Requesting Help with TRT: Early 30s, Low T Diagnosis

Pharma / TRT Testosterone Replacement
1

Hey everyone,

I discovered I have a low T issue about a year and a half ago, with no known cause (brain MRI came back clean, no blood markers for anything else problematic… maybe a semi-serious male injury from a few years ago) and have been on a T Rx since Spring 2017. The Rx and methodology has changed as I try to address some of the symptoms of the low T, as well as the side effects of the Rx(s). But, I need your help.

I’m in my early 30s and, for the record, male.

My doctor wasn’t checking my estrogen/estradiol and I didn’t realize, so I’ve changed to a younger guy who’s much more knowledgeable about this and has really helped me out. He put me on anastrozole and hydrochlorothiazide (originally, metoprolol, but that had ED side effects), which has made a huge difference: my estrogen dropped, and my BP went to normal levels with a more even heartrate.

However:
I’m still experiencing intermittent fatigue throughout the day that seems to come and go with the rise/fall of my hormone levels. When we went from one anastrozole tablet to two, this got better, but it’s still there.

I have a weird experience with caffeine now (and maybe sugar?) – this was even pre-anastrozole --, as it pumps-up my heartrate, blurs my vision (to about 80%), and then makes me drowsy. I’m completely off caffeine and try to minimize my sugar. I’m not diabetic, prediabetic, etc.

My vision also now wavers between 80% and 100% (with some eye pressure), depending on the moment, when I’ve last taken anastrozole, and other factors I can’t figure out. This is despite having LASIK and a comprehensive recent eye exam declaring me in good physical eye health.

I sometimes have headaches, light dizziness, and/or slight tunnel vision, as well.

Although my BP has gone down, my heartrate is still slightly high compared to my normal. I can physically feel the difference, too.

When I was taking anastrozole as a whole pill, my eyes would “burn” and I would get physically hot to the touch.

When I’m at the gym, I get some light dizziness, my vision goes blurry, and I may get slight tunnel vision.

Finally, I’m slightly anemic.

All of my doctors seem confused/stumped and I don’t know what to do now. I would appreciate help. Please keep in mind that I need to keep all of this either Rx or OTC.

Regimen:
T Cypionate (200mg/mL): 0.10mL, five times per week, subcutaneous with an insulin needle/syringe
Anastrozole (1mg tablet): a half-tablet, four times per day (evenly spaced)
Hydrochlorothiazide (12.5mg tablet): upon waking

BCAA capsules: throughout the day

(all below are new and seem to have minimal effects on how I feel)
Vitamin D3: 2000IU after breakfast
Vitamin B12: 500mcg after breakfast
Methyl Folate: 1000mcg after breakfast
Vitamin C (high potency): 1000mg after breakfast
Elemental Iron: 65mg after breakfast

Labs:
Early August (after a month of spreading-out T injections, taking 1mg anastrozole/day, and taking metoprolol):
–labs done approx. 2 days after a 0.10mL injection–
T Total (LC/MS/MS): 790 ng/dL
T Free: 221.2 pg/mL
T Available: 464.5 ng/dL
Sex Hormone Binding Globulin: 13 nmol/t
Albumin Serum: 4.6 g/dL
Estradiol: 23 pg/mL
Heartrate: 75bpm
BP: 110/90

Early June (T only, injecting twice/week for about a year):
–labs done approx. 2 days after a 0.25mL injection–
T Total (LC/MS/MS): 372 ng/dL
T Free: 90.4 pg/mL
T Available: not tested
Sex Hormone Binding Globulin: not tested
Albumin Serum: 4.5 g/dL
Estradiol: 38 pg/mL
Heartrate: 65bpm
BP: 150-180/90

2

Your problem is low SHBG and you should be on an everyday injection protocol because you excrete testosterone into your urine within a very short period of time, usually within 1-2 days.

I need to confirm something, are you really taking 1/2 tablet of anastrozole four times per week?

Also I seriously doubt your doctors are using the Liquid chromatography–mass spectrometry estrogen tests designed for men, a lot of doctors are unaware. The problem with using this incorrect test is they are basing the anastrozole doses off of labs designed for females.

Your estrogen could be much lower than stated, meaning the anastrozole doses is too high. Your description of burning eyes and hot flashes are when someone crashes their estrogen levels. Women also experience hot flashes when estrogen drops during menopause or when they are having their periods.

These doctors are messing you up and you need to seek out someone who knows what in the hell they’re doing. Low estrogen is dangerous!

You need to stop the anastrozole immediately and locate a hormone specialists. You won’t find one inside your insurance network. I was force to go private do to all my endo’s being brain dead, confused, deer in headlights when it comes to TRT.

My endo wasn’t checking estrogen either, you will find similar stories all this and other forums. Most doctors receiving NO training and have little in the way of guidelines to tell them what they are supposed to do.

This is why doctors tend to not want to prescribe testosterone.

3

Systemlord,

Thanks for the quick response!

I’ve moved to a 5/week injection protocol (because 0.50 divided by 7 is hard to measure on an insulin syringe), but would 7/week make a noteworthy difference?

Confirming on anastrozole: no, I’ve been taking a 1/2 tablet (0.50mg) of anastrozole four times per day, for a total of 2mg per day. Before anastrozole, my estrogen/estrodiol was way too high, so we went to one tablet per day (1mg). I’ve recently increased to two tablets total per day (2mg).

Regarding the way that I feel (eyes, hot, etc.): that didn’t present on 1mg per day, but I still felt tired, sluggish, etc. so we pushed to 2mg per day. Prior to taking anastrozole at all, my blood was like sludge and I felt worse than I do now.

How would I increase SHBG?

4

Did you confirm you’re using the LC/MS/MS sensitive E2 testing? You really need to run away from this doctor! Taking an AI four times per days is stupid, it takes 2 days for the reach the half life of the drug.

You’re risking your health with doctors who you claim are stumped and confused. That’s more than enough for me to get out of that situation.

Low thyroid function (low Free T3) can lower SHBG, seeing you have no testing for thyroid it’s hard to tell. Typically you want to check Free T3, Free T4 , Reverse T3 and antibodies.

1 Like
5

No, it looks like it’s not LC/MS/MS for estrogen/estrodiol testing. I’ll cut back on the anastrozole to 1mg/day, now that my estrogen/estrodiol dropped from the tangible high that it was, and see how that goes.

In terms of other labs, they put me (in early June) at:
FSH <0.7 L
LH <0.2 L

Labs in January put me at:
T4 Free: 1.6 ng/dL
TSH: 1.08 mIU/L

Those are all the labs I have, beyond generic panels, glucose, etc.

6

This is a common occurrence because there is no standard of care for TRT, there’s no direction, no instructions to assists doctors on the proper course of action. The only doctors who know how this TRT game is played are those that have been doing it for decades and I can tell you few of them are located within insurance networks.

This forces us to suffer at the hands of doctors and hope they are quick learners or locate a doctor who knows what their doing. I went with Defy Medical, they do telemedicine, consults over the phone and medicine is mailed to me.

Dr. Saya has been treating men on TRT for 20+ years, it’s amazing that doctors have been doing TRT for so long and yet most doctors are still stumped and confused more than two decades later. The truth be told androgen therapy has been ignored by the medical community for decades because it’s not seen as profitable enough.

Being low SHBG means you have a lot of free hormones, Free T and Free E2 and means your estrogen score needs to be closer to your 20 pg/mL rather than closer to 30 pg/mL.