Help Me Dial In After 5+ Years

Pharma / TRT Testosterone Replacement
1
  • I’m 36, male, been on TRT for 5.5 years since summer of 2012.
  • I’m going to use this thread for questions and as a log of my progress getting dialed in. I need some help and will be hoping to get assistance from you guys.
  • I had a prior thread (click here for link) focused on thyroid issues but I want to start this focused on the TRT stuff. I won’t start another one regardless of what comes up, but my thyroid isn’t an issue it seems.

Current Status

  • Injection Schedule: 48mg T-Cyp EOD, have been injecting EOD for years and have no problem maintaining a consistent schedule with frequent shots.
  • AIs: not currently taking an AI, have Arimidex and Aromasin on hand right here at home
  • Issues: oily skin, bloating, weight gain, brain fog, fatigue, low ejaculate volume

Labs

T/FT/E2 (Taken 16 hours after most recent shot)
Testosterone, Serum:       1162        Reference Range: 264-916 ng/dL
Free Testosterone(Direct): 32.9        Reference Range: 8.7-25.1 pg/mL
Estradiol, Sensitive:      40.3        Reference Range: 8.0-35.0 pg/mL

THYROID
TSH:              1.310 mcIU/mL	    Reference Range: 0.358 - 3.800 mcIU/mL
Free T3:          3.44 pg/mL	    Reference Range: 2.18 - 3.98 pg/mL
Free T4 (EIA):    0.89 ng/dL        Reference Range:0.76 - 1.46 ng/dL
T3,Reverse:       11.2 ng/dL	    Reference Range: 9.0 - 27.0 ng/dL

So it looks like my thyroid is really healthy and the core issue is the E2 level and what adjustments if any I need to make to my T levels.

Current Questions

  • Does the timing of these labs make any difference, or are my levels so steady on EOD shots that this is probably a consistent reading for me? I’m not sure whether I have peaks or troughs at all since I inject so frequently.
  • What would determine whether I should lower my dose versus taking an AI? My libido and training are going great and I don’t want to diminish either of those, but I do want to address the bloating, water retention, fatigue, etc. Plus I know having elevated E2 is not good.
  • How do I know how much to take of an AI to calibrate my E2 level down without just guessing and overdoing it? Is Aromasin or Arimidex the right choice? I have ample amounts of both on hand so that’s not an issue. Or will I have to experiment and see which one works better for me?
  • Should I consider trying DIM since my E2 isn’t sky-high? I also have some of that on hand.
  • What’s the best option here? I’m not sure which is a higher priority-- not having to use an AI and backing my dose down until I find a good E2 level, or keeping my TT/FT high and getting my E2 down to see how I feel. I’d be grateful for advice on what course of action is best.
2

There no way you will notice a difference in testosterone levels between 1162 - 800 ng/dL. Bringing yourself down to 800’s could bring your E2 within ranges, some guys are over responders to AI’s so it’s something to think about. It’s a drug and drugs have side effects, if you’re really concerned about diminishing your results lower the dosage.

Have you ever tested SHBG? You can only hold on to so much testosterone before it becomes unmanageable in the form of elevated free T which converts to E2. You’ve resisted the use of an AI for this long so I’m assuming there’s a reason.

There aren’t many guys who can reach your numbers without an AI, I can’t even handle the 800 ranges without an AI. You know what you need to do.

I would try DIM and calcium D-glucarate before an AI if that’s really where you’re headed.

Your thyroid looks excellent even with lower fT4 which is fine since fT3 is optimal.

3

No HCG with your current regimen?

4

None. What makes you ask?

5

Here’s the weird mystery: this is a different lab and the first time I’ve tested over the range on a roughly comparable (within a few MGs) dose.

Here are two labs from the last few years from a different site:

Testosterone, Total
Reference Range: 241 ‐ 827 ng/dL
9/22/17 Test: 648 ng/dL
11/2/16 Test: 620 ng/dL

Testosterone, Free
Reference Range: 47 ‐ 244 pg/mL
11/2/16 Test: 156 pg/ML

I will the next time I draw blood.

I did try both Arimidex and Aromasin from different suppliers a few years ago and am not confident they were any good/legit/etc. They were from a research chemical site and it just felt sketchy and I wasn’t confident in the dosing.

I also tried Adex from a doctor in 2014. Doc was a urologist who claimed to be good with AI stuff. He told me to take 1mg a day and I tanked my E2 down to unreadably low levels. It was miserable.

What happens to you/other guys at the higher levels without an AI? Gyno or other uncontrollable symptoms?

I’ve definitely noticed a decrease in strong morning wood, which is a pretty good indicator for me that something is off. I’m not sure what changed in my body.

Now that I think about it, I do have an idea. I was diagnosed with vitamin D deficiency right after the labs in September 2017. I started taking significant doses of Vitamin D. I wonder if that changed my body’s response to the testosterone and that’s why I tested higher this time? Does that seem plausible?

Back down the dose, then? I think what’s confusing is this is the first time I’ve tested this high in years. Once a few years back I had an anomalous high test like this and the next time it was back to normal.

6

First stop measuring FT directly as it’s pointless and unreliable, we measure our FT using SHBG calculator using TT and SHBG. Reason is the half life of FT is 1 hour or less, so and an hour later it changes = useless.

Gyno isn’t as common as you think, I spent 4 months with high E2 lowering dosage a total of 4 times. Erections started to look constrained and wouldn’t fill easily. Lots of low T men have Vit D deficiency, I had low Vit D when T was low, no more. Perhaps that’s why your T is higher, T restored your Vit D status after being on TRT for awhile.

7

Can you explain what you experienced when you crashed your E2 levels on Adex?

8

It’s been a while, but I recall feeling joint pain (I deal with back issues and they got worse), poor training, soft erections and very low libido, no morning wood, and severe constipation.

What makes you ask?

9

I was dealing with very very low E2 issues for a long while. Just curious about others experience with it. I suffered with ED and pretty severe depression. That’s why I ask. Thank you for sharing that.

10

Just wondered. Most competent doctors have their TRT patients on HCG so that their balls don’t become shriveled up raisins.

11

I don’t think I’d describe my doctor as competent. When I can afford it I want to get a consult from a good doc (there’s one here in San Diego that’s supposed to be great, he just costs a fortune).

12

Gotcha, that makes sense. Did you crash your E2 using an AI or did you have other issues that lowered your E2?

13

No, the opposite is true. I was diagnosed with low Vitamin D in September 2017, after being on TRT for years. My levels were 10.1 ng/mL with a reference range of 30-100 ng/mL. This most recent T level is after supplementing Rx ErgoCal (the D2 form) at 50k IU per week and daily D3 at 5k IU for a few months.

What I’m saying is that I think the feedback goes in the opposite direction you suggest: raising my Vitamin D levels seems to have spiked my T levels given the same injectable dose of T. That’s the only variable I can think of.

Sleep, stress, exercise, and diet are all comparable to the last T labs in September and the Vitamin D status is the only thing that’s changed.

14

That absolutely sucks, man. We trust doctors with our health and frankly our lives, and when they don’t care enough to be knowledgeable it’s insulting. I hope you can find someone who will take the time to give you proper treatment.

15

yeah, my regular GP just tests my now and then before refilling my Rx for Cyp. I saw an endocrinologist last week who was a total nightmare and told me I shouldn’t have ever started TRT.

My GP won’t prescribe AIs or HCG since she says it’s not her specialty. Absolutely sucks. No one in San Diego seems to be on my insurance and actually focuses on getting guys dialed in.

16

I love when a doctor tells you that you shouldn’t have done something in the first place. That’s very helpful.

I’m constantly amazed by how many of you guys get your insurance to pay for your treatment. I pay every dollar out of pocket for my TRT and I’m legitimately jealous of you all.

17

Endo told me last week to come off for 3 months so he could do some testing.

18

I did take an AI at one point and crashed it but bounced back. It crashed again like a year later and never came back up. I’m 7 weeks into trt now and feel awesome. I just did bloodwork yesterday so this will be my first look at my levels since starting. Hopefully I can do some tweaking and improve it even more but if this is as good as it gets I’m still very happy.

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19

Hey man I’m the varicocele guy I’m probably gonna start trt In a year gonna try clomid first I have low e2 and low t at 380 hope mine turns put as good as yours

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20

Insurance doctors will never take the time necessary to get you dialed in, they don’t have time. You want optimisation you pay for it out of pocket, most of the excellent doctors have left the insurance practice.