T Nation

Lab Results and TRT Protocol Feedback

Hey all, first post around here.

Had my labs done 2-3 weeks ago and was diagnosed with hypogonadism. Labs below:

TT: 333 (280-800)
FT: 6.6 (7-28)
Estradiol: 19.6 (8.0-35.0)
SHBG: 69 (16.5-55.9)
LH: 5.6 (1.7-8.6)

So my total t is low, my free T is very low. My SHBG is very high. The proposed TRT protocol is as follows:

Test Cyp: 80mg x2 per week (Monday morning and Thursday evening)
HCG: 400IU same times as test cyp
Arimidex: 0.15 same times as test cyp and HCG

A little about me, I’ 30 (almost 31), suspected low T for a while but the past 1-2 years has been a steady decline to where I’m at now: exhausted all the time, very low sex drive, mental fog, zero motivation, zero assertiveness.

I’m an active guy (lifted weights 3-4 times per week for the past 10 years) and for the past 3-4 months, getting off the couch to go on a walk with my kids has been a challenge. Most days, it’s all I can do to make it through a day at work without breaking down from mental and physical fatigue.

I’m pretty lean (10-12% bodyfat), 5’10" and around 170 pounds. Used to be strong until fatigue zapped me and have seen drastic drop in strength/endurance over past year. Still have been maintaining 1-2 strength training workouts per week despite feeling like total crap.

I am supposed to start this protocol next week, but have a few concerns:

  1. Is it wise to start on an AI immediately, even though my current Estradiol is below 20? I had a guy warn me that he was in similar situation and even a small dose of AI “crashed” his estrogen and it took a few weeks to recover from what he described as a “physical hell he had never experienced.” That freaked me out and made me wonder whether I should first wait and see where my estradiol goes in a few months and adjust as needed?

  2. Is starting at 160mg Test Cyp per week too much? This dose was justified due to my high SHBG, but would it be smarter to start lower (around 100mg per week) and increase if/as needed?

Since I have a few days before starting, was hoping to get some feedback to determine if I should just trust protocol and go for it, or if I should further question AI inclusion and high Test Cyp dosing.


Large doses are used to bring down those with high SHBG, I wouldn’t take the AI until you’re presenting with high E2 symptoms or blood work indicating a problem clearing our E2. Do not take that AI, especially with an E2 of all below 20! I’ve heard of some that it took 4-6 weeks to recovery from crashing your E2, some just recover slowly. 160mg isn’t at the upper limit for test doses, 200mg is the absolute weekly limit. There are some who are hyper metabolizers that end up going through their test faster than most. If I’m not mistaken that AI dose seems a little low compared to the amount of weekly test you’ll be taking if you end up needing it.

Just understand that the overwhelming likelihood is that you will have to adjust your protocol based on labs and symptoms. The KEY to success is to have patience! Get on a protocol and don’t change it for at least 4 weeks. Then run labs halfway between injections. Get the results and adjust as needed. If you start out not taking the AI then need to add it, you’ll be back to square one and will need to test again in 4 weeks and make adjustments. It’s a process. Be patient and deliberate.

Cool, thanks for your feedback. I know TRT changes everything, but how much do individual differences contribute to how much estrogen rises in the presence of more testosterone? Growing up, I was your typical “skinny hardgainer”, didn’t have an ounce of fat on me. Now at 30, with proper nutrition and consistent training I’ve gained 25 pounds of muscle, but still maintain 10-12% bodyfat pretty effortlessly.

If you asked where I carry fat, the answer is “pretty much nowhere specifically.”

Does that play a role in this and the decision to or not to start with an AI combined with my current 19 E2?

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I’m fine with that. I guess I’m just more worried about crashing E2 and having to adjust than I am about having it go too high and having to add an AI.

I understand your concern. I’ll be surprised if you don’t require an AI to help control E2. Some really young guys with 9% body fat and super human genetics can take large amounts of T without using an AI, but that’s the exception not the rule. Again, I get where you are coming from. Low E2 sucks much more than high E2. Just be patient and only change protocol based on labs and symptoms.

Low bf definitely plays a role in E2 conversion. I dropped 35lbs and now need half the amount of adex to keep my E2 in check.

I have a “gut feeling” that starting with an AI is a bad idea for me. Could be 100% off, but I’m going to risk running E2 high and having to adjust by adding an AI rather than risking it going too low for now.

I’ll run the Test Cyp and HCG for 4 weeks as prescribed and get labs done in 4 weeks to bounce off of any symptoms.

Thanks for your feedback.

High E2 is preferable to low E2 since it takes so much longer to recover after an E2 crash, however if you get high E2 symptoms you could then take the AI and feel better in a matter of days.