T Nation

Formula for Success


Bloodwork back. 8 weeks of 80 mg T X2/week, 500 IU hCG X2/week, 25 mg DHEA X2/day.
E2 is very high! Time to knock off the DHEA supplementation, I think. Is TT too high? I need an AI.
Consult tomorrow.


How is that working for you?
Collectively, we have a better handle on TRT than almost all docs.

Your E2 was expected to be a problem, but is staggeringly so.
So your moodiness would be persistent.
AST/ALT does not suggest a liver problem increasing E2.
But note that some meds, Rx and OTC can reduce E2 clearance in the liver.
You should feel vastly better getting near E2=22pg/ml. Results of a anastrozole dose or dose change take around one week to feel. Mood, libido and energy will change.

HTC is a mess as I suggested as a possible outcome.
Avoid iron fortified foods, breads, pasta etc and men should not have iron in their vitamins.
Monitor HTC.

With lower E2, body fat and fat patterns should change.

We do see some guys who freely convert DHEA–>E2 in the adrenal glands. There are many variations in genetic code that code for enzymes and I expect that this is a cause of this effect. 50mg DHEA is often more than needed. Try 25mg/day and test DHEA-S again later.

Reducing DHEA and anastrozole will both effect E2. Thus, changes to DHEA intake may change anastrozole dosing needs.

What was iodine intake at this time? Or how long since high dose iodine.


It’s not working for me, currently, but I will get there and this forum is a great resource.
Iodine intake was 12.5 mg 1x/week, plus my daily multi (150 mcg), and have replaced salt with iodized version. High dose IR was late August/early September.
I don’t eat much bread or pasta, but do eat red meat regularly.
No Rx or OTC’s - not even aspirin
I have some RC Anastrozole. I’ll take 1 mg today, and .5 E3D. I will ask for it during the consult, tomorrow.
Do I need a lower dose of T?



I think that TT and FT are good now. But if you reduce T dosing, adjust anastrozole by same factor.

Any iron in your multi-vit?

Remember that lower DHEA dose may shift E2. A few guys have given up on DHEA supplements, but only one or two that I recall.

What has been going on with oral body temperatures?


Yes, there is iron in my multi. Was just looking that up to see if I can eliminate that. Pre-TRT, I used desiccated liver tablets, but have not used since starting. The dog loves them.
Dr John Crisler was the one who prescribed. DHEA-s was low, but now is high.
Morning temps are consistently 97.6 - 97.9. Afternoon are 98.6 - a couple days have been over that.


Gave blood this morning.
After the consult, NP lowered T to 140 mg from 160 mg/week; cut DHEA to 25mg from 50 mg/day (I use MRM micronized 25 mg); kept hCG at 500 IU x2/week; added .25 Arimidex x2/week. She wanted to add compounded DIM, but I sourced it elsewhere (along with ALCAR & OKG). I asked if she could guess/extrapolate my SHBG number; she said it looks to be mid-range.
Lowering the dose should bring blood count down (family history of high blood count), less chance of aromitization, and TT & FT should remain relatively the same. CBC and E2 tests in a month.
We discussed the 15 mg of Iron in my multi, and the liver tabs. She did not think they would bring my levels up more than a point. She said I could take them. I’ll keep an eye out, and glad that I don’t have expensive dog treats, anymore.


Just got new labs from new protocol changes (70 mg T 2x/week, .4 Anastrozole w/DIM 2x/week, 500 IU hCG 2x/week, 25 mg DHEA/day, Vit D3 daily).

E2 down to 27.4. I have bulk DIM powder so I’ll add a little on off days. Don’t think it’s tremendously effective.

These are still too high:
Hemoglobin 18.4 (12.6 - 17.7)
Hematocrit 54.4 (37.5 - 51.0)
These were border line high before beginning TRT. I am of Scottish descent (not Scotch!). http://www.americanhs.org/celtic.htm
I guess I can donate again by this Saturday (B+, so they called asking already).

Still have no huge improvement in energy levels:
TSH 1.48 (.45-4.5)
Free T4 1.21 (.82-1.77)
Free T3 3.8 (2-4.4)

I have leaned out a little, but progress is slow. Hoping more energy/metabolism will help.


What was your total and free T on the latest lab? Did I miss it?

E2 has come down nicely, and probably close to optimal.

How long do you have to wait for your post-lab appointment? After Crisler left I left them because while the NP seemed more knowledge and was more likable than Crisler, I wanted to put my health in a doctor’s hands.


They did not evaluate TT and FT. By decreasing from 160 mg/week to 140 mg/week, the NP did not think these numbers would change significantly, and aromitization would drop down as she surmised my SHBG was midrange (never tested). She did mention that she had to “adjust” some of Dr Crisler’s last patients’ protocols. She also said that I responded extremely well to the T - was surprised.
I asked for the thyroid panel. I’ve done oral temps twice for a week duration, and waking is 97.7+ and I hit 98.6 in afternoon. I still feel some fatigue and don’t think my metabolism is in gear and feel that I should be losing more waist circumference than I am. On 3/31 my TSH: 0.559 mcUnits/mL (0.350 - 5.000 mcUnits/mL). Then I did KSMAN’s IR protocol and finished a week before this on 8/19: 2.75 (0.450 - 4.50 uIU/ml); 11/4 was 2.0; 1/4 was 1.48. TSH certainly has stayed elevated for awhile after the IR.

We discussed lowering the hCG, but I resisted. I’m on a 3/4 day protocol (hCG 500 IU - Mon, 70 mg T - Tues, 500 IU hCG - Thurs, 70 mg T - Fri). Dr Crisler’s thinking is that there is a natural downer Sun evening into Mon, so use that and change a 3.5/3.5 into 3/4 day protocol. I don’t know any different, this is what I am on. I am thinking of maybe changing the hCG to 350 IU - Mon, 350 IU - Thurs, 350 IU - Sat, but of course I’ll have to discuss that. My consult is out to Jan 26th post lab result. Seems a bit far out, but numbers are improving and I will give blood next week.

While I understand your concerns, once you’re rolling, I don’t think an MD vs NP is critical to dialing in. Especially if the clinic specializes in TRT and sees a wide variety of patients. The biggest challenge for a guy like me who is not used to being in touch with his feelings, is to correlate what I’m feeling with the blood tests - just need experience (time).


Still not seeing much reduction in ab fat. I’m down to #229.4, so weight loss has been very slight.
Since I’m seeing muscle definition in limbs and shoulders, I’m a little frustrated. Diet is good - maybe even too few carbs, but I’m increasing in my poundages and workouts are good so I’ll stay the course.

Hematocrit is still high. Tried to give blood, attendant didn’t get the needle in just right, I started clotting, and they stopped after getting 160 grams. They said after 119 grams they could not keep trying, and I’d have to wait another 8 weeks. Arm bruised up pretty good. So I got a script for TP, the blood bank does them for free, but needs some paperwork filled out. Should have that done by end of week. Once I told them I was on TRT, they said I couldn’t give blood anymore, but they are willing to work with me on the TP. They (TP’s) are a service to the community (good for them!).

I was able to get 1/2 grain Armour from Defy. Noticed it the first week, now I don’t notice much of anything. Been 7 weeks now. It’s pretty low dose, so I don’t know what to think until I do the thyroid panel, again.


#225.8 - progress is slow. New thyroid panel had rT3 at 22.9. Must be pooling. Need to find a way to get this down.
Lipid and Metabolic panels look great. All blood tests done on Fri AM before injection.
New FT is 19.4, TT is 739, and E2 is 18.4, with SHBG at 37.9 (this is @ 140 mg/week). So my new T dose is 180 mg. Strange, I started at 160 and reacted very well, then reduced to 140 and now I’m low, so up to 180.


Men with normal diets do not need any iron. The female blueprint requires iron hording to compensate for blood loss during periods, so males get that iron retention. Males who have GI bleeds need iron. You need to do everything possible.

Your above mid-range fT3 suggested elevated rT3. When rT3 is elevated, when you take T4, you get more T4–>T3. Have you read the thyroid basics sticky re rT3, adrenal fatigue? In any case, your good oral body temperatures show that your body is compensating quite well.

On TRT, one can loose fat and gain muscle and weight may not change. 11 years ago I lost 3" on my waist and weight did not change.

Every time that you change T dose, anastrozole dose required changes by similar proportion. With high HTC, increasing T seems foolish.

Iodine: Did you also start supplementing selenium, yes, 80mcg

E2=27.4: with target of E2=22pg/ml, increase anastrozole 0.4mg X27.4/22=0.5mg, then modify again by subsequent T dose change factors.

If thyroid level management is functional, small amounts of thyroid meds may not change your levels very much as your own production adapts downward.


Thank you, KSman,

Yes, I have read and have now re-read the sticky. The 1/2 grain NDT was a trial, so I will not continue; but I’ll continue to monitor temps. Afternoon temp will be the one to watch for me. I’ll research rT3.

“The mirror doesn’t lie, the scale does.” - I go more by the mirror, but do monitor the scale. I am convinced that I am gaining muscle while losing some fat - just not enough fat for how hard I am trying. Maybe I had much more visceral fat (takes longer to reduce?) than I had anticipated. I guess that slower adaptations are more likely to be permanent, so I’ll take comfort in that. I am making progress.

HTC is trending downward, but I agree that upping to 180 mg seems dubious. I was hoping to go back up to 160 mg. I have a TP scheduled 7/19, and doc did order the CBC for mid-August. I’ll keep a watchful eye. I don’t know why my T numbers dropped so significantly (739/19.4) at the 9th month mark.

I completed your IR protocol last Aug before TRT, replaced salt w/Iodized. My multi has 150 mcg potassium iodide and 80 mcg Selenium. I also take 200 mcg Selenium 1x/2x a week just for insurance.

Lipids are good: 169 total, 80 tri’s, 42 HDL (dropped on TRT), 16.0 VLDL, 111 LDL. I keep my fat intake low, but I’m going to up my EFA’s and fish some more, since I have a few calories to add-in.