Dialing Test-C dose in and Eliminating 'Need' for AI

[Jackerreed]

Hey all recent member, been on TRT for six years now and have been having some issues getting my dose dialed in. I've been given permission by my doctor to reduce my dose albeit without much direction on what amounts to decrement my dose by. I'm having an issue figuring out how to handle this as I cannot tell whether the effects that I am feeling are due to the AI I am taking or if it is due to a dose of testosterone that is too high.

Current protocol, including prescription medication:

4g fish oil,
One multivitamin (pure encapsulations)
15mg Zinc Picolinate
110mg Testosterone Cypionate every 3 days
.125mg Anastrozole 2 days post-injection
500IU HCg day of injection
30mg DHEA
110mg Bupropion daily
40mg Vyvanse daily

What I've noticed:

I feel great when dosing my testosterone and frankly this continues through to the day that I take my AI, at which point I feel a significant reduction in my ability to pay attention to detail and concentrate on work. What I'll mention with the AI is that I'm not 100% certain I actually need to be on this as my estrogen prior to starting the AI was sitting right in the middle (44pg/mL ref range: 19.00-60.00pg mL), whereas now it's consistently sitting between 16.00-22pg/mL

The effect I've felt from taking the AI has led to some difficulties at work and with my interactions with others, specifically in that I become frustrated from these effects and their impact on my work and feel a bit too aggressive when called out on it.

This has led to effects which the secondary medications (bupropion & vyvanse) seem to resolve although there's another list of side effects associated with those medications but yeah that's a different story.

My line of thinking is that my dose of Testosterone may be off by ~20-30mg and that by reducing the dose I could eliminate the need to take an AI, if there ever was a need at all. That being said I can't tell whether I should eliminate AI from my regimen, wait 2 weeks, and then re-test, or eliminate both at the same time. The latter option doesn't seem right as this would be affecting more than one variable.

Any advice in the matter would be greatly appreciated.

 

[tareload]

Hey all recent member, been on TRT for six years now and have been having some issues getting my dose dialed in. I've been given permission by my doctor to reduce my dose albeit without much direction on what amounts to decrement my dose by. I'm having an issue figuring out how to handle this as I cannot tell whether the effects that I am feeling are due to the AI I am taking or if it is due to a dose of testosterone that is too high.

Current protocol, including prescription medication:

4g fish oil,
One multivitamin (pure encapsulations)
15mg Zinc Picolinate
110mg Testosterone Cypionate every 3 days
.125mg Anastrozole 2 days post-injection
500IU HCg day of injection
30mg DHEA
110mg Bupropion daily
40mg Vyvanse daily

What I've noticed:

I feel great when dosing my testosterone and frankly this continues through to the day that I take my AI, at which point I feel a significant reduction in my ability to pay attention to detail and concentrate on work. What I'll mention with the AI is that I'm not 100% certain I actually need to be on this as my estrogen prior to starting the AI was sitting right in the middle (44pg/mL ref range: 19.00-60.00pg mL), whereas now it's consistently sitting between 16.00-22pg/mL

The effect I've felt from taking the AI has led to some difficulties at work and with my interactions with others, specifically in that I become frustrated from these effects and their impact on my work and feel a bit too aggressive when called out on it.

This has led to effects which the secondary medications (bupropion & vyvanse) seem to resolve although there's another list of side effects associated with those medications but yeah that's a different story.

My line of thinking is that my dose of Testosterone may be off by ~20-30mg and that by reducing the dose I could eliminate the need to take an AI, if there ever was a need at all. That being said I can't tell whether I should eliminate AI from my regimen, wait 2 weeks, and then re-test, or eliminate both at the same time. The latter option doesn't seem right as this would be affecting more than one variable.

Any advice in the matter would be greatly appreciated.

Blood work pre "TRT" and then any recent data? Where's your peak/trough TT sit and SHBG if you please on you current regimen? Recent CBC / CMP ?

Based on the answers to those questions my next question would be why you are taking weekly equivalent of ~256.7 (110*7/3) mg of TC for "TRT"?

But of course that question may be premature till I understand your peak/trough TT on this regimen.

 

[Jackerreed]

Blood work pre "TRT" and then any recent data? Where's your peak/trough TT sit and SHBG if you please on you current regimen? Recent CBC / CMP ?

Based on the answers to those questions my next question would be why you are taking weekly equivalent of ~256.7 (110*7/3) mg of TC for "TRT"?

But of course that question may be premature till I understand your peak/trough TT on this regimen.

Ah sorry my number was off there. Also yeah I understand the reason for air quotes. The dose seems off to me as well in that it’s higher than guidelines. That’s a point that definitely adds to my confusion with this.

It's 220mg weekly, in two injections (every 3.5 days).

As a heads up, I only have my trough for my current regiment. Also, I have a recent CBC on paper

Pre-TRT Bloods (two years apart):

1st (first test, pre-TRT)

Total Testosterone	356ng/dL	280-1,000ng/dL
Free Testosterone	9.0pg/mL	8.7-55.0 pg/mL

2nd (two years later, pre-TRT)

Total Testosterone	314 ng/dL	350-1000ng/dL
Free Testosterone	6.5 pg/mL	8.7-55.0 pg/mL

3rd (Post TRT) (Current data taken at trough):

Cholesterol	157 mg/dL	<200 mg/dL
Total Testosterone	969 ng/dL	350-1000ng/dL
Free Testosterone	25.6 pg/mL	8.7-55.0 pg/mL
SHBG	33.7 nmol/L	16.50-55.90 nmol/L
Estradiol	16.2 pg/mL	19.00-60.00 pg/mL
WBC	5*10^e/L	3.4-10.8*10^e/L
RBC	5.1*10^e/L	4.14-5.7*10^e/L
Platelets	295*10^3/uL	130-400*10^3/uL
Hemoglobin	16.2 g/dL	13.0-17.7 g/dL
Hematocrit	47%	37.5-51.0 %
Triglycerides	133 mg/dL	<150 mg/dL
MCV	92 fL	79-97 fL
HDL Cholesterol	54 mg/dL	>=40 mg/dL
MCH	31.8 pg	26.6-31.0
Calculated LDL Cholesterol	76 mg/dL	0 - 99 mg/dL
MCHC	34.5 g/dL	33.00-37.00 g/dL
RDW	12.7 %	12.3-15.4 %
Total Cholesterol/HDL Ratio	2.9	<4.5
Non HDL Cholesterol	103 mg/dL	<130 mg/dL

 

[tareload]

Ah sorry my number was off there. Also yeah I understand the reason for air quotes. The dose seems off to me as well in that it’s higher than guidelines. That’s a point that definitely adds to my confusion with this.

It's 220mg weekly, in two injections (every 3.5 days).

As a heads up, I only have my trough for my current regiment. Also, I have a recent CBC on paper

Pre-TRT Bloods (two years apart):

1st (first test, pre-TRT)

Total Testosterone	356ng/dL	280-1,000ng/dL
Free Testosterone	9.0pg/mL	8.7-55.0 pg/mL

2nd (two years later, pre-TRT)

Total Testosterone	314 ng/dL	350-1000ng/dL
Free Testosterone	6.5 pg/mL	8.7-55.0 pg/mL

3rd (Post TRT) (Current data taken at trough):

Cholesterol	157 mg/dL	<200 mg/dL
Total Testosterone	969 ng/dL	350-1000ng/dL
Free Testosterone	25.6 pg/mL	8.7-55.0 pg/mL
SHBG	33.7 nmol/L	16.50-55.90 nmol/L
Estradiol	16.2 pg/mL	19.00-60.00 pg/mL
WBC	5*10^e/L	3.4-10.8*10^e/L
RBC	5.1*10^e/L	4.14-5.7*10^e/L
Platelets	295*10^3/uL	130-400*10^3/uL
Hemoglobin	16.2 g/dL	13.0-17.7 g/dL
Hematocrit	47%	37.5-51.0 %
Triglycerides	133 mg/dL	<150 mg/dL
MCV	92 fL	79-97 fL
HDL Cholesterol	54 mg/dL	>=40 mg/dL
MCH	31.8 pg	26.6-31.0
Calculated LDL Cholesterol	76 mg/dL	0 - 99 mg/dL
MCHC	34.5 g/dL	33.00-37.00 g/dL
RDW	12.7 %	12.3-15.4 %
Total Cholesterol/HDL Ratio	2.9	<4.5
Non HDL Cholesterol	103 mg/dL	<130 mg/dL

This information from @Cataceous may be of interest:

What is TRT and What is NOT TRT

Note: I originally posted this over at T-Nation so hope it's ok if I share it here @Nelson Vergel. Had an interesting and lively exchange over there with one of the proponents of the "TOT" protocol (Testosterone Optimization Therapy as it is called). This short summary gives guys a look of...

www.excelmale.com

Much simpler than me throwing out my plots. Let's say you are running 1500 ng/dL at peak and ~1,000 ng/dL (using the rule of thumb above). Using TT + SHBG and estimating from online fT calculators:

So I'm with you. I don't see any reason why you are on the AI and you've got some room to titrate down on your T dosing where you could shoot for 600 ng/dL (trough) and ~900-1000 ng/dL (peak) on twice weekly injections.

How did you feel on your protocol before AI was added? Why was it added? Assuming there's no good reason and changing 1 thing at a time:

1. Eliminate AI, how do you feel?
2. Titrate dosing down 30-50% and blood work again in 8 weeks. How do you feel? You may be able to get away from the polypharmacy since you are running supra-physiologic and this may be affecting your CNS/mood/etc.

 

[Jackerreed]

This information from @Cataceous may be of interest:

What is TRT and What is NOT TRT

Note: I originally posted this over at T-Nation so hope it's ok if I share it here @Nelson Vergel. Had an interesting and lively exchange over there with one of the proponents of the "TOT" protocol (Testosterone Optimization Therapy as it is called). This short summary gives guys a look of...

www.excelmale.com

Much simpler than me throwing out my plots. Let's say you are running 1500 ng/dL at peak and ~1,000 ng/dL (using the rule of thumb above). Using TT + SHBG and estimating from online fT calculators:



View attachment 15732
View attachment 15733

So I'm with you. I don't see any reason why you are on the AI and you've got some room to titrate down on your T dosing where you could shoot for 600 ng/dL (trough) and ~900-1000 ng/dL (peak) on twice weekly injections.

How did you feel on your protocol before AI was added? Why was it added? Assuming there's no good reason and changing 1 thing at a time:

1. Eliminate AI, how do you feel?
2. Titrate dosing down 30-50% and blood work again in 8 weeks. How do you feel? You may be able to get away from the polypharmacy since you are running supra-physiologic and this may be affecting your CNS/mood/etc.

Thanks that’s really helpful.



Thanks for the thorough response.

To answer your questions:

Before AI (while originally on 260mg, before the reduction to 220mg):

• Heavy variation in BP readings. Only occasionally seeing above 160/80 but semi-frequently (once or twice a week) getting quite close to that.
• Joints felts far too fluid (i.e. I felt like a flexible woman in a yoga class instead of being more structured in my posture)
• Consistently poor quality sleep, plenty of night sweats
• Less endurance in exercise to a notable extent, felt incredibly heavy in my movements
• Emotional regulation was odd. I found myself getting competitive in conversations and/or arguments with women, including my Mom. This is very uncharacteristic of me.
• Shifts in my gastrointestinal health such that I had larger gaps of time in between BMs
  • Such that I would have a BM within several hours of taking an AI and would subsequently feel far less bloated

Without the AI on 220mg I feel okay, albeit it really doesn’t feel as natural. Most recently I was off of it for 3-4 weeks and got back on it after stressing that I was messing my body up somehow. Only to feel pretty shitty again after a week of taking it.

That being said I’m going to hold off on the anastrozole.

Since I know I feel fine without it would it be safe to reduce ones dose of testosterone rapidly (in my case tomorrow) or does it make more sense to remove the AI and give it a couple of weeks before titrating the testosterone?

 

[Vince]

Ah sorry my number was off there. Also yeah I understand the reason for air quotes. The dose seems off to me as well in that it’s higher than guidelines. That’s a point that definitely adds to my confusion with this.

It's 220mg weekly, in two injections (every 3.5 days).

As a heads up, I only have my trough for my current regiment. Also, I have a recent CBC on paper

Pre-TRT Bloods (two years apart):

1st (first test, pre-TRT)

Total Testosterone	356ng/dL	280-1,000ng/dL
Free Testosterone	9.0pg/mL	8.7-55.0 pg/mL

2nd (two years later, pre-TRT)

Total Testosterone	314 ng/dL	350-1000ng/dL
Free Testosterone	6.5 pg/mL	8.7-55.0 pg/mL

3rd (Post TRT) (Current data taken at trough):

Cholesterol	157 mg/dL	<200 mg/dL
Total Testosterone	969 ng/dL	350-1000ng/dL
Free Testosterone	25.6 pg/mL	8.7-55.0 pg/mL
SHBG	33.7 nmol/L	16.50-55.90 nmol/L
Estradiol	16.2 pg/mL	19.00-60.00 pg/mL
WBC	5*10^e/L	3.4-10.8*10^e/L
RBC	5.1*10^e/L	4.14-5.7*10^e/L
Platelets	295*10^3/uL	130-400*10^3/uL
Hemoglobin	16.2 g/dL	13.0-17.7 g/dL
Hematocrit	47%	37.5-51.0 %
Triglycerides	133 mg/dL	<150 mg/dL
MCV	92 fL	79-97 fL
HDL Cholesterol	54 mg/dL	>=40 mg/dL
MCH	31.8 pg	26.6-31.0
Calculated LDL Cholesterol	76 mg/dL	0 - 99 mg/dL
MCHC	34.5 g/dL	33.00-37.00 g/dL
RDW	12.7 %	12.3-15.4 %
Total Cholesterol/HDL Ratio	2.9	<4.5
Non HDL Cholesterol	103 mg/dL	<130 mg/dL

The only issue I'm having with your labs. I think your estradiol is too low. I would run it up to the high end of the range, consider dropping the AI all together.

How do you keep your HCT under control, do you need to donate blood? Or is it now just stable.

 

[Jackerreed]

The only issue I'm having with your labs. I think your estradiol is too low. I would run it up to the high end of the range, consider dropping the AI all together.

How do you keep your HCT under control, do you need to donate blood? Or is it now just stable.

Yes definitely agree on estradiol.

Hematocrit has been a-ok

last six labs show:

[47, 45.8, 42.1, 46, 46.1]% - (37.50-51.00)

 

[tareload]

Thanks that’s really helpful.



Thanks for the thorough response.

To answer your questions:

Before AI (while originally on 260mg, before the reduction to 220mg):

• Heavy variation in BP readings. Only occasionally seeing above 160/80 but semi-frequently (once or twice a week) getting quite close to that.
• Joints felts far too fluid (i.e. I felt like a flexible woman in a yoga class instead of being more structured in my posture)
• Consistently poor quality sleep, plenty of night sweats
• Less endurance in exercise to a notable extent, felt incredibly heavy in my movements
• Emotional regulation was odd. I found myself getting competitive in conversations and/or arguments with women, including my Mom. This is very uncharacteristic of me.
• Shifts in my gastrointestinal health such that I had larger gaps of time in between BMs
  • Such that I would have a BM within several hours of taking an AI and would subsequently feel far less bloated

Without the AI on 220mg I feel okay, albeit it really doesn’t feel as natural. Most recently I was off of it for 3-4 weeks and got back on it after stressing that I was messing my body up somehow. Only to feel pretty shitty again after a week of taking it.

That being said I’m going to hold off on the anastrozole.

Since I know I feel fine without it would it be safe to reduce ones dose of testosterone rapidly (in my case tomorrow) or does it make more sense to remove the AI and give it a couple of weeks before titrating the testosterone?

Your body will experience a reduction in circulating testosterone over weeks whether you want to or not once you drop the dose given you are using TC. So a reasonable approach would be to drop the AI and then modest dose reduction then wait 5 weeks for new steady state serum levels. You could do this stepwise to shoot for the blood levels mentioned above, which would be consistent with ~125-150 mg/week of TC given the info you've shared.

As a first step drop the AI and lower your dose to 150 mg/week? What do you think? I think the symptoms your describe seem to indicate you may feel much better long term on a lower T dose.

 

[Jackerreed]

Your body will experience a reduction in circulating testosterone over weeks whether you want to or not once you drop the dose given you are using TC. So a reasonable approach would be to drop the AI and then modest dose reduction then wait 5 weeks for new steady state serum levels. You could do this stepwise to shoot for the blood levels mentioned above, which would be consistent with ~125-150 mg/week of TC given the info you've shared.

As a first step drop the AI and lower your dose to 150 mg/week? What do you think? I think the symptoms your describe seem to indicate you may feel much better long term on a lower T dose.

Yeah, I agree. I didn't take the anastrozole yesterday and honestly feel better.


I'm planning on reducing the TC dose from 220mg to 150mg tomorrow morning.

This is a (rounded) 32% reduction, which I'm totally OK with. That being said, is titrating doses by ~30% a good rule of thumb?

 

[JA Battle]

Yeah, I agree. I didn't take the anastrozole yesterday and honestly feel better.


I'm planning on reducing the TC dose from 220mg to 150mg tomorrow morning.

This is a (rounded) 32% reduction, which I'm totally OK with. That being said, is titrating doses by ~30% a good rule of thumb?

For what it’s worth, I’ve gone from 20mg daily to 8mg before. It turns out my levels are around 750-800 on 8mg. This is what studs in their 20s have as a peak in the morning time and levels around 550-600 later in the day.

you will still have healthy testosterone levels. I’m on 6mg daily right now.

 

[Cataceous]

...
I'm planning on reducing the TC dose from 220mg to 150mg tomorrow morning.

This is a (rounded) 32% reduction, which I'm totally OK with. That being said, is titrating doses by ~30% a good rule of thumb?

It's not uncommon for dose reductions to make a guy feel pretty lousy for up to several weeks. Be mentally prepared for that scenario and try to carry through. In support of what @JA Battle is saying, your new dose of 150 TC weekly is still giving you more than twice as much testosterone as the average young guy makes naturally.

Some posts about lowering the dose:

Anyone combine injections and cream? How do you feel?

I’m a long term TRT patient, 39 years old. I’ve been on cypionate and inject a total of 154mg weekly in EOD subQ shots of 44mg each. I have been doing some thinking about the potential benefit of keeping dosing the same but experimenting with using a low cypionate base around 80-100mg weekly...

www.excelmale.com

Anyone combine injections and cream? How do you feel?

Interesting anecdote. I’m curious what what your SHBG and current protocol are? @JoeMatts im curious for this as well

www.excelmale.com

Anyone combine injections and cream? How do you feel?

I’m a long term TRT patient, 39 years old. I’ve been on cypionate and inject a total of 154mg weekly in EOD subQ shots of 44mg each. I have been doing some thinking about the potential benefit of keeping dosing the same but experimenting with using a low cypionate base around 80-100mg weekly...

www.excelmale.com

I too started at too high a dose when starting injections, 150mg/week dosed E3D. It was living Hell having to reduce dose and go through withdrawal getting it right from there over the course of many months.​

Hello, 60yo starting TRT.

Hi All. I'm 60yo, lucky with relatively few health problems so far. Total T 350-400. After about a year of research/consideration, about to start TRT, plan is just Test C, 150mg per week separated into two subq injections/week into delts/VGs, draw/inject using 29G 1ml. Get labs in ~8 weeks...

www.excelmale.com