Protocol change?

[S1W]

Say a guy had been on 120mg/week (60mg E3.5D) for a while, felt ok not bad not great, and had the following labs at trough:

SHBG 23.5 (16.5 - 55.9)
TT 1025 (264-916)
FT 31 (8.7-25.1)
E2 48 (8 - 35)
HCT 51.2

Objectively, just looking at numbers, what would you recommend? Would strongly prefer to keep E3.5D schedule but would consider EOD if the consensus is that it will make a huge difference.

1. Lower dose and keep injection frequency? How much?
2. Keep dose and add low dose AI?
3. Keep weekly dose and inject more frequently?
4. Lower dose and inject more frequently?

 

[Nashtide]

Say a guy had been on 120mg/week (60mg E3.5D) for a while, felt ok not bad not great, and had the following labs at trough:

SHBG 23.5 (16.5 - 55.9)
TT 1025 (264-916)
FT 31 (8.7-25.1)
E2 48 (8 - 35)
HCT 51.2

Objectively, just looking at numbers, what would you recommend? Let's suppose we'll keep the E3.5D schedule, no HCG.

1. Lower dose? How much?
2. Add low dose AI?
3. Change nothing?
4. Other thoughts?

My first thought is this guy has lowish SHBG and might consider switching to EOD injections. Why is that not an option?

 

[S1W]

My first thought is this guy has lowish SHBG and might consider switching to EOD injections. Why is that not an option?

Good point, Nashtide. Mainly because I really do not like the idea of pinning EOD for the rest of my life and if there are other things to try first, that is what I would prefer to do.

But you're right - silly to limit obvious options right out of the gates so I edited my original post.

 

[Vince Carter]

as you asked by the numbers alone, what I see is a need to reduce your dose to a point that your Free T is not so far over the lab range. Consider 55mg E3.5D, maybe need to go to 50mg E3.5D. The SHBG means you have too much Free T...see its over the lab range. In turn with the Free T being high, you probably have high Free Estrogen, as well. Your LC/MS/MS number may need to be close in number to your SHBG.
If money allows in subsequent testing I recommend you do "Estradiol, Free", along with the LC/MS/MS. If not just get your E2 closer to 20. A Cyp dose reduction would be the preferred option to do that.

 

[S1W]

Great post, VC - appreciate it.

If you (or anyone else) had to take a wild guess, would you go to 50mg, 52mg, or 54mg E3.5D?

Also, my SHBG used to be around 28 on a 100mg/week daily cream protocol - not sure if lowering Cyp dose would allow it to come back up a bit again.

 

[Vince Carter]

I think drop it 5 to 55mg, not take to big of a swing at it, might go too far.

 

[Systemlord]

Mainly because I really do not like the idea of pinning EOD for the rest of my life and if there are other things to try first, that is what I would prefer to do.

This is holding you back from reaping the maximum benefits of TRT, when I moved from a 3.5 day protocol to an EOD protocol, it made a huge difference. My SHBG is between 16-18, everyone's SHBG decreases after several months after starting TRT. It's androgens that lowers SHBG, now you have more.

I recommend 25mg EOD. Doing these small -5mg moves and it will be a long, long time before you dial in your TRT protocol.