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90 Day Lab Review - Concerns with Normal TT, High FT, High E2, Low SHBG

Hi all,

I started testosterone replacement therapy back on 11/13/2019 and just had my 90-day labs drawn. I have a review scheduled with my doctor in 4 days, but I wanted to get some input from the members about some of my concerns here so I can better understand things and know how best to move forward.

My relevant numbers are as follows (start-finish):

TT: 244 - 486 (Range: 264-916 ng/dL)
FT: 10.8 - 27.4 (Range: 8.7-25.1 pg/mL)
E2: 13.3 - 40.7 (Range: 8.0-35 pg/mL, Sensitive)
LH: 3.4 - Not Measured (Range: 1.7-8.6 mIU/mL)
TSH: 1.97 - 2.78 (Range: 0.450 - 4.500 uIU/mL)
DHEA: 356 - 478 (Range: 138-475 ug/dL)
IGF-1: 285 - 251 (Range: 98 - 282 ng/mL)
SHBG: 24.2 - 12.6 (Range: 16.5 - 55.9 nmol/L)
Prolactin: Not Measured - 31.7 (Range: 4.0-15.2 ng/mL)
PSA: 1.0 - 1.1 (Range: 0.0 - 4.0 ng/mL)

Cholesterol: 276 - 246 (Range: 100 - 199 mg/dL)
Triglycerides: 168 - 176 (Range: 0 - 149 mg/dL)
HDL: 44 - 44 (Range: >39 mg/dL)
LDL: 198 - 167 (Range: 0 - 99 mg/dL)
T. Chol/HDL Ratio: 6.3 - 5.6 (Range: 0.0 - 5.0 ratio)

Prescription:
Test-C 200mg/ml - .25ml Subcutaneous - E3D, or 150mg/week
HCG 250iu Subcutaneous - E3D
Anastrozole 0.125m 2-3/week, if needed

Dosing worked out to be 150mg Test-C weekly, or .25ml/50mg E3D

Reasons for starting:

Experienced the following symptoms since my early 20’s, yearly testing had always returned bottom of the range numbers for testosterone since I was about 23. Never went higher than 351 even at my youngest labs around 23. After realizing that my doctors continually saying “everything looks fine” despite me not getting or feeling any better might mean the doctors actually didn’t know what they were talking about, I decided to do more focused research and more comprehensive labs and obviously came across testosterone replacement.

Starting Symptoms:

*Chronically low energy
*Low motivation
*Difficulty increasing muscle mass
*Difficulty decreasing bodyfat
*Depression
*Difficulty maintaining erections or achieving erections, felt like a gamble whether my dick would work or not

Personal review of the first 90 days:

Let me start with an important point, I initially did the math wrong and ended up dosing .25ml/50mg EOD instead of E3D from start, 11/13/2019 - 1/15/2020. I didn’t realize until I did some mental math and realized that at the rate I was going, I would run out of my vial of test before it would be renewed. Once I noticed, I switched to E3D on 1/15/2020 and continued that since then. In other words, my initial 9 weeks I was actually injecting 200mg weekly thanks to the EOD schedule. I intend to bring this up to my doctor based on my notes below and since I was just an idiot who read their instructions wrong.

I didn’t really notice anything except for high libido and better erection quality until about the 6th or 7th week, around 12/25/2019-1/1/2020. From there, I started feeling several of the more proclaimed effects of TRT such as higher energy, better mental acuity, and an overall increased sense of well being.These effects continued to increase in a positive way including increased motivation and drive and maintained themselves at that state until roughly the end of January, or the 10/11th week. From the end of January until now (the 13th week), effects leveled off and then actually somewhat pulled back in the last 1.5-2 weeks.

I would say my original problem symptoms saw improvements by at least 30-40% overall until more recently when they started getting worse by a small amount, roughly 10-20%.

Sides:

  • Starting near the middle to end of January, I noticed a little bit of sensitivity around my left nipple. I don’t know how to describe it really except it’s a very subtle burning or throbbing maybe?
  • I haven’t noticed any major changes in mood but there have been some days I just wake up feeling off. Again, I’m not sure how to describe it or if it’s even related to the medication, but there are just some days in the past 2 weeks especially where it’s like I woke up on the wrong side of the bed and can be irritable and grumpy.
  • Despite taking HCG, testicles have become smaller, which kind of sucks since I naturally never really had large testicles. They will now recede quite a bit during sex and during orgasm and sink back down afterwards, but overall the testicles and scrotum have gotten smaller/tighter.
  • The last 3-4 weeks my appetite has been all over the place. I have had a few nights where I jokingly said I must have synced up with my roommates periods because I was craving boatloads of chocolate. Before this I didn’t really notice a terrible difference in eating habits.
  • No other notable sides that I can think of.

Questions/Concerns:

  1. Nipple sensitivity - given this symptom and my lab results showing pretty high E2 as well as prolactin, would this count as a good time to start dosing the Anastrozole twice a week? I’m naturally concerned about gyno as it seems my body is reacting poorly there. I’ve just been hesitant so far because I wasn’t fully confident in how to spot high E2 symptoms or if I’m just being a hypochondriac about my nipple.

  2. Normal Testosterone, High Free Testosterone, High E2, and Low SHBG - Given all of these measurements from my labs, it sounds like I’m what I think you guys call a hyper-secretor. I hope that’s the right term. From everything I’ve read here, I think that means I may be better off either dosing more frequently, or lowering my dose so that I don’t have as much free testosterone floating around to turn into estrogen, or possibly just relying on dialing in my AI, Anastrozole, to keep my E2 levels in a better range.

  3. Testosterone levels and symptoms - Although this is the first time in my adult life that I’ve gotten into a more normal range with my total testosterone, I’m still concerned that this number seems low despite the medication. Additionally, although I’ve seen nominal improvements in my symptoms, it’s not to the extent I’d hope for. Put simply, this is the first time I’ve ever found something that seems to actually be helping my symptoms of the last 10 years. However, I want it to help more than 30-40%. In my simple guy logic, that means take more testosterone and treat the low SHBG, high E2 sides with an appropriate amount of AI. Is that the right approach? Why or why not?

  4. Dosing - Clearly, I think it’s safe to assume there is some correlation between my dosing schedule and symptoms. It seems that when I was accidentally dosing EOD, or 200mg/week, I saw better and more consistent improvements of my symptoms. That being said, since it seems I am a hyper-secretor, doesn’t that mean that a higher dose of test, despite more frequent dosing, could lead to more free test floating around able to be bound up as estrogen? Forgive my ignorance, but that’s my understanding so far. Could that not simply be countered by an AI in minimal required dosage? Also, I’m aware that I may have been riding a honeymoon period for those first 9-10 weeks, so I’m not ruling that out completely.

I’m 30, 6’4", 215lbs, 27% bodyfat as measured by DEXA scans (lost 3% since starting). Moderately active in gym, bicycling, and hiking, and slowly increasing the frequency of those activities. Generally eat a balanced diet, but consume 12-18 drinks of alchohol, mainly beer, per week. Supplement fish oil, vitamin D, niacin, and ZMA. Also take Wellbutrin and Gabapentin for depression, anxiety, and nerve pain, although they’ve obviously never done much for the depression, hence why I tried TRT.

I look forward to hearing your thoughts and I appreciate your time and help on this!

It sounds like your levels got too high and since TRT suppresses SHBG, it’s more than likely lower now and will affect androgen/estrogen balance. I have low SHBG (13) and find daily injections to work out better as far as androgen/estrogen balance and need significantly less testosterone.

The AI is short term with the idea of getting off it, I would do it now rather than later since you haven’t even attempted to make things work without it. You don’t need a high Total T to have good Free T levels, I only need a Total T at 500 to have high normal Free T.

I would stop the HCG for now as well.

I think it’s ironic that doctors prescribe drugs that suppress testosterone (gabapentin), then when your levels are lowered to that of an 85 year old man, they tell you it’s nothing to worry about.

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Everything looks pretty good. Your total test is pretty low normal still. So you can easily go up in dose. I’d also start lifting weights and get your bf % down more.

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I think @maddog352002 nailed it. Start working out and energy should come up with on trt.

Interesting, I definitely felt better when I was doing EOD injections, I’m not against ED, but the extra day in between is a nice compromise. If I could get EOD to work instead of having to ED, I would prefer that. But in the end, I’ll do what I have to do for my body.

Can you explain why? I originally opted for it because I was under the impression it was advisable to use alongside TRT as it was easier to maintain and/or rekindle fertility in the future. I don’t personally care about fertility right now but want the option to remain open later on in life. I’ll happily come off of this, especially if it simplifies the equation of what I’m putting into my body and what’s happening to my labs + side effects.

Absofuckinlutely agree. I’ve never felt a massive effect off of them, but they did at least provide some slight improvements in my life, so it was either use them and at least function or be a complete and total waste of a human being. It wasn’t until I started researching deeply in the past 6 months that I started to see how much havoc it can wreak on your body.

I’m extremely happy I started TRT as it has at least got me beyond that “just barely functioning” level into more of a normal functioning human being level of energy.

Thanks @maddog352002 and @mnben87, I’m definitely going to focus on the gym. Although I’m tall and don’t look fat, I actually carry a lot of fat in my stomach and know I need to get that body fat level down drastically. I’m hoping that not only will I feel better getting down sub 20%, but my lab numbers will be in much better shape as well.

HCG produces more estrogen and may be a factor in nipple sensitivity and throbbing sensation and can sometimes be a factor is prolactin secretion which is also related to gyno.

You may be thinking that’s why you have an AI, but they are bad for bone mineral metabolism and wrecks your cardiovascular system in the long term. Estrogen is important for those free fatty esters generated from estrogen that helps stop the oxidation of LDL, the bad cholesterol.

Fertility can be regained later through various methods, HCG+FSH injections, TRT supresses FSH which stimulates sperm production.

You can also use clomid which restarts your natural LH and FSH production.

For what (little) it’s worth, 50mg E3D is not 150/week…it’s 150 every 9 days…or 116 a week averaged out. That’s assuming you mean dosing on, for example, Monday, Thursday, Sunday, Wednesday etc…that’s E3D.

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Correct. 50/3*7.

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I started out weeks 1-9 dosing 50mg per injection like so: Sun/Tue/Thur/Sat/Mon/etc.
Then I changed up week 10-current to: Sun/Wed/Sat/Tues/Friday/Monday/etc.

So you’re saying that the second one was actually worked out to 116mg/week? Man, I just can’t seem to do the math on these things properly.

Just convert it to daily and multiply by 7

100mg every 3 days? 100/3=33mg a day.

33 x 7 = 231mg per week.

If you’re doing something more complicated then just add up whatever the whole schedule is milligram wise and divide by however many days it is. x 7 and there’s your weekly dose

Yep.

And weeks 1-9 were actually 25/day average, so 25*7 is 175. At week 10, you dropped from 175/wk to 116/wk.

Nice, this makes a lot more sense and makes the dosing easier to figure out. Thank you gents.

It also looks like such a significant drop in dosage from week 9 to week 10 and forward could and probably does explain a large part of the decrease in effects I noticed.

Just wanted to add an update after speaking with my Doc:

*Increasing Test-C dosage to 200mg/week (and injecting at the right frequency, oops lol)

*Stopping HCG as of now since I’m not overly concerned with fertility and accept the possible risk of not being able to regain fertility in the future. This is motivated by wanting to take extra medicine out of the equation in case it’s causing any problems.

*Dosing my AI 2-3/week for a little while and seeing if there’s any relief in my sensitive nips lol. The goal is to only use the AI on a limited basis since it’s not the healthiest thing to use long term. Doc mentioned I should expect to see relief relatively quickly with Anastrazole.

Doctor did mention that although my Total Test isn’t very high, since my Free Test was so high, I wouldn’t need to worry about increasing my Total Test numbers as much. However, we’ll observe how my labs look after this new protocol. Especially my prolactin and estrogen numbers.

If your E2 is still at 40 and you are dropping the HCG, why not allow estrogen to decrease on its own instead of going down the AI rabbit hole?

Your T might decrease slightly after stopping the HCG.

This is probably the result of your hormonal conditions before starting TRT. If so, it should melt away if coupled with proper exercise and diet.