T Nation

Unique TRT Situation

I have what I believe to be a unique situation, but I’m hoping that the problems are straight-ahead and can be figured out here…

I’m 52 and fit (always have been) and still train. About 6 months ago I went to a, “quality of life” doc and discussed TRT. We had labs done, and at the time I was at 451ng/dl total T and 50pg/ml free T. This doc doesn’t go so much by numbers but by symptoms.

He put me on .75ml of test cyp a week (followed by 1mg of arimidex the day after injection). A couple months ago we did some follow-up labs and my total T came in at 1677ng/dl and free T was 210pg/ml. I was shocked at this but the doc wasn’t. He said that most his patients don’t start really feeling positive effects until they are in the 200+ range for free T. He doesn’t pay as much attention to total T. He said he liked what he saw and told me to continue with the same dose.

Now normally I’d be quite happy about this, but I have some reservations and they are these…

For the first few months on TRT, everything was great…good energy and mood, good endurance, and I started to reverse the muscle loss I had started to experience right before starting TRT. This is what got me to the doc in the first place. For the first time in my life, no matter how hard I tried and how much I compensated, I simply started to lose muscle mass and started to hurt all the time. I could not recover from training.

So during the first portion of being on TRT, all that reversed, plus the added bonus of crazy increased sex drive. Life was great. But then a few months ago I started to notice that the sex drive dropped off. Probably to lower levels than before TRT. Also, I started to get deep painful acne in the oddest of places, including the more expected places (back, face etc). I started to also notice I had to pee more often and it seemed slower. I suspected some prostate inflammation.

I mentioned the acne and concern for hair loss to the doc, but the lack of libido and prostate concern slipped my mind at the last appointment.

So what I’ve done for the last few weeks is self-reduce my injections. From .75ml to .6…that is a 20% reduction. I’ve noticed so far that the acne has mellowed out some, but haven’t notice an increase in libido yet. I have softened out and maybe even reduced some muscle already but I’m not 100% sure on that.
My hemoglobin, hematocrit, and estradiol were all within normal range.

So my question is, are all of these symptoms due to my testosterone being too high, or could it be something peripheral…like the testosterone converting into other things at too high a level or out of balance overall? Is reducing my dosage even the right approach?

Main concerns:

  1. Painful and very visually noticeable acne

  2. Risking hair loss (I was told that if you aren’t prone to hair loss, TRT will not affect it. However at these levels, and with the acne problem, I’m thinking the same mechanism may affect hair loss)

  3. Prostate

Obviously I’d like to keep the higher T levels if all this can be sorted out without reduction, but I need the proper information as to what’s likely happening.

Thank you all!

Lol. Not unique at all. First you need to report your doses in mg not ml. Second we need latest labs with ranges. The comment that all other labs are normal makes me want to kick you in the nuts! Post ALL labs then we can help. In all likelihood, your having estrogen issues. But we won’t know until you post labs…did I mention that already? Welcome.

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Nash is right needing labs. Need to monitor your psa regarding prostate. I get shoulder acne too, need to monitor E but it just may be your response to higher T too. If you were not prone to hair loss before then the T won’t cause it. If you are, you need to keep DHT levels in check.

Also, when injecting once per week, labs are affected by timing. IOW, your T and E2 levels will vary greatly over the week. High right after the shot and low a week later. This makes reading the labs difficult. So please let us know when the blood was drawn.

@Nashtide and @blshaw

Hahaha okay, sorry guys, here are the last labs (while I was still injecting the prescribed dose of 150mg/week)…and the blood was drawn on the 6th day after injection.

Total T 1677 ng/dl (250-1100)

Free T 210.0H pg/ml (35-155)

Estradiol 32 pg/ml (<61)

Hemoglobin 17.3 g/dl (13.7-17.5)

Hematocrit 51% (40.1-51)

I have normal blood pressure and a resting heart rate of 52.

My prescribed dose is 150mg Test cyp per week, but for the last 3 weeks I’ve injected 120mg instead.

I only thought the situation was unique because of how high my levels are and the doc being so happy about that and unconcerned about my symptoms. I would LOVE to get this sorted out as I don’t like doing these reduced doses, especially if it’s unnecessary.

Thanks again!.

Also, I don’t know if this is unique or not, but it’s another reason I got concerned for the hair (and for the record, I have good hair genes)…coinciding with the acne, I have started a sesitive burning sensation on the front half of my scalp. I’ve never had this before and since it came at the exact time as the acne, I got very concerned.

Ok. Those T numbers are very high considering they are 6 days after the injection! Also concerned about your hematocrit. You’ll need to donate blood regularly.

Many of the symptoms are E2 related would be my guess. I have all kinds of trouble with estrogen related symptoms if mine gets into the mid 30’s. Your levels are most likely higher right after the injection. So I think reducing your T to 120mg is good. Ideally, you’d inject twice weekly and take the Adex twice weekly. Then after 4 weeks you could retest halfway between injections and get a good picture of your levels. Very tough to get dialed in when injecting once per week.

Speaking of Adex, I had experimented with not only taking 1mg the day after injection, but also taking .5mg on the 4th day after as well. This was for 2 reasons…one, because of the half-life of Adex, and two, because I had seen a graph of test cyp’s typical levels over a week, and on the 5th day it spikes almost as high as the day after injection.

However, I did not do this consistently enough to know if it helped…I wasn’t confident enough in my theory I guess.

As to the timing of Adex, is the day after injection the norm? Or is there a more specific timing (hours)? I’m pretty anal about things and don’t have a problem being tedious and perfectionist about optimal routines.

Hahaha, as for injecting twice a week…I am THAT guy…I’ve always hated needles. I’d rather see a bone hanging out of someone’s arm than see them take a needle. Yet now I’m sticking and inch and a half needle in myself once a week. Twice a week is something I’ll have to wrap my head around.

Either way, I’m glad to hear that you think that the problems are stemming from E2 being too high. That sounds like something manageable as I hope for relief.

Are you new here? Most inject sq with an insulin syringe. No pain. Better, steadier release of T. If you inject twice weekly you can take the Adex at the time of the injections. I need 1.5mg of Adex to keep my E2 where I want it, so I take 0.5mg Sunday morning, Wednesday afternoon and Friday night.

Thank you. And no I’m not new to the site (been aware of it and occasionally buying various products here for 15 years or so), but I am new to the forums and TRT in general.

I don’t have a problem with needle pain, in fact I use a 21 gauge needle and don’t feel a thing. Needles are generally a psychological thing for anyone who hates them.

So I take it you shoot on Sunday and Wednesday? I like the 3X0.5 adex spread…

I am aiming for E2 in the mid 20’s correct?

Oh ok so a needle phobia. That’s not ideal for TRT…lol.

Yes I inject on Sunday and Wednesday. I also inject 250iu of hcg E3D. I like my E2 to be low 20’s, but I think 25 would be ok. Sure don’t want to have your E2 too low. That causes all sorts of problems. I know I’m in the right spot when I’ve got morning wood and high libido.

Morning wood and libido. Now those are the types of scientific indicators I can appreciate.

Also to be clear, do you think the acne is also because of the elevated E2?

And did you ever shoot only once a week and personally found much better results with twice, or did you start out with twice weekly?

I discussed HCG with my doc but it seemed like a whole lot of prep and tons of injections. And one of the things I appreciated about TRT was the relatively low maintenance about it all. So I said no to HCG for now.

I did talk to someone on TRT who said they take 25mg of clomid every other day for 10 days, every 6 months, and he’s happy with that and it keeps his nuts plump.

Which is in fact another concern I had hahaha. Sex and orgasm itself is different. It’s far less “pressure” and kegel oriented, and more of, “I have a raging boner with no particular pressure” based…I don’t know if that makes sense. But I don’t like it, and I have to rage like a full-speed jackhammer to finish. The wife seems okay with it, but I’m sure she’s wondering why it’s only like that all the time now.

I’m truly not sure about the acne. I haven’t had that issue. The libido and wood just let me know I’m in the ballpark every day. Other indicators like gains in the gym are more long term. Also not sure what to say about orgasms. Mine are much more intense than before TRT. It’s all tied to my E2.

Good to know! Thank you for your help! Sounds like E2 is for sure what I have to reduce. Off to the beach for the rest of the day here…

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So my plan is to inject twice a week and bump up the adex to 1.5 to 2mg in three to four spread out doses, and observe symptoms (or lack thereof). Then tweak until I hit 22 with my E2 in the next lab. Sound kosher?

Also, is a 23 gauge needle a noticeable improvement from a 21G? I don’t want to go so thin that it’s difficult to draw or inject, yet if I’m poking myself more often I don’t want to cause internal scarring. Or am I off-base in that thinking?

Pick a dose of Adex and run with it for at least four weeks then test and adjust. I highly recommend sq injections. Takes a few minutes to draw up, but well worth it. Totally painless and I’m not putting hundreds of holes in my muscles.

I’ll look up SQ injections. In the meantime, currently I shoot into the side rear “love handle”, not the glute. I don’t even have to undo my pants to hit it. Though it starts out as fat there, I’m pretty sure at 1.5 inches in, it’s muscle. I’m assuming SQ is in the fat layer somewhere?

Also when people say insulin needle, what gauge is that? Something like #29?

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And thanks for the info btw…previously I had read that injecting T into fat was NOT the way to go. But this site (which seems most knowledgeable) says the opposite.

And another thing about twice weekly injections…I mentioned before that I had read that test cyp levels vary through the week and don’t just smoothly diminish. In fact on day 5 it peaks as high as day 1. This is why I hadn’t put much weight into twice weekly injections. I’ll post the info here…tell me what you think:

“The answer was (likely) given in a study of 9 Japanese men who were put on 125 mg of testosterone enanthate. [1] For those who don’t know, testosterone enanthate has a very similar dosage and half-life profile to cypionate and so the results from the enanthate study will apply to cypionate as well. The testosterone levels posted by this study are very revealing:”

Day 0: 400 ng/dl
Day 1: 750 ng/dl
Day 2: 720 ng/dl
Day 3: 690 ng/dl
Day 4: 650 ng/dl
Day 5: 750 ng/dl

In my opinion, testosterone should de administered into subcutaneous tissue.

Although the good reasons given by Nashtide, intramuscular injections increase AST and ALT levels. Remember, AST and ALT are not “liver specific”, and will increase in muscular damage as well.

It’s not just guys on this site THE guru of TRT, Dr. Crisler uses sq on himself and his patients.

I’m VERY skeptical of the results you posted. Those results don’t make scientific sense as ALL meds have half lives. Also, clinically, many guys report significant ups and downs when injecting once per week.

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