Slowly titrating down after long time at 120mg a week

28 years old, and I've been on TRT since October of 2016. It was a very up and down process in the beginning , and took quite a long time to find the dose that didn't have my estrogen going crazy. I started at 150mg a week and that ended up being way too much so had to work backwards. Ive used A.I and did not like it, and finally settled on 120 mg a week, no aromatase inhibitor, and fell into a comfortable swing. Its been about a year on that protocol, and I've got many benefits so far. Libido still isn't where i want it, but at least it exists, I am able to go hard in the gym and recover, and joints don't hurt like they did when I was lowish T and basically bottomed out on estradiol. I am a lot calmer, more empathetic, relationship improved, and basically back to my old self, except for energy levels. TRT never really helped with energy for me. I will also note there are no thyroid issues, Ive had all the complete tests, not just TSH, and everything is at a good level. I've also completed a sleep study prior to TRT to rule out apnea.

Current stats: 5' 8", 170lbs, 16% BF (currently cutting, down from 185) B/S/DL (305/355/445)

Current protocol:
Test cyp: 60mg e 3.5 days ( mon and thurs)
HCG: 115 IU e 3.5 days(sun and wed) ( I realize the HCG is low compared to what most do, but any higher than that and my e2 goes wild, and I get crazy anxiety, balls are quite full at that dose, am getting sperm test done soon to see how that is)

I also take Adderall 15-20 mg 4 to 5 times a week for energy and focus with work and school ( starting med school in 2019). Only been on it for a few months, and take regular tolerance breaks. No caffeine or anything else stimulatory.

Latest bloodwork:

Total test: 979 (264-916)
Free test: 32.5 (9.3-26.5)
Sensitive e2: 49.9 ( 8-35)

Current problems:
Lack of energy( honestly don't think that is testosterone related though, but I guess could be the e2)
libido still not amazing
Back and face acne, oily skin in general
Morning wood disappeared
Hemoglobin and hematocrit were out of range on last test, gave blood and everything was back in range, retesting soon

*These were all happening before adderall was added to the mix. I consume no dairy, wheat, processed foods, etc. I make sure to hit micro and macronutrient targets.

I apologize for the long entry, but I know many questions are asked and wanted to address the common ones in the beginning. I have started to slowly titrate my dose down in an effort to lower estradiol down, manage hematocrit better, and hopefully get rid of all the acne on my back. I am ok with being slightly out of range, but I think being at 49.9 at trough is too high. I have switched to .29ml from .3ml e3.5 days. I plan to stay at that dose for 4-5 weeks and then retest to see where I am at. I am curious to see what opinions you guys have on my decision, and whether you would go about it differently.

Adderall cause erectile dysfunction and decreases in sexual desire and your E2 level could be contributing to erectile dysfunction and sexual desire. I have ADHD and TRT has done more for focus and concentration than any medication I've ever been on all without side effects.

Adderall cause me erectile dysfunction and decreases in sexual desire and drained the energy out of me, Vyvanse also did the same thing as Adderall. Adderall also causes circulatory problems, it does the opposite of what Viagra or Cialis does, ditch the medications as over time will screw you up.

You have some decisions to make and what's more important to you, strong erections and an amazing libido or focus and concentration?

These drugs always create more problems than they address, always a give and take.

I suggest getting a good thyroid work-up done as well. Many of the symptoms you describe could be contributed to a sluggish thyroid.

Base labs should include:

TSH
FT4
FT3
RT3
Thyroid Antibodies

TSH alone is not a good to evaluate the thyroid in the correct way.

I’ve got no issues with ED and my desire can actually be better on adderall at times. I take l citrulline to combat the vasoconstrictive properties of the medication as well .

I’ve had every one of those tests done, as I stated in the original paragraph. Sorry should have put the actual tests I’d had instead of stating not just TSH.

johnjohnson said:

I've got no issues with ED and my desire can actually be better on adderall at times. I take l citrulline to combat the vasoconstrictive properties of the medication as well .

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It seems like you've made your choice already, you can't take a medication like adderall and have your cake and eat it too. There's is a way to know how effective the citrulline is having, remaining symptoms. The probable reason why all these symptoms existed before adderall was because you suffering from low T.

Systemlord said:

It seems like you've made your choice already, you can't take a medication like adderall and have your cake and eat it too. There's is a way to know how effective the citrulline is having, remaining symptoms. The probable reason why all these symptoms existed before adderall was because you suffering from low T.

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I’ve been on adderall like 2 1/2 months. I’ve been on TRT for a year. I had high T for a long time before starting the adderall, and all the same problems I have now. I have had no negatives from the adderall except from sluggishness on off days, but that’s expected.

Welcome JohnJohnson,

snip...I have started to slowly titrate my dose down in an effort to lower estradiol down, manage hematocrit better, and hopefully get rid of all the acne on my back. I am ok with being slightly out of range, but I think being at 49.9 at trough is too high.

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If you drew blood on injection day before injecting then your E2 on that blood test should be at peak. E follows T and all that jazz.

hth

FeelingLost said:

Welcome JohnJohnson,



If you drew blood on injection day before injecting then your E2 on that blood test should be at peak. E follows T and all that jazz.

hth

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I drew blood on Monday morning, 3.5 days after my Thursday injection, which would be my lowest that I hit all week. In essence it sounds like you are saying my e2 would be lower on fri, sat, and sun, which I'm pretty sure is not correct.

johnjohnson said:

I drew blood on Monday morning, 3.5 days after my Thursday injection, which would be my lowest that I hit all week. In essence it sounds like you are saying my e2 would be lower on fri, sat, and sun, which I'm pretty sure is not correct.

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E is only made with T you have to have the T first then the question is how long does your body take to convert that T to E? That would be when your E2 peaks and that is not on TT trough day.

FeelingLost said:

E is only made with T you have to have the T first then the question is how long does your body take to convert that T to E? That would be when your E2 peaks and that is not on TT trough day.

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Little lost here man. First you told me that right before injection my e2 would be highest, I said I believe that is incorrect. Now it seems like you’re saying something else. Both my testosterone and estradiol will be higher at the 24 and 48hr marks than at 3.5 days after my shot. So essentially when I got bloodwork done is my trough, thus the lowest my estrogen/test is all week, which would mean it is even higher than 49.9 at other points in the week.

johnjohnson said:

Little lost here man. First you told me that right before injection my e2 would be highest, I said I believe that is incorrect. Now it seems like you're saying something else. Both my testosterone and estradiol will be higher at the 24 and 48hr marks than at 3.5 days after my shot. So essentially when I got bloodwork done is my trough, thus the lowest my estrogen/test is all week, which would mean it is even higher than 49.9 at other points in the week.

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Sorry John I basicly said the same thing in both post. I lack the ability to explain to you how E follows T and they do not peak at the same time.

FeelingLost said:

Sorry John I basicly said the same thing in both post. I lack the ability to explain to you how E follows T and they do not peak at the same time.

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If you were saying the same thing in both posts then I guess I just don’t agree. It doesn’t take two whole days for estrogen to rise, when testosterone is higher, estrogen is higher.

johnjohnson said:

If you were saying the same thing in both posts then I guess I just don't agree. It doesn't take two whole days for estrogen to rise, when testosterone is higher, estrogen is higher.

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It's common knowledge that E2 always follows testosterone, add to that it takes longer for your receptors to notice the rise in E2. This is what can make make a guy go mad on AI dosing based off how you feel since you're only feeling what was days ago and that your E2 levels could actually be higher only your body won't notice for awhile.

Systemlord said:

It's common knowledge that E2 always follows testosterone, add to that it takes longer for your receptors to notice the rise in E2. This is what can make make a guy go mad on AI dosing based off how you feel since you're only feeling what was days ago and that your E2 levels could actually be higher only your body won't notice for awhile.

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We’re not talking about noticing effects. We are talking about bloodwork. If I take bloods on Friday, sat, or sun my E2 will be higher than it was on Monday. Therefore, it is my trough.

johnjohnson said:

We're not talking about noticing effects. We are talking about bloodwork. If I take bloods on Friday, sat, or sun my E2 will be higher than it was on Monday. Therefore, it is my trough.

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I was referring to both that E2 follows T and that there's a lag response to notice E2 at the receptors. I'm not going say if it's days apart, because everyone peaks at a different rate which is what's typically stated T peaks in 24-48 hours. I'm sure someone else can better explain why E2 follows T and why, perhaps the pathways are different. It must take time to convert T into E2 and therefore might explain why E2 follows T.

You're so concerned with being right that you're failing to read what's being posted.

Systemlord said:

I was referring to both that E2 follows T and that there's a lag response to notice E2 at the receptors. I'm not going say if it's days apart, because everyone peaks at a different rate which is what's typically stated T peaks in 24-48 hours. I'm sure someone else can better explain why E2 follows T and why, perhaps the pathways are different. It must take time to convert T into E2 and therefore might explain why E2 follows T.

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Now you’re just talking in circles and not really addressing what I’m saying. Lol thanks anyways though man. Have a good night.