T Nation

Help with TRT Protocol, Issues etc

Used to lurk these boards back in the late 90s and early 2000s. I am glad I remembered it existed.

Background
46 year old male that trains 5-6 days a week. 6’3’ 210 pounds. I eat clean and hit my macros. I have 2-4 drinks a week socially with friends. About two months I started waking up with anxiety and dark thoughts. I thought it was nothing, just this pandemic/lockdowns/election bullshit wearing on me. Have a great career and family, no real stress at all. I lost my libido around the same time. Never had an issues in that department prior. Erections are weak and sometimes can not perform, which is a new level of stress/embarrassment.

Here is my protocol with labs to follow
1 ml 200 test cup a week (.5 each pin on Monday & Thu)
.25 ml HCG 12000 iu sub q day after pin
prescribed anastrozole 1 mg a week (i did not take it at the start, wanted to see how my body responded)

Blood work prior to starting TRT
IGF 324 Z score 1.9

Estradiol 16.6
LH 3.93
Test ng 388
SHBG 45.9
Cholesterol 177
HDL 61
LDL 104

9 months into TRT 1/6/21

Test 1270
SHBG 34.5
Free test 127.6
Estradiol 16.9
HDL and LDL are same

  1. I pinned two days before draw and took .5 mg of anastrozole day prior.

  2. I noticed was retaining water pretty bad. My fingers and feet were like damn sausages. Not quite that bad but I could struggled to get my wedding band off.

I called my doc and I told him about my mood swings and ED issues and he told me to take the anastrozole to get my estrogen in check. He told me to take a full 1mg after each shot for 1 week then .5mg after each shot.

I am a calm and patient person trying to this protocol right and dialed in. I knew there would be some trial and error. I did not expect to lose my sex drive and ability. Also, do not want to try to solve it an ED medication.

After rediscovering this board, I wish I would of started here. I have not used HCG since Dec. 25th. I wanted to eliminate as many variables as possible. I feel was I given the standard TRT doc program. Any insights would be amazing. Appreciate it.

Your doc needs to study

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Yeah your E2 is pretty crashed for T that high. Id put the anastrazole away for good unless you are prone to gynecomastia, most arent, and it can cause mood swings. It sounds like you’ve made quite a few changes in the last month. Personally Id stay off the HCG unless you need to make kids right now and stay away from the AI. Take your 100mg twice a week and see how things flush out in 6-8 weeks. Literally and figuratively. Dose changes etc can cause water weight to fluctuate. You need stability to calm that down.

"Within men, E2 plays a critical role with sexual function, modulating libido, erectile function, and spermatogenesis (5) It’s important for fertility. It’s also important for keeping excess pounds off, positive mood, muscle health, bone mineral density, joint health, and heart health.

The effects of E2 on libido alone starts with its direct effects in the brain. Oestrogen receptors (ERs) exist in the pre-optic area and the anterior hypothalamus regions of the brain, which also have high levels of aromatase and ER. These regions are known to be involved in increased sexual libido. Furthermore, if we give exogenous E2 to lower testosterone adult males, we observe an increase in libido (6). Interestingly, a case-study also existed where a male patient with aromatase deficiency and hypogonadism required both testosterone and E2 to increase libido; neither hormone alone could raise libido (6)."

  1. Schulster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl . 2016;18(3):435-440. doi:10.4103/1008-682X.173932
  2. Wibowo E, Schellhammer P, Wassersug RJ. Role of estrogen in normal male function: Clinical implications for patients with prostate cancer on androgen deprivation therapy. J Urol . 2011;185(1):17-23. doi:10.1016/j.juro.2010.08.094

thank you for the response. I forgot to put in first post that I did not take any anastrozole prior to Week of Dec 16th. That is when I did the week of 1mg after each pin so total of 2mg for the week, like he stated. About three days after that my elbow joints were in pain. My goal is to be optimal everywhere from gym, home, and super dad. I have kids and got snipped years ago, my doc sold me on HCG keeping natural production in addition along with increasing sex drive.

I understand. My suggestions stand. Elbows and knees are a sure sign of low E. HCG makes a lot of dudes feel like shit.

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That’s a lot of anastrozole for a testosterone replacement dosage and am not surprised at the outcome.

Your doc has fallen behind in the TRT world, 1mg AI is a path to failure. There are dosages more appropriate for TRT in extreme cases, 0.050, .125 and .250 mg AI dosages you can get via compounding pharmacies.

TRT, HCG and an AI protocols have too many moving parts and good luck finding a balance as AI’s often take things too far in one direction.

It is best to start TRT in isolation and to manipulate testosterone and estrogen by adjusting the dosages and/or injection frequencies to get things working below.

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RIP. Honestly man, if you didn’t have mood swings and ED issues with those numbers then I’d wonder if you were human.

Not sure what you mean RIP? What’s your suggestion? I’m looking for what is out of whack? I know 1200 is the top of the “normal” range. I don’t care what my number says. If it said 600 or whatever I would be completely ok. I’m not into being at the top or whatever range.

He is referring to your T to E ratio. With a T of 1270 you’d expect your E to be around 60-80.

I am to the point of stopping and doing a restart of just test. Or is that not that best method?

TT is high and e2 is low. You’re taking 2mg of AI, which is clearly overkill.

If you’re not worried about fertility then drop the HCG and try to just dial in test only first

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Thank you for clarifying, I just want to be optimal in all aspects in life and be healthy. I would gladly reduce the amount of T per week to have all parts working. I am not a numbers guy when it comes to the amount of T.

2mg was for one week and then went to the dr suggestion to .5mg. I have stopped AI after my blood draw two weeks ago. Honestly, I feel like a fool after reading most of the posts on here. Shame on me for not doing my homework and trusting the clinic I am using.

Your clinic is more to blame for your outcome, but taking some responsibility is good and now you should seek out someone more qualified to direct your treatment.

We have all been there, I was given a 200mg every 3 week protocol from the beginning and came here and learned my doctors are merely writing the prescriptions and protocol decisions are on me as I try to figure this out on my own.

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I agree with System, your clinic gave you a cookie-cutter T+AI+HCG then when you had issues they blamed e2. It happens

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Why? Because you trusted a doctor? Don’t feel that way. We all did, and then we learned better. Stick around and you’ll learn all kinds of useful stuff here.

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Thanks for the input, I appreciate it. I stopped HCG (dec 25) and anastrozole (.5mg on 1/5) and will not use them again unless I develop gyno.
Any suggestions on the amount of test I am currently taking? Would lowering it from 1ml a week to .75 for a few weeks be advisable to prevent the bloat and water retention?

Within physiological ranges the vast majority of bloat and water retention can be controlled by diet and hydration. My current “trt” is probably equivalent to 400mg/w, using the most e2 unfriendly drug on the planet, and I have zero bloat unless I eat Chinese food (no joke).

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Ok. Lets go for a re-start. You’re gonna be alright. Drop your dose to 160mg/wk, no AI, no HCG. If you like to drink beer, enjoy em. It helps bring E up. The reason why you should lower the dose is so that your T/E ratio balances out sooner. Past 40? time to see Cialis as a preventative and not as a necessary. Take .5mg Cialis EOD for prostate health and for overall CV health. At anything below 300mg I doubt you will ever need an AI. As for feeling sensitive allowing a Disney moment to cash in on your humanity, dont resort to taking an AI. Just enjoy the moment, and wipe the tears away with a smile on your face. Then play God of War for a half hour and plot a way to get laid in the afternoon. Be playful mate. Remember, videogames are cool but will never be as good as pussy:)So lower your dose, take .5mg Cialis EOD, and relax. Dont touch an AI. Lets catch up in 3 months to add a cycle of HCG if thats where you want to be.

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Thanks for the advice. I am dropping everything except the test. Lowering the dose and seeing what occurs. I’ll have a few beers and hope the E2 goes up and balances out. I never had libido issues before trt and performance never in doubt. Crazy that 7 months in and goes into the toilet. Will hold off on any Cialis or Viagra for now. Woke up this morning with wood.

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