New to TRT: a couple of questions (after extensive reading on this site).

[Argelius]

Briefly, I'm 52 and had been experiencing classic symtoms of low testosterone which was confirmed with the appropriate lab tests. I was placed on weekly T injections (0.6 ml)

After 6 weeks, I'm generally quite pleased with the results. Libido is back,(possibly) better focus and mood, less fatigue, and noticeably more muscle mass (with same regular work out regimen). Only side effects I can be certain of is testicular shrinkage.

My first follow up lab work showed T (total and free) in mid normal range. Estradiol has gone from <6 to 48). PSA up to 0.8 from 0.6. HGB up to 16.3 from 15.0.

On to my questions :
(1) with the (not unexpected) elevation of Estradiol, is an aromatase inhibitor now indicated? Other than treating the lab value, are there other benefits? (Not currently experience gynecomastia).

(2) are HCG shots, should they be prescribed, for the testicular atrophy purely for "cosmetic" reasons (since fertility is not an issue)? From my reading, the answer is "yes.". But my testes feel "weird" and are constantly disappearing...which I hate.

(3) while my PSA remains low normal, is the doubling of concern? (I realize much too soon to tell; depends on if the trajectory continues).

(4) I'm starting to wonder how much more complicated treatment for "Low T" really is. While I am pleased with my initial results....just now wondering if fixing the T cascades into many other "problems." So much focus online with TRT seems to be about body building, which isn't my reason for pursuing this.

(5) My doctor is definitely knowledgeable and I will obviously be discussing these questions with him next week. Googling about these issues brings up a gazillion of sketchy marketing hype which makes me start getting paranoid about the intersection between established science and profit opportunity for those physicians (and others!) getting on the gravy train.

Thanks for your thoughts!

 

[ERO]

Is your E2 on the ultra sensitive test? If not, the number is not really useful as the regular test is very inaccurate for men. Best advice is not to treat unless you have high E2 symptoms. HCG is a good idea because it is an LH analog, and LH is something that your body needs regardless if you want kids in the future or not. Total T in the mid-range is often underwhelming. The goal should (typically, there are always exceptions) to get it into the upper quartile of the normal range. Most guys on TRT don't even feel like they are "on" until they hit at least 6-700 total T with a good Free T level. Some docs think if they get you to 500, you are "in range" and therefore good to go. (That is like saying, wow I got a C on my test instead of an A or a B, but hey a C is good enough...)

 

[Gene Devine]

Q1: Was your estrogen lab the "Sensitive" lab? If not, and your labs should state so if it was, then they used the standard E2 default lab designed for women not men. The default lab tends to over estimate men's E2 values so if this was not the "Sensitive" lab you need to be retested before making any determination about the use of an AI as they are very powerful antagonists in men. Are you experiencing any other symptoms of elevated E2? Gyno is very rare in TRT and it takes a long time for that to develop so look for other symptoms.

Q2: There is an entire forum here dedicated to HCG that you can learn from; go there and learn.

Q3: PSA can creep up on some men who start TRT and is of no great concern unless the serum level significantly increases which then would require deeper diagnosis of the prostate.

Q4: I don't understand your question. What other problems can arise if one follows their TRT Physicians protocol. TRT is not AAS but one can get some of the same bodybuilding benefits while on TRT if they train hard, eat right and supplement correctly. But one doesn't need to do any of this if they don't want to and just want to enjoy the health and well being that TRT provides.

Q5: There is no need to Google anything TRT then what you can find here on EM. Nelson and I created this site and forum for just that reason. If you can't find something here to answer your questions re TRT (and much more) then please let us know what that is and we'll make sure to update the site but everything you need is here and most all backed by science.

 

[Argelius]

Thank you for your thoughtful response. I'm glad I found your site since it's has been most informative (and I have google to thank for pointing me here)! After continued reading, most of my concerns have been addressed.
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[Argelius]

Been reading and reading and reading. This site is incredibly helpful and well-moderated. Feel so much more knowledgable than I did a few days ago.

From my reading, my experience thus far is nothing unusual or unexpected after 8 weeks-- but I'd love a confirmation of my assessment at this point (see original post for lab details).

My libido improvement seems to have peaked about 4 weeks ago and now seem to be diminishing as have the mood improvements (although those are really hard to objectively assess). I have definitely noted my balls shrinking and feeling "weird" (very hard to describe the sensation).

I have my first follow-up appointment tomorrow where I am guessing HCG will be recommended (and for which, after reading a lot here, I'm all for). Also, based on my reading, an increase in my weekly dose of T will also be recommended. And, at this point, I'm guessing an AI is probably not needed at this point.