T Nation

Prostate Issues Exacerbated from Day 1 (End of Week 2)

46 y/o male, 6’ 8", 220, BF 10%, former heavy lifter in my 20s, did two foolish cycles (no labs or PCT, one test only, one deca only *yikes)) in my late 20s although I did better before cycle. Hard gainer, started at 170lbs then, got up to 300lbs naturally in 7 years (10 meals/d, 10,000 cals, 500 g protein/d, very determined). Not exactly sure when I started having BPH symptoms but it was around that time or in my early 30s (weak stream, splitting of the stream etc.)

Fast forward to age 46. Basically only doing push ups and pullups to failure alternating EOD for the past year, not terrible physique, look athletic but thin overall with some typical abdominal/waist male distribution fat. I did have a small amt of gyno from the previous cycles but only the nipple slightly affected ie no SC fat. I’ve increased my meal intake and work out intensity. My regimen is on the high side for TRT but the low side for a true “cycle”. All meds are pharmaceutical grade, as stated this is the end of wk 2:

-Test cyp 80mg SC M/W/F
-HCG 250iu SC M/W/F
-Adex began at 0.5mg M/W/F now 1mg M/W/F

My very first injection I developed significant lower extremity edema (+2 pitting) by the end of the day. I initially had a 2 year old bottle of arimidex which didn’t seem to be working as well as it might, at least there was room for doubt, though the edema did subside later the next day. By the 1st Wed, I added the HCG in, within an hour or so I felt an uncomfortable sensation in my prostate. Whether that was TC or HCG mediated or both idk. I obtained a new Adex scrip and went to 0.75mg that W and 1mg that F. The following week (this week) I went with 1mg M/W/F as I attributed symptoms to high E2, I actually took another 1mg today for a total of 4mg during wk 2. My urine stream/ejactulation has diminished force, diminished glans sensation and I have a naggingly uncomfortable sensation in my prostate and unable to achieve full erection and the semi erect state is brief.

Now I’m stuck wondering in the following order: is E2 too high? is E2 too low? and as you will see with my labs, did the exogenous test drive my SHBG lower and DHT higher and the combination is exacerbating the prostate E2 exposure? I hate to bail on this 8-12 week intended cycle but prostate has to come first. It took 15 years to reconsider another cycle in first place and I’m regretting it already. Unfortunately I did have the ultrasensitive E2, and the labs are from Quest, early am and several months prior to initiating the KSMAN’s protocol:

A1c 5.5
FT3 2.8 pg/mL (range 2.3-4.2)
FT4 1.1 ng/dL (0.8-1.8)
LH 5.6 mIU/ml (1.5-9.3)
FSH 4.0 mIU/mL (1.6-8.0)
Cortisol 6.0 mcg/dL (4-22)
CRP <0.10 mg/dL
DHEA (not -S) 149 ng/dL (61-1636)
Progesterone 0.7 ng/mL (<1.4)
UA incl micro/CBC/CMP all WNL
B12 and D high end of normal
HDL 61 mg/dL
LDL 106 mg/dL
Non-HDL 138 mg/dL calc.
TG 158 mg/dL

I cut out my nightly pint of ice cream and daily sweets btw. Now the meat and potatos:

TT 611 ng/dL (250-827)
FT 52.3 pg/mL (46-224)
Estradiol, US 25 pg/mL (</= 29)
SHBG 76 nmol/L (10-50)
PSA 1.3 ng/mL (</= 4.0) has been 1+ for years, DRE a few years back est 30g

Clearly states Quest at the top of the report but next to the tests ordered is Estradiol, sensitive (NG140244) which seems to be a lab corp test number but the range matches the Quest 30289. If I go with Quest which my insurance covers, I should have Estradiol 4021? This is a frustrating point to research on this site or any other.

To me this looks like a typical aging male, well the numbers aren’t so typical, but the syndrome of SHBG driving a deceptively high/compensatory TT is clear as obviously the FT is low. I was formerly able to achieve better erections, not those of my youth but much superior to the present.

The main reason for trying this cycle was to improve prostate issues as I’ve read a good bit about T:E ratio being the real culprit here and clearly there is some inflammation of the prostate prior to 2 weeks ago going by PSA.

I’m sure there will be a tendency to think the unpleasant prostate sensation is psychogenic. I have to disagree there. 10 years ago I started some tribulus and experienced the same result. I certainly didn’t imagine the pitting edema although I was quite surprised how quickly that manifested.

I’m still game to try a lower dose of Adex and a lower dose of TC or HCG for that matter. I have nolvadex on hand as well. The alternative is let this wash out and progress to PCT. Labs of course would be helpful but at exactly 2 weeks it is hard to know how to gauge them, especially given the estradiol lab chosen, and to a lesser degree, the lack of DHT.

I’m not very far off Adex to TC ratio of 1mg to 100mg/wk at 3mg and 240mg. Then again I could be an over-responder and it may have crashed. I seem a bit achier in the shoulders but I’ve also upped my training intensity. If the E2 US is way off and my estrogen was sky high to begin with, that also makes sense with the prostate issues and modern theory. The HCG may be doing way too much in the testicles and it could be worth seeing what happens with a week or two of no HCG. At least I could eliminate one variable before either adjusting the Adex lower or possibly (but doubtfully) higher, thereafter possibly lowering the TC.

The alternative is stopping now and proceeding into PCT, getting back to normal for a period of time and seeing where my baseline E2/DHT are. I’m sure everything I’ve put down is a bit scattered but I’m happy to clarify any points. At any rate, thanks for reading and thanks for all the effort to those who have posted such a wealth of info.


SHBG very high. SHBG is made in the liver to scavenge sex hormones. Some liver problems can increase SHBG. Higher estrogens increase and higher T decreases.

Your FT was low and TT not. You had a lot of non-bioavailable SHBT+T inflating TT and TT was very much overstating your T status. High SHBG is also lowering FT.

You need these labs to see whats going on in your liver as a minimum.

  • AST
  • ALT
    Heavy past use of oral steroids can mess up the liver.

Need time of day for cortisol, random cortisol is sort of useless.
AM cortisol is done at 8AM or 1 hour after waking up. A result of 10 should be considered minimum acceptable.

A1C should have a reference range.
5.5 is OK

fT3 and fT4 are below midrange.
Please post oral body temps. Find reference below.
You can easily have problems from not using iodized salt!

Your hCG probably has no connection to prostate.
With that much anastrozole, your E2 cannot be high unless liver problems interfering with liver clearing estrogens.

Prostatitis can have a non-hormonal component. But CRP does not show any major inflammation. https://en.wikipedia.org/wiki/Prostatitis
Do not do PSA labs soon after a DRE, ultrasound or orgasm.
TRT makes prostates larger by reversing some of the effects of low hormones.

Did you get a new supply of anastrozole?

Take 25mg DHEA ED and follow up with DHEA-S labwork.

TG=158 not understood and need ranges, no one here memorizes and we do see different units like pmol/L etc.
total triglycerides…

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.

Abrupt is fine with me. I meant to include all ranges.

I live in the US and eat out at least once EOD, cook with iodized salt and supplement 75mcg iodine daily for past few years.

PSA was not after DRE or US. Don’t recall having an orgasm that morning.

I did get a new Anastrozole by the first Wednesday, Accord is manufacturer, from CVS pharmacy.

Labs were before 10 am, but my redraw, when that occurs will be closer to 8am, cortisol seems in range regardless (am 4-22, pm 3-17).

TG range was <150 mg/dL. A1c is standard <5.7 for IFG cutoff. I’m aware these two are high end of normal hence cutting out the sweets.

TSH 1.59 mIU/L (0.4-4.5)

ALT 17 U/L (9-46)
AST 20 U/L (10-40)
Alk Phos 67 U/L (40-115)

I’ve never used oral steroids. I ran two previous injectable cycles in the 8-12w range, test cyp and the other was deca. I did a good bit of drinking as an undergrad in my early 20s but since my late 20s I’ve barely touched the stuff ie a few drinks per year. I’ve had multiple CT abd as well and other than a small hepatic hemangioma no structural changes. Despite my weight gain I’m naturally ectomorph type. I was pushing some serious poundage before I had real gains (650 dead, 800lb shrug, 350lb bench, 495 squat.) and I traveled everywhere with a full size coleman cooler. If I didn’t eat a meal at least every 2hrs it seemed like major catabolism set in. I was up to 300lb before I did either of first 2 cycles. I was off cycle at least 6 mo before I quit lifting/eating in my late 20s and I dropped down to 200lbs, without truly dieting (I ate the normal 3 squares) in less than a year.

Body temp seems to run lower end. At 6am I’m getting 96.1F sublingual w a CVS brand digital thermometer and 97.5F w an Innovo forehead EF100 and 97.6F both ears same model and this is in a controlled 77F house. I typically am 97.something when checked in clinic.

Don’t think I missed anything you requested but glad to provide whatever else. Not to muddy the waters but I have an older set of labs from Access Labs 6 years ago (again, years after my first 2 cycles).

Liver profile almost exactly the same numbers and ranges as above.
TG 37 mg/dL (<150), again I attribute the dif to a couple years of late night ice cream that I’ve cut out the past month.
TSH 3.25 mIU/ml, was worse then, which I attribute to being more active the past couple years.
DHEA-S 205.2 ug/dL (89-427)
TT 532 ng/dL (280-800)
FT 3.39 ng/dL (2.4-12.2)
SHBG 55 nmol/L (10-80)
PSA 1.11 ng/mL (0-4)
Estradiol 27 pg/mL (7.6-42.6)

As much as you can compare different labs across 6 years and converting pg to ng the picture reflects my being fairly sedentary in the older set (higher TSH, lower TT/FT/SHBG) to several months ago, when I’d been working out again for a year or two (lower TSH, higher TT/FT/SHBG.) I would also infer that the harder/more I train, as TT increases SHBG is on a mission to suppress FT. Still the same basic problem of a 40 something y/o male with TT being decimated by SHBG. I assume the prostate issues center on the ratio of T:E. The most baffling part of all this beyond the SHBG is why my current regimen is affecting my prostate so dramatically and indeed is it just an exacerbation of a process that is normally occurring in me.

Thank you for the effort

Hi there - I was looking at your labs and reading the above - and wanted to offer the following observations.

-First, don’t even worry about the two cycles you did 15+ years ago affecting your current labs now. I did multiple cycles in the 80s, as did many guys of that era, all with no pct, so any issues you are experiencing are from what is going on with you currently.

  • Your estrogen is fine but as you noted your free T is low and so is your total T for the amount of Test you are running - all related to your high SHBG. Most cases of high SHBG are from high estradiol, which isn’t your issue.
  • High SHBG can be lowered by taking Vitamin D3 and DHEA so I would begin taking DHEA since it was on the low end of normal anyway. you mentioned your D is fine.
  • it would be rare to exacerbate a prostate issue in only a day or so when free T is generally low.
  • Liver is fine - another contributor to SHBG - so that’s not the issue.
  • That leaves us with two other possible ways SHBG could be high - one is from other prescription drugs (sedatives, tranquilizers as well as alcohol) - the other is from Hyperthyroidsm. I would get a full thyroid panel.

Remember, higher or lower SHBG out of normal ranges is typically a symptom of something being out of balance (meds, estrogen, other hormones, etc.). Given what you posted - I would suspect other meds or thyroid as I mentioned.

I wish I could help more on the prostate issue.

Meds can increase SHBG. More specifically in my case, Benzos and LISINOPRIL. If your taking lisinopril, STOP. my SHBG was in the 70’s while i was on it, and came down to 49 once i stopped. still high, but not 70.

Stick with oral body temperatures.
Need early AND mid-afternoon body temps.

Wrong: TT increases SHBG

Bio-T lowers SHBG.
SHBG+T probably not so much, some things are not known.

Estrogens suppress SHBG.

AM cortisol is getting ~peak levels. Levels drop during the day and ‘random’ does not tell you much unless very low or oddly high. AM should be >10.0

Your FT=2.8 and lower AM body temperature are self-consistent. If iodine ample, something else is going on. As fT4 is also below midrange, T4 production seems to be the problem. With ample iodine, perhaps we are looking at problems associated with selenium deficiency. 200mcg is widely available in multi-vits that also have other trace elements.

I have been supplementing selenium 200mcg daily for several years.

97.2F oral temp @ 1pm. I’ll check it at 2, 3 and 4pm and post if it’s more than a few tenths off this.

As of yesterday, the beginning of wk3, I lowered my test/adex and M/W/F regimen is:
TC 70mg
Adex 0.5mg

I have an idea what happened with the SHBG. When I stopped training hardcore in my late 20s I severely reduced my food intake, especially carbs, especially early in the day ie really was on intermittent fasting diet and fasting most of the time and not really compensating when I did eat. Also, from the time of the labs 6y ago when SHBG was 55 to this years 76 (again comparing different labs, older set was an anti-aging clinic) I have been using a sleep benzo fairly regularly. Fasting and benzos not a good combo for low SHBG it seems.

My diet is much better in the past few weeks and I’m supplementing everything you advised. I’m also cutting out the sleep benzo. The prostate seemed to stop bothering me for the most part this past wknd before I made any changes. I’m at slight to 1+ pitting BLE but resisting the urge to tweak anything else for a week or two. My guess is with the shorter half life of the Adex that the edema is secondary to higher estradiol. Last week I took 1mg Adx M/W/F/Sat and had no edema (or emotion) until Sunday.

Also, I thought low estrogen was driving the ED. The desire is there but having trouble achieving a full erection. Is it time to get labs or stop and proceed to PCT and get labs in several weeks? Either way I’ll be sure to get them as close to 8am as possible. I appreciate everyone’s input.