Low test, High Free T, low DHEA-s- what to do?

[Gholt10]

Lab results:
Total test- 393ng/dL (range 264-916)
Free T- 22pg/ml (range 9.3-26.5)
SHBG-4.1nmol/L (range is 16.5-55.9)
E2 sensitive- 13pg/ml (range 8-35)
DHEA-S- 154.4 ug/dL (range 164.3-530.5)

I had a reoccurrence of gynecomastia about 7 weeks ago and wasn’t feeling great on high amounts of test, so I made the decision to drop my testosterone dosage down to HRT levels from now on to avoid estrogenic side effects and eliminate the need for aromatase inhibitors. I feel like I’m close to getting things dialed in, but I was hoping for some more input from you all.

I was on about 30mg test cyp EOD when these were drawn and had dropped my Arimidex about 2.5 weeks prior. My total T is low, but I wanted to start low on the dose and work up if need be. As you can see, my free T is high, but I’m assuming this is because I have abnormally low SHBG of about 4.1nmol/L (range is 16.5-55.9). Also, my DHEA is very low as well, so I’m assuming supplementation would be the move there.

My libido, elections, and sleep have all been below average lately, so I’m hoping with some tweaks I can get to feeling good. The sleep has been killing me, since I can only sleep 2-3 hours before waking up and having to fall back asleep.

I’m wondering what you all think would be the next best adjustment(s) to make are. My thoughts would be to increase the testosterone dose to around 160-180mg/week to bring up my T and e2, and to add DHEA in at 50-100mg/day. I’m torn on whether or not to use HCG. If so, should I add it with the DhEA or wait? Any advice is much appreciated.

 

[Vince]

Be careful with DHEA, this going to lower your testosterone and raise your estrogen. If you're going to use it start with 10 mg and skip the HCG for now. Before I started trt I tried DHEA and it really made me feel terrible. Totally tanked my testosterone and raise my estrogen levels. I do take 25mg now, to keep my levels in a good range. I started taking it before bed and it does help me sleep.

 

[Vince Carter]

Youre TT doesn't matter, it's all bound up. Worry about your dosing and were your Free T sits are which I personally wouldn't change the dose as you're very close to the lab range as it is. In low SHBG territory such as you are youre Sens E2 should be fine given it's in close proximity to your SHBG value. I don't recommend treating DHEA that's a garbage thing to treat and just aromatases so very easily in many guys and given you think youve had some Gyno I'd just avoid DHEA altogether.

And FYI you can get all the TRT advice you can handle here but this is not a cycles/AAS environment and you won't get any advice of that nature here.

 

[Gholt10]

Appreciate the input. I posted here because I’ve decided to pursue just using HRT doses long term now, so I figured this would be a good spot to look for advice.

If you don’t think treating DHEA is proper, then what do you think I should do to alleviate these symptoms? I feel like they have to stem from one of these hormones most likely, if not a combination of all of them.

 

[CoastWatcher]

Where does your DHEA sit?

 

[Gholt10]

About 154ug/dL

Just updated the post with it. Didn’t realize I left it out.

 

[Vince]

All your symptoms are probably coming from, low shbg. I would never feel good with testosterone at 400. My only opinion would be try daily injections.

 

[Vince Carter]

if you're doing 30mg EOD you could consider 15mg every day and see how that goes though I think your numbers are fine and peeps get mixed up in TT which doesn't matter at all. maybe 35mg EOD but that SHBG is going to give you fits and working the E issues. In your next batch of tests if you can afford it run all three of these in addition to the usual others:

Estradiol
Ultra Sensitive Estradiol LC/MS/MS
Estradiol, Free

 

[Gholt10]

Do you both think that daily injections offer significant benefits over doing EOD? Also, I’m torn on the TT vs FT. Obviously the free test is in a good range, but maybe my symptoms would improve with a slight dosage increase? I know my low SHBG complicates things.