5 months into TRT

[Shad0w]

Hi all,
So I started testosterone replacement about 5 months ago after testing low for total and free T over the span of a year and a half. My Doctor started me on transdermals but I eventually switched over to injections. I started on 100mg test cypionate twice/week. After a month on only the test cyp I got labs for total, free, and shbg on injection day before injecting. Total testosterone- 599.3 ng/dl. Free T- 19.66 ng/dl (flagged as high). Shbg-11 nmol/L (flagged as low). I continued on the same protocol for about another month until I started feeling what I believe was high estrogen symptoms. My doctor didn’t test my estrogen at this point but gave me a script for anastrozole 1mg. At first I started on an as needed basis for when I’d feel symptoms (water retention, moodiness/emotional, sensitive nipples) but it became so inconsistent that I decided to stick with .25mg eod along with my 100mg test cyp 2/week. I requested an e2 sensitive test from my doctor. Results were, Estradiol- 32. Now I believe this to be high still. Was wondering what ai dosage I should try next? Still feeling fatigue and brain fog off and on. Any thoughts or advice is appreciated!
Other labs-
DHEA-so4- 329ug/dl. reference 85-690
TSH-ultrasensitive- 2.06 uIU/ml. ref .34-5.6
Free T4- .88 ng/dl. ref .61-1.43
Cortisol rand S- 18.9 ug/dl.
Prolactin- 7.8

 

[mooseman109]

I am suprised with 200 mg a week that yoir testosterone did not climb higher. I am not suprised it created estrogen. While that E2 number is not grossly high and alot of guys are ok there, i get symptomatic in that range. Have you considered more frequent shots at lower dose?

 

[Shad0w]

I am just as surprised with my total t. I thought it would’ve been higher as well. I’m thinking that with my low shbg I must be metabolizing it fast. I’ve been splitting the 200mg up into two shots a week since I’ve started. I’ve also tried 50mg eod but I started feeling like my levels were declining. Energy levels fell, no sex drive, workouts were crap. After talking with my doctor this week we decided to do 100mg e3d. During the two 100mg shots per week, the third day after a shot is when I’d start feeling energy levels fall and symptoms return. As for the e2, would .25mg anastrozole/day or .5mg eod be okay? Or is it best to take maybe 1mg with each shot? Since I seem to burn through test fast, I was thinking that I might be burning through the ai as well if that’s possible.

 

[Systemlord]

You need to inject your doses everyday due to your low SHBG, not only are you metabolizing testosterone fast you're also excreting a lot of it into your urine.

If you take the AI once a week, by the end of the week it'll be out of your system and your estrogen will rise, it will be a constant estrogen roller coaster ride. Break up the AI twice-weekly due to the two-day half-life of the drug.

 

[Shad0w]

Thanks for the reply Systemlord. So do you think 30mg test ed with .5 mg eod arimidex would do the trick? For such frequent injections should I be using like a 28 or 29 gauge needle?

 

[MarkM]

Hi Shadow,

30 mg a week is a huge amount of T. Normally guys need less per week when injecting daily to have higher levels of T and to feel better. 30 mg ED, 210 mg a week, will likely put you way over the top with way too much Free T and that creates way too much Free E2.

I would drop down to 20 mg ED and 0.25 mg anastrozole twice a week. The lowered test dose will help bring the E down so you should need less of the AI. You can always increase the AI if you have major symptoms. It is much better to lower the E if it gets high verse trying to bring it up after crashing it.

 

[Vince]

Estradiol levels are not high enough for an AI, I recommend that you don't use one.

 

[Vince Carter]

Estradiol levels are not high enough for an AI, I recommend that you don't use one.

YOu might want to re-read the thread then.

 

[Vince Carter]

Thanks for the reply Systemlord. So do you think 30mg test ed with .5 mg eod arimidex would do the trick? For such frequent injections should I be using like a 28 or 29 gauge needle?

With low SHBG you have to really dial down your thinking in terms of dosing. 30/D is FAR too much. Mark suggested 20 and I'd say 16mg. With your dosing, ignore the Total Test and target your dosing for Free T not letting that go too far over the lab range.

You also need a different E test, the sensitive test you should still use that but you need to add "Estradiol, Free" to every set of labs you run.

Otherwise I concur with MarkM above

 

[Shad0w]

Well after talking with my pharmacist (who is on trt too) he said that injecting every day with test cyp makes no sense since it’s a time released ester. I explained my low shbg situation with him and he said that he’d encountered the same issue and that after he “stabilized” on his trt after about 6 or 7 months his shbg shot back up. He advises against daily injections. So now I’m just confused and don’t know which route to take. Stick with 100mg 2x week to see if my body “adapts” to that or go with the ed protocol with lower dosages?

 

[Vince Carter]

Your pharmacist could be the unicorn out there but who's to say. I don't recommend dailies except for the really tough or unique situations. You correctly observed that SHBG pretty well wipes away the half-life of the ester.

 

[Vince Carter]

Well after talking with my pharmacist (who is on trt too) he said that injecting every day with test cyp makes no sense since it’s a time released ester. I explained my low shbg situation with him and he said that he’d encountered the same issue and that after he “stabilized” on his trt after about 6 or 7 months his shbg shot back up. He advises against daily injections. So now I’m just confused and don’t know which route to take. Stick with 100mg 2x week to see if my body “adapts” to that or go with the ed protocol with lower dosages?

I will go so far as to say when it comes to low SHBG TRT, it's me, MarkM, Systemlord and may be a couple others that are on to making it work and who should listen too.

 

[Systemlord]

30mg daily is too much, 10mg ED is too much for me. When you inject your doses everyday your levels hardly have a chance to decrease, think about it like filling your gas tank up every 50 miles of driving distance, it never has a chance to work it's way towards empty, it stays virtually full.

Your levels decrease very little and are almost static.

 

[Vince]

YOu might want to re-read the thread then.

I requested an e2 sensitive test from my doctor. Results were, Estradiol- 32. Now I believe this to be high still.
With out the right Labs you have no idea what you're treating.

 

[Shad0w]

If my total test was only 599 on the third day after a shot of 100mg, wouldn’t it drop even lower if I dropped to say 20-25mg a day? That third day after a shot is when I start to feel a return in symptoms (ED, no morning wood, low sex drive, less energy). This makes me think that 599 is too low of a level for me. A little background on me- I’m 24, train 4-5 days a week intensely, work a physically demanding job. Maybe all of the physical activity I do during the week requires my body to need a higher test level?

 

[Systemlord]

If my total test was only 599 on the third day after a shot of 100mg, wouldn’t it drop even lower if I dropped to say 20-25mg a day? That third day after a shot is when I start to feel a return in symptoms (ED, no morning wood, low sex drive, less energy). This makes me think that 599 is too low of a level for me. A little background on me- I’m 24, train 4-5 days a week intensely, work a physically demanding job. Maybe all of the physical activity I do during the week requires my body to need a higher test level?

The 3rd days after your injection your levels have dropped dramatically, you need injections everyday. If you were to measure the testosterone in your blood vs in your urine, the urine concentration would be way higher. Low SHBG means your ability to hold onto testosterone is compromised.

When you start an everyday protocol your levels might drop in the beginning but once each injection builds up in your system over 6 weeks, your levels will climb. Target anything above 500 and you'll pay for it with high estrogen levels.

 

[Shad0w]

Okay, I had the pharmacist order 29g needles so I’ll give the ed protocol a try. My only concern is that I won’t get symptom relief with anything under 600. Is it possible with low shbg to still maintain a steady upper-half range of total t while managing e with an ai ed or eod? For instance would 25mg test c ed along with anastrozole .25mg ed or .5 eod keep me in the upper half while effectively controlling estrogen?

 

[Shad0w]

Also if it matters, my shbg level before treatment was 20. At that time I was only on clomid for a few weeks.

 

[a_crossfitter]

I'm on try; however, have noticed that my mood and brain fog correlate with what I eat.

If I eat shitty, I feel like complete shit. When I clean up the diet, I tend to feel better.

 

[Systemlord]

Okay, I had the pharmacist order 29g needles so I’ll give the ed protocol a try. My only concern is that I won’t get symptom relief with anything under 600. Is it possible with low shbg to still maintain a steady upper-half range of total t while managing e with an ai ed or eod? For instance would 25mg test c ed along with anastrozole .25mg ed or .5 eod keep me in the upper half while effectively controlling estrogen?

You're chase labs numbers and believe high normal with make feel good, for low SHBG men high normal means very high estrogen (depression & anxiety) and this will slow recovery, sometimes guys don't heed our warnings and must learn for themselves.