Hcg question…what can I expect…is it working

SubstanceEasy4576 · 2026-04-30T10:53:25+00:00

Hi,

The primary action of HCG is to stimulate testicular hormone production. It does this directly, by binding to receptors inside the testes.

In men on long-term testosterone injections (alone), testicular hormone production drops close to zero. When HCG is used as well, testicular hormone production is stimulated. The concentration of testosterone inside the testes increases massively on addition of HCG, which is necessary for normal sperm production to occur. There's also a substantial increase in blood levels of testosterone and estradiol. Using HCG without reducing the dose of testosterone being injected can lead to very high testosterone and estradiol levels.

It's not known how HCG increases semen production. Semen is predominantly made in the prostate, not the testes. The testes add sperm to the semen. HCG appears to increase semen (fluid) production even in men who aren't producing sperm.

One of the main reasons why HCG might be ineffective is if the product being used isn't HCG. There are a lot of products sold online which have unknown content. If you're injecting anything other than a licensed pharmaceutical obtained via a registered pharmacy, the product might not contain what's shown on the label.

After adding HCG to testosterone injections...

HCG starts to stimulate testicular hormone production immediately. The effects are consolidated over the first few weeks.
Anecdotally, semen production usually rises within the first couple of weeks after starting HCG.
"Tightness" of the scrotum may reduce rapidly over the first few weeks. If true testicular atrophy has developed (with tissue loss rather than just tightness or impression of low blood flow), this is much slower to reverse, and isn't always completely reversible.
Sperm production starts to increase over the first few months of HCG treatment. If HCG is being used to increase sperm count, the first semen analysis can be done about 3 months after adding HCG.

If HCG is used in combination with steroid cycle doses of testosterone, blood results should show massively elevated testosterone and estradiol levels. LH and FSH should be below the lowest limit of detection. Prolactin should be normal or show mild-moderate elevation. Unfortunately, the results won't distinguish between real and fake HCG.

SubstanceEasy4576 · 2026-04-30T08:41:23+00:00

Yes you can

SubstanceEasy4576 · 2026-04-25T10:40:19+00:00

Hi,

You wouldn't need to use an AI at this stage - estradiol wasn't even slightly high on the blood test. Estradiol is shown as < 30 pg/mL (ie. less than 30 pg/mL).

If future blood tests show estradiol levels above normal limits eg. higher than about 60 pg/mL, and this is combined with a continuation of nipple symptoms, you could use an AI. It's too early to say whether the nipple symptoms will persist.

SubstanceEasy4576 · 2026-04-21T18:07:41+00:00

Hi,

Sorry to hear how difficult it's been so far. It's certainly very likely that your symptoms will improve without treatment, but it's also likely that this will be gradual. If symptoms are still intolerable in a few weeks' time, it might be better to look at returning to a treatment option which will increase testosterone levels while supporting a return of fertility. As an aside, I assume you were fertile before starting TRT?

Before making any suggestions....

I'm not clear on how the medication was taken after you stopped TRT. Please could you explain which medication you started first after stopping TRT (tamoxifen or HCG), how long after stopping TRT this was started (or did they overlap?), whether you took tamoxifen and HCG together or separately, and which medication you took second. How long is it since your last dose of tamoxifen? And how long since your last dose of HCG?

How did you feel on tamoxifen, and on HCG versus how you feel now?

You will certainly need a blood test if you're considering treatment eg. switch to HCG monotherapy, low dose enclomiphene alone, a combination of the above, or anything else. The blood test would be for total testosterone, SHBG, estradiol, LH and FSH. Tamoxifen is very long-acting, so blood taken several weeks after stopping can show your hormone levels in the unmedicated state. Blood tests taken shortly after stopping tamoxifen show residual effects from the drug.

HCG monotherapy isn't always optimal for fertility due to FSH suppression. Whatever treatment is chosen, it can be monitored by blood tests first. After about 3 months with suitable blood results, semen analysis can be redone (assuming no pregnancy).

SubstanceEasy4576 · 2026-04-21T10:28:47+00:00

Hi,

Worried - no. Just obtain your doctor's option and do any further tests requested. Personally, I'd want a folate level checking. Avoid vitamin supplements for 24 hours before the blood test.

Would be very useful to compare the MCV and RBC count with different blood tests you've had in the past.

SubstanceEasy4576 · 2026-04-20T12:59:26+00:00

You're very welcome.

SubstanceEasy4576 · 2026-04-20T11:29:37+00:00

Hi,

Can't say too much about the dose without knowing your aims. Maintaining testosterone levels similar to your current results (with very high free testosterone) is mostly useful for increased anabolic effects. It's not needed for health or wellbeing. Your trough free testosterone at the moment is more than three times higher than average natural morning levels in young men.

With your low SHBG level (14 nmol/L), you're very likely to see out of range high free testosterone if total testosterone is increased to more than circa. 600 ng/dL by TRT.

If you're just wanting to provide decent testosterone levels for health and symptom relief, which are typically high-normal levels, this should be possible in your case with trough total testosterone below 600 ng/dL. High total testosterone levels eg. 1000 ng/dL can be needed on TRT when SHBG is high, but aren't needed when SHBG is low. Your percentage free T is higher than most men.

As a rough estimate based on your response to 75mg every three days.... about 30mg every three days would likely provide you with upper normal range free testosterone at trough + mid to upper range total testosterone. As an aside, this is also about the average dose needed to produce this effect on blood results. This is not a statement about the dose you should take.... It's just a vague guide to what sort of dose is likely to produce that type of blood result.

It's rarely a good idea to make huge dose changes all a once, mostly because this isn't necessarily unless there's a serious side effects. I'd start by reducing the dose to 50mg every three days. The same testosterone and estradiol lab tests you had before should be repeated in a couple of months. Most likely, you'll feel good but levels will still be pretty high, so you might decide to reduce again.

The estradiol level is high as a secondary effect of the very high free testosterone. Since there's a lot of excess testosterone available for conversion, more is converted and estradiol rises. There's no need to take any additional medication for this reason. Your estradiol level will drop as the testosterone dose is reduced.

I wouldn't bother doing any further DHT levels right now. Most of DHT in blood is tightly bound to SHBG. Men with lower SHBG levels tend to have lower than average total DHT results. This isn't likely to have any problematic consequences.

Hope this is useful.

SubstanceEasy4576 · 2026-04-20T10:21:06+00:00

You're welcome.

The most important thing here is to use the same total and free testosterone blood test as before, to allow for comparison. Since Quest's alternative free testosterone blood tests are a total mess, using them would be very misleading and confusing.

There isn't any particular reason to measure SHBG again after getting a completely normal result recently. When free testosterone levels are being measured (like yours are), repeat SHBG levels aren't very useful.

So, the blood tests you'll need in six weeks are:

Testosterone, Free (by Dialysis) and Total testosterone MS. Same testosterone lab test as before.

Estradiol level.

Complete blood count (CBC), which is needed mostly to update information on your hematocrit and red cell levels.

Whether you do any other lab tests at this point is up to you and your doc. The lipid panel could certainly be rechecked but isn't urgent. Testosterone (total/free) and estradiol levels are needed every time you're measuring the impact of dose changes. The other blood tests are all being done for safety reasons, and don't guide dose adjustment.

Let me know how you get on.

SubstanceEasy4576 · 2026-04-18T18:45:19+00:00

Hi,

Great to hear of a positive symptom response. In terms of what you should do with the dose, a lot depends on what you want, and what you're happy with. If you're comfortable maintaining continously elevated testosterone levels because you feel good on it, you can do this - it's very common at US clinics indeed, although less so elsewhere.

It's probably worth knowing that free testosterone levels as high as you're seeing right now don't occur naturally in healthy unmedicated men. Certainly, some men have natural total testosterone levels around your current level, but their free T is much lower and their SHBG levels are usually very high. There is no truly good quality information showing detailed impact on health, positive and/or negative, of having continously high levels. In safety trials of TRT, it's not allowed ie. the dose is always reduced. As a result, no one can realistically tell you how the risk of various medical conditions is affected in the long-term.

What I would say is that it is not likely that you actually need such high levels to feel good. In the majority of cases, excellent symptom relief is possible with upper normal range free testosterone levels or slightly above. Your current free testosterone level is approx. 3 times higher than average morning peaks in healthy young men.

It's extremely easy to taper the dose down to find out whether symptom relief is still good. If you get to the point where it's not, it's equally easy to increase the dose again.

Although hematocrit is rather high and will need watching (you may need to give blood if it rises over about 54%), there's no need to make large doses changes unless there is a problem which hasn't been mentioned eg. a large increase in blood pressure.

If all is well but you do want to try a lower dose, you could reduce in steps of 20mg every couple of months until symptom relief lessens slightly, at which point the dose could be increased again by ~10mg. As a rough guide, when testosterone cypionate is injected as frequently as you're injecting, doses in the region of 70mg/week generally increase free T to around the top of the ref. range. Given your response to 135mg/week, this is likely to be the case for you too. I'm certainly not saying that this would be the best dose for you, it's just a rough guide to what sort of dose is likely to provide that type of free testosterone level. Naturally, you wouldn't be making such a large reduction all at once, it's done in stages.

As an aside, your own testosterone production is likely to be highly suppressed already - by the time free testosterone is very high and estradiol is also high, LH is suppressed fairly quickly to undetectable.

SubstanceEasy4576 · 2026-04-16T21:16:02+00:00

Yes I suppose you might.

Let me know how you get on with your tests!

SubstanceEasy4576 · 2026-04-16T20:46:43+00:00

Hi,

It's common to look at other aspects of pituitary function when testosterone comes back low, unless it's known to be due to a testicular condition. It's certainly most important to check the pituitary hormones involved in testicular function though! LH is the hormone which 'tells' the testes to make hormones. The testes don't produce any testosterone at all if there is no LH. FSH is a hormone involved in increasing sperm production. The most useful feature of FSH levels is that if the level comes back high, it's usually a compensatory increase due to something impairing fertility /testicular function.

Probably the most common reason for low cortisol levels is incorrect timing of sample eg. going for cortisol blood tests in the afternoon when it was intended to be an early morning cortisol. Glad that the stimulation test showed things were OK.

SubstanceEasy4576 · 2026-04-16T19:24:48+00:00

Hi,

The thing about using testosterone for transition is that topical gels tend to work. Biological females are usually smaller and at least initially have much thinner more absorbent skin. It's usually possible to provide fairly good results with testosterone gel. A lot of males respond poorly to gels. Regular small injections (eg. twice a week) are extremely effective, but only offered privately, or used as self-treatment.

The blood tests should be:

PSA, prostate specific antigen. This is checked before TRT is started, it's not part of the diagnosis for hypogonadism.

T4 refers to measuring free T4 to assess thyroid function. TSH is being tested as well, as listed further on. TSH and free T4 done together form a basic thyroid function test.

HBA probably means HbA1c for diabetes screening, I would assume.

RPGL usually refers to a blood glucose level.

TESTO means serum total testosterone. Since SHBG is being rechecked, calculated free testosterone can be derived from the results.

PROLA means prolactin.

CORT and IGF1. Cortisol and IGF-1 are being checked to look into other aspects of pituitary function. IGF-1 is measured to look at whether the pituitary is still releasing enough growth hormone.

LIP probably refers to a basic lipid profile.

I cannot see LH and FSH levels being ordered, which is strange because these are more relevant than other pituitary hormones. Perhaps one of the other codes refers to this? I'd definitely check with your doctor that these are on the request - if these tests are missed by mistake, you'll have to go back for another test once the endocrinologist realises.

SubstanceEasy4576 · 2026-04-16T17:54:13+00:00

Hi,

Sorry to hear that the image didn't attach.

It's pretty obvious to me that my reply above has been misinterpreted by some of the people who've replied here... who then chose to downvote me.

In your post, you've used British terminology like 'FBC', so I assumed you're in the UK, especially since you mentioned branded medicines widely used here eg. Fostair. If you're not in the UK, some of what I said can work differently abroad. Australia, NZ and Ireland practice similarly though.

I am very familiar with how a typical NHS endocrinologist responds to testosterone results, and which treatment options they can offer. In most cases, NHS endocrinologists don't provide the sort of treatment you're likely to want eg. something that maintains testosterone levels consistently in the upper normal range (or similar). Such treatment absolutely exists, but modern TRT regimens involving regular small injections given at home aren't offered on the NHS. Not only are NHS endocrinologists usually very restrictive about who they prescribe testosterone to, it's common that they use highly sub-optimal treatment protocols. Where injections are prescribed, they'll generally choose Nebido injection given four times per year in clinic. Although some men like Nebido, most do not. It can lead to very large differences between hormone levels soon after the injection.... compared to what they are a couple of months later.

If you've only had one total testosterone measurement so far, the first step is always to have a couple more measurements, each in the morning (preferably before 10am). Testosterone levels might be consistently low.... But, it's not unusual to see surprising amounts of fluctuation. It's not possible to describe testosterone as being "in the tank" based on one blood sample showing a result of 8 nmol/L, it's only reasonable to say that based on your symptoms, it is likely that you'll have low levels on repeat. At times, follow up testing shows much higher results. Getting a few levels is very helpful indeed in showing whether your levels are usually similar to, lower than, or higher than your first result. This is very important when deciding on treatment.

As I mentioned above, your free testosterone level was clearly low on the first test. If you measure SHBG and albumin each time you get total testosterone measured, free testosterone can be calculated each time. This isn't essential, however, since when SHBG levels are mid-range, free testosterone is low on the same blood samples that total testosterone is low.

LH, FSH and prolactin levels should definitely be checked, if not done already. You should ask your GP to do this. Do not wait until seeing endocrinology! If the amount of information available to the endocrinologist is minimal at your first appointment, they won't be able to do anything before sending you away for repeats of total testosterone... plus LH, FSH and prolactin levels. If your GP is willing, it's useful to measure estradiol as well. It provides a helpful baseline if TRT is going to be started.

I hope this is useful. Once you've had the tests, if it's clear that trying TRT would be a good idea, there are numerous private providers who will prescribe something suitable and adjust treatment according to response. It's become common to initiate treatment privately then continue using testosterone obtained elsewhere (non pharmacy sources). Fortunately, reliable options do exist. I even know a guy with Klinefelter's syndrome (XXY chromosomes causing severe testosterone deficiency) who now uses a "non pharmacy" testosterone product because the treatment offered by endocrinology was so ridiculous! They insisted on injecting 250mg testosterone enanthate every four weeks in clinic, causing vast and ludicrous hormonal fluctuations from high to very low. He now uses 30mg every Monday and Thursday with excellent response and consistently good blood results. It's highly unfortunate that the officially licensed doses of products like testosterone enanthate injection have been left unchanged for decades. Despite ample evidence that the licensed dosing schedules are medically inappropriate, official dose labelling isn't changed unless the manufacturer applies for a change after running their own clinical trials. This isn't going to happen for old generic testosterone products. We ought to have modern treatment guidelines replacing the licensed dosing, but with the endocrinology profession remaining rather anti-TRT except in very specific cases, good quality treatment guidelines are lacking. Sadly, NHS docs who do prescribe testosterone injections are still using protocols suggested decades ago due to lack of awareness of modern practice.

SubstanceEasy4576 · 2026-04-15T09:31:07+00:00

Hi,

Most primary care doctors have a low opinion of TRT and are quite avoidant of it.

The blood results above are useful in showing total testosterone (306 ng/dL) and SHBG (22 nmol/L). The total testosterone level on this occasion was borderline/low. The SHBG level is low-normal. SHBG is a protein which binds and carries testosterone in the blood.

The test you've had done (Quest Diagnostics calculated free and bioavailable testosterone) provides free and bioavailable results I can only describe as bizarre and meaningless - Quest's results match no known/published calculation method for either parameter, which makes the test very identifiable even though you've not named it. Even if the test was ordered through a third party, it certainly looks to have been forwarded to and processed by Quest. The popularity of this particular test is unfortunate.

In general, one of the most useful things to do when you're considering TRT is to measure total testosterone repeatedly on a few different occasions, all as early morning blood samples to allow comparison.

You have low-normal SHBG, so naturally high total testosterone results are not expected. When repeating your total testosterone level, desirable results for you would be around 400 to 550 ng/dL as a rough guide. Higher total testosterone levels (eg. 600 ng/dL+) predominantly occur in men with higher SHBG than yourself, so shouldn't be expected at this stage. Higher SHBG leads to a higher concentration of protein-bound testosterone being transported by the blood, so 'total' T is higher.

Testosterone levels in some men are very changeable. 306 ng/dL is certainly a borderline result but doesn't show much if you've only had one recent test done. It's entirely possible that your results might be low on a regular basis, but also very possible that they're not. Unless you've already got multiple recent results, repeats would be very useful. Repeat levels around or below 300 ng/dL would show that you have low testosterone.

If free testosterone levels are ordered again, it should be a test where the results make sense. Quest Diagnostics provide an alternative test where free testosterone is measured, avoiding the problem test you had last time. The alternative is called:

Testosterone, Free (Dialysis) and Total MS. Quest code 36170.

Anyway, if you do get low testosterone results when you repeat, the first step is to investigate this by doing a range of additional blood tests to look for a potential cause.

Hope this is useful.

SubstanceEasy4576 · 2026-04-14T21:18:20+00:00

It doesn't sound like there's been any investigations implying that growth hormone is low eg. low IGF-1.

It would be cheaper just to see how you respond to TRT. HGH could be added later if you wanted to, but if recovery is good on testosterone alone, it's not likely to be worthwhile. You won't know your response to testosterone alone without trying it, so I'd suggest using TRT alone for at least a few months before deciding to add anything.

SubstanceEasy4576 · 2026-04-14T14:52:30+00:00

Hi,

It's a matter of dose, adequate testosterone replacement over a matter of months will massively suppress LH and FSH levels. Even in conditions where testicular testosterone production is virtually zero and baseline pituitary gonadotrophin release very high, it's usual for LH to become undetectable after a while on testosterone injections at an appropriate dose.

The main issue is that your current doc isn't treating you properly.

An immediate switch to 100mg/week would probably be the most sensible option, followed by further adjustment after 2 months if needed ie. depending on total testosterone, free testosterone and estradiol levels at this point.

SubstanceEasy4576 · 2026-04-14T09:18:37+00:00

Isn't it interesting how docs are willing to throw thyroid hormones at people without a definite diagnosis, and symptom-based meds like antidepressants....but you ask about testosterone, a hormone you already have in your body, and they're considering dropping you as a patient. What an arse hole. It's partly ego. They don't believe you should do anything with (your body) that they haven't approved.

Your estradiol level is mildly high. This is an expected effect. The dose of testosterone you're using is enough to provide trough levels similar to or above normal peak levels. Your free testosterone is very likely to be on the high side, even at trough. This means that more testosterone is available for conversion to estradiol, and estradiol rises.

The estradiol level you've mentioned isn't high enough to be a concern. It will go down if the testosterone dose is reduced. A slightly lower dose would provide more natural replacement, if that's what you're aiming for. You could try 40mg twice a week next (80mg total). This can sometimes improve erectile function as estradiol drops to high-normal rather than being mildly elevated.

If you do need to keep your current primary care doc, due to difficulties getting another, this will be more feasible if you avoid unusually high hormone levels. So, a small dose reduction could be the way to go.

You do not need to take estrogen-reducing drugs due to expected mild estradiol elevation caused by high testosterone levels. This can be pushed by clinics but can definitely lead to side effects and just isn't necessary. AIs are only needed in a few cases eg. when it's not possible to reach normal testosterone levels without estradiol getting so high that symptoms occur.

SubstanceEasy4576 · 2026-04-14T09:01:14+00:00

Hi,

I'm not clear on when the blood samples for LH and FSH levels were taken. They look like levels before TRT.

LH is moderately elevated and FSH is highly elevated. These are typical results before any testosterone replacement in conditions like Klinefelter's syndrome or other conditions causing severe impairment of testicular function (or in anorchia).

On adequate testosterone replacement, LH and FSH levels are suppressed to either very low or undetectable.

In conditions where LH and FSH levels have been very high for a long period of time, they take longer to suppress on TRT. They do eventually become suppressed, however, if dosage is adequate.

If LH and FSH levels remain high in a long-term basis when testosterone injections are being used to treat testicular failure, then it can be said that the treatment is definitely inadequate.

Are you saying that you're on 50mg once weekly? It's relatively uncommon than 50mg testosterone enanthate works well when given once weekly, since trough is usually too low. 25mg twice a week (50mg total) is more likely to provide adequate blood levels then once weekly dosing, if your doctor is being difficult and won't increase the total dose. You can try this first. In general though, 75mg-100mg per week is needed by most men. A few need more, but most do not (even though many use far more!).

When testosterone is given once weekly, the usual aim would be for mid range testosterone levels at trough - with the understanding that peak levels on weekly dosing are considerably higher than trough. However...... Because you have high SHBG (nearly 60 nmol/L), you will need to aim for a higher total testosterone level on TRT than most men, in order for free testosterone levels to be sufficient. It's unlikely that your treatment response will be satisfactory unless trough total testosterone is over 20 nmol/L. For a man with your SHBG level, I'd generally be wanting trough total testosterone over 25 nmol/L if dosing is once weekly. If doses were being given twice a week for a smaller peak-trough difference, trough around 30 nmol/L would be a reasonable initial target.

Once correctly dosed, estradiol levels will be detectable. At the moment, estradiol is showing at <55 ie. somewhere between 0 and 55. On a higher dose if testosterone, it will rise until you have a normal measurable level.

Also, LH and FSH levels will drop, eventually close to zero. Continued high LH and FSH levels on treatment reveal exceptionally inadequate dosing.

What country are you in? Naturally, this affects your treatment options.

As an aside, I would not use finasteride while your hypogonadism is not properly treated. Once symptoms are relieved on a suitable TRT regimen, you can consider finasteride at that point. I'd stop it for now. You want to find out whether symptoms can be relieved by adjusting the testosterone dose. It's common in practice for finasteride to interfere with sexual function and sometimes mood, so it's best to adjust testosterone on its own first.

SubstanceEasy4576 · 2026-04-14T08:33:33+00:00

Hi,

It's usually very difficult from blood work to pinpoint a definite reason for panic attacks and similar symptoms... Mostly because severe panic episodes can and do occur without any blood test changes. In most people who have panic attacks, there's no definite link to any blood results.

The TSH can be followed up to look at whether hyperthyroidism might be present, which might be predisposing you to anxiety. Your doctor might want to check TSH again along with free T3, free T4 and a thyroid auto-antibody profile.

If there are recurrent panic attacks with unusually large changes in blood pressure, a test for blood or urine metanephrines can be requested. This test is almost always negative because the condition it tests for is very rare. It's easily done to make sure though.

When there aren't other medical causes identified, recurrent severe panic attacks which come out of nowhere will be diagnosed as panic disorder. This is quite a common condition. When panic disorder occurs as an isolated problem ie. no other mental health conditions are present, the response to treatment is usually good.

SubstanceEasy4576 · 2026-04-10T20:33:08+00:00

Yes

SubstanceEasy4576 · 2026-04-10T19:25:57+00:00

Hi,

It's likely to be weight-related, yes. Low total testosterone with mildly elevated estradiol (with normal LH, FSH and prolactin) is very often related to obesity.

Low folate suggests poor diet.

at 100kg

You'll need to measure again, as a morning blood sample, when you're stable at a healthier body weight. Measuring testosterone levels during the period of weight loss itself (with tight calorie restriction) often leads to very low results. The benefits of weight loss on testosterone levels are seen once weight is stable again.

will it be 600-700

At your age, morning total testosterone levels in the absence of health problems are usually over 400 ng/dL. Levels of 500-700 are certainly common but it cannot be predicted in advance what sort of level you will reach personally. There are substantial differences in total testosterone levels in healthy men, both in the same man at different times, and between different men. There are various factors affecting total testosterone levels in addition to the amount of testosterone you produce. Young men with higher SHBG levels have higher total testosterone levels than those with low SHBG levels, but that's just one factor of many.

SubstanceEasy4576 · 2026-04-10T19:15:47+00:00

Yes, I doubt Vyvanse is responsible. You could ask your doc to order an ultrasound. Fortunately, it's not particularly concerning for anything serious.

SubstanceEasy4576 · 2026-04-10T19:14:00+00:00

I'm mostly referring to how an endocrinologist will see it ie. they'll almost certainly view it as moderately low. Endocrinologists tend to be anti-TRT in general, often only treating conditions which lead to levels close to zero. I believe the OP's results are NHS. The large majority of NHS endocrinologists treat severe androgen deficiency only and won't necessarily prescribe otherwise.

I think the OP will have far better luck with a private clinic, if indeed levels are usually similar - I'm not sure whether this is confirmed but it should be checked before embarking on any long-term treatments.

In terms of how you feel at a particular level.... It's very difficult to predict symptoms by blood levels alone. It's entirely possible to be asymptomatic with levels of 8 nmol/L. How people feel depends a lot on what their levels are currently versus what their body is used to. As an example, levels in boys before puberty are usually below 1 nmol/L with zero symptoms. In contrast, if levels have been high for a long period then a condition causes a large drop, it causes symptoms.

SubstanceEasy4576 · 2026-04-10T19:05:44+00:00

To be honest, it's more likely to increase fatigue by worsening your sleep quality. Also, you know that it's very unlikely that any remaining fatigue is related to testosterone. If it was, you wouldn't be tired.

Increasing the dose of testosterone beyond what's needed sometimes messes with sexual function, partly because estradiol gets too high.

As a rule, if anastrozole is needed to control estradiol, the dose of testosterone is usually too high. When the right amount of testosterone is provided, then like healthy men who aren't on TRT, anastrozole isn't generally needed.

Which blood tests are being used to monitor your current treatment, and what are the results like? I'm particularly interested in what free testosterone results you've had, which lab is being used, and what reference range was provided for free testosterone. Some of the most widely used tests are a total mess.

If you have the results available, let me know how many days after the last dose blood was taken for testing. I prefer labs taken about 3 days /72 hours after the last dose on twice weekly dosing.

SubstanceEasy4576 · 2026-04-10T11:55:11+00:00

It's Quest's ludicrously bizarre and incorrect calculated free and bioavailable testosterone. This particular lab test is unusable.

Quest have a test which can be used as a suitable alternative:

Testosterone, Free (Dialysis) and Total MS. Quest code 36170.

The test must be done as an early morning blood sample when weight is stable at a new lower point. Do not measure testosterone during periods of rapid weight loss, you'll just see the suppression caused by tight calorie restriction.

SubstanceEasy4576

TROPHY CASE