Blackhawk's journey with TRT

[Vince Carter]

26mg/EOD I think would start to tip your FT to the lab range in your trough if you wanted to tinker a small amount.

I'm curious because I don't see it this time but do you know where your SHBG is...curious where it sits in relation to your E2.

 

[Blackhawk]

26mg/EOD I think would start to tip your FT to the lab range in your trough if you wanted to tinker a small amount.

I'm curious because I don't see it this time but do you know where your SHBG is...curious where it sits in relation to your E2.

SHBG has pretty consistently been around 46-48. Last time measured May 5 2018 at 48.1

I was still symptomatic of high E2 with it at 38 prior to anastrozole. Now have pretty much lost the E2 symptoms.

 

[HealthMan]

The only thought I have for QD at same 84mg/week is it could possibly push Free T trough a couple points higher, while not raising E2 or HCT.

I am still unsure about end point in terms of exercise and my free T. The dosage reductions have been difficult and the last one was the worst, but now around 90 days after lowering to 84mg/week finally it seems I am doing (relatively) OK. I wish I could raise my baseline in terms of exercise, it has been my main challenge since statin muscle damage. I was doing better on higher dose of T, but I can't play cat and mouse with high HCT, low ferritin and blood donations.

Absolute lymphs have been steadily climbing last 1-2 years, broke normal range last 2-3 labs.

You might have chronic inflammation or an injury maybe? My lymphs are always up and down and i do suffer from stress and inflammation.
Daily injections give you the impression of higher testosterone levels but in your case you are basically just averaging out your peaks and troughs (if you had low SHBG you would be literally pissing testosterone too quickly and then daily injections would make more sense) And arguably steadier levels are preferred than peaks and valleys. But again given where your SHBG is i do think daily injections are totally overkill. I would just try to raise a tiny bit your dosage and follow HCT and ferritin closely.

 

[Blackhawk]

You might have chronic inflammation or an injury maybe? My lymphs are always up and down and i do suffer from stress and inflammation.
Daily injections give you the impression of higher testosterone levels but in your case you are basically just averaging out your peaks and troughs (if you had low SHBG you would be literally pissing testosterone too quickly and then daily injections would make more sense) And arguably steadier levels are preferred than peaks and valleys. But again given where your SHBG is i do think daily injections are totally overkill. I would just try to raise a tiny bit your dosage and follow HCT and ferritin closely.

Re: Your lymphs, are you referring to absolute lymph count?

In my case the absolute lymph count is rising due to cells with leukemia mutation cloning themselves. I have not yet researched this enough, and don't know yet whether this is free cells doing so or cell production related to lymph system or bone marrow.

 

[HealthMan]

Re: Your lymphs, are you referring to absolute lymph count?

In my case the absolute lymph count is rising due to cells with leukemia mutation cloning themselves. I have not yet researched this enough, and don't know yet whether this is free cells doing so or cell production related to lymph system or bone marrow.

Yup. Absolute lymph count

 

[ratbag]

It's amazing 1 grain puts your FT3 over range. Your FT4 is low, with 1.295 being 50% you need to increase that for sure. I think you can reduce some of the NDT dosage too, I suspect you are converting ok. LDN may be worth considering for your Leukemia.

 

[Blackhawk]

Yup. Absolute lymph count

Seems to me causation of a slow steady climb is potentially something different than fluctuating level, but really I am not that knowledgeable.

 

[Blackhawk]

Results of consultation w/Dr Saya:

Symptoms: Finally emotionally stable despite the stress of the up coming CLL situation. Anastrozole seemed to do the trick and E2 is in check... no more irascible bee-atch.

Physically closer to OK but still a bit sub par. I want to find definitively if I am below optimal free T level by waiting it out a bit longer. I have permission to increase T cyp dosage from current 24mg QOD to as high as 28mg QOD, but will put this off a while for two reasons, first just to give this more recent steady state some more time, and because we also changed NDT dosage which I started today, so only want to make one change at a time to avoid any confusion regarding future changes in symptoms.

So also adding afternoon NDT 1/2 grain. He's OK with T3 at 5.2 in the AM as long as no hyper symptoms. Hopefully NDT in the afternoon will level my energy through the entire day.

I'd say finally I feel like I almost have TRT dialed in. Not feeling superb yet, but a lot better.

New protocol:
-T cyp 24mg QOD, possible increase over next 90 days to as high as 28mg QOD
-HCG 240iu QOD (unchanged)
-Anastrozole 0.0625 QOD (unchanged)
-DHEA 12.5mg QD (unchanged)
-Pregnenolone 25mg QD (unchanged)
-NDT 1 grain Q-AM ADDING 0.5 grain Q-12-2PM
-Vit D3 5000iu QD (unchanged)
-The rest of my usual supps and aspirin (unchanged)


Next Labs 3 months -
-CBC
-Testosterone free and total
-E2 sensitive
SHBG
-FT3
-FT4
-PSA (Will get with free %)

And reposting labs for reference:

 

[Blackhawk]

This may be my final update to this thread. Basically, I've reached a reasonably stable state and will probably be sticking with this protocol for the longer term. I have Dr Saya's blessing to adjust T, HCG and Thyroid dose within a certain range depending on how I am feeling.


Other things are now of more concern, but also I have gotten way past any kind of freak out. Sooner or later one of these things or something else will kill me. In the meantime, I am just going to try to live life to the fullest. These are long term issues that will play out as they will pretty much regardless of what I do (It is a given I'll continue to do my best to live as healthily as I can within my ability), or depending on future cures for uncurable diseases being discovered if I do end up with prostate cancer or CLL


In the last period between labs, I adjusted T dosage up to 28mg EOD, and Thyroid morning dose down 0.25 gr to 0.75 due to feeling hyper in the mornings.

But I am trying again lowering T dose back to 24mg EOD. It's alittle bumpy, but I am doing OK with it. Reason being, my PSA is up to 4.4 after a low of 3.0 90 days ago, so this remains a concern, but the PSA level change pattern is not defined by any trend and not characteristic of cancer. That said, I probably have at least some cancer cells as do the majority of men at age 60. Whether this progresses to anything life altering remains to be seen. Dr Saya said he believes that the prostate androgen receptors are already saturated at a dose of 24mg EOD anyway so he does not expect to see a change based on T dosage, but I figure I'll try and see. I am considering seeing a urologist, but I am not going down the road of biopsies or jumping to surgery if something is found. At this point I know too much to accept that kind of treatment.

And, I have monoclonal B cell lymphocytosis which may or may not progress to CLL. Time will tell. Absolute Lymphs are continuing to climb but I won't have an actual CLL diagnosis until B cell population reaches a considerably higher level. Could be months, years or never.

So in the meantime my protocol:

T cyp 24-28mg EOD I am still experimenting with the lower dose to see if I adjust over a longer period
HCG 240-350 EOD, adjust based on how testicles feel
Anastrozole 0.625mg EOD
NDT-Thyroid 0.75gr morning, 0.5 gr afternoons. I can bump morning dose to 1 gr when living in cold environments and being more physically active due to increased metabolic need.
DHEA-12.5 mg evenings
Pregnenelone 25 mg evenings
And my laundry list of vitamins/ OTC supplements.

Oh, and in retrospect, I deduce if I had been started on T cyp ~80mg/week EOD I may have felt better from the get go on TRT for the long term, that even with lower levels of T than I have now I would have felt better due to increasing levels from my abyssmal endogenous level rather than having to withdraw from supra physiological to the kind of level I have now. As things happened over time, the transdermal treatments didn't work and starting me on 150mg/week T cyp was very much the wrong treatment.

Cheers Fellas, and thanks for all the help along the way. I'll still be lurking and chiming in from time to time.