There is more going on here other that hypogonadism.
You should have had LH/FSH tested to determine what was going on BEFORE TRT. It is now too late.
What T levels did you get from Axiron, if that was tested. If low, poor absorption and perhaps thyroid problems need to be considered.
Prolactin 41.3 ng/mL 4.0-15.2
- This is a real problem. Please note comments re prolactin in the advice for new guys sticky. Would also contribute to gyno.
- see action items
- can lead to or contribute to depression and low energy
Pregnenolone is low, DHEA-S is not. Are you taking DHEA?
- try oral 50 or 100 mg [hard to absorb, take with meal that has fats/oils
- if not taking DHEA, this is odd as pregnenolone is the precursor for DHEA which is not low
- pregnenolone is the basis for all subsequent steroid hormone production
- also leads to progesterone which is upstream of cortisol and progesterone cream might improve cortisol
Cortisol 6.2 ug/dL 2.3-19.4
- this is very low if AM Cortisol that should be done around 8AM. Repeat if needed. Otherwise, read in the advice for new guys about stress, rT3, Wilson’s book.
- might be a good idea to do a 4 sample saliva test
Thyroid problems can contribute to hormone problems, low energy and weight gain. The symptoms of functional hypothyroidism are largely the same as hypogonadism. We see these two problems together here very often. Please read the thyroid basics sticky and check your body temperatures and think about your long term intake or lack of intake of iodine from iodized salt or vitamins that list iodine.
You need TSH at least, TSH, fT3, fT4 would be very useful. You could reduce anastrozole by 10%. However, your anastrozole dose needs to track your T levels. So a further decrease of 25/30 is required which yields .9*25/30
What are your fasting glucose and cholesterol numbers?
Estradiol 20.3 pg/mL 7.6-42.6 is almost idea. We suggest E2=22pg.ml as a target. To fine tune anastrozole dose, you need a liquid product and you can make your own 1mg/ml with vodka, shake before use and dispense by the drop after you determine the drops per ml.
Do labs 1/2 way between injections and be consistent so changes are not due to timing effects.
- read two stickies
- check body temperatures and eval long term iodine sources <== important
- change anastrozole dosing and method
- retest AM cortisol if need, otherwise confirm timing
- report fasting cholesterol and glucose
- retest prolactin, if still high, get a MRI looking for a prolactin secreting pituitary adinoma, treat with cabergoline
- prolactin can be controlled in any case with 0.5mg/week cabergoline in divided doses
- report blood pressure and pulse
- screen for diabetes risk with A1C lab test
- test LH/FSH just once, should be near zero on TRT. Otherwise if FSH is not, screen for testicular cancer, if clear, suspect pituitary.
- high potency B-complex multi vit with trace elements and iodine
- natural source vitamin E
- EFA’s: fish oil, nuts, flax seed meal/oil
- DHEA - NOT NEEDED
- Ubiquinol form of Co-Q10 IF there are any blood pressure problems
- vit-C and other anti-oxidants
- healthy fats in diet
So the above is a lot of material to deal with. This will take time. Please return to this post to see what you have dealt with and what you have missed. Print this for your PA.
To loose fat, you need high T levels, E2 near 22pg/ml, fT3 mid range or higher, sufficient iodine stores, good cortisol levels. [Testosterone, thyroid function and cortisol.] Pregnenolone is made in the mitochondrial bodies in your cells. Thyroid levels control body temperature via fT3 effects on the mitochondria. So thyroid function can affect pregnenolone levels.