Doc Increased my T and HCG Before seeing these new Labs.

[SkyWarn]

I need some help. I inject 40mg twice a week. One month ago added 250units HCG twice a week. Prior to the HCG my total T was around 500. The HCG spiked up my T to 799 now.
Since adding the HCG no morning wood, difficulty sleeping, high anxiety, itchy nipples. Doc upped my dose of T Cyp to 60mg twice a week (now sub q, before was IM) and upped the HCG to 350 IU twice a week and added Arimidex .50 twice a week for the E2 sides. The results below are prior to the new protocol. Im wondering if its wise to increase my T dose and HCG dose on light of these numbers (he increased because of my lack of libido) I am also wondering if I really need an AI with an E2 level of 48. Its still under "normal" according the lab. I do plan on calling him tomorrow to discuss. But would also like some opinions here.
As a side note, I took .50 of the AI yesterday and for the first time I slept like a baby! probably was just coincidental right?

FERRITIN 15 Low
PROLACTIN, SERUM 27.7 High0
Vitamin D, 25-Hydroxy, Serum 24.2 Low
ESTRADIOL 47.84 (Normal 7.02-49.06)
TESTOSTERONE, TOT.,S. 799.3 High
SEX HORM.BIND.GLOB. 25
TESTOSTERONE, BIOAVAIL. 511.0 High
FREE TESTOSTERONE 196.11 High

 

[CoastWatcher]

You measured your estradiol with the incorrect lab test (reference ranges are giveaway signs). You want to use the sensitive, LC, MS/MS, lab test. It is the only one that men can rely on. Your serum was measured with the women’s test. And...that’s a significant dose of anastrozole in light of an unreliable test result.

When changes are made I’ve always wanted to go very slowly, only one change at a time, and wait...evaluate your response...test. What seems tedious saves time and stress.

When was your blood drawn? At trough, just prior to your next injection?

 

[SkyWarn]

You measured your estradiol with the incorrect lab test (reference ranges are giveaway signs). You want to use the sensitive, LC, MS/MS, lab test. It is the only one that men can rely on. Your serum was measured with the women’s test. And...that’s a significant dose of anastrozole in light of an unreliable test result.

When changes are made I’ve always wanted to go very slowly, only one change at a time, and wait...evaluate your response...test. What seems tedious saves time and stress.

When was your blood drawn? At trough, just prior to your next injection?

Hi there- My blood was taken at trough just prior to next injection. Regarding the E2, I wasn't aware that this was not the sensitive test.Taking that into consideration, would you think my sensitive E2 is likely going to be higher or lower? I think the doctor put me on the AI dosage was because I recently began HCG and my complains were anxiety, itchy nipples, inability to sleep etc. I was expecting to see a much higher E2

 

[SkyWarn]

You measured your estradiol with the incorrect lab test (reference ranges are giveaway signs). You want to use the sensitive, LC, MS/MS, lab test. It is the only one that men can rely on. Your serum was measured with the women’s test. And...that’s a significant dose of anastrozole in light of an unreliable test result.

When changes are made I’ve always wanted to go very slowly, only one change at a time, and wait...evaluate your response...test. What seems tedious saves time and stress.

When was your blood drawn? At trough, just prior to your next injection?

With those numbers, do you think its wise to increase T and HCG? My libido isn't quite right with no morning wood. Although strangely after taking the .5 anastrozole and increasing the T to 60mg sub-Q I slept like a log and had morning wood the next day.
Also, I just switched (yesterday) to sub-q from IM. The lab tests above were on an IM protocol. Any suggestions are appreciated

 

[CoastWatcher]

What’s worrying is that your doctor didn’t realize he had ordered the incorrect estradiol test. Typically, the standard e2 lab test reports inflated values when used by men. But...sometimes it doesn’t. It’s simply unreliable. I would not initiate a course of anastrozole, particularly .5mg of anastrozole, without obtaining the proper lab result (you can order it yourself at www.discountedlabs.com).

Itchy nipples simply indicate that your serum levels are in flux. They are not a diagnostic indicator of elevated anastrozole. Five years into my therapy, I still deal with bouts of nipple sensitivity.

Something may indeed need adjusting in light of your complaints. But you have the wrong lab test and are moving a lot of pieces around the board at the same time. Start by looking at each variable carefully.

 

[CoastWatcher]

The late Dr. John Crisler used to say, “Start low and go slow.” It is always easier, and typically more comfortable for the patient, if he and his doctor adjust upward from reasonable/modest starting points. One can grow impatint. But in the end, I firmly believe one reaches the goal with more confidence.

 

[SkyWarn]

What’s worrying is that your doctor didn’t realize he had ordered the incorrect estradiol test. Typically, the standard e2 lab test reports inflated values when used by men. But...sometimes it doesn’t. It’s simply unreliable. I would not initiate a course of anastrozole, particularly .5mg of anastrozole, without obtaining the proper lab result (you can order it yourself at www.discountedlabs.com).

Itchy nipples simply indicate that your serum levels are in flux. They are not a diagnostic indicator of elevated anastrozole. Five years into my therapy, I still deal with bouts of nipple sensitivity.

Something may indeed need adjusting in light of your complaints. But you have the wrong lab test and are moving a lot of pieces around the board at the same time. Start by looking at each variable carefully.

I thought it might help if I simply link the actual labs her rather then me typing them in, just in case I missed something critical.

 

[Gman86]

I need some help. I inject 40mg twice a week. One month ago added 250units HCG twice a week. Prior to the HCG my total T was around 500. The HCG spiked up my T to 799 now.
Since adding the HCG no morning wood, difficulty sleeping, high anxiety, itchy nipples. Doc upped my dose of T Cyp to 60mg twice a week (now sub q, before was IM) and upped the HCG to 350 IU twice a week and added Arimidex .50 twice a week for the E2 sides. The results below are prior to the new protocol. Im wondering if its wise to increase my T dose and HCG dose on light of these numbers (he increased because of my lack of libido) I am also wondering if I really need an AI with an E2 level of 48. Its still under "normal" according the lab. I do plan on calling him tomorrow to discuss. But would also like some opinions here.
As a side note, I took .50 of the AI yesterday and for the first time I slept like a baby! probably was just coincidental right?

FERRITIN 15 Low
PROLACTIN, SERUM 27.7 High0
Vitamin D, 25-Hydroxy, Serum 24.2 Low
ESTRADIOL 47.84 (Normal 7.02-49.06)
TESTOSTERONE, TOT.,S. 799.3 High
SEX HORM.BIND.GLOB. 25
TESTOSTERONE, BIOAVAIL. 511.0 High
FREE TESTOSTERONE 196.11 High

When your E2 was 47.84, was that before or after adding in the 250iu’s of HCG 2x/ week?

I also agree about not changing too many variables at once. If these labs were at trough, I would say that your dose is just about perfect. These are your trough labs, so everything is going to be a little higher at peak.

I definitely wouldn’t increase your dose. Especially as much as your doctor wants you too. Going from 80mg/ week to 120mg week is a huge jump. I would definitely just keep your dose at 80mg/ week, and HCG at 250iu 2x/ week. If you slept better, and had morning would after taking a dose of ai, you might benefit from taking a small dose a few times per week. The only thing is 0.5mg 2x/ week is going to be too much. It might drop your E2 into a good range after one dose, but it’s going to continue to build up in your system for the next 10-14 days, and at that point, your E2 will be way too low. The most I would take if I were you is 0.25mg 2x/ week. That’s max. You might want to even start with 0.25mg one time per week.

The only other change I would recommend, if you wanted to, is inject everything EOD instead of twice per week. Your SHBG is on the low side, and you could probably benefit from more frequent injections.

 

[SkyWarn]

When your E2 was 47.84, was that before or after adding in the 250iu’s of HCG 2x/ week?

I also agree about not changing too many variables at once. If these labs were at trough, I would say that your dose is just about perfect. These are your trough labs, so everything is going to be a little higher at peak.

I definitely wouldn’t increase your dose. Especially as much as your doctor wants you too. Going from 80mg/ week to 120mg week is a huge jump. I would definitely just keep your dose at 80mg/ week, and HCG at 250iu 2x/ week. If you slept better, and had morning would after taking a dose of ai, you might benefit from taking a small dose a few times per week. The only thing is 0.5mg 2x/ week is going to be too much. It might drop your E2 into a good range after one dose, but it’s going to continue to build up in your system for the next 10-14 days, and at that point, your E2 will be way too low. The most I would take if I were you is 0.25mg 2x/ week. That’s max. You might want to even start with 0.25mg one time per week.

The only other change I would recommend, if you wanted to, is inject everything EOD instead of twice per week. Your SHBG is on the low side, and you could probably benefit from more frequent injections.

Yes those labs were done on my trough. I actually asked to increase the HCG because I did respond well to the 250units twice a week, but felt my testicles could get a little larger. Also my sensitivity in the penis and ejaculate did improve a little.
what's really interesting is, before adding the HCG my trough was about 550 total T. Adding the 500 units HCG weekly gave me a nice bump in T.

 

[Gman86]

Yes those labs were done on my trough. I actually asked to increase the HCG because I did respond well to the 250units twice a week, but felt my testicles could get a little larger. Also my sensitivity in the penis and ejaculate did improve a little.
what's really interesting is, before adding the HCG my trough was about 550 total T. Adding the 500 units HCG weekly gave me a nice bump in T.

Ya so the increase in HCG should be okay. I definitely wouldn’t change your testosterone dose though. I would stay at the 80mg/ week that you were on. I also absolutely wouldn’t take more than 0.25mg of anastrozole 2x/ week. So no more than 0.5mg total per week. Even that I can almost guarantee will be overkill. I can absolutely guarantee 1mg/ week will be overkill. So make sure you don’t take that much.

I also wouldn’t switch to sub Q right now, only because it’s another variable that you’re changing. The less variables that you switch at one time the better. But obviously that’s your call.

 

[Gman86]

What brand of HCG are you using?

 

[SkyWarn]

What brand of HCG are you using?

My doctor sells it to me, he has in the office. I believe its from Empower(?) but I will double check when I get home