Second TRT labs

I started TRT in October, so roughly 6 months ago. My beginning protocol was 64mg test e3.5 (128mg/week), 400iu HCG e3.5, and 0.125mg anastrozole EOD. At the three month mark, my numbers looked like this:
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Total T: 1278 (348-916)
Free T: 37.9 (8.7-25.1)
E2 sensitive: 21.4 (8.0-35.0)
SHBG: 41.1 (16.5-55.9)
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Overall, I was feeling great once my levels settled in (some acne and mood issues early on that went away), but with that high of a trough total and free T, and that low of an e2 number, the decision was made to lower my weekly dose of both testosterone and anastrozole. I was also given the option of trying more frequest injections, so the new protocol was 36mg test MWF (108mg/week), 400iu HCG e3.5, and 0.125 mg anastrozole e3.5 (taken at time of HCG injection). I just got those 6-month labs, and here are the new numbers:
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Total T: 828
Free T: 26.4
E2 sensitive: 22.9
SHBG: 34.2
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Honestly, I felt a lot better on the original protocol. Once I got settled in to the new, I noticed lower energy, less strength, and the return of some of the other symptoms that started me on this journey in the first place (brain fog, etc.). I'm naturally on the higher-side for SHBG (mid-50s), so it's starting to look like I need a trough around 1000 or so to get my free T into the low 30s. I remember at my last consult Dr. Saya was aiming for a trough total T between 900 and 1200 and free T between 25 and 35.
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My e2 also remains low, barely moving despite cutting the anastrozole dosing. I know my test dose also decreased, but when I was on clomid my e2 shot up pretty high. I guess my e2 just doesn't respond the same way with testosterone injections, so perhaps I'll be able to drop the anastrozole entirely. I seem to feel the best when my e2 is around 30.
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My consult with Defy is next week, and I'll be interested to see what tweaks we make. Any thoughts on injection frequency? I'm thinking the feeling worse part if more related to the lower test dosage than moving from e3.5 to MWF, but I was also surpised to see my SHBG drop a fair amount after moving to a lower dosage and more frequent injections.
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Welcome any thoughts!

Id drop the AI entirely and keep everything else the same. By most standards E2 @ 22 is going to be too low, seems like the all to common introduction of an AI as a basic component of a protocol without symptoms and testing warranting it.

Vince Carter said:

Id drop the AI entirely and keep everything else the same. By most standards E2 @ 22 is going to be too low, seems like the all to common introduction of an AI as a basic component of a protocol without symptoms and testing warranting it.

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Thanks, Vince. In Dr. Saya's defense, my e2 went from 30 to 68 while on clomid, and 0.25mg anastrozole EOD only brought that down to 53, so there was legitimate concern when I transitioned to TRT that I might have some estradiol issues. That was specifically the reason he included (a much smaller) dosage in my original protocol. I think now its clear though that my reaction to clomid was very different than to testosterone, from an e2 perspective.

If it was me I would go back to original protocol. I feel good with higher testosterone levels, maybe you're like me in that respect. I don't think I would completely eliminate your AI, you could first try to reduce it to maybe twice a week instead of three times a week. Remember to takes time to get dialed in.

For me it would depend on hematocrit (and PSA)

Vince said:

If it was me I would go back to original protocol. I feel good with higher testosterone levels, maybe you're like me in that respect. I don't think I would completely eliminate your AI, you could first try to reduce it to maybe twice a week instead of three times a week. Remember to takes time to get dialed in.

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I definitely felt better when testosterone levels were higher, and my e2 was basically the same. My current protocol is anastrozole 0.125mg twice/week (prior protocol was 0.125mg EOD). At this point I think my options are either to drop it entirely or move to an even smaller dose. I believe Empower compounds down to 0.05mg. It's a tough call - going from EOD to twice/week anastrozole did basically nothing for my lowish e2, but I also went from 128mg test/week to 108mg, so maybe that offset the anastrozole reduction? If I were to bump test dosage to something between my current 108 and the prior 128, maybe its worth keeping a lower dose of anastrozole in the mix until the next rounds of labs. I'm sure Dr. Saya will have thoughts on the matter.

Blackhawk said:

For me it would depend on hematocrit (and PSA)

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PSA was at 0.8 (0.0-4.0) at the 3-month mark. It was not re-tested at these 6-month labs. Hematocrit was 47 at the 3-month mark and 48.7 at the 6-month mark. Leading up to the 3-month mark, I was doing regular donations, but have not donated in 4 months now (Dr. Saya wanted to see what hematocrit did without regular donations).

Clomid is pretty notorious for E related matters but really tough to tie that response to injections

To close the loop on this, I had my consult earlier this week. We're bumping testosterone to 42mg MWF (126mg/week) and keeping HCG and anastrozole as is. Dr. Saya thinks this will be enough of a bump to get my total and free test numbers back closer to the original protocol when I was feeling better without being quite as high, and should get e2 into the high 20s. He thinks SHBG probably has stabilized, meaning no need to inject more frequently. He also thinks my HCT is stable enough to avoid donations unless I just want to.
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We'll retest again in about 5 months.

Thanks for posting a follow-up!!! Sounds like you guys made some changes that should help you out, hope it works well for ya!!

where do you get your tests, by mail or a local clinic or doctor? Wondering what is the cost difference.