T Nation

2 Weeks on TRT - ED/Energy Loss


#1

Hey guys,

I started TRT about 2 weeks ago. My prescribed dosage is 250mg every 10 days of test enantat. I self inject, so after doing some research I’ve changed to 125e5d. No HCG, no AI (AI could be introduced later if we face severe estrogen sides according to my doc, but he doesn’t expect that due to my low BF). So far I got the first injection of 250mg in my doctor’s office and five days later did my own first one with 125mg, tomorrow I’ll do the second one.
The first 3 days (after the 250mg shot) were amazing, I was bursting with energy and in my best mood for several years. Unfortunately only the first 3 days - then my sleep got worse, I’m tired and I’ve experienced ED (which I never had before - I still have (low) libido, but my erection is not as hard as before TRT and not as consistent) - the second injection didn’t change anything, tomorrow is my third one.
The reason for that has to be a surge in estrogen, correct? Can’t be the test, and I’ll figure my endogenous production hasn’t been shut down so far either (no shrinkage of balls).
My first bloodtest on TRT is scheduled after 8 weeks (6 from now)… So now I’m thinking of taking a little arimidex myself (a friend could supply my a couple of 1mg arimidex pills, I’d do 0,25 e3d) for a couple of weeks. Downside would be, if I go to the doc in 6 weeks he won’t prescribe an AI because my estrogen will be not that high I guess… So I might also just ride it out… He said an earlier bloodtest wouldn’t make sense because it takes a couple of weeks for the body to adjust to TRT.
What would you recommend?

Here are my stats:

-age: 27
-height: 180cm (5’11)
-waist: 80cm (I wear waist 31 jeans, abs are visible, I have a very athletic figure - but got worse over the last years, from eightpack to sixpack)
-weight: 77kg (170lbs)
-body and facial hair: slightly below average
-describe where you carry fat and how changed: belly, glutes
-health conditions, symptoms [history]: no health conditions, symptoms see below
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: no drugs (neither medical nor recreational), no alcohol/tobacco, weed occasionally
-diet: CBL oriented (no/very little junk food, enough fat and I’d say very healthy)
-training: 4 times a week about 1 hour heavy lifting, rep ranges 5-12
-testes ache, ever, with a fever?: Nope
-how have morning wood and nocturnal erections changed: never had/have morning wood

lab results: I’ve had 3 tests done within the last month

  1. 4 weeks ago (at 6PM); 2. 2 weeks ago (at 8AM immediatly upon wakening); 3. 2 days ago (1PM)

Total Testosterone: range: 2.49-8.36 ng/ml: 1. result 0.578; 2. result 4.7; 3. result 2.47
E2: 27.1-52.2 pg/ml: 1. 16.6; 2. 10.9; 3. 14.2
SHBG: 16.00-60.00 nmol/l: 1. 56.86; 2. N/A 3. 56.60
Free Testosterone: range: 1.26-4.11 ng/ml: 1. 0.172; 2. N/A; 3. 0.78
LH: 1.7-8.6 mU/ml: 1. 1.7; 2. 3.3; 3. N/A
FSH: 1.5-12.4 mU/ml: 1. 8.11; 2. 8.62 3. N/A
Prolactin: 4.6-21.4 ng/ml: 1. 6.59 2. 6.72 3. N/A
TSH: 0.3-4.0 mU/ml: 1. 1.47 2. N/A 3. N/A
Vitamin D: 30-70 ng/mol: 1. 52 2.N/A 3. N/A

The first blood work was horrible (in terms of total test), I can’t explain the result (it was taken in the evening but still), the second was okay and the third still slightly below reference. SHBG is pretty high as well.

Symptoms - why did I get my hormons checked in the first place?

  1. Poor sleep quality, concentration issues in work - can’t stay focused in meetings and have problems processing complex issues (was always my strong suit), less “drive”
  2. Sports/gym: muscle&strength loss while adding fat (weight unchanged, waist significantly bigger and abs almost disappeared - I’ve been relatively lean (<12%BF) and now can’t get back to my old stats (I’ve dropped a few pounds in a short cut but almost all muscle loss so stopped), although my nutrition&training is as disciplined as ever
  3. Libido: Just a slight difference luckily, I’ve noticed I’m less horny but erections are still hard and 98% no problems, about 2-3 times sex/week (long-term relationship), a few years ago i wanted more than that, now it doesn’t bother me anymore, so yes, slight decline

#2

Yes, more than likely your e2 has spiked and is negating the effects of high T. Do not start dosing with an AI without knowing where your e2 is. If you don’t have a base of comparison, you’ll be flying blind when needing to tweak your AI dose, which will need to happen down the road.

If your Dr refuses to test your e2 immediately, type in discountedlabs in the web browser, find a lab in your area and schedule to get your e2 tested. Last I checked it was only $30-$40 out of pocket. Take the results to your Dr and tell him you were suffering and wanted to expedite steps to improving your health.

Once you know where your e2 is, you can take intelligent action. Also, I would inject E3D or EOD in order to reduce e2, since e2 aromatization increases with higher T levels. Increased T injection frequency reduces spikes and keeps a steadier level. With smaller EOD injections, you can also dose your AI EOD as well, since the mean elimination time of arimidex/anastrazole is approximately 50 hours.


#3

FSH:LH ratio: Did you have doctors examine you for testicular cancer? It is a young man’s disease and not rare. Any pain or ache in your testes?

Inject twice a week, calculate the dose.

Explain problems to doc and ask to do labs soon to check E2.

If any thyroid and/or adrenal problems, TRT can expose those weaknesses. Check overall thyroid function by checking oral body temperatures as per the thyroid basics sticky.

Please read the stickies found here: About the T Replacement Category

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

#4

Thank you for the replies. My doc did check my testicles, via ultrasound and also with his hands. I’ve never had any pain or ache in my testes.

Injecting twice a week will be problematic, I’ll stick with 125e5d (which is more likely 100-110e5d anyway, see below) for now, because I only have pre-filled syringes of 1ml/250mg (testoviron from jenapharm, I live in Europe, we don’t have vials), and splitting them into 2 doses feels already uncomfortable and some test is lost during the transfer from the pre-filled syringe into another one in the needles.

Yesterday I did my third injection of 125mg and after about 2 hours I felt a tingling sensation in my right nipple, it flared up a few times afterwards during the day. Naturally I’m freaked out about gyno, because I already figure my estrogen is way too high. Furthermore, my sleep quality is really shitty at the moment and the quality of my erection is also worse then 2 weeks ago, before TRT.

My questions now are:

  1. How long does it take to develop gyno? How long can I wait before taking action (taking an AI)? Would you recommend doing something right now because it could be too late in let’s say about 2 weeks (irreversible gyno), when my doctor would consider blood work and an AI?
  2. Is it likely that my estrogen level will stabilize by itself within the next few weeks?

I’ll figure right now my test levels must be very high (especially compared to before TRT) because I’ve injected 500mg (250mg from the doc, then twice 125e5d) within the last few days and also my endogenous production should still be intact by now (so far haven’t experienced any shrinkage/aches of balls). Therefore the reaction in terms of estrogen is also severe, but could balance by itself over time?
Therefore, when I take a blood test right now I guess it is not representative, but on the other hand the benefit would be to have proof of high estrogen and an angle to get a prescription for an AI…


#5
  1. Unknown and individual.
  2. They will stabilize but at a high level, leaving you with high e symptoms.
  3. Your 3rd question is the same as number two asked slightly differently.

#6

You can inject part of the T, swab needle and recap or inject and install a new needle.

T–>E2 is proportional to T levels and there is not time delay for that.

Injecting twice a week will reduce T peaks even more, good for estrogen issues and will make anastrozole work properly. You should start anastrozole soon as your target is E2=22pg/l and you were E2=27 before TRT and SHBG was excessive then can more E2 will make that worse.

Did you read the first two stickies?


#7

I’ve read the stickies, this is where I got the information sheet in my starting post.
Currently I’m drawing 0.5ML out of the pre-filled syringe by inserting another needle attached to another syringe into it, then change needles, and inject. I leave the rest in the pre-filled syringe (recap it of course) and inject that 5 days later with a new needle. I notice when I take the needles off, everytime some test gets lost (when I draw it, when I inject it etc.), so by splitting the pre-filled syringes into 2 dosages I already waste some test. To inject twice per week I’d have to split them into 3 dosages… I’d love to have a vial like you guys and just draw the desired amount, but in my country this is not possible.

Would changing the frequency from every 5 days (this is what I’m doing now, so I inject about 1.5 times a week) to every 3.5 days really make a significant difference in terms of estrogen release? My doctor told me the change from every 10 days 250mg to 125mg every 5 days would do nothing in terms of estrogen release, it wouldn’t matter, so he advised against it… I’m still doing it though because I’d like to have consistent levels, and with an injection every 5 days I feel that’s the case (of course every 3.5 would be even better but e5d is enough for me for now).

Unless the estrogen reduction would be severe from raising the frequency even higher (are there any studies? which percentage change could you expect approxemately?) - then I even would consider getting my test from “another” source where vials are available, but I’d hate to do that since its illegal and danger of pollution.

Btw how did you calculate my E2 before TRT was 27 (is there a formula or did you confuse the starting range with my test result)? I was tested three times:
E2: 27.1-52.2 pg/ml: 1. 16.6; 2. 10.9; 3. 14.2


#8

If I confused the E2 data, do the calculations yourself.
Changes in E2 may be reflecting changing E2 levels and different lab timing simply hits the curve at different places. You need steady T levels to get steady E2 levels so that lab numbers can guide AI dosing etc. This is why I ask for frequent injections and to always do labs halfway between injections to eliminate the noise of lab timing artifacts.

What docs say often has nothing to do with reality. Doc probably thinks that you are already in normal range with what he suggests but doc does not understand the effects of changes withing normal range. Many drug companies state that injecting at two weeks etc is OK because test patients were in normal range at two weeks. Those patients could have been at a “normal” 300, swimming in E2 and we know that many can feel worse this way that before TRT.

If I recommend something, it does not make sense to ask me it if would make a difference. The point is to reduce high T peaks that spike E2 then also have T levels dropping in a sea of E2. And anastrozole needs to match T levels, so steadier T levels are important.

T loss from changing needles: Pull plunger back slightly to pull T from the needle.


#9

Thank you for your reply!

Regarding the E2 level - what calculations did you do/do I have to do? On my labs the amount is displayed in pg/ml, what do I have to change here (I apologize if I miss something, english is my second language and I’m from Austria - metric system).
Again the range of my lab for E2 is 27.1-52.2 pg/ml. My results pre-TRT were:

  1. bloodtest: 16.6; 2. 10.9; 3. 14.2

I have completed a bloodtest yesterday (on day 4 of my 5 day injection cycle), and just got the results, my E2 is at 25.6 pg/ml currently and my total test was >15.000 ng/ml (range is 2.490-8.360). I’m exactly 2 weeks into TRT and have done 3 injections, day 1 250mg, day 6 125mg, day 11 125mg, day 14 bloodtest with these results (today is my next injection).

So the e2 seems almost perfect right? Testosterone is very high, the reason for that is probably that I had the “frontload” at the doctor’s office with 250mg and currently my endogenous production is still running (I haven’t experienced any shrinkage/differnce so far in my testicles). With 125e5d normally I shouldn’t be at 15000, correct?

Right now I feel already a lot better, the low of the last few days has passed and my energy levels are really good. I have the feeling that I need much less sleep and I’m still energized and focused during the day. Other then the sensivity of the nips (could the high test also be the reason for that? Or is ist just the “doubling” of my E2 levels, although they are still not high, they are high compared to my pre-TRT levels), everything is great right now, also erection quality improved again.


#10

Hallo John_german! Ich bin auch aus Österreich und bei mir wurde auch Low T festgestellt. Bin deshalb ziemlich am Boden zerstört, wie du dir sicher denken kannst. Kannst du mir bitte sagen bei welchem Arzt du warst, damit ich versuchen kann auch eine sinnvolle Therapie zu bekommen. Danke für deine Bemühungen!!!