I’ve been reading and learning a huge amount here. Thank you for all of the contributors as this info is damn near impossible to get out of the doctors I’ve seen so far.
I started on TRT about two years ago when myself and my wife couldn’t take my miserable state of body and mind any longer. I had all of the typical symptoms, moody and irritable, increased body fat, loss of muscle tone, zero libido etc. etc. I was 38 and my initial test showed that my total T was in the low 200s with a range of 302-903. I tried the gels and patches and noting worked so I requested injections. Doctor had no problem with that and I was trained to self inject. At this time I had no idea the intricacies of HRT.
Initially I was on a 200mg (200mg/ml) every two weeks dose. This resulted in a horrible crash at the end of that second week. I asked my doc if I could reduce the dose to 100mg once a week. Since it technically was not a larger dose he had no problem with this. Unfortunately he was not versed well enough in this field to also run tests for any other levels besides a PSA. So LH, SHBG, E2 and FT were never checked in the beginning. After doing my own research I found that I needed to know more info about my various levels. I returned and had my E2 and FT levels checked. They came back that they were within acceptable range. Of course I now know that tells me nothing. I also at the time had a TT level in the mid 600 range. I wanted to push that a bit farther towards 800 so increased my dose to 125mg once a week.
I’ve now been on this dose for the majority of the last two years. In the course of this I needed to choose a different doctor as mine was moving out of the area. Enter HRT ignorant doctor number two. On my first visit he wanted to know why I was on TRT and basically told me that he considered TRT to just be a “performance enhancing drug”. Needless to say that pissed me off to no end. At least he did a more thorough set of tests. The first set of results on 06/25/13 were as follows:
Comprehensive Metabolic Panel
NA 140 135 - 144 mmol/L
K 3.8 3.7 - 5.5 mmol/L
CL 104 99 - 110 mmol/L
CO2 29 20 - 31 mmol/L
ANION GAP 7 4 - 13
GLUCOSE 84 60 - 99 mg/dL
BUN 14 6 - 23 mg/dL
Creatinine, Serum 1.10 0.60 - 1.30 mg/dL
CALCIUM 9.5 8.3 - 10.4 mg/dL
ALK PHOS 55 32 - 110 IU/L
BILIRUBIN TOTAL 0.8 0.2 - 1.2 mg/dL
AST 22 11 - 39 IU/L
ALT 30 6 - 42 IU/L
Total protein 7.0 6.1 - 8.0 g/dL
ALBUMIN 4.9 3.2 - 4.9 g/dL
WBC 7. 2 3.9 - 10.6 10^9/L
RBC 5.80 4.40 - 5.90 10^12/L
Hgb 18.0 13.5 - 17.7 g/dL
Hct 53.6 40.0 - 53.0 %
MCV 92.4 80.0 - 100.0 fL
MCH 31.1 26.3 - 33.8 pg
MCHC 33.7 31.5 - 36.3 g/dL
RDW 12.1 11.5 - 14.5 %
Platelet Count 255 140 - 444 10^9/L
MPV 8.4 6.8 - 10.8 fL
TESTOSTERONE 807 302 - 903 ng/dL
My Hgb, Hct, were high and RBC was borderline. The doctor also told me that my T level was very high and to reduce my dose to once every two weeks. So he wanted to drop me from 125mg once a week to 125mg once every two weeks. I told him in the nicest way I could muster that he was crazy and in no way was I interested in dropping my dose that far. Not to mention I thought it was incredibly irresponsible. I agreed to drop it back to 100mg once a week and have my levels tested again in a few months.
At the next set of tests my Hct, Hgb, and RBC levels were still on the climb and my TT was at 696 range 302-903. He still wanted to reduce my dosage to see if he could get my blood levels down to acceptable range. I then requested a referral to see an Endocrinologist. Well after waiting another five months to get my first appointment on 03/03/14 my tests were now as follows. At least this doctor was much more knowledgeable and thorough but still not what I was expecting.
TESTOSTERONE TOTAL 526 302 - 903 ng/dL
TESTOSTERONE FREE 149 47 - 244 pg/mL
The concentration of Free Testosterone is derived from a mathematical
expression based on the constant for the binding of testosterone to sex
hormone binding globulin.
Testosterone, Free Pct 2.8 1.6 - 2.9 %
SEX HORMONE BINDING GLOBULIN 18 13 - 110 nmol/L
ESTRADIOL 52 0 - 357 pg/mL
MALE: 0-40 pg/mL
WBC 9.4 3.9 - 10.6 10^9/L
RBC 6.02 4.40 - 5.90 10^12/L
Hgb 19.4 13.5 - 17.7 g/dL
Hct 54.3 40.0 - 53.0 %
MCV 90.2 80.0 - 100.0 fL
MCH 32.2 26.3 - 33.8 pg
MCHC 35.7 31.5 - 36.3 g/dL
RDW 11.8 11.5 - 14.5 %
Platelet Count 307 140 - 444 10^9/L
MPV 8.3 6.8 - 10.8 fL
NEUTROPHILS % 73.2 40.0 - 81.0 %
LYMPHOCYTES % 19.2 20.0 - 53.0 %
MONOCYTES % 6.4 1.0 - 10.0 %
EOSINOPHILS % 0.8 0.0 - 6.0 %
BASOPHILS % 0.4 0.0 - 2.0 %
NEUTROPHILS ABS 6.9 1.8 - 8.0 10^9/L
LYMPHOCYTES ABS 1.8 1.0 - 4.8 10^9/L
MONOCYTES ABSOLUTE 0.6 0.0 - 0.8 10^9/L
EOSINOPHILS ABSOLUTE 0.1 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.0 0.0 - 0.2 10^9/L
So now my Hgb is nearly two full points above range and my Hct level is 1.3 percent high at 54.3. My RBC count is also now above range. In the first appointment I had asked about donating blood to control my high Hct and Hgb and he responded that he had never heard of that for treatment. Fantastic. During my appointment he asked many questions, one of which was if I snored or had ever had a sleep evaluation done. I do snore but don’t think I stop breathing while sleeping. At least my wife has never noticed it.
After receiving the last test results I was concerned about my E2 level being too high and thought that it could be contributing to some of the problems with my blood levels. In the past few months I have also begun to lose some of the positive results I had when my TT was at 807 and even 696. I was beginning to feel more moody and had gained about ten pounds with no changes in diet or exercise. My libido was also waning to almost nil. All things I’ve learned can be attributed to high E2 levels. I call my Endo. and talk to his assistant about my concerns and she relays the info to him. Later she calls back and says that he is not willing to change any of my current treatment until I do a sleep study for Apnea. Great.
So this is where I currently stand. I have ordered some liquidex (1mg/ml) and will try to lower my E2 levels on my own. My plan is to start off at a low dose (.50mg/wk taken E3D starting with my T injection) for a couple of weeks to play it safe in case I’m highly sensitive to the Anastrozole. I’m also considering going to a twice weekly injection of 50mg TCyp but for now will stay at 100mg every Friday evening. Right now I’m not as concerned with HCG. I will also be making plans to donate blood to get out of stroke risk territory.
With the above numbers does this sound like a reasonable approach? At some point I will have a sleep study done but for the immediate future I want to get back to feeling well again.
Thanks for any advice.
Sorry about the formatting on the tests. They looked fine in the preview window but not in the post. Hopefully they are still clear enough to read.