TRT off to a rocky start, help me get dialed in.

[tom_bell07]

Off to a rocky start I think. I went into my GP with the usual symptoms, low libido, focus, energy, etc.

GP did initial blood work with the following results:

Free Total = 395ng/dL, range (300-890)
Free(calc) = 65.7pg/mL, range (47-244)
% Free(calc) = 1.7%, range (1.6-2.9)
SHBG = not tested, range (13-71)
Estradiol = not tested, range (0-39)

Put me onto 200mg every 2 weeks testosterone cypionate IM injections. Things improved for about 3 weeks and then I started feeling bad on the 2nd week. I asked doctor to move me to 1 week injections and he ordered new blood work.

This was 12 days after a 200mg injection.

Free Total = 206ng/dL, range (300-890)
Free(calc) = 34.8pg/mL, range (47-244)
% Free(calc) = 1.7%, range (1.6-2.9)
SHBG = 40nmol/L, range (13-71)
Estradiol = not tested, range (0-39)

GP referred me to a urologist who took me off of the injections and prescribed 75mg clomid /day to try and restart my natural production and see if I was able to produce my own testosterone . That didn't work, I could feel that it wasn't working.

After 21 days on 75mg clomid / day - 10/14/2015:

Free Total = 296ng/dL, range (300-890) -- urologist only tested Free total for some reason.

After getting results back urologist told me to inject 400mg of cypionate to build me back up, injected on 10/15/2015.

Here is the latest bloodwork results 10/21/2015 -- 6 days after 400mg injection

Free Total = 1471ng/dL, range (300-890)
Free(calc) = 355pg/mL, range (47-244)
% Free(calc) = 2.4%, range (1.6-2.9)
SHBG = 40nmol/L, range (13-71)
Estradiol = 59.2pg/mL, range (0-39)

I'm still not feeling well.. Libido is bad, erections are very hard to maintain, focus is gone.. overall well being is bad. I know I've overshot with the 400mg and now my Estradiol is too high, is that why I'm not feeling right?

Thanks.

[2Sox]

Seems that neither of the physicians you went to knows much about TRT. Lower, more frequent dosing is much more effective than what you were prescribed. A common starting dose is 100mg/week split into 2 doses approximately 3.5 days apart. Higher, less frequent (crazy) doses like 400mg all at once will just drive up your estradiol and put you on a roller coaster ride that will not feel good.

If you are self injecting, I'd advise you do the above. And wait. You'll start to feel better.

Keep an eye on estradiol using the "sensitive or ultra sensitive assay" depending on what lab you use.

When you post, be sure to include the ranges so we can help you better.

[tom_bell07]

Edited my first post with all the ranges I missed..
I am self injecting at home. I am going to start 2x weekly injections of 50mg but when should I start on those 50mg shots? Next week or wait longer?

[2Sox]

Here is something that will help answer your question:

Understanding Esters, Active-Life and Half-Life

[Bodacious]

Agree with 2sox. Also on that last set of BW your E2 is high.

[Bodacious]

Edited my first post with all the ranges I missed..
I am self injecting at home. I am going to start 2x weekly injections of 50mg but when should I start on those 50mg shots? Next week or wait longer?

Just start them on Monday and the do it again on Thus.

Get BW again after 6 weeks to see where you are.

[2Sox]

Edited my first post with all the ranges I missed..
I am self injecting at home. I am going to start 2x weekly injections of 50mg but when should I start on those 50mg shots? Next week or wait longer?

I'd wait for a week or so after the shot of 400mg you took on the 15th. Then start your lower dosing. Be VERY aware of you estradiol levels. The unfortunate symptoms you describe are likely the direct result of your high E2 levels.

[bigdil511]

I'd wait for a week or so after the shot of 400mg you took on the 15th. Then start your lower dosing. Be VERY aware of you estradiol levels. The unfortunate symptoms you describe are likely the direct result of your high E2 levels.

Totally agree. 400mgs is a cycle dose it's just going to elevate your levels for a week than you will crash fuking hard. 100mg split into two doses isa week is much better and wil help keep your estrogen in check.

[tom_bell07]

Injected 50mg this morning, planning to go with 50mg every 3.5 days as everyone suggested. I put together a chart showing my Total Test #'s along with what I think the testosterone concentration would be in my blood using a 8 day half life. Looking at the data it shows that I should have around 175mg active in my body going forward. Will pull new labs next week and see where I'm at.

[tom_bell07]

New blood work in today:

I'm injecting 50mg on Monday's and Thursday's now, been doing that for about 2 weeks now..

Free Total = 923ng/dL, range (300-890)
Free(calc) = 195pg/mL, range (47-244)
% Free(calc) = 2.1%, range (1.6-2.9)
SHBG = 40, range (13-71)
Estradiol = 51.8, range (0-39)

I'm concerned that the Estradiol test is not the sensitive array - can someone comment based off of the ranges the lab has provided?
Also what do you all think of these results?

[Simon1972]

Your results are heading in the right direction. E IS high still. Ate you carrying extra weight? Fat converts T into E. ..you may need an AI . Keep an eye on it, but your bloods look great so far

[tom_bell07]

I'm 5' 10" - 165 lbs, my stomach is flat. I don't think I'm carrying a lot of extra body fat.

[Simon1972]

I'm 5' 10" - 165 lbs, my stomach is flat. I don't think I'm carrying a lot of extra body fat.

get your bloodwork done in a month if you can afford it- check your E in sensitive essay format- get your dr to revise is bloodwork order if he hasnt specified the sensitve essay.

if your e is still on the higher side ( aim for middle to low quater of range for men)
ask for an AI - aromasin etc..

get your bloodwork sent to you before your next drs appointment so you can formulate some questions ahead of time. ( eg post here) .

based on current bloods- you need an AI- but now your pinning twice/week its worth more bloods first.

[tom_bell07]

From the range the lab provided for Estradiol 0 to 39 pg/mL .. is this the sensitive essay?
Is there a good OTC AI that I could look at.. my next appointment with the DR is nov 23rd and in previous conversations with him they were against an AI.

[kelkel]

You're pulling BW to often. Give yourself 4-6 weeks at least to allow your body to adapt to changes and find homeostasis. Standard estradiol is not a sensitive assay and will read higher than the proper sens assay. Your actual E2 level would be lower than what you listed. Other than that, your results look fine.

[DanMan250]

get your bloodwork done in a month if you can afford it- check your E in sensitive essay format- get your dr to revise is bloodwork order if he hasnt specified the sensitve essay.

if your e is still on the higher side ( aim for middle to low quater of range for men)
ask for an AI - aromasin etc..

get your bloodwork sent to you before your next drs appointment so you can formulate some questions ahead of time. ( eg post here) .

based on current bloods- you need an AI- but now your pinning twice/week its worth more bloods first.

The correct word is assay, not essay! An essay is a piece of writing that you hand to your teacher lol.

[Simon1972]

The correct word is assay, not essay! An essay is a piece of writing that you hand to your teacher lol.

You banana. Kiss my ass ay ..lol

[Xphanial]

You banana. Kiss my ass ay ..lol

With pleasure

[tom_bell07]

New bloodwork in from the lab - doc still doesn't want anything to do with an AI, I might have to go another route and try exemestane or something.
Thoughts on results? This is after 4 weeks of 50mg injections on Monday's and Thursdays.

Doc wants me to start donating blood - 2 units every 2 months to make sure we don't run into blood thickness issues.

[Chauffeur]

New bloodwork in from the lab - doc still doesn't want anything to do with an AI, I might have to go another route and try exemestane or something.
Thoughts on results? This is after 4 weeks of 50mg injections on Monday's and Thursdays.

Doc wants me to start donating blood - 2 units every 2 months to make sure we don't run into blood thickness issues.

I wouldn't get too caught up in seeking out an AI at this point. We don't even know what your estradiol value is since it doesn't appear to have been tested on this set of labs.

Yes, there's a good chance that it's a bit high, but that's only because your dose of testosterone is too high. An AI isn't the answer here, lowering your dose of testosterone is though.

If you lower your dose just a little bit, your estradiol will eventually follow suit, and eliminate the need to add another medication to your protocol. AI's are often far from hassle free, it's always best to avoid using on if you can.

[tom_bell07]

I asked the doc today about lowering the dose just a little bit and he told me to stick to the 100mg / week (50mg 2x) for another 6 weeks. I was also thinking to drop down to say 40mg twice a week but I'm hesitant to adjust since I was so all over the place at the beginning with dose amounts.

[kelkel]

When was your BW pulled relative to your last injection?

[tom_bell07]

When was your BW pulled relative to your last injection?

About 3 days later - Injected 50mg on Monday (11/16/15) and blood was pulled on Thursday (11/19/15) before I injected again.

[kelkel]

About 3 days later - Injected 50mg on Monday (11/16/15) and blood was pulled on Thursday (11/19/15) before I injected again.

Ok, then I'd completely agree with Chauffeur's last post. Be sure to test with a sensitive estrogen assay. Be wise to pull SHBG as well.

[tom_bell07]

Ok, then I'd completely agree with Chauffeur's last post. Be sure to test with a sensitive estrogen assay. Be wise to pull SHBG as well.

SHBG was on the last round of bloodwork, it's always right around 40 nmol/L.

I've also started taking 5000iu of D3 and 50mg of zinc daily.

I asked for the sensitive estrogen array with the last set of bloodwork, I don't know why they didn't do the test other than they just missed it. She took 2 vials of blood last time when they normally take only 1 - I figured this was for the sensitive estrogen array.

So everyone's consensus is that I reduce from 50mg 2x per week to what -- say 40mg 2x per week? I'm taking a .25cc -- I'd maybe go down to .20cc?

[Chauffeur]

SHBG was on the last round of bloodwork, it's always right around 40 nmol/L.

I've also started taking 5000iu of D3 and 50mg of zinc daily.

I asked for the sensitive estrogen array with the last set of bloodwork, I don't know why they didn't do the test other than they just missed it. She took 2 vials of blood last time when they normally take only 1 - I figured this was for the sensitive estrogen array.

So everyone's consensus is that I reduce from 50mg 2x per week to what -- say 40mg 2x per week? I'm taking a .25cc -- I'd maybe go down to .20cc?

Absolutely. Dropping your dose down to 40mg twice weekly would be a great next step.

Give it about 6 weeks for your hormones to stabilize and then retest. I think you'll be pleasantly surprised with the results. You can always tweak it from there if your labs don't end up where you want them to be, but I'd say that you're very close to being dialed in.

[tom_bell07]

Absolutely. Dropping your dose down to 40mg twice weekly would be a great next step.

Give it about 6 weeks for your hormones to stabilize and then retest. I think you'll be pleasantly surprised with the results. You can always tweak it from there if your labs don't end up where you want them to be, but I'd say that you're very close to being dialed in.

Just an update - I injected .2cc (40mg) yesterday, will stay at that dose for the next 6 weeks and then I'll pull new BW and post results.
Question though.. I'm sure my Estradiol is high, and by lowering my dose I should convert less T to E and subsequently my E should go down.. question is how quickly does a person's E decline if it's high? Should I feel that affect pretty quickly?

[Chauffeur]

Just an update - I injected .2cc (40mg) yesterday, will stay at that dose for the next 6 weeks and then I'll pull new BW and post results.
Question though.. I'm sure my Estradiol is high, and by lowering my dose I should convert less T to E and subsequently my E should go down.. question is how quickly does a person's E decline if it's high? Should I feel that affect pretty quickly?

Obviously it's not possible to put an exact timeframe on it, but yes, lowering your dose will lower your estradiol.

It doesn't really go down in a linear fashion along with testosterone , but it will gradually go down in the coming weeks. Your hormones will be leveled out in ~ 6 weeks or so.

[tom_bell07]

New BW pulled on Dec 31st by my urologist.. he only pulls Total Testosterone .

Total Testosterone = 688 (300 - 890)

I've got a sensitive estrogen assay from a private lab that should be in later this week.. but overall I think I'm feeling the best I have yet.
Reducing my dosage to 40mg 2x per week (Mon & Thursday) was a good move.

Thanks.

[kelkel]

Great to hear tom!

[dadroxx]

I'm on a topical axi now and feel horrible. Went to endo today and waiting on new bw.

[tom_bell07]

dadroxx.. yes my libido is insane now, running after my wife 2x a day and constant sexual thoughts and erections.. erection quality is probably as good as when i was in my teens..

Estradiol, Sensitive assay is 42.5pg/mL (8 - 35)
Total Testosterone 688 (300 - 890)

Both pulled on Dec 31st on my trough day (Thursday morning).

Thoughts on my Estradiol #?
I've been reading about Estradiol ratios to total T.. T/E = ratio
688/42.5 = 16.2

Opinions on this?

[2Sox]

dadroxx.. yes my libido is insane now, running after my wife 2x a day and constant sexual thoughts and erections.. erection quality is probably as good as when i was in my teens..

Estradiol, Sensitive assay is 42.5pg/mL (8 - 35)
Total Testosterone 688 (300 - 890)

Both pulled on Dec 31st on my trough day (Thursday morning).

Thoughts on my Estradiol #?
I've been reading about Estradiol ratios to total T.. T/E = ratio
688/42.5 = 16.2

Opinions on this?

Your estradiol is a little higher than the top range but there are some that do well with numbers like this - although this may not apply to you, of course. The general consensus here is that running at or near 20 is ideal. Of course, every individual is different and you have to judge this for yourself.

I rather think the anecdotal reports you cite of better libido seem to indicate you're doing well where you are. Keep an eye on things though....and have fun.

[kelkel]

dadroxx.. yes my libido is insane now, running after my wife 2x a day and constant sexual thoughts and erections.. erection quality is probably as good as when i was in my teens..

Estradiol, Sensitive assay is 42.5pg/mL (8 - 35)
Total Testosterone 688 (300 - 890)

Both pulled on Dec 31st on my trough day (Thursday morning).

Thoughts on my Estradiol #?
I've been reading about Estradiol ratios to total T.. T/E = ratio
688/42.5 = 16.2

Opinions on this?

I concur with the wise man above. If it's not broken, don't fix it. And don't get to caught up in ratio's. It's a great concept but it not a panacea for where all will feel great.

[Chauffeur]

dadroxx.. yes my libido is insane now, running after my wife 2x a day and constant sexual thoughts and erections.. erection quality is probably as good as when i was in my teens..

Estradiol, Sensitive assay is 42.5pg/mL (8 - 35)
Total Testosterone 688 (300 - 890)

Both pulled on Dec 31st on my trough day (Thursday morning).

Thoughts on my Estradiol #?
I've been reading about Estradiol ratios to total T.. T/E = ratio
688/42.5 = 16.2

Opinions on this?

I agree with the others. If it ain't broke, don't try to fix it.

The goal of TRT should be to feel good and to alleviate some of the symptoms that you had prior to treatment, not focus on specific lab values. There is no "one size fits all" approach to TRT.

If you've seen improvement, which it sounds like you have, there's not much need to keep switching things up.

I too prefer my estradiol to be above the top of the reference range. That's where I feel good and have the strongest libido, so I don't have any plans to change that.

[tom_bell07]

I too prefer my estradiol to be above the top of the reference range. That's where I feel good and have the strongest libido, so I don't have any plans to change that.

Thanks for this comment, good to hear that being above the reference range isn't bad.. sometimes I get stuck in my own head that I need to be in the sweet spot for all these ranges to be at my best.

Thanks everyone for the feedback!

[tom_bell07]

I went to my GP yesterday for my annual checkup and gave him all of my lab results to put into my file and go over with him so that would be "in the loop". He looked at my Estradiol and said it was too high and prescribed Arimidex - 1mg daily.

I'm going to try .5mg every other day and get some BW pulled in a few weeks to see where I'm at and see if I feel better or worse with the Estradiol lower back and into the normal range.

[Chauffeur]

I went to my GP yesterday for my annual checkup and gave him all of my lab results to put into my file and go over with him so that would be "in the loop". He looked at my Estradiol and said it was too high and prescribed Arimidex - 1mg daily.

I'm going to try .5mg every other day and get some BW pulled in a few weeks to see where I'm at and see if I feel better or worse with the Estradiol lower back and into the normal range.

You are 100% guaranteed to crash your estradiol on that dose of Arimidex. I would not recommend following through with that plan at all. Seriously, it will not end well.

[Simon1972]

I went to my GP yesterday for my annual checkup and gave him all of my lab results to put into my file and go over with him so that would be "in the loop". He looked at my Estradiol and said it was too high and prescribed Arimidex - 1mg daily.

I'm going to try .5mg every other day and get some BW pulled in a few weeks to see where I'm at and see if I feel better or worse with the Estradiol lower back and into the normal range.

1mg daily sounds really high- are you sure he didnt mean 1mg weekly? most AAS cycles use 0.25 EOD

[kelkel]

You are 100% guaranteed to crash your estradiol on that dose of Arimidex. I would not recommend following through with that plan at all. Seriously, it will not end well.

This ^^^^. And why would you take anything if you feel great as stated in post #15?