asking for support on how to proceed with my trt after my last bloodwork

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gingerale

New Member
Hi all

I am new here in the forum, but have been a silent reader for a while.
My current blood work, which is the first time I've had the extent of it since starting my TRT, is now causing me to ask for support here.

Background story
Since the end of my 20s I suffered from a strong depressive mood, lack of drive (also lack of sex drive) and pronounced anxiety. After some time, visits to various doctors and various tests, it was finally determined that my testosterone level is at the lower end of the normal range. However, I was not prescribed any replacement therapy by the doctor here on the grounds that I was too young. It is difficult here in this country. So I took matters into my own hands and started a TRT with Testosterone Enanthate at 125mg/e7d. This was 4 1/2 years ago.

After about half a year I halved the interval but kept the dose (62mg/e3.5d). With the e7d protocol, I clearly noticed that my energy level dropped from the 4th day after the injection and the problems (depressed mood, listlessness, anxiety) came back more or less easily. A good 3 years ago I increased the dose to 125mg/e3.5d. There were honestly two reasons for this. One was I wanted to have even more energy in general, and the other was I wanted to make more progress in the gym.

After my hematocrit value rose to the upper end of the reference over time, I changed my protocol to 62.5mg/e2d.

Previous protocols summarized again:
125mg/e7d Test Enanthate
62mg/e3,5d Test Enanthate
125mg/e3.5d Test Enanthate
62,5mg/e2d Test Enanthate (current protocol)

Current Feeling:
I felt a significant energy boost after switching to 62.5mg/e2d in October 2021. However, this now reversed to the opposite. The above problems are more present than ever and feel like they did before starting trt.

Current bloodwork:

TestName; Result; Reference Range
Hemoglobin 18.4 g/dl ; 13.7-17.5
Hematocrit 53.4% ; 40.1-50.0
PSA 0.93ng/ml ; <4.0
Estradiol 95.9pg/ml ; 11.3-43.2
Prolactin 20.4 ng/ml ; 4.1-15.2
Testosterone >52.0 nmol/l ; 8.64-29.0
Free testosterone 75.25 pg/ml ; 8.85-21.4
Dihydrotestosterone 1078.33 ng/l ; 106-719
SHGB 13.4 nmol/l ; 18.3-54.1


Questions about the result and how to proceed with the trt:
- Should I consider donating blood with this hematocrit value?
- What can I do about the very low SHGB value?
- Should I increase the injection interval to ed to counteract the low SHGB value?

My plan now would be to adjust the dose continuously downwards over a period of 4-6 weeks, so that I end up with 100mg per week?
Why don't I want to set the weekly dose directly at 100mg? I am afraid that estrogen related side effects (e.g. gynecomastia) will occur and that I will have even less energy and more anxiety.

After another 6 weeks on the target dose, I would do another blood work and determine further action if necessary based on the values.

The goal is, of course, to increase the quality of life again. And to keep the values in a healthy (reference) range in the future.

What do you think about this procedure? Do you see a more sensible way?

Many thanks in advance and best regards
 
Last edited:
Defy Medical TRT clinic doctor
I would lower T dose to 50 mg twice per week.

How is your sleep quality?

How old are you? Are you taking any medications?

Any life situations that are bringing you down?

I have been on TRT for 37 years and have learned that small adjustments in dose do not solve low mood/fatigue if other factors are involved.
 
Hi @Nelson Vergel

I am 35.
I am not currently taking any medication. Until 2 years ago I was taking an anti depressant. Since starting trt I had always reduced the dose at certain intervals .

My sleep quality is not so good, at least when I am not supplementing melatonin. Without melatonin I often wake up in the middle of the night and am wide awake until the early morning.

At the moment I am very stressed by everyday life, which in my opinion is due to the renewed anxiety and the low energy level. I am currently very quickly stressed.

Why would you increase the interval again? I had assumed that with a low SHGB level, shorter intervals would be recommended to avoid hormonal fluctuations.

Regardless of the interval, would you recommend lowering the dose gradually over a few weeks?
 
TRT can worsen sleep apnea, maybe a sleep study is in order.

More frequent injections may help. I got compareable levels on 7 mg daily when compared with 20 mg EOD.

The biggest difference was in the estrogen levels, way lower on the daily schedule, 28 versus 49.
 
thank you for the answers so far.

I have now started to reduce the dose. I am now proceeding as follows:

- 2 weeks: 50mg e2d
- 2 weeks 37,5mg e2d
- 2 weeks 27,5mg e2d

After 4 weeks on the target dose I would do a new bloodwork and see where the values level off

What I still wonder is, on the one hand e3,5d is recommended and on the other hand to switch to daily injections.
I would not change the injection interval at first, but if necessary only in the second step.

Since my SHGB level is so low and estrogen is significantly elevated, I tend to test daily injections if the values do not fit in the future.

I will discuss the topic of sleep apnea with my general practitioner.
 
thank you for the answers so far.

I have now started to reduce the dose. I am now proceeding as follows:

- 2 weeks: 50mg e2d
- 2 weeks 37,5mg e2d
- 2 weeks 27,5mg e2d

After 4 weeks on the target dose I would do a new bloodwork and see where the values level off

What I still wonder is, on the one hand e3,5d is recommended and on the other hand to switch to daily injections.
I would not change the injection interval at first, but if necessary only in the second step.

Since my SHGB level is so low and estrogen is significantly elevated, I tend to test daily injections if the values do not fit in the future.

I will discuss the topic of sleep apnea with my general practitioner.
Did you end up donating?
 
Beyond Testosterone Book by Nelson Vergel
Got my blood results now after 4 weeks with 15mg daily test e.

Feel pretty crappy to be honest. No drive, anxious and bitchy. In addition, little assertiveness. Libido is very weak and have ed for the first time in my life. Normally I am a person with a lot of sexdrive. In addition, for several days sensitive and itchy nipples Here are the stats:

Hematocrit 51.2

Hemoglobin 17;3

Estradiol 58.4

Shgb 17.5

Testosterone 31.6

Free testosterone 42.30

Dht 317.51

Prolactin 16;5

Labranges as in First comment

Dht seems very low to me in proportion. Does daily injection inhibit dht conversion?

I am wondering how to proceed. My gut says switch to e3d as soon as possible. (Approx 100mg per week)

Mind says reduce dose further to 10mg daily and test. Just wonder then what will happen with dht. The value will probably continue to drop.

Do you have any opinions or advice?

Thank you and many greetings
 
Last edited:
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