Long time lurker / new member...

[alchemist004]

What's up everyone. Long time lurker/new member. Finally on Cypionate and HCG!


40yo 175 lb endurance athlete. I've been on TRT for almost 2 years now (without HCG support). I started out with Androgel, compounded creams, compounded pellets, to Testopel then finally back to compounded creams. I've been through 3 Endo's all while with a new primary who I started with over 2 years ago who diagnosed LowT after complaining about the poor libido, forgetfulness, etc, etc.


My primary is the man, very attentive, and not too proud to read up on information I bring to him or ask. The Endo's (like every other doctor I've ever dealt with in my life) just suck. Their way is the only way. Through all of this, the only thing that seemed to work was Androgel 1.62 afte working up to 4 pumps a day which brought my total T up to 600 *once. My free T was always crap. He and I have a great relationship and he respects and considers my opinion as it pertains to my healthcare.


I followed everything my primary and specialists told me to the letter but no one ever wanted to give me injections. One said yes but would only do it in his office and one shot every 2 weeks, which seems to be on par with what others have experienced.


I keep my doctors up to date with how I feel from week to week and he knows I'm the type of person who does not take anything without careful consideration. Finally my primary agreed to give me a script for Cypionate & HCG. It was a lot of the information on this site that I provided to him that he was receptive to, did his own research, and spoke with colleagues about, that led him to this decision. I'm beyond grateful.


6 weeks ago, my total T was in the high 300's, Estradiol was in the high 20's, and my LH was .01. Originally my request was just for Cypionate (I didn't want to ask for too much at once) but my Dr spoke with an out of state colleague who deals in TRT who suggested we check LH because I may need HCG. After my LH came back at .01, they wanted me to do 3000units weekly of HCG which I won't do. I told him I would start with the following protocol which I have been on for the last 5 weeks.


Subcutaneous injections of 50mg Cypionate (200mg/ml) and 50units HCG (I reconstituted 10,000iu of Pregnyl with all 10ml water) E3.5 days (Sunday morning / Wednesday night) which should be 100mg Cypionate and 1,000iu HCG weekly.


On this protocol I feel ok. I'm not miserable like I was before though I only feel lively the day after dosing.


I just got my labs faxed to me from Accureference. I am currently (and have been) without insurance but that will change next month. I'll have to call the girls at the office and see why my usual full workup (hematocrit, etc, etc) wasn't ordered. Moving forward with insurance, I'll be going back to Labcorp for bloodwork.

Labs 8/20
Testosterone Total 1267 (198-679)
Testo Free Calculated 127
Estradiol 56.2 (0.0-39.8)
SHBG 34.5 (13.2-89.6)
LH 0.01



Could the fact that I pinned at 6pm the night before (18 hours) cause these the Total and Free T to be that high? I want to know that I have reliable data as my baseline. Is there an optimal time for blood draws?


I understand that Dr. Crisler is an advocate of daily HCG injections so in light of that, I just changed my HCG protocol yesterday where my am dose should have been 50 units. I instead will be doing 10units daily to see if that helps bring down my Estradiol. As it is with the 56, I don't feel good, but I don't feel terrible either (though I am bloating) so I'm hopeful I won't need an AI and maybe only need to get this down below 40 (I have no reason for choosing 40 as a target other than that I've never had it this high before).

Should I change my Cypionate protocol for more frequent doses as well? Instead of 50mg E3.5 maybe something like 20 or 30mg EOD? I have read that 100mg once a week is not the same as smaller injections totally 100mg within the week so would it make sense that I make the change Cypionate to EOD injections in conjunction with the ED HCG injections to bring down my Estradiol?


Just a closing thought. I understand that my body is now on roughly it's 4th synthentic substance since December having gone from Testopel implants, then back to the compounded cream which I was on up until 6 weeks ago, now Cypionate and HCG. With that, I am curious if 5 weeks is enough for the body to acclimate to how it is going to process the new substances, as I would imagine this would take longer than the time to acclimate to a change in protocol since the body is already used to the medications.

I apologize for the long winded introduction, but I want to be as thorough as possible. I really appreciate all of your insight and opinions in advance.

 

[Gene Devine]

Your Total is a bit on the high side and you could reduce your dosage to 80 mg a week as that will bring it down.

I think your issue is your estrogen being in the mid 50's...for many men, that will cause negative symptoms.

IMO, you can either reduce your doses of both Testosterone and HCG as both aroamatase and increase E2 or ask for a very low dose of an AI like .25 mg 24 hours after each Testosterone injection to help manage your E2.

You just need to dial in and it's normal.

 

[alchemist004]

Gene, thank you for you for advice. I will try lowering my doses to 80iu ED of HCG and 40mg E3.5D of Cypionate (subQ) for the next 5-6 weeks

I have never seen a E2 number this high, but then again, my T has only been over 500 once since starting TRT. I did a lot more reading last night and came across information regarding the 14-20% T to E ratio. This may explain why (while I don't feel particularly good) I don't feel absolutely horrible with an E2 of 56. TT and E2 are high, but I see that the ratio is not very far off. Hopefully by lowering both doses a bit, as you've suggested, I will be able to bring both numbers down and dial in that ratio.

Thanks again.

 

[Vince]

You tested too early after injecting, test on your injection day before you inject. If you feel good maybe you should keep your protocol.

 

[alchemist004]

Thanks Vince. It seems logical that testing too soon will show a values of TT. Now you've got me curious about whether or not E2 is that high because of the timing of the blood draw. If that were the case, isn't it safe to say that my E2 still shouldn't get that high (regardless of when I drew the blood) and as a result I should still lower my doses a bit?

While I don't feel good, I'm getting by. I am certainly not miserable like I was prior to getting on injections. I feel confident that it's just a tweak here or there and I'll be good to go.

I'll remember to test on the injection day before injecting. In that case, I would imagine I should not do my morning dose of HCG (since I'm doing daily injections now) the day of blood draws, correct?

 

[Vince]

Thanks Vince. It seems logical that testing too soon will show a values of TT. Now you've got me curious about whether or not E2 is that high because of the timing of the blood draw. If that were the case, isn't it safe to say that my E2 still shouldn't get that high (regardless of when I drew the blood) and as a result I should still lower my doses a bit?

While I don't feel good, I'm getting by. I am certainly not miserable like I was prior to getting on injections. I feel confident that it's just a tweak here or there and I'll be good to go.

I'll remember to test on the injection day before injecting. In that case, I would imagine I should not do my morning dose of HCG (since I'm doing daily injections now) the day of blood draws, correct?

That's correct, no injecting including HCG. Too high of E2, any symptions-nipple sensitivity?
https://www.excelmale.com/?s=162-Elevated-Estradiol-During-TRT-To-Treat-or-Not-To-Treat
https://www.excelmale.com/forum/showthread.php?3767-Man-boobs&highlight=nipple+sensitivity

 

[alchemist004]

No, no, nothing like that. It's mostly feeling lethargic with some brain fog and hot flashes. Morning wood is suspect but before was non existent. Overall my strength is up, I just feel run down. I don't drink, I eat clean and I get a solid 7 hours a night (I'd like to see 8 but it is what it is). I'll have that one day where I'm really good, and then it all goes back to gray.

Again, I'm much better than I was 6 weeks ago. I was a zombie. I think I'm going to roll with the slightly lower doses for the next month and see where we're at. I don't think it can hurt.

 

[Gene Devine]

You tested too early after injecting, test on your injection day before you inject. If you feel good maybe you should keep your protocol.

He's injecting twice weekly so his blood serum levels are going to be very consistent so it really doesn't matter what day he gets pulled.

Plus, estrogen serum levels don't fluctuate like Testosterone as it moves much much slower so it makes no difference what day your pulled for Estrogen labs.

 

[Vince]

Gene I'm sure you're right, but I still feel more comfortable testing before I inject anything. Personal preference.

 

[CoastWatcher]

Gene I'm sure you're right, but I still feel more comfortable testing before I inject anything. Personal preference.

Vince, My doctor gave me the same advice Gene relayed. Nonetheless, call it superstition, I, like you, have blood drawn prior to my injection. Which may defy logic and pharmacology...

 

[Vettester Chris]

Welcome to EM! Glad you joined!!

 

[alchemist004]

Thanks for the clarification gentlemen and thanks for the welcome Chris.


Question of the day (of which I'm certain there will be many):

I have been finding mixed opinions regarding the peak days of Testosterone serum levels after Cypionate injections. I ask because I am currently dosing E3.5D on Sunday am and Wednesday pm (I just happened to get my initial prescription filled on a Wednesday). I would like to schedule my injections so that my levels are at their optimal levels on Saturday and Sunday. Is such a window even relevant given the frequency of my injections?

Thank you.

 

[CoastWatcher]

Thanks for the clarification gentlemen and thanks for the welcome Chris.


Question of the day (of which I'm certain there will be many):

I have been finding mixed opinions regarding the peak days of Testosterone serum levels after Cypionate injections. I ask because I am currently dosing E3.5D on Sunday am and Wednesday pm (I just happened to get my initial prescription filled on a Wednesday). I would like to schedule my injections so that my levels are at their optimal levels on Saturday and Sunday. Is such a window even relevant given the frequency of my injections?

Thank you.

The goal of twice weekly (every 3.5 days) injections is to minimize the peak-and-valley tendency that many injecting weekly experience. Steady-state blood levels are the goal. That being said, if you inject on a Monday morning/Thursday evening schedule you come close to achieving your goal of a weekend "peak." But, maintaining your current schedule will give you something very similar, just some hours earlier.

 

[alchemist004]

The goal of twice weekly (every 3.5 days) injections is to minimize the peak-and-valley tendency that many injecting weekly experience. Steady-state blood levels are the goal. That being said, if you inject on a Monday morning/Thursday evening schedule you come close to achieving your goal of a weekend "peak." But, maintaining your current schedule will give you something very similar, just some hours earlier.

Thanks. This makes sense. I have to wrap my head around the idea that this protocol (when dialed) should minimize the peaks and valleys.

I have been reading up on Anastrozole just to be as well versed as can, should I find that I do in fact need to take an AI after next month's blood work. Is it true that (and I'm paraphrasing) it works by blocking 'future' aromatization, and doesn't actually lower your current estradiol levels? For example, with my first labs showing a E2 level of 56, if I had Anastrozole and took say .25mg (if that were the dosage that was right for me) on Monday after my Sunday injection (again hypothetical), it would prevent additional aromatization of that testosterone I just injected but not necessarily lower my E2 from 56? Would one just have to wait for the body to regulate the existing E2 levels?

I'm sorry for all of the questions. While, again, this scenario may not be relevant to me currently, I am fascinated by how this all works.

Thanks.

 

[alchemist004]

Just an early update: I met with my doctor this yesterday and he agreed that my TT and E2 are higher than we'd like. He did make 2 interesting points though.


Point 1. I had been on 2x 500iu of HCG up until the initial labs. He has no issue with my doing daily injections but does think I should do 10units daily (700iu wk) and not drop it to .8 units daily. I did lose sight of the fact that I had been on 2x 500iu prior to the bloodwork, so this logic I agree with and have been doing 100iu daily.


Point 2. He doesn't think that I need to lower my Cypionate from .50mg E3.5D (100mg /wk) but has no issue with me lowering it to .40mg E3.5D (80mg /wk) if I feel strongly about it. His reasoning for the Cypionate protocol remaining unchanged is that he believe it is possible that (in addition to smaller 100iu daily injections) by lowering my weekly HCG from 1000iu to 700iu should also lower my TT and E2 levels.


Point 2a. He would rather adjust one medication at a time to limit the variables between lab results. It's hard to argue this logic as well.

I have lowered my weekly doses of Cypionate from 100mg to 80mg and my HCG from 1000iu to 700iu.

Protocol (7/15 - 8/26)
50mg Cypionate E3.5D SubQ
500iu HCG E3.5D SubQ

Labs (8/20)Testosterone Total 1267 (198-679)
Testo Free Calculated 127
Estradiol 56.2 (0.0-39.8)
SHBG 34.5 (13.2-89.6)
LH 0.01

Current Protocol (8/26)
HCG -100iu ED SubQ
Cypionate - 40mg E3.5D​ SubQ

 

[alchemist004]

Hello everyone, I'm back with the results of my last 4 weeks on protocol 2.0 and I am completely confused now.

Current Protocol (8/26 - current)
HCG - 100iu ED SubQ
Cypionate - 40mg E3.5D SubQ

TT 1174 (348 - 1197 ng/dL)
TF (direct) 29.5 (6.8 - 21.5 pg/mL)
E2 (sensitive) 42.2 (8.0 - 35.0 pg/mL)
E2 ECLIA 35.9 (7.6 - 42.6 pg/mL)
C-Reactive Protein, Cardiac .58 (0.0 - 3.0 mg/L)
TSH 3.260 (.450 - 4.500 uIU/mL)
T4 7.1 (4.5 - 12.0 ug/dL)
T3 Free 3.7 (2.0 - 4.4 gp/mL)
WBC 6.1 (3.4 - 10.8 x10e3/ul)
RBC 5.41 (4.14 - 5.8 x10e3/ul)
HMG 15.1 (12.6 - 17.1 g/dl)
HCT 47.3 (37.5 - 51.0 %)

I have full CBC, metabolic, hepatic, and lipid panels if those results are relevant, though all in the middle of ranges except my LDL which always seems to come back high *LDL 131 (0 - 99mg/dL)


I am very confused what to do now. The first 5 weeks doing 50mg/500iu of T/HCG E3.5D (100mg/1000iu weekly) I was stronger but just a little off. The thought was that lowering both doses would put me within range. We lowered my weekly doses to 40mg E3.5 / 100iu ED of T/HCG (80mg/700iu weekly) and the smaller more frequent doses appear to have done the job too well as now if I divide 1174 by 42 I'm at 27.9! My morning wood is gone, but most noticeably, my strength and endurance are maybe half of what they were a month ago. Being a cyclist who rides and trains daily, I am very much aware of my physical condition from day to day. The biggest thing I have noticed is that both my power and endurance are about half of what they were a month ago, my body isn't recovering, and my legs have been very heavy.

Before I got the results, I was worried that maybe my RBC was too high and maybe needed to donate blood and that was why I feel the way I do, but now having the results, I guess I was way off.

Based on the 14-20% ratio, does this now mean that I need to actually raise my E2 and lower my T?!?!? Maybe this would explain why I feel better just before my next injection or in 1 case where I was tending to a family emergency and missed a dose by a day and felt better day 4 than I had in 4 weeks.....


I need to wrap my head around this and figure out (if this is now the case) what to do now and what to do going forward. Am I correct in assuming that I need to lower my T and raise my E2 to balance out again? It's my understanding that serum levels of T fluctuate more so that E2 so maybe I can lower my T by skipping a dose or 2 then going back to a higher bi weekly dose of both instead of the lower daily HCG injections?

Please help!
Thank you all in advance!

 

[Nelson Vergel]

I think the number one challenge for me when helping men tune up their protocols is making sure that they understand that all your blood test values can look great but this does not guarantee that every single day you will be feeling great.

There are factors that can get in the way of results and expectations:

1- The quality of our sleep (hardly anyone tells me info about their sleep quality).

2- Blood pressure and medication interaction/side effect issues.

3- Stress and life style (financial, busy schedule with work, children, relatives and everything that takes our energy away).

4- Dopamine and serotonin depletion/ imbalances.

5- Adrenal insufficiency.

Having said all that, I am not a believer in low dose daily HCG injections. Also, I think your estradiol is fine.

Is there a possibility that you pushed yourself harder when you felt good after the start of your program to the point of overtraining?



Here is a figure I like to show to make a point on how complex libido and erectile function are.

 

[alchemist004]

I think the number one challenge for me when helping men tune up their protocols is making sure that they understand that all your blood test values can look great but this does not guarantee that every single day you will be feeling great.

There are factors that can get in the way of results and expectations:

1- The quality of our sleep (hardly anyone tells me info about their sleep quality).

2- Blood pressure and medication interaction/side effect issues.

3- Stress and life style (financial, busy schedule with work, children, relatives and everything that takes our energy away).

4- Dopamine and serotonin depletion/ imbalances.

5- Adrenal insufficiency.

Having said all that, I am not a believer in low dose daily HCG injections. Also, I think your estradiol is fine.

Is there a possibility that you pushed yourself harder when you felt good after the start of your program to the point of overtraining?



Here is a figure I like to show to make a point on how complex libido and erectile function are.


View attachment 1590

Nelson thank you very much for taking the time to reply.

I am 40 years old, 5'9 and 170lbs. My blood pressure is always very good. I don't drink, I don't do any drugs, I sleep 7-8 hours every night (including weekends). My diet is very clean and balanced. I drink at least a gallon of water daily. I have a great job and really no stress in my life (hasn't alway been the case). I do take supplements everyday including a whole food mulit, omega3, probiotic, 5000iu of D, 3g Glutamine, 2g L-Leucine, 1g L-Isoleucine, 1g L-Valine, 1000mg L-Arginine, 1000mg Taurine, and 1600mg of Beta Alanine.

I honestly believe that it's just a numbers game for me at this point. I am not concerned with libido alone as I know there are a multitude of things that can effect this. I will make a point to say that I get minimal morning wood on the morning of my injection. I believe that once I get the numbers to the appropriate balance (not the numbers themselves, just what those numbers are when I find my sweet spot) this will remedy itself.

You make an excellent point regarding overtraining, which is always always a possibility, but once I started feeling weaker, I put myself into recovery mode which has really just been 2 weeks of active recovery. The heaviness will not subside. I do situps and pushups every morning and can do 2/3 of what I could before so besides my legs, I know how I feel every morning, because I do the same exercises habitually after stretching.

My E2 at 40 alone isn't a concern. But in relation to a TT of 1170 I am concerned based solely on the data from this site, as well as how I felt at my after 4-5 weeks at the original protocol. It is totally logical that with a Total T of 1200+ and an E2 of 56 I felt better than I do now when that ration was 22% and I'm currently at almost 28. I could always be wrong as you all are far more experienced in these areas.

This is my logic at this point in time. Please forgive the simplicity.

At face value based solely on these 2 sets of labs:
100mg of Cypionate and 1000iu of Pregnyl net me a TT of 1267.
The E35D frequency of these injections net me an E2 of 56.

80mg of Cypionate and 700iu of Pregnyl net me a TT of 1147.
The E35D frequency of 40mg of Cypionate and 100iu E3.5D frequency of Pregnyl net me an E2 of 56.

Neither of these TT values are alarmingly high but could certainly be lower. That's the easy part take less, net less. But for hypothetical purposes, if I just wanted to dial this in... is this rationale completely off or do I have a decent understanding?

If I were to keep the weekly doses the same as my current protocol of 80mg/700mg, my TT should be somewhere around 1147 again next month correct? My Estradiol should hypothetically be raised if I were to change my doses from say 100iu daily to say 350 E3.5D, correct?

By this logic, it's simply a matter of lowering the overall dose of medication you are taking to lower you TT levels, then figuring out what dosage/frequency of those weekly values your body responds the best to.

I can't overstate how appreciative I am of you taking the time to read and reply. I like to make educated decisions but since I am so new to this, I am going to ask a lot of potentially silly and redundant questions.

Ultimately I would like to take as little medication as possible to feel good. I don't need to be superman, I need to feel like a healthy man. No more, no less.