Beginner Blood Work Questions

[lemonflavor]

I'm wondering what you think about thyroid and basic levels, as marked below in italic.

For now, I'm just really curious. I don't want to go into my whole history and symptoms, but briefly I'm 54 and deal with depression, anxiety, fatigue, and chronic lumbar pain.

I'm doing TRT for the second time around. First time caused too much anxiety/over stimulation. I just got my first real blood work results after being on T for around 10 weeks. I'm going to be consulting with Defy after I can get the records for my physical which is being held up in the health care system's backlog. I know they'll take care of me and can answer more specific questions and instruct me on dosing.

I'm injecting T only, every day for a total of (only) 77 mg a week. Blood was taken in the morning before I injected. Labcorp:

• Testosterone, Serum 930 High ng/dL 264 - 916
• Free Testosterone(Direct) 15.1 pg/mL 7.2 - 24.0 - How does this factor with total T, and then SHBG being mid-range?
• Sex Horm Binding Glob, Serum 41.5 nmol/L 19.3 - 76.4 - Middle?
• DHEA-Sulfate 76.4 ug/dL 71.6 - 375.4 - The supplement form makes me terribly overstimulated.
• Luteinizing Hormone(LH), S LH 0.1 Low mIU/mL 1.7 - 8.6
• IGF-1 Insulin-Like Growth Factor I 229 High ng/mL 61 - 200
• Triiodothyronine (T3), Free 3.0 pg/mL 2.0 - 4.
• Reverse T3, Serum 7.2 Low ng/dL 9.2 - 24.1 - Does this mean anything since free T3 is OK?
• TSH 3.75 (had this done a couple of months ago)
• Thyroxine (T4) Free, Direct, S T4, Free (Direct) 1.34 ng/dL 0.82 - 1.77 (was .9 in the past)
• Thyroid Peroxidase (TPO) Ab <6 IU/mL 0 - 34
• Thyroglobulin Antibody <1.0 IU/mL 0.0 - 0.9 01
  Thyroglobulin Antibody measured by Beckman Coulter Methodology
• Estradiol, Sensitive 31.0 pg/mL 8.0 - 35.0 - I might have some high e2 symptoms like anxiety, but it could very well be from testosterone itself.

My energy is a couple of notches better, which is a worthwhile improvement, but not by a lot. One other improvement is significant lessening of hot flashes, although still some night sweats. I had previously gone up to 90 mg a week, but that was too uncomfortable (stimulated). I was almost hoping that thyroid could explain some of my problems. I certainly have a lot of the symptoms. I had an MRI on the pituitary and I may have a Rathke's cleft cyst. Thanks.

BTW I take 5000iu Vit D a day and it's middle range.

 

[Vince Carter]

With your SHBG there's not much reason just on that alone that you should need to be on daily injections. Notice how low your Free T is...your TT is going to have to go way up maybe 1100's to overcome the SHBG.

How did you arrive on daily injections being right for you?

 

[lemonflavor]

Vince, it's to get the uncomfortable 'activating' or revved up feeling to even out as much as possible. I was also getting night sweats at night when I injected early in the day. Could be some coincidence going on--I realize cypionate is a longer ester--but it did at least seem to even things out (or I got more used to it). Also to attempt to lower any possible e2 symptoms, but that was secondary.

Edit:I have some sensitivity to nipple area when pressed on, but I can't remember if that's new or not.

Is SHBG rather high so that free T could go higher to get more benefit? I don't know what's considered high is for SHBG.

 

[Vince Carter]

well, a 31 E2 Sens could be too high, for you. Nipple issues can be transient and benign on TRT without being a high E symptom though I experience lesser nipple itch/etc with my E much lower. Too the night sweats are more likely to be elevated E.
If you're Free T came up and E stayed at 31 you might do better in a ratio aspect of the two. But E follows T so that might not do the trick. You might need a low dose AI, that might be the easier thing right now, get your E lower than 31 and see how you feel.

 

[Vince Carter]

With Defy...did they give you Anastrozole @ .125mg? That's the typical dose that they give everyone, it seems.

 

[lemonflavor]

I will have my first app't with Defy soon after I can get a hold of my record for my physical I had a couple of months ago. Or get another one. :/ What you described seems to me like a good course of action. We'll see what the doc says.

When you say you experience less symptoms with your E much lower, do you mean much lower than 31, or just a relative basis? Not that the numbers matter much. Just curious.

 

[Vince Carter]

The number is just in relation to where a lot of my negative symptoms seem to resolve to a more satisfying level, if you will.

 

[lemonflavor]

I see. I also have amazingly achy shoulders and elbows, I'm very itchy, and have acne on my back, but it's not conclusive yet that it's estrogen related. I'm doing my best not to make false assumptions. My workouts are going very well, so the inside of the shoulders might not be caught up with the muscles, but nothing to this degree has happened before.