Switch to IM from SQ? Lower E2? Sleep, digestion, maybe lower Free T...

[eyeheartny]

Long-term TRT patient, current protocol is 154mg/week in EOD SubQ shots (into thigh, belly, hip, etc). I've struggled on and off with digestion issues (constipation) and lack of deep sleep. A few months ago I started intermittent fasting and it's been good for dropping some weight. That combined with lots of cardio has also raised my SHBG a bit, which is good based on where it was before (up to 29 nmol/L from 20 nmol/L a year ago).

I got bloodwork done recently because my sleep quality has declined dramatically and my constipation has been worse despite plenty of water and fiber once I break my fast in the afternoon. I'm also retaining water in my hands after I wake up in the morning (Oura sleep ring hard to remove). I take 2.5mg of tadalafil every morning, which I know has long-term effects of shifting the T:E2 ratio toward more T and lower E2. I've been on that about a year. Constipation was better a year ago prior to that addition. Sleep was best a few months ago. No changes to protocol during that time. I am now fasting. I slept great the first few months I was fasting so I don't think it's that.

Test	Result	Range
Testosterone, Total	709.40 ng/dL	240.24 - 870.68 ng/dL
Estradiol, Sensitive (Quest Diagnostics)	34 * H * pg/mL	< or = 29 pg/mL
Sex Hormone Binding Globulin	29 nmol/L	13 - 71 nmol/L
Testosterone, Free Calculation	132 pg/mL	47 - 244 pg/mL

Couple of questions. First, according to the TruT calculator, my free T (based on SHBG and albumin of 3.9) is closer to 271.5 pg/mL. Even the older Vermeulen calculator has me around 215 pg/mL. I'm not too bothered by the number but it's notable how wide the spread is.


In terms of things to try tweaking, I have a few options in mind:

• Switch from SQ to shallow IM shots
• Keep T the same and try a low dose of exemestane to see if lowering that E2 level helps with constipation and sleep
• Raise or lower my T dose a bit to try to target a higher Free T or E2 or lower E2 level

What would you guys recommend?

 

[Jurek Kletsy]

What makes you think lowering your estradiol wil solve the issues you're having?
If anything, I would only raise your T dose and see what happens. But there are so much more variables to consider: diet, stress, sleeping habits...

 

[eyeheartny]

What makes you think lowering your estradiol wil solve the issues you're having?
If anything, I would only raise your T dose and see what happens. But there are so much more variables to consider: diet, stress, sleeping habits...

in the past I’ve lowered my estradiol and my constipation has improved. My sleep has also been better when my E2 was lower. This was of course when my SHBG was lower as well, so my free T was comparatively higher. So that makes me wonder about raising my dose as you suggested to try and boost that free T level.

Stress is very high, sleep habits are decent, diet is good. None of those account for the digestive issues which seem to be tied to hormone levels for me.

 

[Cataceous]

While there are exceptions, I'd say most reports tie higher levels of testosterone to poor sleep. And we would naturally have lower serum testosterone overnight until it starts rising in the early morning hours. If you don't mind greater complexity in your protocol then you could experiment with daily morning injections of a propionate/cypionate blend. I found that switching to such a protocol somewhat improved my sleep quality.

Serum testosterone of ~700 ng/dL seems low for such a high dose of testosterone and normal SHBG. I assume this is at trough, although typically there's not a lot of variation on an EOD cypionate protocol. If accurate it could be reflecting faster than usual absorption and/or metabolism. In general you can expect free testosterone to be proportional to your dose of testosterone, barring significant changes in underlying metabolism.

 

[eyeheartny]

Serum testosterone of ~700 ng/dL seems low for such a high dose of testosterone and normal SHBG. I assume this is at trough, although typically there's not a lot of variation on an EOD cypionate protocol. If accurate it could be reflecting faster than usual absorption and/or metabolism. In general you can expect free testosterone to be proportional to your dose of testosterone, barring significant changes in underlying metabolism.

Yes, test was at trough. Would there be any merit to trying IM to see if it changes the metabolism? Are there any concerns with the fact that I appear to metabolize testosterone fast? Would this point toward doing daily shots as a better option? I inject at night before bed but could also switch to daily AM shots. Would be grateful for any recommendations and thoughts.

 

[Cataceous]

I don't see much to gain in switching to IM. It could lead to marginally faster absorption, increasing peak levels and decreasing the troughs. You can try to get an idea of your absorption speed by attempting to measure a serum peak or even by measuring on a non-injection day. For me, an EOD protocol with a longer ester resulted in negligible variation. If you had substantially higher peak or off-day levels then that would point to fast absorption and an unusually short apparent half-life for you. If you didn't detect much of a difference then that would point to faster underlying metabolism, which results in lower levels of testosterone. I don't know if there are any negative associations with having a faster clearance rate of testosterone.

You have to weigh whether you think experimenting with daily injections and multiple esters is worth the hassle. While I like this approach myself, the benefits, if any, may be subtle.

 

[eyeheartny]

I don't see much to gain in switching to IM. It could lead to marginally faster absorption, increasing peak levels and decreasing the troughs. You can try to get an idea of your absorption speed by attempting to measure a serum peak or even by measuring on a non-injection day. For me, an EOD protocol with a longer ester resulted in negligible variation. If you had substantially higher peak or off-day levels then that would point to fast absorption and an unusually short apparent half-life for you. If you didn't detect much of a difference then that would point to faster underlying metabolism, which results in lower levels of testosterone. I don't know if there are any negative associations with having a faster clearance rate of testosterone.

You have to weigh whether you think experimenting with daily injections and multiple esters is worth the hassle. While I like this approach myself, the benefits, if any, may be subtle.

Appreciate this very much. I don't think it's worth the trouble at this point to try dailies or multiple esters.

Interestingly, I tried a few things last night/today that seem to have helped with both sleep and constipation. I applied a little bit of progesterone cream to my scrotum before bed last night and slept pretty well, much more deep sleep. I also took 25mg of DHEA last evening. This morning I took 20mg of pregnenolone as well as another 25mg DHEA pill. Constipation was much relieved today. So my issues may be unrelated to testosterone and more about other hormones. I know that progesterone can act in opposition to estradiol, and I know that preg can also help produce other downstream hormones, so I wonder if I've been deficient in something downstream and the preg, prog, and DHEA helped. I'll keep trying the combo and see how things go.

 

[Cynice49]

Appreciate this very much. I don't think it's worth the trouble at this point to try dailies or multiple esters.

Interestingly, I tried a few things last night/today that seem to have helped with both sleep and constipation. I applied a little bit of progesterone cream to my scrotum before bed last night and slept pretty well, much more deep sleep. I also took 25mg of DHEA last evening. This morning I took 20mg of pregnenolone as well as another 25mg DHEA pill. Constipation was much relieved today. So my issues may be unrelated to testosterone and more about other hormones. I know that progesterone can act in opposition to estradiol, and I know that preg can also help produce other downstream hormones, so I wonder if I've been deficient in something downstream and the preg, prog, and DHEA helped. I'll keep trying the combo and see how things go.

Have read some of your other threads, any updates to your protocol?