T Nation

Questions About Current TRT Protocol/Sex Drive Issues

Good morning, I have been on a TRT program for the past ten months and have a few questions in regards to my current protocol. My Doctor currently has me taking:

Test Cyp: 300 once weekly (one injection per week)
Arimidex: 3mg weekly (broken up into daily doses)
Cialis: 5mg (daily)
Caber: .5 mg (once weekly)

I am 36 years old, 5’11, and 185 pounds. I train 5 days a week, and feel good overall. Very fit. After reading a lot of posts here, I am questioning the current TRT protocol that I am on, especially as it pertains to the estrogen blocker.

Still fairly new to TRT, I have some experience with other compounds that were un-montiored in the past (Deca, avavar, winstrol, anadrol). As I get older, I feel like it is important to have frequent labs under doctor supervision.

I am due for bloodwork in another 4 weeks, and will take better notes in regards to my levels, as I see here there are many categories to pay attention to.

My lab results 6 weeks after ago were

Total Testosterone- 1100 (7 days after last injection)
Estrogen- 23

The doctor has me on a high dose of Arimidex because previous labs my estrogen levels were 65 while taking 1mg Arimidex weekly…still seems like he has me on way too much of this stuff.

Overall, I feel good. However, my sex drive and ability to reach orgasm is very inconsistent… I am curious to hear what other think about my current program, and what could be causing these libido issues. When I was natural my libido was great, and my test was around the 500 range. Also would like to know what other levels I should keep an eye on when I go back for lab work…Doctor did not check prolactin levels, and I have voiced the sex drive concerns to him on various occasions.

Any advice would be appreciated.

Brett

Agreed.

I would discontinue the aromatase inhibitor.

You are on this without checking prolactin?

Free testosterone, SHBG, DHEA-S, prolactin, CBC, lipids

Your doctor is incompetent. You’re taking way too much AI, that’s not even debatable. Guys run 500mg of testosterone and never need an AI, let alone 3mg of arimidex. Trt should not require an AI unless you’re one of the freakish people whose e2 explodes with even the smallest dose of testosterone. The majority should never need to touch the stuff. Your e2 is low relative to your TT, which is a recipe for low libido and poor consistency in performance.

Also, unless you had a serious prolactin issue there’s zero reason to be on caber. That shit leads to a kind of withdrawal that’ll make you wish you were kicking heroin instead. Did your doctor explain to you how unbelievably hard it is to get off caber and the months long process of getting off of it? Did he explain that smashing your prolactin numbers like that lead to your orgasms being damn near impossible to achieve? Or did he just give you a drug and tell you to take it? (I already know the answer, it was the first sentence I wrote)

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I appreciate it. Will make sure to look at those levels when I go back for labs.

Appreciate the response, and your first sentence is what I was wondering after reviewing many threads…

I have taken the caber for about a month and a half, so I will discontinue that and the Al.

And no, he did not go over any of that. Trying to do the right thing by going to the doctor to monitor my labs, but it seems this guy is not the answer. I occasionally like to cycle another compound as well, though I should find another doctor.

I have a hard time even calling 300mg of T and 3mg of AI TRT. That’s like a mini steroid cycle level without the cycling part to me. Sure, occasionally someone actually needs that much, but it isn’t the norm IMO.

I’d agree with previous… drop the AI and maybe reduce the dose depending on history. How’d you end up on that combo? Did he start you out on that or work up to it or what?

Most people truly don’t need a dose that high. Do you have any labs, history, something that makes you think you do?

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Also…

300mg p/w is a mild cycle. Thats not TRT. If you’ve never been on a lower dose and you’ve been started out on 300mg with estrogen and prolactin inhibiting drugs then you’re under a sports performance doctor- not a TRT doctor who is looking at your long term health!

Appreciate it. Thats why I am here…to get advise from others with experience. Shall discontinue the Al and caber right away.

Started out with 200mg of T, and my initial labs had a lower T level than before I started.

How long was between the last injection vs. taking labs and how many weeks were you on that protocol before testing?

I was on that protocol for ten weeks prior to the first lab results. I always wait 7-8 days between last injection and blood work. The doctor (who I am now questioning his validity) said that the 200 per week protocol may have been too little due to past steroid use leading to the lower T levels.

So at this point I understand that I need to discontinue that Al and caber…thanks for all the feedback. At this point do you recommend that I scale back the test injection dose form 300 to 200 weekly as I find a new doctor?

My guess is SHBG is low and your once per week schedule isn’t optimal. I’d lower to 200mg and do shots 2x per week.

Also Caber is very strong, if you’re taking it without knowing if your PRL is high I’d def stop that.

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Thanks! Caber is stopped for sure.

Probably a combo of low to very low SHBG + waiting a week+ is why you were getting values so low. I imagine your levels were getting quite high right after taking 300mg then dropping fast since it was so long between injections. That is common for low SHBG guys

I’d stop the AI, stop the caber and go to say 200mg a week but split it maybe 3x a week. Try that for 6-8 weeks then get labs at whatever point is trough for the schedule you decide on. I do Mon/Wed/Fri just because it’s easy to remember and would do labs Monday before injection since that should be the lowest for me.

Caber is some crazy strong stuff like already stated… A long time ago 0.25mg/week took me to almost 0 (literally I was down to like 0.6) and I felt horrible from it. I’d drop this one and not add it back unless you have a very good reason to (i.e. prolactinoma level high labs)

Very helpful, and I will take your advise! What role does the SHBG play, and what makes this level increase and decrease?

SHBG binds to the T and keeps it in your system- but also renders it hard for.your body to use.

Its why Full panels with

Total T
SHBG
ALBUMIN
FREE T
E2
PROLACTIN

Are ideal.

If you’ve been doing 300mg on a single shot for a while too I’d get a full blood count to check how high your hematocrit has gotten too.

The advice of dropping to 200mg split up across the week in 2 or more shots is good advice.

You’ll get better advice if we could see a full panel.of bloods after you’ve been doing that for 6 weeks or more.

Bloods at trough.

Good info. I am due for a full panel in a month and will get the exact numbers. Though prolactin levels were not checked, the others were and I was told they were all within a good / healthy range…Ill get the exact numbers on those when I go back. Thank you!

Thinking from a scheduling perspective ill break the 200 mg up into two shots weekly. Sunday mornings and Wednesday evenings…Will take it from there after the next labs. Discontinue Al’s and Caber.

My God. He actually said that?

I will explain the simple version here because you sound like a nice guy who needs help. But underneath this explanation is an ocean of contempt for people like this doctor. He has exhibited absolutely no understanding of the most basic aspects of how the endocrine system functions.

Past steroid use can and does lead to reduced natural testosterone levels. However, that has absolutely no bearing on how you respond to exogenous testosterone. When you start trt your natural production is gone. That’s the whole point of trt. Your levels now depend 100% on the dose you’re taking. Your past is meaningless at that point because your past body, in its natural state, is no longer the baseline against which you measure your new numbers. In other words, 200mg of exogenous testosterone will land you at x ng/dl of TT. There is no natural amount that adds to that number once you’ve been on for a few weeks. So your numbers are entirely dose dependent. This guy knows nothing and he’s legitimately dangerous to your health. We can leave aside the inproper dosing schedule and the bloods being pulled at the wrong time. That’s a whole separate issue. This guy is fucking incompetent.

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