6 Weeks Results: High FT, E2, & Hema. What Next?

[JYD21]

Started TRT and just received my 6-week labs back from DLabs. My protocol has been 40mg, Mon/Wed/Fri, so 120mg weekly of Test Cyp/Prop Blend at 80/20%.

I'm 45. 185lbs. Workout 4-5 days a week. About 17% BF. Diet is above average. Always been pretty healthy. Blood pressure is always great.

Results below
HEMATOCRIT 50.9 H 38.5-50.0 % IG
TESTOSTERONE, FREE 166 H 35.0-155.0 pg/mL
ESTRADIOL,ULTRASENSITIVE, LC/MS 51 H < OR = 29 pg/mL
TESTOSTERONE, TOTAL, MS 996 250-1100 ng/dL

How I've felt in those 6 weeks: still low libido, but my mind was somewhat more optimistic some days of the week, and my workouts have improved, more intense. ...The lack of change in libido is the most disappointing aspect.

These numbers aren't bad. I already donated Whole Blood two days ago.

What should I do? Lower my dose to 100mg weekly? I prefer not to take an AI, but should I, like a very low dose twice a month or something?

I realize these numbers look pretty good, but I'm thinking that high E2 can't be helping me. I don't want it too high or too out of range.

Thanks for your help!

 

[FunkOdyssey]

Your T/E2 ratio looks normal. I would either reduce dose or increase injection frequency.

 

[JYD21]

Your T/E2 ratio looks normal. I would either reduce dose or increase injection frequency.

Thanks. Which do you lean toward? Also, would any OTC AI work? I have a friend that does 100mg weekly and takes an OTC product that helps keep is AI in shape vs. when his doc had him on a scrip AI.

 

[FunkOdyssey]

I would probably increase frequency first to see if that can control hematocrit. Is this 6 weeks on a new protocol or 6 weeks since starting TRT? If your hematocrit is already that high after only 6 weeks on TRT you may have something else going on like sleep apnea.

 

[JYD21]

I would probably increase frequency first to see if that can control hematocrit. Is this 6 weeks on a new protocol or 6 weeks since starting TRT? If your hematocrit is already that high after only 6 weeks on TRT you may have something else going on like sleep apnea.

This is since starting TRT. My hematocrit before starting TRT was a 47. I also have not been drinking enough water and been a little dehydrated.

So would you keep the dose at 120mg, but pin more or drop to 100mg and pin more?

 

[FunkOdyssey]

This is since starting TRT. My hematocrit before starting TRT was a 47. I also have not been drinking enough water and been a little dehydrated.

So would you keep the dose at 120mg, but pin more or drop to 100mg and pin more?

I would change just one variable to isolate the effects.

 

[Vince]

Started TRT and just received my 6-week labs back from DLabs. My protocol has been 40mg, Mon/Wed/Fri, so 120mg weekly of Test Cyp/Prop Blend at 80/20%.

I'm 45. 185lbs. Workout 4-5 days a week. About 17% BF. Diet is above average. Always been pretty healthy. Blood pressure is always great.

Results below
HEMATOCRIT 50.9 H 38.5-50.0 % IG
TESTOSTERONE, FREE 166 H 35.0-155.0 pg/mL
ESTRADIOL,ULTRASENSITIVE, LC/MS 51 H < OR = 29 pg/mL
TESTOSTERONE, TOTAL, MS 996 250-1100 ng/dL

How I've felt in those 6 weeks: still low libido, but my mind was somewhat more optimistic some days of the week, and my workouts have improved, more intense. ...The lack of change in libido is the most disappointing aspect.

These numbers aren't bad. I already donated Whole Blood two days ago.

What should I do? Lower my dose to 100mg weekly? I prefer not to take an AI, but should I, like a very low dose twice a month or something?

I realize these numbers look pretty good, but I'm thinking that high E2 can't be helping me. I don't want it too high or too out of range.

Thanks for your help!

Your labs look really good. I wouldn't change a thing besides drinking lots of water like you mentioned. Hopefully over time your HCT will stabilized. A lot of men who start TRT lose some of their libido. I don't believe we know why. Your estrogen levels look good and should help you in the weight room, joint and bone health.

You could try HCG for your libido.

 

[JYD21]

Your labs look really good. I wouldn't change a thing besides drinking lots of water like you mentioned. Hopefully over time your HCT will stabilized. A lot of men who start TRT lose some of their libido. I don't believe we know why. Your estrogen levels look good and should help you in the weight room, joint and bone health.

You could try HCG for your libido.

Thanks, @Vince ! Yeah, all the feedback so far is that the numbers are good or great. If I keep at 120mg, I may do 4 days a week to see is that helps.

I donated whole blood the other day and will maybe keep at that every 8 weeks if need be.

I’m trying to learn more about E2. So even though it’s high in this ultra sensitive test result, why do you (and others) say it’s in a good place?

Thx!

 

[Vince]

Thanks, @Vince ! Yeah, all the feedback so far is that the numbers are good or great. If I keep at 120mg, I may do 4 days a week to see is that helps.

I donated whole blood the other day and will maybe keep at that every 8 weeks if need be.

I’m trying to learn more about E2. So even though it’s high in this ultra sensitive test result, why do you (and others) say it’s in a good place?

Thx!

E follows T. So of course the higher you testosterone the higher estrogen will be. Men need estrogen it's that simple. I'll find a thread for you and post it here.

 

[Vince]

Higher estradiol was correlated to higher libido in this NIH funded study done by the top researcher in the field (DR Bhasin, the same guy that did a study giving men 600 mg/week of testosterone)

Higher Estradiol, T and DHT correlated to higher libido in older hypogonadal men than T alone

Relation of Testosterone, Dihydrotestosterone, and Estradiol with Changes in Outcomes Measures in the Testosterone Trials (2022) Alisa J. Stephens-Shields, PhD, Peter J. Snyder, MD, Susan S. Ellenberg, PhD, Lynne Taylor, PhD, Shalender Bhasin, MB, BS Abstract Context. Many effects of...

www.excelmale.com

High Estradiol Boosts Libido in Men on Testosterone Therapy

I have been warning men and clinics not to be so aggressive treating estradiol in men with the overuse of anastrozole. Here is a recent study done in Houston. Elevated serum estradiol is associated with increased libido in men receiving testosterone replacement therapy (TRT), according to...

www.excelmale.com

Testosterone Needs to Be Converted into Estradiol to Prevent Fat Accumulation

How Targeting Fat Cells’ Estrogen Receptors Could Fight Obesity Tracy Hampton, PhD In adipocytes, fat cells, a particular estrogen-receptor appears critical for energy supplying mitochondria to function properly. The discovery points to a potential drug target for boosting fat tissue...

www.excelmale.com

 

[Systemlord]

HEMATOCRIT 50.9 H 38.5-50.0 % IG

This isn't high hematocrit. Go to a different labs company and ranges could be 40-52%.

TRT guidelines state hematocrit at 55% action is taken, which is either reduce the dosage, donate or set up reoccurring phlebotomies.

I donated whole blood the other day

This is completely unnecessary and you risk crushing your ferritin/iron levels for a hematocrit level that isn't even high.

 

[JYD21]

This isn't high hematocrit. Go to a different labs company and ranges could be 40-52%.

TRT guidelines state hematocrit at 55% action is taken, which is either reduce the dosage, donate or set up reoccurring phlebotomies.


This is completely unnecessary and you risk crushing your ferritin/iron levels for a hematocrit level that isn't even high.

Thanks for the feedback @Systemlord. Any suggestions on how to optimize? ...I've had a few folks say 'stay where you are, it's only 6 weeks', others say lower the dose, or take the AI, etc, etc.

I'm just getting some qualitative data/feedback. My doc is open to doing any of these, but leans toward slightly lowering current dose.

Cheers.

 

[FunkOdyssey]

If you don't care about hematocrit and your primary concern is libido, I doubt lowering dose would be helpful. I would say either give it more time and see if libido comes up or add hCG. I've heard some people say it took an entire year to manifest full libido benefits of TRT, contrary to the study that put a timeline of 3-6 weeks on libido.

 

[JYD21]

Higher estradiol was correlated to higher libido in this NIH funded study done by the top researcher in the field (DR Bhasin, the same guy that did a study giving men 600 mg/week of testosterone)

Higher Estradiol, T and DHT correlated to higher libido in older hypogonadal men than T alone

Relation of Testosterone, Dihydrotestosterone, and Estradiol with Changes in Outcomes Measures in the Testosterone Trials (2022) Alisa J. Stephens-Shields, PhD, Peter J. Snyder, MD, Susan S. Ellenberg, PhD, Lynne Taylor, PhD, Shalender Bhasin, MB, BS Abstract Context. Many effects of...

www.excelmale.com

High Estradiol Boosts Libido in Men on Testosterone Therapy

I have been warning men and clinics not to be so aggressive treating estradiol in men with the overuse of anastrozole. Here is a recent study done in Houston. Elevated serum estradiol is associated with increased libido in men receiving testosterone replacement therapy (TRT), according to...

www.excelmale.com

Testosterone Needs to Be Converted into Estradiol to Prevent Fat Accumulation

How Targeting Fat Cells’ Estrogen Receptors Could Fight Obesity Tracy Hampton, PhD In adipocytes, fat cells, a particular estrogen-receptor appears critical for energy supplying mitochondria to function properly. The discovery points to a potential drug target for boosting fat tissue...

www.excelmale.com

@Vince Thank you. I'll give these a look-see. I agree I don't want e2 low and if my ratio is good (still learning how to calculate that), then perhaps I look at staying the course. ...Since my numbers overall do look pretty good.

 

[Systemlord]

My doc is open to doing any of these, but leans toward slightly lowering current dose.

I think it's too early to be judging your protocol to be a failure or success. If by 8 weeks things don't improve in the sexual department, slightly lowering your dosage is the next suggested move.

 

[JYD21]

I think it's too early to be judging your protocol to be a failure or success. If by 8 weeks things don't improve in the sexual department, slightly lowering your dosage is the next suggested move.

OK, thank you, sir. I really appreciate all of this feedback.

 

[JRos895]

Is the posted E2 level actually a good one? If it was the non-sensitive test, your E2 might be closer to 75/80 (sensitive is usually 1.5x to 2.0x non sensitive) or potentially higher and people would say that’s high if they saw numbers like that.

I feel like people are saying your E2 looks good because it’s not high above 50, but I think that standard is generally reserved for the non-sensitive test. People often apply the non-sensitive standard for treating high E2 (>50) for sensitive tests and I feel like it’s comparing two different units. The sensitive assay clearly states that the upper range is 30, so why do people just ignore that?

In fact, I believe the famous study that demonstrated that E2 levels between 20-30 was best for reduced cardiac mortality used the ELCIA test, not the sensitive test. An E2 level of 20-30 on a non sensitive test would likely appear as a 15-20 on a sensitive test, yet people who are too pro-E2 would say that 15-20 is far too low, even though it’s on the sensitive test.

Just a thought.

 

[JYD21]

Is the posted E2 level actually a good one? If it was the non-sensitive test, your E2 might be closer to 75/80 (sensitive is usually 1.5x to 2.0x non sensitive) or potentially higher and people would say that’s high if they saw numbers like that.

I feel like people are saying your E2 looks good because it’s not high above 50, but I think that standard is generally reserved for the non-sensitive test. People often apply the non-sensitive standard for treating high E2 (>50) for sensitive tests and I feel like it’s comparing two different units. The sensitive assay clearly states that the upper range is 30, so why do people just ignore that?

In fact, I believe the famous study that demonstrated that E2 levels between 20-30 was best for reduced cardiac mortality used the ELCIA test, not the sensitive test. An E2 level of 20-30 on a non sensitive test would likely appear as a 15-20 on a sensitive test, yet people who are too pro-E2 would say that 15-20 is far too low, even though it’s on the sensitive test.

Just a thought.

It's the ultra-sensitive test.

ESTRADIOL,ULTRASENSITIVE, LC/MS 51 H < OR = 29 pg/mL EZ

Good comments and will keep it in mind.

 

[JYD21]

I think it's too early to be judging your protocol to be a failure or success. If by 8 weeks things don't improve in the sexual department, slightly lowering your dosage is the next suggested move.

@Systemlord clarification: you mean 8 weeks after the initial 6 or 8 weeks into trt n general?

 

[Systemlord]

you mean 8 weeks after the initial 6 or 8 weeks into trt n general?

Per protocol change or starting out on TRT -> if you don't show progress in the time, then I advise a slight dosage reduction.

Onset of effects of testosterone treatment and time span until maximum effects are achieved

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects are ...

www.ncbi.nlm.nih.gov