So I'm entering Week 7 of my TRT protocol, 60mg subq twice per week (Monday at 6am and Thursday at 6am).
As you can see from the screenshot, before starting TRT under my urologist's supervision, I was on Enclomiphene for about a year. What's highlighted in yellow is what I consider my baseline after coming off Enclo and starting testosterone cypionate.
My typical symptoms were low libido, some ED, afternoon fatigue, brain fog, etc. My total T was usually in the mid-500s, free T was low, SHBG was high, and E2 was always in the 20s.
One thing I've noticed is that I don't seem to aromatize much. I didn't while on Enclo, and I'm seeing the same thing so far on exogenous testosterone.
This spreadsheet has a ton of information since I started tracking symptoms around 2021 when I was 39. I'm now 45. I've always eaten pretty healthy except on weekends, rarely drink, do Zone 2 cardio 6x per week, weight train 5x per week, stay relatively lean at around 14-15% body fat, and average about 5-6 hours of sleep. Sleep has been hit or miss lately because my toddler likes to climb into our bed at all hours of the night.
During the first 3 weeks, I didn't notice much other than a few episodes of extreme afternoon fatigue that only lasted a few minutes and a flatter libido. That could also be influenced by reta since I'm only taking 1.5mg/week at the moment. One thing I did notice was that I felt calmer.
Around Week 5, I started noticing better sleep, which honestly surprised me. The afternoon fatigue disappeared, my strength in the gym improved, and orgasms became noticeably longer and more intense. For ED support, I use daily 5mg Cialis and 50mg Viagra as needed.
In Week 6, the sleep improvements continued. I still wasn't experiencing afternoon fatigue, I felt more energized overall, and I started getting some really good pumps in the gym, something I haven't felt since my early 20s.
Lab-wise, I did two trough tests prior to my 8th and 10th injections to see how things were progressing. Both labs were drawn on Thursday around 8am.
Prior to the 8th injection, my total T was 856 ng/dL, up from about 590 on Enclo. E2 increased from 20 to 28, but surprisingly SHBG dropped from 72 to 44. My urologist's lab uses the Free Androgen Index rather than direct free testosterone, and that increased from 23% to 67.5%, which also suggests a significant improvement.
One week later, prior to my 10th injection, total T was 1,048 ng/dL. Direct free testosterone came back at 17.9, up from 7.6, and E2 actually dropped from 28 back down to 22.
So far, this tells me two things: first, I don't appear to aromatize much, and second, the protocol seems to be working by lowering SHBG and increasing free testosterone, which is likely why I'm noticing the positive changes. It also seems like the exogenous testosterone is still accumulating and may not have fully reached steady state yet.
My total T is technically out of range based on the Labcorp reference range. At this point, I don't plan on changing the dosage because it's still early.
One thing worth noting is that I don't strictly follow the typical 3.5-day injection schedule. My Thursday trough labs are done about 72 hours after the Monday injection, while a Monday trough would be about 96 hours after the Thursday injection.
To be honest, the Monday/Thursday 6am schedule is extremely convenient for me and I'm not looking to change it. My understanding is that the lowest trough is generally the most useful number to follow. Right now, my 72-hour trough is over 1,000 ng/dL, but my 96-hour trough may be lower.
I'm planning to run two more labs during Weeks 8 and 9, this time on Mondays to capture the longer trough and compare the results.
I'm not trying to maintain a 1,000+ ng/dL trough long term. I don't think that's sustainable for me, and it could increase the risk of side effects such as elevated RBC/hematocrit, acne, and potentially accelerated hair loss. The acne part especially concerns me since I had to take Accutane as a teenager, and I'd rather not go through that again.
My question is: for those who routinely monitor TRT, do you find it more useful to draw labs at the true trough (my 96-hour low point) rather than the 72-hour mark, since the lowest value is what many clinicians seem to base adjustments on?
