TRT & Liver Issues. Need Blood Work Specialist

Pharma / TRT Testosterone Replacement
1

Alright so a little about my past . November 2016 I almost had to have a liver transplant . Bilirubin was at 65 and AST and ALT were 10x out of range . Anyways about 4-5 months ago AST and ALT were all with in normal range . Bilirubin was at 1.6 and has never been lower since I’ve had my liver issues . They say I now have Gilbert’s syndrome and not to worry about my bilirubin unless it shoots way up . I also had a ultra sound and they said my liver looked completely normal and I could even start drinking alcohol again which I still have not done . ( been two years ) .

So now here is the issue I’m having . My doctor has me on TRT with test cyponiate at 100mgs a week . That’s puts me around 1000-1050 for total testosterone. For two or three months that’s what it was and then I noticed my estridol sensitive was 45. I had some symptoms of high / low estrogen so I started 0.25 mg twice a week of Anastrozole . I started to feel better and went in to do my regular blood work and my total T came back at 575 . I was hoping it was an error so I went in the follow day and then it came back at 1400 . Then one more time 2 days after that and it came back at 692 . My ALT was 49 and my bilirubin went up to 2.2 . My estrogen also was at 9 which yes I know is to low and I since decided to stop the AI because it’s going to be imposing to dial in my estrogen with my testosterone fluctuations.

My last blood work :
Testosterone, Total 692 ng/dL 264 - 916 ng/dL
Testosterone, Free 13.1 pg/mL 8.7 - 25.1 pg/mL
Sex Hormone Binding Globulin 36.2 nmol/L 16.5 - 55.9 nmol/L
Sodium 137 mmol/L 134 - 144 mmol/L
Potassium 4.4 mmol/L. 3.5 - 5.2 mmol/L
Chloride 101 mmol/L 97 - 108 mmol/L
CO2 26 mmol/L 18 - 29 mmol/L
BUN 29.1 mg/dL. 6.0 - 20.0 mg/dL
Creatinine 0.94 mg/dL 0.76 - 1.27 mg/dL
Glucose, Serum 104 mg/dL 60 - 99 mg/dL
Calcium 9.8 mg/dL 8.5 - 10.1 mg/dL
AST 24 U/L 0 - 50 U/L
ALT 49 U/L 0 - 44 U/L
Alkaline Phosphatase 87 U/L 25 - 150 U/L
Total Protein 7.2 g/dL 6.4 - 8.4 g/dL
eGFR 108 mL/min >60 mL/min
Albumin 4.7 g/dL 3.4 - 5.0 g/dL
Bilirubin, Total 2.2 mg/dL 0.0 - 1.2 mg/dL
BUN/Creatinine Ratio 31.0 7.0 - 24.0
TSH 0.526 uIU/mL 0.450 - 4.500 uIU/mL

My current doctor is stumped on what’s going on . Last summer I tried low dose test prop with no AI and this exact same thing happened untill my liver values got to high for my comfort and I stopped taking it . That was about 8 months after my major liver issue so I assumed my liver had not healed completely. Well this time I know it has or at least the doctors said so and yet I’m having the same issues . Trying to figure out what’s going on before I have to go off TRT again .

I also don’t feel the same as I did the first couple months that I was on, I feel better than natural (230ng/dL ) but something is definitely wrong .

I’ve read some of “KSman” s threads and would love some input from him or anyone else that might have an idea .

2

You need to split your dosage up twice weekly, this will lower estrogen on it’s own and then you might not even need the AI at all. Too many guys are started on less than ideal once weekly protocols, infrequent injections invite more estrogen conversion and it’s completely avoidable. Most men pushing 1000+ will have problems, it’s too much for some men to handle long term.

Once weekly injections also cause fluctuations in levels, levels peak in 24-48 hours and start to drop and a week later levels have fallen, as time goes on you feel worse as the dead zone from having your levels fluctuate gets wider and months down the road you wonder why you feel worse. Liver issues could affect your ability to rid yourself of excess estrogen which is the job of the liver.

That what’s wrong, that and you could use a new doctor. I seriously doubt it would matter though, most insurance based doctors are TRT stupid. The real miracle workers are all private, sports medicine and hormone specialists which aren’t part of the insurance healthcare system.

3

You mention most men pushing 1,000 will have problems long term. Are we talking about hematocrit, blood pressure etc or cardiovascular/ prostate issues. My natty T levels before my bout of unfortunate testicular failure were 1052ng/DL and I never had any problems.

If one is healthy and takes appropriate precautions I am under the belief many men can sustain fairly high testosterone concentrations for fairly long periods of time. Hell there’s a few studies showing 600mg/wk for up to 20wks are free of serious adverse affects in healthy young men besides a small drop in HDL and an increase in hematocrit. 600mg would get me up to like… 3000ng/DL!!!

4

I should of been more specific, the 100mgs a week is split into two dosages. So no that’s not the issue . Even at once a week injections there is no way total T should fluctuate from 575 to 1400 and then back down to 695 with in 4 days .

5

I constantly see guys have problems nearing 1000+, excess estrogen conversion, blood pressure spikes, too much testosterone can make you feel unwell and can even cause fatigue. Guys always falsely assume more testosterone equals better, it can cause other systems to go haywire.

6

Drop the AI completely. Your SHBG is high enough that you should be able to inject a decent amount of test without getting too high E2 symptoms.

I thought AI’s were slightly liver toxic…

Use enough T that you don’t need an AI.

7

I dropped the AI completely even tho I don’t think that is causing this since last time I had the same issues with no AI . I was around 1000 total T last time tho . I lowered my last injection so I should be around 750 . We will see what the lower dose does .