New Poster - erratic T levels

Hi,

This site is a little overwhelming. The information I need may be here somewhere, but let give my personal situation:

I am 62.

I started having fatigue symptoms and was starting to get high anxiety. Went to the doc and he looked at a variety of factors. In the end, he said I had low T (301 ng/dL) and we needed to start TRT. His regimen was 200ml T Cyp once a month. I didn't know anything back then and now I'm pretty sure that was a recipe for disaster. He wanted me to wait 3 months before retesting and making any adjustments. Just before the 3 month mark, I was a nervous wreck, so I went to so another doctor.

That doctor put me on T cream 0.5g of 1%. Within a few days I was feeling great, energetic and even had morning erections for the first time in years.

After 1 month, results were 433 ng/dL, free 66 pg/mL. The doc increased me to 1g of 1%.
After another month, results were 432 ng/dL, free 67 pg/mL—basically, no change.
After another month, I started feeling fatigued again and the anxiety came back. Doc increased me to 1 g of 2%.
Another month of inconsistent energy. I was going to get tested (morning test, fasting) and I insisted we test estrogen. Results were 278 ng/dL, free 42 pg/mL, worse than when I started TRT! Docs response: double the dose! Estradiol was 35 pg/mL, so it's too high.

I saw some threads about T cream not working for some people, The weird thing is that I certainly reacted the first time I used it and I was good for a while.

Any insights into the fluctuating T levels?

I've heard that the ideal treatment is T + HCG + Arimidex. The doc wasn't excited about HCG (maybe she read it as HGH?) and she said Arimidex is expensive and it's not a wonderful drug to take. I'll look to see what I can find on ways to lower estrogen levels.

Your E2 does not look bad at all - Was that the sensitive test? If not then your E2 is likely much lower than what you posted.

Cream can work and then lose it's effectiveness over time. It doesn't look like it ever really worked that well for you to begin with (at least with regards to numbers)

And yes the first protocol would have been a disaster.

CSI007 said:

Your E2 does not look bad at all - Was that the sensitive test? If not then your E2 is likely much lower than what you posted.

Cream can work and then lose it's effectiveness over time. It doesn't look like it ever really worked that well for you to begin with (at least with regards to numbers)

And yes the first protocol would have been a disaster.

Click to expand...

I have no idea which E2 test was used. What I've read is that optimal E2 is between 21.80 pg/ml and > 30.11 pg/ml (based on a study: Circulating estradiol and mortality in men with systolic chronic heart failure. JAMA 2009 May 13;301(18):1892-901.)

I'm willing to bet it was not the E2 sensitive test which means your value is probably a lot lower then what you posted. I think most here would agree that if you tried to get that value down from where it is via an AI you are asking for trouble. Trust me, low E2 is terrible.

tonyfr said:

Hi,

This site is a little overwhelming. The information I need may be here somewhere, but let give my personal situation:

I am 62.

I started having fatigue symptoms and was starting to get high anxiety. Went to the doc and he looked at a variety of factors. In the end, he said I had low T (301 ng/dL) and we needed to start TRT. His regimen was 200ml T Cyp once a month. I didn't know anything back then and now I'm pretty sure that was a recipe for disaster. He wanted me to wait 3 months before retesting and making any adjustments. Just before the 3 month mark, I was a nervous wreck, so I went to so another doctor.

That doctor put me on T cream 0.5g of 1%. Within a few days I was feeling great, energetic and even had morning erections for the first time in years.

After 1 month, results were 433 ng/dL, free 66 pg/mL. The doc increased me to 1g of 1%.
After another month, results were 432 ng/dL, free 67 pg/mL—basically, no change.
After another month, I started feeling fatigued again and the anxiety came back. Doc increased me to 1 g of 2%.
Another month of inconsistent energy. I was going to get tested (morning test, fasting) and I insisted we test estrogen. Results were 278 ng/dL, free 42 pg/mL, worse than when I started TRT! Docs response: double the dose! Estradiol was 35 pg/mL, so it's too high.

I saw some threads about T cream not working for some people, The weird thing is that I certainly reacted the first time I used it and I was good for a while.

Any insights into the fluctuating T levels?

I've heard that the ideal treatment is T + HCG + Arimidex. The doc wasn't excited about HCG (maybe she read it as HGH?) and she said Arimidex is expensive and it's not a wonderful drug to take. I'll look to see what I can find on ways to lower estrogen levels.

Click to expand...

Wecome to Excelmale. You are being undone by substandard medical providers providing you with inferior TRT protocols. On top of those challenges, you have some ideas about "ideal treatment" that could send you in the wrong direction.

Your first protocol, 200mg once a month was (as you gathered) a disaster. Then you found out what so many do: topical TRT preparations don't work for a large number of men. It's an unfortunate but simple truth. In my case they were a total bust, in your situation they did a bit of good but you clearly have absorption issues that topicals can't overcome. You'll need to revisit injections with a better protocol than you were initially were given.

You mentioned "an ideal treatment" involved anastrozole. Where did you read that, or who told you that was the case? Anastrozole is a fine drug, but it can be, it frequently is, overprescribed. Please remember this: in the absence of confirmed, elevated estradiol levels that are accompanied by symptoms typically associated with elevated levels of e2, there is no place in a protocol for anastrozole. Period. There is never a justification for adding it to the starting phase of a protocol. That is poor medicine. Estradiol is not a waste product, it's a hormone men need for adequate health - particularly sexual health.

Estradiol should only be measured via the liquid chromatography, dual mass spectrometry lab test. It is known as the "sensitive" or "ultra-sensitive" estradiol test (your lab report will have words to that effect on it if the proper test was run). If you didn't measure with that particular lab test you can't rely on the results. Only the LC, MS/MS lab test is appropriate for men. There is no hard, firm rule as to what's too high a level - it's a combination of labs and symptoms. Many of us let our e2 climb a bit with no problems. Trust us, low estradiol is a ticket to misery.

If yiu list your full labs with the reference ranges included the discussion can be more focused. We're glad you joined us and hope you'll be an active member.

Sounds like you've been suffering through bad protocols. You many have to find a better TRT doctor, so many men give up on TRT because of bad protocols and bad TRT doctors.

CoastWatcher said:

You mentioned "an ideal treatment" involved anastrozole. Where did you read that, or who told you that was the case?

Click to expand...

See www dot menshormonalhealth.com slash testosterone-therapy.html (sorry, I'm not yet allowed to post links).

CoastWatcher said:

Estradiol should only be measured via the liquid chromatography, dual mass spectrometry lab test.

Click to expand...

I doubt it was the "sensitive" test. Sounds like Ineed a re-test.

Thanks!

tonyfr said:

See www dot menshormonalhealth.com slash testosterone-therapy.html (sorry, I'm not yet allowed to post links).



I doubt it was the "sensitive" test. Sounds like Ineed a re-test.

Thanks!

Click to expand...

AI being part of an ideal TRT protocol is totally bogus. Each individual is different. If my doctor had prescribed an AI when I started I would be even worse shape than I am now. When I began TRT with injections my E2 sensitive test was like 6.5 Taking 100mg of T per week brought my T up to almost 800 in 6 weeks. But my E2 only climbed to 18.5 which is still pretty low. can you imagine if an AI had been prescribed to me? I would certainly have crashed my E2 to next to nothing.

tonyfr said:

See www dot menshormonalhealth.com slash testosterone-therapy.html (sorry, I'm not yet allowed to post links).



I doubt it was the "sensitive" test. Sounds like Ineed a re-test.

Thanks!

Click to expand...

Doctors who add anastrozole to a protocol in the absence of lab work indicating elevated levels of estradiol and associated symptoms are making a serious error in judgement.

https://www.excelmale.com/forum/sho...ale-reproduction-libido-and-erectile-function

It is a necessary hormone, essential for health, both objectively and subjectively. Anastroloze is a good drug, but one that shouldn't be used unnecessarily.

CoastWatcher said:

Doctors who add anastrozole to a protocol in the absence of lab work indicating elevated levels of estradiol and associated symptoms are making a serious error in judgement.

https://www.excelmale.com/forum/sho...ale-reproduction-libido-and-erectile-function

It is a necessary hormone, essential for health, both objectively and subjectively. Anastroloze is a good drug, but one that shouldn't be used unnecessarily.

Click to expand...

Here here.

I can testify from personal experience that it was a bad starting protocol for me. I was prescribed .25 mg Anastrozole BIW right from the start. I spent a couple months in low E2 hell before I got educated and took charge of my own protocol. Now using no AI at all and feeling pretty good! Labs are good too.

My doc keeps sending Anastrozole but I just toss it in a bin. Got a pretty good stockpile of it now!

My thanks to everyone who clarified the issue of Anastrozole.

tonyfr said:

My thanks to everyone who clarified the issue of Anastrozole.

Click to expand...

The essential point is not to be afraid of estradiol - and to work with a doctor who understands how essential it is. Should you develop problems related to elevated levels of e2 there are ways to address the situation. You can adjust your protocol, frequent, smaller doses produce robust levels of testosterone while - typically - keeping estradiol at a solid spot. Injections every 3.5 days are actually standard practice now (50-60mg twice a week). Some find every other day injections work, a few inject every day (I inject 16mg every morning). Anastrozole is a potent drug and adds another level of complexity to a protocol when prescribed. There are times it needs to be used, without question, but never at the initiation of therapy.