Need help with recommended protocol

[Tremonti22]

Need help guys
This will be a long post and i'm sorry for that, but i'm at my wits end. Perhaps Nelson Or Vince could pop in to help a brother out. Been on trt for 6 years, been a member of this community for a while, pretty knowledgeable with trt, side effects, etc. I cannot seem to feel good!

Story, sorry for the novel :

The facts : 42 years old, been on injections of test cyp for 6 years. Done about every dose and protocol in the book, once a week, twice a week, sub q, with an ai, without, microdose ai, etc......

I cannot seem to feel healthy and balanced. I am in great shape and the trt has helped my body and muscles, and i have a great libidio, but my mental health and overall sense of well being just isn't there and never has been. i always feel up and down and up and down. I'm tired of the roller coaster, i want to figure some things out. I have labs going back the last 6 years and can provide anything you need, but here is the skinny :

I normally run 120mg cyp injections intramuscular either once a week or twice a week (60mg x 2)
I don't need an ai in that i've never had an E2 level over 50, it usually runs in the mid 30's
yes i'm running the LCMS ultrasensitive test
every time i take an ai, even a micro dose - i crash my estradiol, seriously, i over respond like a big dog. it doesn't take much. i can take 0.2 mg of anastrozole and run my e2 all the way down to 5!!!

what i'm wondering is, is my dose too high? i have a very low SHBG @ 16 and i'm wondering if that's the issue. I have a very high free test level, should i be running a lower dose / lower total and free test because my shbg is so low?

at 120mg weekly i am at 800 ng/dl total test, 191 free test pg/ml, 16 SHBG and 419 bio available test ng/dl. E2 sits at 31 at this dose and i've played with ai to get it lower thinking it was that, but every time i mess with ai, i just feel like shit. Hematocrit sits high 40's here. is there something else i should check?

what do you guys think? i mean if i have that much free test at 120mg, i don't necessarily need to run 120mg week do i? i've tried splitting the dose into two / twice a week, but same result, don't feel good!

need to figure this out, need to feel good. i've been to every doctor you can think of, went to lipshultz here in houston and it was a joke, he blew off the symptoms, actually feel asleep while i was talking to him and just RX'd me 200mg week with 1mg Armidex!!!!!

curious what you guys think
sorry for the novel

 

[bixt]

Broken record - but have you tried daily dosing at 10mg / day?

Massive thread over at another forum. Members are bodybuilders / ex bodybuilders. Used to blasting grams soon grams of stuff for decades.

Yet many of them have found well being at 10mg daily injections.

 

[bixt]

On second thoughts, you state that you have great libido. For me that’s the best hallmark that TRT is optimised for you. That’s often the hardest part to get right.

So that said, have you considered that your lack of mental well being is not necessarily related to things testosterone?

 

[Systemlord]

i always feel up and down and up and down. I'm tired of the roller coaster, i want to figure some things out.

You should consider Jatenzo. I never felt right on injections on any protocol, I had ups and downs even on dailies.

I feel balanced on Jatenzo.

 

[Vince]

Need help guys
This will be a long post and i'm sorry for that, but i'm at my wits end. Perhaps Nelson Or Vince could pop in to help a brother out. Been on trt for 6 years, been a member of this community for a while, pretty knowledgeable with trt, side effects, etc. I cannot seem to feel good!

Story, sorry for the novel :

The facts : 42 years old, been on injections of test cyp for 6 years. Done about every dose and protocol in the book, once a week, twice a week, sub q, with an ai, without, microdose ai, etc......

I cannot seem to feel healthy and balanced. I am in great shape and the trt has helped my body and muscles, and i have a great libidio, but my mental health and overall sense of well being just isn't there and never has been. i always feel up and down and up and down. I'm tired of the roller coaster, i want to figure some things out. I have labs going back the last 6 years and can provide anything you need, but here is the skinny :

I normally run 120mg cyp injections intramuscular either once a week or twice a week (60mg x 2)
I don't need an ai in that i've never had an E2 level over 50, it usually runs in the mid 30's
yes i'm running the LCMS ultrasensitive test
every time i take an ai, even a micro dose - i crash my estradiol, seriously, i over respond like a big dog. it doesn't take much. i can take 0.2 mg of anastrozole and run my e2 all the way down to 5!!!

what i'm wondering is, is my dose too high? i have a very low SHBG @ 16 and i'm wondering if that's the issue. I have a very high free test level, should i be running a lower dose / lower total and free test because my shbg is so low?

at 120mg weekly i am at 800 ng/dl total test, 191 free test pg/ml, 16 SHBG and 419 bio available test ng/dl. E2 sits at 31 at this dose and i've played with ai to get it lower thinking it was that, but every time i mess with ai, i just feel like shit. Hematocrit sits high 40's here. is there something else i should check?

what do you guys think? i mean if i have that much free test at 120mg, i don't necessarily need to run 120mg week do i? i've tried splitting the dose into two / twice a week, but same result, don't feel good!

need to figure this out, need to feel good. i've been to every doctor you can think of, went to lipshultz here in houston and it was a joke, he blew off the symptoms, actually feel asleep while i was talking to him and just RX'd me 200mg week with 1mg Armidex!!!!!

curious what you guys think
sorry for the novel

I'm sorry to hear about your roller coaster ride with your mental health.
This may be off the subject. I stop by my brother, last week Friday. We hung out for a while and I had a awesome time. He has a great personality and super friendly with everyone. OCD does run in our family and he told me he has been taking an anti -anxiety med. He's been doing this for a while and for him it worked 100%.
It makes me wonder, could it be something else besides the TRT.

 

[Fortunate]

When you tried to microdose, how long did you do it? Did you allow enough time for levels related to whatever you were doing just prior to microdosing to settle down before you judged whether or not it worked? What dose were you using it for how long?

You are not alone, brother. You sound a lot like me. I have been trying for a long time to feel good. Fortunately, I go through stretches of time during which I can feel good, but not like some guys who feel good most of the time.

One thing I learned is that how you feel now is not just a reflection of what you injected today and yesterday, but a reflection of what you have been doing over the last several weeks to up to even a month. Context really does matter when judging results of a particular protocol.

Have you ever tried subcutaneous? It’s a bit of a lightning rod of an issue, but some swear that they do better on intramuscular or subcutaneous. have you ever tried a different ester and/or oil? Some believe that can make a difference.

Feel free to give some more details.

 

[Tremonti22]

All,

Thanks for the replies
Yes I’ve tried daily sub-Q at 10 mg
Yes I’ve tried daily IM at 14mg
I’m telling you, I’ve tried everything

I am certainly open to the fact that my issue very well may not be testosterone / hormone related, but I do struggle with that ideology because I do at times feel good, it just doesn’t last. I seem to do best with large once a week injections believe it or not. I will keep searching. I was just curious what best recommended protocol was for low SHBG / high free test guys.

@Systemlord your advice / point about my good libido (it’s through the roof) and body benefits do confirm trt has been a help.

 

[Tremonti22]

I'm sorry to hear about your roller coaster ride with your mental health.
This may be off the subject. I stop by my brother, last week Friday. We hung out for a while and I had a awesome time. He has a great personality and super friendly with everyone. OCD does run in our family and he told me he has been taking an anti -anxiety med. He's been doing this for a while and for him it worked 100%.
It makes me wonder, could it be something else besides the TRT.

Can you find out what anti-anxiety med he’s been taking? Sexual sides?

 

[Vince]

Can you find out what anti-anxiety med he’s been taking? Sexual sides?

Okay I just text him. I know one thing he doesn't have any sexual side effect from it. When he text me the name of the med I'll post it.

 

[Vince]

Citalopram 40 mg

 

[Cyclingislife]

I have a very similar physiology to you. SHBG around 16-19. Took me over a year to dial in. Yes low shbg is the culprit & most docs don’t know how to handle it. It basically means your a hyper excreter & every time you inject your body processes the T too fast & you piss most of it out. You also can’t take too much at one time, it spikes your T/E ratio & you feel like crap. I too have tried higher and lower doses, IM, SQ, with and without AI, HCG, etc. this is what Ive found works. I inject 24mg Cyp, EOD, IM with 27 gauge, 1/2 inch, .5 syringe, in the deltoid. No AI, No HCG, nothing else. I tested my labs 24hrs after inject & I stay around 800-900 total & 240-250 Free. 48 hours after injection at trough & I’m another 15% lower. But still in sweet spot. You have to keep your free T above 200 to feel good. Ocassionally, If I feel my body going too high (not sleeping good) I change my dose to 20mg EOD for a few weeks then back to 24mg EOD. Also, check your blood sugar, low shbg can be linked to T2 diabetes. That being said, the other change I made is I only eat during an 8 hour window, noon -8pm. The rest of the time I fast but I do have coffee with very little cream in the morning, no food. I was an endurance athlete for many, many years, now 54 so I also limit my workouts to 4 per week max, no more than 1-2hours. All of these things together makes me feel amazing & I understand where you’re at, I’ve been there.

 

[RP McMurphy]

I'm sorry to hear that you're having a rough time. I'm not a doctor, but throwing a few things out there for consideration:

1) Have you considered working with a good functional medicine doctor? I've found that the diagnostics are much more thorough/evolved, and that they're generally much better at dealing with chronic challenging health conditions.
Find A Practitioner | The Institute for Functional Medicine
2) Have you tested other hormones? Thyroid: freeT3, freeT4, TSH, thyroid antibodies; pregnenolone, DHEA, cortisol (saliva)
3) Have you tested your vitamin D? And if low do you supplement?
4) A few functional medicine tests that may be helpful: Organic Acids test, Genova NutrEval
5) Supplements you may consider experimenting with: 100mg 5-HTP at night (serotonin precursor), fish oil, over the counter lithium orotate (5-20mg)
6) What's your diet like? I've found low carb/higher fat keto/paleo template to help stabilize mood. Cutting out sugar can have a significant impact.
7) Sunlight directly on your eyes within first hour of waking up:

8) Have you considered neurofeedback or neurostimulation? Powerful tools for optimizing brain function, mood, performance, etc.
9) Have you tried cold exposure? (ice bath, cold shower)
Again I'm not a doctor and don't know the details of your situation, but wanted to throw out a few ideas...wishing you the best, brother.

 

[Simbarn]

All,

Thanks for the replies
Yes I’ve tried daily sub-Q at 10 mg
Yes I’ve tried daily IM at 14mg
I’m telling you, I’ve tried everything

I am certainly open to the fact that my issue very well may not be testosterone / hormone related, but I do struggle with that ideology because I do at times feel good, it just doesn’t last. I seem to do best with large once a week injections believe it or not. I will keep searching. I was just curious what best recommended protocol was for low SHBG / high free test guys.

@Systemlord your advice / point about my good libido (it’s through the roof) and body benefits do confirm trt has been a help.

I would also think that if your libido and erectile function is very good, that you have managed your TRT quite well. Are these ups and downs depression or anxiety?
I did not see any mention of HCG? The possible loss of LH and other upstream hormones may have a greater influence for some men in regards to mental well being. But you have said that you have tried everything so perhaps this has been tried too.
It could be, as others have mentioned that you have a separate issue.

It may be that you have a form or depression, at particular points in the week the testosterone you are on is masking the depression and when this dips, the depressive symptoms possibly show themselves.

I assume you have also tried a lower dose of testosterone? Some men feel much better at lower levels. However, as your sexual function seems to be very good (there are no mention of issues here) the dose you are on may be right for you. It would be interesting to see if the low points in your mood get worse or stay around longer or don't change at all if you did try lowering your dose.

 

[Simbarn]

Citalopram 40 mg

I used this SSRI during a very difficult period in my life and it helped a great deal. I did not notice any sexual side effects and also found discontinuing the drug relatively easy.

 

[Gladiator]

Have you got bipolar ?
All the ups and downs sounds like it’s more of a mental health issue