I just had my first follow up with my TRT provider. The bloodwork confirmed some of my suspicions. I am definitely feeling the side effects of high estrogen and prolactin. The last two weeks my libido has been non existent and sexual performance has been terrible. Other than that I’m feeling pretty good. I’m experiencing less fatigue (need less caffeine) and the gains in the gym are noticeable. I assume the less fatigue could be my thyroid medicine starting to take effect.
The provider recommended I go on Anastrozole but I pushed back considering I’ve had a bad experience with it in the past (crashed estrogen). She is very open to me doing whatever I feel is right so ultimately it’s in my hands to dial everything in. She seemed very hesitant for me to decrease my dose which is 200mg/week. I’ve been splitting this up in to 2 shots per week. Just last week I decided to try out daily IM injections so I’m on day 6 of that. Even though she was hesitant to cut the dose I told her my plan was to cut test before I introduce an AI.
Based on my blood work I’m thinking of going to 20mg/day (140mg/week). Is this too big of a jump? Any thoughts or suggestions?
I personally don’t think it is too much. I was at 30mg daily subq and had similar levels to your labs above. At least total T wise and E2, I didn’t measure free t last round of labs. I dropped to 25mg and moved to shallow IM but not sure where I am yet. Labs are in 2 weeks. We are all different though so I could be wrong, but I think you would land in a decent area with 20mg daily.
The high prolactin could be the only reason I’m having issues but unfortunately I don’t have a baseline pre-trt test result for it. I’ll be putting some time in to researching what elevates prolactin because I did not have these issues before starting treatment.
The simplest answer is to lower your dose. Your E2 is high and there is literature supporting TRT mediated elevation in prolactin. Id suggest lowering your dose to 140mg/week…split 2 shots. Then, reevaluate.
Ok thanks for the insight. The little bit of Google searching I did pulled up studies that suggested the aromatization of T in to e2 caused prolactin levels to increase. I started the lower dose yesterday that will put me at 140/week.
One other thing to consider too is your recent introduction of Thyroid medicine. That is similar to testosterone in that it will take about 6 weeks to know what effect that will have on your endocrine system.
I’m not sure what the direct relationship is, but I think there is correlation with TSH and prolactin too. More TSH - more prolactin. Maybe it was @ncsugrad2002 who pointed it out, don’t recall.
If it were me, I’d drop dose slightly, maybe to 160/150mg a week split e3.5 days, EOD or ED…but whatever you do, stick to it for 8 weeks…and by then the protocol change will yeild its results and thyroid meds will have reached a steady state too.
I was shocked with my test results after I improved my hypothyroidism with Armour Thyroid. Everything jumped drastically and I’m feeling better.
Good luck and can’t wait to read about your progress.
Yes. High TSH means high TRH (actually, it’s the opposite, but still). TRH also increases prolactin though, so that creates the relationship between TSH and prolactin. Oftentimes when prolactin is higher than normal but not tumor levels it is caused by TRH/TSH
There are studies comparing TSH, TRH and prolactin levels of people with premature ejaculation and delayed ejaculation. Delayed tended to be high on all 3. Premature tended to be low on all 3. Average sex time went down a decent amount by taking someone from high to low on those hormones.
Pretty interesting stuff, to me anyways, haha
Here’s one of the studies for your thanksgiving reading pleasure
I explained to him that I am feeling no different and would like to increase my Levothyroxine dose from the 75mcg prescribed. This seemed like the obvious move. I don’t know why it surprised me but his response was “Your FT4 is now within the normal range. Since both TSH and Free T4 is now normal, I would not propose any medication change at this time. Unfortunately, this means that your symptoms may not be thryoid related.”
I immediately made a telemedicine appointment with my TRT provider and started on 2 grains (120mg) of Armour Thyroid today. I’m not even sure why I wasted my time with my primary care doctor. He obviously doesn’t care how I feel and only wants me somewhere within the incredibly wide range.
…Just needed to vent, thanks.
On a good note, the bad side effects of switching protocols have all gone away and I think I’m very close to dialing in my TRT (5 weeks @ 20mg/daily). I have bloods scheduled at the 8 week mark.
Your doctor is just doing what he was taught decades ago. This is the old school way of doing things and it’s been some time since your doctor updated his treatment protocols.
Optimal TSH is 1-1.5, sick care doesn’t usually care about optimal levels, only normal. In other words it’s just a job without passion in ones career.
I just don’t see how a person can believe that anywhere within a “normal” range is right for everyone. This is the same reason I went to a TRT clinic for my treatment. My total T was normal but free T was below the range. Oh well, at least I’m getting what I want after all. It’s just a little more expensive since not everything is under insurance with the TRT clinic.
There are some people who don’t do well on T4 only medicine and need T4+T3 to respond to treatment.
This is the extent of your doctors knowledge, in range is normal, not everyone is different and has their own optimal range where they feel their best.
I’ve tried to get my GP, endo and cardiologist to comprehend that when my potassium is at 3.6 (3.5-5.2) I have debilitating symptoms at these levels and each one said your levels were normal and no action was necessary even after I told them increasing potassium completely annihilated all symptoms.
Now either they are trying to irritate me, are stupid or this is how they choose to managed their patients and being a doctor is just a job, not a passion and don’t care about symptoms, only lab ranges.
You know this isn’t actually true, right? The studies are pretty clear that T4 only is the safest route and supraphysiological levels of T3 are at the very least heart toxic even medium-term. Maybe he actually has a different undiagnosed issue, and ramping him up with thyroid stimulants is just masking the problem.
I don’t really understand this mindset either. I wish everyone had full blood work from a time when they felt great so there was a point of reference of what’s normal for that individual but obviously that’s not exactly how our system currently works
I am actually feeling good! I’ve been on 30mg/day of test cyp since January 2nd. After a bumpy first 5-6 weeks everything just started to click. My latest appointment resulted in a decrease from 120mg/day of Armour to 90mg/day. This was a couple weeks ago and I can already tell this was the right move. I just have an overall “normal” feeling like everything is working well. The only negative out of all this is the back/shoulder acne which I haven’t figured out how to get rid of yet. If anyone has had any success in controlling acne please let me know.
