Where to go from here?

[17chester6]

So It has now been 12 weeks on TRT and the blood work is in.
Background: healthy 59, but lethargy and exhausted by 7 PM, no gains in gym, mild to moderate ED, 6 foot 2 inches, 180 pounds, no medications.
Now on T cypionate 50 mg twice weekly, HCG 250 IU twice weekly, DHEA 25 mg daily, Liquid Cia 5 mg daily, Vit D 4000 IU daily
Blood work shown is pretreatment levels and then last weeks levels and the reference range in brackets:
Total T: 12.9. now 33.5 (8.4 to 28.8 nmol/L)
Free T: 20.5, now 72.8 (25 to 80 pmol/L)
E2 (sensitive E2 is not available to me): <70, now 167 (<150 pmol/L and target range is for a level of 100 to 130)
DHEA: 1.6, now 3.6 ( <9.7 umol/L)
Dihydrotesterone: 1093 but latest result still pending ( 860 to 3406 pmol/L)

Haemoglobin and haematocrit are fine (I donate), thyroid indices are good, PSA stable and 0.61 (<4.0 ug/L) HbA1C unchanged at 0.053 (<0.060). Vit D 68, now 90 (75 to 250 nmol/L).

Cholesterol indices were all good pre-treatment and now still good but with a slight fall in HDL and increase of LDL. C Reactive Protein went from 0.8 to 1.5 (<2 mg/L) and homocystine went from 13 to 12.3 (<=15 umol/L)

Feeling well, lots of energy, no ED and great libido. I do have significant water retention in my legs and some flitting muscle and joint pains that are new and muscle stiffness.

I am to see the doc next week but wanted to be prepared for the visit. From the experience of others should I leave all the doses as they are and go on an AI? Should I try decreasing the T. cypionate and seeing if this brings the E2 down? Do I increase the DHEA as my DHEAS is still in the lower end and if I do might that not increase the E2 further?

Also, I thought that TRT would help cholesterol and health. So why the slightly higher LDL and lower HDL though they are still normal? And why the increased CRP which is marker of inflammation?

Thanks for any suggestions.

[2Sox]

Based on your protocol - which is sensible and conservative - it seems like your doctor knows something about TRT.

I have no reference point for non sensitive E2 testing; others can contribute here. On the scale you provide, the levels are high. And your symptoms - as you describe them - seem to indicate a high E2 level. You might want to consider trying a natural E2 control method: 200mg DIM, 50mg Zinc, 4mg Copper - all daily. I'm doing this now. OR you may want to try beginning on very low dose Adex, perhaps at .25mg a week - splitting it into two doses if you can (access to liquid?). Remember, anastrozole is a VERY strong drug. I have developed a healthy respect for it. These are just some of the options to consider.

[BallSak]

Looks and sounds good.

2sox made some good suggestions.

Up your dhea to 50mg and I bet your cholesterol will come down as your dhea goes up.

[17chester6]

So you guys got it spot on. I'm to up the DHEA to 50 mg while holding steady on the HCG 250 IU twice weekly and the T cypionate 50 mg twice weekly. Also I am to start Adex. He said 0.25 mg twice weekly and I suggested as per 2Sox to half that to 0.125 mg twice weekly.

However I forgot to ask when to take it. I take HCG this Tuesday and T. cyponate on Wednesday. I guess I want to hit the peak Testosterone level to prevent conversion to E2 so I should take it on the same day as T. cypionate? Is that correct?

I almost forgot. I will be getting the Adex compounded in capsules of 0.125 mg so it will be easy to get the correct dosing.

[2Sox]

So you guys got it spot on. I'm to up the DHEA to 50 mg while holding steady on the HCG 250 IU twice weekly and the T cypionate 50 mg twice weekly. Also I am to start Adex. He said 0.25 mg twice weekly and I suggested as per 2Sox to half that to 0.125 mg twice weekly.

However I forgot to ask when to take it. I take HCG this Tuesday and T. cyponate on Wednesday. I guess I want to hit the peak Testosterone level to prevent conversion to E2 so I should take it on the same day as T. cypionate? Is that correct?

I almost forgot. I will be getting the Adex compounded in capsules of 0.125 mg so it will be easy to get the correct dosing.

Regarding the Adex: On a twice weekly T injection schedule, the common advice is to take the AI 24 hours later. Have you considered a more frequent, lower dose T injection schedule to help control E2? I inject 28mg EOD which works out to about 98mg/week.

I haven't taken an AI in about two weeks (but take the "natural" E2 control method I described above. I'm starting to increase to 250mg DIM the day of my injection.) It's wait and see but I seem to be doing fine.

By the way, it's really great that your doctor is actually "listening" to your ideas. Compounding the AI dose you prefer? That's fantastic.

[17chester6]

My 18 week blood work (only T, free T and E done, in another 6 weeks I do the full profile again) are in and I have a couple of queries.

Treatment started on December 1, 2013 with T cypionate 50 mg X2/week and DHEA 25mg daily.
After the January tests 250 IU HCG subQ X2/week was added and DHEA upped to 50 mg daily.
After February blood work Arimidex 0.125 mg X2/week orally added.


Test April 2 February 19 January 9 November 11 2013
Total T
(nmol/L) 32.6 (8.4-28.8), 33.5, 31.9, 12.9 (8.4-28.8),
Free T
(pmol/L 69.4 (25- 80), 72.8, 65.9, 20.5 (25- 80)
Esrtradiol
(pmol/L) 97 (<150), 167, 83, <70 (<150)

Sensitive Estradiol is not available in Ontario, Canada to my knowledge. The doc wants my E to be between 90 and 130 pmol/L.

Overall I feel great but the progression in the gym is not that great, but OK. Joints and muscles in lower limbs do ache after a workout and I walk like a cowboy for a couple of days after a good gym as I am so stiff and sore. Getting in and out of a chair can be bad. Then that wears off till the next big session at the gym. The other muscle groups don't bother me. Libido is 8/10. Testicles grew back after the HCG was started.

The doc was thinking of lowering the Adex to 0.1 mg (using a compounding pharmacy) or increasing the T to 60 mg twice weekly to get the E up a little higher as it was 97 and he likes 90 to 130. I suggested spacing the Adex to every five days for a few weeks to see how I felt and then deciding. An opinion here?

Also I am still using the same bottle of HCG since January and as it is aging I have increased the dose to 350 IU from the 250 IU. Might the HCG not be as effective as before as my total and free T are a little lower (though that might be just normal day to day variation)?

I know "less is more" is the mantra, but I can't help wondering if I upped the T so my free and total T were higher then the gym progression might be enhanced and perhaps the msucle aches might not be as bad. But then acne and other issues could start. Am I asking for too much from TRT and I should be happy with what I have.

The muscle aches in my legs is an issue and I can't blame low or high Estradiol as it is in the lower but good range my doc wants. Might higher T help?

Any thoughts would be appreciated.

[2Sox]

My 18 week blood work (only T, free T and E done, in another 6 weeks I do the full profile again) are in and I have a couple of queries.

Treatment started on December 1, 2013 with T cypionate 50 mg X2/week and DHEA 25mg daily.
After the January tests 250 IU HCG subQ X2/week was added and DHEA upped to 50 mg daily.
After February blood work Arimidex 0.125 mg X2/week orally added.


Test April 2 February 19 January 9 November 11 2013
Total T
(nmol/L) 32.6 (8.4-28.8), 33.5, 31.9, 12.9 (8.4-28.8),
Free T
(pmol/L 69.4 (25- 80), 72.8, 65.9, 20.5 (25- 80)
Esrtradiol
(pmol/L) 97 (<150), 167, 83, <70 (<150)

Sensitive Estradiol is not available in Ontario, Canada to my knowledge. The doc wants my E to be between 90 and 130 pmol/L.

Overall I feel great but the progression in the gym is not that great, but OK. Joints and muscles in lower limbs do ache after a workout and I walk like a cowboy for a couple of days after a good gym as I am so stiff and sore. Getting in and out of a chair can be bad. Then that wears off till the next big session at the gym. The other muscle groups don't bother me. Libido is 8/10. Testicles grew back after the HCG was started.

The doc was thinking of lowering the Adex to 0.1 mg (using a compounding pharmacy) or increasing the T to 60 mg twice weekly to get the E up a little higher as it was 97 and he likes 90 to 130. I suggested spacing the Adex to every five days for a few weeks to see how I felt and then deciding. An opinion here?

Also I am still using the same bottle of HCG since January and as it is aging I have increased the dose to 350 IU from the 250 IU. Might the HCG not be as effective as before as my total and free T are a little lower (though that might be just normal day to day variation)?

I know "less is more" is the mantra, but I can't help wondering if I upped the T so my free and total T were higher then the gym progression might be enhanced and perhaps the msucle aches might not be as bad. But then acne and other issues could start. Am I asking for too much from TRT and I should be happy with what I have.

The muscle aches in my legs is an issue and I can't blame low or high Estradiol as it is in the lower but good range my doc wants. Might higher T help?

Any thoughts would be appreciated.

I'd say that unless someone on this forum knows how to interpret you estradiol readings - for men - you've got to find out how yourself so we can make sense of this. Without knowing this, lots of us (like myself) are left scratching our heads. The E2 level your doc is comfortable with may not be good for you - IF - and that's a big IF - you are still having symptoms of low E2 - the aches you describe. At 59, these just might come with the territory. (I speak from experience. I'm one of the "senior" members of the forum.)

I would also like to offer you this regarding E2 control: After considerable thought and experimentation with Adex/Anastrozole, I feel I would only recommend it for people who cannot get or afford Aromasin/Exemestane. IMO, Aromasin is a more effective and more forgiving drug than Adex, and what I like particularly is that there is no rebound effect with Aromasin; you don't feel worse once it wears off. You just go down to your baseline. I've just started using it and I like it very much. You might want to speak to your doctor about this.

Regarding DIM: From my experience, it's not for serious E2 control. But that's me.