T Nation

Need Advice On Protocol And Symptoms [Bloods Inside]

Current protocol:
30mg Test E EOD
250iu HCG EOD
0.05mg Anastrozole EOD

Testosterone: *40 (7.60 - 31.40) nmol/L
Estradiol: 145 (0.00 - 191.99) pmol/L
TSH: 1.11 (0.27 - 4.20) mlU/L
FT4: 13.5 (12.00 - 22.00) pmol/L
FT3: 4.0 (3.5 - 7.7) pmol/L

I’ve lurked this forum for a while now but haven’t posted before. After implementing the advice that I’ve found here I’ve felt a lot better but still not ‘optimal’.

My erection quality and libido varies greatly. One day I have rock hard erections and can’t stop thinking about sex, the next nothing. I assume this is due to the slightly elevated E2 and above range TT.

I’m going to reduce my testosterone dose to 20mg EOD and keep everything else the same. Does anyone more knowledgeable on the area have a better idea, or is this a good alteration to my protocol?

Does anyone have any ideas as to why I’m so high on such a low dose? Test is pharma grade straight from the doctor. Is it possible 250iu HCG is enough to cause such high levels on lowish dose test? I do not know if I was primary or secondary before starting.

For KSman, I have not taken any oral temperatures but got a thermom coming in the mail. I have been taking a multivitamin for the past year or so that contains 160 ug selenium but no iodine. I bought some iodized salt last night which I’ll start to use.

How long have you been on your current protocol? If you recently started your protocol it’s going to take some time for your body to adjust, a lot of guys expect immediate result and make changes to their protocol before their body reaches a balance making their life miserable never find a balance. It’s taken me 5 months for my erections and sensitivity to start improving, I spent 4 months wondering if I would ever see benefits. Whenever you inject more frequently (same weekly dosage) your levels will be consistently higher since you’re not allowing your levels to start dropping 2-3 days later.

I’ve been on TRT for a year or so now, but on the above protocol for five weeks.

I understand levels would be continuously higher, but I was expecting to see 700 - 800 ng/dL - not 1,200.

I’ve kept everything the same but dropped down the test to 20mg instead of 30. I’ll get more bloods in six weeks w/ other levels like SHBG, thyroid ect.

Thanks for the advice.

Anastrozole 0.05 mg
Did you mean 0.5mg?

fT3 is below mid-range
same for fT4
TSH itself seems OK, but often there is more to the story.
Please describe your history of using iodized salt or vitamins listing iodine. Post body temperatures.

FT not tested
Where are you located?

Target is E2=80 pmol/L
Increase anastrozole dose by a factor of 145/80
You can dissolve anastrozole 1mg/ml in vodka and dispense by volume or count drops. Find a small dropper bottle. No need to refrigerate.

TT=40 may be inflated by increased E2 induced SHBG creating non-bioavailable SHBG+T that inflates TT. If we had FT data, we could infer SHBG status. Lowering E2 will lower SHBG in many cases, but not all as some guys simply have high or low levels. SHBG is made in the liver to scavenge sex hormones.

hCG can make testes contribute to T levels, results vary, increase of 17% for me 11 years ago. Rarely, we have seen one or two cases, hCG at those doses causes too much T–>E2 inside the testes, were anastrozole does not work. If increase in anastrozole dose does not get you near E2=80 pmol/L we can suspect that and reduce hCG. Reducing T dose will complicate things.

hCG is probably 1000iu/ml and you would inject 250iu as 0.25ml or “25” on insulin syringe.

Your high E2 is more than enough to explain waning libido. Expect to see good progress ~7 days after anastrozole dose adjustment.

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.

No, my anastrozole dose is 0.05mg. I dissolve tablets at 0.5mg/ml and take 0.1ml EOD. I had reaason to suspect I was an over responder which doesn’t seem to be the case hence the low dose.

The estradiol is standard assay. I’m struggling to find the consensus as whether the test is accurate or not, it says next to the result on my bloodwork printout that the results may not be accurate.

I had TSH tested five weeks prior and it came back at 3.05 w/ same ref range. Unfortunately fT3/4 were not tested.

I use iodized salt on food but not too much, just a little on my pre-workout meal. My multivit does not contain any iodine. I can’t find my oral thermometer, I’ll pick one up after work and post my PM and AM temps tomorrow.

I do have a lot of symptoms of hypothyroidsm which my doctor laughed away because everything was within range. Feel cold a lot, skin on hands is dry and flaking, severe lethargy/fatigue, heart rate drops very low and moonface.

The moonface could be E2 related, but even when it’s been too low my face/jawline has been swollen and puffy - it’s been like this since starting TRT. Can provide pics if needed. Do you have any idea as to what else could be causing this? I should add that I am not holding water anywhere else and I’m lean, legs look like a river form vasculairty when I’m warm.

Only TT and E2 were tested. SHBG has stayed at 30 +/- 2 (15 - 55) nmol/L both pre and post TRT over the last year. My more detailed bloods are in another four weeks. I’m located in the UK.

My levels weren’t ridiculously low prior to starting. I tested between 350 - 420 ng/dL so testes still had decent function. My HCG is 1500iu/ml and I inject 0.15ml so actually 225iu - sorry for the mistake quoting 250u as dose.

Since this post was a little old I have already dropped test to 20mg EOD and kept everything else the same before your response. Your recommendation to keep dose same and increase AI is a better option, but the only thing that concerns me is hairloss. I’ve noticed extreme thinning all across the top of my head and assumed the 40 nmol/L was responsible being high. I’m only 20 and already noticeably thin up top which has hit my confidence hard.

Thanks for your time.

Hair loss is another factor to consider. I had been hoping to try to avoid sorting out multiple changes.

When calculation an anastrozole dose change, you can also reduce the dose by the same factor as T dose reduction and both calculations can be stacked. Again if E2 does not respond as expected, we can suspect that hCG could be the cause.

I ask for a lot of info in the advice for new guys sticky.

Have you had cortisol tested and high?
Did you have any moon-face or related issues prior to TRT?
Thin limbs and apple shaped body?

  • if no to the above, we are not looking at [very] high cortisol problems

Iodized salt is generally not on the shop shelves in the UK. You are meant to get iodine from dairy foods, even as it is acknowledged that iodine levels in dairy foods is dropping.

references in iodine literature re pregnant women is typical as that is the most at risk population

So if test is going from 30 to 20mg EOD, and currently anastrozole is 0.05mg EOD, should the anastrozole dose be dropped to 0.033mg EOD to keep things constant? I’m not the best with numbers so I may have misinterpreted you.

My hair is now very thin. I seem to be suffering from a diffuse patter of thinning rather than the usual temple recession and loss of vertex hair.

I have not had cortisol tested. I’m going to pay to have it tested privately as when requested my GP refused. I’m not sure what testing method to choose, what in your opinion is the best method out of blood, saliva or urine?

No, zero moon face issues prior to starting TRT. I do have very, very thin limbs and store all of my fat on my torso - specially the love handles and ass. I am still lean however and od not have a torso like the photo’s shown when googling cushington’s syndrome.

Can TRT cause issues with cortisol?

Most of the table salt in the UK is not iodized, but there are specific brands that are. I use Cerebos Iodised salt currently.

Target is E2=80 pmol/L
Increase anastrozole dose by a factor of 145/80

Then apply factor of 20/30 for 145/80 * 20/30