T Nation

Going on TRT, Curious about AI Advice

Hi everyone!
I Just had my consult with Defy Medical who I can’t say good enough things about, I loved talking to Dr. Calkins, and he seemed incredibly knowledgeable and made me feel quite comfy.

He diagnosed me with primary hypogonadism (I think thats how you say it? It’s the primary one), and given my past history and labs has put me on the following protocol:

Test C 2x 70mg (.35 cc at 200mg/ml) per week (total 140 mg/week)
HCG at test injection time 500 iu 2x/week
Arimidex .125 mg 2x a week on day of injection.

Now, I’m 27, my total test is around 500 ng/dl my free test is 10.4, my E2 is 14.1, SHBG- 38.5, LH 4.2
I posted my full bloodwork the other day so I won’t do so again in this space.

Point being, he noted I have low E2 (it was an ultra sensitive test) 14.2 pg/ml male <11.8-39.8, and said that when we raise free T to 25-low 30s which is his goal–a raise of 300% to my free T could potentially raise my E2 by that much which would put me in the low 40s. He said that the 20s and 30s are my friends but that the 40s and up give many people problems.

My ultimate prescription says .125 mg arimidex 2x a week and to “titrate” and he gave me the symptom list of low E and high E to watch out for those things. So on the one hand common sense says stick to the protocol exactly for the 3 months and then do bloods to assess titration. However, given that he gave me the symptoms of high E to watch for , and that an overwhelming number of folks on this board and others (T Nation for ex) recommend holding off on adex at least until symptoms present (which they dont seemingly for many)–should I wait on the adex especially considering my E2 is so low right now and giving me low symptoms?

It seems from what I read that the common advice is to wait until symptoms present, and for low E2 starting guys like me there’s a good chance they won’t? I could get my own test/E2 bloods done in a month to see how it was going before the 3 month check up. What do you all think? Thanks!

Everyone is different. Your SHBG is mid range, you may be fine with once a week injections.

Is hCG to maintain fertility?

Yes, E2 is low, I would hold off on anastrozole at first and see how you respond. Maybe give it six weeks before follow-up labs.

I’m not 100% on the reasoning behind the hcg, I told the dr I wasn’t concerned with fertility (as I am dead set on adoption if anything), but it seems lots of Defy medical patients are given hcg with test, it seems to make lots of folks feel better–but of course I’ve also heard of some feeling worse. I’m going to put it in the same syringe as my Test and inject sub-q or shallow IM with a 27G 1/2" (draw with a 25 or 23).

And yeah, I don’t want to start off by not following the docs orders, but otoh it seems I have a lot of room for that 14 E2 level to climb before there are issues–whereas Adex seemingly dries lots of guys up more than intended. On the other other hand, 1/8mg 2x a week (.25 mg total per week) seems quite low also, but it scares me when I read about guys trying one single 1/10 mg dose (.100) and saying it made everything horrible lol.

Has anyone had success with things like resveratrol, green tea, that calcium Glucarate stuff, etc in terms of keeping a slightly “creeping” E2 down (obviously it wont be in the adex league of action)? I have a fairly low body fat and realize that cardio will be important to keep E2 down as well.

OK, a couple of things, as a patient, I want to have a thorough understanding of what is being proposed and why. Some of these clinics seem to have a cookie cutter approach to TRT. Let’s be honest, they’re in business to sell products, which is fine, but you should be very clear on why you are doing whatever is suggested and what options you have.

As for hCG, really two reasons to use it, maintain fertility and/or prevent testicular atrophy. Unless you are looking to start a family now, you can hold off on it. Some guys experience zero testicular atrophy, so you could also hold off until and in case it’s needed.

Some report hCG helps them lean out. Testosterone also does. Some take it to increase testosterone, 160mg or 180mg will do that too. I used hCG post steroid cycle back in the days, and it worked well. I’ve used it twice in the last five plus years, just to experiment, and it didn’t seem to add anything to what I am already doing. If you start with it, and test, you won’t know how much it helps vs test only.

As for an aromatase inhibitor, as noted, your E2 is already low. Yes, the anastrozole dose is low. So, why not go a little lower? Like zero? You do not know how you will respond to test yet. I could see starting at a low dose if you are already at 30 or 40, with a history of gyno, but you’re not. I could also see not starting with it and adding it if you have high E2 sides. It does work quickly. Read @physiologik’s posts on this subject. I discontinued AIs, last lab test had my E2 at 49/62 and I actually feel much better. I’m 64y/o, with a lot of stressful miles on my joints, so maybe that’s just me. Check out Dr. Neal Rouzier on youtube for more on E2.

You can always add to your protocol, but if you start out with several, and you feel good, you won’t want to stop any part of it and will never know if it was really necessary. I think it is good to learn as much as possible and determine what makes sense for you. Good luck.

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Thanks! This is helpful,
I’m not 100% why the hcg is in there, but given my age–even though I don’t plan on having kids now, reducing testicular atrophy./preserving a bit of sperm production seems responsible. That said, I’m not wed to using it, but since its in the same shot and the cost isn’t really that burdensome I don’t mind following that part of the protocol (though, as a scientist I totally see your point about adding in things slowly in a controlled way).

My doctor was clear that the 40s and 50s for E2 feel good for some men, but that for long term he wants me in the 20s and 30s b/c there isn’t much medical literature on the safety of the upper levels of E2 for >50 . Now it seems lots of men are in the 20s or 30s and feel great, I havent seen too many complaining of levels at 30 and saying they are dry from lack of E2–but I guess the issue is how to get there. Will the 140mg/week take me there naturally, will I need an AI etc? And I guess no one can know until we have more data…

So given all this, I was thinking of holding off on AI at first and getting my own Test/E2 level taken at 6 weeks --and then do the normal follow up at 10-12 weeks and reassess. If at 6 weeks my E is climbing to high 30s/low 40s then maybe start that dose (and then i could see how it made me feel more easily), if its still in the 20s/low 30s maybe keep going? I did read thhe physio thread which helped a lot btw! How long does it take E2 to peak on TRT (I have heard of it later going down as well as the body normalizes, but when does it peak on the way up?)

Thanks!

I really hope they did multiple testosterone blood tests to confirm this. 500ng/dl isn’t THHHATTT bad. It’s low, but multiple tests could show otherwise.

TRT is life long. ANd if e2 is low, there are other, less invasive ways to increase that figure.

I stopped reading here.

YES. I kept my e2 low for a long time and have been paying for it, and most likely will for many more years. The joint pain and other issues that come with messing with e2 are not worth it. I couldn’t run, squat jump for over a year without being in extreme pain.

There are some really scary stories out there regarding arimidex, and the consequences of low e2.

Roscoe88-- In terms of numbers, two AM tests one 490 one 520 ng/dl but the free test only at 10 where my dr says it needs to be in mid 20s at least to feel good (if not even lower 30s)–so we are talking about essentially tripling my free T. I made another post on here with full labs in case anyone wants to see.

Thanks alphagunner for your story. This is really tricky to figure out! It seems more guys than not have issues with it, but plenty of other stories of guys in mid 40s E2 levels on my dose of T even with .25 2x a week arimidex. Mine is only .125 x2 week–is there a middle ground? Perhaps splitting even that dose in half for a total of .125 mg per week? It seems like it dries some folks up completely, but I also don’t normally see people talking about doses as low as mine–.25mg eod is more common right?

Its so much easier to adjust down, than to crash your e2 and have to deal with it that way.

If you start having itchy nipples, then its time to either adjust your dose or look into other natural ways of checking your e2.

There is no way to tell what your e2 is going to do right now, why crush it before you even know whats going to happen.

Im telling you. My life is drastically different because I messed with e2 so long. I live in pain everyday.

How did you messed with e2??

Intentionally through supplements like DIM and CDG, armidex.

and then unintentionally with things like carnitine, curcumin, b6/b12

Was that on TRT? I was thinking about taking DIM supplement first before I start anastrazole.

I vote to hold the anastro for the first 3-4 weeks and feel it out. Once you crash E to the single digit it can take weeks to feel normal again.

Mine was 9 when started TRT two weeks ago. No Anastrazole etc.

start with warm lemon water. That’s probably the most gentle.

Half a lemon into warm water. drink

Don’t take anything for E2. You will regret it. You have no business with any e2 control.

Thank you for that advice.

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Hi thanks for the advice everyone. Balancing all the opinions here and on Excel male I’d say it seems I should stick to my doc’s advice to some degree–but perhaps wait 3-4 weeks for my E2 to climb before taking the adex. It is the lowest dose ive ever seen anyone take, and i’m willing to believe I might need a bit of help at 1200-1500 ng/dl Total T, but probably not week 2-3 with my current E2 at 14 right?

Here’s a q–how long does it take for E2 to rise, and how long to peak on TRT? Anyone with labs had any experience? I’m curious to hold off and drink warm lemon/green tea/resveratrol etc for 3-4 weeks, get lab #s taken and start adex if the numbers are above the 20 range. Anyone have any clue what .125 mg of adex will do to E2 levels? If I was at say 35 would it bring me down to 30? 20? less? Just curious if we have that data at all (or at least qualitative anecdotes! ).

Thanks!

I’m on 200mgs a week (100 mgs x 2) w 250 I/u hcg 3xs a week. I was also given .5 adex 2xs a week. (my e2 was 28 on my orig labs). however after all the research and reading, esp on this and other forums I am waiting on the adex. I am 2 weeks in and so far so good. I have labs set up for the 6th week in to assess e2. just hoping not to have any noticeable sides b4 then. but I am gambling that it is in fact easier and better to lower than to crash e2. we shall see. just my 2 cents.

*also e2 and hct were my two biggest concerns going in to and remain so.

Everyone responds to anastrazole differently. I crashed my E from 30s to single digits taking 0.25mg.

I went down to 0.125 mg and repeated. Each time it took me between 14-20 days to get my E2 levels back up to where I could get and keep an erection.

It took a month to get penile sensitivity back and perhaps 2 months to feel 100% again.