Advice on TRT and latest labs

[jcm]

Hello everyone. I have been on TRT for 3 months and could use advice on my current labs. I am 28yo. I had the usual symptoms of low test so I asked my primary care physician to check it. My test came back at 315 ng/dL. I've never done a cycle or anything like that before.

Labs before TRT:
CBC and CMP Normal
Testosterone , Serum (348-1197 ng/dL) - 315 LOW
TSH (0.450-4.500 uIU/mL) - 0.709
Prolactin (4.0-15.2 ng/mL) - 13.3
LH (1.7-8.6 mIU/mL) - 5.4
FSH (1.5-12.4 mIU/mL) - 2.4
Estradiol (7.6-42.6 pg/mL) - 32.5

Urologist started me on 100 mg/week of test cyp. I split this into E3.5D. Labs a month later showed that my test level was around low to mid 400s. He told me to increase my dosage to 150mg/week. When I first started TRT, the pharmacy gave me a brand of test that produced few results on Google. About 1.5 months into TRT, they gave me Watson test cyp. I know the first brand I received was "pharma" as well but I really feel like it was way underdosed compared to Watson. I had new labs this past week and here are the results.

Labs 3 mo TRT:
CBC and CMP Normal
Testosterone, Serum (348-1197 ng/dL) - 1110
LH (1.7-8.6 mIU/mL) - <0.2 LOW
FSH (1.5-12.4 mIU/mL) - <0.2 LOW
Estrogens, Total (40 - 115) pg/mL - 194 HIGH
Estradiol (7.6-42.6 pg/mL) - 76.1 HIGH

My test levels are now at the high end of the range. However, I am now experiencing sides of high E2. These including feeling bloated, feeling lethargic, and occasional slight nipple sensitivity. There are no lumps or bumps on the nipples. I know the sensitive estriadol assay is supposed to be better in men, but the regular lab shows that my E2 has more than doubled. Given my current numbers, would it be best to start on an AI? Should I reduce the amount of testosterone? Any input would be appreciated. Thanks.

 

[Megatron28]

Everything looks good except your estradiol. Yes, the sensitive estradiol assay is more accurate, but they really comes into play at lower levels. I suspect that at 76pg/ml that it is pretty accurate.

Your choices are to lower your test dose or start using an Aromatase Inhibitor. I personally like my TT at the higher end of the range and I use an AI. I take 160mg/week of Test (split into two doses) and that puts my TT around 1100. I take .25mg of Arimidex twice a week to manage estradiol on that testosterone dosage.

I know you say everything in your CBC and CMP are normal, but it is good to post the results nonetheless. Sometimes normal isn't always "normal".

Are you donating blood every 56 days to manage your hematocrit levels?

I think if you get your estradiol lower that you will be felling like a new man!

 

[Alpin]

You had more Estradiol than Test in your system pre TRT.
I think I am similar to you in that regard in thst I canmot get off low dose a.I. with natty low T

Tell me more about your symptoms...
Were you anxious, felt really alert, some insomnia, irritable, etc?
Your E2 is very high with TRT you arromatize quite a bit....
and you took 50 mg x 2 doses per week?

 

[Alpin]

No man dont increase your dose try to go to 850-950 TT.
You might still need the a.I. though.
You have a lot of body fat. ?

 

[jcm]

Everything looks good except your estradiol. Yes, the sensitive estradiol assay is more accurate, but they really comes into play at lower levels. I suspect that at 76pg/ml that it is pretty accurate.

Your choices are to lower your test dose or start using an Aromatase Inhibitor. I personally like my TT at the higher end of the range and I use an AI. I take 160mg/week of Test (split into two doses) and that puts my TT around 1100. I take .25mg of Arimidex twice a week to manage estradiol on that testosterone dosage.

I know you say everything in your CBC and CMP are normal, but it is good to post the results nonetheless. Sometimes normal isn't always "normal".

Are you donating blood every 56 days to manage your hematocrit levels?

I think if you get your estradiol lower that you will be felling like a new man!

Here are the results after being on TRT for 3 mo:
CBC
WBC 9.7 3.4-10.8 x10E3/uL
RBC 5.14 4.14-5.80 x10E6/uL
Hemoglobin 16.1 12.6-17.7 g/dL
Hematocrit 46.9 37.5-51.0 %
MCV 91 79-97 fL
MCH 31.3 26.6-33.0 pg
MCHC 34.3 31.5-35.7 g/dL
RDW 13.6 12.3-15.4 %
Platelets 278 150-379 x10E3/uL
Neutrophils 64 40-74 %
Lymphs 26 14-46 %
Monocytes 7 4-12 %
Eos 3 0-5 %
Basos 0 0-3 %
Neutrophils (Absolute) 6.2 1.4-7.0 x10E3/uL
Lymphs (Absolute) 2.6 0.7-3.1 x10E3/uL
Monocytes(Absolute) 0.7 0.1-0.9 x10E3/uL
Eos (Absolute) 0.3 0.0-0.4 x10E3/uL
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL
Immature Granulocytes 0 0-2 %
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL

CMP
Glucose, Serum 87 65-99 mg/dL
BUN 16 6-20 mg/dL
Creatinine, Serum 0.79 0.76-1.27 mg/dL
eGFR If NonAfricn Am 123 >59 mL/min/1.73
eGFR If Africn Am 142 >59 mL/min/1.73
BUN/Creatinine Ratio 19 8-19
Sodium, Serum 140 134-144 mmol/L
Potassium, Serum 4.5 3.5-5.2 mmol/L
Chloride, Serum 100 97-108 mmol/L
Carbon Dioxide, Total 23 18-29 mmol/L
Calcium, Serum 9.8 8.7-10.2 mg/dL
Protein, Total, Serum 7.0 6.0-8.5 g/dL
Albumin, Serum 4.8 3.5-5.5 g/dL
Globulin, Total 2.2 1.5-4.5 g/dL
A/G Ratio 2.2 1.1-2.5
Bilirubin, Total 0.5 0.0-1.2 mg/dL
Alkaline Phosphatase, S 86 39-117 IU/L
AST (SGOT) 23 0-40 IU/L
ALT (SGPT) 28 0-44 IU/L

I use to donate blood regularly but with school I just haven't made the time. I do plan on starting back up though.

 

[jcm]

You had more Estradiol than Test in your system pre TRT.
I think I am similar to you in that regard in thst I canmot get off low dose a.I. with natty low T

Tell me more about your symptoms...
Were you anxious, felt really alert, some insomnia, irritable, etc?
Your E2 is very high with TRT you arromatize quite a bit....
and you took 50 mg x 2 doses per week?

No man dont increase your dose try to go to 850-950 TT.
You might still need the a.I. though.
You have a lot of body fat. ?

Do you mean my symptoms before starting TRT? If so, I would constantly feel tired/fatigued, reduced libido, and sometimes it was hard to concentrate.
The E2 value of 76 is at 75mg x 2 per week.
BF is roughly estimated to be about 18-20%.

 

[Alpin]

Do you mean my symptoms before starting TRT? If so, I would constantly feel tired/fatigued, reduced libido, and sometimes it was hard to concentrate.
The E2 value of 76 is at 75mg x 2 per week.
BF is roughly estimated to be about 18-20%.

No HCG ?
Your dose may be high and it may not. Know what I mean?
I would keep TT anywhere between 700-900 ng/dl...
You dont need super high levels bro. It's all in peoples head.
Estradiol is important to be dialed in. Higher levels means more dialing in issues and more DHT side effects over the long term. ( for some ppl)

 

[jcm]

No HCG ?
Your dose may be high and it may not. Know what I mean?
I would keep TT anywhere between 700-900 ng/dl...
You dont need super high levels bro. It's all in peoples head.
Estradiol is important to be dialed in. Higher levels means more dialing in issues and more DHT side effects over the long term. ( for some ppl)

No HCG. Doc will not prescribe that at this time. I've though about self-medicating HCG though. However, won't the HCG also have an impact on my E2?
I may try 60mg x 2 a week to see where that puts me.

 

[Alpin]

No HCG. Doc will not prescribe that at this time. I've though about self-medicating HCG though. However, won't the HCG also have an impact on my E2?
I may try 60mg x 2 a week to see where that puts me.

It def will impact Estradiol.
I've used 60 mg E3D and hit TT of 830 ng