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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[Sandz]

Watched the video, I like that guy a lot, he's thinking root cause, not band aid, I like it.

Let me say I do have elevated cholesterol, family history, I am trying to manage within without a statin by taking bergamot and a few other things which got me from 300 to 210ish. LDL still elevated but down from 210 to 130s.

2nd, my Grandfather was diabetic on my moms side, my dad is 135lbs, little guy, he's diabetic, typed 2.

I carried around a lot of fat as a kid, I lost the weight, but I've never been skinny. I don't trust the smart scale, it says in 15%BF but there is no way that's right, I'm realistic, I bet its low 20s which aligns with what this doc says, I wouldn't doubt if I'm 25% even though I don't think I look it, its possible.

Only related lab test I can find is A1C which with an average estimated glucose 94 (and a few old ones where it was btwn 94 and 102), although if I remember correctly it was not fasted, just part of another panel. When I do my labs again in a few weeks, what marker do you recommend I key in n?

I am not hell bent on lowering my E cause of the labs, I just believe thats the marker inhibiting my sleep and fluid retention (not much has changed but I guess the TRT could be it too, maybe not or everyone?).

Id like to make it work though, I think my mood and stress management is a lot better, my workouts aren't thought he roof but better, and I feel if I could dial in I would be happy overall.

 

[Willyt]

Don't worry you are doing everything right. You just need to ride out this rough patch. I have had same experience over the years with major headaches and joint aches when dropping 20% dose (or going cold turkey). Its a big change for the body to adapt to.

Find a dose where you have a good balance. That overstimulated feeling is a killer for sleep. Many of us have same shitty sleep when near top of or exceeding TT range. Think of it this way - it highly unlikely that your younger self ever produced anything close to 1200+ TT

 

[Sandz]

Willy, thanks, Id agree, probably never produced 1500 plus or 1245. And, remember, I dropped 17% and then 20%, so today my dose is 1/3 less than it was when I started.

I do think what FunkO suggested has merit, I am looking into that too. Maybe a little metformin can do someone like me a little good!

 

[FunkOdyssey]

Only related lab test I can find is A1C which with an average estimated glucose 94 (and a few old ones where it was btwn 94 and 102), although if I remember correctly it was not fasted, just part of another panel. When I do my labs again in a few weeks, what marker do you recommend I key in n?

Fasting insulin and lipid panel (HDL and triglycerides specifically).

I am not hell bent on lowering my E cause of the labs, I just believe thats the marker inhibiting my sleep and fluid retention (not much has changed but I guess the TRT could be it too, maybe not or everyone?).

Id like to make it work though, I think my mood and stress management is a lot better, my workouts aren't thought he roof but better, and I feel if I could dial in I would be happy overall.

Many of us had sleep issues in the beginning, and water retention is pretty much a given. Most or all of the water retention disappears eventually as you adapt to the new levels.

You will certainly be able to find a dose that works with regard to side effects by reducing the dose further, it's just a question of what benefits will remain when you get there. The leaner and more metabolically healthy you are, the more testosterone your body will be comfortable with.
.

 

[Sandz]

HDL - 42 (was often below but ive been working on it)
Triglycerides - 142.

Ill have to get my fasting insulin tested next - If the results are that I am insulin resistant, what do you suggest, Metformin like the doc link you send?

I hear what your saying, eventually ill get to a dose where I can sleep, but maybe the benefit wont be worth it. Well, I need to sleep so as much as I want the edge, and the anabolic benefit.....I could be chasing a pipe dream.

 

[FunkOdyssey]

HDL - 42 (was often below but ive been working on it)
Triglycerides - 142.

These are not good. You are right on the line of metabolic syndrome with these values (HDL <= 40 and Triglycerides >= 150 is the cutoff), and the Trig/HDL ratio of 3.4 is associated with significantly elevated CVD risk, regardless of your LDL.

Ill have to get my fasting insulin tested next - If the results are that I am insulin resistant, what do you suggest, Metformin like the doc link you send?

We had a great discussion on this in a recent thread, where Guided_By_Voices and I gave advice to someone in a similar situation: Help with blood test results and erectile dysfunction - Excel Male TRT Forum