2 months on 200mg test cyp per week for TRT - labs done - have a few questions

[AJAK]

Hey guys,

I'll give you the condensed version of my story. 45 years old, 5'10", 185lbs, guesstimate of 15% body fat, weight train 3 days per week. Suffered from low test symptoms for years, got tested, and I was low. Doc put me on clomid 25mg per day for 2 months, test went up slightly, but I felt worse than before. Doc took me off clomid and put me on 200mg test cyp, once per week self injection 2 months ago. Labs are below, blood was taken 6 days after my last injection. My test came back high, I feel better, but not great, I suspect this is because of my elevated estradiol. Side effects so far: face looks a little puffy, left nipple feels a little itchy on occasion, I suspect these symptoms are due to my elevated estradiol.

Should I ask my doc to prescribe an aromatase inhibitor such as anastrozole? If yes, what would be a good starting dosage?

Should my elevated prolactin be a concern? Could this be causing the itchy feeling in my nipple? Is there a particular drug recommended to combat this? Side note: my sex drive is ok but not great, is this a possible side effect of high prolactin?

You guys run an great forum here. Thank you for your help.

LABS 9/27/2016
Total Testosterone (200 - 1000ng/dl) 1230
Estradiol (<41 pg/ml) 52
Prolactin (3.8-18.9 ng/ml) 18.2
LH (2-12 mIU/mL) <0.100
FSH (1.6-9 mIU/mL) <0.100

 

[Milton]

You guys run an great forum here.

welcome to the boards but the credit goes to all the top minds around here.

 

[Mprtz]

I think you're on the right track with all you wrote. I would start at 0.25mg Anastrozole twice a week. 1mg tablets (typical pharmacy dose) can be hard to divide, but there are other options.

You might consider splitting your weekly dose into two - it can smooth out the hormone levels and may reduce the need for AI.

Prolactin is high but in range... I would leave it alone until you retest in about 4 weeks after adding the AI. There's something to be said for only changing one variable at a time whenever possible.

I'm surprised you're not noticing more after 2 months on 200mg per week - it's a fairly high end dose for TRT. I started on same but have had to reduce it somewhat to keep things in range.

 

[halfwit]

That's a trough result? I'm thinking that you may want to lower your test dose and move to E3.5D injections as Mprtz suggests.

Itchy nipples are often more of a result of high estradiol than prolactin. Bring the estradiol down though, and prolactin should follow.

I'd tackle it that way first, then look at an AI. I wouldn't be surprised if your total testosterone is close to 2,000ng/dL at peak.

 

[AJAK]

I think you're on the right track with all you wrote. I would start at 0.25mg Anastrozole twice a week. 1mg tablets (typical pharmacy dose) can be hard to divide, but there are other options.

You might consider splitting your weekly dose into two - it can smooth out the hormone levels and may reduce the need for AI.

Prolactin is high but in range... I would leave it alone until you retest in about 4 weeks after adding the AI. There's something to be said for only changing one variable at a time whenever possible.

I'm surprised you're not noticing more after 2 months on 200mg per week - it's a fairly high end dose for TRT. I started on same but have had to reduce it somewhat to keep things in range.

Thank you. I appreciate your input.

 

[AJAK]

That's a trough result? I'm thinking that you may want to lower your test dose and move to E3.5D injections as Mprtz suggests.

Itchy nipples are often more of a result of high estradiol than prolactin. Bring the estradiol down though, and prolactin should follow.

I'd tackle it that way first, then look at an AI. I wouldn't be surprised if your total testosterone is close to 2,000ng/dL at peak.

Yes, that's a trough result. And thanks for your help.

 

[daleb]

Im just sayin... this is my opinion. I have not been able to accurately dose an AI off of a non-sensitive e2 test. I try to dose according to symptoms, then weird shit starts happening. Large flares up of subaceous cystic acne. Nerve related junk. Then my non-sensitive e2 tests would come back in the low 20's. Which isnt really good. This was using 1/8 mg of dex to 1/4 mg to a few drops here and there. I dont know how people in Europe or other countries do it without sensitive e2 tests. If your gonna start looking at an AI, get at least one or two sensitive estradiol tests. its a test that uses LC\MS or liquid chromatography mass spectrometry. If you are not around a quest or a labcorp your physician can order it though ARUP Labs out of Utah, the specimen is sent there. The downside is its expensiveish and results take around 2 weeks. Any accredited medical lab can run labs though ARUP. Its not ideal but its an option for ppl that live in the boonies.

Anyways, the nonsensitive e2 test is too unreliable.

*edit* I have not been able to find much research on the high, but not that high prolactin and its etymology. People with prolactin secreting adenomas tend to have prolactin 50 ng/mL or a lot more. What I suspect is that the prolactin is some kind of distress response to slow down some low grade autoimmune disorder that is affecting the adrenals, thyroid, and pituitary. My prolactin bounces between 15-25. I havent ran labs in a while so i dont know if some tweeks i made have worked or not. So should you worry? probably not right now. Establish your TRT protocol and dial it in. See what happens to ur prolactin.

 

[DucBase]

That TT number is probably just too high for TRT. Like the others, I think if you get that sorted out the other stuff will fall into place. And like Mprtz said, you don't want to change more than one variable at once.

I couldn't help myself from tweaking everything on a weekly basis when I started and I think I chased my tail around for at least the first year.

If your script is for more than you need and you are self injecting, then you are in a pretty good place. Don't mess that up. If the other stuff doesn't fall into place it's easy enough to deal with on your own.

 

[AverageMan]

With a TT that high - YES, you will need an AI. You have 2 options:
1. Lower your test dose - It's high for TRT. (FYI - that's where I keep my TT, but need to take .5 of an AI E3.5D and I'm under 10% body fat.)
2. Get an AI - agree starting out at .25 E3.5D

You are in a good place. Just a little tweaking needed. As others have said ONLY change 1 thing at a time.

Agree 100% with the others - try the E3.5D injection frequency VS the once per week. Will really help to level TT and estrogen. Again - change one thing at a time.

Good Luck

 

[AJAK]

Thank you, everyone. Sounds like the first step(s) would be to lower the dose a bit and move to injections every 3.5 days. Any advice on what I should dial the dose back to?

 

[Gainjin260]

Thank you, everyone. Sounds like the first step(s) would be to lower the dose a bit and move to injections every 3.5 days. Any advice on what I should dial the dose back to?

You should work with your doctor on this. However, if I were to hazard I guess: 80mg 2x/wk.

Edit: assuming you want to be on the upper end of the range in the trough.

 

[Mprtz]

Where do you want to come in at for total T? Keep in mind that your trough will be higher when injecting 2x per week.

 

[AJAK]

Where do you want to come in at for total T? Keep in mind that your trough will be higher when injecting 2x per week.

I'd like to trough at the higher end of the normal range. Thanks for your help.