How do you know when to take an AI.

firefighterinNC

New Member
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,
 
JERU!


I meet with doctor again on November 26th i'll ask about the oral TU then. I doubt my insurance will cover it as they gave me a fit over just getting injections covered.

Kyzatrex is a cash pay model only.




Jarenzo

*if commercial insurance rejects coverage, you may pay $150






Tlando

 
I meet with doctor again on November 26th i'll ask about the oral TU then. I doubt my insurance will cover it as they gave me a fit over just getting injections covered.

Kyzatrex is a cash pay model only.




Jarenzo

*if commercial insurance rejects coverage, you may pay $150





Tlando
Thanks for that! I'll certainly ask.

I don't really understand the urologist comment when he said the oral TU wouldn't give me the results i'm looking for. Sort of strange. My PCP said she would prefer I used the oral TU over injections for whatever reason she didn't mention so maybe if the urologist doesn't agree I can go back to her.

Got my lab work done this morning for SHBG and Free + total testosterone.
 
only time I needed an AI, is when i blasted HCG at 10kiu/week in addition to 200mg T. my only symptoms was shitty anxiety, which was resolved by an AI within 8-12h. no clue what my e2 was, but normally I do ok on 60pg/ml so must have been higher
 
You are clearly overmedicated here!
Certainly agree, I just don't know what dose I should be at or frequency. Urologist upping my dose and he's about as vague as can be on what dose frequency. He tells me I have folks who feel fine on one large shot every two 1-2 weeks and then some folks feel better on higher frequency lower dose. I've done once a week and i've done twice a week for a while now without any improvement. Still patiently waiting on lab results
 
Certainly agree, I just don't know what dose I should be at or frequency. Urologist upping my dose and he's about as vague as can be on what dose frequency. He tells me I have folks who feel fine on one large shot every two 1-2 weeks and then some folks feel better on higher frequency lower dose. I've done once a week and i've done twice a week for a while now without any improvement. Still patiently waiting on lab results

You should have never been started on T until your elevated baseline hematocrit was addressed.

To make matters worse you were started off on too high a dose from the get-go.

Even then you should have never been started on T until your elevated baseline hematocrit was addressed.

Standard starting dose if 100 mg T/week whether once weekly or split twice-weekly.

Yes some may inject more frequently off the hop but this is far from common.

Again always best to start low and go slow on a T-only protocol so you can see how your body reacts to testosterone and where said protocol (dose of T/injection frequency) has your trough TT and more importantly FT, estradiol and critical blood markers RBCs, hemoglobin and hematocrit.

Always good to know where your SHBG sits too.

Whether starting therapy or tweaking a protocol (dose of T/injection frequency) every protocol needs to be given a fighting chance 12 weeks before claiming whether it was a success or failure.

It takes 4-6 weeks just to reach steady-state (TC/TE) meaning for blood levels to stabilize and it will take a few more months after levels have stabilized in order for the body to adapt to its new set-point as this is the critical time period when one needs to. gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.

Yes there will always be time to increase the dose or add in hCG if need be.

The goal here is too achieve a healthy trough FT.

You do not want to be hitting too low or too high a trough otherwise you will run into issues.

Trough needs to be high enough so you can maintain the beneficial effects throughout the week.

The body was never meant to be amped up on T 24/7!

As I have stated numerous times on the forum over the years when looking at the bigger picture all that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.
 
You should have never been started on T until your elevated baseline hematocrit was addressed.

To make matters worse you were started off on too high a dose from the get-go.

Even then you should have never been started on T until your elevated baseline hematocrit was addressed.

Standard starting dose if 100 mg T/week whether once weekly or split twice-weekly.

Yes some may inject more frequently off the hop but this is far from common.

Again always best to start low and go slow on a T-only protocol so you can see how your body reacts to testosterone and where said protocol (dose of T/injection frequency) has your trough TT and more importantly FT, estradiol and critical blood markers RBCs, hemoglobin and hematocrit.

Always good to know where your SHBG sits too.

Whether starting therapy or tweaking a protocol (dose of T/injection frequency) every protocol needs to be given a fighting chance 12 weeks before claiming whether it was a success or failure.

It takes 4-6 weeks just to reach steady-state (TC/TE) meaning for blood levels to stabilize and it will take a few more months after levels have stabilized in order for the body to adapt to its new set-point as this is the critical time period when one needs to. gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.

Yes there will always be time to increase the dose or add in hCG if need be.

The goal here is too achieve a healthy trough FT.

You do not want to be hitting too low or too high a trough otherwise you will run into issues.

Trough needs to be high enough so you can maintain the beneficial effects throughout the week.

The body was never meant to be amped up on T 24/7!

As I have stated numerous times on the forum over the years when looking at the bigger picture all that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.
Certainly makes sense, I've a few co-workers who have been on TRT for the better part of a decade and one specifically said he goes no higher than 80 mg a week. He just said it took a lot of trial and error but thats where he feels best. I hate to go against doctors orders on medication but I feel worse on the higher dosage imo.

I wonder if thats my CNS causing the feeling of anxiety and panic from being amped on up to much testosterone. It really didn't happen until I've gone up in dose. My original endocrinologist started me on 140 mg where i stayed for the initial 6-8 weeks. Once he saw my hematocrit and rbc he lowered me down to 100 mg. The new urologist is the one who bumped me back up to 150 mg. It's been sort of a roller coaster ride. Libido to me seems worse on the higher dose, the only time I notice it improving or my desire level increasing is closer towards injection day or even if I were to skip a injection day.

The one thing I recall that the endocrinologist mentioned to me from the beginning was he was a proponent of single doses weekly or even just slightly past the half life of test cypionate which I think was 7-8 days. He said it gives the body's androgen receptors time to sort of cleanse themselves (whatever that meant).

Still waiting on lab work but i'll post it whenever I get it.
 

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⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

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Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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