I would highly advise against AI, and your ratio is not a specific magic number. You’ll have to find your own, though it seems like somewhere in the 15-19 TT/E2 range is pretty common.
If I were you, I would get on 165mg per week split into 3 injections (M, W, F), or even daily subQ. Whichever protocol you choose, stay on it for around 3 months as @hardartery advised before you make an assessment.
For me personally, I went to subQ daily injections from doing IM 3X a week and found that I have a sweet spot at around 168mg / week (24mg daily). I too am a very low SHBG guy (very low teens).
As to the side conversation about some guys feeling worse at higher doses (strong heartbeats, insomnia, etc.), do you guys think this could have anything to do with extremes in SHBG?
I ask because I have these same exact issues when I go up in dosages past 185mg or so a week, and I have an extremely low SHBG. My Free T sits in 25-28 range at a Total T of only around 750-800 on 165mg a week.
I’m theorizing that us very low SHBG “outliers” may just be overly sensitive because higher doses shoot Free T through the roof.
I have thought about this as well and it stands to reason that anyone with lower SHBG would be overly sensitive to hormones because they get higher free and bio-available levels out of a regular, or even lower, dose.
I’ve looked for trends and association relative to SHBG, such as low SHBG guys need more frequent dosing, etc. Cannot find them.
There’s this guy. The same 200mg a week I take that puts me at 200-220 free T puts him at 380! Been with us for years and feels great, we’ve changed nothing from day one.
On the other hand, if this guy is reporting the side effects similar to yours, I’m thinking I know why. His testosterone (free) is through the roof! We’re lowering his dose.
Check this one, this guy was taking 400mg once every two weeks. Felt good for about three days, and horrible the second week. He’s a GP, doesn’t prescribe testosterone, but came to me because a couple of his patients were seeing me for TRT and they told him how great they were doing. The lab below is at day seven following a 400mg injection!
I have no explanation for this, but it’s working for him and he is thrilled.
For me, the lesson is that if you see enough patients, you’re going to come across some weird shit. When that happens, I’m flexible and remind myself to keep an open mind, and not try to shove everyone into the same protocol box that works for the 95%+ of the rest of the guys. Even if I cannot fully understand it or explain why it works.
I agree, great feedback @highpull. I haven’t tried Melatonin/DHEA but sleep fine on Test dosing below 150mg/week, so it was only above that level that insomnia issues started. The only reason I went above in the first place is the lack of libido, which is still non-existent at a range of doses. On a lower dose of 100mg/week, my Total T is 600-ish but Estradiol is strangely below 10ng/mL and I felt pretty sluggish so that might rule out that I’m an outlier that does better on lower doses.
@highpull I noticed you commented in the past you have guys doing perfectly fine on weekly doses and the majority of patients are on weekly? With you only putting the outliers on different injection frequencies?
Yes, that is correct. Almost all start with once a week and almost all are between 140-200mg, most start at 160-170mg. The testosterone is esterified, it’s supposed to be taken infrequently. Works for most.
Great thanks, you seem to have the largest “database” on this forum so very helpful.
What would be the top 1-2 complaints/issues from guys that have been on a Testosterone-only regime for longer than 1 year but are still struggling to dial-in? Is it libido? Sleep? Energy levels? Or is it an even spread among the top issues?
We don’t “dial-in”. To me, that implies there are a lot of minute adjustments to be made. Off the top of my head, I can’t think of anyone taking testosterone only for more than a year and struggling at all. Some may decide TRT isn’t for them, for various reasons, and stop, but that is well within the first year.
What does happen is that some, after being on TRT for an extended period, start experiencing something weird. It can be frustrating and sometimes difficult to pinpoint. However, to answer your question, number one is something related to estrogen, fluid retention, sexual issues, emotional. Of course, there can be other factors involved.
Here’s an example, one of the guys, a patient for over two years, got sick and his PCP put him on prednisone. He’s on it for three weeks when, surprise, his BP elevates to point that he goes to the ER. ER doc tells him testosterone caused it and he has to stop. He does.
Is there a standard dosing of arimidex for a once per week trt protocol?
I think I recall years ago a dr ( can’t recall his name but he was the one who committed suicide) saying a one time arimidex dose per week would be good for a once per week trt protocol. Thoughts?
No. Most do not use it and even fewer start with it.
That would be Jon Crisler. I have some who use once a week, usually 0.25mg. Some use less. Some more. They use as low of a dose and frequency as possible. However, there are a couple TRT clinics in my area for whom the dose is twice weekly, probably considering the half life of anastrozole is about 48-50 hours. We’ve seen a number of their patients come in, they are all on 150-200mg a week testosterone, 1mg twice a week anastrozole, and 500IUs hCG three times a week. It seems obvious they use a standard protocol for all.
My guess is that those practices who use AIs for everyone use it twice weekly.
He changed his tune on AI’s towatds the end. He discussed it on Jay Campbell’s podcast. He stopped using it for most patients unless they absolutely wanted it.
This is awesome information @highpull. My free test has always been upper range or just over (range 8.7-25.1), I briefly had it as high as 30.
Edit: Is the reason a higher dose is effective is boosting the free t? Should I aim to get mine in the mid to high 30’s via the higher dose (soley for libido issues).
Do you always put HCG into your patients protocol and how important is it for the libido in the patients after years of being on TRT-only?
Is it really true that AI doesn’t work at all against HCG induced estrogen increases? If you have a patient in which you add in hcg and that person starts getting estrogen problems, is there really nothing you can do to fix this other than to stop hcg or lower the doses?
No, only if they are currently trying to conceive or wish to avoid testicular atrophy. Some report increased libido with it but I believe that is likely due to increased testosterone.
Yes and no. Testosterone produced due to hCG will aromatize. AIs will limit that. Intratesticular E2 stimulated by hCG will be uneffected.
Few stay on hCG that long. Those on indefinitely are using a small dose. I’m unaware of any who have had trouble with it. If so, I would likely discontinue it or decrease the dose.
So lets say you use 150mg of testosterone and 12.5mg Asin e3.5d with perfect e2. If you then add in hcg and you are one that aromatizes a lot from HCG, raising Asin in this situtation would be pointless (to make things easier, lets assume that the total testosterone is the same in trt-only and trt + hcg).
Also I saw this thread regarding dhea-s, adrenal insuffiency and hcg. DHEA-S Serum as a Predictor for Adrenal Insufficiency Is this all bro-science or could a higher dose of HCG (1000-1500iu per week) in people that have adrenal fatigue (or hpa dysfunction that some prefers to call it) with low levels of dhea-s and possibly cortisol be helped and get the adrenal up and running again?
