Test Replacement Labs - Opinions Wanted

Pharma / TRT Testosterone Replacement
1

Hi T-Nation,

I am so glad to have joined here. After being diagnosed with Low Testosterone over a 18 months ago, I’ve embarked on the TRT Journey. I’ve been working with the same doctor since starting and I’ve had a bit of a turbulent run with getting going in terms of dialing in dosage and attempting to mitigate estrogenic side effects. Any and all of your feedback and guidance is truly appreciated.

Some background - I noticed low T symptoms starting in my mid-20’s. I was tired all of the time, had next to no energy, was putting on weight, and generally lost my lust for life. It took a lot of research to actually figure out that the root cause of all of the above may be low testosterone and not something going on inside of my head. After going to get checked out, my total testosterone was under 300 and all of the other factors were pointing to my having an issue with testosterone. I do not have the initial labs from when I was diagnosed, only the current ones which are the true purpose of why I am posting here.

My stats are as follows:

Age 32
5’8
185 lbs

When starting on TRT, the doctor prescribed me the following protocol:

*210 MG/week testosterone cypionate injection 1x weekly

  • 1x 1mg Anastrozole on the day of my shot
    *2 x 20 mg tabs of nolvadex every 3rd day.
    *500 IU Shot of HCG 3x weekly

I started the treatment and immediately noticed I did not react well to the Anastrozole. I felt extremely dried out, moody, anxious, and just overall shitty. I told the doctor and he advised me to add an additional 20mg tab of tamoxifen to the protocol and cut out the anastrozole all together. The above anastrozole negatives were gone and it took about Three weeks after my first injection where I really started noticing the benefits of T-Cyp. All of my original side effects from paragraph two above were gone and I felt like an 18 year old again. Tons of energy, great libido, workouts seemed to be improving, and so on. About 7-8 weeks in I noticed INTENSE amounts of bloating, mental fogness, sensitive nipples, watches/socks fitting tight, etc. I immediately called the doctor and asked for labs. Again, do not have these labs but I went to Labcorp and my Test Level was above <1500 and Estradiol was at a 91. The doctor recommended I simply scale back the Testosterone to 155mg test cyp weekly.

I’ve been there since and feel AMAZING. While taking 3x tamoxifen citrate per week and the 155mg shot, I’ve had No sides, sex drive is great, and I am living life to the fullest. However, the doctor is arguing with me and states my Estradiol is too high and that I need to add anastrozole back into the protocol (My FULL LABS at the current protocol without anastrozole are below). I am reading conflicting information regarding where estradiol levels should truly be. I understand that everyone is different in terms of their estradiol levels and what makes them feel good, but do I truly need to add Anastrozole to my protocol based on the below? The doctor is stating that my estradiol levels should be closer to 15-20.

Here they are: Any feedback is appreciated -

Glucose: 101
Tot, Testosterone: 1020.00
Alk Phos: 34
Free Test: 227.81
Estadiol: 70.21
Glucose: 101
Total Protein: 7.5
Albumin: 4.9
Globulin: 2.6
Sodium 141
potassium 4.8
chloride 102
C02 25
BUN 16
Creatinine 1.2
E - GFR 80
BUN/Creat Ratio 13.3
Calcium 9.8
bilirubin 0.4
Alk Phos 34
AST 37
ALT 29

Cholesterol 174
Triglicerydes 68
HDL 62
HDL as % 36
CHOL/HDL ratio 2.8

TSH 1.690
PSA Total .66

IGF -I 156

2

Am curious as to the SERM in your protocol. That’s used usually for PCT.

3

I wonder if the serm is blocking the affects of the high e2. Did you every do trt without the serm(novaldex)? Did Dr say why he wanted you to take this? Am so curious because I get boating and an thinking of adding a serm(clomid).

4

That’s an insane starting weekly dose and most guys feel best when their E2 is between 20-30, your E2 is way to high! I wish I had a fast response to T-Cyp, my experience is much slower.

6

HI Charlie - I’ve never done TRT without the SERM. The doctors explanation is exactly what you stated above. The SERM is there to block the estrogen from binding to the receptors (apologies if that terminology is not exactly on).

7

Hi @systemlord - agreed on the starting dose. In regards to the E2 being so high, I’m trying to figure out why I don’t feel any of the negative effects that people typically claim when having high E2?

8

It could be the wrong E2 test, we see guys coming in here with E2 test designed for females as they overestimate, you need the E2 sensitive test for males.

9

What was your starting dose like on test cyp, how long have you been on, and where are you dosage wise now? I’ve been contemplating going from 1x injection per week to 2x injection to help lower the estrogen.

10

Interesting - Any idea how I can confirm which E2 test I was given?

11

Roche ECLIA methodology is the wrong one, LC-MS/MS assay is the correct one for males.

12

I just checked. The Roche method is what was used.

13

I knew it, you’re one of 5 other recent posters who have come here in the last few days with the wrong E2 tests, it happens all the time so unless your doctor specifies E2 sensitive the lab will automatically revert to the Roche ECLIA methodology. I’ve seen guys go in and have their doctor reorder labs only to have the wrong E2 test again, quite frustrating that we must hold our doctors hands.

Imagine if you base your AI dosing off these wrong tests that overestimate our E2 levels, guys end up crashing their E2 all the time because they based their decision off the wrong testing methodology. You can’t even estimate where your E2 levels are with these tests.

14

That could be because of the novladex you are using?
What do you think made you extremely bloated? Am curious because I get that to. Thanks.

15

Absolutely terrible. Any idea how big the typical deviation is between the Roche and LC-MS/MS methods are?

16

There’s no way to estimate, it’s truly useless to even guess. It’s like trying to measure a football field with a ruler.

17

Makes sense - I’ll call the doc tomorrow and chat. Also, on a side note - In your experience, do you recommend twice per week injections rather than once?

18

That depend on your SHBG level, my SHBG was 25 nmol/L before starting TRT, last set of labs was 19. Guys with high SHBG can get away with large weekly injection, mid levels SHBG guys twice weekly and guys with SHBG below 25 find either twice weekly or EOD to best.

Your SHBG grabs ahold of your testosterone and estrogen as if flows through your blood and activates T and E at the receptor sites, low SHBG guys have a lot of the T pass right into their urine that’s wasted, this is why a low SHBG guys injects more frequently.

Mid level and high SHBG guys hold on to their T and E far better, but be careful because if SHBG gets too high your free T will decrease, this is why large weekly injections are best for high SHBG guys, it also suppresses their overly high SHBG to allow for a free T increase.

19

This is phenomenal info. Truly appreciate the education and insight on this.