On TRT. Lab Work, Confusing. Any Advice?

Activator · July 28, 2014, 10:49pm

Hi everyone,

I am 37 years old. I did some blood work last year and here are the results:

Date: 21/8/2013

TT: 243
FT: 58.1 pg/ml lab ranges ( 50 - 300 )

I started TRT like 3 months ago, after a couple of cycles to help with bodybuilding.

my protocol was:

Test E: 250 mg/ml (divided into 2 doses. 125 mg 2x per week)
HCG: 250 3 times a week. (sometimes 500 twice a week)
AI: Letrozole (Femara) 0.62 twice a week ( taken the same time as my Test E shots)

Labs done a few days ago and here are the results:

Date: 27/7/2014

TT: 876
FT: 259 pg/ml lab ranges (50 - 300)
E2: 18.2 pg/ml lab ranges (up to 45)
Prolactin: 10.1 ng/ml lab ranges (2.7 - 16.9)

The results seem great but i don’t know why i feel bad. here are some symptoms that i hope to find some advice for, from you guys.

Acne:
i have terrible acne breakouts on my neck, shoulders and sometimes chest. is there anything i can do about this? it responds to Fusidic Acid creams, but they keep coming.

Bad Mood:
I am moodier now with very noticeable mood swings.

Erectile / Libido Problems:
This is perhaps the most serious of all. I don’t think i am having strong enough erections. I have morning wood, but when having sex erections happen and go away very quickly, although i use Viagra or Cialc all the time before sex. My libido is also not that strong if at all.

Actually I though this is because of E2 issues, but my blood results came back with E2 at 18. Although on that very same week of the tests i only had one dose of Letro. I had the dose on sunday (0.62 mg) and did the bloods on Thursday. I did not want to take the second weekly dose right before the bloods in order no to affect them. Any Idea why i am having these erectile & libido issues??? they are really killing me.

Semen Volume / Testicular Atrophy:
one very noticeable issue is Testicular shrinkage. I usually have big testes but now they have gone smaller, although I keep using HCG regularly even on bigger doses sometimes (500 iu twice/ week). why is shrinkage happening.

I happened to stop HCG last week,the week before the labs because i couldn’t find it then. I ejaculated a few days ago and my load came out little, weak and almost transparent. which means no sperm. fertility is not actually an issue now since i have children already, but I would surely like to keep my load as it was. I used to have huge thick loads.

My last question:
is there really a chance to keep my TT and FT levels as they are now and switch from TRT to another protocol. i heard a lot about Clomid and HCG monotherapy. Is it really possible to start producing my own T? How can I determine if I have primary or secondary Hypogonadism ? doctors, surprisingly seem to know very little.

Thank you all for your support.

KSman · July 28, 2014, 7:38pm

You need lab ranges, especially with FT. So cannot interpret FT number.

Is your hCG Rx or possibly bunk. You can get a home pregnancy test and use that as directed. If you not pregnant your hCG is bogus.

We have had some experience with some guys doing everything right, but they did not feel balanced until they reduced their higher T dose.

Most of the knowledge here is in the stickies. Start with the advice for new guys sticky. Don’t be deceived, it is heavy lifting.

Sexual response and libido depend on many aspects of your health and vitality. So you need to look at other aspects of your health. See issues to consider in the above sticky. Thyroid function is easy to test, check body temperatures.

You are using Test E: 250 mg/ml but did not state the dose! You can edit your post above with “[edit]” in the RH lower corner of the post above.

Acne: Some of that is transient, but can still be a PIA.

If E2 is low, that can mess with libido etc. You messed up your labs, now you don’t know where you normally are.

Please also read the protocol for injections sticky.

“Clomid and HCG monotherapy” -never both at once

Action items:

read the stickies
check hCG with pregnancy test if not Rx
check body temperatures [thyroid basics sticky
Edit post above to provide T dose
provide more info as per the advice for new guys sticky

Activator · July 28, 2014, 11:56pm

Hi Ksman,
Thank you so much for your input.

I edited the post to clarify my T dose and lab ranges. It’s 125 mg 2 times a week.

My HCG is the pharmaceutical powder form known as pregnyl or choriomon . They come in 1500 iu or 5000 iu powder amps. I dilute it to the desired concentration using water for injection. I will use the pregnancy test though. I fill up all my syringes and keep them in the fridge.

I did read most of the stickies. I got very valuable info from them. However, I really need some decisive info on Letrozole. It’s what I have available here and it’s also more cost effective than Adex . I have the pharmaceutical form known as Femara 2.5 mg pills. It’s indeed very difficult to divide , but I usually cut it in 4 quarters.

Any advice on Letrozole dosing?
What’s the optimal E2 level and how can I achieve it?
How can I know if i have Primary or secondary hypogonadism ?
Do I have a chance with monotherapy?

KSman · July 29, 2014, 3:29pm

So your dose is 250mg, not 250mg/ml which might be the potency in the vial.

Your T dose is high and your TT is not. Some guys, quire rare, are hyper metabolizers of T and for those, it appears that they need 300mg per week to get to levels seen with others at 100mg.

hCG should be mixed with BA water, 0.5% benzol alcohol. Sterile water or saline solution will not inhibit bacterial growth.

We shy away from letro as it can be very harsh and dose-response often is not predicable for some guys VS anastrozole. Letro can work once one finds a balance.

Dissolve your letro in vodka and dispense by the drop after you find how many drops you get per ml with that solution and a dropper.

All other questions are in the stickies. It is a lot of reading and I am not going to let you dodge that.

Activator · March 15, 2015, 9:03am

Hi Ksman,
Hi everyone,

AlwaysUp · March 16, 2015, 12:56am

Yes, your E2 is crashed and that will absolutely cause the symptoms you’re experiencing.
Yes, way too high of a dose. I don’t know much about Letro, but you’re taking too much.
Yes, your testosterone dose is also way too high for TRT, and it shows in your lab work.
Yes, I’d cut the dose in half if I were in your shoes.
Tough to pinpoint a specific dose at which no AI is needed. We’re all different and respind differently to certain doses.
If you bring lower your testosterone and AI doses so your hormone levels fall into a reasonable range, things will get much better.

Activator · March 17, 2015, 8:41am

Thanks “Always Up” for your reply.

Actually I always thought that the lack of energy is due to low T not low E2. My TT and FT are supra-physiological, yet I still feel bad, beaten and exhausted especially at work, midday. sometimes is even become very sleepy while driving back home at around 4 pm.

I really do not know what to do. Today (Tuesday) is time for my TE shot. I am going to cut it in half, roughly around 63 mg of TE. I did not take my Letro yesterday to allow E2 to rise a bit. but I still don’t know when to start taking it again and how to dose it . It is the only AI available to me here. Adex and Aromasin are not affordable at all. I also have no access to Alcoholics. I can’t dissolve my Letro in vodca as KSman advised. Any thoughts?

I wish I could reach a point when I would be able to do way with AI altogether, yet maintain T and E levels around normal.

I always wonder, if one is using the normal dose of T that one’s body would normally make. why would an AI be needed?

I am also very concerned about my libido and erection issues. what can I do to overcome those? I’ve heard of supplements like Tongkat Ali (longjack) , L-Arginine , Horny Goat Weed and other herbs. would those actually help ? or those are meant for normal guys ?

Help and advice is very much appreciated.

Thank you

Activator · March 23, 2015, 4:30am

[quote]KSman wrote:
So your dose is 250mg, not 250mg/ml which might be the potency in the vial.

Your T dose is high and your TT is not. Some guys, quire rare, are hyper metabolizers of T and for those, it appears that they need 300mg per week to get to levels seen with others at 100mg.

hCG should be mixed with BA water, 0.5% benzol alcohol. Sterile water or saline solution will not inhibit bacterial growth.

We shy away from letro as it can be very harsh and dose-response often is not predicable for some guys VS anastrozole. Letro can work once one finds a balance.

Dissolve your letro in vodka and dispense by the drop after you find how many drops you get per ml with that solution and a dropper.

All other questions are in the stickies. It is a lot of reading and I am not going to let you dodge that.[/quote]

Hey KSman,

any input on the new labs above?

KSman · March 23, 2015, 9:35pm

Your problems are caused by E2 near zero.
As I have stated in the stickies, Letro is too harsh and dose-response is not predicable. Use anastrozole, start with a small small dose and you will need to start over with labs. BB gear dosing will always be over range.

For normal anastrozole responders, 1mg/week per 100mg/week T is a good starting point. You may need 1/4th that. 2.5 *1/4 = .6mg/week in divided doses. Dissolve in vodka as suggested earlier.

Stop AI for 5-6 days, then resume with anastrozole. Do not front load! If you feel something good, its your E2 recovering.

Men need E2. We are a tweak of the female blueprint. Many systems in the body need E2, just not too much.

When you get an in-range E2 with anastrozole, you can make a dose correction to get near e2=22pg/l. New_dose = Old_dose * E2_result/22. So if your lab result was E2=28, you are changing dose by 28/22. Note that this will adjust up or down as needed.

Do labs 1/2 way between injections.
If you change your T dose, to 125mg/week for example, you would change anastrozole dose by the same factor.

When injecting twice a week, take anastrozole twice a week at time of injections. Then T and anastrozole levels will rise and fall together. The levels should match as this is a competitive drug and ratios are everything.

There are a lot of key points above, try to read and grasp them all.

I know its pointless to suggest that some guys simply cannot get balanced on large amounts of T.

Life will be better when E2 is fixed.

Fat_Boy_33 · March 24, 2015, 4:14pm

I wouldn’t cut your Test in 1/2. I’d drop it to 100mg/week in 2 doses. Keep your HCG where it’s at. Drop the AI all together…

Let things balance out for about 6 weeks, get labs and see where you’re at. If you need an AI at that point, then start up. KSMan likes Anastrozole. Exemestane is also a good option for some.

I don’t need an AI. My body just doesn’t produce enough E2 on it’s own or with a small level of HCG. When I try to introduce an AI, then my E2 drops and I get a lot of joint aches. I haven’t ran into sex problems, but I was probably going in that direction.

Activator · March 29, 2015, 9:20am

[quote]Fat Boy 33 wrote:
I wouldn’t cut your Test in 1/2. I’d drop it to 100mg/week in 2 doses. Keep your HCG where it’s at. Drop the AI all together…

Let things balance out for about 6 weeks, get labs and see where you’re at. If you need an AI at that point, then start up. KSMan likes Anastrozole. Exemestane is also a good option for some.

I don’t need an AI. My body just doesn’t produce enough E2 on it’s own or with a small level of HCG. When I try to introduce an AI, then my E2 drops and I get a lot of joint aches. I haven’t ran into sex problems, but I was probably going in that direction.

[/quote]

Thanks for your input. i am really eager to be able to do away with AI altogether. but i am not sure if this can be done.

i have already cut my T does in half for last week and this week. I missed one AI dose and took a very small dose with my last 2 Test shots. I feel better already. my erection is great and morning wood is sometimes painful. my Testes also seem bigger. i don’t know why, but they do. I’ve also noticed that my load is more abundant.

I take supplements like horny goat weed and also honey with ginseng and Royal jelly. but they made no difference before. now i feel they have a chance to really kick in.

Thank you all

Activator · May 18, 2015, 9:58am

[quote]KSman wrote:
Your problems are caused by E2 near zero.
As I have stated in the stickies, Letro is too harsh and dose-response is not predicable. Use anastrozole, start with a small small dose and you will need to start over with labs. BB gear dosing will always be over range.