T Nation

Best TRT/HRT Threads?


I know there are some good threads here posted by those on hormone therapy. But my searches aren't turning up much (frankly, I'm not sure what a good search term is on the subject)

If anyone can post some links I'd appreciate it.

I've been trying to get fit on and off for several years now - and the last 18 months have found me in a state where I both lack motivation and see little result from exercise efforts - resulting in even less desire to do... well, anything.

In January I once again got to exercising, and for the first time ever really locked down my diet. Results were "OK" (down 20# and 10%BF) - but I still lack energy, focus, and general mood. I literally doze off every day at 4:00.

I finally went and had a complete blood work-up done, and am now on TRT.

I'm 48
6'3" 209#
Total test: 282
Free test: 58
Bioavailable: 115
Estradiol: 48

Not totally "crashed" per se - but low enough that I feel like crap.

Additionally I had a day-long cortisol panel done, and my "evening" (6:00pm) cortisol level was ~400% over normal. My Doc was not surprised I was having a hard time shedding fat / gaining muscle.

I am making efforts to work on stress, diet, "activities that aren't work", and my sleep - progress is slow, but I progress.

Exercise 5 days a week (four lifting, one HIIT)
Diet is high protein, low starchy carbs - tons of veggies, beans, and lean protein. 4 - 5 meals a day, all smaller; nothing from a box or handed to me through a window. LOTS of water. Limited caffeine. Near zero added sugar (all from fruit / other food).

I've just started (3rd injection will be today) on testosterone cypionate - subcutaneously twice a week - .35ml of 200mg/ml (140mg/week).

So far - I feel nothing - hence my desire to once again hear what others on this board have gone through..... I've seen at least one thread that spoke of a "big bang" when starting TRT - so I'm already rather bummed out about my progress....



1 it takes up to 4wks for you to reach good blood levels with cyp.

2 If you are not taking an AI (aromatse inhibitor) like Aromasin,Arimidex you will feel good at first and then feel even worse than before due to E2 billed up.

3 I also like to add HCG to my protocol.

4 It would be a good idea to check TSH FT3 FT4 and RT3. I had so many problems for the last couple years with my TRT until I finally got my Thyroid in order.

5 Read the stickies they have a tone of beneficial information.


Your estrogen was a total train wreck, with TRT it can only get worse.

Why so high? It would be good to see all lab work results. Wondering if your liver is not clearing estrogens properly*. See the estradiol sticky. You will need to lower E2 to the lower 20's for this to work right, but you still need to try to find out why your E2 was high with low T numbers.

*Drugs, OTC or Rx can increase E2 levels by reducing E2 clearance.

You can edit your opening post. Add lab ranges to the data, and other available lab data.

READ the stickies, that is the best thing for now. Start with the advice for new guys sticky**, then protocol for injections, then the estradiol thread.

** then add more info to opening post


Thanks guy - wow, I've been away so long I didn't realize there was a T-replacement forum now! I was in "Over 35..." - likely why I didn't find much. Thanks mods for posting this here.

I will scan and post my full labs - I had a complete panel done.

Not sure why my estrogen was high - my doc said he will look it over on my first follow up.

My thyroid is excellent - my doc told me "People would kill for your thyroid" :slightly_smiling:

I saw one post that talked about a complete program really needing to include an AI and HCG. I will take this up with my doc. I know he has no issue with using an AI (he said it would be likely) not sure where he stands on the HCG. First follow-up is scheduled for mid-August.

I didn't realize that it would be several weeks for my levels to rise. I will keep that in mind and take this a day at a time....

I'm off to do some reading!


Tried to edit my original post and it keeps screaming "b is null" at me every time I hit the post button - whatever that means.

Well, after finding that there's a t-replacement forum and reading a bit further here's some additional information (based on suggestion in the sticky):

At the start of my HRT just turned 48


by the tape - 39". However, I wear 36" waist jeans and they are really loose

At present, 209. This is down from 228 in mid-January
Currently losing weight through "proper" diet
I expect my ideal weigh for my frame is near 190

-describe body and facial hair
Average-to-slight frame. Mostly legs (36" inseam). Fairly lean legs, most fat currently around my mid-section. Facial hair is light, always has been.

-describe where you carry fat and how changed
I have been a "skinny fat guy" since my 20's - arms and legs rather lean, fat in my belly and back.
The only change is that there has been more fat - I peaked at near 235.

-health conditions, symptoms [history]
In general, I am and have been quite robust.

Since ~42 I have noticed a decline in stamina and energy. In the last year or so I find that I have a daily "crash" at like 4:00 in the afternoon, sometimes actually dozing off. A 10 minute power-nap refreshes me, but then I cannot get to sleep at night (1:00am bed time was not unusual)
I've noticed increasing issues with memory and focus.
In the last couple years losing weight has become impossible (in my 20s/30s I could drop 20 pounds in a couple weeks)

My mood / emotional state has been in decline for the last few yeas as well. Slight to moderate depression, lack of motivation, general anxiety. But also some wild swings from happy to sad. I don't seem to "deal" with life as I did in the past....

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
No drugs - OTC or otherwise.
Never any hairloss or prostate meds
Non-smoker, non-drinker.

-describe diet [some create substantial damage with starvation diets]
Currently following guidelines from http://percisionnutrition.com/
- 4 to 5 meals daily, eating slowly, stopping when sated
- fruits and vegetables with every meal
- no processed foods
- no added sugars (only what's in the food)
- lean protein with every meal
- "smarter" carbs (beans rather than rice or potatoes) and then in limited helpings and mostly after exercise
- lots of water
- supplement with fish oil, BCAAs, multi-vitamin, zinc/ZMA, vitamin D3
Limited dairy (no milk, just yogurt and cottage cheese)
No rice, bread intake limited, and then things like spelt or Ezekiel....

-describe training [some ruin there hormones by over training]
Exercise 4x week: M-T/T-F - core training (typically 45 minutes to an hour with warm-up & stretching)
Wed: "active recovery" day - light work with emphasis on movement
Sat: HIIT - brief intervals (usually 6 to 10 minutes)
Occasionally throw in an extra 30-40 minutes on the treadmill here and there

-testes ache, ever, with a fever?
Now, 3 weeks into TRT they are aching a little (and are noticeably smaller) but nothing historical. I am sure you are likely to tell me that is not possible after 3 weeks, but I assure you it's happening.
When I get febrile they definitely ache.

-how have morning wood and nocturnal erections changed
AM erections have been absent for sometime, and nocturnal erections have almost always been non-existent for me (I believe I may have had a lifetime of low-T).
As I have started to examine more about my "boner timeline" I've come to realize that I have not had what I would call a raging hard-on for the last decade or more.
My libido is intact, and I have orgasms fairly regularly, however my erections are not exactly the stuff of legend.

Sexual function is not a primary concern for me in looking to TRT/HRT - it's the rest of it (the way I feel the rest of the day) that are the driving factors for me. A raging boner would be great - but only if I have the energy and good spirits to put it to use.....

This has been an issue. I sleep very little (4 -5 hours / night). I believe this has much to do with my hormonal state.
A test has shown that my cortisol levels are far above normal in the afternoon.
I am working on improving my sleep habits, but it is a slow boat to turn.

My physician:
After asking my primary care physician in mid-2007 about the symptoms above I was told "Yeah - you're getting older". I stopped the conversation there.
After a couple years of debating, some time spent here, and continuing decline in my mojo I finally had some blood work done, and, seeing the results, ended up finding this place:

My physician seems rather on the ball. My first appointment was an hour face-to-face where we went over my labs and talked about hormones, the endocrine system, cortisol, exercise, diet, etc.

His advice was to start with the testosterone and then look at levels in 2 months and determine if other meds were required (specifically an AI and hCG). He talked about HGH, but that is difficult to dispense legally in Ohio and not likely to be in my regimen (at least via legitimate prescription)

When I pointed out my elevated estradiol in my prior labwork he noted it and said we'd keep an eye on it (the results in the labs he ordered was in the low range of "normal")

-lab results with ranges
Here's the results of the labs I had done on my own (April 4th)

This test shows my estradiol as elevated - it's a different type of test than the one below...

Here's the results of the labs ordered by my doc (April 25th)
My cortisol levels:

I'm taking phosphatidylserine mid-day to try and reduce that afternoon spike. Doc also says my afternoon workouts are really, really bad. Unfortunately my schedule really doesn't let me do them any other time...

The doc has me taking .35ml of 200mg/ml testosterone cypionate twice a week, injected subQ. I inject Sunday evening and Thursday morning to try and stay on an "every 3.5 days" schedule.

I am 2 weeks into injections, and the changes I've noted so far are:
Good -
- I'm able to sleep a little longer in the AM (an extra hour)
Not so Good -
- my skin has become incredibly sebaceous again, particularly my face (joy)
- my libido has absolutely tanked
- my seminal volume is down by at least 50%
- my testicles have CLEARLY shrunk and occasionally (at bedtime) ache a little
...which frankly has me more than a little concerned.....


Your TRT is spiking your E2 and causing the problems that you note. That dose of T is also middling [all the more for your body weight], most need 100mg/week to get in the game.

When is your next appointment? Doc should prescribe an AI now because E2 was bogus before and can only get worse with TRT.

Acne can be transient, but that is not much comfort. If you had acne in your 20's, then this could persist for a while.

Sounds like testes are shutting down. Watch for how they hang. Doc should be able to script hCG to prevent damage to your testes, and there are more factors than fertility.

Ft3, fT4 do look good, but TSH is insane. Are you iodine deficient?

DHT follows T levels.

2nd E2 results looks like a complete lab failure! Body builders eat adex or other AI's trying to get near 10. E2=4 is pathological!

You need another lab to break the impasse. Your body and metal/mood attributes do not fit low E2. E2 ultra sensitive seems like the wrong lab order when you know E2 was high and the result should have been >29.

You may need sleep aids. Try 3mg TIME RELEASE melatonin. If that does not work, then you need chemical drugs.


August 17th. He's a bit hard to see in person (his "day job" is an ER physician - the HRT stuff is gravy cash) but he responds to email. I will synopsize my experiences so far and ask for the AI. If he's not keen on the idea I can easily get Arimidex elsewhere.

Hmm - I will try and have conversation with him. I can order the labs on my own. So an "ultra sensitive" test is NOT beneficial? I assumed by the name it was more accurate, but your comment leaves me dubious....

Yeah, I had a serious acne issue at that age. Well into my 20's actually....

This is the contradiction (I should have mentioned above) - they're not all jammed up in my body at all - in fact, they're kind of low-hangin'. Over the weekend they had something of a rebound size-wise, but I'm still concerned. I'd rather speak to the doc about the hCG now than be juggling my nuts every hour and worrying about it...

The Doc stated that the TSH number was likely due to my very elevated cortisol number. The only iodine I get is incidental from food or via my multi. I use sea salt, but even if I didn't I ditched iodized salt as a youth (when I had the bad acne - iodine exacerbates it)

I actually have some stuff that is awesome (a sadly discontinued product called SleepFast) - but I don't use it often. I need to take steps in my personal life to improve my sleep - there are things in my control that I need to adjust first (like staying up on the computer all night). As I said - I am making gains here, but they are gradual. I'd rather cultivate proper habit than turn to another supplement unless it's an absolute must....

Thanks for the feedback. Off to talk to the Doc....


So it's been a few months now, and overall I'm feeling quite awesome. Bodyfat is down, lean mass is up, energy levels awesome - etc, etc,etc. My Doc did put me on a low-dose AI - and I've also started to supplement with DIM and resveratrol, but my system seems to have also done some regulation on its own - I can readily gauge where my E2 levels are by my mood and complexion - when it elevates I get super-oily. But I'm happy to say that, other than some knee pain, things have been on a very even keel for a few months now.

This week I started hCG (I should have started a month ago, but had issues with getting the hCG) - and my Doc has suggested 1,000iu twice a week.

I can't find comments from anyone else running it this high. Doesn't that seem to be a bit much? My Doc insists that the 100-250iu levels are for weight loss, and not for TRT augmentation. I'd like to hear what you guys think.