T Nation

Testosterone Spike - Cause?

Is it common for T levels to have wide variations when TRT treatment remains unchanged? I’ve been on TRT for 6 months now and my labs have been all over the place (always done in the morning of the trough). For 12 weeks I was on the same dosage of Test Cypionate and Anastrozole - my T went from 769 (tested after week 6) to > 1500 (tested after week 12).

I’m sure this is a loaded question. My main concern is that it is so difficult to get dialed in and I’m getting frustrated. The period when my T spiked to over 1500 I was miserable. Very very miserable.

Age: 44 (May 8, 1973)
Height: 6’
Weight: 198
Waist: 32

Describe body and facial hair:
Full, thick head of hair. Shave face/chest EOD. No real back hair except for the crazy ones that have come with age.

Describe where you carry fat and how changed:
Roughly 10% body fat. Predominantly carried around my mid section. I’ve always been fit and had steady weight/shape.

Health conditions, symptoms:
Fatigue can be significant. Often feel exhausted.
Rather weak immune system. Asthma contributes to this.
Catch a few colds a year (more in recent years b/c of my 3yo)
Had 2 major sinus infections in the last calendar year that required significant antibiotic treatment
Recent feelings of stress with work and new baby boy due in November
Sleep monitor shows that I sleep well
Libido has been ok
No issues with ED
Serious brain fog at least 2-3 times a week
Suffer from allergies
Suffer from lower back pain as I have a bulging disc
Suffer from occasional upper back pain. Spasms, knots, etc.
TRT > experienced some lovely highs and serious lows with depression

Rx and OTC drugs
Advair 100/50 (lowest possible dose) taken once every 3-4 days. Supposed to take it twice daily.
Tramadol 50mg as needed for pain. Often take 1 50mg tablet in the evenings. Improves mood, energy, and helps with back pain.
6 months on Testosterone and Anastrozole (see details below)

Vitamins/Supplements (daily)
Adrenal Calm by iVitality (mostly B vitamins)
Vitamin C - 6000 mg (3 divided doses - 2000 mg )
Vitamin B12 - 3000 mcg (3 divided doses - 1000 mcg)
Vitamin D3 Liquid - 5000 iu
Magnesium Citrate - 750 mg
Niacin - 1000 mg (2 divided doses - 500 mg)
Iodine - 20,000 mcg (1 divided doses - 10,000 mcg)

I eat a well-rounded diet of mostly organic foods. My meals are usually on the moderate to small side. I drink 5 smoothies (nutribullet) per week made of carrots, kale, spinach, chia, flax, raw nuts, broccoli, frozen blueberries, frozen banana, frozen raspberries. Will have fish at least once a week - sometimes twice. Will have meat a few times a week - grass fed beef and organic chicken. I avoid sugar as much as possible.

I go to the gym 4 times a week for about 45 mins each visit. No cardio, just weight training. I work out at a rather rapid pace to get my heart rate up - high reps / low weight. I do a ton of stuff around the house outside on the weekends and have a very active lifestyle with my 3yo boy.

Testes ache, ever, with a fever?
I do recall my testes throbbing at times since starting TRT but didn’t pay much attention. Certainly didn’t think to take my temperature. But the throbbing was rare and short-lived.
How have morning wood and nocturnal erections changed?
Since starting TRT, I’ve had a major increase in morning and nocturnal wood. However, it has been very inconsistent.

Current Concerns
I’ve been on TRT for just over 6 months. I signed up for TRT to help combat my fatigue and improve my mood. Physically I have gained nearly 20lbs of muscle without tweaking my gym routine and my libido has improved - all good things. However, it has been one hell of a rollercoaster ride with significant highs (feel great with lots of energy) and significant lows (depression and fatigue). Currently there are more lows than highs. I became very concerned this past Sunday. I woke up with intense brain fog and depression (and serious morning wood strangely enough). It was the darkest feeling I’ve ever experienced in my life - I did not want to talk to anyone, see anyone, or do anything. This is NOT me and I found it to be quite terrifying. I’m considering a HPTA restart if things don’t go well over the next 6 weeks on my newly adjusted TRT schedule.
I’m seeking advice from this community to provide feedback/suggestions/advice on my current situation and next steps. Hopefully you all see something that the Dr. is missing.

Lab 1 (Baseline)
Testosterone: 467 ng/dl (350-781)
Free Testosterone: 8.52 ng/dL (4.60 - 22.4)
Free Testosterone percent: n/a
E2: 37 pg/mL (7.6-42.6)
Prolactin: 9.6 ng/mL (2.0-18)
PSA: 0.9 (<4.1)
hFSH: 7.4 mIU/mL (1.6-8.0)
Cortisol: 10.1 ug/dL (6.7-22.6)
DHE-S: 186 mcg/dL (70-495)
Iron: 128 ug/dL (65-175)
TSH: 1.296 mIU/mL (0.4-4.50)
Transferrin: 213 mg/dL (215-365) LOW
Vitamin B-12: 275 nmol/L (200-900)
Vitamin D: 32 ng/mL (30-100)
HGH: 0.81 ng/mL (0.05-3.00)
IGF-1: 188 ng/mL (121-237)
SHBG: 42.7 pg/mL (10.0-77.0)

Round 1 of TRT (6 weeks)
0.5MG Anastrozole on Thursday
160MG Test Cypionate injection on Friday
0.5MG Anastrozole on Tuesday

Lab 2
Testosterone: 406 ng/dl (350-781)
Free Testosterone: 9.55 ng/dL (4.60 - 22.4)
Free Testosterone percent: n/a
E2: 28 pg/mL (7.6-42.6)
Cortisol: 8.1 ug/dL (6.7-22.6)
DHE-S: 173 mcg/dL (70-495)
SHBG: 28.2 pg/mL (10.0-77.0)

Round 2 of TRT (6 weeks)
0.5MG Anastrozole on Thursday
160MG Test Cypionate injection on Friday
0.5MG Anastrozole on Monday
160MG Test Cypionate injection on Tuesday

Lab 3
Testosterone: 769 ng/dl (350-781)
Free Testosterone: 20.42 ng/dL (4.60 - 22.4)
Free Testosterone percent: n/a
E2: 31 pg/mL (7.6-42.6)
Cortisol: 8.5 ug/dL (6.7-22.6)
DHE-S: 194 mcg/dL (70-495)
SHBG: 24.3 pg/mL (10.0-77.0)

Round 3 of TRT (6 weeks)
0.5MG Anastrozole on Thursday
160MG Test Cypionate injection on Friday
0.5MG Anastrozole on Monday
160MG Test Cypionate injection on Tuesday

Lab 4 New Lab Used
Testosterone: 1500 ng/dl (300-890) ** Why did it climb so high?
Free Testosterone: 462 pg/mL (47.0 - 244.0)
Free Testosterone percent: 3.1% (0.3-2.3)
E2: 43 pg/mL (0-57)
Cortisol: 9 ug/dL (5-25)
DHE-S: 155 ug/dL (80-560)
SHBG: 23.9 pg/mL (10.0-57.0)
LH: 0.1 IU/L
FSH: 0.1 IU/L
Prolactin: 9.9 ng/mL (2.1-17.7)

Round 4 of TRT (6 weeks)
0.5MG Anastrozole on Thursday
120MG Test Cypionate injection on Friday
0.5MG Anastrozole on Monday
120MG Test Cypionate injection on Tuesday

Lab 5
Testosterone: 940 ng/dl (300-890)
Free Testosterone: 242.5 pg/mL (47.0 - 244.0)
Free Testosterone percent: n/a (0.3-2.3)
E2: 49 pg/mL (0-57)
Cortisol: 11.4 ug/dL (5-25)
DHE-S: 144 ug/dL (80-560)
SHBG: 28.6 pg/mL (10.0-57.0)
LH: 0.1 IU/L
FSH: 0.1 IU/L
Prolactin: 9.9 ng/mL (2.1-17.7)

Round 5 of TRT (started today)
1MG Anastrozole on Thursday
100MG Test Cypionate injection on Friday
1MG Anastrozole on Monday
100MG Test Cypionate injection on Tuesday

I’m new to this forum and I’m currently working on my “case.” Getting 6 months of labs together is quite a lot of work.


Your Total test could have taken time to reach the 1500. What is your SHBG?

You are lowering your testosterone dose and increasing your AI to double?

Be careful with going to low with e2 with taking 2mg of Arimidex a week. I’m definitely paying the price right now as far as joint issues.

Are you testing on the same day of the week each time? T has a half life of a week so your responses will be wildly different on a trough day versus a peak day. Your dosage is way too high which is why you were at 1500+. Most on here are at 100mg/week total and others need more to get into the upper levels.

Always tested on the early morning of trough day - usually around 8:30am. Then I’d take injection after blood draw.

Do you have your pre TRT labs? Curious to know your SHBG and your baseline E2.

Lab 1 (Baseline pre TRT)
Testosterone: 467 ng/dl (350-781)
E2: 37 pg/mL (7.6-42.6)
SHBG: 42.7 pg/mL (10.0-77.0)

Yes. I am fine with lowering overall from 160MG 2x week to 100MG 2x a week.

But doubling my Anastrozole scares me as I don’t want to tank my E2. Last lab had it at 49.

Aside from your E2 being a little high, your 4th round looks close to where you want to be. Probably still a little high because you are top range on your trough day. I wouldn’t increase your AI and lower dose, just lower dose first and see what comes out of your next labs.

I’m thinking the same. Thanks for your input!

Yes, I was bringing it up because if you lower your test dose, you definitely don’t want to increase your AI at the same time. That’s asking to crash.

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Is it safe to conclude that my spike was simply do to my body fully adjusting to the Test?

I wouldn’t say that your body was fully adjusting, more like the testosterone was reaching its stable blood level.

The second 6 weeks of the 160 two times a week finally caught up. That’s what it looks like at least. Lab error is always possible also.

Forgot to mention that I did reduce my T from 160MG 2x week (6 weeks) to 120MG 2x a week (6 weeks). Over the course of those 12 weeks I was taking 1MG Anastrozole (.5mg 2x week).

@ 160MG my E2 was 43
@ 120MG my E2 was 49

So my E2 actually increased with a decreased dose of Test. I believe this is why the doc wanted me to move to 2MG Anastrozole per week.