I could use some insight about my apparent failure to respond to TRT thus far. I am 53, 292lb., 6'6" Started TRT injections (0.5ml Cypionate) 8 weeks ago. Total T was prior to TRT 252 and Free T (Analog) was 12.1. My libido prior to TRT was at about 15%, but has now been essentially zero. ED and PE has also been an issue for several years and have certainly not lessened since I started TRT. I had labs done 5 days ago (1 1/2 days after last injection). Total T=812.6 ng/dl; Free T=22.02 ng/dl; %Free T=2.7; I read a lot about E2 on this site so I had that tested (49.41 pg/ml). I started Anastrozole 1 mg. two days ago. Took 1 mg. for next week and am planning to start taking 1 mg. split in 2-3 doses per week starting in one week. I am feeling discouraged because despite all the "what to expect after taking TRT" there is progress. I appreciate any thoughts/suggestions.
TRT not effective after 8 weeks
- Thread starter Janosch
- Start date
Welcome to the forum. What are your goals from TRT? Mostly libido and ED issues? Are you exercising and/or eating differently? What is your total T dose per week (should be in millgrams - mg)? Others on here know far more that me and will be able to provide more input and ask better questions. Good luck. On last thing, re libido and ED, if TRT does help, it takes a long time and for many TRT is not enough by itself. My libido was unchanged in 8 weeks, but I was having more energy and better mood/outlook, which also helped me exercise more and eat better, which also is important.
Systemlord
Member
Estrogen level have more to do with how a guy feels on TRT, if high for you it will affect mood, mental clarity, lower libido and hinder erections. I'm going to assume you meant 200mg 0.5ml Cypionate 100mg once weekly. If SHBG is low to midrange this protocol is wrong for you. If SHBG is midrange splitting your shots up twice weekly is best.
Thank you Saul. My main goal is to increase libido, improve erections and hopefully minimize PE. I've been working out five times a week, watching my nutrition, but I and am not losing any weight. I usually have been able to lose weight if I train two hours a day and restrict food intake, but I in my research it was noted that decreasing calories by 50% will result in an increase in SHBG, which of course will result in a drop in testosterone. My energy level is down as is my drive. It pains me to have no desire for sex with a willing partner I am attracted to. My weekly dose of 0.5ml is 100mg. It seems like that most of the research out there suggests that an increase in libido can be expected after three weeks with improvement in erections following until they plateau at 12 weeks. I am making an assumption that my T levels are acceptable, so I am hoping that my highish E2 levels may be the culprit for my lack in "progress". It is interesting to hear though that it took you longer. May I ask if your libido improved and if so how long it took?!
My weekly dose is 100mg. No improved energy, mental clarity or mood yet. As I said, libido dropped since I started TRT. No morning wood either. It is my understanding that labs should ideally be drawn at half cycle, so 3.5 days following injection. Unfortunately I had to travel for the labs and it did not work out any better. My SHBG is 22.05 nmo/L, Albumin 4.5 g/dl. It is my understanding that my SHBG is low. What would be a better protocol in your opinion?
Systemlord
Member
Those ranges and studies are everyone else, some took much longer to recover and some didn't recover at all that is probably do to some having low SHBG where 200mg every 2 weeks simply won't work. If you were in that study you would probably be one of those who was still left with unresolved symptoms do to low SHBG.
You've already started out on the wrong protocol, you have low SHBG and this protocol will fail. You either have to inject 50mg twice weekly or inject 18-25mg EOD. If you run labs to compare blood testosterone to your urine testosterone, the urine testosterone will be way higher. Compare it to a guy with high SHBG and he will have higher blood testosterone when compared to urine testosterone.
You need a course correction, injecting EOD will ensure you recover faster as EOD is fool proof, it will work. Injecting twice weekly is an unknown and AI dosing could get difficult unless you can get it compounded into smaller doses. You take the AI at time of each injection.
Once you start your new protocol you reset the clock for labs, another 6 weeks. If you make a small change half way through, it's another 6 weeks.
My vote is 20-25mg EOD and I think most here would agree.
You've already started out on the wrong protocol, you have low SHBG and this protocol will fail. You either have to inject 50mg twice weekly or inject 18-25mg EOD. If you run labs to compare blood testosterone to your urine testosterone, the urine testosterone will be way higher. Compare it to a guy with high SHBG and he will have higher blood testosterone when compared to urine testosterone.
You need a course correction, injecting EOD will ensure you recover faster as EOD is fool proof, it will work. Injecting twice weekly is an unknown and AI dosing could get difficult unless you can get it compounded into smaller doses. You take the AI at time of each injection.
Once you start your new protocol you reset the clock for labs, another 6 weeks. If you make a small change half way through, it's another 6 weeks.
My vote is 20-25mg EOD and I think most here would agree.
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Janosch your problem may not be all testosterone. Have you had a full Thyroid panel done? The symptoms are almost identical, no energy, mental fog, ED, weight gain, etc. Here is a good link that explains how the 2 are related:
https://www.restartmed.com/thyroid-symptoms-men/
A full thyroid blood test includes TSH, FT3,FT4, RT3 (very important), T3 and thyroid antibodies TgAB, TPOab. The Reverse T3 and FT3 are very important.
1 mg of Anastrozle is way too much to take with an E2 of 49. You definitely don't want to crash your estrogen, believe me I have. I think .025 mg 2 x week would get your E2 back down to the mid 20's....
Just my opinon and good luck!
Yes, Free T4 was 1.38 and TSH 3rd gen was also 1.38. Interesting that both were the same value. My doc is going to call the lab and inquire if the values were in deed identical. Thanks for the link! I am too concerned that the Anastrozole dose might be too high. Perhaps easy does it and I'll quarter the pill next week and only take it twice for a total of 0.5 mg. I have not found any information how quickly I can expect E2 to go down after taking a dose. Any thoughts on that?
You are giving me good food for thought, thanks. It was my understanding that low SHBG was good because it prevents it from holding on to the testosterone and instead making it bioavailable (free t)?!
Could you tell me how injecting twice a week or even EOD is beneficial over once a week? I can see not injecting every two weeks to keep the spike and valley in check, but thought that once a week would not raise T too much at the time of injection (or 24 hours later) while not making dip T below sub therapeutic levels by day seven. And what does it mean to "recover faster"? Lastly, what is the significance of waiting 6 weeks for labs?
Could you tell me how injecting twice a week or even EOD is beneficial over once a week? I can see not injecting every two weeks to keep the spike and valley in check, but thought that once a week would not raise T too much at the time of injection (or 24 hours later) while not making dip T below sub therapeutic levels by day seven. And what does it mean to "recover faster"? Lastly, what is the significance of waiting 6 weeks for labs?
TSH is of little value when checking the thyroid function. Your Free T4 at 1.38 is at the bottom of OPTIMAL ranges. 1.4 to 1.77 is optimal and if I were in your shoes and feel the way you do, I would ask my Dr. to have the the remaining thyroids ran especially the Free T3, T3 and Reverse T3. Dr. Childs gives a list of OPTIMAL ranges for all thyroid blood test here:
https://www.restartmed.com/normal-thyroid-levels/
Also, another good resource of the thyroid is www.stopthethyroidmadness.com.
Anastrozole can drop your E2 very very quickly so, I would try it for 2 weeks at .5mg week. I would think that E2 of 49 that full 1 mg for the 2 weeks will get it in the lower 30's high 20's. Then .25 per week until you get retested. Maybe we can get some other opinions on how quickly it drops and at what doses. I can't remember my dosage while I took it but, it was very low like .25 mg 2 x weekly and my E2 dropped from 41.8 to 8.4 in about 6 months and it was real tough with the low E2 symptoms.
https://www.restartmed.com/normal-thyroid-levels/
Also, another good resource of the thyroid is www.stopthethyroidmadness.com.
Anastrozole can drop your E2 very very quickly so, I would try it for 2 weeks at .5mg week. I would think that E2 of 49 that full 1 mg for the 2 weeks will get it in the lower 30's high 20's. Then .25 per week until you get retested. Maybe we can get some other opinions on how quickly it drops and at what doses. I can't remember my dosage while I took it but, it was very low like .25 mg 2 x weekly and my E2 dropped from 41.8 to 8.4 in about 6 months and it was real tough with the low E2 symptoms.
Sean Mosher
Member
Echo what 1Draw said about Thyroid and what others above have stated about SHBG and your protocol.
This is a picture perfect case of why it's critical to have a up-to-date/current doc in interventional endocrinology that can properly diagnose and treat you with a full/complete set of labs and appropriate protocols.
This is a picture perfect case of why it's critical to have a up-to-date/current doc in interventional endocrinology that can properly diagnose and treat you with a full/complete set of labs and appropriate protocols.
Your comment actually reminded me of the question; urologist vs. endocrinologist. Any thoughts?
Systemlord
Member
It's true low SHBG means more of your testosterone is free, but we need SHBG to activate our free hormones on our receptors, so without SHBG your testosterone is floating in limbo. When low SHBG guys inject more frequently, it maintains maximum free T at all times never allowing it to drop below a point where you run low. Injecting twice weekly will allow free T to drop lower since you are allowing it to drop for 1 and half days longer before another injection, the longer you go without another injection the lower free T will get.
A comparison, in you were to inject 100mg once a week versus 25mg EOD, you testosterone levels would be much higher injecting 25mg EOD. If you allow free T to drop too much between injections recovery can be stalled and you could be left wondering why TRT isn't working anymore and why you still have remaining symptoms of low testosterone.
Whenever you make a small change to your dosage or start injecting more frequently, your body must adapt and it takes 6 weeks for your blood levels to stabilize as your levels are thrown out and fluctuate for about 4-6 weeks.
It's also true most doctors neglect the thyroid and often miss important tests do to lack of knowledge or perhaps their satisfying the insurance companies by lowering their costs. That means you sometimes you miss an important diagnosement, I've heard these stories where guys always knew something wasn't right and found out years later they had been living with hypothyroidism do to an incompetent doctor year earlier.
You need Free T3 at the very least, this is the free thyroid hormone and is where the rubber meets the road.
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