Help..? I feel worse than pre-TRT

Hi everyone, I’m hoping some experienced members here can help me out.

I’ve been on TRT since August, prescribed by a UK clinic due to secondary hypogonadism. My testosterone levels were initially between 3 nmol and 9 nmol.

When I started treatment, I mistakenly took the wrong dose, which led to excessively high levels. It took about two months to realize this mistake. My testosterone shot up to over 52 nmol, and my E2 (estradiol) spiked to over 700 pmol/L. After realizing this, I lowered my dose to 84 mg of testosterone cypionate daily and 750 IU of HCG split into three doses weekly. After a month on this protocol, my RBC and testosterone levels were slightly above the upper range, but my E2 was still very high at 363 pmol/L.

The clinic then advised me to lower my testosterone to 56 mg per week (injected daily) and HCG to 500 IU per week, which I've split into daily injection.

I’ve been on this lower dose for two weeks now, but I feel absolutely awful. My body feels heavy, I’m constantly exhausted, and my libido has completely disappeared. I’ve spoken to the clinic about introducing an AI (aromatase inhibitor) because I suspect my E2 is still too high, but they want to avoid adding anything while I adjust to the lower doses.

Right now, I feel worse than I did before starting TRT. I have a 7-month-old baby and work responsibilities, but I’m struggling to get through the day—I feel like I need to sleep all the time. I’m starting to wonder if TRT just isn’t for me.

The main issues seem to be my high E2 and elevated RBC levels. I currently take daily aspirin, nattokinase (50 mg every other day), and 5 mg tadalafil daily to help mitigate clot risks. I also have a blood condition, hereditary spherocytosis, and no spleen, which puts me at a higher risk for blood clots.

Has anyone experienced something similar or have any advice? I’m limited in how often I can contact the clinic (understandably, to avoid overwhelming their inbox), so I’m trying to figure this out as best as I can.

I really wanted TRT to work for me, but I’m surprised I feel this bad. Is this just part of the process of finding the right balance on TRT?

- I’m 36 years old, 6’1” tall, and weigh around 19 stone.
- I weight train twice a week, focusing on heavy powerlifting-style lifts with some accessory work, and I also cycle once a week. However, I’m often too tired to train more frequently.
- I have hereditary spherocytosis and had my spleen removed, which increases my risk of blood clots.
- I don’t smoke or drink and generally lead a healthy lifestyle, though I do overindulge in food occasionally. I enjoy eating, and I’ve noticed that carbs seem to make me gain weight easily.
- I know I need to lose a few stone, and I’m actively working on it.
- I was on propranolol for two years, which contributed to weight gain. I started taking it after experiencing a few panic attacks around the time I realized I had low testosterone. At this time when i have 3nmol it felt like the wheels where falling on with my anxiety and health, it was sudden and come out of nowhere. (when i looked back at past blood test it was showing when i was 28 i was 12nmol total testosterone so not great then either.)
- Before starting TRT, I spent two years trying to improve my lifestyle in hopes of naturally raising my testosterone levels to a healthy range.


If anyone can share some knowledge or insight on what the F* is going on? some days i wake up and i just feel horrendous and very weak.


thank you

Luke

Mill3r said:

Hi everyone, I’m hoping some experienced members here can help me out.

I’ve been on TRT since August, prescribed by a UK clinic due to secondary hypogonadism. My testosterone levels were initially between 3 nmol and 9 nmol.

When I started treatment, I mistakenly took the wrong dose, which led to excessively high levels. It took about two months to realize this mistake. My testosterone shot up to over 52 nmol, and my E2 (estradiol) spiked to over 700 pmol/L. After realizing this, I lowered my dose to 84 mg of testosterone cypionate daily and 750 IU of HCG split into three doses weekly. After a month on this protocol, my RBC and testosterone levels were slightly above the upper range, but my E2 was still very high at 363 pmol/L.

The clinic then advised me to lower my testosterone to 56 mg per week (injected daily) and HCG to 500 IU per week, which I've split into daily injection.

I’ve been on this lower dose for two weeks now, but I feel absolutely awful. My body feels heavy, I’m constantly exhausted, and my libido has completely disappeared. I’ve spoken to the clinic about introducing an AI (aromatase inhibitor) because I suspect my E2 is still too high, but they want to avoid adding anything while I adjust to the lower doses.

Right now, I feel worse than I did before starting TRT. I have a 7-month-old baby and work responsibilities, but I’m struggling to get through the day—I feel like I need to sleep all the time. I’m starting to wonder if TRT just isn’t for me.

The main issues seem to be my high E2 and elevated RBC levels. I currently take daily aspirin, nattokinase (50 mg every other day), and 5 mg tadalafil daily to help mitigate clot risks. I also have a blood condition, hereditary spherocytosis, and no spleen, which puts me at a higher risk for blood clots.

Has anyone experienced something similar or have any advice? I’m limited in how often I can contact the clinic (understandably, to avoid overwhelming their inbox), so I’m trying to figure this out as best as I can.

I really wanted TRT to work for me, but I’m surprised I feel this bad. Is this just part of the process of finding the right balance on TRT?

- I’m 36 years old, 6’1” tall, and weigh around 19 stone.
- I weight train twice a week, focusing on heavy powerlifting-style lifts with some accessory work, and I also cycle once a week. However, I’m often too tired to train more frequently.
- I have hereditary spherocytosis and had my spleen removed, which increases my risk of blood clots.
- I don’t smoke or drink and generally lead a healthy lifestyle, though I do overindulge in food occasionally. I enjoy eating, and I’ve noticed that carbs seem to make me gain weight easily.
- I know I need to lose a few stone, and I’m actively working on it.
- I was on propranolol for two years, which contributed to weight gain. I started taking it after experiencing a few panic attacks around the time I realized I had low testosterone. At this time when i have 3nmol it felt like the wheels where falling on with my anxiety and health, it was sudden and come out of nowhere. (when i looked back at past blood test it was showing when i was 28 i was 12nmol total testosterone so not great then either.)
- Before starting TRT, I spent two years trying to improve my lifestyle in hopes of naturally raising my testosterone levels to a healthy range.


If anyone can share some knowledge or insight on what the F* is going on? some days i wake up and i just feel horrendous and very weak.


thank you

Luke

Click to expand...

The clinic then advised me to lower my testosterone to 56 mg per week (injected daily) and HCG to 500 IU per week, which I've split into daily injection.

I’ve been on this lower dose for two weeks now, but I feel absolutely awful. My body feels heavy, I’m constantly exhausted, and my libido has completely disappeared. I’ve spoken to the clinic about introducing an AI (aromatase inhibitor) because I suspect my E2 is still too high, but they want to avoid adding anything while I adjust to the lower doses.




You need labs to see where your current protocol has your trough (24 hrs post-injection) TT and more importantly FT let alone estradiol.

Your are only 2 weeks in and have not even reached steady-state which will take 4-6 weeks when using TC/TE!

Your hormones are still in flux!

It is common for one to experience ups/downs when increasing or decreasing T dose as hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks) as the body is trying to adjust.

More importantly once blood levels have stabilized (4-6 weeks TC/TE) it will still take time (few months) for the body to adapt to it's new set-point and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being!

Most do not understand how exogenous T works and end up making the fatal mistake of tweaking their protocol (dose of T/injection frequency) 6 weeks in because they do not feel stellar!

Dead end road here!

As I have stated numerous times on the forum it's always best to start low and slow on a T only protocol.

Patience is key!

Coming down will always be harder than going up trust me on this one!

Would not even attempt throwing in an AI let alone tweaking your dose T/hCG until you have labs done otherwise you be running around chasing your tail until the cows come home.

Also keep in mind it will take months after lowering your steady-state/trough FT before you see a drop in hematocrit unless you have underlying issues that are also contributing to the high hematocrit such as sleep apnea, smoking, asthma, COPD

Your steady-state/trough FT level was through the roof when you started therapy due to a miscalculation of your dosing/wrong insulin syringe let alone when you lowered your T dose further you were still hitting a high hematocrit which was as of 2 weeks ago seeing as you just lowered your weekly dose of T again.

As I stated in your previous threads you need to make sure you know where your trough FT level truly sits.

Again even then although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Unfortunately you never had your FT tested as you posted FAI (free androgen index) which is not used/relied upon when testing FT.

You need to have your FT tested using what would be considered the most accurate assay which is the gold standard Equilibrium Dialysis especially in cases of altered SHBG in order to know where your FT level truly sits.

If you do not have access to such which is most likely the case seeing as you are from the UK than you will need to use/rely upon the go to calculated method which would be the linear law-of-mass action cFTV.

This can be done online for free using the linear law-of-mass action cFTV by plugging in your TT, SHBG and Albumin.


Just keep in mind that cFTV tends to overestimate FT.

As I have stated numerous times on the forum you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice (1st time was done using TT/SHBG assays no longer available) and was then eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Yes it tends to overestimate slightly but it is nothing to fret over!


* Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103].

Risk factors for developing erythrocytosis after testosterone therapy include:

• Obstructive sleep apnea
• Advanced age
• Obesity
• Type II diabetes mellitus
• Elevated baseline hematocrit (>50%)
• Those who live in high altitudes
• Testosterone formulation, dose and pharmacokinetics
  
  • Short-acting intramuscular (IM) formulations result in supraphysiological testosterone levels achieved days after administration.
  • Extended-release injectable testosterone and transdermal options maintain physiological testosterone levels more effectively and reduce the risk of secondary erythrocytosis.

• Risk/rate of erythrocytosis according to formulation:
  
  
  • Intramuscular injections – 40%
  • Subcutaneous pellets – 35%
  • Transdermal – 15%
  • Androgel – 3%
  • Intranasal testosterone – 0–2%
  • Oral testosterone – 0.03%

Mill3r said:

I really wanted TRT to work for me, but I’m surprised I feel this bad. Is this just part of the process of finding the right balance on TRT?

Click to expand...

HCG can cause side effects for some men, making dialing in on TRT impossible. It's best to start TRT in isolation, changing one variable at a time, adjust dosing up or down, changing shot frequencies to find out what works best. This way you're only dealing with one variable at a time.

Systemlord said:

HCG can cause side effects for some men, making dialing in on TRT impossible. It's best to start TRT in isolation, changing one variable at a time, adjust dosing up or down, changing shot frequencies to find out what works best. This way you're only dealing with one variable at a time.

Click to expand...

I think if my next bloods on the next few weeks come back out of whack I may have to drop HCG. If my HCT is above 54% im guessing the clinic will want me to stop treatment all together.

madman said:

Best possible method of Minimizing Erythrocytosis during TRT (Daily injectables vs. Gels vs. Kyzatrex)

All, I react very badly to injectable T (56 hematocrit @ 100 mg split 3x per week SubQ). My ferritin suffers greatly here and sits in the 20's to low 30's. I want it to be above 70. Testosterone have given me a severe case of periodic limb movement disorder due to low dopamine resulting (I...

www.excelmale.com

Testosterone Therapy and Erythrocytosis - the most common dose-limiting effect of testosterone therapy

https://www.thebloodproject.com/cases-archive/testosterone-therapy-and-erythrocytosis-2/ Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis Muscle and bone health Cognitive function...

www.excelmale.com

Risk factors for developing erythrocytosis after testosterone therapy include:

• Obstructive sleep apnea
• Advanced age
• Obesity
• Type II diabetes mellitus
• Elevated baseline hematocrit (>50%)
• Those who live in high altitudes
• Testosterone formulation, dose and pharmacokinetics
  
  • Short-acting intramuscular (IM) formulations result in supraphysiological testosterone levels achieved days after administration.
  • Extended-release injectable testosterone and transdermal options maintain physiological testosterone levels more effectively and reduce the risk of secondary erythrocytosis.

• Risk/rate of erythrocytosis according to formulation:
  
  
  • Intramuscular injections – 40%
  • Subcutaneous pellets – 35%
  • Transdermal – 15%
  • Androgel – 3%
  • Intranasal testosterone – 0–2%
  • Oral testosterone – 0.03%

Click to expand...

I like the sound of the Oral stuff like Kyza but I dont like the cost..

madman said:

The clinic then advised me to lower my testosterone to 56 mg per week (injected daily) and HCG to 500 IU per week, which I've split into daily injection.

I’ve been on this lower dose for two weeks now, but I feel absolutely awful. My body feels heavy, I’m constantly exhausted, and my libido has completely disappeared. I’ve spoken to the clinic about introducing an AI (aromatase inhibitor) because I suspect my E2 is still too high, but they want to avoid adding anything while I adjust to the lower doses.




You need labs to see where your current protocol has your trough (24 hrs post-injection) TT and more importantly FT let alone estradiol.

Click to expand...

Yes i do every blood test before my next injection, I inject daily.

madman said:

Your are only 2 weeks in and have not even reached steady-state which will take 4-6 weeks when using TC/TE!

Your hormones are still in flux!

It is common for one to experience ups/downs when increasing or decreasing T dose as hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks) as the body is trying to adjust.

More importantly once blood levels have stabilized (4-6 weeks TC/TE) it will still take time (few months) for the body to adapt to it's new set-point and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being!

Click to expand...

I understand what your saying but my point is if i feel like death now then surely it will get worse when i find my new set point as it will be much lower? At this point, I'm trying to find the benefit of TRT if I feel like I did before, but now I have the extra risk of clots etc due to the RBCs being elevated. Before treatment, my HCT always sat around 0.44, and my RBC was all in range.

madman said:

Most do not understand how exogenous T works and end up making the fatal mistake of tweaking their protocol (dose of T/injection frequency) 6 weeks in because they do not feel stellar!

Dead end road here!

As I have stated numerous times on the forum it's always best to start low and slow on a T only protocol.

Click to expand...

I was meant to start lower. Initially, the clinic said 100mg as a start, but I opted for 84mg to stay on the side of caution; as mentioned, I messed up and used the wrong dose, which was 2.5 x times, which probably has fast-tracked my elevated RBCs.

madman said:

Patience is key!

Coming down will always be harder than going up trust me on this one!

Would not even attempt throwing in an AI let alone tweaking your dose T/hCG until you have labs done otherwise you be running around chasing your tail until the cows come home.

Also keep in mind it will take months after lowering your steady-state/trough FT before you see a drop in hematocrit unless you have underlying issues that are also contributing to the high hematocrit such as sleep apnea, smoking, asthma, COPD

Click to expand...

Yes, this is what I feared: that my high dose initially made my RBCs shoot up, and with my elevated ferritin before treatment of 700+, it was like throwing gas on the production of RBCs.
The slight increase in HCT when I moved from the wrong dose to 84mg was still due to that first wrong dose, and I'm hoping next time I will start to see this trend back down, but it has taken a couple of months to show it. My haematologist has seen these results and was too concerned at this stage and said not to go past 54% HCT.

madman said:

Your steady-state/trough FT level was through the roof when you started therapy due to a miscalculation of your dosing/wrong insulin syringe let alone when you lowered your T dose further you were still hitting a high hematocrit which was as of 2 weeks ago seeing as you just lowered your weekly dose of T again.

As I stated in your previous threads you need to make sure you know where your trough FT level truly sits.

Again even then although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Unfortunately you never had your FT tested as you posted FAI (free androgen index) which is not used/relied upon when testing FT.

You need to have your FT tested using what would be considered the most accurate assay which is the gold standard Equilibrium Dialysis especially in cases of altered SHBG in order to know where your FT level truly sits.

If you do not have access to such which is most likely the case seeing as you are from the UK than you will need to use/rely upon the go to calculated method which would be the linear law-of-mass action cFTV.

This can be done online for free using the linear law-of-mass action cFTV by plugging in your TT, SHBG and Albumin.

Free & Bioavailable Testosterone calculator

Just keep in mind that cFTV tends to overestimate FT.

As I have stated numerous times on the forum you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice (1st time was done using TT/SHBG assays no longer available) and was then eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Yes it tends to overestimate slightly but it is nothing to fret over!


* Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103].

Click to expand...

I have used the balance my hormones calculator to work out free testosterone which can be seen on the excel snip and my free testosterone was 0.776nmol/L before i reduced my weekly testosterone to 56mg. I have another blood test plan for 3 weeks time.

Mill3r said:

Yes i do every blood test before my next injection, I inject daily.


I understand what your saying but my point is if i feel like death now then surely it will get worse when i find my new set point as it will be much lower? At this point, I'm trying to find the benefit of TRT if I feel like I did before, but now I have the extra risk of clots etc due to the RBCs being elevated. Before treatment, my HCT always sat around 0.44, and my RBC was all in range.



I was meant to start lower. Initially, the clinic said 100mg as a start, but I opted for 84mg to stay on the side of caution; as mentioned, I messed up and used the wrong dose, which was 2.5 x times, which probably has fast-tracked my elevated RBCs.

Yes, this is what I feared: that my high dose initially made my RBCs shoot up, and with my elevated ferritin before treatment of 700+, it was like throwing gas on the production of RBCs.
The slight increase in HCT when I moved from the wrong dose to 84mg was still due to that first wrong dose, and I'm hoping next time I will start to see this trend back down, but it has taken a couple of months to show it. My haematologist has seen these results and was too concerned at this stage and said not to go past 54% HCT.



I have used the balance my hormones calculator to work out free testosterone which can be seen on the excel snip and my free testosterone was 0.776nmol/L before i reduced my weekly testosterone to 56mg. I have another blood test plan for 3 weeks time.

Click to expand...

I understand what your saying but my point is if i feel like death now then surely it will get worse when i find my new set point as it will be much lower? At this point, I'm trying to find the benefit of TRT if I feel like I did before, but now I have the extra risk of clots etc due to the RBCs being elevated. Before treatment, my HCT always sat around 0.44, and my RBC was all in range.


Just to be clear you need to wait until you reach steady-state (4-6 weeks TC/TE) then have your blood work done at true trough (24 hrs) post-injection.

Again you are only 2 weeks in and your hormones are in flux which can cause one to feel shitty especially if you have just decreased your weekly dose of T as the body is trying to adjust.

Your FT was sky-high from the get go when you started therapy and still high when you finally lowered your dose further.

You just decreased your dose again 2 weeks ago.

This is going to be a big shock to your system!

Unless something is drastically out of whack when your labs come back then you would need to ride it out.

Chances are if you still feel like garbage at the 6 week mark something will stand out on labs.

If so then you will need to decide your next move and what changes may need to be made.

madman said:

I understand what your saying but my point is if i feel like death now then surely it will get worse when i find my new set point as it will be much lower? At this point, I'm trying to find the benefit of TRT if I feel like I did before, but now I have the extra risk of clots etc due to the RBCs being elevated. Before treatment, my HCT always sat around 0.44, and my RBC was all in range.


Just to be clear you need to wait until you reach steady-state (4-6 weeks TC/TE) then have your blood work done at true trough (24 hrs) post-injection.

Again you are only 2 weeks in and your hormones are in flux which can cause one to feel shitty especially if you have just decreased your weekly dose of T as the body is trying to adjust.

Your FT was sky-high from the get go when you started therapy and still high when you finally lowered your dose further.

You just decreased your dose again 2 weeks ago.

This is going to be a big shock to your system!

Unless something is drastically out of whack when your labs come back then you would need to ride it out.

Chances are if you still feel like garbage at the 6 week mark something will stand out on labs.

If so then you will need to decide your next move and what changes may need to be made.

Click to expand...

Thanks for the reply.

This is definitely a right of passage; I was ignorant of the process; I didn't expect it to take this long to feel better, etc. I can see how the NHS one-trick protocol is like a sledgehammer approach.


In regards to HCG. I'm now on 500IU per week, which is now taking micro dosing daily, but from my research, I keep seeing conflicting results. Some say a daily dose helps recreate the natural production, and some say higher doses less often are better as HCG tends to have a double spike, and it's more effective when taken in large, less frequent doses. I need to try and get my e2 down, so I would like to try working on that with the HCG. Do you think there is much difference between daily or 3 times-a-week doses?

Mill3r said:

Thanks for the reply.

This is definitely a right of passage; I was ignorant of the process; I didn't expect it to take this long to feel better, etc. I can see how the NHS one-trick protocol is like a sledgehammer approach.


In regards to HCG. I'm now on 500IU per week, which is now taking micro dosing daily, but from my research, I keep seeing conflicting results. Some say a daily dose helps recreate the natural production, and some say higher doses less often are better as HCG tends to have a double spike, and it's more effective when taken in large, less frequent doses. I need to try and get my e2 down, so I would like to try working on that with the HCG. Do you think there is much difference between daily or 3 times-a-week doses?

Click to expand...

Comes down to the minimum weekly dose needed in order to stimulate maximum ITT (intratesticular testosterone)!

500 IU whether injected once weekly or split into more frequent injection is most likely too low a weekly dose to derive the maximum benefits!

If anything I would be aiming for 250 IU 3X weekly or better yet 500 IU 2-3X weekly.







As you should know the only way to minimize/prevent testicular atrophy let alone maintain fertility when on exogenous T would be through the use of hCG or hCG + FSH unless you plan on using T formulations which will have the least impact such as nasal T-gel or you could throw oral TU (Kyzatrex) in there too!

Catch 22 here is when adding hCG to TTh depending on the dose used not only will it drive up your TT and more importantly FT but also drive up estradiol and in some cases much more than expected depending on how the individual responds to said protocol (dose/injection frequency).

Some men experience a big jump in estradiol which can cause issues for some especially when it comes to libido and erectile function/penile sensitivity.

It is pretty much a given that in most cases use of hCG or better yet hCG + FSH will minimize/prevent testicular atrophy and maintain fertility.

Far from a given that it is going to have a positive impact on your mood, libido and erectile function/sensitivity!

Some feel great when using hCG whereas others may struggle!

Only time will tell through trial and error.

My reply from a previous thread:

If you are just starting TTh then in order to minimize/prevent testicular atrophy 1500 IU once weekly should suffice or better yet 500 IU 2-3X weekly.

The sweet spot would most likely be 250-500 IU 2-3X weekly in order to stimulate maximum ITT (intratesticular testosterone) production which should have a strong impact on minimizing/preventing testicular atrophy and maintaining fertility.

In some cases especially when it comes to fertility the addition of FSH may be needed

If you have been on TTh solo for a long time (years) then you will most likely need much higher doses then 1500 IU once weekly/500 IU twice weekly as your leydig cells will have been dormant for so long and they are more prone to being what we call stubborn to the LH signal.