How do you know when to take an AI.

[firefighterinNC]

Still working with a urologist to get dialed in.

My complaints about lack of libido and sensitivity downstairs are still my biggest issues. Energy and sleep quality seemed to be getting better. I was actually saying to myself I felt pretty good lately and at times for 1-2 days infrequently I think libido is getting better, but it's gone just a quick.

My urologist recently upped my dose to 150 mg of test cyp split into two doses weekly, he did mention he has folks take test cypionate eod and they have good success. My sensitive e2 came back in the at 52 and my testosterone was 1128. He suggested checking prolactin which was 9.7 ng/ml, so that was normal.
He also gave me aromatase inhibitor anastrozole and told me to take a quarter. I don't like that the way that makes me feel at all, depressed and irritable. The previous urologist prescribed aromasin and I did not have that depressed irritable feeling when I took it.
The current urologist just didn't have many answers for me. He said I might not be on high enough dose to get my levels to where they need to be. He said some folks sometimes need an ester change and some folks have to get estrogen under control. He said mine was elevated but not bad ( whatever that means). He wanted me to give it 8 weeks and re evaluate.

His response was to take the AI as needed.
I guess i'm dumbfounded here, when and how do I know when this would be needed? I just had a follow up with my pcp and I told her I felt like the increasing of the dose was the wrong way to go but she told me to just stay the course and see how it went at the 8 week follow up. I'm on week 3 of this dose increase and I can feel this inner anxiety creeping up this week that I didn't have the previous two weeks. Financially I don't have the means to get independent labs so i'm trying to work with my pcp and my urologist.
One thing i have noticed is that towards the end of my week if I miss an injection day or go past an injection date my libido increases. That makes me think i'm on to high of a dose, but what do I know.
Regards,

 

[madman]

Last thing you want to do here is get caught up on use of an AI especially when your trough FT is most likely too high.

Driving up your FT will drive up your estradiol.

The more sensible fix here is bringing down your trough FT if it is too high!

Big mistake upping your dose of T!

You already went from 140 mg T once weekly---> 80 mg T split twice-weekly previously.

I already stated that on the 140 mg T/week protocol you would have been hitting a healthy trough FT and this is a whopping 7 days post-injection.

You were already struggling with elevated RBCs, hemoglobin and hematocrit.

Now you are back on 150 mg T/week split as your urologist just recently upped your dose further which is going to have your trough FT way too high.

Going from 140 mg T once weekly--->150 mg split twice-weekly is going to clip your peak--->trough (soften the peak/bring up the trough) but keep in mind you also increase the weekly dose too.

On your most recent labs 150 mg T/week protocol you only posted your TT and if you tested at true trough (lowest point) before your next injection and you were hitting a high TT 1128 ng/dL then your trough FT is going to be high/very high depending on where your SHBG sits.

Peak TT and more importantly FT will be higher.

Even then you are only 3 weeks in and have not even reached steady-state (4-6 weeks TC/TE) so your TT 1128 ng/dL will be even higher once your. blood levels have stabilized.

Your urologist does not even understand the PK!

Last thing you want to do here is push your trough FT higher!

Post your labs so we can see where the most important blood marker sits on the 150 mg T/week split twice-weekly protocol that you tweaked 3 weeks ago as your uro who is clueless here increased your dose further.

If you never had it tested then post your SHBG and we can easily calculate it.

Posting your TT means nothing here as FT is what truly matters.

F

Thread 'Hello from NC'

Aug 3, 2025

Hi all, been lurking here reading for close to a year. Coincidentally I've been on TRT for just over a year and a half now. Clinically have had low testosterone since I was 29 and now i'm 41. My endocrinologist has been the one Rx'ing test cypionate to me. I've ranged from where he started me on at 140mg weekly and down to 100mg weekly.

I've had quarterly check-ins with the endocrinologist and my blood work has always decent but i've had the normal side effects. High hematocrit, low libido etc. Doctor told me to drop my dose down to 100mg when he saw my hematocrit. In March of this year I...

• firefighterinNC
• Replies: 42
• Forum: Introductions

 

[firefighterinNC]

Last thing you want to do here is get caught up on use of an AI especially when your trough FT is most likely too high.

Driving up your FT will drive up your estradiol.

The more sensible fix here is bringing down your trough FT if it is too high!

Big mistake upping your dose of T!

You already went from 140 mg T once weekly---> 80 mg T split twice-weekly previously.

I already stated that on the 140 mg T/week protocol you would have been hitting a healthy trough FT and this is a whopping 7 days post-injection.

You were already struggling with elevated RBCs, hemoglobin and hematocrit.

Now you are back on 150 mg T/week split as your urologist just recently upped your dose further which is going to have your trough FT way too high.

Going from 140 mg T once weekly--->150 mg split twice-weekly is going to clip your peak--->trough (soften the peak/bring up the trough) but keep in mind you also increase the weekly dose too.

On your most recent labs 150 mg T/week protocol you only posted your TT and if you tested at true trough (lowest point) before your next injection and you were hitting a high TT 1128 ng/dL then your trough FT is going to be high/very high depending on where your SHBG sits.

Peak TT and more importantly FT will be higher.

Even then you are only 3 weeks in and have not even reached steady-state (4-6 weeks TC/TE) so your TT 1128 ng/dL will be even higher once your. blood levels have stabilized.

Your urologist does not even understand the PK!

Last thing you want to do here is push your trough FT higher!

Post your labs so we can see where the most important blood marker sits on the 150 mg T/week split twice-weekly protocol that you tweaked 3 weeks ago as your uro who is clueless here increased your dose further.

If you never had it tested then post your SHBG and we can easily calculate it.

Posting your TT means nothing here as FT is what truly matters.

I certainly agree, I don't think upping the dose is the right call either it's just what the urologist is prescribing me. My PCP agrees but she defers to the urologist as its their specialty. The lab i've shared below was pre trt. That's the only time i've had my shbg tested, every doctor since i've asked about free and shbg and they say they don't need it to treat low testosterone. I'll see if I can't reach out to my PCP about getting a more thorough set of labs that include free testosterone and shbg. Is there anything else I really need?

 

[Vince]

Still working with a urologist to get dialed in.

My complaints about lack of libido and sensitivity downstairs are still my biggest issues. Energy and sleep quality seemed to be getting better. I was actually saying to myself I felt pretty good lately and at times for 1-2 days infrequently I think libido is getting better, but it's gone just a quick.

My urologist recently upped my dose to 150 mg of test cyp split into two doses weekly, he did mention he has folks take test cypionate eod and they have good success. My sensitive e2 came back in the at 52 and my testosterone was 1128. He suggested checking prolactin which was 9.7 ng/ml, so that was normal.
He also gave me aromatase inhibitor anastrozole and told me to take a quarter. I don't like that the way that makes me feel at all, depressed and irritable. The previous urologist prescribed aromasin and I did not have that depressed irritable feeling when I took it.
The current urologist just didn't have many answers for me. He said I might not be on high enough dose to get my levels to where they need to be. He said some folks sometimes need an ester change and some folks have to get estrogen under control. He said mine was elevated but not bad ( whatever that means). He wanted me to give it 8 weeks and re evaluate.

His response was to take the AI as needed.
I guess i'm dumbfounded here, when and how do I know when this would be needed? I just had a follow up with my pcp and I told her I felt like the increasing of the dose was the wrong way to go but she told me to just stay the course and see how it went at the 8 week follow up. I'm on week 3 of this dose increase and I can feel this inner anxiety creeping up this week that I didn't have the previous two weeks. Financially I don't have the means to get independent labs so i'm trying to work with my pcp and my urologist.
One thing i have noticed is that towards the end of my week if I miss an injection day or go past an injection date my libido increases. That makes me think i'm on to high of a dose, but what do I know.
Regards,

I've never in 11 years of TRT taken an AI.

You may have to experiment to find out what works best for you. I would start with once weekly, and see how it works, and if your results aren't good, then try twice weekly.

 

[madman]

I certainly agree, I don't think upping the dose is the right call either it's just what the urologist is prescribing me. My PCP agrees but she defers to the urologist as its their specialty. The lab i've shared below was pre trt. That's the only time i've had my shbg tested, every doctor since i've asked about free and shbg and they say they don't need it to treat low testosterone. I'll see if I can't reach out to my PCP about getting a more thorough set of labs that include free testosterone and shbg. Is there anything else I really need? View attachment 53829

I certainly agree, I don't think upping the dose is the right call either it's just what the urologist is prescribing me. My PCP agrees but she defers to the urologist as it's their specialty. The lab i've shared below was pre trt. That's the only time i've had my shbg tested, every doctor since i've asked about free and shbg and they say they don't need it to treat low testosterone. I'll see if I can't reach out to my PCP about getting a more thorough set of labs that include free testosterone and shbg. Is there anything else I really need?


Any doctor basing labs on TT is out to lunch here!

Anyone in the know who understands this is more concerned with the most critical blood marker free testosterone as its the active unbound fraction of T responsible for the positive effects.

Lots of men suffering from low-T symptoms get misdiagnosed as many have a normal TT but sub-par/low FT as they have high SHBG.

Also keep in mind that many men can end up struggling on T-therapy as their steady-state/trough FT can be too high!

TT does not paint the full picture here!

Even then it is always good to know where your SHBG sits pre/post therapy.

You are going to be running around in circles here chasing the TT without knowing where your trough FT sits.

This is what truly matters here as you are going to run into issues if FT is too low or too high and the only way to know is having it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

Even then you always have the option of calculating it on your own using the linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.

Just need to know where your TT, SHBG and Albumin sit and you can even use the default for Albumin.

The calculator is available online for free to the general public.

Free & Bioavailable Testosterone calculator

Forget relying on your GP unless they are willing to give you a requisition to test your TT and more importantly FT using the most accurate assays and as I stated in your previous thread just pay out of pocket and use Nelson's discounted labs which would be your cheapest option.

Testing will be done through Quest Diagnostics and you can test your markers using the most accurate assays TT (LC-MS/MS) and FT (Equilibrium Dialysis).


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Testosterone, Free (Equilibrium Dialysis) and Total, MS | Discounted Labs

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

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Critical blood markers to test when on therapy (TT, FT, estradiol, SHBG) and CBC which includes the critical blood markers RBCs, hemoglobin and hematocrit.

Always need to test at the true trough (lowest point) before your next injection which is 84 hrs post-injection on a twice-weekly protocol.

Pointless posting blood work if you have no clue where such markers sit.