TT = 3064, E2 <12... How Is This Possible?

Pharma / TRT Testosterone Replacement
61

Thanks KSman. FYI I have not taken hCG and Clomid at the same time. I agree with your assessment of T–>E2 conversion within the testes.

I double-checked the albumin number and it is not a typo. 17 g/dL is the result. You think that’s too low?

I was taking 50mg ED Clomid until 01/08. On 01/09 I began tapering off at 25mg EOD. This was one day before the above blood panel was drawn. My tapering routine was 25mg EOD for 8 days (four doses), then E3D for 6 days (two doses), and then stopped.

The last dose of any Clomid was around 01/21.
hCG injection started on 02/07.

So, there’s a ~17 day gap.

I have a sneaking suspicion that you might be right about hypersensitivity to hCG. Last weekend I started feeling good, but this week it’s waning off.

Maybe it’s worth talking to the urologist one more time to see if he’ll go along with a test-c Rx??

62

The 4 sample saliva cortisol test results came back today (done thru Quest). Sample date was 2/6/2013.

Sample 1 - 7:30am 0.43 ug/dL
Sample 2 - 12:00pm 0.08 ug/dL
Sample 3 - 5:30pm 0.06 ug/dL
Sample 4 - 10:30pm 0.05 ug/dL

Reference range:
8am-10am 0.04 - 0.56
4pm-6pm < or = 0.15
10pm-11pm < or = 0.09

Is such a large drop expected between 7:30am and noon??

63

Do you feel your energy or stress stamina dropping by noon?

hCG can have a significant effect on mood, but that is mostly transient, so you would feel that end.

Most bio-T is FT + albumin+T. With less albumin, you would have less bio-T and more SHBG+T, like to see this in the mid 40’s. So your 17 is quite odd. Might be “normal”, but I do not see levels that low here.

64

I haven’t posted in a while. The hCG didn’t really do much for me in terms of libido or mood.

A friend gave me a name of a doctor at Stanford. The appointment was last Thursday. Here’s how it went.

First I met her assistant Fellow, and let me tell you she was CUTE! I brought all my lab work (everything posted in this thread) and explained my history to her. She took notes and asked questions along the way.

She made the same typical comments about iodine and thyroid, saying my thyroid was normal all along. I showed her the TSH spike after the iodine dosing. All she said was “TSH shouldn’t be that high. It could be that your iodine intake is causing your natural intake to slow down” or some other BS.

I explained that I did feel a lot better after getting on the iodine, and the T3/T4 ratios looked better. She said that some T3 is created in tissue so the ratios may not tell much. Bleh. Whatever.

We moved on and I showed her the lab data while on Testim, and said, “I’m not absorbing it”. She agreed.

Interestingly though, she knew the idiot endocrinologist I was seeing. I explained that he wanted to administer 200mg Test-c E2W (!!) through the gluts, and I wasn’t willing to do that because of peaks and lows.

After a quick exam (and yah she felt my boys but since my T is low, nothing happened… heh), she brought the primary doctor in.

The first thing the doc says is, “I see you’ve done some research… which is good”. Translation - you might understand what I’m saying, but don’t quote stuff you read on the internet to me.

She agreed that peaks and lows with E2W IM test-c isn’t optimal. So she gave me three choices:

  1. Try test-c, 100mg IM per week. Do a trial for a couple of months.
  2. Use Clomid (even though I already had labs showing my E2 went through the roof).
  3. Continue with topical.

For fertility concerns, she would not agree to hCG in conjunction with test-c, so I went with option 1. If I do need hCG, I doubt I’ll need very much.

She also said that they would aim to get T in the “mid-range”, which I think means around 500. I was asking for 700 but we’ll see what happens. We talked about AI’s but I don’t think she was willing to go that route until we get some lab work done.

The pharmacy gave me two 1mL vials of 200mg/mL test-c, but the doctor screwed up with the syringe prescription… so I used one of the hCG needles I have left. It’s a 30 gauge 5/16". Yesterday I drew 250iu, which is 0.25mL, or 50mg test-C. It took a while to load but I expected that.

For injection site, I wanted to try and get close to a muscle, so I flexed my quads and felt for a muscle that was closest to the skin (towards my knee but still in my thigh) and injected slowly.

Now I’m wondering how long until I should feel the effects. What I’m already noticing.

  1. Within 30 minutes, I feel calmer. Much more relaxed and focused. No irritability whatsoever.
  2. Brain fog. I’ve had to proof-read a few e-mails before sending them b/c I realized they made no sense.
  3. No increase to libido (yet… hopefully).
  4. A little trouble falling asleep last night but I guess that’s normal.

My next 50mg dose will be Friday morning.

When should I feel the effects? I read 36-48 hours after dosing?

65

Just a little thought on your last post. If you want to get your levels to 700, inject slightly less than what your doc prescribes so you end up lower than where you’re supposed to be. Say she prescribes 100mg/wk and it gets you to 700, but 60mg/wk gets you to 500 do 60mg (I realize there’s no way to tell until you test, but inject less anyway) that way she’ll think “oh okay, so the 100mg I prescribed hovers him at 500, we’re good to go” when if you’d actually use 100mg it would take you to 700 or more even. Problem is, you won’t know your estrogen, so if she doesn’t prescribe an AI, then it could be a problem.

66

Good tip man! Thanks!!

I guess that means on Sunday I’ll take half as much… so instead of .25mL it’ll be .125mL.

The urologist I saw is willing to hand out orders for T-labs like candy on Halloween. When is a good time to get my levels measured while on test-c?

There was some pain and soreness at the injection site yesterday (note: I injected 48 hours earlier). It was getting a little bad. I took a long hot shower last night and it seems to be gone. Probably crystallization from what I read. For my next injection, I plan to warm up the oil in warm water before drawing, and apply a heating pad to the site after injecting.

67

One other bit of info… primary doc was saying that actual hypogonadism would be T levels less than 75!!! I was quite shocked at that. Everything else she said was

Thought I’d add a post to list out the dates/amounts I’m administering:

Tue 3/26 4pm - 50mg
Sat 3/30 10am - 25mg
Tue 4/2 7pm - 50mg Feeling much calmer, at-ease, and focused on 4/3
Thu 4/4 9am - 50mg Going on a road trip till Mon night
Mon 4/8 5pm - 50mg Felt a LOT better as of last Friday. Libido went WAAAAY up and still looks good. Debating when I should ask for lab testing w.r.t. dosing.
Wed 4/10 7pm - 50mg Felt a little brain fog the last day or two. My drive home on Monday went well. I noticed some libido struggles yesterday. Maybe tomorrow they will improve after today’s injection.
Sun 4/14 11am - 50mg Overall effects seem a little more stable now.
Wed 4/17 11pm - 50mg
Sun 4/21 10am - 50mg
Wed 4/24 6pm - 50mg
Sat 4/27 2pm - 250iu HCG. Took this b/c I think my balls might be shrinking a little, so it might be time to introduce HCG… OTOH I should get around to lab work before continuing.
Sun 4/28 8am - 50mg Noticing a lack of motivation to do stuff. May need to stay on the SSRI a little bit longer and work on this.
Wed 5/1 8pm - 50mg
Sun 5/5 8am - 50mg
Wed 5/8 10pm - 50mg

68

4/11 update - When I took the 25mg dose on 3/30, I felt pretty lousy afterwards. This dose may be high enough to stop natural T production, but low enough to be of little benefit.

From what I have read, after an injection it takes roughly 48 hours for T-levels to peak.

If that is true, then should I try to get blood work done on Friday afternoon? That would be 48 hrs after my most recent injection (yesterday 4/10).

I am already feeling a bit antsy. Libido is feeling pretty good too :slight_smile:

69

Yesterday was an unusual day in that I slept… A LOT! I went to bed late Saturday night, and woke up late on Sunday. All of yesterday was a lazy day. I had no motivation to do anything. Finally at 5pm, I finally went over to my GF’s place, and then fell asleep for almost 4 hours! I left her place at 10, grabbed a salad at Denny’s, came home and slept until 8am today!! And I’m still sleepy!!

The only two unusual things are I forgot to take my SSRI/ADHD meds on Saturday and Sunday, and I drank no coffee this weekend. It’s odd that forgetting those for a couple of days made me THAT sleepy. Even though it’s Monday morning, I have a ton of brain fog and could use another nap.

70

Still doing 2x/week T-cyp injections.

Unfortunately they seem to be wearing off in terms of effect… libido is back down.

I have a follow up on Tuesday where I’ll ask for some blood labs.

Question I wanted to ask you guys… if I aromatize T at a higher than normal rate, could that explain why my T levels are so low? The HPT axis works on negative feedback. My pre-TRT E2 labs all show normal E2 levels from 17-22. If I aromatize faster than normal, I’ll reach those E2 levels quicker. Once those levels are reached, the hypothalamus stops T production, so my T numbers will be low.

In that case, could purely going on an AI solve all my problems? The clomid test indicates that my testes are capable of producing good levels of T when stimulated, so that eliminates testicular function as a root cause.

What do you guys think?

71

I had a follow up with my newest Endo on Tuesday. Here’s what we discussed.

-My blood pressure has gone up a little. Normally it’s 110/70. That day it was 128/84. Other times it’s been as high as 135/90.
-Acne breakout on my upper shoulders/back. This is where I used to apply Testim… not sure if that’s a coincidence or not.
-A small amount of nipple tenderness. I might have exaggerated this in the hopes of getting her to write an Rx for an AI :wink:

We discussed bloodwork, so she ordered:
-TT & FT
-Pregnenolone (at my request, though she didn’t understand why…)
-PSA
-CMP
-Lipid panel
-CBC
… and maybe some others that I’m forgetting.

For the nipple tenderness, she indicated that tamoxifen might be a better choice than an AI. Her reasons were:
-AI’s are expensive. Not really relevant for me b/c I have great insurance.
-Liver side effects. She didn’t elaborate.

My research on tamoxifen is that it works similar to Clomid… so it would only impede E2 activation with receptor cells, but not E2 levels. I asked her if that’s like treating the symptom instead of the problem.

Question - if I took tamoxifen with Test-c, will it have SERM effects on the hypothalamus E2 receptors, and thus stimulate HCG production (and subsequently LH/FSH?), or does the drug only affect E2 activation in breast tissue?

Another question (one I asked above) but didn’t get a response… if I took only an AI like A-dex and stopped test-c, could that alone improve my overall T production numbers?

Thanks!!

72

Had some labs done on Tuesday morning. Draw time was 8am. Here’s what’s tested:

FT & TT
E2
SHBG
Pregnenolone

and some standard stuff…
CBC w/diff/Plt
CMP
Lipid

First result that came back is high E2 at 40 pg/mL. Range of 0-39.8. This is way too high without any HCG. Incorporating that will increase it more.

I will have a tough time selling the doc on writing me an Rx for an AI…

73

Restarting HCG to the mix. 250iu today, will aim for EOD…

74

More lab results are back.

Draw date: 5/28/2013

Total Testosterone…483…250 - 1100 ng/dL
Free Testosterone…131.6…35.0 - 155.0 pg/mL
Estradiol…40…0-39.8 pg/mL Males,16 and over
SHBG…12.80…10 - 57 nmol/L
Pregnenolone…39…13 - 208 ng/dL

More lab results are back.

Draw date: 5/28/2013

Total Testosterone…483…250 - 1100 ng/dL
Free Testosterone…131.6…35.0 - 155.0 pg/mL
Estradiol…40…0-39.8 pg/mL Males,16 and over
SHBG…12.80…10 - 57 nmol/L
Pregnenolone…39…13 - 208 ng/dL

Lipid Panel:

Total cholesterol…209…<200 mg/dL (High)

Desirable: <200 mg/dL
Borderline: 200-239 mg/dL
High: >240 mg/dL

Triglyceride…116…<150 mg/dL
HDL cholesterol…32…>40 mg/dL (Low)
LDL Calculated…154…<130 mg/dL (High)

LDL CHOLESTEROL CLASSIFICATION
<100 mg/dL Optimal
100-129 mg/dL Near or above optimal
130 - 159 Borderline high
160-189 High

189 Very high

Cholesterol to HDL Ratio…6.5…1.0 - 4.0 (High)
VLDL (Calculated)…23…5 - 40 mg/dL

Liver Tests:
Calcium…9.0…8.2 - 10.2 mg/dL
Total Protein…7.4…6.4 - 8.2 g/dL
Albumin…4.2…3.2 - 4.7 g/dL
Total Bilirubin…0.5…<1.1 mg/dL
ALP…126…26 - 137 U/L
AST…17…0 - 37 U/L
ALT…50…15 - 60 U/L

75

bump… anyone?

76

I e-mail the results to the doc. THIS is the stupid a** response I get:

“Estradiol level is only mildly elevated. My question about the duration of the treatment was not when to check with next blood test but what would be the ultimate goal and total duration of therapy?”

I asked her to put me on a-dex for a “short term trial” to see how it would work at reducing E2. She asked what I meant by “short term” and I replied 10-12 weeks followed by lab work.

Now she wants to know what the ultimate goal is and total duration of therapy, PLUS she thinks E2 of 40 is only “mildly” elevated… how the hell do I answer this?!? My only thought was to point out that T:E2 ratio is worse but I doubt she’ll go for that…

Help guys!!!

77

You need to be close to E2=22. Doc has no concept of optimal, only disease states.

T = mid range is what doc expects 1 week after a weekly injection.

Have you read the stickies? - I will not review all posts.

Get [research chemical anastrozole], google that. Then dose as per stickies. Better control than splitting tablets and probably cheaper than co-pays, if insurance will cover at all.

78

I’ve read all the stickies multiple times :slight_smile:

What I don’t understand is why my T is mid-range after taking 50mg Test-C twice/week for several weeks. Shouldn’t it get me up in the 800-900 range???

I just bought some research a-dex drops, which should arrive next week and I’ll dose per stickies. It looks like the doc won’t write an AI Rx so I’ll need to get her to keep writing the Test-c Rx.

Here is the fundamental questions I was asking:

If I aromatize at a faster than normal rate, could that explain my low T? If yes, would simply taking an AI raise my overall T production?

The reasoning: the HPT axis works on negative feedback. My pre-TRT labs show normal E2 levels from 17-22. If I aromatize at a faster than “normal” rate, then E2 levels rise faster as more T is produced. Once those levels are reached, the hypothalamus stops T production, so my T numbers will be low.

In that case, could going on just an AI solve all the problems? The clomid test excludes primary hypogonadism, so that eliminates testicular function as a root cause.

79

AI will be very helpful. When on TRT, without hCG, there is no T production. You seem confused about this.

With hCG for two days, there is some doubt about what your labs represent.

You may be a hyper metabolizer of T.

Your T–>E2 may be higher, but perhaps your E2 liver clearance is impeded. What are your ALT/AST levels while on TRT?

Does higher T–>E2 reduce TT levels? -yes, but not that much

80

Wow great call! I updated the lab post w/AST and ALT numbers while on TRT:

AST…17 (0-37) U/L
ALT…50 (15-60) U/L
ALP…126 (26-137) U/L

Elevated ALT and ALP. No more alcohol or Tylenol.

I do understand that normal T production stops while on TRT. I was asking about HPT feedback when not on TRT (i.e. before I started)… and if over-metabolizing T–>E2 could cause low T output. Clomid test shows that the testes can produce >700ng/dL of T, but E2 skyrockets.

Do you have any thoughts why the TT is low after being on TRT for 2 months? I’m injecting using a 29 gauge 0.5" needle into the side of the quad (vastus lateralis). Next ones might go into the deltoids or biceps as there’s more muscle definition there.