7 Months on TRT. Feel Awful

I’ve been on try for 7 months… been very up and down. 150mg once a week… .5mg arimidix 48 hours after shot… bad brain fog, fatigue, headaches…
Provider just tells me it’s not testosterone related…
Started with test levels about 280
Only results I have…

I HAVE to feel better than this, although, after a tremendous amount of reading, I’m leaning towards stopping the ai

Stop the AI and in a couple weeks you’ll start to feel better. In about 6 weeks you’ll start to feel much better. I felt like crap on an AI and I’ve got the exact same SHBG as you. It seems some guys with lower SHBG (20s-ish) have a harder time with estrogen. Plus your AI dose is pretty high. You’re lucky your E2 didn’t fully crash.

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I agree. I think your E2 is low compared to your TT.

What kind of e2 level works for you with these shbg levels?

I’d think you’d want it higher, so drop the ai and see how you feel. Everyone is different. I’d shoot for 40-50 actually. That would be a good ratio T/E, or so they say…

This might just be a matter of dropping the ai…

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It’s common. Many many guys same story. Don’t feel good cause of the Damn ai.

Now when you stop the ai you need to give it time. You may temporarily feel high e2 symptoms. They are only temporary. Patience is hard with this.

And you have room to lower dose.

Check thyroid function too.

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If there are no thyroid problems, then I would say your problem is levels are too high or you are one of those men who do not do well on large infrequent injections. Your levels are peaking within 48 hours and decline afterwards and then 6 days later levels are lower, some men do not do welling on these types of protocols.

I feel terrible injecting weekly or when my hormone levels are fluctuating between injections. I and am surprised your provider hasn’t had you inject smaller doses more frequently, clearly your provider is inept to manage your TRT protocol because they believe in a one size fits all approach and put everyone on similar protocols expecting optimal results because everyone in the population is not biochemically unique and we are all clones.

I done it all, every 3 weeks, weekly, twice weekly, EOD and daily injections and the latter is by far the best experience I have had on TRT, my body prefers small very frequent injections and I notice each time I moved injections closer together I would feel better.

TRT can deplete minerals and other hormones, did your provider order a mineral panel checking for deficiencies? Your provider isn’t even using the correct estrogen panel, the Liquid Chromatography–Mass Spectrometry is the correct E2 test as it’s more sensitive which is what men require.

A lot of providers claim to be hormones specialists, most are doing things wrong and have no clue how to managed men on TRT.

@crmabry

My E2 sits @ 77. I’m doing 200mg divided into daily doses. Just let E2 get to whatever it’s going to get to. After 6-8 weeks get blood tests and use those results with how you feel and it’ll give you an idea of what to do next. It may make sense for you to try dividing your dose into 2 weekly injections (every 3.5 days) but really dropping the AI should be a game changer it in itself.

The only option they gave me was 300mg injections every 2 weeks or monthly injections…

I’m starting to think I need to try to find a different provider. But searching Google locally only comes up with the Low T clinic I use…

Here–> Figure 1 graph B

In fact, the present study confirmed serum levels of T which were lower than pre-ART value levels on day 14 after administration. Therefore the further decrease in serum T levels on day 14 after administration is considered to relapse of hypogonadal symptoms and to reduce the patients quality of life.

I’ll refer to to my last comment, these people have no clue how to manage men on TRT, they are blindly following guidelines, guidelines are used in place of knowledge to make it easier for doctors who are clueless.

When you have the knowledge to manage men on TRT, you don’t need guidelines, you know what has to be done. I clinical study came out in 2005 where men were injected with 200mg every 2 weeks, the outcome wasn’t good, these protocols create estrogen dominance in men and anyone willing to prescribe them has their head buried in the sand and doesn’t specialize in this area of medicine.

You need to seek a private doctor are you’ll never feel good on TRT. I’m signed on with a telemedicine clinic, there are alot of them out there.

Never heard of a telemedicine clinic… any suggestions?

I’m signed on with Defy Medical, they hinted at an iron deficiency without any iron panel, when I ran an iron panel I saw iron and ferritin below range. Too bad I didn’t sign on sooner, weeks later critical iron deficiency struck me hard.

The above is inaccurate.

ECLIA vs LC/MS/MS TESTING FOR E2

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

While some may believe the ECLIA test is for women, on the contrary, as it pertains to women on anti-estrogen therapy, such as breast cancer patients, the LC/MS/MS is the test for women as CRP levels are a consideration and it is necessary to know if the treatment has achieved an estrogen level of zero.

On the other side of the coin, LC/MS/MS equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results. Any estradiol management should not be utilized without symptoms confirmed by lab results.

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If there are no thyroid problems, then I would say your problem is levels are too high or you are one of those men who do not do well on large infrequent injections. Your levels are peaking within 48 hours and decline afterwards and then 6 days later levels are lower, some men do not do welling on these types of protocols.
I feel terrible injecting weekly or when my hormone levels are fluctuating between injections. I and am surprised your provider hasn’t had you inject smaller doses more frequently, clearly your provider is inept to manage your TRT protocol because they believe in a one size fits all approach and put everyone on similar protocols expecting optimal results because everyone in the population is not biochemically unique and we are all clones.
I done it all, every 3 weeks, weekly, twice weekly, EOD and daily injections and the latter is by far the best experience I have had on TRT, my body prefers small very frequent injections and I notice each time I moved injections closer together I would feel better.
TRT can deplete minerals and other hormones, did your provider order a mineral panel checking for deficiencies? Your provider isn’t even using the correct estrogen panel, the Liquid Chromatography–Mass Spectrometry is the correct E2 test as it’s more sensitive which is what men require.
A lot of providers claim to be hormones specialists, most are doing things wrong and have no clue how to managed men on TRT.

I think this answer of yours should be pinned on the forum for every second topic containing once a week + AI keywords

This is a good idea.

The sensitive method has no such limitation. The only other factor for the LC/MS/MS method is the technician skill which is usually spot on with an occasional screw up, but mostly accurate and more reliable.

They make you come in for your injection then? If so find someone else, as they just want to take your money.

If I were to google hormone replacement near me my provider would not show up. You might have to do some digging in order to find one near you. My doctor is a naturopath in a chiropractor office so it is not the bulk of the offices practice therefor would not show up. I would imagine there are others all over that are the same way. You could also contact your local compounding pharmacy and ask if they could point you to some doctors that are known to prescribe testosterone.

Good luck brother.

@crmabry

If you’re in the US and need a cheap TRT doc that’ll do everything over the phone then email me (email in bio). I can put you in touch with my doc. There’s a ton of docs out there. Mine runs $150/month 200mg/week shipped to your door to do what you want with. Not super hands on though so if you need hand holding you may want to check out defy.

No, and I don’t know how you know it’s “mostly accurate” or “more reliable”, but let’s say the immunoassay method is altered by high CRP (how often do you think this happens?) or other steroids and reporting falsely elevated E2. What do you think the problem is when the LC/MS/MS method indicates an even higher E2 level?

I have multiple labs from multiple guys to back this up. Let me know if you’d like to see some of them. I’d love to see your examples.

Really, this should be moot anyway. It’s the change in E2 which is most important, not the actual number, unless taking an AI and crashing E2, in which case either test will tell you it is low.

I have one set of labs that indicate exaggerated levels, there is no 100% guaranteed accuracy on any lab test. You’re going to have errors from time to time with any lab testing, the LC is shown to be more accurate the majority of the time.

Your quoted repost says as such, that the LC is more reliable.