HELP! Adjusting TRT Protocol-Acne, Libido, Low Free T

[DAbears]

Hello, I am 35 175lbs 5’11 and have been on TRT for 2 years. I have been trying to find my sweet spot and get dialed in the majority of the 2 years. I work out 6 days a week and eat very healthy etc…My current issues are:

Back acne
Oily face
Low libido
Testes and penis always feel cold and have a shrunk look when flaccid
Also a loss of sensitivity during intercourse. No erection issues however.
Have a hard time putting on muscle still as well
Random facial flushing in the afternoon where It gets red and hot

Current protocol-30MG MWF for a total of 90MG a week.

I have been as high as 150MG a week but that made my acne and oily skin worse without much help in the other areas so i backed down again. I have tried once a week, twice a week all felt the same with no resolution to symptoms.

Below are my current labs taken last week. I was shocked to see my E2 was in range as all the research and reddit talk i see is my issues are most likely related to high E2 but its within range. I was also shocked at how low my Free T is. Granted this is my trough levels but from what i gather Free T levels are more important than total T. My SHBG seems to be right around average so not sure if injecting frequency needs to be more or less? I have ordered HCG thats on its way. From research this could help with my libido and sensitivity issues but I also read it could make my acne worse, thoughts on adding HCG? I have also made a app with Defy for the end of the month to see what they say about it all but hoping for some guidance until then…Any advice on what I can do to enhance my numbers and symptoms would be greatly appreciated!



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[Systemlord]

The Tru-T calculator has your Free T at 18.70 ng/dL, healthy levels. I think your problem is your body doesn’t respond well to moderately size doses. The bigger the dose, the larger the spike in hormones.

Usually when someone has facial flushing, acne and oily skin with normal levels, it means exogenous T is having a supraphysiological effect on you.

I would just lower your dosage to 70 mg weekly and if that doesn’t resolve your symptoms, you may need smaller more frequent dosing.

hCG is a mistake given your current issues, it will likely exacerbate your side effects.

As for building muscle, hormones, nutrition, and proper lifting technique are important to those wanting to increase muscle mass and size. Genetics plays the biggest role in your ability to build muscle.

 

[madman]

The Tru-T calculator has your Free T at 18.70 ng/dL, healthy levels. I think your problem is your body doesn’t respond well to moderately size doses. The bigger the dose, the larger the spike in hormones.

Usually when someone has facial flushing, acne and oily skin with normal levels, it means exogenous T is having a supraphysiological effect on you.

I would just lower your dosage to 70 mg weekly and if that doesn’t resolve your symptoms, you may need smaller more frequent dosing.

hCG is a mistake given your current issues, it likely exacerbate your side effects.

As for building muscle, hormones, nutrition, and proper lifting technique are important to those wanting to increase muscle mass and size. Genetics plays the biggest role in your ability to build muscle.

Here we go again!

what is the 2 % of Total Test

I'm understanding that let SHBG alone, free testosterone should be 2% of total, how do we calculate that? let's say Total Test is 800 ng/dl and FT is in pg/ml? 800 x 0,02 = 16?

www.excelmale.com

*This Phase IIB proposal aims to continue the development of the TruTTM algorithm by validating it in common conditions characterized by altered estradiol (E2), T, and SHBG concentrations and incorporating the interaction of E2 with T for wider commercial adoption in women in whom E2 levels vary greatly across the menstrual cycle and in TGD population.

 

[madman]

The Tru-T calculator has your Free T at 18.70 ng/dL, healthy levels. I think your problem is your body doesn’t respond well to moderately size doses. The bigger the dose, the larger the spike in hormones.

Usually when someone has facial flushing, acne and oily skin with normal levels, it means exogenous T is having a supraphysiological effect on you.

I would just lower your dosage to 70 mg weekly and if that doesn’t resolve your symptoms, you may need smaller more frequent dosing.

hCG is a mistake given your current issues, it likely exacerbate your side effects.

As for building muscle, hormones, nutrition, and proper lifting technique are important to those wanting to increase muscle mass and size. Genetics plays the biggest role in your ability to build muscle.

Blood Test Results Age 37, 39, 43....Should I (Can I) get TRT?

Age Sample Date Testosterone Indicator Ref. Interval Unit TSH Indicator Ref. Interval Unit 37 10 Nov 2015 21.68 8.64 - 29.01 nmol/L 2.806 0.35 - 5.50 mIU/L 39 02 Jul 2018 17.33 4.94 - 32 nmol/L 1.79 0.35 - 4.94 mIU/L 43 02 Aug 2018 23.91 8.33 - 30.19 nmol/L 1.81...

www.excelmale.com

 

[sammmy]

Your calculated free testosterone at trough is 12.4 ng/dL and is healthy in the middle of the normal range, where it should be. It should not be in the upper normal or above the normal range. Normal range for calculated testosterone for young males is 5-25 ng/dL.

Free & Bioavailable Testosterone calculator

 

[madman]

Hello, I am 35 175lbs 5’11 and have been on TRT for 2 years. I have been trying to find my sweet spot and get dialed in the majority of the 2 years. I work out 6 days a week and eat very healthy etc…My current issues are:

Back acne
Oily face
Low libido
Testes and penis always feel cold and have a shrunk look when flaccid
Also a loss of sensitivity during intercourse. No erection issues however.
Have a hard time putting on muscle still as well
Random facial flushing in the afternoon where It gets red and hot

Current protocol-30MG MWF for a total of 90MG a week.

I have been as high as 150MG a week but that made my acne and oily skin worse without much help in the other areas so i backed down again. I have tried once a week, twice a week all felt the same with no resolution to symptoms.

Below are my current labs taken last week. I was shocked to see my E2 was in range as all the research and reddit talk i see is my issues are most likely related to high E2 but its within range. I was also shocked at how low my Free T is. Granted this is my trough levels but from what i gather Free T levels are more important than total T. My SHBG seems to be right around average so not sure if injecting frequency needs to be more or less? I have ordered HCG thats on its way. From research this could help with my libido and sensitivity issues but I also read it could make my acne worse, thoughts on adding HCG? I have also made a app with Defy for the end of the month to see what they say about it all but hoping for some guidance until then…Any advice on what I can do to enhance my numbers and symptoms would be greatly appreciated!



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You are injecting 90 mg T split (M/W/F) so your true trough would be Monday morning before your next injection.

What day did you have labs done?

You tested your FT using the known to be inaccurate direct immunoassay.

Need to have it tested using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Otherwise for the time being you will need to use/rely upon the linear law-of-mass action cFTV.

Keep in mind the calculated methods have their flaws.

Using the cFTV with a robust TT 552ng/dL, normal SHBG 30.4 nmol/L, and Albumin 4.3g/dL (default) as we have no idea where it sits since you never had it tested or did not post the results your FT would be 12.4 ng/dL.

Definitely not really low but keep in mind as of now cFTV tends to overestimate FT.

If you had it tested using and accurate assay such as Quest Diagnostics ED your FT would most likely be lower.

When it comes to oily skin/acne high estradiol is not the culprit!

If the lab results you posted are true trough (Monday morning) then your peak TT, FT, and estradiol are going to be higher!

You are missing critical blood markers RBCs, hemoglobin, and hematocrit.

 

[madman]

Your calculated free testosterone at trough is 12.4 ng/dL and is healthy in the middle of the normal range, where it should be. It should not be in the upper normal or above the normal range. Normal range for calculated testosterone for young males is 5-25 ng/dL.

Free & Bioavailable Testosterone calculator

View attachment 33966

LMFAO!

I and many others run higher-end troughs (upper end) and that is with healthy blood markers let alone no sides.

Let the endos keep pushing that nonsense, you should know better.

 

[Systemlord]

healthy in the middle of the normal range, where it should be. It should not be in the upper normal or above the normal range.

If you employ the same strategy to 1000 different individuals, you’re left with a portion of those men who are still not optimized and therefore symptomatic.

This isn’t individualized hormone replacement, it’s a cookie cutter treatment plan. Multiple peer reviewed papers suggest upper normal range is healthy, not midrange if you go by the most recent data.

This guidelines suggesting to aim for mid normal ranges is flawed, based on fear, stigma and lack of knowledge, fear of the unknown, play it safe, drive these decisions.

 

[sammmy]

This forum has enough examples of people getting exacerbated side effects when the trough is at the upper end. The OP of this thread clearly stated that running higher levels did not resolve the problems and had more side effects.

TRT is about achieving physiological levels, not being above them 100% of the time. Otherwise, you can ran a "cycle" and you may be lucky to not have side effects, although judging by your constant angry outbursts here, you definitely have sides.

 

[Systemlord]

The OP of this thread clearly stated that running higher levels did not resolve the problems and had more side effects.

And that’s why I recommended lowering his dosage to 70 mg. My reply to you about repeatedly telling members to target mid normal ranges. It’s a cookie cutter approach.

TRT is about achieving physiological levels

TRT is about symptom resolution, whether that’s in the low normal range, mid normal range, high normal range, or above the normal range, as long as your bio markers are healthy.

When the doctor prescribes insulin, they don’t check insulin levels. They run labs to see what effect the insulin is having on the body.

 

[madman]

This forum has enough examples of people getting exacerbated side effects when the trough is at the upper end. The OP of this thread clearly stated that running higher levels did not resolve the problems and had more side effects.

TRT is about achieving physiological levels, not being above them 100% of the time. Otherwise, you can ran a "cycle" and you may be lucky to not have side effects, although judging by your constant angry outbursts here, you definitely have sides.

LOL!

You clearly have no experience with cycling, blasting/cruising.

Most would consider 300mg T/week getting their feet wet!

Many are banging 400-600 mg/week.

Where do you think one's levels would be on a low-dose test cycle?

Sure as hell just not above the physiological range.

Need to give your head a shake.

Even then if you think running a 1200 ng/dL peak --->900 ng/dL trough on a twice-weekly protocol is running a cycle because levels are slightly supra-physiological then you clearly have no clue what you are talking about.

When looking at peak--->trough injection frequency is going to have a big impact.

A big difference between one running a high-end trough once weekly vs EOD or daily!

 

[sammmy]

@DAbears

If your libido and penile sensitivity problems are not resolved at normal levels of free T, which you currently have, and are not resolved at the higher dose that you tried before, it means T is neither the problem nor the solution for you.

There is no current treatment for libido and sensitivity - they are both controlled by the nervous system and other factors so you can only try stuff and feel lucky if you find something that works. Libido especially is an integrative measure of health - people do not want sex if they don't feel healthy. Improving libido requires restoration to absolute health, which contemporary medicine is not capable of doing.

The skin oiliness (seborrhea) is typically aggravated by eating too much simple sugars (added sugar in drinks/desserts, fruits, lactose in milk). These also lead to more water retention in the body, covering the muscles with a flabby fat layer.

If you want to reduce the oiliness, build more muscle and decrease the fat, you should eat less simple sugars and more complex protein like in meat. Artificially concentrated protein shakes absorb fast and lead to insulin spikes just like simple sugars, so overusing those instead of natural slow digesting protein can also lead to flabbiness. Eating natural meat and complex carbs (rice, beans) and vegetables is the best diet for better looking physique.

 

[DAbears]

You are injecting 90 mg T split (M/W/F) so your true trough would be Monday morning before your next injection.

What day did you have labs done?

You tested your FT using the known to be inaccurate direct immunoassay.

Need to have it tested using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Otherwise for the time being you will need to use/rely upon the linear law-of-mass action cFTV.

Keep in mind the calculated methods have their flaws.

Using the cFTV with a robust TT 552ng/dL, normal SHBG 30.4 nmol/L, and Albumin 4.3g/dL (default) as we have no idea where it sits since you never had it tested or did not post the results your FT would be 12.4 ng/dL.

Definitely not really low but keep in mind as of now cFTV tends to overestimate FT.

If you had it tested using and accurate assay such as Quest Diagnostics ED your FT would most likely be lower.

When it comes to oily skin/acne high estradiol is not the culprit!

If the lab results you posted are true trough (Monday morning) then your peak TT, FT, and estradiol are going to be higher!

You are missing critical blood markers RBCs, hemoglobin, and hematocrit.

 

[DAbears]

I am in good shape not fat exercise hard 6 days a week and eat a very clean diet. That is not the issue. I am on a statin for my high cholesterol for the last year that the dr diagnosed as hereditary. Cholesterol was even higher prior to TRT.

 

[DAbears]

@DAbears

If your libido and penile sensitivity problems are not resolved at normal levels of free T, which you currently have, and are not resolved at the higher dose that you tried before, it means T is neither the problem nor the solution for you.

There is no current treatment for libido and sensitivity - they are both controlled by the nervous system and other factors so you can only try stuff and feel lucky if you find something that works. Libido especially is an integrative measure of health - people do not want sex if they don't feel healthy. Improving libido requires restoration to absolute health, which contemporary medicine is not capable of doing.

The skin oiliness (seborrhea) is typically aggravated by eating too much simple sugars (added sugar in drinks/desserts, fruits, lactose in milk). These also lead to more water retention in the body, covering the muscles with a flabby fat layer.

If you want to reduce the oiliness, build more muscle and decrease the fat, you should eat less simple sugars and more complex protein like in meat. Artificially concentrated protein shakes absorb fast and lead to insulin spikes just like simple sugars, so overusing those instead of natural slow digesting protein can also lead to flabbiness. Eating natural meat and complex carbs (rice, beans) and vegetables is the best diet for better looking physique.

My libido and sensitivity issues only began on TRT. My levels were low 200s T prior to TRT but had all the other issues like fatigue and brain fog. It’s like I traded issues since getting on TRT.

 

[sammmy]

Your liver enzymes are consistently abnormal on the hepatic panel. That should be addressed by your doctor. Check if they were abnormal before TRT and the statin. Keep in mind that "healthy" supplements can also affect those.

 

[sammmy]

Statins can increase liver enzymes (AST in your case) due to liver injury but your suppressed alkaline phosphatase would still be unexplained.

Studies on whether statins affect sexual functioning are conflicting but it is not ruled out.

Also take into account all other drugs/supplements that you are taking before suspecting the statin.

Have you done a thyroid panel testing, not only TSH? Thyroid affects sexual functioning.

 

[Systemlord]

I always recommend testing ferritin prior to starting TRT and then 6 months after starting therapy, because it’s not uncommon for ferritin to decline a bit from baseline.

Also, estrogen increases serotonin and if too high can have a similar affect to anti-depressants which are known to cause low libido and erectile problems.

The facial flushing is usually a sign your dosage is too high.

I had a similar problem, penis would randomly be cold at the tip or pulled up inside itself and not fully flaccid. My testicles would also pull up and be cold at times. Cialis 5 mg daily fixed all of these problems.

Of note, the one thing Cialis did for me was greatly reduce my blood pressure!

So if your blood pressure isn’t under control, this could cause these symptoms as well.

 

[DAbears]

Statins can increase liver enzymes (AST in your case) due to liver injury but your suppressed alkaline phosphatase would still be unexplained.

Studies on whether statins affect sexual functioning are conflicting but it is not ruled out.

Also take into account all other drugs/supplements that you are taking before suspecting the statin.

Have you done a thyroid panel testing, not only TSH? Thyroid affects sexual functioning.

The raised liver enzymes are from the statins and we’re never raised prior. I have tried just about every statin and this current one raises them the least.

 

[DAbears]

I always recommend testing ferritin prior to starting TRT and then 6 months after starting therapy, because it’s not uncommon for ferritin to decline a bit from baseline.

Also, estrogen increases serotonin and if too high can have a similar affect to anti-depressants which are known to cause low libido and erectile problems.

The facial flushing is usually a sign your dosage is too high.

I had a similar problem, penis would randomly be cold at the tip or pulled up inside itself and not fully flaccid. My testicles would also pull up and be cold at times. Cialis 5 mg daily fixed all of these problems.

Of note, the one thing Cialis did for me was greatly reduce my blood pressure!

So if your blood pressure isn’t under control, this could cause these symptoms as well.

Already taking daily 2.5mg cialis. And that the exact thing that is happening to me. Tip of penis is cold, testes are high and tight and my flaccid hand is just so much smaller than usual. Just feels dead and like not connected to me. I will say I have noticed that once I get into bed at night it feels normal again…no cold tip and everything fills up again?