New on Excelmale. 3 years on trt. Need help with getting dialed in!

[tj]

Hi Al,

I have been reading a long time here on the forum but decided to post here and interact more.

Some background info and labs. ( Because i live in Europe i made the conversion to the us)
before trt (2015) lab was:
total t 274 ng/dl
shbg 14.6
free t 7.86 ng/dl
estrogen 23 pg/ml
Could not build muscle, tired, low libido.


Almost 3 years on sustanon with different protocols. Started with androgel but quickly went to Sustanon injections. Prescribed was 250 mg Sustanon every 3 weeks. After a trough of 260 i got prescribed 250 mg every 2 weeks until now 150 a week but have 250 mg ampoules so i can use more if needed.


Protocols i tried:
Once a week 125mg 150mg 250mg. (felt nothing)
Every 3,5 days 62.5mg 70mg 80mg 100mg (still nothing)
And since december 2018 60 mg eod
Never used an ai.

Lab on 60 mg eod was 6 weeks after starting and exacly 48 hours after injecting:
total t 836
estrogen 75.18 pg/ml (non sensitive)
free t 27.2 ng/dl
shbg 14.4
hematocrit 0.50
dhea 7.6 umol/l (= i think 280 ug/dl of i did the conversion correct)

then went on 65 mg eod (227 a week) because i still didn feel good.
Total t after 6 weeks on this protocol and exactly 48 hours after injection 778 ng/dl.
Hematocrit 0.49
Thats on a higher dose a lower level of testosterone??

Still i dont really feel optimized. Libido is still not were i want it to be. Erections only at night sometimes weak morning wood. Orgasms sometimes good.

Stats

• 38 years
• 195 cm (6,5)
• Bw 105 kg (230 lb)
• Waist 94 cm
• Bf 13-14%
• Training 3 times a week bodybuilding training
  
  My questions are:
• Should i up the dosage of testosterone. Or is it better going to ed shots because of low shbg.
• Should i add dhea?
• What to do with the low shbg? It was low before i started and never was higher than 18.5 on all the different protocols.

Thyroid and glucose levels last year:
tsh 2.3
t4 16.5 pmol/l
t3 5.4 pmol/l
hba1c: 5,20%


My goal is fatloss, building muscle feeling confident and have good libido and erections.
What are my options?

 

[Cataceous]

It's possible your high estradiol is holding you back. Your calculated free estradiol is around 2.3 pg/mL. The top of the normal range is more like 1.5 pg/mL. It's admirable that you've held off on using an AI, but it may be time to reconsider that.

It's not ideal that you haven't been able to verify the estradiol measurements with a mass spectrometry-based test. But the numbers are high enough that even with significant cross-reactivity in the test you're likely still well above the normal range.

Do you have access to a shorter testosterone ester, such as propionate or enanthate? Since you don't seem to mind frequent injections, using a short single ester would allow for faster evaluations of protocol changes.

If you do start an AI, low and slow is the rule. Even though you appear to have excess aromatase activity, you may still be quite sensitive to these drugs. You don't want to push estradiol too low, which can be worse than too high.

BTW, individual testosterone measurements can vary quite a lot, so I wouldn't worry about the inconsistency in getting a lower reading after raising the dose.

Another thing to consider is adding hCG, which is sometimes helpful when TRT alone isn't sufficient. But I would experiment with lower estradiol first, due to hCG's propensity to raise it.

 

[tj]

Thanks for your reply cataceous!
There is no way i can test a lcms estradiol in my country and i only have acces to sustanon.

I am confused about the estradiol since the latest insights seem to be not to treat high estradiol. There is a lot of conflicting info. I even hear that estrogen of even 120 pg/ml on a sensitive test is fine. (actualy al lot of this is coming from the tot roundtable)

I have thought about HCG but it might indeed raise estrogen even higher.

 

[Cataceous]

...
I am confused about the estradiol since the latest insights seem to be not to treat high estradiol. There is a lot of conflicting info. I even hear that estrogen of even 120 pg/ml on a sensitive test is fine. (actualy al lot of this is coming from the tot roundtable)
...

Extremism on either side is harmful. It's good to avoid AI use, especially in the first year, before all the benefits of TRT have kicked in. But I think that some men will not see optimal results with supraphysiological estradiol. And guys with low SHBG often have a harder time than most in this regard. Do read Curt Moyer's page on normal estradiol levels in men. An important point from this and the underlying reference is that your level of estradiol is higher than that of all but one in several million normal men. Do you really want to experiment on yourself this way?

 

[YBWV]

Your estradiol is undoubtably high, however Before resorting to an AI, particularily where no "sensitive" testing is available, I would look at raising androgens (FT & DHT) to balance hormones. While always keeping up the good work in minimising body fat.

As you're in Europe, have you tried mesterolone (Proviron)? Before the advent of the modern AI's it was used to inhibit E2.
As a DHT analog it also has the potential to improve mood and Libido.
(DHT, in my opinion, is what puts the "drive" into "sex drive" a synonym for Libido).

Alternatively you could try adding, alongside your Sustanon injections, a small daily amount of the transdermal gel that you used previously (say, initially, ~20% of the monotherapy dose). Applying to inner thigh and/or scrotum, if tolerable, disproportionately increases DHT conversion.

Either method has the potential to improve your androgen:estrogen balance, as the DHT displaces the E2 at the receptors.

Caveats- There is a risk that your SHBG would be lowered further.
Any guy prone to androgenic alopetia would potentially see an acceleration of the balding process.

 

[Systemlord]

Your SHBG is very low and therefore I would recommend daily injections regardless of the type of ester, know a guy on Nebido doing daily 20mg injections and doing very well.

 

[tj]

YBWV,

I wish i could get some proviron. It's not possible to get it prescribed. Buying from underground labs isn't a long term solution for me.

Balding is not a problem anymore. Sinds i was 20 i started shedding hair. Now just a shaved head

 

[tj]

Will start the daily's and see how it goes..