Still trying to figure this out - 120mg to 100mg to now 80mg - what a rough week

[Sandz]

What a wile ride, and a terrible week I have had.

I started my journey at 120mg 2x a week sub q. Primary driver for starting TRT at 48 was low free T, always below 5.

120mgs my numbers were -
Total T - over 1500
Estradiol - 60
Free T - 17.3
SHBG - 67
Sensitive estradiol - 53
Hemoglobin - 16.6
Hematocrit - 49

So after 8 weeks I lowered my dose to100mg because I wasn't sleeping well and felt I was retaining a lot of fluid. I tested and my labs where and was surprised to see E going up! At this point I was a week into going down to 80mg.

Total T - 1245
Estradiol - 77!
Free T - 14
SHBG - 60
Sensitive estradiol - 68
Hemoglobin - 17.7
Hematocrit - 52

80mg - 10 days in
Started having the absolute worst headache on the planet. I think the lowering the dose exacerbated the hormone rebalance, and estrogen clearance, but I don't know for sure. I asked Chat for help and it told me to support with TUDCA and NAC and could be a rough week and it was. I tried everything in my power to not use an AI but I gave in and took .5 and I am hoping its a 1 time thing. I was taking some headache meds and got a shot of Toradol too. I am feeling some relief today, a week later.

I just didn't want to run my T that high personally. I would like to optimize not go crazy. I am remembering when I was on enclo my T was 900-1100 and free T `14-17ish and my estradiol was 40 or under. I just didn't love the feeling and it was inconsistent and I was getting eye flutters so I stopped and eventually moved to TRT. I am hoping I can dial in with TRT to similar numbers but its still up in the air. I'm thinking on 100mg if I was around 1245 I can be under 1000 on 80mg and get my estrogen in check and sleep!

Any thoughts on the uptick in numbers, and when can I expect for these to level out....because after 7 weeks on 100mg things surely didn't, they were quite the opposite.

This is a strange game I'm learning, the TRT game!

Any advise is surely appreciated!!!

 

[FunkOdyssey]

These free T numbers you are reporting are bogus - likely labcorp direct free T if I had to guess. Your real free T (vermeulen calculation) with 100 mg was 21.8 ng/dL assuming 4.3 albumin, which is a very reasonable level for men on TRT. You have a high SHBG, so this reasonable free T is paired with what might look like an unreasonable total T (it's not in your case). The high total T is an artifact or side effect of the high SHBG and is not necessarily implying too high a dose.

It doesn't look like your hematocrit will allow you to tolerate typical levels though, given it is already 52 when you just started recently. Are you a smoker? Do you snore (sleep apnea)? Insulin resistant and/or overweight? Until you deal with one or more of the above, you'll probably need to drop the dose to 80 mg or lower just to keep hematocrit in range.

Sometimes switching to IM will drop estradiol or feel better symptomatically even if it doesn't change your levels. I would never suggest anyone start with subq at this point, that's more like something to experiment with down the road, once you're dialed in. If you switch to IM though, you'll want to inject more frequently (like EOD) to avoid higher peaks that can drive hematocrit higher.

Check your blood pressure anytime you are experiencing headaches with TRT.

 

[Sandz]

Thanks funkO.

Maybe I won't get hung up on the numbers, total and free. The estrogen though is what I think what was killing my sleep which is why I lowered my dose I want to keep that number down. I feel I'm estrogen sensitive no gyno or sensitivity but sleep and mood. BP is always in check. I have a feeling I'm somewhat insulin sensitive based on slightly elevated fasted insulin but very close to within range. I don't and have never smokes. Lost 80+ and workout every day for 25yrs ago and eat very clean. I'm trying really hard to do everything right. I think in my case the 2nd drop to 80mg was the trigger and the estrogen clearance and aramorization are the issue.....I think. Here to get out and others advice / experiences.

 

[FunkOdyssey]

I have a feeling I'm somewhat insulin sensitive based on slightly elevated fasted insulin but very close to within range.

Do you recall what it was?

 

[Sandz]

95, most recently 94. I don't eat a lot of sugar but have family history. How does that all play into it?

 

[FunkOdyssey]

95, most recently 94. I don't eat a lot of sugar but have family history. How does that all play into it?

That's your fasting glucose, not fasting insulin. You want to see your fasting insulin to determine whether you have insulin resistance. Your lipid panel has some big clues also, between HDL, triglycerides, and their ratio.

Insulin resistant men often have a rough time on TRT. They aromatize more of their testosterone into estradiol, have higher hematocrits, and more side effects overall. The doses they can tolerate are sometimes too low to deliver the full benefits of testosterone.

This video goes into much more detail if you're interested:

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