T Nation

1 Year Into TRT, Not Pleased with Recent Lab Work, Please Advise

Hey Guys,

Ive been on TRT for 1 year with fairly good success. quick background: 29 year old male, 195lbs @ 10%bf. 135mg of test cyp split into mon and thurs injections. anxiety/depression down, libido and erections improved, however, still low energy and fatigued. I have a much better than most doc, fairly educated on the matter and willing to listen to what i have to say.

Ive dealt with erratic E (ranging from 50pg/ml - 75pg/ml) from the onset of TRT and have tried numerous things. started at once weekly at 150mg per week and reduced to 135mg done twice per week. Then when E was still too high, dropped HCG all together. Still too high, doc suggested Iron… Still too high, doc suggest DIM. Well after all this, E is still high, lab work below (done Mid May):

TESTOSTERONE, TOTAL, LC/MS/MS [B][U]744[/U][/B] 250-1100 ng/dL
TESTOSTERONE, FREE [B][U]164.6 [/U][/B]46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE [B][U]324.3[/U][/B] 110.0-575.0 ng/dL
ESTRADIOL [B][U]74 H[/U][/B] < OR = 39 pg/mL

I dont have any signs of gyno what so ever, my sex drive is healthy along with good erections; I dont have any prostate problems and i havent gained any weight… I do sweat excessively, very mild edema if standing but i do feel weak and lethargic in the gym

The time has come where i think it evident i need to start using an AI. Ive done a ton of research and it varies SOOO widely (understandably what works for someone may not work for another). People also tend to be pretty nonchalant about it, carelessly taking and suggesting WAY to much AI. the prevailing consensus tends to be .25mg Anastrozole on shot days. my doc only deals with exemestane and i can seem to find a consensus on that. some take 12.5mg daily, others 6.25mg twice a week. I totally understand everyone is different but bearing in mind my situation, what suggestions do you guys have for me?

Please see these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

The above is a lot of reading. You will know more than your doc. Good that he is working with you. His resistance to anastrozole is silly. It is an aromatase inhibitor used in a TRT context to modulate E2 levels.

E2=74 suggests a possible liver issue in that the liver is not clearing E2 properly. And we would then expect the liver to produce more SHBG to scavenge E2, but SHBG is low; again pointing to the liver.

Some medical conditions can lower SHBG, but your labs are very narrow.

Take 0.5mg anastrozole at time of injections. This is 1mg/week and more cost effective than https://en.wikipedia.org/wiki/Exemestane while been a lower drug load on the body. In any case, you adjust dosing to get desired E2 levels and I suggest E2=22pg/ml.

You can inject 250iu hCG SC EOD

LH/FSH should have been done before any TRT was started
prolactin - one time, do not have sex for 48 hours and do not cuddle babies or puppies
fT4 [please not T3, T4]
fasting cholesterol
fasting glucose
AM cortisol [at 8AM please]

Energy can be affected by thyroid.
Have you been using iodized salt to support thyroid hormone production?
Do you get cold easily?
Outer eyebrows sparse?
Generalized hair thinning?