T Nation

Year 2 TRT Test Results - Help

Hi all, received my test results and am a little confused. Need help. Sorry for the long post. :slight_smile:

History:
49 Male, low T (254 initial test scale 250-1100)

First 18 months was feeling good and had good gains. Still struggled with sleep and energy at times.

Last Sept my Dr increased my Test dosage to 1.2CC/week 210MG from .8CC/week.
I started to have acne issues and elevated E2. He then prescribed Exemestane 20MG/week, acne settled after a few weeks and E2 stayed on the high range or normal.
Dec labs were perfect, slightly elevated E2 but manageable (never did get as high as 1.2CC was feeling great at .9CC/wk, higher than that and I started to get acne again).

In Mar I had a lab result with a spike in PSA, my Dr lowered my Test to .7CC/wk 210MG, removed the Exemestane. In May I still had a slightly high E2, still high PSA, Total test now at 800. I lowered my Test to .4/wk as recommended by my Urologist. Not feeling great on .4/wk and continue at this dose today…

Now to current. I just received my latest lab results and am perplexed. Good news is my PSA is back to normal, likely unrelated to TRT as per my Urologist… Test is higher than expected as is my E2, DHEA is borderline low, LH and FSH are low.

Results:
E2 = 66(H) range <=39 PG/ML - that is my highest E2 to date…
Total T = 779 range 250-1100 (thought it would be lower with such a lower TRT dose)
Free T = 111 range 35-155
TSH, T3, T4 all in normal range
FSH <.7(L) range 1.6-8
LH = <.2(L) range 1.5-9.3
Full metabolic panel all in normal range
IGF 1 = 95 range 52-328 — Z Score (MALE) -0.8 range range -2.0 - + 2.0
DHEA = 171 range 147-1760 (this is lower than expected)
CBC & Cortisol all in normal range
SHBG = 40 range 10-50

Any thought on above? Higher E2 is making me feel bloated, energy not where it normally was and not getting as good a pump in the gym, likely due to lower energy I suppose. Now that I have the clear on my PSA’s I need to readjust my dosage, however with my total and free where they are, not sure that’s the best idea. I did start the Exemstane again - 20MG/week to address the E2, left my test where it is. My Dr tends to prescribe much higher than I take so he isn’t much help.

It could have been a urinary tract infection which could be the reason for elevated PSA.

I don’t know why your doc is testing these values while on TRT, TRT almost completely suppresses the (HPTA) LH and FSH, so it’s to be expected.

Once weekly dosing can create problems for some people, one weekly dosing can cause estrogen to spike high, try splitting up your doses twice weekly.

Thank you Systemlord.

I should have specified my dosing routine.

Up until May I was breaking my dose into EOD (.2CC) SubQ. When I reduced my weekly total to .4CC, I changed to 2X weekly SubQ at .2 per dose. I have never done single weekly injections and I rarely do intramuscular unless I need to give my injection sites a break.

I was actually dealing with UTI (suspected) at the time, so that makes sense.

Since I am doing 2x / week SubQ at such a small dose, surprised by my E2. Any other thoughts on what could be driving it up. Good news is even with the small dose my total and free test is good as well which is also a surprise. My blood work was on the morning I was scheduled for my injection but before I took it.

Just a heads up, this is not a dose. This a volume with an injection schedule. How many mg’s per injection is a dose, the CC’s are irrelevant because they change dpending on what you are using. Always give your dose in mg’s.

I included the MG in my post, 210MG. So .4Weekly = 84MG weekly currently.

So in Dec I was taking .9CC = 189MG
Mar lowered to .7CC = 147MG
May lowered to .4CC = 84MG (current) Realistically I take between .2CC (42MG) to .25CC (52MG) 2X weekly. Never higher or lower.

Thanks for the help.

Yes, but you didn’t say in how many mL. It wasn’t enough info for us to do the math ourselves. That’s why no one posts in volume, there are too many options to know what you have. CC’s are completely irrelevant unless your math is wrong.
Is the lab with an E2 if 66 with Exemestane or without?
Your E2 is not causing your gym issues, just to be up front, not because it’s too high anyway. Your E2 can be expected to be above range when taking TRT, it’s not handled exactly the same as natural test and the labs aren’t necessarily going to be the same. So, what EXACTLY were the issues you were having with E2 that prompted the AI?

Totally get it, was my oversight.

E2 @ 66 is without Exemestane, I restarted the 20mg/week after receiving my results, so have taken 1 pill so far.

When my E2 gets elevated, so too does the bloating feeling, trouble sleeping then lower energy as result and nipple sensitivity. I feel my best when my E2 sits just below mid range however I struggle to keep it there. Before Exemestane I tried 1MG/week Anastrozle however couldn’t get a dose that wouldn’t flatten my E2 which felt way worst than the high. Was even breaking into 1/8 bits at one point.

I would suggest that you stay away from the AI and just ride it out. Those symptoms are not uncommon, but usually short-lived. If you had ED or actual gyno it would be different, but the experience of many here is to just ride out those symptoms for a couple of monts and they go away on their own. Your body needs time to adjust to having enough test, and it can take some time. I bloated like the Michelin man initially, but I’m okay now. Just pick the dose you like for living your life and don’t change anything for a few months.

Thanks for the advice. I have been on TRT for 2 years so this is not new. My E2 has been climbing over the last 6 months even though I’ve been lowering my Test Cyp MG/week.

That said, it sounds like there was nothing in my test results that raises concern, so if that is the case I’ll keep working to tweak my dose for the right balance.

He isn’t saying that your E2 levels will drop but the way they effect you will. I had sore nipples for almost 3 months. Like wearing a shirt was torture. Accidentally brushing against one was bad, hitting one was like tear provoking. My E2 is above range and I like it there. Never took an AI, don’t need to. If you make it 2 months then give in and take an AI for a week then it’s like starting over from day one and your body has to get use to it all over again

Jimmy, thank you for the comment. I get that this is likely the case 90+% of the time however I think we’re disconnected.

I have been on TRT for over 2 years
I have not taken an AI (until last Sat) for 8 months
I have struggled with E2 since the beginning and at the start they had me on Anastrozle (early 2019) however even with .125MG/week it would flatten my E2 so I couldn’t take it
They prescribed me Exemestane however I just took my first dose last Sat, I still had the full prescription from early 2019 (hope it doesn’t expire…)
I followed this communities advice early 2019 by changing to EOD injections and dropping the AI. I even tried DIM as someone suggested awhile back and made diet adjustments.

So at least 8 months with no AI, actually lowered my doses due to the PSA issue and even with 85MG/week my E2 continued to climb. My nipple sensitivity has persisted for months, recently worst with bloating and can even feel it in my cheeks (I’m a lean guy at 180lbs 6.1) so a little bit of bloating is really noticeable.

I thought the blood work would have provided clues. Just ignoring, as I’ve done for the last 8 months isn’t an option.

Yes I must have misunderstood. I thought you had continually been trying to adjust your E2. Everyone is different I guess.