T Nation

TRT Pellet Working?

I started down this path a few months ago after noticing a lack of motivation in general as it relates to being active/libido/motivation, etc. I am about 6 weeks in to my TRT journey now and I have noticed a significant increase in libido, mild increase of energy and really no increase in a gym pump or any type of gym type motivation. I just received my second blood test results and I am trying to understand what might be going on. My T levels have moved significantly, but so have others. I am trying to determine if this if it just me and I am expecting something different, but shouldn’t? Or is something wrong? So, I thought I would bounce it off the community and see if anything stood out to any of you.

The numbers indicate the first blood test / second test. The first was approximately 7 weeks ago and the second was last week.

White Blood Cell 5.8 4.7
Red Blood Cell 4.95 4.69
Hemoglobin 15.3 14.7
Hematocrit 46.0 43.8 (It seems my blood counts have decreased, is this something to be concerned about? The way I understood it, my hematocrit should be increasing?)
Neutrophils (Absolute) 2970 2143 (Should this be lowering?)
Estradiol 22 50 (I am wondering if one of my issues is here)
Testosterone Total, LC/MS… 340 1215 H
Testosterone Free, serum 71.9 274.7 H

The first test was more conclusive and had additional testing done, so I am posting those as well for awareness.

Thyroid Peroxidase Antibo… 3
T4 Total 7.0
TSH 1.59
PSA Total 0.9
Free T3 5.5 H (the doctor mentioned this was something to keep an eye on. I’d be interested in hearing other thoughts on this)
Vitamin D 25-OH, Total 26 L

One of the main questions I have is it seems my Estriadol is at the higher end of normal. And recently have noticed some very mild nipple soreness. After reading on this forum for a while, I’ve ran across a few cases where folks have great T levels, but higher Est levels and they’ve experienced similar symptoms as I. Is this what you would focus on? I will ask the doctor about that as well, but with pellet therapy is there a specific way to adjust that?

Does anything else stand out? I have heard/read a lot of people are not fans of pellets and I am trying to understand if it’s just a cost related thing or if it really is not as good of a treatment, but I haven’t found anything definitive. If anyone has any clarification on that topic, that would be great. Pellet was recommended by the doctor, but I am not married to that idea.

Thanks in advance for any and all help!

So your T is at 1200 and your E2 is at 22? Are you taking an aromatast inhibitor?

Hi, first let me say that you won’t get much assistance here on pellets. I am one of the only “bastard children” experimenting with pellets.
:slight_smile:

Your pellet doctor should have automatically encouraged you to take DIM. Pellets generally cause Estradiol to rise, and doctors try to nip that in the bud with DIM supplements. I take Indolplex DIM which my doctor admitted is better than the DIM he was selling.

If anyone does jump in here, you will be told that your numbers mean nothing without the reference RANGES. Every lab is different and there is not way to tell what is considered in line or not.

IMO (<— notice that disclaimer) … pellets are not going to give you the roid rage to go and pump iron 8 hours a day. I’m exaggerating, but I think you know what I mean. I am still finding my balance, but I won’t be flexing in the mirror.

You should be happy your hematocrit isn’t rising. Testosterone is known to increase it. I wouldn’t worry about this. If your red blood count is low, it can indicate anemia.

I’m not about to comment on thyroid. There are others here who are experts.

Because of my problems, I can’t stress enough to get SHBG tested. I am guessing it isn’t high because of your free t; but if you are going to go down this road, get it tested (along with Albumin, which is included in Complete Metabolic Panels).

That is my two cents.

PS: Just for curiosity, what pellets are you on (brand/type) and how much were inserted (mg)?

This line will get you LOTS of attention.
@systemlord

:slight_smile:

1200 and E2 is at 50 now

Not alarming. Especially with no real sides.

The chart I have access to just gives me the values and says whether it is low or high.

Ok good to know. I will look into this. I haven’t heard of this yet, but I definitely want to keep tabs on as much as I can. Thank you.

I don’t know the brand, but I believe it was 9 pellets. I can find out if there is a brand to stick with/stay away from.

The one thing I have realized is how important it is to be up to speed on as much as possible. It seems there is a wide variety of opinions, especially when it comes to the doctors and medical professionals.

I appreciate the response and help!

Do you think E2 could be one of the contributors to a lack of energy and the nipple tenderness? Do you think it is something I should address? I plan on bringing it up to the doctor, but I don’t want to have a knee jerk reaction if it’s probably nothing.

I’d really like to understand why so many people seem to be against pellets. The only thing I have been able to find is that it generally costs more, so that could be why doctors push it. And the risk for infection since it’s a minor operation. Any other reasons?

You’re only 6 weeks in. See how you feel in 4 weeks or so. Energy should come back given you are getting enough sleep. Also your Vit D is low so you should probably get that number up.

Pellets cause levels to be higher in the beginning and lower before your next pellet insertion, it will always be like this and this is why injections are preferred. We can keep levels stable and feel the same all of the time rather than feel the effects of low testosterone towards the end when the pellets start wearing off, it will take a week or more for levels to rise again.

Unless you are scared to death of needles, I don’t see you doing pellets long term.

Thanks for the info. I understand everyone has different dosages, but typically, would that be a single shot per week or multiple to regulate it as you described?

Everyone is different, most men can do two injections per week, other need more. The current trend is if SHBG is closer to 30, these men do fine twice weekly. Lower SHBG men closer to 20 or lower do better on EOD protocols.

To a sick care doctor who manages healthy care by the numbers, none of what I just started computes, they just throw everyone on the same 200mg once every two weeks to get you out of their faces because they don’t have the time to figure out your specific case in 10 minutes or less.

50mg twice weekly is a good starting point, 20-25mg EOD or 10-12mg daily should all see levels midrange or better unless you are a hyper excreter and or hyper metabolizer. These men may need 200-300mg weekly.

First, I think it is good that the doctor ran follow-up labs. I’ve known quite a few on pellets and it seems a disproportionate number do not get follow-ups. Makes some sense, as there is not much they can do anyway, never heard of anyone have them removed, but I suppose it happens. They are timed release of course. Keep in mind it may take a few more months to achieve the full benefit of TRT.

Some put an AI in the pellets. You could manage high E2 with an oral AI. I don’t know if they would adjust the test dosage downward next time, but that would lower E2.

SHBG is nice to know, but I do not know if it matters with pellets.

You have 2.26% free test, pretty good and your SHBG it likely not real high or low. If you did decide to move to injections, I would start with once a week and maybe 140mg, nothing wrong with 100mg though I think you’ll be happier with the larger dose.

You’ll see many here, if not most, doing multiple injections. If you went to a gym and took a poll, you’d find the vast majority of guys do just fine with weekly dosing. Guys are here because they are having issues with their dosing protocol. Guys doing well and happy aren’t on the internet looking for solutions to their TRT programs.

Yes, it can be frustrating. Even the so called experts disagree at times. Bottom line, we are all different, whatever works for you, as long as it doesn’t hurt you, is good.

How do you like DIM? I’m experiencing weird symptoms and TRT clinic told me to take it since my estradiol was around 34.

Sorry, I can’t agree with that post at all. When it comes to SHBG, it does not matter whether it is pellets, injectibles, or anything else.

Of course, I don’t know what weird symptoms you mean, but I have not had any issues with DIM, other than trying to determine where my sweet spot is. At first, I took very little; increased it; then decreased it … and will likely increase slightly again.

But I do know that supplements can be different …

I should have been more clear. They want me to take the DIM for the symptoms I’m having.

Never?

That’s one thing I’m confused on. I’ve heard that between 4-6 weeks I should be peaking and then it will slowly start to taper off. I’ve also been told it takes 4-6 weeks to notice any libido/mental improvement and it ramps up from there. Recently I was told it’s usually the 2nd time you do pellets is when you notice a difference. All different people and I’m really not sure what to believe. Any clarification or can you explain why you think it may take longer to notice/adjust? Thanks!