Bloodwork 2 Yrs After Stopping TRT- Where to Go from Here?

Pharma / TRT Testosterone Replacement
1

Background
29 Years Old
170 lbs, 12% BF
5’10"

AAS use followed by unsuccessful PCTs. Resorted to TRT with androgel for 1 year. After disliking it, attempted another PCT restart with HCG/Clomid. After that failed, decided to see what my hormone levels did on their own. Stayed patient for 2 years. To date, these are the best results I’ve had since stopping TRT.

I feel alright, not awesome. Sex drive comes and goes but no problem performance wise. Training has been good for the most part, my weight is down a bit due to a recent injury, normally about 175-180 lbs at this bodyfat %.

Given this recent bloodwork, I’m giving thought to another restart attempt. Although I should note that these numbers are about 30% higher than a year ago, which also makes me wonder if I should be a little more patient without the use of any further drugs. The only real concern besides the test on lower end of the spectrum is the high SHBG.

Thoughts?

Follicle Stimulating Hormone (FSH)
4.3 (<9.5 IU/L)

Luteinizing Hormone (LH)
3.1 (1.1-8.8 IU/L)

Prolactin
4.9 (3.8-20.6 ug/L)

Estradiol
<40 (<157 pmol/L) - Wish I got an exact # for this…Not sure why I didn’t

Testosterone
14.1 (8.4-28.8 nmol/L)

Testosterone Free Calculated
195 (115-577 pmol/L)

Testosterone Bioavailable Calculated
4.6 (2.7-13.5 nmol/L)

Sex Hormone Binding Globulin
58.4 (10.0-70.0 nmol/L)

And TSH was 1.98, not on the test before this.

Thanks

2

Bump. Any insight would be appreciated

3

You may not be able to get a direct FT lab done where you are.

With low E2, we can assume that low fT means low fT–>E2 and lower E2 levels.

SHBG increased with higher E2 and decreases with higher T levels, probably bio-T. If you increase T levels, SHBG may improve.

SHBG can be elevated by liver problems in some cases. Liver produces SHBG to scavenge sex hormones from the blood stream.

Your PCT could easily be wrong as body building and steroid forums typically suggest doses of SERM’s and hCG that are way too high which leads to very high E2 levels that anastrozole cannot manage. And stacking SERM’s or SERM+hCG is really wrong.

fT levels, direct or calculated have a lot of noise because fT is released in pulses and fT has a very short half-life. A lab value can easily catch a high or a low. Your high SHBG implies that fT is getting reduced by SHBG+T which is not bio-available.

You did not do well on TRT. Most likely reason is elevated E2. On TRT, E2=80 pmol/L - 22 pg/ml seems optimal for most guys in terms of mood, libido, energy etc.

TSH=1.98 is not good, the ranges are useless.
Your body temps, libido and energy may be low and often this is caused by not using iodized salt. Because the symptoms of low thyroid function are mostly the same as low=T, one could be on TRT and think that the TRT was not right.

See last paragraph in this post to self-eval overall thyroid function.

Low thyroid function slows down every cell, tissue, organ and system in your body and might limit ability to recover your HPTA with a restart.

Labs:
AST/ALT
CBC
hematocrit
fasting glucose
fasting cholesterol - can be too low

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • HPTA Restart

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

4

Thanks for your input. I have iodine supplement on order from a link in that thread. What course of action might you recommend?

  1. HPTA restart as outlined in your sticky

and/or

  1. Re-test values in the future after correcting thyroid function

Thanks again

5

Sometimes people feel better with iodine replenishment within a week. So you can see what timetable that suggests.

Your body temps may tell you more than thyroid lab work.

If your PCT was not good VS suggestions in the Restart sticky, then another attempt may yield good results.

What are you going to do to provide selenium?

6

Ok, I will update this thread in a couple of weeks with new bloodwork to see where I’m at. I already tested body temps and they were lower than what was suggested as optimal in your sticky. My average daily temperature was 97.7

My PCT was actually mild, tough to remember exactly as it was a couple years ago but I’m certain no AI was involved. Just a mild dose of HCG + Clomid. So in that respect there was no management of estrogen levels and was no good.

Based on my current diet, it seems I should be getting enough selenium already and shouldn’t be too worried about it.

If my next round of bloodwork does not yield favorable results I will attempt the restart.

7

Should never stack hCG and a SERM together, both are pounding on the LH receptors and E2 can be high. You stop and the high E2 shuts down your HPTA.

8

Yeah, a PCT done on bad information of course. I’ll be sure to do it right if the next round of bloodwork is just as bad.

Thanks again, I will bump this in a couple of weeks

9

An updated lab, almost a year later with not much changes. Added Iodine supplement into mix and eating a stupid amount of Brazil nuts hasn’t yielded much improvement. Temperatures still low. Labs:

ALT
32 <50U/L

AST
27 <36U/L

Hematocrit
0.42 (0.40-0.50 L/L)

WBC
4.7 (4.0-10.0) 10*9/L

RBC
4.64 (4.20-5.40 10*12/L)

Hemoglobin
143 (135-170 g/L)

Glucose Fasting
5.0 (3.3-5.5 mmol/L)

Cholesterol
3.61 (2.00-5.19 mmol/L)

TSH
4.14 (0.32-5.04 mU/L)

T4 Free
13.0 (10.6-19.7 pmol/L)

Follicle Stimulating Hormone (FSH)
4.5 <9.5 IU/L

Luteinizing Hormone (LH)
2.8 (1.1-8.8 IU/L)

Estradiol
75 (<157 pmol/L)

Testosterone
16.2 (8.4-28.8 nmol/L)

Testosterone Free Calculated
236 (115-577 pmol/L)

Testosterone Bioavailable Calculated
5.5 (2.7-13.5 nmol/L)

Sex Hormone Binding Globulin
56.0 (10.0-70.0 nmol/L)

10

Bump

11

Why did you stop TRT ( I read your OP, but it just says you disliked it?)? Have you been doing anything else to try a restart?

12

Stopped in hope to do a restart, considering I was only 27 at the time I stopped it

Also didn’t have access to good endocrinologists. Prescribed me Testosterone and that was it. Didn’t think about fertility nor managing high E2

13

Did you do another PCT after April 2017, as per the TRT sticky?

14

Yes I did, not per the sticky but somewhat similar using HCG and Clomid. Of course bad knowledge did not manage E2 with an AI and should’ve used nolva instead. It failed, causing my levels to crash again and I’m wondering if I should try another restart as outlined in the sticky, or just get back on TRT.

15

You’ve been very patient so far, so unless you’ve felt terrible for a while, I’d try the restart in this TRT forum - after asking more questions to ensure you’re doing it correctly. Doesn’t seem like you’ve much to lose from another PCT

16

That’s what I was thinking. My symptoms aren’t terrible, but poor enough that I feel some action should be taken. That bloodwork isn’t great for a 30 year old, and problem is no endocrinologist will see me with these “normal” numbers

17

Sounds like doctors are treating the numbers and not the symptoms.

As TSH of 4.0 is insane. No Free T3, no antibodies tested is not a complete picture of what’s going on. It sounds as if they would rather not find a problem so the state healthcare can treat only the most severe cases.

Even self medicating TRT will yield mediocre results with a TSH of 4.0.

18

Updated labs as of today 05-06-2018:

Follicle Stimulating Hormone (FSH)
5.6

<9.5
IU/L

Luteinizing Hormone (LH)
2.6

1.1-8.8
IU/L

Testosterone
19.4

8.4-28.8
nmol/L

Testosterone Free Calculated
276

115-577
pmol/L
Method of Vermeulen

Testosterone Bioavailable Calculated
6.5

2.7-13.5
nmol/L
Method of Vermeulen Interpret BAT and cFT results with
caution in presence of significant
hypoalbuminemia.

Sex Hormone Binding Globulin
59.9

10.0-70.0
nmol/L
When assessing testosterone status,
testosterone and SHBG should be tested on
the same specimen.

Total testosterone not bad but high SHBG yet again…Quite lost at this point. Numbers within range so can’t get a referral to an endo. Tempted to try the restart

19

SHBG is the problem, it’s killing your free T, which is 1.43 %, 2-3% is considered normal. You won’t feel better until you hit at least 2-3% free T. In your case Total T should be ignored as it’s inflated do to high SHBG.

You just need a knowledgeable doctor to make the high SHBG connection, don’t give up because of a foolish doctor. All your doctors have to do is calculate TT and SHBG to see your free T is low.

Free T measured directly has it’s problems, the half life of Free T is an hour, so half hour later it could be low again. Flirt with an attractive woman and see it sore.

These ranges for SHBG are so absurd, our labs here in the states would have you over the top of the ranges at 55 nmol/L, your state healthcare has stacked the deck in their favor, not yours.

Restarts don’t work man, you need to go private.

20

Thanks for the input! Agreed 100% with what you’re saying, I’m in Canada, and even private endos won’t see me due to bloodwork and age. I do have a consult with a US clinic though

I know restarts have high failure rate, but right now I’m feeling like I have nothing to lose from it. If it fails, then TRT