TRT not working how I'd hoped

[Sfox1324]

Hi all? I'm in the UK and have been put on 1000mg nebido every 10wks, my consultant also privately prescribes HCG and anastrozole.

My latest bloods (which are not sensitive) testosterone 21, estradiol 103, haemoglobin 17, PSA 2.6 & thyroid function is normal.

I've been taking 0.12mg of anastrozole every other day this week and for the first time in a long time awoke with a morning erection but absolutely no sexual desire. I'm at a loss as when I take anastrozole my lips cracks as do my toes but when I don't, I bloat and end up with a turkeys neck!! Please help as its weighing heavy on my mind. I just want to be secure with my sexual ability in my marriage as I currently do not have regular sex given my frequent inability to function.. Cheers in advance.

As I've had a vasectomy would i receive better benefits from a nebido protocol alone?

 

[PAUL-E]

welcome to excel male!, if you post lab work with ranges in the blood test section you might get more of a response.

 

[Sfox1324]

Unfortunately the above info was all that's given in a written letter.

 

[socks]

Test at 21 should be nmol/L so 600ng/dL for us Americans. Someone with more knowledgeable will chime in shortly, but your testosterone dosing should be smaller/more frequent to avoid the excess aromatizing to estrogen, which is clearly what you're experiencing.

Also, are you getting a 1000mg shot of Nebido/testosterone undecanoate only ONCE every 10-weeks?

Typical dosing is 100mg 2x/week or even smaller doses more frequently of testosterone cypionate or enanthate, which (someone correct me if I'm wrong) have a similar half-life.

Bottom line, large doses can result in large amounts of estrogen. The most progessive protocols utilize smaller doses so as to minimize/eliminate the need for an AI like anastrozole/arimidex.

 

[PAUL-E]

Test at 21 should be nmol/L so 600ng/dL for us Americans. That's a decent spot to be in, BUT your estradiol is WAY TOO HIGH. Someone with more knowledgeable will chime in shortly, but your testosterone dosing should be smaller/more frequent to avoid the excess aromatizing to estrogen, which is clearly what you're experiencing.

Also, are you getting a 1000mg shot of Nebido/testosterone undecanoate only ONCE every 10-weeks?

Typical dosing is 100mg 2x/week or even smaller doses more frequently of testosterone cypionate or enanthate, which (someone correct me if I'm wrong) have a similar half-life.

Bottom line, large doses can result in large amounts of estrogen. I believe you're experiencing this. The most progessive protocols utilize smaller doses so as to minimize/eliminate the need for an AI like anastrozole/arimidex.

Its the Nebido it has a very long half life I wonder if that's not what is causing the high E2

 

[socks]

Its the Nebido it has a very long half life I wonder if that's not what is causing the high E2

Much longer than even testosterone undecanoate, it's a patented suspension apparently.

"Following intramuscular administration of this depot formulation the release rate is characterised by a half life of 90±40 days."
https://www.medicines.org.uk/emc/medicine/15661

 

[Sfox1324]

Thank you for your input Paul it's truly appreciated! Unfortunately this is the only protocol available in the UK by the NHS.

 

[Sfox1324]

Thanks Socks, I'm at a loss as when I take just 0.5mg of anastrozole my lips crack,dry skin and I get discomfort in my right hand and ankle leading me to believe I'm low E2!
Could this just be a side effect of anastrozole even if I'm not low?

 

[socks]

Oestradiol, UK spelling, of E2(estradiol) is taken in pmol/L so you're 103 is likely 28 pg/mL for us Americans...and that's in the ideal range. 20-30pg/mL is considered ideal.

A .5mg dose will absolutely tank someone with your E2 levels and elicit the symptoms you just mentioned.

Search arimidex and research dosages TRT guys here have success with in their therapy. Something like .12mg 1-2x/week might be more prudent.

 

[Sfox1324]

So considering I am at ideal levels of both test/e2 what else in your opinion would cause such sexual dis function and lack of sexual desires?

 

[socks]

So considering I am at ideal levels of both test/e2 what else in your opinion would cause such sexual dis function and lack of sexual desires?

A lack of bioavailable/free-testosterone is what first comes to mind. But Gosh, it could be a lot of things, a lot of threads here discuss that topic, ideal levels, but low libido. The endocrine system is incredibly complex and you might go mental trying to figure out the role of neurotransmitters (dopamine etc), free-testosterone, dht, prolactin, shbg, estrogen, dhea, and more.

I believe one of the first places to look is the level of "free-testosterone" and SHBG on your labs, if it's too low or high in case of SHBG, that can be a cause. However, I'm don't think this option of evaluating free-t or SHBG is available to you, perhaps on your next set of labs?

 

[Sfox1324]

Also should I continue using HCG and at what measure? My urologist prescribed 30,000iu for 8 wks use. I don't use that amount but am unsure of the amounts to use to support TRT without affecting oestradiol levels.

 

[socks]

250-500iu dose 2x/week usually 3-4days apart is what most guys are doing. Some people can be more sensitive necessitating a smaller dose, but a good rule is not to exceed 500iu per dose to avoid excess estradiol conversion.

 

[CoastWatcher]

Welcome to Exclemale. We hope you become an active member. As someone with experience with the U.K., U.S., and Canadian healthcare systems I understand your frustration. Your protocol has everything to do with economy of scale and very little to do with patient health. But that, as long as you stay with the NHS, is what you have to deal with.

Your estradiol test is no more than a good guess. The value it reports is based on the wrong methodology for use with men. You want the LC, MS/MS test, but it isn't available outside the U.S. - the lab technology is expensive and it can't be found. You are, likely, in a reasonable spot with your E2. The assay your lab used overestimates estradiol in men. All of which means you and your doctor are flying with less than precise instruments to guide you. Your symptoms sound as if your estradiol is far too low - how is your sexual function when you have a "turkey neck" (and what does that mean)?

You note that your thyroid function is normal. How is that determined? You should have run a panel consisting of TSH, T3, T4, and RT3. Can you provide those numbers?

 

[Sfox1324]

Very hit and miss sexual ability with thick semen and struggle to climax. My turkey neck is that I spear to have a 2nd chin of water if I fail to take anastrozole. With regards to my thyroid,the only confirmation is that my urologists recent correspondence states that is functioning normally! I have no blood panel figures to divulge as I merely get s letter stating my levels as in my original post.

It's so frustrating that something like the NHS are unable to deliver secure and accurate results! I'm having marriage counselling to try and save my relationship given my sexual ability has affected us for 3 years now...... I'm at a loss

 

[CoastWatcher]

Very hit and miss sexual ability with thick semen and struggle to climax. My turkey neck is that I spear to have a 2nd chin of water if I fail to take anastrozole. With regards to my thyroid,the only confirmation is that my urologists recent correspondence states that is functioning normally! I have no blood panel figures to divulge as I merely get s letter stating my levels as in my original post.

It's so frustrating that something like the NHS are unable to deliver secure and accurate results! I'm having marriage counselling to try and save my relationship given my sexual ability has affected us for 3 years now...... I'm at a loss

Are you willing to go outside the NHS? I believe we have suggested the names of private practitioners in the U.K. For other members. You could contact Defy Medical here in the States for an "opinion only" consultation. You could present their treatment recommendations to your local physician. In short, there are options, but they will be more expensive.

 

[Sfox1324]

Any direction would be truly appreciated! Thank you

:0)