Advice on Dialing In My Levels

Pharma / TRT Testosterone Replacement
1

I started TRT on 1-22-15 after I requested for my labs to be drawn the previous week. Started off on 2 pumps of androgel 1.62% and retested in march. Levels not where he wanted and added 100 mg injections (IM) per week to my current regimen. Felt much better for a few weeks then stared experiencing the hi/low effect, though not extreme, it was noticeable.

Retested on 4-13-15, E2 was starting to rise so he added .5 mg 2x per week. Within 3 weeks, erections period (morning or otherwise) were next to impossible. felt mildly depressed and generally exhausted. After much reading on this site & others, I stopped taking my AI and started splitting my dose into 3 separate shots and administered them sub-q.

Inside of 2-3 weeks stared to feel better, erections came back, sometimes enough to wake me up. Mood & exhaustion seemed to be improving. Stayed with this protocol up until 7-13-15. During which time I recall just feeling normal, not low or great as some others seem to. I did start to feel fatigued again towards the 7-13-15 lab work. Doc recommended that I go from 3 smaller shots to 2 larger doses and start on a E3D schedule. He also told me to pay attention to how I feel and re start my AI along with my shots (AI at .25 mg this time).

Meanwhile, he is running some additional blood work to which I will go over with him on Monday. I would like to get that “feel great” feeling that apparently comes along when everything is dialed in correctly. Looking for any questions, comments or observations on my current setup. Thanks in advance.

-39 years old
-6’1" tall
-34" waist
-201 lbs.
-Average facial / body hair
-carry fat around waist / stomach area
-no chronic or acute health conditions other than low T
-Current Rx meds: 100 mg/week Test C (200mg/ml) sub-q every 3 days
: 2 pumps androgel (1.62%) every day
: .25mg anastrozole taken same day as injections
no hair loss or prostate drugs ever.
OTC: none other than acetominophin/ibuprophin when needed
2 multivitamins-daily
1 1000ui Vd3-daily
1 Krill oil-daily

-most recent labs from Clinical Pathology Laboratories:

Testosterone, free 444 ng/dl (300 - 1080)
SHBG 17 nmol/l (16.5 - 55.9)
Calc. Free Test 12.6 ng/dl (4.8 - 25.7)
Pregnenolone 44 ng/dl (23 - 173)
c-reactive protein HS 1.2 mg/l (1.0 - 3.0)
DHT 284 pg/ml (112 - 955)
Vit D, 25 OH 33 ng/ml (30 - 100)
Vit B12 366 pg/ml (250 - 1100)
DHEA S 107 ug/dl (103 - 446)
Cortisol A.M specimen 12 ug/dl (7 - 25)
Prolactin 10 ng/dl (3.0 - 30.0)
PSA, Total 0.8 ng/ml (<4.0)
Estradiol/non ultra 44 pg/ml (< 63)
Progesterone <0.2 ng/ml (0.15 - 1.15)
Hemoglobin A1c 5.5 % (4.0 - 5.6)
T3 Total 119 ng/dl (60 - 181)
Free T3 3.5 pg/ml (2.3 - 4.2)
Reverse T3 17 ng/dl (9.0 - 27.0)
T4, Free (Thyroxine) 0.99 ng/dl (0.73 - 1.95)
Thyroid Peroxidase AB <1 iu/ml (<9)
Thyroglobulin AB <1 iu/ml (<4)
Homocystine 16 umol/l (5.0 - 12.0)
Iron, Serum 158 ug/dl (35 - 158)
Unsat. IBC 270 ug/dl (155 - 300)
Calc. Total IBC 428 ug/dl (250 - 450)
Calc. % Iron Sat. 37 % (20 - 50)

Lipid Panel
Cholesterol 207 mg/dl (<200)
Triglycerides 144 mg/dl (<150)
HDL Cholest. 37 mg/dl (>39)
Calc. LDL 141 mg/dl (<100)
Risk Ratio LDL/HDL 3.8 ratio (<3.55)

Comp. Metabolic Panel
Glucose 91 mg/dl (65 - 100)
Bun 15 mg/dl (8 - 25)
Creatine 1.2 mg/dl (0.8 - 1.4)
Sodium 139 meq/l (133 - 146)
Potassium 4.4 meq/l (3.5 - 5.3)
Chloride 103 meq/l (97 - 110)
Carbon Dioxide 24 meq/l (18 - 30)
Calcium 9.4 mg/dl (8.5 - 10.5)
Protein, Total 7.6 g/dl (6.0 - 8.4)
Albumin 4.7 g/dl (2.9 - 4.7)
Calc. Globulin 2.9 g/dl (2.0 - 3.8)
Calc. A/G Ratio 1.6 ratio (0.9 - 2.5)
Bilirubin, Total 0.7 mg/dl (0.1 - 1.3)
Alkaline Phosphate 50 u/l (30 - 132)
SGOT (ast) 21 u/l (5 - 35)
SGPT (alt) 26 u/l (7 - 56)

CBC w/auto diff with platlets
WBC 6.5 k/ul (4.0 - 11.0)
RBC 5.4 m/ul (4.10 - 5.70)
Hemoglobin 16.4 g/dl (13.0 - 17.0)
Hematocrit 47.6 % (37.0 - 49.0)
MCV 88.3 fL (80.0 - 100.0)
MCH 30.4 pg (37.0 - 34.0)
MCHC 34.5 g/dl (32.0 - 35.5)
RDW 13.4 % (11.0 - 15.0)
Neutrophils 55 % (40 - 74)
Lymphocytes 31 % (19 - 48)
Monocytes 8 % (4 - 13)
Eosinophils 5 % (0 - 7)
Basophils 1 % (0 - 2)
Platlet Count 247 k/ul (130 - 400)

Diet: skip breakfast most days (just coffee). Cook most of my meals (lunch & dinner), fast food on occasion. Not really bad but not ideal either.

Train 3 days a week @ 1-1.5 hours per session

Testes do not / have not yet ached.

I do have morning erections most every day. Ability to maintain is not yet affected.

2

Were labs done one week after a weekly injection?

This is our standard reference protocol:
100mg T cyp/eth per week in EOD or twice a week divided doses [you may need 300mg, see below]
1mg anastrozole per week in divided doses at time of injections - best done with liquid 1mg/ml dispensed by the drop
250iu hCG SC EOD to support testes

Testes make a significant amount of pregnenolone. Low pregnenolone leads to lower DHEA and progesterone.

Low progesterone, DHEA-S both point to adrenals.

Injecting T with transdermal T does invite higher E2 levels.

You should take 25mg DHEA per day.
Some [2%] “KAL” brand progesterone cream might be helpful [Amazon]

Get 5,000iu vit-D3 tiny oil based capsules and take one per day, 25,000 for first 5 days.

Why krill oil and not fish oil?

Homocystine is associated with endothelial dysfunction [damage to arteries]. DHEA, T, fish oil, B-complex multi-vits are helpful. Low HDL, estrogen dominance or very low estrogens is harmful]. Some meds can increase homocysteine.

Thyroid: Have you been using iodized salt? Some suggestion of inadequate iodine.
Poor or low absorption of transdermal T products is a symptom of low thyroid function.

Check overall thyroid function:
Measure oral body temperatures

  • when you first wake up. 97.7-97.8 is good, higher is OK, 97.3 is a problem
  • mid-afternoon should be 98.6

E2=22pg/ml is our suggested target. Your lab’s range for E2 is oddly high.

You may be a testosterone hyper metabolizer and guys like that seem to need 300mg/week T cyp/eth to achieve high normal TT/FT.
With this condition, half life of T is short and you need to inject EOD [E2D] or E3D]
Suggest that you try that and drop the transdermal T.
You will have to find balance again with anastrozole as major T–>E2 in skin from transdermals will stop.

Transdermals create large swings in FT, so FT labs are less useful than expected as lab timing can cause major changes in results.

You need steady T levels so anastrozole can balance T levels and provide E2 control and management.

Please read these stickies:

  • advice for new guys
  • protocol for injections - note #29 insulin syringes for injecting T [or hCG].
  • if body temperatures are low, read the thyroid basics sticky

Why do don’t feel better:
T is too low
E2 is too high
thyroid - body temperatures may be low
Training will-power seems great, but training might be exceeding what your body can tolerate

You have done a good job reading and refining your protocol. But it simply is not effective. T4 and poor transdermal T suggest low thyroid function and checking body temperatures will resolve that issue. Lack of iodine might be a cause of that.

3

KSman, thank you for your quick response.

Yes, labs were taken on Monday morning (fasted state) following last injection (Friday a.m.).

I am going in Monday afternoon to go over some additional blood work the doc wanted. I will let you know exactly what it was for & the results ASAP. At that time I am going to push to drop the transdermal and request an increase in my test-c as well as adding Hcg to the list. I had a feeling that I might need to increase my D3 and I will take your advice and up that dose.

As far as the krill vs. fish, doctor suggestion, but he has no problem with me trying the other. He is a very understanding physician and due to what I have learned so far from this site, is extremely impressed with my understanding of everything.

The salt I have been using is non-iodized sea salt. Maybe switch back to iodized salt or supplement?

I have indeed read the stickies, more than once (lots of info to process) and they have helped tremendously in how I approach my doctor concerning my treatment. I am going add DHEA to my morning supplements starting this Monday. I am also going to start adding to my logbook the daily temps / blood pressure. I will post the findings of the additional blood tests this upcoming Tuesday. Thanks, again.

4

Why are you using Androgel and testosterone together? This is odd, and I’ve never heard of this being done or why it would be prescribed together by a physician. Just, totally strange to me, unless there is some good reason I don’t know about.

Plenty of men feel just fine without an AI, so long as estradiol is under 50 and T is in the mid-to-high normal range, about 600 to 1000 ng/dl, such as myself.

You might not even need more T if you decide to drop the Androgel and AI.

HCG is great! I use 100 mg T per week with 500 IU of HCG per week, no AI.

5

KSman, thank you for your quick response.

Yes, labs were taken on Monday morning (fasted state) following last injection (Friday a.m.).

I am going in Monday afternoon to go over some additional blood work the doc wanted. I will let you know exactly what it was for & the results ASAP. At that time I am going to push to drop the transdermal and request an increase in my test-c as well as adding Hcg to the list. I had a feeling that I might need to increase my D3 and I will take your advice and up that dose.

As far as the krill vs. fish, doctor suggestion, but he has no problem with me trying the other. He is a very understanding physician and due to what I have learned so far from this site, is extremely impressed with my understanding of everything.

The salt I have been using is non-iodized sea salt. Maybe switch back to iodized salt or supplement?

I have indeed read the stickies, more than once (lots of info to process) and they have helped tremendously in how I approach my doctor concerning my treatment. I am going add DHEA to my morning supplements starting this Monday. I am also going to start adding to my logbook the daily temps / blood pressure. I will post the findings of the additional blood tests this upcoming Tuesday. Thanks, again.

6

You are iodine deficient. Please get the requested body temperatures.
Please use iodized salt, sea salt is ruining lives.
Others in your household will also have low iodine.
You need an iodine supplement. Suggest 2mg per day for two weeks and note changes in mental clarity.
You can find a multi-vit that lists iodine+selenium and other trace elements.

  • read the thyroid basics sticky

Krill oil is expensive compared to fish oil. There are different grades of fish oil, note the concentrations.

7

Ok, was tested for CMV (Cytomegalovirus) & EBV (Epstein-Barr Virus), both negative. He had concerns this may be a source of my fatigue, test results showed otherwise. After going over results with Doc. he agreed to drop the Transdermal gel. TT was @ 444 (350-1080) / Calc. FT was @ 12.6 (4.8-25.7), so he increased my injectable dosage form 40mg E3D to 80mg E3D. Also taking .5 mg of Anastrozole with every injection. Will have to work on finding the sweet spot again with AI. E2 was 44 (<=63 range). I also added 25mg of DHEA (KAL tablet), Fish Oil gels, 2500iu D3 gels and Kelp (Natures Way capsules per Thyroid stickie-may up the dose)to my morning Multivitamins. I am switching back to iodized salt as well. Waking body temp for the last 5 days has been around 97.1 to 97.3, however, mid afternoon is right on target 98.6 to 99 (in South East Texas). He does not feel Hcg would be of any benefit and therefore did not prescribe it. I will be retesting blood exactly 1 month from today to evaluate how well I responded / feel to the change in protocol. Hopefully, the newly added supplements will help level things out as well. Updates to follow after 8-28-15 lab review.

8

Brickhead, my apologies for not responding earlier. To answer your question: I was initially started on the gel (1.62% @ 2 pumps per day) to begin with. After my next blood work, Test - C injections. were added @ 1ml every other week (200mg/ml).he instructed me to split the dose in 1/2, .5ml per week and continue the gel. This would, in theory keep the hi’s and low’s more stable. I did notice the hi/low effect. At my next blood work, TT was 690 (292-1052), Cal. FT was 20.3 (4.8-25.0), E2 was 69 (<=63). I felt great up until around 2 weeks prior to labs, very mild depression, little to no morning erections, very tired around mid-day. After lab review kept, meds the same but added .5 mg Anastrozole on Mon. & Thurs…

I stopped taking the AI on account of how i felt after 2 weeks (terrible) After which i split my weekly dose into 3 smaller doses and started sub-q injections. inside of a short time started to feel much better.The next labs (most recent)are the ones in my original post. I have not yet been able to persuade him to add Hcg to my list yet. Long winded, I know, but tried to think of things taht you may want to know.

9

Well, from my previous post on 7/28/15, after adding the recommended supplements, I can honestly say I am starting to feel better. waking temperature has been, on average, 97.4F. BP upon waking is around 123/86. I really like the E3D schedule as well as the increased dose (80mg per shot/sub-q). I have noticed that my arms (@ elbows & wrist) seem to be aching. Not unbearable but uncomfortable, for certain. All else is starting to feel much better. Increased energy, libido, erections,etc. Any suggestions on what I can do for the elbow / wrist aching?

10

Joints may be indicative of low E2. Can you get labs soon?

Any progress on body temperatures?

11

Most recent lab results. Taken the day after injection on 8/26/15 (Doc’s advice). I am on a E3D injection schedule, 80 mg / sub-q. I feel fantastic, joint pain/discomfort subsided. Here we go:

CBC W AUTO DIFF WITH PLATLETS
WBC 5.20 4.00 - 11.00 K/UL
RBC 5.36 4.10 - 5.70 M/UL
HEMOGLOBIN 15.70 13.00 - 17.00 G/DL
HEMATOCRIT 47.80 37.00 - 49.00 %
MCV 89.20 80.00 - 100.00 fL
MCH 29.30 37.00 - 34.00 PG
MCHC 32.80 32.00 - 35.50 G/DL
RDW 13.50 11.00 - 15.00 %
NEUTROPHILS 51.00 40.00 - 74.00 %
LYMPHOCYTES 32.00 19.00 - 48.00 %
MONOCYTES 12.00 4.00 - 13.00 %
EOSINOPHILS 5.00 0.00 - 7.00 %
BASOPHILS 0.00 0.00 - 2.00 %
PLATE CNT 245.00 130.00 - 400.00 K/UL

VITAMIN D, 25 OH 43.00 30.00 - 100.00 NG/ML

DHEA-S 171.00 103.00 - 446.00 UG/DL

CMP
GLUCOSE 94.00 65.00 - 100.00 MG/DL
BUN 19.00 8.00 - 25.00 MG/DL
CREATINE 1.30 0.80 - 1.40 MG/DL
eGFR AFR.AMER 74.00 >60 ML/MIN/1.73
eGFR NON AA 61.00 >60 ML/MIN/1.73
CALC BUN/CREAT 15.00 6.00 - 28.00 RATIO
SODIUM 139.00 133.00 - 146.00 MEQ/L
POTASSIUM 4.30 3.50 - 5.30 MEQ/L
CHLORIDE 104.00 97.00 - 110.00 MEQ/L
CO2 26.00 18.00 - 30.00 MEQ/L
CALCIUM 9.70 8.50 - 10.50 MG/DL
PROTEIN, TOTAL 7.00 6.0 - 8.40 G/DL
ALBUMIN 4.50 2.90 - 5.00 G/DL
CALC. GLOBULIN 2.50 2.00 - 3.80 G/DL
CALC. A/G 1.80 0.90 - 2.50 RATIO
BILIRUBIN, TOTAL 0.60 0.10 - 1.30 MG/DL
ALKLN PHOSPHATE 43.00 30.00 - 132.00 U/L
SGOT (AST) 19.00 5.00 - 35.00 U/L
SGPT (ALT) 19.00 7.00 - 56.00

ESTRADOIL 38.00 <=63 PG/ML

T3 TOTAL 113.00 60.00 - 181.00 NG/DL
FREE T4 1.01 0.73 - 1.95 NG/DL
TSH 1.50 1.50 - 4.70 UIU/ML

LIPID PANEL
CHOLESTEROL 243.00 < 200 MG/DL
TRIGLYCERIDES 105.00 < 150 MG/DL
HDL CHOLES 36.00 > 39 MG/DL
CALC LDL 186.00 < 100 MG/DL
RISK LDL/HDL 5.17 < 3.55 RATIO

TESTOSTERONE, FREE/TOTAL W SHBG
TESTOSTERONE 1052.00 300.00 - 1080.00 NG/DL
SHBG 12.00 16.50 - 55.90 NMOL/L
FREE TEST 36.60 4.80 - 25.70 NG/DL

==============END OF TESTED LAB RESULTS==================
As of a few posts back, I have cut out sea salt and switched back to iodized. I have also been supplementing with Natures Way Kelp capsules. The mulit vitamin I take has iodine / selenium as well. Body temps seem strange, immediately upon waking, prior to ANY activity, have been from 96.3 - 97.3. Yet, daily temps prior to lunch time and before leaving work (office job) have been 98.6 on the dot. What do you think?

HEMOGLOBIN A1c 5.60 4.00 - 5.60 %

12

You can be cold in AM and normal later.
T3 and fT4 are a bit low
fT3 lab work would have been good, that regulates your body temperature and metabolic rate

Cholesterol is adverse and RISK.
Suspect blood pressure getting higher, check later in day.
Suggest for hear/artery health:
vit-D3 as suggested earlier
increase DHEA to 50mg/day and take with meal that has less fiber and more fats/oils
high potency B-complex multi vits with trace elements including iodine and selenium
chromium picolinate to improve insulin sensitivity
continue fish oils and do not take with high fiber foods
red rice yeast, large bottles at Sam’s Club, do not know where else
get E2 nearer to 22pg/ml
ubiquinol form of C0Q10
vitamin C
natural source vitamin E

Need to reduce A1C:
Avoid sugars, white bread, rice and other high glycemic index foods.

If you can improve thyroid function, mitochondria will burn more lipids in your blood stream.
CoQ10 in ubiquinol form, get spelling right, will help mitochondrial function as well.

Your insulin resistance, cholesterol levels are linked and thyroid function is a common element.

Lower E2 will enable some more fat loss potential and enhance the benefits of your TRT.
To change E2=38–>22, increase dose of anastrozole by a factor of 38/22 = 1.72, so new dose is 0.25 x 1.72 = .43 mg
To dispense amounts of anastrozole in such doses, you need a liquid product. Dissolve tabs in vodka to get 1mg/ml and dispense by the drop. Doc needs to Rx more anastrozole. Count drops per ml, and calculate to nearest drop.

Suggest higher intake of iodine for a while.

Your earlier fT3 and low body temperatures suggest elevated rT3 which can be from adrenal fatigue which can be from stress or high stress events. See thyroid basics sticky for these terms and note Wilson’s book on adrenal fatigue. Cortisol profile could be adverse.

1 Like
13

I’m going to go down from the top and address each line item. I do have questions on most of them.

T3 was 113 in a range of (60 - 181). fT4 was 1.01 in a range of (0.73 - 1.95),what is a good level to shoot for?

fT3 will be pulled on 10-20-15. Do you recommend any additions or subtractions to the list of labs that I posted on 7-23-15?

Cholesterol is being addressed with my diet. I have been making changes to try and better manage this issue.

I check my BP most days in the morning (127/83 today). Seems to be pretty consistent but will continue to monitor. I have not noticed any reading that gave me cause for alarm, yet.

I take 1 Vit D3 gel 2,000iu in addition to my multi every morning. The multi contains Vit D 2,000iu as well, Should it be more?

I will increase my DHEA dose to 50mg. my current level is 171 (range of 103-446 ug/dl). What level should I try for and why?

The multivitamin I take (Ultraman from Vitamin World) has B1-50 mg, B2-50mg, B6-50mg, B12-100mcg, Iodine-150mcg, Selenium-200mcg. Is this enough or do you recommend a different Multi? I am taking 3 Natures Way Kelp capsules each morning. They contain: Iodine 360mcg, Sodium 35mg, Kelp 600mg per capsule. I decided on those per the Thyroid sticky. Your thoughts on that?

I will pick up some chromium picolinate on my next supplement run. Brand & dosage?

Fish oil is good.

Red rice yeast, same as CP above. Brand & dosage?

E2. Doc has no problem prescribing me Anastrazole. I am currently taking .5mg the morning after my injections. Should I change when I take it? I noticed your calculation for changing the AI dose. You came up with .43mg and I am taking just a tad over that. Do you see any issues with the .007 over? I would like to try the liquid form and am looking into converting my tablets onto such.

UBQ COQ10, same as CP above. Brand & dosage?

Vitamin C. Multi has 300mg. Is that enough?

Natural source vitamin E hopefully will come from improved diet.

Reducing A1C, again better overall diet should suffice.

Higher intake of Iodine. Does the amount of Iodine I am getting from my multi + kelp capsules look sufficient or should I look into other means?

Thanks again for you help.

Will

14

[quote]Cadmus1 wrote:
I’m going to go down from the top and address each line item. I do have questions on most of them.

T3 was 113 in a range of (60 - 181). fT4 was 1.01 in a range of (0.73 - 1.95),what is a good level to shoot for?

*** mid range for T3 is 120, you are 113. midrange for fT4 is 1.34, you are 1.01

fT3 will be pulled on 10-20-15. Do you recommend any additions or subtractions to the list of labs that I posted on 7-23-15?

Cholesterol is being addressed with my diet. I have been making changes to try and better manage this issue.

*** most cholesterol is made in your liver. Health news recently concluded that reducing cholesterol in foods is not very effective. Lowering fat intake can be useful. TRT often reduces total cholesterol while not changing HDL.

I check my BP most days in the morning (127/83 today). Seems to be pretty consistent but will continue to monitor. I have not noticed any reading that gave me cause for alarm, yet.

*** check BP during the day, could be higher.

I take 1 Vit D3 gel 2,000iu in addition to my multi every morning. The multi contains Vit D 2,000iu as well, Should it be more?

Optimal target for vit-D25 lab work is 60, many need more than 4000iu.

I will increase my DHEA dose to 50mg. my current level is 171 (range of 103-446 ug/dl). What level should I try for and why?

*** above mid range. Lower DHEA is associated with cardio specific problems. DHEA starts dropping in most men by mid 30’s

The multivitamin I take (Ultraman from Vitamin World) has B1-50 mg, B2-50mg, B6-50mg, B12-100mcg, Iodine-150mcg, Selenium-200mcg. Is this enough or do you recommend a different Multi? I am taking 3 Natures Way Kelp capsules each morning. They contain: Iodine 360mcg, Sodium 35mg, Kelp 600mg per capsule. I decided on those per the Thyroid sticky. Your thoughts on that?

*** above looks VERY good!!! great choice

I will pick up some chromium picolinate on my next supplement run. Brand & dosage?

*** its in your multi-vit now

Fish oil is good.

Red rice yeast, same as CP above. Brand & dosage?
*** Can’t recommend above suggestions I may have made

E2. Doc has no problem prescribing me Anastrazole. I am currently taking .5mg the morning after my injections. Should I change when I take it? I noticed your calculation for changing the AI dose. You came up with .43mg and I am taking just a tad over that. Do you see any issues with the .007 over? I would like to try the liquid form and am looking into converting my tablets onto such.

*** continue with .5mg and see where labs go. E2 may go towards 22 * .5/.43

UBQ COQ10, same as CP above. Brand & dosage?

***Ubiquinol 50mg might be good enough. Not cheap. I have been using from lef.org
DO not confuse with [ubiquinone, ubidecarenone, coenzyme Q]
Friend was on high dose statin drug and had chronic cough from statin drug induced low CoQ10, weakening muscles and reduce left ventricle output caused high blood pressure in lungs and the cough. The result is the same symptom of congestive heart failure. Ubiquinol 100mg fixed that. He took bottle to a nutrition store and they provided their house brand and his cough returned. So not all are the same or kid in the store confused.

Vitamin C. Multi has 300mg. Is that enough?
*** You could take more.

Natural source vitamin E hopefully will come from improved diet.
*** probably not enough!

Reducing A1C, again better overall diet should suffice.
*** chromium picolinate, improved thyroid function and improved mitochondrial function will reduce lipids and improve insulin sensitivity. Vitamins, antioxidants and fish oil also help mitochondria as well as improving cell wall permeability and receptor function.

Higher intake of Iodine. Does the amount of Iodine I am getting from my multi + kelp capsules look sufficient or should I look into other means?
*** vitamin has 150mcg, barely enough. Using iodized salt with this will help.

Thanks again for you help.

Will

[/quote]

15

My biggest concern is insulin sensitivity and arterial health.
E2 when too high is toxic to the endothelial cells in the arteries.
Suggested supplements address endothelial health, cell wall permeability.
Improving metabolic rate, thyroid and mitochondrial function will improve A1C and burn calories.

Mitochondria produce free radicals that can damage the mitochondria and the cell. Suggested antioxidants help with enzyme actions that clean up the free radicals. r-Alpha lipoic acid and cetyl-L-carnitine [ACL] are very targeted towards mitochondrial health.

Mitochondria make ATP inside the cells and ATP is the universal currency of cellular energy.

16

Recent labs, drawn on 10/19/15 @ 9:08am (fasted state):

CMP
…current…last…range
Glucose909465-100 mg/ml BUN````````````````21````````````19``````````8-25 mg/ml Creatine```````````1.3```````````1.30.8-1.4 mg/dl
eGFR AA7474ml/min/1.73 >60 eGFR Non AA``````61````````````61ml/min/1.73 >60
Calc. Bun/Creat```1615``````````6-28 Ratio Sodium139``````````139133-146 meq/l Potassium4.44.3``````````3.5-5.3 meq/l Chloride103104`````````97-110 meq/l CO2`````````````````23`````````````2618-30 meq/l
Calcium9.89.78.5-10.5 mg/dl Protein, Total```````7.8````````````7````````````6.0-8.4 g/dl Albumin``````````````4.74.52.9-5.0 g/dl Calc. Globulin```````3.1``````````2.52.0-3.8 g/dl
Calc. A/G Ratio`````1.5``````````1.8````````````0.9-2.5 Ratio
Bilirubin, Total```````0.5``````````0.6````````````0.1-1.3 mg/dl
Alkalin Phosphate``````5043`````````````30-132 u/l SGOT (AST)`````````````2319`````````````5-35 u/l
SGPT (ALT)`````````````25```````````19`````````````7-56 u/l

Lipid Panel
…current…last…range
Cholesterol``````````````````255`````````````243<200 mg/dl Triglycerides````````````````98``````````````105<150 mg/dl
HDL Cholesterol43``````````````36>39 mg/dl
Calc. LDL Cholesterol`````192186`````````<100 mg/dl Risk Ratio LDL/HDL```````4.475.17`````````<3.55 Ratio

CBC W/Auto Diff with Platlets
…current…last…range
WBC6.1````````````````````5.2``````````````4.0-11.0 k/ul RBC```````````````````5.635.364.10-5.70 m/ul Hemoglobin``````````17.0``````````````````15.713.0-17.0 g/dl
Hematocrit````````````51.147.8`````````````37.9-49.0 % MCV```````````````````90.889.2`````````````80.00-100.00 fl
MCH```````````````````30.229.3`````````````37.0-40.0 PG MCHC33.332.8`````````````32.0-35.0 g/dl RDW```````````````````13.5`````````````````13.5``````````````11.0-15.0 % Neutrophils```````````52````````````````````51````````````````40-74 % Lymphocytes`````````33`````````````````````32```````````````19-48 % Monocytes`````````````9`````````````````````12````````````````4-13 % Eosinphiles````````````````5`````````````````````5`````````````````0-7 % Basophiles`````````````1`````````````````````0`````````````````0-2 % Platlet Count``````````259245````````````````130-400 k/ul

Iron Binding Capacity & % Saturation
…current…last…range
Iron, Serum````````````93158``````````````35-158 ug/dl Unstaturated IBC```````346270``````````````155-300 ug/dl
Calc, Total IBC```````439``````````````````428``````````````250-450 ug/dl
Calc. % Iron Sat.`````21````````````````````37```````````````20-50 %

…current…last…range
PSA0.9```````````````````0.8``````````````<4.0 ng/ml E2```````````````````52`````````````````````38``````````````````<=63 pg/ml HA1c````````````````5.8````````````````````5.6````````````````<4.5 % progesterone``````0.4````````````````````<0.2```````````````0.15-1.15 ng/ml Prolactin````````````5.0````````````````````10.0```````````````3.0-30.0 ng/ml Free T4`````````````1.02````````````````````1.01``````````````0.73-1.95 ng/dl TSH``````````````````1.10```````````````````1.50``````````````0.5-4.7 uiu/ml B-12452366```````````````250-1100 pg/ml C-Reactive protein``<0.5<0.5<0.8 mg/dl DHEA Sulfate````````225`````````````````````171```````````````103-446 ug/dl Free T3`````````````3.5`````````````````````3.5````````````````2.3-4.2 pg/ml Reverse T3```````````16.9``````````````````17`````````````````9.0-27.0 ng/dl Homocysteine`````````10.7```````````````````16`````````````````5.0-12.0 umol/l Pregnenolone`````````14````````````````````44``````````````````23-173 ng/dl Total Testosterone```886```````````````````1052````````````````300-1080 ng/dl SHBG```````````````````13`````````````````````12```````````````16.5-55.9 nmol/l Free Testosterone`````29.7```````````````````36.64.8-25.7 ng/dl
Vit-D 25 OH``````````````50`````````````````````43`````````````````30-100 ng/ml
DHT``````````````````````486```````````````````284````````````````112-955 pg/ml

Current is as of 10-19-15, last indicates last time test was run. E2 is higher, Doc recommended upping Anastrazole from .5mg on injection day to 1mg EOD and retest on 4 weeks.
Cholesterol is still climbing, have been tracking what I eat now on a regular basis to try and mitigate this issue. HDL increasing (good) but not at ideal level. LDL is also high. Suggestions?

Still no Hcg yet, don’t really know if its worth pursuing that much. I did however give him a copy of the Hcg protocol of Dr. Crisler from this forum. He did express a lot of interest in it. Maybe next time.
He did mention to me about IGF-6 & IGF-3 injections as well as Reservatrol. told me to read up on it and see if I would be interested in that. Opinions on that?

I also mentioned that I would like to incorporate a B-complex Injection along side my current protocol. Didn’t have a problem with that, just needed info from my pharmacy. Opinions/Suggestions?

DHEA at 50mg every day. Increase dose?

Considering increasing my fish oil. what would be a ideal EPA / DHA dose to shoot for?

COq10: took your recommendation with me to the Vit shoppe, but ending up picking up the regular Coq10 by mistake (Homer Simpson moment). Should I set it aside and get the ubiquinol style?

WT

17

More than 50mg DHEA could drive up E2
Take will meal that has more fats and oils and avoid high fiber meals.
Same for fish oil.

E2=52:
new anastrozole dose would be = 1.16 X 52/22 = 2.75mg/week
1.75mg E3D or .79mg EOD
E3D would be a easier routine with your injections

You might be better dropping the transdermal T. I think that its why E2 is so high.

Increasing anastrozole from 1.16 mg/week to 3.5mg/week is insane.

TSH is nicer, but fT4 is still low.
How are body temperatures?

Try Ubiquinol and see where cholesterol goes.

I think that low body temperatures, low fT4, iodine deficiency are a big factor. What have you done about iodine?
fT3 should be supporting good body temperatures. rT3 is not an obvious problem, but might be a contributor and my thoughts re mitochondria still stand. Focus is now not on fT3.

What physical exercise are you getting?

Most cholesterol is made in the liver and dietary changes do not have large effects.

A1C suggests that your average glucose levels have increased.
Are you avoiding high glycemic index foods?

18

I’ve attached an image of what I currently take on a daily basis, usually at lunch time. here is a breakdown if pic doesn’t show up:

1 - Multi (Vitamin Shoppe 1 daily mens)
3 - Kelp (natures way 600mg)
1 - Vitamin C (Solaray 500mg)
1 - CoQ10 (changing to ubiquinol form)
1 - D3 (Jarrow 2500iu)
2 - DHEA (KAL 25 mg)
1 - Fish oil (VS 1000mg fish oil / EPA 300mg / DHA 200mg)

Currently taking .40ml of 200mg/ml concentration E3D, sub -q. Figured it is about 168 mg of test,after the ester is cleaved off, in 6 days.
Also taking .50 mg of Anastrazole on day of injections (AM Injection)

*Transdermal Test was discontinued in January

I spoke with my Pharmacist and he told me he could easily convert my Anastrazole prescription to a liquid form and be administered by a graduated dropper. He just needs the concentration.
Would 1 mg/ml as suggested be sufficient?

As far as body temps go, I have been hovering around 97 upon waking, and have been at 98.6 around lunch time prior to eating. I have switched back to Iodized salt exclusively since August and have been taking the Kelp capsule daily. Would you recommend that I take an Iodine test,such as the 24 hour urine,or supplement with an additional source?

Exercise: 4 days a week 1-1.5 hours at a time at a moderate level (increased heart rate, heavy breathing, sweating ) Lots of water during along with Creatine & BCAA’s.

A1C - Yes I have been actively trying to reduce those types of foods from my overall diet.
I have actually started to analyze (macro/nutrients) the content of what I eat and have been taking steps to get this under control. Although I don’t think I eat too terribly bad, there is obvious room for improvement .

19

If you are taking 3x600mcg iodine in kelp you should be OK.
TSH did improve. fT3 should have you warmer in AM.
Getting thermometer deep under tongue?

1mg/ml anastrozole works well for normal anastrozole responders. Count drops per ml with a dropper bottle, do math and dispense in drop increments.

20

I have been using a digital thermometer, sublingual, since I’ve started checking my body temps. The last 3 days have been: 96.8, 97.0, 96.9. I check as soon as I get audible conformation from the thermometer. I have read on a few different website about using a traditional glass tube mercury thermometer for better accuracy. Either way, I do test prior to any activity. If my temps do not rise to & stay steady at the desired levels, should I increase my Kelp dosage or add and additional iodine supplement?

Pharmacy will have my AI (oral suspension) ready this Friday @ 1mg / ml. This will undoubtedly help with better dosing in place of cutting small pills up.

What do you think about adding any peptides to a TRT regimen? Doc mentioned them on the last visit. He is not pushing them but he knows I am not a typical vanilla patient and like to be informed more than the average guy. Some claim them to be a great addition while others say to skip and just increase test dose. Just looking for thoughts form people in the know.

Dropped CoQ10 as of last post (10-29-15) and added ubiquinol CoQ10 50mg in its place.

Will have some follow up labs near the end of the month. Mainly for E2 level. but I’m going to run another lipid panel again. Hopefully the Ubq-Coq10 will have an affect on my cholesterol levels. Any other tests that might come in handy in 4 weeks or just wait until my next regular appointment?