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Confusing New Bloodwork. Do I Increase AI Dosage? Lower T Dosage?

Hi guys,

We introduced HCG into my TRT last July 2019. My protocol has been the same since then, that is test has been 75mg once a week with .25mg of anastrozole once a week with the injection. hCG has been 500units every 3rd day. Two of my last results from last Nov '19 then this January…

Nov. (few days before next T injection)
Total T: 1106 Ng/ml out of 264 - 916 scale
Free T: 26 pg/ml out of 8.7 - 25.1
Estradiol: 21.5pg/ml out of 7.6 - 42.6

Jan. (day of next injection)
Total T: 787ng/dl
Free T: 15.9 pg/ml
Estradiol: 26.2 pg/ml

Now nothing has changed in my protocol, but my test results as of this last Thursday on the day of my next injection are:

Total T: 961 ng/dl
Free T: 18.0 pg/ml
Estradiol: 46.4 pg/ml

Now the doctor said last Nov/Jan that the T being a little high was fine. My concern now is this high E2 level all of a sudden. I have had several symptoms of high E2, but did not associate them as being related to that until now (low sex drive since around February, softer muscle mass, worse erections, extra emotional, prostate type issues such a weaker urinary flow).

Anyone have any thoughts on this? Is there something that would cause a change to make my E2 spike this year that I should worry about? Is it simply an adaptation to the AI dosage that needs to be adjusted? Appreciate any help with this situation as I’m not sure what the next best steps would be.

Why do you think you need the AI at all?

Hint: you don’t. Drop it.

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@ csugrad2002 Sorry, that got posted before I was finished typing from my phone. Just finished it.

Note: started AI couple years ago after my E2 was always high outside of the normal range.

Why are you using hCG?

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@highpull fertility; cured the ‘sucked up’ testes and aches that it caused; overall better feeling while on the TRT compared to the previous couple years of it before introducing HCG.

Get off the AI

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OK, I’d discontinue the anastrozole and decrease hCG to 250IU MWF.

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Can you elaborate? To add more personal info, I went on the AI a few years ago after my E2 levels were high (45+ every lab) from the TRT and I was showing symptoms of it, so the AI brought it down into the 20’s in which I felt better and got rid of the symptoms similar to what I have again now.

To add more personal info, I went on the AI a few years ago after my E2 levels were high (45+ every lab) from the TRT and I was showing symptoms of it, so the AI brought it down into the 20’s in which I felt better and got rid of the symptoms similar to what I have again now. Can you expand on how stopping the AI and reducing hcg would help? Also my GF and I are planning on kids in the next year or two, so I’m concerned about potentially lowering hcg too much and not getting as much of a fertility benefit?

Also just to be clear, I’m asking for expansion in order to understand, not to put doubt on any suggestions. I just have a feeling my Dr will recommend increasing the AI to combat the e2 so I want to make sure I’m covering all bases a bit more before talking to him. I haven’t been on this board in a while but I see some opinions have changed and even the stickies are gone, so I feel like I may have missed some new info over the last year or so.

Thanks!

You’re following what is referred to as the bro-science myth (that we were all once guilty of), that the magical range of E2 is 20-30. Nothing could be further from the truth. If you’re experiencing symptoms, it has nothing to do with E2 and everything to do with your protocol requiring some fine tuning. E2 of 45 is not high by any stretch of the imagination. E2 is a paracrine hormone making serum levels virtually irrelevant. Not to mention, the ranges aren’t based on men on TRT. What most men consider to be ‘high E2 issues’ are basically just symptoms that occur due to fluctuating hormones. Sometimes injection/application frequency needs to be increased in order to keep serum levels more stable and these symptoms go away. Symptoms that occur at the onset of TRT are often normal and go away on their own once things balance out. HCG has a tendency of spiking E2 in some guys which throws off the balance the body is trying to maintain. I only recommend HCG for fertility purposes otherwise it’s usually best avoiding it. Some men do feel better with it but they should only use it once their testosterone protocol is optimized. If your doctor is giving you an AI to combat your 45 E2, holy crap… you need a new doc.

Watch this to get caught up:

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Ok, I know there are outliers and we’re all different. I think, at TRT dosing, very few have trouble with E2. As a competitive weightlifter, we took 200-800mg of testosterone weekly on top of other injectables and oral anabolic steroids. Not many had trouble related to estrogen, which must have been at sky high levels given what we were doing, there were some, but no one got off them because of it.

I think you can decrease hCG and still have the desired effect. Men have very low hCG levels and over time, some start having trouble with it. I think it is more likely to be causing your symptoms than estrogen. You can even go on and off, unless actively trying to conceive.

I don’t think those E2 levels are high enough to be an issue, generally. I talked to two guys today who were pushing 100. Both doing great. I know, it’s only two, but this is typical and consistent in my experience.

Also, I don’t know the rest of your history, but I would avoid blocking estrogen for overall heath reasons, particularly cardiovascular health, bone and joint.

I also suspect your doctor has a number in mind, basing treatment recommendations on it, and I don’t agree with that approach.

But, this is just me. If you find something that works best for you, I’m not stepping in to that. Good luck moving forward.

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This… all of this… up above… read it twice if you need to.

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Ye I dunno about this. Its so freaking common that guys issues resolve after they get their e2 down with AI - as did i, even tho very randomly.

If you suffer from the typical high e2 symptoms of bloating, low libido, shitty erection, moodyness, emotional tantrums/acting like a woman, defensiveness - then you use AI, get your estrogen down - suddenly your libido is great, erection is strong, bloat is gone, u feel calm and collected: Then it is indeed the e2, that is quite obvious.

But it isn’t. Man I have so much I can teach you… And I would…but you’re stuck. Let me know when you can open your mind a bit.

I thought that for almost 7 years. Then @dbossa set me straight, and showed me that it wasn’t an E2 issue. I’m sensitive to hormones, and all I had to do was let my body adjust itself WITHOUT AN AI. Now that my body has adjusted, I haven’t touched the poison since January. No more joint pain, and my feeling of “well-being” is better than ever.

Open up your mind, listen to @dbossa, and your body will thank you.

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Ye im trying to understand it but im naturally stubborn.

Its quite logical to me.

When I used large doses of T only = No libido, low mood.
Added AI = Libido appears and cock gets hard again, mood gets better, albeit for a short period of time before estrogen went too low (or too high) again.

Only by adding some freaking AI, things go better - what AI does is decrease estrogen, hence it would make sense that estrogen can actually be too high for an individual, as things get good, or better, when estrogen is reduced.

Or does AI do some other fucking magic im missing here? What would else be the reason of symptom resolution when estrogen gets decreased?

I’m stuck right with ya equal
I’m trying the Bossa Way and it’s miserable tried increasing dose and it just wasn’t working to many side effects - no sleep - Anxiety -gained 6lbs in 3 days bloated to hell and just not feeling it.

Dropped back to 20mg daily and much better. I still believe micro dosing ai is good for me but I’m trying bossas way For a while

It’s pretty simple, you’ve researched the pros and cons of blocking E2. You’ve tried different protocols and achieved differing results. Once you’ve found what works for you, go with it. Everyone responds differently.

I see too many one size fits all approaches to TRT. Saw it again today. If the patient is coming from particular TRT practices, I don’t have to ask what they are taking.

@highpull I’m curious… Being a fan of Rouzier’s work, do you ever prescribe an AI in your practice? If so, what are the signs you need to on your opinion?

So two things here. Either that dose was too high for you or you didn’t wait long enough for your body to adjust. If you feel better at 20mg daily then that’s usually a good sign that it’s either a better dose for you or you made a jump up a bit too high and your body didn’t like it. When it comes to water retention, this can occur with a lot of guys when hormones are in flux. Just taking a mild over the counter diuretic can help flush the body out and it typically doesn’t return. Anxiety and insomnia typically indicate a dose that was too high (been there, done that).

None of this has anything to do with E2 levels as you can see. Hope this helps.

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