T Nation

Dropping Dose & Splitting It?

I started TRT last April. I have been on 200mg/week split into twice weekly injections, and taking .5 anastrozole with each injection. Labs were always very good up until my most recent one in December. I have started having issues with elevated blood pressure, minor bloating, etc. I feel like the honey moon phase of high Testosterone levels is over.

I have been kicking around the idea of dropping my dose down to 100mg/week split into two injections with maybe .25 anastrozole taken only once per week, or .25 taken with each injection. I’m wondering if anyone with experience here thinks this would be an ok idea to try. Here are my last labs:

000173 - LIPID PANEL
002210-CHOLESTEROL 185 MG/DL <200 No

002232-TRIGLYCERIDES 51 MG/DL <150 No

002220-HDL CHOLESTEROL 63 MG/DL >39 No

002237-CALC LDL CHOL 112 MG/DL (H) <100 No

002238-RISK RATIO LDL/HDL 1.77 RATIO <3.55 No

    UNLESS OTHERWISE INDICATED, ALL TESTING PERFORMED AT:

CLINICAL PATHOLOGY LABORATORIES, INC. 9200 WALL ST, AUSTIN, TX 78754
CLIA NUMBER 45D0505003 CAP ACCREDITATION NO. 21525-01

001000 - CBC W/AUTO DIFF WITH PLATELETS
001001-WBC 5.7 K/UL 4.0-11.0 No

001002-RBC 5.71 M/UL (H) 4.10-5.70 No

001003-HEMOGLOBIN 17.4 G/DL (H) 13.0-17.0 No

001004-HEMATOCRIT 49.6 % (H) 37.0-49.0 No

001005-MCV 86.9 fL 80.0-100.0 No

001006-MCH 30.5 PG 27.0-34.0 No

001007-MCHC 35.1 G/DL 32.0-35.5 No

001038-RDW 13.5 % 11.0-15.0 No

001008-NEUTROPHILS 55.5 % 40.0-74.0 No

001010-LYMPHOCYTES 30.8 % 19.0-48.0 No

001011-MONOCYTES 10.6 % 4.0-13.0 No

001012-EOSINOPHILS 2.4 % 0.0-7.0 No

001013-BASOPHILS 0.7 % 0.0-2.0 No

001015-PLATELET COUNT 224 K/UL 130-400 No

    UNLESS OTHERWISE INDICATED, ALL TESTING PERFORMED AT:

CLINICAL PATHOLOGY LABORATORIES, INC. 9200 WALL ST, AUSTIN, TX 78754
CLIA NUMBER 45D0505003 CAP ACCREDITATION NO. 21525-01

002606 - PSA, TOTAL
002606-PSA, TOTAL 0.72 NG/ML <=4.00 No

 NOTE: Methodology is Roche Cobas Electrochemiluminescence
 Immunoassay traceable to WHO reference standard 96/760.


    UNLESS OTHERWISE INDICATED, ALL TESTING PERFORMED AT:

CLINICAL PATHOLOGY LABORATORIES, INC. 9200 WALL ST, AUSTIN, TX 78754
CLIA NUMBER 45D0505003 CAP ACCREDITATION NO. 21525-01

002675 - ESTRADIOL
002505-ESTRADIOL <17.0 PG/ML <=60.7 No

   Note: Estradiol sensitivity is 17 PG/ML.  If lower levels of
         quantitation are necessary, consider ultrasensitive
         estradiol by LC-MS/MS.


    UNLESS OTHERWISE INDICATED, ALL TESTING PERFORMED AT:

CLINICAL PATHOLOGY LABORATORIES, INC. 9200 WALL ST, AUSTIN, TX 78754
CLIA NUMBER 45D0505003 CAP ACCREDITATION NO. 21525-01

002830 - TESTOSTERONE
002830-TESTOSTERONE 1288 NG/DL (H) 300-1080 No

    UNLESS OTHERWISE INDICATED, ALL TESTING PERFORMED AT:

CLINICAL PATHOLOGY LABORATORIES, INC. 9200 WALL ST, AUSTIN, TX 78754
CLIA NUMBER 45D0505003 CAP ACCREDITATION NO. 21525-01

002835 - TSH, THIRD GENERATION
002821-TSH, THIRD GENERATION 3.770 UIU/ML 0.400-4.100 No

    UNLESS OTHERWISE INDICATED, ALL TESTING PERFORMED AT:

CLINICAL PATHOLOGY LABORATORIES, INC. 9200 WALL ST, AUSTIN, TX 78754
CLIA NUMBER 45D0505003 CAP ACCREDITATION NO. 21525-01

009179 - COMPREHENSIVE METABOLIC PANEL
002217-GLUCOSE 95 MG/DL 70-99 No

002208-BUN 18 MG/DL 6-20 No

002214-CREATININE 1.04 MG/DL 0.80-1.40 No

023000- eGFR AFRICAN AMER. 110 ML/MIN/1.73 >60 No

023001- eGFR NON-AFRICAN AMER. 95 ML/MIN/1.73 >60 No

002235-CALC BUN/CREAT 17 RATIO 6-28 No

002231-SODIUM 142 MEQ/L 133-146 No

002228-POTASSIUM 4.4 MEQ/L 3.5-5.4 No

002215-CHLORIDE 100 MEQ/L 95-107 No

002206-CARBON DIOXIDE 27 MEQ/L 19-31 No

002209-CALCIUM 9.8 MG/DL 8.5-10.5 No

002229-PROTEIN, TOTAL 8.1 G/DL 6.1-8.3 No

002201-ALBUMIN 5.3 G/DL (H) 3.5-5.2 No

002240-CALC GLOBULIN 2.8 G/DL 1.9-3.7 No

002234-CALC A/G RATIO 1.9 RATIO 1.0-2.6 No

002207-BILIRUBIN, TOTAL 0.4 MG/DL <=1.2 No

002204-ALKALINE PHOSPHATASE 80 U/L 40-112 No

002218-AST 28 U/L 9-50 No

002219-ALT 36 U/L 5-50 No

    UNLESS OTHERWISE INDICATED, ALL TESTING PERFORMED AT:

CLINICAL PATHOLOGY LABORATORIES, INC. 9200 WALL ST, AUSTIN, TX 78754
CLIA NUMBER 45D0505003 CAP ACCREDITATION NO. 21525-01

Abnormal Flags Legend

Flag Description Flag Description
L Below Low Normal A Abnormal
H Above High Normal AA Critical Abnormal
LL Alert Low S Susceptible
HH Alert High R Resistant
< Panic Low I Intermediate

Panic High NEG Negative for Drug Interpretation Codes and Discrete Microbiology
N Normal POS Positive for Drug Interpretation Codes and Discrete Microbiology

I would absolutely not recommend cutting your dose in half. If you think the honeymoon phase is over now, try that out and get back to me. I don’t think you’d enjoy it.

Why are you taking an AI? 1mg a week is probably what’s hurting you more than anything else.

Stop taking your AI. Go cold turkey. Give your body a few weeks to adjust. You may feel worse before you feel better. You do NOT want to be taking an AI… especially 1mg a week.

Do you want some videos to watch on this subject? I’ve done several.

Thanks for the reply. I’m taking an AI because I began my protocol without one. When I went in for bloodwork 4 weeks after beginning, my E2 was at 78. I was placed on it then.

I used to very foolishly play around with pro-hormones and steroids when I was in my teens/early 20s. This up and down jacking with my hormones led to a host of problems. The biggest was when I got complacent and didn’t use a proper PCT, and thus ended up with a pretty severe case of Gynecomastia. I’ve since had surgery to correct the Gyno, but all the childish experiments in my younger days left my endocrine system tanked. To be honest, after experiencing true gynecomastia first hand, I’m honestly terrified to try TRT without some sort of AI. I would love to be able to throw the AI in the trash, but it’s a legitimate fear I have.

You’ve been taught that estrogen causes gyno and, believe it or not, it isn’t the case. Your estrogen is LESS THAN 17 (their measurement system cannot measure any lower than that). This means it could be 16 or it could be 1. You have no idea. I know plenty of guys with E2 over 100 doing better than both of us combined. You have no labs for Free Testosterone (this is the most important one to measure). At least if you had SHBG I could make an educated guess as to what your free is but you don’t have that either. Total T of 1288. Lots of guys here will say “Supraphysiological!!” but it’s a non-concern. Your levels aren’t anything crazy from my standards.

I’m going to post a few videos on the subject that I’ve done on my YouTube channel. Give me a moment.

Interview with Jordan Grant (we will be doing another one soon going more in-depth into this subject)

Me discussing gyno:

One more:

I’ve had gyno before TRT and take 200mg with no AI and my estrogen is 77 (literally same as yours) and haven’t had any gyno issues. If you’re worried about gyno get some Tamoxifen and keep it on hand. Otherwise you’re making yourself get half the benefits because you’re scared of something that hasn’t even happened yet. You’re screwing yourself for no reason. Plus the Tamoxifen is a better choice for gyno anyway. It not only can prevent it but can reverse it if you have it.

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Drop it. E2 isn’t bad. Mine is 73, no issues.

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Dexter, at that high E2 do you feel symptoms related to high estrogen? You said you haven’t had Gyno at that level while on TRT, but have you get anything else?

Yes, not knowing exactly where my E2 is at is bothering me. I’m also not sure why they didn’t run free test or SHBG. I do labs after I finish a vial, and my next lab will be scheduled for next Friday. I will make sure one, or both, of those tests are run. You’ve now got me wondering if I could drop the AI next week and see what my labs look like when I get tested Friday. You may be right, and I may not need one. I’m definitely in agreement that 1mg a week is obviously too much for me. If anything, I may dial it back to .5 a week starting Monday.

There is no such thing as symptoms of high estrogen. I know this will break your head (it broke mine at one point).

Hormone fluctuations throughout the week can cause issues. Some men can do one injection a week and be fine. Others need to do more frequent shots.

Some men take too much and that causes issues (their bodies just can’t handle it)

Some men don’t take ENOUGH and that causes issues (androgen deficiency)

There are LOTS of reasons to have issues.

Here is something else that will break your head:

The doctors that I deal with don’t even MEASURE it anymore because they realize half the benefits you are looking for on TRT comes from the conversion to estrogen. As long as you are worried about something you should be worried about, you’ll never get it figured out. It will be dose and protocol dependent.

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By the way, you don’t just drop and AI and do labs a week or two later. There is no reason to do labs after you finish every vial. Do labs 8 weeks after you’ve made a change to your protocol, not before. You may even feel like crap for a couple of weeks while your body gets balanced out with the AI so don’t panic. Your crashed E2 is what is hurting you more than anything right now. Don’t go so much with the numbers. Go with how you feel. You try more or you try less until you figure out the best dose for you. When you change something, wait 8 weeks before you make any other changes.

I guess once I let go of the fear and anxiety of getting Gyno again I will feel much better. I still work out extremely hard. I’m coming off of a “dirty” bulk I did this winter where I took myself from 190 up to 220lbs. This could be causing my bloat, and the whole time I’m thinking it’s due to my high test level and/or E2 level. I just started my cutting phase this week and I’m back to my normal clean eating habits. I take pride in my appearance and body, so that’s why Gyno is to me what nightmares are to a child.

On another note. Thank you to everyone who has responded so far. Great information that truly has me rethinking the entire way I view things. I look forward to hearing and talking more about it with y’all.

So would your recommendation for me be to continue 200mg/week (split into 2 injections of 100mg) and reduce the AI dosage, or ditch the AI completely and see how I feel?

Excellent videos Danny. I’ve watched the first two. The doctor you had on made some outstanding points.

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Stick to that dose for now and ditch the AI. Tell yourself that over the next few weeks you’ll be all over the place. At one point you’ll stabilize and things will improve. Once it does, you’ll never touch an AI again, I assure you.

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Your TSH might be hinting at a problem and rarely do I see guys claiming to feel optimal on TRT with TSH 2.5>. The median TSH level is 1-1.5, I would at least check free thyroid hormones to be sure.

AI’s are bad long term, so you should make plans to dial in on TRT in isolation because this is the end game.

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Yes, agreed with @systemlord (again ffs!!!)

Add Free T3 and Free T4 to your labs next time. Ensure your doc knows something about thyroid.

To me, the glaring variable was the 1mg of Arimidex. That has to go. Once I saw that I really didn’t bother looking at anything else lol

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No symptoms. Everything I associated with high estrogen in the beginning turned out to be just my body getting used to hormones and learned the hard way time heals all wounds. Now I’m living my best life. Only wasted a year before I got there. I’ve never felt or looked better. Get on the train.

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I’ll definitely bring this up when I go back for labs. I’ve made up my mind I’ll try the advice I was given here and ditch the AI for a little while and then go have more labs done, and see what they look like. I’ll keep everyone updated as I go along.

Stop. What if your labs show E2 at 100 but you feel better than ever? Will you take an AI? Will you blame your issues on the ‘high E2’ or will you, instead, fine tune your protocol?

Spoiler alert: Fine tuning your protocol and forgetting about the E2 is your best bet.

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