Little advice for cessation of trt

[Cataceous]

... wouldnt the fact I have moderately high shbg generally mean i dont metabolize T that fast? Which is why lower shbg guys tend to need to inject more frequently?

Aka how far could I potentially drop in 3 days time?

This is based on a misunderstanding. With TRT the rate-limiting factor for testosterone metabolism is how fast you absorb the testosterone. This is generally independent of SHBG. In the case of injections there is a depot of oil under the skin or in a muscle that is slowly dissolving and thus slowly releasing the testosterone ester. On average you can't use up this testosterone faster than it is released.

I try to explain the overall situation with a fluid-flow analogy here.

 

[klepp0906]

This is based on a misunderstanding. With TRT the rate-limiting factor for testosterone metabolism is how fast you absorb the testosterone. This is generally independent of SHBG. In the case of injections there is a depot of oil under the skin or in a muscle that is slowly dissolving and thus slowly releasing the testosterone ester. On average you can't use up this testosterone faster than it is released.

I try to explain the overall situation with a fluid-flow analogy here.

ah, will take a look - thanks for the link.

So apart from the ratio of total T that will be free T, shgb has little bearing on anything else it sounds like.

Any suggestions on how i can optimize my chances at getting the "pro's" of trt without the assault on my prostate/bph/luts? I imagine that means a protocol that will minimize DHT and thus PSA without requiring finasteride while still keeping my Free Testosterone in the higher end of the range. Is this even possible or is it more of a find a happy medium thing? lesser of evils etc?

as compelled as I am to use the script I have sitting next to me...theres enough evidence to its potential to destroy the very thing that motivated me to start trt.

 

[Cataceous]

ah, will take a look - thanks for the link.

So apart from the ratio of total T that will be free T, shgb has little bearing on anything else it sounds like.

Any suggestions on how i can optimize my chances at getting the "pro's" of trt without the assault on my prostate/bph/luts? I imagine that means a protocol that will minimize DHT and thus PSA without requiring finasteride while still keeping my Free Testosterone in the higher end of the range. Is this even possible or is it more of a find a happy medium thing? lesser of evils etc?

as compelled as I am to use the script I have sitting next to me...theres enough evidence to its potential to destroy the very thing that motivated me to start trt.

SHBG is important for both intracellular and extracellular transport of sundry hormones. Low and high levels may cause various difficulties. But speeding up the overall absorption and elimination of exogenous testosterone is not one of them.

Regarding improving your odds of success with TRT, I can give you some ideas. The most basic is to use the minimum amount of testosterone necessary to get the benefits. This isn't necessarily possible with standard protocols. Injecting frequently—EOD or ED—with a longer ester such as cypionate should give pretty steady levels. For most guys this is preferable to less frequent dosing that results in fairly large swings in hormones over several days. However, constant hormone levels aren't natural either. We're supposed to have a nice diurnal rhythm, with testosterone peaking in the morning and dropping off by about 40% at the evening trough. With the thought that nature knows best, I've floated the hypothesis that some of the good things we get from testosterone are a function of the daily peak, while some of the bad stuff is perhaps related more to elevated trough or average levels. If the idea has merit then the solution is to better imitate the natural daily rhythm. I've found that a mixture of testosterone enanthate and testosterone propionate injected daily can at least provide the appropriate variation in serum testosterone, even if the timing is off, with troughs and peaks both occurring in the morning.

A more complicated protocol such as this would be of greater interest to those who can't find the appropriate balance with a conventional approach. Those who are already doing well with TRT might only see subtle differences, if any, in adopting this approach.

 

[madman]

yea, in that regard all I have is what the doctor runs. That being said its always been ran the same way so the number relative to where it is in other cases at least holds relevance relatively speaking. Id argue thats more important than the specific number itself in this regard no?
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Treating symptoms is what matters but it is still critical to know where your levels truly sit as in many cases they can be too high or too low which can have a negative impact on the overall effectiveness of trt protocol.

Too many are relying on inaccurate assays when it comes to FT and many may very well be running much higher levels than they think let alone some of these men are struggling on such protocol clueless to the fact that their FT levels are too high.

Testing using accurate assays is critical.






man, if this is the case - there is a whooooole slew of conflicting and thus misinformation on the web. (shouldnt come as any surprise) Its evident by your posts you know quite a bit about hormone replacement, but if what youre saying is true wouldnt the fact I have moderately high shbg generally mean i dont metabolize T that fast? Which is why lower shbg guys tend to need to inject more frequently?
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This was already explained by Cataceous and if you search through some of his previous threads/posts you will have a much deeper understanding.





Aka how far could I potentially drop in 3 days time?

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You would need to test at peak using an accurate assay for TT (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration) to truly know what levels you are hitting.

 

[Cataceous]

...
Any suggestions on how i can optimize my chances at getting the "pro's" of trt without the assault on my prostate/bph/luts? I imagine that means a protocol that will minimize DHT and thus PSA without requiring finasteride while still keeping my Free Testosterone in the higher end of the range.
...

Something I forgot to mention that is even more specific to your concerns is to monitor your progesterone and consider supplementation if it gets low. Among other things, progesterone acts to oppose DHT. It can also improve mood and sleep. TRT frequently pushes this hormone down to very low levels. For younger men, taking hCG as part of the protocol may be sufficient to avoid this problem. But research has shown that older men are less likely to experience this benefit. Supplementation of progesterone can be direct via injections or topical applications, or indirect through taking pregnenolone in various forms. I do better with the direct method.

 

[klepp0906]

The prevalence of misinformation thats practically been ingrained in trt users in general is pretty eye opening. I've always tried to make it as "least" imposing on my life as possible.

I had a bit of a double whammy. I was an opiate addict years ago and after conquering it, I have a profound disdain of being dependent on any substance, therefore I want to take as few things as possible and make it as little of a burden as possible.

Not too long after (ironically as I was going in to have my test levels checked due to symptoms) they found kidney cancer.

These things along with having children a bit later in life has turned me into someone bordering on hypochondria regarding health and longevity.

Ive always tried to find the balance between injecting as infrequently as possible, while doing it frequently enough to keep estrogen in check, and peaks and valleys from being to profound as these things were drilled in by the general populace.

Apart from the inconvenience injecting more frequently would present (which I'd be willing to get over) I'm kept from trying due to the fact I inject IM. Only so many sites to rotate between.

I tried SubQ four times now and each time was a failure. It results in lower TT and FT and higher DHT/PSA/E2 at trough than the identical protocol IM. I also feel a good deal worse subjectively. Libido disappears entirely and ED is to an embarrassing degree, even married. (ive actually found i had less ED pre trt regardless)

The aforementioned has left me with every 3 days as the most frequent ive tried.

I do find that the higher my FT goes, the better I feel by the metrics i sought to gain in ala trt. The problem is the sides, namely the prostate issues. My PSA began a few years ago at ~.5 and my most recent labs have it at 1.01 so essentially double. Makes orgasms mind blowing, but also makes me wake several times a night to pee which results in some profound carb craving thing and the inability for me to get even remotely as lean as i was pre trt.

Never mind the dribbling after voiding and the urgency during the day. I feel like TRT made me instantly old, not the opposite.

I'm considering ONE more go at subQ (cause why not at this point) based on the fact I have hcg coming and would afford me less invasive injections.

As far as dosage goes I have no clue what someone would need EoD. Since 60 E 3.5 keeps me over 1000, I'd imagine something like 30 EoD perhaps? Even 20 since im adding hcg with it?

One more inquiry for you guys - is the Elevation in DHT is the result of high TT or high FT? If there were a way to make the ratio of TT to FT such that I keep my TT at ~800 and still keep my FT high, that'd be great which I assumed a "less" frequent injection schedule would accomplished based on my shgb. I apparently was misinformed.

I appreciate all the information guys, gonna be a crazy winter. I'll either add the hcg and prosper, or add the hcg and begin my exit.

 

[Cataceous]

...
As far as dosage goes I have no clue what someone would need EoD. Since 60 E 3.5 keeps me over 1000, I'd imagine something like 30 EoD perhaps? Even 20 since im adding hcg with it?

One more inquiry for you guys - is the Elevation in DHT is the result of high TT or high FT? If there were a way to make the ratio of TT to FT such that I keep my TT at ~800 and still keep my FT high, that'd be great which I assumed a "less" frequent injection schedule would accomplished based on my shgb. I apparently was misinformed.
...

Regarding doses, we can make some rough guesses. I assume you are referring to trough measurements around 1,000 ng/dL, so peaks may be as high as 1,500 ng/dL, and average about in the middle. As an aside, these are nearly double what's typical for a man in his prime, so it's no surprise that side effects pop up. In any case, lowering your TC dose to 30 mg EOD means your average daily testosterone intake drops from 12 mg to 10.5 mg. If SHBG and albumin don't change much then your average total testosterone will change proportionally, dropping from ~1,200 ng/dL to a little over 1,000. Peaks and troughs should be quite subdued, to the extent that you can ignore them.

Of course what's mainly of interest is whether this change is enough to help. This is uncertain. You will have knocked down the peaks, but average and trough testosterone are still supraphysiological. It's probably good that the average is reduced, but it would be better if some of the reduction came from a lower daily trough, which can't be done with longer esters.

DHT is more directly related to free testosterone than total; the testosterone must be unbound before the conversion occurs. Trying to micromanage DHT is likely a mistake. @madman has posted research emphasizing that DHT should be considered more of a locally-created, locally-acting hormone. Systemic levels are just a vague conglomeration of all that local activity. High levels might generally reflect high free testosterone, or alternatively the use of transdermal testosterone. This once again emphasizes that using high levels of testosterone to overcome some problems can easily create others.

Just curious if you have an SHBG measurement while on TRT? Mine went from low 40s nMol/L pre-TRT down to around 30 with TRT.

 

[trtthings]

Something I forgot to mention that is even more specific to your concerns is to monitor your progesterone and consider supplementation if it gets low. Among other things, progesterone acts to oppose DHT. It can also improve mood and sleep. TRT frequently pushes this hormone down to very low levels. For younger men, taking hCG as part of the protocol may be sufficient to avoid this problem. But research has shown that older men are less likely to experience this benefit. Supplementation of progesterone can be direct via injections or topical applications, or indirect through taking pregnenolone in various forms. I do better with the direct method.

I remember reading on here that John Crisler's view was that progesterone should rarely if ever be supplemented. But you feel better doing it? I always thought pregnenolone was a bi more interesting due to conversion to pregnenolone.

I suppose this is the reason to do HCG but I don't feel like adding that at the present time.

 

[klepp0906]

VERY good information, thank you. I learned quite a bit of value from this post alone.

As for DHT, I just went over all the labs I have on it and post TRT (dont have any pre trt unfortunately) and it seems to hang around in the 500-600 pg/ml area. Whatever it was before, crossing into the aforementioned territory was enough to balloon my prostate and bless me with bph symptoms that I've never experienced - and make my hairline go on a very fast march backward. (my father is 60, 22 years older than I and has roughly the same amount of hair I do at current). I admittedly started taking the finasteride a few days back. I'm in like a midlife crisis area about my hair (being of benefit to the bph is a fringe, thats how bad im fretting). I feel like its now or never. I act on it and I have the opportunity to stop it in a realm that if i ever chose to have a FUE i could. If i dont, thats gonna be all she wrote.

Its a real hard pill to swallow since the hair was fine, the bph didnt exist, none of this was a thing before TRT. The finasteride gave me some waaay crazy night sweats the 2nd night. All seems normal now but i skipped a day on dosing as I keep going back and forth whether i should mess with things of that nature. Truly a predicament. A bit disappointed that something as superficial as hair is creating this kind of turmoil but i digress.

SHBG is as follows

the 55 was pre TRT. The 33 was the lowest ive seen it, that was first labs after starting at 80mg twice a week and .25 adex EoD. Ive cut out the adex and dropped the dose but apparently need to drop it further.

 

[trtthings]

VERY good information, thank you. I learned quite a bit of value from this post alone.

As for DHT, I just went over all the labs I have on it and post TRT (dont have any pre trt unfortunately) and it seems to hang around in the 500-600 pg/ml area. Whatever it was before, crossing into the aforementioned territory was enough to balloon my prostate and bless me with bph symptoms that I've never experienced - and make my hairline go on a very fast march backward. (my father is 60, 22 years older than I and has roughly the same amount of hair I do at current). I admittedly started taking the finasteride a few days back. I'm in like a midlife crisis area about my hair (being of benefit to the bph is a fringe, thats how bad im fretting). I feel like its now or never. I act on it and I have the opportunity to stop it in a realm that if i ever chose to have a FUE i could. If i dont, thats gonna be all she wrote.

Its a real hard pill to swallow since the hair was fine, the bph didnt exist, none of this was a thing before TRT. The finasteride gave me some waaay crazy night sweats the 2nd night. All seems normal now but i skipped a day on dosing as I keep going back and forth whether i should mess with things of that nature. Truly a predicament. A bit disappointed that something as superficial as hair is creating this kind of turmoil but i digress.

SHBG is as follows
View attachment 11347
the 55 was pre TRT. The 33 was the lowest ive seen it, that was first labs after starting at 80mg twice a week and .25 adex EoD. Ive cut out the adex and dropped the dose but apparently need to drop it further.

Your SHBG levels are quite similar to mine without TRT. However I've never seen below maybe 46.

What's your current protocol and do you do good on it? I seem to be very sensitive to E2.

 

[Cataceous]

I remember reading on here that John Crisler's view was that progesterone should rarely if ever be supplemented. But you feel better doing it? I always thought pregnenolone was a bi more interesting due to conversion to pregnenolone.
...

I seem to recall Dr. Crisler saying that progesterone is too feminizing in men. This may be the case if you push levels too high, but I'm pretty convinced that having a mid-range serum level is healthier than sitting at the bottom. It takes only 600 mcg daily to get me there. Progesterone is also said to be helpful as a balance against estradiol, and it may slow down skin aging. "These findings suggest that progesterone, like estrogen, also has beneficial effects on the skin, and may be independently protective against skin aging."[R]

I've tried pregenolone several times and was never happy with the way I felt on it. With direct administration of progesterone I see a linear response to dose and can easily set serum levels where I want them.

 

[Cataceous]

...
Its a real hard pill to swallow since the hair was fine, the bph didnt exist, none of this was a thing before TRT. The finasteride gave me some waaay crazy night sweats the 2nd night. All seems normal now but i skipped a day on dosing as I keep going back and forth whether i should mess with things of that nature. Truly a predicament. A bit disappointed that something as superficial as hair is creating this kind of turmoil but i digress.
...

I understand the hair thing. It is stressful. I took finasteride for over a year and boy was I sorry. The symptoms came on gradually so that it took a while for me to connect cause and effects. I had ED, PE and constant low-level gut pain. It took a couple years after stopping the drug before I was mostly back to normal. It was also unnecessary, as I didn't even have much of a problem back then.

After starting TRT I did experience a lot more shedding. It still wasn't too severe until last year, when I was experimenting with daily propionate and probably inadvertently getting relatively high peaks in serum testosterone. Interestingly, something this year is totally different, and the hair loss stopped abruptly—though unfortunately the thin areas are not regrowing. The change could be a coincidence, or it could be related to the various protocol changes, including the addition of progesterone, the testosterone dose reduction made possible by mixing propionate and enanthate, or the experimentation with adding back upstream hormones.

 

[trtthings]

I understand the hair thing. It is stressful. I took finasteride for over a year and boy was I sorry. The symptoms came on gradually so that it took a while for me to connect cause and effects. I had ED, PE and constant low-level gut pain. It took a couple years after stopping the drug before I was mostly back to normal. It was also unnecessary, as I didn't even have much of a problem back then.

After starting TRT I did experience a lot more shedding. It still wasn't too severe until last year, when I was experimenting with daily propionate and probably inadvertently getting relatively high peaks in serum testosterone. Interestingly, something this year is totally different, and the hair loss stopped abruptly—though unfortunately the thin areas are not regrowing. The change could be a coincidence, or it could be related to the various protocol changes, including the addition of progesterone, the testosterone dose reduction made possible by mixing propionate and enanthate, or the experimentation with adding back upstream hormones.

Interesting, if I recall your doses are really really small these days. Do you reckon that's the main thing?

 

[Cataceous]

Interesting, if I recall your doses are really really small these days. Do you reckon that's the main thing?

I'm really not sure. It's possible, but it's also plausible that progesterone is helping through its opposition to DHT.

 

[klepp0906]

Your SHBG levels are quite similar to mine without TRT. However I've never seen below maybe 46.

What's your current protocol and do you do good on it? I seem to be very sensitive to E2.

eh, good is subjective right? I've had times where ive been pretty satisfied in most ways, but the tradeoff has always been to reach that point, I require high enough levels of testosterone that I end up with savage hair loss and BPH symptoms.

its not been made any easier by the fact I dont "settle-in" to a protocol for what seems like months. I can make a change that at first one would think is not bearing fruit, weeks would pass - no morning wood, no libido etc. Then out of nowhere like 2 months later BAM. My brain just takes its time in adjusting which makes changes time consuming and I spent the first year and a half of trt making changes and discovering these types of things.

To answer your question though, currently im on 60mg 2x a week. no ai, and no hcg. Dont feel the best, but its early. I know at 70mg 2x a week I felt great so im likely in one of those "settle-in" periods. Plus I had just made another stab at subQ which failed again, so I havent been back on IM but 3 weeks or so.

Frustrating stuff. As for E2, I dont "think" i have a problem with it, but im pretty hellbent on keeping AI's out of the equation at this point so its only marginally relevant as i have limited control over it, much less testing it out.

I have had periods in my early days where I took an AI at .25 EoD, kept my E2 in a 16-26 range and felt stupendous, but ive had periods where I took 140mg a week with no AI at all and felt good too.

I'm just exhausted with this whole TRT thing at this point lol, its cost me far more than ive gained.

 

[Charliebizz]

Assuming secondary hypogonadism, your previous natural testosterone production is not going to be predictive of the maximum possible output; the underperformance is due to low upstream hormones, not a testicular problem. The hCG is directly stimulating the testicles, so technically you don't even need to reduce the exogenous testosterone. However, it could still be a little helpful to reduce overall serum androgens and estrogens, which reduces their negative feedback at the hypothalamus and pituitary. This might save a little time down the road in a restart. It's hard to predict the amount of endogenous testosterone you'll get from this dose of hCG. Anecdotally there is a lot of variability, ranging from very little to almost physiological levels. Whatever you produce will indeed be added to your exogenous testosterone.

How haven't we figured out how to fix those upstream hormones enough to not need trt yet ?

 

[Forty2]

Oh i've had many-a-labs done over the past few years with varying protocols. At current these are my levels at 60mg 2x a week

View attachment 11329

That's a pretty high test level. Maybe you could have kept your hair if you stuck to a dose of 40mg twice a week, which would have still boosted your levels about 50% higher than they were pre TRT.

 

[Cataceous]

How haven't we figured out how to fix those upstream hormones enough to not need trt yet ?

Many possible reasons, such as a lack of public funding for research, a hostile regulatory environment—see enclomiphene—that discourages private funding, and certainly the complexity of the problem itself—we need a better understanding of the hypothalamus before we can do some serious tinkering. Add to this the fact that TRT is relatively simple compared to replacing upstream hormones such as GnRH or kisspeptin.

 

[CanadaJim]

The prevalence of misinformation thats practically been ingrained in trt users in general is pretty eye opening. I've always tried to make it as "least" imposing on my life as possible.

I had a bit of a double whammy. I was an opiate addict years ago and after conquering it, I have a profound disdain of being dependent on any substance, therefore I want to take as few things as possible and make it as little of a burden as possible.

Not too long after (ironically as I was going in to have my test levels checked due to symptoms) they found kidney cancer.

These things along with having children a bit later in life has turned me into someone bordering on hypochondria regarding health and longevity.

Ive always tried to find the balance between injecting as infrequently as possible, while doing it frequently enough to keep estrogen in check, and peaks and valleys from being to profound as these things were drilled in by the general populace.

Apart from the inconvenience injecting more frequently would present (which I'd be willing to get over) I'm kept from trying due to the fact I inject IM. Only so many sites to rotate between.

I tried SubQ four times now and each time was a failure. It results in lower TT and FT and higher DHT/PSA/E2 at trough than the identical protocol IM. I also feel a good deal worse subjectively. Libido disappears entirely and ED is to an embarrassing degree, even married. (ive actually found i had less ED pre trt regardless)

The aforementioned has left me with every 3 days as the most frequent ive tried.

I do find that the higher my FT goes, the better I feel by the metrics i sought to gain in ala trt. The problem is the sides, namely the prostate issues. My PSA began a few years ago at ~.5 and my most recent labs have it at 1.01 so essentially double. Makes orgasms mind blowing, but also makes me wake several times a night to pee which results in some profound carb craving thing and the inability for me to get even remotely as lean as i was pre trt.

Never mind the dribbling after voiding and the urgency during the day. I feel like TRT made me instantly old, not the opposite.

I'm considering ONE more go at subQ (cause why not at this point) based on the fact I have hcg coming and would afford me less invasive injections.

As far as dosage goes I have no clue what someone would need EoD. Since 60 E 3.5 keeps me over 1000, I'd imagine something like 30 EoD perhaps? Even 20 since im adding hcg with it?

One more inquiry for you guys - is the Elevation in DHT is the result of high TT or high FT? If there were a way to make the ratio of TT to FT such that I keep my TT at ~800 and still keep my FT high, that'd be great which I assumed a "less" frequent injection schedule would accomplished based on my shgb. I apparently was misinformed.

I appreciate all the information guys, gonna be a crazy winter. I'll either add the hcg and prosper, or add the hcg and begin my exit.

Just wondering...what is the reason that subQ could be the cause of disappearing libido and ED? I have been injecting subQ for the last few months...seems much more convenient but I have noticed a drop in libido. Never thought it could be the means of administration.

 

[Charliebizz]

Many possible reasons, such as a lack of public funding for research, a hostile regulatory environment—see enclomiphene—that discourages private funding, and certainly the complexity of the problem itself—we need a better understanding of the hypothalamus before we can do some serious tinkering. Add to this the fact that TRT is relatively simple compared to replacing upstream hormones such as GnRH or kisspeptin.

It's just crazy how easily it is thrown off. I was completely normal till my mid 20s when I decided to diet and train like a crazy person. I wasn't eating even close to enough calories and that's when all my problems started. Now 10 years later I'm still in the same situation and struggle to make trt work with my low shbg. How did my body not figure this out on its own after I stopped diet and over training.