T Nation

1 Month on TRT. Need Advice on Bloodwork and Protocol

I am one month in on TRT and need help interpreting bloodwork as well as protocol. Current protocol is .5ml twice a week of cypionate and now due to high estrogen levels .5mg of anastrozole 2x weekly day of injection. Stats and bloodwork are:

Age 47
Weight 180

First results before starting TRT:

Hematocrit 46.1
Estrodiol 19.9
Testosterone 609
PSA 1.2
SHBG 62.4
Estradiol 19.9

Labs after 1 month on TRT

Hematocrit 49.4
Estrogens 208 (confused why Dr tested total estrogens vs 1st blood test of Estrodiol and I was told 208 is extremely high)
Testosterone >1500
Free testosterone 37.3
On second round of blood work there was no SHBG done or PSA. I’m not sure if this is normal.

My main questions are how to interpret Etradiol vs total Estrogen and could the high values be the cause of some of my side effects. Unable to concentrate at times (brain fog), anxiety, trouble sleeping.
Also my Dr didnt seem to be concerned that my Testosterone was over 1500. I have always run high (900ish) even before TRT several years ago which is why he considered my starting point of 609 low since I had all the classic symptoms of low T. Is there a considered safe level? The last question is what other bloodwork should I be asking for since this Dr that has very high reviews doesn’t seem to order all the bloodwork recommended in most threads. Also any thoughts on my protocol would be greatly appreciated. Thanks in advance.

You ran tests to earlier as you levels won’t reach a stable state until 6 weeks, any testing done before 6 weeks is not going to show the full picture of where you will be in 2 weeks. SHBG may continue to decrease over the next few months, this is a good thing for you.

Your high SHBG is binding up the majority of your free testosterone and the correct course of action may be supraphysiological doses of testosterone as excess androgens suppress SHBG, which in your case is exactly what you need. In your case total testosterone should be ignored because it’s a bound hormone, free T is what matters most as it’s the free hormone circulating in your blood and is what your body responds to.

If you are injecting from a 200mg vial and you inject .5mls, that would 100mg twice weekly. Please describe dosages in mgs.

Total estrogens has no diagnostic value whatsoever, all of the hormone experts would never test for it. Your doctor used the wrong estrogen testing, the Roche ECLIA methodology is designed for the investigation of fertility of women of reproductive age and for the support of in vitro fertilization.

The Liquid Chromatography Mass Spectrometry (LC/MS/MS) method is designed for men and is more sensitive since men have lower serum levels of estrogen vs women, the majority of doctors still continue using the wrong testing methodology that can have many false prophets when elevated, however it seems to be more accurate when lower.

If E2 is elevated then you are force to go back and retests which is a waste money. dosing an AI dosage on an elevate Roche ECLIA methodology testing is associated with crashing estrogen since your results are greatly exaggerated and false.

It just means doctor is a bit old school and it’s clear that this doctor is practicing medicine the way it was done 10 years ago and stuck in his ways and hasn’t stayed up to date on the latest testing methodology.

This doesn’t means he’s not a good doctor, he just hasn’t stay updated is all.

@systemlord. Thank you for that very helpful response. That makes perfect sense. Since my doctor is apparently of a little older mindset can you recommend the blood panels I would want to run in another 2 weeks (the 6 week mark). I don’t want yo be on an AI if it is not truly needed buy wasnt sure what was causing the symptoms I described. Thank you again for the response.

You’re welcome.

I always run Total T, Free T (directly measured) SHBG and E2 sensitive (LC/MS/MS) the balance my protocol. I don’t believe you need an AI, your E2 is probably somewhere around 20 and AI would be insane at this point. The majority of your androgens are bound to SHBG and I seriously doubt you’ll ever require an AI.

Actually I would like to see estrogen higher and that may just happen when if SHBG decreases, estrogen is an important hormone and forces minerals into bones and is good for joints and tendons. If you feel good I see no reason to test in 2 weeks, I would run testing in 2-3 months to see where you are. I expect to see SHBG levels lower in the months to come, how low is anyone’s guess as everyone is different.

I like to do testing either when I’m feeling my best or my worst because I want to see what that looks like on paper, over time you are going to piece together a range of levels that’s optimal for you.

Chose a particular lab company and stick with it because you cannot compare your labs with other lab companies since all their ranges are incompatible. I prefer Labcorp because they are the 800 pound gorilla.

It’s usually better to control e2 by lowering dose especially in your car since you free t is over the top.

If taking an AI can be avoided then that’s the way to go.

I use privatemdlabs for my BW. I stop by a convenient Labcorp for the draw. Slick system. I like to know for myself and also as a confirmation with my TRT doc’s tests.

Your total T is at the top level they test to. You can get a test at privatemdlabs that shows actual value. Glad you got on TRT with a 609. 800 is the target for my age.
1500 could get a guy kicked off the program if sustained, in my state/my Dr.

I need an AI or I get the nip symptoms. We only test E2, not total E.
Seems like 30 free T would be in line with your 1500 total T, but I’m not a doctor and we don’t know how much over 1500 you are.

Something’s odd.

A couple of things, yes, you do not need total estrogens tested. Regardless of which E2 test was utilized initially, it needed to be followed with the same test.

As for ECLIA testing, it is thought that it overstates E2 levels, and it can, but not usually significantly enough to impact treatment and as you can see below, in this case the LC/MS/MS result was actually higher than the IA, not the other way around. Immunoassay is not “wrong”, it is just different. There are pros and cons to both methods and doctors that do this understand them, it’s not unheard of for experts to have differing opinions.


I’ve resorted to getting both tests because I find this interesting and I do not mind paying extra. LC/MS/MS is more expensive than IA.

So, what do you do? It is troubling that your doctor ordered total estrogens. With your initial E2 level, I would hold off on starting an AI in the absence of overt high E2 symptoms. Whatever lab test you end up using, go with how you feel over the number. Look for sexual dysfunction symptoms, water retention, tender, puffy nipples, crying at movies……… before adding an aromatase inhibitor.

1 Like

Does it seem odd that he’s over 1500 on 200mg/wk - assuming 200mg/ml cyp?
He went from 609 to over range on that - and with weird estrogen references.

Seems like he must have done tons of cardio before his pre TRT test, or is a hyper responder, or…

Also, it would be smart to keep that Anastrozole on hand, either way, just in case. I get puffy nips w/o it. I get my free T by calculation these days but you need SHBG to calc it;

@ restart. I didn’t do any cardio pre TRT. I’m not sure about being a hyper responder or what you are trying to imply by the “or” comment. I am new to this and looking for quality advice as has been given so far because I have gone from 609 to over 1500 on 200mg cypionate weekly and was told my estrogen was high but I really dont want to take an AI if I can help it. The doctor did not lower my test dose but did want me to start an AI.