T Nation

2 Years In. Protocol Advice?

Hi all,

Ive been on TRT for about 2 years now and dont seem to be able to find my optimal protocol.

I am currently on enantate E4D at 120mg.

My Free T is 677 pmol/L (225-725)
SHBG 22 nmol/L (10-70)
E2 21.25 pg/mL

Mentally I dont feel like I should be where I need to be, tired, anxious, jealous. Just feeling horrible and seem to be getting injured all the time and taking forever to heal.

One thing I would like to try to EOD to see if that could boost my E2.

It would 56mg EOD.

Thoughts?

Have you seen any benefit in two years?

Your peak would not be as high, and your trough level would not be as low, so it would be higher at the time of your lab draw.

This will make many go crazy, but assuming you have ruled out other causes and testosterone is the issue, I would increase testosterone.

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At times yes.

So increase T but still at EOD?

Would doing it EOD increase E2?

Depends on the dose. For example, I dropped my dose from 200mg once weekly to 70mg twice weekly (140/week) to 40mg every 60 hours (120mg every seven and a half days. At twice weekly, my trough levels were higher at twice weekly and at three x/week, not really much of a trough, my levels were even higher. Just messing around.

However, overall, I felt no different. I’m back to weekly injections now.

I would tell you to forget about increasing a number. Instead, try different dosing regimens until you hit on what works best for you based on the way you feel.

Another option, not sure I’d recommend this in your case, maybe, but you can simply add estradiol, say 2mg/day orally. I’ve done that with a few guys coming from elsewhere with trashed E2 levels.

Is your doctor giving you any guidance here?

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Increase testosterone to increase E2. If that doesn’t work you can use exogenous estradiol (yes, some men do need it).

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I’d try reducing you T dosage. I found my E2 was “sticky” meaning that at my absolute lowest TT of 81 my E2 was still 17. When my TT was 672 my E2 was 28…I’ve gotten my TT down to 400ish and my E2 is 24. So my ratio went from 20 plus to its current roughly 16.

For comparison sake my completely natural 19 year old has a TT of 625 and and E2 of 35 for a ratio of around 17.

All of the above assumes ratios matter and I’m not sure they do.

They don’t. Neither does E2.

If E2 doesn’t matter, why did you tell him to increase T to increase E2?

I’m not sure they don’t matter. E is a paracrine hormone…it is possible that the body needs a certain amount of E2 and will use as much of the available T in order to get what it needs.

The only thing you need to worry about is that you don’t have a deficiency. As long as you have sufficient levels, you’re good.

U shouldn’t make blanket statements. In addition to recovering my libido I noticed that when my ratio between e and t is lower I can last as long as I want(makes the wife happy).

Money shot:

In the very first paragraph it states the following:

“The ratio of estradiol to testosterone was significantly higher for subjects with ED.”

What does this mean? It means that taking an aromatase inhibitor will lower your estradiol levels which in turn will increase your ratio. As per this study: not good, as expected.

  1. Ensure you have sufficient levels of estradiol. If you are deficient you may need to use exogenous estradiol (yes, it happens)

  2. Dont take an AI

  3. Don’t concern yourself with targeting a certain ratio.

Optimized guys will detemine ideal weekly dose of T as well as ideal frequency of injection. The body typically keeps estradiol in a ratio that it requires. There are extremely rare cases where men have an aromatase deficiency and require exogenous estradiol. Then there are unbelievably rare cases of men with an aromatase disorder where their E2 winds up in the several hundreds pg/mL. I have a single physician friend who has seen one such case.

In the study they were looking at ED(dick doesn’t work) and PE(come too fast). PE was caused by too much testosterone relative to E2. ED was caused by too much E2 relative to T.

By the way, my experiences totally jive with this. 400ish T with a 25 E(16ish ratio) means I can pretend to please the wife all night long. 675ish with 28 T and I can’t even pretend to please the wife.

I partially agree with the study, as will most physicians I know.

What they would all tell you is this:

ED wasn’t caused by too much E2 relative to T. ED was caused by an androgen deficiency. They would demonstrate this by raising androgens, which would also wind up raising E2, and ED would typically improve. ED is not only a factor based on T and E2 levels. There are significantly more factors at play.

We do have tons of literature that high ratios are bad.

Ensure sufficient androgens. Don’t worry about E2. Don’t target a ratio.

What about the PE patients? Too much T and not enough e2? I’ve been trying to figure out why I slowly developed PE over the years I was on finasteride but haven’t really seen a good explanation so just curious. Not an issue since I stopped taking it but I never had any bloodwork done while I was on it. It’s more of a curiosity than anything at this point.

Edit: I wish this study has also tested TSH. I’ve seen a study that connects delayed ejaculation with hypothyroidism and PE with hyperthyroidism, it was pretty interesting.

If I go like 10 minutes , that’s not pe is it?

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Def not. That study is calling “average” about 6 minutes of actual banging while the PE group was averaging more like 40 seconds. With PE it’s literally all you can do to last those 40 seconds too. I mean, sometimes it could be super intense when you needed to be quick and could be, but the rest of the time it can be pretty shitty. Esp if you were like me and in a shitty relationship where once a week was about all you were getting… so it was like wtf, I waited a week for that? Haha. Not any more at least.

Here’s the study I mentioned last night

These are both normal things, actually. Your body would normally try for a certain minimum level of E2, and Free T is the decider on how much of that desired number it can make. Available hormones also have a direct bearing on serotonin and catecholamine production. More serotonin means you can last loger - up to a point. Too much will make it difficult or impossible to finish.