T Nation

35 y/o, Bloodwork Analysis and Recommendations?


#1

I am a 35 y/o male that has been morbidly obese most of my life. I recently lost 100lbs and am finally within a normal weight of 220lbs. I am 6’0" tall and recently had a test to find out my body fat % is 24.2. For the last year I have trained 6 days a week and worked hard to lose the weight. I didn’t use any supplements, pills, powders etc. I did all of it with diet and exercise. As I sit here today, I feel better than I ever have however, I realize that comparing the new me to the old me isn’t a fair comparison. I started to realize that I just accepted being fatigued, tired, worn down all of the time. I have a low libido and carry most of my remaining fat in my midsection. My trainer (a doctor) mentioned to me that I should think about being tested for low testosterone. I finally found a doctor who I trusted and he ordered bloodwork. Here are my results. I meet with the doctor tomorrow to determine treatment protocol. Would anyone be willing to provide their expert opinion on what they see here? Just want to make sure I am prepared for tomorrow. I have spent months reading topics on this forum in preparation for treatment.


#2

Met with the doctor today. He has prescribed 100mg cyp once per week and 250iu HCG twice per week. Said he wanted to monitor E2 level before prescribing anastrazole.

Thoughts?


#3

Your doc seems to know a bit more about what he’s doing than mine does. I think this is a good start. KSman can chime in on the thyroid thing, but I would recommend reading up on the thyroid sticky to make sure you’re good there. Check your temps, make sure you’re getting iodine/selenium.

Good luck on your journey. Many people are having a pretty rough time even getting to this point. You’re at a good starting place for success.

Is he allowing self-administration? This forum recommends every other day subcutaneous injections. I’ve read the research and there’s a lot of benefit to this, so I agree with it. Again… check those stickies!


#4

Thanks for the reply. Yes, he is allowing me to self-inject. I just picked up the HCG and cyp this morning and I’ll be doing my first HCG injections on Friday and Saturday and the first cyp injection Sunday.

I just purchased a thermometer and I’m going to test thyroid.


#5

Target on TRT is 22pg/ml which seems optimal for almost all guys [a few are different] with regards to mood, libido, energy and fat loss/patterns. You are at E2=20 with low T, you will need anastrozole for sure. But your doc might easily have no concept of optimal and may only react to high levels. Doctors are THE problem.

Cholesterol OK?

Other health issues?

Are you using a statin drug or any other medications?

For your body weight, you may need 140mg/week to get high end TT and FT.

Diet should have lots of proteins as TRT will drive a need for more and you might otherwise get a hunger that will not go away. Whey shakes can quench that hunger and keep you away from other inappropriate foods and eating.

Thyroid problems can drive fat gain by lowering metabolic rate.
TSH should be closer to 1.0, 1.9 is a problem.
Thyroid lab ranges are stupid and doctor follow like zombies.
Your problem might be caused by not using iodized salt, and doctors never ask about that.


Important:

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


Cortisol lab done at 8AM or 1 hour after waking? Otherwise sort of unusable. Cortisol affects energy levels in short term, thyroid longer term.

Starvation diets can be quite harmful to sex hormones and to thyroid function by increasing rT3 that interferes with the active hormone fT3.

Have you tested A1C?

Most guys injecting T once a week do not do well with T peaking and crashing and E2 goes up and as T levels drop into a cesspool of E2 they flounder. Please inject T twice a week. You will get steadier T levels. Better injected subq and not IM for smoother release and no IM muscle damage.

pinch up skin over upper leg, inject into end of the fold with needle parallel to muscles. #29 1/2" 0.5ml [not 1.0ml]

If/when you get anastrozole, take 1/2mg at time of T injections. If you have a sudden crash, you are an anastrozole over-responder, stop for 5-6 days and resume at 1/8th mg at time of injections. Adjust dose after later labs to get near E2=22pg/ml. If you get E2=30, new dose = old dose x 30/22

Your testes will mostly likely shrink and pull uptight. on TRT as LH/FSH–>zero. Can effect ones sense of sexual identity and many wives care too. Testes may ache 24x7. 250iu hCG subq EOD prevents that and many find a mood improvement too.

Great work on the weight loss!

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

#6

Thanks for taking the time to respond. I had a feeling you would say that
about anastrazole. In three months, I fully expect to be given an RX for
anastrazole given my E2 levels will be high.

Cholesterol is at 200. That’s the highest it has ever been and was taken in
March. I’m going to have it retested because it’s usually around 170.

No other health issues or medication.

You aren’t the first to say about the increased need for protein. I eat an
awful lot of it now but will most likely need your suggestion for a daily
whey protein shake.

Reading these forums has awakened me to the thyroid issues. I’ve ordered a
digital thermometer and will be testing as you prescribe to detect thyroid
issues.

Cortisol test was done within one hour of waking. Should be a pretty
accurate result.

I haven’t been on a starvation diet at all. I have consumed a proper number
if calories with a well thought out macro breakdown and trained and often
to lose the weight.

I didn’t have A1C tested but it was tested in March and it was 5.1 (range
of 4-6).

I was insistent on injecting cyp twice per week but doctor said he wanted
to make sure I was capable of injecting regularly once per week. I will be
pushing him again for that.

Doctor has me on 250iu HCG twice per week.

I will be starting the regimin tomorrow and be doing HCG Friday, HCG
Saturday and cyp Sunday.

Thanks for your advice.


#7

If nipples act up or you feel bloated or bitchy, ask your wife if she understand these things ;), you need to call doc and get E2 tested then after explaining what is going on. Better yet, get anastrozole Rx as I suggested based on symptoms. With 3 months, I expect that you will feel a TRT benefit and have E2 make it go away.

Read those stickies and review my post above as your learning curve allows you to get it all.


#8

Doc has prescribed me anastrazole at .25mg on day of injection and .25mg 4 days later. Current protocol is the following:

100mg test cyp IM once weekly (Sunday)
250iu HCG subq twice a week (Friday and Saturday)
.25mg anastrazole twice a week (Sunday and Thursday)

I have tested thyroid as you suggested in your stickie and I’m satisfied that I do not have an under or over active thyroid.

The only problem I’m having at this point is that I’ve gained over 5 pounds since my first injection 7 days ago and my midsection is bloated. Physically and emotionally I feel good but have a tough time getting over the number on the scale given how far I’ve come over the last year on my weight loss journey.

Thoughts?


#9

This is clearly wrong as there will not be enough anastrozole<-- [note spelling] early in the week with high T levels then too much with lower T levels.

Good to hear that your body temperatures indicate good thyroid function.
BUT TSH=1.9 TOTALLY CONTRADICTS THAT.

Doc thinks that hCG is going to lift T levels a bit as T is fading. This does not provide an ideal solution at best. Should have some benefit as you had primary hypogonadism.

hCG has a longer half-life, you could space it out.

Many will need more anastrozole than that. The issue really gets down to what your doc considers a therapeutic result for E2 AND your symptoms. While you can get a decent E2 lab in three weeks, your symptoms of elevated E2 take time to develop as there are changes to brain patterns that take time.


#10

Thanks.

I may have spoken too soon on the thyroid test. I’m going to retest for a week and report back.

I really didn’t think that was enough anastrozole either given that I have been directed to dose entire 100mg cypionate at once. I’ll talk with him about taking 1mg a week with a majority of it at time of injection. Would you consider .75mg at TOI and .25mg 4 days later sufficient?

I had read about hCG having a longer half life. My guess was that he was hoping to extend the T level during the last two days of the week. Your comment confirms my suspicion. Upon additional research I see that my doc is following the Crisler method pretty closely. I’m not surprised given that he has just started his TRT practice and maybe isn’t aware of all the alternatives and variations necessary to get to optimal.

I’ll follow up again with a second round of thyroid temp testing and my conversation with the doc.


KSman is Here
#11

Thyroid test for the past four days:

96.7/96.6
96.7/97.1
96.7/97.0
96.7/96.8

I guess this indicates hypothyroidism? Any suggestions on amount of iodine to start and then a maintenance dose?

Besides that, I feel great. Energy is high. Mental clarity is good. More endurance at the gym. Morning wood has seemed to go down a bit but I just started AI yesterday.


#12

I just did my fourth injection of 100mg test cyp today. I am feeling pretty good. I’m working to drop some initial water weight gained following my first injection and I’m taking anastrazole .50mg weekly in .25mg doses twice a week. The HCG is at 500IU weekly in 250iu doses twice a week. Other than the water weight, I have not had any other symptoms of high E2.

So I have decided to proceed with IR therapy. I just received a bottle of iodoral from Amazon at the 12.5mg dose. My plan is start at 1 pill a day (12.5mg) for 7 days and then increase to 2 pills a day (25mg) until I reach 750mg.

I have two questions:

  1. What is an appropriate maintenance dose for someone who has reached 750mg and decides not to use iodized salt?
  2. What amount of selenium is required during the IR loading phase to avoid any ill effects of the high dose iodine supplements?

To paint a clearer picture, I am including my current list of supplements. The amount following the plus sign is the amount of the supplement in the multivitamin (GNC Mens Sport). I just switched to this multi and after looking at what I’m taking now and what is included in that multi, I will probably drop the vit b complex as shown below.

Magnesium 400 + 100 = 500mg
Fish Oil 2000mg
Turmeric 1200 + .5 = 1200.5mg
l-Carnitine Tartrate 500 + 6 = 506mg
Vitamin D 5000 + 1600 = 6600iu
Probiotic
Iodoral 12.5mg + 150mcg = 12.65mg

Vitamin B Complex
-Vitamin C 60 + 300 = 360mg
-Thiamin 25 + 50 = 75mg
-Riboflavin 5 + 50 = 55mg
-Niacin 25 + 50 = 75mg
-Vit B6 5 + 50 = 55mg
-Folic Acid 400 + 400 = 800mg
-Vit B12 100 + 50 = 150mcg
-Biotin 1000 + 300 =1300mcg
-Pantethonic Acid 5.5 + 50 = 55.5mg
-Sodium 10mg


#13

selenium 200mcg is in your vitamins

6.25 mg iodine once a week is a good maintenance dose

If you will not inject T twice a week, you could do a 2/3 1/3 split. If you do not have or make a liquid solution, arbitrary doses are impossible.


#14

Thanks. Wasn’t sure if 200mcg selenium was sufficient during the loading phase.

The cypionate is in liquid form and I will begin injecting twice a week after my next labs and consult with the doctor.

You are a great resource and I appreciate your willingness to spend as much time responding to all of us.