T Nation

TRT Bloodwork: 1 Year In

One year on TRT, was hoping I could get some feedback on my lab results. Going to see my doc in a few weeks.

current protocol: 70mg depo T: weekly, 2ML HCG 2x week, 2x anastrazol 1mg tab a week.

started on TRT a year ago, at 50mg test a week. Doc bumped it up to 70mg a week, after 4 months lab work came back and doc thought my estradiol was too high, so had me start taking anastrazol 2x a week.

Overall i’m feeling ok, not as amazing as i was the first few months. But one year in I’ve put on some weight that i havent been able to take off. A good portion is muscle, but also a fair amount of water weight and fat around midsection.

My results came in a different format than most post on this board, so i tried my best to convert them online. I included the orig format just in case.

thanks.

ESTRADIOL = 160 pmol/l = 43.58 pg/ml

TSH (THYROID PROFILE) = 2.07 MIU/L

Test Total = 39.58 nmol/l = 1141.566 ng/ml

Test bioavailable = 25.33 nmol/l = 730 ng/ml

Sex Hormone Binding Globulin = 28.2 nmol/l = 2.679 ug/ml

Albumine = 44 g/l

I have some other tests that were included as well.

Would love some feedback on how you think my lab work 1 year on TRT looks.

Labs look pretty good for 70mg a week. Why the HCG? A side effect of anastrozole is weight gain, among other things. Most people on 70mg of T a week don’t need it.

I think you pretty much outlined the key to feeling your best in your own words.

I’d slowly wean off the AI and see how you feel in a few months.

How many days after your injection was this blood drawn?

Was the decision to start anastrozole based solely on the lab number?

I inject every 7 days.
this labwork was taken on the 7th day (before my injection) so it had been the maximum amount of time passed (7 full days) since my last injection.

yes, the decision was to take anastrazole was based only on the lab number. The doc said he doesn’t usually recommend it, but for about 10pct of his patients it’s needed.

Thanks for the reply!
using HCG because we might have one more kid in the next 2 years, and the doc said this was the best way if we decide to do that.

Anastrazole: originally the doc didn’t prescribe it and after spending time on these forums i was reluctant to take it. But apparently my 4 month in bloodwork estrogen was high enough for the doc to want to get me on it.

I want to ask him on my next visit if my bloodwork looks good enough for me to atleast 1/2 the dose to 1mg per week.

How does the current ratio of e2 to test look?

Wow, those are incredible levels at that dose. I’ve seen a lot of lab results, nothing close to that and most of my guys take more than double your dose. At 200mg a week my total testosterone comes back in the 900s.

Your E2 level is not that high and compared to your testosterone, not high at all. Plus, 2mg weekly anastrozole is a fairly heavy dose.

I know you asked about your labs, and not treatment or dosing. Those labs look good, and if you are feeling good and happy with your results, I wouldn’t change anything.

overall i’m feeling pretty good. like i mentioned earlier the first few months i was feeling incredible.
my only concern was that before TRT i was actually leaner. I lift regularly, and my lifts have all gone up but i have more fat around my midsection and chest than before TRT. enough so that my waist size has increased 1.5 inches.

This past year i’ve stopped drinking alcohol and have been doing 18/6 Intermittent fasting. I would have expected more of a physical change. I guess if the lab work looks fine, i’ll just keep focusing on dialing in the nutrition.

I had this same issue until I brought my e2 up. It was impossible for me to lose weight, even taking weight loss meds, while my e2 was low

It is helpful if you post lab results with the lab’s normal ranges. No need to convert units, it is much better to look at numbers relative to normal values than absolute numbers (in any units) because normal ranges vary from laboratory to laboratory.

Overall, you numbers appear to look good, particularly with the lower end dose you are using. I suspect this is because you SHBG levels appear to be at the lower end of the range but it’s difficult to tell without the lab’s actual normal ranges.

Recommendations? I agree with the general consensus of the replies you’ve received regarding the use of an AI (anastrozole). That is, that I’d consider decreasing the dose and/or eliminate it all together. Again, without seeing you pre-anastrozole labs with ranges, it’s difficult to interpret you labs. However, 2 mg per week is a big dose for such a small amount of T per week.

Another recommendation is to consider more frequent dosing of smaller amounts. You could start with breaking the 70 mg dose up into at least 2 injections per week of 35 mg. Alternatively, 30mg every 3 days (E3D). It will be the same overall dose per week either way, but there will be smaller peak T levels and higher naidr T levels. This will help lower the conversion to E2 and the need for an AI.

If you do switch to more frequent dosing, you may also wish to consider increasing the overall dose to around 100 mg/week for a trial (e.g., 43 mg E3D). This is generally what I recommend as a starting dose for TRT.

Regarding HCG, we need to know how many IUs you are getting per week to give any constructive feedback. Knowing the volume you are injecting (i.e., 2 mL) does not inform us as to the dose. Actually, I am wondering too if that was a typo or if you are reading the syringe incorrect. Two mL of anything is a very large volume to be injecting. Ar you sure it’s not 0.2 mL? I reconstitute mine to 1000 IU/mL. A dose of 0.2 mL of a 1000 IU/mL solution yields an HCG dose of 200 IU per injection. A typical TRT weekly dose of HCG to maintain testicular size and function is around 500 IU per week.

I have my 4th kid on the way I take 23 mg daily and no HCG. She actually got pregnant like a month or two after I stopped the HCG.

thanks very much for the detailed reply!

here’s some clarification on my post.

ESTRADIOL = 160 pmol/l (RANGE <=206.0)

TSH (THYROID PROFILE) = 2.07 MIU/L (RANGE = 0.40-4.40)

Test Total = 39.58 nmol/l (RANGE = 2.80-21.60)

Test bioavailable = 25.33 nmol/l (RANGE = 3.60-11.30)

Sex Hormone Binding Globulin = 28.2 nmol/l RANGE(13.3-88.5)

Albumine = 44 g/l (RANGE = 38-52)

Glucose = 4.6 nmol/l (RANGE = 3.9-11.0)

Creatinine = 94 umol/l (RANGE = 55-110)

Prolactin = 4.9 ug/L (RANGE = 2.6-13.1)

I’ll bring up decreasing the dose of the AI when i see my doc in a few weeks. I dont have those first 2 lab results (pre TRT and 4 months in where the E2 spiked) but i’ll ask for those as well, to be able to better compare going forward.

In regards to HCG. i reconstitute it at 10,000 USP units per 10 ml vial or 1000 IU per ML. my script is for 1 injection of 2000 units (2ml) subcutaneous 2 times a week. you are right though, it is a lot of fluid to inject 2x a week. I go through 10,000 iu’s every 5 weeks.

*edit: meant to say i go through 10,000 IU’s every 2.5 weeks.

This could explain why you are getting such good numbers with such a small dose of testosterone per week. Your HCG dose amounts to 4,000 IU per week. To say that’s a lot is a gross understatement. Perhaps you should check with your doc to see if there is an error in the script.

A typical dose of HCG while on TRT to maintain testicular size and function is around 500 IU per week. There is some published data that shows a healthy male requires about 1000 IU per week to fully restore testicular function. See the graph below from data I extracted from two studies. The subjects in the experiments were given 200 mg/week T-eth to suppress gonadotropin secretion and thus, shut down testicular function. They used intratesticular testosterone (ITT) as a surrogate marker of testicular function.

At the start of the experiment, there was nearly a 100% reduction in ITT, meaning the testicles were fully shut down. They then measured ITT at various doses of HCG and when the data is plotted out, you see that the lines cross 0% suppression (i.e., full restoration of testosterone production) at around 1000 IU per week. At your dose, the graph indicates that testosterone production will be around 30% above normal. So, not only are you getting about 130% of normal T production, you are supplementing it with the T you are injecting.

So, is this good or bad? Some are in the camp that using HCG to stimulate the testicles causes increased conversion of T to E. I’ve not seen any published data substantiating this theory, so I reserve judgement. However, HCG is a very expensive form of TRT and 2 mL per injection is a lot of fluid to be regularly injecting. So, my general recommendation is to cut the dose to 1000 IU per week and if/when you wish to conceive a child, consider increasing the dose and/or adding in clomid and/or FSH injections.

Youthful55guy.
I can’t thank you enough for the detailed information and response. I’ve been making an effort understand more about the process as opposed to leaving it in my doc’s hands - afterall, it’s my health and wellbeing and I need to be involved and educated to make the best decisions.
After looking around on this site and others, I cannot find a single other person who is using as high a dosage of HCG. So that might very well be the reason my Test numbers are high on my relatively low TEST dosage and perhaps why the doc put me on AI in the first place.

I have blood work in 3 weeks and a doc’s appointment 5 days after that. I’m going to cut back the dosage on my HCG to 1000 IU a week (2x 500IU) and see what that changes on my upcoming bloodwork.

thanks for the info on HCG. I’m curious to see how my body reacts to such a substantial decrease in weekly HCG dosages.

I would consider increasing the frequency to every 3 days or a MWF protocol. HCG has a half life of about 36 hours. In the above studies, I believe they used an every other day protocol if I recall corrctly.

Here is a link to an excellent and recent (2018) review paper on the use of HCG in men. Lots of good information in it to bring you up to speed.