First Lab Draw After Starting TRT - Feedback?

[norwegian_blue]

Been on 100mg cyp for about 6 weeks. Here are the results from my bloodwork. I think the only thing a little off is my estrogen. Is it high enough to worry about? I am planning on switching to twice weekly injections; currently on weekly. Would that be enough to lower the estrogen a little? I've not yet had my doctor consult after the labs. Do I need to fool with a low dose AI? Just looking for feedback.

 

[Systemlord]

I think the only thing a little off is my estrogen.

It's perfectly normal to have high estrogen when your testosterone is also high while on TRT. Abnormal T:E2 ratios, low estrogen in relation to testosterone can cause problems with libido and problems with sexual function.

https://journals.sagepub.com/doi/10.1177/1557988314539000

Our study did not link high estradiol levels with diminished sexual performance. Paradoxically, patients with low estradiol below 42.6 pg/ml had more patients complaining of low libido as defined by ICD-9 of 799.81 in the problem list. Patients with higher estradiol levels above 42.6 pg/ml had less sexual dysfunction problems identified by their providers.

I am planning on switching to twice weekly injections; currently on weekly. Would that be enough to lower the estrogen a little?

Not necessarily, but if your sole purpose switching to a twice weekly protocol is to reduced estrogen, this is a fool's errand when there are no symptoms present.

My advice stop focusing on your lab values, hormone levels when you're responding well to treatment, because what's normal for you may not align with what you think what is normal for you.

Do I need to fool with a low dose AI?

If you introduce a drug as powerful as anastrozole in the absence of symptoms, it can only go downhill from there. A low dose AI can have the potential to wreck some men, often for weeks, months and even years after only a few doses.

Manipulating a hormonal pathway is playing with fire.

 

[norwegian_blue]

It's perfectly normal to have high estrogen when your testosterone is also high while on TRT. Abnormal T:E2 ratios, low estrogen in relation to testosterone can cause problems with libido and problems with sexual function.

https://journals.sagepub.com/doi/10.1177/1557988314539000

Not necessarily, but if your sole purpose switching to a twice weekly protocol is to reduced estrogen, this is a fool's errand when there are no symptoms present.

My advice stop focusing on your lab values, hormone levels when you're responding well to treatment, because what's normal for you may not align with what you think what is normal for you.


If you introduce a drug as powerful as anastrozole in the absence of symptoms, it can only go downhill from there.

Thanks for the info! That's not my sole reason for switching to 2x/week. I tend to feel great for about 5 days after the injection. On day 6 and 7 I feel like crap again. Fatigue, brain fog, some anxiety, etc. After the injection, it all improves. So, I was hoping that more consistent levels might help. Is that reasonable?

 

[Systemlord]

That's not my sole reason for switching to 2x/week. I tend to feel great for about 5 days after the injection. On day 6 and 7 I feel like crap again. Fatigue, brain fog, some anxiety, etc. After the injection, it all improves.

Then you absolutely should consider switching to a twice weekly protocol. You might even feel better on a every other day protocol. I was originally on a weekly protocol, for 6 months before I started feeling off on day 6 even though my testosterone was 400-500.

 

[42HRT]

Was this a trough reading?> right before injection?

 

[norwegian_blue]

Was this a trough reading?> right before injection?

Yes.

 

[madman]

Been on 100mg cyp for about 6 weeks. Here are the results from my bloodwork. I think the only thing a little off is my estrogen. Is it high enough to worry about? I am planning on switching to twice weekly injections; currently on weekly. Would that be enough to lower the estrogen a little? I've not yet had my doctor consult after the labs. Do I need to fool with a low dose AI? Just looking for feedback. View attachment 47821

Driving up your FT will increase your estradiol it's a given.

Would not get to caught up on manipulating higher e2 if you feel great overall and are not experiencing negative symptoms.

Definitely would not start tinkering with an AI to try and bring your level in some kind of so called magical range.

Ts metabolites estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterones beneficial effects on (cardiovascular health, brain health, libido, erectile function, bone health, tendon health, immune system, lipids, and body composition).

Regarding your protocol the downfall when injecting once weekly is there will be a big difference in peak--->trough and blood levels will not be as stable throughout the week.

This can result in what we call the roller coaster effect where T levels will be very high or in some cases absurdly high (depending on dose of T) at peak (8-12 hrs) post-injection/during the first few days followed by lower levels come weeks end which can have a negative impact on mood, energy, libido, erections and recovery.

Keep in mind most men overmedicated on those dime a dozen run of the mill T clinic protocols of 200 mg/week are still hitting high/very high trough FT (7 days) post-injection.

Although you were started on a sensible dose of 100 mg T/week as you can see you are still hitting a robust TT 732 ng/dL and with a normalish SHBG 28 nmol/L your FT 18.1 ng/dL would still be high-end!

Free & Bioavailable Testosterone calculator

Your FT was calculated using the linear law-of-mass action Vermeulen.

More importantly your peak TT, FT and estradiol will be much higher!

You are most likely hitting a peak TT not too far off 1500 ng/dL with a peak FT in the high 30s ng/dL!

Also keep in mind if you decide to jump on twice-weekly injections which will clip your peak--->trough and result in more stable blood levels throughout the week if you keep your weekly dose the same 50 mg T twice-weekly you are going to bring up your trough and clip your peak which means that you will be hitting a much higher trough FT then were you sit as of now 18.1 ng/dL which will put your trough FT very high which is not going to have a big impact on driving down your estradiol.

Just to put this in perspective most healthy young males are hitting a peak cFTV 12-15 ng/dL and this is a short-lived daily peak!

On your current protocol 100 mg T injected once weekly your peak would blow this out of the water and more importantly your current TROUGH FT 18.1 ng/dL (7 DAYS) POST-INJECTION is above where a healthy young males SHORT-LIVED DAILY PEAK would sit!

If you decide to go with the twice-weekly injection protocol be prepared for the higher trough FT which will drive up your estradiol.

Regardless twice-weekly is the more sensible route to go.

Follow-up with labs 6 weeks in once blood levels have stabilized so you can see where your new trough TT, FT and estradiol sit let alone you need to test other critical blood markers RBCs, hemoglobin and hematocrit which will be driven up further if you increase your trough FT.

Metabolic benefits afforded by estradiol and testosterone in both sexes

Enjoyed this one! As we very well know T s metabolites estradiol and DHT are needed in order to reap full beneficial effects of testosterone. Ts metabolites estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterones beneficial effects on (cardiovascular...

www.excelmale.com

*Anecdotally, male patients on TRT often enquire about their E2 levels due to fear of “too much female hormone.” Men s’ health clinics even prescribe aromatase inhibitors to suppress E2 production while raising T concentrations. However, we discussed the essential role of T’s conversion to E2 in male bone and vascular health, as well as glucose and lipid homeostasis (not to mention libido and erectile function). Thus, it is our view that E2 should not be suppressed in men, and in fact clinical trials of E2 supplementation should be considered in some men on TRT to decrease LDL cholesterol and improve endothelial function.


*Finally, current laboratory measurements of serum T and E2 levels (total or free) poorly reflect tissue and cellular T and E2 concentrations, catabolism, and elimination. Novel assays that provide accurate measures of cellular T and E2 outputs will be informative in clinical studies and are desperately needed.

 

[norwegian_blue]

Thank you for the info! I had no idea that my levels would rise that much on 100mg/week. Here were my pre TRT numbers:

First Test:
TT: 289ng/dl
Free: 67.4pg/ml
SHBG: 24

So I should split my dose and check the numbers. Is 1500 peak too high? The reason I started to begin with were brain fog, low energy, low libido, etc. This is all new to me and I guess it will take time for my body to adjust.