T Nation

Peak=Trough on E7D Dosage? Crashed E2. Need Help


#1

Hey everyone, first post here. I have read just about every thread on this forum, including all of KSman’s stickies and threads, as well as other forums and I could not find the answer I was looking for, hence this post. Given that TRT is highly individualized process with treatment protocols that differ from person to person (i.e. one size does not fit all), I knew very well going into this that I may experience some ups and downs and may have to work hard to find the right balance. One thing for sure is that TRT is both an art and a science b/c it requires someone truly listening to their body to optimize TRT.

That being said, I started TRT on 11/21/2016 due to being hypogonadal (secondary) and feeling all of the usual sides of low T. By the 3rd week of my TRT regimen, I started to feel crappy with symptoms of what I perceived to be low E2 (zero energy, zero libido, strong wood, brain fog, night sweats, headaches, painful joints, dry mouth, anxiety). The PA @ my drs office thought I was having high E2 symptoms when I thought low. Nonetheless, opposing views ensued whereby she recommended that I take 1MG EOD (along with my Test Cyp protocol listed below), which is the standard protocol issued by my doc for all new TRT patients. I pushed back on 1MG of ADEX as I had educated myself from the various TRT forums where most guys recommend starting low then working up b/c its harder to recover from low E2 (i.e. body has to reach homeostasis over time to correct) than it is from high E2 (pop a pill and lower). Well, long story short, I wanted to do .10MG or .20MG every MWF and the PA wanted 1MG every MWF. We settled in the middle @ .50MG every MWF and nuked my E2 into the single digits. I am now in a world of hurt now with low E2 and I feel worse than just low T and no TRT.

Here’s the current situation, I pinned 200MG of Test on 12/19/2016 (Monday this week) and took my last dose of ADEX of .50MG on 12/13/2016 (Tuesday a week ago) and have not had any more ADEX since then. Given the half-life of ADEX, the plan was to stay off ADEX until 12/26/2016 (next Monday) so that I can get it out of my system and minimize/weaken E2 suppression then focus on raising my E2 by injecting test cyp with no ADEX until I can get my E2 levels back-up. In the meantime, I pulled some very basic BW and my trough T levels came back almost similar to my peak T levels. I would think this would be normal on a E3.5D cycle not E7D cycle. I am perplexed given the half-life of test cyp that this is even happening. Now I am really not sure what to do as it is obvious that my body is processing/metabolizing the injections differently than most people. Peak = Trough over 7 days?? Seems odd but I do feel somewhat even energy throughout all 7 days, just not good progress overall b/c of all the low E2 sides.

My understanding is, the higher your T, the more that coverts to E2, hence the need for an AI like ADEX. Well, if my peak and trough are almost the same, maybe more will convert to E2 b/c I am constantly at higher levels without any true peak or trough. I really want to avoid going from low E2, which sucks a$$, to high E2, which also sucks a$$ from what I hear. Based on the above info and my stats, should I get back on ADEX sooner b/c my peak and trough levels are similar? When should I do it? How much? Need some help on determining future dosage and frequency. Thanks guys for any input.

Protocol:
Test Cyp: 200MG (200MG/ML VIAL)
Injection Type: IM (Glute)
Adex: None currently, previously on .50 MG
Test Cyp Frequency/Day: Every M
Adex Frequency/Day: Every MWF

Stats Pre-TRT on 11/4/16:
Weight: 165
Height: 71.5"
Body Fat: 16%
Age: 47
TT: 184 (Range 250-827 NG/DL)
FT: 3.5 (4.8-25.7 NG/DL)
SHBG: 28 (16.5-55.9 NMOL/L)
E2 (Sensitive): 26 PG/ML
Cortisol: 14.2 (4.0-22.0 MCG/DL)
LH: 3.2 (1.5-9.3 MIU/ML)
FSH: 2.9 (1.8-8.0 MIU/ML)
HCRIT: 45
CHOL: 134
HDL:49
LDL: 85
GLUCOSE: 88

Current Stats:
Weight: 170
Body Fat: 15%
Body Temp: 97.3 - 98.5

PEAK Stats on 12/07/2016: thirty-six (36) hours after Test Cyp injection on 12/05/2016
TT: 995 (348-1197 NG/DL)
FT: 20.3 (6.8-21.5 PG/ML)
E2 (SENSITIVE): 8.8 (8.0-35.0 PG/ML)

TROUGH Stats on 12/19/2016: two (2) hours before Test Cyp injection on 12/19/2016
TT: 828 (300-890 NG/DL)
FT: 24.4 (16.5-55.9 NMOL/L)
SHBG: 19.5 (16.5-55.9 NMOL/L)
E2: <17.0 PG/ML (LAB GOOFED AND DIDN’T PULL SENSITIVE…URRRRRGH)


#2

You only need to stop anastrozole for 5-6 days, you are not seeking zero.

Steady T levels are the objective so anastrozole can match a steady amount of T.

Remember that you could be an anastrozole over-responder.

1/3rd mg anastrozole at time of injections would be worth trying.
Make a 1mg/ml solution in vodka and dispense by the drop or volume.

Your cholesterol is too low. Total cholesterol <160 is associated with increased all-cause mortality.
Are you using a statin drug?

AST/ALT tested?
E2 was oddly high VS low FT

If TT and FT do not come up, you may need more T.

Consider injecting with #29 0.5ml 1/2" insulin syringes SC/SQ over top of quads. You can see and avoid surface veins and avoid risks of glute injections - major blood vessels and nerves.

TSH tested?
Are you using iodized salt to support your thyroid hormone production?

Any meds or medical conditions?


#3

KSman, thank you for the response.

Couple points to the above:

  1. Re the anastrazole, I do dissolve in vodka (thanks to reading your threads) to get the .10 increments. Do you recommend that I take 0.30MG per week and at the time of injection or other frequency/dosage since I am clearly an over-responder??
  2. Re the other BW you mentioned, see below. Btw, I did my check my cholesterol history this year and it has been in the 130s. I made an error in my post as cholesterol was not checked on 11/04/2016 but rather on 10/29/2016 it was tested @ 173. I dont know where it is today, probably should get checked as I did not know that was a risk that great under 160. All of the other BW and values are correct.
    AST: 26
    ALT: 29
    TSH: 2.19
  3. Re statin drugs, none taken
  4. Re medical history, none other than low T, hepatitis B @ 15 yrs of age (not a carrier), and run of the mill colds/flus. No surgeries either.
  5. Re iodized salt intake, what protocol do you recommend?
  6. Since my peak and trough levels are close, does this mean I should stay on E7D or would I benefit more from E3.5D frequency?

Thank you again for your input. Of all the forums I have visited on this subject, your comments are simple and str8 to the point. Good stuff.


#4

Forgot to add, no meds, just the following supps:

  • multi vitamin
  • magnesium glycinate: 800MG ED
  • salmon oil: 2300MG ED
  • vitamin D3: 10,000ID ED
  • Zinc: 50MG ED
  • Ubiquinol: 100MG ED
  • Lutein & Zexanthan
  • Methyl Folate: 400MCG ED
  • Vitamin A: 10,000IU ED
  • Coenzyme Vitamin B-Complex: ED

#5

Iodine and selenium in the multi vits?

Have you not been using iodized salt?
TSH=2.19 is indicating a problem
Body temps: Should be 97.7 or better in the AM

Adex: Not too sure where to go given your info above. That is why I suggested 1/3rd mg with injections twice a week.


#6

Have not been taking iodine suppementation. I also noticed that my thyroid peroxidase antibodies were 2 IU/ML on the BW pulled on 11/04/2016. I will start this ASAP.

Re temps, AM runs about 97.8

Will try 0.20MG ADEX at time of bi-weekly injections. Worried about going to high, horrible feeling. Bump from there.

BTW, pulling some simple BW (TT, FT E2) next Tuesday (12/27) to see where my basic levels are so that I can get me E2 under control. If you think I should run anything else let me know. Next Monday will be the beginning if my 6th week on TRT. Thanks again for all of the sound advice and if I don’t hear back I wish you and your family a happy holidays!


#7

Hey KSman, hope you had a happy new year. Here’s a recap/update on the anastrozole issue.

PEAK Stats on 12/07/2016: thirty-six (36) hours after Test Cyp injection on 12/05/2016
TT: 995 (348-1197 NG/DL)
FT: 20.3 (6.8-21.5 PG/ML)
E2 (SENSITIVE): 8.8 (8.0-35.0 PG/ML)
NOTE: THIS WAS MY 3RD WEEK ON TRT AND THIS PEAK IS QUITE DIFFERENT THAN THE PEAK MEASURED ON 01/10/2017

TROUGH Stats on 12/19/2016: two (2) hours before Test Cyp injection on 12/19/2016
TT: 828 (300-890 NG/DL)
FT: 24.4 (16.5-55.9 NMOL/L)
SHBG: 19.5 (16.5-55.9 NMOL/L)
E2: <17.0 PG/ML (LAB GOOFED AND DIDN’T PULL SENSITIVE…URRRRRGH)

TROUGH 12/27/2016: one (1) hours before Test Cyp injection on 12/27/2016
TT: 774 (300-890 NG/DL)
FT: 21.5 (16.5-55.9 NMOL/L)
E2 (SENSITIVE): 55.1 PG/ML
NOTE: STOPPED ANASTROZOLE ON 12/13/2016 AND ON 12/27/2016, RESUMED @ 0.20MG EVERY MWF. ALSO, 12/26/2016 WAS MY INJECTION DAY AND LABS WERE CLOSED, SO THIS TEST IS ACTUALLY ON DAY 8 WHEN I NORMALLY INJECT E7D)

PEAK Stats on 01/10/2017: twenty-five (25) hours after Test Cyp injection on 01/09/2017
TT: 1062.7 (348-1197 NG/DL)
FT: 31.4 (6.8-21.5 PG/ML)
E2 (SENSITIVE): 17 (8.0-35.0 PG/ML)
NOTE: SINCE 12/27/2016, ANASTROZOLE DOSE HAS BEEN 0.20MG EVERY MWF. I MEASURED A BIT EARLIER THAN LAST TEST AS I “FELT” LIKE I WAS PEAKING SOONER THAN 48 HRS.

I feel like I found my anastrozole dose and finally feel like TRT is working on all cylinders. I have not split my dose into E3.5D frequency as I wanted to dial-in E2 first. However, are there any issues with my free T being as high as it is??? Where is it going? Any other thoughts/comments?


#8

I’m interested in seeing your next E2 labs. You shooting for 22 with E2?


#9

hey tallyho, thanks for asking. Since I restarted anastrozole after being off for 2 weeks from crashed E2, I have been on 0.45MG a week (0.20MG on M, 0.15MG on W and 0.10 on F). Since I pin E7D, I was trying to dose anastrozole on a sliding scale so that it mimics decreasing testosterone. Not sure if this is the right approach but so far its appears to be working as I am an overresponder that is not quite ready to make the jump to pinning twice weekly. E7D seems to work for me as I don’t feel like I am going to high and low.

After reviewing my dosage history and my daily notes, I think I will feel my best with E2 in 20-30 ng/dl range. That said, now that I am closer being dailed-in, I am just trying to let my body tell me what feels best and not get caught up treating the E2 numbers too much as they will fluctuate. In the meantime, I am keeping my fingers crossed that I don’t run into another hiccup (i.e. hematocrit, thyroid, adrenals, etc). If I do, I gotta roll with the punches and make it work as best as I can.

BTW, I ran BW again today (to get my E2 trough levels) and will let you know. I use Nelson Vergel’s discountedlabs.com, so its cheap to run.


#10

Got my trough BW, looks like my E2 came in were I needed it. Definitely feel better now that everything appears to be under control. Libido is definitely much better with slight higher E2 (17 vs 25).

Trough Stats on 01/16/2017: Day 7, an hour before next injection (200MG E7D)
TT: 800 (348-1197 NG/DL)
FT: 19.7 (6.8-21.5 PG/ML)
E2 (SENSITIVE): 25 (8.0-35.0 PG/ML)
NOTE: Staggered my anastrozole doses every MWF (0.20MG; 0.15MG; 0.10MG)


#11

Nice outcome. Labs are good, now that you are dialed in, it may take a bit longer for brain to get settled. Fat loss and proportions to take a while and could progress rapidly if thyroid function is good.

Please note that selenium is essential, lack of selenium could be damaging. I do not memorize thyroid peroxidase ranges, so “2” does not mean anything to me.


#12

Sorry to bring this one back from the past but it’s great info. My question is how are you testing so often? Some sort of kit at home?