braketest2
Member
Thanks again! Real people should always be heard experience and wisdom wins the day!
Need Help- New to TRT
- Thread starter braketest2
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braketest2
Member
Good afternoon madman! I am sitting wondering if I dare ask another question but I guess I will. I will return to the 100mg dose for six weeks but if you recall, I pushed my E2 to 50 while on 1x per week somewhere in the 8 week range. I'm not sure how your projection would have estimated this on 2x per week. Would I be better off or worse you think on 100mg 2x per or 3x per week? Just an opinion before I commit to the new protocol. Did you think I was a fast aromatizer at 100mg 1x per week? Thanks!Harmonized reference range for TT 264-916 ng/dL, look over post #7 of the thread I posted at the end of my reply.
You were hitting a high trough TT 920 ng/dL.
This is trough (lowest point) before your next injection we are talking about here not peak which is going to be higher!
070001: Testosterone, Total, Women, Children, and Hypogonadal Males, LC/MS-MS
Labcorp test details for Testosterone, Total, Women, Children, and Hypogonadal Males, LC/MS-MSwww.labcorp.com
View attachment 56730
View attachment 56731
The most accurate assay for testing the most critical fraction free testosterone is the gold standard Equilibrium Dialysis.
I calculated your FT using the go to linear law-of-mass action Vermeulen which is the next best testing method and most widely used which will give a good approximation.
The calculator is available online for free to the general public.
If we plug in your high trough TT 920 ng/dL, normalish SHBG 36 nmol/L and Albumin 4.3 g/dL (default) then your high-end trough cFTV 20.9 ng/dL would be close to the top-end of the reference range for cFTV which is 6.5-25 ng/dL.
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Again you were hitting a high trough TT 920 ng/dL and more importantly high-end trough FT 20.9 ng/dL 3 weeks in.
If you had waited until blood levels stabilized and tested 6 weeks in then your trough TT/FT and DHT would have been higher.
There was absolutely no need to increase your dose!
Again.
Too many caught up on that more T is better mentality bulls**t!
Always need to be mindful of your injection frequency/where trough FT sits.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high!
The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.
Need to keep in mind that there is a big difference between one running a high-end/high trough FT 20-25 ng/dL injecting daily vs twice-weekly vs once weekly.
Also going to be a big difference in peak--->trough on said protocol!
Many tend to overlook this and gun for a high-end/high trough FT only to end up struggling with sides especilly in the long run.
Just to put this in perspective most healthy young males would be hitting a cFTV 13-15 ng/dL or 10-12 ng/dL tested using the most accurate assay the gold standard Equilibrium Dialysis and this is a short-lived daily peak to boot!
Even if you take those natty outliers in the 97.5 th percentile hitting a high FT 25 ng/dL again this is a short-lived daily peak to boot!
You have guys on T hitting a trough FT 25-30+ ng/dL injecting daily with FT elevated 24/7, EOD as in every 2 days (48 hrs post-injection),twice-weekly as in every 3.5 days (84 hrs post-injection) or once weekly as in 7 days post-injection.
Hopefully you get the point.
Look over post 1 and 7 from this thread!
It will open your eyes!
Crystal clear!
post #1/7
madman
Super Moderator
Just stick with the 2x weekly protocol for now as you will be clipping the peak--->trough and blood levels will be more stable throughout the week.
Dampening the spikes and smoothing out levels throughout the week will help.
This is where injecting more frequently shines!
There will be lots of time to try injecting more frequently if need be.
High aromatizers would tend to be men with excess adipose especially visceral fat or impaired liver function which can slow estrogen clearance.
Most men that end up struggling with elevated e2 are most likely carrying a lot of adipose or are genetically high aromatizers.
* The rates of conversion of testosterone to DHT and E2 vary among people due to polymorphisms of genes that encode the steroid 5α reductases and the aromatase enzyme as well as other host-specific factors that affect the activity of these enzymes
*Circulating testosterone is converted in many peripheral tissues to its two active metabolites, 5α dihydrotestosterone (DHT) and 17β estradiol (E2)
*In many androgen-responsive tissues, a family of steroid 5α reductase enzymes converts testosterone to DHT, and the aromatase enzyme, a product of the CYP19A1 gene, converts it to E2
*Many tissue-specific biologic effects of testosterone are mediated through DHT and E2
*The rates of conversion of testosterone to DHT and E2 vary among people due to polymorphisms of genes that encode the steroid 5α reductases and the aromatase enzyme as well as other host-specific factors that affect the activity of these enzymes
*It is not known how the circulating concentrations of testosterone’s metabolites – DHT and E2 – modulate the effects of testosterone on various outcomes and how their circulating levels rank in their contribution to the observed effects of testosterone treatment on physiologic outcomes
braketest2
Member
Aye aye Captain! It all makes sense! I do believe with my short history I am Estradiol sensitive and Anastrazole is best kept at a distance no matter who you are if possible. I have struggled the whole time with erect nipples and keeping the wife happy but the morning wood is alaways there. No other symptoms of high E2 but then again after the crash I have no idea where my E2 sits. All this and I am on a daily 5mg Cialis for BPH and it doesn't last. This is a symptom of E2 being a little high is it not? And a reason I went to 3X per week.Just stick with the 2x weekly protocol for now as you will be clipping the peak--->trough and blood levels will be more stable throughout the week.
Dampening the spikes and smoothing out levels throughout the week will help.
This is where injecting more frequently shines!
There will be lots of time to try injecting more frequently if need be.
High aromatizers would tend to be men with excess adipose especially visceral fat or impaired liver function which can slow estrogen clearance.
Most men that end up struggling with elevated e2 are most likely carrying a lot of adipose or are genetically high aromatizers.
* The rates of conversion of testosterone to DHT and E2 vary among people due to polymorphisms of genes that encode the steroid 5α reductases and the aromatase enzyme as well as other host-specific factors that affect the activity of these enzymes
*Circulating testosterone is converted in many peripheral tissues to its two active metabolites, 5α dihydrotestosterone (DHT) and 17β estradiol (E2)
*In many androgen-responsive tissues, a family of steroid 5α reductase enzymes converts testosterone to DHT, and the aromatase enzyme, a product of the CYP19A1 gene, converts it to E2
*Many tissue-specific biologic effects of testosterone are mediated through DHT and E2
*The rates of conversion of testosterone to DHT and E2 vary among people due to polymorphisms of genes that encode the steroid 5α reductases and the aromatase enzyme as well as other host-specific factors that affect the activity of these enzymes
*It is not known how the circulating concentrations of testosterone’s metabolites – DHT and E2 – modulate the effects of testosterone on various outcomes and how their circulating levels rank in their contribution to the observed effects of testosterone treatment on physiologic outcomes
braketest2
Member
Good Afternoon madman!Just stick with the 2x weekly protocol for now as you will be clipping the peak--->trough and blood levels will be more stable throughout the week.
Dampening the spikes and smoothing out levels throughout the week will help.
This is where injecting more frequently shines!
There will be lots of time to try injecting more frequently if need be.
High aromatizers would tend to be men with excess adipose especially visceral fat or impaired liver function which can slow estrogen clearance.
Most men that end up struggling with elevated e2 are most likely carrying a lot of adipose or are genetically high aromatizers.
* The rates of conversion of testosterone to DHT and E2 vary among people due to polymorphisms of genes that encode the steroid 5α reductases and the aromatase enzyme as well as other host-specific factors that affect the activity of these enzymes
*Circulating testosterone is converted in many peripheral tissues to its two active metabolites, 5α dihydrotestosterone (DHT) and 17β estradiol (E2)
*In many androgen-responsive tissues, a family of steroid 5α reductase enzymes converts testosterone to DHT, and the aromatase enzyme, a product of the CYP19A1 gene, converts it to E2
*Many tissue-specific biologic effects of testosterone are mediated through DHT and E2
*The rates of conversion of testosterone to DHT and E2 vary among people due to polymorphisms of genes that encode the steroid 5α reductases and the aromatase enzyme as well as other host-specific factors that affect the activity of these enzymes
*It is not known how the circulating concentrations of testosterone’s metabolites – DHT and E2 – modulate the effects of testosterone on various outcomes and how their circulating levels rank in their contribution to the observed effects of testosterone treatment on physiologic outcomes
I am touching base if that's alright. I am two weeks into dropping back down from 140mg 3x per week to 100mg 2x per week. I am just wondering if dropping 40 percent I should feel like I do. I am taking 25mg DHEA in the morning and 3mg melatonin at night. I am sleeping better than I had been butI am somewhat of a moody SOB and have felt little in the libido dept. Morning stuff is there but indiference seems to be the order of the day since switching. Seem normal given the drop??? Thanks if you care to answer.
madman
Super Moderator
I am two weeks into dropping back down from 140mg 3x per week to 100mg 2x per week. I am just wondering if dropping 40 percent I should feel like I do.
Hope you meant 40 mg not % as it would be 28.6 %.
Yes it's normal and expected for one to experience downs/bumps along the way when decreasing your dose of T as your hormones will be in flux during the weeks leading up until blood levels stabilize (4-6 weeks TC/TE) and the body is trying to adjust.
This is expected and means nothing when looking at the big picture here.
This is why starting low and going slow is key here as it will always be much easier going up then having to come down.
Again once steady-state is achieved and your. blood levels have stabilized it will still take the body time as in a few more months to adapt to its new set-point and this is the critical time period when one need to gauge how they truly feel overall.
How you feel 6 weeks is misleading.
Once labs are done 6 weeks in to get a snapshot of where said protocol (dose T/injection frequency) has your trough TT and more importantly FT and estradiol as long as you are hitting a healthy trough FT then you need to give the protocol a fighting chance as in a few more months for your body to adapt to its new set-point.
Otherwise you will get caught up on that never ending merry go round twerking your protocol left and right because you do not feel well off the hop.
This is where many make the grave mistake and end up ncrease their dose every 6 weeks only to end up struggling in the long run run!
If you truly understand how exogenous T works then patience is key here!
braketest2
Member
I was injecting 140mg split into 3 injections as per our fruitful talks. I am now splitting 100mg into 50mg 2x per week (your advice based on the lab #s I have provided). Sorry I am no where near as polished and versed yet and thanks again for the sensible advice!
braketest2
Member
Hi Madman I am now going into week 4 of my 100mg 2x per week. I am actually getting worse, morning wood is so so. Inabilty to maintain an erection has worsened. I have switched to taking DHEA in the morning at 20mg per day. Should I drop DHEA? My original diagnosis and and labwork showed me at 71 which was at the low end but still in range. I was taking 10mg at night. Is this screwing me up you think? Should I still get tested in three weeks? Not panicked at all! Thanks. I take daily Tadalafil at 5mg daily for BPH and it seems to do nothing which I guess is normal when you are out of balance.I was injecting 140mg split into 3 injections as per our fruitful talks. I am now splitting 100mg into 50mg 2x per week (your advice based on the lab #s I have provided). Sorry I am no where near as polished and versed yet and thanks again for the sensible advice!
FunkOdyssey
Seeker of Wisdom
I would. DHEA doesn't usually follow normal hormone logic, where low levels produce a deficiency syndrome, which causes symptoms, which are then resolved by supplementation. In practice, DHEA supplementation often causes problems, or fails to produce any net benefit, regardless of whether your baseline levels were low or not. There are outliers who do seem to benefit from DHEA but they're rare (you probably aren't one of them).
What DHEA does when a man takes it, especially orally, is produce a modest E2 bump, and a ton of estrone (E1). Get a fractionated estrogens lab and you'll see the dramatic E1 effect.
braketest2
Member
Thanks! My life on T has been mismanaged since I startted in November as you have probably followed in this thread. I have not felt great but a couple of weeks and have not been fully functional at all. I am seeking a new provider in the mean time and appreciate all the guidance which has been reasonable to say the least. Everything madman has said makes sense to me. I am 3 weeks out from a six week swing back to the protocol my GP originally chose. I am no longer listening to him as he would have poisoned me with AI. Defy raised my dose 40 percent as madman has stated when my numbers on the original dose looked pretty good. I have no provider I trust right now. I will stop DHEA and continue but will my labs be skewed from DHEA? Thankls!
FunkOdyssey
Seeker of Wisdom
In 3-5 days your DHEA-S should have returned to baseline, based on the 5 x half-life formula. I would guess after a week, all traces of downstream metabolites will also have disappeared.
braketest2
Member
Thanks man I mean really thanks! At least I know I get get a good luck in 3 weeks!
braketest2
Member
Good morning
all! Within 3 days of stopping DHEA my mornings have become more like a teenager and this even at the new lower protocol. I was wondering Mr. FunkOdyssey if you have a preferred supplement group for men in their sixties on TRT. Mine includes D3, Omega3's (2G) C Pure One(multi) NAC Sunflower Lecithin Aged Garlic with Hawthorne Boron(3G) and Magnesium. I have wondered whether any of the B Vitamins specifically would be a good addition P5P has been mentioned. I led a pretty sedentary life in my career and lost my thyroid to cancer ten years ago so permanent levothyroxine supplementation. I am also on a mission with Nattokinase and Serrapeptase with low dose aspirin to turn around any suspected arterial health issues and reduce BP which after six months I am looking good. Thanks for listening!
FunkOdyssey
Seeker of Wisdom
That's awesome, fingers crossed you continue to have success.
The things you're already taking are good, except sunflower lecithin - I'd rather get choline from whole food sources (meat and eggs). You mentioned "suspected arterial health issues". I would want to determine conclusively whether you have cardiovascular disease, and/or risk factors for it, before formulating any regimen to address it.
You'll want to do some imaging. The basic low-cost starting point here is the coronary artery calcium (CAC) scan. If this is zero, your CVD risk is much lower than most men your age. If it isn't zero, you have established atherosclerosis, and you'll want to treat that aggressively. If it's substantially elevated, you'll want to progress to better (and more expensive) imaging like Coronary Computed Tomography Angiography (CCTA).
For labs, you want to run ApoB, Lp(a), lipid panel, A1c + fasting glucose + fasting insulin, hs-CRP, and CMP/eGFR + urine albumin/creatinine ratio. Start tracking your blood pressure if you aren't already, with a home monitor.
At the end of this process, you'll have a much clearer picture of your CVD risks and will be ready to consider interventions.
braketest2
Member
Solid advice and I had the labs done a my own request and I have elevated A1C but yet Triglycerides are a good LDL is a little high but HDL was off the chart good. Lpa was good ApoB was normal range hs-CRP a little high urine was good. I led a sedentary life for a while and basically accept the fact that I probably have plaque but at 67 who doesn't! Funny how you can't count on a single DR today to run these tests and I have asked for all of them. My wifes cardiologist puts her on a statin and never once suggested running an advanced lipid panel and it comes back pretty darn good after we asked for one. I hate doctors.
braketest2
Member
Hi madman, I am five weeks in and feeling like maybe things are feeling better. I am injectting 50mg Tuesday's (11AM) and Friday's before bed. I am scheduled for BW after this week and next tuesday before my injection. Does this all sound proper at this point? Thanks!
madman
Super Moderator
Glad to hear!
Will be interesting to see where your protocol (dose T/injection frequency) has your trough TT and more importantly FT.
Make sure to include estradiol and SHBG.
Hope you are testing your TT and estradiol (LC-MS/MS) and FT (Equilibrium Dialysis).
braketest2
Member
madman
Super Moderator
You need to make sure the proper test codes are specified on your requisition.
If you are going to test SHBG then go with the first one!
1. TT/FT/SHBG
2. TT/FT
3. ESTRADIOL
braketest2
Member
They wrote no codes on my script just tests requested. The last time I went to Quest same deal and the tech wasn't sure they could process the request but they did somehow!
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