When to get new bloodwork?

I understand a lot of people on this sub are against using an AI. However, I know some also do well on a low dose AI. I want to preface the post with some history, I have been on TRT for almost two years now. Like many I have had ups and downs with it. Ive been stable on the same protocol for over a year now. My estrogen is always slightly high in the mid 40s at trough, and I deal with symptoms. I started this whole journey with almost no e2 naturally, and that was hell. Ive also taken too much arimidex before and put myself right back into that hell, hence why I have stayed away from it. However, I have never tried a very low dose. I have looked at every other angle for fatigue ( multiple sleep studies, full thyroid panels, and I mean full, every recommended test and my levels are close to optimal in all those areas). I am very active, and have used diet to feel better, but it has never quite done the trick. I have also tried every supplement known to man as well.

Symptoms:
night sweats
low libido
bloating
fatigue


Protocol:
Mon morning and thur night:
test cyp 58mg
wednesday night and sunday morning:
HCG 125IU

Latest Labs:
total test always 750-900
free test upper end of the range
Shbg: 23.9 (16-55)
Dht: 61 (30-85)
Dhea: 346 ( 138-475)
Last two e2: 45 and 41 on sensitive test. I have never been in range for this as long as Ive been on.

I also regularly have cbc, cmp, psa, and other labs drawn. I manage hematocrit with blood donation.

New AI dose:
.125 mg on testosterone injection day. So far I am two doses in, had one day with spontaneous libido and desire, but could have just been placebo. I have also had better energy on days after the AI.

My question: I know how long to wait for labs with changing testosterone dose, but not with adding an AI. Do I still need to wait 6 weeks to draw bloods, or can it be sooner?
 
You could probably be assured with the SHBG ~24 that you have a fair amount of Free E in your system which the LC/MS/MS test isn't going to show. Like your Free T being over the lab range (you say) you can be pretty assured that Free E is the same. I would shoot for your LC/MS/MS sensitive E to be closer to what your SHBG is.
 
You could probably be assured with the SHBG ~24 that you have a fair amount of Free E in your system which the LC/MS/MS test isn't going to show. Like your Free T being over the lab range (you say) you can be pretty assured that Free E is the same. I would shoot for your LC/MS/MS sensitive E to be closer to what your SHBG is.
Thanks Vince. I read elsewhere where you talked about the same thing and was curious about free E. I will see if its feasible to add it to my next round of bloodwork.
 

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TRT Hormone Predictor Widget

TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

ℹ️ Input Parameters

Normal range: 300-1000 ng/dL

Predicted Hormone Levels

Enter your total testosterone value to see predictions

Results will appear here after calculation

Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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