~2 Years In on TRT - Feeling Tired all the Time

I think maybe my E2 / Estradiol is too high (it is under the top of the range 162 but I know that can be meaningless) and if it is, how can I reduce this? Do I have to use an AI? Is there a goto product that’s better than the rest? Any side effects? I really don’t want to add anything but I’m thinking now that I may not have a choice. Any and all advice welcomed and very much appreciated. Thank you for your time.

48, 5’10", 172lbs, diet is clean, no drugs / alcohol, training 6-7 days per week. Lifting 2 days, cardio on the 3rd day.

0.45 ml Cypionate rotating quad injections 2 x per week.

Most recent markers (Dec 2021)… I was feeling lethargic at that point as well.

Estradiol 144 pmol/L
Total T 30.4 nmol/L
Free T 738 pmol/L
Hematocrit 0.483 L/L
Ferritin 119 ug/L
TSH nothing current, last was 2020 1.89
SHGB nothing current, last was 2020 41.1 nmol/L

My lethargy peaked two years in. I’ve dropped my dose and increased frequency which has helped. I believe it was sleep-apnea induced. My blood pressure has been a pretty good indicator of my sleep quality, that and tension headaches.

I was going to say Iron but your ferritin looks fine.

How’s your sleep doing?


Taking an AI with normal estrogen is most likely going to be a big mistake. Your problem is more than likely coming from something else.

Too much T can also make you tired.


Does that Free T seem low?

Sleep isn’t the best; I wake up at least once a night so I get about 4hrs,go to the washroom, back to sleep for another 2-3hrs. I’ve had sleep apnea tests in the past and no challenges there. But they indicated that I’m restless when I sleep and I snore - tried everything for snoring, even a CPAP but I don’t have Apnea and frankly, it didn’t really do anything for the lethargy I was experiencing. So it could still be the snoring that’s the problem… not sure.

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Last result was Oct 2020 11.6 ug/L. Probably have to get that updated for it to be meaningful to anyone here. I’ll add it to the list for my doctor. thx

I was thinking that. Maybe I need to drop my dosage by 0.05 for each injection for a total of 0.10 per week. Too much? Maybe just 0.025 for a total of 0.05 per week to start. Thx.

Yes… thinking about dropping dosage. Not sure by how much at this point. I don’t think increasing frequency more than twice per week (current schedule) is going to change anything but maybe? Twice a week already seems like the “best practice” (if not once a week).

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These results were from trough (prior to next T injection)? Also you didn’t provide ref ranges.

Honestly I would try improving sleep quality before adding compounds or trying to change protocol. Reduce blue light exposure, no screens for an hour before bed, cool down the room, etc.

I’m glad to see you’ve gone lengths to check your sleep already; I find Occam’s solution to sleep problems is usually best in most cases - may or may not be your case.

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In this instance, this may be due to elevated TT/fT from too much exogenous T. Chronic sleep disturbance from TRT+ (but I’ll reserve conclusion until I hear back on whether these are trough values).

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That’s quite a bit of T, and can cause problems with estradiol.

You’re also 48. I’m 43. Ever since 41 I can’t remember a long streak of time in which I wasn’t fatigued.

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Testosterone is not subject to circadian variation in the same way that cortisol. There is sleep-dependent increase in testosterone that requires 3 h of SWS or perhaps a bit longer with increasing age. Testosterone remains elevated for the duration of sleep. The subsequent decrease in testosterone depends on the duration of wakefulness; decreasing more with prolonged wakefulness.

OSA per se is not a cause of low testosterone, rather it is due to obesity, and is increased by weight loss but not CPAP. Shift work does not affect testosterone and unless severely disrupted, sleep quality is not a determinant of testosterone. Testosterone deficiency may have a deleterious effect on sleep quality that may be improved with testosterone replacement. However, large doses of exogenous testosterone and anabolic/androgenic steroid abuse are associated with abnormalities of sleep duration and architecture. Further clarification is required about the relationships between sleep and testosterone in older age, psychiatric disease (depression, post a stress disorder, and psychotic disorders such as schizophrenia) as well as any interaction with the presence of other chronic diseases.


No doubt I’m 100% on board. I think per week is absolutely fine, I’m now on twice a week. But, I think E2 def has a role, as I believe it drives water retention and fluid levels, and the day after I inject I wake up with sausage fingers.

I took half a dose one week, then skipped the next dose entirely. Felt F’ing AMAZING. Strong, erections back 100%. I think I just overloaded system, even at 100-120mg/week. Missing an entire dose let my levels fall back to where I felt noticeably better going into that 2nd week.

So I answer this correctly; I inject Wednesday morning and Saturday evening. I get my blood work done Saturday mornings. That’s when the men’s clinic told me to get it done. Would that be the trough? thx

So I answer this correctly; I inject Wednesday morning and Saturday evening. I get my blood work done Saturday mornings. That’s when the men’s clinic told me to get it done. Would that be the trough? thx

So you skipped 1.5 doses in a week than went back to your regular protocol? Or did you switch to a new protocol / lowered dosage at that point? thx