Calling for the experts - Daily injections routine failure

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Appassionato

Active Member
As posted in previous posts around the forum, I've dropped the HCG 5 weeks ago, because it was impossible for me to control the spike in E2 it was giving me, despite injecting only 50IU 3 times a week.
I gave a daily T enanthate injections protocol a go, starting with 10mg per day.
2 first days I felt immediately better and my gynecomastia shrank considerably, at the point it wasn't visible anymore. Things got worse soon though. I developed an insane amount of anxiety throughout the whole day, sweating insanely (while the others around me were fine), terrible sleep (as documented in other posts), increased hair shedding and gynecomastia. I waited 2 weeks and I dropped to dosage to 7.5 mg per day and I've got lab 3 weeks after, with the blood drawn in the morning before the next injection:

Free T = 28.20 pg/mL (4.2 – 30.4 pg/mL)
E2 = 61.71 pg/mL (10 – 40 pg/mL)
Prolactin = 13.56 ng/mL (2.1 – 17.7 ng/mL)

Consider that I am temporary on Cabergoline 0.375 mg per week in 2 doses to control the spike of prolactin due to high E2, otherwise it would have been 48 ng/mL like the previous blood test.
Anyway, for now I've dropped the dosage further down to 5 mg per day, the minimum I can count effectively on the syringe, but I think that won't work due to the Free T/E2 ratio at the moment.
After almost 2 years of protocols trials and meticulous blood tests, I know my E2 don't have to exceed 35 pg/mL or I start having symptoms. I post here some of my previous blood tests to show you what I have tried and what has been the outcome, hoping you could help me.

On a 2x week injections protocol (100 mg first, then 80 mg, then 60 mg per week) my E2 was always 42-43 pg/mL the day after the injection, giving me symptoms, while total T was around 1000. I did also a blood test on 60 mg per week divided in 2 doses the day before the next injection, and total T was 712 ng/dL with E2 at 42.8 pg/mL. The day after, before the injection, total T would have been probably around 400-500 ng/dL, which means I don't really do good on 2x week protocol and I have to go more frequent (SHBG are always between 22-26).

So now, if 5mg per day fails, I won't have any other choice than going EOD, as 2x week puts me on a rollercoaster, but I don't know which dosage to try to keep E2 in range.
Then, if I won't be able to control E2 like that, I will have to introduce exemestane unfortunately, because it seems I'm doomed with crazy aromatization, despite a healthy lifestyle and a fit shape.

Just to give you an insight, last year I tried as well 25 mg of T 2x week along with 6.25 exemestane once a week. The day after the injection total T was 962 ng/dL, E2 27.7 pg/mL and prolactin 9.28 ng/mL for the first time in my life without any cabergoline. That's where I felt the best.
Issue is that I repeated the test the month after, but this time the day before the injection, and total T was 470 ng/dL, E2 29.7 pg/dL and prolactin 13.11 ng/dL, which means I need to pin more frequently.

Sorry for the long post, but I hope you could give me some suggestions.
 
Defy Medical TRT clinic doctor
I too aromatase like crazy, had been down to 10mg and I didn't feel good there, 12/14 per day had my trough FT under the lab range. I wanted to be ~ at the top of the lab range in my trough so its been 16mg per day now.

Don't be leery at introducing the AI. I have to have it, and you may have to have it, too. Daily small injections aren't the controller of E for me, or you.

Exemestane works a bit better for me than Anastrozole. I had been using .25mg EOD and still having remarkable E problems. Talked to my Dr about the Exem and we decided to try it. I titrated that from 12.5mg twice per week to a progression that resulted in 12.5mg EOD.

What works, for me: E2 in the single digits, trough. I didn't see your SHBG but try having your E2 mirror your SHBG value. This absolutely works for me.

Try, too, if it's affordable for you run "Estradiol, Free" alongside the LC/MS/MS. At my worst points my Free E was up over the lab range even in a trough.
 

fifty

Well-Known Member
You are taking so much stuff with so many troubles. Have you ever considered just tapering off virtually everything and focusing your healthy diet and lifestyle?

Either that or go back to when you felt the best. Seems like you’re chasing feeling good and numbers. F the numbers.
 

Appassionato

Active Member
I too aromatase like crazy, had been down to 10mg and I didn't feel good there, 12/14 per day had my trough FT under the lab range. I wanted to be ~ at the top of the lab range in my trough so its been 16mg per day now.

Don't be leery at introducing the AI. I have to have it, and you may have to have it, too. Daily small injections aren't the controller of E for me, or you.

Exemestane works a bit better for me than Anastrozole. I had been using .25mg EOD and still having remarkable E problems. Talked to my Dr about the Exem and we decided to try it. I titrated that from 12.5mg twice per week to a progression that resulted in 12.5mg EOD.

What works, for me: E2 in the single digits, trough. I didn't see your SHBG but try having your E2 mirror your SHBG value. This absolutely works for me.

Try, too, if it's affordable for you run "Estradiol, Free" alongside the LC/MS/MS. At my worst points my Free E was up over the lab range even in a trough.

Hey Vince.
I know, we have a lot of similarities, but I'm trying to stay on as less medication as possible, hence the reluctance on getting on Exemestane on a long term.
My SHBG has been in the 22-26 range for the past year and a half, so I didn't check it again because it's stable. I've had both sensitive and non-sensitive E2 tests (and I didn't see much difference to be honest), but not free E2, as I don't think it's available.
Considering my SHBG, I would say it's high anyway.

Seeing my past labs as well, what would you use as EOD T only protocol?
 
Free Estradiol is avail at both Quest and LabCorp, it might be an eye opener for you. Where you see your Free T close to the lab range you can reasonably be assured that Free E is also up there. SHBG binds to E just like it does to T, you have a lower amount (more than me, I run ~12) of binding material so your free hormones are up there.

Twice daily injections is something I considered. But I'm actually in a very good spot right now with my protocol and besides some ED that lingers, things are way better now than I've ever been.

If you wanted EOD, just start low and work up...I did a long history over months time of 2mg at a time. I'd so 16mg EOD and see where you're at.
 
Last edited:

Appassionato

Active Member
You are taking so much stuff with so many troubles. Have you ever considered just tapering off virtually everything and focusing your healthy diet and lifestyle?

Either that or go back to when you felt the best. Seems like you’re chasing feeling good and numbers. F the numbers.

Dude, I think you missed all my previous posts in the forum: Just a small recap:

- Took steroids in early twenties for 2 years and a half.
- Ditched everything and I've been put on finasteride for 7 years.
- My health deteriorated quickly and I started a journey to understand what was the issue.
- Diagnosed with post finasteride syndrome and secondary hypogonadism, I've tried letting my body heal by itself for months, then went on a supplement regime, then on clomid + AI and eventually on AI monotherapy.
- Everything failed.
- So I started TRT with T enanthate only on different protocols, as mentioned above.
- I had to throw in HCG in the mix for fertility reasons and I've lost 1 year trying to make it work.
- Ditched HCG and now I'm trying to get dialed in with T enanthate only.

And btw, I have been having a healthy lifestyle since years, pre and post TRT. On diet since I was 18, no alcohol at all, no gluten, heavy workouts 4 times a week with weights.
 

Appassionato

Active Member
Free Estradiol is avail at both Quest and LabCorp, it might be an eye opener for you. Where you see your Free T close to the lab range you can reasonable be assured that Free E is also up there. SHBG binds to E just like it does to T, you have a lower amount (more than me, I run ~12) of binding material so your free hormones are up there.

Twice daily injections is something I considered. But I'm actually in a very good spot right now with my protocol and besides some ED that lingers, things are way better now than I've ever been.

If you wanted EOD, just start low and work up...I did a long history over months time of 2mg at a time. I'd so 16mg EOD and see where you're at.

I'm in Europe and I never heard about it here, but I can ask.
A way I've learned to recognize my E2 levels is by my gynecomastia and the ring test. When I see my left nipple popping out and getting bigger, along with the wedding ring coming out hardly from my finger, I know my E2 is high.
 
Dude, I think you missed all my previous posts in the forum: Just a small recap:

- Took steroids in early twenties for 2 years and a half.
- Ditched everything and I've been put on finasteride for 7 years.
- My health deteriorated quickly and I started a journey to understand what was the issue.
- Diagnosed with post finasteride syndrome and secondary hypogonadism, I've tried letting my body heal by itself for months, then went on a supplement regime, then on clomid + AI and eventually on AI monotherapy.
- Everything failed.
- So I started TRT with T enanthate only on different protocols, as mentioned above.
- I had to throw in HCG in the mix for fertility reasons and I've lost 1 year trying to make it work.
- Ditched HCG and now I'm trying to get dialed in with T enanthate only.

And btw, I have been having a healthy lifestyle since years, pre and post TRT. On diet since I was 18, no alcohol at all, no gluten, heavy workouts 4 times a week with weights.

Too be fair every time some one creates a new thread because X bothers them on a particular day you lose some of the history, it's always better to just add to a thread than start a new one.
 

Appassionato

Active Member
Too be fair every time some one creates a new thread because X bothers them on a particular day you lose some of the history, it's always better to just add to a thread than start a new one.
Yeah you're right, I'm just tying to get things neat as Nelson was rightly complaining of seeing threads in wrong sections of the forum, so I thought it would have been better to post this in the blood test section.
 

madman

Super Moderator
Nope, I just did free T, as that's what really matters for me.
Also, checking hormones on monthly base, that saves me a bit of money.


Everyone goes on and on about the importance of testing e2 using the estradiol sensitive assay (LC/MS-MS).....yet they persist to use the wrong testing method when is comes to free testosterone which is and should be of significant importance when on trt.

You have no idea where your FT levels truly sit as you are not even using the proper testing method.....you should know by now that the direct analog test is inaccurate.


Curious about labs


Unfortunately regarding testing ones FT (free testosterone) most are using the direct analog-based free testosterone immunoassays which are inaccurate.

If anything you should be getting the equilibrium dialysis or better yet save yourself the money and use the Calculate free testosterone with TruT by FPT - Try the public free testosterone calculator at tru-t.org

Do you truly know your FT levels?
 

Appassionato

Active Member
Everyone goes on and on about the importance of testing e2 using the estradiol sensitive assay (LC/MS-MS).....yet they persist to use the wrong testing method when is comes to free testosterone which is and should be of significant importance when on trt.

You have no idea where your FT levels truly sit as you are not even using the proper testing method.....you should know by now that the direct analog test is inaccurate.


Curious about labs


Unfortunately regarding testing ones FT (free testosterone) most are using the direct analog-based free testosterone immunoassays which are inaccurate.

If anything you should be getting the equilibrium dialysis or better yet save yourself the money and use the Calculate free testosterone with TruT by FPT - Try the public free testosterone calculator at tru-t.org

Do you truly know your FT levels?

As said before, I'm in Europe and I don't have access to some of the test you guys have in US. Regarding E2, I tested it with both methods and they are about the same, so I won't spend extra money on LC/MS. Also, I recall a post on the forum showing how actually the standard E2 test was more reliable than LC/MS, but I have to do some digging to find it.

So, should I check total T and albumin? My SHBG throughout almost 2 years have been fluctuated between 22 and 26 with different protocol, not much to justify testing them all the time, considering that there always a margin of mistake in lab tests.
 
I agree with Testing Free T alone, I dont see the value in paying for TT, but then it's an unreliable test in itself so you get in a quandry...TT and Albumin and SHBG, or a faulty FT test...ha!
 

madman

Super Moderator
As said before, I'm in Europe and I don't have access to some of the test you guys have in US. Regarding E2, I tested it with both methods and they are about the same, so I won't spend extra money on LC/MS. Also, I recall a post on the forum showing how actually the standard E2 test was more reliable than LC/MS, but I have to do some digging to find it.

So, should I check total T and albumin? My SHBG throughout almost 2 years have been fluctuated between 22 and 26 with different protocol, not much to justify testing them all the time, considering that there always a margin of mistake in lab tests.






TT (LC/MS-MS), SHBG and albumin will give you your FT results.

If you do not have albumin tested than results will still be accurate when using 4.3 nmol/L (mean)....unless you had a presence of significant hypoalbuminemia (abnormally low).

On average most men have albumin levels in the 4.0-4.6 nmol/L range.


Try the public free testosterone calculator at tru-t.org
 

Appassionato

Active Member
TT (LC/MS-MS), SHBG and albumin will give you your FT results.

If you do not have albumin tested than results will still be accurate when using 4.3 nmol/L (mean)....unless you had a presence of significant hypoalbuminemia (abnormally low).

On average most men have albumin levels in the 4.0-4.6 nmol/L range.


Try the public free testosterone calculator at tru-t.org

Alright, I'll get it tested once for all next time. Thanks.
 

Appassionato

Active Member
Hi everyone, a quick update after another blood test. These are the results at through (30 minutes before injection) on a protocol of 15 mg of T enanthate EOD + 1 mg of exemestane ED at bedtime:

Total T = 792.18 ng/dL (241 – 827 ng/dL)
Free T (calc.)= 31.18 pg/mL (4.2 – 30.4 pg/mL)
E2 = 38.57 pg/mL (10 – 40 pg/mL)
Albumin = 3.9 g/dL (3.5 – 5 g/dL)

I've calculated my free T as @madman advised with an SHBG of 25, as it has always been between 23 and 26 since almost 2 years of TRT.

So far I'm doing way better with an AI and exemestane in particular (I don't tolerate anastrozole well), but still have some issues. Anxiety and sleep has improved a lot and I haven't slept so well in a long time. But I do still feel on the edge sometimes.
Gynecomastia has improved, but not gone yet.

Now bad notes. Tiredness has improved considerably as well, but I still feel tired the morning when I inject and the afternoon before the injection day. So basically the pattern looks like this:

- feeling pretty well starting from lunchtime on the day of the injection, until lunchtime of the day after

- feeling tired in the afternoon of the day without injecting and until lunchtime of the day of injecting

My theory is that I feel better when I have a higher T, so my T/E2 ratio is higher and I start feeling worse when my T start dropping. That would explain probably why mornings when I inject are the worst for few hours, until T kicks in probably, and then I start feeling better until the levels start to drop the afternoon of the next day.
E2 should be constant due to the daily exemestane.

Solution to that would be lowering E2 further down with a higher dose of exemestane, as I want to come out of cabergoline and I know from previous blood tests that when my E2 is below 30 pg/mL, my prolactin will go below 10 ng/mL.
That should give me a better T/E2 ratio and hopefully resolves symptoms.

Another solution would be increase the T dose, but that would lead me to increase my AI dose anyway, due to my crazy aromatization.

What do you guys think? Does that make sense?
 
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