Struggling with getting dialed in

[Voltz]

Hi there, been reading the past week or so in search of a solution to my problems listed below.

- Age, 43
- Weight 284
- Height 6'1
- 22 year lifter, former competitive powerlifter
- Absolutely zero libido
- Fatigue, no motivation, do not find enjoyment in activities I normally would.
- Feel stuck in a very monotone area when it comes to mood. Mood is stable but I'm rarely happy.
- Tough to make gains or see body composition changes over the past 5 years I've been lifting.
- Erection quality is 70% and sensitivity is approx. 40% to 50% of what it should be.

I've been seeing a hormone specialist based out of a well known hospital in RI. I've complained about these symptoms I've been experienced since 2018. Test Cyp prescribed @ 180mg/wk. I typically have blood drawn 6 days post injection.

My latest results

- Albumin 4.4
- Total test 655
- SHBG 18.1 ( been as low as 14.1)
- Test free 185.3
- Test bioavailable 444.0
- Estradiol 55.4
I don't recall ever having prolactin or DHT tested. From what I've read I would be considered to have a low SHBG which could be one of the factors in the way I feel. I understand micro dosing may help to manage my estrogen better and possible raise my SHBG. I'm a bit frustrated knowing a low SHBG is a well known issue from what I've read here but my doctor never addressed it.
I am going for labs on Tuesday ( test, estrogen, LDL/hdl) and requested they add vitamin D, B12, DHT and Prolactin. Anything further I should add to the list ?
Any advise other than finding a more aggressive/ progressive doctor as I've been stuck in this hole for the past 3 years and it's having a major impact on my quality of life.

Thanks

 

[Systemlord]

I understand micro dosing may help to manage my estrogen better and possible raise my SHBG.

Estradiol has a minimal effect on SHBG.

Mood is stable but I'm rarely happy.
- Tough to make gains or see body composition changes over the past 5 years I've been lifting.
- Erection quality is 70% and sensitivity is approx. 40% to 50% of what it should be.

It sounds like micro-dosing is the way to go, however if that doesn't work you might consider Jatenzo, a new form of oral testosterone that is dosed 2x daily.

It takes micro-dosing to another level and levels peak and decline in a more natural way versus injections.

I'm a bit frustrated knowing a low SHBG is a well known issue from what I've read here but my doctor never addressed it.

There nothing to address, you can attempt to minimize the effect your protocol has on SHBG.

TRT has a suppressive effect on SHBG levels in almost everyone.

I don't recall ever having prolactin or DHT tested

DHT is the main driver of libido, it's what gives you the wellbeing on TRT.

 

[Voltz]

Estradiol has a minimal effect on SHBG.



It sounds like micro-dosing is the way to go, however if that doesn't work you might consider Jatenzo, a new form of oral testosterone that is dosed 2x daily.

It takes micro-dosing to another level and levels peak and decline in a more natural way versus injections.



There nothing to address, you can attempt to minimize the effect your protocol has on SHBG.

TRT has a suppressive effect on SHBG levels in almost everyone.

DHT is the main driver of libido, it's what gives you the wellbeing on TRT.

From what I understand men with low SHBG are more sensitive to the effects of estrogen. I didn't mean to portray it as managing estrogen could potentially raise my SHBG. I am disappointed the doctor didn't make a correlation between my low SHBG and symptoms I complain of. It would have been nice to know splitting doses or Mico dosing could help manage the effects. It's been 3 years, I would have made the change much sooner had I known. Has me questioning his expertise and experience.

 

[Systemlord]

Has me questioning his expertise and experience.

Well with TRT being a relatively new field of medicine (forgotten, ignored for decades), the medical community is now starting to focus on hormonal issues.

So expect most doctors to be a little bit behind on treatment protocols or able to figure out how to alleviate any side effects.

 

[madman]

Hi there, been reading the past week or so in search of a solution to my problems listed below.

- Age, 43
- Weight 284
- Height 6'1
- 22 year lifter, former competitive powerlifter
- Absolutely zero libido
- Fatigue, no motivation, do not find enjoyment in activities I normally would.
- Feel stuck in a very monotone area when it comes to mood. Mood is stable but I'm rarely happy.
- Tough to make gains or see body composition changes over the past 5 years I've been lifting.
- Erection quality is 70% and sensitivity is approx. 40% to 50% of what it should be.

I've been seeing a hormone specialist based out of a well known hospital in RI. I've complained about these symptoms I've been experienced since 2018. Test Cyp prescribed @ 180mg/wk. I typically have blood drawn 6 days post injection.

My latest results

- Albumin 4.4
- Total test 655
- SHBG 18.1 ( been as low as 14.1)
- Test free 185.3
- Test bioavailable 444.0
- Estradiol 55.4
I don't recall ever having prolactin or DHT tested. From what I've read I would be considered to have a low SHBG which could be one of the factors in the way I feel. I understand micro dosing may help to manage my estrogen better and possible raise my SHBG. I'm a bit frustrated knowing a low SHBG is a well known issue from what I've read here but my doctor never addressed it.
I am going for labs on Tuesday ( test, estrogen, LDL/hdl) and requested they add vitamin D, B12, DHT and Prolactin. Anything further I should add to the list ?
Any advise other than finding a more aggressive/ progressive doctor as I've been stuck in this hole for the past 3 years and it's having a major impact on my quality of life.

Thanks

Most likely a horrible protocol for someone with lowish SHBG.

What is your BF% at bodyweight 284?

If anything you would most likely do much better injecting lower doses of T more frequently as in EOD or daily or even twice weekly (every 3.5 days) if you are not dead set on pinning more frequently.

The downfall of once-weekly injections especially strictly IM is that there can be a big difference in peak--->trough as peak TT/FT/e2 levels will be much higher 8-12 hrs post-injection/during the first few days let alone blood levels will not be as stable throughout the week.

This can have a negative impact on mood, energy, libido, erectile function.

Seeing as you have lowish SHBG you will not need to run a very high TT in order to achieve a healthy FT level.

Injecting lower doses of T more frequently will clip the peak--->trough let alone achieve more stable blood levels throughout the week.

Top it off that some may notice less impact on driving up estradiol/hematocrit when injecting more frequently but this is not a given as many men still get caught up in running too high an FT level.

The goal is to find a protocol that will allow you to achieve a healthy FT level experiencing the beneficial effects while at the same time minimizing/avoiding any potential side effects.

You are injecting a fairly high dose of 180 mg T once weekly and are hitting a TT 685 ng/dL 6 days post-injection which would have FT levels descent let alone your estradiol is sitting at 55 (not sure what assay was used)?

Your peak TT/FT-e2 levels will be much higher!

Have no idea where your FT level sits as you did not post reference ranges let alone the testing method used (calculated/direct)?

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Critical to know where your trough FT level sits.

 

[madman]

Much more involved than just DHT let alone TT, FT, estradiol, prolactin when it comes to erectile function/libido.

Not everyone will experience a drop in SHBG when on trt as it is not a given.

I was injecting 150 mg T/week split into twice weekly (75 mg every 3.5 days) hitting a very high trough TT/FT level and pre-trt SHBG 34 nmol/L.....has sat around 31 nmol/L for the past 4.5 years!

 

[Voltz]

What is your BF% at bodyweight 284?

Mid 20's a bit higher than I like. Although, I do not notice a difference in lethargy or libido when BF is in the mid teens.

if you are not dead set on pinning more frequently

I wouldn't be interested in daily pinning if it was intramuscular but sub q isn't a problem

Seeing as you have lowish SHBG you will not need to run a very high TT in order to achieve a healthy FT level.

I wouldn't know where to start as far as daily dosing since this is something new I've discovered. If I had to guess 20mg or less to achieve a lower TT and healthy free test level?

Have no idea where your FT level sits as you did not post reference ranges let alone the testing method used (calculated/direct)

My results are posted through a health app. I am provided with very limited information. I can ask for the complete version. I am not sure which method is used to measure estradiol either. As far as free test reference ranges, should I ask for that specifically? All I am provided with is one number which I provided in my 1st post. I do not know whether they are calculated or direct but these are questions I can ask so I can provide more accurate information later. I will also inquire about the testing method specifically whether or not it is gold standard Equilibrium Dialysis or Ultrafiltration. I have a feeling that isn't the case however.

 

[madman]

Mid 20's a bit higher than I like. Although, I do not notice a difference in lethargy or libido when BF is in the mid teens.

I wouldn't be interested in daily pinning if it was intramuscular but sub q isn't a problem


I wouldn't know where to start as far as daily dosing since this is something new I've discovered. If I had to guess 20mg or less to achieve a lower TT and healthy free test level?

My results are posted through a health app. I am provided with very limited information. I can ask for the complete version. I am not sure which method is used to measure estradiol either. As far as free test reference ranges, should I ask for that specifically? All I am provided with is one number which I provided in my 1st post. I do not know whether they are calculated or direct but these are questions I can ask so I can provide more accurate information later. I will also inquire about the testing method specifically whether or not it is gold standard Equilibrium Dialysis or Ultrafiltration. I have a feeling that isn't the case however.

If you plan on going with more frequent injections using a lower dose of T then it would be more sensible to start low and go slow.

14-16 mg/daily would be a good starting point and you may achieve good levels on such.

You could start higher but you need to keep in mind that with a lowish SHBG you will not need to hit a very high TT to achieve a healthy FT level.

When having blood work done you should be using the most accurate assays TT/e2/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Quest Diagnostics

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2.https://www.discountedlabs.com/testosterone-free-dialysis-and-total-ls-ms-ms

3 ESTRADIOL , Ultra Sensitive (LC/MS) Blood Test


Labcorp

1. 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp

2. 070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

3. 140244: Estradiol, Sensitive, LC/MS | Labcorp

 

[Voltz]

If you plan on going with more frequent injections using a lower dose of T then it would be more sensible to start low and go slow.

14-16 mg/daily would be a good starting point and you may achieve good levels on such.

You could start higher but you need to keep in mind that with a lowish SHBG you will not need to hit a very high TT to achieve a healthy FT level.

When having blood work done you should be using the most accurate assays TT/e2/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Quest Diagnostics

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2.https://www.discountedlabs.com/testosterone-free-dialysis-and-total-ls-ms-ms

3 ESTRADIOL , Ultra Sensitive (LC/MS) Blood Test


Labcorp

1. 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp

2. 070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

3. 140244: Estradiol, Sensitive, LC/MS | Labcorp

Great, I have a LabCorp right around the corner. I'll consult with my doctor when I have my follow up in September to see what assays he is provided with or requests through lifespan. If they aren't the assays you recommend I will ask him to order those specifically through LabCorp. I hope it isn't an issue. In the meantime I will follow through with getting my upcoming labs done this Tuesday anyway then I will switch to every day dosing. That should give my system enough time to adjust and provide accurate results for my follow up and blood draw.

 

[Voltz]

When having blood work done you should be using the most accurate assays TT/e2/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Results of today's blood work. As I mentioned earlier I will pursue the recommended assays with my next appointment. Figured I'd post these anyway.

I also realized that the test results I previously posted were 7.5 days post injection not 6. These results are 6.5 days post injection @ the same 180mg. I realize some of these numbers may not be necessary to post but I figured I'd add them.

- Total test 793
- SHBG 19.2
- Free test 228.8
- Test bioavailable 548.1
- Estradiol 58.5
- TSH reflex 1.664
- Cholesterol mg/dl 154
- Triglycerides 165
- HDL 31
- LDL 90
- NON HDL 123
- Cholesterol total / HDL ratio 5.0
- B12 439
- Vitamin D 24.2
- Glucose 103
- Bun 18
- Creatinine 1.17
- Sodium 137
- Potassium 4.0
- Chloride 103
- C02 25
- Anion gap 9
- Calcium 9.3
- Hemoglobin A1c 5.3

 

[madman]

Results of today's blood work. As I mentioned earlier I will pursue the recommended assays with my next appointment. Figured I'd post these anyway.

I also realized that the test results I previously posted were 7.5 days post injection not 6. These results are 6.5 days post injection @ the same 180mg. I realize some of these numbers may not be necessary to post but I figured I'd add them.

- Total test 793
- SHBG 19.2
- Free test 228.8
- Test bioavailable 548.1
- Estradiol 58.5
- TSH reflex 1.664
- Cholesterol mg/dl 154
- Triglycerides 165
- HDL 31
- LDL 90
- NON HDL 123
- Cholesterol total / HDL ratio 5.0
- B12 439
- Vitamin D 24.2
- Glucose 103
- Bun 18
- Creatinine 1.17
- Sodium 137
- Potassium 4.0
- Chloride 103
- C02 25
- Anion gap 9
- Calcium 9.3
- Hemoglobin A1c 5.3

With a trough (almost 7 days post-injection) TT of almost 800 ng/dL and lowish SHBG 19.1 nmol/L then FT would be on the high end.

Your peak TT/FT/estradiol will be much higher.

Variance in Peak and Trough T Levels in Men Using Intramuscular T Injections

MP85-14 VARIANCE IN PEAK AND TROUGH TESTOSTERONE LEVELS IN MEN USING INTRAMUSCULAR TESTOSTERONE Bruno Nascimento*, Helen L Bernie, Elizabeth Schofield, John P. Mulhall, New York, NY INTRODUCTION AND OBJECTIVES In men using intramuscular testosterone (IM T), clinical experience shows us that...

www.excelmale.com

 

[Voltz]

With a trough (almost 7 days post-injection) TT of almost 800 ng/dL and lowish SHBG 19.1 nmol/L then FT would be on the high end.

Your peak TT/FT/estradiol will be much higher.

Variance in Peak and Trough T Levels in Men Using Intramuscular T Injections

MP85-14 VARIANCE IN PEAK AND TROUGH TESTOSTERONE LEVELS IN MEN USING INTRAMUSCULAR TESTOSTERONE Bruno Nascimento*, Helen L Bernie, Elizabeth Schofield, John P. Mulhall, New York, NY INTRODUCTION AND OBJECTIVES In men using intramuscular testosterone (IM T), clinical experience shows us that...

www.excelmale.com

Understood, consistent dosing yeilds much more stable peak and trough levels.

First sub q injection was today after labs@16mg. I know it's going to yeild much more consistent values. Hopefully there is an improvement in one or more areas. Doctor messaged me today to make recommendations due to my labs. He wanted to know how I felt about starting a low dose of anastrozole. I declined and told him about the switch to micro dosing and we will re evaluate during my next visit in September. I also mentioned the sensitive LC Ms Ms Estradiol test and his response was that the ultra sensitive test is used to detect estradiol levels below the threshold of detection on the standard assay. I can see it's going to be fun trying to convince him to request the labs you recommended from LabCorp.

 

[madman]

Understood, consistent dosing yeilds much more stable peak and trough levels.

First sub q injection was today after labs@16mg. I know it's going to yeild much more consistent values. Hopefully there is an improvement in one or more areas. Doctor messaged me today to make recommendations due to my labs. He wanted to know how I felt about starting a low dose of anastrozole. I declined and told him about the switch to micro dosing and we will re evaluate during my next visit in September. I also mentioned the sensitive LC Ms Ms Estradiol test and his response was that the ultra sensitive test is used to detect estradiol levels below the threshold of detection on the standard assay. I can see it's going to be fun trying to convince him to request the labs you recommended from LabCorp.

Smart move on avoiding the AI.

You can get labs $$$ on your own if need be.

Keep in mind that seeing as you are switching to daily injections (sub-q) that hormones will be in flux during the weeks leading up until blood levels stabilize (4-6 weeks) and during this transition it is common to experience ups/downs as the body is trying to adjust.

Many make the mistake of gauging the effectiveness of their protocol during this time which can be very misleading.

Once blood levels have stabilized it will take another 2-3 months for the body to fully adapt to those new levels and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

Need to give the new protocol atleast 12 weeks (including 4 weeks blood levels to stabilize) otherwise you are just wasting your time as you will be one of those poor bastards that keep tweaking his protocol (dose T/injection frequency) every 6 weeks because they do not feel great.

These are the same men that end up chasing their tales on that never-ending merry go round which is sure to end in failure!

The only time you would increase the T dose at the 6-week mark is if you truly felt unwell due to your trough T levels still being too low which is far from common.

Patience is key.

 

[Voltz]

You can get labs $$$ on your own if need be

I'm prepared to go that route if need be.

I was expecting it to take awhile for my system to adapt. Wasn't sure how long but with the information you provided I can now set a goal and stick it out in the event I start to feel discouraged.

I will update this post with September's blood work.

Thanks for the help

 

[robinhood_1984]

I hope you don't mind me jumping in here but this post has been incredibly enlightening as I'm in a very similar position to the OP, though I'm new to TRT.

According to my pre TRT labs, my SHBG was 16.4 (16.5 - 55.9) so very much at the lower end and it would seem, much lower than ideal.

My total testosterone was at 215 ng/dl (264-916) and my free testosterone was at 9.5 pg/mL (8.7 - 25.1)

Anyway, for the past 3 weeks I have been on my starting protocol of 180mg per week, split into 3 doses per werk of 60mg snd to be totally honest, since the second or third dose, all of my low T symptoms seem to have gotten noticeably worse and I felt pretty awful before.

Anyway, given what I've since learned about SHBG I am taking it upon myself to change my protocol and lower to approximately 100mg per week and shift to injecting every day snd remain with that until my 3 month labs etc.

As for the SHBG itself, I suspect that I have insulin resistance and I have been on an intermittent fasting regime for a couple of months now to try and reverse that, though since starting TRT I'm finding it very difficult to go 16 hours without eating, let alone my preferred 18, whereas it was pretty easy before.

Again, thanks for this great post, and others on this forum.

 

[Gus80]

I hope you don't mind me jumping in here but this post has been incredibly enlightening as I'm in a very similar position to the OP, though I'm new to TRT.

According to my pre TRT labs, my SHBG was 16.4 (16.5 - 55.9) so very much at the lower end and it would seem, much lower than ideal.

My total testosterone was at 215 ng/dl (264-916) and my free testosterone was at 9.5 pg/mL (8.7 - 25.1)

Anyway, for the past 3 weeks I have been on my starting protocol of 180mg per week, split into 3 doses per werk of 60mg snd to be totally honest, since the second or third dose, all of my low T symptoms seem to have gotten noticeably worse and I felt pretty awful before.

Anyway, given what I've since learned about SHBG I am taking it upon myself to change my protocol and lower to approximately 100mg per week and shift to injecting every day snd remain with that until my 3 month labs etc.

As for the SHBG itself, I suspect that I have insulin resistance and I have been on an intermittent fasting regime for a couple of months now to try and reverse that, though since starting TRT I'm finding it very difficult to go 16 hours without eating, let alone my preferred 18, whereas it was pretty easy before.

Again, thanks for this great post, and others on this forum.

If they are still active on the forum, please update us on microdosing protocols...

Dr Chrysler recommended cyp 25mg/eod subq.

The reports on jatenzo I've read so far, ed 2x, are excellent.

The closest thing to jatenzo in injectable esters is propionate. In my test I varied between 10mg and 20mg ED without side effects.