First Post - Testosterone, E2 and Anastrozole

[JNole]

Hi Guys - first of all, I really appreciate this great forum & site. It has certainly educated me on TRT while opening my eyes regarding different protocols and treatment. Also entertaining sometimes!

I am 54 years old and began TRT in April 2014. I have been a consistent non-competitive body builder and fitness guy for 39 years now. I am 5'11" 194 lbs and have less than 10% body fat.

I am seeing a physician who has specialized in HRT for 20+ years. I finally took the step to TRT after experiencing brain fog, decreased muscle mass, increasing aches, hot flashes and joint pain for probably 4 years prior to my treatment.

Pre-TRT blood results from Doc:

Total Testosterone 273 (300-890 ng/dl)
Testosterone, Free 49.6 (47-244 pg/ml)
SHBG 37 (13-71 nmol/ml)
Estradiol (NON-sensitive) 19.6 (0-39 pg/ml)

Prescribed Protocol After Above Results, April 2014 from Doc:

150 mg Test Cyp e7 days (inject subQ Thursday AM)
CLOMID, 51 MG M-W-F

6 Week Blood Results After Beginning Protocol from Doc:

Total Testosterone. 1231 (300-890 ng/dl) *Blood drawn 1 day after injection
Testosterone, Free 269 (47-244 pg/ml)
Estradiol (NON-sensitive). 42 H (0-39 pg/ml)

Doc does not want to just yet to prescribe AI

3 Month Blood Results from Doc:

Total Testosterone. 1073 (300-890 ng/dl) *Blood drawn mid-week after Thurs injection
Testosterone, Free 209 (47-244 pg/ml)
SHBG 48 (13-71 nmol/ml)
Estradiol (NON-sensitive) 43 (0-39 pg/ml)

Doc prescribes Anastrozole, .25 MG twice per week

About this time, I learn how powerful Anastrozole can be depending on the individual but follow protocol for this. After 4-6 weeks following this, I begin to feel some pre-TRT symptoms and I OBTAIN OWN BLOOD TEST from LabCorp with the following results:

Total Testosterone. 736 (348-1197 ng/dl) **Blood drawn day of Test injection, prior to, and also
Prior to next Anastrozole dose
Testosterone, Free 9.5 (7.2-24 pg/ml)
Estradiol (SENSITIVE) 21 (3-70 pg/ml)

After this result, I change my Anastrozole protocol to once every 4 to 5 days for the next 4-6 weeks because of the weird symptoms I was getting on the twice per week regimen since my 21 E2 result was the day before I was supposed to take my next Anastrozole dose.

Test results FROM DOC after the above 4-6 weeks of my personal change with Anastrozole dose:

Total Testosterone 1106 (300-890 ng/dl) *Blood drawn mid-week
Testosterone, Free 257 (47-244 pg/ml)
Estradiol (NON-SENSITIVE) 36 (0-39 pg/ml)

After learning about how the non-sensitive E2 test could be 10-20 pg/ml's over actual E2 levels, I decided to take my Anastrozole on the day after my Thursday injection, once per week.

FINALLY, after 4-6 weeks of my latest day after injection taking one .25 MG capsule of Anastrozole, I just obtained the following blood test results FROM DISCOUNTED LABS/DEFY/LabCorp (thanks Nelson!):

Total Testosterone 1271 (348-1197 ng/dl) *Blood drawn day of and prior to Thursday injection
and day before Anastrozole dose
Testosterone, Free. 20 (7.2-24 pg/ml)
Estradiol (SENSITIVE) 41 (8-35 pg/ml)

*I am now not sure how to dose my Anastrozole. In addition, I am wondering if I should lower my Test Cyp dose since I seem to be a little high and to also lower E2 but I am not sure how much to lower by.

Suggestions, comments, etc. are appreciated!

Thank you.

 

[Vince Carter]

Most of those blood draws I think I only saw one or two that are just prior to your injection. I saw one that was day after your injection, some "mid-week" on a Thursday injection. Those are all serious timing mistakes. It should always be in your trough as we call it....right before an injection is due; Thursday AM.
That's skewing a lot of your results.
My other opinion tied to your wild E2 testing is that 150mg once a week is too high a dose, and get's aromatized rather easily. 1200 by most accounts is going to be a limit. However, like you, I love the gym benefit, I'm sure that you've noticed that. I wouldn't decrease your dosing, you're far better off spreading it to twice a week or E3.5D.

 

[JNole]

Thank you for your input, Vince. 2 of the blood tests I personally obtained including my last one were in fact taken on the day of my injection, prior to injection (Thurs AM). When I took .25MG Anastrozole every 3.5 days, my E2 trough was 21 (sensitive). Now that I switched to once per week the day after injection ( when Test is peaking), I am not sure how to adjust. Also, not sure how much to begin reducing 150 MG Test Cyp one a week dose.

 

[Vince Carter]

Thank you for your input, Vince. 2 of the blood tests I personally obtained including my last one were in fact taken on the day of my injection, prior to injection (Thurs AM). When I took .25MG Anastrozole every 3.5 days, my E2 trough was 21 (sensitive). Now that I switched to once per week the day after injection ( when Test is peaking), I am not sure how to adjust. Also, not sure how much to begin reducing 150 MG Test Cyp one a week dose.

To lower your dose what I'd consider is dividing 150 / 7 = ~20mg/daily. Maybe you cut down to 15mg a day and continue the once a week Anastrozole .25mg. Which ever you choose, commit to it for a month and draw blood no sooner than 4 weeks. Keep a diary of how you feel. You could find that you don't need anastrozole. It's NOT a required part of TRT, at all. Me personally I've been working Anastrozole based on feeling, NOT a number on a test, at least trying to.

 

[Nelson Vergel]

JNole


Ok, first of all I want to say that you win the prize for most detailed post ever on ExcelMale.com

I hope guys read it so they get a feeling about what a post with enough details looks like. It is so hard to help people with tiny fractions of information.

You are pretty much where you should be. I am assuming that you are keeping an eye on your hematocrit so that it does not increase over 53 and your PSA to make sure it is under 4.

What people forget is that the "normal" estradiol range (ultrasensitive) was determined with a population analysis from Labcorp users . That range includes 95% of men, and most did not have testosterone over 700 ng/dL. I would not worry about a estradiol of 41 pg/mL and would keep dosing anastrozole as you are doing now. I would also explore bringing in HCG as per my suggestion in my video. That may increase estradiol probably by 20 percent but not enough to worry. One more thing: You may want to take 30 mg zinc per day (1-3 mg copper with it) since it has been shown to also help decrease estradiol.

Video: How to Use HCG with Testosterone To Preserve Fertility, Libido and Testicle SizeTwo studies looking at fertility showed that testosterone-to-estradiol ratios of over 12-14 were best to ensure good sperm production in men not on TRT (divide total testosterone in ng/dL by ultrasensitive estradiol in pg/mL). Your ratio is 31.

Gynecomastia and high estradiol symptoms happen in an environment of estradiol dominance (low T, high E2). It usually happens when T to E2 ratios are low.

Welcome to the group. I love detailed guys who do their homework!!

 

[JNole]

LOL! I wanted to make sure everyone got the complete picture to allow them to provide their input!

In addition to my concern with E2 stabilization after 9 months of TRT, I also would prefer to not take or only have to take a small amount of AI. My doc prescribed Anastrozole when E2 got into the 40's on HIS non-sensitive blood test. After reading this forum, I knew I needed to do some self-testing since my prescription was for .25 MG twice per week until my next office visit that was 3 months away!

Thoughts on Clomid for testicles? I seem to tolerate this well, but I would explore HCG if this was better for my health.

 

[Robbie63]

Great thread. Most all of us could keep a better journal. I agree that some numbers such as total "test" and E2 are a good benchmark but tracking how you feel at those benchmarks and daily are as much or more important.

 

[JanSz]

54 years old and began TRT in April 2014
SHBG 37
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Consider changing your protocol to:
Testosterone + HCG injections EOD, Every Other Day.
Testosterone + HCG in same syringe.
Use insulin syringes 0.5cc
no Clomid

Frequent EOD injections are conducive to stable testosterone levels
that should minimize Estradiol elevations.
With luck one may avoid need for Arimidex.

Higher blood testosterone levels are conducive to muscle development
Good blood DTH, dihydrotestosterone, levels are conducive to better sex.

Injectable testosterone, on average, specially when injections are infrequent
result in higher E2.

Transdermal (low %)(1%, 1.62%, 2%) testosterone gels are conducive to raisng DHT.
There is 5ar enzyme is the skin that converts testosterone to DHT.
One may acept lower totalTestosterone (less pressure on producing E2)
and still have a good DHT level for good sex.
Using testosterone gels TT~700ng/dL may be acceptable, even 500ng/dL may be acceptable
when there is sufficient DHT.

Lower (but still adequate) TotalTestosterone levels are minimizing estradiol,
and need for AI.
Using Arimidex or any other AI is rather last resource method,
it is mostly hard to find stable AI dose that would produce stable E2 level.
It is preferable to arrange protocol that would not require AI.


Add prolactin to your tests.
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To process estrogens include in your died good amounts of cruciferous vegetables.
cabbage, cauliflower, Brussels sprouts, other

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SHBG 37
is not overly high but definitely highish.

Most commonly first would be good idea to do good blood test for thyroid Panel
and follow it up with proper adjustments if need
that should include not only
TSH, T4, T3, FT4, FT3, RT3
but also
both types of thyroid antibodies
selenium
iodine/iodide

Next correlation with highish SHBG is Growth Hormone, at first check
IGF-1
IGFBP3



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