Need help with potential causes of ED (labs included)

[Golfboy307]

Is your Estrogen reading at 190 vs. the range of < 150. If so, high E2 levels might be the cause of your problem, even with the lower dosing.

 

[Gman86]

Who would put you on such a horrible protocol?

Your ferritin is too low and if these labs were done at trough than you were hitting way too high TT/FT levels 7 days post-injection and your peak TT/FT would be insanely high.

You drove down a perfectly normal SHBG 30nmol/L pre-trt to 18.4 nmol/L from using such a high dose of T injected once weekly.

You stated I'm thinking that if after 6 weeks at 120/mg, that I dont see any difference, I think I will try going to 175 or 200mg/no AI, as 150mg is the highest I've been previously without an AI.

This would be a bad move as 175-200mg/week would surely be too high let alone have your e2 through the roof without the addition of an aromatase inhibitor.





Jan 2020 200mg/wk 1mg Adex

Ferritin -------------------48 24-444 ug/L
T4 Free --------------------12.1 10.6-19.7 pmol/L
T3 Free --------------------4.76 2.60-5.80 pmol/L
Prolactin ------------------7.5 3.8-20.6 ug/L
Estradiol ------------------80 <157 pmol/L
Progesterone ---------------0.5 0.4-1.8 nmol/L
DHEA Sulphate --------------7.5 <15.0 umol/L
Testosterone ---------------41.3 8.4-28.8 nmol/L
T Free Calculated ----------1316 115-577 pmol/L
T Bioavailable Calc --------30.8 2.7-13.5 nmol/L
SHBG -----------------------18.4 10.0-70.0 nmol/L
25-Hydroxyvitamin D --------92 75-150 nmol/L

What’s an ideal ferritin level in ur opinion?

 

[Nixter]

Seeing as you are on the 3 times weekly protocol (M/W/F) if you tested at true trough than you had blood work done Monday morning before your injection.

Keep in mind that on such injection protocol that your trough TT/FT/E2 levels will be even higher throughout the week as you are injecting M--48hrs-->W--48hrs-->F--72hrs-->M (true trough).

So your TT/FT/E2 levels would be higher on the Wednesday morning trough and Friday morning trough seeing as it is only 48hrs between your injections.

Whereas when you test true trough on Monday morning it is 72hrs since your F (last injection).

Those are decent TT/FT levels mind you I would not trust your FT as it was calculated using the Vermeulen method which is used at Labs across Canada.

You stated:

I should note that the most recent labs in Jan were while I was on AI. I have been on 100mg/wk, no AI previously, as well as 150mg/no AI, and I'm currently 4 weeks into 120mg/no AI. ED has been present throughout all various protocols, AI or not. I've also tried varying HCG protocols.

My level of ED is such that I can get it up but not for very long and the quality of the erection is often poor. I also require way more stimulation as I believe sensitivity is down as well. When I was natural, I had no problems in any of these departments. Cialis and Viagra both work for me but i'd love to not have to rely on them. Libido is fine btw

I would definitely look into trying out a pde-5 inhibitor as was already suggested.

Thanks for the feedback!
I pin Monday morning, Wednesday midday, and Friday evening, so the spacing is even. Bloods were taken Wednesday before pin

I would prefer not to rely on pde-5s if possible so I will lower dosage to 90mg and see how that goes. I also have the option of coming off TRT. I didn't have ED issues prior to starting.

 

[madman]

What’s an ideal ferritin level in ur opinion?

I would say 100-150 ug/L would be considered optimal

If you have hypothyroidism optimal levels are critical.


Keep in mind:

A serum ferritin concentration of <30 µg/L is the most sensitive and specific test for the identification of iron deficiency in patients with or without anemia. However, patients may be iron deficient at much higher concentrations of ferritin.

 

[Gman86]

I would say 100-150 ug/L would be considered optimal

If you have hypothyroidism optimal levels are critical.


Keep in mind:

A serum ferritin concentration of <30 µg/L is the most sensitive and specific test for the identification of iron deficiency in patients with or without anemia. However, patients may be iron deficient at much higher concentrations of ferritin.

Thanks for that info. I’ve heard some doctors recommend around 70-90, but I’ve also heard some recommend having around the low 100’s to be optimal.

Another quick question that I was trying to figure out with someone recently. Do u think it’s possible to be iron deficient, while having a HGB and HCT at the top of the range, or slightly over? Like what if a male has a HGB of 18, HCT of 54, and low ferritin, say 30 or below. Can that person be iron deficient while having high HGB and HCT levels? Or does having a high HGB and HCT level automatically tell u that u have sufficient iron levels?

Also, where does ur ferritin usually hang around at while on TRT?

 

[madman]

Thanks for that info. I’ve heard some doctors recommend around 70-90, but I’ve also heard some recommend having around the low 100’s to be optimal.

Another quick question that I was trying to figure out with someone recently. Do u think it’s possible to be iron deficient, while having a HGB and HCT at the top of the range, or slightly over? Like what if a male has a HGB of 18, HCT of 54, and low ferritin, say 30 or below. Can that person be iron deficient while having high HGB and HCT levels? Or does having a high HGB and HCT level automatically tell u that u have sufficient iron levels?

Also, where does ur ferritin usually hang around at while on TRT?

My ferritin usually hovers around 90.

Of course, it is called Non-anaemic iron deficiency (NAID).

You must remember this thread.

Iron Deficiency Without Anemia – Common, Important, Neglected

Iron Deficiency Without Anemia – Common, Important, Neglected (2019) Esa Soppi* Department of internal medicine, Eira Hospital, Laivurinkatu 29, FI-00150 Helsinki, Finland Abstract A serum ferritin concentration of

www.excelmale.com

Abstract

A serum ferritin concentration of <30 µg/L is the most sensitive and specific test for the identification of iron deficiency in patients with or without anemia. However, patients may be iron deficient at much higher concentrations of ferritin. Iron deficiency without anemia and with normal red blood count is a clinical challenge, and many patients have been diagnosed with a multitude of conditions ranging from hypothyroidism to depression to chronic fatigue syndrome over the years when they have sought help for their often debilitating symptoms. The keys to a correct diagnosis are assessment of the serum ferritin concentration and a meticulous medical history focusing on the possibility of life-long blood losses and diseases such as celiac disease. Differential diagnostic causes for the symptoms must be sought for. The mainstay of therapy is oral iron in sufficient doses for at least 6 to 9 months together with serum ferritin monitoring. Some patients who do not respond to oral iron treatment may need intravenous iron. The longer the iron deficiency has lasted, the more challenging the therapy may be. Some iron-deficient patients without anemia may have had the condition for over a decade, and may not fully recover. The amount of human suffering, the loss of quality of life and the indirect costs to society caused by iron deficiency are huge.



Taken from another article:

A diagnosis of iron deficiency can be made when a person has both low hemoglobin and hematocrit and low serum ferritin. Serum iron and, transferrin-iron saturation percentage will also be low in a person who is iron deficient. Iron deficiency without anemia can occur when a person has a normal hemoglobin, but below normal serum ferritin and/or transferrin saturation. Iron deficiency with anemia can occur when a person has low values of both serum ferritin and hemoglobin.

 

[Gman86]

My ferritin usually hovers around 90.

Of course, it is called Non-anaemic iron deficiency (NAID).

You must remember this thread.

Iron Deficiency Without Anemia – Common, Important, Neglected

Iron Deficiency Without Anemia – Common, Important, Neglected (2019) Esa Soppi* Department of internal medicine, Eira Hospital, Laivurinkatu 29, FI-00150 Helsinki, Finland Abstract A serum ferritin concentration of

www.excelmale.com

Abstract

A serum ferritin concentration of <30 µg/L is the most sensitive and specific test for the identification of iron deficiency in patients with or without anemia. However, patients may be iron deficient at much higher concentrations of ferritin. Iron deficiency without anemia and with normal red blood count is a clinical challenge, and many patients have been diagnosed with a multitude of conditions ranging from hypothyroidism to depression to chronic fatigue syndrome over the years when they have sought help for their often debilitating symptoms. The keys to a correct diagnosis are assessment of the serum ferritin concentration and a meticulous medical history focusing on the possibility of life-long blood losses and diseases such as celiac disease. Differential diagnostic causes for the symptoms must be sought for. The mainstay of therapy is oral iron in sufficient doses for at least 6 to 9 months together with serum ferritin monitoring. Some patients who do not respond to oral iron treatment may need intravenous iron. The longer the iron deficiency has lasted, the more challenging the therapy may be. Some iron-deficient patients without anemia may have had the condition for over a decade, and may not fully recover. The amount of human suffering, the loss of quality of life and the indirect costs to society caused by iron deficiency are huge.



Taken from another article:

A diagnosis of iron deficiency can be made when a person has both low hemoglobin and hematocrit and low serum ferritin. Serum iron and, transferrin-iron saturation percentage will also be low in a person who is iron deficient. Iron deficiency without anemia can occur when a person has a normal hemoglobin, but below normal serum ferritin and/or transferrin saturation. Iron deficiency with anemia can occur when a person has low values of both serum ferritin and hemoglobin.

Exactly the info I was looking for. Thanks for clearing that up. Do u think ferritin is the best lab to check to assess iron status in the body? I just don’t see how the standard iron test has any value. Doesn’t serum iron change depending on what u ate recently?

 

[OMI100]

What E2 test was used. Standard or Sensitive?

 

[Nixter]

What E2 test was used. Standard or Sensitive?

Standard. We dont have the sensitive E2 test in BC with LifeLabs so I understand the numbers may not be very accurate. However, this 190 values is MUCH high than i've ever been at. Another potential confounding factor is that I take biotin, which i just found out can affect certain assays including E2, depending on the detection method. I haven't been able to find which collection method is used my LifeLabs.

Starting this morning I've lowered my dose to 90mg/wk