T Nation

25 Y/O - 8 weeks into TRT. AI Added to protocol. Updates below

You will absolutely need an AI and unless your SHBG is high you need to split those shots up twice weekly. I started out 100mg weekly but since I started injecting EOD I had to reduce my dosage down to 80mg weekly split EOD, no AI, no HCG.

my endo did not bother to test SHBG because he said it simply “doesn’t matter”

I am not sure of the pros and cons, this is beginning to be a big issue though.

Your doctors an idiot, nothing matters more than SHBG! If you’re SHBG is low you will need more shots since you are basically excreting most of your T into your urine. High SHBG and you could get away with weekly shots, mid levels SHBG twice weekly. It matters, I wasted time injecting once weekly with low SHBG, wondered why it was taking so long to feel good. Time for a new doctor, this one can’t help you if he fails at the basics.


He is a specialist in this field and it takes me months to have an appointment. He seems to be better than the previous one and I have no more options at this point. Do you think it’s fine to start TRT or to get more blood work tested before? @KSman

How has that protocol been working out for you sense you reduced you dosage have you feel any better?

I have started with hcg, not sure what you mean about dosage changing. But I feel pretty well the same as I did on Clomid… Nothing significant or no real improvements unfortunately

should i get SHBG tested before starting testosterone??

@jboy14, you should definitely get a base line on your SHBG. You need to know where it is now as it will be driven down lower after you introduce exogenous testosterone.

If you start TRT and inject once a week and your SHBG is low it’s going to be a long time before you start feeling better, I didn’t start feeling incredible until I started injecting EOD and was originally put on weekly injections which will not work on low SHBG guys. After doing my own research I requested that my doctor allow me to inject more frequently, you need to takes your health into your own hands because today’s doctors triage everyone.

The problem is all doctors learn next to nothing in medical school regarding TRT, they begin practicing medicine and a guy comes in needing TRT. Do to the lack of knowledge they order only half the labs needed and put a guy on a terrible protocol designed for everyone, only everyone doesn’t have the same SHBG levels. Then when a patient asked about SHBG the doctor chuckles and says it’s not necessary because they don’t want you to find out that they are clueless and save face by making stupid statements.

We call it stupid things doctors say and it’s out of pure ignorance. Your best bet without knowing your SHBG is inject twice weekly.

If SHBG are low than wouldn’t this mean I have more bioavailable tesosterone as it is more readily available for me to use? I would think this is more beneficial to have it low as opposed to high?
I thought if its high then my Test would be tighltly bound and then it would be harder for my body to use the test that is currently there… would you mind explaining this concept as i seem to have misunderstood it

The exception is that you need SHBG to activate T to drive it into the receptor sites that causes gene expression between target tissues. It’s a double edge sword. You would be dumping most of your unbound T anyhow, the only T that you would hold on to is the bound T locked away in SHBG.

And your doctor believe it doesn’t matter, lol!

I will get it checked before beginning TRT… SO for example if its low vs if its high how would my protocol change. I know you mentioned if its low then I’d be excreting a lot via urine meaning more frequent injections… If its high, then what do i do ? do i require other medications to help level it out if theres an issue? thanks @systemlord

If SHBG is high you need large injections of T to force overly high SHBG down to free up some FT, SHBG goes down FT goes up and you feel better. Low SHBG you need smaller injections otherwise you will force already low SHBG even lower, you still need SHBG to activate T to the receptors.

Back when I was on 75mg weekly the improvements were subtle, then I went to 50mg twice weekly which was little better, it wasn’t until I started injecting 25mg EOD that my muscles really started getting sore and harder. I had some high E2 symptoms and reduced dosing down to 20mg EOD, it’s been 3 weeks since I lowered it and am already feel better. My erections seemed to come alive on 25mg EOD, but now at 20mg EOD they seemed to have waned.

My point is everyone has a sweet spot that is unique to them and why these cookie cutter protocols will not work for everyone. You will most likely require an AI to help control E2 since guys on TRT tend to convert more T–>E2. Not all doctors are willing to prescribe AI’s out of fear and lack of knowledge.

thanks so it’ll basically influence the frequency of injection for my TRT protocol. and my Estradiol is currently 121 range: <158.99 pmol/L so i will ask about an AI since it is kinda high i am guessing ?

If your E2 is that high now you will have high E2 issues within a short period of time unless you’re on an AI.

is it possible that those E2 levels could be giving me my current symptoms? i was on clomid for approx 8 months under another docs supervision and not once did he check my E2 … he just looked at test and said it was high and in normal ranges… these are both urologists mind you!! supposed to be specialists in dealing with this . wow this site has been a big eye opener

I don’t think so your E2 levels are problematic, usually guys feel good in the 20-30 pg/mL range and 2.9 points isn’t going to catapult you into full blown symptoms. Your T is low and your E2 isn’t consider high or low. The fact that you are near the top of range for E2 will mean the moment you start TRT you will have high E2 symptoms in the first few weeks of treatment, you need to find a doctor that is onboard with prescribing an AI.

Any doctor who refuses an AI isn’t in a position to manage your hormones and should consider a reeducation or an early retirement. Guys end up producing more E2 on TRT than they would naturally. You are estrogen dominant meaning your E2 ratio is higher than that of your T.

@systemlord So do you think my I should get shbg and free test checked before I begin trt? I can then discuss those results with my doctor in a couple weeks at my appt? Would it be unwise to begin without having those checked?

Yes you need SHBG tested otherwise you have no idea what protocol you require.