T Nation

31 Y/O. 4 Weeks on TRT Still No Positives

Thank you for trying to help me!

Age 31
Wight 90 kg
Height 5’7
Waist 36

Long story short, I live in a under developed country where there is literally no concept about TRT. So I am all on my own.

Started with levels of 259 test and 19 E2.
I have just completed 4 weeks after the first injection.

The initial protocol was 100 mg Test E/ week ( divided into two shots per weeks).

During the first month initially I felt decent, positive changes like less anxiety, good sleep, better mood. Still no libido or morning wood. But towards the end of the first month I started to feel bad again.

Went for the labs after 4 weeks.

Total T =721
E2=46( normal test, not sensitive. Sensitive E2 is not available in my country. Sadly !)

Forgot about SHBG :frowning:

So I discussed my problem with veterans in TRT like you people and decided to up the dosage from 100 to 150 per week( divided into two shots per week), and adding 0.25 mg of arimidex with the shots( twice per week).

Main reasons of changing the protocol is that I still have zero libido, no morning wood and muscle fatigue.

I assumed my E2 was a little high at 46 on a non-sensitive test. So in my eyes probably this high E2 was not allowing me to feel the benefits of TRT.

Few questions:

1)I am confused if my E2 test was sensitive, what would be my numbers approximately, higher than 46 or lower?

2)Do you think I am on a right protocol right now?

3)Why I have not seen any improvements in libido and morning wood? 721 testosterone is low for me? Or 46 non sensitive E2 is high?

4)Is it too early to expect results?

Is there any suggestion you have, at least up my libido a bit?? Really depressed ATM.

Thank you so much for your time.

You have unrealistic expectations, you can’t expect libido and erections to happen right away as these can take the longest to fully resolve. Your pituitary gland shut down in the first month and this is why you started feeling bad. It takes between 1-3 weeks for your pituitary gland to shut down. You must wait for TRT to start working and you didn’t give enough time.

I started noticing tiny improvements until 2 months, been on TRT for 10 months and libido and erections still improving. Way too soon to expect anything. Those initial numbers at the 4 week mark looked great and were typical numbers for your age groupe, perhaps slightly higher.

Testosterone takes time to affect tissue changes between cells, how long this takes depends on how much SHBG you have, expect you don’t have those tests so it’s a shot in the dark. If SHBG is low your current dosage is going to cause issues and you will never be able to control excess free hormones.

These female E2 tests should be ignored, you are better off going based on how you feel. These female E2 tests overstate a mans E2 levels, yours was likely in range at 100mg weekly. I think you made the wrong move to increase dosage and you didn’t give it enough time to be able to feel the changes.

Blood levels after a protocol change take 4-6 weeks to stabilize and perhaps longer to feel significant changes in the way you feel.

If you have any thyroid issues TRT will not do anything for you.

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I can’t thank you enough for your time, effort and such a detailed answer. I really appreciate it.

I have three supplementary questions for you.
what if my Shbg is low? Those excess free T will cause problems? ( Going for test soon and will post it here).

I am deciding to go back to the same 100 mg protocol with no AI? I have just one shot of the two 75 mg injections/ week.( only pinned 75 mg single shot now, two days back). With 0.25 mg arimidex.

Should I go back to the initial protocol and give it one more month?

As you have told that the pituatary shut off in the 3rd week or so. So how we should compensate that? By increasing the dosage? Please note that I have no HCG available atm.

Thank you again for your worthy inputs.

P.S. I have no thyroid issues. My TSH is fine.

@systemlord is right . Give it some more time , i’ve felt good in the beginning and started to feel like shit after 3-4 weeks . Started to feel better 2 weeks later. Erections were dead during that time but are coming back with libido too . Sometimes its good sometimes its not but i’m progressing . If I was you I would wait a month on same dose and see what your levels are !

So basically @systemlord and @tuckerleonie are saying that I should continue my same dosage of 100 mg per week.

And quit current 150 mg with 0.25 mg arimidex with bi weekly injections.( Not an issue I had only single shot of this protocol and easily revert back,).

So same dosage for another 4 weeks,right? But pls note that I had not a single morning wood or libido with previous dosage. Still continue with it?

That is a very low dose. I would keep taking it. Trying to guess what the error is in your E2 results is simply a guess. Your symptoms did look like your E2 was rising and 0.25 mg of arimidex is less than most need with 100 mg Test E.

If you go back to 100mg weekly (50mg twice weekly) and only give it a month, you are not understanding it takes 4-6 weeks for blood levels to stabilize so a month isn’t enough time. Those who lack patience will eventually give up on TRT because you’re not giving it enough time between protocol changes.

TSH is not a good indication of thyroid status, it only measures thyroid function and not thyroid hormones. We don’t use words like fine, ok or normal to describe our thyroid status. We back it up with labs showing our thyroid hormones and leave little to guessing. Check fT3, fT4, rT3 and antibodies. Just because TSH is in ranges doesn’t mean that it’s good, these ranges are bogus.

Most men do very well in the 600-800 ranges so it’s a little confusing why you gave up so quickly at 721 ng/dL, 721 is NOT low for anyone. It’s near the top of the ranges.

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Let me just put these graphs up for a guideline for you. But you need to understand that these things can take longer than even outlined here.

Thank you @systemlord and all other respected members who have helped me. I have decided to go back to same initial protocol 120 mg Test E ( 60 mg every 3.5 days). I see now that 721 total testosterone is not bad by any means.

Only confusion still left is whether to add 0.25 mg arimidex with it or not. I had 46( non sensitive) estradiol last checked as mention before. It might read 30- 35 on sensitive test. So should I add 0.25 mg arimidex or not?

Your guidance really gave me great confidence!

Thank you all.

according to this (albeit small) study. The average testosterone level in men is 723 Ng/dl. It seems reference ranges have been getting lower and lower over the past decade or so.

Study: https://academic.oup.com/jcem/article/96/8/2430/2834349

Fairly sure this graph is related to reandron (testosterone Undecanoate IM) although I may be wrong. If that is the case then it would take longer to perceive benefits compared to test enth or cyp. I don’t know how long it takes to get full benefits from trt, however I don’t think it’s gonna take 2-3 years for a guy taking test cyp, probably closer to 1-1.5 years.

The only thing taking 2-3 years for maximum benefit is hip to waist ratio, bone mineral density, and decrease in fat mass. Why would it take longer for different TRT delivery methods? The goal is always to get your testosterone within range or optimized so that is the focus. How would the delivery method change that?

Testosterone undecanoate takes longer to get testosterone within range, When one starts treatment with nebido/reandron injections are given at weeks 1,6 and then every 12 weeks after. The reason for the front loading is because it takes a while for testosterone undecanoate to build up enough in the bloodstream to give “normal” testosterone levels. If you look at the studies on test U the elevation of levels is also less than what one would receive off say 100-150mg test cyp weekly. Test cyp should give a faster improvement because it normalises testosterone levels quicker and gives higher TT and FT levels.

@systemlord and @verne pls take a look on my lastreply on this thread about arimidex dosage.

Thanks.

Interesting. I will look further into the source for the European Journal of Endocrinology meta-analysis. This source was cited for the graphs.

Most of the pubmed information I found on testosterone effects used T enanthate. There was a large article on obesity and TRT that did use undecanoate. Since there are no citations on the EJE site its really guess work.

https://www.nebido.com/en/hcp/research/testosterone-tools/effects-tool.php You can see the graph on nebidos website (testosterone undecanoate)

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It’s difficult to recommend AI dosing when you don’t have proper E2 labs in your country, if you start on a lower AI dose you don’t have to worry about crashing your E2 levels.

.25mg AI dosage taken with injections. See how you feel in 4-6 weeks.