Blackhawk's journey with TRT

Thanks Ratbag, new info to ponder, but

LOL!!! Friggin shape shifting quicksand.

There's no way I can re-evaluate every time I change elevation. The next labs in two weeks will be drawn a moderate-low elevation. I am at elevation on and off seasonally, not year round. Maybe I can gain some kind of idea about dosage adjustment relative to elevation, but no way I can track labs every time I change elev. I'll ask Saya about this at next consultation in a month.

It's not that complicated all you need is more T3. And we know you have underlying thyroid issues already. So elevation makes it tougher on you is all. Now because of this you are forced to address it . You will feel better once you get it sorted out. There is lots out there on elevation and thyroid so you'll have plenty to absorb.

ratbag said:

It's not that complicated all you need is more T3. And we know you have underlying thyroid issues already. So elevation makes it tougher on you is all. Now because of this you are forced to address it . You will feel better once you get it sorted out. There is lots out there on elevation and thyroid so you'll have plenty to absorb.

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Question is how much extra in what situation? Ultimately it seems that does depend on blood tests.

I'm not too keen on the whole Thyroid panel repeatedly, it is just too expensive. At some point trial and error in self adjusting dosage seems like the way to go.

ratbag said:

I never saw a complete thyroid panel from you. Is there one posted here? and how old is it?

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On the road buddy. Sporadic internet access to say the least.

It's all there in this thread, though no single tests had the entire comprehensive thyroid panel.

Here's the run down on 1gr/day:

T3 Good 4.0
T4 A little low 0.91
RT3 consistently around 15 the last couple years
TPO- no problem
Thyroglobulin antibody high, around 2.0 consistently for a couple years

You are being vague. Is that FT3 and FT4 you just posted? High Thyroglobulin means either hashimoto's or graves? Do you know how your cortisol is? Do you know your ferritin? Because without that we are only guessing.

I am not intentionally being vague. I am not currently in a situation to spend the time to dig up every detail you are requesting... again.

You've seen and commented on my thyroid numerous times already on this thread. There is nothing new or different since we went around on this before. Please refer to posts # 40, 42, 66, and 74

Cortisol is posted previously in this thread.

Ferritin was in lower normal range when last checked. That was not recent. Has not been recently tested.

And, I am confident Dr Saya has it in hand on my behalf.

At this point I am pretty certain it is not the thyroid causing my current lack of recovery, symptomatically it seems a heck of lot more like the decreased T dosage and falling levels of Total/freeT and E2

Blackhawk said:

On the road buddy. Sporadic internet access to say the least.

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Hi BlackHawk are you and the wify chasing the sun yet, heading someplace warm for the rest of the winter?

How is the new reduced protocol feeling?

I did a full Thyroid panel on my last blood test. Should have a report in 6-7 days from now. As a fellow high altitude guy would you be willing to look at my numbers and give me your opinion? I have read that altitude has an effect on the thyroid and our numbers are a little different, have you heard that?

FeelingLost said:

Hi BlackHawk are you and the wify chasing the sun yet, heading someplace warm for the rest of the winter?

How is the new reduced protocol feeling?

I did a full Thyroid panel on my last blood test. Should have a report in 6-7 days from now. As a fellow high altitude guy would you be willing to look at my numbers and give me your opinion? I have read that altitude has an effect on the thyroid and our numbers are a little different, have you heard that?

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Southern AZ, rock climbing.

I am perking up a little compared to post #77 above, but still feeling a bit below par exerting 6 out of 7 days. Now a couple days rest as ordered before blood draw Tuesday. Numbers may help tell the story.

I'm happy to look at your results, but haven't had the time to research the altitude aspects of thyroid treatment, so don't have any special knowledge there. I plan to do the reseacrh when I have better connectivity and time.

I reckon Ratbag and Vettester Chris would be good to ask.

Jan 23 labs:

PSA still high but looks like free PSA is a good number, cancer unlikely, probably some kind of of prostatitis. I don't see any urinalysis concerns.

Hematocrit high again. I am going to pull ferritin before another donation.

Total and free T in target ranges, E2 a bit high.

Atypical Lymphocytes may indicate bacterial or viral infection, but I am not symptomatic that I know of.

Consultation w Dr Saya next Tuesday.

Thoughts???

How are you feeling with those TT and FT numbers? That is about what I am shooting for now that i know what 1175/35 feels like.
Your E2 should be easy to drop 12 of so points. Do you have a target you would like to try for your E2?

Everyone is different with E2. You won't really know unless you try to bring it down some. I suspect it won't take much anastrozole or arimidex to do that. Perhaps .125 twice per week would be a good starting point.

FL, I am doing Ok, but not what I would consider great. I have been moderately active with some higher exertion days, but nothing at all extreme. Physical recovery is not as good as the few weeks prior to and into Xmas time.

Re: E2, I Am not symptomatic, but concerned about the relationship to prostate. Dr McClain commented about certain types of estrogen's relationship to prostate cancer, and I don't know whether that also might relate to other inflammation or prostatitis.

Notes from consultation with Dr Saya Feb 5:


New dosage for T cyp:
-42mg (.21ml 200mg/ml solution) E3D for 96.6mg/week


other stuff remains the same:
-HCG 500iu E3D,
-NDT 1 grain every morning,
-DHEA and Pregnenelone 25mg each evenings,
-the usual OTC supplements daily, though will start dropping a few things (see below)


Reduce T cyp from 48 mg to 42mg E3D, a 12.5% reduction. Mainly to bring down hematocrit which is at 52%. This is more important than my current symptomatic concerns. Also to decrease E2 down into normal range which may help reduce possible estrogen provocation of the prostate. I remain asymptomatic otherwise regarding estrogen.


“Walking a tightrope” with the hematocrit at 52%. I live mainly at altitude (9300') so there is a little more leeway before donating, and platelets are OK. Last donation was last October at about 50.5% which brought it down to around 47, but I had ferritin drawn this time, and it is at 27. Dr Saya wants to see it at 50 or higher for safe donation, so we are deferring phlebotomy until hematocrit reaches 54%. May be in a tough spot if reducing T does not also reduce hematocrit, and/or ferritin does not come up.


We will do a full iron panel including ferritin again with next labs. Don't know why I have low feritin; blood loss is unlikely, no signs of GI bleeding, ulcers etc. Possibly malabsorption. I eat red met every 3-4 days, chicken, fish, and lots of dark leafy greens etc so should be getting enough from regular food intake. Jury is out until further testing.


Ratbag will be happy to hear that along with an iron panel, a full thyroid panel will be pulled next time as well. It will be the first time in about 3 years for comprehensive thyroid lab with iron panel at one time. Otherwise, there are no specific changes in terms of thyroid symptoms or treatment this time around. Still on 1 gr NDT each morning.


Prostate: PSA down a couple points but still at 6.9. The Free PSA test at 26 for age 59 puts me at a 5% possibility for cancer. I will be headed home to find a primary care doc and/or Urologist for digital rectal exam, and then go from there for possible prostate diagnosis. I expect the average uro would love to jump right to needle biopsy, but I'll do everything else I can within reason before submitting to that in order to get a good diagnosis. (which may be a particular challenge since our fine state system put us on medicaid.)


However, things going for me: The rapid onset of high PSA is not typical with cancer, and points more likely to some kind of prostatitis. We caught the increase in PSA right away, so if it is cancer, we've caught it early. And most prostate cancer is slow growing, so it is no dire rush.


We will continue to travel for a few more weeks while I try to track down a more progressive doc to work with on this rather than grasp at the first needle happy uro with an open appointment.


With the lab consult cycle having been at every 8 weeks, costs have been more than anticipated for me. Luckily, Dr Saya recommended next labs at 3 months, not 6 weeks. I think since we have reached the desired range for T hormone levels. I am stabilizing in that regard. The other aspect to costs has been ordering HCG from overseas which reduces my cost by a little more than half, and shopping for best bang for the buck supplelents from good companies, but not bottom of the barrel.


We reviewed all the supplements I've been taking on the recommendation of a previous doc (the one who initially put me on a bad TRT protocol). and I'll judiciously do self study and possibly cut the following from my daily supps.
-L glutathione in favor of NAC 1000mg/day
-Alpha lipoic acid
-PQQ
-A balanced amino acid formula which is costly, but possibly continue glycine, taurine and glutamine which are cheap in bulk.
-Seek cheaper but stiff effective protein supplements for my needs. Currently using undenatured grass fed whey, pea protein isolate and great lakes gelatin.

Saw a new Primary Physician yesterday who seems very receptive to working as an ally and advocate. He was deferential regarding my hormone management with Dr Saya, and depending on next PSA test recommended a very progressive urologist as possibly the next step with my prostate issue. He also was interested in a couple articles I took along about 4K score and 3T-mp-MRI vs prostate biopsy... very encouraging.

So I had a DRE. Right side of prostate is enlarged which is not consistent with typical BPH, but no nodules. He wants to wait a few more weeks then pull PSA + free PSA again. If it remains the same or decreases, we'll continue on as such, if it rises, off to the uro.

And, In the context of what's going on with my TRT and the prostate, I am thinking it might be good to get the next round of T, Free T, E2 and hematocrit tests at the 6-8 week interval and possible tweak T dosage down again slightly rather than waiting the full 90- days that Saya ordered. My PCP ordered these tests for me with the PSA test to be submitted through insurance!

In the meantime, even though cancer has not been diagnosed, I am dropping a few supplements that are controversial in terms of possibly fueling cancer once it is established. Mixed bag, because they are generally shown to be preventative of cancer mutation, but just like they help all cells grow, possibly also promote growth in cancer cells once they are growing. And likewise, cutting down on dairy to reduce IGF-1 which does fuel cancer growth. Mixed bag of course, but I'd rather be lean and cancer free with low IGF-1 than built and ill.

And finally I have gained weight. I'm up to 155lb which is heavier than I have ever been... going to dial it back a bit, reduce total calories, and exercise like mad.

Update: I had labs on 3/31 and am just thinking through the current situation and possible next steps. Appreciate any thoughts/input

Pertinent from CBC:

-RBC Minor variation in size and shape.
-Hemoglobin 18.2 HIGH Reference Range: 13.0-17.7 g/dL
-Hematocrit 52.5 HIGH Reference Range: 37.5-51.0%
-RDW 16.2 HIGH Reference Range: 12.3-15.4%

Hormones:

-Testosterone, Serum 879 NORMAL Reference Range: 264-916 ng/dL
-Free Testosterone(Direct) 20.9 NORMAL Reference Range: 7.2-24.0 pg/mL
-Estradiol, Sensitive 45.0 HIGH Reference Range: 8.0-35.0 pg/mL

-PSA Total+% Free
Prostate Specific Ag, Serum 5.9 HIGH Reference Range: 0.0-4.0 ng/mL
Roche ECLIA methodology.

-PSA, Free 1.38 NORMAL Reference Range: N/A ng/mL
Roche ECLIA methodology.

-% Free PSA 23.4 NORMAL
The table below lists the probability of prostate cancer for men with non-suspicious DRE results and total PSA between 4 and 10 ng/mL, by patient age (Catalona et al, JAMA 1998, 279:1542).
% Free PSA 50-64 yr 65-75 yr
0.00-10.00% 56% 55%
10.01-15.00% 24% 35%
15.01-20.00% 17% 23%
20.01-25.00% 10% 20%
>25.00% 5% 9%

So, the current concerns:

-High Hemoglobin and HCT, now with slight RDW changes: T cyp was lowered last revision Feb 5. Luckily HCT did not rise further since previous labs. I am going to ask Dr saya about possibly lowering total weekly T cyp dosage and going to daily injections to try to lower the HCT further ( and possibly E2)

Not sure what to think about the RDW issue, last bloods had slightly high MCV (RBC size). Something going on with RBC production.

-I think most concerning at this point is that systolic BP is up 10-12 points. This is kind of freaking me out (which doesn't help the BP!)

-Total and free T are in what I consider to be good range. I have not felt as super, but could also be due to high E2. First time I have had bloating coming and going. I haven't shed the extra 10 pounds which I don't know whether is partly water weight or new belly fat, my outer belly fat has become softer and a bit jiggly. Never had this happen before. I have been climbing and hiking a lot recently and my upper leg muscle mass has also increased, so ???

-Also have been having a lot of joint pain in fingers and toes. These tend to get a bit inflamed when I am climbing a lot, but this has been out of the ordinary. One toe in particular has become swollen and lost mobility. Could be arthritis or gout, though not the degree of an acute gout attack. I'm a little confused here, I know low E2 can cause these symptoms, but high? Anyway, first time I am concerned about E2 being high. Dr Rand McClain also posted about some estrogens contributing to prostate issues.

-PSA: I'll see the PCP again tomorrow to discuss these results.

I started self treating for the PSA issue with diet and supplement changes to reduce inflamation and increase anti cancer benefits, partly based on the late Lee Meyer's info about his bout with PSA, plus some of my own research. Actions include:

Change diet:
-Close to eliminated dairy to help lower IGF-1 and casein which can fuel cancer. Only eating @ an ounce of cheese on salads for flavor
-Added soy (isoflavones), higher amount of cooked tomatoes (lycopene) and flax (lignans) all which show efficacy in reducing PSA (Note: quite concerned about effect of all of these on E2, with the current level at 45.)
-Broccoli sprouts daily for sulforaphane (anti-cancer) (strong crucifer effect could also help lower E2)
-Pomegranate juice minimal amount due to sugar.

Supplements:
-dropped glutathione, dropped amino acid supps which are controversial, can prevent cancer prior to cancer growth, but can fuel growth once cancer cells are present. Still using some whey protein which does not raise IGF-1.
-added curcumin, quercetin and green tea extract
-also will be adding boswelia and CBD oil asap for joint pain and further anti inflammatory effect


General comment: Except for the joint issues, I am feeling more even physically and mentally overall on an ongoing basis, though still not super despite the concerns.

PCP said the dropping PSA number is not characteristic of prostate cancer so we'll do another PSA and free PSA again in another 90 days.

Good luck, Blackhawk.

I'd strongly consider taking a look at the metabolic theory of cancer if you're concerned. There's a great book on it and the history of cancer research by Travis Christofferson called "Tripping Over the Truth" and quite interesting new papers on the topic if you do a quick search.

Reason said:

Good luck, Blackhawk.

I'd strongly consider taking a look at the metabolic theory of cancer if you're concerned. There's a great book on it and the history of cancer research by Travis Christofferson called "Tripping Over the Truth" and quite interesting new papers on the topic if you do a quick search.

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I read it. Found the superfluous fluff tedious to wade through. Just wanted the meat of the research info. That info is indeed compelling. Shame that the number of issues he writes about have been defunded, dropped, ignored etc.

New labs, drawn May 5:





Next consultation w Dr Saya This Tuesday.

same protocol since early february except reduced HCG slightly :

-T cyp: 42mg (.21ml 200mg/ml solution) E3D for 96.6mg/week
-HCG 500iu E3D, reduced to 420-440iu. based on testicular response. Any lower and I feel the pinch again
-NDT 1 grain every morning,
-DHEA and Pregnenelone 25mg each evenings,
-the usual OTC supplements daily

Symptoms have changed again:

What I think was HCT related has calmed down: feeling flushed, chest fullness, more noticeable heart beat especially with exertion have all decreased, plus most importantly systolic BP is back to normal. HCT and HGB are indeed slightly lower, a relief, but still feeling like they need to drop further. And ferritin is up 20 points. Feeling pretty blessed here.

However I have been a bit cranky... easier to anger with mild bouts of depression and mild reduced enjoyment of life. Again, this is mild, but noticeable. Also libido is somewhat decreased along with consistent erection quality and sensitivity during sex. Part of this is no doubt psychological as my wife's libido is decreased and I'm a bit frustrated with our sex life. I have no suspicion of any circulatory cause due to nighttime erections raging on. I also have had decreased physical stamina and recovery once again, and the joint and tendon problems are ongoing. I still have no nipple sensitivity issues, rarely have the bloating and puffy feeling I had a month ago, so wondering whether these are related to high E2 or not. Would appreciate input on these symptoms relative to Estradiol, and any other observations.

RDW still off.

Also had the toe looked at, xray shows bone spur with arthritis.

No new news on the prostate. Next PSA around June 20.

And ratbag will be pleased to see full thyroid numbers! (Note:blood draw was less than 3 hrs after taking NDT, and fasting. My interpretation is free T3 at 5.1 is fine under such conditions, but free T4 is low, so not sure how my levels stack up later in the day. I have had inconsistently some tiredness late afternooon early evenings... not consistently. Happy to see RT3 at 10.6)