TRT low, minimal E2 suggestions

[low_T]

New user, long time lurker reading up. I'm a 42 yr old male, and I was diagnosed primary hypo around 2012. Ive been on TRT for 8+ years or so.
Im using 100mg every 7 days IM. My question is, is it typical for my E2 to be in the lower range? My last test result was 13.1 in the range of

8.0 to 35.0 pg

I'm having some ED symptoms, and feeling anxious a lot and have been on anxiety medicine for the longest I can remember.


I'm going in Fri to my PCP for follow-up blood work. I plan on having the following checked-

Total T
Bio/Free
SHBG
E2
CBC
CMP

Anything else I should be looking at? Ive not had my SHBG checked in along time. But I'm wondering if that is binding to all my free and not to my E2?

Also, ive never had a higher serum than 700 on T. I would like it to dose a a bit higher, but my hemotacrit is close to 50.

So, should I inject more frequent? Should I add anything to my protocol? Adding HCG is very expensive for me as my insurance is the greatest. Ive obviously never need an AI as my E2 has never been over 20. I'm not sure why my E2 is so low even while on TRT.

But, looking to feel a bit better and relieve some of my ED symptoms.

 

[Cataceous]

Are these tests at pre-injection troughs? If so your T dose is actually rather high. On weekly injections, a trough around 600-700 ng/dL means the peak may be more like 1,500-2,000, and the average well over 1,000. With these numbers I would for starters try cutting back to 40 mg TC injected twice a week.

Your estradiol is low relative to the testosterone. This would be a good reason to add hCG, except for the cost. You might check out AllDayChemist/ReliableRx to see if they are more affordable. Though it's not common, some guys do supplement estradiol directly when it's low.

 

[gerardo]

Are these tests at pre-injection troughs? If so your T dose is actually rather high. On weekly injections, a trough around 600-700 ng/dL means the peak may be more like 1,500-2,000, and the average well over 1,000. With these numbers I would for starters try cutting back to 40 mg TC injected twice a week.

Your estradiol is low relative to the testosterone. This would be a good reason to add hCG, except for the cost. You might check out AllDayChemist/ReliableRx to see if they are more affordable. Though it's not common, some guys do supplement estradiol directly when it's low.

What is the recommended T / E ratio?

 

[JA Battle]

What is the recommended T / E ratio?

.3-.4% e2/tt

or 5-7% e2/tt if cross comparing units pg/ml:ng/dl

 

[low_T]

Are these tests at pre-injection troughs? If so your T dose is actually rather high. On weekly injections, a trough around 600-700 ng/dL means the peak may be more like 1,500-2,000, and the average well over 1,000. With these numbers I would for starters try cutting back to 40 mg TC injected twice a week.

Your estradiol is low relative to the testosterone. This would be a good reason to add hCG, except for the cost. You might check out AllDayChemist/ReliableRx to see if they are more affordable. Though it's not common, some guys do supplement estradiol directly when it's low.

No, post injection. Ive never had a serum level post injection over 700. They normally see around 400-500 maybe. I dont know If im one of those that absorbs it and it escapes via urination. I forget what that is called. T normalizer? Or, something like that. But, I dont see high levels at all.

I will look into HCG. I assume 250 IU is a good start?

 

[Cataceous]

No, post injection. Ive never had a serum level post injection over 700. They normally see around 400-500 maybe. I dont know If im one of those that absorbs it and it escapes via urination. I forget what that is called. T normalizer? Or, something like that. But, I dont see high levels at all.

I will look into HCG. I assume 250 IU is a good start?

How long after injections do you test? The numbers seem pretty low for 100 mg. Are you a big guy? Except for injection site leakage, absorption should be close to 100%, and the only way for metabolites to escape in urine is by having the testosterone in your blood first.

With hCG I'd start with 250 IU twice a week and work up as needed.

 

[low_T]

How long after injections do you test? The numbers seem pretty low for 100 mg. Are you a big guy? Except for injection site leakage, absorption should be close to 100%, and the only way for metabolites to escape in urine is by have the testosterone in your blood first.

With hCG I'd start with 250 IU twice a week and work up as needed.

Well, for ex: i just injected this week on Tues. My blood work is tomorrow. I wanted to get in right after my Tshot on tues, but my PCP office was booked up. Tomorrow was the closest I could get in. Since T only has a shelf life of around 8 days or so, I inject once a week. My doc wanted me to up the dosage and inject every 14 days, but I nixed that idea.
Im about 6'4 228lbs or so. Im somewhat fit, but do carry some belly fat.

So, what I plan on doing is getting my results and then go back 6-8 weeks again and test again.

I plan on doing twice a week starting next week. So, probably once on tues, and then again on friday or so.

Im still wondering if most of my T is tied up in SHBG. But, I guess the only way around that is more T.

Im still quite concerned with my Hemotacrit. Its right at 50. If the number isnt down at all, I dont want to increase the dosage. I suppose I will need to donate some blood every 3mos or so to get it under control. I've also heard dehydration is a big part of it. Are we talking dehydration where you drink only a few liquids a day? Or are we talking 2 days without drinking anything or what? There doesnt appear to be a definitive answer

 

[slicktop]

Cataceous is spot on, as usual. You're definitely going in the right direction switching to twice a week shots, so good decision there. As far as the hydration thing is concerned, I feel like there's a whole gulf that's left out in between the words "dehydrated" and "hydrated". Basically, hydration isn't a problem unless there's a problem, right? The chances are though, you'd do your entire body a favor by drinking more water. Your kidneys, your liver, just literally everything is happier with plenty of fresh water. But it's water you need, not iced tea, not Snapple, but straight up water (non-flavoed sparkling is also fine).

Regarding SHBG: some men find a quality DHEA supplement lowers their SHBG levels. I tried it, and it seemed to work well for me.

 

[Cataceous]

Have you ever measured SHBG? I'll hazard a guess that it's on the low side. Your size can partly account for lower total testosterone with that dose, but low SHBG is often a contributing factor. This would mean your free testosterone is higher than expected, and it would help to explain the elevated hematocrit.

 

[low_T]

I've not. And I have that on the list for tomorrow.

My last free was on the low side. Granted, my last results were before my shot injection.

Testosterone

283 ng/dL >18 years 264 - 916

Free Testosterone %

1.3 % Adult Males: 1.5 - 3.2

Testosterone Free

37 pg/mL Adult Males: 52 - 280

Estradiol Sensitive

13.1 pg/mL

8.0 to 35.0 pg/mL

Does a low SBHG contribute to a higher RBC? To my knowledge red blood cells do not contribute to blood clotting. Its the platelets? But, those arewithin range. So, hard to tell.

In addition, dont I want a low SBHG? Isnt that a good thing? That means more free T to where I need it. But, Ive also not had DHT checked either.

So, something is contributing here to my 'ED symptoms'. Ive pretty much tapered off of my anxiety meds and its helping. But, long term, I'm not sure I can be off of one.

 

[Cataceous]

...
In addition, dont I want a low SBHG? Isnt that a good thing? That means more free T to where I need it. But, Ive also not had DHT checked either.

So, something is contributing here to my 'ED symptoms'. Ive pretty much tapered off of my anxiety meds and its helping. But, long term, I'm not sure I can be off of one.

You don't want low SHBG either; reports say it's worse than high. It seems to make it harder to get things right. It can mean more free T, but not necessarily where you need it, and it can also raise free estradiol relative to free T.

In any case, it will be easier to tell what's going on after you measure SHBG. It looks as though you had a higher quality free T test, but with total T so low it's unclear what's happening in the rest of the injection cycle.