First post. Can’t get E2 under control, starting to worry

RotnGun said:

I definitely agree with this. Most guys really want to take 150mg to 200mg a week for bodybuilding purposes. I can definitely say that muscle growth effects of a test dosage of 150 to 200mg a week will wear out after 3 months of bodybuilding. It is really wrong to take TRT for bodybuilding purposes because of the eventual lack of bodybuilding returns. To really avoid side effects, it would be best for someone to do a test dosage of 100mg per week or less. And if they wanted to get an extra boost of muscle growth in the gym, then all they have to do is go on a steroid cycle for 3 months at maybe 2 times per year. If I can keep a total test level at 556 ng/dL and estradiol at 23 pg/mL on just 10mg of test a day and not have any problems, then I can't see why anybody else can't achieve the same results

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Or how about this one. Most men just want to feel good on trt. And for majority of them 100mg or less doesn’t cut it.

And anyone using testosterone alone for bodybuilding is not using doses that low. 200mg a week will work ok using other anabolics. Or for maintaining what they have, from getting big with other compounds. This post is way off base.

Cataceous said:

Many words, but no scientific evidence that supra-physiological estradiol is safe in the long run. What is clear in the literature is that high and low levels of hormones have negative associations over time. You can argue against causality, but that's just speculation. Healthy young men have physiological testosterone and estradiol, around 600-700 ng/dL and 30 pg/mL respectively. It's a straw-man argument to say that anyone is advocating AI use at these levels. You also skipped the part where I said that AI use is likely also problematic. For most men on TRT there's a simple solution to high estradiol: lose the more-is-better mentality and cut the dose.

There are a few men who seem to aromatize at an unusually high rate. We could debate whether AI use is appropriate for them in the presence of symptoms and normal or low-normal testosterone. However, you can't reasonably argue that estradiol has only local action. The HPTA itself is regulated by systemic estradiol, and this estradiol does influence various other tissues and organs, including the brain.

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Can’t lower my dose I’ve already tried that. My testosterone came back at 650 and estradiol at 74. Any lower and I’d go back to my pre TRT levels of just under 300.

Charliebizz said:

... Most men just want to feel good on trt. And for majority of them 100mg or less doesn’t cut it.
...

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I disagree. I assume you're relying on a few anecdotal claims, which mostly involve men who started TRT with at least 100 mg TC/week, already above what their physiology can accommodate. But because "more is better", symptoms are attacked with higher and higher doses — foolishness that's encouraged by the self-proclaimed experts on the Internet. It is plausible that certain symptoms can improve with higher doses. For example, even though high estradiol is best addressed with a lower TRT dose, pushing far enough into supra-physiological territory may reduce relative estrogenicity due to the saturation of aromatase. But in the meantime, other symptoms can worsen, including elevated HCT, etc.

According to your assertion, Xyosted "doesn't cut it" for the majority of men. Recall that this product comes in three doses, 50, 75 and 100 mg TE/week. Yet somehow the drug made it through clinical trials and is now a successful product.

Stalerigatoni said:

Can’t lower my dose I’ve already tried that. My testosterone came back at 650 and estradiol at 74. Any lower and I’d go back to my pre TRT levels of just under 300.

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What is the lowest dose you've tried? If you're on 120 mg TC per week then you're taking in almost double the testosterone the average healthy young man makes naturally. With twice-weekly injections, your lab work at the troughs is misleading. Peak and average testosterone are both considerably higher. If you switch to EOD injections then you'll get a better sense of your overall response.

What testing method was used for your estradiol measurements? If results are immunoassay-based then you should try to rule out cross-reactivity with other substances, such as C-reactive protein, before fully accepting them. Do you take biotin?

Cataceous said:

I disagree. I assume you're relying on a few anecdotal claims, which mostly involve men who started TRT with at least 100 mg TC/week, already above what their physiology can accommodate. But because "more is better", symptoms are attacked with higher and higher doses — foolishness that's encouraged by the self-proclaimed experts on the Internet.

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Actually this foolishness is encouraged by hundreds or perhaps thousands of doctors whose practices include TRT management. With few exceptions, it seems the more a doctor specializes in TRT and grows in clinical experience, the more they are inclined to deviate from physiological ranges in the direction of more. The examples are too numerous to count, but just a couple off the top of my head: the entire Defy Medical group, madman's urologist, who targets a trough free T of 16-31 ng/dL, and highpull from T-Nation, whose average patient reporting satisfaction with results has a total T of 1029 ng/dL, a trough free T of 29 ng/dL, and an E2 of 57 pg/mL. I wonder what you make of that and how you are able to integrate that information with your views on the efficacy and tolerability of higher vs lower dosing.

Cataceous said:

According to your assertion, Xyosted "doesn't cut it" for the majority of men. Recall that this product comes in three doses, 50, 75 and 100 mg TE/week. Yet somehow the drug made it through clinical trials and is now a successful product.

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I think boosting a man from hypogonadal to normal physiological range can certainly be beneficial in many cases, enough to support successful clinical trials. Is it maximally beneficial though, for a maximum number of patients? They aren't interested in exploring that question. It is more important to limit side effects and liability from a manufacturer perspective. You can see that in their dosing guidelines, which completely ignore symptoms and focus exclusively on the numbers:

Charliebizz said:

Or how about this one. Most men just want to feel good on trt. And for majority of them 100mg or less doesn’t cut it.

And anyone using testosterone alone for bodybuilding is not using doses that low. 200mg a week will work ok using other anabolics. Or for maintaining what they have, from getting big with other compounds. This post is way off base.

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I think we need to clarify what most of our top bodybuilders are really doing and this come directly from one of them. So what is really a bodybuilding dose....This is a direct quote for an IFBB Pro bodybuilder:


So when we talk about using 150mg - 200mg for bodybuilding purposes, no bodybuilder is using doses that low, even off season. You will certainly grow a little better with 200mg than 100mg but that is just not going to cut it. Yes, way off base is right.

I think I remember Dr. Lipshitz puts quite few of his guy on 200mg/wk because they can handle it with no side effects and claims they actually do feel better. I know at my age I can no longer handle anything close to that dose but that is me. I am not going to criticize any man that says they feel better at 150-200mg/wk and is absent of any side effects doing it. That is between them and their doctor. Your body, your choice.

I think the biggest thing men have to remember when they make the decision to start this is we are on TRT, not trying to be a bodybuilder. I do see guys all the time talking about their TRT doses and have to laugh a little. TRT doesn't include blasting and cruising and shouldn't need testosterone and 3-4 other anabolics. If you really want to be a bodybuilder, just quit telling yourself it is TRT.

FunkOdyssey said:

Actually this foolishness is encouraged by hundreds or perhaps thousands of doctors whose practices include TRT management. With few exceptions, it seems the more a doctor specializes in TRT and grows in clinical experience, the more they are inclined to deviate from physiological ranges in the direction of more. The examples are too numerous to count, but just a couple off the top of my head: the entire Defy Medical group, madman's urologist, who targets a trough free T of 16-31 ng/dL, and highpull from T-Nation, whose average patient reporting satisfaction with results has a total T of 1029 ng/dL, a trough free T of 29 ng/dL, and an E2 of 57 pg/mL. I wonder what you make of that and how you are able to integrate that information with your views on the efficacy and tolerability of higher vs lower dosing.
...

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When it comes to testosterone, the more-is-better mentality is ubiquitous. The doctors you refer to are responding to business pressures. Of necessity, health optimization and longevity are secondary concerns. You've doubtless seen the report correlating higher all-cause mortality with higher testosterone levels. If this holds up then maybe there will be renewed interest in finding the underlying reasons why some men still have problems when testosterone is in the physiological range. I think that part of the issue is that most TRT protocols do a subpar job of mimicking natural serum testosterone levels. And then there are the possible secondary issues caused by HPTA suppression. Nonetheless, I've seen no compelling evidence that testosterone is fundamentally different from other hormones with respect to having negative correlations outside of the physiological ranges.

My main objection concerns guys not being instructed to give physiological levels a chance. We see it on here constantly. They are started on 100+ mg TC/week and develop all kinds of problems. I believe this cohort is overrepresented — because those on more sensible protocols are less likely to have problems and seek external help. My collection of anecdotes shows that actual harm is being done when doctors do not use a low-and-slow approach with TRT.

FunkOdyssey said:

...
I think boosting a man from hypogonadal to normal physiological range can certainly be beneficial in many cases, enough to support successful clinical trials. Is it maximally beneficial though, for a maximum number of patients? They aren't interested in exploring that question. It is more important to limit side effects and liability from a manufacturer perspective. You can see that in their dosing guidelines, which completely ignore symptoms and focus exclusively on the numbers:
...

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It's premature to talk about exploring the supra-physiological before seeing if physiological variations are significant. For instance, what about a blinded crossover trial to see if there are discernible differences between serum testosterone of 500, 650 and 800 ng/dL? In actuality it would be based on free testosterone, but you get the idea.

BigTex said:

I think we need to clarify what most of our top bodybuilders are really doing and this come directly from one of them. So what is really a bodybuilding dose....This is a direct quote for an IFBB Pro bodybuilder:

"Off season - at least 1g of testosterone per week.​

​

In season - Several grams of test per week, several grams of anabolics per week, up to 2g/week of trenbolone, a shit load of orals, insulin several times a day year round, GH as much as can be afforded - 15 to 30IU/day, etc. And ancillary use is huge - liver aids to the max, anti-e's, dht blockers, cardio supps, cholesterol supps, etc.​

​

Still, most of them are complete wrecks. They can't control bodily functions,​

they pass out from walking a flight of stairs, they get drenched in sweat from tying their shoelaces. Gyno, baldness, dry skin, gout, excess bodily hair, acne, etc are ALL existent in virtually all of them."​

So when we talk about using 150mg - 200mg for bodybuilding purposes, no bodybuilder is using doses that low, even off season. You will certainly grow a little better with 200mg than 100mg but that is just not going to cut it. Yes, way off base is right.

I think I remember Dr. Lipshitz puts quite few of his guy on 200mg/wk because they can handle it with no side effects and claims they actually do feel better. I know at my age I can no longer handle anything close to that dose but that is me. I am not going to criticize any man that says they feel better at 150-200mg/wk and is absent of any side effects doing it. That is between them and their doctor. Your body, your choice.

I think the biggest thing men have to remember when they make the decision to start this is we are on TRT, not trying to be a bodybuilder. I do see guys all the time talking about their TRT doses and have to laugh a little. TRT doesn't include blasting and cruising and shouldn't need testosterone and 3-4 other anabolics. If you really want to be a bodybuilder, just quit telling yourself it is TRT.

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Cataceous and all his infinite wisdom and complete lack of clinical experience just will never understand, or know what he doesn't know. He can't open his mind enough to understand where the normal values come from. Like with estradiol for instance, he gave us a quote of a normal range or young men, but he doesn't even understand where that number came from or what it represents or what it does not represent. He's completely oblivious, but yet he gives advice. I will tell you I can show you different lab normals in different areas of the country as well as in different decades and the normal estradiol level for some of those labs was 20-90 not the 8-35 for labcorp. The normal range for LabCorp was not for me on testosterone and actually, they have no idea where those numbers came from because they have no data. It was collected several decades ago and most likely represented male volunteers that worked at endocrine sciences at that time which was the precursor to LabCorp. So we know nothing about the man at all. We know nothing about their health status order testosterone levels or anything else. I talked to the medical Director for an hour and she did the research over a period of two weeks to try to find out where the normal range came from. Ultimately, she had to call the medical Director, who worked there a couple of decades ago and told her that there were no studies, and that they had no records of how they developed that normal level but that it most likely represented male volunteers. But yet men, like Cataceous, want to take that as gospel, and nothing could be further from the truth. The normal range of 20 to 90 that I quote was in the New England Journal of Medicine in a study that was being done on a man and that was the normal range in that lab. Of course that was a 1997 when testosterone levels were higher than they are now in men. He also cannot understand that, aiming for a physiologic number that we would produce ourselves, when we give testosterone, does not result in good clinical outcomes in most men or in clinical studies. There's plenty of clinical studies out there, giving me a testosterone and keeping the numbers in the mid physiologic range where the men didn't get any improvement at all. He also is unaware that there is no harm of having a super physiologic number within reason. What is that within reason well that within reason is, there's no harm with a level of 1 to 2000 at all. When we look at clinical outcomes in men that get testosterone dosed to resolve symptoms. We see that when those symptoms resolve their numbers are typically outside of the normal physiologic range. So-called supraphysiologic. No harm in that at all. He also doesn't understand that testosterone works directly through its active metabolites, such as estradiol. When we take testosterone, we will raise estradiol because that's how testosterone provides us with benefits. It provides benefits through its active metabolites. No study, and I mean no study in 85 years of utilizing testosterone showed men got benefit when we blocked or controlled estradiol but instead, every study that did show an improvement in men, while taking testosterone, they did not block or control estradiol, but in every one of those studies, when they raise testosterone levels, they also raise levels of its active metabolites, because that's how testosterone works. He can't wrap his head outside of the normal range. He is constrained by a fear that is not founded by the medical literature. He is constrained by his belief perseverance. He is constrained by his actual lack of medical knowledge. He also refuses to understand that the recommendations that we aim for the mid normal range when giving me a testosterone is not based on any actual medical data that shows that's what works best. There is also no medical data to support staying within the so-called normal physiologic range when giving men testosterone. These are all just recommendations and opinions, but not recommendations or opinions that are based on actual medical data. Larry lip, Schultz author this study, and they're based on patients that they treated, and they treated patients outside of the normal physiologic range to supraphysiologic levels.

Lipshultz, what a smart man huh? Hey how long ago was it that 1000ng/dl was towards the top end of "normal?" Now it is superphysiological, amazing concept. This is the problem with establishing norms over the years. We continue to lower the bar because T levels have diminished rather quickly over time, but instead of finding out why and correcting the problem, medical science just lowers the bar. This makes the same kind of sense as lowering the crime rate by not arresting criminals. As I see it E2 and HCT levels are all established the same way. Its little wonder doctors are treating numbers and never dealing with the symptoms.

Norms just aren't what they use to be.



I know of a whole lot of bodybuilders with E2 up in the 80's - 100's and no symptoms of high E2.

BigTex said:

Hey how long ago was it that 1000ng/dl was towards the top end of "normal?" Now it is superphysiological, amazing concept. This is the problem with establishing norms over the years. We continue to lower the bar because T levels have diminished rather quickly over time, but instead of finding out why and correcting the problem, instead in medical science we just lower the bar. This makes the same kind of sense as lowering the crime rate by not arresting criminals. As I see it E2 and HCT levels are all established the same way.

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Dr. Andrew Winge just released a great video on this topic:

Its amazing so many doctors keep saying the same thing, yet we keep treating numbers.


Doctor, I feel like shit all the time and have all the symptoms of low T. But patient, your T numbers are 252ng/dL which is still at the low end of the norm range so you should feel good.

BigTex said:

Its amazing so many doctors keep saying the same thing, yet we keep treating numbers.


Doctor, I feel like shit all the time and have all the symptoms of low T. But patient, your T numbers are 252ng/dL which is still at the low end of the norm range so you should feel good.

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That's one extreme. At the other end is the doctor who puts him on 150 mg TC/week and says now you should feel great. But then you may end up like "crashnet":

Cataceous said:

That's one extreme. At the other end is the doctor who puts him on 150 mg TC/week and says now you should feel great. But then you may end up like "crashnet":

I can't really blame her. Most of what you read is of the mindset more is better. But here’s the approach I wish she would have taken, “Your test results reveal an 81 TT, let’s see what happens if we bring you up to 400.” Would have saved me those 8 years of countless blood donations, countless nights of frustration for the wife, countless bouts of insomnia, and countless episodes of “dude, why is your face so red”.​

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But then you know I always say start on the low end and titrate upwards until the patient does say, I feel good now doc. More is better only if the individual can safely tolerate more and need it to feel better. Here is another direct quote from a professional bodybuilder:

Individual genetics are very important. We all don't have the genetics to handle 1g of testosterone a week and we all won't feel good doing <75mg/wk or having T levels of 400-500ng/d. So back to the guy doing TRT, since genetics are pretty important to how we react to medication, its very hard to use the averages that fall under a bell curve to treat everyone that walks into a doctor's office. But when you start on the low end and gradually titrate upwards to where the patient feels good and the side effects are absent you are much more successful. Numbers at this point are worthless. There is certainly nothing wrong with a doctor such as Dr, Larry Lipshults prescribing 200mg/wk to a guy who not only safely tolerates that amount but actually feel much be

BigTex said:

... There is certainly nothing wrong with a doctor such as Dr, Larry Lipshults prescribing 200mg/wk to a guy who not only safely tolerates that amount but actually feel much be

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To me it seems a little questionable. "Safely" tolerating the treatment in the short term does not imply long-term safety. Recall @tareload's graphs suggesting that risk can accumulate over years to decades. There should also be more medical curiosity about why the guy appears to need triple the typical heathy production rate. In any case, I'm not suggesting that treatment be denied if all else has failed, but the patient must be well-informed.

Cataceous said:

I disagree. I assume you're relying on a few anecdotal claims, which mostly involve men who started TRT with at least 100 mg TC/week, already above what their physiology can accommodate. But because "more is better", symptoms are attacked with higher and higher doses — foolishness that's encouraged by the self-proclaimed experts on the Internet. It is plausible that certain symptoms can improve with higher doses. For example, even though high estradiol is best addressed with a lower TRT dose, pushing far enough into supra-physiological territory may reduce relative estrogenicity due to the saturation of aromatase. But in the meantime, other symptoms can worsen, including elevated HCT, etc.

According to your assertion, Xyosted "doesn't cut it" for the majority of men. Recall that this product comes in three doses, 50, 75 and 100 mg TE/week. Yet somehow the drug made it through clinical trials and is now a successful product.

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I respect you a ton. And I believe you are a super intelligent person. However it’s more than a few people on the internet. I’ve seen at least 10 legit Md’s (not trt clinic docs) speak on where, the patients they have on trt feel the best. Most of them have them minimum 120 a week. And then between all the forums and groups I’m in a few thousand men have been polled and feel better on doses over 100mg. Take it for what it’s worth. And assuming everyone that feels better on more t then “you” deemed necessary, is in it for body building and muscle growth is crazy. I have no difference in muscle mass keeping my t levels mid range or top of range. But what I do have at top of the range is great libido and erections. And I don’t feel like the walking dead 24/7. All my other lab parameters are perfect. And my vitals are excellent. And that said some men that do great on lower doses see much better levels then me. Sh1973 had higher levels then me on his true through. Before is once weekly injection the. I did 24 hours after and injection. And he was on 60mg a week and I was on 100.


My question to you is what’s the point of trt if you do not feel any better?

Cataceous said:

According to your assertion, Xyosted "doesn't cut it" for the majority of men. Recall that this product comes in three doses, 50, 75 and 100 mg TE/week. Yet somehow the drug made it through clinical trials and is now a successful product.

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Who is actually using xyosted with success? Are they mainly older men where feeling any bit better will be considered a win ? Do we know if they were to bump the dose up would they get even better symptom relief. Just because it made it through clinical trials doesn’t mean it’s the best way to do things. Look no further then androgel

FunkOdyssey said:

Actually this foolishness is encouraged by hundreds or perhaps thousands of doctors whose practices include TRT management. With few exceptions, it seems the more a doctor specializes in TRT and grows in clinical experience, the more they are inclined to deviate from physiological ranges in the direction of more. The examples are too numerous to count, but just a couple off the top of my head: the entire Defy Medical group, madman's urologist, who targets a trough free T of 16-31 ng/dL, and highpull from T-Nation, whose average patient reporting satisfaction with results has a total T of 1029 ng/dL, a trough free T of 29 ng/dL, and an E2 of 57 pg/mL. I wonder what you make of that and how you are able to integrate that information with your views on the efficacy and tolerability of higher vs lower dosing.


I think boosting a man from hypogonadal to normal physiological range can certainly be beneficial in many cases, enough to support successful clinical trials. Is it maximally beneficial though, for a maximum number of patients? They aren't interested in exploring that question. It is more important to limit side effects and liability from a manufacturer perspective. You can see that in their dosing guidelines, which completely ignore symptoms and focus exclusively on the numbers:

View attachment 41915

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You hit the nail on the head. Highpull had an excellent spreadsheet on his patients and what dose the took and what numbers they achieved. That man does not advertise his practice on the web and isn’t trying to grab clients. He just shares his knowledge. And isn’t making money off the drug sales like some of these clinics that also charge membership fees. What incentive’s do you think these legit drs have other then having the patients feel good @Cataceous ?

Cataceous said:

When it comes to testosterone, the more-is-better mentality is ubiquitous. The doctors you refer to are responding to business pressures. Of necessity, health optimization and longevity are secondary concerns. You've doubtless seen the report correlating higher all-cause mortality with higher testosterone levels. If this holds up then maybe there will be renewed interest in finding the underlying reasons why some men still have problems when testosterone is in the physiological range. I think that part of the issue is that most TRT protocols do a subpar job of mimicking natural serum testosterone levels. And then there are the possible secondary issues caused by HPTA suppression. Nonetheless, I've seen no compelling evidence that testosterone is fundamentally different from other hormones with respect to having negative correlations outside of the physiological ranges.

My main objection concerns guys not being instructed to give physiological levels a chance. We see it on here constantly. They are started on 100+ mg TC/week and develop all kinds of problems. I believe this cohort is overrepresented — because those on more sensible protocols are less likely to have problems and seek external help. My collection of anecdotes shows that actual harm is being done when doctors do not use a low-and-slow approach with TRT.


It's premature to talk about exploring the supra-physiological before seeing if physiological variations are significant. For instance, what about a blinded crossover trial to see if there are discernible differences between serum testosterone of 500, 650 and 800 ng/dL? In actuality it would be based on free testosterone, but you get the idea.

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I love this forum. And I’m not taking a shot at anyone here. But on this forum in particular I see the most men trying to keep the dose low and levels mid range. And you know what I see the most complaints in this forum if never seeing symptom resolution. I see way too much talk of estrogen being the culprit when it very well could be guys just not getting the levels of t high enough to feel good. Also another observation that I’ve made. Is tons of men actually do feel better on the cream vs injectables for whatever reason. I am one of them and trust me I would much rather inject.

I’ve had low t since I’m 26 years old.(42 in a few months) I did whatever I could not to be on trt. I’ve been in the trt space for almost 17 years. I tried everything I could to avoid trt. I dabbled in it a few times. T cyp at any dose made me feel awful. I tried 60mg a week up to 120. Just felt horrible. Then in 2020 I decided to commit. And try something new. I started with defy. They want me to start at 120mg a week split m-w-f. I was afraid. I asked for enanthate. And it was a completely different experience. I started at 90mg a week but was getting some symptom relief. I tried pushing the boundaries because I was still having some erection issues and energy issues. I went up to 160 and all the way back down to 60 a week. I just couldn’t get it right. But then I found cream. While it’s not perfect it’s the best I ever felt trt wise hands down. I can’t explain why. But my point is trt isn’t always as cut and dry as people think. And for a good amount of people keeping average levels while having your hpta shut down from medication just doesn’t cut it.

I’m sorry if my posts come off all messed up. My phone does not work correctly in this forum for some reason.

Cataceous said:

To me it seems a little questionable. "Safely" tolerating the treatment in the short term does not imply long-term safety.

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My endo recently said to me, "Be careful gauging success just about how you feel. History is full of stories of failures based on people who judge success based on feeling."

Charliebizz said:

I love this forum. And I’m not taking a shot at anyone here. But on this forum in particular I see the most men trying to keep the dose low and levels mid range. And you know what I see the most complaints in this forum if never seeing symptom resolution. I see way too much talk of estrogen being the culprit when it very well could be guys just not getting the levels of t high enough to feel good.

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I love reading this forum, but I have to agree with this. On paper, yes, the average male is producing somewhere in the 4-10mg per day or 4-7mg per day range. So what happens when you replace that and you don't have symptom resolution, but they are symptom free at double the dose? Certain members would say this is not TRT anymore. But at a certain point TRT dose become more about symptom resolution and not just numbers.

On a lot of forums more geared towards bodybuilding or a more liberal approach to TRT dosing, you see a lot less issues with guys on their TRT doses and rarely do you see guys taking under 100mg a week. Issues are easily resolved. Rarely do guys take more than 2 shots a week and usually its 1 shot per week when they're between cycles.

But its about perspective too - Its also possible this forum attracts a slightly older demographic or guys interested in a more conservative approach, and men coming from a state of poorer health, rather than generally healthy guys who got into AAS for performance enhancement. This site can definitely be a huge help for a lot of people and is very informationally dense compared to other forums, and there are some great minds and thinkers here. ExcelMale is definitely a positive place to read and gain information, even if it can be overthinking/overanalyzing sometimes which can lead to the perception of symptoms in intself, something you don't see as much of on the BB forums.

How many guys here, or on any forum, do you see get their issues figured out if they're struggling on TRT? Unless its something very obvious, like crushing E2 into single digits, or taking a single shot every 3-4 weeks, I don't think its super common for guys to fix themselves based on forum advice in general.

Edit: Certainly hope it doesn't sound like I'm being critical of Excel. I'm here reading every day for a reason.