Ask Anything You Want about TRT Thread........

[JonnyBravo22]

In my experience, which is generally low except when it comes to restarts - Nolvadex is preferred in a lot of cases. Clomid is used alot - but mostly because guys just think Nolvadex is for gyno only. Clomid causes a bunch of sides in many men, from emotional swings to eye floaters - whereas Nolvadex does not. In three years of Nolva, I just had low libido. In 3 weeks of Clomid, I couldn't watch TV without crying. Virtually never have I read about someone having trouble with a Nolva restart that was then successful from Clomid.

On the SERM scale they go something like this (10=best, 1=worst)
----------------
SERM / Side effects / Impact on HPTA / Gyno protection and and reversal
----------------
Clomid / 7 / 10 / 1
Nolvadex / 3 / 10 / 7
Raloxifene / 2 / 3 / 9

-Jim

Thank you Jim. My only option right now is the 10mg a day through the doctor. I am thinking about getting all new baselines including thyroid panel before starting as I am having a problem with terribly cold (feel frozen) feet all day everyday now.

Question about the tamoxifen restart: Is it true that a 800 level on a SERM is not the same as an 800 level of injections?? I was reading that the SERMS don't increase Free T like the the injections do?? Do you think that this Tamoxifen restart at 10mg a day is worth a shot??

 

[Megatron28]

I have been on TRT for 7 months. I am 3 weeks into my new protocol of 200mg a week and .25mg Anastrozole every 3.5 days. I changed from my old protocol of 300 mg EOW with no AI. I have noticed that my face is starting to break out with this new protocol. Is this a sign of estradiol being too high? I was getting acne on my back and chest with the old protocol but at least it was not on my face. I don't get labs done for about 6 more weeks so I don't have any current numbers for you. I did have labs done with my old protocol and my total test was 2115 and my estradiol was 93 at LabsMD (peak with no AI). Even though I am taking an AI now, I am taking more test as well. I have the freedom to raise or lower my dosages and injections of test and AI as I need to. Any thoughts? It has been 48 hrs since my last injection and I have felt hot all day even though its snowing and cold outside. Another sign of high estradiol?

Go in and get blood work. Otherwise we ate guessing along with you. See below in my signature for the PrivateMDLabs. Spend the $50.

 

[Megatron28]

Thank you Jim. My only option right now is the 10mg a day through the doctor. I am thinking about getting all new baselines including thyroid panel before starting as I am having a problem with terribly cold (feel frozen) feet all day everyday now.

Question about the tamoxifen restart: Is it true that a 800 level on a SERM is not the same as an 800 level of injections?? I was reading that the SERMS don't increase Free T like the the injections do?? Do you think that this Tamoxifen restart at 10mg a day is worth a shot??

TT of 800 is always 800 regardless of how it was derived.

As for what happens to your Free T and SHBG, who knows but I personally would not be overally concerned. I think if you manage your estradiol on this protocol that everything else will sort itself out.

 

[4150]

Go in and get blood work. Otherwise we ate guessing along with you. See below in my signature for the PrivateMDLabs. Spend the $50.

I have a few questions:

1) Last time I got the Hormone Panel For Females from LabsMD. Is that the test I should get this time?

2) I have read the term sensitive assay referring to estradiol; should my test include the "sensitive assay"? I don't think the last labs had this.

3) Is 3 weeks into a new regimen too early to get labs done? (I could just be impatient)

4) I inject on Thursday evening so Saturday evening would be my "peak" and Thursday afternoon would be my "trough". Do you suggest getting my peak or trough levels tested? This Wednesday would be the ideal time for me to leave work early (2 hour drive to lab).

 

[4150]

Your total test is 2100+ and your just on trt ?
Dude you are on a full blown cycle , no wonder your breaking out.. What was your baseline numbers before getting on trt ?

That was my old protocol at peak level. Since I injected EOW, my test would go all the way down to a trough of 468 at the end of the 2 weeks and I would feel like shit again. I have not had labs done yet on this new protocol so I don't know what my numbers are currently. My original total test number that got me on TRT was 168 and 220. I never used AAS.

 

[Megatron28]

I have a few questions:

1) Last time I got the Hormone Panel For Females from LabsMD. Is that the test I should get this time?

2) I have read the term sensitive assay referring to estradiol; should my test include the "sensitive assay"? I don't think the last labs had this.

3) Is 3 weeks into a new regimen too early to get labs done? (I could just be impatient)

4) I inject on Thursday evening so Saturday evening would be my "peak" and Thursday afternoon would be my "trough". Do you suggest getting my peak or trough levels tested? This Wednesday would be the ideal time for me to leave work early (2 hour drive to lab).

1). Yes, that one or the Hormone Panel for Males which includes the sensitive estradiol assay. Another option that might be cheaper is the Hormone Panel for Females and add in the Estradiol Sensitive al la carte. Depends on how much money you want to spend. Up to you.

2). Sensitive assay is preferred but regular assay is informative and costs a lot less. You have tk make the choice.

3) It is not too early if you are having complications, which you are.

4). Yes, checking peak and trough is useful, but I would recommend that when you are dialed in so you can know your range -- unless time and financial resources are not a limiting factor for you.

My recommendation: since you want your thyroid checked, get the Hormone Panel for Males as it includes some labs for that.

 

[4150]

1). Yes, that one or the Hormone Panel for Males which includes the sensitive estradiol assay. Another option that might be cheaper is the Hormone Panel for Females and add in the Estradiol Sensitive al la carte. Depends on how much money you want to spend. Up to you.

2). Sensitive assay is preferred but regular assay is informative and costs a lot less. You have tk make the choice.

3) It is not too early if you are having complications, which you are.

4). Yes, checking peak and trough is useful, but I would recommend that when you are dialed in so you can know your range -- unless time and financial resources are not a limiting factor for you.

My recommendation: since you want your thyroid checked, get the Hormone Panel for Males as it includes some labs for that.

My thyroid and prolactin has already been tested by my old doctor and deemed as normal. I see that the Hormone Panel for males is $100.00 more than the Hormone Panel for Females and since money is definitely an issue will the Female Panel give us enough info? I hope so.

 

[Megatron28]

My thyroid and prolactin has already been tested by my old doctor and deemed as normal. I see that the Hormone Panel for males is $100.00 more than the Hormone Panel for Females and since money is definitely an issue will the Female Panel give us enough info? I hope so.

Sorry, I was thinking of someone else who indicated wanting to check thyroid.

As I said before, getting the Female Panel is a great way to go. Cheaper and you get the results back faster. You just have to remember that the E2 number is likely overstated 10-20 points.

 

[4150]

Sorry, I was thinking of someone else who indicated wanting to check thyroid.

As I said before, getting the Female Panel is a great way to go. Cheaper and you get the results back faster. You just have to remember that the E2 number is likely overstated 10-20 points.

I will get the Female Panel this week and post results when they come in. As always, thanks for your help!

 

[Jimstigator]

Thank you Jim. My only option right now is the 10mg a day through the doctor. I am thinking about getting all new baselines including thyroid panel before starting as I am having a problem with terribly cold (feel frozen) feet all day everyday now.

Question about the tamoxifen restart: Is it true that a 800 level on a SERM is not the same as an 800 level of injections?? I was reading that the SERMS don't increase Free T like the the injections do?? Do you think that this Tamoxifen restart at 10mg a day is worth a shot??

SERMs raise SHBG, which yes, means less free T. And yes, it doesn't feel the same. I had a TT of 900+ on SERMs and low free T due to high SHBG. With 900 TT on TRT, my SHBG is low, so my free T is high.

While SERMs are excellent to try a restart, I never felt as good on them long term. For me a few months was ok, but after that, SHBG climbed too high and I started to feel shitty.

-Jim

 

[Megatron28]

SERMs raise SHBG, which yes, means less free T. And yes, it doesn't feel the same. I had a TT of 900+ on SERMs and low free T due to high SHBG. With 900 TT on TRT, my SHBG is low, so my free T is high.

While SERMs are excellent to try a restart, I never felt as good on them long term. For me a few months was ok, but after that, SHBG climbed too high and I started to feel shitty.

-Jim

I just wanted to share some studies. They show SERMs and estrogen can raise SHBG. Based on all the studies it sounds like a lot of things are at play here, so who knows what the actual mechanism is. I don't have a firm conclusion other than it is probably complicated. The last study says clomid lowers Free T while raising SHBG. Some of the studies are on women and may not apply directly to men as well.

Clomiphene citrate reduces serum insulin-like growth factor I and i... - PubMed - NCBI

Resistance Training increases SHBG

Resistance training increases SHBG in overweight/obese, young men. - PubMed - NCBI

Estradiol increases SHBG

Estradiol increases the production of sex hormone-binding globulin ... - PubMed - NCBI

Thyroid helps regulate SHBG

Thyroid hormones act indirectly to increase sex hormone-binding glo... - PubMed - NCBI

Olive Oil increases SHBG

Oleic acid increases hepatic sex hormone binding globulin productio... - PubMed - NCBI



I found this one interesting in the it states the Clomid raises SHBG but also decreases Free Testosterone.

The effect of clomiphene citrate on sex hormone binding globulin in... - PubMed - NCBI

The findings of this study indicated the CC causes an increase of SHBG concentration, which is probably related to the rise of E2 concentration. This SHBG change, combined with the intrinsic oestrogenic activity of CC might be one of the factors responsible, through a decrease of free T and a T to E2 imbalance, for the lack of significant effect on parameters of seminal quality in so treated patients.

Jim: Anything else we should be looking at?. I didn't do an exhaustive review of the research out there so I easily could have missed something.

 

[Alpin]

I just wanted to share some studies. They show SERMs and estrogen can raise SHBG. Based on all the studies it sounds like a lot of things are at play here, so who knows what the actual mechanism is. I don't have a firm conclusion other than it is probably complicated. The last study says clomid lowers Free T while raising SHBG. Some of the studies are on women and may not apply directly to men as well.

Clomiphene citrate reduces serum insulin-like growth factor I and i... - PubMed - NCBI

Resistance Training increases SHBG

Resistance training increases SHBG in overweight/obese, young men. - PubMed - NCBI

Estradiol increases SHBG

Estradiol increases the production of sex hormone-binding globulin ... - PubMed - NCBI

Thyroid helps regulate SHBG

Thyroid hormones act indirectly to increase sex hormone-binding glo... - PubMed - NCBI

Olive Oil increases SHBG

Oleic acid increases hepatic sex hormone binding globulin productio... - PubMed - NCBI



I found this one interesting in the it states the Clomid raises SHBG but also decreases Free Testosterone.

The effect of clomiphene citrate on sex hormone binding globulin in... - PubMed - NCBI

The findings of this study indicated the CC causes an increase of SHBG concentration, which is probably related to the rise of E2 concentration. This SHBG change, combined with the intrinsic oestrogenic activity of CC might be one of the factors responsible, through a decrease of free T and a T to E2 imbalance, for the lack of significant effect on parameters of seminal quality in so treated patients.

Jim: Anything else we should be looking at?. I didn't do an exhaustive review of the research out there so I easily could have missed something.

Mega, I've had a diet rich in olive oil all my life. Do you think it's been detrimental to me along the way?

 

[Chiefy]

I will get the Female Panel this week and post results when they come in. As always, thanks for your help!

Megatron gave you solid advice, I just wanted to add my thoughts on the non-sensitive E2 assay.

Personally, I'll never use the standard assay, as it has been insanely unreliable for me. The sensitive test is by far the preferred assay but I get it, if you're paying out of pocket for labs it's much easier to go with the cheaper option.

It's not the end of the world to only have the standard test done, it's just important that you don't make any rash treatment decisions based on the results. MANY guys have overreacted to their results and gone way overboard with AI dosing when no AI may actually have been needed at all.

It's not a good idea to aim for the "sweet spot" range that other patients aim for, as the range of ~20-30 is in the context of the sensitive test. If your standard E2 test puts you around 20, your E2 is way too low.

If you're going to use the standard assay, I'd suggest sticking with it for the long haul and only having the standard test done from there on out. Go by how you feel and focus less on the actual number. Pick a test and stick with it.

The sensitive test is far superior, but if you're going to be paying for frequent labs out of pocket, no harm in saving yourself a few bucks as long as you take the results with a grain of salt.

 

[Megatron28]

Mega, I've had a diet rich in olive oil all my life. Do you think it's been detrimental to me along the way?

Try contacting the authors of the following study.

Oleic acid increases hepatic sex hormone binding globulin productio... - PubMed - NCBI

 

[4150]

Megatron gave you solid advice, I just wanted to add my thoughts on the non-sensitive E2 assay.

Personally, I'll never use the standard assay, as it has been insanely unreliable for me. The sensitive test is by far the preferred assay but I get it, if you're paying out of pocket for labs it's much easier to go with the cheaper option.

It's not the end of the world to only have the standard test done, it's just important that you don't make any rash treatment decisions based on the results. MANY guys have overreacted to their results and gone way overboard with AI dosing when no AI may actually have been needed at all.

It's not a good idea to aim for the "sweet spot" range that other patients aim for, as the range of ~20-30 is in the context of the sensitive test. If your standard E2 test puts you around 20, your E2 is way too low.

If you're going to use the standard assay, I'd suggest sticking with it for the long haul and only having the standard test done from there on out. Go by how you feel and focus less on the actual number. Pick a test and stick with it.

The sensitive test is far superior, but if you're going to be paying for frequent labs out of pocket, no harm in saving yourself a few bucks as long as you take the results with a grain of salt.

I had the Hormone Panel For Females done on my last protocol and my Estradiol was 93. So taking into account the 10-20 point margin of error that would still put me in the 73-83 range which is double or more the top of the scale. That's why I switched doc's so I could get an AI to control it and inject more frequently. I'll get my labs done this Saturday, which will be 4 1/2 weeks into my new protocol and also my peak. I gotta say I have felt like a new man since I have been on TRT and I feel like a million bucks now except for a couple minor glitches such as some acne and sometimes erections aren't what they should be and hot flashes. Hopefully these labs will shed some light on something that can be adjusted a little. Thanks

 

[Megatron28]

I had the Hormone Panel For Females done on my last protocol and my Estradiol was 93. So taking into account the 10-20 point margin of error that would still put me in the 73-83 range which is double or more the top of the scale. That's why I switched doc's so I could get an AI to control it and inject more frequently. I'll get my labs done this Saturday, which will be 4 1/2 weeks into my new protocol and also my peak. I gotta say I have felt like a new man since I have been on TRT and I feel like a million bucks now except for a couple minor glitches such as some acne and sometimes erections aren't what they should be and hot flashes. Hopefully these labs will shed some light on something that can be adjusted a little. Thanks

The higher the result the less likely that there is as much error in it. The "regular" assay is less accurate at detecting low levels.

 

[4150]

The higher the result the less likely that there is as much error in it. The "regular" assay is less accurate at detecting low levels.

Good to know. You guys are great!

 

[JonnyBravo22]

I requested all new baseline bloodwork from my Doc. We will see if he approves it or not...what do you guys think about this list

Full CBC
Testosterone Total
Free T
SHBG
Estradiol sensative
SHBG
Prolactin
TSH
t3
t4
Free t3
Free t4

We will see if he approves it.

 

[Alpin]

Try contacting the authors of the following study.

Oleic acid increases hepatic sex hormone binding globulin productio... - PubMed - NCBI

They say low SHBG is linked to cardiovascular disease.
TRT guys usually have lower SHBG levels...
Whats the connection that you would make between the two?

 

[Mprtz]

They say low SHBG is linked to cardiovascular disease.
TRT guys usually have lower SHBG levels...
Whats the connection that you would make between the two?

My more recent tests of SHBG have been pretty normal ( 27 and 30 ), even though I'm still on the fairly high TRT dose.
At a time I suspected my SHBG must have been low (due to high free T), but it was never confirmed with a test.

Things can also be linked (associated) without a causal connection.