Please review my Lab Results

[jobshopper]

I am hoping that you guys will give me some feedback on my current labs.

Protocol: I have used 80mg of Test C E3.5D (mono) for the past 4 years. I am prescribed 5mg of Tadalafil and 4mg of Terazosin daily for BPH. I also take a bunch of other supplements and amino acids every day.

During this past 4 years I have enjoyed a very strong libido. That started changing around October of last year. Shortly before Christmas my libido along with all other sexual functions took a nose dive. I have made no changes to my protocol that I can recall.

I decided to have both E2 tests done since I had never had a sensitive test done before. You will see by my labs that there doesn't seem to be much of a difference between the two tests in my particular case. They were both done on the same day at the same time.

I am trying to decide if I should try an AI to bring down my E2 in hope that it will restore my libido and sexual functions.

Also, do you have any thoughts on perhaps trying HCG?

Your thoughts and productive input are greatly appreciated.

Testosterone Total MS: 824 ng/dL (250-100 ng/dL)
Testosterone, Free: 179.2 ng/dL (30-135 ng/dL)
Estradiol: 54 pg/mL (< or = 39 pg/mL)
Estradiol - Sensitive: 58 pg/mL (<29 pg/mL)
DHEA Sulfate: 287 mcg/dL (20-217 mcg/dL)
DHT: 118 ng/dL (12-65 ng/dL)
Prolactin: 9.3 ng/dL (2.0-18.0 ng/dL)

Update: 3 weeks ago I lowered my Test C from 80mg E3.5D to 60mg E3D to see if it would help with my issues but so far I have not noticed a substantial difference.

 

[Systemlord]

Also, do you have any thoughts on perhaps trying HCG?

You’ll likely get higher estrogen on hCG because you’ll be getting your estrogen from two different sources, aromatase and within the testes.

On TRT you only get estrogen from aromatase.

It’s doubtful you need Free T levels this high to relieve the symptoms of low-T.

 

[jobshopper]

You’ll likely get higher estrogen on hCG because you’ll be getting your estrogen from two different sources, aromatase and within the testes.

How about if I drop my Test C accordingly to compensate for the HCG increase?

 

[Systemlord]

How about if I drop my Test C accordingly to compensate for the HCG increase?

Don’t get ahead of yourself, can you even tolerate hCG?

Many men can’t at any dosage.

 

[jobshopper]

Don’t get ahead of yourself, can you even tolerate hCG?

Many men can’t at any dosage.

I do not know. That's why I am asking you guys what you think. The anecdotal evidence that I have seen on this forum leads me to believe that it works for some guys. Is it worth trying? If I try it what do I have to lose... downside?

 

[Systemlord]

I’m confused, I thought you wanted to decrease estrogen. hCG takes things in the opposite direction.

As far as downsides on hCG, you tell me.

As of right now I think you’re in excess and your dosage is too high. It’s as clear as day.

 

[jobshopper]

I’m confused, I thought you wanted to decrease estrogen. hCG takes things in the opposite direction.

As far as downsides on hCG, you tell me.

As of right now I think you’re in excess and your dosage is too high.

Please correct me if I am wrong. My understanding is that guys who use HCG lower their Test C to correct any rise in E2 caused by the increase from HCG.

 

[jobshopper]

I’m confused, I thought you wanted to decrease estrogen. hCG takes things in the opposite direction.

That's why I am asking for input on an AI. I am thinking about trying .1mg/wk to start to see how it goes. I am not interested in using too much AI and crashing my E2.

 

[JmarkH]

Only change one variable at a time or you will never know what is affecting what. It's true for any multilayered process whether it's loading ammo or adjusting medications for a given desired result.
It would seem that @Systemlord 's suggestion of lowering the T dosage is a logical place to start. You could always try hcg in two to three months.

 

[jobshopper]

Bump.

 

[Systemlord]

My understanding is that guys who use HCG lower their Test C to correct any rise in E2 caused by the increase from HCG.

You'll still be stimulating estrogen from two sources rather than one and it's doubtful you'll have the same T:E2 ratios on TRT+hCG than if you were on TRT in isolation.

If you have lower cortisol, progesterone and DHEA, the hCG may actually benefit you. However if either of these are on the higher end, you'll be one of those guys that can't tolerate hCG at all.

 

[jobshopper]

... same T:E2 ratios on TRT+hCG than if you were on TRT in isolation.

Systemlord,
Thank you for your reply.
Therein lies the rub as they say and the source of my confusion. I looked at the lab numbers posted by a well known and well respected member of this forum; Vince.
Here are the lab numbers he posted in April 9, 2022:

###
My protocol, same as last labs.

16 mg of testosterone cypionate daily, 500 iu of hcg twice weekly and no AI.

Pregnenolone 10 mg and 25 mg of DHEA.

My last injection before labs, about 28 hr.s.

Testosterone, Total, LC/MS, 1035.9 High ng/dL 264.0-916.0

Testosterone, Free 33.77 High ng/dL 5.00-21.00

% Free Testosterone 3.26% 1.50-4.20

DHEA-Sulfate01 499.0 High ug/dL 30.9-295.6 age adjust

Dihydrotestosterone 56 ng/dL

Estradiol, Sensitive 18.7 pg/mL 8.0-35.0

Sex Horm Binding Glob, Serum. 41.2 nmol/L 19.3-76.4

Hemoglobin. 16.7 g/dL 13.0-17.7

Hematocrit 47.7 37.5-51.0)
###

I'm sure you will notice that he has an E2 of 18.7. That makes his T/E2 ratio 55.4
His Test C is 16mg D (112mg/wk) and he uses 500iu of HCG 2x/wk.

So my question is: which one is kingmaker? Is it having an E2 <29 (Quest Ultra-Sensitive Estradiol range) or having a T/E2 ratio between 14 and 20?

I have seen other examples on this forum where E2 numbers were in range but the target T/E2 ratio was out of range.

I dropped my Test C to 60mg E3.5D a few weeks ago. I have no problems dropping it further to bring my E2 down and/or adding an AI and/or Hcg if it will help to restore my libido, sexual functions and help to restore my testicular function. Currently my testicles are about the size of a grape.

I am hoping that there are others here who have been in this situation before and can guide me through it.
Thanks

 

[Deleted member 16042]

I am hoping that there are others here who have been in this situation before and can guide me through it.
Thanks

I don't think my case is a great example for YOUR needs, but in my mind, it does relate to "this situation".

160mg of testosterone is more than I have ever taken. I was started on 150mg/week, dosed E3D for starters. This sent my HGB/HCT high along with E2. My testosterone and free testosterone were robust, and above range, close to your results.

It was too much.

Phlebotomy and lowered dose repeatedly until maintaining ~90mg/week, TT and FT remained supraphysiological. My medical guidance targeted keeping Free T at top of range, and I remained a bit above, in the mid/high 20's. E2 remained too high so I played with microdoses of anastrozole for less than 0.25mg/week, which kept E2 at about 25. It was a pretty happy place, but I suffered from a three day bloat/water retention cycle. I also have taken HCG all along which definitely contributed to the bloat, which moved along with that dosage schedule. Somewhere in there I went to every other day for both T and HCG which smoothed out the 3 day bloat cycle. It evens out when I take less per dose at more frequent intervals, then just remain constantly slightly bloated, but is controversial whether frequent dosing of HCG is as effective for testicular effect. HCG every other day for a total of 800iu/week worked OK for me for a long while

Over years, more incremental reductions. Every reduction hurts when adjusting, but once on the new lower level, I am just fine, with no significant side effects like impaired libido. Even at 20mg every other day (70/week), my TT and FT remained at and slightly above top of "normal range", and health wise, I was just fine thank you. I was able to drop the anastrozole.

Then some real wild cards: illness, and liver challenge, anemia, transfusional iron overload, then rebound an EPO problem and high hematocrit, and most recently, I needed to try lowering yet again. Otherwise, the only side effect all along which was minor, but present was water retention.

The latest change was to a T cyp/prop blend at the equivalent of ~8mg/day including ester. This is the first time in the last 5 years that my T levels have really lived back in normal range, and life is good. I might benefit from just a bit more, but until the hematocrit is fully in control I am very happy staying right here. This is 56mg/week.

I find it interesting how men on TRT avoid the concept of reducing dose to achieve normal range rather than fixate on more is better. Typically there is a desire to be big and have big muscles. I get that, but that's not me, my athletic passions require a strong nimble lean body. I started because I was hypogonadal, for general health and fitness, not to look like the hulk.

Not saying it will work for you, match your personal goals etc. YMMV. Just food for thought.

 

[Vince]

Systemlord,
Thank you for your reply.
Therein lies the rub as they say and the source of my confusion. I looked at the lab numbers posted by a well known and well respected member of this forum; Vince.
Here are the lab numbers he posted in April 9, 2022:

###
My protocol, same as last labs.

16 mg of testosterone cypionate daily, 500 iu of hcg twice weekly and no AI.

Pregnenolone 10 mg and 25 mg of DHEA.

My last injection before labs, about 28 hr.s.

Testosterone, Total, LC/MS, 1035.9 High ng/dL 264.0-916.0

Testosterone, Free 33.77 High ng/dL 5.00-21.00

% Free Testosterone 3.26% 1.50-4.20

DHEA-Sulfate01 499.0 High ug/dL 30.9-295.6 age adjust

Dihydrotestosterone 56 ng/dL

Estradiol, Sensitive 18.7 pg/mL 8.0-35.0

Sex Horm Binding Glob, Serum. 41.2 nmol/L 19.3-76.4

Hemoglobin. 16.7 g/dL 13.0-17.7

Hematocrit 47.7 37.5-51.0)
###

I'm sure you will notice that he has an E2 of 18.7. That makes his T/E2 ratio 55.4
His Test C is 16mg D (112mg/wk) and he uses 500iu of HCG 2x/wk.

So my question is: which one is kingmaker? Is it having an E2 <29 (Quest Ultra-Sensitive Estradiol range) or having a T/E2 ratio between 14 and 20?

I have seen other examples on this forum where E2 numbers were in range but the target T/E2 ratio was out of range.

I dropped my Test C to 60mg E3.5D a few weeks ago. I have no problems dropping it further to bring my E2 down and/or adding an AI and/or Hcg if it will help to restore my libido, sexual functions and help to restore my testicular function. Currently my testicles are about the size of a grape.

I am hoping that there are others here who have been in this situation before and can guide me through it.
Thanks

I would try adding in HCG 250iu twice a week. Hopefully it will improve your libido. Keep your testosterone at 60 mg twice a week. I would inject both on the same day and see what results you get.

If you need to, you could try a higher dose of HCG but hopefully it won't be necessary.

I think your estrogen is good. I wouldn't add in an AI.

 

[jobshopper]

I don't think my case is a great example for YOUR needs, but in my mind, it does relate to "this situation".

160mg of testosterone is more than I have ever taken. I was started on 150mg/week, dosed E3D for starters. This sent my HGB/HCT high along with E2. My testosterone and free testosterone were robust, and above range, close to your results.

It was too much.

Phlebotomy and lowered dose repeatedly until maintaining ~90mg/week, TT and FT remained supraphysiological. My medical guidance targeted keeping Free T at top of range, and I remained a bit above, in the mid/high 20's. E2 remained too high so I played with microdoses of anastrozole for less than 0.25mg/week, which kept E2 at about 25. It was a pretty happy place, but I suffered from a three day bloat/water retention cycle. I also have taken HCG all along which definitely contributed to the bloat, which moved along with that dosage schedule. Somewhere in there I went to every other day for both T and HCG which smoothed out the 3 day bloat cycle. It evens out when I take less per dose at more frequent intervals, then just remain constantly slightly bloated, but is controversial whether frequent dosing of HCG is as effective for testicular effect. HCG every other day for a total of 800iu/week worked OK for me for a long while

Over years, more incremental reductions. Every reduction hurts when adjusting, but once on the new lower level, I am just fine, with no significant side effects like impaired libido. Even at 20mg every other day (70/week), my TT and FT remained at and slightly above top of "normal range", and health wise, I was just fine thank you. I was able to drop the anastrozole.

Then some real wild cards: illness, and liver challenge, anemia, transfusional iron overload, then rebound an EPO problem and high hematocrit, and most recently, I needed to try lowering yet again. Otherwise, the only side effect all along which was minor, but present was water retention.

The latest change was to a T cyp/prop blend at the equivalent of ~8mg/day including ester. This is the first time in the last 5 years that my T levels have really lived back in normal range, and life is good. I might benefit from just a bit more, but until the hematocrit is fully in control I am very happy staying right here. This is 56mg/week.

I find it interesting how men on TRT avoid the concept of reducing dose to achieve normal range rather than fixate on more is better. Typically there is a desire to be big and have big muscles. I get that, but that's not me, my athletic passions require a strong nimble lean body. I started because I was hypogonadal, for general health and fitness, not to look like the hulk.

Not saying it will work for you, match your personal goals etc. YMMV. Just food for thought.

Thank you for taking the time to share your story with me. This is the kind of input I was hoping to receive.
Best wishes for continued good health!

 

[jobshopper]

I would try adding in HCG 250iu twice a week. Hopefully it will improve your libido. Keep your testosterone at 60 mg twice a week. I would inject both on the same day and see what results you get.

If you need to, you could try a higher dose of HCG but hopefully it won't be necessary.

I think your estrogen is good. I wouldn't add in an AI.

Thanks Vince, I value your input on this!

 

[Pnw0031]

I don't think my case is a great example for YOUR needs, but in my mind, it does relate to "this situation".

160mg of testosterone is more than I have ever taken. I was started on 150mg/week, dosed E3D for starters. This sent my HGB/HCT high along with E2. My testosterone and free testosterone were robust, and above range, close to your results.

It was too much.

Phlebotomy and lowered dose repeatedly until maintaining ~90mg/week, TT and FT remained supraphysiological. My medical guidance targeted keeping Free T at top of range, and I remained a bit above, in the mid/high 20's. E2 remained too high so I played with microdoses of anastrozole for less than 0.25mg/week, which kept E2 at about 25. It was a pretty happy place, but I suffered from a three day bloat/water retention cycle. I also have taken HCG all along which definitely contributed to the bloat, which moved along with that dosage schedule. Somewhere in there I went to every other day for both T and HCG which smoothed out the 3 day bloat cycle. It evens out when I take less per dose at more frequent intervals, then just remain constantly slightly bloated, but is controversial whether frequent dosing of HCG is as effective for testicular effect. HCG every other day for a total of 800iu/week worked OK for me for a long while

Over years, more incremental reductions. Every reduction hurts when adjusting, but once on the new lower level, I am just fine, with no significant side effects like impaired libido. Even at 20mg every other day (70/week), my TT and FT remained at and slightly above top of "normal range", and health wise, I was just fine thank you. I was able to drop the anastrozole.

Then some real wild cards: illness, and liver challenge, anemia, transfusional iron overload, then rebound an EPO problem and high hematocrit, and most recently, I needed to try lowering yet again. Otherwise, the only side effect all along which was minor, but present was water retention.

The latest change was to a T cyp/prop blend at the equivalent of ~8mg/day including ester. This is the first time in the last 5 years that my T levels have really lived back in normal range, and life is good. I might benefit from just a bit more, but until the hematocrit is fully in control I am very happy staying right here. This is 56mg/week.

I find it interesting how men on TRT avoid the concept of reducing dose to achieve normal range rather than fixate on more is better. Typically there is a desire to be big and have big muscles. I get that, but that's not me, my athletic passions require a strong nimble lean body. I started because I was hypogonadal, for general health and fitness, not to look like the hulk.

Not saying it will work for you, match your personal goals etc. YMMV. Just food for thought.

Something people don’t realize about test doses is that more and more doesn’t automatically equal better gains and more muscle. I’ve been my strongest and biggest at 120 a week of test c. There is such thing as diminishing returns!

 

[jobshopper]

Something people don’t realize about test doses is that more and more doesn’t automatically equal better gains and more muscle. I’ve been my strongest and biggest at 120 a week of test c. There is such thing as diminishing returns!

Thank you for your input and I agree.

The puzzling thing to me is why my libido crashed after 4 years with no changes to my protocol. I've gone from having sex 3 or 4 times a week to having just about no interest in sex or women. All related sexual functions have also nose dived. I have been hypersexual my whole life and now the thought of sex is just blah!

Very puzzling! Has this happened to anyone else?

 

[jobshopper]

In the past I have had people ask me why I am/was on such a high dose of Test C and why I don't lower it. I think this is a good question and after thinking about it for awhile here is the reason why.

My PCP who is not real knowledgeable in TRT, but seems to tolerate my desire to do this started me on a very high dose; much too high.

We backed the dosage off a little at time until I ended up with a protocol of 80mg E3.5D. This worked very well for me for four years and all of my labs with the exception of my testosterone and E2 were money. All of the numbers on my labs that had given me trouble for years came into range. I lost 60 pounds and became stronger than I had been in years. I felt good with exception of some occasional brain fog.

In short, I didn't change my protocol because it was working for me and I felt good on it.

What's the old saying? If it ain't broke, don't fix it!

 

[Systemlord]

I have been hypersexual my whole life and now the thought of sex is just blah!

Very puzzling! Has this happened to anyone else?

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