New bloodwork after 6 weeks with new provider and new protocol

[Helboi]

So here are the most important numbers from my last test, 6 weeks ago (I was then on 155mg of T, one shot every 7 days, no HCG, DIM and IC3 400mg/day each). Note, both tests were taken on a trough day before that days injection.

Total T: 788 ng/dl (range is 348-1197)
Free T (direct): 25.2 pg/ml (range is 8.7-25.1)
Estradiol (sensitive): 28.8 pg/ml (range is 8.0-35.0)
Hematocrit: 55.1 (range is 37.5-51)

And here are the results I got back today from my 6 week checkup test (protocol for the entire 6 weeks has been 75mg T, injected twice weekly, 250iu HCG twice weekly, DIM and IC3 400mg/day each, and Zinc 50mg twice a day...also had one therapeutic phlebotomy done, which is why the hematocrit value dropped some):

Total T: 712 ng/dl (range is 348-1197)
Free T (direct): 25.9 pg/ml (range is 8.7-25.1)
Estradiol (sensitive): 33.3 pg/ml (range is 8.0-35.0)
Hematocrit: 53.0 (range is 37.5-51)

Over the past 6 weeks I've noticed the following changes in symptoms:

Mood issues (depression) are about the same
Anxiety has increased about 20%
Irritability increased about 10%
Libido is about the same
ED issues about the same (still no real morning wood to speak of)
Body composition changes have slowed some
Energy level decreased by about 15%

So do you think these changes are the drop in total T? The higher estrogen? Nothing to worry about? Should I be looking to change my protocol? I would like to improve energy levels, mood/irritability, erectile function and of course body composition still and I'm not sure having a higher T would help or taking an AI would help?

 

[Gene Devine]

Nothing wrong with labs you posted; they all look very good in fact.

Something else is at play in why you feel like you do.

Did you get a complete thyroid work-up done?

TSH
FT4
FT3

Also, what's going on in your personal life that may be causing your symptoms.

TRT is not a cure all for all things so you need to investigate both physiological and psychological as well.

BTW, keep an eye on Hematocrit; it's still high.

 

[ERO]

Your E2 is fine (Ratio is 21, which is just outside of the ideal range of 14-20). What is your SHBG level? Guys with low SHBG (like me) typically do not feel much in the way of subjective benefit from TRT no matter how "perfect" we look on paper.

 

[Helboi]

Thanks Gene. There were definitely some things going on that was contributing to how I felt for a few weeks in the beginning, but that's chilled out quite a bit over the past few weeks and symptoms are still the same. But you're right, TRT isn't a cure-all and I know some of these issues will always haunt me as they have for decades before TRT.

I haven't done a full workup on thyroid, but I need to...my insurance is crap so it's expensive for me to do all of this. I'll get to it soon I hope.

I have a standing order for therapeutic phlebotomy, but have only done it one time so far (it was ordered about a month ago). Because of an antibody issue with my blood, I can't donate, so I have to pay out of pocket for these and it's $150, so doing it monthly isn't an option. I'm hoping hematocrit will adjust some over time with only a few phlebotomy's a year.

 

[Helboi]

ERO: the new place doesn't test for SHBG, which I thought was strange. But the provider I was with for the 4 months prior did and the last result I can find SHBG was 25.5 nmol/L (range is 16.5-55.9). Is that part of my problem? The previous time they tested for it, it was 27.2, so it was trending down.

 

[ERO]

No issues there - "low SHBG" is typically under 20, often well under, so you are good to go on that anyway.