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

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marshall

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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)
Free t 13.9( 6.8-21.5)
DHEA-sulfate 178.0 ( 71.6-375.4)
Estradiol 25.8 ( 7.6-42.6)
RBC 5.85(high)( 4.14-5.80)
Hematrocrit 52.0 (high)( 37.5-51.0)
LH <0.2 (low)( 1.7-8.6)
TSH 6.760 (high)( .450-4.500)


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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Defy Medical TRT clinic doctor
I think you are in good hands. Looks to be very thorough. Does he have an issue with your hematocrit and if so what has he suggested to counteract it?
 
not really, he said it wasnt anything to worry about...he mightve said something about giving blood, i may be wrong...i just cant remember..
 
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?????
Click to expand...

For me personally, I think 200 mg per week starting out is way too high. That said, your total of 400 based on 100 mg per week may be the trick but only blood work will tell you that. I am just a big believer that for otherwise healthy men who are age related androgen deficient that it is best to start low and go slow. Test and move things up slowly over time.

I would have liked to seen SHBG, it's a cornerstone lab essential in assessing your overall androgen health.

Your E2 is fine and now your adding in 1 mg of an AI weekly. For me, I would have asked to wait 6 weeks before labs and see if you have any symptoms of elevated E2 with the additional 100 mg of Testosterone per week. I would also ask to split that 200 mg into twice weekly 100 mg injections to lower aromatase synthesis as well and provide for more stable serum levels.

Good on the DHEA. How are you taking this? Pill or transdermal?

You may also want to ask about adding in Pregnenolone as well to help back fill your pathways.

No HCG? Really??? When your Testes start to ache you'll be asking for it;)

Finally, you need more labs done on your Thyroid...period. If all the Doc did was look as TSH and than throw Armour at you he did you an injustice. The Thyroid is very complex and your elevated TSH points to possible Hypothyroidism. One must know that Hypothyroidism will and can cause Hypogonadism. You need a much more thorough assessment of your thyroid to see what's going on.
 
i really feel better at 200 mg per week than 100 mg. With my estrogen levels high at 200 mg i would asume that is why he started the AI..it will only be a matter of time before i need it.. I didnt see anything on the lab for SHBG. I may switch to twice a week, i just want to get started, give it a month or so and see how i feel by the 5 th day. The DHEA is pill. And no Hcg:), I know, but i really havent had any shrinkage or pain in 10 months and the Dr. said i could start anytime if i wanted to..and finially, concerns about the thyroid issue..i do have an appointment with my local doctor to check this out..but I did make a call to my long time dr and friend, and he said that the thyroid does decrease starting at age 20 and levels 6-7 are very common with my age..even with that, i will have it checked closer. with the low T and thyroid being a little underactive, could be a big part of my fatigue. I am excited about getting this started and know i will probably need to make changes but its a start. its got to be better than what ive been doing for the last 10 months. with the help from you, Nelson and Defy, i know i will get this right...Thanks Gene!!
 
Glad to hear you're feeling better about things, Marshall. Do you know which estradiol test was done by your previous doctor when you got a reading of 95? Was it a "sensitive" estradiol test or the same one they use on women? If it was not the sensitive test, there are some like Dr. Crisler and Dene Devine who believe that the test may not be accurate or appropriate for men. Also, were you experiencing any symptoms of high estradiol at that time?

Finally, I'm guessing that Defy did not use the sensitive estradiol test either? If it were me, I would not want to take the anastrozole until you see how you are responding to the higher dose of testosterone. You may not need it, and it's better to go without if you can.
 
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).
 
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).
Click to expand...

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.
 
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.
 
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.
Click to expand...

Many of these symptoms may be attributed to your Thyroid and not your elevated E2.

Hypothyroidism has many of the same symptoms as Hypogonadism and while you may get your androgen levels dialed in if the thyroid is not treated correctly you may not feel any better.
 
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.
 
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.
Click to expand...


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.
 
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.
Click to expand...

Thanks Gene that makes sense with regards to SHBG. I have discussed it w/ several physicians and they always remark that there's nothing you can do about it so why waste the money for the test. Makes complete sense when considering injection protocols.
 
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.
Click to expand...

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.
 
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.
Click to expand...


In bold above.
 
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
 
Beyond Testosterone Book by Nelson Vergel
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
Click to expand...

I was hoping some of the trt docs would find their way to the site. Welcome Dr. Saya.
 
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