Updated Labs - Help Please

[mr.craig.smith]

Something is really off here, and I think it relates to the slashes: cyp/enanthate, shallow IM/subQ. With labs this wrong, you need to isolate variables, and eliminate the slashes.

I feel like you are either injecting a bunk formula or subQ'ing into some thick "black hole" fat like the love handles. See if you can revert to the formula you were using when your levels were decent and switch to strictly IM injection.

What's weird is that I'm injecting the same exact Rx as I was previously, but I'm injecting a higher dose (started at 16mg > went to 18mg > went to 20mg while lab values have gone down).

I rotate injection sights from shallow IM delts, quads, ventroglutes, and occasionaly love handle fat. Using 31g insulin syringes.

I think my testes are completely shut down (primary), and I don't think that I'm getting any response from the HCG other than the other downstream metabolites. Not 100% sure if I should stick with daily doses or go to a less frequent schedule.

 

[FunkOdyssey]

Using 31g insulin syringes.

This is a problem. These are only 5/16" long. I would suggest at least half inch length while eliminating love handles from your rotation.

I've gone months at a time injecting daily in only the ventroglutes with 30G 1/2" needles, with no issues or scar tissue buildup. You don't need a billion sites with needles this thin and oil depots this small.

 

[Guided_by_Voices]

What's weird is that I'm injecting the same exact Rx as I was previously, but I'm injecting a higher dose (started at 16mg > went to 18mg > went to 20mg while lab values have gone down).

I rotate injection sights from shallow IM delts, quads, ventroglutes, and occasionaly love handle fat. Using 31g insulin syringes.

I think my testes are completely shut down (primary), and I don't think that I'm getting any response from the HCG other than the other downstream metabolites. Not 100% sure if I should stick with daily doses or go to a less frequent schedule.

I've had issues with unexplainably low E2 as well but it seemed to resolve after a while and rose to more normal levels (a while being a year or so). A lot of things I wouldn't have expected can interfere with the aromatase enzyme, such as zinc, so you might want to review you supplements and see if any of them could be an issue. My issue seemed to resolve with time, although I did supplement with a low dose of e2 very briefly, so perhaps that did something as well.

 

[Seagal]

It's strange that your e2 is suddenly at the low end.

IMO it's not necessary to inject ed when injecting SQ. I would go with eod SQ.

What's going on with your wbcc and bilirubin?

 

[mr.craig.smith]

This is a problem. These are only 5/16" long. I would suggest at least half inch length while eliminating love handles from your rotation.

I've gone months at a time injecting daily in only the ventroglutes with 30G 1/2" needles, with no issues or scar tissue buildup. You don't need a billion sites with needles this thin and oil depots this small.

That makes sense. I have some 29g ones as well. I was just enjoying the 31g since I am quite the pincushion with the current protocol. I'll go with the longer ones for glutes and the shorter ones for the delts/quads and see if that makes a difference.

 

[mr.craig.smith]

I've had issues with unexplainably low E2 as well but it seemed to resolve after a while and rose to more normal levels (a while being a year or so). A lot of things I wouldn't have expected can interfere with the aromatase enzyme, such as zinc, so you might want to review you supplements and see if any of them could be an issue. My issue seemed to resolve with time, although I did supplement with a low dose of e2 very briefly, so perhaps that did something as well.

I'm not supplementing with anything; just eat a 100% whole food diet of grassfed meats, organic vegetables, and certain grains (e.g. oatmeal, wild/jasmine rice, beans, etc).

Did the low dose e2 help at all? I'm reluctant to add another variable, but I also read that adding a small daily pump of transdermal T could help increase aromatase activity to a certain degree.

 

[mr.craig.smith]

It's strange that your e2 is suddenly at the low end.

IMO it's not necessary to inject ed when injecting SQ. I would go with eod SQ.

What's going on with your wbcc and bilirubin

Thanks for the suggestion. I am considering going to EOD injections to see if that would help increase aromatase activity.

I have consistently had high bilirubin and low alkaline phosphotase for years; doctors have told me I likely have Gilbert syndrome (benign for all I can tell). Not sure about WBCs.

 

[FunkOdyssey]

That makes sense. I have some 29g ones as well. I was just enjoying the 31g since I am quite the pincushion with the current protocol. I'll go with the longer ones for glutes and the shorter ones for the delts/quads and see if that makes a difference.

5/16" is subq no matter where you inject. Even if you manage to puncture the muscle, the oil is leaking back out into the subcutaneous layer. I would urge you to leave the 5/16" needles for peptides, hCG, etc, and use nothing less than 1/2", at least until you have normal levels again for the dose you're injecting. If you want to rechallenge later with 5/16" to determine conclusively whether that was the problem, then go for it.

Just to reiterate the logic here, your levels of both free T and E2 are MUCH, MUCH lower than they should be given your protocol. If your testosterone is not bunk then 100% of the problem is in your current injection practices, which would need to radically change.

 

[Seagal]

5/16" is subq no matter where you inject. Even if you manage to puncture the muscle, the oil is leaking back out into the subcutaneous layer. I would urge you to leave the 5/16" needles for peptides, hCG, etc, and use nothing less than 1/2", at least until you have normal levels again for the dose you're injecting. If you want to rechallenge later with 5/16" to determine conclusively whether that was the problem, then go for it.

Just to reiterate the logic here, your levels of both free T and E2 are MUCH, MUCH lower than they should be given your protocol. If your testosterone is not bunk then 100% of the problem is in your current injection practices, which would need to radically change.

Could just inject more SQ if it's not enough. I don't think that SQ is generally wrong or inferior.

 

[FunkOdyssey]

Free Testosterone: 12.1ng/dL
- Estradiol: 10 pg/mL (LOW)

These are his levels on 20 mg DAILY with hCG on top. Based on these labs, if nothing about the bioavailability of testosterone improves, he would need to double his dose to 40 mg daily or 280 mg weekly to have what I would call decent levels on a daily protocol. If money is no object, his doctor is willing to prescribe a dose that high, and subq is the hill he wants to die on, then by all means, continue with the status quo.

 

[Seagal]

These are his levels on 20 mg DAILY with hCG on top. Based on these labs, if nothing about the bioavailability of testosterone improves, he would need to double his dose to 40 mg daily or 280 mg weekly to have what I would call decent levels on a daily protocol. If money is no object, his doctor is willing to prescribe a dose that high, and subq is the hill he wants to die on, then by all means, continue with the status quo.

If that's the goal, I would need about 250mg TU per week. One SQ injection at glute region. No problem.
Oral or topical requires even much more T and money. That's not the point here, right?

I thought only the sudden lower E2 is the problem. Now that I understand your intention, it makes sense.

I think both IM or SQ do work. The problem seems to be the switching and then expecting the same levels.

 

[mr.craig.smith]

These are his levels on 20 mg DAILY with hCG on top. Based on these labs, if nothing about the bioavailability of testosterone improves, he would need to double his dose to 40 mg daily or 280 mg weekly to have what I would call decent levels on a daily protocol. If money is no object, his doctor is willing to prescribe a dose that high, and subq is the hill he wants to die on, then by all means, continue with the status quo.

I am not dying on any hills haha. I am open to all suggestions.

My primary goals with TRT are to be able to operate/function like an adult male, be able to workout and make steady progress, and to have a healthy sex life with my wife. I have found that sexual health/performance wasn't as optimal on higher total tesosterone doses, so I'm reluctant to go too much higher simply for the sake of chasing numbers.

I subjectively feel better after doing IM injections vs subQ, but I enjoy the ease/benefit of not having to put another needle into my muscle bellies, so they get rotated in occasionally.

I think my biggest question right now is if I should follow my provider's guidance of (1) increasing 20mg to 25mg daily, OR if I should consider a more infrequent dosing protocol to increase aromatization? I have really enjoyed the daily protocol for the most part vs previous more infrequent schedules (less of a roller coaster). I know that Nelson is a champion of biweekly injections w/HCG, but there are others like you guys and Vince who are pro daily.

All things considered, I don't have any major complaints about my current protocol except that my estradiol dropped so low, my libido could be improved, and my joints have hurt on occasion. I'm also curious why my total & free T levels keep going down on higher doses over time, as well as if the daily injection schedule is increasing my SHBG (it used to be in the low 30's). I am not someone who thinks SHBG is the enemy it's made out to be, but I have noticed it's increasing at the same time the other values are decreasing.

 

[Guided_by_Voices]

I'm not supplementing with anything; just eat a 100% whole food diet of grassfed meats, organic vegetables, and certain grains (e.g. oatmeal, wild/jasmine rice, beans, etc).

Did the low dose e2 help at all? I'm reluctant to add another variable, but I also read that adding a small daily pump of transdermal T could help increase aromatase activity to a certain degree.

IMO, if you are in a generally good place, I would stay where you are for a while and see if your e2 improves over time. It's hard enough to get symptoms sorted out, let alone trying to optimize numbers as well. It's impossible for me to tell if the brief supplemental e2 possibly reset my natural set-point higher since the improvement may have happened anyway without it. If you try a slightly higher dose of cialis, that may help your libido as well. I never test SHBG because I have never heard a compelling action that can come from that test that would not be the result of something else.

 

[FunkOdyssey]

I have found that sexual health/performance wasn't as optimal on higher total tesosterone doses, so I'm reluctant to go too much higher simply for the sake of chasing numbers.

The dose doesn't matter, it's how much you absorb that matters, and the resulting serum levels of testosterone.

I subjectively feel better after doing IM injections vs subQ

Very common sentiment.

I think my biggest question right now is if I should follow my provider's guidance of (1) increasing 20mg to 25mg daily, OR if I should consider a more infrequent dosing protocol to increase aromatization?

I don't think either of these options will be effective. Assuming your levels increase proportionately to your dosage, which they do in most cases, and nothing else changes, your 5 mg daily increase will move your free T up to 15 ng/dL and your E2 up to 12.5 pg/mL. Still not great. And injection frequency does not usually affect the aromatization rate in practice, it just moves the peaks and troughs around. If you maintain the dosage and injection methods, and space out your injections, you may end up with an E2 that is even lower than 10 pg/mL at trough, and a hypogonadal free T.

I have really enjoyed the daily protocol for the most part vs previous more infrequent schedules (less of a roller coaster). I know that Nelson is a champion of biweekly injections w/HCG, but there are others like you guys and Vince who are pro daily.

Higher frequency is generally better for everything, except occasionally libido, which in a minority of men can be better with lower frequency. In these cases where lower frequency is preferred, I would theorize their levels, especially E2, are not being maintained in an optimal range for them on the high frequency protocol. The large swings on the lower frequency protocols allow you to spend some time at levels that are optimal for you, despite the overall dosage / levels being wrong.

I'm also curious why my total & free T levels keep going down on higher doses over time, as well as if the daily injection schedule is increasing my SHBG (it used to be in the low 30's).

The daily injection isn't what is increasing your SHBG. Your SHBG is rising because your absorbed dose of testosterone, and your free T, are dropping. Testosterone is what depresses SHBG here, and the lack of it allows SHBG to rise. Be careful not to mix up the causal relationship.

In my opinion, there is nothing wrong with your protocol that needs to be adjusted here in terms of dosage. If anything, your current dosage SHOULD be too high for someone that wants to avoid supraphysiologic levels. It is the execution of the protocol that is wrong. 5/16" needles are wrong [for you]. There are men in the world pinning subq with 5/16" needles with great levels, but you are not one of them. We have objective evidence that what you are doing is not working correctly, and in fact, is working less and less correctly over time.

For context, my levels on 20 mg of test cyp daily with no hCG were: Total T 1502 ng/dL, Free T 35.5 ng/dL, E2 37.5 pg/mL. These are with 1/2" needles in the ventroglute, buried to the hilt and then pushed a bit further so as to depress the subq fat. If you want to mix it up with delts and quads, great. 1/2" needle, bury it in the muscle, repeat labs, and behold your transformation into a normal responder to testosterone.