Concerned about results 2 months into TRT - Advice Please

S1W

Well-Known Member
I just got my results back after my first two months on TRT, and things are not perfect, which doesn't exactly surprise me based on the way I've been feeling.

Background: 39 year old male, fit/athletic, no other health issues prior to starting TRT (aside from those associated with low T - I had most of those issues).

Pre-TRT:

TOTAL T: 333 ng/dl (250-1100)
FREE T: 51.3 pg/dl (35-155)
FSH: 3.3 mIU/ml (1.7-8.6)
LH: 2.8 mIU/ml (1.5-12.4)

Those were all of the tests done before starting TRT, including several more total T tests, all of which came back on the low end of normal. I was prescribed 200mg/g (20%) compounded cream, and I have been applying 1/2g daily. No HCG, no AI.

Post-TRT:

TOTAL T: 795 ng/dl (264-916)
FREE T (DIRECT): 25.2 pg/ml (8.7-25.1) High
ESTRADIOL, SENSITIVE: 38.4 pg/ml (8-35) High
HEMOGLOBIN: 17.3 g/dl (13-17.7)
HEMATOCRIT: 50.5 % (37.5-51) (not flagged as high but close)
SHBG: 26.9 nmol/L (16.5-55.9)
TOTAL CHOLESTEROL: 203 mg/dl (100-199) High
HDL: 56 mg/dl (>39)
LDL: 122 mg/dl (0-99) High
PSA: 0.9 ng/ml (0-4)
LH: 0.1 mIU/ml (1.7-8.6) Low
DHEA: 337.3 ug/dl (102.6-416.3)
TSH: 2.080 uIU/ml (0.45-4.5)

Happy to provide more numbers for the various other tests that were run, but those are the highlights. My concerns are with hematocrit, estradiol, and cholesterol.

Experience:

I started out feeling amazing for the first few weeks. I have since heard this referred to on this board and elsewhere as the "honeymoon phase", and that sounds right to me. The next several weeks I would say that I felt moderately better than before TRT, but not as good as first few weeks. The last several weeks through present, I feel ok but hard saying if any better than pre-TRT. I noticed some fogginess, occasional low moods, mild discomfort around nipples that weren't there in the first few weeks - all of which I guessed even before seeing this may have been due to high E2.

My thoughts: as T levels increased, E2 increased and effectively offset any of the benefits I might have been feeling.

What thoughts or advice to you guys have on where to go from here? I'm in the process of switching to a more knowledgable TRT doc, but until then, I'd really appreciate any thoughts you guys might have.
 
I don’t think you should be concerned about your cholesterol levels. Your HDL looks fairly good and you didn’t list trigs, so HDL to trig ratio can’t be calculated. But from everything I’ve studied, having high HDL, low trigs, low fasting insulin and reasonable a1c are what’s most important. If you are low carb, check out the site cholesterolcode for some good diet perspectives and analysis.
 
Your numbers don't look back, it does that time to get dialed in. You could get a complete thyroid panel, just to be on the safe side.
 

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⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

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Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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