T Nation

Struggling to Dial in TRT

Been on TRT for a year now, but I believe I’m having trouble dialing in e2.
First here are bloods.
This was my protocol during this blood test.
Test cyp 200mg/week split dose, HCG 1000iu/week split dose.

This was my first time having estrogen( I’ve had E2 checked before)checked and I was completely blown away with how high it was. At the time I had it checked I was not using Arimidex, as I had a bad experience the last time I used it thinking I went too low and just stayed away. I had bloods checked a year ago Test was at 975 (believe I was 4 weeks into TRT), free test 23, and E2 43. I’ve been having ED issues consistently and things have just started to get somewhat better, but still can’t go even 3 days straight with morning wood and flaccid definitely feels deflated most days which isn’t something Ive experienced. I have Cialis on hand and it works very effectively each time so I don’t believe I have any veinous leakage although not sure If that can be ruled out.

Currently I’m still on 200mg test cyp split into two shots a week (100mg on Tuesday and Friday). I have HCG on hand however I have recently gone off it. My goal was to eliminate as many factors that could effect estrogen. The first time I took HCG was 8 months ago. I was having excellent results on HCG by the 4th week doing two injection of 500iu every 3.5 days. HCG as of late was not having the same results. First time I took HCG provided increased penile sensitivity, testicular size maximized, and great erection quality. As of recent I was just getting a slight increase in testicular size.

I have arimidex on hand and truthfully think this is where I stumble with a proper protocol and reading my body when to take more. I am very careful not to overdue arimidex and don’t take more than 0.25mg in a single dose. I had been doing 0.25mg twice a week every 3.5 days.

I’m trying to figure out how things have changed in my body as as I used to compete and would cycle no more than 700mg a week total. I have only ever take Test cyp, enenthate, propionate, deca (6 years ago never again), and sustanon. I definitely have struggled with estrogen control this entire time and admit to being quite uneducated in regards to how to dial in hormones earlier on. Many of my cycles I have never had ED issues but little by little it has gotten worse.

1 year ago I could not get a strong erection(70%) but was able to orgasm normally multiple times a day. Now I am getting quite strong erections most days of the week, but am having trouble with libido, achieving orgasm, and flaccid size is smaller than its been in past. I’m seeing my Endo this week and he might not be the best but he certainly is very cautious and will provide scripts. Any insight into the issues I’m struggling with would be greatly appreciated as I’m not sure how to proceed moving forward.

This was taken on a trough day?

Why don’t you lower your testosterone dose to a “replacement” level instead of 1400. You will probably have a lot less issues with E2, if your test is in the 1000 range.

Bloods were taken on a Thursday so one day before next 100mg cyp.

Estrogen is way too high. I had the same issue but my doctor won’t give anything for it, so I cut my dosage. Overall your Total T and Free are too high for therapy. If I was you, I’d see how you felt on 140 divided twice a week instead of 200 and go from there. More is not always better.

Most need 1mg anastrozole per 100mg T ester.
Take 1mg at time of injections.

Your goal is E2=22pg/ml

A few, not rare and no way to know in advance, are anastrozole over-responders who need 1/4mg per 100mg T.

So you could start with 1/2mg at time of injections for a week, two doses and if you feel OK, not crashed, take 1mg with each injection.

A steady dose takes a week to get to final serum anastrozole levels. So no quick seat of the pants dose changes based on how you feel except for as suggested above.

There is no need to test total estrogens.

Most guys who come here have some degree of low thyroid function, often a result of not using iodized salt. Please eval via oral body temperatures as per below.

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
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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 Aand 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.

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If you want to get your TRT working right you will pay attention to all of the material provided above.

Describe your history of using iodized salt.
Post oral body temps for both times of day.

Please do not be a selective reader.

Keep your case in this one thread.

Hi KSman not sure how to start a new post or private mail.
Could you help on some information regarding low FSH 1-1.4 levels over severa bloods LH always 5-6 , test low - low normal over space of 1.5 years
Trying to gather information as getting various advice.

My most recent blood test, this is on 160mg test cyp/ week split between Tuesday and Friday. 0.25mg arimidex on injection days=0.5mg/week. This blood test was taking at 8am on a Thursday morning, so 2 days after injection and one day before next injection.

Currently erections have returned but literally almost impossible to orgasm and penile sensitivity is very low and libido is low. This would seem like symptoms of low e2. This seems strange to me as I have manipulated my e2 to be as close to “ideal” as possible. Not really sure what my next move should be so looking for some advice.
Going to start checking morning and night temperatures next to see if thyroid is off but I feel like its highly unlikely. I’m incredibly lean, about 8-9% BF at 5’9" 194lbs. Diet consists of 4100 calories a day. My energy levels are incredibly high and I feel great, but seriously not being able to get my TRT right is getting beyond frustrating. I’m staying positive though and looking to try whatever to get myself right.

This is a link to the blood test I had previous to the one I just posted, sorry for making it somewhat confusing but KSman recommended I keep it all on one thread. If any clarification is needed please let me know.

You stated erections have returned, does that mean you recently reached 6 weeks after a protocol change?

If so you may need to spend some time with your levels in this range and at a stable state before you notice much of a difference on penis sensitivity and orgasm quality. I’m 3.5 weeks into a new protocol in my erections are back, however orgasm quality and penis sensitivity is still lacking.

It always takes a couple more weeks for the penis sensitivity to return and a bit longer for the ejaculation quality to improve.

There does seem to be logic with what you said however it has been over 12 weeks since I last changed protocol so I believe things should have progressed since then.

If you don’t mind me asking what is your new protocol??

160mg test cyp/ wk split between Tuesday and Friday.
0.5mg arimidex split between Tuesday and Friday.

This is exactly my protocol. It has worked great for me!

Drop the AI for 6 weeks then reassess how you feel. I went through this exact situation with my E2.

Recently, there has been a lot of information coming out supporting Test/e2 ratios being a better guide for targets vs a rigid range for e2. Your TT and FT are out of range high which means your “normal” e2 is actually low for these high levels of testosterone.

I suffered the same sexual disfunction when my TT and FT were high and my E2 was in the normal range due to AI. I dropped the AI and reduced my dose to 160mg per week divided. My TT and FT came down to high normal and my sensitive E2 is now 46-50 and I feel the best I ever have.

Best advice I ever received on this forum was to go by how you feel and stop trying to hit some BS e2 target.


You better drop the eclia method of testing and use e2 sensitive. Might be accurate might not but based on what your describing it sounds like low e2.

Dropping the AI was exactly what I was thinking, glad someone else has gone through similar experience. I’m dropping the AI now and will report back in 6 weeks how I am feeling. 100% agree that results are much more important than “ideal” e2.

I get the eclia method and the e2 sensitive. My doctor just never took the eclia off my bloodwork when I told him to add the sensitive test. we have been using the sensitive as the baseline.

Have you noticed a difference between the two test? I’ve seen some guys bloodwork where it was very close and some guys who show massive differences between the two and sensitive being more accurate.

I’ve dropped my weekly dosage down to 120mg as of two weeks ago and completely removed the AI. I’m getting a blood test fairly soon because I’m going to start working with Defy to route out these symptoms quickly. However I truly wish I can recover the same way you did after dropping your dose and dropping the AI. Honestly in the past 6 years I had run trt or cycles(back when I competed), I’m quite sure my steady use of Arimidex in the past year has been the only time I lost sensitivy and ability to orgasm. I did have erection issues in the past but I believe that was related to incredibly elevated e2.