What should be the next step? Stay on TRT?

[ipi]

Note: I was never tested for prolactin or SHBG by Defy before starting the TRT.

In order to lower my E2, I just recently changed from IM to sub-q on the following protocol:

1- HCG 350iu: Thursdays and Monday (twice a week)
2- TestCyp 60 gm Fridays and Tuesday (twice a week)

E2 levels improved a bit like on the third day of inject TestCyp it used to be 58 but now 48 but still high:

Here are the results:

BLOOD DRAWN ON SATURDAY:

27 hours after TestCYP and about 51 hours of the HCG INJECTION:

Free T = 29.5 (HIGH), THIS INCREASES EVEN MORE IN TWO DAYS- SEE BELOW
Total T= 708
E2, sensitive= 55.6 (HIGH).


Blood drawn the following Monday (Before the HCG injection and a day before the TestCYP):


Free T = 35.3 (HIGH, BUT STRANGE AS IT WAS LOW AFTER 27 HOURS, BUT TWO DAYS LATER EVEN HIGHER)

Total T= 660

DHT=51
DHEA-S= 342.8(71-375)
PROLACTIN= 31.7 HIGH, (4.0-15.2) - MY LH WAS 5.1 BEFORE STARTING TRT AND FREE T3 ARE GOOD SO CAN WE STILL THINK ITS A TUMOR?

E2, SENSITIVE= 48.9 HIGH (reduced by 10 points on a sub-q).

IGF-1= 109
FERRATIN=20 (30-400)
fREE t3= 3.8 (2.0-4.4)
SHBG= 12.8, LOW (16.5-55.9), I CHECKED MY ONE YEAR OLD BLOOD WORK before TRT and I was EVEN low THEN with a total T of 178.

QUESTIONS:

1- SHBG was always low and is still low, but what I red is that low SHBG means that TRT is not going to work for you, where do I stand?

2- PROLACTIN IS HIGH, SO IS THE E2 THE CULPRIT HERE. I SOMEWHERE ON ANOTHER FORUM READ THAT HIGH E2=HIGH PROLACTIN= ED, IS THAT CORRECT?

3- Does suppressing E2 with an AI increase total T and lower Prolactin?

4- MY LH was 5.1 before starting TRT and Free T3 is in a very normal range (3.8), if I improve Ferratin I think it will improve further, should I still be concerned about a Pituatary cancer because of high PROLCATIN?

5- SHBG IS VERY LOW and I read that people with low SHBG doesn't benefit from TRT even if there Free T and TT levels are high, is that right?

6- What should I do with low Ferratin when i Have to give blood every 2 months?

 

[CoastWatcher]

In response to your questions.

1. Low SHBG can work against TRT success. It does not mean that it is impossible, however. Your total testosterone and free testosterone are actually solid. That would suggest you can make this work.

2. High prolactin and high estradiol work against libido and can certainly comtribute to erectile dysfunction. However, high E2 and high prolactin are two very different issues. Many men have high estradiol, they do not have high prolactin. Two very different things.

3. An AI will not reduce prolactin.

4. Pituitary tumours are rarely malignant.

5. There is a good chance you can work around the SHBG issue.

Your failure to respond to TRT are more than likely the result of high estradiol and elevated prolactin. An AI can deal with the former, an evaluation of your pituitary, followed by additional medication, is warranted to sort out the prolactin issue. I don't think you should abandon TRT. You just have additional medical issues to sort out.