First set of Follow Up Labs since Starting TRT. Looking for Feedback

[joetown2001]

So I just got back my first follow up labs since starting TRT a little over two months ago. I was pretty pleased for the most part, as a lot of my numbers improved from a non-hormone standpoint. I was happy to see the drop in my hematocrit, and a lot of that has to do is me stopping iron supplements for a hemorrhoid bleed that I had. I believe those numbers were just elevated with my initial labs because I have been taking supplements for a long time.

I have been suffering from some mild prostate discomfort and inflammation off and on, and I was happy to see that it was not reflected negatively in my PSA numbers. I had it checked out by my primary care physician a few weeks back, and the digital rectal exam showed some slight swelling, but no other issues. He was not worried and he said it was most likely my body adjusting to TRT.

Now from a hormone standpoint, my numbers were taken at trough last Wednesday. I inject Monday, Wednesday and Friday with a total of 100 mg each week divided up into three shots. I injected Monday morning at 9 AM, and my labs were taken Wednesday morning at 8:30 AM, so almost a 48 hour trough.

Over the past 3 to 4 weeks, I haven’t felt great on my regiment. I’ve been short tempered, been suffering from anxiety and have gotten lightheadedness off and on. I am also showing a lot of sleepiness around dinner time before I eat, especially on the days I inject. My libido has not been very good, and I am suffering from moderate erectile dysfunction and struggling with arousal. My sleep hasn’t been very good, and I wake multiple times at night, with sometimes struggling to fall back asleep.

I also had my DHT tested this time around to see if it was contributing to my prostate issues, and obviously it is not as it is in range. The other thing I noticed is my IGF-1 Numbers went up quite a bit. Honestly, I’m not really sure what that means. I do feel like him a little over medicated, and my estrogen is high based off of my symptoms. The biggest benefits I’ve seen are I have lost about 12 pounds, but the weight loss has plateaued over the last month. I’ve also seen really good body composition changes for it only being two months, as I am lifting weights 3 to 4 days a week.

I would love some feedback from some of you guys, especially @madman. I find you knowledge quite valuable. My labs are posted in the attachment. The document shows my initial labs on April 10, as well as my most recent labs pulled last week.

 

[FunkOdyssey]

Over the past 3 to 4 weeks, I haven’t felt great on my regiment. I’ve been short tempered, been suffering from anxiety and have gotten lightheadedness off and on. I am also showing a lot of sleepiness around dinner time before I eat, especially on the days I inject. My libido has not been very good, and I am suffering from moderate erectile dysfunction and struggling with arousal. My sleep hasn’t been very good, and I wake multiple times at night, with sometimes struggling to fall back asleep.

Free T is 23.6 ng/dL, pretty reasonable. E2 is on the high side at 39.6 pg/mL given the lower 18.8 nmol/L SHBG. IGF-1 is elevated by TRT via aromatization to E2, so this will drop if you get your E2 down a bit. IGF-1 is also driven higher by insulin, which you can bring down by cutting carbs (this would also assist weight loss). In the short-term it is fine, however, you don't want to be running around for years with IGF-1 that high as it may increase cancer risk.

I might drop the dose by 20 mg weekly until aromatization rate improves. You didn't specify your injection method, but if you are currently injecting subq, you might try IM instead and see if you respond with lower E2, as some of us do.

 

[Cataceous]

... I do feel like him a little over medicated...

You already know the answer.

C

Post in thread 'Starting TRT Soon'

Apr 20, 2025

... I agree to hope to start out between 100-150 a week as well. ...

Allow me to offer an even more conservative perspective. That 100 mg per week of testosterone cypionate would already be giving you more testosterone than most men ever make naturally. The average testosterone production for healthy young men is equivalent to around 60-70 mg of testosterone cypionate per week. This is a safer starting point for TRT as long as it's in divided doses. Although a lot of men seem to tolerate supraphysiological doses, many experience side effects and regret starting higher rather than...

• Cataceous

• 

 

[joetown2001]

You already know the answer.

C

Post in thread 'Starting TRT Soon'

Apr 20, 2025

... I agree to hope to start out between 100-150 a week as well. ...

Allow me to offer an even more conservative perspective. That 100 mg per week of testosterone cypionate would already be giving you more testosterone than most men ever make naturally. The average testosterone production for healthy young men is equivalent to around 60-70 mg of testosterone cypionate per week. This is a safer starting point for TRT as long as it's in divided doses. Although a lot of men seem to tolerate supraphysiological doses, many experience side effects and regret starting higher rather than...

• Cataceous

• 

Agreed. Just need to figure out how much to drop

 

[joetown2001]

Free T is 23.6 ng/dL, pretty reasonable. E2 is on the high side at 39.6 pg/mL given the lower 18.8 nmol/L SHBG. IGF-1 is elevated by TRT via aromatization to E2, so this will drop if you get your E2 down a bit. IGF-1 is also driven higher by insulin, which you can bring down by cutting carbs (this would also assist weight loss). In the short-term it is fine, however, you don't want to be running around for years with IGF-1 that high as it may increase cancer risk.

I might drop the dose by 20 mg weekly until aromatization rate improves. You didn't specify your injection method, but if you are currently injecting subq, you might try IM instead and see if you respond with lower E2, as some of us do.

I did take .125 anastrazole a few times when symptoms got really bad. Every time it killed the anxiety and light headed feeling. Sometimes it fired up my libido, other times it did not. I had not taken any for almost two weeks before my labs. I inject sub q, most recently in my fat caps above my buttocks.

 

[FunkOdyssey]

I did take .125 anastrazole a few times when symptoms got really bad. Every time it killed the anxiety and light headed feeling. Sometimes it fired up my libido, other times it did not. I had not taken any for almost two weeks before my labs. I inject sub q, most recently in my fat caps above my buttocks.

Yeah, sounds like the problem is more estrogen than you can handle (this is almost always the problem). I had my absolute worst results on TRT, and a personal record for lowest T/E2 ratio injecting in that exact location. I would urge you to experiment with injecting in the ventroglutes or delts instead. In some people, it can make a big difference with T/E2 ratio.

You'll want to drop the dose, change injection method, or both - whatever it takes to get E2 under control without chemotherapy drugs.

 

[Nelson Vergel]

I would love some feedback from some of you guys,

Your numbers are great. Don't change a thing. What are your "high E2" symptoms?

 

[joetown2001]

Your numbers are great. Don't change a thing. What are your "high E2" symptoms?

I’ve been short tempered, been suffering from anxiety and have gotten lightheadedness off and on. I am also showing a lot of sleepiness around dinner time before I eat, especially on the days I inject. My libido has not been very good, and I am suffering from moderate erectile dysfunction and struggling with arousal. My sleep hasn’t been very good, and I wake multiple times at night, with sometimes struggling to fall back asleep.

 

[Nelson Vergel]

My sleep hasn’t been very good, and I wake multiple times at night, with sometimes struggling to fall back asleep.

Your symptoms seem to be related to sleep issues. Are you taking any other medications? Your hematocrit is not high, so I rule out apnea.

 

[joetown2001]

Your symptoms seem to be related to sleep issues. Are you taking any other medications? Your hematocrit is not high, so I rule out apnea.

I am not taking any other meds except for 5 mg daily cialis in the mornings and a low dose atorvistatin. I know you are a big advocate of keeping estrogen higher, but it does not treat me well. I do appreciate your feedback and thoughts on what might be causing my issues.

 

[Phil Goodman]

My thoughts, take it fwiw…


You have officially reached the point where your natural production is completely shut down. And right around the time that happened your issues stated to emerge. Your body is settling into a new normal, and this process is different for everyone. A lot of the issues will likely reduce over time if not completely go away, but you also shouldn’t suffer needlessly if there are things you can do to improve your situation. Whatever you choose to do, only adjust one thing at a time and allow adequate for your body to adjust. I’d say the best recommendation at this point was already given above, which is to switch to IM. Go that route while your body continues to adjust to a state where natural product has ceased and it tries to reach a new homeostasis with various hormones. Your dose is not high, and your numbers aren’t really too high either. On that note, the symptoms you listed can’t be accurately attributed to estrogen and I’d imagine if you’d never seen those lab results you wouldn’t be doing that. Plus, your results show your T at trough but your E2 would not be at trough at that point, so your ratio is often much better than that. Either way, switching to IM may improve them even further. Also, it may seem counterintuitive if you’re viewing high E2 as a problem, but HCG may help at some point since it would bring some natural production back online.

But as stated earlier, I’d say the first step would be to leave everything alone and just switch to IM for about six weeks. Then see how you feel and consider next steps at that point if you still have issues.

 

[FunkOdyssey]

A couple of you challenged his attribution of symptoms to estrogen. He took anastrozole and his anxiety and light-headness disappeared: not once, but many times. This is how someone can confidently and accurately attribute a symptom to excess estrogen.

I would never suggest ongoing use of an AI as the solution, but you can't dismiss it's value as a diagnostic tool.

As Phil said, some of your symptoms would probably go away if you didn't change anything and just endured them for long enough. Sleep disturbances early in treatment often fall into that category, as there is a psychostimulant effect of testosterone when you first begin that you will develop tolerance to. However, you sound profoundly uncomfortable with your current situation, so I would not recommend doing nothing and waiting.

 

[Cataceous]

.. Your dose is not high, and your numbers aren’t really too high either. ...

The usual more-is-better thinking that leads to a total loss of objectivity and harms many.

Not sure why you say this when: the dose is more testosterone than all but a small fraction of men could produce naturally; it's probably on the order of double what the OP would have produced at his healthy best; it's leading to over-range free testosterone even at trough; he has symptoms of excess.

Just because some men tolerate excessive dosing doesn't make it wise to use as a starting point for everyone. Why are so many opposed to a low-and-slow approach?

 

[joetown2001]

The usual more-is-better thinking that leads to a total loss of objectivity and harms many.

Not sure why you say this when: the dose is more testosterone than all but a small fraction of men could produce naturally; it's probably on the order of double what the OP would have produced at his healthy best; it's leading to over-range free testosterone even at trough; he has symptoms of excess.

Just because some men tolerate excessive dosing doesn't make it wise to use as a starting point for everyone. Why are so many opposed to a low-and-slow approach?

First off, I want to thank everybody giving feedback on this thread. I appreciate it all of your views, and I agree with a lot of what all of you were saying. I know I’m definitely overmedicated on some level for me, but it might not be for other people. Having all the sexual side effects, along with no nocturnal erections or morning wood, as well as the anxiety and short temper.

Even today, I injected my normal .17 Wednesday injection at 6:30 in the morning, and by midday that light headed dizzy feeling and mild fatigue have already kicked in. I haven’t had my follow up from my lab scheduled yet, but it should be sometime next week.

I’m pretty much gonna be at the point where I’m going to drop my dose regardless. I feel like just experimenting and dropping it on my own to see how I feel on a lower dosage. The choice to go 100 a week was mine, as my PA wanted to go 150 a week. I can’t even imagine how messed up I would’ve been if I would’ve stuck to the protocol that they wanted. I have no ill will or am mad, but I know how my body has reacted to other types of therapy in the past, and knew I needed to start lower.

I feel like I’m close to where I need to be, and all I ever hear is that your trough free T should be over 20. I feel like a free T trough in the high teens would probably be best for me based on how I feel with a 23.7 trough currently. My question for some of you guys is, why does everybody feel like the 20 free T trough is what has to be done to feel good? Again, thanks for all the feedback. This forum is great.

 

[Phil Goodman]

The usual more-is-better thinking that leads to a total loss of objectivity and harms many.

Not sure why you say this when: the dose is more testosterone than all but a small fraction of men could produce naturally; it's probably on the order of double what the OP would have produced at his healthy best; it's leading to over-range free testosterone even at trough; he has symptoms of excess.

Just because some men tolerate excessive dosing doesn't make it wise to use as a starting point for everyone. Why are so many opposed to a low-and-slow approach?

1.) I’m not of the “more is better mentality”, but I do agree that plenty of guys suffer needlessly by taking that approach. My starting dose was 120/week and I’ve never gone above that, always running between 100-120/week.

2.) comparing exogenous testosterone to endogenous is not an apples to apples comparison. You say his dose of 100/week is over double what he produced naturally, but you’ll find very few if any that would feel similar to their prime days while running 50 mg/week. There are many variables at play which result in different outcomes between producing 50 per week naturally and supplementing with 50 per week.

3.) he has just now ended his honeymoon phase and his body is adapting to the fact that it no longer produces testosterone, resulting in both upstream and downstream impacts on his hormonal system. Also, the body has various mechanisms it can utilize to achieve homeostasis to mitigate the negative side effects he’s currently experiencing. I went through a similar patch of having a few weeks of moderate anxiety and sleep disruptions around the same timeframe OP is in (the 8-12 week section). To hear you tell it, I was absurdly over-medicated and should’ve substantially lowered my dose (by as much as 50%). However, the issues resolved on their own and here I am five years later feeling and looking as good as ever with great lab work and physical results every year. And to top it off I added HCG along the way so my levels are even higher. I sit at the top of the range for most lab values, all while you would say I’m heavily over-medicated.


4.) as stated above I do agree that many are over-medicated, but I think dropping a starting dose down to 50 mg/week would probably not result in full optimization in most men. I also think OP is at an important point when his body is trying to adjust to the new reality of not producing testosterone, and for most guys the body will adapt adequately. Cutting the dose in half doesn’t seem like the right step at this point imho, but he can do whatever he feels is best and I hope he finds resolution for his issues.

 

[joetown2001]

1.) I’m not of the “more is better mentality”, but I do agree that plenty of guys suffer needlessly by taking that approach. My starting dose was 120/week and I’ve never gone above that, always running between 100-120/week.

2.) comparing exogenous testosterone to endogenous is not an apples to apples comparison. You say his dose of 100/week is over double what he produced naturally, but you’ll find very few if any that would feel similar to their prime days while running 50 mg/week. There are many variables at play which result in different outcomes between producing 50 per week naturally and supplementing with 50 per week.

3.) he has just now ended his honeymoon phase and his body is adapting to the fact that it no longer produces testosterone, resulting in both upstream and downstream impacts on his hormonal system. Also, the body has various mechanisms it can utilize to achieve homeostasis to mitigate the negative side effects he’s currently experiencing. I went through a similar patch of having a few weeks of moderate anxiety and sleep disruptions around the same timeframe OP is in (the 8-12 week section). To hear you tell it, I was absurdly over-medicated and should’ve substantially lowered my dose (by as much as 50%). However, the issues resolved on their own and here I am five years later feeling and looking as good as ever with great lab work and physical results every year. And to top it off I added HCG along the way so my levels are even higher. I sit at the top of the range for most lab values, all while you would say I’m heavily over-medicated.


4.) as stated above I do agree that many are over-medicated, but I think dropping a starting dose down to 50 mg/week would probably not result in full optimization in most men. I also think OP is at an important point when his body is trying to adjust to the new reality of not producing testosterone, and for most guys the body will adapt adequately. Cutting the dose in half doesn’t seem like the right step at this point imho, but he can do whatever he feels is best and I hope he finds resolution for his issues.

Well, I can tell you I have no intentions on dropping my dosage down to 50 mg a week. The lowest I would even think about going right now would be 80, and I’m not even sure I’m going to do that. My biggest concern really is the sexual side effects. They are as bad if not a little worse than when I started TRT in the beginning of May. I feel like the anxiety and short tempered nurse will settle once my body kicks in. I don’t want to take anastrozole, but when I did to alleviate symptoms, it gave me a libido boost some to most of the time in the first two months. I took a very low dose .125. It’s not something I wanna do regularly, but it also tells me that my body doesn’t like where my estrogen is sitting right now, even though for a lot of guys it would be perfect.

 

[Cataceous]

Well, I can tell you I have no intentions on dropping my dosage down to 50 mg a week. The lowest I would even think about going right now would be 80, and I’m not even sure I’m going to do that. ...

Stop to think about this. There's no reasonable basis for ruling out most of the physiological range for dosing. Don't succumb to pressure from those who are simply rationalizing their excessive doses. Suppose you would feel the best at 60-70 mg per week in divided doses? We haven't emphasized enough that it's much easier to raise the dose than to lower it. Going up is more likely to give a boost, even if temporarily, while going down can trigger temporary symptoms of low testosterone, leading many to give up before they really know what the dose is like. If you start low and give each level plenty of time then you will have a better idea of what is going to work for you.

 

[Cataceous]

1.) I’m not of the “more is better mentality”, but I do agree that plenty of guys suffer needlessly by taking that approach. My starting dose was 120/week and I’ve never gone above that, always running between 100-120/week.

The main problem I have with this is that you have no idea what physiological doses are like.

...
2.) comparing exogenous testosterone to endogenous is not an apples to apples comparison. You say his dose of 100/week is over double what he produced naturally, but you’ll find very few if any that would feel similar to their prime days while running 50 mg/week. There are many variables at play which result in different outcomes between producing 50 per week naturally and supplementing with 50 per week.
...

What you haven't demonstrated is that one can compensate for the differences between endogenous and exogenous testosterone simply by giving more exogenous testosterone. I would argue that such compensation is making things worse overall—promoting side effects and further interfering with other hormones. I'd also argue that the main difference between endogenous and—long-lasting—exogenous testosterone is the HTPA shutdown that accompanies the latter. HCG helps many to compensate, but I feel there is much more going on.

Give that the exogenous testosterone here is bioidentical, if we discount the effects on other hormones, and dose to achieve a diurnal rhythm, then it's hard to argue that 5 mg T per day injected is significantly different from 5 mg per day made by the testicles.

...
3.) ... To hear you tell it, I was absurdly over-medicated and should’ve substantially lowered my dose (by as much as 50%). However, the issues resolved on their own and here I am five years later feeling and looking as good as ever with great lab work and physical results every year. And to top it off I added HCG along the way so my levels are even higher. I sit at the top of the range for most lab values, all while you would say I’m heavily over-medicated. ...

Using the norms of any other medication you are overmedicated. At least the risks from excessive testosterone use aren't as immediately severe as those from adrenal/thyroid/etc. meds. The main objection is that you don't even know how you'd feel with physiological doses. In any case, I'm not trying to change your mind. If you have good lipids, good HCT, etc., then your risks aren't bad, and you're free to make that choice.

4.) as stated above I do agree that many are over-medicated, but I think dropping a starting dose down to 50 mg/week would probably not result in full optimization in most men. I also think OP is at an important point when his body is trying to adjust to the new reality of not producing testosterone, and for most guys the body will adapt adequately. Cutting the dose in half doesn’t seem like the right step at this point imho, but he can do whatever he feels is best and I hope he finds resolution for his issues.

I agree that 50 mg TC/week is likely to be too low for most men. However, if you start there as a matter of course then you help the ones that do best there. Others simply continue to titrate up as needed. With Xyosted you start at 75 mg TE/week and either drop to 50 mg or go up to 100 mg. This might be a little harsh on those who are titrating downward. But you save time for the others. It's a tradeoff.

 

[Guided_by_Voices]

What else are you doing to prevent ED? That is one of the things T alone is least likely to fix, and in cases like yours where you are likely overdosed it can make it worse. Something in the Viagra family is an obvious first step but there are lots of other things as well.

 

[joetown2001]

What else are you doing to prevent ED? That is one of the things T alone is least likely to fix, and in cases like yours where you are likely overdosed it can make it worse. Something in the Viagra family is an obvious first step but there are lots of other things as well.

5 mg daily cialis. Started 6 grams of citrine a day this week. It’s libido as much as arousal. That’s the concerning part. Even before therapy, my libido was strong, arousal and erection quality was up and down.