Introduce an AI or Dosage Adjustment?

I posted a few weeks back about having no benefits of TRT after a few weeks in with a protocol of 70mg E3.5D and 200IU of HCG EOD (HCG only started for the last 2 weeks..and I had no effects of 4 weeks TRT without it). I am now in my 7th week, still with no effects. My libido and erections are my first priority and there have been no improvements but my last blood test, taken last week, revealed high E2 (63 pg/ml).

I am waiting for my appointment but am curious what your thoughts are as I would like to make any adjustment sooner than later. Should I look into splitting my T-Cyp to EOD at the same 140mg weekly dose? Maybe only do 2 weekly injections of HCG at 250IU (instead of 700IU weekly at EOD)? Or am I destined to go the AI route to maintain a level of mid 700ish Total T? I will try anything at this point as I am miserable.

My primary symptoms are very low libido, ED, insomnia lately (waking up after 4-5 hours and not getting back to sleep), brain fog, low energy, started noticing more pimples on my forehead and neck this week, water retention. I am 35, 6'2" and 200lbs. I started the Stronglifts 5x5 workout 2 months ago and have been enjoying that and doing it consistently.

Pre TRT:
Total T = 193 ng/dL 241-827
Free T = 3.50 ng/dL 3.70-23.28
SHBG = 33.2 nmol/L 11.0-57.0
E2 = 2.0 μg/24hrs 0.8 – 7.0
FSH = 0.9 [IU]/L 1.4 - 18.1 mIU/mL
LH = 1.3 [IU]/L 1.5 - 8.1 mIU/mL
DHT = 1.6μg/24hrs 3–16
TSH = 1.020 uIU/mL 0.350-5.500

Post TRT (6 weeks):
Testosterone Total - 712 ng/dL 240 - 950 ng/dL
Testosterone, Free - 173.9 pg/mL pg/mL
SHBG - 20 nmol/L 10 - 57 nmol/L
Estradiol (E2) - 63 H pg/mL 10-40

Now that you're SHBG is @ 20 you can definitely think about injecting EOD, moving your shots closer together, that typically helps remove excess testosterone and the subsequent aromatization. You may be able to avoid an AI that way. Your Estrogen is indeed too high and you've got symptoms so a change may be necessary. Typically here we like to adjust dosing than use an AI and if an AI is used, its a very low dose, <.25mg.

EOD would be 40mg based on your now use of 140mg weekly total.

I'll try EOD injecrions. Would you recommend I keep my HCG dosage of 200IU EOD the same? I've only been on HCG for 2 weeks and I guess I haven't noticed anything from that specifically. What is strange is with my increased testosterone, my low libido and ED issues are exactly the same as Pre TRT. I guess I would've thought the feeling would be different even though I am not dialed in to a protocol that works for me. Just trying to be patient but that is tough to do for me and my wife.

LIbido and erections is what most of us are still chasing, it gets better of course but that's the singular complaint, if you will, that most of us chase as the last piece of the puzzle. We all get really good results from TRT but this one last thing...

Im one I use HCG because I know it's good to keep the testes alive, but I don't like it, never "feel" anything from it, contrary to other men that do claim to feel a libido bump, penile sensitivity, and/or a general feeling of well being. We're all different. I would stay the course...one of the toughest things to do is this 4-6 weeks of reaching a steady state.

With those symptoms and numbers, a low dose AI would be something to consider. If you've never taken it before, you may be shocked at how well anastrozole works (at least with most guys). Whether T or an AI, I'm an advocate for relatively small doses to start. Be patient and see how it goes for a month. There are a couple guys here that recommend starting higher and working down. I remember someone suggesting I start with 25mg of DHEA twice daily, for 50 mg per day. By the time I stopped DHEA, I could hardly stand 6mg. As for AI, 1/8th mg may do wonders for your high AI and symptoms. Best part, you should begin feeling it fairly quickly after taking it. As Vince suggests, an EOD protocol will help as well.

Question on starting EOD, on Monday, I injected my normal 70mg dose. Should I divide the remaining 70mg and take half today, half on Saturday and then start my routine of 40mg EOD on Monday?

Also, is there benefit in cutting back my HCG from 200IU EOD to 250IU E3.5D?

That test/hcg schedule should be fine. I've never taken hcg and haven't had any testicular atrophy. I keep saying I'm going to try it one day...

riverside said:

Question on starting EOD, on Monday, I injected my normal 70mg dose. Should I divide the remaining 70mg and take half today, half on Saturday and then start my routine of 40mg EOD on Monday?

Also, is there benefit in cutting back my HCG from 200IU EOD to 250IU E3.5D?

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When I changed from EOD to daily I went right at it...Thurs 50mg like I was due, and then Fri right in with 24mg and daily from there. I saw no reason to put in some pause there.
Dr Saya has a case-study posted here about HCG dosing and frequency. Otherwise seems to be a highly individualistic thing. There'd be nothing wrong with 250 E3.5D if that's what you want.

I told my doctor that I switched to EOD Cypionate and 250IU E3.5D HCG. He prescribed .25mg Anastrozole EOD on injection day and asked me to front load 1mg for my first dose (yesterday). Thoughts? I am at this point almost hopeless..

riverside said:

I told my doctor that I switched to EOD Cypionate and 250IU E3.5D HCG. He prescribed .25mg Anastrozole EOD on injection day and asked me to front load 1mg for my first dose (yesterday). Thoughts? I am at this point almost hopeless..

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.25mg EOD seems like a dose that will crash your estrogen and leave you feeling even worse

PAUL-E said:

.25mg EOD seems like a dose that will crash your estrogen and leave you feeling even worse

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I agree that's way too much. And def do not take 1mg to front-load (no such thing). My recomendation is .25mg twice per week. No more than that until you get another sensitive E test.

I agree with Paul, that AI will crash your estrogen. I'm one who really likes the effect of HCG. I use 500iu every 3 1/2 days along with my T injection. I've never used an AI.

Ok, I already took the 1mg yesterday. I will plan on starting with .25 e3.5days along with my HCG injections. This is a well known testosterone doctor which had me conflicted. How long did it take any of you to feel the AI benefits? At this point of 8 weeks in with no changes I am starting to be pessimistic on the whole treatment even though my T levels are horrible before TRT.

haiving taken 1mg I'd maybe do the .25mg, next week. 1mg is a very heavy dose and your Dr isn't the wisest "well known" Dr we've seen around here.

riverside said:

Ok, I already took the 1mg yesterday. I will plan on starting with .25 e3.5days along with my HCG injections. This is a well known testosterone doctor which had me conflicted. How long did it take any of you to feel the AI benefits? At this point of 8 weeks in with no changes I am starting to be pessimistic on the whole treatment even though my T levels are horrible before TRT.

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That is a significant dose. Why front-load? In the hormone game it's always easier to adjust upwards from small doses. The phrase "start low and go slow" has been proven over and over again. I would do nothing more until next week.

Vince Carter said:

haiving taken 1mg I'd maybe do the .25mg, next week. 1mg is a very heavy dose and your Dr isn't the wisest "well known" Dr we've seen around here.

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CoastWatcher said:

That is a significant dose. Why front-load? In the hormone game it's always easier to adjust upwards from small doses. The phrase "start low and go slow" has been proven over and over again. I would do nothing more until next week.

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Good question! Ok, I will hold off until next week and proceed with a protocol of .25 Anastrozole E3.5D.

My ultra sensitive estradiol E2 results from this past Monday that I requested on my own after my change to EOD injections came back from Quest today at a whopping 100 on their scale of <=29. Should I be worried? How long before my AI should presumably lower that some? Thanks again

Are you taking DHEA and/or Pregnenolone? and if you what type...tablet, micronized capsule, cream, etc etc

Vince Carter said:

Are you taking DHEA and/or Pregnenolone? and if you what type...tablet, micronized capsule, cream, etc etc

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Neither actually. I took my first AI dose a day after this blood draw. Maybe 1mg wasn't too high afterall?

riverside said:

Neither actually. I took my first AI dose a day after this blood draw. Maybe 1mg wasn't too high afterall?

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We're going to find out. That was an astonishing value you posted.