T Nation

Is 1500 Total Test Too High?

I’m 29, 5’8", 140lbs, and started TRT slightly more than a month ago using one of the online dealers. Before total test was in the 300s and e2 was 19.
I suspect the low numbers were from high cortisol, which I’ve been struggling to fix for the past few years. (To give more background, I’ve had insomnia since I was a kid, and usually have trouble digesting food.)

So I start TRT. One injection of 100mg cypionate a week, a daily clomid, and a once a week AI.

After the first week in, I start feeling hot all the time. Dropped the house temp to 65F and yet I still wake up in the middle of the night feeling hot. Couldnt figure out if it was just muscle gain or high e2. But it seemed to get worse, so I do a lab test (through Quest Diagnostics, not labcorp). Take in mind that I did this test at a bad time. It was the day after my third injection, so most docs will probably be like “wtf this is useless”. But the results were surprising:

Total test: 1840 ng/dL (250-1100 normal)
Free test: 392.6 pg/mL (35.0-155.0 normal)
Estradiol: 93 pg/mL (<29 normal)

All numbers too high. I googled a bit, and a lot of studies I looked at gave the idea that the day after an injection, total test levels tended to be 300 above what they were immediately before injection. So napkin math says this is equivalent to a baseline of 1500, which is more than I’m looking for. I dont want to be some ripped hulk, just want good levels. Somewhere in the 800-1000 range.

I talk to doc, and he says its fine, keep doing the protocol, donate blood (because hematocrit went up a bit), and take two AI doses a week instead of one.

I think thats an absurd answer and that I should lower the dosage. So I do another blood test the morning before my fifth injection:

Total test: 1560 ng/dL (250-1100 normal)
Free test: 312.8 pg/mL (35.0-155.0 normal)
Estradiol: 38 pg/mL (<29 normal)

E2 went down at least, but I still think that total test is way too high. I email doc and the only response I get is that I should continue current protocol. He doesnt answer any of my questions, and doesnt explain his reasoning at all, which really pisses me off.

So I guess my question is: Is this really an acceptable number? I figure if I lower the dosage, I’d get a decent number while also reducing the need for an AI and bloodletting (for hematocrit). Are there other attributes that matter more than total test? Maybe the numbers spike more in the first month? And what about my weight? I’m 140lbs. Shouldnt I start with less than the average starting dose, since most people weigh way more than me?

I’d also like to know if these numbers indicate that clomid on its own is good enough for me and I dont need injections. Perhaps I merely have secondary hypogonadism due to high cortisol, and clomid clears that up and gets my balls running in top gear. Some of my old labs indicate low LH and FSH, so that conclusion could be logically sound.

So far I’ve switched to do twice a week injections of 50mg. (In my first convo with doc, he said twice a week injections were acceptable, but then put “once a week” on the prescription and said to follow it exactly). But idk if thats low enough, because my understanding is thatll keep the baseline consistent and decrease e2, but wont actually drop the total test numbers at the end of the week.

And also, if I adjust dosage, how should I adjust the AI dosage to match? Additionally, how long after a change should I wait to do a blood test to see its effects?

So far I have very low confidence in the doc. Literally every interaction I’ve had with this company has left me feeling pissed off, and I figure theyre just pill pushers that just want their $200/month.

I really think my logic makes more sense. But I also dont want to anything wrong and then fuck myself up. So what do you guys think?

That is a supraphysioligic level. Are you sure about the dose? Because that would be amazing for 100mg a week, it looks more like what I would wxpect from 200mg a week

Yeah, its weird. I’ve triple checked it so many times. But its for sure 100mg/week.

How much liquid do you put in the syringe?

It was 0.5mL of 200mg/ml cypionate once per week. But I’m switching to half that twice a week.

So do I, this protocol is not a normal protocol, Clomid with TRT and anastrozole is usually a disaster. The clomid will more than likely work against you and is known for a lot of side effects. The anastrozole I think is unnecessary, you can adjust the T dosage up or down and/or change injection frequencies to mitigate any side effects.

I had nothing but side effects on the anastrozole and found changing injections frequencies and lowering the dosage fixed most of my issues.

Don’t shoot for a particular number, aim for symptoms resolution, if that happens at 1000 ng/dL and an E2 at 50-60, so be it. If you feel your levels are already too high, splitting the dosage twice weekly will more than likely see levels even higher because there is less decline in levels when injecting with greater frequency.

Your trough levels (lowest levels right before your injections) will more than likely be higher as well than they were on once weekly injections.

When I first started cream after being on injections I I was able to adjust the dose slowly over time until everything just felt perfect. I tested there three times now and the number came back around 1300 to 1450 and 20-30 free T. Everything else blood wise perfect.

Just feel great any higher T level I start to loose libido and get alittle water retention/acne. Any less I loose focus clarity, energy and great mood.

I check labs every 3 months now (unless I feel I need to test again sooner) as long as everything stays good blood wise don’t plan on any changes. Without numbers figured in just feel, I feel perfect at my current dose with zero negatives.

I moved up a extra click on my dose early on because like most folks you feel good then you think maybe I can feel alittle better. In my case more wasn’t better I hit around 1700+ T and upper 30’s free good for about two weeks then libido died and acne came out. It sucked and took a couple weeks to balance back after reducing dose.

Your body will tell you the sweet spot once you find it stay there my advice.

Drop the Clomid and the AI. Also, testing one month into it is not a good way to gauge things properly. Also high T levels doesnt equal ripped hulk, you still have to work for it. Lol

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Go to T only. Drop everything else.

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1500ng/dl total t is not supraphysiological level, no matter what the pity lab ranges say. However for some people it can be too high.
Depends whether you will get side effects on it, worsened blood picture or cholesterol levels. If you feel optimal and your blood markers are fine, then there is nothing to be affraid of being on that level.

Some people are pretty sensitive to exogenous t and can get high levels with small mg. Other people need a lot more mg to get these levels. Also the different esters put the same person at different levels.

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Also the elevated levels can be from the clomid. For some people clomid can keep some production even on TRT.

How do you feel with that clomid and why the doc put you on that drug?

Thanks for the replies everyone. I really appreciate it. I especially like the variety of responses, as its giving me a more in-depth view to help me figure out what to do next.

I was expecting to get t plus hcg, but apparently they dont do hcg. In one convo, they said “as you know, we dont do hcg anymore”. And when I asked why, they said its because of recent government regulation. I later checked it out, and it seems to be that the drug companies arent allowed to mix t and hcg in the same vials, but you can still get them separate and do everything yourself. But I didnt look all that deep into it, so dont know for sure if thats true.

So they chose t plus clomid since I’m younger and “might want to have children”. I dont plan to have kids, but I just went with it because it kinda took me off guard and I wasnt prepared for that in the prescription. I didnt research it much beforehand since I wasnt expecting to get it.

I asked about longterm side effects and doc sounded surprised and then said hes had patients on clomid for 20 years with no side effects. Which to me means that even with 20 years experience, hes relying on anecdotal evidence entirely. Which is weird because he should have been asked that question before and done the actual research by now. Plus that kind of anecdotal evidence is biased and doesnt take into account the people who have died of various types of cancers over that time period, and what caused those cancers.

Right now my current side effects are red skin (already had that problem but its worse now), feeling hot, and erect nipples. So I figure its just high estrogen, which can be solved by lowering my t numbers and then waiting. I think I’ll start by lowering the injection dose slightly. And ask doc about dropping clomid+ai. And alternatively switch to a different clinic. Is there a thread here with clinic recommendations? I’d especially like a clinic where the people dont have communication issues. And also one that wont disappear and rebrand as a new company every few years. Am I best off just finding a local “anti aging” place?

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I understand the idea for the clomid.
But still it is bad idea, because clomid will cancel many of the benefits that TRT is supposed to provide you. And most probably with time how you feel on clomid will get worse

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I think it’s funny that your doc seems to think clomid doesn’t have any side effects. The lack of or low libido on clomid is because clomid blocks estrogen from passing through the brain barrier which is by design in order to increase LH secretion by the pituitary gland.

The low or complete lack of libido is very common of men who take clomid and is only the tip of the iceberg as far as side effects are concerned, the fact that you doc seemed surprised at the notion that clomid causes side effects comes across as someone living in denial and/or someone who doesn’t have experience prescribing clomid.

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Got some updates after a few months. I dropped everything but injections. And now most of my numbers look good. Except I’m in the 600 range for total t (250-1100). I think I just need to increase dose, because I’ve been intentionally going a little low. So thats all good. Or at least will be optimal soon.

I suspect my original problem was my pituitary/hypothalamus never told my balls to make test. So they filled up with test precursors, waiting for the green light. And then clomid suddenly brought those requests back. To which my balls said “we got you covered”. And thus big test. I imagine such a scenario would eventually level off, had I continued clomid.

What I’m having trouble with now is blood pressure. It’s at 160/85, which is way higher than the 110/75 i used to always have. First I tried decreasing salt intake, but that didnt do anything. Then I checked around this forum, and people say it could be caused by an allergic reaction to sesame seed oil in the injections. And using grapeseed oil instead might solve it. That allergy logic makes sense, since I’ve been feeling hot and my skins gotten new shades of red since starting trt. At first I thought it was because of high e2, but those numbered improved while the symptoms continued. So I contacted doc, asking if they had any clients with similar issues. And their response after 4 days was a short “sure, we’ll do grapeseed in your next shipment at the end of the month”.

So now I’m for sure switching to another doc, since this one doesnt believe in punctuality or answering questions. I previously checked out a bunch of local places, and none of them do injections, just pills and pellets. Whats the one everyone uses thats actually good? Some older posts on this forum say defy medical is the best. And I’ve also seen people talk about tier1. Are those still good choices to go with? I would like one thats not afraid to increase my dose if it looks like i need it. I’d also really enjoy talking to one thats got a brain full of trt knowledge and wants to talk my ear off about it.

I like mine a lot. They use empower for test and it’s made with grape seed oil. Rejuvenation Care Clinic.

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What are “good numbers”? Good numbers for who?

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