Not feeling as good - Compared to first starting TRT - lots of updated Labs included - Nelson ratio

[probablyatworkqq]

Gonna post this here, I didn't get any help on the reddit trt sub.

First three months on TRT I felt so damn good. Couple changes have happened since original protocol. I am 5 months in now. (Total)

Changed to a doc covered by insurance.

I don't use HCG or an AI anymore - will explain

E2 was previously higher than this test here, and honestly I am primary hypo - didn't feel it was doing that well for me and just raised E2 even more. Kids aren't an issue. I don't want any.

AI - I was using Arimidex - my only gripe with arimidex... I had only one side effect, and that was heart palpitations with this medication. It sucked and didn't like that feeling at all. As soon as I discontinued Arimidex, it fixed itself in a week. Not sure why, and didn't matter the dose. Current new doc won't prescribe an AI anyway. (Which sucks) No, I don't want to change doctors, it was hard to find one as is. If I have to find an online source i'd rather that. At least this doc knows T converts to E - other doctors laughed at me and said higher T suppresses E.... LOLWTF?

Here is current protocol

M/W/F injections - SubQ - 190 MG / wk - split into 3 doses - Test Cyp

Here are the labs : They were taken Monday morning BEFORE injection - (I still did my previous Friday injection)

Total Test : 870 ng/dl

Free Test : 26.1 ng/dl

SHBG : 31.8 nmol/L

E2 Sensitive : 49.9 pg/ml

Albumin : 4.3 g/dl

Globulin : 3.0 g/dl

I'll even include my thyroid panels, and if I missed anything else, please ask as I am sure I have it here. Lots of bloods being drawn.

Thyroxine T4 : 6.2 ug/dl

T3 uptake : 30

Free Thyroxine Index : 1.9

TSH : 1.960 uiu/ml

RBC : Normal and Hematocrit is normal just fyi, no sneaking up on it at the moment.

Why am I not feeling great on this protocol? Lost that confidence, anxiety coming back a bit, losing SOME drive, libido is way less compared to that 3 months, and energy went down by like 30% or so.. Anything I am doing wrong? Is the E2 Wilding controlling this? Could really use some help about this. Was feeling like a goddamn star prior, were my T levels in supraphysiological ranges in that time, and once I shut down it just crashed me? I am super confused. When I was feeling that great my E2 was in the 60's lol it doesn't make sense what is going on. Any help is appreciated.

Also a reliable source for Aromasin would be great. Would love to try that out, since Arimidex gave me a horrible side effects, and I think I convert T to E so fast, it might be a better option anyway since I did experience estrogen rebound with arimidex as well.

Really looking for some help here, please.

Here is my post regarding this exact same topic - so you can see my replies if it helps answer questions

https://www.reddit.com/r/Testostero...t_feeling_as_good_compared_to_first_starting/



Here are my labs PRE-TRT

https://www.reddit.com/r/Testostero...dering_trt_need_some_opinions_and_blood_test/



Here are my labs TRT 6 weeks in - when I felt like a bad ass for 3 months.

My E2 was actually higher here - yet I still felt like a damn super star.

https://www.reddit.com/r/Testosterone/comments/88b329/lab_results_after_6_weeks_am_i_dialed_in_and/


Based on a post I read by Nelson, my E2 fits in that 'ratio' divide by T by 14 and then divide my T by 20... it fits in it perfectly... That's why I have no clue wtf is wrong at the moment.

 

[Systemlord]

It sounds as if your arimidex dosage was too high likely crashing your estrogen therefore causing heart palpitations, this is where having a skilled doctors pays off. Your sensitive E2 jumps out at me as likely being a problem. Unless your willing to locate a hormone specialists, you must lower your test dosage to lower estrogen. For me high estrogen equals anxiety, moodiness and feeling worse than pre-TRT.

Also estrogen became a real problem after the first 6 month on TRT out of the blue, it just got out of control. Your liver can only clear out the access estrogen so fast until it can't, then estrogen becomes a problem.

Aromasin is a suicide inhibitor!

What was your AI dosing previously?

 

[probablyatworkqq]

It sounds as if your arimidex dosage was too high likely crashing your estrogen therefore causing heart palpitations, this is where having a skilled doctors pays off. Your sensitive E2 jumps out at me as likely being a problem.

What was your AI dosing previously?

I am a high aromatiser. My pre-trt labs showed a E2 sensitive test level of 38.7

We started out at .25 arimidex and increased to .50

I even halved the doses, still had heart palpitations and nightmares from arimidex.

PS - I halved them for testing purposes when I was experiencing these side effects. I think I am that 1% that specifically has weird side effects to arimidex specifically.
I cannot link it, but if you google search 'arimidex heart palpitations' you'll see people on breast cancer forums specifically having the same issues on even smaller doses.

 

[probablyatworkqq]

I am confused. These numbers are not what you posted above. What is your E2 level when you are not feeling well?

And BTW: "Took exactly 1 week off on all injections prior to labs. (No HCG, No test)"

WTF? Why did you undermine your own labs that way?

That was my first 6 weeks trt labs results. I wish I could link it. I was showing you labs where I felt super awesome.

I was doing doctors orders. I questioned it, but listened to him.

My CURRENT labs are the ones I posted at the very top of my post.

 

[probablyatworkqq]

"Honeymoon"

When you start, your testicles are still producing testosterone. It is common when that shuts down you don't feel as good.

You have not really described your symptoms. Are they symptoms of elevated E2? Ratio of T to E is only a data point. it is not a proven fail safe guideline for E2 level in every patient, and Doctors have differing approaches to E2 levels and management that work with different men.

Urinating issues 1/10 or 2/10 times - maybe? - 10% of the time for the ending bit of pissing. If I don't shake, and force push, i'll have dribble - this is random so hard to put exact 'numbers'

Loss in confidence / well being by about... 30-40%

Anxiety coming back by 20-30%

Libido drop by 50% or more

Energy level down about 30% maybe more here..

 

[probablyatworkqq]

It sounds as if your arimidex dosage was too high likely crashing your estrogen therefore causing heart palpitations, this is where having a skilled doctors pays off. Your sensitive E2 jumps out at me as likely being a problem. Unless your willing to locate a hormone specialists, you must lower your test dosage to lower estrogen. For me high estrogen equals anxiety, moodiness and feeling worse than pre-TRT.

Also estrogen became a real problem after the first 6 month on TRT out of the blue, it just got out of control. Your liver can only clear out the access estrogen so fast until it can't, then estrogen becomes a problem.

Aromasin is a suicide inhibitor!

What was your AI dosing previously?

Here is a link for PRE-TRT Labs

https://www.reddit.com/r/Testostero...dering_trt_need_some_opinions_and_blood_test/



Here is a link for 6 weeks TRT labs and protocol when I was feeling like a damn superstar for 3 months.

https://www.reddit.com/r/Testosterone/comments/88b329/lab_results_after_6_weeks_am_i_dialed_in_and/


and link to current post where my labs are at the top, in case I confused people with format cause I could not post links previously until now.

https://www.reddit.com/r/Testostero...t_feeling_as_good_compared_to_first_starting/

 

[Systemlord]

I am a high aromatiser.

You and me both, I has a sensitive E2 of 70 with a total t of 677. The advantage of ordering from a compounding pharmacy is you can get arimidex compounded into customized dosage, whatever the heart desires.

 

[Deleted member 16042]

Urination trouble is typically due to prostate. Estrogen and DHT can provoke this.

Other symptoms can be from the end of the honeymoon, and somewhat from E2.

I'd urge you to not make changes in preparing for labs. It takes time for every change to reach steady state in your body. If you change something prematurely you will never know why things are not right.

steady state after changing T dosage 6-8 weeks.
steady state starting or increasing arimidex, about 10 days
recovering after crashing estrogen can be months.

 

[probablyatworkqq]

You and me both, I has a sensitive E2 of 70 with a total t of 677. The advantage of ordering from a compounding pharmacy is you can get arimidex compounded into customized dosage, whatever the heart desires.

Correct, like I stated though - Everyone is different - I could be that 1% of people who experience 'sides' of a medicine that does really weird things. My previous doctor - who is a sponsored trt clinic from this site - stated arimidex does not cause heart palpitations. And arimidex doesn't even have that listed as a side if you google... but if you look at other forums like here it says otherwise. I just react differently with arimidex than others.

https://forum.breastcancercare.org.uk/t5/Hormone-therapy/Heart-flutters-on-Arimidex/td-p/349278


-EDIT- Cleaned up original post, so format looks way better than previous, can post links now, so it makes more sense of my time line. Thanks.

 

[probablyatworkqq]

Urination trouble is typically due to prostate. Estrogen and DHT can provoke this.

Other symptoms can be from the end of the honeymoon, and somewhat from E2.

I'd urge you to not make changes in preparing for labs. It takes time for every change to reach steady state in your body. If you change something prematurely you will never know why things are not right.

steady state after changing T dosage 6-8 weeks.
steady state starting or increasing arimidex, about 10 days
recovering after crashing estrogen can be months.

PSA went from .06 (Baseline / Pre-TRT) to .09 - and has stayed there. No changes otherwise FYI

I have kept the same M/W/F protocol except dropping HCG - And upping dosage. From nelsons post - roughly 25mg can be added if you use hcg.

I was on 150/wk + hcg

Now I am 180 M/W/F

When I was feeling like a rock star - My e2 was actually higher believe it or not. Had high e2 symptoms though - which is why doc increased arimidex - till I figured out it was the arimidex causing odd issues for me.. PERSONALLY that are not common. Heart palpitations / nightmares.

 

[lowe2sucks]

your body adjusted to extra T and put you back to baseline.. when you started TRT you started feeling good because your androgens were going up.. when androgens going up man feels great when they are going down he feels negative symptoms (depression, anxiety).. you can't feel the way you felt all the time that would require raising dosage whenever your body adapts to new baseline.. you should still feel better than pre trt
when you are in androgen surge/honeymoon you won't even notice high e2 because you feel high from androgens going up but eventually when it's over high e2 can be catching up with you

 

[probablyatworkqq]

your body adjusted to extra T and put you back to baseline.. when you started TRT you started feeling good because your androgens were going up.. when androgens going up man feels great when they are going down he feels negative symptoms (depression, anxiety).. you can't feel the way you felt all the time that would require raising dosage whenever your body adapts to new baseline.. you should still feel better than pre trt
when you are in androgen surge/honeymoon you won't even notice high e2 because you feel high from androgens going up but eventually when it's over high e2 can be catching up with you

Ok, now we are getting somewhere. And this makes sense to me. Question is - Regarding E2 ratios now. Based on Nelsons post regarding ratios - I fit that perfectly VIA where my T is at currently. So, is 20-30 THE hot spot to hit now, and always? Is ratio a BS thing - unless we enter supraphysiological ranges? OR is ratio still considered here? Just let me know your thoughts sir, and thank you.

 

[Deleted member 16042]

So, is 20-30 THE hot spot to hit now, and always? Is ratio a BS thing - unless we enter supraphysiological ranges? OR is ratio still considered here?

If we knew these things definitively, everyone would be managing perfect estrogen levels with no symptoms. Estrogen problems are one of the main points of discussion on this forum. There is no magic number nor a magic bullet to get it right. It can take time to try different things to find out what works.

 

[lowe2sucks]

20-30 sweet spot is BS.. guys with 300-400 total t have this level of e2 imo as long as it's not super high like 2x over range it's ok. testosterone converts to dht which antagonizes estrogen so unless you are on finasteride or other dht blocker your testosterone conversion to dht will help to fight elevated e2. i am very against e2 blockers but some guys swear they need one probably they have feminine genes so they can't take testosterone without turning to female
too low e2 is bad for health so it's better to have slighty highish then supressing it too low if your goal of trt is to keep yourself healthy

 

[CoastWatcher]

Ok, now we are getting somewhere. And this makes sense to me. Question is - Regarding E2 ratios now. Based on Nelsons post regarding ratios - I fit that perfectly VIA where my T is at currently. So, is 20-30 THE hot spot to hit now, and always? Is ratio a BS thing - unless we enter supraphysiological ranges? OR is ratio still considered here? Just let me know your thoughts sir, and thank you.

The ratio is one metric, just one, that a patient and a doctor consider when balancing a protocol's factors. Is it "a BS thing?" Hardly. It is not, in my opinion (or my doctor's opinion), an infallible guide to dialling a patient in. Numbers in this game point in certain directions, must be correlated with symptoms, and lead to conclusions in time...patience being the key term in this game.

Start with the fact that estradiol is not a waste product to be furiously flushed out of a man's system, it's a key hormone necessary for sexual and cognitive function, you'll find that many of us have found we feel better with an e2 value somewhat higher than popular opinion suggests is appropriate.

 

[S1W]

Just chiming in with a simple observation: 5 months is not that far into TRT for frustration, and almost certainly too little time considering the various changes you have experienced with your protocols.

IMHO, its seems like a good progression would be to start with T only and get that dialed in. That alone will likely take months since you need to wait about 8 weeks to give each respective dosage/protocol a chance, and it is unlikely that you're going to nail it on your first or second try. So let's say you try 3 or so different T only protocols (it could easily take more than 3 tries to find your ideal T dosage) to get that end of the equation dialed in - you're already pushing 6 months and nobody here would be surprised if you still weren't perfectly dialed in after that period.

Then you might consider adding in HCG etc - this might also affect your protocol and require several trials and adjustments. Rinse, repeat. It could easily take a year or more to get dialed into a protocol that is ideal for you.

This certainly isn't the case for everyone - some guys do manage to get dialed in fairly quickly. However, those guys seem to be the ones that started on a lower dose and titrated up to find their sweet spot. For guys like you who start on a high dose (190mg/week is higher than what most guys on the forum use), it often seems like a longer period of tweaking and adjusting is in the cards.

I know you probably know all of this, but just wanted to point it out for others who might come across your thread. Hang in there and be consistent - all of this takes time to come together.