Latest Blood Tests

I just had my 6 week blood work after starting a protocol with Defy of 80mg Test Cyp x2 weekly, 500u HCG x2 weekly, and 0.25mg anastrozole x2 weekly and 25mg DHEA x2 daily (after a horrible protocol with a urologist). The only other meds I take is Hyzaar 100/25 daily for systolic HBP, Flonase, and Elavil 25mg as needed for sleep. I've got my energy back, exercising more, eating a bit better but I continue to be unable to lose weight (and slowly gaining a bit). I'm 6'5 at 285 and was at 245 a year ago with no significant changes in diet/exercise (until recently now that my energy levels have improved). Just wondering if anybody here can see something I'm not? I've got a f/u with Defy in a few weeks, but wanted to be prepared with any ideas I can get from you all!

Testosterone, Serum 1383 High ng/dL 348 - 1197 (up from 881 - started at 396)
Free Testosterone(Direct) 19.9 pg/mL 8.7 - 25.1 (up from 11.5 - started at 3.1)
Estradiol, Sensitive 19.6 pg/mL 8.0 - 35.0 (down from 44.4)
Sex Horm Binding Glob, Serum 62.4 High nmol/L 16.5 - 55.9 (down from 80.2)

Iron Bind.Cap.(TIBC) 294 ug/dL 250 - 450
UIBC 233 ug/dL 111 - 343 01
Iron, Serum 61 ug/dL 38 - 169 01
Iron Saturation 21 % 15 - 55
Ferritin, Serum 155 ng/mL 30 - 400

TSH 1.52 0.40-4.50 mIU/L
T3 UPTAKE 36 H 22-35 %
T4 (THYROXINE), TOTAL 7.0 4.5-12.0 mcg/dL
FREE T4 INDEX (T7) 2.5 1.4-3.8
T3, TOTAL 110 76-181 ng/dL FINAL
T4, FREE 1.3 0.8-1.8 ng/dL
T3, FREE 3.6 2.3-4.2 pg/mL
Reverse T3, Serum 19.6 ng/dL 9.2-24.1

Cortisol 8.8 ug/dL (Cortisol AM 6.2 - 19.4)
(I submitted a 4 tube cortisol saliva test last week but haven't gotten the results yet)

Historical Labs (6 weeks ago - didn't run these after 6 weeks)
Cholesterol, Total 158 mg/dL 100 - 199 01
Triglycerides 144 mg/dL 0 - 149 01
HDL Cholesterol 35 Low mg/dL >39
Hemoglobin 15.3 g/dL 12.6 - 17.7 01
Hematocrit 45.0 % 37.5 - 51.0
Prostate Specific Ag, Serum 0.8 ng/mL 0.0 - 4.0
DHEA-Sulfate 107.5 ug/dL 102.6 - 416.3





One other historical - my PCP wouldn't run anything other than TSH, but I did get her to run it several times and it's been dropping:
12/15/15 - 2.221
3/17/16 - 1.578
7/8/16 - 1.472
7/21/16 - 1.52 0.40-4.50 mIU/L

4/12/16 - Vitamin B12 492 pg/mL 211 - 946
4/12/16 - 25-Hydroxy, Vitamin D 67 ng/mL
4/12/16 - 25-Hydroxy, Vitamin D-2 1.1 ng/mL
4/12/16 - 25-Hydroxy, Vitamin D-3 66 ng/mL

Anything stand out that would be causing this weight gain / inability to lose it no matter what I've tried? My PCP tried me on Topamax, Wellbutrin, and Belviq with no success (gained on all of them). I've asked my PCP about my low temperature (I'm almost always 97.2 to 97.5) and when she ran a baseline EKG during my first physical it alarmed because my resting heartrate was 59 (I'm averaging around 66 on my fitbit lately) but she has been unconcerned about either one.

Ideas?

Well I got the saliva cortisol tests back.
AM: 5.6 (3.7-9.5) NORMAL
Noon: 1.7 (1.2-3.0) LOW NORMAL
Evening: 0.7 (0.6-1.9) LOW NORMAL
Night: 1.1 (0.4-1.0) HIGH

Zorro, the first item noted regarding your weight gain is the Elavil you are taking. Elavil is a TCA antidepressant. This was one of the first drug classes of antidepressants with a multitude of side effects with weight gain being one of the primary ones. I have seen people gain 40-50 pounds on TCAs. It is prescribed off label for insomnia, as in your case, for its sedative effects. There are more efficient medications used to treat insomnia without all the side effects. We will discuss those options with you at your appointment as well as a full and comprehensive review of your labs. I know you just started the regimen 6 weeks ago so you may gain muscle before you lose fat if you just started exercising. Pay close attention to your diet, tighten up on the carbohydrates, engage in cardio daily, as well as incorporate weight training. You may need to titrate off the TCA. TCA's are not as commonly used as SSRI's are now available. It will be our goal to restore you to a place where you do not need these medications. Give it some time. We will see you soon, cover all your questions, and propose a more effective regimen for your insomnia.