T Nation

How Long to Dial In a Protocol Before You Give It Up?

46M, 160lbs, 5’10", Test Cyp 26-27mg EOD IM, no AI, no HCG, no other prescribed drugs, no alcohol, 1.5g of alkalyne creatine per day / before workout or exercise, small amounts of Marijuana at night, no smoking but I used to and I do take a nicotine supplement for now which I am slowly weaning myself off of, diet is clean / no sugar whole foods 90% of the time.

Pretty lost on what to do at this point. Still experiencing fatigue and headaches 7 months out. Still haven’t dialled in. From the looks of it I need to lower my dose again but I feel like I’m pretty low already.

Where to go from here; stay on EOD and lower to maybe 20mg or move back to E3D with the same dose I’m using now at 26mg?

I feel like maybe TRT isn’t going to work for this guy. I do have muscle gains but the head stuff, the temp changes in my body (high and low), the lethargy unless I’m doing something physical, and the general lack of feeling good most days is driving me absolutely nuts. I’m lucky I’m working from home but I only have another couple of months to get this right.

I am going to try a men’s clinic next week where they specialize in HRT but man, I was really hoping to get things close to where I need to be to function like a normal human being by this point.

All opinions / insights are always welcome. Thank you in advance for your reply.

Historical blood work (4 instances) starting with oldest:

Feb 6th 2020 (before Testosterone)
Total T 11.7 (8.4 - 28.8)
Free T 139 (196 - 636)
Estradiol <40 (<162)
SHGB No Data
TSH 1.41 (0.32 - 4.00)
T4 13 (9 - 19)
T3 4.2 (2.6 - 5.8)
Hematocrit 0.449 (0.400 - 0.500)

April 21 2020 (first blood test 8 weeks 40mg EOD)
Total T 50.7 (8.4 - 28.8)
Free T 1103 (196 - 636)
Estradiol 329 (<162)
SHGB 47.4 (10 - 70)
TSH 1.49 (0.32 - 4.00)
T4 10 (9 - 19)
T3 5.7 (2.6 - 5.8)
Hematocrit 0.465 (0.400 - 0.500)

June 22 2020 (second blood test 8 weeks 32mg EOD)
Total T 43.0 (8.4 - 28.8)
Free T 974 (196 - 636)
Estradiol 277 (<162)
SHGB 40.9 (10 - 70)
TSH 1.89 (0.32 - 4.00)
T4 10 (9 - 19)
T3 4.8 (2.6 - 5.8)
Hematocrit 0.490 (0.400 - 0.500)

Aug 26 2020 (third blood test 8 weeks 26mg EOD)
Total T 40 (8.4 - 28.8) nmol/L
Free T 884 (196 - 636) pmol/L
Estradiol 220 (<162) pmol/L
SHGB 41.1 (10 - 70) nmol/L
TSH 2.1 (0.32 - 4.00) mIUL
T4 not tested
T3 not tested
Hematocrit 0.508 (0.400 - 0.500) L/L

Edit: Something strange is going on with my Ferritin so I’m adding it below. Hematocrit (I could have been dehydrated so I won’t really know here until next workup when I conciously hydrate before the test) is up but I seem to be losing Iron or the ability to store Iron (Ferritin) since I started TRT. Diet hasn’t changed; still eat whole foods and red meat a few times a week.

JAN 2019: 227 (22-275) ug/L
SEP 2019: 234
FEB 2020: 196 start TRT
AUG 2020: 80

T/E Ratio = 3.5

T/E Ratio = 3.5

T/E Ratio = 4.0

Your ratios are the same despite your reductions. I’m not an advocate of AIs but in your case I think its justified.

Get your T levels back up and VERY SLOWLY titrate your E2 down with incremental doses of Arimidex (anastrozole).

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But my T levels are already high and arguable too high. Why would I want to get them back up? If I lower my T dosage, won’t that bring down T and Estrogen? Or is it really just the ratio that matters and not the Estrogen measurement itself? Scared to use an AI or add anything else into the mix at this point. Plus I’ll have to find someone to prescribe it… good luck here in Canada. We’ll see what this clinic says / will do.

AI’s can be bought offline no problems (in the USA, unsure about Canada). A lot of companies that sell peptides also sell AI’s

I think your math is off my man. If 40 on a range of 8.4 - 28.8 is only 884, that is one odd lab range. I think maybe OP’s math on the dosage is not adding up. If at 91 - 94 mg a week he’s over top of range, with an SHBG of 40, something is up. He is barely above range on E2, but way above on total.
@rb74, how sure are you that you are dosing correctly?

Pretty sure; I use 1cc/ml syringe 25G 5/8" and do Glutes or Quads at the 26-27 line marker (hard to get it exact) on the measurement scale. My Test cyp vial is 1000mg / 10ML.

Personally I like my Test greater than 850. Here is some lab work I had done to show my point about ratios.

I’m 55 and I feel great with no libido or erection issues whatsoever. Now I dont keep my test at that level year round but I do run
250 mg/week with no AI

Ok so you naturally don’t have an Estradiol problem even with a high dosage. So it is really about the ratio and not the measurement itself. So even if I lower my dosage, I might still feel like shit because my ratio of T to E is not where it needs to be to feel well. I think that’s the logic here…

You are citing a Total Test lab, his FREE test is that high, his Total is actually much higher.

Back when I was under a Dr’s care, he was dosing me at 50 mg/week and my e2 shot up even higher than my wife’s. I felt like shit and TRT wasn’t doing anything for me. Now I self treat and about 4 times more than he was giving me and life is great.

I was demonstrating that his changes did nothing for his T/E ratios. Doesn’t really matter if I used Free Test or Total Test

On his first lab, for example, his Total T is almost double lab range, and so is his E2. That puts his Total T roughly where yours is in your posted lab, but your E2 is easily triple range and his is only double. The idea that that equals an AI doesn’t make sense, he’s already quite low by comparison. And that’s at 140mg a week. What are you running to get that same level? I’m guessing it’s a lot more than 140mg a week.

Any chance you could post a pic of the vial label and a syringe?

I’m not really sure I understand your point here.

He kept thinking that his dose was somehow the culprit so he reduced his dose all the way down to 26mg/eod. We all know that “ranges” don’t really mean a lot when you feel like dogshit. Something needs to change and I don’t think his current protocol is working, hence my advice that he reduce his E2 and get his Test levels in the supraphysiological range

How important is T/E ratio? I’m still trying to dial in, and I notice when I was using 125mg/week E3.5 SQ I had a better T/E ratio than my current 160mg/week E3.5 IM, despite having twice the total and free T now. And I felt better then with half the T and a forth of the e2.

Its a split crowd. Some believe its critical and some don’t. I happen to think it plays a big role in well being. I’m sure others will post with their thoughts

His test IS in the supraphysiological range, at 91 mg a week.

I agree. Some guys don’t do well with hormone levels that high. I think further dose reduction may help.

And his E2 was way too high. My original suggestion was that he begin a regimen of Arimidex even though I’m not a huge fan of AI’s.

@rb74, you may also want to consider a SERM since we dont want you to crash your E2 levels.

I’ve been tweaking my protocol for probably 2 years. I started with 200mg a week with anastrazole. Me and my doc messed with the anastrazole dosage for about 8 months and figured out I just didn’t do well with anastrazole(low libido, headaches, mood issues) Swithced over to exemestane and things were much better but still not where I wanted them to be. Went to daily injections with no AI and it was OK but high E2 seemed to effect my libido. Added back exemestane, 12.5mg twice a week and made my E2 too low at 15 so now I’m scaling it back to 12.5mg a week of exemestane and I think I’m finally getting where I’d like to be. Injections aren’t easy for some people and you have to stick with a protocol to see if it works so it seems like it takes forever to dial it in sometimes.

I started with testosterone pellets and those things are amazing!!! My total T was 1400-1500 at my peak(6 weeks after insertion) and my E2 was 40. Felt fantastic!!! I think more people should try those instead of injections. Pellets are a nice slow drip of testosterone as they dissolve that ramps up smooth and ramps down smooth.