T Nation

Klippe: An HRT journey

Thanks for the reply KSman.

Just an interim report back to where I find myself:

It’s been about 3 weeks since I started with the TRT protocol, on top of my other HRT protocol.

I still “feel” like crap, I don’t even feel as though I am on TRT, but as we all know anecdotal evidence is not the end all and be all of TRT, but it does play a big role. I have set myself a target of new bloods around the 15th of Dec, so only a few days to go before I can see what it going on inside.

My original bloods indicated a measure of adrenal fatigue on top of the fact that we proved that I was primary.

I started, in a way to treat the adrenal fatigue by way of HRT in the hope that seeing as the adrenals no longer have the responsibility to make these hormones that the adrenals could rest. I have added in Vit B complex & 12, selenium, magnesium and multiple daily doses of Vit C. my ACE should arrive shortly and I will be taking that for 3 months to see if it can help the adrenals rebuild. (This is based on my reading of Dr WIlsons book as suggested by KSman.)

So, at the end of the day, I will just about be supplementing with almost everything that the HPTA axis is responsible for…here’s hoping for success.

I do believe however that the new labs on the 15th will hold a big piece of the puzzle.

Hi All, KSman. I trust all are well and enjoying the Christmas break?

So, it has been 5 1/2 weeks since starting my TRT with the standard TRT protocol, to refresh, I have been taking:

  1. 62.5mg Test cyp twice a week SQ for a total of 125mg’s Test Cyp a week
  2. 250 IU hCG twice a week SQ at the time of Test injection
  3. 0.4mg’s Anastrozole twice a week in water at the time of Test injection for a total of 0.8 mg’s a week.

Whilst the above dosages are not exactly what is recommended, they were chosen for their proximity to the recommended amounts and the units my stuff came in.

I am still supporting my adrenals and my thyroid as per previous posts with the addition of 600mg bovine ACE and the addition of Zinc and Copper to my daily supplementation.

I have received the new blood results today and they confirm my suspicions as verbalized earlier.

It seems that I am a hyper-metabolizer of Test and an over responder to Anastrozole. Keeping in mind the above dosages, my results are:

Date 17/12/2015

E2-----------------40-161 pmol/L------43 pmol/L (Ideal is around 80 isn’t it?)
TT----------------->12nmol/L----------12 nmol/L
SHBG---------------11.1-78.1nmol/L----14.10 nmol/L
FT-----------------180—739pmol/L----355 pmol/L

Now, I am not sure how these results relate to the American ranges (except for E2…) so even though I can see that my levels of FT are in the lower quarter for our ranges, I cannot deduce how they would compare to your ranges…

From what I have read from the stickies, the relationship between FT and E2 is more or less linear when on this protocol, so, I could quite conceivably double my Test dose, keep my Anastrozole dose the same and I should end up with upper levels of FT and optimum levels of E2…correct? This is of course assuming that SHBG remains more or less the same throughout.

So, that is my supposed course of action for the next 5 / 6 weeks until I retest, unless KSman or someone else here can advise me better. That is in fact the point of this post after all.

As an aside, I assume that I will have to regularly check my E2 levels to adjust the AI dose as my BF% reduces as this will have a direct effect on aromatise activity?

So, thanks for reading and I look forward to your comments and suggestions.

When were labs done relative to prior injection?

Because your T is burning so fast, hard to know what to do without the above.

Yes, doubling down on T and holding AI seems like a good path.

More to the point of the fast burn is the need to inject more often as your T half-life is short. Please try injecting EOD. Adjusting AI then needs a liquid dispensed EOD by the drop.

80 pmol/L is the same as 22pg/ml, so a good target.

Need to point out that we do see T hypermetabolizers who need 300mg/week to get where others are on 100mg. So you are in uncharted territory. If you get things close, you may feel that things a better.

Hi KSman, thanks for the reply.

My last shot was Monday morning, the labs were Thursday morning. 3 days.

Okay, if I understand you correctly, double the Test dose to get closer to the upper range. This would increase my E2 to roughly 86. 86 is almost 10% higher than the present “ideal” figure of 80. Currently my AI dose is 20 drops per week supplying 0.8mg of Anastrozole. I plan to increase my AI dose by 5% to 21 drops, this will get me closer to the 80 we are striving for, leaving me at around 82/83 and fits in nicely with my 3 doses per week (explained below). My Test dose would be 1ml of 250mg/ml Test Cyp per week (double my current dosing). With the EOD dosing (explained below) that equates to .35ml EOD (giving 1.05 ml / week, which allows for the small amount of test left in the needle after injecting). My current hCG seems to be spot on at 500iu’s/week. So I will split that 500iu’s into three doses which will supply 525iu’s. A moderate 5% increase

Timing…I am a stickler for routine, so my EOD routine will be split into one week, this is achieved by dosing every 2 days 8 hours, so Monday morning 6am, Wednesday 2pm and Friday evening 10pm. Works perfectly. Given the above my suggested dosing protocol is as follows…

Monday 6am: 0.35ml Test Cyp (250mg/ml) / 7 drops Anastrzole (supplying 0.28 mg’s of the AI) / 0.07ml hCG (supplying 175iu’s)
Wednesday 2pm: As per Monday
Friday 10pm: As per Monday

Rinse & Repeat weekly.

Follow up labs on Wednesday morning 27 Jan 2016, 5.5 weeks from this coming Monday (start of new protocol) and 2 days since the shot on the Monday.

How does that sound in light of my hyper metabolisation of Test and over response to the AI? Or did I misunderstand you?

I think that this could be a keeper…

Klippe there’s a conversion tool for nmol/l to ng/dl at:


And also at:


There’s an estradiol converter at:



TT: 12 nmol/L = 356 ng/dL
FT: 355 pmol/L = 0.355 nmol/L = 10.2 ng/dL
E2: 43 pmol/L = 11.7 pg/mL

My E2 level is broadly the same as yours, and I believe that optimal is about twice as high.

Hi Graemsay, thanks for the reply, those tools will make life a lot easier!!!

I do believe that I have a type of the final solution here, I do not think any major changes will be needed after this, maybe some further fine tuning but no more doubling etc.

I am curious as to what KSman will say about the suggested new protocol as well as to how often I should check E2 as my BF% decreases due to the higher T…

That sounds good. 3x/week does not equal EOD. EOD cycle repeats every 14 days.

If you inject with #29 1/2" 0.5ml insulin syringes there is no waste in the needle.
Otherwise: If a needle has a tiny bubble, it will push out what is in the needle.

FT ranges can vary wildly from one lab to another, so simply using a conversion is not very useful.

You can do labs after 3 weeks and see where you are. But if things are feeling right, you can wait longer to allow things to be closer to a steady state end point.

Hi All, this is Klippe, now going by Stones…for some reason my password changed??:persevere:

Just wanted some advice, its been 3 weeks since changing my injection protocol to a more frequent EOD and doubling down on T whilst keeping Ana the same (according to the above labs)

Now, nothing seems to have changed / improved except for a creeping, nagging semi depression that seems to be following me around.

Above, Ksman hinted that I could go for new labs before the 5 weeks was up…so I am planning to do that.

What worries me is that 250mg of Test Cyp for 3 weeks has made no real difference in my symptoms other than improving fatigue (which was E related anyway). I will post new labs once I have them, but what would this be, a problem with E2? To high or to low?


E2 too high or too low can do this.
Joints might ache if too low and feel depressed.
Can get emotional when high and short tempered after a while.

Thanks KSman, what would you suggest?

  1. New Labs
  2. Choose a direction in which to adjust AI dose and expriment with dosage according to anecdotal feelings (how I feel)?
  3. How would I choose a direction?


I suggested some criteria in my prior post to help you decide/guess if you need more/less.

Note that it takes a week for a dose change to lead to the final serum levels.

When AI dose is too high, one can feel bad quite soon. Then you stop for 5-6 days and resume at a lower dose. You will not get better advice from a doctor. Meanwhile you want to be on a steady dose for a week to get steady blood levels and another week for E2 to move. So you can’t really rush to labs either.

When you stop AI and feel a wave of feeling good, your dose was too high and you just fell through a sweet spot.

It is best to get feeling decent so you have labs that can be used to calculate a final dose. If you get E2<7.0, you know you are low but do not know where.

Thanks KSman, what you suggests makes sense…

I have done some digging and it would seem that my E2 is too low (relevant to me) according to the “symptoms” or rather, the way I feel…but I am guessing that I am not that far off the mark, so I think that a cautious approach is warranted now.

So, I was planning on keeping the status quo re dosages until new labs on 13/01/2016 and to then reduce AI dose by one drop on every dosing day and then see how we go. After three weeks I will do the same again and continue to do so until I settle in a better place than I am now…

BTW, my temperatures have started to stabilize in the upper regions, this happened after I started supporting adreanls with ACE, so there is that improvement at least.

If you reduce AI be one drop three times per week, there will be a one week lag and blur on the effects.

Consider decrease of 30-40% in one step. The effects will take a week to evaluate. Or skip some dosing then do lower dose to reach end point faster. If when you skip dosing, you have a point where you feel better, that was from increased E2 and you know which way is north.

Is ACE injected or oral?

Body temps are mostly thyroid, not adrenals, but they are part of the equation.

How do you know that ACE is working VS cumulative effects of progesterone–>cortisol?

Hi KSman, many thanks for the reply, much appreciated.

If I understand the overview of your suggestion, to my mind it would mean that seeing as I already have a baseline E2 measurement and have already changed dosages, I do not need to do new labs but rather go by how I feel to change E2 dose? I have no problem with that, albeit I would like to see what my FT is now after increasing T dose, allowing E2 to increase with the concomittant effect on SHBG - FT.

Anyway, a 30% drop in AI dose equates to 2 drops per dosing session less, 40% leans to 3 drops less…I would prefer not to stop dosing and then restarting. I will reduce the AI dose and keep an eye on the way I feel…when I do this depends on your response regarding new labs.

Re the ACE, all I could find here in ZA are imported orals, I take a total of 600mgs bovine ACE / day in two doses, 400mg in the am and 200 mg in the early pm.

I realise that body temps are mostly thyroid but even after supplementing with Iodine (I did take care of the deficiency first) my body temps did not show enough of an increase and still failed to hit temp targets. Since starting with the ACE I have been hitting the temp targets easily.

It could well be the progesterone, but I have been supplementing with progesterone since August 2015, I would have thought that the effects would have shown up earlier…perhaps the ACE was the final key to complete the puzzle?

It is not an easy situation. Sometimes body temp regulation gets messed up. I found that T4+T3 meds were not restoring body temperature. So now I am finding that T3 alone can get my body temps up. That suggests that rT3 is a issue for me.

Still seems odd that a ACE would improve body temps. But may be an indirect action.

Your mood and energy improved. Has there been any issues with mood/depression - changes?

Whilst mood and energy have improved from what they were, they are far from ideal.

I went to do new labs this morning, did not want to wait until Wednesday morning.

Should have results by tomorrow.

Had a big scare over the weekend. Went to see my GP relating to a dull aching pain in the right side of my middle back. She had BP checked and it came back at 187/119 Pulse 102. I was shocked and not happy to say the least, I have never had problems with BP or pulse. Can pain / inflammation cause this? Or would this rather relate to the hormonal changes?

I have a short course of diuretics on hand to drive down any water and have cut down my coffee to one cup per day. BP hovers around 145/88 pulse 88 now, which, whilst better is still not where I want it to be…

Will keep all up to date re new labs tomorrow…

New labs are in and it appears that I overshot and underthought the new dosing protocol.

Old protocol 0.5mg T / week two doses. Result: All levels were half of what they thought they should have been. Remedy, double T dose, keep AI the same. I thought everything would be in line.
New protocol 1mg T / week three doses. Result: levels are overhsot by ± 30%.

The huge change in levels (3x original levels) come from the excessive increase in dose, the calculation of which was done without taking into account the difference in the timing of the tests in relation to each other and the concomittant troughs and their levels differing due to the new injection protocol.

I.E. Prior test was done ±3.5 days since last injection. Newest test was performed ± 2.3 days since last injection.

All that changed from last labs to new labs was the doubling of the T dose.

1st figures are prior labs, 2nd new labs.

E2: 43 pmol/L : 132 pmol/L
SHBG: 14.1nmol/L : 15.5 nmol/L
TT: 12nmol/L : 32.4 nmol/L
FT: 355 pmol/L: 1047 pmol/L

So, T dose is doubled but all figures trippled? At least they are in line with each other…This makes me think that my supposition above is correct.

This kind of like explains the E2 symptoms movement between low and high mentioned in my previous post as well as explaining excessive BP readings (High E2 = water retention = increased BP) (Maybe…)

So my recommendation is to reduce T dose to .75ml/w which represents around a 30% reduction in T dose. If all else is linear, I should expect to see E2 reduce to about 93/94 not so? If so, E2 is still to high. By my calculations, by adding 1 drop AI to every dose, I should come in at around 80…

What I am thinking of now of course is that these are trough values, not maximum…is that a problem?

Make these changes, let it rest for another 4 weeks and see where we are. How does that sound?

Not showing lab ranges…

Why lower T to lower E2? Adjust AI dose.

When you increased T by x%, should have increased AI by x%

Hi KSman, thanks for the reply.

There is a lot of information in this thread re doses, changed doses, changed injection protocols and targets etc coupled with the many threads that you reply to, I understand that you might be a bit in the dark, sorry if I contributed to this by not explaining properly in my last reporting post.

After prior labs T was half of what it should have been, so too E2, therefore the decision to double T and keep AI dose the same.

Upper range for free T is 749, mine, at last testing was 1047, hence the decision to lower T dose. I do not want to be on a cycle…the plan is to get everything in optimal areas and then adjust according to how I feel.

Seeing as T is reducing, that would also reduce E2 by reduced aromatisation, but not by enough. I did the math to get to the new dosages that is why T dose came down by 30% and AI dose increased by 15%. Error in changing original dosing was due to simulatenous changing of injection frequency.

Hi All, back again after the latest labs…the labs were done two days after last doses, which in turn is the day of my next doses (EOD)

The results are as follows:

E2: 134 pmol/L (Range 40 - 161)
TT: 24 nmol/L(Range >12 nmol/L)
SHBG: 19.2 nmol/L (Range 11.1 - 78.1)
FT: 691 pmol/L (Range 180 - 739)

I am happy with the TT levels and fairly happy with the FT levels. My E2 levels are about 40 - 50 points to high. My SHBG has also increased a bit. So I suppose I should increase my AI (anastrozole) dosage? This will bring down both the E2 count and SHBG, not so?

My question now is by how much would I increase my AI dose?

To help answer the above, the following is my current dosing:

Test Cyp: 0.25ml of Test Cyp (250mg/ml) 3 x week / EOD (Total 0.75 ml = 187.5. mg Test Cyp / week)
HcG: 250IU 3 x week / EOD = 750 Iu’s / week
Anastrozole: 0.32 mg’s 3 x week / EOD = 0.96 mg’s / week

Is the E2 level and Anastrozole dose linear?

Would that mean that I would have to calculate the increase in my AI dose by:
80 (desired E2 level) / 134 (current E2 level) = 0.6
Current dose giving 0.6 = 0.96 mg’s / week. Therefore new dose would be 0.96*/0.6=1.6 mg’s / week = .53 mg’s 3 x week / EOD.

Is that right? It seems a bit excessive, especially considering that in the posts above I thought I was an AI over responder…

I am at a loss for words seeing as my new labs show the same level as the previous labs and this after the Test does was reduced by 75%. It seems that this reduction in Test had no effect on the E2 level at all. Is that even possible?

I am even wondering whether my body may be taking a very long time to respond to the therapies, although the T levels did decrease with the exact factor of the decrease in dosage so E2 is the problem…HEEELLLPPPP :grin:

Thanks, all help would be greatly appreciated…