Thoughts on new labs?

[SLADE]

Hey guys new to website and pretty new to TRT also. After learning a little from facebook and other sites I recently sought out more knowledgeable doctor than my family physician that had gotten me started. I started in Janurary at 6'4' 308lbs. I started back working out and on better lifestyle diet. Since then i'm down roughly 90lbs. In end of June I went in for annual physical and after some advice from friends had family doctor test my Testosterone levels. I TURNED 35 IN JULY BTW.
Here are my results;

TOTAL CHOLESTEROL- 155 (100-199)
TRIGLYCERIDES 70 (0-149)
HDL- 43 (>39)
LDL- 98 (0-99)

TSH-1.68 (0.45-4.5)

TOTAL FREE DIRECT TESTOSTERONE- 5.0 (8.7-25.1)
TOTAL TESTOSERONE SERUM 235 (348-1197)

Yes I know he didnt test estradiol or shbg but at that time i didnt have a clue about them. He originally wanted to start me on a shot once a month of 400mg test cypinate. After doing little beginning research i talked him into letting me do my own shots and he prescribed 200mg every 2 weeks. I have actually been taking 100mg weekly dose though. After still not feeling full benefits and more research I saught out TRT clinic with what seems to be good doctor. I had been taking 100mg weekly for rought 3.5 months. Here are those reults

TOTAL CHOLESTEROL- 150 (<200)
TRIGLYCERIDES 88 (<150)
HDL- 39 (>39)
LDL- 93 (<100)

WBC- 5.8 (4.0-11.0)
RBC- 5.71 (4.10-5.70)
HEMOGLOBIN- 16.7 (13.0-17.0)
HEMACRIT- 49.6 (37.0-49.0)
PLATELET COUNT- 259 (130-400)
FREE T3- 3.4 (2.3-4.2)
FREE T4 THYROXINE- 1.19 (0.73-1.95)
TSH- 1.3 (0.5-4.7)
ESTRADIOL- 41 (<63)
DHEA SULFATE- 342 (103-446)
PSA- 0.7 (<4.0)
INSULIN- 4 (4-13)
HOMOCYSTEINE- 6.6 (5.0-12.0)
HIGH SENSITIVITY CRP- 0.6 (<1.0 LOW RISK)

TESTOSTERONE SERUM TOTAL- 418 (292-1052)
TESTOSTERONE FREE DIRECT- 9.0 (4.8-25.0)
SHBG- 30 (16-94)
HEMOGLOBON A1C- 5.6 (4.0-5.6)

AFTER CONSULT AND TALKING OVER OTHER ISSUES WITH ME HE PRESCRIBED
ZINC 60MG A DAY & USE NATURAL BEAUTY CLEANSING BAR TO HELP WITH ACNE ON CHEST AND BACK THAT I WAS HAVING.
TEST CYPINATE 200MG WEEKLY
ANASTROZOLE 0.5MG TAKEN TWICE WEEKLY
AND THYROID I BELIEVE 1 GRAIN DAILY IN MORNING 20-30 BEFORE ANY FOOD/ PREWORKOUT SUPPLEMENT

AFTER SOME OTHER QUESTIONS WHEN DISCUSSING TEST LEVELS HE ASKED IF I EVER HAD ANY SIGNIFICANT HEAD TRAUMA IN SPORTS, I TOLD HIM NO BUT THAT ROUGHLY 9 YRS AGO DURING FIGHT I TOOK BLOW TO THE HEAD FROM 5LB WEIGHT BUT WAS NEVER KNOCKED OUT BY IT AND HAD MY FATHER STITCH IT UP HIMSELF. HE SEEMED TO THINK THIS COULD HAVE BEEN WHAT STARTED ISSUE WITH PIT GLAND COMMUNICATION. WE DISCUSSED SOME FATIGUE I WAS STILL HAVING AND HE ASKED TO FEEL MY HANDS WHICH WERE COLD AS NORMAL FOR ME AND ASKED IF MY FEET WERE THE SAME WAY NORMALLY. I TOLD HIM YES AND AFTER THAT IS WHEN HE SUGGESTED THE THYROID.

SO I STARTED 200 MG TEST CYPINATE INJ ON TUESDAY THAT JUST PASSED. I STILL HAD SUPPLY OF TEST CYP FROM FAMILY DOCTOR PERSCRIPTION AND ALSO STARTED ON THE 60MG ZINC THAT DAY ALSO. IM WAITING ON ANASTROZOLE AND THYROID WHICH SHOULD BE HERE EITHER SATURDAY OR MONDAY IN THE MAIL. SO DOES THIS SOUND NORMAL FOR HIS TREATMENT OR DO YOU GUYS SEE ANY OTHER ADVICE IM NEEDING. HE WANTS ME BACK IN 8 WEEKS TO RETEST/EVAL AND GO FROM THERE UNLESS I HAVE ANY OTHER CONCERNS. ALSO I KNOW MY RBC IS HIGH BUT ITS ABOUT TIME FOR MY NORMAL BLOOD DONATION WHICH HE SAID SHOULD HELP WITH THAT. I NORMALLY DONATE 5-6 TIMES A YEAR ANYWAYS.

 

[Gene Devine]

Here's my quick assessment.

While we're seeing more and more younger guys (relatively speaking) presenting with low testosterone serum levels you want to rule out all pathologies first and foremost.

I didn't see a Prolactin lab; this would go to help rule out a Pituitary Adenoma which can cause Hypogonadism.

Your Total and Free Testosterone labs are still somewhat suppressed even at 100 mg of T Cyp per week. The increase in your dosage will see that rise for sure.

Be careful about the Anastrozole; this drug is a very powerful antagonist in men and can drop your E2 fast. While our labs show your E2 assay was a bit elevated I don't think it was anything to worry about. The increase in dosage will most likely see E2 elevate more so the AI will help with that.

I may suggest that you consider splitting the 200 mg per week into twice weekly shots of 100 mg. This will help provide more stable Testosterone serum levels and help reduce aromatase synthesis.

You may want to start giving blood every month. Your Hematocrit levels are at the top of the reference range and you don't want Polycythemia as your Doc will most likely stop your treatments as this can be a life threatening condition.

I am a little surprised about the Thyroid meds as your T4 and T3 look pretty solid. What was your Doc's rational for this?

Do you supplement with daily DHEA and Pregnenolone?

From my point of view, you have a knowledgeable Doctor and your course of action seemingly correct.

If it were me, I'd do the twice weekly injections. It had a profound effect on my protocol and eliminated the need for an AI.

Keep us posted in this thread on your progress, any changes or new symptoms (watch for low E2) and your next round of blood work.

BTW, one last question: in the past, have you ever used steroids for performance reasons?

 

[SLADE]

Thanks for all the great info Gene. Dont see anything labeled prolactin on labs though but everything else that was there was in normal range. I do not supplement dhea or pregnenolone. Only other supplements I take is 3 d3 2000iu daily, 4000 cla, 3-4000 l- carnitine, multivitamin, 2 500mg vitamin C, 3 1500mg triple fish oil, pre work neon volt, neon bcaa's, ON gold standard whey, and ON casein protein.
The doctor rationale on thyroid was after dicussing fatigue I was still having along with cold feet/hands temp he suggested trying that to see if it helped things improve. Think there were couple other contributing questions he asked but was on little info overload trying to get everything down that I could from him. Good thing is can call anytime and discuss or change things up if notice anything he said, was very comforting to know dont have to wait to 8 week blood work if something just doesnt seem right or have some other idea. As for the AI he even said same as you on levels but when told him I did have slight tenderness of nipples and slighty puffy around there also is when he wanted to start AI to try to help cut that out. I was glad when i showed him acne that was having that he recommended more natural approach using zinc and special ph cleansing bar and said only that if those couldnt help with it then he could prescribe something to eliminate it. Nice to see not just throwing drugs at everything. Thanks for all the advice and always feel free to weigh in and help this newbie out. I appreciate any knowledge I can gain and if there is anything else im not doing id love you guys to let me know.

 

[Nelson Vergel]

Slade

Who is your doctor? He seems good. I am building a doctor's directory and may include him.

Blood donation of 1-2 units every two months will be ok. Avoid hematocrit values of over 52

Get some nizoral shampoo at Walmart and shower with that also.
https://www.excelmale.com/forum/thr...ent-Table?highlight=testosterone+side+effects

 

[SLADE]

Joseph R. Feste, MD is doctor I just started seeing. He is located in Bryan/College Station Tx and works at NBH Lifetime Health Clinic. They have other clinics in Austin, Odessa,and one in Louisiana also I believe. Thanks for the advice Nelson. I've got blood donation scheduled for the 15th of this month.

 

[Gene Devine]

Joseph R. Feste, MD is doctor I just started seeing. He is located in Bryan/College Station Tx and works at NBH Lifetime Health Clinic. They have other clinics in Austin, Odessa,and one in Louisiana also I believe. Thanks for the advice Nelson. I've got blood donation scheduled for the 15th of this month.

He's primarily an OB/GYN BUT is trained in HRT.

You got a good one Slade.

Next time you see him tell him about Excelmale.com and have him join up; we can always use knowledgeable Doc's on here!

Good stuff man

 

[SLADE]

New labs in, these were taken 1.5-2 days after last 200mg inj of test cyp
Estradiol- 62 range <63
Dhea-376 range 103-446
Test, free total with shbg 1139 range 292-1052
Shbg-22 range 16-94
Free test-34 range 4.8-25.0
Cholesterol - 146
Hdl- 35
LDL- 95
Triglycerides- 81
Carbon dioxide 31 range 18-30
Protein 7.5 range 6.0-8.4
Hemoglobin-16 range 13-17
Hemacrit-47.1 range 37-49
Platelet-237 range 130-400
Free t3-4.7 range 2.3-4.2
Free t4-1.05 range 0.73-1.95
Tsh- 1.1 range 0.5-4.7
Hemoglobin a1c 5.0 range 4.0-5.6

 

[Gene Devine]

New labs in, these were taken 1.5-2 days after last 200mg inj of test cyp
Estradiol- 62 range <63
Dhea-376 range 103-446
Test, free total with shbg 1139 range 292-1052
Shbg-22 range 16-94
Free test-34 range 4.8-25.0
Cholesterol - 146
Hdl- 35
LDL- 95
Triglycerides- 81
Carbon dioxide 31 range 18-30
Protein 7.5 range 6.0-8.4
Hemoglobin-16 range 13-17
Hemacrit-47.1 range 37-49
Platelet-237 range 130-400
Free t3-4.7 range 2.3-4.2
Free t4-1.05 range 0.73-1.95
Tsh- 1.1 range 0.5-4.7
Hemoglobin a1c 5.0 range 4.0-5.6

Looks like you need to increase your AI or reduce your weekly Test dosage. 200 mg of Test Cyp a week is a lot for HRT and your E2 shows that here.

That 200 mg of Test each week is putting you at or near the supraphysiological levels as you can see in your Total and Free labs. Might want to think about reducing your Test dosage to something like 75 mg twice a week. This will help with E2 as it will lower aromatase synthesis as well.

Everything else looks pretty good. Need to get E2 down one way or the other....

 

[SLADE]

I agree Gene.Question for you, will swapping from injecting once a week to splitting dose and doing 2x 0.5ml twice a week be better? Ive been taking 1ml every tuesday and the taking 0.5 anastrozole on Thursday or Friday and 2nd dose of AI on saturday/sunday. So these labs were taken at about peak ranges of everything and before taking my AI on thursday morning. Not sure if that changes much. Doctor was pleased overall and not as worried with number as checking for any signs from high estradiol.

 

[Gene Devine]

I agree Gene.Question for you, will swapping from injecting once a week to splitting dose and doing 2x 0.5ml twice a week be better? Ive been taking 1ml every tuesday and the taking 0.5 anastrozole on Thursday or Friday and 2nd dose of AI on saturday/sunday. So these labs were taken at about peak ranges of everything and before taking my AI on thursday morning. Not sure if that changes much. Doctor was pleased overall and not as worried with number as checking for any signs from high estradiol.

Yes, reducing higher spikes in Testosterone serum levels reduces aromatase synthesis thus lower E2 levels. Therefore, splitting your injections like Monday mornings and Thursday nights will go to help keep more stable serum levels and lower aromatase activity.

The best way to take an AI is 24 hours after your Test injection. Test serum levels peak at about 72 hours after injection and an AI has about a 50 hour half life; this way you are getting both to peak at the same time for optimal benefit.

IMO, I think your Testosterone dosage is a bit high. If it were me, and I really wanted to dial in my protocol, I'd reduce the Testosterone injection to 75 mg twice weekly for a total of 150 mg weekly. I'd take the AI 24 hours after each injection.

The bigger question here is how you feel overall. You're labs look good only that Testosterone and E2 serum levels are a tad high and that can be because you were peaking that day.

 

[LuckyDK711]

Here's to reviving old dead thread. Could not remember old account so i created this new one. Well because of work and kids etc i had started using PCP that provided my testosterone cypinate free covered under insurance. But they would not prescribe over 80mg a week. Steadily my symptoms have come back and weight increased etc amplifying effects. My labs on 80mg Test Cyp injected once weekly are below and 1mg aromatase inhibitor weekly.
Total T- 617
Free T- 177.5
SHBG- 18.3
DHEA-?
Estradiol- 19.3
Tsh- 1.98
Free T3-?
Free T4- ?

TOTAL CHOLESTEROL- 156

TRIGLYCERIDES- 131

HDL- 29

LDL- 101

PSA- 1.38

RBC- 5.62

HEMOGLOBIN- 17.5

HEMACRIT- 50.9

Then due to corona lockdown and Dr office being closed he prescribed so I could inject myself and agreed to increase my dose to 100 mg weekly and stop aromatase inhibitor completely. I do feel a little better but still get drowsy feeling and brain fog with fatigue some. At levels above i couldn't stay awake at work. Here are my latest from April.
TOTAL TESTOSTERONE- 822
FREE TESTOSTERONE- 228.4
SHBG- 22.5
DHEA- 244
ESTRADIOL- 74.5
TSH- 1.74
FREE T3- 3.5
FREE T4- 1.19
TOTAL CHOLESTEROL- 164
TRIGLYCERIDES- 86
HDL- 30
LDL- 155
PSA- 1.44
RBC- 6.22
HEMOGLOBIN- 18.3
HEMACRIT- 53.5

I started back with Dr Feste around first of may on Thyroid he was treating symptomatically like before and those issues are back like when with him before. I just scheduled appointment to swap back to him for TRT also. I'm thinking of seeing if he will try 150mg weekly and let me dose at .75mg twice a week as Gene suggested. We are also going to discuss HCG and Peptide therapy as well. My erections in last year have went to crap. I can get them but they dont last and overall drive is way down also. I've been taking Cialis 20mg every 3 days and its like I'm in my 20's again but still not much desire.
I would like to hear everyones thoughts on this.