42, Fresh Eyes on TRT Treatment

Pharma / TRT Testosterone Replacement
1

Good Afternoon,

After reading for several months now and following the advise in all the well executed stickies, I am finally jumping in and posting all of my information. Like most I have read, brain fog, low libido, tired, unmotivated, moody, belly fat gain… are what I am feeling. Let me say thanks to KSman for a plethora of very valuable information and would welcome his analysis on this post. Let’s start with the basics and feel free to remind me of anything I have forgot.

-age - 42
-height - 6 foot
-waist - at the hips - 32 inches at the waist 40 inches
-weight - 195lbs

-describe body and facial hair - middle hairline balding. Chin and lip grow thick and coarse but patchy on the rest of the face. Thin but unified on leg’s, chest and arms. Heritage of French (Louisiana) and Cherokee Indian.

-describe where you carry fat and how changed - The only place I carry more than 1/2" of fat is around my waist.

-health conditions, symptoms [history] - Had asthma till the age of 10 until a brilliant doctor thought it was unresolved pneumonia. After 2 months of erythromycin I have have been symptom free since. 2005 UPPP and tonsils removed for sleep apnea. 2006, great left toe broke and pinned.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - Eythromycin/Zythromax various times, Alupent and theophyllin for asthma as a kid, No hair loss drugs since I started shaving my head in high school when I saw my fathers receding hair line. Never any prostate drugs. Fish Oil, Resveratol, CLA, Optiman vitamins which only have 150mcg of iodine. Nasonex.

-describe diet [some create substantial damage with starvation diets] - 90% clean and moderate alcohol use. Never under 2500 calories a day. I have been a Paramedic for 20 years and have a degree in Kinesiology. Iron-man in 2003 and 2004 and Army until October 2011. Brachieal Plexus injury during a mission and left arm is paralyzed. Medically retired in October 2011.

-describe training [some ruin there hormones by over training] - Has been limited and didn’t really have any problems until my injury. Never “over trained” even during my Iron-man days.

-testes ache, ever, with a fever? - never
-how have morning wood and nocturnal erections changed - yes, almost non-existent and no libido.

5 day temperature readings prior to labs.
06 April 07 April 08 April 09 April 10 April
0600 96.8 96.9 97.0 96.3 96.6
0900 97.5 97.7 97.5 97.8 97.9
1200 97.6 97.5 97.6 97.3 97.2
1500 97.2 97.0 97.1 97.2 97.9
1900 97.5 97.3 97.7 98.0 97.8

-lab results with ranges - as follows. All labs have been done by Quest. The first TT labs were prior to learning about ALL the labs that I needed. Forgive me, I don’t have the CBC and such from the first labs.

December 2011
Lab Values Ranges
TT 330 ng/dL 200-1100

This was my first lab. Since I have a amazing doc, well a P.A. actually here in North Texas, he let’s me do just about anything I want. At this point I was given T cream, formulated at the pharmacy, and no AI. After 3 months, I still felt like crap and then was given Testosterone Cypionate 200mg/ml to inject and Anastrolzole 1 mg. I injected 100mg twice a week and .5mg of Anastrolzole on same day of injection. This seemed to work well until January of 2013.I started feeling very lethargic and having panic attacks. After researching on my own and finding this great site, I found it could be high E. Erections were great but libido was low. I upped my AI to .5mg EOD. Without any relief, I went back for more labs. They are as follows in the order reported.

15 January 2013
Lab Values Ranges
Cholesterol, Total 193 mg/dL 125-200
HDL Cholesterol 52 mg/dL > or = 40
Triglycerides 158 mg/dL <150
LDL Cholesterol 109 mg/dL (calc) <130
Chol/HDLC Ratio 3.7 (calc) < or = 5.0

Uric Acid 4.3 mg/dL 4.0-8.0

Glucose (fasting) 96 mg/dL 65-99
Urea 11 mg/dL 7-25
Creatinine 1.22 mg/dL .60-1.35
Sodium 142 mmol/L 135-146
Potassium 4.4 mmol/L 3.5-5.3
Chloride 104 mmol/L 98-110
Carbon Dioxide 26 mmol/L 19-30
Calcium 9.9 mg/dL 8.6-10.3
Protein, Total 7.6 g/dL 6.1-8.1
Albumin 5.2 g/dL 3.6-5.1
Globulin 2.4 g/dL (calc) 1.9-3.7
Alb/Glob Ratio 2.2 (calc) 1.0-2.5
Bilirubin, Total 1.8 mg/dL 0.2-1.2
** I have always had varying bili levels over the years. From 0.8 to 2.5. Yet I have never had yellowing of the scalera or skin tinting.
Alkaline Phosphatase 69 U/L 40-115
AST 34 U/L 10-40
ALT 46 U/L 9-60
Sed Rate 2 mm/h < or = 15

WBC 3.2 Thousand/uL 3.8-10.8
RBC 5.49 Million/uL 4.20-5.60
Hemoglobin 18.8 g/dL 13.2-17.1
Hematocrit 54.4% 38.5-50.0
MCV 99.1 fL 80.0-100.0
MCH 34.2 pg 27.0-33.0
MCHC 34.5 g/dL 32.0-36.0
RDW 13.4% 11.0-15.0
Platelet Count 190 Thousand/uL 140-400
Absolute Neutrophils 2122 ells/uL 1500-7800
Absolute Lymphocytes 787 cells/uL 850-3900
Absolute Monocytes 211 cells/uL 200-950
Absolute Basophils 0 cells/uL 0-200

ANA Negative Neg or Pos
Rheumatoid Factor 9 IU/mL <14
Thyroid Peroxidase Anti <10 IU/mL <35
T4, Free 1.2 ng/dL 0.8-1.8
T3, Free 3.5 pg/mL 2.3-4.2
Testoterone, Total 1010 ng/dL 241-827
TSH 1.77 mlU/L 0.40-4.50
Estradiol 37 pg/mL < or = 39

My P.A. said that in some guys, including himself, that E levels SOMETIMES level out as the body compensates. I held until mid March when I couldn’t take it anymore. I stopped all injections and AI around 10 March. Weaned off of course. I wanted “clean labs” so waited until 15 April to get them done. They are as follows.

15 April 2013
Labs Values Ranges
Iron, Total 134 mcg/dL 45-170
Iron, Binding 342 mcg/dL 250-425
% Saturation 39% (calc) 20-50

Ferritin 401 ng/mL 20-380
Magnesium 2.2 mg/dL

Glucose (fasting) 98 mg/dL 65-99
Urea Nitrogen (BUN) 20 mg/dL 7-25
Creatinine 1.17 mg/dL 0.60-1.35
Sodium 139 mmol/L 135-146
Potassium 4.2 mmol/L 3.5-5.3
Chloride 100 mmol/L 98-110
Carbon Dioxide 24 mmol/L 19-30
Calcium 10.2 mg/dL 8.6-10.3
Protein, Total 8.0 g/dL 6.1-8.1
Albumin 5.5 g/dL 3.6-5.1
Globulin 2.5 g/dL (calc) 1.9-3.7
Albu/Globu Ration 2.2 (calc) 1.0-2.5
Bilirubin, Total 2.5 mg/dL 0.2-1.2
Alkaline Phosphatase 66 U/L 40-115
AST 42 U/L 10-40
ALT 55 U/L 9-60
T3, Reverse 36 ng/dL 11-32
Progesterone <0.1 ng/mL < or = 0.2
DHT 61 ng/dL 16-79
Pregnenolone 42 ng/dL 13-208

WBC 3.6 Thousand/uL 3.8-10.8
RBC 5.15 Million/uL 4.20-5.80
Hemoglobin 17.9 g/dL 13.2-17.1
Hematocrit 51.6% 38.5-50.0
MCV 100.2 fL 80.0-100.0
MCH 34.8 pg 27.0-33.0
MCHC 34.7 g/dL 32.0-36.0
RDW 13.8% 11.0-15.0
Platelet Count 164 Thousand/uL 140-400
Absolute Neutrophils 2113 cells/uL 1500-7800
Absolute Lymphocytes 929 cells/uL 850-3900
Absolute Monocytes 306 cells/uL 200-950
Absolute Eosinophils 245 cells/uL 15-500
Absolute Basophils 7 cells/uL 0-200
Neutrophils 58.7% N/A
Lymphocytes 25.8% N/A
Monocytes 8.5% N/A
Eosinophils 6.8% N/A
Basophils 0.2% N/A

Thyroid Peroxidase Anti 11 iU/mL <35
DHEA-S 532 mcg/dL 45-345
FSH 4.3 miU/mL 1.6-8.0
LH 3.5 miU/mL 1.5-9.3
Prolactin 4.4 ng/mL 2.0-18.0
T4, Free 1.4 ng/dL 0.8-1.8
TSH 2.30 mIU/L 0.40-4.50
Estrodiol (sensitive) 32 pg/mL < or = 39
Cortisol A.M. 9.4 mcg/dL 4.0-22.0
** This was serum level since my P.A. does not do the saliva test.
PSA, Total 1.4 ng/mL < or = 4.0

Vitamin B12 474 pg/mL 200-1100
Folate 11.5 ng/mL <3.4->5.4
HCG, Total <2 mIU/mL <5
T3, Free 3.7 pg/ml 2.3-4.2
Vitamin D-25 OH, Total 50 ng/mL 30-100
Vitamin D-25 OH, D3 50 ng/mL Not established
Vitamin D-25 OH, D2 <4 ng/mL Not established

TT 655 ng/dL 250-1100
Testosterone, Free 84.5 pg/mL 46.0-224.0
Tstosterone, Bio 210.6 ng/dL 110.0-575.0
SHBG 34 nmol/L 10-50
Albumin, Serum 5.5 g/dL 3.6-5.1

After these set of labs, I came home and injected .25mg of test SC and .5mg of AI. My thought was to inject SC EOD along with AI after reading the great research on here. Felt like crap the very next day but continued the week out with no relief. Have stopped injections and AI until I talk to my P.A. and maybe some sound advise from here. Based on these labs, from my point of view, I need IR as suggested in the thyroid stickies and to start on the TRT protocol as stated here. KSman, if there is any other insight you can give, I would greatly appreciate it. Just to be clear, I welcome all helpful advise and thoughts. Ksman seems to be leading the way on this and is why I asked him specifically.

Thanks in advance,
Beauxdee

P.S. I apologize for the layout as the website change my original spacing.

2

rT3 can explain some aspects of thyroid labs. So you need to look into adrenal fatigue. Cortisol is at lower end of range for AM cortisol. What time of day was the lab done?

IR may be helpful, but rT3 is still there. What was your historic intake of iodine? Who else in your household shares your iodine intake profile? There temperatures?

Your hematocrit is a problem. You need to avoid iron fortified foods. Your high end ferritin confirms the problem. Can be more than that as well. Can you do a blood donation? If you feel better for a while after that, that is a major lesson.

Between cortisol and thyroid issues, TRT can be tough, as you have read.

Your last TRT attempt may have had an E2 crash as your T levels were lower and anastrozole is fast acting. But that is guess work. Your E2 from when you were on TRT was high. With 200mg T per week, you were only taking around 1/2 of the anastrozole expected. We have someone else here from your area, sounds like could be same doctor. Your E2=37 suggests that dose should have been 1mg/week * 37/22 = 1.7mg/week or .5mg EOD

Action:

  • get Wilson’s book on adrenal fatigue at amazon.com
  • you need to loose fat! When you get your hormones right, you should be able to get lean
  • donate blood if you can, or if you can get the kit, do your own bleed out and see how that feels
  • eliminate iron fortified foods, bread, cereals
  • get 12.5mg Iodoral and try IR
    – above may have reduced potential benefit because of rT3
  • watch your PSA, need to keep lower E2 to protect, consider a prostate herbal OTC product
  • report iodine history
  • report blood pressure [headaches?]

Great write up and prep!

3

KSman,

Thanks for the input. Thanks for the compliment as well but all you really have to do is read and report what is requested. Patients and dedication seems to be a lost art.

My doc appointment is tomorrow so I am making a list of things to discuss. The rT3 is throwing me off a bit. Is it caused by high Iron/Ferritin? Low Cortisol? Adrenal fatigue? Low selenium? All of the above? Have been reading Wilson’s book as you advised. Liver cleanse and possible Milk Thisil. Would Cytomel for 2-3 months help this due to the loop feedback of T4?
Will donate blood this week and have stopped using cast iron to cook in. Not sure how much this will effect iron levels since I have been using this all my life.
Ordered Lodoral 12.5 to have on hand to go that route. Should I take selenium with this for absorption rate?
Could my Hematocrit but not enough H2O? I take in around 80oz a day.
Have broke up anastrozole into quarters to get E down to a good range slowly so I don’t get another “dump”. Could I be a high convertor?
Iodine history has lacked since moving to DFW in 2003. Grew up near Galveston in Texas City in a Louisiana family so shrimp, crawfish and oysters were a regular meal in some form. Now just occasionally boiled shrimp, dozen oysters and crawfish just a few times during season. I do use iodine infused sea salt but have read in several places that it’s mostly evaporated during processing and no where near what the body needs, including the iodine sticky. No one shares my iodine profile. Never had a family hx of thyroid problems. Grandparents lived well into the 90’s and just a vague hx of heart attacks and strokes but that was the obese side of the family who smoked and ate way to much.
Will get prostate OTC supplement. I have seen where PSA levels go down when on the right TRT so may wait to see if that will do the trick. Thoughts?
Can’t remember my last headache and my last bp was 129/90. The highest it’s ever been in my life. Normal is 110/68. Could be not enough cardio as I used to run and swim all the time. Jogging is limited now and swimming is almost impossible, almost.

Thanks again for all your insight.

Beauxdee

rT3 can explain some aspects of thyroid labs. So you need to look into adrenal fatigue. Cortisol is at lower end of range for AM cortisol. What time of day was the lab done?

IR may be helpful, but rT3 is still there. What was your historic intake of iodine? Who else in your household shares your iodine intake profile? There temperatures?

Your hematocrit is a problem. You need to avoid iron fortified foods. Your high end ferritin confirms the problem. Can be more than that as well. Can you do a blood donation? If you feel better for a while after that, that is a major lesson.

Between cortisol and thyroid issues, TRT can be tough, as you have read.

Your last TRT attempt may have had an E2 crash as your T levels were lower and anastrozole is fast acting. But that is guess work. Your E2 from when you were on TRT was high. With 200mg T per week, you were only taking around 1/2 of the anastrozole expected. We have someone else here from your area, sounds like could be same doctor. Your E2=37 suggests that dose should have been 1mg/week * 37/22 = 1.7mg/week or .5mg EOD

Action:

  • get Wilson’s book on adrenal fatigue at amazon.com
  • you need to loose fat! When you get your hormones right, you should be able to get lean
  • donate blood if you can, or if you can get the kit, do your own bleed out and see how that feels
  • eliminate iron fortified foods, bread, cereals
  • get 12.5mg Iodoral and try IR
    – above may have reduced potential benefit because of rT3
  • watch your PSA, need to keep lower E2 to protect, consider a prostate herbal OTC product
  • report iodine history
  • report blood pressure [headaches?]

Great write up and prep!

4

Many of your questions are secondary issues or you already know the answers. With IR, the amounts are high and absorption is probably not a concern. You should be using a B-complex multi vit with trace elements and iodine in any case.

Keep your list of questions for you doc to a manageable length.

Your low cortisol is more of a symptom of AF, not a cause.

Thinner blood improving circulation may improve some things.

5

**** 04/04/13 UPDATE ****

Dr. Appt. was on 30 March. Here is my new TRT protocol with additions.

Test Cyp @ 200 mg per mL - .3ml or 66.5 mg 3X a week SC
HCG - 200 iU, or .200 ml, 3X a week SC (10,000 iU in 10 ml of Dia water)
Anastrolzol - .5 mg on days of injections
Vitamin B12 - 500 mcg injections once a week SC
Cytomel - 5 mcg every day before breakfast as soon as I wake up and retest in 2-3 months.
Iodine (Lodoral)- 12.5 3X a week and test in 6 weeks with T labs.

So far this week has been good. The B12 shot was amazing but can feel it fading as the week goes on. It will take a few weeks to feel the effects of the Cytomel but feel really good to fix the T4 loop with it and bring my rT3 down. Morning erections have returned with a vengeance but libido is still low. Brain fog has lifted and focus is improved. We decided to start on the lower range of T and HCG, then increase slowly in order to not over shoot the sweet spot. I will update improvements and disappointments as they arise. Labs will be reported as I get them. He felt the iron was not a big concern since the ranges was not high critical. Will address them if they are still high at next labs. Thank you KSman for the input and feel free to comment any time.

6

[quote]KSman wrote:
Your hematocrit is a problem. You need to avoid iron fortified foods.
[/quote]

…and multivitamins containing iron. There should be a health warning on multis with iron stating that they are not for men.

7

Thanks seekonk. With my background, I did know this.

8

**** UPDATE 05/29/2013

This is my 8th week on the protocol. I made some minor adjustments after the 4th week to try and dial in by the way I felt. I increased the HCG to 250IU MWF SC. I also took my T SC on those days. I take .25mg Anastrozol M-F. Taking the AI by .5 mg I noticed dizziness and feeling bad as I may be a over responder. The lower dose has seemed to work well so far. I did a B-12 Load of 1000 mcg MWF for the first 2 weeks and will continue 1000 mcg 2X a month. I am taking 1000 IU D-3 2X a day. Adjusting my sleep exercise and protein intake along with a Medrol pack to combat the possible adrenal fatigue has helped 1000X’s!

With in the last 7 - 10 days I have felt AMAZING! I have lost 10 lbs. Libido, morning AND night wood are great. Clarity, focus and drive has also returned to 90%. I did find out by way of an injury that if you don’t use the extra T you are putting in you will feel worse, not better. Watch your caffine and alcohol intake, too high and it will have a negative effect, this includes pre-workout supplements. My testicles have not returned to the very droopy state of youth but they have dropped some and enlarged a bit. I feel this is a normal place they should be with the right body chemistry. I will get labs done in 2 weeks then report. I will include body temps at this time as well.