9 weeks on TRT and doctor wants to stop for now.

To begin, sorry for the long post but have see by reading post from others many on forum ask for more information always. Hope that this is what is needed to get some reference. My doctor who specializes in TRT has stopped me on TRT till I see a urologist due to a doubling of my PSA from 3.610 to 6.620 in week 9 of TRT. I believe that it is due to estradiol levels along with high T levels causing the rise. Also the fact that my PSA went up so fast wondering if all connected? Having urination problem now as well. So I am sure that an enlargement of the prostate is going on. Doctor thinks it is prostatitis but wants to have urologist check it out and to be safe (cancer). I just do not think he looked at everything such as high Estradiol level , maybe lowering dose of injection, ect.

I am 53 and workout 6 out of 7 days. I was having all the symptons of low T - falling asleep on the chair at 3 pm, not loosing weight, libido starting to go down a little, ect. I began TRT approximately 9 weeks ago and within the 2-month period I saw that I was having some of the side effects that happen in some individuals. Oily skin (forehead), atrophy of testicles, red flushing face and lastly urination issues began. When my sons told me the other day Dad your face is super red (my sons know I am on trt) . I was also feely that my BP was high due to head and neck pressure. I looked up others posts on forum and decided to give blood the next day. Red Cross said my (HGB was 19 high) and the nurse said I would feel better after giving blood. Well she was correct and I felt better and red flushing face went down dramatically. So that was during the weekend (I take my injection on Sunday). Called my doctor Monday and he sent me for new panel that (INCLUDED ESTRADIOL) and PSA again. See results below from 1[SUP]st[/SUP] and 2[SUP]nd[/SUP] panels.

*Doctor has me on TEST CYP 200MG/ML – 1ML 1x a week

LABS – 2 months ago: NO ESTRADIOL DONE

CBC – all within range (Below what I think you need to see)
WBC 8.3 4.5-11.0 K/uL
RBC 5.10 4.30-5.90 10*6/uL
HGB 15.5 13.5-17.5 g/dL
HCT 44.1 40-53 %

TEST PROFILE:
TEST TOTAL 410 300-890 ng/dL
SEX BINDING 40 18-66 nmol/L
TEST FREE CALC. 74.2 30-170 pg/mL
TEST FREE % 1.81 1.00-2.70 %

VITATIM D (LOW) 27.2 30.0-100.0 ng/mL

*PSA TOTAL 3.6 <4.000 ng/mL

LABS AT 9 WEEKS – I GAVE BLOOD 2 DAYS BEFORE THIS PANEL DUE TO FLUSH FACE AND BP

WBC 7.9
RBC 5.50
HGB 16.8
HCT 49.2

TEST PROFILE:
TEST TOTAL >1500 (Took injection on Sunday/ labs on Monday)
SEX BINDING 55
TEST FREE CACL. (NO RESULTS AS ANALYTE CONCENTRATION IS BELOW DETECTION LIMIT)
TEST FREE % (NO RESULTS AS ANALYTE CONCENTRATION IS BELOW DETECTION LIMIT)

VITAMIN D 66.5 30-100 ng/mL

ESTRADIOL 95.3 <60.7 pg/mL

*PSA TOTAL 6.620 <4.00 ng/mL

Thanks reading!

There's a number of issues here. First of all, your estradiol was measured with the incorrect test. Men should only evaluate their e2 with the LC, MS/MS (sensitive, also known as ultrasensitive) test. The reference range you provided for your estradiol is a dead giveaway that your doctor ordered the incorrect test. That means you can't rely on the results you have, they are typically inflated. Healthy estradiol levels are necessary for a man: it's a critical hormone, not a waste product.

Now, your protocol. Why in the world are you on a whopper of a dose? That's a once a week injection?

Finally, your PSA did climb quickly, which is typical of prostatitis, not prostate cancer. It should certainly be addressed, but stopping TRT at this point would be premature.

We hear new members all the time state that thier doctor specializes in TRT, that's not what I'm seeing here! I see a lot of problems here, you are injecting way to much testosterone in a single injection, most guys start out on 50mg twice weekly and you're double that amount. High hemoglobin, hematocrit are expected and likely would have continued to climb eventually getting out of control. Your doctor has no business prescribing testosterone!

When a guy injects very large doses of testosterone, the larger the dosage, the large the testosterone peaks, therefore the larger estrogen peaks and this is bad for you. Most of us inject smaller doses of testosterone more frequently to control estrogen and hematocrit and to maintain stable levels throughout the week, however your levels are peaking high and start dropping within a few days and you're lower by the end of the week, then the roller coaster begins again when it's time for your next injection.

The red face flushing is normal one one starts TRT, it happened to me but subsided months later after my body adjusted. Most of us have gone private because the truth is most endo's are clueless as it pertains to TRT. I doubt your doctor even ordered the correct E2 labs, the LC/ms/ms method is the only one that should be used.

Thanks Systemlord and CoastWatcher for your insight. I agree wrong not to test E2 and not to tie in what I see and you as well. I knew that I needed to come down on dosage and go with 2 injections a week. When I spoke with my doctor today I he thinks it is prostatitis and not cancer. He also said he can get everything dialed in after he knew. But for me I was looking at all the other evidence that pointed directly to too much testosterone, not being able to calculate free test levels
(red flag) and of course the symptoms i related.

Most obvious issue is your dose. That's the very high end of TRT, and as you can see from your own labs, you're well above physiological TT levels. That you'd have undetectable levels of FT with total that high also makes no sense to me. Possible lab error perhaps. Most docs start people on an overly low dose and or poor dose schedule as the major problem, yours appears the rare case of the opposite issue. Simply lowering the dose to say 120-150mgs weekly may at least be the place to start and re test at proper interval to see where that brings you.

Will Brink said:

Most obvious issue is your dose. That's the very high end of TRT, and as you can see from your own labs, you're well above physiological TT levels. That you'd have undetectable levels of FT with total that high also makes no sense to me. Possible lab error perhaps. Most docs start people on an overly low dose and or poor dose schedule as the major problem, yours appears the rare case of the opposite issue. Simply lowering the dose to say 120-150mgs weekly may at least be the place to start and re test at proper interval to see where that brings you.

Click to expand...

Yes - I am going to request to see him and ask why stop and not just lower dose to see how that helps. In the mean time still need to check prostate but many say Urologist tend to be on the heavy side of treatment.

Just some info - so i asked to come in for office visit to talk more about labs. And it will cost me $175.00 to speak with him. Business is Business

SOCAL2018 said:

Just some info - so i asked to come in for office visit to talk more about labs. And it will cost me $175.00 to speak with him. Business is Business

Click to expand...

So your doctor created this entire problem and you are left paying for it in more than one way, why pay for this level of incompetence. He doesn't even know he ordered the wrong estrogen labs.

He is showing he isn't well versed in TRT, most aren't as this is a grey area of medicine for them.

From my understanding PC is androgen-dependent. Having low T would deprive a tumor and cause the tumor to shrink, thus lower PSA. Introducing high T levels will cause a rapid saturation and increase PSA. But sure, it could be prostatitis and BPH. But I’d take the advice of your urologist.

Wanted to follow up on last post - Went to doctor who is a D.O. after second labs (results ). He actually spent a lot of time with me going over labs and he actually did the prostate exam as well due to the high PSA results. Said the prostate was boggy (prostatitis). And he recognized the high estradiol at 95.3 (normal I believe). I did ask him how come the labs did not include E2 LS/MS/MS and he felt the normal was enough information.

So doctor prescribes for:
*Estradiol 95.3 pg/mL results - .5 anastrozle ( M,W,F ) today is Friday have yet to take.
*PSA results of 6.620 (he did do a prostate exam said it was boggy/prostatitis) CIPRO 500MG 2X a day.
Was worried about potential side effects of CIPRO ( seem to be very scary ).
*Lower's my injection from 1ML/1x a week @ 200MG CYP to .75/1x a week.

NOW - erections this week are weak compared to last couple of weeks ( even with high estradiol)? Kinda of bummed right now because they are 10x worst before starting TRT ( or at least this week). Looking at the veterans for some guidance.

I’ve had my PSA go from 1.2 to 1.5 to 1.7 to 5.6 before. When it got to 1.7 the doctor did a digital exam. Then he put me on antibiotics 500mg. Six weeks later my PSA went to 5.6. So then the doctor recommended a biopsy. The biopsy revealed slight BPH and prostatitis and no cancer. So the doctor put me on a heavy dose antibiotics (1000mg) to get rid of the of prostatitis, and that worked. My PSA has been a 1 for the last 10 years now.

Have you tired heavy dose of antibiotics?


If antibiotics don’t bring your numbers down. I’d get a biopsy. Or just get one now. The fact that you PSA doubled while on TRT is a littler alarming. A biopsy isn’t fun but you’ll get the answer you’re looking for.

some men have ed when their e2 gets too low.. im one of them i have no libido and ed when taking anything that lowers estrogen. you should contact this doctor that prescribed you AI and say you think you might need less dosage of AI because you lost erections. cheers

I am actually going in for labs tomorrow on my own - I just want to check myself after a week of this protocol. I went through discountedlabs and I am going to check specifics that were not check on the last two labs.

* Estradiol and Sensitive (LS/MS/MS)
* DHT
* CMP
* PSA (again after one week of CIPRO) just to see!!!
* Test, free and total

One thing I have learned from this forum is to take charge of your labs. I would rather spend the $250 every other month to keep a better check on myself. The E2, CMP and DHT test will give me a better understanding of were my body is with all this. One positive - is that I have lost about 20 lbs in the last 10 weeks while gaining muscle. The TRT has helped me with more energy and the results in my workouts have been positive.

One large I injection per week is far from ideal, it's time you start searching for a real hormone specialist. This doctor may have good knowledge about prostate issues, but his TRT knowledge is still old school.

You'd probably feel so much better inject twice weekly.

I have some post on my past PSA issue.
It hit 8.1....
History of prostate infections...
Cipro did nothing but hold the infection is place.
Doxycycline did the trick.... Took it for a bit...
Last PSA was 4.4.....
When it hit 8.1 the USO was singing the biopsy song...
I had him do a 4k blood test. Great results...
Still singing the biopsy song...
I had him do the 3T-MP-MRI.... Came back clean...
Kept on the Doxy.....
Do your homework before a biopsy....
Any history of PCa in your family?
Any other "indicators"?
Look at my past post on my story.....
Here is a "Shot Gun" listing of resources to look at if you wish.
********************************
First step is education....
********************************
Cannot tell how much research you have done on TRT.
If not a lot, I recommend you get a few books.
Get a few good books and educate yourself now:
1. Get Nelsons book "Testosterone: A Man's Guide".
2. Get Lee Myer's book "Natural Versus Testosterone Therapy".
3. Get “Testosterone for life - Dr. Abraham Morgentaller “.
4. Get “The Definitive Testosterone Replacement Therapy MANual: How to OptimizeYour Testosterone For Lifelong Health And Happiness” by Jay Campbell.
These books will give you a much better understanding of TRT....
********************************
ExcelMale.comGuide to Testosterone Replacement
https://www.excelmale.com/forum/showthread.php?5823-ExcelMale-com-Guide-to-Testosterone-Replacement
**********************************
One other forumthat has great info that might be useful to you is:
http://www.peaktestosterone.com/
GREAT article onE2 &#8211; A MUST READ
http://www.peaktestosterone.com/Hdr_Estrogen.aspx
********************************
Dr Saya's Videos on Testosterone Therapy and Side Effect Management
https://www.excelmale.com/forum/showthread.php?15207-Dr-Saya-s-Videos-on-Testosterone-Therapy-and-Side-Effect-Management
*********************************
DR.Saya's HCG Study
https://www.excelmale.com/forum/showthread.php?6133&p=32234#post32234
**********************************
Second step might be to have a look at your thyroid and see if any issues there.
********************************
Do some research.
I do like Tiredthyroid as a starting point.
Easy to read sections.
References at the bottom of each section (and NOT from people wearing "tinfoil" hats)
See below:
Basic sources to research Thyroid issues and testing:
******************************************
https://stopthethyroidmadness.com/
Spend time here and get the 2 books, “STTM: The Revised Book” and “STTMII:Authored by Doctors”.
*******************************************
http://www.tiredthyroid.com/
Great simple to understand articles.
Get her book.... “Tired Thyroid: From Hyper to Hypo to Healing—Breaking the TSHRule”, https://read.amazon.com/kp/embed?asi...Channel=system
A lot of clear researched information that is easy toread and understand.
***************************
https://hypothyroidmom.com/
Good info here. Look around.
*************************
https://www.restartmed.com/?s=thyroid
A LOT of good articles and a youtube page.
Spend time here looking around and reading after getting labs back.
************************************
Do you have Hypothyroidism?
The CompleteHypothyroidism User Guide for Patients (2018 Edition)
https://www.restartmed.com/hypothyroidism/
*********************************
Need information on thyroid testing....
Read here:
http://www.tiredthyroid.com/what-labs.html
And here:
http://www.tiredthyroid.com/optimal-labs.html
and here:
https://stopthethyroidmadness.com/recommended-labwork/
and here:
https://www.restartmed.com/thyroid-tests/
and here:
https://www.restartmed.com/hormone-testing/
And here:
https://www.restartmed.com/normal-thyroid-levels/
**************************************
Some additional links to read before you receive the books you have already ordered
Go here:
http://www.allthingsmale.com/publications.html
and download:
TRT: Recipe For Success
Print out.
and
HCG Update.
andthe TRT Power Point presentation.

Dr. Crisler is one of the "TRT Cutting Edge DR's" here in the states....
Also go here:
http://www.drjohncrisler.com/the-cri...part-deux.html
and also print out the article.
***************************
ALSO look at the videos that are posted on this site. A LOT of great info to take in....
******************************
Now you will have a great reference library and knowledge base to go forward on!

The test results are showing not the real picture T of 1500 sounds sky high but you injected Sunday and did labs on Monday at the peak. Labs should be done just before the injection.

Agreed - I was having symptoms of high estrogen going into 10th week and my doctor sent me out for them. I knew that my T level would be high but that was sky high. So he lowered my dose at my request to .75 (150cc 1x week ). I asked about going 2x a week every 3.5 days. He did not like that as he felt that at 3.5 there were more ups and downs than 1x a week?
Just finished 1st week with new protocol 1x a week at .75mL. Did not feel the same energy levels this week or the same libido or erections either. While taking 1x a week 1ml @200 I felt energized, libido great and waking up to solid morning erections!!

So today - I made a decision spilt my dose to 2x a week (Sunday evening and Thursday morning). Hoping that this will help with Estradiol levels, prostatitis, etc. I do not want to use anastrozole if possible and right now on CIPRO (which actually scares me given potential side effects). Made decision to go 2x a week based on all the information for others on the forum. Do you gentleman feel it was a good decision?

Your doctor has it backwards, the more frequent the injection, the less you levels will fluctuate. It takes 6 weeks for testosterone levels to stabilize after a dosage change, anything felt within this 6 week window is irrelevant, you are expected to feel poorly.

So if you decide to again switch things up you will reset the clock and it's another 6 weeks to reach a stable state. It's a good decision in the long run to split those injections up twice weekly. I still believe you dosage is just too high and you'll just have the same problems as before, you need to aim for 60mg twice weekly as a starting point.

This doctor is moving in the wrong direction, starting you out high and coming down instead of start low and going slow. This is a marathon, not a sprint.

Many thanks to those of you that have replied to my post as it is greatly appreciated.

Quick recap - As I stated in last post my doctor at 10 weeks had me do 2nd labs - (due to symptoms I believed were due to high estradiol (non-sensitive) 95.3 pg/mL on second labs. Doctor lowered dose to .75 @200 MG 1x a week. He also prescribed .5 Anastrozole M,W,F and CIPRO due to PSA jump from 3.6 to 6.620 in 10 weeks. Doctor diagnosed via digital exam prostatitis.

So I went had blood done again one week after last draw on my own through labcorp. Just to check blood work on test not requested by my doctor on last two labs that many believe should have been. Had my CMP, Estradiol, Sensitive (LS/MS/MS), DHT, PSA (3[SUP]rd[/SUP] time to see if any change one week after taking CIPRO). Labs were taken on Saturday morning before my Sunday injection this time. Last time doctor sent me out day after injection my Test levels were 1500.

*Info/ This week I split my injection2x a week every 3.5 days to see if that would help with outcomes. Looking at the new results &#8211; I think I need to reduce from .75 (150 MG split every 3.5) to .5 (100/120 MG split every 3.5) as a few of you mentioned.

New labs below after new protocol:

Testosterone,Free and Total

Testosterone, Serum 1460 High ng/dL 264 - 916
(still way to high for end of cycle pre-injection)

Free Testosterone(Direct) 25.0 High pg/mL 7.2 - 24.0
(I am o.k. with this for now)

Dihydrotestosterone 96 High ng/dL
(DHT high but my knowledge is lacking and is this level helping to increase my PSA)

Estradiol, Sensitive 10.0 pg/mL 8.0 - 35.0
(Freaking out that this is low due to Anastrozole for one week 3x/.5 M,W,F)

Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 9.3 High ng/mL 0.0 - 4.0 01
(Biggest concern is the PSA going up again even though on a week on CIPRO. Was reading that sex my also increase PSA levels. Been getting ultra busy with wife during that week?)

I recall a urologist saying antibiotics will case a false positive. That's why you are supposed to wait 2 weeks after the 4 week course of antibiotics is completed before you take another PSA test. And if those numbers are correct it would lead me to believe you have some prostatitis going on there, IMO. But often when PC is present there is almost always prostatitis also.