Request help and recommendations with my TRT results

[willj427]

Requesting your inputs and advice on my TRT regime and the results I have received thus far.

50 year old, BMI - 24.3, pretty active and works out on a regular basis. Prior to TRT treatment had brain fog, stressed, joint pain, zero libido and just did not feel right. I was and still am going through some internal stress with marriage.

Blood work prior to TRT:

Testosterone Total: 662 (250-1100 ng/dL)
Testosterone Free: 64.9 (35.0-155.0 pg/mL)
Estradiol: 31 (< or = 39 pg/mL)

TRT Plan:
inserted pellets: 1400mg and 16mg Anastrozole

Results: About a week or two after insertion I started to feel better, have better work outs, etc, and about three weeks after insertion I noticed atrophy so doctor gave me HCG (25mL, 3 times a week), which has helped the atrophy.

Did blood work 2 months after TRT pellets were inserted:

Blood work after to TRT:

Testosterone Total: 1113 (257-827 ng/dL)
Testosterone Free: 197.1 (46.0-224.0 pg/mL)
Estradiol: 66 (< or = 39 pg/mL)

The doctor recommended I go on Estradiol and the he is having me take 1 mg Anastrozole tablets 3 times a week. I have been taking this for about a week. I had started to notice breast tenderness and water retention about 6 weeks after pellet insertion.

Right now, here is my plan and the doctor concurs:

• Holding off on anymore Testosterone until Total Testosterone gets within normal range. Will continue with the HCG and the Anastrozole as prescribed. Do blood work in about a month and reevaluate.

My concerns:

• Concerned about Gynecomastia (Man Boobs) with my high levels of Estradiol the way it is.
• Concern over pellets. I don’t want to do pellets anymore. If I continue with TRT it will be via shots. The pellets hurt for about 1.5 weeks and it was too much too soon.
• Concerned I may have jumped the gun with going on TRT replacement too early. Was/is having some marital issues that has caused a lot of stress and wondered if this impacted my overall feeling/moods/libido, etc.
• Although I have felt better on the TRT, I am thinking of geting off testosterone completely. The plan (and I would talk to doctor) would be to not do anymore T (pellets or shots) and gradually let the pellets already inserted wear off. I would also taper off the HCG and Anastrozole at some point and then let my body take over. I would then look at other ways to improve feeling/health.

Questions:

• Is the doctor’s plan, prescribed dose of HCG and Anastrozole consistent with what you know to be a good plan?
• Should I be concerned about potential side affects (man boobs) of the high Estradiol or does this take a long time to formulate?
• If I want to taper off the TRT, what is the best way forward for this and is this wise?

Know I am bit all over the place with this post, but a lot has happened in the past few months. It can be a bit overwhelming, but I am taking a chill pill and going to let the Rx stabilize, listening to doctor etc. In any case, I would appreciate your inputs. Thank you.

 

[HealthMan]

Anastrozole dose makes no sense. You will crash your estradiol in no time. A more sensible dose would be 0.25mg twice a week then retest in a few weeks. HCG you need to specify the dose in IU so that anyone can comment (25ml doesn’t make sense). Pellets are a terrible choice in my opinion. Very difficult to control and adjust things.
Lastly why did you start TRT? Your pre TRT levels dont look that bad.

if i were you i would try to find another doctor that knows what he is doing and use injections instead of pellets. OR like you said stop TRT. You might not need a restart given you just started (depends how long the pellet lasts).

 

[willj427]

I take 250 IU per shot, three times a week, for a total of 750 IU HCG a week.

I started TRT because I had zero libido, joint pain, brain fog, a bit depressed.

Forgot to add my SHBG if it matters.
Before TRT: SHBG 37 (10-50 mol/L
After TRT: SHBG 50 (10-50 mol/L

 

[HealthMan]

750IU a week seems resoanable and you mentioned it reverted the atrophy. Like you said your symptoms were maybe related to the stressful situation you were going through so maybe you should reconsider TRT. If you decide to do that a restart protocol might be helpful (there is plenty of information about restart protocols here).
Regarding gynecomastia do you have any lumps? Like i said the crazy anastrozole dose you are taking will most likely bring you estradiol close to zero so if you dont have gyno now you wont get it using this current anastrozole dose. If you decide to quit TRT if not done properly you can have a estradiol rebound and that could cause gyno.

 

[willj427]

I don't have any lumps under my skin on the chest and breast area, just muscle and the normal fat.

I will start reading up on restart protocols too, especially using pellets. That may be difficult to find as the reading I have done thus far on restart protocols revolves around taking shots and not pellets.

 

[HealthMan]

I don't have any lumps under my skin on the chest and breast area, just muscle and the normal fat.

I will start reading up on restart protocols too, especially using pellets. That may be difficult to find as the reading I have done thus far on restart protocols revolves around taking shots and not pellets.

The restart protocol can begin once the pellet is out of your system. You can surgically remove the pellet and start the restart protocol

 

[willj427]

HealthMan, when you were taking about lumps, where would you look for them? I'm not sure after two months if the pellets can be removed, although I can ask.

 

[fifty]

Estradiol at 66 for a few months should be virtually no concern regarding gyno. Some guys roll with a value like that for years and are fine. Personally I would try to get it down a bit with some ai.

 

[HealthMan]

HealthMan, when you were taking about lumps, where would you look for them? I'm not sure after two months if the pellets can be removed, although I can ask.

Lumps would show underneath your nipples. I heard that pellets can last up to 6 months. So if you cannot remove them have bloodwork done once a month so you can determine when they are gone (your TT would be lower and LH/FSH would start to rise). That way you can start the restart

 

[HealthMan]

Estradiol at 66 for a few months should be virtually no concern regarding gyno. Some guys roll with a value like that for years and are fine. Personally I would try to get it down a bit with some ai.

It is very individualized. I get gyno with estradiol at 30. I know of many other cases where you dont need an astronomically high estradiol to get gyno. So careful when giving advise like that. Also high estradiol may cause other symptoms very similar to low estradiol. + there has been some recent debate about long term effects of high estradiol levels in men on TRT (dr crisler started a nice thread about this here)

 

[Vince Carter]

Gyno, like MPB has much more to do with genetics than a certain level or high level of E, or DHT, etc etc

 

[Vince Carter]

It is very individualized. I get gyno with estradiol at 30. I know of many other cases where you dont need an astronomically high estradiol to get gyno. So careful when giving advise like that. Also high estradiol may cause other symptoms very similar to low estradiol. + there has been some recent debate about long term effects of high estradiol levels in men on TRT (dr crisler started a nice thread about this here)

A+

 

[willj427]

Not sure if my doctor is ghosting me or not, but he has not responded to my question about the possibility of removing the pellets. The pellets were put in almost 4 months ago. At this point it is probably too late to try and take them out, but it would be nice to hear back from my doctor.

Need some assistance/have some questions:

1. Is there a site/location to go in order to find doctors in my area versed in TRT?

2. Should I keep taking my current medications the way the doctor prescribed or change it up?
I'm currently on the following medications:
- Inserted pellets back in July: 1400mg and 16mg Anastrozole
- Currently taking 1 mg Anastrozole 3 times per week
- Currently taking 250IUs 3 times per week

3. I will research the restart program, but at what point would I know to begin the restart, once my blood work testosterone goes down to what it was before inserting the pellets?

I appreciate the inputs. Right now, I feel like I'm blowing in the wind without doctor responding. Thanks for the help.

 

[HealthMan]

Not sure if my doctor is ghosting me or not, but he has not responded to my question about the possibility of removing the pellets. The pellets were put in almost 4 months ago. At this point it is probably too late to try and take them out, but it would be nice to hear back from my doctor.

Need some assistance/have some questions:

1. Is there a site/location to go in order to find doctors in my area versed in TRT?

2. Should I keep taking my current medications the way the doctor prescribed or change it up?
I'm currently on the following medications:
- Inserted pellets back in July: 1400mg and 16mg Anastrozole
- Currently taking 1 mg Anastrozole 3 times per week
- Currently taking 250IUs 3 times per week

3. I will research the restart program, but at what point would I know to begin the restart, once my blood work testosterone goes down to what it was before inserting the pellets?

I appreciate the inputs. Right now, I feel like I'm blowing in the wind without doctor responding. Thanks for the help.

If you are in the US you can give Defy Medical a call.
Regarding your other questions. If you cant get the pellet removed you have no option other than wait. You will know they are gone by doing blood work and checking LH/FSH levels (assuming you know your baseline for those). Your LH/FSH will begin to rise. However there is possibly a delay there because the body might yake sometime to start producing those hormones again. Checking your T levels will give you a good hint as well. It is pointless to start any restart protocol before the pellets are out of your system.
Regarding anastrozole HCG i already replied to that question.
Best of luck

 

[Mary@DefyMedical]

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