Trt too high?

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mchadcota

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Brief history. Been on trt for 7 years and have never felt what I would consider dialed in. Up until a year ago I did it myself but joined a clinic to better manage. I had to get off for about 3 weeks before getting labs at clinic. First labs with no trt was T 45 E 11. Started me on 100mg per week. Labs came back trough 425 E33. Actually had some libido at this level. The clinic wanted to get me to 8-900 so I was excited that I was going to get better n better. They increased me to 150 per week with 0.5 AI once a week. Labs 485 17. Started not feeling quite as well. Bumped up to 170 mg and 0.25 AI. Labs 889 and E 54. Not much libido. Started split dose 90 and 90 and 0.25 AI with each injection. Labs 1050 E2 26. Not much libido. Had about a 2 week period of grear mental clarity. Decreased me to 90 and 80. Labs 1040 E 38. Still not much libido. Now I’m doing 80 and 80 with Ai each injection. My question is, can my T level be too high for me even if my E2 is kept in range? I also feel like they may have messed up when they increased me to 150 because my T level didn’t jump up much at all but then doubled when they increased from 150 to 170. Should I try a much lower dose?
 
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I think adding the AI is killing your libido, even with normal estrogen. The act of inhibiting aromatase hard enough can cause symptoms with normal estrogen.

Your testosterone has been at various levels and still having libido issues, that means it has to be estrogen or AI related.

It seems your libido issues started after adding in the AI.

https://journals.sagepub.com/doi/10.1177/1557988314539000
Our study did not link high estradiol levels with diminished sexual performance. Paradoxically, patients with low estradiol below 42.6 pg/ml had more patients complaining of low libido as defined by ICD-9 of 799.81 in the problem list. Patients with higher estradiol levels above 42.6 pg/ml had less sexual dysfunction problems identified by their providers.
 
They increased me to 150 per week with 0.5 AI once a week. Labs 485 17. Started not feeling quite as well.
This is mismanagement at it's finest! Your provider should have decreased the AI to 0.25 or stop it completely as your estrogen was a bit low and kept the 150 mg TRT dosing unchanged.

Instead they increased the TRT dosage to treat the low estrogen, instead of decreasing the AI.

This provider is incompetent!
 
So when my labs were 889 and E2 was 54, would the lack of libido still be from low E2? When I was doing my own injections I was doing anywhere from 150-200 mg a week and never used an AI. Libido was never great. So that’s why I’m wondering if maybe a much lower dose, like 120ish would be better
 
So when my labs were 889 and E2 was 54, would the lack of libido still be from low E2? When I was doing my own injections I was doing anywhere from 150-200 mg a week and never used an AI. Libido was never great. So that’s why I’m wondering if maybe a much lower dose, like 120ish would be better
Too much testosterone can lower libido, men on cycles report diminished libido and even erectile strength. There's two types of causes for low libido, primary and secondary. Primary you can do nothing about, it's your natural baseline level, a genetic lottery, secondary low libido can have multiple causes.
 
Thanks so much for the advice. I think I will try a slightly lower dose and drop the AI. I feel like having a trough level at 900 is really high compared to natural levels.
 
The majority of men do need to be near the top end of the ranges to feel their best. This seems to be consistent from provider to provider.

 
So when my level was 889 and I was taking 0.25 AI once week my E2 was 54. Libido not good. Would you say that my T level was good and I should’ve not taken AI? That would mean my E2 wouldn’t been I’m guessing 70 or so. Do you think I would’ve felt better at that high of E2?
 
So are y’all of the opinion that you can go to the higher end of the T range and just let your E2 fall where it may without AI, OR focus on keeping your E2 in that 20-40 range by adjusting your T level? For example, if you can’t get your T level above 500 without your E2 getting high, then you should keep your T below 500.
Which school of thought are you?
 
OR focus on keeping your E2 in that 20-40 range by adjusting your T level?
Men aromatize 0.2 0.3% of testosterone to estrogen. The normal ranges for estrogen were derived from men with a total testosterone <500. Your total testosterone is higher therefore your estrogen is going to be higher.

This is perfectly normal and to be expected.
 
If it was good to let you estrogen run high when test is high, it would seem like the clinics would have alot of patients saying “quit giving me an AI because I feel better when my estrogen is allowed to go higher along with my high T.
 
If it was good to let you estrogen run high when test is high, it would seem like the clinics would have alot of patients saying “quit giving me an AI because I feel better when my estrogen is allowed to go higher along with my high T.
Or they go in search of help on men’s health forums. We get guys like you in here all the time, you’re a dime dozen!

What happens a lot of the time is the patients quit these clinics because they don’t feel any better, and search for a more knowledgeable provider.

You don’t even know the patient turnover rate for this clinic. For all you know, it could be near 50%.

It’s very common for men to go through multiple providers before they find the one that the right fit for them.
 
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Or they go in search of help on men’s health forums. We get guys like you in here all the time, you’re a dime dozen!

What happens a lot of the time is the patients quit these clinics because they don’t feel any better, and search for a more knowledgeable provider.

You don’t even know the patient turnover rate for this clinic. For all you know, it could be near 50%.

It’s very common for men to go through multiple providers before they find the one that the right fit for them.
Yeah maybe I’ll get away from them and back to managing myself
 
I wanted to add when you take an aromatase inhibitor, you’re also lowering estrogen within the tissue, which is where it’s made and does its amazing things.

Measuring the serum levels, the leftovers, the scraps doesn’t tell you how much estrogen is in the tissue, which is where you’re blocking the conversion of testosterone to estrogen.
 
Thanks so much for the advice. I think I will try a slightly lower dose and drop the AI. I feel like having a trough level at 900 is really high compared to natural levels.
Yes, regardless of what dose you use, drop the ai.

'Natural levels' implies that you knew what your level was before libido and erections declined. Most of us don't know what endogenous levels we had when we were young(or younger) and sexual function was fine. Not just testosterone but DHEA, pregnenolone, thyroid, HGH, GnRH... When our hormones and peptides were in balance we just functioned! We didn't have to 'think' about getting an erection. They happened spontaneously, as well as when we were in a sexual situation.

EDIT: I've been reading many threads on Reddit from men who couldn't get 'dialed in', subscribed to the 'no ai' mantra, like me, and were miserable; no erections, weight gain, mood and sleep issues...until they listened to their doctor and added an ai. Those who were running a high dose of T were(and are) taking 1 mg weekly in split doses. I'm beginning to think this is an issue with me. As for dosing/frequency, I've tried them all and the only one to which I saw some response was 100 mg E5D. My E2 was 61. I experienced one daily erection, mid evening. No nocturnal erections, no morning erection, nothing during the day. Too high E2? Hyper metabolizing or hyperexcreting? Can't lose weight...except when I go off of T, which leads me to ponder if E2 is involved. I'm tired of the 'no ai' message. When dose changes don't work or changing injection frequency doesn't work, that might be the time to add an ai.
 
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Also wondering, there are a lot of drs out there that say don’t worry about E2. Don’t even check it because it doesn’t matter. And never use an AI. Can anyone tell me what their approach would be then for someone that has a T level of 1000 but has no libido?
 
I would try to find a dose that works for you without an AI first. Start at 60mg twice a week. Give that 8 weeks and see how you feel. If still having symptoms, try increasing by 10mg (70 mg/twice a week). If things improve but still have some symptoms go up by 10mg again. If things improve but still have some symptoms go up by 10mg again. If things aren't improving with increasing the dose, try decreasing by 10 mg. Keep iterating until you find the right dose. If you have symptoms of high estrogen, then try an AI using the lowest dose that resolves your symptoms. For some this can be way lower than is typically prescribed. Personally, I take 30 mcg of anastrozole every other day.
 
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