6 Week Blood Test Results - Low SHBG/High Estrogen

[TLawyer]

Hello all:

I have been on the TRT train for 7 weeks now after a few months of research (much of which was done on this fantastic website!). I am 43 and for about the last year and a half I have been experiencing symptoms (lethargic, weight gain, crappy erections, low libido, loss of muscle mass, etc.). I had a testosterone blood test with a GP who flat out refused to test me for anything other than total, free testosterone and SHBG ("We don't test estrogen levels unless there is a problem with the testosterone level"). Total testosterone came in at 388 ng/dl, free testosterone at 65.9 pg/ml, and SHBG at 23 nmol/L. Not happy, I jumped over to the experts at Defy.

My initial lab results with Defy before beginning treatment (11/29/19):

Total Testosterone: 334 ng/dl
Free Testosterone (Direct): 12.0 pg/ml
DHT: 17 ng/dl
DHEA - Sulfate: 169.1 ug/dl
TSH: 1.570 ulU/ml
LH: 4.4 mlU/ml
Prolactin: 17.6 ng/ml
PSA: 0.8 ng/ml
Estradiol (Sensitive): 16.2 pg/ml
SHBG: 17.6 nmol/L

I was put me on the following protocol:

T cyp 200 mg/ml - 0.32md IM/SQ twice a week (3.5 days)
HCG 6,000 IU - 40 units SQ twice a week (3.5 days)

I had also been a long-time user of Propecia for about 18 years (which worked great for my hair, didn't notice any sexual side effects - well, I guess except for the past year and a half), which I had stopped for a few weeks already before the blood tests. I haven't gone back to it. I'll take great sex and libido over hair at this point.

I was advised that the SHBG would be challenge that would probably require more frequent injections, and that we'd see if my DHT level would rise given some of the post-finasteride syndrome reports and my long-time use of the drug. It was mentioned that testosterone cream on the scrotum could help rectify that issue if we needed it.

I wasn't due for labs until March, but I am impatient so got a set at the 6-week mark (1/29/2020) as that is when things can start to stabilize. Here are the results, which were taken about 73 hours after my last injection.

Total Testosterone: 486 ng/dl
Free Testosterone (Direct): 15.7 pg/ml
DHT: 35 ng/dl
DHEA - Sulfate: 168.6 ug/dl
TSH: 1.040 ulU/ml
Prolactin: 9.1 ng/ml
PSA: 1.4 ng/ml
Estradiol (Sensitive): 42.5 pg/ml
SHBG: 15.0 nmol/L

Overall, I have felt some improvements. The biggest is joint pain - I have had nagging shoulder pain for a few years that went away almost immediately, which I attributed to correcting a low estrogen issue. I felt really good in week 2, better libido, sexual function, sensitivity. I felt ok (and overall better) for the next few weeks, but the last 2 weeks not so much. Libido has taken a dive, as has sexual function and sensitivity.

I attribute that to my rising estrogen levels. I think I may have hit a sweet spot in week 2, but now I've blown past it. I have definitely felt the highs and lows between injections and felt almost immediately that I'd be better off on more frequent injections (every day would honestly be fine with me if it works). Honestly, I expected my total/free testosterone to be much higher, but I view my rising DHT as encouraging and hopefully that will get near the higher end if we can get the testosterone higher. I have felt a little better overall using SubQ rather than IM (I get a nice rush from IM for about 24 hours or so, but then can feel it crashing, whereby SubQ seems to be more level - if I could get the rush that I get from IM all the time, though, I'd take that!).

I will set up an early call with Defy to see if I can perhaps switch to EOD or daily injections (which hopefully will stop the highs/lows and get the estrogen under control), but I am interested in anyone's thoughts/suggestions. Sexual function and libido are my primary concerns at the moment.

Thanks,

TLawyer

 

[Cataceous]

Your Tru-T free T at this near-trough is about 18 ng/dL, which is still in the normal healthy range of 16-31 ng/dL. We can very roughly estimate that your peak serum testosterone is around 700-750 ng/dL (Tru-T ~27 ng/dL), and average is possibly around 600 ng/dL (Tru-T ~22 ng/dL). Your calculated free estradiol is relatively high at 1.25 pg/mL (0.2-1.5). Others may disagree, but I think this dosing is adequate because of your low SHBG. Dividing the dose into more frequent injections is a good idea. It will dampen the oscillations, though it won't change average levels.

You're still pretty early on, so I wouldn't change anything besides the dosing frequency at this point.

 

[TLawyer]

Your Tru-T free T at this near-trough is about 18 ng/dL, which is still in the normal healthy range of 16-31 ng/dL. We can very roughly estimate that your peak serum testosterone is around 700-750 ng/dL (Tru-T ~27 ng/dL), and average is possibly around 600 ng/dL (Tru-T ~22 ng/dL). Your calculated free estradiol is relatively high at 1.25 pg/mL (0.2-1.5). Others may disagree, but I think this dosing is adequate because of your low SHBG. Dividing the dose into more frequent injections is a good idea. It will dampen the oscillations, though it won't change average levels.

You're still pretty early on, so I wouldn't change anything besides the dosing frequency at this point.

Awesome info! Thank you! Do you think that the more frequent dosing would bring down the estrogen level without use of an AI? The estrogen level where it currently lies has just killed my libido and erection quality.

 

[TLawyer]

Your Tru-T free T at this near-trough is about 18 ng/dL, which is still in the normal healthy range of 16-31 ng/dL. We can very roughly estimate that your peak serum testosterone is around 700-750 ng/dL (Tru-T ~27 ng/dL), and average is possibly around 600 ng/dL (Tru-T ~22 ng/dL). Your calculated free estradiol is relatively high at 1.25 pg/mL (0.2-1.5). Others may disagree, but I think this dosing is adequate because of your low SHBG. Dividing the dose into more frequent injections is a good idea. It will dampen the oscillations, though it won't change average levels.

You're still pretty early on, so I wouldn't change anything besides the dosing frequency at this point.

An additional follow-up question. I had some bloodwork done in December 2017 before I noticed any signs of testosterone issues (good sexual function, average libido, mood seemed to be ok). The doctor tested only total testosterone and free testosterone, which came in at 420 ng/dl and 99.1 pg/ml, respectively. Is there anyway using the calculators to estimate any of the other elements, for example estimating what my estrogen level would have been at that point? My thought is that if I felt ok at that level, if I can determine what the estrogen level would have been then (or figure out a ratio), I can try and duplicate it with the current treatment.

 

[Systemlord]

A daily doser and low SHBG guy myself, daily (5-7mg) was the only protocol where estrogen was not a problem. The EOD protocol (20mg) wasn't as good as the daily protocol, E2 was higher by 20 points while Total T and Free T were identical to the daily protocol.

You may want to consider testing Free E2 which tends to be higher in men with low SHBG even with what looks like normal estrogen levels.

 

[Cataceous]

... Do you think that the more frequent dosing would bring down the estrogen level without use of an AI? ...

More frequent dosing should bring down peak estradiol, which may explain the benefits some guys experience.

... The doctor tested only total testosterone and free testosterone, which came in at 420 ng/dl and 99.1 pg/ml, respectively. Is there anyway using the calculators to estimate any of the other elements, for example estimating what my estrogen level would have been at that point? ...

Estradiol is going to be roughly proportional to testosterone, assuming your rate of aromatization doesn't change much over time. But estimates based on this are questionable, especially when trying to compare to your natural state, where all you have is a single snapshot of testosterone in its constantly varying daily cycle.

What time of day was the 2017 measurement? If it was 8-9 am then it should be close to a peak. The proportionality would put estradiol at 42.5 pg/mL * 420 ng/dL / 486 ng/dL = 38 pg/mL. Not that any of these numbers should be trusted, but if this was your peak estradiol then it is much lower than your current predicted peak estradiol of 42.5 pg/mL * 700 ng/dL / 486 ng/dL = 61 pg/mL.

 

[TLawyer]

A daily doser and low SHBG guy myself, daily (5-7mg) was the only protocol where estrogen was not a problem. The EOD protocol (20mg) wasn't as good as the daily protocol, E2 was higher by 20 points while Total T and Free T were identical to the daily protocol.

You may want to consider testing Free E2 which tends to be higher in men with low SHBG even with what looks like normal estrogen levels.

Thank you very much. What size needle do you use for daily dosing? Do you do IM or SubQ? I will definitely look into the Free E2 test. At this point, I’ve just been going with the tests recommended by Defy.

 

[TLawyer]

More frequent dosing should bring down peak estradiol, which may explain the benefits some guys experience.


Estradiol is going to be roughly proportional to testosterone, assuming your rate of aromatization doesn't change much over time. But estimates based on this are questionable, especially when trying to compare to your natural state, where all you have is a single snapshot of testosterone in its constantly varying daily cycle.

What time of day was the 2017 measurement? If it was 8-9 am then it should be close to a peak. The proportionality would put estradiol at 42.5 pg/mL * 420 ng/dL / 486 ng/dL = 38 pg/mL. Not that any of these numbers should be trusted, but if this was your peak estradiol then it is much lower than your current predicted peak estradiol of 42.5 pg/mL * 700 ng/dL / 486 ng/dL = 61 pg/mL.

Wow, that’s quite a difference. Yes, the 2017 test was during a peak time (8 a.m.). That does help put things into perspective a bit and maybe explain why I feel the way I do.

 

[Systemlord]

Thank you very much. What size needle do you use for daily dosing? Do you do IM or SubQ? I will definitely look into the Free E2 test. At this point, I’ve just been going with the tests recommended by Defy.

SQ was terrible, IM is for me and inject in the deltoids and quads. I use Easy Touch 29 gauge insulin syringes (no dead space) so I don't waste medicine and run out before my next refill. I would purchase the syringes online because you can get them much cheaper.

You need the 1ml syringes with 10 units (not 5 units) every .10 ml so you can dose more accurately.

 

[TLawyer]

SQ was terrible, IM is for me and inject in the deltoids and quads. I use Easy Touch 29 gauge insulin syringes (no dead space) so I don't waste medicine and run out before my next refill. I would purchase the syringes online because you can get them much cheaper.

You need the 1ml syringes with 10 units (not 5 units) every .10 ml so you can dose more accurately.

Thanks. Do you use HGH as well? I opted for it to keep some of my own production and because I had read that it helps with libido in some, but then later read about the downside of some guys having trouble keeping estradiol levels in check with it.

 

[TLawyer]

Thanks. Do you use HGH as well? I opted for it to keep some of my own production and because I had read that it helps with libido in some, but then later read about the downside of some guys having trouble keeping estradiol levels in check with it.

Sorry, I meant HCG, not HGH.

 

[TLawyer]

After speaking with Defy, my protocol has been adjusted to the following:

Testosterone cypionate - 200 mg/ml - 0.10 ml daily
HCG - 150 IU daily
Testosterone cream 50 mg/ml - 1 click daily (can move up to 2 clicks in 4 weeks).

I have also been prescribed Anastrozole 0.125 mg to be used perhaps for the first week to get high estradiol levels down. Recommendation is to take twice weekly. I am leery about taking it and hoping that the daily injections can quickly help resolve it before the Anastrozole arrives.

Hopefully this will help resolve my high estradiol issues and help me feel the effects of the testosterone more.

 

[Cataceous]

They raised your average doses a little, which I might have tried to avoid. The change in frequency should nearly eliminate peaks and troughs. If the peak in estradiol was causing you problems then this may be an improvement. On the other hand, if your average estradiol had been something like 50 pg/mL it could now be more like 55 pg/mL, absent the AI. That's only accounting for the testosterone increase. The increase in hCG from 800 to 1,050 IU per week might or might not have a significant effect on estradiol; it's impossible to predict.

I hope it works for you, but don't become disillusioned if you need a few iterations to get dialed in.

 

[TLawyer]

They raised your average doses a little, which I might have tried to avoid. The change in frequency should nearly eliminate peaks and troughs. If the peak in estradiol was causing you problems then this may be an improvement. On the other hand, if your average estradiol had been something like 50 pg/mL it could now be more like 55 pg/mL, absent the AI. That's only accounting for the testosterone increase. The increase in hCG from 800 to 1,050 IU per week might or might not have a significant effect on estradiol; it's impossible to predict.

I hope it works for you, but don't become disillusioned if you need a few iterations to get dialed in.

Thanks. Yeah, I was a little hesitant with the weekly increase in HCG (I had actually thought we might even remove it entirely), but they told me that in their experience you won't get any benefit from anything less than 150 IU per day and that it does typically have a big impact on libido/erection quality. The increase in testosterone was more to make measuring easier at the .10 mark, although they are also thought that a slight increase may give more a boost/surge. They seemed to be very optimistic about the cream making me feel "like a caveman," so we'll see.

 

[SilverSurfer]

I really think it’s a mistake to start making any changes to one’s TRT program until they’ve hit their first 90 days on TRT, THEN take bloodwork and evaluate. So often the body adjusts just fine if you give it a little time. It seems like a number of people are constantly tweaking their protocols to manage their stress and mental well-being and are here 2, and 3, and 4 years later still futzing with protocol and swapping in/out entire classes of drugs and supplements. Just my 2 cents.