion on whats going on.
Men should never start out on 1 mg per week, if anything it would be prudent to micro dosing using 0.050, .125, .250 dosing from compounding pharmacies.
I have used Defy Medical in the past and would recommend them over other private TRT clinics.
Systemlord: If my estradiol (remember, this was NOT the ultrasensitive test) was 46, wouldnt it be inadvisable to start the prescribed anastrazole at any dose? I thought estradio needed to stay above 40 for bone health? I do carry all my extra weight (lotsa fat) in my belly, and im struggling to understand the dynamic here. Ive read that fat is great at converting testosterone into estradiol, and then also SBHG comes into play. I dont understand the context here with why the NP is wanting me to take the anastrazole.
After being stopped on the cypionate roughly 1 1/2 weeks ago, i started the enanthate yesterday (60mg twice a week). I was feeling pretty bad, then did my first enanthate injection yesterday morning. By night my mood had improved a decent amount, i slept better. Today, i had a harder time at th gym fatigue-wise, im increasingly irritable, and my dry skin isssues have come back.
That seems like low-T symptoms? Which is why the estradiol/anastrazole situation is confusing me.
If symptoms aren’t from high E2, then no. My previous comment was if men are having symptoms from high estrogen, start out on micro dosing.
Last time I checked, we don’t have natty young men (20-35) with bone problems.
Sex hormones is a blank in most doctors training. They are merely keeping hormone levels in range, beyond that, knowledge is limited.
The one reason why high estrogen is bad for a natty man is because it forces the pituitary into reducing testosterone production, men on TRT don’t have that problem because our testosterone is controlled by TRT dosing.