TRT, 5-1/2 Months In and Levels Still Aren't Stable

Pharma TRT
1

First off, I’ve read the stickies and am most indebted to the contributors and the ones who’ve done the research that most doctors, mine included, won’t seem to to do.
I am 48 years old and was suffering from very poor libido, ED, falling asleep at my desk in the afternoons even when taking 70mg Vyvanse (amphetamine) per day for ADHD, bald shins, zero energy or motivation, etc.

After verifying that no thyroid issues were present, the doc checked my testosterone levels and put me on Testim 1% (50mg test/tube), 1 tube per day. I felt great at 3 weeks, then went to crap as apparent in the test results below.
I had been reading the stickies here and wanted to know what my other levels were. So at my follow-up appt, I asked the doc if he would at least check my FT levels. But he said he could only treat TT, so he had no need to test FT! Grrrr!!! That is the reason the first 2 tests are so incomplete.
I subsequently joined LEF and started ordering the basic male hormone panel every 2 weeks so I could get the levels I knew I needed.

When my TT came back at 50, he agreed to let me self-inject T-Cyp 200mg every other week. After a single 200mg inj with a 23ga 1-1/2" pin in my arse, I started 28mg SC EOD with a 29ga 0.5" pin.

Ranges:
TT: 348 - 1197
FT: 6.8 - 21.5
DHEA-S: 71.6 - 375.4
E2: 7.6 - 42.6

Date … TT … FT … DHEA-S … E2 … Notes
07/11/14 … 360 … Initial testing
10/23/14 … 50 … 1 tube of Testim per day
11/12/14 … 377 … 10.3 … 325.5 … 24.1 … T-Cyp injections, 28mg EOD
11/26/14 … 507 … 12.7 … 337.6 … 24.2 … T-Cyp injections, 28mg EOD
12/10/14 … 778 … 21.6 … 351.1 … 29.8 … T-Cyp injections, 28mg EOD
12/24/14 … 602 … 10.1 … 335.6 … 56.4 … T-Cyp injections, 28mg EOD

OK, all that being said, here is my dilemma: This week I mentioned to the doc that my itchy, tender nipples were bothersome and asked if he could give me an AI, i.e. anastrozole. His response, we don’t do that. It’s just a side-effect of TRT.
I said I am also suffering with aching “raisinets” and would he consider hCG to restore testes function and stop the shrinking/aching. “No, we don’t do that. That’s also just a side-effect of TRT”.
Really?!?! I hate to be mean, but I hope he slams hit nuts in the car door on the way home! My E2 levels are going through the roof, and I feel like crap. I am assuming that the drop in T levels reflect the T => E conversion since I test the day between injections and there’s been no change in dosage since starting with injections in late Oct.
I managed to find some hCG that came in last week, so I started 250iu SC EOD this week on the same day as the T-Cyp and can’t wait to look in the mirror and not look like I just climbed out of an outdoor pool in the winter…
My problem is finding the anastrozole. The “research chem” search turns up so much crap that I’m having trouble wading through and separating the wheat from the chaff.
Any input or thoughts would be greatly appreciated.

2

There is a fining a TRT doc sticky.

What are the numbers: “After verifying that no thyroid issues were present”
Take your body temps and eval long term intake of iodized salt as per the thyroid basics sticky.

Your detailed labs show E2 climbing, decreasing TT and FT.

When you get E2 controlled, you may need 150mg T per week to get to high normal T levels. Some guys metabolize T faster than others.

3

KSman, I’m so glad you popped in, especially since I’ve plagiarized so much of your writing putting together a handful of documents for myself and my doc.
As for the thyroid labs, I don’t have a printout, so no ranges. However, here is what he said is “normal”…
FR Index - 2
T-Uptake - 31%
T4 - 6.3 ug/dl
TSH - 2.93 uLu/ml
I use iodized salt and have a tendency of putting salt on my salt. My temp has always been right at 98.6F, but I’ll read the “thyroid stickie” again a little more closely.

I should have some anastrozole on the way, so I will start 0.4mg EOD (235lbs/160= ~1.5mg/wk), waiting 2 weeks, then running the labs again. Hopefully, I can get my E2 level dialed in fairly quickly.
I’ve got a lead on a doctor that has prescribed anastrozole to a male patient in the past. I am going to try to get more info on her and see if she is a little more open-minded and/or willing to work with me.

[quote]KSman wrote:
There is a fining a TRT doc sticky.

What are the numbers: “After verifying that no thyroid issues were present”
Take your body temps and eval long term intake of iodized salt as per the thyroid basics sticky.

Your detailed labs show E2 climbing, decreasing TT and FT.

When you get E2 controlled, you may need 150mg T per week to get to high normal T levels. Some guys metabolize T faster than others.

[/quote]

4

Anastrozole can be dosed VS mg of injected testosterone … normally. But it really needs to match your T levels in your blood. As your T levels a bit low, you many need .6-.8 mg/week. Again, with your injecting once a week and lab timing issues, we don’t have a good measure of your T levels. Have never seen one scale AI dose by body weight before; interesting but might be leading you way off target.

5

[quote]EatonB3 wrote:

I had been reading the stickies here and wanted to know what my other levels were. So at my follow-up appt, I asked the doc if he would at least check my FT levels. But he said he could only treat TT, so he had no need to test FT! Grrrr!!! That is the reason the first 2 tests are so incomplete.
I subsequently joined LEF and started ordering the basic male hormone panel every 2 weeks so I could get the levels I knew I needed.

When my TT came back at 50, he agreed to let me self-inject T-Cyp 200mg every other week. After a single 200mg inj with a 23ga 1-1/2" pin in my arse, I started 28mg SC EOD with a 29ga 0.5" pin.

Ranges:
TT: 348 - 1197
FT: 6.8 - 21.5
DHEA-S: 71.6 - 375.4
E2: 7.6 - 42.6

Date … TT … FT … DHEA-S … E2 … Notes
07/11/14 … 360 … Initial testing
10/23/14 … 50 … 1 tube of Testim per day
11/12/14 … 377 … 10.3 … 325.5 … 24.1 … T-Cyp injections, 28mg EOD
11/26/14 … 507 … 12.7 … 337.6 … 24.2 … T-Cyp injections, 28mg EOD
12/10/14 … 778 … 21.6 … 351.1 … 29.8 … T-Cyp injections, 28mg EOD
12/24/14 … 602 … 10.1 … 335.6 … 56.4 … T-Cyp injections, 28mg EOD

OK, all that being said, here is my dilemma: This week I mentioned to the doc that my itchy, tender nipples were bothersome and asked if he could give me an AI, i.e. anastrozole. His response, we don’t do that. It’s just a side-effect of TRT.

I said I am also suffering with aching “raisinets” and would he consider hCG to restore testes function and stop the shrinking/aching. “No, we don’t do that. That’s also just a side-effect of TRT”.

Really?!?! I hate to be mean, but I hope he slams hit nuts in the car door on the way home! My E2 levels are going through the roof, and I feel like crap. I am assuming that the drop in T levels reflect the T => E conversion since I test the day between injections and there’s been no change in dosage since starting with injections in late Oct.
I managed to find some hCG that came in last week, so I started 250iu SC EOD this week on the same day as the T-Cyp and can’t wait to look in the mirror and not look like I just climbed out of an outdoor pool in the winter…
My problem is finding the anastrozole. The “research chem” search turns up so much crap that I’m having trouble wading through and separating the wheat from the chaff.
Any input or thoughts would be greatly appreciated.[/quote]

This is the type of deal that really chaps me. You have to endure this nonsense, but we (as a group) are considered assholes when we call the doc an ‘idiot’. Sorry, if it walks like a duck and quacks like a duck…

And so you’re in the position of research chem A.I.'s and locating hCG on your own. Well, the information is clearly available and the problem is that the docs either don’t want to do the investigation on what best practices actually are or they’re incompetent. Take your pick. Either way, the patient loses. It really does suck.

FWIW, I think 0.4mg of anastrozole EOD is a bit high. I know you’re trying to knock your E2 down, but you’re not trying to knock it out. You’ll probably be happier if you start with a lighter dose (say 0.25 EOD), get it down to maybe 30 and then use the KSman adjustment to dial it into the low 20’s. If you have a big response, you’re likely to really tank yourself and feel like crap on the other side.

6

I guess I made my post a little unclear in the process of trying to include all of the pertinent information.
My doc prescribed 200mg in a single injection every 2 weeks, but I have been injecting 28mg subcutaneous every other day after the first IM. I always get my labs done at 8:00 AM on the day between injections, so the numbers should be pretty accurate. Or at the very least, relational.
As for scaling the AI dosage, I am “almost” positive that I derived that information from one of the posts here, but obviously it wasn’t from you. In any case, I’ll strip that out of my documents and begin with 1mg per week in divided doses, then run another lab a couple of weeks after starting.
My doctor says that he won’t try to get me above 500 TT. However, based on what I’m understanding, I should be targeting somewhere around 1000. So I’m seeking out another doc in the area that is more willing to help. Hopefully I’ll be successful before he has a chance to test me himself and reduce my dosage to what he “thinks” it should be.

7

Thanks FB, your rant echoes my sentiments exactly. I’m a gainfully employed electrical engineer and father of 4 with a non-existent criminal record. And it royally chaps my ass to have to put all that on the line and risk losing everything to circumvent the law or tread into grey areas in order the procure the medications that I need, and all because of inept medical care. Sorry. I’m about to go off on a rant of my own.

In any case, thank you for your response. I’m going to start off with 1mg per week in divided doses and see where that takes me based on the followup labs.

[quote]Fat Boy 33 wrote:
This is the type of deal that really chaps me. You have to endure this nonsense, but we (as a group) are considered assholes when we call the doc an ‘idiot’. Sorry, if it walks like a duck and quacks like a duck…

And so you’re in the position of research chem A.I.'s and locating hCG on your own. Well, the information is clearly available and the problem is that the docs either don’t want to do the investigation on what best practices actually are or they’re incompetent. Take your pick. Either way, the patient loses. It really does suck.

FWIW, I think 0.4mg of anastrozole EOD is a bit high. I know you’re trying to knock your E2 down, but you’re not trying to knock it out. You’ll probably be happier if you start with a lighter dose (say 0.25 EOD), get it down to maybe 30 and then use the KSman adjustment to dial it into the low 20’s. If you have a big response, you’re likely to really tank yourself and feel like crap on the other side.
[/quote]

8

Your FT was good before E2 surged.

You might need more AI, but it is better to work up then find your way after crashing E2. It take 6-7 days for ones serum levels of anastrozole to level out after a dose change, then E2 levels need to balance out between production and metabolization. So wait a while before doing labs.