On TRT, Need Help - First Time Poster

[Case Manager]

Hey all. I've come here often, read a lot of posts, and learned a lot from this forum. So thank you for all the advice so far. Unfortunately, I'm having some issues of my own and the doctor seems to just be experimenting with my body at this point, so I thought I'd see if I could get some answers from you folks.

About Me
I'm a 35 year old male in pretty good shape, but I'm a small giant. I'm 6'6" and about 275, with a BF% of around 16%. I work out regularly doing a circuit training/weight lifting routine 3 to 4 times a week for about an hour each session. I try to eat healthy, but not perfectly. I've never been a drinker (maybe 3 beers a month) and rarely smoke (only cigars). No recreational drugs. I do take Tramadol for pain almost daily. I've been on TRT for about 10 months now. I started due to problems in bed. I believe they are caused by low testosterone , high estrogen, or both. Those problems include getting an erection, keeping one once I have it, very low libido, and extreme difficulty with ejaculation.

More Background on Me
These issues haven't always been present, or at least not to the degree they are now. I believe my libido has always been kind of low and I have always had trouble ejaculating, but things were much better when I was in my teens. None of the other issues I face now existed when I was in my in my teens. When I got into my early 20's, I believe I started a downward slide to now. Things got really bad starting about 4 years ago. I also believe I am a preferential aromatizer (more on that later).

I've never used steroids (before TRT) or any other PED. I can say however, that some version of low testosterone and high estrogen runs in the men in my immediate family. I know for a fact my brother (same mother and father) started taking viagra when he was at least 25, but it could have been younger than that (I only found out about it at when he was 25). And my dad has/had extremely low libido. By the way, I take sildenafil and I am able to perform successfully, but naturally it doesn't help with the libido or ejaculation trouble. I actually feel really bad for my girlfriend. It might sound cool to be able to pound away for forever, but when it goes on for like an hour and she wasn't into it 30 minutes ago, it's not fun for me or her at that point.

Luckily, I had my first blood panel done when I was about 22. And although I don't have access to that report (that I know of) the doctor at the time was concerned that my estrogen was high. I believe the number he stated was 110 or so. At the time I was having significant depression, but now I realize it could very well have been hormone related.

Current Status
Ten months later, the TRT has not helped at all. In some respects, I think it's actually made the ED worse, and that's not even taking into account the other side effects. I literally can count the number of times I felt much hornier and could achieve a rock hard erection with no trouble at all, on one hand. Additionally, I've now got horrible acne, way way worse than I had in my teens which is being managed by Accutane. But as I'm sure anyone who is aware of accutane knows, that's causing a whole host of issues itself. Such things as mild depression, lips peel off every few days, and contacts won't work because my eyes are so dry, are among the big ones. On top of that, I'd like to start having children soon (within the next year). I don't currently have any.

I've also had a lot of brain fog (mostly memory issues) that seemed to have stopped when I started taking the magnesium/calcium/zinc complex about 2 weeks ago. The last blood test for the accutane showed that my cholesterol was up and my liver showed impairment. My cholesterol has never been high. Wonderful. I was told by the doctor's office that the liver impairment could be causing or contributing to the brain fog. I just changed my injection regimen from once every 2 weeks to once every week thanks to the advice I read on here, but I haven't noticed any change.


(The guy just below my post used a great template so I'm shamelessly just copying his. Thanks, FreshStart!)

Medical Issues and Medications

• Low libido, erectile dysfunction, extreme trouble ejaculating (taking 75mg Test Cypionate 1/week, 1 mg Anastrozole/day)
• hypertension (10 mg lisinopril/day)
• acne vulgaris (40 mg Isotrentinoin/day)

Nutrition

• Limit fast food, no sodas, juice, or refined sugars.

Supplements

• Fish, flax, and borage oil 3x/day (this is mostly to help the oils in my eyes so I can wear contacts)
• Simple Multivitamin without A or derivatives (so it doesn't interact with the Accutane)
• Calcium, magnesium, and zinc 3x/day (this really seems to help with the brain fog)
• Cinnamon and chromium 1/day
• Turmeric complex
• CoQ10

Blood Work


In the meantime I'll relay what I can about the tests. Like I mentioned, my estrogen has always been high and I believe my testosterone has always been low. At least I think it has since my early 20's. To start recently, my levels were tested by my GP about a year and a half ago. At the time, my free test (I think) was just over 300. Then the urologist tested them again and it was just under 300 and my estrogen was 110 or so. I was put on a regimen of 100 mg test cyp. once/2 weeks. Came back and retested after a month. Testosterone had dropped to 250 and estrogen had gone up to 160. Doctor changed my regimen to 150mg once/2 weeks. Came back 6 months later and retested. Testosterone has gone up to 450, but estrogen had shot up to 250. Doctor started me on 1 mg arimidex /every other day. Retested after a month, estrogen only went down to 150. Doctor then put me on 1 mg arimidex/day. That was about a month ago now.


So that's the story so far. Sorry if it was unnecessarily long-winded. I tried to keep it germane to the issue. I'll ask questions after I've posted my lab work because I can already see the posts asking for the lab work.

[Youthful55guy]

I was put on a regimen of 100 mg test cyp. once/2 weeks. Came back and retested after a month. Testosterone had dropped to 250 and estrogen had gone up to 160. Doctor changed my regimen to 150mg once/2 weeks. Came back 6 months later and retested. Testosterone has gone up to 450, but estrogen had shot up to 250. Doctor started me on 1 mg arimidex/every other day. Retested after a month, estrogen only went down to 150. Doctor then put me on 1 mg arimidex/day. That was about a month ago now.

A couple of quick suggestions:

1) You absolutely need to make sure you are getting the correct estrogen test. With numbers like "110 and 160", I suspect your doc is running the standard E2 assay, which is intended for women (even though they supply male ranges). All hormone assays have range through which they are more sensitive to detecting actual levels and changes in levels of hormones. In biochemical terms, it's called the linear portion of the assay (way too technical to get into here). The standard E2 assay was designed to be "linear" over the range of E2 values that are normally encountered by women. If men use the same assay, it simply generates bogus results and more often than not, reads way on the high side. You must request the "sensitive" or "male" E2 assay. It need to say that the method used was LC/MS/MS. Here's a link for more information: https://www.discountedlabs.com/estra...itive-lc-ms-ms

2) Your TRT protocol is absolutely out of the stone age of medicine. Any doc who prescribes TRT with T-cyp on a 2 week injection cycle obviously does not know what he/she is doing. At a MINIMUM, injections with T-cyp need to be on a weekly basis (starting dose about 100 mg). Many of the top TRT docs are now recommending twice weekly or every 3 day (E3D) protocols of 40-50 mg. This will provide a MUCH smoother hormonal ride and help to prevent spikes in E2 by preventing spikes of T. T convers to E2, so when T spikes, so does E2.

3) You need to request copies of your labs and keep a log of them. Asking people for advice without knowing what labs were done and the actual values and normal ranges is going to get you very conflicting advice. Also keep in mind that guys in this forum tend to come from two very different perspectives. Some like you and me are doing TRT for medical reasons, while others are using TRT to get from one anabolic steroid cycle to the next without proper Post Cycle Therapy (PCT) to restart their endogenous productions of T. They call it "Blast and Cruise". I'm not passing judgement, but their perspective is very different from ours, so their advice will often be very different. Our goal with medically necessary TRT is to get on a stable and sustainable protocol for the rest of our lives.

[kelkel]

Agree with all YG55 said and I'll add that if you cannot educate your doctor on proper TRT protocols then you should find another one.

[Case Manager]

Thank you for the replies. I am working on gaining access to the labs today and I'll post them as soon as I get them.

[Case Manager]

A couple of quick suggestions:

1) You absolutely need to make sure you are getting the correct estrogen test. With numbers like "110 and 160", I suspect your doc is running the standard E2 assay, which is intended for women (even though they supply male ranges). All hormone assays have range through which they are more sensitive to detecting actual levels and changes in levels of hormones. In biochemical terms, it's called the linear portion of the assay (way too technical to get into here). The standard E2 assay was designed to be "linear" over the range of E2 values that are normally encountered by women. If men use the same assay, it simply generates bogus results and more often than not, reads way on the high side. You must request the "sensitive" or "male" E2 assay. It need to say that the method used was LC/MS/MS. Here's a link for more information: https://www.discountedlabs.com/estra...itive-lc-ms-ms

1) So I ordered an E2 sensitive test from the link you posted. Should I wait until a day or two before my next injection like the blood draws I have taken before for this? I just did a 75 mil injection Wednesday evening. Also, I don't need to fast beforehand, do I?

I'm actually running out the door to get my labs right now. Post them when I get back.

[Case Manager]

Added panels.

[Youthful55guy]

1) So I ordered an E2 sensitive test from the link you posted. Should I wait until a day or two before my next injection like the blood draws I have taken before for this? I just did a 75 mil injection Wednesday evening. Also, I don't need to fast beforehand, do I?

I'm actually running out the door to get my labs right now. Post them when I get back.

Yes, all routine labs should be done just prior to your next injection.

I assume you mean 0.75 mil. I can't imagine injecting 75 mL of T. If you were to break that same 0.75 mL into an E3D protocol, that would be about 0.16 mL which can very easily be injected with a 28G insulin syringe. I inject 0.2 to 0.25 mL E3D and it only takes me about 1 minute to draw up and 5 seconds to inject.

[Case Manager]

I assume you mean 0.75 mil. I can't imagine injecting 75 mL of T. If you were to break that same 0.75 mL into an E3D protocol, that would be about 0.16 mL which can very easily be injected with a 28G insulin syringe. I inject 0.2 to 0.25 mL E3D and it only takes me about 1 minute to draw up and 5 seconds to inject.

Sorry, yes .75 mL. I'm thinking if I did a E3D protocol, I should probably up mine a bit since it has less effect when broken up? So match your .25 and try that. Also, I have no idea where to get insulin syringes. Any recommendations? Aren't the needles on insulin syringes relatively short? So that would be more of an intradermal injection than an intramuscular one, right?

Anyone want to weigh in on my labs, or do you want to wait for the good ones?

[Youthful55guy]

Sorry, yes .75 mL. I'm thinking if I did a E3D protocol, I should probably up mine a bit since it has less effect when broken up? So match your .25 and try that. Also, I have no idea where to get insulin syringes. Any recommendations? Aren't the needles on insulin syringes relatively short? So that would be more of an intradermal injection than an intramuscular one, right?

Anyone want to weigh in on my labs, or do you want to wait for the good ones?

Actually, you can get by with less on a more frequent injection protocol like E3D. You will have much more stable levels, so your lows aren't as low. Therefore, you can get by with less. Also makes for much more stable and lower E2 levels in that you don't go super high out of range early in the injection cycle and drive faster conversion to E2.

Regarding the exact dose, I suggest you start with 0.2 mL and see what your labs look like in 4 to 6 weeks and then adjust from there. Everyone is different and it is highly dependent on SHBG levels. I have very high levels, but I bring that down into range with either low dose Winstrol (10 mg/day) or low dose Anavar (20 mg). Which keeps me in the zone. I find that when I'm in the zone, that 0.2 is adequate and 0.25 is on the high side.

I get all of my syringes from TotalDiabetes.com. Here's the exact syringe I use: https://www.totaldiabetessupply.com/...g-1cc-1-2-inch. They deliver via USPS in most states, fast and easy. It's a 1/2 inch long needle and it works just fine with the quad muscle. For me, I know it goes into the shallow muscle (I can feel it). It's debatable too whether there's any difference between IM or SC.

[Case Manager]

1) Actually, you can get by with less on a more frequent injection protocol like E3D. You will have much more stable levels, so your lows aren't as low. Therefore, you can get by with less. Also makes for much more stable and lower E2 levels in that you don't go super high out of range early in the injection cycle and drive faster conversion to E2.

2) Regarding the exact dose, I suggest you start with 0.2 mL and see what your labs look like in 4 to 6 weeks and then adjust from there. Everyone is different and it is highly dependent on SHBG levels. I have very high levels, but I bring that down into range with either low dose Winstrol (10 mg/day) or low dose Anavar (20 mg). Which keeps me in the zone. I find that when I'm in the zone, that 0.2 is adequate and 0.25 is on the high side.

3) I get all of my syringes from TotalDiabetes.com. Here's the exact syringe I use: https://www.totaldiabetessupply.com/...g-1cc-1-2-inch. They deliver via USPS in most states, fast and easy. It's a 1/2 inch long needle and it works just fine with the quad muscle. For me, I know it goes into the shallow muscle (I can feel it). It's debatable too whether there's any difference between IM or SC.

1) Huh, I thought it was opposite.

2) Will do. Should I stay on the 1 mg Anastrozole/day to start still?

3) Buying those needles now. Thanks!

Did you happen to take a look at my labs?

[Youthful55guy]

1) Huh, I thought it was opposite.

2) Will do. Should I stay on the 1 mg Anastrozole/day to start still?

3) Buying those needles now. Thanks!

Did you happen to take a look at my labs?

1) A common misconception. With more frequent injections like E3D, the goal is to always be within normal physiological range for T (mostly FT). The goal is to keep FT at the end of the 3 day cycle at about the 66th percentile for a man 20-29 years of age. With the LabCorp test, that's about 20.7 pg/mL (Normal Range = 9.3 to 26.5). Your SHBG will determine how much TT you need to attain that level. However, if your SHBG is too high (as is mine), the amount of TT you need pushes you out of range for TT, and even though it is still bound, there are side-effects to excessively high TT. BOTTOM LINE IS TO GET YOUR LABS DONE AND USE THE DATA TO DRIVE YOUR DECISIONS.

2) I don't recommend anastrozole (or any other E2 inhibitor or blocker) unless your labs indicate you need it. Guys on TRT are WAY TOO PARANOID about gynecomastia because of all of the chatter from bodybuilders that use abusive levels of T. If you keep your TT and FT within range, there should be no need for E2 control, or if you do, minimal at most. I use extremely low levels of anastrozole (about 0.5 mg per week) using the vodka eye dropper method. However, I've got countless labs to show that this amount will keep me within range, and even when I don't use it, I'm usually still within the upper end of the range. Did you know you need E2 for normal erections? many guys find that out the hard way when they use way too much anastrozole and get a really bad case of ED. Did you also know that you need a certain level of E2 in the brain to maintain normal GH levels? Again, crash E2 and it can have a cascade effect in the body.

3) Let us know how the insulin syringes work or if you need advice. The first few times pulling it up can be frustrating. You need to learn proper technique. Insert the needle, invert the vial and syringe, and pull ALL THE WAY BACK on the plunger and keep it there for about a minute as the oil slowly seeps into the syringe. Then SLOWLY push out the excess as the air bubbles coalesce and rise to the top and out the needle back into the vial.

[Case Manager]

1) A common misconception. With more frequent injections like E3D, the goal is to always be within normal physiological range for T (mostly FT). The goal is to keep FT at the end of the 3 day cycle at about the 66th percentile for a man 20-29 years of age. With the LabCorp test, that's about 20.7 pg/mL (Normal Range = 9.3 to 26.5). Your SHBG will determine how much TT you need to attain that level. However, if your SHBG is too high (as is mine), the amount of TT you need pushes you out of range for TT, and even though it is still bound, there are side-effects to excessively high TT. BOTTOM LINE IS TO GET YOUR LABS DONE AND USE THE DATA TO DRIVE YOUR DECISIONS.

2) I don't recommend anastrozole (or any other E2 inhibitor or blocker) unless your labs indicate you need it. Guys on TRT are WAY TOO PARANOID about gynecomastia because of all of the chatter from bodybuilders that use abusive levels of T. If you keep your TT and FT within range, there should be no need for E2 control, or if you do, minimal at most. I use extremely low levels of anastrozole (about 0.5 mg per week) using the vodka eye dropper method. However, I've got countless labs to show that this amount will keep me within range, and even when I don't use it, I'm usually still within the upper end of the range. Did you know you need E2 for normal erections? many guys find that out the hard way when they use way too much anastrozole and get a really bad case of ED. Did you also know that you need a certain level of E2 in the brain to maintain normal GH levels? Again, crash E2 and it can have a cascade effect in the body.

3) Let us know how the insulin syringes work or if you need advice. The first few times pulling it up can be frustrating. You need to learn proper technique. Insert the needle, invert the vial and syringe, and pull ALL THE WAY BACK on the plunger and keep it there for about a minute as the oil slowly seeps into the syringe. Then SLOWLY push out the excess as the air bubbles coalesce and rise to the top and out the needle back into the vial.

1) Yep, doing labs late Tuesday and I'll post the results ASAP. The doctor wouldn't have put me on as much AI, but he has no idea why they TRT isn't helping with the ED. He thinks the high levels of ED are masking the effects that he believes testosterone should have, i.e. high libido, strong erections, etc.. I've been doing a lot reading on here recently and I see that ED is based on a lot more than testosterone/estrogen balance, still I'm hoping the accurate labs will show something out of whack. I did know that you need E2 for normal erections. I didn't know that about the GH levels, but I'm not surprised. I know E2 is just as important to men, in its own way, and in the correct proportion (though that differs from individual to individual), as it is to women. The last thing I want to do is crash E2, but ED is aggravating. When a medical specialist says take 1mg/arimidex daily, you're inclined to believe them (at first).

2) I think I'm gonna cut back to 1 mg every other day or more. I'm worried if I cut back any more the doctor might cut me off from meds altogether right away.

3) Ok. Yeh, I've been using the big needle/small needle technique until now. Thanks for the detailed steps. I'm sure it saved me a lot of troubleshooting time.

[ryobi1]

while your pulling labs, maybe get your thyroid checked as well.
TSH,T3,T4...wouldnt hurt

[Case Manager]

while your pulling labs, maybe get your thyroid checked as well.
TSH,T3,T4...wouldnt hurt

I may have a Thyroid panel from my last blood draw for the Accutane. Lemme see if I can get my hands on that and post it.

[Youthful55guy]

2) I think I'm gonna cut back to 1 mg every other day or more. I'm worried if I cut back any more the doctor might cut me off from meds altogether right away.

That's still a lot of anastrozole for someone taking 160 mg T-cyp every two weeks. I would doubt if your E2 even registers on the sensitive lab, which is designed to measure down to 5 pg/mL.

[kelkel]

Op know that 1mg adex daily is basically a breast cancer dosage.

[Case Manager]

Yeh, I have to admit I've been feeling pretty awful and out of it lately. I've been on 1mg/day for about 3 weeks now. Before that I was on 1mg/every other day for about a month. Didn't take the arimidex today and if I didn't know any better I'd say I feel better already. Also, had some libido today for the first time in awhile which was great. I think the 1mg/day totally crashed me. I'm really glad I started a dialogue on here.

[kelkel]

Oh there's no doubt you're crashed. It'll bounce back! Amazing how doc's prescribe some meds without really understanding the ramifications.

[bullshark99]

Your getting spot on advice so I'm gonna stay out of it but..................................lay off the Adex! stuff is super strong, you have successfully mitigated the high levels, now you are prob non-existent. You said you/your family runs high, totally appreciate, I'm down to .25 per week on a 180mg weekly pin.
Everybody is different but that's strong stuff.

[Case Manager]

Your getting spot on advice so I'm gonna stay out of it but..................................lay off the Adex! stuff is super strong, you have successfully mitigated the high levels, now you are prob non-existent. You said you/your family runs high, totally appreciate, I'm down to .25 per week on a 180mg weekly pin.
Everybody is different but that's strong stuff.

I thought Adex (in pill form) only had a half life of around 48 hours or so. How are you guys taking so little all week?

So yesterday, on day two of being off the Adex I was feeling amazing. I felt like my old self again. Today I'm a little sluggish, but I just woke up. Also, I just got a CPAP machine yesterday and last night was the first night using it. Let's just say I did not sleep like a baby.

Getting my E2 labs done today. Pretty excited for results. Those take about a week to come back from LabCorp, right?

[kelkel]

Labcorp doesn't handle E2 Sens in-house, they have to send it out so yes, about a week. If you sign up for Labcorp-Beacon you can get all your own BW on line, if you haven't already.

Guys can get by with only a little adex (if needed) due to timing the peak of both test and the adex. It's ok to have some swings in E2 just like we do with test levels. They don't have to be linear.

[Youthful55guy]

I thought Adex (in pill form) only had a half life of around 48 hours or so. How are you guys taking so little all week?

I call it the "Vodka method". I have an eye dropper that dispenses 0.75 mL calibrated to a line on the dropper barrel. I dissolve a 1 mg pill into 1.5 mL vodka 9 two droppers). I then dispense 4 to 5 drops per day into my first glass of drinking water of the day. This dispenses approximately 0.4 to 0.5 mg anastrozole per week in very small daily doses. I did a number of weight experiments using a sensitive pan balance to arrive at that dose. I suspect most medical droppers will yield similar results.

[Case Manager]

I call it the "Vodka method". I have an eye dropper that dispenses 0.75 mL calibrated to a line on the dropper barrel. I dissolve a 1 mg pill into 1.5 mL vodka 9 two droppers). I then dispense 4 to 5 drops per day into my first glass of drinking water of the day. This dispenses approximately 0.4 to 0.5 mg anastrozole per week in very small daily doses. I did a number of weight experiments using a sensitive pan balance to arrive at that dose. I suspect most medical droppers will yield similar results.

Is that safe? I thought Adex sat in your stomach and slowly dissolved over a period of many hours. Wouldn't this method effectively get all the Adex into your bloodstream at once? I realize it's not like an intravenous injection, and it's not nearly as much medicine, but still way faster than pill form, right?

Day 3 off Adex and still feeling pretty good. I think may feel the same as I did the first two days, it's just that my reference feeling at that point was in the toilet so naturally I'm going to report I felt way better since anything was better at that point. Gonna go on the new regimen for 3 weeks or so and then get labs redone and post.

[Youthful55guy]

Is that safe? I thought Adex sat in your stomach and slowly dissolved over a period of many hours.

Yes, quite safe. Been doing it for years.

No, the stuff dissolves in less than a minute in liquid, whether that be in a bottle or your stomach.

The stuff is not very stable in a polar solvent. Alcohol is less polar than water but still polar (and Vodka contains a good slug of water). Therefore, you have to make it up fresh, one pill at a time. I find that at 4-5 drops per day it lasts me about 2 weeks and then I make it up fresh again. Works just fine.

[Case Manager]

So my labs came back, 7.2 That was taken about 2.5 days after stopping Arimidex . I see now that it is a balancing act. For me, I think my body quickly converts test to estrogen, so I have to take a certain amount of AI per the testosterone dosage.

[Youthful55guy]

So my labs came back, 7.2 That was taken about 2.5 days after stopping Arimidex. I see now that it is a balancing act. For me, I think my body quickly converts test to estrogen, so I have to take a certain amount of AI per the testosterone dosage.

Best advice I can give is to stop all the AI for at least 2 weeks while keeping the T level constant, then retest to get an idea of what your E2 is like on your protocol without an AI. If, and only if, it is high, then consider adding a very small amount (no more than 0.5 mg per week using the vodka method) for 2 weeks and retest. That will give you an idea of how your respond to the AI. Slowly adjust the dose of AI until you are in range and then keep it there.

[Case Manager]

Best advice I can give is to stop all the AI for at least 2 weeks while keeping the T level constant, then retest to get an idea of what your E2 is like on your protocol without an AI. If, and only if, it is high, then consider adding a very small amount (no more than 0.5 mg per week using the vodka method) for 2 weeks and retest. That will give you an idea of how your respond to the AI. Slowly adjust the dose of AI until you are in range and then keep it there.

If you don't mind me asking, on your dosing schedule, what is the average range for your testosterone ? Would attempting to keep mine in the 600-800 range at any given time make sense considering my age (35)? Or is that too high or too low?

[Youthful55guy]

If you don't mind me asking, on your dosing schedule, what is the average range for your testosterone? Would attempting to keep mine in the 600-800 range at any given time make sense considering my age (35)? Or is that too high or too low?

Total T range varies tremendously, depending on SHBG. I've discussed this in other threads. The higher your SHBG, the higher will be your Total T for a given dose of T. This is because SHBG protects T from metabolism in the liver, so a given dose of T ester (e.g., T-cyp) will produce higher TT levels in a guy with a SHBG of 70 pf/mL than it will in a guy with 30 pg/mL. I read a doc posting about this in a different forum and my own experiments with SHBG suppression with Winstrol and Anavar support his theory. however, this does not mean that the guy with high TT and high SHBG will be feeling better than the guy with more normal TT and SHBG because the guy with high TT/SHBG will have lower Free T than the guy with more normal TT/SHBG. Again, my own labs and experience support this.

I preface my answer to you because my TT numbers depend on how well I control my SHBG. Typically, when my SHBG is under control (in the 25-35 range with LabCorp test), my TT at my standard dose of about 0.2 to 0.25 mL T-cyp (200 mg/mL) will be around 650 to 900, with Free T generally at the high end of the range. When my SHBG is high (70-80 range), my total T is in the 1200 to 1600 range, but my Free T is only mid-range at best.

So, as you can see, it's not a straight-forward answer and shows the importance of obtaining Free T and SHBG labs in addition to Total T and on making dosing decisions based on Free T.

[Case Manager]

Total T range varies tremendously, depending on SHBG. I've discussed this in other threads. The higher your SHBG, the higher will be your Total T for a given dose of T. This is because SHBG protects T from metabolism in the liver, so a given dose of T ester (e.g., T-cyp) will produce higher TT levels in a guy with a SHBG of 70 pf/mL than it will in a guy with 30 pg/mL. I read a doc posting about this in a different forum and my own experiments with SHBG suppression with Winstrol and Anavar support his theory. however, this does not mean that the guy with high TT and high SHBG will be feeling better than the guy with more normal TT and SHBG because the guy with high TT/SHBG will have lower Free T than the guy with more normal TT/SHBG. Again, my own labs and experience support this.

I preface my answer to you because my TT numbers depend on how well I control my SHBG. Typically, when my SHBG is under control (in the 25-35 range with LabCorp test), my TT at my standard dose of about 0.2 to 0.25 mL T-cyp (200 mg/mL) will be around 650 to 900, with Free T generally at the high end of the range. When my SHBG is high (70-80 range), my total T is in the 1200 to 1600 range, but my Free T is only mid-range at best.

So, as you can see, it's not a straight-forward answer and shows the importance of obtaining Free T and SHBG labs in addition to Total T and on making dosing decisions based on Free T.

Indeed. This gets more and more complicated, but not impossibly so. Ok, another question - I'm assuming estrogen is the most important to get under control since that's where we started with all this and the only thing the doc has mentioned besides T. So once that is under control, and assuming SHBG is not, would steps taken to get SHBG under control also affect the estrogen balance?

[Youthful55guy]

This thread is getting long and I don't remember all of the details. I seem to remember you were on an archaic 150 mg every 2 week dose of either T-cyp or T-Eth (doesn't matter which), and you were given a huge amount of anastrozole (1 mg per day) to take because your labs showed high total estrogens.

You then decided to break up the dose into an E3D protocol and stopping or decreasing the anastrozole (don't remember which).

I don't recall seeing any SHBG or Free T labs.

My gut feeling is that:

1) Your starting dose should be around 0.2 mL (40 mg) to 0.25 mL (50 mg) E3D.

2) You should get the correct estrogen labs done, which is the LabCorp E2 sensitive (LC/MS/MS) lab. The total estrogen lab may be giving you an artificially high value. It's intended for women.

3) Stay on that E3D protocol for about 4 weeks without any anastozole and then get labs done just prior to your scheduled injection. You should request TT, FT, SHBG, E2 sensitive.

4) You can then adjust your T dose as the labs dictate. If (and only if) your E2 labs are high, then I would consider starting on a low dose of anastrozole and titrate up as the labs indicate.

5) I would not be too worried about SHBG at this point until you know whether or not it's actually an issue. Only labs can tell.

[Case Manager]

So I went to the once a week protocol for two weeks and then went to E3D. I've been on E3D since your last post and I can say that I feel so much better. ED has apparently vanished and I don't have any brain fog at all which has plagued me since before I started TRT. I've been using a CPAP machine now for about a month and half though as well so some of the "fog" reduction may be from using that. I'm going to get labs done next week and I'll post the report once I receive it.

[Case Manager]

So I got my labs back after switching to the E3D routine at 2.5 mL. My estrodial showed about double the high end of normal at 74. Unfortunately, I don't have the actual labs yet, but I will post them on Monday when I get them from the office. So I started the vodka method. I'll post new labs in two weeks and see how things are going on it.

[Youthful55guy]

So I got my labs back after switching to the E3D routine at 2.5 mL. My estrodial showed about double the high end of normal at 74. Unfortunately, I don't have the actual labs yet, but I will post them on Monday when I get them from the office. So I started the vodka method. I'll post new labs in two weeks and see how things are going on it.

Assume that's 0.25 mL (50 mg) E3D.

Please specify which E2 lab was done. Doctors more often than not order the incorrect lab for men. If they order the standard lab, which is designed for women, you may very well show high levels of E2. When the test is ordered for men, it does more hard than good by giving them incorrect information and sending them down a path of treating a problem that doesn't exist and creates new problems.

The best lab men that I have seen is offered by LabCorp and uses the LC/MS/MS method. If this is not your lab, and your doctor will not or can not order it, I strongly suggest you order it yourself and pay out of pocket. Here is a link where you can purchase it (in most states) for about $50: https://www.discountedlabs.com/estra...itive-lc-ms-ms. The web site also offers numerous other tests that you can order yourself to monitor your protocol closer than a doctor usually will (or insurance will allow).

[Case Manager]

Assume that's 0.25 mL (50 mg) E3D.

Please specify which E2 lab was done. Doctors more often than not order the incorrect lab for men. If they order the standard lab, which is designed for women, you may very well show high levels of E2. When the test is ordered for men, it does more hard than good by giving them incorrect information and sending them down a path of treating a problem that doesn't exist and creates new problems.

The best lab men that I have seen is offered by LabCorp and uses the LC/MS/MS method. If this is not your lab, and your doctor will not or can not order it, I strongly suggest you order it yourself and pay out of pocket. Here is a link where you can purchase it (in most states) for about $50: https://www.discountedlabs.com/estra...itive-lc-ms-ms. The web site also offers numerous other tests that you can order yourself to monitor your protocol closer than a doctor usually will (or insurance will allow).

I believe I got the one you suggested. I actually showed my doctor the LabCorp page with the information because he had never heard of the term "sensitive" used to refer to a test related to estrogen. There were some additional storage and collection techniques that had to be used for the sensitive test, but luckily my nurse that does the blood draws actually used to work for LabCorp so she was familiar with them. I didn't get a copy of the labs yet because the office just called me with the results late Friday afternoon and I was rushing to get to a business appointment, but I'll get them on Monday and post them. And I'll get the test name they used. If it's not correct, I'll get the discounted labs done. No biggie. Oh, and yes, my doctor office uses LabCorp to do the testing. And I've got a really good insurance program with Anthem BlueCross. They cover everything (so far, anyway). lol

[Youthful55guy]

You can now access all of your LabCorp tests through their patient portal. Once you register for the portal, you can not only retrieve the results of the current test, but also your past tests. Here is the link to register for portal access and log in: https://patient.labcorp.com/ui/

[Case Manager]

And here are the labs.

9-7-17 Labs.pdf

[Youthful55guy]

Hmmm,

Your test method is not the same as mine, but that's not to say yours is wrong. I just don't know. I've only used the LC/MS/MS method, so it is easy for me to compare one test to another. I don't know enough about the ECLIA method to advise you, but the normal range for the test method is very close to the LC/MS/MS method. Here's a cut and paste from one of my recent tests:

Estradiol, Sensitive 30.2 pg/mL (Range: 8.0 - 35.0)
This test was developed and its performance characteristics
determined by LabCorp. It has not been cleared by the Food and Drug Administration.
Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)

[Case Manager]

Ok, so I did a little research. The ECLIA method is similar to the standard method. Unfortunately, it was also designed with women in mind and therefore tests men and children artificially high. However, it is also a much more stable test than the (LC/MS/MS) method. Apparently LC/MS/MS results, although staying in a lower, correct range, will vary more than in the other tests. Bottom line, though, sounds like I still need to get the LC/MS/MS method done. And I'm sure repetitive testing will normalize any anomalies.

Alright, one more try to get the doctor office to do the correct test. After that I'll just order it online. The money is less of an issue than the draw site location. They closed the one location in my city, so I have to drive at least an hour and a half one way to the nearest walk-in LabCorp clinic.

Did some more research and it appears that the ECLIA method was the first one used to try to account for differences in estrodial among men, post-menopausal women, and children compared to women of reproductive age. So that's why the range is similar. They then created yet another test to specifically test men in the same range as differs from children and post-menopausal women, which is where we get the LC/MS/MS test. So it sounds like the ECLIA test is more accurate than the standard test, but not quite as accurate as the LC/MS/MS method.

[Youthful55guy]

The correct LabCorp test number for your doc to order is 140244. Here's a link to the LabCorp site where I got the number: https://www.labcorp.com/test-menu/24...nsitive-lc-ms#

Regarding "sensitivity", tests are designed to be within a standard range. They test the sensitivity range by spiking blank serum or plasma samples with known amounts of the hormone and then plot the results vs. the known amount. This usually results in a sigmoidal shaped curve. The part of the curve where the line is mostly linear is the range of sensitivity. The further you go above or below the linear portion of the curve, the less sensitive the assay is to your range of hormones being tested.

Believe it or not, I actually developed an published an assay for E2 in pigs long, long ago, before even the ECLIA method was commercially available. Back then (early 1980's) it was still experimental. My assay used an RIA (radioimmunoassay) method, which is rarely used anymore due to health and environmental concerns (it uses radioactive isotopes). However, the principles of sensitivity still apply.

[Case Manager]

I'll try that number and see if it helps. I just hope my doctor office uses the same order numbers at LabCorp.