TRT Blood panel follow up.

Hi guys,

here you have a follow up on my TRT journey.

43 y/o. Lean and active/healthy lifestyle.

Started in March due to deep fatigue, focus, low mood and ED symptoms that had been going on for several years already (ED since my mid 20s). Blood test confirmed very low T, probably due to primary HG. No other major health issues.

The urologist made me start with 100mg Test cyp IM every 2 weeks. Didn't feel any change. After about one month we switched to 250mg every two weeks. That resulted in a huge boost followed by a crash. Couldn't stand the ups and downs of such infrequent injection protocol, plus the doctor didn't seem experienced enough on the topic, so I decided to change to an endo.

We started with 100mg EW in April, progressed to E5D, and for the past 4 weeks I've been injecting 50mg on M-W-F, shallow IM with an insuline needle.

Just got my latest blood panel. Blood extraction right before my Monday morning shot, so I guess that would be my lowest point, after the weekend.

--->Keep in mind that I live in Spain, where the range of blood tests available is kind of limited compared to the US.

Free T: 18.60 pg/mL (3.64-19.30)
17 Beta Estradiol: 55 pg/mL (<56)
Prolactine: 8.1 ng/mL (3.5-19.4)
SHBG: 39.3 nmol/L (13.5-71.4)
Vit D: 22.10 ng/mL (30-100)
Magnesium: 1.83 mg/dL (1.80-2.60)

How do I feel? What changes have I experienced so far?

Generally speaking I feel great on 150mg a week. 50mg x 3 shots a week makes me feel very stable. Definitely better mood. Gained some good weight. More physical energy and libido/sex interest went up.

No symptoms of high estradiol other than hard nipples most of the time. Not painful though. Just slightly more sensitive than before starting TRT. I tried Zinc supplementation (30-40mg every day) for a few weeks but felt more tired, headache, brain fog, so I dropped it.

ED still there though. Not as bad as before, but I still need some extra help through Viagra (usually 50mg at the time) or Cialis (20mg) if I want to function properly in bed. Without ED pills I have no problem getting aroused but the erection is usually weak and inconsistent (lots of ups and downs).

Also, no morning wood at all on 150mg T a week. No spontaneous erections during the day or at night. Actually I haven't had a spontaneous morning erection in probably 20 years. The only exception, when I got my first 250mg shot. After that shot I remember waking up at night with a strong erection and getting morning woods for 4-5 days after that single shot.

Right now I feel great. I'm at the top of the range as far Free T goes, and Estradiol is pretty high too, although asymptomatic. Any increase in T dosage would probably cause high E symptoms, I guess.

So my questions is. How do I improve my ED problem? Should I ask the endo about AI medications to lower E? A better T/E ratio would help with ED?
Standard treatment here in Spain is usually just T, once a week, without any AI or HCG.
I'd love to keep it as simple as possible, but at the same time I feel there's a lot of margin for improvement on the ED front.

Any ideas?

I'll see the endo in a few days and I'll keep you posted, hoping this can help other members.

Thanks for all the help and support!

It looks like you have dialed in your treatment well. I wish you had also shown your total T and your hematocrit.

I would not take an AI since adding an AI has not shown to improve ED. I would just cut the 20 mg Cialis pill in quarters and take it daily. A study found that after a few weeks of daily low dose Cialis, ED can improve even after stopping Cialis. Adding HCG may also help.

Thank you for the reply, Nelson. And sorry for posting in the wrong section.

This time the endo didn't ask for total T. Kind of weird, I thought.

Anyway, hematocrit level was 48.30% (40-55).

Other blood parameters that might (or might not) be related to ED:

- Vit D 25OH 22.10ng/mL (30-100)
- Tot Cholesterol: 243 mg/dL (130-220)
- Cortisol: 10.80 (3.70-19.40)

I'll try the daily 5mg Cialis thing and see if that helps. Do you have any link to the study?

Thanks again for the great info (as usual)

Nelson Vergel said:

A study found that after a few weeks of daily low dose Cialis, ED can improve even after stopping Cialis.

Click to expand...

Anecdotally, I have cut my Cialis dose from 5.0mg/daily to 2.5mg/daily and have the same results that I had on the higher dose. The goal is to see if I can eliminate it totally. All the best!

surprised that no one has questioned this test:

17 Beta Estradiol: 55 pg/mL (<56)

That is high unless his total T is high as well. If his total T was 1100 this would be fine. 1100/55 = 20

no, its the wrong test.

Vince Carter said:

surprised that no one has questioned this test:

17 Beta Estradiol: 55 pg/mL (<56)

Click to expand...

He may have trouble having the sensitive test run. He lives in Spain and the availability of the more sophisticated/accurate test is limited in more places than you'd expect. It's hard to find here in Canada, for example.

It's still the wrong test, regardless. Do you convert that in some way? It's not in his interest for us to say much especially anything to influence his care. I'd back off my argument if the methodology of the test is the LC/MS/MS that we use in the states. Admittedly I have no clue about 17 Beta...never saw it before. Everything I'm reading refers to female hormone replacement.

Agreed that a "male specific" panel for E2 should be taken.

Also, Vitamin D3 is very, very low. OP, ramp up your vitamin D. There's so many areas that benefit from vitamin D3, one being the thyroid. Speaking of, that would also be (thyroid) something to review with everything else.

I *think* it refers to the full name of the hormone, "17 beta estradiol." I believe it may be the way it was reported from his lab. Here in Canada, still bearing some British influence, there are references occasionally to "oestradiol" and "beta oestradiol." I don't think we know if it's LC/MS/MS unless we can infer something from the fact that the stated range is <56.

https://en.wikipedia.org/wiki/Estradiol
http://europepmc.org/abstract/med/6437878

"Estradiol, or more precisely, 17&#946;-estradiol, is a human sex hormone and steroid, and the primary female sex hormone."

17 beta estradiol = E2

It's the name used here for the hormone.

Thyroid function seems fine. We tested T3/T4 before I started TRT. No problem there.

Vit D is very low though. What kind of supplementation do you guys suggest? I'll talk to the endo about this.

This time she didn'd ask for Total T. Weird, I know. In any case, based on how I feel (really good, really stable), and seeing where my Free T is right now (almost top of the range on my lowest day), my guess is that my total T is pretty high as well. I'll make sure to include tot T in the next panel.

Thanks again for the help!

Your Endo can put you on Drisdol 50,000iu/wk for a few months. That would probably get you up in the 70's or 80's, you can sustain it from there with 5,000iu/day up to 10,000iu/day, depending on what works best for you.

Not sure we have Drisdol here in Spain but I'll see what my endo suggests and I'll let you guys know.

Thanks!

Anybody else getting really tired/sleepy when taking zinc supplements?

I've tried for the second time taking 30mg a day of Zinc to see if that could lower my Estradiol and possibly improve ED.
This time as well, just after a couple days of zinc supp, I start feeling tired/exhausted almost like I felt pre-TRT. If I stop taking zinc I'm back to normal, good energy levels in a day or two.

Anybody else with the same experience?

Any other ideas on how to lower E without extra meds?

P.S. I'm not overweight. About 10% BF right now.

Thanks!

Some guys, myself included, use DIM as our only AI. Its not expensive and worth a try. http://www.amazon.com/Natures-Way-DIM-plus-Estrogen-Metabolism/dp/B00014IGXS

Thanks ERO!

Hi everybody,

Just got back from my endo visit. She looked at the blood tests (see above) and seemed quite pleased with the results. We're gonna stay on this protocol, 140/150mg Test cyp a week, split into three injections (M-W-F), and retest in three months. I'm starting with some Vit D supplementation as well.

She didn't seem worried about Estradiol being at the top of the range. She checked my nipples and said everything is OK. No gyno, just some extra sensitivity. I asked about AI, but she said it's not needed in my case.

I'm still convinced that my ED and total absence of night/morning spontaneous erections might be caused by a slightly unbalanced T/E ratio, but if she keeps me at 150mg I can't really complain, 'cause energy levels and libido are pretty good right now.

I just ordered some DIM. Let's see if that makes any difference. If that's not the case I might look for a second opinion, either from another endo or a new urologist.

Can you get Proviron prescribed in Spain?

I'm not sure...