One Year Update with Labs, Still Need Improvements

Pharma TRT
1

Been on TRT for one year. Initially I went on to see if I could improve symptoms of depression. Overall, it has been a bit of a roller coaster. It was very difficult to get E2 dialled, and whenever my e2 is off I feel terrible.

My initial protocol was 140mg T and 800 HCG divided in two doses weekly, with daily desiccated thyroid at 30mg. It took about 0.5mg of adex weekly to balance E2 on this protocol, but over the course of the first year this dropped toward 0.2 mg weekly. As of May, I had e2 in range on this protocol. I was unhappy with my energy levels however.

In June I added DHEA at 50mg daily. It made me more energetic, but more irritable and eventually started causing insomnia. It was also very estrogenic; I needed to up my adex toward 0.6mg weekly. (I am sensitive to adex – this amount would have crashed me into a brutal depression prior to adding dhea) This was enough to bring my e2 below range, yet I was still irritable and still had nipple sensitivity.

I lowered the DHEA to 25mg daily July 13th. Currently my protocol is 140mg T and 800 HCG divided into three doses weekly. I am on daily desiccated thyroid at 30mg and DHEA at 25mg. I take adex dissolved in vodka daily at 0.05 mg – 0.35 mg weekly.

In Canada we do not have the ultra sensitive e2 lab. Usually felt best at 100 pmol/L, which is my Dr’s target. Any less than that I start to feel depressed.

My current labs are attached. My e2 is below the 100 pmol target. I am having mixed e2 symptoms which are really frustrating.

Low e2 symtoms: feel somewhat depressed, clicking and sore joints
High e2 symptoms: some nipple pain / sensitivity, hot flashes
Poor erections – good enough for sex, but they’re honestly at 50 or 60%, going soft very fast without stimulation
Energy is less than I would like

What gives? I am seriously frustrated with this. Been at the lab 16 times trying to get dialled and feeling good. The main benefit I have is a gain of about 10lb in muscle, but overall I do not know how much my mood, energy, or erections have improved.

One thing that sticks out on my current lab is that my progesterone has dropped from 0.6 pre TRT to <0.4, below the low end of the range. I have heard that this can cause erection difficulties, and that it acts as an anti-estrogen in some way. I am wondering if the added DHEA is metabolizing into other estrogens (not estradiol).

I am also wondering about pregnenolone, I have heard it can bring some benefits.

Any insights?

WBC 4.9 4.0-10.0 109/L
RBC 5.57 4.20-5.40 1012/L
Hemoglobin 163 135-170 g/L
Hematocrit 0.49 0.40-0.50 L/L
MCV 88 82-98 fl
MCH 29.3 27.5-33.5 pg
MCHC 331 300-370 g/L
RDW 12.6 11.5-14.5 %
Platelet Count 189 150-400 10*9/L

Differential
Neutrophils 3.0 2.0-7.5 109/L
Lymphocytes 1.2 1.0-4.0 109/L
Monocytes 0.5 0.1-0.8 109/L
Eosinophils 0.1 0.0-0.7 109/L
Basophils 0.0 0.0-0.2 109/L
Granulocytes 0.0 0.0-0.1 109/L
General Chemistry
Glucose Fasting 5.1 3.3-5.5 mmol/L
Creatinine 101 45-110 umol/L
Estimated GFR 84 >=60

Lipids
Cholesterol 4.05 2.00-5.19 mmol/L
LDL Cholesterol 2.63 1.50-3.40 mmol/L
HDL Cholesterol 1.15 >0.99 mmol/L
Chol/HDL 3.52 <4.9
Non HDL Cholesterol 2.90 mmol/L
Triglycerides 0.60 <2.21 mmol/L
Homocysteine 7 <15 umol/L

Thyroid Function
TSH 1.13 0.32-5.04 mU/L
T4 Free 12.5 10.6-19.7 pmol/L
T3 Free 4.40 2.60-5.80 pmol/L

Adrenal Function
Cortisol Random 276 nmol/L

Prostate Specific Ag 0.81 <2.5 ug/L

Reproductive and Gonadal
Estradiol 79 <157 pmol/L
Progesterone <0.4 0.4-1.8 nmol/L
DHEA Sulphate 7.2 <15.0 umol/L
Testosterone 41.9 8.4-28.8 nmol/L

Serum Proteins
C Reactive Protein 3.4 <4.8 mg/L

2

Don’t be surprised if you never feel good while your taking the AI. First order of business would be to ditch it, if at all possible.

3

These AI’s can cause problems, some never find the correct dosage for long, it difficult to find the correct dosage becauses you move to far in one direction and it turns out to be an endless roller coaster.

You need to think about injecting smaller doses more often, this will see estrogen lower.

4

I’m injecting 3x weekly. I could lower my T dose to the point I don’t need an AI - but in my case the DHEA adds more E2 than the testosterone. Also, I am taking only a small amount of AI as it is - 0.35mg weekly total.

No comments on out of range progesterone?

5

The progesterone is on range, albeit at the bottom. You don’t strictly need the DHEA, so if that’s causing your e2 to be at the point that you’re using an AI it seems pretty easy to simply drop it.

6

Progesterone is measured at <0.4, with 0.4 being the low end of the range.

Prior to DHEA, I wasn’t entirely happy with energy levels. I thought DHEA was supposed to improve things … so far it has failed to do that and put me in mixed e2 symptom land.

7

Sounds like you have an answer then. If it isn’t working and it’s making things worse what’s the harm in dropping it? I never found DHEA to be particularly useful either, frankly.