34 Y/O Test Results and Docs Protocol

Age: 34
Height: 5’11
Waist: 46
Weight: 241
Body Hair: arms, legs, chest, some back
Facial Hair: can grow a beard if i let it go
Carry Fat: mainly midsection, legs/booty a bit too it seems. always have seemed to have belly/love handle fat, gained about 50lbs the last couple years
Health conditions: typical low T symptoms
Rx drugs: escitalapram, finasteride

Hemoglobin A1c 5.4 (< 5.7)
TSH 1.82 range .4 - 4.5
fT4 1.2 (.8 - 1.8)
fT3 3.4 (2.3 - 4.2)
rT3 18 (8-25)
Total Cortisol 16.5 (4.6-20.6)
Free Cortisol 1.34 (out of range .07-.93)
Estrone 70 range <=68
DHT 5 range 16 - 79
Hemotocrit 44.9 range 38.5 - 50
DHEA 211 range 106 - 464
FSH 4.8 range 1.6 - 8
LH 3.4 range 1.5 - 9.3
Prolactin 11.1 range 2 - 18
Estradiol 42 range <=39
TT: 394 range 250 - 1100
FT 65.7 range 46 - 224
BioT 126.5 (110-575)
SHBG 25 range 10 - 50
IFG1 224 (53-331)

Diet: Mainly higher protein, reduced carb, healthy fats mixed in with some pizza, oreo, craft beer days. A couple times did a 10xBW diet.
Training: Not much due to low energy/motivation, try for a 4x week lifting
Testes ache: no
MW: pretty much nonexistant since my 20s. 1/month maybe?

Doc recommendations:
HCG x 300iu M-W-F
1/2 pill anestreloze M-Th
Zinc 100mg

My thoughts:
Seems he is rec’ing the kinda standard protocol mentioned, minus the test, which seems to me to be the most important part. After a month I’m doing another T test to see where I’m at, and either staying on that, or adding HGH, and then next step after that is adding testosterone instead (or in addition to? didn’t really say). I’m guessing as proposed it should get me to a better place than I am now - but might not get me to where I should be? He seemed overly concerned with fertility since I’m younger. Which I’d rather not go sterile, but also am not trying to have kids right at this time either. In hindsight I think I should have pushed harder to go straight to test, with the understanding if I was going to try for kids that I would go off it/lower dose and increase hcg dose…

he said the anetereolze should be good to up my TT about 100, and the HCG a couple hundred too, to get me in more of the 600-700 range. seem legit?


Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Those two drugs are not helping.
finasteride can cause major problems for some. Does timing line up?

Do you have these labs?
fasting glucose
fasting cholesterol - can be too low
AM cortisol - at 8AM please

Check oral body temperatures as per the thyroid basics sticky, there can be issues not covered by the set or labs. Better to test fT3 and fT4. Thyroid has a big impact on energy and mood.

With less FT for FT–>E2, and high E2, we need to suspect that the problem is reduced E2 clearance by the liver. SSRI’s can do that as well as some OTC meds and other things or pathologies.

At your age, low-T is not the symptom, its the symptom and we need to try to find the cause.

1mg anastrozole probably too much for your T levels and E2 may crash, and that is another whole level of misery. Try 1/2mg/week and see how you feel in a week. Note that some are anastrozole over-responders who need 1/4th the expected amounts.

Your doc look very promising. Please read as much of the stickies as you can in the order listed.

Increasing TT is not a very good goal when most of it may be T+SHBG that is not cleared by the liver. Your TT probably is inflated.

Your doctor suspects that you have heavy metal exposure or to other toxins?

Fin has been a few months now, the SSRI a few years. I’ve had some of the symptoms for years before starting either, but I think they may have pushed me down even further. I’ve tried halving the dose of the SSRI, and it seems okay for awhile but then start feeling worse and go back up on the dose. The fin after doing some reading, I’ve switched now to .5 EOD rather than 1 ED. Seems it lasts a’lot longer in your system.

I do have CBC, is there specific ones off it you would want? I don’t see AST/ALT. No fasting glucose either, but there was a hemoglobin alc he did that sounded like something similar. That was 5.4 range < 5.7. No cholesterol either, although I think I had one a few years I could try to find. I had ‘good cholesterol numbers’ according to my reg doc. Cortisol was done:
Total Cortisol 16.5
Free Cortisol 1.34 out of range
The T4, T3 do say free on it, I guess I didn’t know there was a difference. It also has T3 Reverse 18 range 8-25

The temp/thyroid/iodine stuff is interesting. I don’t have a thermometer, I’ll pick one up next time I’m out to test it. I did do the iodine patch on my skin, which did seem to go away in 24hours.

I’ll go with .5 anastrozole to start then, but you’re saying even with whatever increase from the HCG .5/wk is better?

He is more of a specialist/holistic doc that has experience so went to him. I agree he seems to know what he is doing. A bit disheartening when we were talking and he mentioned that my levels were pretty low, and that he at about twice my age had twice the levels I did normally…

Per EDTA, he did a hair test as well. He said he expected to see more mercury and aluminum in the results, since he didn’t, he said I was probably ‘holding on’ instead of getting rid of certain things, so he was going to add the EDTA to see if that would help clear it out.

The 300iu HCG M-W-F sounds good? Should it be more/less?

If hCG and other things significantly increase T, then 1mg/week anastrozole would probably be needed.

This hCG use looks good. Typical recommended is 250iu SC EOD, so quite close.

You are fortunate to have found this doctor!

Morning temp: 97.6
Noon temp: 97.4 ???

something seems off…i’m thinking i will try again later.

So is there a timeframe when you should start “feeling” things? Had a couple hcg shots now, and an adex, don’t feel any different.

Also, is there a good way to travel with the stuff? Could I prefill some syringes and take them with me on a flight/cruise? Just stop taking it for a week? “frontload” it before I leave?

So about a month now of doing the protocol. New blood work values:

TT: 621 (250-1100)
FT: 124.1 (46-224)
BioT: 239 (110-575)

Original Values:
TT: 394 range 250 - 1100
FT 65.7 range 46 - 224
BioT 126.5 (110-575)

I really don’t feel much different though, still basically no MW, not much change in energy it seems. I guess it did boost a bit to where he was saying and the numbers look better. But I’d rather feel better…that was more the goal with me pursuing this.

Pre-vaca I did 600mg HCG once since I didn’t take any along for the week. Didn’t seem to do anything different.

I think the next step he mentioned was trying HGH, then if still no-go, test injections. Although HGH seems to have some interesting effects from what I’ve read, it seems like maybe I should push for the test? That would seem to (hopefully) get me where I feel better.

This seems like enough time for testes to recover and produce. T levels are not stellar.
We do not know if E2 is a spoiler, always need to test. You need more T.

E2 was pathological when T was low. Please see my earlier comments. That high E2 was causing some of your low T and with low FT, liver issues suspected or interference by medications.

hCG will not do much for T
Were you, are you using iodized salt?

I do not get a sense that you are following my leads and taking these things seriously.

Body temps were low and could be indicating low thyroid function that can rain on your parade, even if T was high. You have not tested fT4, fT3. If fT3 is mid-range, low body temps could be suggesting adrenal fatigue leading to elevated rT3.

Please read the thyroid basics sticky.

Sorry you feel that way KSman, I am mucho appreciative of your help and comments, and have been trying to follow them.

I agree E should have been checked too, I didn’t realize he had not put that on my followup test, I’ll make sure the next one gets both E and T tested.

Yes I do and have been using iodized salt. After reading your comments, taking my temps, and the thyroid sticky, I did order some iodural and was taking it to see if that helps.

Per the fT4/3 values, I thought I mentioned in a comment those were what was tested, as well as some other values you asked about, that might have been lost in the shuffle though, I’ll go back and update the first post with the following info from my first blood work that I had replied with. I’m sure it’s easier to have it all in the first post I did. Should have done that to start with. My bad.

(first blood work values adding/editing in first post)
Hemoglobin A1c 5.4 (< 5.7)
Total Cortisol 16.5 (4.6-20.6)
Free Cortisol 1.34 (out of range .07-.93)
fT4 1.2 (.8 - 1.8)
fT3 3.4 (2.3 - 4.2)
rT3 18 (8-25)
IFG1 224 (53-331)
BioT 126.5 (110-575)

Does that being free values change any thoughts on t3/t4/rt3?

I’ve got a followup appt this friday to discuss what to do. I’ll probably mention the iodural i’m taking to see his thoughts on that.

Thanks for the help KSman.

*also edited the new values post, to include my old values for easier comparison.

Thanks for the updates.

fT3 should be supporting good body temperatures. You are reporting low temperatures and rT3 does not appear to be a cause. When you take temps, no eating, drinking, talking, walking, exposure to cold for some period of time prior. Getting 98.6 with thermo on someone else creates confidence in the thermometer, many are flaky and only good for indication of a fever or not.

Remember that you need selenium with iodine supplements. This is important. Many find a mulit-vit that lists iodine 150-180mgc and 100-200mcg selenium.

Iodoral or any larger amount of iodine does increase TSH and this is expected and harmless, but does make TSH lab results a bit useless.

What dose of anastrozole are you on and how long?

Your on-hCG labs did not check E2 and E2 is a major issue.

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Not sure if my thermo is messed up or what. I’m pretty consistently getting low 96s in morning, low 97s in the day…It is winter and I keep the temp pretty cool inside, not sure if thats forcing my body temp down too?

I’ve been popping the biotest minerals which includes selenium so I think I should be set there. When I talked to the doc he ended up ‘prescribing’ me iodine synergy which is a mix of iodine and selenium, might switch to that since he got it to me.

Kindy dopey move, but I split the adex into however my splitter did it, so either into 3 pieces or 2, taken twice a week. Not sure if I necessarily observed anything. I didn’t really seem to notice any changes, a couple days I did seem to be quite a bit lower mood wise, might have played in with where my e2 would have been at?

Next blood work will include e2 and a few other things, but won’t be for awhile after trying a few more things. still sticking with the M-W-F 300 HCG. Next is trying 5 on 2 off sermorolin to see if that helps my symptoms. If in 3-4wks it doesn’t, I call in the prescrip for test cyp, 100/wk.

He seemed to be happy with the 600s for my increase level, thought the hCG worked out well. Luckily he is open to treating symptoms and not numbers otherwise I’d probably be stuck. I didn’t really think low 600s would be something to aim for? I mean better than it was but I’d expect him to want me to be higher than that. a 200ish increase didn’t seem huge to me.

I’d be surprised if the sermorolin did anything, but it looks like it’s pretty good for sleep, so wouldn’t mind that side effect. I’m guessing I will need to go the T route, but will see. I’m a bit apprehensive neither of these upcoming steps will get me out of the rut.

TT=600 is marginal and not good if E2 is elevated.

Watch that you are not double dosing selenium.

“Getting 98.6 with thermo on someone else creates confidence in the thermometer”

If thyroid function is poor, TRT will leave a lot of symptoms on the table.

You can dissolve anastrozole in vodka 1mg/ml and then dispense accurately by volume or by the drop. When you get E2 labs, this will guide dose change, so important to have been on a steady and known dose for 7-10 days or longer.

For TT=600, aim for .5-.75 mg anastrozole per week. If you feel crashed, you need to know issues re anastrozole over-responders from the stickies. You would want to get that sorted out and balanced on any new dose prior to E2 labs.

With the biotest one, I was getting about 100 of selenium. This iodine synergy i’m switching to is 10000 iodine and 40 selenium. I also just realized the Vit D/K supplement I’m taking has 1000 iodine in it too. I know you had written about iodine artificially inflating TSH levels - would that have been a high enough dose that when I got my blood work it showed higher than it actually was? If it would, I’m more confused on my levels/temps…

I did finally get someone else to try the thermometer, they were also reading a little over a degree low. So either my thermo isn’t good, or we both have thyroid issues…

I’ve only saw 5ml droppers in the store, so I’m planning to pick one up online thats 1ml to help dose a bit more accurately without including a shot of vodka rather than a few drops of vodka.

I’m a bit confused on the symptoms since both high and low e2 have a lot of crossover it seems. To try to narrow it down I haven’t taken a dose of adex for a week, and the week before I did two .3 doses. So I’m guessing I have been on a steady incline of levels of e2 and haven’t noticed hitting any ‘sweet spot’. I’ll pop back on it starting at a lower dose and see if i can tell anything, adjusting up as the weeks go by. The only real difference from high or low seems to be popping joints when low? seems like energy/libido/etc goes in the dumps both high and low.

I really wish he would have included e2 to see where that was, makes it much more a shot in the dark.

Can’t say I’ve really noticed anything from the sermorlin, which is unfortunate, I had read things about great sleep, etc. But also about it taking time for some other effects to be noticed. At the price, not sure I am going to keep that in.

If you have one of those cheap digital thermometers like mine. Mine will beep in just maybe 30 seconds but if I leave it in my mouth for 5 minutes the temp will keep going up, and eventually stop rising.

Moral of the story: just because it beeps doesn’t necessarily mean it’s reached your actual temperature yet.

Just got part of my last blood work back…estrone is down now to <=20
“value based on dilution” down from about 70 in my initial work. 1mg adex
slit twice a wk. I’m guessing I should drop it to .5 adex split twice a wk?

You might have your estrogens confused?
E1 = estr one
E2 = estra DI ol
E3 = es TRI ol

E?=<20 simply means that the lab test was not selected properly, need to specify a lab method that is sensitive for the low E? levels of males, not one useful for females. So you may need to select sensitive or ultra-sensitive and such terms are specific to each diagnostic lab and are not universal in their meaning.

With males, we have FT–aromatase enzyme–>E2
Typically E2 is tested and E1, E3 are never looked at.
We have guys feeling great near E2=22pg/ml who never have seen E1 tested [a few need higher, sort of rare, as they are wired differently].

What was your E2 lab result?

You had this earlier: Estrone 70 range <=68

It was estrone. I can’t get in for an appt for a couple weeks and asked if they could get me the results for dht and estrogen since those were the ones I was mainly curious about. They sent me one page of the blood work and didn’t have the estradiol on it, just estrone. Since I was at 70 for estrone, and now < 20, I was making an assumption the adex reduced my levels to about 25%. I was also assuming it might have done the same to estradiol so that might be at 10ish? So was wondering if that assumptoin was valid and could cut my adex dosage in half to hopefully get to the 20 level. If there’s no relation to the various estrogens though perhaps the estradiol is still high or even lower, independent of the estrone level.

DHT is up to 25, from 5. Switched from 1mg fin ED, to .5mg fin EOD. Seems kinda crazy quartering the dose still kept it relatively low, even though I’ve saw things it can drop levels pretty easily.
edit Just realized the DHT musings can’t really be compared since when I was at 5 it was only at my 400 TT levels, and this 25 is with 100mg test and 250iu HCG.

Okay sounds like my assumptions were way off from estrone/estradiol. Called today to get the Estradiol number, and it was 24. Darn near perfect (according to the forum’s protocol). I was actually assuming it was going to be off. So a bit of a surprise. Some other numbers I got below:

TSH 1.92 (.4 - 4.5)
fT3 3 (2.3 - 4.2)
rT3 15 (8-25)
Estrone <20 (<=68)
DHT 25 range (16 - 79)
Hemotocrit 47.8 (38.5 - 50)
Estradiol 24 (<=39)
IFG1 225 (53-331)

Odd my TSH increased a bit. rT3 went down a bit which is good. But also fT3 seemed to go down a bit, which doesn’t seem right…?

So at the time of the blood work (done wed morning), protocol was:

Test: 40mg sunday night, 60mg wed night
HCG: 250iu M/W/F morn
adex: .5mg M/Th night
fin: .5mg M/W/F night

TSH=1.92 is not good. But we know that higher iodine doses increase TSH and that is expected. Should then not test TSH on higher dose iodine.

Still taking iodine?
Oral body temperatures increased?
Changes to energy and clarity of thought?

No new lab data for TT, FT?

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Still taking the iodine synergy, and would pop the iodural here and there too. I had stopped the iodural I think a week before the blood test…I can’t recall now when I stopped the synergy one but I thought it too was a few days before the blood test. Not sure how long the “washout” period would be between taking iodine and getting a blood test??

Last time I checked the temps weren’t much different, I should probably go through and track a few days again to get a average though to see. Considering I’ve gone through probably a half a bottle of iodural I’d think my levels should have improved…

Took the test, no difference. Waited about a month, still didn’t seem any difference. When I got the blood work it was about the same time I got some sort of superflu that took my out for a few weeks. Once I got better from that, I did seem to go to somewhere between “okay” and “good”. Which, is awesome despite what it sounds like. I’ve got back into lifting consistently and typically feel good from a mindset perspective even with the half dose SSRI i switched to. I will admit I went up to 120mg/wk after not feeling any different so not sure if that played a role too. Recently switched to M/Th fin to see if that helped too.

I’ll get the full blood workup (and hair analysis and blood digestive test) when I go in a couple weeks. Was more curious on the estradiol/dht so only got those pre-emptive from them.