8 weeks into TRT - need help with protocol adjustments

[Deleted member 25692]

34yo male, 5′10, 185lb, low(ish) bodyfat, healthy diet, weight training 3-5/week

I've read the stickies and I'm sorry I won't have all the required lab test results for you to provide. Still working this thing out with my doc who for some reason doesn't want to order too much labs so might have to switch or do my own labs in the future..

All below results labcorp, same location

Initial 1, Initial 2 (after 4weeks), TRT 1 (4w mark), TRT 2 (3w mark)

TT: 360, 367, 547, 985 (264-916)
FT: 7.3, 6.5, 8.1, 23.2 (8.7-25.1)
SHBG: N/A, 38, 63, NA (not measured but calculated from Albumin + TT/FT data)
DHEA: 258.3, NA, NA, NA
E2: 18.1, 14.1, NA, 44.6 (8-35) (first two with ECLIA method, last one with Sensitive, range for sensitive)
Estrogen Total: NA, 116, 124, NA (40-115)
Estrone Serum: NA, 57, 55, NA (12-72)
Lipids: NA, NA, OK- in range, NA (can post more details if you need)
Thyroid: not measured, something I now regret I didn't do in the Initial labs.

Protocol and sympthoms:
Initial: fatigue/no energy, brain fog, no libido, no muscle gain, bad sleep, no willingness for social interaction etc. + mild gyno!
TRT 1: Cream 50mg 1gram/mornings
-> gave me some energy (but not as steady as in TRT2 often fading towards evening) , slept better, no effects in libido, felt like could be still better overall. Labs taken 1.5h after cream application.
TRT 2: E3.5D Injections, 75mg/time
-> weeks 1-2 were rough, ups/downs, flu symptoms etc. but now in week 4 more steady energy, still sleep well but no libido. Gyno might be getting worse - hard to say so quickly! Labs taken 3.5d morning before injection.

What do you think I should try next? Libido is clearly a problem and I'm worried of the high E2/Gyno - they're likely connected together. I'm not too excited of starting with AI since it's another med to eat for possibly for the rest of the life then and I'm young..

I'm thinking of adding HCG into protocol, lowering the T dose a little + trying EOD injections? I know having the SHBG would help in deciding the protocol but it seems my FT went up quite well without going over 1000 with the TT and I'm thinking SHBG might not be that high anymore and I could better tolerate more frequent injections without in need to go for AI.

Thank you!!

 

[MarkM]

Hi Burger,

Going forward you need to not run labs for 6 weeks of changing your protocol only because it takes 6 weeks for us to reach a steady state at a minimum. I prefer to wait 8 weeks but at least 6 weeks. Until 6 weeks your body is still adjusting and whatever labs taken before then won't mean much.

Total T and Free T look good and E2 is not terribly high but for some people that would be extremely high. It has gone up because your T has gone up.You mention gyno might be getting worse. Do you have a history of gyno? Do you have burning and itching nipples or a lump underneath the nipples? Some men get itchy nipples just from starting testosterone but it goes away.

We really need to know what the SHBG is. That will tell so much in and of itself. All protocols are or should be established in large part off what the SHBG is. Your SHBG is probably lower than when you calculated it from the cream. The injections of testosterone will suppress it somewhat.

If you stay on the same protocol your E2 is probably going to go up a little more which may present an issue for you. EOD injections can work with low SHBG and guys with low to moderate SHBG. An EOD injection protocol will help mitigate the E2 and might bring it down just enough to help you.

 

[Deleted member 25692]

Thanks Mark!

Gyno - I’ve got visible lumps under both nipples and have had them since i was a teenager. It’s hard to tell if they’re getting bigger but definitely sensitivity and strange feeling in them (on/off not all the time).

I will get new bloods done after some weeks on this protocol with SHBG. I know I’ve been a bit quick on my moves but just wanted to get better fast.

 

[MarkM]

Have you spoke with your doctor about medication to treat the gyno? There are some medications that can knock it out if it has not progressed to far.

 

[Deleted member 25692]

Have you spoke with your doctor about medication to treat the gyno? There are some medications that can knock it out if it has not progressed to far.

Are you referring to AIs or something else? Haven’t talked about this with him yet.

 

[MarkM]

Are you referring to AIs or something else? Haven’t talked about this with him yet.

Something like tamoxifen?

 

[Vince Carter]

I agree With MarkM I'd really like to see followup labs with SHBG, E2 LC/MS/MS, if it's affordable for you "Estradiol, Free", would be useful too I think. Your FT level looks good I prefer to see it at the lab range but youre close enough I wouldn't adjust the dosing there.

 

[Deleted member 25692]

I agree With MarkM I'd really like to see followup labs with SHBG, E2 LC/MS/MS, if it's affordable for you "Estradiol, Free", would be useful too I think. Your FT level looks good I prefer to see it at the lab range but youre close enough I wouldn't adjust the dosing there.

Thank you Vince. I really appreciate all of you guys with years of experience on TRT giving me feedback.

I edited the original post: added one SHBG number that I was able to calculate that was missing + added the following for Estrogens:
Estrogen Total: NA, 116, 124, NA (40-115)
Estrone Serum: NA, 57, 55, NA (12-72)
- Don’t know if those really tell anything more - I’m under the assumption E2 mainly matters, right?

Had a chat with my doc and he suggested starting of HCG (3*week 2,000 IU ramp up dose with possibly to lower it later) for the libido. I’m thinking I’ll give the Testosterone some time still with twice/week method and maybe start the HCG next month. Will also get full labs done around that time and post them here.

Energy is really good but still waiting for that libido to appear from somewhere...

 

[Vince Carter]

Unfortunately those E tests are the wrong tests and just not usable for anything. If anything with the HCG, youre more likely to boost E production through that kind of direct stimulation in the testes and given you have some Gyno symptoms I'd not do that; HCG. Maybe some much lower dosing in the range of 250iu E3.5D is a pretty typical TRT dose, what your Dr is prescribing is way too much.

 

[Deleted member 25692]

Unfortunately those E tests are the wrong tests and just not usable for anything. If anything with the HCG, youre more likely to boost E production through that kind of direct stimulation in the testes and given you have some Gyno symptoms I'd not do that; HCG. Maybe some much lower dosing in the range of 250iu E3.5D is a pretty typical TRT dose, what your Dr is prescribing is way too much.

That’s what I thought.. the plan is still to hold back and let the T do it’s job and I’ll then start with small amount of HCG E3.5D like you suggested later. Will keep that EOD T protocol as an option for later if gyno gets worse.

 

[HoustonTX]

Did I read that corrrectly? A 2500iu dose? That’s what a doc would give you to try and restart your hpta, if you were getting off testosterone. You think you feel bad now. You would feel awful if you injected 2500ius at once

 

[HoustonTX]

If your doc really suggested that, I would seriously consider finding a new doc

 

[mooseman109]

I did not like hcg, it did nothing for me except raise my e2 some. For me a reading of e2 in 44 range like yours would have me so freaked out with anxiety I would be a mess. So, as Mark mentioned, it can affect some of us. My guess would be that high of e2 is contributing to your libido. As much as I would rather not go on an AI, it may be your choice. My only concern with AI's is that it is just one more thing to try to juggle and work out.

 

[Deleted member 25692]

Did I read that corrrectly? A 2500iu dose? That’s what a doc would give you to try and restart your hpta, if you were getting off testosterone. You think you feel bad now. You would feel awful if you injected 2500ius at once

That’s what he wanted, 3x2000iu. I knew it was high, suggested 500iu and he said ‘no, it’s normal dose’ go with it. I’m thankful for forums like this and guys like you to provide me an “alternative opinion”. Got the HCG now and will start in few weeks. I’m interested in adding it for two reasons: seeing if it effects libido and things down there but also to hopefully maintain fertility as I’ve got no kids yet but hopefully will one day (years ahead).

Libido has gotten little better but still not feeling like I’d like to. By the way: my nipple sensitivity and the occasional test ache has stopped- either it’s all good now or I’ve shut down the axis and the levels have gone down a bit. Does that make sense? It’s now been about 5weeks since I started the injections and about 10weeks overall.

 

[Deleted member 25692]

Update

I eventually added HCG into the protocol after I felt I was well dialed in with my T shots, things started going much worse from there. In consideration that HCG might increase T levels I also reduced the dosage (and switched to E3D instead of E3.5D protocol for convinience). The results correlate well with my labs: lost the libido (again! After just getting it back), mild ED problems, slept worse,gyno worsened and overall didn’t feel like energized winner guy anymore that I did for a while.

What are your thoughts? I’d like to form an educated opinion before seeing the doc again. I’m in my 30s so fertility is important and so is stopping the gyno for which I’m clearly prone to. Popping AIs for the rest of my life also doesn’t seem appealing. I was also thinking going back to creams with the cost of lower T levels if I’d help with E levels..

Timeline
Initial 1, Initial 2 (after 4weeks), TRT 1 (+4 weeks of previous), TRT 2 (+3.5 weeks), TRT 3 (+9 weeks, on the protocol 4w before labs)

Protocol
TRT 1: Cream 50mg 1gram/mornings
TRT 2: E3.5D Injections, 75mg
TRT 3: E3D injection 60mg + 500IU HCG

Tests
TT: 360, 367, 547, 985, 693 (264-916)
FT: 7.3, 6.5, 8.1, 23.2, 15 (8.7-25.1)
SHBG: N/A, 38, 63, NA, 33.5
E2 ECLIA: 18.1, 14.1, 24.1, NA, 48.4 (7.6-42.6)
E2 Sensitive: NA, NA, NA, 44.6, 40.7 (8.0-35.0)
Estrogen Total: NA, 116, 124, NA, 168 (40-115)
Estrone Serum: NA, 57, 55, NA, 90 (12-72)