T Nation

Re-Dialing In To TRT with NO AI

Hey Guys, I’ve been on TRT for around ~2 years and was using 180mg of Testosterone Cyp (split into 2 shots a week) with around 0.5mg Anastrazole (hard to measure with the tablets). What originally encouraged me to go on to TRT was a combination of secondary hypogonadism and a history of crashing my E2 due to using AI’s, was at ~10 when I started.

My Test was last measured at 1262 ng/dl and free test was 40.1. E2 was at 22.5pg/ml but symptomatically I’ve always felt better at around ~30-35pg/ml.

I’ve decided that for longevity, I want to decrease my TRT intake to a sharp 140mg per week and get test closer to ~900-1,000ng/dl and get to a point where I can drop the AI. Currently, I’ll be testing it this upcoming week by using a compounded capsule version of Anastrazole at 0.3mg taken per week.

Now, where I need help;
a.) Because this is a re-dialing in process and I have no bloodwork to evidence my new testosterone levels and E2 levels, I want to ask, because I am symptomatically experiencing a combination of anxiety, shortness of breath, and a variety of other panic-like feelings, would you presume I am experiencing low E2 or more rather the latter of it being High E2. I want to set in stone that 0.3mg is too high and drop the AI once I evidence that my E2 levels are low with the upcoming bloods.

b.) What level of E2 do you guys consider your cushion baseline for measuring E2. Is it the labcorp suggested 35pg/ml or a more internationally acceptable measure of ~45pg/ml?

c.) Where would you articulate I need to be at in terms of TRT dosage to drop the AI granted how sensitive I am to the nasty side effects of AI’s and how easily it can tank my e2 levels.

d.) Completely unrelated where do you aim to have your Thyroid levels at where you consider them optimized where they aren’t in “hyperthyroid” territory?

I don’t have necessarily high BP or anything of the like, but because I suffer from allergic asthma/need to occasionally use inhalers, and don’t necessarily have a strong desire for the physical “size” aspects of utilizing high TRT doses, where would you articulate I need to be at to keep my physical/mental/and emotional being in check? I know there isn’t one answer to this question but there are some smart ass people on this forum that I’d love to soak in any advice from.

Watch this (I’ve queued it up to the relevant part):

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Thank you for the response! I watched it all and have a few questions.

a.) What is your target total testosterone and free testosterone numbers that you aim for, and generally encourage others to aim for in TRT?

b.) Did dropping the AI increase blood pressure at all for you and is there any correlation between utilizing AI’s and decreases of blood pressure, or does the utilization of AI’s and reduction of estradiol have nothing to do with blood pressure? For some reason, I always presumed that utilizing AI’s on TRT would not only reduce estradiol but also reduce blood pressure as well, maybe that was a myth. Hoping you can educate me here.

c.) How is your caffeine intake like? I have ADHD and I have prescribed Mydayis Adderall, going to reduce it to 25mg from what I was currently taking. Did dropping the AI lower or heighten your tolerance for Caffeine?

d.) I saw the comments on the tissue level, do you measure estradiol despite not taking an AI? Is there a forum consensus on what numbers to target for testosterone, free t, and estradiol without the utilization of AI’s?

e.) Did utilizing AI’s cause anxiety for you? How long after dropping it did anxiety tend to get better? Right now, shortness of breath (lung capacity is good) albeit I deal with allergic athsma, generalized anxiety, are amongst the things I’m feeling and I’m convinced its the E2 factor from personal history

I definitely want to drop the AI, and Saturday’s dose will be the last time I take it as I will have drawn blood by Tuesday and will have confirmed the “tanking” I am feeling symptomatically even now, but because I take a combination of Armour Thyroid, TRT, and Adderall, I want to make sure I can co-effectively manage all three medications in a healthy medium long term.

a) We don’t have a ‘target number’ because everyone is different. What we are seeing is the majority of guys doing well once they hit a free T of roughly 30ng/dL. People in this group will cry about it, but it is what we are seeing and I’m not going to lie about it to avoid hurting someone’s feelings. Nothing to gain by telling you that.

b) No increase in blood pressure whatosever.

c) I’m Italian and I drink two or three espressos throughout the day. The AI had no effect on this whatsoever.

d) We don’t even measure estradiol anymore unless it’s a very odd case of not aromatizing enough. Why measure something we’re not going to do anything about? Total is irrelevent. Free is what matters here.

e) I felt off the whole time I was on an AI but didn’t realize it until I stopped taking it. The first really strange thing I noticed by the second week is I felt I could breathe better - a noticeable difference that I couldn’t explain. I wouldn’t take an AI now if you paid me.

Keep in mind that when you stop taking an AI, you may feel worse before you feel better. It is normal. It will take several weeks for your body to balance out. Just have faith in the process and give it time.

You need to control your injection frequencies to dial in, you also need to forget the AI exists because you are an AI over-responder and anytime you take it, you will always end up with crashed estrogen. I can’t even take 1/8 of a 0.050 without problems.

You might need daily dosing which will go a long way towards dropping estrogen because you will be using less testosterone while still getting good levels. I don’t believe in internationally accepted anything when hormones are concerned, too many doctor get this hormone game wrong.

I have little faith in western medicine when hormones are concerned, it has to do with hormones are left out of teachings in medical school and residency. There are too many men being told levels are normal when in fact it couldn’t be farther from the truth.

I don’t even need labs, I can dial in on how I feel. I had low testosterone and I haven’t forgotten how it feels, I’ve also had high testosterone and don’t feel good. You’re not ever going to control estrogen with an AI, you always be changing the dosage and never reach homeostasis.

None of the physicians I work with determine dose based on E2 levels. E2 levels are not even part of the equation. Dose is based on the goal of symptom resolution, nothing more.

Thank you again!

a.) Is 30ng/dL a minimum or maximum parameter? Right now, my Free T is 34.4. Am i good here?

b.)That’s amazing to hear!
d.) So, I don’t pay attention to Total T but make sure Free T is above 30ng/dL?
e.) I don’t think it’s strange at all personally, I’ve been having this feeling on the AI which got me to come back here after browsing as I knew the people here would be the only people to understand.

The important thing is the breathing and anxiety attacks. I am willing to ride it out so as long breathing gets better within a few weeks.

Additionally, are there any things that you would suggest to lower AST/ALT, I’ll be using TUDCA at 1g to 1.5g per day to get it down and am looking into Paleo as my primary care suspects i may be hyperinsulinenemic and that i should be extra cautious as while my glucose and Hemoglobin A1C are in range to protect myself from the future as my dad has diabetes. Anything outside of exercise, diet modifcations and lifestyle changes you’d suggest to manage the diabetes prevention and a healthier liver?

a) If you feel good and have no symptoms, they you’re good and your number is irrelevant. For lots of guys, 30 is where things really start to improve. Again, some need to go higher and some do fine with lower. There is no perfect number.

d) Follow free T. Find the minimum amount required to resolve symptoms… whatever that number is.

For the rest I don’t have sufficient experience in that area to make recommendations.

If you workout, those enzymes can raise from muscle damage and are not considered an issue. If you do workout and are concerned about it you could avoid exercise for 5-7 days and retest to see if they do come down.

Thank you! I can relate to @dbossa in the video stating that low e2 symptoms feel like high e2 symptoms and when you’re symptomatically feeling things you second guess is it the high e2 or the low e2 so I always get confused there!

I think the first thing I will do is start shooting EOD once i drop the AI and then move to ED eventually. At ED you can do sub-q injections right? Is there any resources for education or training you can send me to watch and learn for sub-q daily injections? If I am at EOD dosing do i still go IM at 3 weekly ~46mg shots?

The only thing I noticed in regards to caffeine and hormones was that I was able to tolerate more caffeine on lower doses of test, but that may just be in my head as well.

There is a TON of content on the TRT and Hormone Optimization YouTube channel, enough to last you for years lol

Yes, you can do SubQ every day if you wish. Here is one video (queued up to the relevant bit) that may be useful:

You can do SQ at any time you choose, but it’s not for everyone. I felt terrible on SQ.

YouTube will be your best resource and where you can learn from the doctors leading the field of TRT. There aren’t many papers with regards to TRT, it’s a new field of medicine and not a lot of true specialists, they are few and far between.

A lot of doctors aren’t doing hormone therapies, it’s not an area of medicine where doctors are flocking to in big numbers.

Then that’s not an EOD protocol, every 2 days is Mon/Wed/Fri/Sun/Tues/Thurs/Sat->back to Monday. What you are doing is 3x weekly and your doses aren’t evenly space apart.

If you want to really do an EOD protocol, you can set seven different alarms on your phone to repeat every 14 days.

What dose do i use as the baseline when i start out since the first week will have 4 injections? 35mg? Please assist me on setting up the 14 days as it appears the cycle would reset every 2 weeks, right?

M/W/F/SU 35mg each shot
T/TH/SA 46mg each shot or still the 35mg?
M/W/F/SU 35mg each shot

Thank you I will subscribe to this channel and do a bunch of research.

Started experiencing some GI distress when i was on antibiotics from pneumonia and I’m wondering if the AI is irritating the stomach as well. Currently on 80mg nexium but want to get off soon enough. I noticed that when i took nystatin it helped, funnily enough. This is all just an awakening to getting re-dialed in, no AI this time :slight_smile:

Make believe that weeks are 8 days and not 7, otherwise you’ll cause yourself a headache. So if I inject 20mg EOD, I consider it 80mg weekly because I prefer no headaches.

Don’t overthink things, make it simple.

This isn’t accurate though, because there are 7 days in a week, not 8.

@noaitrtlife - how much do you want to inject weekly?

At one point, I was taking 140mg “weekly”, but dosing EOD. I injected 40mg EOD. Which is either:

40mg*7 (7 injections in a 2 week span, to normalize it) = 280/2 = 140

Or

40mg*3.5 = 140

Some weeks you inject 3 times, some 4… But our bodies don’t know a week is 7 days… It only knows what you inject and when.

If you are looking to inject a specific weekly number/amount using an EOD dosing protocol, just divide the total by 3.5, fill your syringe to that amount (based on strength per ML) and inject it.

Great advice everyone, I am extremely appreciative :slight_smile:

Is there any literature on estradiol relaxing the lungs, I know estradiol has feel-good properties but I’m trying to discern whether not the anxiety, shortness of breath, lung obstruction (taking deep inhale/exhale breaths on demand), and the manifestation of the recent anxiety attacks has anything to do with taking the aromatase inhibitor and having a low E2.

Has anyone started TRT at a 200mg dose and then tapered down to the 140mg dose range, if so please describe your experiences and transitions to the new dose, as I’d like to hear if there are any similar experiences.

I will begin doing an EOD protocol once my bloods are drawn so i have one last baseline before I truly re-dial in.

Estradiol is cardioprotective and has a number of beneficial effects over the entire system including protecting/improving the endothelial lining of your heart and blood vessels.

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Great to hear man! I had read on the t-nation High Estro Vs Low Estro article about the blood pressure thing but i think there is a lot of "information going around. Helps that you guys are able to help out and boost my self esteem as i plow through this period of time.

I’ve also decided to the F*CK the AI altogether and just start doing the EOD dosing protocol. As you and the doctor said in the podcast, “E2 isn’t going to change anything we’re doing” so it’s pointless and self-misery just to confirm that I do indeed have low E2 before cutting it out.

I have to say you guys have helped this guy out a ton and I am eternally thankful!

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When I first began TRT I used no AI. However, when bloods were drawn my old Endo measured Estradiol using the , LCMS, Endo Sci Estradiol, Serum, MS method and it came back at 69. I just found out this isn’t the same as measuring Estradiol using the Roche ECLIA methodology, which my new TRT doc has been using. Additionally during this period and reflected on the original labs I took @KSman’s advice of self-diagnosing my thyroid with iodine, where previously my TSH was around 3.5 TSH and skyrocketed to 7.3 using KSmans’s thryoid iodine suggestion. This got the endo to prescribe me thyroid meds but i think it skewed my overall perception of estrogen and TRT

At the point of the original test coming back at 69 (on the LCMS) i started the AI and the next time bloods were drawn it was a 19.5 using the Roche method.

a.)Does anyone know what is the difference between the LCMS method and the Roche method? Which one is the correct one, are they the same, meaning which one should I be testing with?

b.) I’m also thinking what caused my side effects at the time of TSH coming back at 7.3 and Estradiol LCMS coming back at 69 was the high TSH and not necessarily the E2, but can someone specify if 69 on the LCMS method is normal and what that converts to the Roche method?

Thank you @KSman :confused: