Hey folks - new here, long time lurker though!
Started TRT around 9 weeks ago. 42 yrs old. 120 a week of cypionate, 500 x 2 hCG weekly.
So far, feeling good. My starting stats in SI units:
- Total test: 10.4 nmol/L
- Free test: 248 pmol/L
- Estradiol: 59 pmol/L
At a recent blood test around 8 weeks in, they are now:
- Total test: 37.2 nmol/L
- Free test: 1,213 pmol/L
- Estradiol: 230 pmol/L
No obvious high estogen side effects. Mood has been stable, no nipple pain, no obvious water weight or other issues. I
am up about 10lbs overall, but I've also been hitting the gym hard and trying to put on some mass (was 178lbs at 5'8, now around 189). I also look leaner, though I'm under no illusion this is muscle and expect it's water redistribution and fat.
Is that E level anything to be concerned about?
Someone else said to watch for erectile issues at that level. So far, erections have been better than ever and libido has been through the roof (almost annoyingly so). Was never low to begin with but damn.
Anything I should be watching for? Next blood test is in a few weeks.
Thanks!
Standard starting dose is 100 mg T/week or 50 mg twice-weekly.
Most men on TTh are injecting 100-200 mg/week whether once weekly or split into more frequent injections.
The majority of men can easily hit a healthy/high trough FT on 100-150 mg T/week especially when split into more frequent injections (twice-weekly, M/W/F, EOD or daily).
Some can achieve stellar levels injecting <100 mg/week especially when injecting more frequently.
Yes there will always be this outliers who may need the higher-end dose 200 mg/week but its far from common as in rare.
The majority of doctors in Canada even the few specializing in TTh rarely go above 150 mg/week as they clearly understand this.
Those run of the mill T-clinics littered in the US, clueless doctors and so called GURU specialists pushing that more T is better mentality and its all about optimal bulls**t are the half-wits to blame for this!
Always best to start low and go slow on a T-only protocol so you can. see how your. body reacts and where said protocol (dose of T/injection frequency) has your trough TT and more importantly FT, estradiol and critical blood markers RBCs, hemoglobin and hematocrit.
There will always be time to increase the dose of T or throw in hCG if need be.
Downfall of starting therapy on T + hCG is if you run into any sides it will be hard to pinpoint the culprit.
You are one of the luck ones but many will run into issues.
When first starting therapy keep in mind that hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common for one to experience what we call the honeymoon period due to T levels rising, increased dopamine and lighting up ARs (androgen receptors) and it is common for one to experience a euphoric feeling, increased energy and for many a strong increase in libido and erections (morning/spontaneous).
Unfortunately for the majority this is temporary and short-lived as the body is trying to adjust to the elevated T/dopamine boost and eventually the body will adapt to its new-set point and for many the increased libido/erections and euphoric like state will tend to wane over time back to what we call the norm.
Even if you are one of the lucky ones that maintains the honeymoon feeling longer it will eventually wane to more in the norm.
The first 6 weeks means nothing when looking at the bigger picture because once blood levels have stabilized (4-6 weeks) it will still take time for the body to adapt to its new set-point over the next few months and this is the critical time period. when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.
Every protocol needs to be given a fighting chance (12 weeks) before claiming it was as success or failure.
When starting TTh or tweaking a protocol (increasing/decreasing dose T) or manipulating injection frequency you need to wait 6 weeks for blood levels to stabilize before getting blood work done otherwise your results will be skewed.
We always want to test at true trough (lowest point) before your next injection.
Not sure when your blood work was done but if these are your labs from true trough then you can clearly see that you are hitting a high trough TT 1072.9 nmol/L and more importantly very high trough FT with elevated estradiol to boot due to the high FT.
Your peak TT and more importantly FT and estradiol would be higher.
Where does your SHBG sit?
You left out critical blood markers RBCs, hemoglobin and hematocrit most likely because your are only 9 weeks in and levels need to be checked 3 and 6 months in then at the 12 month mark.
As you should very well know increased hematocrit is a given when using exogenous T and can end up high for the majority due to running too high a trough/steady-state FT.
Chances are with your high FT that hematocrit is going to be high but only time will tell and keep in mind that where it sits 3 months in is not where it will end up at the 6 month mark as the biggest increase will be seen in the first 6 months and it can still increase further 12 months in.
Your starting dose 120 mg T/week (60 mg every 3.5 days) is a little higher than the standard starting dose which is no big deal but as you can see with the hCG (500IU) thrown in off the hop to boot your most likely trough TT and more importantly FT let alone estradiol are high.
Even without the hCG your FT would still be high as you are would be well over the top-end of the reference range for calculated FT which is the used/relied on method in Canada as it replaced the known to be inaccurate direct IA years ago.
Anytime you post labs always include the testing method used/references ranges especially for FT.
Two of the biggest labs in Canada (Dynacare and Lifelabs) test the most critical blood marker FT using the calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.
The only way to know where your FT truly sits is testing it using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.
Unfortunately it is very expensive and not commonly used in Canada, hopefully this will change going forward.
Seeing as you are feeling great overall minus any sides 9 weeks in then I would stick with it and not stress over your elevated estradiol.
You still need to give the protocol a full 12-16 weeks to truly see how you feel overall.
Chances are your libido will wane over time but as long as you have a healthy libido and erections are strong you feel well overall, minus any sides and blood markers are healthy then I would not change anything here!
Just make sure to keep an eye on your RBCs, hemoglobin and hematocrit and make sure to. test your iron/ferritin.
The majority of that 10 lbs you gained is intracellular water/lean mass as there will be an increased storage of glycogen in the muscle which will pull water in the cells.
Yes some can be extra-cellular (water retention/bloat) which can make one look puffy/soft and in some cases can be extreme especially when throwing in hCG.
I put on 15 lbs (185--->200) in 4 weeks and my strength shot up when I started TTh (100 mg TC/week) but I was eating 4000 calories/day and a shit load of starchy low GI carbs and training heavy so I felt swole!
