Protocol Suggestions / Bloodwork Interpretation

Pharma / TRT Testosterone Replacement
1

Been on TRT for 3 years. Still having issues and currently focusing on improving my shitty metabolic health but I could still use some suggestion or help with bloodwork.

180lbs.
5’10"

120mg/week (once a week)
Synthroid 50mcg/daily
B12 randomly

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  • I’ve tried vitamin d in various doses, and even with K2 and every time my calcium goes to the top range or above so I don’t take vitamin D
  • albumin is constantly high but my piss is clear with a slight yellow tent
  • my fT3 is decreasing on synthroid (need armour or dose increase?)
  • I’ve tried increasing test dose but I always feel too revved up. I even tend to feel better the days before my next dose?
  • my lipids are shit

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As you can see I’m not super fit but I don’t think I’m fat enough to cause the shit show in my lipids.

Any suggestions would be appreciated.

2

What’s going on with your lipids dude?

3

Good catch. I don’t know man. They’re crazy. For the 2 months before I basically ate only beef, fruit, and some potatoes but they got worse. I don’t drink or smoke.

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4

I mean, aside from your lipids, your TT/fT looks good to me (as in medically okay).

How do you feel?
You getting the benefits you’ve wanted from TRT (divorcing this question from how you felt on your TRT ‘honeymoon’)?

5

To be honest I never had a honeymoon phase. I’m not even sure my symptoms are related to testosterone at all. I still don’t feel good but I do think testosterone has helped a degree. Do you know anything about thyroid?

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6

Your test dosage is pretty low (for symptom relief, medically it is perfectly fine) so this doesn’t surprise me.

Not really, sorry. @systemlord knows a bit, along with some others who might comment down the line.

7

That low vitamin D might explain the high albumin both of which indicate dehydration which is common to those with vitamin D deficiency.

As someone who started TRT with a vitamin D deficiency, muscle growth is nearly impossible and you’ll lose muscle fast!

Vitamin D deficiency even with high testosterone will still make you extremely fatigue.

Also low vitamin D and low testosterone go hand in hand, not that your Free T is rock-bottom, actually very decent.

Fix the vitamin D and report back.

You also need more thyroid hormone as your Free T3 is not even close to acceptable.

Fixing these two things should improve your situation ten fold.

8

I’ve got my vitamin d up before. But everytime I take any amount of vitamin d my calcium is the very top of the range or above and I feel worse.

My free t was the same off trt, do you think maybe I can do without trt?

Armour or increase in synthroid?

9

And can you explain how the albumin and vitamin d are connected? I lm definitely not dehydrated or if I am I don’t know how to fix it because I drink almost a gallon of water daily, eat a lot of salt and my piss is always clear with a yellowish tent but not much.

10

I’d look into Armour or a T3/T4 combination bioidentical.

11

@highpull @Andrewgen_Receptors Do y’all think it would be worth trying to stop TRT if my pre try levels were:

11/27/2019

  • Estradiol: 20.9 (7.6 - 42.6)
  • TT: 368 (264 - 916)
  • Free Test: 18.1 (9.3 - 26.5)

12/13/2019

  • Estradiol: 7
  • TT: 336

I’m 32. I’ve been on TRT for about 3 years.

@systemlord do you know why any amount of Vitamin D with or without K2 would cause my calcium to go to 10.2 every single time I take it which is the very top of the range? And on one occasion it was 10.6? Also, Albumin has always been high on TRT.

12

You can, but I think I would address the thyroid first.

13

Your free test hasn’t budged from Pre to Post TRT. I think you would need to increase dose to feel any difference from the T, but as you said - doing this doesn’t work out well for you.

Yes, i would consider stopping TRT under the assumption you can fire up your HPTA to it’s previous state.

14

@highpull @Andrewgen_Receptors if it makes any difference. My LH was 3.2 (1.7 - 8.6) and FSH 2.6 (1.5 - 12.4). That would indicate it was something else causing low T correct?

I’m also getting a prescription of Armour in the mean time.

15

And to give some background on my nutrition to hope clear any thing up because I don’t understand. A pretty typical day of eating is as follows for the last 4 months or so.

Morning:

  • banana
  • 2-3 eggs cooked in butter w/ sea salt
  • 3 pieces of bacon or 4-6 oz hamburger
  • Avocado
  • 8oz 100% orange juice

Lunch:

  • Salmon, sardines, or hamburger w/ sea salt (roughly 8oz)
  • Cup of blueberries, watermelon, and honey blended in a smoothie

Dinner:

  • 8-12 oz of steak or hamburger with butter and sea salt
  • banana or some other fruit

Snack:

  • peanut butter or mixed nuts

I don’t drink soda. I drink like 3 sips of black coffee. I’ll have pizza or something unhealth once a week and sometimes snack on unhealthy but overall my diet is pretty similar to above. Also, if I feel like I want more carbs, I cut up a white potato and make home fries with sea salt and olive oil.

I have not trained in 3 years since my health journey started but I do walk 1-2 miles every day and have been stretching 30mins to an hour each day for the last 2 months.

16

First place to start is getting real with your diet. Rule of thumb is anytime someone says, “I typically eat…” the results are not accurate. In the last 6 months your triglycerides have skyrocketed and your VLDL has gone up 30 points. You should start with writing down everything you eat for a week straight to see EXACTLY what you are eating and the choices you’re making. Examples just from what you listed - How much butter do you cook with? Bacon probably not a good idea with your lipids. What is the fat ratio on your hamburger? What type of steak cuts are you eating? What are your unhealthy choices for snacks and cheats? I doubt you’re eating as much salmon as you say because your HDL has gone down. You are consuming a lot of fat and more than you’re taking credit for is my guess. Also - not a SINGLE vegetable listed. Your listed diet is trash and your actual diet is probably worse. Lipid clean up first, second, and third through your diet.

Your synthroid dosage is too low. On synthroid your TSH should be closer to 0.5 - 1.0 realistically.

Vit D is really low and need to get built back up. What was your D3 supplement dosage when your calcium would go up? How high did it go since D3 does increase Calcium absorption?

High Albumin may indicate a high protein diet or dehydration as mentioned above. You’re listing a high fat, high protein diet. How much water do you drink (actually - not guess-timated) a day?

Test values look fairly middle of the road for being on TRT. I would think that needs to be adjusted based on how you feel AFTER the above get addressed first. My hunch that you feel “wired” on higher dosage has more to do with your cardiovascular health (see lipids and apo protein again). Are you self dosing or working with a doc on your TRT? What were your labs prior to starting TRT?

Diet clean up, start consistent exercise, Vit D and thyroid adjustment. How is your sleep and digestion?

The more I look at this, the more concerned I get with your cardiovascular health - not your metabolic health. You have other markers supporting your thickening bloods like most of your blood measurements creeping high, A1C, CRP, and APO protein levels. Are you working with a doc with these and on your thyroid and TRT? Get your diet cleaned up and exercise. What is your walking pace when you walk?

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17

There’s two things going on here with vitamin D and calcium homeostasis, one is too much vitamin D will increase the calcium level, and depending on vitamin K levels determine where the calcium goes, soft tissues or bones and you want it in the latter.

If I miss my vitamin K dosage, within a short few hours I’ll feel very high, strange mentally and my bones and testicles hurt.

18

About 4 months ago I really committed to diet. So since then, what I have listed is absolutely a typical day.

Probaby a quarter stick of butter a day on average.

80/20 or 85/15 whatever is cheaper.

Ribeye or T bone. Whatever I can get in bulk on sale

Pizza, homemade French toast, chips, cookies. Not as much as my lipids might indicate. I mean you can look at my photo and see I don’t pound Mountain Dew and Twinkies. I’m not in the best shape but I don’t think my body reflects my metabolic state.

I eat 4-8oz of salmon or sardines every week.

I eat a lot of fat now because I have reduced carbs which is reflected in my insulin going down (I think).

Nope. Vegetable suck. I’m following Paul Saulodino diet of nose to tail animal protein, fruits, and honey. He advises to stay away from vegetables because of toxins or something. Think Jordan Peterson. Maybe it’s crazy but vegetables suck so its easy for me to follow.

This has been my “actual” diet. My friends and family think it’s crazy too because I even eat 1-3oz of raw beef liver a week too. What would be a better diet?

If you look on the google doc below you’ll se my ft3 actually has gone lower on a higher dose of Synthroid and ironically my tris have gone higher. Correlation?

I have tried 5000iu/daily, 5000iu/ every other day, 5000iu with k2, 2000iu daily, 2000iu every other day. Each protocol made my calcium go to 10.2 (top range 10.2). and on one occasion 10.6. This is on the attached google doc as well.

3-5 32oz tumblers. Again, my pee is clear with a slight yellow tent so I’m not sure how I can be dehydrated. on the attached sheet you will see my albumin has constantly been high except before TRT when all my issues started it was actually low.

Working with a internist and functional doctor.

All labs before and during are attached below.

Sleep is 8-9 hours just about every night and has been great since I started thyroid and stretching. I use the bathroom once every morning. Brown and regular. No bloating. Digestion is good.

Here’s a spreadsheet of all my bloodwork

19

Thanks. Do your actually calcium labs go high with vitamin D supplements with or without K2. I’d love to see it since I don’t see anyone else with that issue.

20

I’ve actually experienced both high calcium and calcification. I can tell you the symptoms are vastly different…

So a lack of vitamin K doesn’t increase calcium levels, but does dictate where the calcium goes.

It took over 3 months for vitamin K to do it’s thing.