T Nation

8 Weeks of TRT - Concerns Valid? Will Not Consider AI and More


#1

I’ve been on TRT for about 8 weeks now, and have just received my latest labs. I’m taking 50mg test cyp weekly, and 200IU of HCG every 3 days. Here are my labs… It was a struggle to get my doc to even test for estradiol… The labs below are taken on a Thursday, i injected 50mg test cyp on Sunday, and HCG on tuesday.

Estradiol: 164pmol/L (0-160)
Albumin: 37g/l
FSH/LH - <1IU/L
Prolactin : 21 ug/L (0-15)
SHBG : 19 nmol/l
Testosterone : 30.3nmol/l (8-29)
Free Test : 1020 pmol/l (175-700)

My doctor advised he is not concerned about the estradiol level, and didn’t consider an AI, advising that i have no reason to be concerned. He also shrugged off prolactinoma as he said the reference range to warrant worry is between 75-100ug/L. I’m going to go for a full semen analysis to see if the HCG is working, and then eventually more labs. Currently i have next to no libido which is very odd for me, and i’ve been irritable.

Just wondering your guys thoughts… Am i good to not worry about these results?

Edit: Forgot to mention, went in for ED initially, found my T levels to be 4.6nmol/l, second test 4 weeks later was 6.7nmol/l and doc prescribed me test, and eventually HCG.

Edit: added Albumin


#2

The issue with E2 levels is doctors simply don’t know where the ranges are for E2 in men, so to play it safe the largely ignore it. The correct way to play it is to refuse an AI unless a guy is presenting symptoms, if you can’t get ahold of an AI simply lower the dosage a little.

Am I reading correctly, 50mg once weekly? How do you feel towards the end of the week?

I’m on 50mg weekly but splitting it up 13mg EOD, so far so good. However injecting EOD is a different animal, I’m fine injecting 50mg twice weekly. I figure why allow my T and E2 to rise and fall when I can keep them stable and flat on a lower dosage.

Ignore directly measured free T, we calculate our TT and SHBG using an SHBG calculator to get out free T score. Your free T is 1.29 nmol/mL = 4.26 %, 2-3 percent is considered normal. Lower the dosage and E2 will drop.

Here-> http://www.issam.ch/freetesto.htm


#3

Yes you are correct, 50mg per week. To be honest i feel pretty worn out towards the end of the week, but that could just be from my job being stressful. I don’t mind the 30g needle for HCG, but I’m not sure if i want to IM test twice weekly… If I lower the dosage, do you think my prolactin will fall in line as well? I’m thinking that’s what’s causing my low libido.

Also, maybe lowering the HCG to 150IU E3D instead of lowering the test? I’ve read that HCG can have more of an effect on E2 than exogenous testosterone.

Also, with my Albumin level being 37g/l, my free test is bang on with that calculator versus my bloodwork at 3.4%.

Thank for the reply!


#4

50mg once weekly will not work, you testosterone levels in the first half of the week are higher than towards the end of the week, you don’t want to play it like this. You’re running on empty near the end of the week, this is a poorly designed protocol, nobody does TRT like this.

The longer you continue this protocol the worse you’ll feel as time goes on, you’re creating what’s known as a dead zone, this space or gap is at the end of the week when your levels are lower than in the beginning. The dead zone gets wider with time and eventually you will feel no relief from injections of testosterone.

This protocol makes no sense, you won’t find a protocol like this anywhere.


#5

Gonna go out on a limb here and say that these two things are related. Your doctor doesn’t seem to know what he/she is doing. Most of them don’t, frankly. That’s a recurring theme you’ll see on this site.


#6

Where are you?

You need to let us know lab timing relative to last T injection. With once a week and T levels dropping, lab results are determined by timing and sort of useless.

You should be looking at E2=80pmol/L as a target.

Any gyno, chest feels like grains of rice? Nipples sensitive?

Can you get anastrozole on your own?

On TRT, FSH/LH–>zero. Should not do this again.

We have guys with elevated prolactin that caused secondary hypogonadism. Risk of growing adinomas is pressing on optic nerves and one can notice a reduction of width of peripheral vision that should be almost 180 degrees.

E2 killing libido, tell that to doctor.

Thyroid OK? - see oral body temperatures below. Most who come here have some degree of low thyroid function.


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 number Aand 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.


#7

Hi KSman,

In my original post i put that i Injected 50mg test cyp Sunday morning, HCG 200IU on tuesday, and then had the labs taken on Thursday (4 days after test cyp, 2 days after HCG). The labs were taken at 8:30am. I’m Canadian.

What do you mean by grains of rice? As in fibrous muscles? I’m pretty sure i’m starting to get gyno, i have small lumps under my nipples the size of a penny, similar to what i had when i was 15 going through puberty. My nipples can also be quite sensitive at times. Doctor again said this is normal…

Doctor advised i have secondary hypogonadism, but said that my elevated prolactin is normal in my case, and won’t worry unless my levels double or triple…

I could get anastrazole or aromasin from a local guy, but i have a seemingly good rapport with my doctor and I’m not sure yet if i want to go behind his back to obtain these meds. I’ve told my doctor that the Estradiol is killing my libido, and he just told me it’s down to anxiety and if i take cialis my libido will come back by proxy…

I don’t think I’ve had any optic issues, i had a full eye exam done late last year and passed all test with flying colors, 20/20 vision.

I haven’t noticed any issues with thyroid other than going slightly hypothermic a couple of times last year… No issues with that since last September. My doctor seems to think I’m being chicken little at the moment, and it seems to be a bit difficult to request more things to get checked. Should i request to see an Endo? I feel like they’ll ask me to go off treatment for 4 weeks to get all levels rechecked, which would feel awful.


#8

High E2 = anxiety. Some doctors just don’t take their job seriously, it’s obvious that it’s time for another doctor.

And another one, and another one, and another one until you find one that knows what he/she is doing.


#9

Gidday fellow Canuck! I was going to PM you but I don’t see any type of private message function here. LOL My doctor is clueless too, a urologist in fact, in the nation’s Capital. Are you here too?


#10

Negative, I’m out west. Seems like we’re a bit behind on treatment/protocol here in Canada. Luckily my doctor likes to read studies I bring him sometimes.