Down-titration helped reduce E2 a bit, but it isn't enough. Time for an AI?

[TestQuest22]

All --

I just got my labs back and thought to share them with you to get your input and advice. I'm going to discuss the latest labs with my Physician this Friday, but I'm thinking of strongly advocating for an A.I. My back and shoulders are a minefield in terms of acne. It's out of control. I also retain water like crazy (my socks leave an imprint for 5-10 minutes after I take them off).

I clearly respond to treatment well, but I am what I would call a "hyper aromatizer," if that's a term.

Thoughts from you guys?

Currently on Test. Cyp. only, no hCG. As the chart says, I'm injecting daily (due to my extremely low SHBG). I also take Cialis at 10mg daily for the BP and pumps. Working out 4x a week with high intensity.

 

[Cataceous]

Your aromatization rate is nothing unusual, 0.55%, within a normal range of roughly 0.3-0.6%. Your dosing is high; you're taking more than double the testosterone the average healthy young guy makes naturally. You should disregard Labcorp's direct free testosterone results; they are too inaccurate to trust. Even the calculators are better. In other words, it's highly unlikely your free testosterone was cut in half by a minor 16% dose reduction. Furthermore, your original numbers do not necessarily reflect hypogonadism; Vermeulen calculated free testosterone is in the healthy normal range, while Tru-T is borderline. A test of free testosterone via equilibrium dialysis would help to resolve the issue.

There's a reasonable chance your SHBG has dropped further since you started TRT; androgens tend to reduce production. Low SHBG artificially lowers total testosterone, so total testosterone can appear normal even when free testosterone is elevated. Or it can appear low even when free testosterone is normal. It's better to focus on free testosterone if it can be determined accurately.

My first suggestion is to abandon conventional TRT and try Natesto or enclomiphene instead. Otherwise a further dose reduction makes sense, while continuing to inject daily. Physiological dosing is usually achieved with 50-100 mg of testosterone cypionate per week, so you have plenty of leeway before you're in danger of being low. These suggestions are made with the assumption that your priorities are long-term good health and a minimization of side effects.

 

[eli]

Are you doing SubQ?

 

[TestQuest22]

Your aromatization rate is nothing unusual, 0.55%, within a normal range of roughly 0.3-0.6%. Your dosing is high; you're taking more than double the testosterone the average healthy young guy makes naturally. You should disregard Labcorp's direct free testosterone results; they are too inaccurate to trust. Even the calculators are better. In other words, it's highly unlikely your free testosterone was cut in half by a minor 16% dose reduction. Furthermore, your original numbers do not necessarily reflect hypogonadism; Vermeulen calculated free testosterone is in the healthy normal range, while Tru-T is borderline. A test of free testosterone via equilibrium dialysis would help to resolve the issue.

There's a reasonable chance your SHBG has dropped further since you started TRT; androgens tend to reduce production. Low SHBG artificially lowers total testosterone, so total testosterone can appear normal even when free testosterone is elevated. Or it can appear low even when free testosterone is normal. It's better to focus on free testosterone if it can be determined accurately.

My first suggestion is to abandon conventional TRT and try Natesto or enclomiphene instead. Otherwise a further dose reduction makes sense, while continuing to inject daily. Physiological dosing is usually achieved with 50-100 mg of testosterone cypionate per week, so you have plenty of leeway before you're in danger of being low. These suggestions are made with the assumption that your priorities are long-term good health and a minimization of side effects.

Thank you for your insights.

I will advise that my initial levels were lower. The first set of levels you see are after 6 months of clomid, which my PCP wanted to try in lieu of diving right into TRT. My initial set of lab results showed 244 total and 7.1 free.

 

[eli]

Thank you for your insights.

I will advise that my initial levels were lower. The first set of levels you see are after 6 months of clomid, which my PCP wanted to try in lieu of diving right into TRT. My initial set of lab results showed 244 total and 7.1 free.

Are you doing SubQ?
If so, maybe try intramuscular.... Deep muscle

I have a friend in your situation, was doing SubQ. Now doing IM and no more crazy high e2.

 

[bixt]

I also want to know, are you doing subq? Awfully poor response to 168mg/week done
daily.

 

[Cataceous]

...
I will advise that my initial levels were lower. The first set of levels you see are after 6 months of clomid, which my PCP wanted to try in lieu of diving right into TRT. My initial set of lab results showed 244 total and 7.1 free.

Got it. Given your limited response to Clomid then you probably shouldn't bother with enclomiphene. Natesto or a generic nasal gel is still a worthwhile option, though at this point a dose reduction is the easier choice. Keep in mind that the symptoms you describe can be caused in part by high testosterone directly, as opposed to via estradiol. A further dose reduction makes sense, but if you insist on using an AI then be careful with dosing. Only 0.25 mg of anastrozole over a week lowers my estradiol by ~20 pg/mL, and that's not unusual. It's strong stuff, so you need to micro-dose.

... Awfully poor response to 168mg/week done
daily.

It is expected for total testosterone to be low when SHBG is low. His free testosterone is most likely high. Free testosterone is more important; that's largely what drives our results.

 

[TestQuest22]

I also want to know, are you doing subq? Awfully poor response to 168mg/week done
daily.

No. (Shallow) IM in delts, ventroglutes, and quads. 29G 1/2" insulin needle.

 

[eli]

No. (Shallow) IM in delts, ventroglutes, and quads. 29G 1/2" insulin needle.

You're just deep SubQ perhaps, you need 1inch
Same study says absorbtion of insulin was greater IM

 

[TestQuest22]

You're just deep SubQ perhaps, you need 1inch
Same study says absorbtion of insulin was greater IM

But isn't subq (assuming I'm actually there, though I know that I feel the needle hit and go into the muscle) better for E2 management?

 

[eli]

But isn't subq (assuming I'm actually there, though I know that I feel the needle hit and go into the muscle) better for E2 management?

For some people yes for some people no.
It's not a one size fit all, you have to experience it on your own, but I have seen it all over the years

 

[madman]

No. (Shallow) IM in delts, ventroglutes, and quads. 29G 1/2" insulin needle.

If you are lean enough 1/2"(12.7MM) needle length is easily shallow IM.

Even then you will feel the difference between a sub-q/IM injection.

 

[nodoctor]

Assuming you made other diet and exercise changes? Triglycerides, ldl, hematocrit, glucose all down on T doesn’t make sense to me. Did I miss your weight/height?

 

[TestQuest22]

Assuming you made other diet and exercise changes? Triglycerides, ldl, hematocrit, glucose all down on T doesn’t make sense to me. Did I miss your weight/height?

6'2" 255lbs. I'm eating way cleaner, got back in the gym (from nothing at all to 4-5x a week), and am seeing a pretty decent body recomp.

 

[nodoctor]

Good for you man! You're a large dude, but I'd still echo others that the T dose you quoted still seems pretty heavy. There's lots of literature that high E is not as bad for many as people once thought, and the symptoms you describe certainly ring of excessive T to me (which would aromatise more anyway) so if I were you (which I'm not of course) I'd drop T first a bunch and then titrate back up if NEEDED before messing with AIs or eblockers.

 

[TestQuest22]

I remain fairly confident I'm one of those rare "hyper-aromatizers." I lowered my dose to 16mg a day (sub q) and my estrogen is still not in control. I made this decision (moving down from 24mg a day) just to see if I could get my estrogen into the lower or middle range. No luck. See my labs below after 3 months of running this protocol.

Yes, I know, this isn't the highly touted sensitive test, but I have been retaining crazy amounts of water my entire journey, even 10 months in.

At this point, I think it's time for an AI.

 

[equel]

Ur total and free is shit, but e2 too high. Up the dose and take the ai ffs​

 

[Systemlord]

Yes, I know, this isn't the highly touted sensitive test, but I have been retaining crazy amounts of water my entire journey, even 10 months in.

Why not try dandelion root?