T Nation

Need Some Advice 4-Year TRT User

So I don’t normally post here just read every so often…

I have been on TRT for the past 4 years… a little background, I went to the Dr. when I was about 24 years old feeling very bad emotionally, physically, etc. they ran loads of blood work and decided it was either hypothyroidism or low T (my total T was 185). I went on taking synthroid after a few months really didn’t feel any better so my dr put me on TRT (keep in mind this is a family physician) I was getting 200mg shot of test cyp once every 2 weeks without hcg or any kind of AI…

I felt great for the first week and then terrible the next week… long story short I went to a mens clinic and started taking 100mg shots every 3.5 days along with .4UI of hcg and I have never felt better my total test was at 1080 and my free at nearly 150 (e2 was 47) the issue I am having is that I have started getting terrible cystic acne and regular acne all over my chest, back, and shoulders since i’ve started 4 years ago.

I’ve went to the dermatologist and he prescribed me a dabber for bad spots and minocycline to take orally but nothing has really helped. I’ve consulted with the clinic and i got my test lowered from 100mg every 3.5 days to 70mg every 3.5days which dropped my e2 to about 35 and my total test to 840.

What should I get done to determine the cause of this? is my e2 to high? is my test to high? any other blood work that I need I will get. I just need someone to point me in the right direction… I’ve gotten screwed the last 4 years and the only thing that anyone has told me is the only way to get rid of it would be to stop TRT which I’ve highly considered…

Sorry for the wall of text, I can also post any blood work if anyone is interested… I have lipid panels, metabolic panels, liver, e2, test, blood counts, etc.

So, how are you feeling? Any complaints other than acne? For me, E2 at 35 is too high.

Any labs you can post are always helpful here along with any additional stats. Your protocol is very similar to mine. I take .5ml every 5 days. My Rx is for 1ml/wk. For me that was too high. My E2 is also high. You are more than likely going to need an AI to go along with your TRT therapy. This is the same boat I am in right now. You will find this forum very helpful. The mods here are very knowledgeable.

I feel great, I mean when I dropped test from 100 to 70 I had a really bad breakout and felt terrible for a few weeks but it seemed once it regulated I went back to feeling good.

I started this not knowing anything about trt just going by my dr… and after learning a little more I realize that they have no idea how to treat trt. I’ve been getting my own labs done and showing them to my dr but I mostly go by how I feel, I make sure nothing is to out of whack though… but the acne thing has me stumped I do have anastrozole maybe I should try an lower my e2 some and see if it clears up?

as you probably know, AAS kicks your sebaceous glands into overdrive causing oily skin and more breakouts. E2 certainly has a role in your breakout too. I seriously doubt your dermatologist is going to do alot to make you happy. My suggestion to you is get yourself some accutane. (A very low dose to protect your liver). A 2 month long cycle will do wonders for your acne. Most docs wont prescribe accutane anymore. I had to go to an overseas pharmacy to get mine. I took about a 1/4 dose for my bodyweight and had no problems whatsoever. Been running 500mg of test E/week for a LONG time now with no more acne.

My dermatologist suggested trying accutane actually, he told me to be patient with trying the other drugs first so when he refers me to a dermatologist who prescribes accutane it will be easier to get on it. My sister has actually taken accutane and it removed most of her cystic acne she still gets patches of regular but nothing nearly as bad. I just wanted to see if lowering my e2 would be a better option then just jumping on accutane

I had bad acne on my chest that started shortly after commencing TRT. I tried several things including adjusting test, arimidex, and thyroid dosages. Long story short, lowering my t dosage a little worked… a little. However, what worked best for me and totally eliminated the acne was a change in diet. I was eating 1/2 lb of grassfed beef every single day for lunch. I eliminated the beef completely and my chest acne cleared up within a few days. If I eat a cheeseburger or six over the weekend, I will occasional get a pimple still, but I don’t stop it from indulging every once in a while.

I think all the saturated fat was accumulating in my body and coming out in my pores or something. That, in combination with increased activation of androgen receptors from the TRT probably caused it. If you haven’t done so already, try adjusting your diet, starting with the elimination of saturated fats, sugars, or anything you may have a sensitivity to (i.e. grains, dairy, peanuts, eggs, etc). Replace the saturated fats with good fats from raw olive oil, nuts, fish, fish oil, etc.

I think one lesson I learned from all this is to vary my diet… don’t eat the same thing day after day.

I was curious did you get the Accutane prescribed by your doctor I’m nervous to tell my dermatologist about wanting Accutane while taking replacement therapy do you think that would matter. I only ask because the dermatologist I use now doesn’t prescribe Accutane but he said he would refer me to someone who did should I mention that I take replacement therapy or not

Part of your response is transient and that goes for skin as well. If you had acne when young, expectations are increased. 200mg/week will certainly do this if you are predisposed to such things.

I’m only at 140mg per week, although I wasn’t taking anastrozole and I think I was taking too much HCG at 400 units twice a week

No I self prescribed. I knew a dr wouldnt give it to me for androgenic acne. So I got it from an overseas pharm.

Can I ask what you started with? Dose? Did you get your labs done on it? My insurance won’t cover anastrozole for TRT so I get mine from overseas pharm

Like i said in my previous reply, I think my acne was effected more by my diet, and less by my protocol, but below is a summary of where I started and where I’m at now with my protocol.

I started at 200 mg once/per week IM, and 1 mg anastrozole per week (divided in two doses). This was my docs standard protocol. My e2 was high, at this dose, around 39 if I remember correctly. My T was also very high, at around 1500 ng/dl at the end of the week (low point). I slowly dropped my T dose down, and introduced HCG (self prescribed, overseas pharm) over the course of a year. I had bad chest acne, but was also eating A LOT of saturated fat (albeit from supposedly healthier grassfed beef).

I’m currently at 20 mg (10 ml) T EOD sub q (70 mg per week), 200 iu HCG EOD, and 5 drops of liquid anastrozole ED (about 1 mg per week still). This puts my test at about 1000 ng/dl at the midpoint and my e2 at about 25. I respond well to HCG, so I don’t need much exogenous T. I have no acne at this dose, but I’ve also replaced the daily grassfed ground beef with chicken breast. I think the latter was the key.

Hope this helps. Everyone is different.

When I was really cutting weight I ate mostly organ green vegetables along with only chicken breast and white fish for about 12 weeks, I did eat peanut butter and eggs which I think we’re the only things that had any significant saturated fats. I am not 100% yet but my blood tests will tell. My e2 was always above 35 and I think that’s why I felt crappy and had acne

Eating healthy I will say did make a noticeable difference but I still had a good amount of acne, more than I want and it’s cystic kind… I wouldn’t care if I got a few pimples every other day or even every day as long as it wasn’t the painful cystic kind

Another question did you set a limit for yourself on saturated fat? Or just kind of try to eliminate it

I think i was taking 40 mg/day. it was about 1/4 of what the recommended dose was for my weight. Sorry its been a couple of years

I didn’t necessarily put a limit on it. I just decided to try something different, and it happened to work for me. Everyone is different… especially when it comes to acne. However, changing your diet can have dramatic effects on every aspect of health and fitness, so to me it’s always worth a try. It may be worth a shot for you to try to eliminate peanut butter and at egg yolks. You still need to get good fats in you though (from nuts, fish, olive oil, etc). I shoot for 100g per day of good fats. If you are cutting, maybe 50g minimum.

As far as the E2 goes. My experience has been that when E2 fluctuates, I break out. However, once it stabilizes high, low, or in the middle, my acne will clear up. You definitely want to get your E2 down closer to 22 though, and keep it there. Consider daily dosing of liquid Adex if you aren’t doing that already. If you haven’t stabilized on a particular protocol for several weeks (I’d say six weeks minimum), that could be contributing to the acne. Stable hormones are key. Fluctuations are bad. I believe this is why women tend to have adult acne more often then men… because their hormones are in a constant state of flux.