My journey so far -- a year of Labs and attempts to relieve symptoms. Pls Help

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jpw1585

New Member
Here is a breakdown of many labs over the past year. The actions taken after each one and the effects of those actions. Currently a bit confused as to what to do next and would love some insight.

I have taken much interest and allocated a lot of time to learning this stuff and accordingly my Dr's have given me the freedom to pretty much choose what I want to do next. So I am hoping to source the wisdom of this community and your individual experiences to perhaps elucidate some things that I may not see.
 

5/2/2022

8/6/2022

9/23/2022

11/25/2022

2/6/2022

4/24/2023

4/25/2023

5/15/2023

Total Test

287

349

550

--

314

--

763

509

Free Test

69

96.8

141.7

--

91.6

--

167.9

143.35

FTI %

--

--

--

--

77%

--

--

66%

E2

20.9

27.1

45.7

--

35.98

--

77

67.56

TT/E

13.73

12.88

12.04

--

8.73

--

9.91

7.53

FT/E

3.30

3.57

3.10

--

2.55

--

2.18

2.12

SHBG

15.1

17.9

23

--

14.4

--

34.82*

18.07*

TSH

1.87

1.6

--

--

--

--

--

--

T4 Free

0.81

0.79

--

--

--

--

--

--

T3 Free

3.4

2.7

--

--

--

--

--

--

Ferritin

117

143

--

--

--

--

--

--

Prolactin

9.38

8.53

--

--

8.25

--

--

--

a1c

5.7

5.2

--

--

5.3

--

--

--

CRP

34.22

10.23

21.51

39.7

--

10.5

--

--

Insulin

15.5

2.5

--

--

--

--

--

--

LH

--

4.7

7.9

--

6.9

--

--

22.3

FSH

--

5.7

7.8

--

5.44

--

--

19.85

DHEA

195

194

188

--

317

--

--

--

PSA Total

--

0.75

--

--

0.88

--

--

--

PSA Free

--

--

--

--

0.2

--

--

--



5/2/2022

Baseline test - inquiring about low - T symptoms led to discovery of pre-diabetes. Prescribed Metformin 500 mg ER + started serious weight lifting

8/6/2022

90 day follow up - Pre-diabetes reversed. CRP lowered. TT/FT increased. Symptoms better. Start CLOMID 25mg EOD

9/23/2022

1 month CLOMID follow up. TT and FT increased, but E2 increased more. TT/E2 ratio worse and horrible E2 symptoms. I quit CLOMID shortly after. Discover RA factors

11/25/2022

Baseline CRP number for my RA specialist. Start Hydroxychloriquine for RA

2/6/2022

Baseline test with Urologist. 5 months off CLOMID and T is low with E2 still elevated. Horrible ratio. All the symptoms. Prescribed ENCLO 25mg EOD and .25mg Anastrazole 1x per week. Feel great for a week or two

4/24/2023

RA follow up after 5 months of Hydroxychloriquine. CRP way down as well as Arthritis symptoms

4/25/2023

I ordered my own labs bc I felt E2 symptoms. Sure enough, TT and FT are way up, but E2 is up more and the ratio and symptoms are bad. Doc increases Anasatrazole to 1mg 3x per week

5/15/2023

Urologist follow-up and labs. TT is down bc I went to 25mg E3D. Tell the doc that Anastrazole is not inhibiting aromatase in testicles. Switches to Letrozole 2.5mg 2x a week

NOW

Slight symptom relief with stronger AI, I still don't think it does much for intratesticular aromatase inhibition.



When I saw the most symptom improvement was actually on 8/6/2022 before any SERM deployment but as the result of reversing pre-diabetes. Gym + no gluten + cardio. The CLOMID was horrible. The ENCLO was great before my E2 went through the roof

It would appear that I am now a hyper aromatazer, but before CLOMID, it would appead that I wasn't such an aromatizer .... but maybe that was bc my TEST was very low too

Could Inflammation (CRP) be the culprit here? I would like for ENCLO to work so that I do not have to shut down my balls, but I am reaching the end of my patience here and would just like to feel normal

From my research there is a strong correlation between Testosterone, T/E ratio, and inflammation and the manifestation of auto-immune diseases.... Insulin Resistance, Pre-diabetes, and RA

I am 38 and quite young for RA.... Which leads me to believe that the inaction of my PCP for years set the stage for auto-immune problems

When I discovered Pre-diabetes, I was definitely overweight (225lbs @ 24% body fat.... I am now 196lbs @ 17% body fat)

 

Should I cut gluten again?

Should I lower Enclo dose (when I spaced it out an extra day, my TT dropped significantly, while my E2 barely budged)?

Should I say fuck it and start TRT + HCG? I have no issues with committing to a protocol, but if I can keep my balls online I would prefer that?

 
Defy Medical TRT clinic doctor
Should I say fuck it and start TRT + HCG? I have no issues with committing to a protocol, but if I can keep my balls online I would prefer that?
If you go this route, you can’t have your cake and eat it too. The hCG will increase testicular estrogen as well as estrogen from aromatase.

The only way to shut down intra-testicular estrogen is to allow testicular atrophy.
 
If you go this route, you can’t have your cake and eat it too. The hCG will increase testicular estrogen as well as estrogen from aromatase.

The only way to shut down intra-testicular estrogen is to allow testicular atrophy.
That is what I was thinking as well as I digested more and more of that the Urologist was saying.

However the method of action is a bit different right... Currently the ENCLO is causing a spike in LH and FSH, which are in turn producing T and some of that is being converted in the testes...

Where as exogenous T would be in the blood and the bulk of that aromatase would be happening outside of the tests...

Would 500 x 3 IU of HCG / week cause such a drastic increase of endogenous T in the tests ( and thus the conversion ) ?

Or would there be some conversion in the testes, with the bulk of the conversion happening elsewhere and thus being more easy to regulate with an AI?

PS... I have read a lor of your documentation about your story with Jatenzo... This is what my Urologist suggested for me actually.... Jatenzo + HCG.

Was curious if Jatenzo + Lower dose / less frequent ENCLO would also be a possibility.
 
Was curious if Jatenzo + Lower dose / less frequent ENCLO would also be a possibility.
Doubtful, I haven’t read of a single account where someone on TRT using clomid restored testicular size. Dr. Saya of Defy Medical, who has tried clomid in men on TRT noted no measurable HPTA response and no “perceived” benefit.

Jatenzo and hCG would be better than injectable testosterone as far as aromatization is concerned, because the androgen levels rise and fall quickly.

I would recommend 198 mg twice daily Jatenzo together with the hCG and 237 mg twice daily without hCG.
 
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Doubtful, I haven’t read of a single account where someone on TRT using clomid restored testicular size. Dr. Saya of Defy Medical, who has tried clomid in men on TRT noted no measurable HPTA response and no perceived benefit.
Thanks... I saw one of the bigger T clinics posted a YT video saying they were switching their TRT patients to ENCLO from HCG.... and that it was "better" for preserving testicles on TRT...

But this was also at the time when HCG supply was low and its future in question... could have been a PR effort.
 
Regarding gluten, I would think that gluten would be hard NO for anyone with RA, and the AutoImmune Paleo Protocol or full carnivore (for a while) would be pretty much mandatory. Until you eliminate whatever your body is reacting to I would think it would be hard to figure out what else is working or not working.
 
Regarding gluten, I would think that gluten would be hard NO for anyone with RA, and the AutoImmune Paleo Protocol or full carnivore (for a while) would be pretty much mandatory. Until you eliminate whatever your body is reacting to I would think it would be hard to figure out what else is working or not working.
Good point... I have just been following the Dr's protocol... This is a great idea, thank you
 
I would keep the Metoformin and drop everything else to get a propper baseline for assesment if you need any form of TRT or the Hydroxychloriquine.

You have a low SHBG, so your free T was decent on 8/6/2022 - if you feel well without TRT, don't do it. Your CRP on that date was comparable to the one while using Hydroxychloriquine, so there is no point of it. Your CRP started increasing after using Clomid and you suppressed it by Hydroxychloriquine - it's like you are treating a side effect of one drug by adding another drug. Best is to not use both.
 
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I would keep the Metoformin and drop everything else to get a propper baseline for assesment if you need any form of TRT or the Hydroxychloriquine.

You have a low SHBG, so your free T was decent on 8/6/2022 - if you feel well without TRT, don't do it. Your CRP on that date was comparable to the one while using Hydroxychloriquine, so there is no point of it. Your CRP started increasing after using Clomid and you suppressed it by Hydroxychloriquine - it's like you are treating a side effect of one drug by adding another drug. Best is to not use both.
The hydroxychloriquine was added by my RA specialist to combat the arthritis... and since it mostly worked, prevented me from getting on a Biologique
 

Your report on body fat change made me thinking. Maybe we are missing all along the crucial part of the neurosystem. Unfortunately I have no answer to that. It seems we have very limited control over this, especially on the impact of early childhood stressors.


Thinking about possible effects of higher dose of anti-inflammatory vitamines.
Has anyone experience with that?
 
Did you have arthritis on 8/6/2022 when your CRP was as low as your CRP now on Hydroxychloriquine and can you say that your symptoms of arthritis now are better than on 8/6/2022.

Adding bunch of drugs, then adding other drugs to treat side effects of the previous drugs is a never ending spiral. Best is to use as few drugs as possible.
 
Also, although your A1C is at the lower boundary of prediabetes, what was your fasting blood glucose on 5/2/2022?
96
Did you have arthritis on 8/6/2022 when your CRP was as low as your CRP now on Hydroxychloriquine and can you say that your symptoms of arthritis now are better than on 8/6/2022.

Adding bunch of drugs, then adding other drugs to treat side effects of the previous drugs is a never ending spiral. Best is to use as few drugs as possible.
Yes... and it was much worse than it is now. I was taking 800mg of ibuprofin and smashing the gym. This likely was not the best thing I could do, but I was ignorant to my underlying conditions and had to fight against insulin resistance as hard as possible.

I think by reversing the pre-diabetes, my CRP came down a lot and that inflammation due to pre-diabetes being gone, lessened the overall effect of the arthritis.

Currently, with pre-diabetes reversed and RA medicated, I have a CRP of 10...

However, and interesting timing, this Friday I am getting a periodontal deep cleaning. I am taking an anti-biotic ahead of this appointment and then have ordered some pro and pre biotics to re-boot the gut. The products I bought are stacked, and include lactobacillus reuteri and lactobacillus parascei...

basically, I think it is safe to say that I have (and have had) a low level bacterial presence for a while in the form of periodontal issues. Perhaps eradicating this will lower that CRP number even more.

In general, yes, I felt better immediately after reversing pre-diabetes... even with a low total t, bc the low SHBG made that FT relatively out-perform.

Since CLOMID, going cold turkey, and before tyring ENCLO.... Felt like shit... as the T/E ratio grew in the wrong direction.

Beginning on ENCLO, I felt amazing, but the E2 increased faster.

Currently I have reduced my ENCLO dose in half.

But the real question(s):

- Why is my e2 so quick to increase?
- Why does Letrozole 2.5mg twice a week barely move the needle
- Chicken and the Egg: Low T is associated with auto-immune disease and insulin resistance... so, fighting these things with a low T system seems futile, but are they the cause of low T or the product of low T?
- Is my SHBG still that low bc of something systemically wrong with me? or just my genetics?
- I am now removing gluten from my diet completely, this is the only thing that has changed from when "I felt good" after reversing PD... I put quote on "feel good", bc while I did feel better than before, I would hardly say that I felt optimal

Since starting the ENCLO, libido went way up but as the e2 crept up, those effects diminished... If I "make myself horny"... erections are quite good. But when I first started ENCLO, before the disproportionate e2 spike, a random thought would send me into a horny rage with a 10/10 boner.

The gym gains are still stellar.... I am working out pretty hard and eat pretty damn good.

Still improving sleep duration.
 
basically, I think it is safe to say that I have (and have had) a low level bacterial presence for a while in the form of periodontal issues. Perhaps eradicating this will lower that CRP number even more.
But the real question(s):

- Why is my e2 so quick to increase?
- Why does Letrozole 2.5mg twice a week barely move the needle
- Chicken and the Egg: Low T is associated with auto-immune disease and insulin resistance... so, fighting these things with a low T system seems futile, but are they the cause of low T or the product of low T?
- Is my SHBG still that low bc of something systemically wrong with me? or just my genetics?
- I am now removing gluten from my diet completely, this is the only thing that has changed from when "I felt good" after reversing PD... I put quote on "feel good", bc while I did feel better than before, I would hardly say that I felt optimal


Maybe your T was low but normal for you, i.e. in balance. What symptoms did you have?

Maybe your E2 is really a reaction to inflammation. I don't know what interactions the Hydroxychloriquine might has in that.

Regarding SHGB: is it below some clinical value? Not sure but think clomid and AI would rather decrease it.

Too many heavy workouts can also be a stressor.

There are a few changes in medicines you take. Cannot tell where your E2 would be without AI. However one would expect that it reduces E2 by 30-60%.

Reversal of all low T symptoms takes on average one year, according to scientific research....

I would ditch the em/clomid, you can anytime restart fertility if needed.
 
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basically, I think it is safe to say that I have (and have had) a low level bacterial presence for a while in the form of periodontal issues. Perhaps eradicating this will lower that CRP number even more.
But the real question(s):

- Why is my e2 so quick to increase?
- Why does Letrozole 2.5mg twice a week barely move the needle
- Chicken and the Egg: Low T is associated with auto-immune disease and insulin resistance... so, fighting these things with a low T system seems futile, but are they the cause of low T or the product of low T?
- Is my SHBG still that low bc of something systemically wrong with me? or just my genetics?
- I am now removing gluten from my diet completely, this is the only thing that has changed from when "I felt good" after reversing PD... I put quote on "feel good", bc while I did feel better than before, I would hardly say that I felt optimal


Maybe your T was low but normal for you, i.e. in balance. What symptoms did you have?

Maybe your E2 is really a reaction to inflammation. I don't know what interactions the Hydroxychloriquine might has in that.

Regarding SHGB: is it below some clinical value? Not sure but think clomid and AI would rather decrease it.

Too many heavy workouts can also be a stressor.

There are a few changes in medicines you take. Cannot tell where your E2 would be without AI. However one would expect that it reduces E2 by 30-60%.

Reversal of all low T symptoms takes on average one year, according to scientific research....

I would ditch the em/clomid, you can anytime restart fertility if needed.
You’re saying that you would ditch the enclomiphene?

As much as the high e2 sides of libido issues suck… it’s still better than it was before I started.

If anything I have thought about ditching the enclomiphene and maybe trying an AI mono therapy.

However, I felt like a billion dollars before the e2 crept up… I’d like to get back to that.

Deciphering the hieroglyphics of possibly why my e2 is dominant (on enclo or not) is daunting and I feel like I am reading reports and in between the lines. Essentially doing my doctors job… it is what it is… but a big part of me thinks that going the TRT route and managing the fuck out of it… while it sucks to have to do this… would produce the results in terms of symptom alleviation, but also, in an environment that is controlled and optimal, reduce the symptoms of RA and other inflammation.
 
Something else. At the beginning of this journey. Well actually before it started. I did a DUTCH test and two things that stood out at that time.

I was not good at e2 methlyation … so I have thought that the “used” e2 that isn’t being removed could be getting put back in rotation and I don’t really have an over aromatization problem ?

And also that my body, to a significant degree, prefers 5B reductase.. meaning my DHT could be sub optimal and this could explain the estrogen dominance ?
 
Something else. At the beginning of this journey. Well actually before it started. I did a DUTCH test and two things that stood out at that time.

I was not good at e2 methlyation … so I have thought that the “used” e2 that isn’t being removed could be getting put back in rotation and I don’t really have an over aromatization problem ?

And also that my body, to a significant degree, prefers 5B reductase.. meaning my DHT could be sub optimal and this could explain the estrogen dominance ?

That's interesting, i have had the same 'feeling' for myself. Unfortunately here where I live they only test for total testosterone. Did myself salvia test and the result stated estrogen dominance but then again I use androgel prescription and this cause accumulation of T in salvia etc... Here, if you are not seriously ill in their perspective one is on it's own. What I'm now trying is I3C(DIM) + CDG. CDG is supposed to help with 'clearance' of estrogens and androgens.
In Europe MDs mostly insist that one first loses weight if one is overweight. In your case I can now see that it sometimes makes sense, because now you have no glue how you would feel with having lost 30pounds and regular excercise.
 
That's interesting, i have had the same 'feeling' for myself. Unfortunately here where I live they only test for total testosterone. Did myself salvia test and the result stated estrogen dominance but then again I use androgel prescription and this cause accumulation of T in salvia etc... Here, if you are not seriously ill in their perspective one is on it's own. What I'm now trying is I3C(DIM) + CDG. CDG is supposed to help with 'clearance' of estrogens and androgens.
In Europe MDs mostly insist that one first loses weight if one is overweight. In your case I can now see that it sometimes makes sense, because now you have no glue how you would feel with having lost 30pounds and regular excercise.
Ya. That was my original course of action. Reverse IR / PD … which for me entailed getting into shape. Now I’m in the best physical shape of my life with a very frustrating hormonal cascade.
 
Beyond Testosterone Book by Nelson Vergel
You did not have "prediabetes" but insulin resistance (high insulin to keep the blood glucose normal) probably from bad diet with too much simple sugars - your fasting blood glucose of 96 was not high enough and your A1C was high normal at the boundary with prediabetes. Your A1C is slightly lower now, mostly because you changed your diet and lost some weight. You don't need any Metformin or other drugs for that.

The elevated CRP and joint aches can be caused by gazillion of problems - arthritis is a symptom not a diagnose of the root cause. Your immune system is attacking your joints and there may be a reason for that - it's frequently triggered after a bacterial or viral infection. If you think it is a bacterial infection, the most probable location is the intestines and the oral cavity - they constantly exchange bacterial flora. A reasonable approach is to try probiotics that have anti-inflammatory properties i.e. will calm down your immune system. Important foods to avoid are inflammatory simple sugars glucose, sucrose, fructose(even in fruits and especially junk food) and lactose in milk - they feed auto-immunity. If you suspect gluten as a source of inflammation, then test for that. The hydroxychloroquine is covering up the problem, not addressing it.

Low SHBG can be either genetic or due to diet high in simple sugars (elevated Triglycerides is an indicator of that):

Your free T is completely normal at such a low SHBG so it is unlikely that TRT will solve any of your problems - your body simply does not need to produce more T with your low SHBG. Claims that "low T is associated with this and that" means absolutely nothing in medicine - take older people, they have lower T and you will find all kinds of correlations with other deceases.

So my advice is better diet, probiotics, and find the root cause of the inflammation, which probably means finding a better doctor. Don't try to explain everything with high/low T or E, as they often do on this forum - it will lead to years of chasing your tail.
 
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