Ready to Try Again

Pharma TRT
1

age: 49
height: 6’ 2"
waist: 30
weight: 174
body hair: have lost almost all the hair on my lower legs and much on my upper legs.
facial hair: thick in the mustache and goatee areas, sparse elsewhere. I’ve noticed no changes.
body fat: I had a DEXA scan in March 2012. 16% body fat, most carried around my navel. Has increased recently, probably to 17%.
health conditions: low libido, low energy, low motivation since my early 30s.
diet: cyclic low-carb paleo. Nutrient-dense, low toxin. Mostly shrimp, pastured eggs and bacon, grass-fed beef and liverwurst, smoothies made with kale, celery, wild blueberries, whey concentrate.
training: brief heavy weightlifting sessions or HIIT every 3-7 days. Walking 2-6 days per week.
My testes have never ached, but I do suffer from periodic epididymitis. It has bothered me off and on for close to 20 years.
Morning wood: sporadic before AI, then every morning, and now sporadic again.

Labs, Free Cortisol Rhythm - Saliva (collected 4/12/2013):

06:00 - 08:00 AM: 14 (13-24 nM)
11:00 - 1:00 PM: 5 (5-10 nM)
04:00 - 05:00 PM: 4 (3-8 nM)
10:00 - Midnight: 5 (1-4 nM) elevated

Cortisol Load: 28 (22-46 nM)

Labs (collected 3/7/2013):

TSH: 1.66 (0.450-4.500 uIU/mL)
Thyroid Peroxidase (TPO) Ab: 10 (0-34 IU/mL)
Reverse T3, Serum: 3.0 (2.0-4.4 pg/ml)
Antithyroglobulin Ab: <20 (0-40 IU/ml)
T4, Free (Direct): 1.30 (0.82-1.77 ng/dL)

PSA, Serum: 1.1 (0.0-4.0 ng/mL)

Glucose, Serum: 83 (65-99 mg/dL)
BUN: 24 (6-24 mg/dL)
Creatinine/Serum: 0.94 (0.76-1.27 mg/dL)
eGFR If NonAfricn Am: 95 (>59 mL/min/1.73)
BUN/Creatinine Ratio: 26 (9-20)
Sodium, Serum: 142 (134-144 mmol/L)
Potassium, Serum: 4.8 (3.5-5.2 mmol/L)
Chloride, Serum: 103 (97-108 mmol/L)
Carbon Dioxide, Total: 27 (20-32 mmol/L)
Calcium, Serum: 9.8 (8.7-10.2 mg/dL)
Protein, Total, Serum: 7.0 (6.0-8.5 g/dL)
Albumin, Serum: 4.5 (3.5-5.5 g/dL)
Globulin, Total: 2.5 (1.5-4.5 g/dL)
A/G Ratio: 1.8 (1.1-2.5)
Bilirubin, Total: 0.6 (0.0-1.2 mg/dL)
Alkaline Phosphatase, S: 59 (25-150 IU/L)
AST (SGOT): 27 (0-40 IU/L)
ALT (SGPT): 33 (0-44 IU/L)

Immature Granulocytes: 0 (0-2%)
Immature Grans (Abs): 0.0 (0.0-0.1 x10E3/uL)
Baso (Absolute): 0.0 (0.0-0.2 x10E3/uL)
Eos (Absolute): 0.2 (0.0-0.4 x10E3/uL)
WBC: 6.6 (4.0-10.5 x10E3/uL)
RBC: 4.62 (4.14-5.0 x10E6/uL)
Hemoglobin: 14.2 (12.6-17.7 g/dL)
Hematocrit: 43.1 (37.5-51.0 %)
Lymphs (Absolute): 2.1 (0.7-4.5 x10E3/uL)
Monocytes (Absolute): 0.5 (0.1-1.0 x10E3/uL)
MCV: 93 (79-97 fL)
MCH: 30.7 (26.6-33.0 pg)
MCHC: 32.9 (31.5-35.7 g/dL)
Platelets: 292 (140-415 x10E3/uL)
Neutrophils: 58 (40-74 %)
Lymphs: 32 (14-46 %)
Monocytes: 8 (4-13 %)
Eos: 2 (0-7 %)
Basos: 0 (0-3 %)
Neutrophils (Absolute): 3.8 (1.8-7.8 x10E3/uL)
RDW: 13.5 (12.3-15.4 %)

Vitamin D, 25-Hydroxy: 56.0 (3.0-100.0 ng/mL)

Labs, Male Hormone Panel - Saliva (collected 3/7/2013):

DHEA/S: 4 (3-10 ng/ml)
Progesterone: 33 (5-95 PG/ML)
Androstenedione: 107 (151-350 pg/ml)
Estrone: 27 (30-58 PG/ML)
testosterone: 34 (40-70 PG/ML)
estradiol: 4 (1-3 PG/ML)
DHT: 38 (52-123 PG/ML)

Labs (collected 5/21/2012):

Testosterone, Total, LC/MS/MS: 634 (250-1100 ng/dL)
Testosterone, Free: 52.2 (35.0-155.0 pg/mL)
Cortisol, Total 13.2 (4.0-22.0 mcg/dL)
DHEA Sulfate: 248 (45-3 45 mcg/dL)
Estradiol: <15 (< OR = 39 PG/ML)
SHBG: 79 (10-50 nmol/L)

Here’s my history:

Been on anastrozole since 2007.
For a few months in 2010 I tried bio identical testosterone cream at 75 mg/mL daily. It improved my total and free testosterone somewhat, but I noticed no improvement in libido, energy, etc. The only thing I noticed was extra sensitivity and periodic tingling in my nipples, despite the fact that my estradiol only got as high as 9. So the treatment was somewhat effective, but I certainly wouldn’t say that it worked. I lost confidence in that doctor and was sufficiently creeped out by the nipple sensations that I lost interest in HRT. (lab work numbers at the bottom of this post)

Total testosterone: 576 before, 682 after (range: 280-800)
Free testosterone: 8.6 before, 14.46 after (range 5-21)
estradiol: <5.1 before, 9 after (range: 3-70)

2

Interesting to hear about your AI-only approach. Do you have any side effects from low E2?

3

Low E2 can mess with the brain.

Please read the advice for new guys sticky.

  • carefully not the opening paragraph
  • provide lots of info, and all of your labs with ranges

SHBG is made in the liver on response to estrogen levels. When those are down and SHBG is high, this is a liver abnormality. So we need to see AST/ALT. Drugs, Rx and OTC, toxins, fumes can affect the liver, report all.

AI only can help when E2 is elevated and T levels are mid to lower. If lowering E2 to the lower 20’s provides benefits, it works. If not, it does not.

4

[quote]nomadic wrote:
Interesting to hear about your AI-only approach. Do you have any side effects from low E2?[/quote]
When I started using anastrozole only 5 years ago, it worked, to a degree. I started experiencing morning wood just about daily, but no change in libido, energy level, etc. I screwed up with my anastrozole dosage partly because I am an extreme over-responder and partly due to my own negligence. As far as side effects, none that I have noticed. However, I did have a DEXA scan in March 2012 indicating the onset of mild osteoporosis. That’s when I cut my dosage in half.

I will have new lab work in about a week.

5

[quote]KSman wrote:
Low E2 can mess with the brain.

Please read the advice for new guys sticky.

  • carefully not the opening paragraph
  • provide lots of info, and all of your labs with ranges

SHBG is made in the liver on response to estrogen levels. When those are down and SHBG is high, this is a liver abnormality. So we need to see AST/ALT. Drugs, Rx and OTC, toxins, fumes can affect the liver, report all.

AI only can help when E2 is elevated and T levels are mid to lower. If lowering E2 to the lower 20’s provides benefits, it works. If not, it does not.[/quote]

OK, I’ve updated my initial post with all the lab work I have currently. I see the doctor tomorrow and she will have the results of a saliva hormone panel.

6

OK, following KSman’s instructions, I’ve updated my initial post. Twice now. Seeing the doc tomorrow, would love input and suggestions.

7

So to clarify, the labs collected on 3/7/2013 and 5/21/2013, were you still on Anastrozole? Did you ever have DHT tested other than on 3/7/2013?

8

[quote]B WS6 wrote:
So to clarify, the labs collected on 3/7/2013 and 5/21/2013, were you still on Anastrozole? Did you ever have DHT tested other than on 3/7/2013?[/quote]

Yes, I have been on anastrozole since 2007. Looks like I’ve only had my DHT tested one other time. In 2008, the measured 71 ng/dL on a scale from 25-75.

9

OK, I’ve been to the doctor. She prescribed depo testosterone, 1/2 mL every two weeks. I told her that the wisdom on this forum is that injections should not be spread so far apart and that twice-weekly or even every other day would probably work better. She said I could break up the injection schedule however I liked.

I mentioned hCG to her and she was unfamiliar with its being prescribed to maintain testicular size and function. I think she would prescribe this if I asked for it. Should I ask for it?

And, stupid question: is there anything wrong with generic testosterone?

I have an appointment with the doctor’s PA Monday to teach me how to inject. If I need to ask my doctor for hCG or anything else, y’all please let me know ASAP!

Thanks.

10

Depo 100 mg or 200 mg/ml? Dose is to low either way

11

[quote]iw84aces wrote:
Depo 100 mg or 200 mg/ml? Dose is to low either way[/quote]

Shoot, I don’t know. I already dropped off the written prescriptions to the pharmacy. I only have what I scribbled down to refer to.

12

I would push for hcg but as for an aromatase inhibitor I don’t think they will give you that with low e2

Read the protocol for injections sticky

13

[quote]iw84aces wrote:
I would push for hcg but as for an aromatase inhibitor I don’t think they will give you that with low e2

Read the protocol for injections sticky[/quote]
I have been on an aromatase inhibitor since 2007. I am in over responder and that is reflected in those exceptionally low numbers. I have since modified my dose.

When I start the injections on Monday, I’ll increase my dose. Hoping that injections combined with my AI will not lead to weird nipple sensations like I have on the bio identical cream.

14

Why use it if your low? Stop it for a while and see how you feel. Clomid or nolvadex would block e2 at the nipple but possibly raise itt estrogen…

I don’t see prolactin?? Am I blind or no one has tested it?

This is a must in your situation

15

The recommended way of changing an Ai dose here is stop for one week and go back at 1/4 the dose.

It is possible that you don’t need one.

My e2 dropped after starting trt and being on it for a while.

16

[quote]iw84aces wrote:
Why use it if your low?

This is a must in your situation [/quote]

I’m only low because of the AI. That’s why I started using it in the first place. My estradiol was off the charts high. It only got so low because I am an over responder to anastrozole.

17

[quote]iw84aces wrote:
Why use it if your low? Stop it for a while and see how you feel. Clomid or nolvadex would block e2 at the nipple but possibly raise itt estrogen…
[/quote]

What is itt estrogen?

18

[quote]iw84aces wrote:

I don’t see prolactin?? Am I blind or no one has tested it?

This is a must in your situation [/quote]
I guess no one has tested my prolactin. Why is it important in my situation? Thanks.

19

A) because it could be the cause of your problems to begin with and should have been on the first set of blood work your doctor sent you for.

B) cause you have itchy nipples and low E2

C) cause it can cause other problems

D) cause if you have a prolactin secreting tumour you may be secreting other hormones that are not normally tested with low T

This needs to be addressed immediately

Goodluck man

20

Intertesticular estrogen

Disregard the clomid/nolvadex comment and test prolactin