Current protocol-with Bloodwork-Anything you would adjust?

[jm100]

Hey there! I've lurked here for a while. I feel pretty knowledgable on HRT because I've been on it for so long, and like a lot of people here done my own research throughout. I work in medicine, so I have the benefit of choosing who I know to be a a good endo who's pretty up to date on research and open to trying things if I suggest them.

Background: 33 Years old, I've been on HRT since about 19, had a Traumatic Brain Injury and for whatever reason my body never really snapped back with some HPTA stuff, specifically LH--HcG monotherapy was a no go for me, high dose HCG my body just doesn't respond well to, tons of sides and not especially effective. So I've been on T for about 14 years.
5'11" 190. <15% body fat. Exercise 5-6 days a week. Mostly weightlifting.

I feel decent, but could be better on the front of libido and I do feel like I have a wider variation in water fluctuations than other men. I definitely notice specific periods where I feel on top of the world, gym is good, pumps are good and also minimal/no bloat--contrasted by periods where I'm facially/abdominally bloated, less pump and vascularity, and less energy at the gym, etc. I've monitored my sensitive E2 a ton over the last year trying to pinpoint it with that and adjusting Adex doses, but no huge breakthroughs. I've gotten bloodwork done in periods where I don't feel as hot, and had E2 be on the lower end, but other times when I've felt off and had it done and be on the higher end too

Current Protocol:
Test Cypionate: 80mg q3.5d
Anastrazole: 0.25mg every other day (I've tried both less and more of this and haven't noticed much of a difference in whether it changes or not. Mostly when I'm doing a lower dose of it and do notice moodiness / bloating creeping up ill add another 0.25 and it does help with bloat and mood I feel like)
Cabergoline: 0.625mg same day as the Testosterone (initially after my TBI I had high prolactin and started Caber with my hormone replacement--I've had pituitary scans etc. no tumor it's just assumed to be from the injury--My prolactin had been <2 undetectable for several years on the standard dose of 0.25 every 3 days, and I'd seen studies that low prolactin could cause low libido so my doc and I gradually have tapered it down and my body has tolerated that well. So now I do 1/8 of a tab every 3 days, which has my current Prolactin at 7.1 (2.1-17 scale).
Hcg: 250iu q3d. Although with the new laws getting rid of compounded HcG I may be forced into getting rid of this one? I know lots of people are mixed on liking/disliking HcG anyways.
Otherwise some basic vitamins, Vitamin D, Zinc before bed, I take a 2.5mg Cialis a day which keeps my blood pressure good <130/80, without it sometimes my BP read higher

Labs:
Testosterone 800 ng/dL (241 - 827 ng/dL)
Free Testosterone MALE 190 pg/mL (47 - 293 pg/mL)
% Free Testosterone MALE 2.4 %
1.6 - 3.3 %
Sex Hormone Binding Globulin 30.9 nmol/L (15.0 - 94.0 nmol/L)
Estradiol, Sensitive LC/MS = 34 (Quest diagnostics, their scale says <29) ---I should note on the identical regimen at quest diagnostics I've had a 10 before, a 18 before, and another above 30 before all from the same Quest Diagnostics LC-MS test. So This leaves me a little unsure of what to do as far as E2 management and the adex.
Prolactin 7.1 (2.1 - 17.7 ng/mL)
TSH 1.322 mU/L (0.400 - 4.000 mU/L)
Free T4 0.98 ng/dL (0.84 - 1.51 ng/dL)

CBC/CMP were all 100% good, not posting just to avoid a wall of text.


I guess I'm looking for adjustments on what YOU would do with this to optimize this. I feel like there's something 'off' during some periods for sure, where my mood/skin/bloat/temperature sensitivity/reduced vascularity/back acne/libido and erection quality are all reacting at the same time but I have varying/conflicting thoughts on what to do. But I've gotten bloodwork done during those periods and had E2 read anywhere from 10-35. And some of the periods where I've felt awesome and wanted to see where the E2 is, it's variably low or high also.

Right now I'm debating moving the Test to a 60 mg M/W/F dosing regimen instead of the 80mg q3.5d, and seeing if It'd be possible to cut down the adex even more (or eliminate it?), but I also feel a little hesitant about that because my sensitive E2 is already above the recommended level and I feel like a lot of guys prefer it in the 20's.
I feel okay a lot of the time, but I know it could be better.


(Side note: What are most of you doing now that HcG/Biologics aren't allowed to be compounded? Just ordering online? I've heard some people talk about doing Clomid? )

[Youthful55guy]

My opinion on the use of an AI (anastrozole) has changed over time. I'd consider discontinuing it all together.

I think most guys are way to paranoid of E2. I've found that my E2 (even with the LC/MS test method) varies a lot from test to test and has little correlation with my dose of T. Why? I have no idea, but I am questioning the validity of what we are measuring. I now no longer get excited about my E2 unless the labs go way out of range. I've used the LabCorp LC/MS test for several years and their normal range is 8-35 pg/mL. I typically have E2 levels (without any AI) in the 9 to 60 range with no correlation with T dose. In fact, the two lowest levels 8.9 and 9.1 were at some of the highest levels that I will go with T (160 and 180 mg/week in an E2D protocol). Conversely, one of the higher tests came back at 63.5 pg/mL and that was when I was taking 110 mg in an E3D protocol.

Regarding dosing, I'd consider an E3D dosing protocol instead of a MWF protocol. It's a personal choice, but I prefer to have even injection intervals at all times. That way I am not stuck with running labs on a particular day of the week so that the labs are comparable to each other.

Regarding HCG , I haven't used compounded product in many years. My doc gave me a script for Pregnyl and I get filled at a local pharmacy.

[jm100]

My opinion on the use of an AI (anastrozole) has changed over time. I'd consider discontinuing it all together.

I think most guys are way to paranoid of E2. I've found that my E2 (even with the LC/MS test method) varies a lot from test to test and has little correlation with my dose of T. Why? I have no idea, but I am questioning the validity of what we are measuring. I now no longer get excited about my E2 unless the labs go way out of range. I've used the LabCorp LC/MS test for several years and their normal range is 8-35 pg/mL. I typically have E2 levels (without any AI) in the 9 to 60 range with no correlation with T dose. In fact, the two lowest levels 8.9 and 9.1 were at some of the highest levels that I will go with T (160 and 180 mg/week in an E2D protocol). Conversely, one of the higher tests came back at 63.5 pg/mL and that was when I was taking 110 mg in an E3D protocol.

Regarding dosing, I'd consider an E3D dosing protocol instead of a MWF protocol. It's a personal choice, but I prefer to have even injection intervals at all times. That way I am not stuck with running labs on a particular day of the week so that the labs are comparable to each other.

Regarding HCG, I haven't used compounded product in many years. My doc gave me a script for Pregnyl and I get filled at a local pharmacy.

Thanks! This is helpful, I've been having similar thoughts with the sensitive E2 also. Same thing, there have been times I've been on the same anastrazole regimen with a significant higher test dose and somehow had lower E2 results.

I'd been compounding so many years I hadn't even thought to check pricing at my regular pharmacy! A few years ago when I started compounding it was because Pregnyl through my pharmacy was several hundred dollars more expensive, so I did the cheaper option. But I just looked it up, looks like these days the cost is pretty comparable to what I'd been doing at the compounding pharmacy anyways. Doh.
Thanks!

[AR's King Silabolin]

Simple, are u eating enough fruits and greens?
After i stopped pasta, rice, most of the bread and started to eat more veggies along with clean protein, everything become so much easier.
Lots of greens are good for maintaining an optimal estrogen/"prolactin profile in men too!!
Also i prefer atleast 1500 ng/dl and there are no lifeshortening aspects to it as long as u go plenty greens. Except a little prostate growth, but limit the liquid 3 hours before bedtime and u migth get by with only one nigthly toilet visit.

If u have paranoia, u may monitor hct and donate, but recognized experts say more test will not give u clots, even if hct elevates.
How often does BBs die from stroke?.. Rare.

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