T Nation

6 Month Mark on TRT and Labs are All Over the Place

You might have seen my name on here over the last 6 months trying to give what little advice I know about TRT and my experiences and obstacles over my 6 month journey.

Over the last several weeks I have experienced on and off episodes of acute shortness of breath with chest tightness on exhertion. I have worked as a Firefighter for the last 24 years and recently while at a fire noticed that I felt extremely winded and like someone was sitting on my chest. In addition to that I also felt an extreme flushed feeling in my face and had a dull headache for several days. I am also a Paramedic so I decided to do a 12 lead EKG, monitored my pulse oximetry and blood pressure.The results were an extreme wake up call for me. My blood pressure was 170/114 and my oxygen saturation in my blood was 96%, which is acceptable but not great. My EKG looked OK so I decided that I wasn’t going to fool around and made an appointment with a new Cardiologist at Men’s Health Boston, Dr Evan Applebaum. Dr Applebaum was great, he listened to everything I said and did a thorough exam to include a stress test and labs. My Troponin levels came back within normal limits, however, my MCV ( mean corpuscular volume) came back at 79 FL normal range 82-98 FL. Hemoglobin 15.1 g/dL normal range 13.7-17.5 g/dL, Hematacrit 44% normal range 40-51 %. Wondering if my MCV is low because my blood is too viscous (thick).

Fast forward 1 week. Today I went to my Urologist for my 6 month visit to go over my labs that I had done on 3/15/18, which couldn’t have come at a better time so I could discuss my recent symptoms. My Dr increased my Testosterone 6 weeks prior to 160 Mg weekly x 2 injections per week, 1000 IU of HCG every other day and 1/2 MG of Arimadex X2 per week. I felt as though my testosterone was going to be through the roof due to the increase in dose + Newly added HCG to the protocol. My labs were as follows from Quest Diagnostics.

3/15/18
Hemoglobin 15.1 range 13.7-17.5
Hematocrit 44.9 range 40-51 %
Total Test 106****** Range 250- 827 ng/dL
E2 52**** range <39 pg/ml
PSA .7 range <4.0 ng/ml
SHBG 17 range 10-50 nmol/L

My Dr decided to do labs again because the total testosterone was not making any sense. So here are the lab values taken 4 days after the above.

3/19/18

Total test 919
Hemoglobin 14.9
Hematocrit 45
Estradiol 52
PSA .69
SHBG 17

I asked how there could be such a variation in the total Testosterone level, his reply was, “probably lab error.” He still could not answer why my E2 was soo high. I guess the moral of the story is that don’t be too quick to adjust your protocol without a repeat of labs!

I see zero evidence that your blood is too thick.

You need more anastrozole. At 320 mg T per week I would expect that you need 3.2 mg anastrozole per week.

You got E2=52 with a dose of 0.5mg twice a week. With a goal of E2=22pg/ml your new dose should be 0.5 X 52/22 = 1.18 or 2.36 per week. The difference of 2.32 vs 3.2 could be from lowish SHBG with more FT for FT–>E2 or from reduced E2 liver clearance and that can be from medications.

Why are you seeing a urologist every 6 months? Only for TRT? He can through T at a problem, but is an idiot for not checking FT. SHBG gives us a clue. Looking at FT your T dose may be too high. If you reduce, reduce AI dose by same factor.

High E2 can create major brain problems and panic attacks. We see same with low thyroid function too. Eval thyroid function via oral body temperatures - see below

Bromine fire retardant fabrics can put bromine in your system displacing iodine from where is needs to be. No problem if body temps are good.

BTW, E2=52 is really bad for the prostate and the brain. +more

Take fish oil and also aspirin until things settle down. Avoid dehydration.

How much hCG? 250iu SC EOD would be appropriate. Larger amounts can spike E2 via testicular T–>E2.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re Thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab numbers and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

My dose of Test is 160 weekly broken into 2 injections a week

Thanks for correcting me.

You still need more anastrozole as calculated. But the focus not changes to impaired clearance or effects of hCG.

I was hoping that you would state your hCG dosing. Could you be dosing too much? If 1000iu/ml, 0.25ml, “25” on insulin syringe would be 250iu. There are some guys who simply have very high T–>E2 in there testes and hCG must be reduced or dropped.

In my opinion your dose is too high given your low SHBG, low SHBG and high normal testosterone levels creates an excess of free hormones, free estrogen and free T.

Large doses of testosterone usually always drive SHBG down, this is not ideal for low SHBG guys. Trt is about balancing all of your hormones and not just raising your testosterone to the limits.

Lowering your testosterone might allow your SHBG to come up a little and this is a good thing.

I am doing 1000 iu’s Of HCG every other day. Instead of mixing 10CC’s of saline with the HCG powder, I cut it to 5cc’s, so I am getting the same concentration with less volume at 5cc’s. I think i am going to cut my HCG to 500 IU’s weekly and give that a shot and see if this helps. Amazing my E2 was 21 5 weeks ago. Thanks for your help KSman and Systemlord