Blood Work at 35 weeks of TRT

Hey Guys:

I wanted to share my blood work with the forum here after 35 weeks of TRT. I sought out the therapy because my A1c had crept up to 6.4 last year, and nothing seemed to work to get it down. Scouring the internet I found that raising your T levels to the higher ranges has been very effective in treating diabetes and pre diabetes. I'm 53 years old, 6'3" lean at 220lbs. My first 6 weeks of the therapy didn't do much for me at 80mg Test Cyp once a week injections. We increased it to 120mg once a week injections for the second 6 weeks......my total T had increased from 479 to 579 and Free T followed from 14 to 21. My protocol was then shifted to try 80mg twice a week to see how I would respond....the thinking that I'm a high absorption rate guy. By week 22 my total T at trough levels were showing at about 1100, free T at 56 and E2 at 60. I wanted to leave things alone and see if my E2 would settle out with the use of an AI, however it would not. My feet were swelling and acne had set in. I added the AI (Arimidex .5mg compounded with 2500mg DIM twice a week). My ankle swelling went away, and the acne flare ups greatly slowed down.

Right now I feel fantastic, I think I'm dialed in pretty good. The gym is great, body is recomping great, mental focus and well being is great. Libido and erections are great. Life is great.

Only concerns with the blood work: A1c is at 6.1, which is not bad for me. I was at 6.4 at the beginning of the therapy. Hematocrit is now at the high end of the normal range. Should I go ahead and start scheduling regular blood donations? Estrodial at 29.....maybe a little low? Any feedback, comments, anecdotal advice would be very much welcomed! Thanks guys!


CBC With Differential/Platelet

WBC 4.4 x10E3/uL 3.4 - 10.8 01
RBC 5.48 x10E6/uL 4.14 - 5.80 01
Hemoglobin 16.4 g/dL 12.6 - 17.7 01
Hematocrit 50.9 % 37.5 - 51.0 01
MCV 93 fL 79 - 97 01
MCH 29.9 pg 26.6 - 33.0 01
MCHC 32.2 g/dL 31.5 - 35.7 01
RDW 15.4 % 12.3 - 15.4 01
Platelets 306 x10E3/uL 150 - 379 01
Neutrophils 46 % 01
Lymphs 40 % 01
Monocytes 11 % 01
Eos 2 % 01
Basos 1 % 01
Neutrophils (Absolute) 2.0 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 1.8 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.5

Eos 2 % 01
Basos 1 % 01
Neutrophils (Absolute) 2.0 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 1.8 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.5 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Comp. Metabolic Panel (14)
Glucose, Serum 93 mg/dL 65 - 99 01
BUN 15 mg/dL 6 - 24 01
Creatinine, Serum 1.32 High


mg/dL 0.76 - 1.27 01
eGFR If NonAfricn Am 61 mL/min/1.73 >59
eGFR If Africn Am 71 mL/min/1.73 >59
BUN/Creatinine Ratio 11 9 - 20
Sodium, Serum 139 mmol/L 134 - 144 01
Potassium, Serum 5.3 High mmol/L 3.5 - 5.2

Chloride, Serum 97 mmol/L 97 - 108 01
Carbon Dioxide, Total 28 mmol/L 18 - 29 01
Calcium, Serum 9.3 mg/dL 8.7 - 10.2 01
Protein, Total, Serum 7.0 g/dL 6.0 - 8.5 01
Albumin, Serum 4.9 g/dL 3.5 - 5.5 01
Globulin, Total 2.1 g/dL 1.5 - 4.5
A/G Ratio 2.3 1.1 - 2.5
Bilirubin, Total 0.6 mg/dL 0.0 - 1.2 01
Alkaline Phosphatase, S 48 IU/L 39 - 117 01
AST (SGOT) 27 IU/L 0 - 40 01
ALT (SGPT) 45 High


IU/L 0 - 44 01
Testosterone,Free and Total
Testosterone, Serum 1420 High


ng/dL 348 - 1197 01
Comment:
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) >50.0 High pg/mL 7.2 - 24.0

Sex Hormone Binding Globulin 10.7 Low


nmol/L 03
Reference Range:
>49y: 19.3 - 76.4
Hemoglobin A1c
Hemoglobin A1c 6.1 High


% 4.8 - 5.6 01
Please Note: 01
Pre-diabetes: 5.7 - 6.4
Diabetes: >6.4
Glycemic control for adults with diabetes: <7.0

Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.9 ng/mL 0.0 - 4.0 01
Roche ECLIA methodology.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory
PSA value 0.2 ng/mL or greater.
Values obtained with different assay methods or kits cannot be used
interchangeably. Results cannot be interpreted as absolute evidence
of the presence or absence of malignant disease.







Estradiol, Sensitive


28.9 pg/mL 8.0 - 35.0 02
This test was developed and its performance characteristics
determined by LabCorp. It has not been cleared by the Food and
Drug Administration.
Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)

Congratulations on getting dialed in and feeling good! That is not always as straightforward as one would expect. I would go ahead and just donate at the Red Cross every 56 days, that way no worries about high hematocrit and you can help some people at the same time. Other than that, as long as you are feeling great, I would say don't change anything. The elevated ALT can just be from a hard workout the day before. Maybe add Metformin if you can get a script (and if you are not already using it) but overall you look like you are good to go.

I know you have worked hard, and waited a good while to reach this point. As ERO noted, you seem to in a good place. All the best!

ERO said:

Congratulations on getting dialed in and feeling good! That is not always as straightforward as one would expect. I would go ahead and just donate at the Red Cross every 56 days, that way no worries about high hematocrit and you can help some people at the same time. Other than that, as long as you are feeling great, I would say don't change anything. The elevated ALT can just be from a hard workout the day before. Maybe add Metformin if you can get a script (and if you are not already using it) but overall you look like you are good to go.

Click to expand...

Thanks for looking over for me Ero........good advice on donating blood......that's a win - win. My PCP did prescribe Metformin 500mg a day.........it doesn't seem to be adding any benefit regarding my A1c number. I will review with the Doc and see if increasing the dose may help and we'll keep watching it.

CoastWatcher said:

I know you have worked hard, and waited a good while to reach this point. As ERO noted, you seem to in a good place. All the best!

Click to expand...

Man you are absolutely right Coastwatcher...........it does take patience and constantly monitoring and connecting the numbers versus how you actually feel. I've been getting labs every 8 weeks utilizing Discounted Labs, what a great service. Thanks for your well wish and have a Great Day!

Test, looks like your are becoming insulin-resistant, I would use metformin. A better diet would also help.

TestAdvocate said:

Man you are absolutely right Coastwatcher...........it does take patience and constantly monitoring and connecting the numbers versus how you actually feel. I've been getting labs every 8 weeks utilizing Discounted Labs, what a great service. Thanks for your well wish and have a Great Day!

Click to expand...

Labs every 8 weeks, wow. Your Labs are very thorough, did you get all of them through discount labs? If so what was the cost.

Vince said:

Labs every 8 weeks, wow. Your Labs are very thorough, did you get all of them through discount labs? If so what was the cost.

Click to expand...

Yeah.......these are about $200.00 each time. Since this is my first year of TRT, I just wanted to be darned sure everything is in order. Prostate, Hematocrit, E2. Kind of overkill, I just wanted to be sure. I'll probably taper it off next year.

Vince said:

Test, looks like your are becoming insulin-resistant, I would use metformin. A better diet would also help.

Click to expand...

Yeah Vince I know. Unfortunately! Thus, my whole reason for going on TRT........suspected insulin resistance. It has helped a lot, I think my A1c would be creeping up to 6.6 on some of these labs if not for TRT. This summer I had it down to 5.7 and I was jumping with joy. Metformin was added in after my A1c dipped down to 5.7, and it hasn't seemed to help much at 500mg a day. My diet is very low carb......no wheat or grains or potatoes. Mostly meats and green vegetables. Not much more I can do. My workouts are similar to HIIT, but with old school bodybuilding exercises. Wish I could figure this out. It scares the schiz out of me........as long as I don't go higher than 6.1 I guess I'll be kind of ok styled happy. Have a great holiday next week Vince........I always love your feedback and research!

Test, is that only 500mg a day of metformin, way too low. Personally I would use 1500 mg a day of metformin.

Tuesday 3 July 2012Diabetes drug breakthrough to ease heart failure impact
CAROLYN CHURCHILL



A DRUG commonly prescribed to patients with type 2 diabetes could help transform the lives of people suffering from heart failure, according to research from a Scottish university.

CAROLYN CHURCHILL


It found metformin, the world's most commonly prescribed diabetes medicine, could have "very promising" benefits for some of the 100,000 patients in Scotland who suffer from heart failure.
The drug is already used to help reduce the complications of diabetes and is often prescribed to people, particularly those who are overweight, who have not been able to control their blood glucose levels through diet and exercise alone.
Now scientists at Dundee University have carried out the first clinical trial using metformin on patients with heart failure, a debilitating long-term condition which can seriously affect quality of life.
Patients with heart failure often suffer from fatigue and shortness of breath, leading to reduced mobility, but the new research suggests metformin not only enables them to do more exercise, but also helps them lose weight and improve the performance of their fat hormones.
Professor Chim Lang, Professor of Cardiology at Dundee University, said he believed the research could help lead to a new treatment strategy for patients with heart failure.
He said: "This is the first clinical trial that looked specifically at potential beneficial effects of metformin in pre-diabetic heart failure patients, and the results are very promising.
"These results are hypothesis generating. We believe that our findings may have the potential of developing into a new treatment strategy for patients with heart failure."
Previous research carried out by Mr Lang has shown patients with heart failure are at risk of diabetes and have insulin resistance, which causes their body to be less effective at lowering blood sugar levels and leaves them feeling lethargic.
Metformin has already been shown to help protect patients with type 2 diabetes against other conditions such as cancer and cardiovascular disease.
Around 200,000 Scots suffer from type 2 diabetes but it can cause an increased risk of complications such as kidney and nerve damage.
Last month a team from Dundee University, led by Dr Graham Rena, announced a new understanding of how the drug works, saying that this could lead to scientists developing more effective, second-generation medicines.
They said the responses to the drug depend on its metal-binding properties and work is now under way to investigate how effective it can be in treating a wide range of conditions.
Dr Rena, speaking last month, said: "We have demonstrated that cellular actions of metformin are disrupted by interference with its metal-binding properties.
"This link will illuminate a better understanding of the molecular mechanisms enabling drug action.
"Further research is now needed to exploit the new tools that we have developed to establish how this unusual property of metformin enables it to be such an effective medicine.
"Identification of metformin's target will stimulate the development of second-generation drugs based on metformin, which has been impossible up until now."
The latest study, which was funded by the British Heart Foundation and carried out by Mr Lang and his colleagues, is published in the European Journal of Heart Failure.
Mr Lang said: "We are grateful to all the patients who took part in this study, and we would like to thank British Heart Foundation for funding it."

Could be physiological insulin resistance. Do you eat breakfast?

norenred said:

Could be physiological insulin resistance. Do you eat breakfast?

Click to expand...

Yes, I sure do. I eat two boiled eggs first thing every morning within 30 minutes of waking up. I concentrate on protein intake throughout the day. I wish I knew why my A1c is so stubborn.

Vince said:

Test, is that only 500mg a day of metformin, way too low. Personally I would use 1500 mg a day of metformin.

Tuesday 3 July 2012Diabetes drug breakthrough to ease heart failure impact
CAROLYN CHURCHILL



A DRUG commonly prescribed to patients with type 2 diabetes could help transform the lives of people suffering from heart failure, according to research from a Scottish university.

CAROLYN CHURCHILL


It found metformin, the world's most commonly prescribed diabetes medicine, could have "very promising" benefits for some of the 100,000 patients in Scotland who suffer from heart failure.
The drug is already used to help reduce the complications of diabetes and is often prescribed to people, particularly those who are overweight, who have not been able to control their blood glucose levels through diet and exercise alone.
Now scientists at Dundee University have carried out the first clinical trial using metformin on patients with heart failure, a debilitating long-term condition which can seriously affect quality of life.
Patients with heart failure often suffer from fatigue and shortness of breath, leading to reduced mobility, but the new research suggests metformin not only enables them to do more exercise, but also helps them lose weight and improve the performance of their fat hormones.
Professor Chim Lang, Professor of Cardiology at Dundee University, said he believed the research could help lead to a new treatment strategy for patients with heart failure.
He said: "This is the first clinical trial that looked specifically at potential beneficial effects of metformin in pre-diabetic heart failure patients, and the results are very promising.
"These results are hypothesis generating. We believe that our findings may have the potential of developing into a new treatment strategy for patients with heart failure."
Previous research carried out by Mr Lang has shown patients with heart failure are at risk of diabetes and have insulin resistance, which causes their body to be less effective at lowering blood sugar levels and leaves them feeling lethargic.
Metformin has already been shown to help protect patients with type 2 diabetes against other conditions such as cancer and cardiovascular disease.
Around 200,000 Scots suffer from type 2 diabetes but it can cause an increased risk of complications such as kidney and nerve damage.
Last month a team from Dundee University, led by Dr Graham Rena, announced a new understanding of how the drug works, saying that this could lead to scientists developing more effective, second-generation medicines.
They said the responses to the drug depend on its metal-binding properties and work is now under way to investigate how effective it can be in treating a wide range of conditions.
Dr Rena, speaking last month, said: "We have demonstrated that cellular actions of metformin are disrupted by interference with its metal-binding properties.
"This link will illuminate a better understanding of the molecular mechanisms enabling drug action.
"Further research is now needed to exploit the new tools that we have developed to establish how this unusual property of metformin enables it to be such an effective medicine.
"Identification of metformin's target will stimulate the development of second-generation drugs based on metformin, which has been impossible up until now."
The latest study, which was funded by the British Heart Foundation and carried out by Mr Lang and his colleagues, is published in the European Journal of Heart Failure.
Mr Lang said: "We are grateful to all the patients who took part in this study, and we would like to thank British Heart Foundation for funding it."

Click to expand...

Hey Vince.......I wanted to get back with you on this.........did much more reading on Metformin dosing, and you're right.......the 500mg a day dosing was way too low. I saw where some guys were taking 1000mg and these guys were basically taking it as a supplement for anti aging properties.......these guys were not even insulin resistant. So, I did get my dosage increased to the 1500mg a day. I use the SR (Steady Release) and have absolutely no stomach problems with it at all. Thanks for the advice! Take care and Merry Christmas!

At 1500 mg a day with the Metformin, I would bet that your next tests will show a lower A1C number.

Yeah, you need to increase the damn Metformin. You need to cut the carbs WAY down too. I would max out Metformin (2500 mg). It's a very safe medication, and if your A1c is in the 6's, then you ARE insulin resistant, pre diabetic.
It's totally justified to increase the metformin (slowly as GI tolerated).

That being said, congrats on becoming more dialed into optimizing your T.

BTW, I'm insulin resistant as well. You can't fight it. You need to go lower carb, take metformin, optimize T, and work out (resistance and cardio). It is what it is.

GA8314 said:

Yeah, you need to increase the damn Metformin. You need to cut the carbs WAY down too. I would max out Metformin (2500 mg). It's a very safe medication, and if your A1c is in the 6's, then you ARE insulin resistant, pre diabetic.
It's totally justified to increase the metformin (slowly as GI tolerated).

That being said, congrats on becoming more dialed into optimizing your T.

BTW, I'm insulin resistant as well. You can't fight it. You need to go lower carb, take metformin, optimize T, and work out (resistance and cardio). It is what it is.

Click to expand...

Yeah, thanks man. What a battle! I am up to 1,500mg a day now. What is you A1c?

TestAdvocate said:

Yeah, thanks man. What a battle! I am up to 1,500mg a day now. What is you A1c?

Click to expand...

Well, I didn't have a baseline A1C, BUT I was doing fasting blood glucose checks and my numbers were always in the mid-high 90's and every now and again 100 or 101, which is pushing into pre diabetes land. So, for sure I was insulin resistant. My tolerance for carbs is very very low unless I'm doing lots of high intensity cardio (which I'm not nor plan on doing a lot of).

I "fought" it for years, but I finally simply accept that my genetics make me insulin resistant. I can't even tolerate much fruit...... It blows, but it is what it is. Metformin has helped a lot. It's like T in many ways. You need to give it time and it's very subtle. I didn't notice anything until 6 weeks into taking high dose metformin. I suspect this is highly variable amongst people though. Low carb, for me, is the way to go to maintain a decent weight.

Jay Campbell (of FabulouslyFitOver40) put it very succinctly, and I'll paraphrase "the single most important thing anyone can do for their weight and healthy is determine their sensitivity to insulin"...... Soooooo true.

The good news is AFTER doing all this, my A1C was 5.3 so not too shabby. But, for SURE I would have been way higher, and also my fasting glucose levels have come down to the 80's which is good for me....... Way better than high 90's.......

I'm convince that had I continued with the SAD (standard american diet) I would have entered full blown diabetes like my grandfather did......

I honestly believe that DM-II is a choice (before insulin dependence and maybe even after if you do serious fasting and wean the insulin). It's a tough reality, but if you are strongly insulin resistant then you have to make some tough choices. The wrong carbs (i.e. almost anything refined and even high glycemic fruits) will really hurt your progress....

GA8314 said:

Well, I didn't have a baseline A1C, BUT I was doing fasting blood glucose checks and my numbers were always in the mid-high 90's and every now and again 100 or 101, which is pushing into pre diabetes land. So, for sure I was insulin resistant. My tolerance for carbs is very very low unless I'm doing lots of high intensity cardio (which I'm not nor plan on doing a lot of).

I "fought" it for years, but I finally simply accept that my genetics make me insulin resistant. I can't even tolerate much fruit...... It blows, but it is what it is. Metformin has helped a lot. It's like T in many ways. You need to give it time and it's very subtle. I didn't notice anything until 6 weeks into taking high dose metformin. I suspect this is highly variable amongst people though. Low carb, for me, is the way to go to maintain a decent weight.

Jay Campbell (of FabulouslyFitOver40) put it very succinctly, and I'll paraphrase "the single most important thing anyone can do for their weight and healthy is determine their sensitivity to insulin"...... Soooooo true.

Click to expand...

Yeah.......me too. My insulin resistance problem didn't start until just a few years ago. We watched long term use of statins get me into the insulin resistance "range". Horrible! My weight has never been a problem, low body fat etc....grew up more of an fast muscle twitched guy, very lean. I eat a very low carb diet already. I was hoping T therapy was going to help, it did seem to at first.......my A1c was down to 5.7 during the summer last year, but now has crept up to 6.0 again. I'm with you........low carbs, HIT resistance training (more old school bodybuilding at a faster pace), high dosed Metformin (I'm taking 1500mg SR right now) and keep the T up in the high range. Just keep plugging away. We'll have to keep each other motivated. Thanks for posting on this thread.

TestAdvocate said:

Yeah.......me too. My insulin resistance problem didn't start until just a few years ago. We watched long term use of statins get me into the insulin resistance "range". Horrible! My weight has never been a problem, low body fat etc....grew up more of an fast muscle twitched guy, very lean. I eat a very low carb diet already. I was hoping T therapy was going to help, it did seem to at first.......my A1c was down to 5.7 during the summer last year, but now has crept up to 6.0 again. I'm with you........low carbs, HIT resistance training (more old school bodybuilding at a faster pace), high dosed Metformin (I'm taking 1500mg SR right now) and keep the T up in the high range. Just keep plugging away. We'll have to keep each other motivated. Thanks for posting on this thread.

Click to expand...

I really think a big part of it is genetics. It just is what it is.

Consider going to regular formulation (shorter acting) Metformin 500mg and taking up to 2500mg daily. For you it is surely justified.

Intermittent fasting has been a winner for me also. Especially if I can't get in the exercise as much..... I've found diet is key to 80% of it. It's also amazing how important sleep and stress play in all of this. Unfortunately those are two areas I need improvement on....

All the best and good luck to you brother!

TestAdvocate said:

Yes, I sure do. I eat two boiled eggs first thing every morning within 30 minutes of waking up. I concentrate on protein intake throughout the day. I wish I knew why my A1c is so stubborn.

Click to expand...

Interestingly, I saw an interview with Doug Brignole (old school bodybuilder from 70's) and he was saying that all of the "mass monsters" of HIS day (thus not on GH and Insulin to get big then) are now kinda fat in their later years. He attributes their size gains as a result of relative insulin resistance, but once they are no longer on gear or training, apparently a great many of them (surely not watching diets and who knows what exercise they are now doing) have now gotten fat.

Doug contrasts that with himself, which he says he's very insulin sensitive, thus easy to stay lean even though harder to put on muscle.

I have heard others speak of this before. Insulin resistant guys able to put on mass but trouble staying lean (the latter is more logical than the former).

Anyone have any experience with this?