Help dialing in my protocol (recent bloods 04/16/2021)

[VitalityD]

Hello all, I apologize if this the right place for this post. I’ve been lurking around the site for a few weeks now looking for answers and decided to ask for some guidance from some of the more experienced users here. Long story short, been on TRT since Nov. 2020 through my urologist. Started on 100MG a week split into 2 I.M. shots every 3.5 days. After few months on that protocol ran bloods and the results were as follows:

04/16/2021
Test Total: 1041
Test Free: 281.7
Estradiol: 54

CBC was normal hematocrit in range.

Felt like I was getting some estro sides so changed to 100Mg a week split EOD I.M. Instead to try and lower T to E aromatization. Ran that for a while and continued feeling bad. Brain fog, bad memory, headaches, bad sleep, libido issues, very tired irritable and a kind of wired but tired feeling where I’m tired but have too much energy to sleep. Began taking Pregnenolone micronized 50MG and DHEA micronized 10MG. Had added that for about 2 weeks before bloods. These are the latest results:

Test Total: 1006
Test Free: 207.3
Estradiol: 46
Dhea-S: 499 ( above range)
SHBG: 20

Dropping DHEA after this as it looks like I’m overdoing it but continuing Preg unless someone advises against that. Also waiting on HCG to arrive to see if that would help as I’ve read that can be helpful to some. Where do I go from here? Is my estradiol still too high? Should I drop my dosage? Currently EOD Sub Q would ED be better for me?
Im also thinking of running a full panel for thyroid and a 4 point saliva test for cortisol as I read these can be issues as well. If anybody can shed some light on my situation I would greatly appreciate it. Feel like I’m going at this alone right now since my urologist is no help at all past prescribing the actual medication. Thanks for your time everyone.

 

[Gman86]

There’s a really good thread going on about progesterone, maybe check it out and also have ur progesterone levels checked as well. Not saying it will be the answer, but might be something to look into, especially in the sleep department. Seems like the guys using progesterone get quite a nice benefit when it comes to restful sleep. One or two also mention some mental benefits I believe

Progesterone Dose for Men

https://hardingmedicalinstitute.com/progesterone-for-men-the-feel-good-hormone/ https://www.tamparejuvenation.com/healthtips/why-we-need-progesterone/ Was just doing some research on progesterone. Has anyone had it tested and corrected a deficiency? Anyone noticed an improvement in symptoms...

www.excelmale.com

 

[Cataceous]

There's a very high chance that the TRT dose is excessive for you. The average healthy young man has total testosterone around 600-700 ng/dL. He also has higher SHBG, around 30 nMol/L. Your numbers pretty much guarantee that your free testosterone is excessive, well above any standard range. Unless physical strength is the only thing of importance to you I'd suggest cutting the dose to 60-70 mg per week. This could be 18-20 mg EOD. Typically there's no need to inject more often than this with a long ester such as cypionate. Subcutaneous injections work fine for most. You might try this method, and if you like it then you can save yourself from a lot of muscle punctures. It's common to temporarily feel worse with a dose reduction. You need to give it some months before evaluating. HCG is a useful addition to TRT for many. It's worth trying. Be aware that it can increase estradiol, causing other problems. Go low and slow on the dosing.

References for lowering the TRT dose:

Anyone combine injections and cream? How do you feel?

I’m a long term TRT patient, 39 years old. I’ve been on cypionate and inject a total of 154mg weekly in EOD subQ shots of 44mg each. I have been doing some thinking about the potential benefit of keeping dosing the same but experimenting with using a low cypionate base around 80-100mg weekly...

www.excelmale.com

Anyone combine injections and cream? How do you feel?

I’m a long term TRT patient, 39 years old. I’ve been on cypionate and inject a total of 154mg weekly in EOD subQ shots of 44mg each. I have been doing some thinking about the potential benefit of keeping dosing the same but experimenting with using a low cypionate base around 80-100mg weekly...

www.excelmale.com

Anyone combine injections and cream? How do you feel?

Interesting anecdote. I’m curious what what your SHBG and current protocol are? @JoeMatts im curious for this as well

www.excelmale.com

Hello, 60yo starting TRT.

Hi All. I'm 60yo, lucky with relatively few health problems so far. Total T 350-400. After about a year of research/consideration, about to start TRT, plan is just Test C, 150mg per week separated into two subq injections/week into delts/VGs, draw/inject using 29G 1ml. Get labs in ~8 weeks...

www.excelmale.com

Have you ever DECREASED your dose?

Hey guys. I've only been on TRT for about 9 months. I'm on Test Cyp 100 mg Q3.5d with 350iU of HCG IM. I recently (this week) lowered my Anastrozole from 0.5 mg on injection days to 0.25mg to see how it will effect me (side effects, changes in libido, and also then lab values). ****I'm happy...

www.excelmale.com

Hello, 60yo starting TRT.

Hi All. I'm 60yo, lucky with relatively few health problems so far. Total T 350-400. After about a year of research/consideration, about to start TRT, plan is just Test C, 150mg per week separated into two subq injections/week into delts/VGs, draw/inject using 29G 1ml. Get labs in ~8 weeks...

www.excelmale.com

TRT patient feeling better after lowering my prescribed dose

Hey Guys, Hope all's well and Happy 4th! I'm looking for feedback. As a young male battling ED and low T, hopefully sharing my experience on what worked helps someone too. Almost 32 now and I use to have severe ED as long as I can remember, maybe late teens. No clue on cause. Maybe it's...

www.excelmale.com

 

[Systemlord]

I think you need to lower your dosage. Also HCG will jack up your estrogen.

 

[VitalityD]

There’s a really good thread going on about progesterone, maybe check it out and also have ur progesterone levels checked as well. Not saying it will be the answer, but might be something to look into, especially in the sleep department. Seems like the guys using progesterone get quite a nice benefit when it comes to restful sleep. One or two also mention some mental benefits I believe

Progesterone Dose for Men

https://hardingmedicalinstitute.com/progesterone-for-men-the-feel-good-hormone/ https://www.tamparejuvenation.com/healthtips/why-we-need-progesterone/ Was just doing some research on progesterone. Has anyone had it tested and corrected a deficiency? Anyone noticed an improvement in symptoms...

www.excelmale.com

Thanks Gman.... had a look at that just now. Will continue later today. There’s a lot of talk about Progesterone.... any value in Pregnenolone since it’s the upstream hormone...? Why is Prog preferred?

 

[VitalityD]

@Cataceous @Systemlord thanks for the input regarding the dosages will lower them starting tomorrow on my next pin and see if symptoms resolve...what would be the smart way of incorporating HCG as like system lord said it will raise my e2. Should i get my e2 and test about midrange before introducing HCG to allow some buffer for the HCG to still leave me in range?

 

[Wolverine]

Thanks Gman.... had a look at that just now. Will continue later today. There’s a lot of talk about Progesterone.... any value in Pregnenolone since it’s the upstream hormone...? Why is Prog preferred?

Dr. Crisler (RIP) preferred to increase progesterone via pregnenolone as you state. As stated, you should have your progesterone levels tested. With that amount of pregnenolone I would think that you have adequate levels of progesterone but get tested to find out.

 

[Cataceous]

@Cataceous @Systemlord thanks for the input regarding the dosages will lower them starting tomorrow on my next pin and see if symptoms resolve...what would be the smart way of incorporating HCG as like system lord said it will raise my e2. Should i get my e2 and test about midrange before introducing HCG to allow some buffer for the HCG to still leave me in range?

The main issue you'll have is in matching causes and effects if you change two things at the same time, e.g. lower the dose and add hCG. If that's not a big deterrent then I would start with 250 IU of hCG a couple times a week—low and slow is the idea. If you get good results with a low dose then no need to go higher. Up to 800-1,000 IU per week in divided doses is common. There's the occasional guy who uses 1,500 IU per week, though that's getting to be a lot to use with TRT. Hormone levels may stabilize in a month or so, but it can take considerably longer for your body to adapt to the new levels. It's after this adaptation that you can fairly evaluate a protocol.

Your previous lab results show an aromatization rate (E2/T) of about 0.5%. This is pretty normal. What you'll look for when using hCG is if this rate seems to increase. That is, if your estradiol ends up higher than 0.5% of testosterone then hCG may be to blame for the excess. If you don't have any troublesome symptoms then a little elevation in estradiol is probably harmless.

 

[VitalityD]

The main issue you'll have is in matching causes and effects if you change two things at the same time, e.g. lower the dose and add hCG. If that's not a big deterrent then I would start with 250 IU of hCG a couple times a week—low and slow is the idea. If you get good results with a low dose then no need to go higher. Up to 800-1,000 IU per week in divided doses is common. There's the occasional guy who uses 1,500 IU per week, though that's getting to be a lot to use with TRT. Hormone levels may stabilize in a month or so, but it can take considerably longer for your body to adapt to the new levels. It's after this adaptation that you can fairly evaluate a protocol.

Your previous lab results show an aromatization rate (E2/T) of about 0.5%. This is pretty normal. What you'll look for when using hCG is if this rate seems to increase. That is, if your estradiol ends up higher than 0.5% of testosterone then hCG may be to blame for the excess. If you don't have any troublesome symptoms then a little elevation in estradiol is probably harmless.

Understood, with that in mind I’m leaning towards getting to a stable level with the lower dose mentioned earlier, running bloods then beginning HCG. At a dose of 1,000 I.U.s a week of HCG split into several doses, is there an average test production that I can expect from that from your experience or does it also vary from person to person? The reason I ask is i’d like to hover around high normal after the HCG addition as long as sides aren’t present. Wondering where I should be with test alone before adding HCG so it wouldn’t push me to far ....

 

[madman]

Hello all, I apologize if this the right place for this post. I’ve been lurking around the site for a few weeks now looking for answers and decided to ask for some guidance from some of the more experienced users here. Long story short, been on TRT since Nov. 2020 through my urologist. Started on 100MG a week split into 2 I.M. shots every 3.5 days. After few months on that protocol ran bloods and the results were as follows:

04/16/2021
Test Total: 1041
Test Free: 281.7
Estradiol: 54

CBC was normal hematocrit in range.

Felt like I was getting some estro sides so changed to 100Mg a week split EOD I.M. Instead to try and lower T to E aromatization. Ran that for a while and continued feeling bad. Brain fog, bad memory, headaches, bad sleep, libido issues, very tired irritable and a kind of wired but tired feeling where I’m tired but have too much energy to sleep. Began taking Pregnenolone micronized 50MG and DHEA micronized 10MG. Had added that for about 2 weeks before bloods. These are the latest results:

Test Total: 1006
Test Free: 207.3
Estradiol: 46
Dhea-S: 499 ( above range)
SHBG: 20

Dropping DHEA after this as it looks like I’m overdoing it but continuing Preg unless someone advises against that. Also waiting on HCG to arrive to see if that would help as I’ve read that can be helpful to some. Where do I go from here? Is my estradiol still too high? Should I drop my dosage? Currently EOD Sub Q would ED be better for me?
Im also thinking of running a full panel for thyroid and a 4 point saliva test for cortisol as I read these can be issues as well. If anybody can shed some light on my situation I would greatly appreciate it. Feel like I’m going at this alone right now since my urologist is no help at all past prescribing the actual medication. Thanks for your time everyone.

Started on 100MG a week split into 2 I.M. shots every 3.5 days. After few months on that protocol ran bloods and the results were as follows:

04/16/2021
Test Total: 1041
Test Free: 281.7
Estradiol: 54


Need to post reference ranges let alone what testing methods were used especially when it comes to FT.

I have stated numerous times on the forum that even though TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Have no idea what testing method was used for your FT but you can be rest assured that with a trough TT 1041 ng/dL and SHBG 20 nmol/L it is a given your trough FT will be very high.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Critical to know where your trough FT sits on such protocol (dose T/injection frequency).

Where your SHBG sits will have a significant impact on TT/FT achieved let alone can dictate what injection frequency may suit you best.

Keep in mind that these are trough levels on your previous protocol 100 mg/week T (50 mg every 3.5 days) and your peak TT/FT/e2 levels will be higher.

Depending on the individual running too high an FT level can cause issues for many.




Felt like I was getting some estro sides so changed to 100Mg a week split EOD I.M. Instead to try and lower T to E aromatization. Ran that for a while and continued feeling bad. Brain fog, bad memory, headaches, bad sleep, libido issues, very tired irritable and a kind of wired but tired feeling where I’m tired but have too much energy to sleep. Began taking Pregnenolone micronized 50MG and DHEA micronized 10MG. Had added that for about 2 weeks before bloods. These are the latest results:

Test Total: 1006
Test Free: 207.3
Estradiol: 46
Dhea-S: 499 ( above range)
SHBG: 20



You switched over to more frequent injections 100 mg T/week (split EOD) to try and lower your e2 and you.....Ran that for a while and continued feeling bad. Brain fog, bad memory, headaches, bad sleep, libido issues, very tired irritable and a kind of wired but tired feeling where I’m tired but have too much energy to sleep.

Even with splitting your T dose (100 mg/week) into EOD injections, you are still hitting a high-end trough TT 1006 ng/dL and more importantly, your trough FT level would still be high and your estradiol only went from 52-46.

You should be more concerned with where your FT level sits.

High FT will drive up e2 let alone RBCs/hemoglobin/hematocrit.

Keep in mind that although some men may have high hopes that injecting lower doses of T more frequently will result in lowering of e2 and hematocrit it is not a given and in many cases regardless of the daily low dosed protocol, many make the mistake of running too high a TT/FT level let alone if one has low/lowish SHBG than even though TT may not seem that high FT will be high.

You made the mistake of not lowering your overall weekly T dose.

Here comes the icing on the cake.

Many fail to realize that when starting trt that not only will your hpta shutdown (2-6 weeks) depending on dose T but hormones will be in flux during the weeks leading up until blood levels stabilize (4-6 weeks) and it is common for many during this transition to experience what we call the honeymoon period where there may be a strong increase in libido/erections and overall euphoric feeling due to increasing T levels/dopamine.

Unfortunately, this is temporary and short-lived for most as the body will eventually adjust.

It is also very common for many men to experience ups/downs in energy/mood/libido/erections/recovery during the transition as the body is trying to adjust which can be very misleading.

Even then do understand that once blood levels have stabilized (4-6 weeks) it will take another 2-3 months for the body to fully adapt to those new levels and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

When looking at the big picture the first 4-6 weeks is very misleading for most!

2-3 months after blood levels have stabilized if you continue to feel great overall and blood markers remain healthy then one can truly claim that your protocol is effective!

Patience is key.


* Keep in mind that all of this would apply to men already on trt when tweaking a protocol (dose T/injection frequency).

 

[madman]

Overlooked let alone misunderstood by many!



26.What is a reasonable timeline to begin to observe improvements in the signs and symptoms of testosterone deficiency?

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.76,77 As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6-months. 77 In addition, patients should be counseled that diet and exercise in combination with testosterone therapy are recommended for body composition changes.

*Appreciating this pattern of response to testosterone therapy is fundamental when determining the impact of treatment and the appropriate timing of follow-up evaluations while on therapy. For example, if patients undergo a symptom review and measurement of testosterone levels too early (< 3 months), it may lead both physicians and patients to conclude that the treatment has not been impactful (i.e. normal levels of testosterone without symptomatic/structural/metabolic benefit). However, if the same assessment was scheduled 3-6 months after the initiation of therapy, the clinical response tends to be more reflective of normalized levels of serum testosterone.

 

[madman]

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.

 

[Cataceous]

Understood, with that in mind I’m leaning towards getting to a stable level with the lower dose mentioned earlier, running bloods then beginning HCG. At a dose of 1,000 I.U.s a week of HCG split into several doses, is there an average test production that I can expect from that from your experience or does it also vary from person to person? The reason I ask is i’d like to hover around high normal after the HCG addition as long as sides aren’t present. Wondering where I should be with test alone before adding HCG so it wouldn’t push me to far ....

Endogenous testosterone from hCG is quite variable at TRT add-on doses. Even at over 1,000 IU per week I saw little to none. Others have reported up to a few hundred ng/dL. If I had to guess I might say 100-200 ng/dL could be more typical. I wouldn't worry too much about it. You can always make further adjustments if needed.

 

[madman]

Understood, with that in mind I’m leaning towards getting to a stable level with the lower dose mentioned earlier, running bloods then beginning HCG. At a dose of 1,000 I.U.s a week of HCG split into several doses, is there an average test production that I can expect from that from your experience or does it also vary from person to person? The reason I ask is i’d like to hover around high normal after the HCG addition as long as sides aren’t present. Wondering where I should be with test alone before adding HCG so it wouldn’t push me to far ....

Pros and cons of using TRT vs HCG for treatment low-t symptoms

Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility (2020) Julius Fink, Brad J. Schoenfeld, Anthony C. Hackney, Takahiro Maekawa & Shigeo Horie Abstract Introduction: Low testosterone and its symptoms is a condition affecting...

www.excelmale.com

At a dose of 1,000 I.U.s a week of HCG split into several doses, is there an average test production that I can expect from that from your experience or does it also vary from person to person?

No one can say for sure how much such dose will bump up your T.....doubtful it would be anything significant.

Only time/labs will tell.


The reason I ask is i’d like to hover around high normal after the HCG addition as long as sides aren’t present.

Again on your current protocol 100 mg/week T (split EOD) and previous protocol 100 mg T (split every 3.5 days), you are hitting a high-end trough TT (1000s) but more importantly, you would be hitting a very high trough FT as your SHBG is only 20 nmol/L.

You need to sit back and think this through.

You need to bring your FT down and it is pointless to drop your T dose if you still plan on achieving the high-normal T levels after the addition of hCG!

Men with low/lowish SHBG can get away with running a lower TT while at the same time still achieving a healthy FT level.

Everyone so caught up in running high-end trough T levels let alone absurdly high levels.

Where your trough FT truly sits on such protocol (dose T/injection frequency) is what really matters and your SHBG will have a significant impact.

 

[VitalityD]

Pros and cons of using TRT vs HCG for treatment low-t symptoms

Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility (2020) Julius Fink, Brad J. Schoenfeld, Anthony C. Hackney, Takahiro Maekawa & Shigeo Horie Abstract Introduction: Low testosterone and its symptoms is a condition affecting...

www.excelmale.com

At a dose of 1,000 I.U.s a week of HCG split into several doses, is there an average test production that I can expect from that from your experience or does it also vary from person to person?

No one can say for sure how much such dose will bump up your T.....doubtful it would be anything significant.

Only time/labs will tell.


The reason I ask is i’d like to hover around high normal after the HCG addition as long as sides aren’t present.

Again on your current protocol 100 mg/week T (split EOD) and previous protocol 100 mg T (split every 3.5 days), you are hitting a high-end trough TT (1000s) but more importantly, you would be hitting a very high trough FT as your SHBG is only 20 nmol/L.

You need to sit back and think this through.

You need to bring your FT down and it is pointless to drop your T dose if you still plan on achieving the high-normal T levels after the addition of hCG!

Men with low/lowish SHBG can get away with running a lower TT while at the same time still achieving a healthy FT level.

Everyone so caught up in running high-end trough T levels let alone absurdly high levels.

Where your trough FT truly sits on such protocol (dose T/injection frequency) is what really matters and your SHBG will have a significant impact.

Many thanks Madman for that detailed explanation, thank you for taking the time and putting all that together for me. I understand now the importance of having a free T within range due to my low SHBG as well as the length of time it’s gonna take to properly test out the protocol. You were absolutely right by the way my free T was well above the reference range.

207.3 (reference range of 35-155 LCMSMS).

Thanks for reiterating as well, that me being in the high end of normal may not be optimal for me. I understand now. Would there be any benefit in raising my SHBG, can it be done? And also seeing as my SHBG is low is there any benefit in your opinion to pinning every day? Currently on an EOD protocol.

 

[VitalityD]

Endogenous testosterone from hCG is quite variable at TRT add-on doses. Even at over 1,000 IU per week I saw little to none. Others have reported up to a few hundred ng/dL. If I had to guess I might say 100-200 ng/dL could be more typical. I wouldn't worry too much about it. You can always make further adjustments if needed.

Thank you for the input Cataceous and all the guidance. Truly appreciated.

 

[VitalityD]

Dr. Crisler (RIP) preferred to increase progesterone via pregnenolone as you state. As stated, you should have your progesterone levels tested. With that amount of pregnenolone I would think that you have adequate levels of progesterone but get tested to find out.

Thanks Wolverine. Will run the test and my next set of bloods.