TRT Sub Q injections, now no more Anastrozole!

[ERO]

I also noticed my psa is at .09 up from <.01 before. Maybe from the DHEA? Read dhea can raise it and my DHEA level is high. I have an appt next month with my doc to go over blood work and figure it out. Very frustrating, but I feel good and sex drive is excellent. Any opinions?

As long as you feel good and have a good sex drive, I would not worry about it. Sex drive never really comes back as promised for many of us on TRT.

 

[Vince Carter]

My opinion on your TT of 640 is due, in part to your SHBG of 18.4.

On a 2x week injection routine and low SHBG, you're testing that trough and by the time you hit that 3.5day, your body has pretty burned through that T. You should consider EOD injections, may 40mg EOD, you should have a smoother ride, suffer less peaks and valleys that way. IN that paradigm your T is going to be higher and stay higher from injection to injection.

 

[chrismez]

My opinion on your TT of 640 is due, in part to your SHBG of 18.4.

On a 2x week injection routine and low SHBG, you're testing that trough and by the time you hit that 3.5day, your body has pretty burned through that T. You should consider EOD injections, may 40mg EOD, you should have a smoother ride, suffer less peaks and valleys that way. IN that paradigm your T is going to be higher and stay higher from injection to injection.

Thanks for the reply Vince. I do 80 MG every 3 days. All my previous tests put my T from 800-1200, this is the first where its been that low. My SHBG is considered low? What level is it supposed to be at? Any way to raise it? I have an apt with the Doc on the 18th of next month..

 

[Vince Carter]

SHBG can't be raised, it seems that for some it comes down when they start TRT, but in a simple sense it's how fast your body uses the T. Typically your Free T is going to show as High, which is good. For me I see 24hr peak TT of 1475, but then a 3.5 trough of 814....that's a wild swing up and down in just three days time. Closer together injections level off the peaks and valleys. SHBG isn't a good or bad thing, there's not a number or a value that is "right", it's just something (that can) dictate how often you need to inject.

 

[chrismez]

OK, Just did another lab test and got the results back. Total T 1063 and E at 53.1. Finally not less than 6 like all my previous tests. I had a feeling it might be a little high. Have some water retention around the jaw line and been irritable the past couple weeks with some anxiety. I'm going to take .25MG of anastrozole e3d and see how that works out...have doc appt on Monday to discuss as well. these last few months of low E results have been bugging the crap out of me...LOL

 

[maxadvance]

I've read this entire thread twice, and not once did I see where the OP ran a sensitive E test, looks like it's always been a straight E test. He even ran a womens hormone wellness test to save money.

 

[ERO]

If you have been low E2 all along, its unlikely - possible, but unlikely - that you are now all of a sudden high and need 0.25mg or Anastrozole every 3 days. Especially if your E2 test was not the sensitive test. Right now, according to the T:E ratio you are at 19.5, which is in the desired zone of between 14-20. If that was not the sensitive test, then you are most likely still low E2 as the regular test typically overstates your true level.

 

[Jackie Treehorn]

OK, Just did another lab test and got the results back. Total T 1063 and E at 53.1. Finally not less than 6 like all my previous tests. I had a feeling it might be a little high. Have some water retention around the jaw line and been irritable the past couple weeks with some anxiety. I'm going to take .25MG of anastrozole e3d and see how that works out...have doc appt on Monday to discuss as well. these last few months of low E results have been bugging the crap out of me...LOL

Your E2 has been tanked for the last...what...5-6 months, and now that it has finally recovered to 53 (on the wrong test), you're going to start on an AI to knock it down again? I don't get it.

Why don't you get a sensitive E2 lab, so we can have an accurate look at your TE ratio? The sensitive E2 assay typically comes in about 10 points lower than the standard female E2 lab, which is what you've been getting, as far as I can tell. If that assumption holds true for you, then your E2 level really isn't high at all, considering your total Test level.

If I were you, I would hold off on the AI barring any high E2 symptoms (nipples, etc), and get the correct lab work done. I'd bet you a dollar to a doughnut that if you start that .25mg Anastrozole BIW, you're going to tank your E2 again.

 

[chrismez]

Ok, I'll run the sensitive test. My trt doc used the standard e test as well. So is the target range for the sensitive test around 20?

 

[ERO]

OK, you really have to get this concept down or else you are never going to feel good on TRT - there is no static target number for any E2 test - it is wholly dependent on the ratio of T to E. Think about it - an E2 of 20 when your Total T is 500 and an E2 of 20 when your Total T is 1100 are going to provide your body with two totally different outcomes, right???

 

[chrismez]

OK, you really have to get this concept down or else you are never going to feel good on TRT - there is no static target number for any E2 test - it is wholly dependent on the ratio of T to E. Think about it - an E2 of 20 when your Total T is 500 and an E2 of 20 when your Total T is 1100 are going to provide your body with two totally different outcomes, right???

Ok, sorry....Don't mean to sound like a bozo on here.. Ill get the sensitive test done and see where its at and go from there. Can you explain the T to E ratio and how you figure what your E should be. Thanks

 

[ERO]

Sure thing. Nelson is the true expert on the T to E ratio but I can give you a quick overview and then I think it may make more sense. The overall idea is that in young healthy men that have a strong libido, feel awesome, etc...testing has found that in these men, their Testosterone to Estrogen ratio is between 14 and 20.

First a quick definition: A Ratio is defined as the relation between two amounts showing the number of times one value contains or is contained within the other. Think of cooking rice as a simple example: The ratio to cook it properly on the stove is 2 cups rice per 1 cup water. Think of rice as Total T and water as a fixed E2 #...now imagine you want to cook 4 cups of rice...would you still want to use 1 cup of water (the same E2 level for twice the Total T)...or would you want to use 2 cups? What if you were having guests and needed to cook 6 cups of rice? One cup water or 3 cups? See what happens when your Total T (or rice in this example) varies...you need to vary your E2 as well to maintain the proper ratio between the two.

So, that said, you can now see why shooting for, say, an E2 of 20 regardless of your Total T makes no sense, right?

 

[chrismez]

k, just did the discounted labs test and here are my results. Total T 1082 , Free 39.8 and sensitive E2 at 43.1 taking .25mg of anastrozole e5d. Feel pretty good, good morning wood but sex drive a tad sub par... any opinions?

Thanks

 

[Vince Carter]

I'd cut the AI to .10 or .15mg. In the ratio theory you have room for a higher E2, your ratio is 25 on the 14-20 theorized goal.

 

[Jackie Treehorn]

I'd cut the AI to .10 or .15mg. In the ratio theory you have room for a higher E2, your ratio is 25 on the 14-20 theorized goal.

Good plan.

Chris,

I probably would have told you to stop the AI completely, because of your past history of tanking your E2. However, I think Vince's plan of titrating down (baby steps) is a little more conservative, and better for you.

 

[Vince Carter]

I figured he's close to something that could be ideal (theoretically) and to creep up on it.

 

[chrismez]

I feel pretty good where im at now as far a well being is concerned.. Workouts are the best ever. Prob in the best shape of my life psychically . Feel a tad facial bloating and mild ED, sex drive is not as good as before and i'm a little irritable. I guess I'm hung up on the 20-30 optimal E2 level I read about so often. Even my T doc who is with Defy tells me 20-30 E2 levels is where one should be. Never mentioned the 14-20 T to E ratio. I hate the idea of chasing numbers. the T to E ratio makes sense but then my E should be higher which concerns me ...I see some members on here state under 20 bad over 40 bad.... so many different opinions....Ugh

 

[CoastWatcher]

I feel pretty good where im at now as far a well being is concerned.. Workouts are the best ever. Prob in the best shape of my life psychically . Feel a tad facial bloating and mild ED, sex drive is not as good as before and i'm a little irritable. I guess I'm hung up on the 20-30 optimal E2 level I read about so often. Even my T doc who is with Defy tells me 20-30 E2 levels is where one should be. Never mentioned the 14-20 T to E ratio. I hate the idea of chasing numbers. the T to E ratio makes sense but then my E should be higher which concerns me ...I see some members on here state under 20 bad over 40 bad.... so many different opinions....Ugh

Estradiol management is the last frontier of TRT. All of the discussion, T:E ratio, minimum of 20/maximum of 40 is just that - discussion. Doctors and superbly informed non-medical observers such as Nelson are all contributing to a conversation that is very much in flux. The goal is, certainly, to come down with some solid, quantitative values. It's still very much a work in progress. I know I feel great when my E2 is between 25 and 38, anything under 40. Given my testosterone level, that's outside the ratio. Still, it's where I feel good. That is the first question you have to be comfortable with. Finally, if your a Defy patient, you are in good hands. Add your voice to the conversation and engage your doctor with your concerns.

 

[Vince Carter]

Ive talked ratio with Dr Saya, he's I won't say a believer, but listens and entertains the idea as a promising area to explore. those are my words, not his.

 

[Dr Justin Saya MD]

Ive talked ratio with Dr Saya, he's I won't say a believer, but listens and entertains the idea as a promising area to explore. those are my words, not his.

Correct, Vince.

I'm a believer that T:E ratio is another tool/metric among many others to consider. It also helps to ease some patients concern when they see "HIGH" on their lab report so they don't panic. Everyone is different and EVERY case is different, so I never like to lock into hard and fast ranges (including E levels, T:E ratio ranges) when making clinical decisions...it is truly case specific as it should be.