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Topics - Dugosian

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About 8 weeks ago I started with a new Dr. for my TRT and at the time was taking 140 mg/week and .5 mg Anastrazole (divided into two doses per week).  It's been my long standing goal to try to find the minimum T dose which would alleviate symptoms and minimize side effects (my particular issue being acne on the back and shoulders).  So I switched from 140 mg per week to 120 mg per week.

Things seemed fine for a about a month and then all of the sudden I started getting significant anxiety.  The way it manifested with me was the at any kind of conflict or difficulty (wife wanted to talk about finances, daughter was unhappy about some decision I had made, friends arguing about some point, etc...) I would suddenly heat up and start to sweat.  When it first started happening I thought it may have been too much caffeine, so I cut that out but things didn't really get better.  I wondered about cortisol, diet, sleep, lots of different things.

Ultimately I thought about it and realized that I had likely tanked my E2 by the double whammy of lowering my T dose and staying on the same dose of Anastrazole.  I didn't get a new set of labs to verify but after my last injection (last Friday) I didn't take my AI and within a day or two, the issue has gone away. 

So I am just sharing my experience in case anybody else on here has suddenly found themselves with strange anxiety and might need a place to start looking for the cause.

[MODERATOR SPLIT FROM HERE: http://www.peaktestosterone.com/forum/index.php?topic=10339.0 ]

So I just got back from the doc and it's his opinion that the reason my H&H went up so much (3 points in 3 months) is because I am injecting twice per week, and creating two "peaks".  He told me that each time I inject I am stimulating red blood cell production from bone marrow and its building up the count each time.  He then went-into his pitch for switching to pellets (which I shut down right away as I don't believe in them as a good treatment option for me). 

An alternative change he did suggest was to switch from IM to SubQ, which he thinks will blunt the increase in H&H.  He did say that the spinach could possibly contribute to the problem on a small scale but was unlikely to be the main issue.

Overall I'd say that I felt pretty good about the conversation but it's the first that I have heard about increased injection frequency having an affect on H&H.

I had a blood draw the other day and got quite the surprise today when I got the numbers back:  my hemoglobin and hematocrit are both way up (18.0 and 53.0 respectively).  I've been scratching my head about this for a few minutes as I've had numbers on the high end in the past but never this high.  This result is even more strange, as I've split my weekly dose into two injections and reduced the total dose from 160 mg to 140 mg specifically to address higher H&H.

Then I started doing some internet research and have a theory as to the cause of my surprisingly elevated numbers:  spinach.  For the past several months I've been having a big spinach salad for lunch most days and I've read that spinach can cause issues with H&H due to the high iron content.

Anybody else ever ran into this issue before?

FWIW my other numbers were as follows:

Total T: 905
Free T: 30.6
E2:  22.4 (sensitive)

Testosterone, Hormones and General Men's Health / Cycling HCG?
« on: April 06, 2016, 03:20:09 pm »
So my TRT clinic insists on cycling HCG (2 months on and 2 weeks off I believe) on the theory that constant administration could lead to desensitization.  When I talked with my doc about this yesterday I also brought-up how the HCG cycling and the timing of my blood tests could cause a mild to moderate swing in my Total T reading depending on when the labs were drawn (possibly even more significantly since I was originally a low LH guy). 

Anybody else run into this with their Dr?

So I finally decided to pay the extra money and get back-to-back tests of my bloodwork with the standard Estradiol test (ECLIA) and the sensitive test (LC/MS).  In the past I've talked to a doc at my TRT clinic about why they don't use the sensitive test and he basically said that they have lots of patients and have been successful in treatment so the standard test seems good enough.

Anyway, as to why I think that they don't use it:  It takes for freaking ever!  The paperwork says it could take up to 14 days to get the results back (Labcorp).  Tomorrow will be one week since the draw and I don't have any results yet (standard test results were back the next day).  So I'm eagerly anticipating the results to be able to compare apples to apples and will let you all know the results when they are in.

I've yet to solve the acne problem myself and I am on 160 mg/week.  I have my quarterly labs coming up soon and may discuss dropping lower with my doc but I am also concerned about getting too low.  In the past I went as low as 120 mg/week and after 6 weeks, some of my low T symptoms started coming back.  Please keep us informed if you do lower things and how that may/may not help your acne.

[MODERATOR SPLIT FROM HERE: http://www.peaktestosterone.com/forum/index.php?topic=9350.0 ]

Imo you definitely want a target testosterone level based on symptoms and lab reads.

I totally agree and this may end-up as a separate topic but in the absence of symptoms (as most of us who have been on TRT for a while are), what levels should we be using as our reference?  The highest point our Total T gets to (ie, 48-72 hours post injection), the lowest point it gets to (we all seem to draw our labs at the "trough" and adjust from there), or some way to determine an average?  There are lots of published numbers, people's own experiences, etc...that lead us down our individual paths, but in the absence of hypogonadal symptoms (which I no longer really have since I've been on TRT for over two years) how much is too much or how much is the right amount?

I'm guessing that I will eventually need to try to titrate-down again to find a minimal amount needed which prevents my hypogonadal symptoms but also keeps me from having high hematocrit and acne (my two personal bugaboos).

I realize that this is going to vary from individual to individual based on lifestyle factors and whatnot, but I've been curious about how much testosterone is "used-up" by the body each day.  The doc I see says it's around 100 "points" on the Total T scale of ng/dl.  The specific reason I'm wondering about this is that over the years I have been chasing the best dose for me and have plotted-out a theoretical rise and fall of injecting certain amounts over time.  The end-result of the thought exercise is that with some doses, the Total T goes down over time and with others it goes up.

So for example: if I am injecting 160 mg per week, I am expecting to see a rise of about 800 points on my Total T level from where I started.  Then, given the elimination of 100 points per day throughout the week, I would see a net "gain" for the week of about 100 points on the scale.  Over time, if lifestyle factors stay the same, I could see a situation where my total T creeps-up to undesirable levels due to the net gain each week.

Has anybody else thought about this and can perhaps point-out where I am wrong with this line of thought?

Hi, everyone

I have no idea if this is TRT-related but I wanted to ask the board if any of you have had this issue.  In the past week, out of nowhere I suddenly have persistent dark circles under my eyes.  I've been getting over 8 hours of sleep each night (or so my Fitbit tells me), been drinking water, etc...I can't seem to figure-out what is going on.  Things I've considered so far:

Not currently ill
No known allergies
I have an adjustable bed and sleep with my head elevated
I *may* have low E2, but since my TRT clinic doesn't do the sensitive assay, I'll need to go out of pocket for this.  Likely to do this in the next week or so
My hematocrit/hemoglobin is a bit high now (around 52) and am going for phlebotomy next week
I suspect that I may be iodine deficient; but no tests to back this up

Anybody else dealt with the dark circles issue and if so, any idea what caused it?

Hi, all

I've been on TRT for nearly 2 years now but have yet to frequently feel "great", as I think some others do.  I certainly feel MUCH better than I did with a Total T of 217 (my low point) but very rarely do I feel great.  Over the course of treatment I have bounced around with my protocol; began with one big shot per week (up to 200 mg when I first started), worked my way down to 100 mg/wk due to the side effects of such a large one time dose (that turned-out to be too little), and I am currently doing 2 injections per week at 90 mg per which is ok, but not great.

My question is this:  Do any of you feel "great" with your TRT protocol?  Let me give you an idea of how I would describe great for me.  A couple of times, 2 hours or so after getting a large IM shot, I've been driving around on the freeway, some tune I really like comes on the radio and I feel fantastic.  I'm rockin' out, I feel really in the groove, like I can see traffic a few moves ahead; aggressive but not angry.  My brain and body are really in tune with each other (for you athletes out there, I'm in the zone).  This feeling has lasted about 30 minutes each time it happened and then is gone.

If you do feel "great" (even sometimes) please let me know what your numbers look like.  My numbers look pretty good at this point, but I am curious if I've tuned things to where they are about as good as they will be or if I am missing something which may put me over the top and make things great.


Have any of you ever successfully switched from IM injections to a compounded cream? 

I've been with a TRT clinic for almost 2 years but recently switched my Primary care provider and was considering taking all of my health business to one person.  He initially suggested a compounded cream as an alternative to injections (which frankly might be more convenient as I go to the TRT clinic twice a week for injections currently) but I'm weighing my options and was looking for input from the community.

FWIW, I started on Testim/Androgel with my old PCP 2 years ago, but that guy had no idea what he was doing and so I went to a TRT clinic.  I suspect that my body may not respond that well to topicals, but I also don't know if some people do better on compounded creams vs. Testim/Androgel.

In the past, I believe that I have read that supplementing T shots with HCG will increase the serum T level above what T-only would provide.  This lead me to wonder about timing of blood draws.

If I have blood drawn one month where I am on HCG and T vs. another month with T only, would the results be significantly different?  I'm not currently doing blood draws frequently enough to test this out myself, but my Dr. has me on a two months on HCG and one month off regimen and my numbers don't seem to be that static.  I wonder if that could be contributing?

Hi, all

Since I started TRT about 1.5 years ago, I have been battling to get things "dialed-in".  This has meant several changes to T dosage, frequency, etc...as well as a nearly constant need to add-in an AI.  Thinking about this has lead me to a question that I've never been able to answer for myself and I can't recall seeing anyone else mention it, so I thought I would throw it out here:

If some of us are attaining "youthful" levels of Testosterone (say 800+) with our TRT, why do we need to worry so much about controlling our E2?  During puberty most of us had high T levels, but yet we didn't need to worry about controlling E2.  Is there some significant difference between youth and older age which increases the conversion of T to E2?

Due to the rough peak timing of T. Cyp at somewhere between 1 and 3 days (depending on who you ask), is there no longer a true trough when injecting E3D or more often? 

With once a week injection protocol you're getting a big spike of T over the short period and then it drops off to its lowest point somewhere around 7 days; when you would normally get another injection to boost you back up.  With multiple injections per week, it seems as though there would never be a significant drop off and perhaps an almost steady-state.  Thoughts?

Around 6 weeks ago I switched from a once weekly IM injection of 140 mg of Test Cyp (which had me around 750 Total T at my trough) to twice weekly IM injections of 80 mg of Test Cyp.  I chose to split the dosage as a response to acne that I could not get under control, and I increased the total volume as over the last 6 months to a year my Total T had been progressively dropping from around 1000 to around 750 at trough.

I just got my labs back and have found that despite raising the total amount that I was injecting per week, my trough Total T is now 438.  I  can understand that halving the dosage at each injection probably should reduce the Total T, but it seems like a pretty dramatic reduction. 

Additionally, I'm also more moody, less energy and noticing that nighttime erections are starting to go away, so the reduced Total T is certainly bringing back some symptoms.

Anybody else who has split their dosing experienced this kind of reduction and if so, did you have to increase the total weekly dose of T to get the trough numbers back into the more desirable 600 - 800 range?

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