T still low, E crashed - follow up labs

[TMI]

New to TRT. I felt sick shortly after starting my protocol in July (below) but stuck it out for 10 weeks before getting my first follow up labs in October. Felt truly horrible toward the end of September (zero energy, flu-like symptoms, thought I had the flu, maybe I did!)

Have a follow up with my doc in a month, but would appreciate any of your thoughts at this point.

I discontinued the anastrozole immediately after the blood draw as I suspected my estradiol had crashed (it had). Testosterone is still quite low. I have some leeway to increase my dose prior to my follow up visit, and am open to more frequent injections (daily, if needed). Might test cyp 60 grams three times a week be a reasonable increase at this point (140 vs 180 mg/week)?

July 2016/October 2016:

Test: 290 (348 - 1197) / 430
Free test: 12.7 (7 - 24) 20
Estrodiol, sensitive: 30 (8 - 35) 4.1
DHEA: 200 (70 - 375) 365

Protocol: 70 mg testosterone cypionate, 400 HCG subcutaneously, and anastrozole 0.4 mg orally every 3.5 days. DHEA/pregnenolone orally every evening.

I also had progesterone checked in October (no comparison number) and it was high (0.5, range 0.0 to 0.1)

Thanks for any ideas on how I might proceed.

 

[Vince Carter]

When was your blood drawn in relation to when you inject...blood should only be drawn for testing immediately prior to your next injection.

 

[TMI]

When was your blood drawn in relation to when you inject...blood should only be drawn for testing immediately prior to your next injection.

The blood draw was done about an hour prior to my injection.

 

[TMI]

The draw was last Tues, actually, just got the results (hence the Oct date). I inject at 8:30 AM on Tuesdays, and the draw was at 7:45 AM, 45 minutes before my injection.

Even though it's been just a week since stopping anastrozole, I don't feel so awful. Do notice swelling of my ankles now, however. Little or no change in libido or erections (I do have ED). I'm 50 y/o, btw. Thanks.

 

[Vince Carter]

Perfect, thanks, TMI. Have you had your SHBG tested ever? If you're injecting 70mg E3.5D and pulling a trough @ 430 I'd go straight to SHBG, clear indication you're metabolizing T very quickly.

 

[TMI]

I had it tested in the past, well before ever starting TRT. It was low normal. In general, how does low SHBG with fast metabolism effect protocol? Should I expect to dose more frequently, higher dose, or both?

 

[Vince Carter]

SHBG typically goes down once you get on Test, and usually dictates smaller more frequent doses like EOD. I and a few others do daily injections. I would test that again at your next set of labs and decide where to go from there.

 

[Vitamin_C]

Perfect, thanks, TMI. Have you had your SHBG tested ever? If you're injecting 70mg E3.5D and pulling a trough @ 430 I'd go straight to SHBG, clear indication you're metabolizing T very quickly.

that's what I was thinking, 70mg twice a weekly as well as 400 IU of HCG should boost most men into the high range. I am doing 60mg twice weekly and 250 IU of HCG twice weekly and I sit anywhere from 900-1100 TT and over the top range for free T.

 

[TMI]

Well, I'm going to do 24 mg T cyp/day (168/week, up from 70 twice a week) till I see my doc next month. I don't understand the usefulness of SHBG. It's my understanding that one can infer that it is low if your total T is low but your free T is within range. And it tends to go up with TRT. Not sure how the SHBG would affect protocol, though.

 

[Vince]

I would say don't worry about SHBG. https://www.excelmale.com/forum/showthread.php?6401-Shbg

 

[Jackie Treehorn]

Protocol: 70 mg testosterone cypionate, 400 HCG subcutaneously, and anastrozole 0.4 mg orally every 3.5 days.

You're not starting up the anastrozole again, are you? I hope that was just a typo.

 

[TMI]

You're not starting up the anastrozole again, are you? I hope that was just a typo.

No, that was my original protocol (it was anastrozole/DIM, actually). That stuff destroyed my life for 10 weeks! Not going back to it if I can help it!

 

[Vince Carter]

I would say don't worry about SHBG. https://www.excelmale.com/forum/showthread.php?6401-Shbg

This is bad advice and linked to a thread where you give even more bad advice, Vince.

 

[Vince Carter]

Well, I'm going to do 24 mg T cyp/day (168/week, up from 70 twice a week) till I see my doc next month. I don't understand the usefulness of SHBG. It's my understanding that one can infer that it is low if your total T is low but your free T is within range. And it tends to go up with TRT. Not sure how the SHBG would affect protocol, though.

Usefulness...I don't know. Useful to know what yours is I think is imperative to an effective program. Think of it as how fast your body metabolizes T. Someone on 3.5D is barely adequate for an SHBG in the teens, pointing, again, to how low your T was at testing. It's a wild up and down rollercoaster over those three days. The closer you get to smoothing that rollercoaster the better of you typically are, fewer highs and lows. Think you inject and 24hrs later your TT could be >1300, but 3.5D later in your trough you're pushing...700? (for sake of conversation)...that's an extreme up and down. You smooth that out with EOD or daily injections.
As you noted, Estrogen management was a problem for you, goes along with low SHBG (which we're still guessing you have). High Free T is the same with Free Estrogens. So again the closer you get to small dosing like a daily regimen, the less there will be as excess to be aromatized which will better you E and (should) result in no need for an AI.

SHBG is not a boogeyman, you have to know it and how it affects your program.

 

[CoastWatcher]

Like Vince Carter, I inject every day due to low SHBG and high estradiol. As he notes, SHBG is simply something that factors into the management of a successful protocol. In almost every instance you will be able work around the challenges it presents. Knowing what it is, however, is crucial.

 

[TMI]

Like Vince Carter, I inject every day due to low SHBG and high estradiol. As he notes, SHBG is simply something that factors into the management of a successful protocol. In almost every instance you will be able work around the challenges it presents. Knowing what it is, however, is crucial.

Why is knowing SHBG crucial?

 

[ERO]

Your SHBG level pretty much determines how often you need to inject your T for best results. Low SHBG guys typically inject EOD or daily, where guys with a more normal SHBG level can inject every 3.5 days. You need to know the level in order to design a successful protocol.

 

[Vince Carter]

Why is knowing SHBG crucial?

and answered in this thread already.

 

[TMI]

Your SHBG level pretty much determines how often you need to inject your T for best results. Low SHBG guys typically inject EOD or daily, where guys with a more normal SHBG level can inject every 3.5 days. You need to know the level in order to design a successful protocol.

Thanks, ERO. I just don't understand why. Is low SHBG correlated with fast metabolism/excretion of testosterone? It's not clear to me why one would have to inject more frequently with it being low, otherwise.

 

[TMI]

and answered in this thread already.

I'm not sure it's crucial, though. Knowing your total T, free T, and your hematocrit would be crucial while on TRT. Knowing SHBG doesn't seem to be crucial. And it's not an inexpensive test.