General HRT Q&A

I’m starting this post to gather all the info pertaining to general HRT, as well as a Q and A type discussion base. I notice that all the greatly informative posts made by members don’t begin under the proper topic, but an asked question which goes off on a tangent. I will be cut-and-pasting the great posts on this forum in time, and they will be identified by a “REPOST” at the top. Kindly head the reposts in this fashion if you have a post you’d like on here, to keep the flow digestable. Also, I will give credit to the authors.

Feel free to ask, answer, or comment as appropriate.

About me: I am currently self-administering adex with recent low test numbers but no E2 readings (thanks Doc). It has, almost overnight, taken me from a crying vaginal wreck, to half a man. I am seeking to T Cyp to fill out my HRT, and restore full manhood.

(I actually had a question but now forgot, so the whole reason for starting this thread… ha, ironic. Is this what brain fog feels like?)

Anyway, I’ll remember the question later but for now, I’ll begin with an informative re-post…

REPOST:

[by KSman; discussing everything]

[quote]T-Nick wrote:
Here is some great info I cut and pasted from an old post of ksman.

Needle size: Large needles can core the rubber and you do not want rubber in your muscles. A shorter needle will have less flow resistance than a longer one. So a 1" #25 syringe might flow as well as a 1.5" 23?22 gauge. One can inject test cyp in small amounts with #29 .5" insulin syringes; the small pistons of a .5 ml syringe develops high forces that make injection times reasonable. Time to fill the syringe is extended.

Injection force: If you are having to push hard to get flow, it should not matter and should not create discomfort at all. You hand should absorb all of the forces involved. Do not push on the needle plunger with your injection site providing the opposing force. The plunger force required also depends on the diameter of the piston. Smaller pistons create larger pressures. So use a smaller capacity syringe if you can. For the glut’s when self injecting with one hand, a 3ml syringe, while way larger than one needs for TRT doses, may be easier to handle… mostly from the point if view of one handed aspiration.

Injection site: All of the injected dose gets absorbed and it does not matter if glut’s or vastus lateralis. Yes the glut’s are more difficult for some and more time consuming. Injecting in the vastus lateralis is simply easier and you can visualize and avoid veins as well. When you read that someone started injecting in the glut’s for a few weeks and then switched to the vastus lateralis and then really got a strong T effect, that is the delayed effect of starting TRT and would have occurred if injections had continued in the glut’s. Note that the injection site in the glut’s is very important to avoid major nerves and blood vessels. You need know how to landmark things properly.

Soreness: If the muscle injected is tight or tense, the result will not be good. For the glut’s, massage and feel for any tight muscles (quite common). If you feel such, then the results can be unpleasant. The resulting pain can last for days and refer down the leg etc. If you massage the tight muscles and get them supple, then the injections can be painless. The upper leg can be quite insensitive to the needle penetrating the skin. Veins can hurt when punctured.

Bleeding and bruising: With the legs and lower fat, you can see the larger veins and the smaller surface veins. You can’t see much of anything on your glut’s. When you get used to injecting, you will notice that when you bleed and bruise, that this is also distinctly painful. That pain also is spread out and does not seem to refer to the point of injection like the skin prick does. When you go through a larger vein, two punctures, there can be a lot of blood. Apply firm pressure to stop bleeding for a while. A good injection can be totally blood free, at least with smaller needles (larger gauge numbers).

Injection site preparation: Other than the proper swabbing; one needs to carefully choose the site. In the glut’s, to land mark you have to touch the area so it must be swabbed after that and then you can’t see the location and need to start over… but you can’t touch the swabbed area. Find a piece of larger plastic tube, 3/8" would be ideal, or a plastic pen top. Select the location and press on the skin to mark it. Then swab that location, and the target is clearly in view when you inject. This is particularly useful if for glut’s you are standing and using a mirror to landmark, then lay down to inject.

Injection depth/needle length: For divided doses, the injected amounts can be quite tiny. For such small amounts, the depth into the muscle need not be very deep. For glut’s, 1.5" is needed to get through the fat. For vastus lateralis; the skin and fat can be quite thin and 1" will be fine for larger doses and .5" will be fine for smaller doses.

Injection rate: This is mostly a concern for the larger doses. For smaller vastus lateralis doses, if a small (larger gauge number) is used, the flow rates will be automatically be slower from the gauge restriction and then there is no issue.

Massage: For larger doses, this may cause more damage as the pocket of fluid is forced around causing more tissue separation.

Heating the testosterone: Warm oil will flow better than cold. The temperature should not be an issue from a muscle trauma point of view. I can’t see that this makes any difference other than the force required on the plunger and time to inject. Room temperature oil might be better to limit the flow rate for larger doses where fast rates can be painful. Test cyp is cotton seed oil based and test eth is sesame oil. I cannot recall which has the greater flow resistance. If you are happier warming the injection, no problem. Just don’t assume that this is needed.

Injection frequency: When test cyp and such drugs were first approved, the product use guidelines were then approved and cannot be easily changed from a regulatory point of view. So these are carved in stone and do not reflect current best practices. So injecting every two or three weeks is totally insane. The T levels after the injection will cause higher levels of E and SHBG. The dropping T levels are unnatural and will leave you feeling crappy. Even injecting once a week is not good enough. If you have been doing so and feel drained and worse for a few days… you know. Inject more often… what works best for you is best. Blood work and your doc are not authoritative on how you feel.

Blood work: Blood work should be done 1/2 way through your injection cycle. If on a 3 week cycle, no meaningful results can be had at all.

Half-life of test: This is around 8 days for the larger doses that were used in the original studies; which were high to go with 2 or 3 week injections at the doctor’s office. For 100mg weekly doses, the half-life will be shorter… and you will feel the drop off. When you see a reference to something like 14 days; that is not the half-life, but the time when the T levels drop back to baseline and the increase in T is no longer detectable. In continued dosing, as a dose wears off with weekly or longer injections; the levels can drop to levels that are lower than when you started TRT as the HPTA has shut down. So you can feel lower and worse off then when you started TRT… waiting for your next injection. And as the high T levels from these larger doses for longer injection cycles can trigger greater amounts of aromatization of T–>E, the E starts to interfere with T receptors which makes test less effective and reduces libido after a while.

Transient effects: The first few injections might not seem to do too much. Then there comes a few weeks of hyper sexuality as the body starts to respond to the higher levels of free testosterone. Then the body also ramps up SHBG which reduces the free T and T–E atomization increases. The resulting E competes with T at the T receptors which interferes with the action of the T. Libido then goes down and for some, libido and ED issues are worse than when they started TRT. This short term increase in sexually that then goes away is a very cruel event. You see what you can have then it gets taken away.

HCG & Sore and shrinking testicles: An effective TRT dose will shut down LH production and the testes will stop doing what they are designed to do. They will shrink and this causes soreness/pain for some. For young guys who need TRT, this also threatens fertility; but should not be depended on as a form of birth control. HCG, a female hormone of pregnancy, is almost the same as LH and has the same effects when men take it. It will keep the testes working. It is a protein structure, otherwise referred to as a peptide hormone. As such, it is in water and must be kept refrigerated when reconstituted. You would need the multidose vials, typically 10,000 IU. Do not get glass ampules! Inject with an insulin syringe into belly fat. IM injection is not needed, so spare the muscles from unneeded scarring. Research published in early 2005, which most docs are not aware of, showed that 250iu EOD of HCG injected SQ, not IM, maintained baseline testicular function in ‘normal men’ who has LH suppressed with T injections. Older men, 70’s and older, may not be responding to their own LH and will not respond to HCG either. When you take HCG, any T that the testes produces will be added to the amounts injected. Docs have not had research based rational for dosing before, and practice has been to inject once or twice a week on the days before the injection. Do not use high doses of HCG, as this will cause the testes to down regulate the LH receptors. When you read about high doses, these are simply wrong or otherwise not applicable to continued use in TRT. When you mix HCG power with water, inject the water into the vial slowly down the side of the vial and swirl gently to mix - never shake. Load and inject slowly. These are the cautions for HGH which is also a peptide hormone. As water flows so well, it take care to keep flow rates slow through the needles.

Scrotum: Also see above section. When TRT shuts down LH production and the testes shut down; the scrotum also reacts and pulls up tight to the body in a manner similar to a prepubescent boy’s. When HCG is administered, the scrotum will hang down the way that it should. This action of the scrotum pulling up to the body is a very obvious indicator that there is little or no LH.

Anti-E: Anti estrogens reduce the amounts of T that are automatized to E, which lowers E levels. Increased E will reduce the effects of T, kill libido and can cause breast tissue growth AKA gyno. The most well known anti-E is perhaps arimidex AKA adex or dex. The generic name is anastrozole. As a drug in tablet form, it is very expensive, costing $8-$10 per 1mg tablet. There are other products. You do not want to reduce E to extremes as that will also kill libido. High levels of T from large dose injections for longer cycles will cause higher amounts of T–>E conversion. Transdermals are also known to have higher conversion rates. If you are on TRT for a while and getting into high range on blood tests, you should be getting lots of nocturnal erections or wood. If you do not get morning wood, the problem can be levels of E that are too high for you. Blood work readings do not tell you much. Then if you take arimidex, perhaps the typical 1mg/week in 1/2 tablet divided doses, morning wood should happen. Along with that, libido should increase and ED problems reduced if your blood vessels are healthy. So let your morning wood be your guide to determine if T:E ratios are ok. You will have had morning wood during the early parts of your TRT when you also had the hypersexuallity. The morning wood goes away over time. Some docs/clinics will start anti-E at the start of TRT.

HCG+T: If you are injecting both and the HCG is EOD, then you can also inject your T on the same day. So for 100mg/wk of test T, you can inject 28mg of test EOD (which would be 0.14ml for a 200mg/ml compound). 0.5" #29 .5ml insulin syringes can be used for both. When drawing up test cyp/eth into these syringes, the preservative alcohol will boil or ‘flash’ as it hits the vacuum in the syringe. This boiling stops as the vapor pressure of the alcohol balanced in the syringe and the vapor will reincorporate with the fluid. That does take time. Injecting takes about 10-14 seconds for 0.14ml. The small piston of the 0.5ml syringe creates very high pressures.

Building muscle mass and loosing fat: This should be easy with a high normal range of total T. I will not get into wieght training etc. Just note that you need protein to build muscle. If you start to work out and start to gain some muscle, and start to feel persistant hunger between your normal meal patterns; this is your muscles talking to you. Don’t eat carbs to curb that hunger, you probably have enough carbs in your diet. Get a whey protein power ‘shake mix’. These are inexpensive in large formats at Sam’s Club and Costco. Otherwise can be found in some pharmacies, GNC and WalMart. Do not use a meal replacement product such as slim-fast. Look for around 22-23 grams of protien per serving which is usually a 60ml scoop. You might want to use two scoops per serving. As you gain muscle, that muscle mass uses carbs 24x7. So gained muscle helps you loose fat.

Cholesterol: Often an effective TRT dose will also lower low density cholesterol while keeping high density cholesterol the same or slightly increasing it. Triglicerides can also be lowered. Some progressive docs will use TRT as an cholesterol lowering therapy. One can avoid statin drugs in some cases.

Costs: Insurance may cover injectables or refuse to pay for any injectables. Test cyp and eth are very cheap compared to transdermals. Some insurance will pay for the expensive transdermals and refuse to pay for the less costly injectables. 10ml of test cyp (20omg/ml) at Walgreen’s seems to be going for $99 for a generic. The same generic can be had for $42 at Sam’s Club with a business membership. So for some without insurance, injectables can be cheap… it is the doctor consults and blood work that makes TRT costly. Buy syringes in boxes of 100. At Sam’s 1.5" #23 3ml syringes are $18/100. Walgreen’s will ten in a bag for you and charge more than $1.00 each.

How do you feel?: Mood should increase with TRT and many also report improvements when HCG is used after been on TRT. Same with anti-E. But if HCG and/or anti-E starts when TRT is started, one would not notice independent effects. It one has been low on T for a long time, there long term effects will have created changes in brain function that will take longer to resolve, part of that been habit of thought process etc. Many men with low T are also depressed and that an other life circumstances may also contribute. Vitamin T can do wonders. With its boost, get motivated to improve your diet, build some muscle mass and try to take some actions to improve external factors that affect how you feel about life. You may find that as you start to feel better on T, that the negative effects of alcohol are more noticeable. Listen to your body. Alcohol is also thought to increase aromatization as well. T should allow you to be better able to judge what your body wants and dislikes. And if you smoke… stop.[/quote]

and another…

REPOST:

[by KSman; discussing T+HCG+AI]

T is like a one legged tripod…

When you add the T, your E will increase. Elevated E will ruin everything. You will feel great on the T … for a while. Enjoy your sexual reawakening. The intensity will not last. Have your wife/GF stick with you and know that this is a one time deal and make the best of it.

As E increases, SHBG will increase and that reduces your FT.

I would not test E2 without some anastrozole, so your first lab can be a dose adjustment instead of “that was expected”. And until E2 is known to be where it should be… for a while, I do not see the point of testing SHBG!

You need arimidex/anastrozole to get your E2 into the lower 20’s, it will not stay there with the T. 20pg/ml would be great if you can get there. Ask for 1mg per week. It is insane to wait until things go bad. You can have it on hand and start when you feel things start to fade.

If your TRT is working right, your HPTA and testes will shut down. Not a good self image when you testes are small and things never hang down again. hCG injections will fix that, 250iu SC EOD. The testes are the biggest single source of pregnenolone for men. You need that to make DHEA and your brain needs preg to make neural steroids. Preg is important for memory and other mental functions.

Getting a doctor who will do this or even to understand why can be a [common] problem for most.

The ideal start before labs and dose corrections is:
The tripod: T+AI+hCG
100mg/wk+1mg/wk+250iu EOD is an ideal start
(100mg/wk is injected)

With transdermals (TD), absorption rates vary wildly by individual and some who absorb well to start may stop absorbing.

Some on TD start well, E increases and T levels drop and can feel worse after 2 months than when they started. I am not trying to poop on your progress, but hoping that you will know what might happen and know what to do or ask if things become adverse.[/quote]

Al, great thread idea, and reposting KSman is the best start you could make.
Now as I have basically taken over my own medicating and have been progressively feeling much better the past three weeks with 150mg T per week and 1mg adex twice a week, I will check labs next week and see where my vital numbers are at. I do plan to start HCG soon as well.
There are numerous posts about the idiocy of so many doctors out there, but there are still questions that need to be raised. For instance, as KSman points out the best end point will be the subjective knowledge that HRT is working great, fixing erectile/libido issues, clearing brain fog, improving mood, etc. The lab tests and doses of meds to achieve this end result is clearly unique to the individual, although the collective wisdom is growing on how best to achieve this. Happydog has posted intelligently on achieving a proper T/E2 ratio, at least 10-15 as I recall. Total T numbers to shoot for in the minds of the “progessive” are in the “upper third” of the normal physiologic range (depending on the lab, but typically 900-1200). And several posters have commented on aiming for E2 levels of about 15-25, and after my estrogen poisoning I certainly believe them.
But we must have a “devil’s advocate” to occassionally challenge the T-Nation “best practice” wisdom. For instance, I have had many people PM me with stories which suggest the tripod is not necessary in ALL cases. One gentleman has been on 100mg T-cyp for years, done well and had no problems with elevating E2 and only minimal testicle shrinkage. Another gentleman wrote me and stated he was on T pellets, which last 4-6 months, and he also has done very well without the other two legs of the tripod. I think these are clearly the exceptions, lucky individuals to be sure. And I don’t even think I would recommend trying the T alone unless you monitored your labs like a hawk to avoid the hell I went through with spiking E2. But I would like the science of HRT progress to see which indicators or markers might help predict best practice patterns for individuals. We must admit to ourselves, right now HRT is mostly a trial and error type process.
But don’t misinterpret my comments as anything truly against HRT. The vast majority of the practice of my field, psychiatry, is a trial and error practice with more unique and unpredictable responses than HRT! I always envied fields like Endocrinology, where I thought things were really cut and dried, organ systems easily assessed through examinations and labs, direct identical hormone replacements available to correct the clear imbalances. It is what we call “elegant” medicine. Yet clearly, in the current state of Endocrinology and urology, there is nothing elegant about the way most docs are handling our low T/high E and related problems. Doc

Great points, Doc. And you can surely play our collective “devils advocate” to keep us sharp.

I too, believe I underwent estrogen poisoning, but have no numbers to back it up. THE VERY next day after my first .25mg dose of adex had me feeling 100x better, and so ever since. Laughing with my wife again, a brighter world in general is enough to tell me what’s what… although my libido is still dead and no morning wood has me still trying to get on supplemental T. My right nut is the size of a peanut, indicating my left teste is bearing the load of producing what little test I have running through me.

Eating low-no carbs, high fat/protein with lots of greens and olive oil has helped a lot. Alpha Male, which I began two weeks prior to the adex, made me feel a smidget better, but I was on the whole, still a blubbering idiot. Maybe the adex both lowered my E2 and allowed the Alpha Male to work better? Maybe, but my T would have increased anyway (as E2 came down), and still will as time goes on and the E2 stops filling up all the receptor sites.

Ah, I remember my question from this morning:

Has anyone used the farmed out blood test from LEF? I understand I should get a membership and save some money, but is it accurate and effective?

Also, how is Dr. Crisler and his clinic at allthingsmale.com? Is it something worth looking into for someone who has exhausted all other (and local) means?

Thanks.

REPOST:

[from a T-Nation article; discussing lab results (endocrine is towards the bottom)]:

A Comprehensive Look at Lab Tests
by Cy Willson

http://www.T-Nation.com/readTopic.do?id=461891

This is an awesome post. I will definitely be following as I have just begun HRT. Thanks for compiling.

REPOST:

(“V R” responding to KSman; discussing E2/HCG)

[KSman wrote]

I do not know where all of this HCG-E concerns come from. Perhaps from some of the insanely high doses that have been used in PCT. I am glad to see some speaking out against those practices.

[VR’s response]

Very true. However, I think alot of whats going in is that alot of people, myself included, are already having eatrdoil issues even before they start TRT. Alot of these guys have estradoil levels in the 40’s and 50’s…Add in hCG 250iu EOD, and the little extra test conversion to estrogen, even as minute as it may be, is often enough.

The hCG might just be enough to push ones estradoil over the tipping point.

Your probably right in that people with normal hormone profiles would be just fine cycling in some hCG standalone.

[VR continues in another post:]

Very true. Im wording it wrong. I don’t mean to say that hCG as a compound causes estradoil to go up. It causes an increase in test which in turn causes an increase in estradoil.

The thing about hCG though is there isn’t a whole lot of data that says it causes X amount. Meaning, no one can really predict what kind of increase in test one will get. Its all over the map.

Where as with test/androgel, things are a little more stable. You inject or absorb X amount of test, your test levels generally go up X amount, and you can expect an X amount of estradoil increase. With hCG, because it has been used regularly for only a year or so, there really isn’t a whole lot of data to look at. Noone really knows what kind of an increase in test or estradoil to expect.

Not taking anything away from it. It should be a staple for any TRT program. It will be for mine. Im just saying to use caution and make sure to keep an eye out for estradoil.

REPOST:

(by KSman; discussing AI and E2)

Arimidex/anastrozole acts quite fast. I had strong initial changes in less than two weeks. Changes to outlook, mood and energy take longer as cellular changes occur, thinking patterns change and perhaps SHBG declines in response to lower E2 levels. I think that the changes probably take 3 months to unfold, at least in my case. Things have been getting better.

I have been doing PMs with a couple of guys who have started anastrozole. One reported significant changes to weight and shape after 2 weeks - an unusual thing, but his baseline situation was not typical. Another reported large improvements in mood/depression, energy, brain fog and handing plans (forward planning*) and scheduling - again in two weeks.

  • One complaint of low T is passivity and avoidance. This, and other problems, can occur even with good TT ant FT level responses to TRT. And in some[many?] cases where these problems persist, E can be the cause and AI can reduce the E and these types of problems improve greatly.

So the short term effects can be significant, and the magnitude of the changes seems to relate to addressing things that have been the problems that folks have been suffering from. Having a report of relief from longer[er] term depression that anti-depressants could had not cleared up is notable.

As in all things of this type, blood work results are only one piece of problem. Complaints and symptoms are also critical. This only acts as a guide to prescribe or self medicate. Then one sees how they feel afterwards and how things keep progressing.

You will feel the changes and you will not need BW to know that E levels have changed. With 1mg/wk, E will not go too low as the effects are self limiting with this drug. That is not the case with femara which can depress E to unhealthy and unsafe levels.

Some are more sensitive to E and will suffer greater consequences than others. I am starting to believe that those with the biggest problems stand to have the largest [relative] benefits from AI. So if you feel like sh1t or feel that your TRT is a state of hell, then you really need to investigate this option.

The bottom line is that you either try AI or you don’t. Most will really know if they are needing something else other that test or test+HCG. For research chems, the cost is trivial. If you do not feel that it is helpful, you are only out $50. If it works well for you, you get over one year of benefits for $50.

If you get a prescription, all the better. You have the option on how you have it filled. In any case, your doc will see a change in your E levels and most likely a change in you.

REPOST:

(and some comedy relief… this is VR’s response to someone who’s Doc (female) believes HRT is not working for him because he asked for an AI)

When I first seen the word “She” I knew something was not right.

This lady is an idiot. Sorry. First off, your test numbers are fine, they are NOWHERE near to “high”. The very fact that she thinks so already proves her idiotic and untrained nature in HRT.

REPOST:

(link to a great thread that eloo began):

http://www.T-Nation.com/tmagnum/readTopic.do?id=1200966

REPOST:

(by KSman, from eloo’s link; discussing lots)

HGH: I was feeling like it was not quite working right. Partly mood and partly some of the pain in the testes coming and going. That was on the 250iu EOD on days 5,6 of the weekly injection cycle. I was reading this site like crazy and also sifting through the internet when I found the 250iu EOD research. I emailed my doc with the research abstract and he said to go ahead the next week. The added HCG does also add more test to the injected amounts. I think that my comments about there finally been a research based guidance for LH replacement appealed to his HRT goals. And after getting on that EOD, my muscles really started to respond to CNS demands for strength. Mood improved too.

Libido: This is my understanding. You start to inject or whatever. You react to the increased T levels as well as the transient increases. You get horny. Meanwhile the body does not get off on the transient levels any more. And E levels start to accumulate as T aromatizes to E. The E also kills libido. The liver sees the higher E levels and increased SHBG. I expect that the liver also increases SHBG from T levels. The increased SHBG reduces free T levels below what you felt during your early horny phase. So T and FT increase, transient increase effects fade, E increases, SHBG increases and FT decreases. E competes for T receptors and that also blunts libido.

Anti-estrogen: I was getting lots of persistent nocturnal wood. Often to the point of discomfort. But morning wood had become non-existent. I told the doc what was going on and stated that we should be working to get morning wood as an indicator that the treatment was working right and expressed my opinion that E was the problem. He put me on Arimidex and I obtained liquid anastrozole to fill the script as the costs for Arimidex were too much without health insurance. It is working quite well, morning wood is back and all other libido aspects are improved. Still not where I was in June feeling like I could line up the ladies and to them all.

Weight and fat: When I felt that I was getting flabby, but still thin; I reduced calories and probably was simply loosing muscle, loosing weight, but not loosing any fat. Low muscle mass then means that the fat cells can take most of the nutrients after a meal. It was a real loosing situation, that steeled my resolve to seek HRT/TRT.

Syndrome X /metabolic disorder: Carrying fat around the waist and belly is a classic indication of this. Then low test, high E is also typical as is insulin resistance. This fat state increases T–>E and is a trap that you cannot get out of. Cholesterol can go wacky too. As well as TRT, nutritional changes to tackle the insulin resistance is needed which also improve the cell wall permeability, and response to insulin and other steroid and peptide hormones. Chromium supplements improve insulin receptivity. Insulin resistance leads to higher blood sugars and more glycated proteins that are an aging process.

“Glucose is the prime source of fuel for generating energy; but glucose has its dark side. Glucose can bind tightly to proteins and form abnormal (glycated) complexes that progressively damage tissue elasticity. An increased stiffness in the cardiovascular system, which leads to high blood pressure and an overworked heart, is one of the striking features of aging.”

Mood, energy and CNS: These are all related. And as the CNS improves, more can strength can be called up from the muscles, the muscles start to respond to the CNS demand for force and training response can increase very dramatically. If you make the changes to improve cell wall functions, the brain works better. Fish oil is very important for this. The bulk of the dry mass of the brain is essential fatty acids and if one has been eating the wrong fats for years, the CNS will not be as it should be. Other things to take improve energy levels by improving how the mitochondria function. Antioxidants, C0Q10, acetyl l carnitine, alpha lipoic acid are all valuable.

REPOST:

(a classic by KSman about how docs and their ranges are NOT your symptoms):

I am thinking that most men need anti-estrogen when on TRT. Gyno should be the last of ones concerns, that does not mean there is a fire risk… but the house has already burnt down. I am getting a strong feeling that morning wood should be the indicator that E levels are appropriate.

High T is not enough and if E is within normal ranges, the competition of E for T receptors can mess things up, even with high T levels.

And folks are probably getting tired if hearing my rants about HCG…

Blood levels of E are not really highly useful. Everyone is different and the levels that make you feel and perform better are unknown. Things need to be tried and the only one fit to make such judgements is yourself… not a doctor. 0

A doctor should be probing to find out how you are doing, not just looking for pathological extremes and keeping you withing normal ranges. My doctor visits are one hour give or take. If a doctor is stuck in some kind of dogma and range numbers only, this will not work. Your responsibility should be to make careful notes about how you feel and get a doc that pays careful consideration to what you have written. You need written notes to control the agenda in the visits.

So the take home message is that you can be on T, you can loose fat, make muscle, gain weight, improve skin and nails, faster hair growth and for many lots of new hair. Those are good anabolic and androgenic responses. However libido, morning wood and other mental balance/energy/mood-attitude issues can still be bogus if E is interfering with the actions of free T; even when the numbers for E are in normal range.

Another energy issue… are thyroid levels ok?

Reading through some of the old stuff made me realize a new happening…

My AI has led to nocturnal erections but no morning wood.

On the way but not there yet, it seems - according to these posts.

What we’re really dealing with here is HPTA management.

It isn’t about T or E or any particular one thing because they’re all tied together.

Different guys can arrive at the same place through different pathways but how you got there is just an important as where you’re at. If your T is low because your testicles aren’t functioning correctly, you’re in a different situation from someone who, for example, has a fully functioning HPTA but his “set points” have deteriorated. Production problems vs. control problems, as it were.

Plus, it is patiently obvious that a 35 year old guy with below normal T levels is in a different boat than a 55 year old guy who has the low T and high E profile consistent with “normal” aging issues.

So it is to be expected that we will have different experiences as we go down our different pathways and that’s why the simple act of sharing our different experiences is helpful. Patients as well as doctors need to be aware that there is no one size fits all treatment or approach.

Don’t forget that it’s usually the guys with problems that go looking for answers. Guys doing fine on their Androgel aren’t out looking for answers to why their TRT isn’t going well. Just because a lot of the posts here deal with people having problems doesn’t mean that guys doing well should be afraid to speak up. It’s important to know as much as we can about our different experiences and that includes the good and the bad.

I believe that caution is always best and I don’t fault doctors for taking a “let’s try one thing at a time and see how it goes” approach. The problem is when those same doctors ignore their patient’s symptoms in favor of blood numbers. “Your T & E are in range so your problem is elsewhere.” “In range” means almost nothing yet it is often regarded as the only thing that matters.

Doc, if your doctor had been aware that elevation of E is often a problem and that she should be ready to administer an AI at the first sign of elevating E issues, then your experience would have been a lot different.

It isn’t necessarily that every guy should automatically take an AI, it’s that every doctor should be aware that elevating E is a common side effect of exogenous T administration and they should be looking for it and be ready to treat it immediately if it shows. It isn’t that every guy should be on hCG, but every doctor doing TRT should be aware of it’s use and be ready to use it if indicated. If you have functioning testicles and your T treatment shuts them down, then hCG makes a lot of sense as it isn’t just T that you get from functioning testes.

Read Crisler’s protocol. He isn’t advocating that people jump in with both feet first, but he’s waiting in the wings with the knowledge and willingness to go the both feet approach if the need surfaces.

I am the individual that Doc mentioned who is using the testosterone pellets. However, I should clarify my situation. As Happydog said, guys who are doing well should speak up and hopefully my experience can help someone.

I found a doctor who specializes in HRT. At that time my E2 was 36, TT was in the 450 range and my thyroid was “low” (sorry I do not have the number), according to my doctor.

I chose to treat the thyroid and E2 first to see if that would get me back to feeling the way I used to. Armour thyroid brought my thyroid numbers in line and 1 mg of Adex per week dropped my E2 from 36 to 22. A lot of my symptoms like brain fog, libido, etc. improved greatly.

Wanting even more improvement, I added TRT in the form of implantable pellets. Even though Crisler views the pellet procedure as barbaric and rife with potential problems, it has been a great experience for me. My total test is up to the 750 level, with no daily or weekly needles, no need for HCG, no noticeable testicular shrinkage and no E2 conversion.

In fact, when tested last month, my E2 was at 15. My next round of pellets is scheduled for Jan 8, and we have agreed to increase the number of pellets to push the TT numbers toward 1100.

I never see pellets mentioned here as an alternative method, but anyone who has that option should consider it IMO.

Happydog, I like your attitude towards TRT; you always have a refreshing viewpoint. Thanks for posting.

undone, thanks for sharing a successful experience. So you went in for symptoms, got your blood work done, and first treated your elevated E2 and thyroid? How long did you continue on the adex (before introducing any T) before you took notice of the improved feelings and libido?

I ask because I am taking adex alone and altough I feel better, there is little or no change in libido/morning wood. I know I need to get tested for E2, but finding a Doc… blah, blah, you know the rest.

Question to anyone:

If I get blood work done through the LEF website, would it stand as credible in the eyes of a future doc that I may find down the road?

About some who do well on T only.

Doing well is relative and the state of wellness may not be optimal.

If is rare that ones E2 levels would be ok when on T alone. Probably never are the E2 levels optimal. All should check their E2 levels in any case and take action from there.

Any guy on T without an AI who seems to not have adverse symptoms, should/could be ‘challenged’ with 1mg anastrozole per week, perhaps more depending on body weight/fat. I expect than many would report that they are at a whole new level and do not want to go back to where they were. (For some, the results and progression will not be good as they are very sensitive to anastrozole and some in that state will need to use around 1/8th to 1/4 of a mg per week.)

TRT, when effective, shuts down the HPTA and the testes suffer from lack of LH. The amount of shrinkage does seem to vary. The way that the scrotum allows the testes to hang is an other issue. With HPTA shutdown, the largest single source of pregnenolone in males shuts down. DHEA levels can the also drop as a result. Pregnenolone is used in the brain to create neural steroids. Mental well-being has also been shown to be affected by DHEA status as well. The effects of HPTA can be much wider than appearance. Given the above, the fact that many/most men report an improvement in mood when hCG is started after HPTA shutdown; the ‘data’ about pregnenolone and DHEA effects takes on a whole new meaning.

Studies have tracked the survival of men who had heart attacks, checking DHEAs status when admitted to hospital. Those with lower DHEA-s status had greatly reduced survival rates (not dead in six months or something like that.) Men with heart attacks as a group also have lower DHEA then a representative sample population of men.

There are many far reaching effects that are not well understood that can provide guidance. Many doctors will be ignorant about these issues. We all need to be our own doctors in many ways.

[quote]sifuinkorea wrote:
Happydog, I like your attitude towards TRT; you always have a refreshing viewpoint. Thanks for posting.

undone, thanks for sharing a successful experience. So you went in for symptoms, got your blood work done, and first treated your elevated E2 and thyroid? How long did you continue on the adex (before introducing any T) before you took notice of the improved feelings and libido?

I ask because I am taking adex alone and altough I feel better, there is little or no change in libido/morning wood. I know I need to get tested for E2, but finding a Doc… blah, blah, you know the rest.

Question to anyone:

If I get blood work done through the LEF website, would it stand as credible in the eyes of a future doc that I may find down the road?[/quote]

I felt better in all aspects within a week to ten days, and it topped out in a month. After about two months I introduced the exogenous T.

Also, during the last eight months I really dialed in the diet and lost about 15 pound of fat around my waist. My BF is probably somewhere around 9-10%. I think that helped push the E2 figure down to 15.

[quote]sifuinkorea wrote:
Happydog, I like your attitude towards TRT; you always have a refreshing viewpoint. Thanks for posting.

undone, thanks for sharing a successful experience. So you went in for symptoms, got your blood work done, and first treated your elevated E2 and thyroid? How long did you continue on the adex (before introducing any T) before you took notice of the improved feelings and libido?

I ask because I am taking adex alone and altough I feel better, there is little or no change in libido/morning wood. I know I need to get tested for E2, but finding a Doc… blah, blah, you know the rest.

Question to anyone:

If I get blood work done through the LEF website, would it stand as credible in the eyes of a future doc that I may find down the road?[/quote]

Hey there,

Glad to read of your progress. Way to take things into your own hands. Have you added another element (T or hCG)to the Adex you have already started with? Any new developments. I am still trying to tweak the AD and have been feeling better of late. Morale is more ocnsistent and I feel a surge after my refeed day. I am still left wanting however. I guess knowing how great we can potentially feel makes it difficult to accept mediocrity.

Credibility has nothing to do with it. Any doctor worth his salt is going to order new blood work for a new patient simply because it’s the right thing to do.

However, having the blood work from LEF will give you the knowledge about your situation that you need to have and it may also convince your new doctor that he should also test for some of the stuff that often gets overlooked (thyroid, estradiol, etc.).

It sounds kind of crazy, but having your blood work handy puts you in a good position for your NEXT blood test.