T Nation

Guys with Issues - These Videos Cover Estrogen, TRT, and DHT

I’m going to provide you with the most important video that you must watch that will blow your minds and completely change the way you think about TRT:

Then I would strongly urge you to watch the podcast I did with ‘The Lifting Dermatologist’ on YouTube in regards to all the mistakes I made with TRT and everything I learned. This will save you guys a TON of time getting things figured out:

I hope you enjoy them.

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They administered 1mg of Adex DAILY. Of course that is going to have detrimental effects on sexual function. How can you compare that to the normal TRT regime of .5 to 1mg WEEKLY? Apples with oranges

@juice7 where do you come up with “normal TRT regime”. The whole concept of an AI was taken from the bodybuilding community and has no place in TRT. I can provide you the names and numbers of 10 high level doctors, each with hundreds of patients, and not a single one uses an AI.

Watch this clip from the ‘rainman’ of the medical world, Dr. Eric Serrano, where I ask him this very question:

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I’m with you, believe me, I’ve just dropped out my AI based on this forum and another major TRT forum site and I’m already feeling heaps better!
When I say normal I’m only basing it on what I read on many users regimes. So perhaps that wording wasn’t appropriate.
It just think that any study where you are giving men 1mg Adex a day is going to be detrimental on a raft of measures. I’m sure both pro and anti AI advocates would agree on that?

I used to take KSmans word as gospel, but thanks to you and a few others sharing new data I’ve definitely changed my approach on a few things.

Dbossa, I have a question for you that I’ve been unsuccessful in solving myself. I’ve seen you indicate that you do not use hcg.

I’ve used a variety of protocols: trt only, trt with ai, trt with ai & hcg, trt with only hcg, trt with a serm etc and have been on a variety of hrt for about 5 years.

I feel best with only trt. The issue that I have is testicular atrophy which I believe negatively impacts ejaculate volume which makes orgasms extremely unsatisfying and less pleasurable.

I’ve read others reporting that spermatogenesis in the testes is only responsible for a very small amount of the actual ejaculate volume, but anecdotally, this hasn’t been the case for me.

Curious what your experience has been and if you have any tips or ideas outside of obvious ideas like “stay hydrated”.

Apologies for all of the ejaculate terminology being thrown around.

I can’t recommend taking HCG unless you need to be fertile at that moment. I did HCG for that purpose, got my wife pregnant, and then got off.

The guys that claim that they feel better with T plus HCG have typically never had their T levels high enough when doing T only. In virtually every single case, ditching HCG and getting free T levels up made them feel better with everyone I’ve dealt with… with very, very few exceptions.

I’ve done experiments taking much larger doses than my TRT protocol. My TRT protocol is 250mg a week which gets my free T to 28. When I did an experiment using 500mg, ejaculate volume was, much to my surprise, significantly more than ever before. I’ve had the same thing confirmed to me, anecdotally, by many guys as well.

Where are you free T levels currently?

YES! This is what the AI controversy in TRT all boild down to.

Do you need an AI for bodybuilding doses of testosterone (esters), especially when stacked on top of synthetic anabolics with progestin-like activity? Bodybuilding lore and bro science says yes, and I would be forced to agree (though I lack experience in the area).

Do you need an AI when you use doses and injection frequencies of testosterone (esters) that are designed to keep your testosterone (free T) levels within normal ranges at all time (peak and nadir)? No. T converts to E in a mass-action fashion. The more T you throw at the aromatase enzyme, the more that it convertsstrong text to E2. So, for most guys (there’s always the exception) when you keep T within range, you should also keep E within range.

Bottom line is that you should never start an AI unless you have labs that indicate you need and AI (that covers the exceptions). If you use reasonable doses of T and a dosing schedule of at least twice weekly (I know I’ll get flamed by certain individuals for that one), you should not need an AI.

Regarding testing (another potential flaming subject), you need to make sure you have the correct test procedure. Many docs don’t have a clue. Make sure your doc (or you) do not order the regular (non-sensitive) assay which is designed for women. You will always test high in E2 on this assay. The sensitive ELISA assay designed for men is a better choice but has potential cross-reactivity issues that may cause you to test high. Best option if the LC/MS/MS assay.

Let’s say a guy takes 200mg a week of testosterone, has free T at 40 ng/dL, and E2 at 110 pg/mL. The guy has never felt better. Libido and erections through the roof and no symptoms of anything of any kind. Would you give him an AI?

Unsure about current levels. Currently injecting 70 mg’s every 3 days, so 140 mg’s per week.

I feel better with no hcg, but the atrophy in the tests aesthetically bothers me. Even more so that given enough time with no hcg and as I mentioned, ejaculation volume seems to decrease more and more over time which reduces how pleasurable orgasms are.

I’m going in for blood work in the next week or two. You believe getting FT in the mid to upper 20’s will solve this problem, at least, the volume issue?

Do you worry about the long term effects on your heart and the effects on HDL at this level? Or do you feel those claims are typically over drawn? I’m asking because I’m a younger guy on TRT and have not found my sweet spot yet. I’ve been tempted to try 200mg a week but worry about longer term negative effects.
Your thoughts are appreciated, thanx.

I don’t want to speak for @dbossa here, but in my own personal experience, when my Free T was @ 19 I felt way better than “pre-TRT” but I still felt “off” like there was room for improvement. I switched to daily injections and that seemed better after about 8 weeks. Since then I have gone up in my dosage (from 165mg to ~ 180mg weekly) keeping the daily injection schedule. I felt WAY better. Free T in the mid 20’s.

Now here’s the human side of me that will proves that some people blame TRT for things that have nothing to do with TRT.

I bought a new house a couple months ago and, as you would imagine, my life got REALLY hectic. Scouting, negotiating, inspecting, closing, and then moving…and then realizing that you need more storage space so you spend every night and weekend trying to build a storage shed out back in order to reclaim your garage! Lol

That in mind, my workout, diet, and sleeping habits started going to shit. That in turn made me start feeling very unbalanced and unstable. My immediate thoughts told me “well you raised your dose a few months back…maybe it’s too damn high”. Even though I technically knew better, in a moment of doubt, I decided to lower my dosage just to prove or disprove this thought. Weeeelllll…

Fast forward 6 weeks later and things are calming down, my sleep is still shit, and in turn I’m even more prone to anxiety…

Long story short…I should have left my dose alone, got back into my regular eating habits (that’s taken care of now), and hit the gym harder than I ever have. It wasn’t the test, it was my immediate change in life habits that caused my issue. Now, I’m raising my dose back to 180mg / week and getting my shit back together. Time to get back to good!!

We don’t really have any compelling evidence to show harm at those levels but we also don’t have any studies on large numbers of men doing trt for decades. All I know is that I will get a full health check up once a year and make sure I am keeping up to date on everything. If I start to see some numbers starting to go to one side or another I can always adjust if necessary. It’s not like it will cause a sudden negative impact over the course of a week. This could take several years and would be a somewhat slow process regardless. As long as everything is being monitored properly I can see if something is going wrong and take action. My lipid profile has never had an issue regardless of what those I’ve tried so far.

I may give 200mg a try this go around and see if I can get further improvement. Mostly just my libido that has not come back 100%. I also still do not sleep well.

I would like to try daily injections but my life doesn’t really allow me to do that, I travel all the time with work and can’t be carrying testosterone and needles around with all the time. Glad to hear you’ve found what works for you after trying a few different protocols, I’m still searching for my sweet spot.

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Some of the benefits of TRT take way longer than I had expected. The only thing that happened quickly was the brain fog lifting and gym motivation. The feeling of wellbeing and energy levels seemed to ramp up over a couple months and then steady out. My libido improved a bit early on (the usual week 3 boost), but then went away for a couple months, and then came back with a vengeance. ED issues were on and off until about 2 months ago, and now seem to be gone (woohoo!). Anyway, I’m saying all that to say this. This is not an overnight fix and your body takes a while to adjust to it’s new normal. I’m in my 6th month and just starting to feel the benefits to the level I was expecting when I started. I think a lot of people screw themselves up with constant changes after early frustrations. The only change I would ever recommend early on is increase dose.

First, I’d make sure he’s using the correct assay.

Second, I’d recommend breaking that dose up into at least twice weekly and lower the T dose. I’d start with 50mg twice weekly and work up from there until there is symptom relief. My experience is that free T of 30 ng/dL is more than enough on an E3D protocol. I get that from about 60mg T-E3D (140mg/week). That should bring the E2 down.

Third, if the individual insisted on that high of a dose and weekly injections, and there are no overt adverse effects from the high E2, then I would say a trial of low dose anastrozole might be worth a try to bring the E2 closer to the normal range. He can always stop if it causes problems. The caveat being that he’s not messing around with other synthetic anabolics.

My preference is simply not to jump to that high of a dose without working your way up.

The next best thing I’ve found protocol wise has been 3x weekly. Mon, Wed, and Fri.

If your schedule allows, you should give that a try.

What is your protocol now?

70mg E3D works out to 163mg/week, but I agree with you that using HCG is more than aesthetics (not to say that normalizing testicular size is not important). I too notice a reduction in the volume of ejaculate without HCG. The testicles contribute very little to seminal volume ( I seem to remember ~5% from my reproductive physiology classes). The majority of the volume comes from the seminal vesicles and to a lesser extent the prostate. I also remember from my reproduction classes that the seminal vesicles are rich in LH receptors. I’ll need to track down some papers I remember reading about the hamster SV test for HCG activity. They measured HCG activity by weight of the SV.

Regarding Free T in the 20’s solving the volume problem, no. I don’t think that boosting FT will solve the problem. Per above, HCG works independently on the SV and that will solve (or at least help mitigate) the volume problem.

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@youthful55guy

Keep in mind that if you are secondary, then HCG is stimulating the testicles to produce endogenous testosterone, which is actually raising your overall test levels, in turn raising your free T (generally speaking of course).

What @dbossa is saying is to do the exact same thing but using only exogenous testosterone. His approach is not a lot different than yours except for the fact his method will work for primary AND secondary guys, thus making it more universal. It also simplifies the protocol by having to only adjust and dial in a single compound.

I’m a proponent of using low dose statins to improve lipids. My experience is that starting TRT pushed my cholesterol levels and ratios and lipids into the undesirable range. I think the effect is real. I was in denial for a couple of years and then my doc finally convinced me to trial a low dose of Lipitor (atrovastin). At just 10mg per day (the lowest dose they make), my lipid labs came down nicely.

Regarding doing at 200mg/week. See my previous post. I think you should work your way up to symptom relief and not just jump to that dose.

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