Recommendations on newly started therapy

[Dks888]

Hi guys,

as you can see from my pre treatment blood works, T is very low with a relatively high E2.

I started 100mg test-e + 500ui HCG and 0.25 AI every 3 days, two weeks ago. So far i feel little difference and the most notable effect is a lack of libido plus the last few days, a bit of anxiety. What would you recommend in terms of dosage changes, how long should I allow for a certain level before trying another?

Further about me if i may help,

i am 29y old, physically active (BF less than 20%) and I eat well. I currently live in Japan where real TRT doctors may be hard to come by (at least English spoken ones).

I would appreciate your help very much!

regards,
DKS

 

[Vince Carter]

YOu can't draw any conclusions in two weeks times. Stay on your protocol for at least 6 and then retest, and compare symptoms making very small changes from there. Marathon...not a sprint. It takes weeks and months to reach a stable place, the body adjusts and it takes a significant amount of time. Two weeks is nothing. Two weeks worth of labs was wasted money.

 

[Dks888]

Hi Vince,

thanks for your input.

The labs were taken before I started just to give you guys an idea of where i am at. I will take your advise and go for 6 weeks then! Any thoughts on the dosage though?

regards,

 

[Vince Carter]

The only part of your dosing protocol that is suspect is the inclusion of an AI, we typically suggest no AI until that first set of labs @ 6 weeks and then compared with symptoms, we're very AI cautious here, it's a powerful drug that is overprescribed and overdosed when there may be no need for it though .25mg isn't too heavy-handed.

 

[Vince]

I agree stay away from the AI, too many issues. Wait and see if it's necessary.

 

[Dks888]

Noted, you dont see any issue not using an AI with my already high estrogen levels?

 

[Vince Carter]

I dont think you're pretreatment levels mean anything right now, starting treatment that whole dynamic has changed, best to wait and see.

 

[jimmyt33]

I would definitely take aromasin to bring the extremely high E2 levels down. if there's already a high baseline of E2, and adding more T that could aromatize, I would imagine the E2 levels either stay the same or increase?

 

[madman]

Hi guys,

as you can see from my pre treatment blood works, T is very low with a relatively high E2.

I started 100mg test-e + 500ui HCG and 0.25 AI every 3 days, two weeks ago. So far i feel little difference and the most notable effect is a lack of libido plus the last few days, a bit of anxiety. What would you recommend in terms of dosage changes, how long should I allow for a certain level before trying another?

Further about me if i may help,

i am 29y old, physically active (BF less than 20%) and I eat well. I currently live in Japan where real TRT doctors may be hard to come by (at least English spoken ones).

I would appreciate your help very much!

regards,
DKS

Your pre trt total testosterone of 10.07 is definitely low barely borderline as most ranges in Canada where I reside are 7.6-8.4 nmol/L for the low end of the lab range. Your e2 is more than likely the standard assay which tends to overestimate most of the time and is not as accurate as the sensitive assay which is used in the US but not Canada or most European countries. Sensitive assay is what you would need to truly know an accurate reading for e2 and your e2 of 103.8 pmol/L is basically in the middle of the range of 41.4-159 pmol/L not high and more than likely overestimated and I would say your aromatase inhibitor was not needed and more than likely why you feel shitty as you might have crashed your e2. I would try dropping your ai and see how you feel. Regarding your protocol it will take atleast 6 weeks to reach stable blood testosterone levels and you need to be retested 6 weeks in to see where your total t and e2 are let alone you should have your free testosterone/dht/hemoglobin/hematocrit/tsh and complete blood count levels checked also. Usually in the first 2 weeks for most you should notice an increase in libido especially when starting out as you are still producing testosterone endogenously for the first few weeks before your hpta shuts down and you are also injecting the exogenous t. It takes time to start to feel the full effects of trt and libido should be one of the areas that you will notice quickly. Shame your doctor would put you on an aromatase inhibitor especially right away as your levels are mid normal not high on the standard e2 test you had done and yes e2 will increase when starting trt or increasing dose thats why it is imperative to wait 6 weeks before testing bloods as when starting trt to allow testosterone blood levels to stabilize and also e2 and other hormones so you can get an good idea of how your levels are on at that particular dose of testosterone and how it is effecting your overall symptom relief than a doctor should decide depending on how you feel overall/your lab numbers if you need a dose increase and also if you are experiencing high e2 related symptoms than and only than implement an aromatase inhibitor in your protocol. Do you have more thorough blood work as not only total t/e2 but shbg/dht/prolactin/lh and fsh/full cbc which includes hemoglobin/hematocrit and psa should be done PRE-TRT. You definitely need to find a new doctor that specializes in treating trt but in Japan as you say it seems to be difficult. Hopefully other members will offer advice but I would drop the ai and see how you feel after a few weeks!

 

[madman]

You could just stay on the 100mg once weekly for the first 6 weeks and see how your body reacts to that particular dose and how it effects your blood levels and overall lab work mind you it would be more effective if you split your 100mg/week into 50mg every 3.5 days ( inject Monday evening and Friday morning as an example ) pick days that suite you best as by splitting your dose you will soften the peaks and valleys and even out your trough/peaks and most also attain better total/free t numbers and some times lower e2 by splitting up 1 large weekly injection into 2 smaller injections basically for you 50mg every 3.5 days and you will feel more stable throughout the week and better overall but you need to drop the ai from your protocol and see how you feel.

 

[madman]

Noted, you dont see any issue not using an AI with my already high estrogen levels?

Your e2 test is more than likely the standard assay not sensitive and 103.8 pmol is MID NORMAL not HIGH if the range on your lab work is 41.4-159. High would be close to the high end of 159 or over/well over. Also if it is the standard assay and not sensitive your number of 103.8 is more than likely overestimated. Your LH is 13.02 mU/ml range 1.7-8.6 well over were you diagnosed as PRIMARY HYPOGONADAL?

 

[Dks888]

No but i believe it may be the case, ive had my testicles examined in the past without issues found but, it certainly seem to be something going on there... Will take your advice and drop the AI and see how it goes! thanks a lot for your help

 

[Dks888]

Hi,

as a follow up on this, i found some 4y old blood work where testo levels are higher and LH within range (tests taken in AM before breakfast). The tests below were taken while on holidays when eating and sleeping irregularly while drinking more than usual.

Regarding Primary hypogonal, is it something i could have developed? Are there different degrees of the severity?

thanks again,