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

[jpw1585]

On other thing I was doing “when I felt good” and reversed PD was hill sprints. I will restart those as well. But Jesus…. Heavy lifting. Hill sprints. Logging everything I eat. Macros. All of this shit… just to barely feel good. And. I great way to find out why e2 dominates regardless of SERMs or “natty”. If that is my lot in life, then I shall adapt and overcome, but it just seems like the missing puzzle piece is right there but I can’t see it

 

[jpw1585]

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):

Low SHBG: Levels Chart, Symptoms, Causes, Treatment, and More

Sex hormone-binding globulin (SHBG) is a protein produced in the liver. It binds certain hormones. When SHBG is low, more of these hormones are available, and when it's high, less are available. Here's what this means, warning symptoms, management tips, and more.

www.healthline.com

Your free T is completely normal at such a low SHBG so it is unlikely that TRT will solve any of your problems. 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.

Wow. Thank you sir.

Turns out on Friday I am getting a deep clean at the periodontal dentist. Starting a. Antibiotic ahead of time and just ordered some probiotics and prebiotics and was just about to cut gluten and dairy again.

Perhaps this latent periodonatal issue (bacteria in the gums) is the source of all of this shit… or at least the inciting factor.

When I have tried to go without metformin I notice higher deviations on my CGM, but generally speaking, they normalize within 2 hours post eating.

I know there have been studies showing that metformin causes ~ 15% reduction in testosterone… perhaps cutting this off and getting more strict on the elimination of gluten and dairy could help w the perceived e2 dominance.

I don’t really eat simple sugars a la junk food but I am pretty sure the body will convert carbs into those sugars.

 

[sammmy]

What are your Triglycerides in fasted state? This is usually found on a Comprehensive Metabolic Panel, that also contains the fasted blood glucose.

 

[jpw1585]

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

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

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

4) Too many heavy workouts can also be a stressor.

5) 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.

1) very hard to lose fat / put on muscle
mild ED
low libido
brain fog / low motivations
depression symptoms
etc

2) very possible, and about the only thing that makes sense at this point

3) It is at the very low end of "normal"... I know that low SHBG is associated w IR / PD, so I thought that with reversing that, that SHBG would rise... butit hasnt... maybe pointing to the remaining inflammation factor as the reason why this SHBG is chronically low?

4) I am usually not sore much after a day if at all, I do the 531 for beginners religiously, and take care to not overtrain

5) after a month or so on Enclo, my E2 was 77.... This was with .25 adex 1x a week

 

[jpw1585]

What are your Triglycerides in fasted state? This is usually found on a Comprehensive Metabolic Panel, that also contains the fasted blood glucose.

I will look these up and post later, but after that "reversal" they were all optimal

 

[Guided_by_Voices]

Regarding diet, there should be no need to log what you eat over the long-term. I always recommend the protocol described in the book The Perfect Health Diet by Paul Jaminet. I recommend everything he suggests, but getting rid of seed oils. wheat and eating within an 8 hour window should go a long way to get you on the right path, and they require almost no effort once you get used to them.

 

[jpw1585]

Regarding diet, there should be no need to log what you eat over the long-term. I always recommend the protocol described in the book The Perfect Health Diet by Paul Jaminet. I recommend everything he suggests, but getting rid of seed oils. wheat and eating within an 8 hour window should go a long way to get you on the right path, and they require almost no effort once you get used to them.

thanks for the suggestions. I am done w Gluten as of 48 hours ago... I never use seed oils, but this is a great point because it is next to impossible to know if a restaurant does, and roger that to the intermittent fasting window.

I will check that book out asap

I use myfitnesspal bc I am obsessed with data and it helps me stay on top of my macros and overall calories... are you saying that this is unnecessary after I get to where I need to go?

 

[Guided_by_Voices]

thanks for the suggestions. I am done w Gluten as of 48 hours ago... I never use seed oils, but this is a great point because it is next to impossible to know if a restaurant does, and roger that to the intermittent fasting window.

I will check that book out asap

I use myfitnesspal bc I am obsessed with data and it helps me stay on top of my macros and overall calories... are you saying that this is unnecessary after I get to where I need to go?

Unless you're peaking for a physique competition or have some other extremely rare situation, I would say that it's not only unnecessary, but it could be harmful in that it creates an additional degree of stress and potentially "guilt", neither of which are healthy in most cases. In most cases I have seen where people went from an unhealthy state to a healthy one, factors such as food quality, timing and activity type and level were what drove the changes, not calorie counting. Also, you want to get to a point where your body is sending you accurate hunger signals, especially as your fitness improves which will in turn increase your fuel requirements.

 

[Seagal]

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 ?

MethylFolate might help with methlyation. I'm going to test it.

 

[Seagal]

1) very hard to lose fat / put on muscle
mild ED
low libido
brain fog / low motivations
depression symptoms
etc

2) very possible, and about the only thing that makes sense at this point

3) It is at the very low end of "normal"... I know that low SHBG is associated w IR / PD, so I thought that with reversing that, that SHBG would rise... butit hasnt... maybe pointing to the remaining inflammation factor as the reason why this SHBG is chronically low?

4) I am usually not sore much after a day if at all, I do the 531 for beginners religiously, and take care to not overtrain

5) after a month or so on Enclo, my E2 was 77.... This was with .25 adex 1x a week

To ease your mind about bodyfat, imho i don't think you were 'clinically' obese before with BMI of about 25%.
Prior to starting TRT I lost weight and restarted regular exercise. One year later I felt worse. No ED issues, but libido down, heavy depression, brain fog, extrem lethargy, anhedonia, tiredness, naps during day needed. Finally when I got knee joint pain just from sightseeing tour walk, i realized that something was really off and it's not just in my head. Did salvia T test and free T was borderline. Then did total T test at GP and it was far below normal range, even lower than for a 80yr old.
Androgel almost immediately cleared up my brainfog and depression, libido returned and joint pain disappeared.

It's not all dependent on life style, eating healthy, sports etc. I wish it were.

 

[jpw1585]

MethylFolate might help with methlyation. I'm going to test it.

I will start to research this as well

To ease your mind about bodyfat, imho i don't think you were 'clinically' obese before with BMI of about 25%.
Prior to starting TRT I lost weight and restarted regular exercise. One year later I felt worse. No ED issues, but libido down, heavy depression, brain fog, extrem lethargy, anhedonia, tiredness, naps during day needed. Finally when I got knee joint pain just from sightseeing tour walk, i realized that something was really off and it's not just in my head. Did salvia T test and free T was borderline. Then did total T test at GP and it was far below normal range, even lower than for a 80yr old.
Androgel almost immediately cleared up my brainfog and depression, libido returned and joint pain disappeared.

It's not all dependent on life style, eating healthy, sports etc. I wish it were.

Thanks for the info... Ya, I knew that I was not in the best shape but far from a pile of shit (like a lot of my peers).

When the doctor told me I was pre-diabetic, I presumed she was trying to wake me up... My a1c was technically pre-diabetic, but one foot in and one foot out.

Regardless, becoming more insulin sensitive is crucial no matter how you slice it.

Having a CRP that is still elevated leads me to believe that I have a low level bacterial infection that could be driving the systemic inflammation and leading to my persistent e2 issues.

Such crazy timing that I am having a periodontal procedure to eliminate a bunch of bacteria + a short run with an antibiotic + starting a rather robust probiotic...

I will SHIT myself if this lowers my CRP and helps with the RA / LowT symptoms. Literally been in front of my face the whole time.

In the meantime, cut out gluten again and also didn't take my metformin last night... I am watching my cgm like a hawk, but all of this in concert could really move the needle (put intended again).

I guess worst case, I will have left no stone unturned and my Uro is down to play ball in any therapy option that I want to pursue next.

 

[jpw1585]

To ease your mind about bodyfat, imho i don't think you were 'clinically' obese before with BMI of about 25%.
Prior to starting TRT I lost weight and restarted regular exercise. One year later I felt worse. No ED issues, but libido down, heavy depression, brain fog, extrem lethargy, anhedonia, tiredness, naps during day needed. Finally when I got knee joint pain just from sightseeing tour walk, i realized that something was really off and it's not just in my head. Did salvia T test and free T was borderline. Then did total T test at GP and it was far below normal range, even lower than for a 80yr old.
Androgel almost immediately cleared up my brainfog and depression, libido returned and joint pain disappeared.

It's not all dependent on life style, eating healthy, sports etc. I wish it were.

What was your age / T levels when you decided to start therapy?

 

[Seagal]

What was your age / T levels when you decided to start therapy?

46 / 1.3, minimum normal range was about 2.4, max around 10, if i recall correctly.
Was not much of a decision....

 

[jpw1585]

46 / 1.3, minimum normal range was about 2.4, max around 10, if i recall correctly.
Was not much of a decision....

Absolutely. Sounds like you made the right move for yourself!

Wondering if you or anyone else subbed to this thread knows…

I have researched this and haven’t found much…

But what about the long term effects of frequent alcohol blackouts.

Most things I see are related to how alcohol poisoning will wreck your memory / memory components of the brain long term.

I know that alcohol binging and blacking out can effect everything, including hormones, in the short term…

But I have wondered about how a long history of blacking out could potentially impact hormone optimization / homeostasis long after one quits drinking.

 

[Seagal]

Absolutely. Sounds like you made the right move for yourself!

Wondering if you or anyone else subbed to this thread knows…

I have researched this and haven’t found much…

But what about the long term effects of frequent alcohol blackouts.

Most things I see are related to how alcohol poisoning will wreck your memory / memory components of the brain long term.

I know that alcohol binging and blacking out can effect everything, including hormones, in the short term…

But I have wondered about how a long history of blacking out could potentially impact hormone optimization / homeostasis long after one quits drinking.

Now it's getting interesting;-)
There is probably no study which investigated that quantitatively. Are you serious about this question?

I have a question. What do think is the root cause of your periodontitis?

 

[jpw1585]

Now it's getting interesting;-)
There is probably no study which investigated that quantitatively. Are you serious about this question?

I have a question. What do think is the root cause of your periodontitis?

Very serious. The first time I drank alcohol as a teenager, I blacked out… and I’d have to imagine that 80% of the time until I quit drinking I blacked out.

No accurate way to estimate, but a minimum of 500 times based on conservative math.

Periodontal —> shitty self care as a teen, not staying up on dentistry as an adult. Party animal. Blacking out. Smoking weed like a rapper, sleeping in hotels and on couches. By sleeping I mean napping or blacking out. Living like a hyper stressed out rockstar for 12 years.

Haven’t had a sip of alcohol, a blackout, or a hangover in 4 years. I will never go back.

My body is the best it’s ever been. My career took off. Stress is lower. Getting better sleep.

But near the end of my party animal phase, I did a deep cleaning at the dentist. Hurt like a XXXXX. But then Covid happened and I stopped.

Before that deep cleaning in 2019 I probably hasn’t been to the dentist in the decade while drinking, smoking cigs and weed, and generally living hard.

When I was 19 I had mouth pain and was told I had the beginning of periodontal issues but I just did nothing about it and kept fucking off.

Tomorrow I am having a deep cleaning w laser bacterial therapy. And they have me on an antibiotic

Hopefully will see a decrease in CRP and improvement of hormone symptoms.

 

[jpw1585]

It’s been 6 weeks or so

- had the periodontal deep clean + laser treatment on bacteria.
- they put me on 2 antibiotics for 7 days after.
- I started taking a good probiotic (and prebiotic)

- eliminated gluten completely
- crushing the gym
- hill sprints

- stopped taking enclomiphene
- still taking letrozole 2.5mg twice a week
- running this AI for a few more weeks. Than more bloods. Then doc again where I can pretty much choose if I want to go down other routes or what to do.

I did bloods last week privately… as I was super interested in seeing where I was 2ish weeks off enclo

TT = 513 ng/dl
FT = 130 pg/ml
E2 = 27 pg/ml
PRL = 13.1 ng/ml
SHBG = 13.1 Nmol/L
DHT = 28 ng/dl

Def don’t feel as estrogenic as when I was on enclo.. but wouldn’t say that I feel great either. Certainly not optimal.

My research has led me to the current stance of my SHBG is too low. I have realized how important SHBG is and also what it’s levels mean in terms of health and also a driver of how to administer hormonal therapy if one decides to go down that road.

As noted earlier. I was borderline prediabetic and certainly insulin resistant. Found out 18 mos ago but was likely this way for years.

Reversed it 90 days later… have worn CGMs ever since and I am reasonably insulin sensitive. I lift heavy 3-4 days a week on a plan. I track my diet.

Recently started eating at a slight surplus.

Best shape of my life.

However. My SHBG is LOWER now than when I was much fatter. Much worse shape. Much worse over all

What gives.

Also have RA… it’s the LEAST painful it has ever been. No gluten really helped!

Does RA just cause chronic elevated inflammation? Is this why my SHBG is low? It’s it effecting my liver?

My liver markers are all on point. I handle glucose good now. Workout hard often.

I’m hesitant to explore TRT (& HCG) bc of the low SHBG.

It’s my theory that the low SHBG. When T was elevated from enclo, led to my e2 sides (aromatase in testicles).

Even w the elevated sex hormones. My SHBG just stayed low.

If I do go down that road… I presume it would be be done with daily injections and slow and steady w HCG?

Would Jatenzo or Natesto be more favorable for someone w autoimmune/low Shbg ?

I feel the importance of making a decision… as the risks of fucked up hormones while hosting an autoimmune disease + just suboptimal hormone levels as we age is riskier than real TRT of some modality.

Thanks for the suggestions, the time to read this, and welcome and comments. Feedback. Or questions .

 

[Guided_by_Voices]

It’s been 6 weeks or so

- had the periodontal deep clean + laser treatment on bacteria.
- they put me on 2 antibiotics for 7 days after.
- I started taking a good probiotic (and prebiotic)

- eliminated gluten completely
- crushing the gym
- hill sprints

- stopped taking enclomiphene
- still taking letrozole 2.5mg twice a week
- running this AI for a few more weeks. Than more bloods. Then doc again where I can pretty much choose if I want to go down other routes or what to do.

I did bloods last week privately… as I was super interested in seeing where I was 2ish weeks off enclo

TT = 513 ng/dl
FT = 130 pg/ml
E2 = 27 pg/ml
PRL = 13.1 ng/ml
SHBG = 13.1 Nmol/L
DHT = 28 ng/dl

Def don’t feel as estrogenic as when I was on enclo.. but wouldn’t say that I feel great either. Certainly not optimal.

My research has led me to the current stance of my SHBG is too low. I have realized how important SHBG is and also what it’s levels mean in terms of health and also a driver of how to administer hormonal therapy if one decides to go down that road.

As noted earlier. I was borderline prediabetic and certainly insulin resistant. Found out 18 mos ago but was likely this way for years.

Reversed it 90 days later… have worn CGMs ever since and I am reasonably insulin sensitive. I lift heavy 3-4 days a week on a plan. I track my diet.

Recently started eating at a slight surplus.

Best shape of my life.

However. My SHBG is LOWER now than when I was much fatter. Much worse shape. Much worse over all

What gives.

Also have RA… it’s the LEAST painful it has ever been. No gluten really helped!

Does RA just cause chronic elevated inflammation? Is this why my SHBG is low? It’s it effecting my liver?

My liver markers are all on point. I handle glucose good now. Workout hard often.

I’m hesitant to explore TRT (& HCG) bc of the low SHBG.

It’s my theory that the low SHBG. When T was elevated from enclo, led to my e2 sides (aromatase in testicles).

Even w the elevated sex hormones. My SHBG just stayed low.

If I do go down that road… I presume it would be be done with daily injections and slow and steady w HCG?

Would Jatenzo or Natesto be more favorable for someone w autoimmune/low Shbg ?

I feel the importance of making a decision… as the risks of fucked up hormones while hosting an autoimmune disease + just suboptimal hormone levels as we age is riskier than real TRT of some modality.

Thanks for the suggestions, the time to read this, and welcome and comments. Feedback. Or questions .

Congratulations on your progress. I'll let others comment on SHBG as I have never paid much attention to that, but what does raise a yellow flag for me is whether your workouts are creating a degree of stress that could result in chronically elevated cortisol. In the short term cortisol is anti-inflamatory, but if I understand it correctly, you don't want constant excess cortisol and if you're grinding reps and hence risking overtraining, that could create an issue. I've started to pay a lot more attention to cortisol recently as I think it may have been causing me issues. A lot of activity is generally a very good thing, but frequent maximal efforts almost certainly are not.

 

[jpw1585]

Congratulations on your progress. I'll let others comment on SHBG as I have never paid much attention to that, but what does raise a yellow flag for me is whether your workouts are creating a degree of stress that could result in chronically elevated cortisol. In the short term cortisol is anti-inflamatory, but if I understand it correctly, you don't want constant excess cortisol and if you're grinding reps and hence risking overtraining, that could create an issue. I've started to pay a lot more attention to cortisol recently as I think it may have been causing me issues. A lot of activity is generally a very good thing, but frequent maximal efforts almost certainly are not.

Thanks for the insight. I am aware of that but from what I have read, while over training is a real thing… people tend to over estimate their output … I’m not a power lifter or athlete.

I have started a caloric surplus and have decreased time in gym from 1.25 hrs to 45 mins. Prioritizing recovery.

The point about cortisol is real though … and this is precisely the thing I suspect the chronic and latent inflammation from RA could be doing.

Thus the reason why I am heavily researching and considering hormone intervention.

I have done all the hard work and spent all the time researching and utilizing urologists instead of just going to a clinic

But with RA and said inflammation I feel like I’m pushing a boulder up a hill constantly. Literal perfect lifestyle to just to maybe feel 6/10

Conversely, obtaining an optimal hormone profile would likely decrease inflammation and other fun things that come along w autoimmune disease.

Chicken and the egg

 

[Systemlord]

Does RA just cause chronic elevated inflammation? Is this why my SHBG is low?

Inflammation is what drives SHBG down, overexertion, stress will trigger RA.

Vitamin K decreases inflammation, so might want to check to see where your levels are.