Need help with high T and E levels

[DrJay71]

Hello all. Glad I found this forum.

I am a 48 y/o male who has been on TRT for the past 7 years. I currently receive 200 mg testosterone cypionate injections every 10 days at my local Low T Center. Well, I was at my family practitioner's office the other day for my annual exam and blood work which showed:

TESTOSTERONE, TOTAL, IGMALES (ADULT), IA 2238

ESTRADIOL 124 H

Granted, I just had my injection 2 days prior but both the high T and E levels were quite shocking. I actually feel OK. Get good morning wood and drive is average.

What dose of Arimidex do you think I should start with? What else can I do to bring my E and T levels down to a more therapeutic level?

PS - I do take one 25mg DHEA supplement tablet every day as well.

Thanks!

 

[CoastWatcher]

Do NOTHING until you test properly. The only way to evaluate a protocol is by having blood drawn just prior to your injection. You capture your testosterone at trough, allowing you and your doctor to determine how effective your protocol is at sustaining healthy levels across the period between shots, at the same time, drawing blood at your testosterone trough will capture your estradiol near peak ("E follows T"). All we know from your numbers is that you react to testosterone - a whopping big dose of testosterone. Was the estradiol captured with the appropriate, sensitive (LC, MS/MS) lab test? The standard test is unreliable when used to monitor men. What is your SHBG? High? If not, why a single, substantial injection? You've raised many questions...

 

[blitzen]

The routine "every 10 days" sounds as if a very old school injection schedule happens. Unless your SHBG is skyhigh it sound wrong.
a) increase injection frequency (depending on your SHBG) which should reduce aromatization
b) do it yourself (easy enough and easier than driving to a center for injections)
c) get a test just before the scheduled injection (either now or 6-12 weeks after you made a change)
d) use E as a guideline not as an absolute ...one feels better with 25 the other with 50

 

[Vince Carter]

Do NOTHING until you test properly. The only way to evaluate a protocol is by having blood drawn just prior to your injection. You capture your testosterone at trough, allowing you and your doctor to determine how effective your protocol is at sustaining healthy levels across the period between shots, and you capture your estradiol near peak ("E follows T"). All we know from your numbers is that you react to testosterone - a whopping big dose of testosterone. Was the estradiol captured with the appropriate, sensitive (LC, MS/MS) lab test? The standard test is unreliable when used to monitor men. What is your SHBG? High? If not, why a single, substantial injection? You've raised many questions...

This is spot on, great post.

 

[Nashtide]

This is spot on, great post.

I've been testing halfway between injections for two years. I inject on Sunday morning and Wednesday afternoon. I always test on Friday morning. I thought it would be more useful to have neither a peak nor a trough level to see where I stand. Good news is I feel great and am having a very successful TRT journey. Someone explain why measuring at trough is better. I assumed with twice weekly injections, I was minimizing the difference between peak and trough.

 

[CoastWatcher]

I've been testing halfway between injections for two years. I inject on Sunday morning and Wednesday afternoon. I always test on Friday morning. I thought it would be more useful to have neither a peak nor a trough level to see where I stand. Good news is I feel great and am having a very successful TRT journey. Someone explain why measuring at trough is better. I assumed with twice weekly injections, I was minimizing the difference between peak and trough.

A trough level permits you and your doctor to determine if the protocol is delivering a robust level of testosterone across the entire week. Capturing testosterone at its trough also permits you to evaluate estradiol somewhere near its peak (E will follow, but trail, T). I learned this when I was injecting twice weekly and, to work out an idea, drew blood every morning for seven days. I had an impressive peak when it came to total testosterone, held it for a day, and crashed at trough. Low SHBG was the culprit and it was dealt with by going to daily injections. Meantime, my e2 climbed significantly during the final 48 hours of the week. Had I relied on a level obtained when T was peaking I'd have had a false sense of where E was.

 

[Nashtide]

A trough level permits you and your doctor to determine if the protocol is delivering a robust level of testosterone across the entire week. Capturing testosterone at its trough also permits you to evaluate estradiol somewhere near its peak (E will follow, but trail, T). I learned this when I was injecting twice weekly and, to work out an idea, drew blood every morning for seven days. I had an impressive peak when it came to total testosterone, held it for a day, and crashed at trough. Low SHBG was the culprit and it was dealt with by going to daily injections. Meantime, my e2 climbed significantly during the final 48 hours of the week. Had I relied on a level obtained when T was peaking I'd have had a false sense of where E was.

Okay, but if we inject twice weekly, don't we spend more time in a steady state than we do at either peak or trough? Isn't that the point of injecting twice weekly? If so, then wouldn't a more steady state lab test be more valuable? I'm not trying to be an a$$,
just trying to understand .

 

[Vince Carter]

"Steady State" is a pretty good fallacy and a term that is overused. No one is in a steady state, even on daily injections there is a peak and valley.

 

[Nashtide]

"Steady State" is a pretty good fallacy and a term that is overused. No one is in a steady state, even on daily injections there is a peak and valley.

That makes sense, but it still seems like we would spend more time in that area between peak and trough than we do at peak or trough. I guess I assumed that if I alter my protocol based on troughs, that I might over correct. IOW if my TT trough is low, I might be encouraged to increase my T dose and if my E2 is elevated, I might be encouraged to lower my T dose. Does that make sense?

 

[Deleted member 17030]

That makes sense, but it still seems like we would spend more time in that area between peak and trough than we do at peak or trough. I guess I assumed that if I alter my protocol based on troughs, that I might over correct. IOW if my TT trough is low, I might be encouraged to increase my T dose and if my E2 is elevated, I might be encouraged to lower my T dose. Does that make sense?

I asked my dr this very thing at my last visit and he said the same thing you wrote. He has me on 1 injection every 7 days and tests 4 days after injection to catch the "midrange", not peak or trough, he further stated the reference range intervals are not based on a sampling of peak or trough patients where the intervals are generated, and that's why he tests that way.....................

and now for the, "Your doctor is an idiot" posts surely to follow lol. And he might be.

 

[Will Brink]

Hello all. Glad I found this forum.

I am a 48 y/o male who has been on TRT for the past 7 years. I currently receive 200 mg testosterone cypionate injections every 10 days at my local Low T Center. Well, I was at my family practitioner's office the other day for my annual exam and blood work which showed:

TESTOSTERONE, TOTAL, IGMALES (ADULT), IA 2238

ESTRADIOL 124 H

Granted, I just had my injection 2 days prior but both the high T and E levels were quite shocking. I actually feel OK. Get good morning wood and drive is average.

What dose of Arimidex do you think I should start with? What else can I do to bring my E and T levels down to a more therapeutic level?

PS - I do take one 25mg DHEA supplement tablet every day as well.

Thanks!

Re test the day before your next shot and see what you see, then work on finding a doc who has a clue what they are doing dose/schedule wise. Two, you can do your own shots and save $ and time. Forget about an AI until you get that all sorted out. Good luck

 

[Nashtide]

I asked my dr this very thing at my last visit and he said the same thing you wrote. He has me on 1 injection every 7 days and tests 4 days after injection to catch the "midrange", not peak or trough, he further stated the reference range intervals are not based on a sampling of peak or trough patients where the intervals are generated, and that's why he tests that way.....................

and now for the, "Your doctor is an idiot" posts surely to follow lol. And he might be.

this makes sense to me especially given that the shot is only once per week.

 

[CoastWatcher]

An now we return to DrJay71 and his issues...

 

[1Draw]

I've been testing halfway between injections for two years. I inject on Sunday morning and Wednesday afternoon. I always test on Friday morning. I thought it would be more useful to have neither a peak nor a trough level to see where I stand. Good news is I feel great and am having a very successful TRT journey. Someone explain why measuring at trough is better. I assumed with twice weekly injections, I was minimizing the difference between peak and trough.

I wouldn't change a thing. Keep doing what you are doing as long as you feel the way you do...

 

[FeelingLost]

"Steady State" is a pretty good fallacy and a term that is overused. No one is in a steady state, even on daily injections there is a peak and valley.

Steady State has nothing to do with peaks and valleys. Steady State is when you have double the T in your body than you inject.

99% of people on TRT don't realize that after 5 half lives of any medication, you will have double the amount in your system. Just multiply the half life of a medication by 5, and this will give you how long it will take to reach a "steady state" of a medication a.k.a double the amount of that medication in your system compared to your first dose.-Gman86

@Dr Jay
Here's a great E2 test. I use them all the time to see if I need one of my AI's.
If you can get thru this without a tear your E2 is fine no matter what your mid injection reported ;-)