T Nation

High T, HIgh Free T, but Wood Issues

Hi all, I am in desperate need of some guidance. I start off with stats and information leading up to my current protocol (see CURRENT SITUATION below if you want to skip ahead).

Stats: I am 52 years old, 191 lbs, 23% BMI. Lost 15 lbs over the last 4 months.

May 2011 Started TRT under PCP
300mg Test E once per 3 weeks
Used DIM
Spring 2012 noticed mood issues and realized TRT did not seem to work anymore thus premature ejaculation, problems with getting and maintaining erections
Switched on my own at some point to 200mg once per 2 weeks

December 2012
Hit bottom with lethargy, sense of worthlessness, depression, no libido, no erections. Significantly increased use of Anti E supplements (DIM, etc.), while I waited to get appointment with my Uro. This dramatically helped mood issues and resulted in better interest in sex, but little impact on erection, e.g., no night or morning wood.

January 2013 sought help (i.e., an AI) from PCP Uro and Endo, with no luck in getting an AI from them. But following are labs

February 16, 2013
Total T 7.90 ng ml (no range)
Free T 189.4 pg ml (35 thru 155)
Free T percent 2.40 (1.1 thru 2.8%)
E 174.7 pg ml (no range)
E2 44.5 pg ml (less than 52)
TSH 2.28 miu ml (0.32 thru 5.50)
T Protein 6.5 g dl (6.3 thru 8.3)
Albumin 4.1 (4.0 thru 5.4)
ALT 19 u l (0 thru 50)
AST 24 u l (9 thru 53)
Alkaline Phosphatase = 52 u l (35 thru 129)
T Bilirubin 0.5 mg/dl (0.2 thru 1.3)
Direct Bilirubin 0.2 md/dl (0.0 thru 0.3)

March 12, 2013
T Cholesterol = 194
HDL 133
Non-HDL 61
LDL 54
Triglyceride 33
Glucose 100
B12 1930
Folate greater than 20
Vitamin D, 25 Hydroxy 92 (30 thru 100)
Hematocrit 46 (40 thru 51)

April 17, 2013 did labs as baseline before starting new TRT protocol under private clinic (see below): By this point, moods were still good, had rare erections, with no morning or night woods
Total T 699 ng ml (348 thru 1197)
Free T 23.49 ng ml (5 thru 21)
E 114 pg ml (40 thru 115)
E2 31.8 pg ml (7.6 thru 42.6)

Here is my CURRENT SITUATION:

April 21, 2013 (Sun) Started a new TRT Protocol
Test C 100mg twice per week (Sun and Wed nights)
DHEA-Pregnenolone Cream 0.25mg daily
Anastrozole (capsule 0.5mg twice per week (Sun, Wed nights) (HOWEVER, I DECIDED TO START WITH 0.25 mg)
HCG 500iu twice per week (Sun, Wed)

April 24, 2013 (Wed)
Anastrozole 0.25 mg

April 24, 2013 (Wed)
Temp 97 (1114 AM)
Started Potassium Iodide (daily 11.25mg)
Anastrozole 0.5 mg

April 25, 2013 (Thurs)
Awoke with an ok erection in early morning (first time in many months)
Temp 96.3 (348 AM)

April 26, 2013 (Fri) Labs (because I knew I needed to manage my E2 closely
Total T greater than 1500 ng ml (348 thru 1197)
Free T greater than 52 ng ml (5 thru 21)
E2 31.3 pg ml (7.6 thru 42.6)
DHEA 263.4 ug ml (44.3 thru 331.0)

April 27, 2013 (Sat)
Temp 97.1 (348 AM)
Ok Erection at approximately 930pm

April 28, 2013 (Sun night)
Temp 97.4 (741 AM)
Test C 100mg
DHEA-Pregnenolone Cream 0.25mg
Anastrozole 0.5mg
HCG â?? 500iu

April 29, 2013
Temp 97.6 (330 AM)

April 30, 2013 Plan to do more labs TODAY as soon as I get my lab slip
Temp 98.1 (511 AM)

MY PROBLEM/CONCERN/FRUSTRATION â?? I look at my wife with desire and want her, but not getting erections. With my numbers as of Apr 26, why am I not having night and morning wood or wood when we are cuddling. This frustration is exacerbated by the fact that my wife and I have been struggling with my lack of libido (Prostate Cancer treated by radiation) for years and she is nearing the end of what she is capable of handling.

Thanks in advance for any help you guys can provide to help me get better and save my marriage.

I’m not even remotely qualified to review all that and give you great advice or anything but I would say your E2 is still too high. Ideal is low 20s, most hone in on 22.

Dosing Test Cyp 100mg 2x/week it is typically said that for every 100mg of T you need about 1mg of AI/week. You seem to be a slight over-responder based on your E2. The calculation and what you may want to use to help get you honed in is

new dose/week = old dose/week * (current E2/ideal E2) = (1mg/week) * (31.2/22)= 1.4227mg/week

So if you are gonna stick with only having an AI 2x/week, then you need to bump it up to .71mg. This is easier done with drops and I didn’t read if you had those or pills. If you do 3 days a week, .47mg. EOD is .41mg. If you have pills, 3 days a week may be the best bet as you can easily split into .5mg tabs. You’ll have to make that decision but I would definitely attempt it. I will say I just made a similar change myself in regards to my Arimidex dosing, increasing it to account for my current E2 and I have been getting amazing erections.

If it’s gotten bad to the point you are both at your wits end, have you tried cialis/viagra/levitra?

Also, unfortunately this stuff takes time. You were changing your dosing around and getting labs done the same week. As much as it sucks, you have to be more patient than that. E2 changes can be pretty quick but if you are changing everything else around at the same time, you can’t hone in

Thanks for the reply Dawg. I really appreciate it.

I keep hoping it’s JUST an E2 issue, that’s why I’ve done labs twice with less than 2 weeks on this protocol. I want to keep an eye on E2 to help dial it in and not also let it get to low. I’ve also been thinking that I need to get E2 down in the 20’s and hoping that it will make THE difference, but worry that since I have a ton (?) of Free T, why aren’t things working <- this is my internal thought, but looking for experienced people to help me understand. I have read about 5 pages of the Estradiol sticky. Will keep reading while I wait for others to chime in.

For my AI, have 0.5 mg capsules rather than pills. I’m on a 10 week protocol and have just enough to last the 10 weeks. However, I know there are other means, e.g., drops…that I could pursue.

Cialis used to work, but once I started experiencing these problems, which I believe are E-related, I haven’t had any luck with it. However, I took some this morning to see how it works considering my new numbers.

Thanks again.

Thanks again Dawg. Under this new protocol (started April 21), I won’t be changing anything around. Last year and early this year, I tried things without remotely having a clue of what I was doing - my Uro was no help with that. However, I do know I need to be patient. It’s just hard to have it right now with so much at stake. I’m hoping that feedback such as yours at this site will help me control my patience :slight_smile: as well as dial-in…

[quote]TX-Pete wrote:
Thanks for the reply Dawg. I really appreciate it.

I keep hoping it’s JUST an E2 issue, that’s why I’ve done labs twice with less than 2 weeks on this protocol. I want to keep an eye on E2 to help dial it in and not also let it get to low. I’ve also been thinking that I need to get E2 down in the 20’s and hoping that it will make THE difference, but worry that since I have a ton (?) of Free T, why aren’t things working <- this is my internal thought, but looking for experienced people to help me understand. I have read about 5 pages of the Estradiol sticky. Will keep reading while I wait for others to chime in.

For my AI, have 0.5 mg capsules rather than pills. I’m on a 10 week protocol and have just enough to last the 10 weeks. However, I know there are other means, e.g., drops…that I could pursue.

Cialis used to work, but once I started experiencing these problems, which I believe are E-related, I haven’t had any luck with it. However, I took some this morning to see how it works considering my new numbers.

Thanks again.[/quote]

What do you mean 10 week protocol? You mean a 10 week supply? Or are you cycling this stuff?

Btw, for point of reference on arimidex: I just bought what comes out to about a 30 week supply of research arimidex to give to my pet camal for 65 shipped.

Your T dose is almost certainly too high, and your blood test of T > 1,500 confirms this. You are taking about twice the usual recommended amount of T.

High T can wreck your sex drive and erections just like low T, no matter what your E2 is. Most people actually do better sexually with more moderate T levels.

Try halving your current dose.

[quote]coolnatedawg wrote:

[quote]TX-Pete wrote:
Thanks for the reply Dawg. I really appreciate it.

I keep hoping it’s JUST an E2 issue, that’s why I’ve done labs twice with less than 2 weeks on this protocol. I want to keep an eye on E2 to help dial it in and not also let it get to low. I’ve also been thinking that I need to get E2 down in the 20’s and hoping that it will make THE difference, but worry that since I have a ton (?) of Free T, why aren’t things working <- this is my internal thought, but looking for experienced people to help me understand. I have read about 5 pages of the Estradiol sticky. Will keep reading while I wait for others to chime in.

For my AI, have 0.5 mg capsules rather than pills. I’m on a 10 week protocol and have just enough to last the 10 weeks. However, I know there are other means, e.g., drops…that I could pursue.

Cialis used to work, but once I started experiencing these problems, which I believe are E-related, I haven’t had any luck with it. However, I took some this morning to see how it works considering my new numbers.

Thanks again.[/quote]

What do you mean 10 week protocol? You mean a 10 week supply? Or are you cycling this stuff?

Btw, for point of reference on arimidex: I just bought what comes out to about a 30 week supply of research arimidex to give to my pet camal for 65 shipped.[/quote]

No. It’s not a cycle. The clinic I use provides 10 weeks supply at a time, and makes adjustments as necessary along the way. I will wait for my recent labs to check my recent E2 and if necessary (I should have results by Thursday), I think I will have to do some research too(wink)

Your free T is more than twice the upper limit.

What you are doing is not TRT but a steroid “cycle”, just permanent. It’s no wonder you have problems, like many bodybuilders do on cycle.

There is no formula for how much arimidex you should take. Sometimes arimidex cause sexual problems no matter what your E2 is, so if you can reduce your T dose, which reduces E2, to the point where you can cut out the arimidex, that would be preferable.

Thanks for your input Seekonk. I really appreciate you taking your time to respond to my post.

I am really trying to learn how to manage my TRT and I am sincerely open to all comments. My protocol is not self-prescribed. It is prescribed by a doctor from a known TRT clinic. I have done quite a bit of reading before I started with the clinic and I have never read that T can be too high as to cause my issues - not saying it is not true, but…

I am definitely willing to discuss that with my doctor now that you have presented that it might be a problem - remember, I am brand new at this with less than 2 weeks on an actual TRT program. However, there is the other perspective that Dawg presents that ‘E2 is still too high’ and that is what is causing my issues. I have read a lot of what KSMan has presented and he indicates E2 should be closer to or at 22. Hmmm - is my T too high, my E2 too high or both?! That is what I am trying to get help on with my post. The other thought I am having is whether my HCG dose (500iu 2x per week) is too high. My understanding is that can add substantially to Total T levels.

Also, if you notice my labs from April 17, my E2 is approximately the same at Ttl T 699 (no AI, but used Anti-E supplements) as my Ttl T 1500 (April 26 1.0 mg Anastrozole).

Much of what I have read on this forum, another forum and via other Google searches, clearly indicates that 200 mg per week is well within reason for TRT and is not considered a Cycle. Whether that dose is what is best for me or not, that is what I am trying to learn here and with my doctors - again I have not even been on a true TRT program for 2 weeks yet. A babe in the TRT woods.

You make the appropriate observation that my Free T is 2x upper limit. How much of a negative is that.

Again, thanks for your input!!

Texas,

Did they ever test your prolactin levels? Elevated prolactin can cause issues getting and maintaining erections.

many things can cause Ed. My e2 is also high but have no problems with erections. No cut and dry answer here. You’re not on a cycle a lot of docs start at 200mg and some people need 300. U just may not that’s all.

[quote]Kaynon311 wrote:
Texas,

Did they ever test your prolactin levels? Elevated prolactin can cause issues getting and maintaining erections. [/quote]

Thanks Kaynon

Feb 1, 2013. My prolactin was 9.55 ng/ml. Range 0.47 thru 18.0.

Seems to be ok?!?

[quote]iw84aces wrote:
many things can cause Ed. My e2 is also high but have no problems with erections. No cut and dry answer here. You’re not on a cycle a lot of docs start at 200mg and some people need 300. U just may not that’s all.[/quote]

Thanks for giving me some feedback. It means a lot!!

As I said, I was not qualified to expand on your entire lab series.

I would be inclined to listen to seekonk and look into the possibility of reducing dosage. While 200mg/week is NOT really considered cycle level, levels as high as yours may indicate that for YOU it is too much. I am on that much, and 600iu hCG 2x/week and my levels are about 1100-1200 1 day post injection and free T is still around the middle of the lab range due to high SHBG. I’m trying to raise my free T to top of range, which reducing E2 will accomplish.

When my E2 is where I need it, I may find my free/total T is too high and I might need to come down a bit to a safer value and then manipulate T/AI dosage some more. It takes a while to hone all this in so don’t get discouraged. I think it’s actually kind of exciting although it is frustrating

Note: Reducing hCG dosage would help bring T down. For me, I find I was still experiencing atrophy at 500iu 2x/week so I bumped it up another 200iu a week. The goal is to get E2 set, free T at top of range, and hCG to where your nuts don’t hurt/shrink. I believe your best bet for living a healthy lifestyle is to reduce your dosage of T to maybe 50-75mg 2x/week, find the lowest dose you can run hCG, and get E2 where you need and then re-evaluate based on labs DONE AT THE SAME TIME EVERY TIME.

(I feel like I rambled a lot so I hope you got some actual information out of that)

[quote]coolnatedawg wrote:
As I said, I was not qualified to expand on your entire lab series.

I would be inclined to listen to seekonk and look into the possibility of reducing dosage. While 200mg/week is NOT really considered cycle level, levels as high as yours may indicate that for YOU it is too much. I am on that much, and 600iu hCG 2x/week and my levels are about 1100-1200 1 day post injection and free T is still around the middle of the lab range due to high SHBG. I’m trying to raise my free T to top of range, which reducing E2 will accomplish.

When my E2 is where I need it, I may find my free/total T is too high and I might need to come down a bit to a safer value and then manipulate T/AI dosage some more. It takes a while to hone all this in so don’t get discouraged. I think it’s actually kind of exciting although it is frustrating

Note: Reducing hCG dosage would help bring T down. For me, I find I was still experiencing atrophy at 500iu 2x/week so I bumped it up another 200iu a week. The goal is to get E2 set, free T at top of range, and hCG to where your nuts don’t hurt/shrink. I believe your best bet for living a healthy lifestyle is to reduce your dosage of T to maybe 50-75mg 2x/week, find the lowest dose you can run hCG, and get E2 where you need and then re-evaluate based on labs DONE AT THE SAME TIME EVERY TIME.

(I feel like I rambled a lot so I hope you got some actual information out of that)[/quote]

Thanks Dawg. I appreciate all your comments and I understand exactly what you are saying. It’s just good to have someone to chat with and help me control my FRUSTRATIONS and maintain patience. It is quite helpful to remind me that I am just starting and I need to let things settle.

BTW - I ran my numbers by my TRT clinic folks and asked about reducing T or HCG - they were not concerned as of yet. Their program is to test at 4 weeks and adjust from there if necessary. I hope that in that time period, libido/erections will improve. As my mind is starting to settle from yesterday, it makes sense - I read that it can take a couple of weeks for estradiol to adjust to the AI, and I have only been on it a week. However, I am looking at the formula you provided for the AI dose and considering…

However, being patient may mean just let things be for now. We will see.

Thanks again for putting up with my panic. :slight_smile:

It’s completely understandable to panic or overthink these things. There is a lot of information out there, most of it conflicting, so you have to be able to realize that and take a step back and get some altitude on where you are currently. Just know you are ON YOUR WAY to a fix. You aren’t there yet but you are better off than where you were.

If they aren’t willing to change your T or hCG dose yet, you have 2 options: adjust T/hCG on your own (you are self-injecting?) or do your own AI changes. You have to decide if you want to screw around with what they have you on as they are Rxing and I wouldn’t want to piss them off even though some docs are stupid and don’t really focus on individual patients. Understand you are at supraphysical and potentially unhealthy (longterm) doses FOR YOUR BODY.

Clinics keep pushing 200mg/week. But that is still wrong.

[quote]KSman wrote:
Clinics keep pushing 200mg/week. But that is still wrong.[/quote]

Yes, a lot of these clinics (typically operating out of Florida) are shady operations. They charge high prices, often forcing the patients to buy the medications from them at hundreds of times the actual value of the drugs, and prescribe very high doses so that patients can see rapid bodybuilding results so as to be competitive with other clinics of the same type.

Here’s an update on my situation midway through week 2 of my TRT program. Things this morning are 180 degrees from my first post and I thank all who took the time to respond.

@Dawg I listened to what you said about the AI dosage. I upped my dosage and changed my AI schedule. Instead of 0.5 MG 2x per week (on the day of T pin), I upped to 0.5 mg on 1st, 3rd and 5th day of the week (pins on Sun and Wed nights). So in this case, I pinned Sunday NIGHT, I took 0.5 mg on Sunday and Tuesday NIGHT (and Thursday night). On Wednesday morning, I awoke for work with a good erection. I felt good, but that was only the beginning. However I did not feel much of a libido - possibly anxiety?! Anyway, my wife and I went to lunch on Friday, and on the way home, I felt a pretty strong libido but didn’t push anything yet. Friday night we’re sitting in front of the TV, my wife made a move (she may have sensed my earlier mood), and I responded - Free Willy!! HA! Say hello to my little friend LOL. Later that night, my wife reached out to me to cuddle (an intimate moment and not a sexual moment - it was great!!) I have been the one who has had to initiate in the past because of our situation. That was a big plus. We went to bed and I woke in the middle of the night with a raging Willy LOL and gave my wife some attention WINK. Clearly things are on the mend - I just have to manage whatever this sweet spot is. In that regard, (@Dawg) I found a pet Camel on sale. LOL Should be here next week. I think I need to nourish it probably EOD.

Again - thanks all for your responses.

BTW As of Tuesday MORNING (lab draw), my T ( greater than 1500) and Free T (greater than 52) had not changed at all but my E2 had increased to 35. But this lab was before my next 2 AI dosages. I wish I could have taken labs this morning to see where my E2 is. Oh well I will just manage by feel for a while especially once my Camel arrives.

In my case, this is a lesson in patience and lets me know that TRT works with the right guidance and management.