T Nation

Microdose AI or Lower My T Dose?

38 years old
5’ft 11.5 in
191 lbs
Body fat 8%

Been on trt for about 1.5 years. 200mg Tcyp 100mg biweekly IM. For the 12 months I’ve been fighting E2 mostly low and need advice.

1/2017: loss of erections
Labs: E2 20 estro sensitive, test 1400, free 38
Action from doc: reduce to 0.5mg 2x / week from 3x a week. Cialis Daily 7.5mg

2/17 - 8/17: stability. Not in sweet spot but cialis working OK. More premature ejac than ever before in my life.

9/2017: taking dex 0.5mg 2 x / week. loss of erections when standing (weird) wasn’t in tune with what was going on.

10/17/17: no libido, weak erection, loss of penile girth, bat shit crazy emotional, paranoid. Flat, weak in gym.
Labs: E2 < 17pg/mL non estrogen sensitive
Total T: 1307, free 36.9, SB 27.3
Action: stopped anastrazole for two weeks, at end of 2 weeks felt slightly better. Took 0.5mg on 10/31 then recheck E2 a day later.

11/01/17 : labs: E2 < 2pg/mL estro sensitive
Total test 1400, weak /no erection, loss of girth, smaller load.
Action: call Doc. Stop AI.

11/10: labs E2 estro sensitive 20pg/mL
Test : total 1300’s, Free 37, SB 26
Actions: switch to SQ test 100mg 2x /week

11/29: sweet spot hit but back acne starting

12/1: no AI for 1 month. Libido thru roof, erections strongest in over a year. Girth markedly bigger, loads bigger, back acne noted.
Labs: E2 40 estro sen, text total 1200
Action from doc: take 0.25 5 days After lab draw then 0.25 q 3 days.
Up cialis to 13mg daily

12/10: loss of erection loss of girth, SMFH I crashed again.
Labs: 24pg non estro sen but I know it’s low.
Action: stop AI. It’s been 7 days today.

Long story short. I’m waiting not so patiently for it to rebound. Upon rebound when should I dose the AI and how much.

Looking at my trends it took 2 weeks for my E to go up 20 points.

I’m considering diluting in a solvent and micro dosing the AI 0.125mg once a week maybe?

Or would a better option be to Lower my T to 160-180 and kick the AI all together?

I’m desperate for stability and consistent libido /erection strength. Any advice appreciated.

You are injecting T every two weeks? Biweekly creates a lot of confusion.

When are labs done relative to injections?

Should inject T twice a week and take anastrozole at that time. Anastrozole is a competitive drug that needs to match serum T levels and steady T levels are required.

Some are anastrozole over-responders, not rare, who need 1/4th the expected dose. Try 1/8th mg twice a week after stopping for 5-6 days.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

SB=SHBG? Spell it out.

“Action from doc: take 0.25 5 days After lab draw then 0.25 q 3 days.”

What does “lab draw” have to do with injections?

Labs should include CBC and hematocrit as those can be adversely affected in some men, not rare.

Biweekly means twice a week in the medical field. I’m injecting 100mg SQ twice a week.

HCT 46
TSH 1.9
Free T3 2.5
Free T4 1.03
Lab draw = blood work. My doc told me to take 0.25mg AI 5 days after my most recent lab work on an injection day.

The problem with that is most here are not in the medical field hence the confusion.

Other than this: https://en.wikipedia.org/wiki/Biweekly

Your post is confusing…

200mg T a week often does not work well as some cannot get balanced.

Injecting T twice a week and taking anastrozole at that time can work well as the decline of T is roughly matched by decline of serum anastrozole. Most guys are good with ~1mg anastrozole for every 100mg T. Over-responders need 1/4mg per 100. We have one guy here who needed 1/8th mg per 100. These variations are probably differences in aromatase enzyme DNA or DNA expression or something similar in liver clearance/metabolism of anastrozole.

When you make an anastrozole dose change, half-life dictates that it normally take 5-6 days for serum levels of the drug to reach steady state. So you cannot be making short term dose changes based on how you feel.

Most guys get good libido, energy, sexual function ~E2=22pg/ml. But there are some, sort of rare, who need higher levels to feel right.

When you change E2 levels, there can be brain adjustments that a few weeks to complete.

Always do labs half-way between injections to reduce changes that are driven by lab timing changes. Labs at time of doctors office visit can be wrong.

We need lab ranges going forward.

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There’s your problem, AI’s have a shorter half life when compared to T-cyp so later in the week E2 begins to rise again, so your E2 is lower earlier in the week and higher towards the end. No one takes an AI once a week. If you’re injecting twice per week take AI twice per week. Your doctor is a moron! Your post make it sound like you’re constantly changing your AI dosage based on how you feel, it usually takes 4-6 weeks for bloods to stabilize. When I was on 200mg I was bouncing all over, lowered dose to 100mg weekly and fluctuations slowed. Just reduced my dosage to 80 mg weekly split EOD do to high E2 symptoms, get this, no AI! I was doing perfectly fine on 100mg twice weekly, but going EOD shot my T upwards and also shot my E2 up. Two days after reducing my dosage I’m starting to feel like I did weeks ago.