Extensive Bloodwork After 3 Months on TRT

[mopes]

Got bloodwork back. Total t is lower than I would have guessed but free t looks good. Estradiol is in line with the addition of arimidex. Prolactin has come down nicely since discontinuing zoloft. DHEA-S and IGF are above range from 50mg DHEA a day. PSA is half of what it was at initiation of therapy. B12 is sitting nicely with the addition of multi vitamin, should balance out well once metformin dose is titrated up. Cholesterol is up with LDL way up. Thyroid function appears to be low on all fronts.

This was at 50mg Test Cyp SubQ, 250 IU hCG, and 1 mg Arimidex on Monday, Wed, Friday. So total weekly dose of 150mg Test Cyp, 750 hCG, 3mg Arimidex (yes I know this is high).

Going to drop the hcg and arimidex completely and go to daily test cyp 20mg subq. Then retest. Time to try some Desicated Thyroid? Would love any thoughts. Formatting is always horrendous so I'll add the data as attachments too.

CBC With Differential/Platelet WBC	6.0		3.4-10.8 x10E3/uL
RBC	5.50		4.14-5.80 x10E6/uL
Hemoglobin	15.2		12.6-17.7 g/dL
Hematocrit	46.7		37.5-51.0 %
MCV	85		79-97 fL
MCH	27.6		26.6-33.0 pg
MCHC	32.5		31.5-35.7 g/dL
RDW	13.6		12.3-15.4 %
Platelets	252		150-379 x10E3/uL
Neutrophils	48		%
Lymphs	40		%
Monocytes	10		%
Eos	2		%
Basos	0		%
Neutrophils (Absolute)	2.9		1.4-7.0 x10E3/uL
Lymphs (Absolute)	2.4		0.7-3.1 x10E3/uL
Monocytes(Absolute)	0.6		0.1-0.9 x10E3/uL
Eos (Absolute)	0.1		0.0-0.4 x10E3/uL
Baso (Absolute)	0.0		0.0-0.2 x10E3/uL
Immature Granulocytes	0		%
Immature Grans (Abs)	0.0		0.0-0.1 x10E3/uL
Glucose, Serum	88		65-99 mg/dL
BUN	17		6-20 mg/dL
Creatinine, Serum	1.06		0.76-1.27 mg/dL
eGFR If NonAfricn Am	90		>59 mL/min/1.73
eGFR If Africn Am	105		>59 mL/min/1.73
BUN/Creatinine Ratio	16		8-19
Sodium, Serum	138		134-144 mmol/L
Potassium, Serum	4.4		3.5-5.2 mmol/L
Chloride, Serum	97		97-108 mmol/L
Carbon Dioxide, Total	23		18-29 mmol/L
Calcium, Serum	9.4		8.7-10.2 mg/dL
Protein, Total, Serum	7.4		6.0-8.5 g/dL
Albumin, Serum	5.0		3.5-5.5 g/dL
Globulin, Total	2.4		1.5-4.5 g/dL
A/G Ratio	2.1		1.1-2.5
Bilirubin, Total	0.5		0.0-1.2 mg/dL
Alkaline Phosphatase, S	58		39-117 IU/L
AST (SGOT)	25		0-40 IU/L
ALT (SGPT) Urinalysis, Routine Specific Gravity	26 <=1.005	ABNORMAL	0-44 IU/L 1.005-1.030
pH	7.5		5.0-7.5
Urine-Color	Yellow		Yellow
Appearance	Clear		Clear
WBC Esterase	Negative		Negative
Protein	Negative		Negative/Trace
Glucose	Negative		Negative
Ketones	Negative		Negative

Occult Blood	Negative	Negative
Bilirubin	Negative	Negative
Urobilinogen,Semi-Qn	0.2	0.2-1.0 mg/dL
Nitrite, Urine	Negative	Negative
Microscopic Examination	Comment

Microscopic not indicated and not performed.

Cholesterol, Total	203	HIGH	100-199 mg/dL
Triglycerides	90		0-149 mg/dL
HDL Cholesterol	43		>39 mg/dL

VLDL Cholesterol Cal 18   5-40 mg/dL   LDL Cholesterol Calc 142 HIGH 0-99 mg/dL   [TD="colspan: 5"]Iron and TIBC

[/TD]

Testosterone, Serum 862 348-1197 ng/dL
Free Testosterone(Direct) 30.3 HIGH 8.7-25.1 pg/mL
Hemoglobin A1c 5.6 4.8-5.6 %
T4,Free(Direct) 0.97 0.82-1.77 ng/dL
DHEA-Sulfate 453.9 HIGH 102.6-416.3 ug/dL
TSH 3.220 0.450-4.500 uIU/mL
LH 0.1 LOW 1.7-8.6 mIU/mL
FSH <0.2 LOW 1.5-12.4 mIU/mL
Prolactin 6.2 4.0-15.2 ng/mL
Prostate Specific Ag, Serum 0.6 0.0-4.0 ng/mL
Insulin-Like Growth Factor 273 HIGH 88-246 ng/mL
C-Reactive Protein, Cardiac 0.80 0.00-3.00 mg/L
Estradiol, Sensitive 14.7 8.0-35.0 pg/mL
GGT 17 0-65 IU/L
Magnesium, Serum 2.4 HIGH 1.6-2.3 mg/dL
Insulin 5.5 2.6-24.9 uIU/mL
Ferritin, Serum 21 LOW 30-400 ng/mL
Triiodothyronine,Free,Serum 3.3 2.0-4.4 pg/mL
Sex Horm Binding Glob, Serum 27.3 16.5-55.9 nmol/L
Pregnenolone, MS 42 ng/dL Reference Range: Adults: <151
Dihydrotestosterone 61 ng/dL Reference Range: Adult Male: 30 - 85
Vitamin D, 25-Hydroxy 68.7 ng/mL 30.0 - 100.0
Vitamin B12 967 High pg/mL 211 - 946

 

[Zooka15]

Your TSH is on the high end, but your estradiol is very low. if you keep it this low in the long run , it can lead to cardiac and bone issues.

 

[mopes]

Your TSH is on the high end, but your estradiol is very low. if you keep it this low in the long run , it can lead to cardiac and bone issues.

I realize it's low, that's why I'm cutting the arimidex and hcg out and moving to daily t injections.

 

[PAUL-E]

Hemoglobin A1c 5.6 4.8-5.6 % almost pre diabetic starting to become insulin resistant, try to cut out sugar and go low carb. look into thyroid more TSH seems high and free t4 is on the low end. If on an AI maybe cut back a little but considering if this is your low point doesn't seem real bad. otherwise to me things look ok

 

[mopes]

Hemoglobin A1c 5.6 4.8-5.6 % almost pre diabetic starting to become insulin resistant, try to cut out sugar and go low carb. look into thyroid more TSH seems high and free t4 is on the low end. If on an AI maybe cut back a little but considering if this is your low point doesn't seem real bad. otherwise to me things look ok

Thanks, started some metformin a couple weeks ago at 250mg and titrating up. Have also cut carbs considerably and doing Intermittent Fasting from 8pm - noon daily.

 

[PAUL-E]

Thanks, started some metformin a couple weeks ago at 250mg and titrating up. Have also cut carbs considerably and doing Intermittent Fasting from 8pm - noon daily.

sounds good! I would still look into the thyroid more though.

 

[mopes]

sounds good! I would still look into the thyroid more though.

Been wondering about trying some desicated thyroid for a while now, now that I've got the data likely makes sense to give it a go. Only concern is my TIBC, which may be due to my recent purchase of cast iron pans, and if that could be throwing the thyroid levels out of wack or not. Otherwise seems reasonable to try some armour or wp thyroid.

Iron Bind.Cap.(TIBC)

466

HIGH

250-450 ug/dL

 

[K_T_F]

Been wondering about trying some desicated thyroid for a while now, now that I've got the data likely makes sense to give it a go. Only concern is my TIBC, which may be due to my recent purchase of cast iron pans, and if that could be throwing the thyroid levels out of wack or not. Otherwise seems reasonable to try some armour or wp thyroid.

Iron Bind.Cap.(TIBC)

466

HIGH

250-450 ug/dL

Hi Mopes,tell us how are you feeling. Good lab numbers mean nothing if your symptoms are not corrected.

 

[mopes]

Hi Mopes,tell us how are you feeling. Good lab numbers mean nothing if your symptoms are not corrected.

Feel much better than I did before starting TRT, stronger, gaining muscle, etc. Still tired most of the time if I'm not forcing myself to be up and moving. Lately been sucking down 4-5 cups of coffee a day to keep going, sleep isn't ideal when drinking that much caffeine, only 6ish hours a night and wake up feeling unrested. Recently have noticed wicked bags under my eyes which I haven't hand in the past. Nelson's webinar tomorrow, on fatigue, is timely.

Picked up a ZRT cortisol test so gonna give that a whirl soon.

 

[Smokey]

Feel much better than I did before starting TRT, stronger, gaining muscle, etc. Still tired most of the time if I'm not forcing myself to be up and moving. Lately been sucking down 4-5 cups of coffee a day to keep going, sleep isn't ideal when drinking that much caffeine, only 6ish hours a night and wake up feeling unrested. Recently have noticed wicked bags under my eyes which I haven't hand in the past. Nelson's webinar tomorrow, on fatigue, is timely.

Picked up a ZRT cortisol test so gonna give that a whirl soon.

These bags are usually due to low estrogen.

 

[mopes]

Got my ZRT Labs cortisol/DHEAS results back. High in the morning.

DHEAS (Saliva) 19.5 ng/mL 2-23 (Age Dependent)
Cortisol (Saliva) 10.4 H ng/mL 3.7-9.5 (morning)
Cortisol (Saliva) 2.7 ng/mL 1.2-3.0 (noon)
Cortisol (Saliva) 1.8 ng/mL 0.6-1.9 (evening)
Cortisol (Saliva) 0.5 ng/mL 0.4-1.0 (night)

Anything worth pursuing further here or would you guys say looks relatively normal and should be good to move forward with some NDT?

 

[Vettester Chris]

Got my ZRT Labs cortisol/DHEAS results back. High in the morning.

DHEAS (Saliva) 19.5 ng/mL 2-23 (Age Dependent)
Cortisol (Saliva) 10.4 H ng/mL 3.7-9.5 (morning)
Cortisol (Saliva) 2.7 ng/mL 1.2-3.0 (noon)
Cortisol (Saliva) 1.8 ng/mL 0.6-1.9 (evening)
Cortisol (Saliva) 0.5 ng/mL 0.4-1.0 (night)

Anything worth pursuing further here or would you guys say looks relatively normal and should be good to move forward with some NDT?

Mopes, IMO, I don't think the results should prompt drastic actions, but I think it's worth taking note of things like sleep, caffeine, stress related events, illnesses, ect., anything that could be causing a higher demand on stress (?).

The AM profile should be right at the top (top 90%tile), so that's pushing a bit over the reference range. The two mid labs would probably be a bit more in balance towards the middle of the reference range, so again, that confirms there's maybe a bit more of a demand for stress than one might desired.

Is there anything right off the top that you can think of that can be attributed with some stress in life? If you're like most of us there should be a few things. Also, just getting some decent amount of exercise and eating healthy can do wonders with how you feel, which improves sleep, ... It all works in a synergistic fashion.

You could & should be exploring thyroid hormone treatment, BUT, I think your doctor needs to look closer at your ferritin level before going ALL-IN. Although your iron serum isn't that bad, the binding protein to transport it is quite low. In similar fashion to SHBG, total serum can yield to be quite normal, but the "free serum" can be below par there's not enough binding proteins in the body (SHBG and albumin in this case).

If looking at the whole scope of your iron, including TIBC, serum and ferritin (BTW, saturation will always be dividing your iron serum to TIBC (IS/TIBC)), I might speculate to say you are donating blood fairly frequently? Regardless, talk with your physician, as the iron /ferritin subject will play a crucial role with how T3 reaches the cells.

 

[mopes]

Mopes, IMO, I don't think the results should prompt drastic actions, but I think it's worth taking note of things like sleep, caffeine, stress related events, illnesses, ect., anything that could be causing a higher demand on stress (?).

Thanks Chris. Number of things I can think of off the top of my head stress related. Wife totaled her car six months ago and still has bad back/neck pain, two daughters under 3, bathroom remodel, work in the financial industry so brexit and now all time highs in the market have caused good amount of stress. Guess I'm not surprised to see it slightly out of range in the morning as there is good amount of stress/anxiety upon waking. Frankly I was shocked that my cortisol wasn't more out of wack.

Coffee intake was very high for the past month of two, 4-5 cups a day. Have ratcheted that down to 1-2. Sleep has improved recently to 7-8 hours a night but still wake up fatigued and lethargic.

I lift weights 2 days a week (squats and overhead press one day, deadlifts, bench and pullups the other day) and mountain bike 1-2 days a week so feel pretty covered on the exercise front.

The ferritin level is the one thing holding me back from moving forward with thyroid. Bizarre because I've never donated blood and up until recently was usually cooking with cast iron. Five months ago I ran a similar extensive blood panel and my Iron serum was above range as shown below:

	2/10/2016	6/15/2016	Range
Iron Bind Cap	374	466	250-450 ug/dL
UIBC	173	339	111-343 ug/dL
Iron, Serum	201	127	38-169 ug/dL
Iron, Saturation	54	27	15-55 %
transferrin-iron saturation percentage	53	27	%
Ferritin, Serum	98	21	30-400 ng/mL
Vitamin B12 Reflex	480	967	180-914 pg/mL

Not sure what happened to swing things so far the other way as it relates to Iron/Ferritin. Only two things jump out in my mind, a few months ago I started adding 2.5g of cocoa to my coffee, I know cocoa contains Iron but looks like it can also interfere with the binding. The excessive coffee intake may have had a similar impact?

Other thing that I've been wondering about is the increase in my b12 levels vs. 5 months ago. Wasn't on a multi vitamin or b complex during first test, then added in a daily multivitamin with cyanocobalamin. Since the most recent testing I've found out that about the MTHFR c677t gene mutation I carry and have switched to a multi with methylfolate and methylcobalamin as opposed to the inferior version in the previous multi.

Grasping at straws though as it relates to ferritin and iron. Going to retest in another month or so to see what's going on before adding the thyroid med. Any thoughts?

 

[mopes]

Had a couple blood draws since my last update. Started WP thyroid and have been tapering up the dose. Added some iron to try and bring my levels back up. Also switched to daily injections to see if I could eliminate the AI. Here are some screenshots.

 

[mopes]

Got sick of daily injections and also liked the idea of cutting my injections in half so I have since moved to EOD injections @ 50mg instead of 24mg daily. Also on 1.75 grain WP Thyroid daily. Have bloodwork on thyroid but haven't yet run my bloodwork on T,e2 and DHEA-S. Should be this week or next.

 

[mopes]

For the past six months I've wondered what my labs would look like on T without hcg or an AI. Finally got the data I was looking for. Doesn't seem like hcg bumps my E up too much.

Gettin closer to having things dialed in. 50-55mg of cyp EOD, 25mg of DHEA in morning and 2.5 grain WP Thyroid. No AI or HCG. Now that I have proper baseline labs on just T may add back .25 AI and 1000 IU hcg a week split in two doses. Been getting some chest and neck acne and anxiety has been ramping up noticeably.

 

[johndoesmith]

For the past six months I've wondered what my labs would look like on T without hcg or an AI. Finally got the data I was looking for. Doesn't seem like hcg bumps my E up too much.

Gettin closer to having things dialed in. 50-55mg of cyp EOD, 25mg of DHEA in morning and 2.5 grain WP Thyroid. No AI or HCG. Now that I have proper baseline labs on just T may add back .25 AI and 1000 IU hcg a week split in two doses. Been getting some chest and neck acne and anxiety has been ramping up noticeably.

When are you testing relative to injection? Instead of adding in an AI, you could lower your dose so that you're in range, If you have to be at 1500 trough to have a 43 E2, you can definitely be high normal and manage E2.

The 10/18/16 labs, were you sick at the time? Your WBC is elevated, neutrophils as well.

Your iron situation is mildly concerning, Did you donate blood at all during that time when ferritin dropped?

Oh you asked about B12 suddenly dropping or increasing, B12 is water soluble so it will fluctuate quickly. It doesn't mean anything.

 

[mopes]

When are you testing relative to injection? Instead of adding in an AI, you could lower your dose so that you're in range, If you have to be at 1500 trough to have a 43 E2, you can definitely be high normal and manage E2.

The 10/18/16 labs, were you sick at the time? Your WBC is elevated, neutrophils as well.

Your iron situation is mildly concerning, Did you donate blood at all during that time when ferritin dropped?

Oh you asked about B12 suddenly dropping or increasing, B12 is water soluble so it will fluctuate quickly. It doesn't mean anything.

Yes, could certainly lower the dose a bit. Perhaps 40-45 mg EOD. Didn't feel sick on those labs with the elevated WBC but very well could have been fighting something, concerned me but normalized by the next labs.

Iron situation is concerning to me as well, have never donated blood so not sure what's going on there aside from diet? Did some intermittent fasting and was sucking down a ton of coffee/cocoa which binds the shit outta iron from what I've read. I don't have another explanation for it so maybe I'm just grasping at straws...

Worth pointing out that I have been taking supplemental iron since I found out how low it was as I was also getting ready to start WP thyroid at the time. Any thoughts on the iron/ferritin levels?

 

[mopes]

Labs were taken on shot day, before shot, first thing in the morning. I follow this same procedure each time I do labs.

 

[CoastWatcher]

Labs were taken on shot day before shot, first thing in the morning. I follow this same procedure each time I do labs.

May I suggest lab work the day of shot, just prior to injection (as is reasonable)? It will give you a better picture of your trough.