Balance Acne TRT Side Effects and Symptom Relief

[futbolplayer]

Hello,

I am a 31 y.o male who has been on and off TRT for around 5+ years. I've recently had a problem finding a balance in receiving the benefits of TRT without side effects. When I dose TRT at 2x60mg per week (120mg total), I have complete symptom resolution. However, I have noticed at the dosage I begin to have out of control acne, oily skin, and also begin to get the appearance of tiny specs on my skin. I looked up what these red specs were and came across the term "cherry angiomas." While causes of these tiny red dots are usually hereditary, I did find from multiple sources these have been linked to elevated estrogen levels.

My philosophy is to always avoid as many medications as necessary, so I have avoided jumping to adding an AI at my 120mg dosage (with the assumption that estrogen is the issue). Instead, I have tried to lower my dosage to around 80mg-90mg a week, to see if I can get symptom resolution without these skin related side effects. I am injecting subcutaneously anyways and have heard this is an acceptable dosage for subq. On a dosage of 120mg per week, my total testosterone level was around 1200 ng/dl. While I understand that is a bit above the normal range, it seems I only get symptom resolution when my levels are this high. Perhaps I can get opinions on how I can get this symptom resolution as a lower dosage (this is ideally what I am after).

My question to the forum members is as follows. I am injecting subcutaneously twice a week. Can I get away with a lower dosage of 80mg-90mg per week to maintain the benefits of TRT and reduce the side effects I am experiencing? If this is possible, how long does it typically take for the body to adjust to see if this dosage will work? I dropped down to ~90mg per week around 2 weeks ago and I am back to my orignal symptoms before starting TRT (low libido, ED and low energy).

I am looking recommended strategies to deal with my situation and people's opinions on what may be the cause. To summarize, I feel great at around 120mg per week, however I experience skin related side effects that are intolerable. I am trying to lower my dosage to mitigate these side effects but I loose the benefits of TRT when doing so. The main symptoms I use TRT to treat are low libido, low energy, ED, and low grade depression. I have a script for HCG but have yet to add it to my regimen as I am trying to minimize variables to get dialed in at a lower dosage.

Thank you.

 

[stx359]

I also had terrible, acne, hematocrit and sleep issues on 70 mg test cyp twice a week all of which resolved by switching to daily injections under Dr. Saya's care. I started at 20 mg daily, then 18 mg, then 16 mg, now 14 mg which is a total weekly does of 98 mg. My last labs were a TT of 1020. It is fascinating how little test cyp you need to maintain testosterone levels using sub q daily and my skin is perfectly clear which was NOT the case before. My skin was torture to me and I looked like a leper. Some patients are just more sensitive to those massive peaks.

 

[futbolplayer]

Hey stx359,

Thanks for the quickly reply. Any experience with the tiny reds dots on the skin by chance as well? I've had to have at least 30-50 of these pop up over the course of a year once my dosage got to 120mg/week. I appreciate your response and it seems like daily subq dosing might be in my next experiment. It's great to hear you have symptom resolution and clear skin now -- I hope this is in my future as well. Do you use HCG by chance as well?

 

[stx359]

Hey stx359,

Thanks for the quickly reply. Any experience with the tiny reds dots on the skin by chance as well? I've had to have at least 30-50 of these pop up over the course of a year once my dosage got to 120mg/week. I appreciate your response and it seems like daily subq dosing might be in my next experiment. It's great to hear you have symptom resolution and clear skin now -- I hope this is in my future as well. Do you use HCG by chance as well?

I have not dealt with the red dots but that would bother me as well. I do use HCG at 150 IU a day and DHEA 25 mg twice a day (a high dose by most standards).

 

[futbolplayer]

Thanks for the input. I am going to try to lower the test to around 80-90mg per week. If this fails, I will start experimenting with the daily injections. Yes, the red dots are bothersome and are correlated with around the time I started to get acne on the TRT. To me it is too coincidental to not be related. Research tells me they are related to elevated estrogen states. I believed I am getting spikes in testosterone, which in turn is causing spikes in estrogen with my current dosing regimen. I will keep everyone posted.

 

[Cataceous]

Dose reductions can be difficult. It does seem as though many guys get low-T symptoms for at least a month or two. But once you adapt to the lower dose then things should be better, especially when starting from such high serum testosterone as you are. Your protocol of 120 mg (T cyp?) per week is giving you 12 mg per day of testosterone. This is well above the 3-9 mg range of endogenous production seen in normal men. Your new protocol will put you at the top of the range with 8-9 mg per day.

If in the end you are unable to find a balance point between low- and high-T symptoms then you might consider a more esoteric protocol. Daily use of a propionate/cypionate blend may allow use of less testosterone while keeping the benefits. The hypothesis is that some of the benefits of testosterone relate more to daily peak levels than to average levels. Normal men have significant variation in daily testosterone, so it could make sense to emulate this.

 

[futbolplayer]

Cataceous, I appreciate your input on this matter. I have a lot of things to consider and implement over the coming months. I am going to start with first allowing my body 1-2 months to adapt to the drop in testosterone levels and see if my symptoms will abate. Should that fail, I will likely begin the experiment of daily injections or talk to my doctor about a blend. I am very grateful with the input from the forum members in terms of getting myself back to a high quality level of life. I will continue to keep everyone posted on the solutions I implement and their effects. For now, It is simply a waiting game for the next 1-2 months.

Thanks again.

 

[futbolplayer]

Hey just a follow up to the previous poster. Any idea on why it takes the body this amount of time to adjust?

 

[S1W]

Cataceous, I appreciate your input on this matter. I have a lot of things to consider and implement over the coming months. I am going to start with first allowing my body 1-2 months to adapt to the drop in testosterone levels and see if my symptoms will abate. Should that fail, I will likely begin the experiment of daily injections or talk to my doctor about a blend. I am very grateful with the input from the forum members in terms of getting myself back to a high quality level of life. I will continue to keep everyone posted on the solutions I implement and their effects. For now, It is simply a waiting game for the next 1-2 months.

Thanks again.

Please do update this thread to let us know how things went for you.

 

[futbolplayer]

Changed my routine to 3x26mg and 3x150 IU per week HCG. Hoping to reduce acne and other skin related side effects which I believe are related to elevated estrogen states. I will keep everyone posted on the results in 4-6 weeks as I adapt to the changes. I am back to a lot of pre-TRT symptoms most days currently at this lower dosage.

 

[futbolplayer]

Been about 4 weeks and I have dropped my dosage down to at times 70mg per week. No reduction in acne and all the low-t symptoms I had before starting TRT. I've become very fatigued and have extreme ED. I am bumping the dosage up to somewhere between 90-100mg right now and experimenting with 2x.125mg Arimidex weekly. Any advice or suggestions?

 

[calmcalmcalm]

I also had terrible, acne, hematocrit and sleep issues on 70 mg test cyp twice a week all of which resolved by switching to daily injections under Dr. Saya's care. I started at 20 mg daily, then 18 mg, then 16 mg, now 14 mg which is a total weekly does of 98 mg. My last labs were a TT of 1020. It is fascinating how little test cyp you need to maintain testosterone levels using sub q daily and my skin is perfectly clear which was NOT the case before. My skin was torture to me and I looked like a leper. Some patients are just more sensitive to those massive peaks.

Can I ask where is your injection site? I am considering rotating between left and right love handles but is that okay to do for ED or EOD injection? I am worried about the scar tissue build up.

 

[calmcalmcalm]

Been about 4 weeks and I have dropped my dosage down to at times 70mg per week. No reduction in acne and all the low-t symptoms I had before starting TRT. I've become very fatigued and have extreme ED. I am bumping the dosage up to somewhere between 90-100mg right now and experimenting with 2x.125mg Arimidex weekly. Any advice or suggestions?

You should try EOD or ED injection, Dr Saya told me the stable levels would most likely help with estrogen issues.

 

[futbolplayer]

I alternate between the fat to the left and the right of the belly button. My supposition is that my issue is related to high estrogen. Could I be wrong? Absolutely. I have tried a lower dosage for 4-6 weeks now without any resolution in symptoms or improvement in acne. I seem to have this issue where I cannot get symptom resolution on a lower dosage and begin to get skin related side effects at a dosage that eliminates my symptoms. It's very frustrating but also the reason I have begun to experiment with an AI. I have always struggled with acne on TRT, even at dosages as low at 60mg per week. I think biologically I have issues with estrogen and perhaps a liver that does not clear it quick enough. I have MTHR mutation, which is a detox pathway issue. Perhaps this is playing a part in my issues?

If I am unsuccessful with a dosage of around 90mg with a small amount of AI each week, I will likely switch to daily injections of around 10-14mg.

This skin related side effects I am having are cystic acne on back, chest, and shoulder. I also get these occasional red pin pricks dots on my skin that I have learned through my research are called Cherry Angiomas. While the exact causes of them vary, they have been linked to hormonal changes, specifically elevated estrogen states. Thus, my desire to begin to experiment with an estrogen blocker. I am starting at a very low dosage of .125mg twice a week.

My current routine, pinning 30mg test cypionate 3x per week and taking .125mg arimidex twice a week. Should my acne begin to clear up on this routine, I think it'll be safe to conclude my issue is estrogen related. Updates will follow.

 

[calmcalmcalm]

I alternate between the fat to the left and the right of the belly button. My supposition is that my issue is related to high estrogen. Could I be wrong? Absolutely. I have tried a lower dosage for 4-6 weeks now without any resolution in symptoms or improvement in acne. I seem to have this issue where I cannot get symptom resolution on a lower dosage and begin to get skin related side effects at a dosage that eliminates my symptoms. It's very frustrating but also the reason I have begun to experiment with an AI. I have always struggled with acne on TRT, even at dosages as low at 60mg per week. I think biologically I have issues with estrogen and perhaps a liver that does not clear it quick enough. I have MTHR mutation, which is a detox pathway issue. Perhaps this is playing a part in my issues?

If I am unsuccessful with a dosage of around 90mg with a small amount of AI each week, I will likely switch to daily injections of around 10-14mg.

This skin related side effects I am having are cystic acne on back, chest, and shoulder. I also get these occasional red pin pricks dots on my skin that I have learned through my research are called Cherry Angiomas. While the exact causes of them vary, they have been linked to hormonal changes, specifically elevated estrogen states. Thus, my desire to begin to experiment with an estrogen blocker. I am starting at a very low dosage of .125mg twice a week.

My current routine, pinning 30mg test cypionate 3x per week and taking .125mg arimidex twice a week. Should my acne begin to clear up on this routine, I think it'll be safe to conclude my issue is estrogen related. Updates will follow.

So you only rotated between left and right belly fat everyday? No other injection site? Do you have any scar tissue?

I would advise you to stop trying to play around with the dosage and try to do EOD or ED injection

 

[futbolplayer]

No scar tissue as it is just subcutaneous. I am currently trying 3x per week, which is essentially EOD. Will increase frequency if necessary.

 

[futbolplayer]

Libido and erections are back on 30mg 3x per week with .125 mg arimidex 2x per week. I think I discovered the problem being estrogen, we'll see if the acne begins to fade as well. I've had some nighttime erections which hasn't happened in years. I am very happy. I am not pro nor con arimidex, however it seems to be giving me symptom relief I have not found any other way. Thus, I am happy to use it and not quick to remove it at this point.

 

[calmcalmcalm]

Did you take any bloodwork prior to starting the AI?
How about your mental state? Any anxiety or depression?

 

[futbolplayer]

No blood work prior to the AI, this has all been experimentation by myself. In the past however, when I have suspected high estrogen, I have come back with pretty normal blood work for E2. Usually, it is around 20 pg/ml, which is right where you want it to be. However, I am measuring estrogen in the trough and my theory is that it is elevated during other times of the week.

I have tried literally everything else apart from using an AI because I am generally against the idea. It is without a doubt the fix in my case and I am grateful. I just hope there isn't any long-term effects from taking it because it works so well for me.

Nothing in terms of mental effects, I have no depression nor anxiety that I can note, in fact I feel pretty damn good right now. I'd say I had depression and anxiety from the fact that I couldn't get dialed in. We will see if the last issue, that is my skin side effects, resolve from this added AI. I am also on an incredibly low dosage. I had acne on dosages as low as 60mg test cyp per week, so I just think my body handles estrogen really poorly. This is 100% the best I have ever felt on TRT and I am looking to hear others input about the long-term safety on an AI at this dsoage.

I think with acne and cherry angiomas, both symptoms of elevated estrogen, I have found my fix. I will see if these skin symptoms go away. I will say I had neither of these skin side effects when my TRT clinic was adding AI to my TRT cyp without me realizing. So I do think I finally found my fix

Now if others can just chime in about the long-term safety of an AI.

 

[Tman]

Been about 4 weeks and I have dropped my dosage down to at times 70mg per week. No reduction in acne and all the low-t symptoms I had before starting TRT. I've become very fatigued and have extreme ED. I am bumping the dosage up to somewhere between 90-100mg right now and experimenting with 2x.125mg Arimidex weekly. Any advice or suggestions?

Check your estradial levels...too high?