One month into TRT journey, looking for advice

Pharma / TRT Testosterone Replacement
1

Hello Everyone,

New to T-Nation. Looking to become more educated from this community & to hear everyones opinions and experiences.

Before deciding to go on TRT I had my bloods taken. I am 35, 5’10", 190 lbs. lean with some minor belly fat, very active, resistance train 5 days a week and do cardio 3 days a week. I eat very well and sleep well. All of my basic health blood tests were all normal and in healthy ranges. So I wont dive into those markers as nothing was flagged (CBC, Metabolic, Lipid, TSA, HBCA1C, VitD.)

My symptoms that were of concern which led me to be interested in TRT was fatigue, loss of motivation, nose acne (never had this until the past year), libido, erection quality, but mainly just overall mental well being felt off. Life was a bit cloudy.

My hormone labs were as follows:
Total T: 815 ng/dL, Free T: 15 pg/mL, Estradiol: 55 pg/mL, PSA: 1 ng/mL, SHBG: 47.5 nmol/L, IGF-1: 178 ng/mL. (This was all that was tested. I know some tests have more extensive Thyroid things tested as well as prolactin. But I don’t know these markers for me yet.)

TRT doc started me on 150/mg per week. Split into two shots each week. Along with an AI (First week 1mg 2x a week day after TRT shot, then 0.5mg 2x a week day after TRT shot.)

My first question I’d like to know from the community is based upon my hormones and pre TRT symptoms, does this protocol seem right? I’ve been reading so much about the T/E2 ratio and its all over the board. I’ve always had a very high natural Total T but on the blood work they flagged my E2 and SHBG. Doc said my Free T is low and that I need to decrease my estrogen and raise my free T. Im wondering if I need to just run the TRT only and see if when my free T/total T increases more if then my symptoms will subside in ratio to my estrogen being high or if having the AI from the start seems correct because of my bloodwork? The last thing I want to do is make my ED or libido worse from using an AI. Even if my E2 decreased a bit using an AI, I know just having that medication in your system causes ED in itself for a lot of people like how anti depressants do.

Looking forward to chatting.

2

No, you’re not low T. Your FT is mid range.

IMO that’s also way too much AI.

1 Like
3

Appreciate the reply. I started TRT because I don’t feel great or optimal. So Im interested to see if an increase in Free T will help me feel better than I have been. Im mainly concerned about how to manage my estrogen correctly moving forward. I was using the AI the first two weeks and by the end of week 2 I felt terrible. So I completely stopped the AI and now one week later I feel better again overall. Im wondering if I should just let me body handle the estrogen the way it will and maybe try some natural alternatives?

4

I’m not a fan of AI use until you get your first labs draws. T solo for 6-8 weeks. Adjust dose or add AI after follow up labs or as symptoms arise. Add AI sparingly. When I use it I do .125mg 2 x a week.

FWIW I don’t think your problem is low T related. How is your sleep? Do you snore?

5

Do you think my pre-treatment E2 level is already a cause for concern in comparison to where my other hormone markers are at? My Doc thinks my symptoms are stemming from that.

My sleep is pretty normal I’d say. I usually go to bed between 1030-11pm and get 7-8 hours each night. Sometimes I wake up naturally early and toss and turn a bit. I snore sometimes but not crazy at all.

I’ve read in these forums that a lot of guys don’t start feeling much better until their free t is in the mid 20’s and up. Thoughts?

6

Maybe. What was the range from your lab for confirmation?

These forums are full of “special people” not the norm. Think about how many men are on TRT, way more than visit the forums. Forums are usually for the 1% that are proactive first, then the other 1% that have problems. The other 98% probably never visit a forum and just follow their protocol without issue. Any of these mythical ranges are just that… things that work for a small subset. As long as your FT is in the teens, you’re not likely having a T issue IMO.

1 Like
7

Range is 7.0-42.0 for E2. I forgot to mentioned that for the past 3-4 years I’d say I would cycle on and off natural test boosting supplements just to try and aid in all the things naturally. Im wondering if any of those supplements spiked my estrogen and it got stuck there. I was 3 months clean on nothing before I had my bloods done.

8

No, Probably not.
Was your E2 test E2 “sensitive” ? Look and see.
Sometimes the regular E2 panel can over exaggerate estrogen numbers. Being as lean as you are. I wouldn’t think you would need an AI at all. Are you having high E2 symptoms?

9

I had both the regular E2 and Sensitive one done. Still waiting on the sensitive results to come back to me.

The main symptoms I was having before TRT was declining ED, some nose acne, fatigue, lack of motivation.

E2 was at 55 before TRT and the E2 test I got last week was still at 55 after 4 weeks on TRT. So my E2 has stayed the same basically. Which is why I’m wondering if my symptoms then and now are because my E2 is just too high.

Which is why Im seeking advice on my ratio because something is for sure off. Im healthy as hell and my erections should be completely normal / great. My drive is there and always has been. I just cant keep it up or fully hard ever right now, which is really frustrating.

10

For what its worth.
Most men that have issues here are the ones that are so engrossed with the “Numbers” than the actual issue itself.
They say. “My FT. is to low” So, they raise the Test dose and now their E2 is out of range.
So, then they take an AI and crash their E2 and now “THINK” that they have ED.
Back and forth we go. Chasing numbers on a piece of paper.
Never truly letting their hormones settle in.
You just started, correct?

11

I totally get what you’re saying. But the reason why I even dove into starting TRT was because of the symptoms I was having even before treatment. Those bloods are pre treatment levels which is why I’m concerned my E2 was too high to begin with. Yeah, This will be my 5th week on TRT. But I’m concerned because I feel my ED has gotten even slightly worse than before treatment.

12

Man, I totally get it.
All im saying is to be patient with TRT and with yourself.
Give it some time and try not to let it bother you to much.
I was all over the place when I first started and thought “Damn. This isn’t what I expected at all”
Soon enough. all the bad went away and was slowing replaced with the good.
Mind you I’m still tired fatigued and can be foggy at times. But that comes with the territory of getting older too.

13

Yeah I’m trying to keep my head in that space. But it’s tough when I feel my energy has spiked tremendously but my guy downstairs isn’t working. So I’m concerned I’m doing more harm than good, you know?

14

It could be plausible that the small amount if ED you were experiencing before treatment is still happening after treatment because it’s a circulatory issue and not hormonal at all.
Just a thought.
Thats why I think it’s important to not change to many variables.
It would be a shame to have to struggle though a bunch of hormone protocol changes in order to find out you have high blood pressure our something related. or even a mental emotional issue.
For instance, If you can jerk off to your favorite “material” and not lose an erection. But lose erections while having sex with your partner. Then that’s not your T or your E.

15

I’m having trouble even keeping it up even trying to jerk off. Which is concerning.

16

no, I would not have started you on replacement given your TT/FT were fine, e2 was little elevated but fine, and thyroid was fine. you were not in need of TRT IMO

2 Likes