A little help with dose adjustment based on labs please

[klepp0906]

Okay, its been an eventful one. I apologize for what is surely to become a long post.

I made 1 post here prior just as i was starting out, and now im ~3 months in, a few lab results in - and I feel like im finally getting closer. A quick recap, im 36 and was a poster child for almost ALL low t symptoms. My blood work came back at 195 TT with an SHBG of 55. I was prescribed 200mg/wk of tcyp.

I started out by splitting the dose and as one would imagine, felt great at first. Then I fell off a cliff. I blew up like a balloon, sex drive went back to nil etc etc. I was impatient and didnt take into consideration my body needed time to adjust and quickly requested an AI from the doc due to ankle water retention among other things.

This went away, due to either my body acclimating or the AI, maybe both. I really dont know. After 6 weeks I was referred to an endo. She didnt even run my E2 so all I saw were my levels. I came back at 1106 total test and 188 free. I quickly left her for a multitude of reasons and my GP agreed to simply continue treating me.

He was happy with the levels and so we went for another 6 weeks. I self lowered my dose to 160mg split into 2x80mg injections. I wanted to bring my T down in an effort to perhaps eliminate the presumed need for an AI, and i noticed my BP increasing where it used to be perfect. (on bad days my systolic was as high as 144, diastolic was always good, and my resting heart rate was obnoxious ~90)

One of the largest issues I needed to address to feel good, was my libido. I wasnt having much luck in this area, nor was I getting any type of consistent morning wood. I kept my T dose the same and began tinkering with AI. I noticed that when id increase the dose to .5 twice a week, I'd get my wood back, then id lose it again, so id drop the AI. I'd get my wood back, then I'd lose it again. I hypothesized I had to be overshooting. I began taking .25 eod and 80mg twice weekly of testosterone. This has had the best results for me so far, but it wasnt right away. Took weeks before things started to feel a little better. (still nowehere near id like unfortunately). That plus the fact I got emotional at the end of a stupid cartoon, I assumed my E2 had to still be really high but I wasnt going to go blind any longer so I requested bloods.

I'm now here looking for advice on moving forward. My goals are to increase my darned libido, and ideally stop my hematocrit from increasing any further, maybe even lower it and/or help my bp down. I heard a lot of high shbg guys say they felt better on weekly injections, and I was intending to make the swap, but based on the following labs i'll be linking - the treatment has actually driven my SHBG down to 33. I dont think this is really considered high anymore? It makes sense as at injection time your Test will be much higher so your likely to feel its effects more pronounced, coupled with what I assume may be better libido due to fluctating hormones throughout the week. (going off the fact that as often as i changed my AI is as often as I got morning wood lol).

I really dont know, hence my being here. What would you guys advise? Do i need to be concerned about my hematocrit where it is now? Its risen from ~48 just before i started to where it is now. What about my cholesterol readings? Should i continue on my twice weekly and drop another 20mg a week? Or should I go to weekly and keep injection at 160? E2 seems on point at .25 eod, how will dropping my dose 20mg (if thats suggested, effect that dosage?)

FWIW my labs were taken on Saturday morning and I do my 2nd injection saturday evening. It did fall on an arimidex dose day which I take in the mornings, and i skipped until I gave blood.

here are the labs and thanks for any time and help!

EDIT: in case anyone is wondering, i requested the sensitive assay which I assume is what I got as theres a notation after the reading if you click the link mentioning the The Elecsys Estradiol assay? Says adult male <39

 

[Vince]

When you start the trt protocol. I think it's better to start too low then too high like you did. If it was me, I would drop the AI and inject 50 mg of testosterone twice a week. After you start your new protocol, would have Labs again in 6 to 12 weeks and then make your adjustments.

 

[klepp0906]

yea, its a shame. I wish I would have started lower too. But already struggling with libido, I think slashing my testosterone dose that drastically might be the opposite of what i need. I have to find a balance between #'s and symptoms right?

I already struggle mentally to drop 20mg which of course is in my head ;p

If im being honest, my doctor - while malleable and reasonable, im sure has a limit. He isnt so freewheeling that hes gonna be okay with me being my own doctor and has already tried to hand me off to an abysmal endocrinologist once. If he sees my numbers take a nose-dive, he's going to know im medicating myself and a lot of doctors arent keen on that.

I do appreciate the feedback however. Ive certainly been through every thread on every result that google has returned on this and similar matters for what seems like, ever now.

Ive dried up just about all resources so opinions and anecdotal is exactly what im looking for at this point ;p

for example, if i were to change from biweekly injects to weekly injects (also trying to take scar tissue into consideration, and convenience since I have alotta years ahead of me i hope) would I wait a full week from my last inject before starting, or would I just start on a normal inject day, and let it adjust itself? (would likely end up extra high at first i imagine?).

Im just exhausted with all the changing, i know 3 months isnt that long considering how long it takes some people to dial in, but with young kids, a wife, and the acne finally settling down - I just want to move forward asap ;P

There is merit in what your saying, but that would almost be like restarting, whereas i feel like now im so close and know where i stand, i can just walk it back or adjust in smaller increments so to speak. The only symptoms that seem to still be plagueing me are libido and subpar sleep. Lifts have gone up, energy has gone up, mood has gotten better overall. Apetite is insatiable. (the weight gain to show it, ugh!)

Impatience - bane of my generation ;p

 

[fifty]

I’m reading several guys here taking ai separately from their shots. Guys if you’re gonna use anastrozole then take it with your shot not a day later.

 

[klepp0906]

I’m reading several guys here taking ai separately from their shots. Guys if you’re gonna use anastrozole then take it with your shot not a day later.

i think theres two schools of thoughts on this. 1 based around half life that dictates to take with shots depending on frequency of shots. Either day of or day after relative to schedule (weekly vs e3.5). The other, supported by a study (which was cited, but i did not save) that showed whether it was a large dose or a spread out dose, the effect on Estrogen worked out to the same more or less.

I cant weigh in other than the anecdotal with wood coming and going (which i still dont have consistent now) yet my numbers are argueably spot on.

 

[Vince]

Because of the half life of testosterone, better to take an AI 24 hours after injection. But to be honest with you I don't think it really matters that much.

I've been on trt 4 years now, it did take me about 3 years to get completely dialed in. I did feel great at the beginning but then again I kept adjusting my protocol until I felt that I was completely dailed in.

 

[klepp0906]

Because of the half life of testosterone, better to take an AI 24 hours after injection. But to be honest with you I don't think it really matters that much.

I've been on trt 4 years now, it did take me about 3 years to get completely dialed in. I did feel great at the beginning but then again I kept adjusting my protocol until I felt that I was completely dailed in.

yep, its tricky. So ive read (and found) thus far. Ive even seen some evidence pointing to Levels peaking the day after an injection and others arguing it takes ~3 days. Exhausting. At the cost of growing hair on my back i never had, and losing hair on my hairline faster than I have, im hoping to glean just a little more return on my investment so to speak.

Time will tell. As you said it took you ~3 years god forbid ;p

Im going to drop my dose another 20mg and my ai from eod to 2x a week and see what happens. After a month or so there depending on how i feel, ill consider trying the weekly.

Doc doesnt want me in for blood work until january'ish.

Does 50 hematocrit warrant giving blood or should I be okay to watch how it behaves with dropping my test dose a little further until next bloods a few months out?

 

[Gman86]

A HCT of 50 is nothing to be concerned about. Just see what it is on your next blood work, and if it’s more than 50 maybe consider donating blood. But definitely no need to worry at 50.

Also, you might want to look into supplementing with DHEA. Your level is sub par. Obviously you want your DHEA level at the top of the range, and some doctors like it even higher. Dr. Rob Kominiarek, a well known doctor around here, likes his patients’ DHEA level around 500-800. Increasing DHEA can improve libido, amongst other benefits, so I think it’s a no brainer to start supplementing with it, especially considering you’re low in it. I personally don’t take it, but am most likely going to add it to my protocol if my level keeps declining like it has. I know a few members here use Douglas labs brand. You can get a bottle on amazon. No prescription needed.

 

[Vince]

I would have to agree of HCT of 50 isn't too high but you may want to start donating blood, so it doesn't get too high and then you have to donate. It took my HCT two years to stabilize and I believe going to daily injections also help stabilize it. Be careful with DHEA it will convert testosterone into estrogen for men.

 

[Gman86]

Ya good point. It can have some conversion into E2. If I was you, I would personally keep your protocol the same, and just add DHEA to see if it helps with libido.

 

[madman]

Okay, its been an eventful one. I apologize for what is surely to become a long post.

I made 1 post here prior just as i was starting out, and now im ~3 months in, a few lab results in - and I feel like im finally getting closer. A quick recap, im 36 and was a poster child for almost ALL low t symptoms. My blood work came back at 195 TT with an SHBG of 55. I was prescribed 200mg/wk of tcyp.

I started out by splitting the dose and as one would imagine, felt great at first. Then I fell off a cliff. I blew up like a balloon, sex drive went back to nil etc etc. I was impatient and didnt take into consideration my body needed time to adjust and quickly requested an AI from the doc due to ankle water retention among other things.

This went away, due to either my body acclimating or the AI, maybe both. I really dont know. After 6 weeks I was referred to an endo. She didnt even run my E2 so all I saw were my levels. I came back at 1106 total test and 188 free. I quickly left her for a multitude of reasons and my GP agreed to simply continue treating me.

He was happy with the levels and so we went for another 6 weeks. I self lowered my dose to 160mg split into 2x80mg injections. I wanted to bring my T down in an effort to perhaps eliminate the presumed need for an AI, and i noticed my BP increasing where it used to be perfect. (on bad days my systolic was as high as 144, diastolic was always good, and my resting heart rate was obnoxious ~90)

One of the largest issues I needed to address to feel good, was my libido. I wasnt having much luck in this area, nor was I getting any type of consistent morning wood. I kept my T dose the same and began tinkering with AI. I noticed that when id increase the dose to .5 twice a week, I'd get my wood back, then id lose it again, so id drop the AI. I'd get my wood back, then I'd lose it again. I hypothesized I had to be overshooting. gan taking .25 eod and 80mg twice weekly of testosterone. This has had the best results for me so far, but it wasnt right away. Took weeks before things started to feel a little better. (still nowehere near id like unfortunately). That plus the fact I got emotional at the end of a stupid cartoon, I assumed my E2 had to still be really high but I wasnt going to go blind any longer so I requested bloods.

I'm now here looking for advice on moving forward. My goals are to increase my darned libido, and ideally stop my hematocrit from increasing any further, maybe even lower it and/or help my bp down. I heard a lot of high shbg guys say they felt better on weekly injections, and I was intending to make the swap, but based on the following labs i'll be linking - the treatment has actually driven my SHBG down to 33. I dont think this is really considered high anymore? It makes sense as at injection time your Test will be much higher so your likely to feel its effects more pronounced, coupled with what I assume may be better libido due to fluctating hormones throughout the week. (going off the fact that as often as i changed my AI is as often as I got morning wood lol).

I really dont know, hence my being here. What would you guys advise? Do i need to be concerned about my hematocrit where it is now? Its risen from ~48 just before i started to where it is now. What about my cholesterol readings? Should i continue on my twice weekly and drop another 20mg a week? Or should I go to weekly and keep injection at 160? E2 seems on point at .25 eod, how will dropping my dose 20mg (if thats suggested, effect that dosage?)

FWIW my labs were taken on Saturday morning and I do my 2nd injection saturday evening. It did fall on an arimidex dose day which I take in the mornings, and i skipped until I gave blood.

here are the labs and thanks for any time and help!

EDIT: in case anyone is wondering, i requested the sensitive assay which I assume is what I got as theres a notation after the reading if you click the link mentioning the The Elecsys Estradiol assay? Says adult male <39




------------------------------------------------------------------------------------------------------


SHBG of 55. I was prescribed 200mg/wk of tcyp.

- that dose would drive ones SHBG down and definitely increase e2.

I started out by splitting the dose and as one would imagine, felt great at first. Then I fell off a cliff. I blew up like a balloon, sex drive went back to nil etc etc.

- high e2

I self lowered my dose to 160mg split into 2x80mg injections. I wanted to bring my T down in an effort to perhaps eliminate the presumed need for an AI,

- in many cases lowering overall t dose/FT will result in decreased estradiol.

One of the largest issues I needed to address to feel good, was my libido.

- libido is much more complex than simply TT/FT/e2 levels as one can have healthy FT levels along with e2 in balance and still have issues regarding libido/ed as both are mult-faceted- dysfunctional thyroid/adrenals, excess physical/mental stress, poor cardiovascular/endothelial function, lack of sleep, neurotransmitters function(dopamine/serotonin),poor diet, underlying health issues, overall unhealthy lifestyle.....you get the picture!


I wasnt having much luck in this area, nor was I getting any type of consistent morning wood. I kept my T dose the same and began tinkering with AI. I noticed that when id increase the dose to .5 twice a week, I'd get my wood back, then id lose it again, so id drop the AI. I'd get my wood back, then I'd lose it again. I hypothesized I had to be overshooting. I began taking .25 eod and 80mg twice weekly of testosterone.

- do understand that achieving morning wood is not always related to T/E2 levels and that one does not need to achieve nor have morning wood every morning upon waking 7 days a week to be considered dialed in and T/E2 levels are optimal.....huge mistake.

-NPT (nocturnal penile tumescense) happens during REM stage (rapid eye movement) when you are dreaming and depending upon when you awake morning wood should not always be expected.

-if anything when testosterone levels are healthy and other hormones are in balance one should have a healthy functioning libido (increase sexual thoughts/desire) but again other factors come into play as I stated above and if one is expecting that when all other hormones are in balance that they should be waking up everyday of the week thinking about and craving sex without taking into account other factors which can negatively effect libido than it will be a loosing battle if one is always chasing numbers or gauging when and how often they achieve an erection.....the mind is the bodys most powerful sex organ.

-regarding erectile function/health sure if testosterone levels are healthy and other hormones are in balance one should have firm erections/experience nocturanal penile tumescense/achieve spontaneous erections but again other factors come into play as I stated above and if one is expecting that when all other hormones are in balance that they should be getting rock hard erections, waking up with morning wood 24/7 and having spontaneous erections often without taking into account other factors which can negatively effect erectile function/health it will be a losing battle if one is always chasing numbers or how often they achieve an erection....ones cardivascualr/endothelial health play a big role.



My goals are to increase my darned libido, and ideally stop my hematocrit from increasing any further, maybe even lower it and/or help my bp down.

- in many cases lowering overall t dose/FT will result in decreased hematocrit

- not saying in your situation but in general one needs to keep their expectations of a healthy libido realistic as in many cases a lot of men seem to think that when going on trt that they are going to achieve a raging sex drive 7 days of the week along with rock hard erections at will when in fact than they will be in for a world of hurt as both libido/ed are much more complex than simply having healthy testosterone levels.


the treatment has actually driven my SHBG down to 33.

- seeing as your SHBG is now 33 nmol/L and your TT is 1137 ng/dL on your current protocol if we take your TT/SHBG and use the calculated (Vermulen) method for Free & Bioavailable Testosterone:

- your FT is 28.6 ng/dL= 2.51% and your BT is 671 ng/dL= 58.9%

- not saying you need to but you do have room to lower your dose slightly and bring down your FT a little possibly leading to the elimination of an aromatase inhibitor.

- most men do well with FT 2-3% of TT but many think higher as in 3% FT is always better when in fact some may do better overall closer to 2%.

- although TT is important to know FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive benefits.

- even though we all aim for healthy FT levels there is still such a thing as excess FT which can lead to excess DHT/E2 among other issues!

 

[klepp0906]

Thank you VM for taking the time on that thorough reply. I know how valuable of a resource it is

I am trying my best to keep things realistic, just coming from a non existent (even perhaps an aversion) to sex - I was expecting a larger increase in drive. I do think about sex more, the connection to actual physical DRIVE seems to be missing. Spontaneous erections during the day certainly do not happen, and I do not sleep well so I imagine my wake/timing may in fact have somethign to do with the infrequent "morning wood" so to speak.

I do find it more often in the middle of the night than I do during my final "wake" and did not consider it in that way.

To be fair, as far as libido being complex and multiple faceted, I too realize this, however assumed (evidently incorrectly) that add enough testosterone, and it will overcome any other issues.

I do have a very high stress life (an infant and a toddler) and made some really bad choices when I was younger. (opiate addict and likely ruined my brains reward system to some degree or another). Perhaps i need to give it more time. Most people say that libido is the first thing to come back, but i HAVE heard people say it was the last for them as well.

The numbers by and large look good, but i figure im a fair amount over range at my peak, and starting TRT did increase my bp a bit (and hct) so i figure lowering it cant do much harm if it doesnt hamper my already struggling libido. Id even consider keeping it the same but i doubt my doc is going to be too happy with things over range cause.. you know... doctors and ranges ;p

Cortisol and thyroid look good?

What is everyones take on switching to weekly? Bad idea?

Anyone heard any anecdotal evidence surrounding lowering T helping with libido? (or sleep?)

Lastly, it will be some time before I go back for more labs, assuming i were to drop to 140, what do you guys recommend I do with my AI? I dont want my doctor to think im going all willy nilly adjusting things all the time so if my E2 blows up sky high he's gonna know something changed, and by the same token if its bottomed out next time... so if its currently taking me almost 1mg a week to keep me at 26 would dropping 20mg off my test dose and keeping the AI the same take it way too low? or just a few points?

Sincerely, thank you for the time guys. Hopefully i can pay it forward after a few rounds and some more introspection/experience with this journey.

 

[klepp0906]

well, just posting back instead of creating another thread. Libido has gotten a little better yet. Still minimal morning wood, but i think its due to having sleep issues. I sleep very bad, I have for maaaaaany years. Ever since i got clean from opiates basically. Assumed it would work itself out, never did. I fall asleep ez-pz but staying asleep is almost an impossibility. I usually get about 6 hours and thats with waking up 4 times or so a night. Likely the crux of many of my issues, also something to be tackled at a later time, once i get this sorted.

I did speak with the doctor. He wasnt put off by being over the range, confirmed hematocrit was fine. That leaves me with 2 concerns. I'm just thinking aloud here so I apologize if this is a bit "all over the place".

I know numbers are based on ranges, and at some point, im going to age beyond the point that the top end of my range will drop. Doc can look past me being 50 points over, but doc wont be my doc forever (he's older) and when my -age for range- value changes, i wont be ~50 over ill be like ~250 over. (i think next step down drops to like 890 being the top).

What i mean to say is, Im satisified more or less with how ive begun to feel with my current protocol, and I dont want to drop my dose in an effort to lower my TRT based on the future range, at the same time - i imagine I will have to some day to appease the powers that be. I was a participant in how long it took for things to start feeling right using this protocol and would hate to restart the clock.

That is concern 1

concern 2 is my bp. went from "this is actually the best reading i saw today" (117 systolic from nurse) to "yea this is a little high" (when i came back at 146). Do we think dose has a dramatic impact on bp?

Im trying to ascertain whether i should bite the bullet and adjust downward now, or just keep on keeping on until the point at which it becomes an issue (at least regarding ranges).

I have to address the bp rapidly, heart disease and strokes run rampant in my family on both sides so i dont want to press my luck.

I will say, the dose, protocol, and bp issue is compounded by the fact I live a bodybuilder type lifestyle, and made a ton of changes right around the time I started TRT.

I went into bulk season, and loosened the reigns a little bit too much right around the time i started TRT. In short, im now 40lbs heavier than I was in august. Sure some of it is good lean tissue, some of it is water, but a lot of it is adipose tissue which doesnt help estrogen from what i gather.

In short, now that my body has acclimated to much more substantial amounts of testosterone, I wonder if its all the bad weight I put on contributing to the blood pressure.

gonna start cutting new years day, and hopefully peel off 20 pounds by march. Hope that does the bp in, but also concerned its going to take my now "almost ideal" protocol and drive my e2 super low. (if fat really affects aromatization that much).

thoughts?

if .25 eod of arimidex gets me where i need to be @ 18% bodyfat, is it a certainty it will be too much @ 10%? If so, how/at what point would one begin to address this? Would i taper when the weight starts dropping?