T Nation

Help with Refining HRT

Hey guys, awesome forum and members. I’ve been lurking for a couple of months and find this stuff fascinating, especially KSman who has some very insightful posts so I’m hoping I can catch his attention in my questions.

I’ve been on HRT for about 4 years now, I’m 41 years old and initially my TT levels were in the low 200s. I’ve kind of bounced around different things in this time, and part of the reason was I got greedy with TT levels before fully understanding all the nuances and interworkings of all the different hormones and factors.

Initially we started on 100mg test/week, we tried all different combinations, cyp, enanthate, they even threw in nandrolone at one time which I absolutely hated. My TT was usually coming in around high 700s with FT about 15-18. We got to a point where I would take a break before doing my tests and my TT would come in low, so they would raise the test injections first to 200/week and then we even went to 300/week. Needless to say I felt incredible in the gym, but the things I initially went for like libido, anxiety, motivation etc all got worse. I had to go through this myself as I’m hard headed and wouldn’t believe it otherwise, but now I realize less is more as I keep hearing.

Now here are where some of my questions come up. I’ve always (regardless if I was on 100/200/300 test/wk) had a protocol of 1500iu HCG/week (500 x 3)and 3mg anastrazole/wk (1mg x 3) and always felt that this was an issue that was not positive. The days I took the HCG or the anastrazole I felt good in the morning, but by mid morning would crash, very tired and sleepy, very moody, at times I would even get E2 symptoms like bloat and sore nipples. This was a conundrum because this was supposed to lower my E2 levels and my doctors could not understand this.

This last cycle of 20 weeks they agreed to let me do test by itself with no anastrazole and HCG, I needed to see for myself what my labs would look like and if those substances were causing an issue. I also made the decision to go very low on the test and see how I felt and work my way up, part of the thought process was the high levels of test were increasing my E2 and that less test would give me a better T/E ratio without having to use the anastrazole. So I brought it all down to 120 test cyp/week given in 2x60 IM injections per week, no HCG, no anastrazole.

20 weeks later we did labs, I only have the values he told me over the phone, but they will fax it to me next week and I can post it on here. I did wait one week after my last 60 injection before doing the labs. here are the numbers as I can best recall them, I’ll post up the official numbers next week: TT: 642, FT: 15, E2: 26, LH: 0.1, DHEA: 152. Those are the numbers I remember, this is after a 20 week program of 120 test cyp/week, no HCG, no anastrazole.

Honestly I felt pretty good during that 20 weeks, no mood swings, I wasn’t my usual a$$hole self but I was actually pretty caring individual. I lost a good amount of muscle mass but I kept fairly lean and kept most of my strength, best of all I didn’t really care, you tend to build up a body image you feel you need and the more test you take the worse this gets it was nice to not have this worry as much.

Now the issue I’m having, my number 1 issue is Libido. I don’t have an issue with ED if I have libido, and I was tested for any ED type stuff by my urologist so there are no physical issues there. The higher and higher the test went the worse the libido was, although it was cyclical, when I would first start a cycle my libido was great, but then it would taper down to nothing. In fact all positive aspects were like this, start off great then taper down as I reached a steady state, this is one reason why cycling is a good thing.

OK so fast forward to my latest labs and examination. Testes are very small, one of them aches, libido is down to nothing, but I feel great overall and the very last thing I need to fix up is the libido. Doc says that LH is really a big issue and I need to get back on the HCG, he says E2 looks ok, but is more comfortable with some anastrazole, although he agrees it needs to be a lower dose.

I proposed I stay on the 120/wk, but add in 250UI HCG 2x week for total of 500, and .25 to .5 of the anastrazole 2x/week. HCG the day before the test shot, anastrazole the day after to coincide with the test peak. The reason 2x/week is both economy (can cut tabs in half), and from reading some of KSman’s posts if I am one of the anastrazole over responders it seems that issue may be slower clearing of the anastrazole by the liver, which may indicate less frequent AI would be beneficial.

Last week I started on my new protocol, I’ve only done one half week cycle so far. HCG x 250 UI, next day 60/test cyp, and yesterday .5 anastrazole (cut in half one of my old 1mg capsules until pharmacy fills my new order). I’m still feeling like crap on HCG and anastrazole days. HCG days I will feel very moody and sleepy, possibly an E2 spike? Anastrazole days I’ll feel very foggy and VERY sleepy, like I can just sit down and close my eyes and I’ll fall right asleep. But the next day after anastrazole my libido will feel great so I’m assuming I’m on the right track.

Well that’s about it. No real concrete questions, just a lot of variables for you guys to look over and tell me what you think and what I should think about tweaking. My number one concern is libido, number 2 is that sense of happiness and well being, number 3 is just to look good but I’ve learned that this shouldn’t be number one.

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You are right - those doses were way high. In my experience doses that are too high will definitely kill libido.

It doesn’t sound as if the HCG or anastrozole is doing you any favors (in fact your E2 seemed to be great before at 26, so why the anastrozole?). Maybe dropping those and adjusting your T dose might be a better bet. There is still some room for reducing your T dose down to 100 or even 80 per week.

Why a real TRT doctor would describe nandrolone (a notorious libido and erection killer whose effects can sometimes last many months after you stop it) boggles the mind. In addition, the legality of prescribing nandrolone for TRT is questionable. That is a red flag, and personally I think you would be well advised to look for a good TRT specialist rather than the chop shop clinic that is currently treating you.

Yes I’m concerned with some things with the clinic, although they’ve been great in listening and adjusting things when I’ve asked. I’ve been doing the 120/week (60x2) for about a week now, I’ve done also the 250IU of HCG twice this week and have done .5 of the anastrazole/arimidex twice also, 24 hours after my test shot. So far I am feeling tired and achy on the arimidex days, and very sleepy in the afternoons. Overall I still feel good moods, but I feel as if I lost the energy and drive I had before on just the test.

I’m concerned with losing my testes function so it seems like the HCG is a must no matter what, but I seem to feel ok on the HCG days. My concern is the arimidex, but I will know more after my first test after this new protocol. I’m also bringing the arimidex down to .25mg 2x/week and see how my E2 looks then.

I just got my labs, here are the values, this is after 20 weeks of 120mg test cyp/week with no HCG and no AI, I waited a week after my last shot before doing the labs.

LIBIDO is still the issue, any advice would be appreciated.

T3/free 3.2
T4/Total 6.9
T4, free 1.30
TSH 2.400

PSA 0.482

FSH 0.2
LH <0.100
Estradiol 27.8

DHEA Sulfate 180.5
Testosterone total 645
Sex Hormone Bind Globulin 29
Testosterone, Free 15.57
IGF-1 300

Vitamin D,25-OH, Total 19

[quote]spinedoc wrote:
Yes I’m concerned with some things with the clinic, although they’ve been great in listening and adjusting things when I’ve asked. I’ve been doing the 120/week (60x2) for about a week now, I’ve done also the 250IU of HCG twice this week and have done .5 of the anastrazole/arimidex twice also, 24 hours after my test shot. So far I am feeling tired and achy on the arimidex days, and very sleepy in the afternoons. Overall I still feel good moods, but I feel as if I lost the energy and drive I had before on just the test.

I’m concerned with losing my testes function so it seems like the HCG is a must no matter what, but I seem to feel ok on the HCG days. My concern is the arimidex, but I will know more after my first test after this new protocol. I’m also bringing the arimidex down to .25mg 2x/week and see how my E2 looks then.

I just got my labs, here are the values, this is after 20 weeks of 120mg test cyp/week with no HCG and no AI, I waited a week after my last shot before doing the labs.

LIBIDO is still the issue, any advice would be appreciated.

T3/free 3.2
T4/Total 6.9
T4, free 1.30
TSH 2.400

PSA 0.482

FSH 0.2
LH <0.100
Estradiol 27.8

DHEA Sulfate 180.5
Testosterone total 645
Sex Hormone Bind Globulin 29
Testosterone, Free 15.57
IGF-1 300

Vitamin D,25-OH, Total 19
[/quote]

Add the lab ranges. Vit D looks low. Your TSH is over 2 which indicates a possible problem. Start using Morton Iodized salt (not sea salt or kosher) and get a full thyroid panel. Also check cortisol. Your T looks alright not on the low or high side.

Thanks, I absolutely hate the taste of salt so I never get any, and when I do have salt I bloat up pretty quickly for some reason. I’ll try forcing myself to add some in, or possibly an iodine supplement, I’ll have to look that up. I also started on 1000 IU of D3/day.

So far on week 2, still on 120mg test cyp/week at 60 2x/week, 250IU HCG the day before my test shot, and I brought the anastrazole to .25 2x/week the day after my test shot. I’d say libido is feeling decent this week, but I’m not sure if that’s from what I assume are slightly increased test levels from the HCG. HCG days I feel a nice boost in the mornings, but then the rest of the day feel sleepy and a lot of E2 type symptoms, possibly it’s spiking up my test? Test days I feel great, and on anastrazole days I’ve been feeling good as well. Considering doing the HCG and the anastrazole on the same day, any input on this?

As for my clinic, I am going thru a HRT anti aging clinic and it’s very expensive. I had a frank discussion with my urologist who initially put me on androgel 1.62%, but we changed that since I have a 7 month old and now he just prescribed 200mg test cyp EVERY 3 WEEKS!! OK he will be a work in progress, but my insurance paid for everything, labs are free, 10ML of test was $30, which is much nicer than the $150/month and $300 labs I’m spending with the HRT clinic, not to mention the consults. Now the hard part will be addressing bi-weekly injections, although if he can just bring me to my current level of 100-120/week I can just buy my own needles and inject at my own frequency. HCG and anastrazole may be hard sells as well, but I’ll cross that bridge when I come to it.

So where is everyone on these forums? Seemed like an awesome place to get advice so I’m hoping more of you guys chime in.