T Nation

Trying to Get My TRT Dialed In

I am currently 50 years old, 5’11" and weigh 375 lbs. I’m working on losing weight via low-carb diet and strength training/aerobic exercise. I may have a gastric bypass in the future if non-surgical means are not sufficient.

I’ve been on TRT for six or seven years, most of the time on Androgel (worthless) but via injection for the past two years.

My initial protocol was thru a local clinic and I was getting 230 mg T Cyp once weekly, 1mg Anastrazole, once weekly and 500 IU HCG, once weekly. This gave me the following numbers:

Total T 1203
Free T 31.2
E2 44.6
SHBG 18.6

I then switched to another provider who prescribed 50 mg T cyp via injection M-W-F, 300 IU HCG M-W-F and .25mg Anastrazole M-W-F. This gave me the following numbers at 2 months:

Total T 845
Free T 22.7
E2 20.0

I wasn’t getting a lot of relief so they upped my T cyp to 60mg M-W-F and left everything else the same. After two months I requested an E2 test and it came back 39.7.

Flash forward several months to December, 2017 and I felt like I had low E2 so over the course of three weeks, I took two .25mg doses weekly, instead of three .25mg doses. A quick test gave the following:

Total T 924
Free T 27.2
E2 75.4

At the follow-up appt. my provider recommended I drop the T cyp to 54mg M-W-F, drop the Anastrazole to .25mg twice weekly and keep the HCG the same.

I started this protocol five days ago and this weekend I’ve been dragging…feeling pretty much like I do when my Testosterone is low. My provider said the lowering of the T cyp dose should not affect the benefits I get but that it should have a big impact on lowering E2 levels.

Is this “down” feeling something that is temporary and that is likely to go away once the new dosages settle in? I’m doing an E2 test this morning, just to get a baseline but I don’t think I can follow this protocol if I continue to feel the way I’ve felt the past three days.

Just curious, on what protocol over the two years of injections did you feel best at? Seems like the first protocol numbers were a little high (Test 1203 and E 44) but not too bad? Was it the provider switch that made you change it or was it not effective?

Your testosterone is too high given your low SHBG, when estrogen gets high you will feel as if TRT isn’t working anymore. Follow advice here and inject 50mg twice weekly, you can’t hold onto all of that testosterone anyhow so ease up on the dosage of T. Cut down AI to match 100mg to 1mg AI weekly split up on injection days.

My SHBG is 18 and felt terrible in the 800 ranges, it felt like TRT wasn’t working anymore.

I never consistently felt “good” or had a good libido/erections. I protocol kept me from being miserable but I only really felt “good” at seemingly random intervals. I didn’t know enough at that point to monitor myself so I can’t even say when I felt “good” in relation to injections or Anastrazole.

My main reasons for switching were that I wanted better results and I wanted to self-administer and I wanted to inject more than once daily. My current protocol is also much cheaper.

So you are recommending significantly lowering the T injection (100mg weekly from 162)) and raising the Anastrazole (1 mg weekly from .5mg)? Do you think there is a chance of crashing my E2? I’ve read enough horror stories about it that I’ve probably become overly cautious.

How soon might I be able to tell if a new protocol is or is not working? I guess I’m afraid of going a month, or even 2 weeks, feeling miserable, waiting to find out if a given protocol works.

You will not feel well for the first few weeks after a protocol change, it will take a total of 4-6 weeks to stabilize. You could just keep going down the path you’re on now, but that means no erection or libido.

Lab ranges in-line with results always needed.
Any other labs?

With E2=39.7pg/ml anastrozole should have been increased by a factor of 39.7/22 with a target of E2=22pg/ml

But 900iu hCG per week could be the problem as that happens for a few men.

This often does not work "I felt like I had low E2 "

With E2=75, 0.25mg twice a week, new dose could be .25 x 2 x 75/22 = ~1.5mg per week, close to the expected 1mg per 100mg T.

Anastrozole has a long half-life and is not forgiving of missed doses.

Anastrozole is a competitive drug that needs to match T levels.

T and anastrozole levels need to be match and steady for 2 weeks to get meaningful lab results.

E2=75pg/ml is insanely high.

Inability to absorb T gels is a symptom of low thyroid function, often caused by iodine deficiency from not using iodized salt.

Sea salt and pink salts ruin lives if not iodized.

Most guys here have some degree of thyroid issues, please use oral body temps to eval your thyroid status - see below

Do not take comfort in “normal” thyroid labs, the ranges are very useless.

Thyroid problems can make even perfectly controlled TRT feel like shit. Also:

  • fat gain
  • low energy
  • brain fog
  • sparse outer eyebrows
  • feeling cold
  • dry skin
  • general hair thinning

Your dosing 3x per week is great.


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
  • finding a TRT doc

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 numbers and 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.

KSman,

Thanks for taking the time to share you knowledge and experience. It really is appreciated.

I will read the stickies you recommend, that I haven’t already read. The only thyroid related numbers I have are

TSH 2.150 in March 2017
TSH 2.86 in July 2017

I checked my E2 on 03/19/2018 and it was 51.9 reference range 8.0 - 35.0

I had a good 10 weeks of 60mg T cyp, 300 IU HCG and .25 Anastrazole M-W-F

On 3/14/2018 I lowered my T cyp dosage to 54mg, kept 300 IU HCG and took .5 mg Anastrazole due to symptoms of high E2.

On 03/16/2018 I took 54mg T cyp and 300 IU HCG with no Anastrazole.

My blood draw was the morning of 03/19/2018 and resulted in an E2 level of 51.9.

Does this information warrant any other changes in my protocol? I’m still doing 54mg T cyp, 300 IU HCG and .25 Anastrazole twice weekly. That was my prescription from the doctor and they said I could add a 3rd .25mg of Anastrazole. I’m inclined to add more Anastrazole, maybe .5 three times weekly but I don’t know how much less I need based on my lowered T cyp dosage.