TRT for 4 months, need advice

[nwolfe88]

50mg test cyp (1" into delt) and 600iu HCG 2x per week 1/2" sub q). 25mg dhea and 25mg pregnenolone every morning (pill).

Total T 731, estradiol 53. This is 3.5 days after last injection.

Feeling ok but very little libido and weak erections.

Have a couple options.
Option 1. Lower HCG to 250iu 2x per week instead of 600iu 2x per week and see effects on E2.
Option 2. Stop taking the dhea and pregnenolone (is this really necessary???)
Option 3. Combination of both 1 and 2.
Option 4. Combination of both 1 and 2, and also raise test cyp dose to 60mg 2x per week.
Option 5. Keep everything the same but add in tiny dose of AI one day after each injection.

Any thoughts or opinions? Especially on the dhea and pregnolone?

 

[madman]

50mg test cyp (1" into delt) and 600iu HCG 2x per week 1/2" sub q). 25mg dhea and 25mg pregnenolone every morning (pill).

Total T 731, estradiol 53. This is 3.5 days after last injection.

Feeling ok but very little libido and weak erections.

Have a couple options.
Option 1. Lower HCG to 250iu 2x per week instead of 600iu 2x per week and see effects on E2.
Option 2. Stop taking the dhea and pregnenolone (is this really necessary???)
Option 3. Combination of both 1 and 2.
Option 4. Combination of both 1 and 2, and also raise test cyp dose to 60mg 2x per week.
Option 5. Keep everything the same but add in tiny dose of AI one day after each injection.

Any thoughts or opinions? Especially on the dhea and pregnolone?

50mg test cyp (1" into delt) and 600iu HCG 2x per week 1/2" sub q). 25mg dhea and 25mg pregnenolone every morning (pill).

Total T 731, estradiol 53. This is 3.5 days after last injection.


You are missing the most important blood marker Free Testosterone!

As I have stated numerous times on the forum over the years 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.

At least you tested at the true trough (lowest point) before your next injection and even though you are hitting what would appear to be a robust trough TT 731 ng/dL your trough FT may still be subpar if you have high SHBG!

Need to know where your trough FT sits!

The most accurate assays for TT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration next best) would be the assays which need to be used.

The only way to know where FT truly sits is to have it tested using the most accurate methods/assays (ED/UF) especially in cases of altered SHBG.

The gold standard would be Equilibrium Dialysis.

If you do not have access (highly doubtful if you reside in the US) to such then you would need to use/rely upon the go to calculated linear law-of-mass action cFTV which will give a good approximation but keep in mind it 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]




Did you have your FT tested?

If not then we can easily calculate it if you know your SHBG by using the linear law-of-mass action cFTV which should give a good approximation.

Otherwise you will need to test your FT using what would be considered the most accurate assay the gold standard Equilibrium Dialysis in order to know where your FT truly sits especially in cases of altered SHBG.

 

[nwolfe88]

50mg test cyp (1" into delt) and 600iu HCG 2x per week 1/2" sub q). 25mg dhea and 25mg pregnenolone every morning (pill).

Total T 731, estradiol 53. This is 3.5 days after last injection.


As I have stated numerous times on the forum over the years 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.

At least you tested at the true trough (lowest point) before your next injection and even though you are hitting what would appear to be a robust trough TT 731 ng/dL your trough FT may still be subpar if you have high SHBG!

Need to know where your trough FT sits!

The most accurate assays for TT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration next best) would be the assays which need to be used.

The only way to know where FT truly sits is to have it tested using the most accurate methods/assays (ED/UF) especially in cases of altered SHBG.

The gold standard would be Equilibrium Dialysis.

If you do not have access to such then use would need to use/rely upon the go to calculated linear law-of-mass action cFTV which will give a good approx. but keep in mind it tends to slightly underestimate 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]




Did you have your FT tested?

If not then we can easily calculate it if you know your SHBG by using the linear law-of-mass action cFTV which should give a good approximation.

Otherwise you will need to test your FT using what would be considered the most accurate assay the gold standard Equilibrium Dialysis in order to know where your FT truly sits especially in cases of altered SHBG.

Sorry, free test is 23.3. Top of that scale is 25

 

[madman]

Sorry, free test is 23.3. Top of that scale is 25

With a top-end reference range 25 it was most likely tested through Labcorp using the know to be inaccurate Direct analog enzyme immunoassay (EIA).

What is your SHBG?

 

[nwolfe88]

With a top-end reference range 25 it was most likely tested through Labcorp using the know to be inaccurate Direct analog enzyme immunoassay (EIA).

What is your SHBG?

It wasn't in this last set of bloodwork

 

[madman]

It wasn't in this last set of bloodwork

Do not really want to dish out advice on where your trough FT sits seeing as you never had it tested using an accurate assay and without knowing where your SHBG sits.

If it truly sits on the high-end then highly doubtful driving up your trough FT further will improve your libido/weak erections.

If anything you would notice a temporary boost in libido when you increase your dose of T but unfortunately this will be a short-lived honeymoon period and it will eventually wane as the body adapts.

Libido let alone erectile function is multifactorial and having healthy T levels is only one piece of the puzzle.

It's a myth that one needs high let alone absurdly high FT for healthy libido/erectile function.

Would not put to much weight behind DHEA/Preg when it comes to boosting libido/erectile strength.

Are you taking a daily PDE5i?

If not would be a smart move!

I would drop the hCG for a while before f**king with an AI and even then I would want to know where your trough FT truly sits before making a move!

 

[nwolfe88]

Do not really want to dish out advice on where your FT sits seeing as you never had it tested using an accurate assay and without knowing where your SHBG sits.

If it truly sits on the high-end then highly doubtful driving up your trough FT further will improve your libido/weak erections.

If anything you would notice a temporary boost in libido when you increase your dose of T but unfortunately this will be a short-lived honeymoon period and it will eventually wane as the body adapts.

Libido let alone erectile function is multifactorial and having healthy T levels is only one piece of the puzzle.

It's a myth that one needs high let alone absurdly high FT for healthy libido/erectile function.

Would not put to much weight behind DHEA/Preg when it comes to boosting libido/erectile strength.

I would drop the hCG for a while before f**king with an AI and even then I would want to know where your trough FT truly sits!

Thanks. Questions:
Do I even need the dhea and pregnolone?
Drop the HCG to 250iu twice per week? I am only looking to prevent atrophy.
Keep testosterone dose the same?
Where can I get more accurate bloodwork?

 

[madman]

Thanks. Questions:
Do I even need the dhea and pregnolone?
Drop the HCG to 250iu twice per week? I am only looking to prevent atrophy.
Keep testosterone dose the same?
Where can I get more accurate bloodwork?

I and many have never used it.

Would not supplement unless levels were low.

Some may find beneficial effects when it comes to mood and overall well-being but trial and error would be the only way to know.

Yes you could cut the dose of hCG but again I would want to know where your trough FT truly sits before making any changes.....do what you feel is best for you.

Yes you can lower your weekly dose of hCG and stick with the same T dose but again we have no idea where your trough FT truly sits.

You can order the most accurate assay the gold standard Equilibrium Dialysis through Nelson's discounted labs there are numerous threads/posts on here.

Otherwise you need to find out where your SHBG sits and calculated your FT.

 

[nwolfe88]

This one?

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

 

[nwolfe88]

I and many have never used it.

Would not supplement unless levels were low.

Some may find beneficial effects when it comes to mood and overall well-being but trial and error would be the only way to know.

Yes you could cut the dose of hCG but again I would want to know where your trough FT truly sits before making any changes.....do what you feel is best for you.

Yes you can lower your weekly dose of hCG and stick with the same T dose but again we have no idea where your trough FT truly sits.

You can order the most accurate assay the gold standard Equilibrium Dialysis through Nelson's discounted labs there are numerous threads/posts on here.

Otherwise you need to find out where your SHBG sits and calculated your FT.

Do I need to test shgb or is that one FT panel enough?

 

[madman]

Look over post #3 gets deep!

Testosterone + Men's Sexual Health

Dr. Dubin is a fellowship-trained urologist and andrologist focusing on men’s health. He cares for men with fertility problems, sexual issues (erectile dysfunction, premature ejaculation, delayed ejaculation, etc.), Peyronie’s disease, low testosterone, testicular pain and other problems...

www.excelmale.com

This needs to be hammered home!

Much more to the story when it comes to testosterones impact on libido/erectile function!


*Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

*Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

*Have realistic expectations especially when it comes to libido and erectile function!

How to Fix Erectile Dysfunction: Qualified Sexologist’s Expert Advice

Erectile dysfunction (ED) is a common issue that affects men of all ages, yet it remains widely misunderstood. In this video, I'm breaking down the myths about ED, discussing its causes, and exploring the effective solutions we use to treat patients at Restorative Health Clinic. From lifestyle...

www.excelmale.com

Look over post #30

ED issues with TRT absolutely lost and local doctors dont seem to have any answers.

I don't think it makes sense in using HCG if you're having Estradiol issues, as HCG is known to increase it to a good degree. You should find what works for by using the least amount of substances, adding other substances should be done after you stabilized the protocol you currently run. Also...

www.excelmale.com

Look over post #4

ED issues with TRT absolutely lost and local doctors dont seem to have any answers.

I don't think it makes sense in using HCG if you're having Estradiol issues, as HCG is known to increase it to a good degree. You should find what works for by using the least amount of substances, adding other substances should be done after you stabilized the protocol you currently run. Also...

www.excelmale.com

 

[madman]

Do I need to test shgb or is that one FT panel enough?

Always good to know where your SHBG sits on said protocol but the test will suffice as we want to know where your FT truly sits!

 

[Vince]

50mg test cyp (1" into delt) and 600iu HCG 2x per week 1/2" sub q). 25mg dhea and 25mg pregnenolone every morning (pill).

Total T 731, estradiol 53. This is 3.5 days after last injection.

Feeling ok but very little libido and weak erections.

Have a couple options.
Option 1. Lower HCG to 250iu 2x per week instead of 600iu 2x per week and see effects on E2.
Option 2. Stop taking the dhea and pregnenolone (is this really necessary???)
Option 3. Combination of both 1 and 2.
Option 4. Combination of both 1 and 2, and also raise test cyp dose to 60mg 2x per week.
Option 5. Keep everything the same but add in tiny dose of AI one day after each injection.

Any thoughts or opinions? Especially on the dhea and pregnolone?

What was the reason that you started TRT and how did you feel before you started?

 

[nwolfe88]

I will read those.
Again

What was the reason that you started TRT and how did you feel before you started?

Low T (200s). Worse than I do now.

 

[Vince]

Thanks. Questions:
Do I even need the dhea and pregnolone?
Drop the HCG to 250iu twice per week? I am only looking to prevent atrophy.
Keep testosterone dose the same?
Where can I get more accurate bloodwork?

I do use pregnenolone 10 mg and 10 mg of DHEA. Just to keep my DHEA levels in a good range. Do I feel anything from it? No.

 

[Vince]

I've been on trt a little over 10 years now. I do feel great. Good workouts, good libido and good energy levels. I'll let you look at my latest Labs if you like.

You probably know, but with trt everyone's different.

Vince's Labs from October 14, 2024 - Excel Male TRT Forum

Same protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg every third day and no AI. Pregnenolone 10 mg and 10 mg of DHEA. My last injection before labs, about 27 1/2 hrs. Labs are from LabCorp. I did "not" get the Equilibrium Ultrafiltration for testing free...

www.excelmale.com

 

[nwolfe88]

I've been on trt a little over 10 years now. I do feel great. Good workouts, good libido and good energy levels. I'll let you look at my latest Labs if you like.

You probably know, but with trt everyone's different.

Vince's Labs from October 14, 2024 - Excel Male TRT Forum

Same protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg every third day and no AI. Pregnenolone 10 mg and 10 mg of DHEA. My last injection before labs, about 27 1/2 hrs. Labs are from LabCorp. I did "not" get the Equilibrium Ultrafiltration for testing free...

www.excelmale.com

Thanks!

 

[madman]

I've been on trt a little over 10 years now. I do feel great. Good workouts, good libido and good energy levels. I'll let you look at my latest Labs if you like.

You probably know, but with trt everyone's different.

Vince's Labs from October 14, 2024 - Excel Male TRT Forum

Same protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg every third day and no AI. Pregnenolone 10 mg and 10 mg of DHEA. My last injection before labs, about 27 1/2 hrs. Labs are from LabCorp. I did "not" get the Equilibrium Ultrafiltration for testing free...

www.excelmale.com

I'm still injecting shallow IM and Subq.
It's been almost 8 years since I had to donate blood.
I'm having good workouts, sex and libido, no issues.


I would put money on it that the hCG and daily use of a PDE5i play a big part when it comes to the impact it has on your libido/erectile function!

Take away the hCG and daily cialis or on demand use of a PDE5i and get back to me on how great your libido/erectile function would be!

Highly doubtful running a high FT level would save you!

 

[Vince]

I did skip PDE5i for a few weeks to see if I still would get wood. Surprisingly I did. I was able to have sex in the morning and at night no issues. I really do like the pump I get in my workouts and of course strong wood. Remember I'm not a young man haha

 

[Phil Goodman]

My first suggestion would be to drop the pregnenolone. Before starting trt I could take it with no issues, but now it always causes problems for some reason. I’m also sensitive to DHEA, and only take 1/4 of a 25 mg pill daily. It’s not a good idea to change multiple variables at once, so just adjust one thing and wait a few weeks. I’ve tried adding pregnenolone multiple times since starting trt, and every time my libido and well-being take a dive around the 5-7 day mark. I’ve done it enough times to know that’s what causes it. See if that provides any improvements. If you decide to make adjustments beyond that, I’d say lower the HCG dose and possibly also increase frequency. I started on 500 ius twice/week but ended up changing to 250 three times/week and feel that works better for me. After that I’d say the most likely options would be to increase test or lower DHEA dose, but as Madman pointed out I’d recommend an accurate free t test before deciding to increase test. Overshooting the mark would likely lead to/exacerbate issues. Adding an AI should only be a last resort.

But as I said, start by completely dropping the pregnenolone and see how you feel in a few weeks. I’d be surprised if it doesn’t improve things at least a little.