New to Forum with some questions on TRT regimen.

[DDD]

I have read a number of things on this forum to try to educate myself on TRT. I've been on TRT for about two years and wish I would have known some of the things I've learned when I started TRT.


Recently, after doing a lot of research, I switched to E3D injections hoping to control E2 and having more consistent levels.


May I ask a few questions?

First, I am 43 years old, 6'1, and 185 pounds. I started TRT two years ago when my T came back 159 and 238. Before then, I've never needed any long term medication. My health, other than Low T, is very good.


I didn't know much about TRT when I started it at a local Low T clinic.


1. I have noticed many of those who post recommend Defy. I have been emailing Defy inquiring about their services. Could you tell me why men like Defy so much, when they could probably go to a Low T clinic in their own city?


2. I began TRT at a local TRT clinic which offers a monthly fee and provides the T and regular blood tests for that monthly fee. After consultation with the doctor, I was started with compounded cream, but it seems my body didn't absorb it well and my libido wasn't consistent. Then I went to weekly injections of 200 and then 150 milligrams. That did well for a few months and I could tell the difference in energy and in the gym, but then experienced arousal and libido issues and that's when I learned about the effects of high estradiol-- something of which I was never told when I started TRT. So I used Anastrozole for a time ( .5mg twice per week) which took my E2 from the 40s to the teens. I didn't want to be on an AI term so I stopped. After a few weeks same issues arose, I started using it again. I've had much trouble trying to use an AI. This summer it crashed my E2 to 5 and 10 and I felt horrible. (I had used 1mg twice per week, won't be doing that again!) Since then I haven't been about to dial in one the right regimen and have consistent energy and libido. I've tried many different doses.


So two months ago I decided to start injecting 60 mg twice a week hoping this would curb my aromotization. I tested at TT 832, FT 239 (scale 30-150), E at 37 (standard) (scale 7-42) 4 days after injection right before next one. Then I upped it to 80 milligrams twice a week and tested at TT 844 and E at 38. Had some libido issues so I decreased to 60 mg twice a week with .25mg anastrozole 3x week and tested at TT 601 FT 123 and E2 at 30 (this was a different lab and I think they used the sensitive assay).


Then I switched to 40 mgs E3D thinking I could eliminate an AI. Basically since switching to twice a week or E3D my energy, libido, arousal have been inconsistent and I'm frustrated. Am I doing something wrong? It seems that 40 mgs dose is too low. Was I supposed to boost my T with a larger dose and make sure my count was in the 800s before starting a low dose e3D regimen?


3. On top of that, using anastrozole not only lowers my E2 but it lowers my TT also. Is that supposed to happen? So if I get my TT into the 800s and 1000s, then my E will go to highs 30s and 40s. And I noticed I have libido issues when it reaches high 30s. Doesn't happen all the time. Is that normal? I've been told 30s is a good level. If I take an AI my TT goes down to 600.

Maybe I'm not being patient. As soon as I sense a drop in energy or libido, I want to change my regimen. It wasn't like this when I first started TRT. Things were going well. I'm not sure what happened.


I currently use a TRT clinic locally where I pay a monthly fee and they provide the T. I can go to the clinic for an injection, or they will let me self inject. They also provide blood tests which lately I've been doing monthly until I can get the right dose and regimen. I've tried so many different doses I almost feel like I need to just start over.

I can add a post showing my different does and levels over 2 years, if that helps.




Am I interested to hear from others who have experienced this? I joined this forum because I wanted to hear from people who understand what I am talking about. Thank you.

 

[ERO]

Many of us use Defy because they truly know what they are doing - much more so than most local clinics, plus they are less expensive in most cases as well.

In your case, your local clinic did not understand how to monitor your E2 nor did they understand how to properly dose your AI, no did they seem to understand that tipical Testoerone has a low success rate. Most guys, like you, don't absorb it well and eventual switch to twice weekly injections. They should have been checking E2 (and other things) periodical instead of waiting until your libido was gone and then overdosing you on AI. A dose of 0.5 mg twice a week doesn't sound like much, but it is a HUGE dose of AI. Most of us here on the forum either use no AI at all, or a tiny dose like 0.15 mg twice a week.

Don't go by a set number on anything. It is the ratio that is important not the number. An E2 of 30 is ideal - if your Total T is around 600. But, what if your Total T is 1000? Saying any E2 over 30 is bad is like saying that any guy over 200lbs is fat - without knowing how tall he is, what percent body fat he has, etc...It just makes no sense.

 

[DDD]

Thanks ERO. So what is the ration supposed to be? When my TT was in the 600s, my E2 was in the high teens. When my TT was in the 1000s or 1100s my E2 was in the high 30s or mid to high 40s.

I've read that E2 should ideally be 20-30. Is that generally true? I weigh 185 and my body fat is about 12-14%.

When they started me on cream, I didn't mind applying it daily, but the highest I measured on it was TT 600s.

I've also recently learned the difference between the standard estradiol test and the ultra sensitive. I am always going to insist on the ultra sensitive now. But from past labs, how do I calculate the difference between the those numbers on the standard and those numbers on the sensitive? Is there a certain % by which the standard tests are too high?

 

[ERO]

The ideal T to E ratio is between 14 and 20, but it only works with the ultra sensitive test. So for example, when your Total T was 1000 and your E2 was 40, your E2 was too LOW, not too high. 1000/40 = 25, which means your E2 is too low. It's actually worse because this was the regular test, not the ultra sensitive, and your real E2 was probably 25 or 30.

Recall my analogy about weight; does it make any sense to say any guy over 200lbs is fat? No, of course not, right? Well, then by the same logic does it make sense to say that any E2 number higher than 30 is too high?

 

[CoastWatcher]

The single most important aspect of a successful TRT protocol is the doctor-patient relationship. If your doctor is not current with all the aspects of androgen replacement, and that includes monitoring estradiol via the appropriate assay, you will be fighting an uphill battle. Just as importantly, if your doctor fails to understand that you are a partner in this process, with a right to inquire and suggest in regard to your course of treatment, you are not well served. If, like me, you are fortunate to find excellent local care - great. Sadly, that doesn't happen as often as it should. That is why Defy is popular.

 

[DDD]

Thanks guys. This throws me for a bit of a loop because I've been thinking my E2 is too high but you're suggesting it is too low. The reason I thought it was too high is when my E2 hit 69 (with TT 1056 and FT 321) I noticed an arousal and erection issue. So I figured my E2 is too high.

 

[DDD]

I have seriously thought about Defy. What has been your experience with them? The TRT clinic I go to opened up about 2-4 years ago. The doc running it is a medical director of Aetna and has nurses staffing the clinic. He's not usually at the clinic but looks over the lab results when they come in. He is quite personable and anytime I've wanted to meet with him personally to ask questions, he has obliged. I know the clinic is growing now and I'm wondering just how much individual attention they can give. He gives me advice but allows me choose the direction I want to go. I do value that aspect.

 

[CoastWatcher]

I have seriously thought about Defy. What has been your experience with them? The TRT clinic I go to opened up about 2-4 years ago. The doc running it is a medical director of Aetna and has nurses staffing the clinic. He's not usually at the clinic but looks over the lab results when they come in. He is quite personable and anytime I've wanted to meet with him personally to ask questions, he has obliged. I know the clinic is growing now and I'm wondering just how much individual attention they can give. He gives me advice but allows me choose the direction I want to go. I do value that aspect.

A doctor not regularly on the premises, who gives advice, and allows you to choose the "direction" you want you want to go in. Yet, you seem to be regularly looking for help in regard to your TRT protocol; how is this a reasonable way to manage your health? That is an honest question, not a criticism.

 

[DDD]

Coast Watcher, I hear what you are saying. It's a good question. He gives me options based on the symptoms I describe plus my lab work. He lets me choose the option. That worked well in the beginning, but now something has changed and I'm trying to put my finger on it. It is why I am thinking of making a change.

You have stressed waiting 4 weeks after you change something the protocol. He has been telling me the same. I guess it started last year when I thought my T was going too high when it reached 1100 and 1284. (I was on 150 mgs weekly injections). So I started lowering it every two weeks. While doing that, my T level did not go lower (at least not right away). So I thought maybe I didn't need TRT anymore. I lowered it all the way to 40 mgs a week and started realizing that's too low. So I started bumping my dosage back up and that's when I hit a high E2 level (or at least what I thought was high). Haven't been able to find a regular regimen since. Perhaps I should have stayed where I was with 150 mg weekly and T at 1000-1200. You are right, in that I have not been patient.

 

[CoastWatcher]

Coast Watcher, I hear what you are saying. It's a good question. He gives me options based on the symptoms I describe plus my lab work. He lets me choose the option. That worked well in the beginning, but now something has changed and I'm trying to put my finger on it. It is why I am thinking of making a change.

You have stressed waiting 4 weeks after you change something the protocol. He has been telling me the same. I guess it started last year when I thought my T was going too high when it reached 1100 and 1284. (I was on 150 mgs weekly injections). So I started lowering it every two weeks. While doing that, my T level did not go lower (at least not right away). So I thought maybe I didn't need TRT anymore. I lowered it all the way to 40 mgs a week and started realizing that's too low. So I started bumping my dosage back up and that's when I hit a high E2 level (or at least what I thought was high). Haven't been able to find a regular regimen since. Perhaps I should have stayed where I was with 150 mg weekly and T at 1000-1200. You are right, in that I have not been patient.

The relationship a patient has with his doctor is the single most important variable, I believe, in a successful TRT protocol. If you are not working with a knowledgeable doctor who treats you as a partner in your health care, you are working against your own success. As for being patient, it is fundamental. By starting on exogenous testosterone, you knocked out you body's ability to produce testosterone (absent a restart protocol); how in the world did you think you no longer needed TRT? By lowering your dose to 40mg/week you tanked your testosterone, and were, more than likely, profoundly hypogonadal. Now you are chasing shadows, worrying that your estradiol is too high/too low, worrying about single instances when your libido didn't drive itself as you hoped. It is a losing game you are playing. Success comes when the multiple aspects of hormone replacement have an opportunity to work-and that takes time. You need a doctor who will provide you with an efficient protocol, and you need to stick to it, no changes, for at least four weeks. No matter what.

 

[DDD]

CoastWatcher, I had one thing incorrect in the post. I lowered my T to .4cc weekly which is 80 mgs, not 40. Sorry about that. The reason I thought maybe I didn't need TRT anymore, was because as I was slowly lowering the dose every two weeks my T was still staying steady or even increasing. For example, going from 200 mgs weekly down to 100 mgs week (over a period of months) my TT was still 1045 (higher than it was on 100 mgs weekly).

The TRT doc said it was probably just the way my body was storing the T cyp. He also told me that it was not likely my body was producing T again (not at normal levels anyway). I know I should not have done that. But I hadn't educated myself on TRT at that time.

I know that when my TRT was good and E2 more stable, sexual function was fine. I just want to get back to that. I only took an AI if there was an erection issue.

I may very well look at Defy and I will try to be patient.

Thanks for your advice. One other question-- when you talk about the multiple aspects of hormone replacement, could tell me what aspects you are specifically referring to?

 

[DDD]

The ideal T to E ratio is between 14 and 20, but it only works with the ultra sensitive test. So for example, when your Total T was 1000 and your E2 was 40, your E2 was too LOW, not too high. 1000/40 = 25, which means your E2 is too low. It's actually worse because this was the regular test, not the ultra sensitive, and your real E2 was probably 25 or 30.

Recall my analogy about weight; does it make any sense to say any guy over 200lbs is fat? No, of course not, right? Well, then by the same logic does it make sense to say that any E2 number higher than 30 is too high?

Thank you EROS and others, I do appreciate your comments. I am having to think this through because I thought my E2 was too high but you're saying it is too low. Even at E2 of 69 I still had same issues of erection and libido which I interpreted to be too high E2.

I also had the same symptoms when my E2 crashed to 5 and 10. What am I to make of this?

I will keep that 14-20 T-E ration in mind. Where does that come from?