First Labs, any advice?

[waltkowalski]

Here are my labs.... fairly depressing, I am 6' 4" 330LBs 50 Years old, high BP, normal cholesterol, PSA 1.1, doc prescribed Androgel 1.63% two pumps
in AM, one pump in PM

After years of a high stress life, determined to get in shape and get healthy., Estradiol is through the roof should I be on Anastrozole?

Relatively new to this, appreciate any advice.

Estradiol 76.9 pg/ml range 10 - 30
FSH 15.3 mIU/ML range 0.70 - 11.1
LH 8.0 mIU/ML range 0.80 - 7.60

SHBG 35.7 nmol/L range 13.0 - 71
Free T 11.4 ng/mL range 250.0 - 300.0
Testosterone 67.3 ng/dl range 300 - 1600

Albumin 4.5 g/dL range 3.5 - 5.0
Prolactin 4.3 ng/dl range 1.9 - 25.0
Insulin 14.7 uIU/mL range 6.0 - 30.0

CRP 14.7 mg/L range 1.0 - 3.0

TSH 3rd Generation 4.56 uIU/mL range 2.6 - 6.9

Free T3 4.2 pg/mL range 1.4 - 4.1
Free T4 0.9 ng/dl range 0.8 - 1.9
Total T3 113 ng/dl range 84.0 - 172.0
Total T4 7.2 ug/dl range 4.5 - 12.5

TBG 23.4 ug/mL range 13.0 - 39

HGB 13.9 g/dL range 13.5 - 18.0
HCT 43.4 % range 37.0 - 53.0

 

[ERO]

Any chance your doc would be willing to switch you to twice weekly Test injections? Topical T has a low success rate as you are seeing now. Your E2 is high but a very small dose of Anastrozole is likely all that you need. Something like 0.25 twice a week to start.

How long have you been on TRT?

 

[CoastWatcher]

First of all, how long have you been using Androgel relative to these tests? For many (I'm one of them), topical testosterone was an utter failure. It's a rational approach, and a reasonable first-line treatment, but there's a point one has to admit you're not absorbing the gel or cream. I'm not saying you're at that point, but if these reflect a good-faith effort, it's time to consider you're next step. In regard to your estradiol, we're guessing that, based on the range provided, your estradiol results reflect the "sensitive" (LC/MS,MS) test, can you verify that? The standard test is of no real value to men as it overestimates E2 levels. Make sure you had the correct test run. You have a very elevated CRP (C-Reactive Protein). It's produced by the liver and is an indication that there's inflammation active in your body. It's a marker, not a specific diagnostic, but one that your doctor should certainly discuss with you.

 

[waltkowalski]

Sorry guys those are pre TRT labs just got scrip filled for Androgen today.....

 

[waltkowalski]

Andro gel. darn auto correct!

 

[CoastWatcher]

What about the questions we did raise? Was your estradiol measured via the sensitive test? What did you doctor say regarding your CRP?

 

[waltkowalski]

Labs were done in house at Dr's office. Don't know what test he ran.
Since he is a Doc that only does TRT I hope he ran ultra sensitive.
Is there a more specific description of the estradiol test so that I can verify?

Regarding CRP he said gee you have a lot of inflammation in your body. maybe we should
consider curcumin. I do have a lot of arthritis, joint replacements so chalked
it up to that.

Any advice on suggested use/dose of anastrozole given that I am just starting?

 

[waltkowalski]

Re; the CRP. the Doc did inquire if my primary care doc was aware
and had checked for Cardiac issues, which he has. I am also sceduled
for a treadmill ECG stress test in a couple of weeks as part of
a thorough physical exam.

 

[waltkowalski]

Wondering if I should just wait for after my next labs to start
anastrozole worried about high estradiol getting higher and gettimg

gyno symptoms

 

[CoastWatcher]

The proper test you to measure your estradiol is the liquid chromatography/dual mass-spec (LC, MS/MS) lab. And NEVER assume any doctor understand or knows the ins and outs of TRT until that has been demonstrated. Many, probably most, of us have stories about ignorant physicians. We have to be our own advocates.

As for Anastrozole, a little, a very little, goes a long way. But gynecomastia is not an overnight phenomenon. When are you scheduled for your next labs?

 

[waltkowalski]

I believe you regarding being own advocat, I will call Dr's office on Monday.

Next labs are scheduled for Aug 15 (8 weeks after starting TRT)

 

[Vettester Chris]

Your thyroid needs addressed! FT4 is sitting at the very bottom of the ref range, FT3 is sitting over 100% of the reference range. Suspect T3 pooling, meaning the T3 is building and unable to get into the body/cells. For starters you need a Reverse T3 lab, and you will also want antibodies (TPO & TgAb) to check for autoimmune. Other variables like cortisol, iron, and electrolytes can play into this, BUT, I'd start with the other labs mentioned, and I'd raise the subject for discussion with your physician.

 

[trt4me]

Your lh and fsh are high and your total t is very very low. With T that low anyone would feel half dead.
But with your E2 high (if sensitive) I have to ask if you have tried lifestyle changes first, diet, excercise?
I know the latter will be tough because the T is so low.
Looks like your Hpta is working hard but the testes are not producing or it's getting converted to E a lot.
I would discuss this with the doc more.

 

[PAUL-E]

To help compare the e2 test(tests are about 1-2 months apart though but no change in protocol during that time)
Estradiol, Sensitive 51.2 High pg/mL 8.0 - 35.0
there lab Estradiol 39.6 10-30

I agree with Chris and would also look into thyroid more.

 

[CoastWatcher]

The consensus seems clear. Low testosterone, potentially high estradiol, thyroid function challenges, elevated CRP suggesting inflammatory issues, and some weight to lose. What about your blood sugar and prostate? We're an Hb1AC and PSA run?

 

[waltkowalski]

Yes fasting glucose was 96, Hb 1Ac was 5%, PSA was 1.1

 

[waltkowalski]

I have started walking 30mins 5X per week any other suggestions for cardio?

That's an excellent start. Look to increase the duration over the course of the summer. As was noted above, lifestyle changes are so important.

 

[waltkowalski]

I am trying to make lifestyle changes, walk more, eat less, lift weights and cut back on beer/wine.

I am going to start the tRT though, i was first diagnosed with low T (250ish total T at questlabs) 10 years and 80lbs ago, so I really think the odds of me being able to get to a decent level of T without replacement is unlikely.

Perhaps their are others out there who get to this point and think "how the hell did I let it get this bad....", but I am determined to get healthy and get back in shape.

Appreciate all help and comments. Thanks again.

 

[CoastWatcher]

I am trying to make lifestyle changes, walk more, eat less, lift weights and cut back on beer/wine.

I am going to start the tRT though, i was first diagnosed with low T (250ish total T at questlabs) 10 years and 80lbs ago, so I really think the odds of me being able to get to a decent level of T without replacement is unlikely.

Perhaps their are others out there who get to this point and think "how the hell did I let it get this bad....", but I am determined to get healthy and get back in shape.

Appreciate all help and comments. Thanks again.

Oh, I beleive you 're right; you present numbers that are astonishing and certainly suggest TRT. But loss of weight may, note the word is "may", help with your estradiol level by potentially limiting the aromatization process. We wish you the best!

 

[waltkowalski]

I was thinking the same, think I will wait on the AI