Initial and First Follow-up labs, E2 and SHBG concerns

[Mission]

Hi guys,

I started TRT about 8 weeks ago and recently got some followup labs back. My doctor's office didn't think it was necessary to get followup labs until 6 months in, which I was not comfortable with, so I ordered from LabCorp. Hoping to get some feedback on these results.

Brief intro first:
34 y/o, 5'8, currently 184lbs, ~22% BF, mesomorph frame
Pursued TRT after non-existent libido for too long, poor sleep, awful belly fat increasing, difficulty losing weight, slow recovery, ability to get erection but poor at maintaining. Was 195 lbs when I started TRT, was about 205 coming into 2018.

Initial labs:
TT=338 (264-916)
FT(direct)=9.4 (8.7-25.1)
LH=3.5 (1.5-9.3)
FSH=5.1 (1.4-18.1)
E2, sensitive=23
SHBG=22 (15-55)
TSH=0.67
T3 free=3.6
T4 free=1.4
CBC and metabolics were within normal ranges

TRT:
Mondays & Fridays
50mg T-cyp, subq
0.25mg anastrozole
500IU hCG troche sublingual
*This is all half of what was initially prescribed - I was nervous to start at 200/wk so told the doc I'm starting slow and can work up if necessary*

Followup labs after 7 weeks through, bloods taken between doses:
TT=848 (264-916)
FT(direct)=19.2 (8.7-25.1)
E2, sensitive=16
SHBG=48 (16.5-55.9)
CBC and metabolics were within normal ranges still

I have dry mouth, lips, and eyes since week 4 or so - eyes are tired looking and lower eyelids twitch much of the day. I'm thinking that E2 could be the reason why? Feeling anxiety as well - anxiety/panic attack symptoms a few times in the past couple weeks. Haven't had anything like this since I was a younger guy and it was a transient 'phase'. And is my free T an issue with the elevated SHBG? It really shot up. Not sure what protocol changes, if any, to make here. Stop AI for a few weeks and test again? Do 1 big injection per week instead of splitting into 2 injections? Is it elevated simply because I'm on exogenous test?

On the plus side, libido is improved a bit, feeling like I'm making weight-loss progress, clothes fit a little better, and recovery is improved after tough gym days. Diet is fairly clean, 1600 net cals/day with a cheat day every week.

 

[CoastWatcher]

A sensitive estradiol clocked in at 16 may well be a factor in the discomfort you mention. I would consider setting the AI aside, you can always pick it up again if things get out of hand. A further question does suggest itself - has your thyroid been evaluated beyond the TSH value that was obtained prior to the start of TRT? By the way, congratulations on being your own advocate and engaging in self-testing to monitor your progress. You're certainly moving in the right direction.

 

[Vince Carter]

E is possibly to low for YOU and also considering your SHBG, I would reduce the AI to once per week and reassess in 6 weeks keeping everything else the same.

 

[Vince]

I agree it sure looks like your estradiol levels are too low, I wonder if he even need an AI or at least I would cut it in half and use .125 pills twice a week. I would stop the HCG troche, they don't work. Go to injectable HCG that's what men on trt use but using the right injectable HCG could increase your estradiol levels.

 

[Vince Carter]

Great observation on the HCG troche, Vince.

 

[Mission]

Never had any thorough thyroid tests, just the TSH and free 3&4. TSH has always been between .6 and .8 for me, but I know TSH is not the end all be all. I've read around that guys with a poor thyroid function don't respond well to TRT and I'll consider that if I'm not getting results or feeling well. I didn't retest thyroid with the latest bloodwork. Thanks for the reply CoastWatcher

 

[Mission]

E is possibly to low for YOU and also considering your SHBG, I would reduce the AI to once per week and reassess in 6 weeks keeping everything else the same.

Thanks that seems like a reasonable next step. But can the AI alone be raising my SHBG? Raising SHBG with dropping E2 is a weird combo I haven't been able to find a lot of solid info on.

 

[Mission]

I agree it sure looks like your estradiol levels are too low, I wonder if he even need an AI or at least I would cut it in half and use .125 pills twice a week. I would stop the HCG troche, they don't work. Go to injectable HCG that's what men on trt use but using the right injectable HCG could increase your estradiol levels.

Yea it didn't take me long to find that the hCG molecule is too large to permeate the tissues of the mouth and is useless according to many TRT guys. Doesn't give me a lot of confidence in my doc - between the troche, trying to start me at 200mg/wk, and not wanting to do bloodwork until 6 months into a new therapy - yikes