Blood lab results, input needed

[LukeAndrews39]

Hello all... I got my yearly blood labs back today and am looking for some input...

From what I've been reading online, it looks like i'm secondary?

FSH is 1.46
LH is 3.54
Total T is 269 ng/dl
Free T is 57 pg/ml
SHBG is 23
D3 is 27
Free T4 1.01 ng/dl
TSH 1.96 uIU/ml
PSA .8 ng/ml
Hematocrite 46%
Free T3 4.13 pg/dl
E2 is 26

My cholesterol was good (HDL in the 50s and total under 170) and my glucose was 80, so also good

I am 39 (40 in November), 6'5" 265lbs (muscular but definitely overweight), have a desk job but have light exercise in the evenings.
The highest my total T has been since i started testing, was 527 ng/dl (but that was at 2pm...didnt know to test early, back in 2012) and my highest free T was 93 (also at 2pm, in 2012)... i was way more active back then, lifted regularly and only weighed around 230lbs (if that makes any difference) but my diet and sleep were not that great.

My doctor has prescribed 100mg per week of testosterone cypionate, self injected at home (any frequency and IM or SubQ etc is up to me) and then re-access after 8 weeks.

I do have panic disorder that i've been able to manage pretty well for the past decade... the main reason i havent started shots is due to worries that it could cause that to become worse... yet i also wonder if it could make it better?

With all of that said, knowing that (had i tested at 8am instead of 2pm...and had a better sleep and diet habit) my total t was likely in the upper 500s or 600s back in 2012... should i start TRT, or does anyone here think that if i drop back down to around 210-220 lbs and bring my Vitamin D up...get back to lifting and exercising and following a good diet... could i get myself back to the 5-600 range? Or would i be wasting my time and should just start TRT?
Anyone with panic attacks/panic disorder go on TRT and have good or bad results from it?

Thanks again for all of the tips/advice etc... feel free to ask any questions, also!

 

[LukeAndrews39]

 

[Cataceous]

You results are indeed suggestive of secondary hypogonadism.

Hard to say in advance what improvements you'd get via lifestyle improvements alone. The problem is that you're wanting to double your total testosterone, which may be a stretch. If accurate, your estradiol seems high relative to your testosterone, and could be contributing to some HPTA suppression. If so it might respond to some weight loss. I also wonder about AI microdosing in these situations, but there's not even anecdotal evidence in support of this kind of treatment—just some research trials showing that it does increase testosterone.

You are still a bit young to get into the whole TRT/HPTA shutdown thing. You could instead try a course of enclomiphene to see if that combined with lifestyle improvements would get you to a better place.

 

[LukeAndrews39]

You results are indeed suggestive of secondary hypogonadism.

Hard to say in advance what improvements you'd get via lifestyle improvements alone. The problem is that you're wanting to double your total testosterone, which may be a stretch. If accurate, your estradiol seems high relative to your testosterone, and could be contributing to some HPTA suppression. If so it might respond to some weight loss. I also wonder about AI microdosing in these situations, but there's not even anecdotal evidence in support of this kind of treatment—just some research trials showing that it does increase testosterone.

You are still a bit young to get into the whole TRT/HPTA shutdown thing. You could instead try a course of enclomiphene to see if that combined with lifestyle improvements would get you to a better place.

I would be willing to give that a shot, but have no idea how or where to get enclomiphene... And yes, the E2 is accurate...my level has been right in that area for a few years, while low T

 

[Cataceous]

If you find a cooperative doctor then he could call in an enclomiphene prescription to Tailor Made Pharmacy. This assumes you're US-based. If you can't find a local doctor who's comfortable with this then there's always Defy Medical. But this option may cost more.

 

[LukeAndrews39]

If you find a cooperative doctor then he could call in an enclomiphene prescription to Tailor Made Pharmacy. This assumes you're US-based. If you can't find a local doctor who's comfortable with this then there's always Defy Medical. But this option may cost more.

I am U.S. based, but not being really up to speed on such things, I don't see my doctor doing that, honestly.
What's the success rate of enclomiphene for secondary guys? Any common side effects? How long do you have to use it and what dose?

 

[Cataceous]

Enclomiphene is new enough that there's not even a lot of anecdotal evidence out there. The assumption is that it's going to give a better success rate than Clomid/clomiphene. This is based in part on the idea that the estrogenic zuclomiphene isomer of Clomid contributes to a lack of success for many guys. But getting better results than with Clomid is a pretty low bar, as success stories are uncommon.

I believe the side effects profile for enclomiphene is similar to that of Clomid, with visual disturbances being the one to look out for the most. At lower doses these should be rare. There is some speculation that enclomiphene reduces libido by blocking other brain estradiol receptors than the desired ones. Only time will tell if this idea has any merit. Anecdotally I can say that I have improved libido on 12.5 mg a day. But enclomiphene is just one component of a complicated protocol, so not much can be said about cause and effect.

The clinical trial for enclomiphene (Androxal) used doses of 6.25, 12.5 and 25 mg daily. I think the 12.5 mg dose is likely to be a good starting point for most. There are not really any rules on treatment length. In your case if using it led to improved body composition then it's possible the results would be sustained after stopping use of the drug. Alternatively, if you had decent subjective results but no lifestyle modifications then indefinite use is a possibility.

 

[LukeAndrews39]

Enclomiphene is new enough that there's not even a lot of anecdotal evidence out there. The assumption is that it's going to give a better success rate than Clomid/clomiphene. This is based in part on the idea that the estrogenic zuclomiphene isomer of Clomid contributes to a lack of success for many guys. But getting better results than with Clomid is a pretty low bar, as success stories are uncommon.

I believe the side effects profile for enclomiphene is similar to that of Clomid, with visual disturbances being the one to look out for the most. At lower doses these should be rare. There is some speculation that enclomiphene reduces libido by blocking other brain estradiol receptors than the desired ones. Only time will tell if this idea has any merit. Anecdotally I can say that I have improved libido on 12.5 mg a day. But enclomiphene is just one component of a complicated protocol, so not much can be said about cause and effect.

The clinical trial for enclomiphene (Androxal) used doses of 6.25, 12.5 and 25 mg daily. I think the 12.5 mg dose is likely to be a good starting point for most. There are not really any rules on treatment length. In your case if using it led to improved body composition then it's possible the results would be sustained after stopping use of the drug. Alternatively, if you had decent subjective results but no lifestyle modifications then indefinite use is a possibility.

what all do you use in addition to the enclomiphene? What clinic would be best to go through to try it, if my doctor isnt wanting to go that route?

 

[deletedacct]

You results are indeed suggestive of secondary hypogonadism.

Hard to say in advance what improvements you'd get via lifestyle improvements alone. The problem is that you're wanting to double your total testosterone, which may be a stretch. If accurate, your estradiol seems high relative to your testosterone, and could be contributing to some HPTA suppression. If so it might respond to some weight loss. I also wonder about AI microdosing in these situations, but there's not even anecdotal evidence in support of this kind of treatment—just some research trials showing that it does increase testosterone.

You are still a bit young to get into the whole TRT/HPTA shutdown thing. You could instead try a course of enclomiphene to see if that combined with lifestyle improvements would get you to a better place.

Hey great info, hate to hijack the thread. Do you mind taking a look at my labs posted on here? I’ve already had some great info from some of the other guys. Wouldn’t mind if you could help break down my labs. Thanks!!

 

[Cataceous]

what all do you use in addition to the enclomiphene? What clinic would be best to go through to try it, if my doctor isnt wanting to go that route?

My protocol also includes T enanthate, T propionate, GnRH and progesterone.

I recommend Defy Medical. They prescribe enclomiphene and have a relationship with Tailor Made Pharmacy.

 

[Gman86]

My protocol also includes T enanthate, T propionate, GnRH and progesterone.

I recommend Defy Medical. They prescribe enclomiphene and have a relationship with Tailor Made Pharmacy.

Any specific reason u prefer straight progesterone over pregnenolone that should theoretically increase ur progesterone?

 

[Cataceous]

Any specific reason u prefer straight progesterone over pregnenolone that should theoretically increase ur progesterone?

Poor subjective results with pregnenolone every time, mainly via increased anxiety. The opposite with progesterone: improved sleep and mood.

 

[Gman86]

Poor subjective results with pregnenolone every time, mainly via increased anxiety. The opposite with progesterone: improved sleep and mood.

Very interesting. Do u mind if ask what brand u use, route of administration, dose and time of day u take it?

Do u have before and after progesterone levels by any chance?

 

[Cataceous]

Very interesting. Do u mind if ask what brand u use, route of administration, dose and time of day u take it?

Do u have before and after progesterone levels by any chance?

Using the injectable Susten brand from AllDayChemist, which I dilute. Taking 0.5 mg before bed. Earlier measurements:

Blood test results, all with LabCorp and the 0.0-0.5 ng/mL reference range:​

Baseline: 0.1​

7 mg scrotal: 0.3​

3 mg subQ: 1.2​

1 mg subQ: 0.5​

 

[Gman86]

Using the injectable Susten brand from AllDayChemist, which I dilute. Taking 0.5 mg before bed. Earlier measurements:

Blood test results, all with LabCorp and the 0.0-0.5 ng/mL reference range:​

Baseline: 0.1​

7 mg scrotal: 0.3​

3 mg subQ: 1.2​

1 mg subQ: 0.5​

Any reason to use injectable over oral?

How did u feel at all those different doses? Do u feel best currently on 0.5mg subQ before bed?

 

[Cataceous]

Any reason to use injectable over oral?

How did u feel at all those different doses? Do u feel best currently on 0.5mg subQ before bed?

From Wikipedia: "The metabolism of progesterone is complex, and it may form as many as 35 different unconjugated metabolites when it is ingested orally."

I don't want the added unknowns.

I felt/slept better on higher doses, but higher serum levels have correlations with bad things, so I target mid-range for safety.

 

[Gman86]

From Wikipedia: "The metabolism of progesterone is complex, and it may form as many as 35 different unconjugated metabolites when it is ingested orally."

I don't want the added unknowns.

I felt/slept better on higher doses, but higher serum levels have correlations with bad things, so I target mid-range for safety.

And no effects on libido and erections, good or bad?

 

[Cataceous]

And no effects on libido and erections, good or bad?

When I started supplementing it correlated with an increase in the frequency and duration of nocturnal directions. But things eventually returned to baseline.

 

[Gman86]

When I started supplementing it correlated with an increase in the frequency and duration of nocturnal directions. But things eventually returned to baseline.

Awesome info, thanks a bunch!