T Nation

TRT After 1 Month - Lab Test Interpretation


#1

Hi guys,
I’ll try to keep the post as short as possible to avoid annoying you.
Basically, I’ve been diagnosed with post finasteride syndrome 1 year ago, after 6 years of taking the medication. The main symptoms were an early awakening insomnia, extreme fatigue and difficulty focusing, plus low libido and ED. The lab tests were showing low T, high prolactin and SHBG, normal estradiol (20ish).
In terms of lifestyle, I’ve always been muscular since I started weight lifting when I was 17, and I never stopped since now that I’m 30. I’m 85 kg with a 13% BF, never smoked or drunk.

So that’s what I tried in order across last year:

  • Functional medicine, that helped me find the problem, but after lots of money and tests done, didn’t provide any solution to my problem.

  • Tried few months with natural supplements: pine pollen, tongkat ali, mucuna pruriens, vitamins etc. Nothing changed.

  • Contacted a famous endocrinologist in London, who decided to put on Clomid + Anastrazole, stacked with Cabergoline twice a week to lower prolactin. After 3 months of tweaking doses of both, I ended up having not bad lab tests (1100 Total T, 50ish Estradiol, still high SHBG), but still feeling awful with no libido, like most of the men on Clomid. And most of all, my sleep quality was still bad.
    After 3 months I decided to quit any medication, except for Cabergoline, waited 1 month, and tried to do a blood test. I was shocked with the results: I went back to the starting point, like I didn’t ever do any treatment. Low total T, extremely low free T, high SHBG, normal Estradiol.
    We tried, on my suggestion, to do an AI mono-therapy treatment, first with Aromasin, then with Arimidex. Not a good idea, as my Estradiol was 32 and I ended up crashing it even with a low dose AI. My Total T did get better, around 500, but I was feeling destroyed, due to the low Estradiol.

  • Moved country in the meanwhile, I tried with another doctor here that doesn’t really have a clue on TRT, but has the rare virtue of listening to his patients. We tried first to fix my slightly hypothyroid with Eutirox, to see if it was boosting my hormones. I’ve thrown it in the trash bin after 2 weeks, as I was feeling even worse.

  • So after a bit of hesitation, I managed to convince him to put me on 100mg of Testosterone Enanthate per week, divided in 2 injections weekly (Wednesday and Saturday). I started feeling way better in 1 week, my libido was restored by the second week and my sleep improved a bit, even if it wasn’t still good.
    On week 3 the effects started to fade, libido was getting low again and I was feeling a bit more tired, even if not even close to the exhaustion I was experiencing before. The only side effect was a bit of nervousness overall.
    So I waited week 4 to do a blood test and that’s the result:

Total T = 1107 ng/dL
Free T = 29.80 pg/mL
Estradiol = 43.1 pg/mL

I blamed the surge of Estradiol for the lack of results with TRT and I decided to add 0.5mg of Arimidex twice a week, the day before the injection, to lower a bit the Estradiol, but it seems that I’m really sensible to AIs and I got a really bad insomnia and anxiety, like when I was on AI mono-therapy. I can’t fall asleep and I roll in the bed for hours, while before I didn’t have any problem falling asleep. My problem was with staying asleep rather than falling asleep.
So now, I wanted to ask you your suggestions to keep Estradiol on track without taking any AIs, that my body doesn’t tolerate. Should I lower the dose of each injection to 40mgs? Should I try to add a natural anti-aromatase supplement? What do you reckon?
I don’t really trust my doctor, because he’s not experienced on TRT, and here in Cyprus where I’m living now, I couldn’t find any doctor with some knowledge on the matter. That’s why I’m asking you.
Thanks.


#2

Lower dose, DIM is OTC that lowers e2. Zinc 50mg zinc/2mg can help with e2 conversion.


#3

Thanks for the reply.
I will lower the dose then.
Regarding DIM, some people claims it has some estrogenic effect in the body. Do you have any link to studies that demonstrates his estradiol inhibition effect?
As for Zinc, some doctors advise to stack it with copper to avoid any mineral unbalance.
What do you think?


#4

if you the money try a dht derivative at a low dose. I know for many men taking proviron or masteron (make sure it is real) can increase well being and heavily increase libido. Also eat healthier, we assume we eat healthy but analyze it to see if your missing any specific vitamins.


#5

What would be a low dose of DHT supplementation?
I tested it before starting with TRT, when I was on AI mono-therapy, and the level was 460 pg/mL.
I didn’t test it again on the last blood test, because it’s quite expensive, but I’m assuming is gone higher due to more testosterone available to convert.


#6

DIM for me has lowered my e2 from 30 to 16. So be careful with it. Also yes, Zinc 50mg must be taken with copper 2mg or you will have a copper deficiency.


#7

How much DIM were you taking daily?


#8

I started with the max recommended dose, I think it was 2 pills twice a day, and it QUICKLY brought me down, in a matter of a few days I had strong night erections. When I checked my e2, it was 16, so I backed off, and then I was only taking like 1 pill every 5 days or so and it was still going too low sometimes. So. Be careful


#9

Sounds like a pretty strong supplement. What’s your protocol now?


#10

Completely different now. I currently take 50mg Test Cyp twice a week. and somewhere between 2mg -6mg of aromasin a week. still dialing in. I was using the DIM when I was taking a lower dose of test. It still worked for me when I was using 80 a week. I only switched to aromasin because I wanted more free test and lower shbg. Stuff DIM would never do, because of how it works.


#11

So here’s the updated blood test after 2 months of TRT. I’m on 40 mg Testosterone Enanthate twice a week, plus 200 mg of Indole 3 Carbinol every day in the morning on an empty stomach. The blood test has been done on the day before the injection, so after 3 days of the last one:

Total T = 1023 ng/dL
Estradiol = 44 pg/mL
Prolactin = 13.1 ng/mL
SHBG = 26 nmol/L

Basically anything changed from my last blood test , as expected, and the estradiol is still on the same level, despite the i3c supplementation. I’m assuming I can throw it in the trash bin.
SHBG finally went down on TRT after years and that’s the good news. Prolactin obviously went from 3 ng/mL to 13.1 after I quit Cabergoline, but I prefer to be on less drugs as possible.
So what do you guys suggest to lower that Estradiol? I feel that’s the reason why I don’t feel good yet and I’m usually more nervous on my relationships, while I used to be really calm. Another problem is with the low libido and the lack of motivation on lifting weights, even I’m always going 4 times a week to lift heavy anyway.
All your suggestions will be appreciated.
Thanks.


#12

What was your SHBG before you started TRT?

Are you on any AI? Did you end up trying the DIM? DIM will work, natures way DIM is what I use. Honestly, be careful, I figured out that I had driven my e2 too low for a long time and it caused some bad joint pain for months.


#13

That’s amazing you made it to over 1000 ng/dL on 80mg of test, everything except your E2 look great.


#14

Thanks for the reply guys.
I bought indole 3 carbinol, because I read it was safer to supplement with, but 200mg a day basically did nothing.
I’m not taking any AI at the moment, because as you read from my first post, they were giving me anxiety and bad insomnia. I think before trying with them again, I will buy DIM and give it a go.
I was just wondering if will lose efficacy after months of supplementation.
My SHBG were on 55 on AI monotherapy before starting TRT, that’s why I’m pretty happy with the level now.
It’s all about trying to find a way to manage the estradiol surge at the moment.
What dose should I supplement DIM with?


#15

Quick update. I woke up this morning and felt sore around my left nipple. I was always checking my left nipple because I was having a mild gynecomastia since years, due to finasteride. I was feeling that just underneath the left nipple gynecomastia was gone, but I discovered this morning with my big surprise that I have a big 6-7 cm mass slightly right of my left nipple, really though and sore. I then checked the right nipple and a small one is growing underneath it as well. I got a bit scared a took 0.5 of arimidex this morning, just to try to block it, as I never had it that big. It was just a monolateral 1cm gynecomastia.
Such a big gynecomastia with my blood values doesn’t make any sense to me, and that’s probably explain why I’m not feeling really good yet, with the symptoms I described. I would like to have advices from you guys, on how to revert it and maybe with some other blood values to check. I always knew that prolactin is the responsible for gynecomastia, but I don’t think that a value of 13 can lead to this problem.


#16

Another blood test after 1 month on 30 mg twice a week and 2 capsules of Nature’s Way’s DIM every day. This time I’ve checked DHT, which turned out to be quite high with my big surprise, but there’s no way to lower that estradiol level. As i3c, DIM didn’t do anything for me, except for terrible daily headaches that stopped as soon as I stopped the supplement.
I did the blood test the morning I was supposed to do the injection, so it’s basically 4 days since the last one:

DHT 1179 pg/mL (300 - 1200)
SHBG = 26 nmol/L (13 - 71)
Estradiol = 42,8 pg/mL (<39,80)
Total T = 712 ng/dL (241 - 827)
Prolactin = 18.6 ng/mL (2,1 - 17,7)

As you can see, testosterone went lower than the previous one and SHBG and Prolactin got worse, but the damn estradiol doesn’t want to go down even with the initial testosterone dose halved. I don’t really know what else to do to fight it back and reverse the sore gynecomastia I developed on both nipples. Should I introduce again cabergoline to lower prolactin and see if it’s going to reverse my gynecomastia? And should I lower the testosterone dose even more to 20 mg twice a week?


#17

Need reference ranges for your labs. Your SHBG is fine, don’t stress about it… What was your Prolactin before this?

E2 is high enough to cause issues.


#18

I added the lab ranges in the previous post.
Prolactin was 13.1 one month ago and around 3 when I was on cabergoline.