got labs back, starting new regimen monday!!!!

marshall said:

ive delt with 5 different doctors over the last 10 months that didnt know what they were doing. i never had the right protocol. started with total T of 280, 10 months ago and the last labs i got done before heading to Defy, my T was 960 and estrogen was 95. Ive only taken testosterone (anywhere from 50 mg every 7 days to 200 mg every 10 days) doctor didnt know what to do with my estrogen so he just pasted me on. I dropped down to 100 mg every 7 days and called Defy.. got my labs done and a consult with Dr..my results from Defy

Total t 400( 348-1197)
Low, especially on 100 mg of test a week. We know this needs to go North.
Free t 13.9( 6.8-21.5)
This looks decent but could be better. I don't see SHBG here, did you get that tested?
DHEA-sulfate 178.0 ( 71.6-375.4)
Best at the higher end of the range.
Estradiol 25.8 ( 7.6-42.6)
PERFECTO!!!!
RBC 5.85(high)( 4.14-5.80)
Fine.
Hematrocrit 52.0 (high)( 37.5-51.0)
High, start giving blood each month.
LH <0.2 (low)( 1.7-8.6)
HPTA suppresed. Normal.
TSH 6.760 (high)( .450-4.500)
Did you get more Thyroid labs beyond this?

Dr. prescribed 200 mg T every 7 days, 60 mg of Armour Thyroid daily, 1/2 mg Anastrozole twice a week, 5000mg of D3 daily, and 30 mg of DHEA daily..
Any thoughts out there?????

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robs2nd75 said:

Gene what can be done if SHBG is high or low?
How do you feel the elevated TSH should be handled? T4, T3, rT3 before medication? (I seem to recall Marshall's weight hovering around 300).

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marshall said:

is was the "sensitive" test at both places...i was experiencing some fatigue and loss of libedo..i dropped to 100 mg a week to lower the estrogen and get ready to have defy help me out, i didnt want to quit completely...having a rough time making myself work out and really low libedo, no desire at all. we will see how this all works out. i know i will have to make changes and expect that. i have to get started and see what the next labs say.

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Nelson Vergel said:

I am trying to find a reference that clearly states that men need the ultrasensitive (and more expensive) test for estradiol. I have not found any.

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Gene Devine said:

SHBG finds its own level in men and while we want to know the serum level as it plays directly on Free Testosterone there's not much we can do to control levels.

One way to reduce elevated SHBG is increasing androgen levels.

If one has elevated SHBG they would be better served doing one bigger weekly injection as opposed to someone who is mid range or lower where twice weekly injections are better.

Anyone who says TSH of 6 or 7 is "normal" at any age has no clue...all due respect. Hypothyroidism is probably the most misdiagnosed and under treated pathology in America today and it's at epidemic levels.

Go here and learn: http://www.stopthethyroidmadness.com/

Marhsall, HCG does much more for men than just maintaining testicular volume...learn why you need it when you are HPTA suppressed.

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Gene Devine said:

I believe Quest Diagnostics now has it as a statement on their Estrogen Lab that the "Sensitive" assay should be ordered for men with the reasons why.

Most of what you will find from the labs is that the "Sensitive" assay should be used in men to diagnose gynecomasita.

Most Doc's who have been testing E2 long enough know that that the default E2 lab designed for women can/may over estimate a man's E2 levels...I have seen that first hand myself.

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paco said:

This is one place where I think Defy is falling short. As I understand it, they customarily use the "regular" estradiol test rather than the sensitive test, with the rationale that they are saving their patients money. That's well-meaning, but given that the regular test tends to overestimate estradiol levels, this can lead to over-prescribing anastrozole. Defy is really wonderful in many respects, so hopefully this will change in the future.

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JSayaMD said:

Have just registered for this forum and will try to be involved as my life schedule permits (with work and three kids at home)...

Hello to everyone!

Marshall and others:

In general, members should be cautious of taking advice and getting all worked up from other members whom are not medical professionals...they are trying to help with advice, but for some people this just breeds anxiety and is more harmful than beneficial.

Regarding the issues posed...

In my experience, the ultra sensitive E test and regular E test are fairly equivalent unless we start talking about VERY low E levels ( <15), which would be too low anyways. At those VERY low E levels the ultra sensitive test is exactly that - more sensitive (this is evidenced by the fact that the regular E test will not detect anything less than 5.1 - it will read <5.1 ... It is not SENSITIVE enough to detect those low levels). The ultrasensitive test is also more expensive and he's welcome to order it, but IMO is a waste of $ that could be better spent elsewhere. In other words, the regular estradiol test will give us a good idea of if E2 is "low", "acceptable/OK", or "high"... which is really what we're interested in anyways. If your interested in knowing EXACTLY how low (ie: 3 vs 10) or EXACTLY how high (ie: 50 vs 65) then the ultrasensitive test would give you that, but at additional cost...

With regards to the thyroid... high TSH, fatigue, being overweight = basically guaranteed hypothyroidism. Sure we can check additional labs (free T3, free T4, reverse T3) but again this is additional cost to the patient and will likely NOT ultimately change our treatment plan as 99% probability with his TSH level (>6) that his T3/T4 will be off. In addition, as I do with most patients, but don't recall specifically my convo with him, I usually give the option of more thorough testing up front (at more cost, with the understanding that it likely will NOT alter the treatment plan) or to empirically start thyroid treatment and monitor on follow-up accordingly... and most patients , Mr Shell included if I recall, choose to start empiric treatment. We ARE monitoring free T3 and free T4 on his 90 day f/ u labs to make sure the armour dosage is dialed in accurately.

Regarding anastrozole, E is 25 (perfect) with total T 400 (fairly high ratio), has history of high E with early breast/gyno symptoms, has relatively high body fat % (= more aromatase activity). He ABSOLUTELY needs an AI. How much?? Well that's the art of it and to be determined through treatment and follow-up. 0.5 mg twice weekly is a good bet of what he'll need ... Maybe a bit more or a bit less, we'll see on follow-up labs. E will begin to rise as soon as T rises (aromatase enzyme doesn't take any vacations), so should start the AI together when starting the T injections ESPECIALLY in patients with a proven history of high E conversion and the related side effects. His current E level is perfect at 25, but it WILL NOT stay there as his T comes up without an AI especially with his high aromatase activity.

I spent over an hour discussing many issues with this patient, once again, he should be cautious of getting worked up or stressed out by posts from forum members that do not know his entire clinical picture, are not medically trained, and have not had an official (1 HOUR) medical consult with him. Some aspects of HRT are more art than exact science, and this is where CLINICAL experience is crucial. Many people have various differing opinions, but I have quite a bit of experience with these and similar hormonal abnormalities and am well versed in the intricacies and caveats of treatment... forum posts by non-medical members should not be taken as the gospel especially if they will breed uncertainty and anxiety.

Good day all!

Dr Saya

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