36 yr Male - 220lbs - TRT for 5 years
I do im injection of .75 Cypionate weekly
First time in 5years while being on TRT that I have had an issue.
The past week I have totally shut down mentally. My numbers seem to be higher than ever. My doctor says this isnt a miracle drug your within range. Something is wrong. Symptoms are same as LOW T . Just miserable for work , Not social. Feel down more than ever. I am not ME. If hes looking by numbers everything looks fine. What could it be?
April Results
SHBG 17.8 nmol/l 16.5 -55.9
Testosterone Free 164.2 pg/ml range 47-244
Testosterone 571 ng/dl range 300-1080
Estradiol 37.9 pg/ml <=60.7
I don’t know if I would call 571 ng/dl high, it’s a mediocre level and am confused why your doctor hasn’t increase your dosage to youthful levels. I will say your estrogen is high in relation to your testosterone.
Your doctor sounds uninterested in your symptoms and sounds like a real jackass, uh “you’re within range”. What this really means is he’s lazy and doesn’t care to spend the time to figure out what’s going on. He would rather go on to the next patient since he probably has to see 30 patients in an 8 hour shift.
Low SHBG men can tolerate almost no estrogen, I believe your estrogen levels is causing your cognitive issues. Whenever estrogen gets high it feels as if TRT isn’t working anymore, in the last few weeks my estrogen has been rising and it felt as if my mind was clogged up. You require an AI to help with the excess conversion of estrogen, bet your doctor has no clue.
Find a doctor new doctor as this one seems uninterested do to he probably doesn’t do TRT on a regular basis. Most guys start out at 50mg twice weekly to keep levels stable and to help lower estrogen peaks.
You have yet to feel your best on TRT, you’ve been on a louzy protocol and I feel bad for you since you’ve been on it for 5 long years.
E2 is a little high, enough to cause symptoms. On top of that, your TT is on the lower end, not terrible, but your E2 being that high definitely cancels out the benefits of the decent T level.
Also, your SHBG is low, you should probably be injecting at least twice a week. Your low SHBG also allows larger amounts of test to be converted to e2 , so smaller injections more frequently would be wiser to prevent that conversion.
Check thyroid labs also. (seems to be an issue for a lot of people here)
So 112.5mg once weekly, this protocol is wrong for a low SHBG man. If self injecting at home inject 50mg twice weekly, example, Monday morning and Thursday night. You will feel much better in 6 weeks. My SHBG is the same as yours and when I went from one shot a week to 2 shots it was dramatic.
As alphagunner suggested a lagging thyroid can mimic low T symptoms, if new protocol doesn’t work yield results and numbers look bette, look into a full thyroid panel checking fT3, rT3, fT4 and antibodies.
When you inject once a week you get a high T peak then a trough level. Then your lab results are largely determined by lab timing and thus relatively useless as a measure of your hormone status.
E2 is killing you.
Inject 75mg twice a week
Get Rx for 0.5mg anastrozole oral at time if each T injection.
Always do labs halfway between injections to eliminate lab timing changes to lab results.
Target is E2=22pg/ml which seems optimal for most guys for:
fat levels
fat patterns
libido
mood and tolerance
energy and initiative
We normally ask that guys inject 250iu hCG subq EOD to preserve testes and fertility. But after 5 years there may be no point with permanent damage.
We find that even with optimal T and E2 levels guys with low thyroid function have most of the same symptoms as low T. See below and post oral body temperatures and discuss your history of using iodized salt or vitamins that list iodine, selenium.
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.
KSman is simply a regular member on this site. Nothing more other than highly active.
I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.
The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.
You are a good strong contributor. You could focus more on body temperatures and if they are good the thyroid labs may not be needed and try to get guys to discuss iodine intake as that can be key to most thyroid issues.
In this case, with SHBG=low, and E2 high, I do not see path to higher SHBG and I expect that it will get lower as E2 is lowered.
I am seeing my thyroid numbers come in line when my t and e2 are dialed in.
Now if I followed much of the advice on here I would have perhaps unnecessarily medicated myself.
I just don’t agree telling some on here to take iodine at replacement levels which are close to 40-50 mg. The daily recommended dose is 150 mcg.
There has to be a better way to confirm that IR is necessary.
I’ve seen my body temperature fluctuate and thyroid numbers due to I believe my protocol adjustments.
We have had guys take higher doses of iodine and resolve a lot of problems. Take less if you want and results may come slower. But don’t do nothing. Body temps are a great guide and often the first sign of progress is feeling awake like you have not been and clarity of thought with improved mood and libido.
We used to get iodine in bread, that is gone. Used to get iodine in dairy from iodine teat wash, that is gone or going away. We used to cook food at home using iodize salt, now many do not use that and prepared meals from stores and restaurants do not use iodized salt. So the old 150mcg in a supplement, supplement to other iodine we used to get does not stand up very well to the iodine we are not getting from other food sources and cooking. The suggestions that I have made here are from other sources and not unique.
In your fixation on IR dosing, do not overlook the role of selenium in your thyroid health. This is not a nice to have sort of a thing, think must have.
Note on labwork : change dose to 1ml weekly your levels are low
How do I balance this out? No sex drive , No morning wood, I feel better than I did before the AL but still not right and the sex part isnt there. Is upping my dose going to help the low estrogen level ?
With target of E2=22pg/ml, modify AI dose by a factor of 18.9/22=.86 a ~15% reduction.
You have not posted thyroid labs, AM or mid-afternoon body temperatures or discussed your history of using iodize salt. Your libido related issues may be hidden in those details. Your hormone labs are otherwise able to support good sexual function.
This statement from your doctor is troubling, basically he’s saying that even if you have hypothyroid symptoms I’m not doing anything about it for the fact that you’re in the normal ranges.
This doctor doesn’t care about symptoms, he cares about lab numbers on paper because this is how most doctors are trained, it turns them into robots who have no critical thinking.
Find another doctor or go private, this is horrible care. This doctor has a relationship with insurance companies and doesn’t work for you. Decisions are being made behind your back about when to initiate treatment. What good is it if you have insurance and can’t even use it when you’re sick?
T4 should be midrange, it’s total thyroid hormone produced. Your temperatures suggest iodine deficiency. I think your main problem is low E2, your E2 was not terribly high and the .5mg Arimidex dosage seems a little high.
Also you’re low SHBG, you shouldn’t be injecting once weekly, you need to inject either 40-50mg twice weekly or small doses EOD. My SHBG is the same as yours and TRT doesn’t relieve all symptoms unless I inject 17-20mg EOD.
You’re dealing with incompetent doctors and that’s why you’re suffering. TRT is not as effective at these injection frequencies you doing, and you’re only dealing with high or low E2 sides as a result.
