T Nation

40 Y/O, TRT and Starting AI, Need Some Input


Wish I had my original labs from prior to starting TRT but I don’t have a copy. I know total T was 209, free was 4 and change, E2 was 34 (range 7.6 - 42.6). Started TRT at 140 mg test cyp per week, single dose. I’m using a T clinic that requires you to go in for shots and at $40 a pop it adds up. Anyway, I felt amazing during weeks 3 and 4 of TRT. Then things started getting crappy again. Morning and REM wood are fine (wakes me up occasionally, in fact) but now there’s brain fog, bad mood, and all of a sudden I couldn’t ejaculate without a lot of manual intervention. That got worse and now I can only get off once a day at most and orgasms kinda suck when I finally get there. If I try to go a second time in the same day, I’ll feel the beginning of the buildup to an orgasm and boom, it’s gone, and my junk falls asleep. Feels like all sensitivity has gone. Even with low T I could go multiple times a day with no issues whatsoever. Went back for my 6 weeks labs and they are as follows:

Total T: 492 (350 - 1000 ng/dL)
Free T: 12 ng/dL
Bioavailable T: 282 ng/dL
E2: 44.5 pg/mL (high) (7.6 - 42.6) Roche ECLIA methodology
SHBG: 25 nmol/L (16.5 - 55.9)
Hemoglobin: 15.7 g/dL (13.0 - 17.7)
Hematocrit: 47.5 (37.5 - 51.0)

No lab for prolactin, which is disappointing, because I’m wondering if that + E2 or that alone are the cause of my sexual issues.

Clinic told me that they like to keep E2 below 60, even though above 42.6 is considered high, but since I’m symptomatic they prescribed 0.5 mg Arimidex to be taken 48 hours after my shot once per week. They also increased the test cyp dose to 160 mg/week because they want to get me to 600 - 800 ng/dL at trough. I know dosing test cyp twice a week (or more) would be ideal but isn’t an option for me. That said, should I do AI in a single weekly dose as the clinic said or should I split it in to 0.25 mg doses two days after the shot and 3.5 days after that? Is 0.5 mg a week even appropriate for the test cyp dose I’m on and with the last E2 lab result? Last thing I want to do is crash my E2 and all of the reading I’ve done shows a lot of contradictory opinions. Looking for input.


Your a paying customer, you need to inject twice weekly at a minimum if you ever want to feel good all the time. You’ll never have a great sex life or feel good with E2 in the 60’s! You never take an AI once weekly, it will have cleared out of your system by the end of the week do to the shorter half life.

This clinic is only concerned about your wallet, your health is a distant second. Taking the AI 48 hours after your shot is stupid, testosterone and estrogen have already peaked by this time and it’s too late to be thinking about taking an AI.

If you remain with this clinic you will feel worse as time goes on and you’ll be force to seek other alternatives, there’s always another option. You can’t make a decision to maintain everyone’s E2 in the 60’s and expect a good outcome, everyone has their own optimal range and this cookie cutter approach is done to make things easy on these clinic doctors.

They don’t even realize they are running the wrong E2 labs.


Ideally you should inject twice a week, SUB Q will help keep e2 lower also.

You should shoot for NO AI.
Some people do need it, but you should do everything possible to not use one.


I went and got my labs done on my own last week with the correct E2 test. Total T, free T, and E2 have all shot up and SHBG has gone down a bit. All labs, with the exception of T and E2, are within range. Biggest E2 symptom I’m dealing with at the moment is fatigue and being a bit emotional.

Testosterone, Total, LC/MS 1013.1 High ng/dL 264.0 - 916.0
Free Testosterone(Direct) 29.1 High pg/mL 6.8 - 21.5
Estradiol, Sensitive 61.4 High pg/mL 8.0 - 35.0
Sex Horm Binding Glob, Serum 20.9 nmol/L 16.5 - 55.9


It takes time for things to normalize after starting TRT. I’ve been on for about a year and just recently feel stable and dialed in. I chased E2 numbers and what I thought were high E2 symptoms for months and crashed my E2 with AI multiple times. If I were in your shoes I would push to get twice a week injections and let it ride for a bit. Your other numbers look solid. Get a blood test in 6 weeks and go by feel, not by numbers. Also, I’d be looking for a different clinic that allows you to do your own injections.


Whenever SHBG decreases it frees up more free hormones, more free testosterone and more free estrogen.