T Nation

Beginner Questions


#1

I've been on TRT for about a year now and for what ever reason I'm just not feeling like I should. I have no problem getting my TT in the normal range and often 900 or 1000. But my E2 is where I'm having the most problems. I see lots of information about AI over responders but what about no responders?

I started out taking .25 Arimidex ED but it was having no effect on my E2. So I switched over to Aromasin, which I take M,W,F. It did come down a bit but still not where it needs to be. I know that the high E2 is what's making me feel like crap.

Should I increase my Aromasin or is there something else I should consider for controlling E2?

I received results for my latest blood work yesterday.
TT = 1114
E2 = 72

My Urologist wants me to inject a little less T in hopes that it will bring down the E2. Does this make sense?

I apologize if I haven't provided enough information. Please let me know if there is anything else that would be helpful. I will do my best to provide the additional info.

Thanks for your help.


#2

I should also include that I inject HCG twice a week and my Urologist has me taking Clomid M,W,F. So that's T injections, HCG injections, Clomid, and Aromasin.


#3

You were doing this:
.5ml test cypionate injected once/week
1ml HCG twice/week
Clomid 3x/week
Arimidex EOD

The above is insane.

Clomid dose is what? If that is working and you are producing LH, the LH+hCG can be expected to cause a lot of T-->E2 inside the testes and competitive aromatase inhibitors cannot work there.

Please read the advice for new guys sticky. If you had done that, you would not be in this situation.

What is 1mg hCG? hCG is dosed in international units [iu]. 2000iu per week is really asking for trouble and is expensive and unnecessary.

Suggest:
100mg T per week in divided doses, twice a week or EOD
250iu hCG SC EOD
no clomid
1mg anastrozole per week in divided doses

For fertility, you can switch to clomid from hCG for a while sometimes, but may not be needed at all.


#4

Thanks for responding KSman!

Yes, I agree it does not seem right to me either. In fact, I asked my doctor on more than one occasion if she was positive I needed to be taking Clomid and HCG at the same time. Each time she assured me that the Clomid was required for fertility.

I did read the very informative stickys when I first started my treatment. I brought the new guys sticky with me to my doctor visit and told them I think this is where I need to be. They got me most of the way there but insisted on adding the Clomid.

Here is my most current regimen:
.5ml test cypionate injected once/week
1ml HCG twice/week
Clomid 3x/week (50mg)
Aromasin 12.5mg ED

Here is what my HCG prescription says:
HCG 2000U/ML solution
Inject 1ml 2x/week
Im not sure how to convert the ml to international units. Can you assist with that?

Keeping fertility in mind can you tell me what a Clomid / HCG cycle might look like? Would it be HCG for a month, Clomid for a week, then back to HCG?

Im going to use the information you provide and have a talk with my doctor. Ive attempted to talk to them about the HCG / Clomid combination before without any luck. How would you recommend I approach this and explain to them my reasons for having too much E2?

I will say this about my doctor, she is very open to listening to new ideas and has been very accommodating to me and my suggestions. However, she is really stuck on this Clomid thing so I need some information to back up my plan.

Thank you so much for taking the time to help me out. Iâ??ve read most of your post on this forum so I know how busy you are.


#5

Its your life. You always have the ability to reduce your dose.

You are injecting 4000iu of hCG per week, that is more than 4X what is needed and we have seen other guys with the same E2 issues as you with ineffective AI. All of this is made worse by whatever LH the clomid is causing.

You risk desensitizing your LH receptors.

What needs to be done is very clear. Suggest that you go to 100mg T per week in divided doses and stop clomid, reduce hCG to 250 iu EOD. Then do labs. If testes shrink, then it is clear that your LH receptors have been changed. In that case, you can ramp up hCG dose to try to find what works while you watch for E2 levels that are not manageable. Your doc is enthusiastic but only knows enough to be dangerous. What your doc is doing looks more like bro-science than anything else.


#6

Can you help me understand the conversion of ml to iu? What does 250iu look like in a 1ml syringe?

Also, in your first response you mentioned what sounded like cycling between Clomid and hCG. Is this something I should consider for fertility?

Once I figure out what 250 iu looks like I will reduce my hCG. Iâ??m also going to stop Clomid. I had a feeling that Clomid and hCG was too much but could not find any data online to prove it.

Im going to put this information together and email it to my doc and hopefully help her understand my reasoning for stopping the Clomid. Thanks for all your help.


#7

Use 0.5ml insulin syringes. 29 gauge will work for T and hCG

If hCG is 1000iu/ml, you need .25 ml or "25" on an insulin syringe. If 2000iu/ml, 0.125 and "12.5"

hCG is a natural human hormone. Clomid and Nolvadex are not and are not something that you want to take for the rest of your life. You do not need much hCG to get the job done. You can monitor sperm counts to see how you are doing. With hCG, most do not have a problem with fertility. You can switch from hCG to SERM occasionally for a tune up with the FSH that will be released. That would be helpful if needed.

Also suggest Nolvadex, not Clomid. Both are dosed the same and you might do well with 10mg/day of either.


#8

If hCG is 1000iu/ml, you need .25 ml or "25" on an insulin syringe. If 2000iu/ml, 0.125 and "24.5"

Looks like a typo. If 2000iu/ml, 0.125 and "12.5"


#9

fixed


#10

Thank guys for the information. I've already stopped the Clomid and I'm cutting my hCG intake in half for now. I will keep track of my sperm count and adjust as needed.

You mentioned switching from hCG to SERM for a tune up. Would this be something like a month on hCG then a month on SERM? How would I know when I need to switch for a tune up? Is there something in the blood work I should watch for?

I think for now that SERM will have to be Clomid since I still have lots of it. I will ask for the Nolvadex when I run out.

Thanks again for all your help.


#11

The hCG - SERM swap is a great idea. But there really is no hard data to suggest how to do this. So you can only guess. Perhaps 1 week of SERM per month.