TRT Protocol Advice

[edvedder]

Hello, I started TRT about 10 months ago at age 40 and am still trying to dial things in. I initially started on 80mg T cyp and 250 iu hcg - both taken twice a week. The honeymoon period only lasted about a month before i started getting bloated, overly emotional, lethargic etc. 3 months later when I dragged myself back to the doc, we found all my numbers elevated and I was put on Anastrazole which i initially overdid. I did some experimentation and went down to 70mg E4D but the AI dose was always hard to get right.

I changed things up in July and went down to 40 mg E4D with no AI and .25 mg cabergoline E4d and once a week Hcg of 150iu. I was feeling lighter and was doing better at the gym but libido and mood were not good. So in the last week of July I bumped it up to 50mg to see if things would improve but instead I again got the high e2 signs that i know quite well. So my last shot was on a Tuesday and I went for my blood test on Friday:

Free T 163 pg/mL (35-155)
T 685 ng/dL
Prolactin 4.3 ng/mL (2-18)
SHBG 15 nmol/L (10-50)
Estradiol 69 pg/mL (<=39)
Dhea 309 mcg/dL
tsh 1.66

Was good to see my prolactin come down from 20 a couple of months ago but my SHBG also dropped from 20 to 15. I have been reading some accounts here about daily shots with 1/2 inch insulin needle. Do you think with the numbers above it would be a worthwhile experiment to start such a protocol with a low dose like 10mg/day? Also, do these insulin needles only work if you are pretty lean ?

 

[Vince Carter]

Id leave your dosing as is, your TT/FT/SHBG all look like they should be workable but the problem is your E and trying to get that down which will take a fair amount of Anastrozole probably atleast .25mg EOD. You have to know here that low SHBG = Free T (your dosing here is good) but also = high Free E.

You should add to your tests "Free Estradiol" and I bet you see it way over the lab range. You sensitive LC/MS/MS E2 level probably needs to be very close to your SHBG of 15.

 

[MarkM]

You could/should go to every day or EOD injections with an SHBG of 15.

Which estradiol test did you take? Was it the ECLIA or the Sensitive LC/MS/MS assay? It makes a big difference. It seems high with the small testosterone dose you have been taking. Possibly you are sensitive to estradiol..........

I don't know what 150 IU of HCG is going to do for someone at such a low dose. I probably wouldn't even take it at that dose and save myself a needle stick.

 

[Vince]

I agree about doing daily injections, it seems like 16 mg is a good starting dose. I wonder if HCG is causing issues? You may want to stop HCG and see if that helps.

 

[Systemlord]

Low SHBG guys here, twice weekly is suboptimal for me. I feel a massive difference going from 50mg twice weekly to 20mg EOD, night and day! I require anastrozole .250 EOD do to the fact low SHBG men have a ton of free hormones, that means free estrogen as well.

Truth is low SHBG men also excrete the majority of your testosterone into the urine quite fast and Free T levels bounce all over the place as a result. We don't hold onto our testosterone very well. You shouldn't be targeting high normal testosterone, you can't hold onto most of what's injected, however you will hold onto the estrogen that is converted from the high testosterone.

 

[edvedder]

You sensitive LC/MS/MS E2 level probably needs to be very close to your SHBG of 15.

Thanks Vince. Was curious about the above point. Is that something you have observed for yourself personally or a more general concept ? Just thought of checking as I hadn't heard this before.

 

[edvedder]

Which estradiol test did you take? Was it the ECLIA or the Sensitive LC/MS/MS assay? It makes a big difference. It seems high with the small testosterone dose you have been taking. Possibly you are sensitive to estradiol..........

It was the regular test. I know I should take the sensitive one but my doc insists that the accuracy of the sensitive test only comes into play when measuring low levels of e2. I plan on testing sensitive e2 once i feel stable for a few weeks to know where my optimal value lies.

 

[edvedder]

I agree about doing daily injections, it seems like 16 mg is a good starting dose. I wonder if HCG is causing issues? You may want to stop HCG and see if that helps.

Thanks Vince, I do remember reading about your and Coastwatchers daily protocol. The only concern I had was that both of you seem fairly lean and not e2 prone as I am ; hence my thought process of starting quite low at 10mg and working up.

 

[edvedder]

Low SHBG guys here, twice weekly is suboptimal for me. I feel a massive difference going from 50mg twice weekly to 20mg EOD, night and day! I require anastrozole .250 EOD do to the fact low SHBG men have a ton of free hormones, that means free estrogen as well.

Truth is low SHBG men also excrete the majority of your testosterone into the urine quite fast and Free T levels bounce all over the place as a result. We don't hold onto our testosterone very well. You shouldn't be targeting high normal testosterone, you can't hold onto most of what's injected, however you will hold onto the estrogen that is converted from the high testosterone.

sigh.. that is true. I was hoping to ditch AI but it does seem it will be a constant fixture in my protocol. Right now I'm getting the cheap 1 mg tablets and breaking them up and hoping that the 1 mg AI is equally distributed across the tablet. I see that empower sells them in tiny .125mg sizes which probably makes things easier to measure.

 

[MarkM]

You may not need the AI when all is said and done. Are you having high E2 symptoms? Dont pay much attention to the 69 you have on the non-sensitive E2 test. My non-sensitive E2 was 91.0 and my Sensitive E2 was 35.3. Had I just went off the non-sensitive test I would be taking a big ole dose of an AI and probably done myself some harm. As it is, I take no AI with a Sensitive E2 of 35.3, just over the top of the range.

 

[Vince]

Thanks Vince, I do remember reading about your and Coastwatchers daily protocol. The only concern I had was that both of you seem fairly lean and not e2 prone as I am ; hence my thought process of starting quite low at 10mg and working up.

Coastwatcher inject 16 mg daily same as me but I inject the higher dose of HCG then he does. He uses it to help control his estradiol I use it to help control my HCT. For whatever reason it did help both of us. When I went to Daily's I was able to finally stop donating blood. Here's my present protocol and labs.

My protocol is 16 mg of testosterone cypionate daily, 500 iu of HCG twice a week, 25 mg of DHEA and no AI.

testosterone serum 1117 ng/dL range 264 - 916
Free T 30.3 pg/mL range 6.6 - 18.1
DHEA - Sulfate 347.3 range 48.9 - 344.2
Estradiol, Sensitive 29.5 range 8.0 - 35.0
SHBG 48.8 range 19.3 - 76.4
HCT 47.9 range 37.5 - 51.0

 

[Vince Carter]

Thanks Vince. Was curious about the above point. Is that something you have observed for yourself personally or a more general concept ? Just thought of checking as I hadn't heard this before.

Im doing this myself right now. Run that Estradiol, Free lab I referred to in my post and you'll be surprised at how much Free Estrogen you have. This right there is why low SHBG guys have trouble. Translates to a LC/MS/MS that is probably going to have to be under 20, if not 15. Dr Crisler has stated that he has some low SHBG guys that can tolerate very little Estrogen.