TRT Review - Low SHBG, High E2, Crashing Libido

[rdrg-fmtnc]

Hey guys,

Looking for some advice on my TRT protocol. I'm 21, had testicular cancer last year (orchiectomy + chemo, now in remission). Been on TRT for about 3 months, trying to dial it in since I'm still having issues.

Here's the situation:
Complaint: Zero libido, some anhedonia, water retention.
Protocol: 62.5mg Sustanon E3.5D (so 125mg/week), plus 500 IU HCG twice weekly (1000 IU total).
Labs (trough, 12h pre-injection):
- Total T: 921 ng/dL
- Free T: 294 pg/mL
- E2: 68 pg/mL
- SHBG: 15.9 nmol/L
- Prolactin: 12 ng/mL
- TSH: 2,49 mcUI/mL
- T4: 1,32 ng/dL
- T3: 133 ng/dL
- HCT: 53.3%

Background:
Tried Clomid initially, crashed hard with emotional sides and libido. HCG monotherapy didn't do much. Now on TRT + HCG, but libido is still MIA. Doc isn't super knowledgeable about TRT nuances, so I'm trying to figure this out myself.

My Thoughts:
I'm thinking my low SHBG is causing issues. The Sustanon is a blend of short and medium esters, so I'm probably spiking and crashing hard. My E2 seems high relative to my SHBG, even though Total T isn't crazy high.

The Question:
Given the low SHBG and high E2, does it make sense to switch to more frequent injections (EOD or daily) with a lower overall dose to stabilize things? Any other suggestions on how to dial this in and get my libido back? Also, any thoughts on the HCG dose?

Thanks in advance for any input!

 

[radman]

Hey guys,

Looking for some advice on my TRT protocol. I'm 21, had testicular cancer last year (orchiectomy + chemo, now in remission). Been on TRT for about 3 months, trying to dial it in since I'm still having issues.

Here's the situation:
Complaint: Zero libido, some anhedonia, water retention.
Protocol: 62.5mg Sustanon E3.5D (so 125mg/week), plus 500 IU HCG twice weekly (1000 IU total).
Labs (trough, 12h pre-injection):
- Total T: 921 ng/dL
- Free T: 294 pg/mL
- E2: 68 pg/mL
- SHBG: 15.9 nmol/L
- Prolactin: 12 ng/mL
- TSH: 2,49 mcUI/mL
- T4: 1,32 ng/dL
- T3: 133 ng/dL
- HCT: 53.3%

Background:
Tried Clomid initially, crashed hard with emotional sides and libido. HCG monotherapy didn't do much. Now on TRT + HCG, but libido is still MIA. Doc isn't super knowledgeable about TRT nuances, so I'm trying to figure this out myself.

My Thoughts:
I'm thinking my low SHBG is causing issues. The Sustanon is a blend of short and medium esters, so I'm probably spiking and crashing hard. My E2 seems high relative to my SHBG, even though Total T isn't crazy high.

The Question:
Given the low SHBG and high E2, does it make sense to switch to more frequent injections (EOD or daily) with a lower overall dose to stabilize things? Any other suggestions on how to dial this in and get my libido back? Also, any thoughts on the HCG dose?

Thanks in advance for any input!

This all actually looks really good, except your hematocrit. Generally 54% is considered at risk for hyperviscosity and associated clots.
Your E2 is only high because your T is high. The ratio of T:E in your case is 13.5, which is pretty optimal.
I don't think these labs explain the low libido.
You probably need to consider strategies to combat the high HCT immediately. Giving blood is the typical response, but it is not clear that this actually reduces risk. It also results in losing a lot of iron, and if done repeatedly will deplete iron stores.
Effective options for managing the elevated HCT include changing the formulation of Testosterone from an injectable to one that does not cause the high spikes and troughs, such as Natesto, topical Testosterone Gel, or Testosterone Undecanoate oral (eg. Kyzatrex). Also, Angiotensin II Receptor Blockers (such as Telmisartan) can modestly reduce HCT due to a reduction in renal production of erythropoetin.

 

[Cataceous]

Any way you look at it the your dosing is excessive—basically double natural production. But regardless, before you head down other rabbit holes consider trying a more sensible initial strategy for treating primary hypogonadism, which I assume is what you have with one or both of the "boys" missing. I describe the approach in this post, and it is discussed in more detail in this thread, With this approach hCG is unnecessary—because you resume production of LH—and removing hCG may resolve the estradiol imbalance. Basically, the goal for you is to find the dose of testosterone your body wants, which is communicated to you by normalization of the level of LH. Unfortunately, with your current high dose it is possible you will have withdrawal symptoms as you.reduce to more sane doses. You will need patience, but rest assured it will be worth it.

Sustanon is not ideal for this, though you can make do if you have no access to pure esters. The mix of esters in Sustanon s less predictable and the decanoate ester extends the stabilization period. Enanthate or cypionate would be better for dialing in, ideally with EOD dosing, though twice weekly is probably viable. If you really want to minimize injections in the long-run then a switch to testosterone undecanoate is possible once the correct amount of testosterone is determined. Then injections could be reduced to weekly and possibly even every other week.