Low LH & FSH. High E2, Moderate Test

Pharma / TRT Testosterone Replacement
42

Then I do not know how to read the hormone results as things are in a state of change.

43

@KSman I understand that. I might be an over responder because i felt good the first time I took the AI and then I started to feel like crap. Once i get back on AI I will do maybe .25mg/week.

My main concern is my low FSH. This would mean that I am infertile and that my testes are failing? Would a clomid restart protocol be advised? I have clomid already but im just asking. I also want to be more informed before I seek a doctor since it’s obvious that people around here know more than most doctors.

44

Low FSH is odd, but some LH is keeping T levels up.
Hard to understand this odd situation. Maybe part of the transient.

Start AI again and stay steady, need to allow whole HPTA to adjust, then do labs: TT, FT, E2, LH/FSH.

See what the labs are later. There is always a sperm could option later on.

45

@ksman, i’ll start AI again. The only info i’ve been able to find is from searching Isolated FSH Deficiency in males.

1 Like
46

Hi guys I’m back. Sorry I’ve been gone so long. I kinda just gave up on life for a few months.

Long story short, I got prescribed Test Cyp, Anastrozole and HCG. I was prescribed 200mg Test Cyp weekly but I know I should only do 100mg weekly, at least to start. Protocol is 2x/week 50mg test cyp, .5mg Anastrozole, and 250u HCG.

I’ve read around that 100mg test cyp weekly gets a male to roughly 500-600. Is this true even if my baseline level is ~450?

Should I consider taking 150mg (75,75) test cyp weekly in hopes of reaching 800-1000? Since 800-1000 seems to be a good range for most folks.

Since I am taking T+HCG+AI, should I expect the 100mg test cyp weekly to get me to 800-1000?

I am starting off at .5 mg anastrozole twice weekly and will adjust up or down to hit the sweet spot of E2=22

Is 4 weeks enough time for blood work or should I wait 6 or 8 weeks? And blood work should be taken in between shots? So approximately 42 hours after my last shot?

Am I ok doing the simple panel that is CBC, TT, E2, LH and FSH. Or is free test and shbg necessary each time?

Thanks again guys.

47

Guess I messed up the HCG frequency. It seems I should be doing 250iu EOD instead of just twice weekly with my test cyp injections.

I was given a 5000iu bottle of HCG which will last me about 7 weeks. From reading around it seems that HCG is only good for 4 weeks after reconstituting. I’ve also read about freezing it in individual syringes. But I also read that freezing it damages the HCG. Thoughts anyone?

48

Many use 10,000iu at 250iu EOD lasting 80 days no problem. The pharma companies have not tested how long the vials last. Regulations require a number and they make it up.

5000iu 250iu EOD will last 40 days, 20 doses EOD.

TRT wipes out your own production, it is testosterone replacement, not supplementation. Does not matter what your baseline was.

100mg normally gets guys to ~850-900, hCG ads a bit more, in my case at age 47 it increased T by 17% and that response can be highly individualistic. Body weight can be a factor in TT, FT response to T injections.

Lab timing affects results. If you change lab timing, results can change from that. Try to always do labs halfway between injections. Time of office visit can be bad.

Try to have labs setup and get tested 10 days before you see doctor so you can discuss results with the doctor instead of having a nurse call a say things are good after an office+labs visit.

4 weeks would yield good numbers and allow for a E2 tune up.

However, if you feel great, what is the hurry? If you feel like crap, then we need to do labs sooner to try to find out whats going on.

Never test LH/FSH on TRT as they will be ~zero.

At 4 weeks test only:
TT
FT
E2

CBC, hematocrit, AST/ALT may take more than 4 weeks to show any changes of interest.

If you have TT,FT,E2 there is normally little reason to test SHBG in most cases as it reflects your E2 management.

49

All good info, thank you.

All labs will be private labs. I’m going to a small clinic and I always go straight to the doctor. He has never prescribed Test, AI or HCG to anyone before. He has only prescribed Test gel and patches but still with no AI. I had to educate him on the subject. The only part I screwed up on was the HCG. Everything else I have a 10 wk supply but the HCG only 40 days. I’ll have to go in there in 30 days or so and ask for more, shouldn’t be a problem.

I’ll do TT, FT and E2 at 30 days just to see where I’m at and show the doctor. I need to go in to ask for more HCG anyway and visits are only $25. Everything is out of pocket.

Thank you KSman, for everything you do. I only wish you would give us your PayPal address so we could all send donations to you.

50

@KSman

Sorry to bug.

I seem to be peeing a lot. This would be due to the AI?

Also, what do you know about HCG causing leukemia? My doctor said that was his only concern with prescribing HCG but he prescribed anyway because I insisted. I’m guessing that happened with people that use high amounts of HCG for long periods of time? I have not been able to find any info on HCG causing leukemia. What should I pay attention to in blood tests for this matter?

51

Wanted to add. Shortly after my 3rd shot of HCG 250iu I experienced a lot of sweating. I had to turn on the A/C and point it straight at me. Is this normal, what could it be?

52

It’s not unusual to have some side effects before your system gets used to the T again. I had some pretty profuse sweating and anger for a few months. Seems to have subsided.

53

Update.

Yesterday was my 4th shot of test cyp 50mg and I took only .25mg adex. Previous 3 shots have been taken with .50mg adex and I feel as if my E2 went too low? The day after my 3rd shot test with .50mg adex I woke up with really sore knees. A weird type of pain that I have never experienced in my life. It was 6am when I woke up with the pain and I could not fall back asleep or even relax. I had to get up and start walking around and I did some unweighted squats real quick to get the joints moving. I just felt like I needed to get them moving to reduce the pain and it worked. The pain slowly went away in the next few hours and has not returned. My guess is that .50 adex was too much and E2 got way too low.

I know I haven’t even been on trt for 4 weeks yet and no blood work, but I also have to go with how my body feels right? So far so good with the .25mg adex taken 24 hours ago. I have had gyno before and currently still have some so I know how itchy nips feels…

54

@ksman

So I just got results back from 4 weeks on trt.

Protocol:
50mg test cyp 2x week
250hcg EOD
.5mg Anastrozole at time of test injections

WBC 5.4 (3.4 - 10.8)
RBC 4.63 (4.14 - 5.80)
HEMATOCRIT 45 (37.5 - 51)
AST 26 (0-40)
ALT 23 (0-44)

Total T LC/MS 936.1 (348 - 1197)
Free T (Direct) 25.7 HIGH (8.7 - 25.1)
Estradiol Roche ECLIA 26.2 (7.6 - 42.6)

Ok now, these numbers look great compared to 400 TT and 42 E2 from before. But I kinda almost feel the same. Do you think the sense of well being, more energy, more strength etc is yet to come as time goes on? I’m still lacking motivation to workout and some days I just don’t feel like getting out of bed.

Only thing I forgot to add was that my libido and sex drive is at an all time high! I need it from my gf constantly. Before trt we could go a few days without sex etc but now I need it daily at least.

55

What is catching my attention is that your low HTC which was normal for your low-T is not increased. Maybe 4 weeks is too soon for that.

MCV high is a concern and RBC as well.
Could you be B-vitamin deficient?

Hemoglobin might be sub-optimal, but the number can be inflated by dehydration.

Low iron in men is not normally an issue unless there is a GI bleed or mineral malabsorption which can also lower B-12. That would be unusual for your age, however PPI’s and other heart burn meds can lead to that.

If you are blood doner, stop that for now.

Maybe you are exhausted from chasing your GF around the house.

You may have a thyroid issue. How are body temperatures now?
Did you read the thyroid basics stick? Did any of the discussion re affects of stress mean anything to you? Thyroid could be holding you down.

Low thyroid function symptoms:

  • low body temperatures - yes
  • thinning outer eyebrows
  • general hair thinning - yes

Lab timing can affect TRT hormone results. Try to test half-way between injections so changes will not be lost in the noise of lab timing artifacts.

Increase anastrozole dose by a factor of 25.7/22=1.17 to get closer to E2=22pg/ml. With your history of gyno, play it safe. This will also help with fat loss and fat patterns where mid-section and upper body fat can be hard to shed. You will get rid of that 34" waist and buy new jeans.

56

@KSman , thank you for the quick reply

You’re right about HTC, in order of oldest to most recent it has been 48.8, 45.5, 42.8, 43.9 and now 45. I have no donated blood in atleast 10 years.

RBC is too low?

Hemoglobin, I am probably very dehydrated. I’m no where near 1 gallon per day or probably even half gallon per day.

Heartburn meds, i take the occasional tums or pepto bismal when I have heartburn which is really rare.

I think maybe I am exhausted from chasing the GF around.

Thyroid temp right now 6:30PM (98.0, 98.0, 98.2, 98.0)

So body temps seem low. Yesterday and today my ears have been super hot, not sure what that means. I will post pictures of eyebrows later, not exactly sure what classifies as thinning. One thing I noticed is that my outer mustache hairs are really light and blonde instead of black like the rest of my facial hair. Maybe this is new facial hair growth since starting trt though. I thought my hair was thinning before trt but now im not sure, it seems normal. It’s defintely not falling out though.

Lab timing. I was doing injections every 3.5 days or 84 hours. I took my blood work approximately 52 hours after my last injection, so I was slightly over halfway to my next shot. Leads me to believe TT and E2 would have been slightly higher if taken exactly halfway between injections, but not by much.

I myself increased Anastrozole the day after lab work (even before getting results). My boobs felt bloated but they feel a lot better now. You mixed up my FT with E2 so it’s actually 26.2/22=1.19, which would mean 1.19mg anastrozole/week. My new and current protocol is 1.16mg/week, pretty darn close. Waist seems slimmer already without many dietary changes.

I will give a better response later, must leave for my hockey game now.

Oh and a little random, but would low Vit D and/or coq10 lead to my low energy/motivation?

New Protocol, everything EOD:
30mg Test cyp
250u HCG
33.33mg Anastrozole

This equates to 105mg Test cyp/wk
1.16mg Anastrozole per week.

Hard to say how much that extra 5mg test cyp per week will raise my E2. Technically I should be at 1.19mg Anastrozole + 5% because of the 5mg extra test cyp…so that would mean 1.2495mg or 1.25mg Anastrozole per week. Might give that a try due to my gyno history.

Sorry I totally cluttered my response.

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Hello @KSman

New Labs 5/1/2017, I inject and take Anastrozole EOD. Labs were taken halfway between injections.

MCV and MCH are high. “Lab Tests Online states that high MCV and MCH levels both indicate larger than normal red blood cells. Large red blood cells can be caused by inadequate folate intake or vitamin B12 deficiency.”

I have been supplementing with 2000mcg B-12 softgels daily (as cyanocobalamin)
I have been supplementing with 800mcg Folic Acid from Multi Vitamin daily.

Should I just inject Vitamin B-12 instead? If so, how much? I just dont know how much a good starting dose and maintenance dose may be? Maybe something I can take EOD since I am taking TRT EOD?

TT is off the charts, E2 is much better at 20.8. I still feel somewhat bloated, so im not sure if it’s worth it to try and get down to about E2 = 15-18…since I’ve read that some prefer it that low. Overall energy seems low, but maybe it’s B-12 deficiency? Have you heard of people needing E2 closer to 30 to feel better?

Temperatures are between 97 waking and 98.3 highest.

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  • WBC 5.7 3.4-10.8 x10E3/uL 01

  • RBC 4.72 4.14-5.80 x10E6/uL 01

  • Hemoglobin 15.6 12.6-17.7 g/dL 01

  • Hematocrit 45.9 37.5-51.0 % 01

  • MCV 97 79-97 fL 01

  • MCH 33.1 HIGH 26.6-33.0 pg 01

  • MCHC 34.0 31.5-35.7 g/dL 01

  • RDW 13.6 12.3-15.4 % 01

  • Platelets 182 150-379 x10E3/uL 01

  • Neutrophils 43 % 01

  • Lymphs 48 % 01

  • Monocytes 8 % 01

  • Eos 1 % 01

  • Basos 0 % 01

  • Neutrophils (Absolute) 2.5 1.4-7.0 x10E3/uL 01

  • Lymphs (Absolute) 2.7 0.7-3.1 x10E3/uL 01

  • Monocytes(Absolute) 0.5 0.1-0.9 x10E3/uL 01

  • Eos (Absolute) 0.1 0.0-0.4 x10E3/uL 01

  • Baso (Absolute) 0.0 0.0-0.2 x10E3/uL 01

  • Immature Granulocytes 0 % 01

  • Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL 01

  • Comp. Metabolic Panel (14)

  • Glucose, Serum 89 65-99 mg/dL 01

  • BUN 19 6-20 mg/dL 01

  • Creatinine, Serum 1.16 0.76-1.27 mg/dL 01

  • eGFR If NonAfricn Am 84 >59 mL/min/1.73 01

  • eGFR If Africn Am 97 >59 mL/min/1.73 01

  • BUN/Creatinine Ratio 16 9-20 01

  • Sodium, Serum 137 134-144 mmol/L 01

  • Potassium, Serum 4.3 3.5-5.2 mmol/L 01

  • Chloride, Serum 98 96-106 mmol/L 01

  • Carbon Dioxide, Total 25 18-29 mmol/L 01

  • Calcium, Serum 9.4 8.7-10.2 mg/dL 01

  • Protein, Total, Serum 7.0 6.0-8.5 g/dL 01

  • Albumin, Serum 4.5 3.5-5.5 g/dL 01

  • Globulin, Total 2.5 1.5-4.5 g/dL 01

  • A/G Ratio 1.8 1.2-2.2 01

  • Bilirubin, Total 0.5 0.0-1.2 mg/dL 01

  • Alkaline Phosphatase, S 60 39-117 IU/L 01

  • AST (SGOT) 28 0-40 IU/L 01

  • ALT (SGPT) 28 0-44 IU/L 01

  • Testosterone, Serum 1215 HIGH 348-1197 ng/dL 01

  • Estradiol 20.8 7.6-42.6 pg/mL

58

@KSman

I also still feel some nipple sensitivity. Not sure why since I am E2= 20.8 now…

What are your thoughts on low dose Tamoxifen for sensitive nipples? 10mg EOD maybe? I wouldn’t want this to be a permanent thing. I just think it’s weird that my nips are sensitive at all with my E2 being where it’s at.

59

@KSman

Maybe I should test progesterone, prolactin, vit D?

Pre TRT levels of prolactin and cortisol… My natural Prolactin level was close to being above range. Would the TRT increase prolactin?

Prolactin 14.2 (4.0-15.2)
Cortisol - AM 17.2 (6.2-19.4)

7:30pm here and oral temps were 98.5, 98.4, 98.4, 98.5
Wow I have never tested this high. I will Check AM temps tomorrow.

60

Have not received any response but that’s ok. I’ll still use this thread as a log.

My current temp reading at 3:45pm was 98.3, 98.6, 98.4, 98.6. My temps are hitting 98.4 - 98.6 more consistently now. They never got above 98.3 before TRT. So trt increased temps where as iodine did not. I failed to take morning temps.

These were my most recent thyroid labs:

TSH 5.360 (0.450-4.500) High due to 2 weeks 50mg Iodine. Temps did not increase.
Free T4 Direct 0.97 (0.82-1.77)
Free T3 3.0 (2.0-4.4)
Reverse T3 17.8 (9.2-24.1)

9 months prior my labs were:

TSH3 Ultra-Sens - 1.72 (0.55 - 4.78)
Free T4 - 1.03 (0.89 - 1.76)
Free T3 - 3.24 (2.30 - 4.20)

So it’s safe to say that my true TSH is still around 1.75. Is TRT somehow reducing Reverse T3? Maybe because I started exercising and being more active? I also cleaned up my my diet and I am not restricting my calories And that is why my temps are getting higher?

61

@ksman or anyone that can help…

Just yesterday I started feeling a dull pain in my right testicle. And today it felt a little uncomfortable during sex. I am getting blood work tomorrow. My last blood work showed

TT = 1215
E2 = 20.8

Protocol was 112mg test cyp/wk, 250iu hcg EOD and 1.33mg anastrozole/wk.

I lowered test cyp to 98mg/week and Anastrozole to 1.16mg per week. Hcg stayed at 250iu EOD.

Could the pain be caused by too low hcg dose and I am shrinking? They do seem smaller and don’t hang as low. I’m also getting a testicular ultrasound to be sure it’s not something else.