T Nation

Aussie Bloke After Advice on Protocol, Test and e2 Levels

Firstly I want to thank all the guys on here who post and offer advice / expertise on TRT. In Australia its near on impossible to find a knowledgeable doctor and as such I have scoured the forum for information on the subject.

6 foot
34 inch
Hair on chest, arms and legs
Carry weight around belly
-anxiety & depression (not debilitating and nil meds)
-previously used propecia
-clean diet of lean meats, salad, vegetables
-lift weights 4-5 times per week and 25 mins cardio on those days
-testes ache only when started TRT
-occasional morning wood before TRT now daily

As per above stats I am a 40 year old male who presented with many of the low T symptoms including depression, fatigue, brain fog, low libido, weight gain and loss of lean muscle mass. I am still in reasonable physical condition - 180cm & 90kg but have noticed a deterioration over the last couple of years in lean muscle mass despite maintaining the same training regime.

Approximately 6 months ago I foolishly started taking propecia for MPB with immediate adverse physical and mental side effects. I ceased taking the propecia after one month due to these side effects the most concerning of which included ED, brain fog, fatigue and persistent burning sensation in the nipples. After talking to a mate about the symptoms mentioned above - before, during and after propecia he recommended I get some blood work done and mentioned TRT.

Pre TRT Blood work

TSH (Roche) 1.25 mU/L 0.5 - 5.5
S Folate: 36.7 nmol/L >6.0
Total Vitamin B12: 559 pmol/L 200 – 700
S Sodium: 142 mmol/L 135 - 145
S Potassium: 4.7 mmol/L 3.5 - 5.5
S Chloride: 101 mmol/L 95 - 110
S Bicarbonate: 23 mmol/L 20 - 32
S Urea: 6.9 mmol/L 3.0 - 8.0
S Creatinine: 96 umol/L 60 - 110
eGFR 86
S Bilirubin: 11 umol/L 4 - 20
S Alkaline Phosphatase: 75 U/L 35 - 110
S Gamma-GT: 6 2 H U/L 5 - 50
S ALT: 1 4 6 H U/L 5 - 40
S AST: 6 1 H U/L 10 - 40
S Total Protein: 67 g/L 66 - 83
S Albumin: 41 g/L 36 - 47
S Globulin: 26 g/L 26 - 41
S Cholesterol: 4.4 mmol/L 3.5 - 5.5
S Triglycerides: 1.0 mmol/L <1.5
S HDL-Cholesterol: 1.45 mmol/L >1.00
S LDL-Cholesterol: 2.5 mmol/L <3.5
LDLC/HDLC 1.7 <4.0
Chol/HDLC 3.0 <4.5
Fasting S Glucose 4.9 mmol/L 3.6 - 6.0
LH 6.2 IU/L 1.8 - 9.2
Prolactin (Total) 241 mIU/L 90 - 400
S Oestradiol 123 pmol/L <160
S Testosterone 20.9 nmol/L 9.9 - 27.8
SHBG 49 nmol/L 17 - 56
Free Test (VC) 357 pmol/L 170 – 670
PSA 0.62 ug/L 0.2 - 2.1
B Glycosylated
Haemoglobin (Hb A1c):
5 . 7 H % 4.4 - 5.6
HBA1c (IFCC) 3 9 H mmol/mol 25 - 38
Estimated Average
Glucose 6.5 mmol/L
HAEMOGLOBIN 155 g/L 130 - 180
Haematocrit 0.49 0.39 - 0.51
Red cell count 5.0 x10^12/L 4.3 - 5.8
M.C.V. 97 fL 80 - 100
M.C.H. 31 pg 27 - 34
M.C.H.C. 319 g/L 310 - 360
RDW 14.4 11 - 17
PLATELETS 194 x 10^9/L 150 - 450
WHITE CELL COUNT 5.9 x10^9/L 4.0 - 11.0
Neutrophils 3.6 x10^9/L 2.0 - 7.5
Lymphocytes 1.5 x10^9/L 1.0 - 4.0
Monocytes 0.6 x10^9/L 0 - 1.0
Eosinophils 0.1 x10^9/L 0 - 0.5
Basophils 0.0 x10^9/L 0 - 0.3

My physician is pro testosterone therapy and stated I was in the low normal range and may benefit from treatment.

In November 2017 I my doctor prescribed the following protocol. 125mg test IM & 1mg of adex weekly. I has already read a lot on this forum and went with the following 3.5 day protocol: 62.5 mg test e subq, 0.5mg adex,

Initially I felt amazing both physically and mentally but within a week I felt lethargic / moody and had persistent burning pain in the left pec, predominantly above the nipple. I also had a strong aching pain in my right testicle. Concerned about gyno I jacked up the adex to 0.75mg and after reading about HCG I requested a script from my doc who prescribed 1500 IU once a week . I decided to take 500IU HCG every 3.5 days. The pain in the chest continued but was transient in nature so I had an ultrasound which was clear of any masses or glandular tissue.

I had further blood taken on 12/01/18 which showed I had high free test but crashed estradiol.

6 Weeks TRT blood work

S Oestradiol <44 pmol/L <160
S Testosterone 3 1 . 8 H nmol/L 9.9 - 27.8
SHBG 30 nmol/L 17 - 56
Free Test (VC) 8 1 8 H pmol/L 170 - 670
Calculated free testosterone (cFreeTesto) estimates the biologically active
fraction of the testosterone.

2 weeks ago I commenced an EOD protocol. 30 grams of test, 250 IU and .125mg of adex. I immediately ceased adex after receiving the follow up blood work for 7 days before reducing the dosage to .125mg.

As you can see my doctor is happy to prescribe test, HCG and adex but from what I have read the weekly protocol and dosages are not current best practice.

In the last couple of days the burning nipple thing has returned. Could that simply be Estrogen rebound after reducing adex?

I guess really I am hoping for advice on the following:

  1. Are my test levels too high after 6 weeks?
  2. Should I change my protocol? What do you recommend?
  3. Thoughts on crashed E2 and Adex dosage?
  4. Any explanation for nipple sensitivity with crashed E2?

I hope I have posted this in the appropriate place - thanks in advance gents.

It sounds like your doctor is not that bad. Im not that great at reading labs that use those units of measure. I will let another do that.

I sounds like you have gone over the stickies but

My advice based on not enough information yet.
You seem to be changing your protocol too quickly, slow down. One change at a time
Going to twice a week SQ injections was a good idea. as was dropping your Adex dosage
But you need new blood tests before changing your protocol again. It takes a could of weeks for your E2 to drop. Changing your protocol based on symptoms alone is not a great idea. In some cases a little Adex goes a long ways. others need more. Some need none. Try to give us more info before the smarter guys here get to you. Read the stickies, answer the questions, don’t make a new thread just work with this one

This constant shotgunning isn’t going to work, it seems like you’re running the show and your doctors is just along for the ride happy to prescribe whatever. HCG once a week is stupid as the half life is 2-3 days.

Your going to have hormonal imbalances after a protocol changes for 4-6 weeks, you increase/decrease AI dosing only after labs confirm E2 levels, if you chose to do it any other way you will never find a balance.

When you’re tired of feeling like crap, 50mg twice weekly, HCG 2-3 times weekly and .5mg AI taken at time of injection of T. However I always recommend the smallest dose AI possible.

I predict you will eventually quit TRT if you don’t slow down and quit this "I’m changing this because I feel like this today, nipples got sensitive so I increased AI dosage today without first confirming through labs.

The only way you will balance out is if you make small course corrections every couple of months, every time you make a change it takes 6 weeks for those ripples to reach the other side of the pond.

I agree that changing my protocol was a bad idea. I guess you live and learn. I think I’ll stick with the eod protocol and dosages as they are until I get blood work done. I am due for bloods in a few weeks anyway. I may well end up simplifying the protocol down the track to 50mg twice a week etc as you mentioned but I’m loathe to change everything yet again. I’d certainly prefer my doctor to be driving this ship but his recommendations fly in the face of the experts on here and the docs leading the way in the states. Appreciate the replies and advice.