Dosage vs Side Effects(Acne, Puffy Nipples)

[htownhomie]

Hi everyone this is my first post so go easy on me lol...I am 22 years old, and approximately a year and a few months ago, I started suffering from a deep depression, non-existent libido and rapid and aggressive weight loss. I was pretty close to just calling it quits honestly, and upon recommendation of my dad who started TRT close to a year ago, recommended that I check my baseline T level for my age given I was natural my entire lifting career and maybe my hormones were out of whack. I was surprised when I went into the doc and he read my total at 132, w/ my free being at 11. A couple more tests validated the initial one and thus began my testosterone recovery journey. I first started on Clomid, but quit because of the side effects by the third week, that medication scared me and the depression was coupled with bipolarity. I then started HCG monotherapy for three months and it got my levels up but my state of being was still s*** and the e2 conversion was way too high. I then began standalone testosterone and I'm coming up on nine months now. Not to be a jerk, but I really don't care for your opinions regarding my age and the protocol, I went through many doctors and many months of struggle, and I'm not chasing gains, I'm chasing stability, so with respect, please answer the questions without judgment.

My protocol was initially at 140mg in two injections per week. I was doing great, e2 was escalated but I was alright.(honeymoon phase?) By month 4, my acne set in and it was everywhere. From what I've read, reducing the dosage and amending lifestyle should control DHT related issues, which I did via diet, cutting alcohol and fatty foods, sleeping well yet to no avail. I went to Larry Lipshultz, a reputable urologist who suggested I do 200mg/wk, 1500iu HCG/wk, and .5 Anastrozole twice a week(1mg total). Gents, this f****d me up. I eventually dropped the HCG and dwindled down my AI dose from 1mg to no ai over the course of 2 months. I tapered my dose down to 80mg EOD and here are my labs after 2 months of the 80mg EOD and no AI protocol:

Total: 658
Free: 159
SHBG: 8 (I am low SHBG and have appointments with an internal medicine doc to check for hypothyroidism)
E2: 15
DHT: 35

Here's my question gentlemen, I suffer from acne and puffy nips even tho my E2 is low, and DHT is perfectly in range. Overall, my dosage still gets me feeling normal, but the energy and libido I had at 140mg+ was amazing. Why is it that I am still having visible side effects given my numbers are in range or even slightly lower than normal yet maintain side effects? I had acne at 200mg, and a tiny bit less at 80mg. In your humble opinions, does acne/scarring and puffy nips outweigh the alpha feeling of a higher dose? I have tried splitting the dose into more frequent injections to balance the hormonal rebound and low SHBG, but don't feel the effects of the T as much. Since this is a lifelong protocol, despite feeling moderately okay now at 80mg, I do want to mitigate the visible side effects and make this a manageable protocol for the long haul. Additionally, being a low SHBG guy, I understand my body doesn't require excessive T to get me where I need to be, however, just from feeling a lower dose, it's beginning to make me question if I should go by feeling instead of numerical values. Your thoughts on my protocol, dosage for a low SHBG, acne/sides, etc? Thanks in advance and I appreciate your candor and guidance. If you need more info, I'd be more than happy to provide if possible.

 

[xqfq]

I know that the serum DHT test may not be indicative of actual DHT activity the body. DHT binds very strongly to SHBG. So I think DHT, when produced by a cell, is used locally almost immediately or bound to SHBG. I’ve read studies that used proxies for 5-alpha reductase activity (measuring metabolites) rather than measuring serum DHT for this reason.

In your case, SHBG is low so it makes sense that the DHT blood test reads low.

If I had your SHBG I would try daily injections FWIW.

 

[S1W]

I'm 2.5 years into this and still don't have my protocol exactly dialed in. Getting closer, but it is a slow game given how much time is needed to truly give a protocol change a chance.

You touched on an interesting thought, "Is the acne/scarring worth the feeling?" I sometimes think about that too. It often seems like to a certain extent, the negative sides like acne, etc are signs that it's working lol.

I felt my best on a 60mg E3.5D protocol (120mg/week), but I did have sides like acne, elevated E2, and high HCT. I'm now trying 17mg/daily, which is basically my old weekly dosage broken into daily doses. No labs yet. Acne has subsided and although I don't have labs, I suspect HCT has subsided too (I no longer get that odd heavy heartbeat feeling). However, not feeling as great on this protocol either.

TL;DR: There are always trade offs. Can't have your cake and eat it, too. If you run high doses and numbers but like the way you feel, know that there will likely be negative sides, too.

 

[htownhomie]

Thanks for your replies gents! I appreciate them! @qxfq, I did not know that DHT has such a high binding affinity to SHBG, DHT is a tricky b*stard lmao. To both qxfq and s1w, you both mentioned the ED injection protocol. S1W, how long did you run an ED protocol for you to notice the acne subside? And to your point, while the acne subsides, the feeling of energy and high libido diminish when I run EOD. So that begs the question do I go back to 140 and try to ED thing, and then if I still have acne adjust it accordingly? At this point, bloods do jack for me because my numbers do not line up with my sides. And also, have any of you encountered a lack of libido even if your numbers are in range? I'm a horny little s***, what 22 year old isn't? But physically, body wise, there's a disconnect between liking sex and acting on it, and I don't have as much of a drive anymore..? It's almost not me lol

 

[S1W]

S1W, how long did you run an ED protocol for you to notice the acne subside? And to your point, while the acne subsides, the feeling of energy and high libido diminish when I run EOD.

Not long at all - a few weeks. Note that I've always been prone to acne though, even pre TRT. So it's not like I don't have any acne now, but just the odd pimple here and there. At it's worst on TRT, it was in places I've never had it before, like upper arms and chest, etc. That's the part that has cleared up.

Similar experience for me on dailies so far - acne and some other sides have subsided, but noticeable drop in energy/drive. Note that I'm only 4 weeks in and things can still change, but at this point based on past experience I'd be surprised if things turned around dramatically. I'm going to give it another week or two and if no dramatic change, try something else.

Some guys here have no problem with it but I think pinning every day gets old - for me, dailies would have to provide a noticeable improvement to make the added hassle worth it.

 

[jmzwy]

I had bad acne between months 2 and 4. I backed off my original dose of 160/week 2 injections) and titrated down at 2x a week at various levels, and since then have since worked down to my current 112 week (16 daily). Been on dailies for 3 months and I feel good. The switch to dailies was an experiment of my own to control hematocrit; my next labs will tell the tale. Interestingly though when I first switched to dailies at an initial dose of 20 mg per day (140 a week), the acne came back full force ( I had no acne when I was at 140 on 2x a week). I seem to get the same positive effects with the lower daily dose. I still get a little acne but it’s not bad. Get a lufah with a handle so you can wash your back, and use a body wash with b5. And a good moisturizer with b5.

As for the nipple puffiness, this is the last side effect I continue to deal with - I have minor water retention and fat accumulation in my chest in general. No gyno from what I can tell and really I was always soft/smooth in this area my whole life.Drinking lots of water seems to help, and I’ve been improving this with diet.

I can handle hcg (for now) at 100 every other day. Have been all over the place with HCG - very sensitive to it and may drop it if it should be that even 100 is too much. I recognize this may exacerbate acne and nipple issues, but again this low dose seems to work for me, and I get the positive effects from it.

The AI turned out to be poison for me as well; I’m not an anti AI guy but I cannot even tolerate .125 once a week.

Sorry for being so long - your post reminds me a little bit of me in that I was super low pre therapy, but interestingly am seemingly a super responder to whatever I put in my body. For me, lower doses have equaled better results.

 

[htownhomie]

Not long at all - a few weeks. Note that I've always been prone to acne though, even pre TRT. So it's not like I don't have any acne now, but just the odd pimple here and there. At it's worst on TRT, it was in places I've never had it before, like upper arms and chest, etc. That's the part that has cleared up.

Similar experience for me on dailies so far - acne and some other sides have subsided, but noticeable drop in energy/drive. Note that I'm only 4 weeks in and things can still change, but at this point based on past experience I'd be surprised if things turned around dramatically. I'm going to give it another week or two and if no dramatic change, try something else.

Some guys here have no problem with it but I think pinning every day gets old - for me, dailies would have to provide a noticeable improvement to make the added hassle worth it.

I wasn't acne prone prior to TRT so it's definitely a new challenge for me to endure w/ all the other hormonal fluctuations. It's more the scarring than anything now but that's a separate issue. I know people have mixed reviews with dailies, but with my SHBG so low, it might be the best protocol for stabilization.

 

[htownhomie]

I had bad acne between months 2 and 4. I backed off my original dose of 160/week 2 injections) and titrated down at 2x a week at various levels, and since then have since worked down to my current 112 week (16 daily). Been on dailies for 3 months and I feel good. The switch to dailies was an experiment of my own to control hematocrit; my next labs will tell the tale. Interestingly though when I first switched to dailies at an initial dose of 20 mg per day (140 a week), the acne came back full force ( I had no acne when I was at 140 on 2x a week). I seem to get the same positive effects with the lower daily dose. I still get a little acne but it’s not bad. Get a lufah with a handle so you can wash your back, and use a body wash with b5. And a good moisturizer with b5.

As for the nipple puffiness, this is the last side effect I continue to deal with - I have minor water retention and fat accumulation in my chest in general. No gyno from what I can tell and really I was always soft/smooth in this area my whole life.Drinking lots of water seems to help, and I’ve been improving this with diet.

I can handle hcg (for now) at 100 every other day. Have been all over the place with HCG - very sensitive to it and may drop it if it should be that even 100 is too much. I recognize this may exacerbate acne and nipple issues, but again this low dose seems to work for me, and I get the positive effects from it.

The AI turned out to be poison for me as well; I’m not an anti AI guy but I cannot even tolerate .125 once a week.

Sorry for being so long - your post reminds me a little bit of me in that I was super low pre therapy, but interestingly am seemingly a super responder to whatever I put in my body. For me, lower doses have equaled better results.

Thanks for sharing man..I too have titrated up and down to find the sweet spot, and it's just difficult getting dialed in. My acne and nipples in the grand scheme really aren't THAT bad, but they serve more as an indication that there's still imbalance in the body. I am super sensitive to Anastrozole and HCG as well, I felt my worst when I was on HCG and the AI crashed me every single time. I think I might need to start doing dailies. Questions for all, but what do you use to pin doing dailies? I'm pretty lean and didn't like sub-q, but what works best needle-wise for daily pins?

 

[htownhomie]

Go with the 140 or even 200 if you like, but split it into daily and ditch any idea of an ai. Wait it out.

Acne is going to be an issue for many of us on TRT no matter what short of nuking e2. With very stable levels on daily injections while not messing with your e2 it should level off a bit. Beyond that, 10% BP acne soap showering twice a day helps A LOT. Additional BP cream will go even farther. That’s my experience after trying all Kinda of stuff.

You are definitely overthinking this a bit. Get hormones into reasonable numbers where you feel well. Then combat side effects.

I definitely agree, I'm sure you understand that getting dialed in is easy for some and horrendous for others. I try not to overthink it, but with my e2 sensitivity and the acne and the switching of protocols because I'm trying to find the right doc, so on and so forth, it's just been a rollercoaster. I think I do better in how I feel with a higher dose, it's really trying to identify the right way of doing so I get the least amounts of side effects possible relative to the dose. I think I'm going to go more by how I feel instead of the testing because like I said before, when my numbers are more in check, I tend to feel like s***. But when my numbers are higher, I for some reason feel great, libido's high, energy is up. I think the bottom line is w/ my SHBG being an 8, dailies are looking more and more like a plausible answer to my question, with a moderately higher dose that gets me where I need to be. Thanks for your input.

 

[madman]

Thanks for sharing man..I too have titrated up and down to find the sweet spot, and it's just difficult getting dialed in. My acne and nipples in the grand scheme really aren't THAT bad, but they serve more as an indication that there's still imbalance in the body. I am super sensitive to Anastrozole and HCG as well, I felt my worst when I was on HCG and the AI crashed me every single time. I think I might need to start doing dailies. Questions for all, but what do you use to pin doing dailies? I'm pretty lean and didn't like sub-q, but what works best needle-wise for daily pins?

Measuring Delastryl. Shortest of Depot-Testosterone


When following a protocol such as daily......injection volume will be small due to using lower doses of T!

Your best bet would be using insulin syringes (fixed needle) in 27-29 gauge 1/2 inch needle length.

Many use the 1 ml syringes but it would be more sensible to use the .5 ml or even .3ml syringes when injecting daily.

I only inject twice weekly (every 3.5 days) and use the .5 ml syringes as I found them easier to hold in the hand when drawing/injecting as they are very compact let alone drawing from the vials is slightly quicker and for many they may be easier to read markings/measure an accurate dose.

 

[madman]

EasyTouch Insulin Syringe 29 Gauge, .5cc, 1/2" - 100ct


EasyTouch Insulin Syringe 30 Gauge, .3cc, 1/2" - 100ct

 

[htownhomie]

You said you agree but then go on to overthink it some more. Took me about 4 years of experimenting to find that opinion. Got dialed in 3.5 yrs in.

Go with the higher dose if you like. Daily without ai and wait out the symptoms. Or ignore advice and keep on with tour own theories not backed by experience.

Hahah i got called out, yeah I'm an overanalytical thinker, its a blessing and a curse. Thanks for the advice and checking me, I'll switch to dailies and allow some time for everything to be smooth sailing hopefully. Thanks bud

 

[Joe Sixpack]

Questions for all, but what do you use to pin doing dailies? I'm pretty lean and didn't like sub-q, but what works best needle-wise for daily pins?

I have 8% body fat. it is very difficult for me to pinch an inch of fat anywhere on my body. So I know the challenge of being lean. But for SubQ injects I use a 31G 3/8" needle. It's effortless and painless with that small of a needle.