T Nation

Started Test/AI/Hcg. Have Some Sides and Questions

Very long post so apologies in advance but hoping some experienced individuals can help me out.

June 20th I started my HRT. A little background on why I started. I am 40 years old. I have been getting full panel bloodwork done since the age of 30. From 30 to 35 my test levels were always very good yearly when checked ranging from 750-850 (Dr range on test was 290-1100). Not sure about my free test levels. At 36 I started to get a lot of anxiety for no reason. Bloodwork time came around and it was around 550. I did not think much of the drop. The next year came around and my test levels dropped to 310. I started wondering if the daily anxiety that was getting worse was related. I kept ignoring it but I started to slowly get more and more issues over time from 37-40.

Issues I am referring to are:

Complete lack of energy at times sometimes lasting weeks at a time. And not the I am tired I feel lazy but I am so tired I don’t even want to stand up to the bathroom.

My libido completely went away. ZERO desire despite my wife being gorgeous.

Year after year my muscle mass slowly kept diminishing. I have always been a smaller guy but always shredded so it was very obvious to me I was losing muscle. At 37 I was 144lbs 5%ish body fat and at 40 down to 137lbs. Even during a bulk I could not put the muscle back on.

Anxiety and moderate depression getting worse and worse year to year

The straw that broke the camels back was this past December it started feeling like my penis was not even connected to my body anymore. It literally felt lifeless and dead. After talking with my Dr suggested seeing a endo but I bypassed that and went to a hormone Dr who put me on a HRT protocal.

My starting protocal was:

200mg test 1x a week

1mg anstrozole 2x a week

50 units HCG 2x a week

I started to feel great again. I literally felt like I did in my 20s. I started to experience a couple issues though roughly after 2 months in. One was that I was tending to hold a lot of water on and off…typically the day after test injection around my midsection that would last for about 2-3 days. The other which was my major fear was hair loss. I initially was losing hair on my legs which I could care less about but then my scalp started to thin. And it was happening fast! My father has a full head of hair at 70 and very thick and my grandfather when passed had a full head of hair as well. I have always had thick hair but not anymore. It is very thin and sparce now.

After 3 months he wanted to recheck blood work. Well my test levels skyrocketed.

I went from 310 to 3036

Bloodwork Results

FREE T3 2.5 (range 2.3-4.2 pg/ml)

Estradiol 44 (range <or = 39)

DHEA 795 (range 61-1636)

5-A-Dihidrotest 71 (range 16-79 ng-dl)

Test 3036 (range 250-1100 ng/dl)

Bioavailable 1232.4 (range 110.575)

SHBG 46 (range 10-50)

Test Free 612.2 (range 46-224)

Albumin 4.4 (range 3.6-5.1)

So since then he has changed things up. At first he had me go to (changes underlined):

150mg text 1x a week

1mg anstrozole 2x a week

50 units HCG 3x a week

My water retention increased, my mood has seemed to be all over the place and my sex drive not only went away again but I could not keep an erection again. He then told me to start taking 1mg anstrozole 4x a week . That has not seemed to help. Sex drive still low again since his initial change, water retention the same and mood still all over the board. I just made the switch on my own last week to injections 2x a week dividing each one in half. I wanted to give it a month to see if it helped splitting it up. Today is only the second week second injection so I still think it is too soon to see if it is working. Again I will give it a month to assess.

Any advice on hair loss, water retention, moodiness and most importantly sex drive would be great. Not doing this for aesthetics at all but who wants to lose hair and hold a ton of water if they still are not feeling optimal. Sorry for anything I have left out that may be helpful info. Just ask and if I know I will let you know.

You’d have to be on the 150mg/week for 4-6 weeks and retest bloods. Then make changes from there. Your DR started you way too high of a dose at 200mg/week I believe. The better course would have been to start low, test, then go higher if necessary.

Personally I think you’re on too high of a dose. A lot of guys will feel better on lower doses.

Holy crap. That’s insane. I see system Lord typing. He will explain further.

Your TRT protocol is to blame for everything that’s happening, we convert our testosterone into estrogen and your bioavailable testosterone is insanely high. Your Free T is very high which is strange considering your somewhat high SHBG, which probably means it’s not very sticky.

It’s going to take at least 6 weeks for testosterone levels to reach stable state, after this time you will know if this protocol is a success or failure.

You might be able to do away with the AI completely if you decrease testosterone enough to where you don’t have to overcompensate from the massive TRT dosage. My suggestion if this protocol fails, a more conservative protocol of 50mg twice weekly may show good results, it’s not to overly aggressive and may easier to manage.

Anastrozole can cause hair loss.

Free T3 is low and is scraping along the bottom of the ranges, I would do a thyroid panel also checking ferritin and cortisol.

HCG could be the causing of water retention and moodiness. If fertility isn’t a concern drop the HCG, more often than not it causes more problems than it solves. However there are a few who actually need HCG to make TRT work, they are in the minority.

Thank you for this. I will wait it out the full 6 weeks and see what happens and move from there. I will update how everything goes. I apppreciate your feedback.

Also what do you mean by “it’s not very sticky” in regards to SHBG?

Testosterone binds to SHBG and usually the higher SHBG decreases Free T, basically SHBG prevents you from clearing out testosterone to quickly, Total T is a reservoir for Free T, the stuff that makes all the magic happen.

I’ve seen guys in here with SHBG well above the ranges and feeling great, yet a guy comes in here feeling terrible with an SHBG similar to yours, so there is a variability in the stickiness of SHBG from person to person.

Got ya. Thank you for explaining. Just hoping to figure this all out in the next few months and get stable and feeling great again.

Wow! Those are incredible numbers. I’ve been doing 200mg weekly for over five years. Last blood test came back with total test at 902 and free test at 220. I also do not think you needed anastrozole. Your free test is at 2.0%, pretty good with your SHBG.

Yes the Dr was extremely surprised it shot up so high. I will get retested in a month to see where things dropped to after the decrease to 150.

Contacting Dr tomorrow for a blood work panel.

See where my numbers are at.

For hair loss I was on a regime of a hairless loss shampoo (with saw palmetto in it) and saw palmetto oral supplement. I am pretty sure this is causing depression and other symptoms to worse.

Stay away from hair loss medications if you value your sex life, finasteride and accutane! Google either of these and you’ll see guys permanently fu*****.

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Yeah I new that about finasteride. Didn’t realize Saw Pallmetto would have such a hardcore effect. Don’t wanna lose my hair but feeling good is ultimately what made me go the route of HRT. So hair as much as I don’t wanna lose…nothing is worth feeling mentally and physically like shit. Feel like I did pre HRT and maybe even a little worse.

I had bloodwork done Wednesday so I should have results this week hopefully. I have a question maybe someone could answer. I have literally been sick since the last week of September. Each time has taken about 3 weeks to feel better. I will feel fine for about 5 days and boom sick again. Body aches, sore throat, headaches, zero energy, fever…the typical cold or flu symptoms. Could this be related toy elevated levels? Where my body just can’t shake what I have going on.

Finally got my bloodwork results back.

Currently still doing the following protocol:
150 test 2x per week split into 2 doses inter muscular. Anstrozol 1mg 4x per week. HCG 50 units 3x per week.
My schedule looks like this: Friday 75 test 1 mg anstrozol, Saturday 1mg anstrozole, Monday 75 test 1mg anstrozole, Tuesday 1 mg anstrozole 50 units HCG, Wednesday 50 units HCG, Thursday 50 units HCG

Bloodwork taken on a Wednesday morning fasted at 6am.

Still facing some of the same issues.

  • Libido seems to be coming back slowly but only late at night.
  • Still facing the same amount of hair thinning now. I have stopped saw pallemetto for 3 weeks now as I was taking for hair but that was making depression very bad and libido was totally gone.
  • Body temps all over the bored. One minute I am freezing the next sweating. I live in NY state and it is currently averaging 22 degrees F to give an idea on climate temps.
  • Water retention
  • Erections in the morning are coming back but not full.
  • During sex or masturbation I cannot get a full erection until just before orgasm. Up until then it is a soft/semi erection.
  • Still have been getting random anxiety and heavy depression but not daily but when I get it it is very bad. I have dealt with depression issues since I was 19. Suicide attempt at 25 and I state that so when I talk about depression you can understand its severity. Currently the depression is not on that level at all but it is still very harsh.
  • I am red and flush quite a lot of the time.

Any advice on the above issues would be greatly appreciated. Just trying to feel normal again before I started having all these hormone issues a few years ago. I will be talking to the Dr. about my results in a couple days so hoping I can get some good advice before going so I can ask some questions etc.

Lipids results and ranges they use: (first number result 2nd set of numbers ranges)
Some of the kidney results have always been off for me since first getting tested over 10 years ago. Most likely due to lifting.

NA 142 136-145 MMOL/L
K 4.8 3.4-5.0
CL 100 98-107
CO2 32 22-29
Anion Gap 15 10-20
GLU 102 70-99
Creat 1.3 .7-1.2 MG/DL
BUN 28 6-20
CA 9.2 8.6-10.2
TF 7.3 6.4-8.3
Albumin 4.7 3.5-5.2
Total BILI .6 0.0-1.2
ALK PHOS 47 40-129 u/l
AST 45 0-40
ALT 29 0-41
GFR >60
Chol 230 0-199 mg/dl
Trig 72 0-149
HDL 84
LDL 132 0-99
Insulin 3.9 2.6-24.9
PSA .55 0.0-4.0
B12 1298 232-1245
Folate 6.4 3.1-17.5

Free T4 1.15 .9-1.7 ng/ml
T4 6.2 5.1-14.1
TSH 1.710 .27-4.20
LH 0.1

WBC 5.7 4.3-11 k/ul
RBC 5.52 4.2-6.2
HGB 16.5 13.5-17.5
HCT 51.1 40-54
MCV 92.6 75-105 FL
MCH 29.9 26-33 PG
MCHC 32.3 31-36 g/dl
RDW 12.2 0.0-16
PLT 201 150-400k/ul
MPV 9.6 8.7-12.3
BEYT 54.1 47-76
Lymp 34.33 12-44
MONO 7.2 2-12
EOS 3 0-6.0
BASO 1.2 0-3.0
ABS NEUT 3.07 1.5-7.5 l/ul
AbS Lymph 1.95 .8-2.8
AbS Nibi .41 .2-1.0
ABS Baso .07 0.0-.2
Immature Gran .2 0.0-.6
Abs IMM gran .01 0-.04
NRBC 0.0

FREE T3 2.6 2.3-4.2 pg/ml
Estrodiol 34 <or=39 pg/ml
DHEA Sulfate 244 106-464 mcg/dl
5-A-Dihydrotest 57 16-79
Test FR/TOT/BIO 2544 250-110 ng/dl
Testo Bioavail 163.1 110-575 ng/dl
SHBG 40 10-50 nmol/l
Testo Free Albumin 516.9 46-224 pg/ml
Albumin 4.5 3.6-5.1 g/dl
IGF-1 LC/MS 143 52-328 ng/ml
z-score-male 0.0 -2.0-+2.0 SD


On the empirical side of things, it does seem there is some correlation between higher endogenous testosterone and decreased immune function. However, it should be noted that testosterone, in some studies, has been found to be only immunomodulatory rather than immunosuppressive. Maybe your problem is the upregulation of all systems (due to high levels of exo test) beyond their ability to sustain the burden, thus sickness.

Your test levels are insane for HRT and 1mg Anastrozole 4x per week is also insane. What does your doctor say about this? You said you checked in with them, did they lower your dose?

You really need to get this sorted out since you mentioned worrying mental health issues. My hormone issues gave me crippling anxiety/panic attacks and moderate depression on some days, it’s much better now. It also gave me horrible, intrusive thoughts that have gotten so much better since starting TRT again. Hormones fuck with your mind man, you’re ok, it’s not you, just your endocrine system (I know it’s easy for me to say right now).

I had to cancel my apt yesterday due to an emergency but should be talking with Dr. tomorrow. And yes they are very high and that is why my Dr. had me on 1mg Anastrozole 4x per week. I have not taken any more or any less than the Dr. has told me to. He initially lowered my test dose as my test levels were even higher than this previous test. He is obviously going to need to lower again.

And yes I hear ya. It can majorly mess with your head and I just keep reminding myself of that.

To be clear, he recommended this much Anastrozole to block the conversion effect of test to estrogen?

Holy crap. This is very damaging.

You mean 4 mg a week. Right? Wow