T Nation

45 yo Starting TRT

After reading through the stickies/posts about over responders, I took .25 mg Adex on Sunday and am waiting 6 days to begin the suggested protocol of .25 mg/week (divided into EOD).

I dissolved 2 mgs into 112 drops of Grey Goose vodka in a 15 ml dropper bottle. If my math is correct, then taking 4 drops EOD will yield the .25 mg/weekly.

Will start the .25 mg/week (4 drops EOD) with my next Test/HCG injection and go from there.

Lab from 9/15/2014:

WBC 9.2 3.4-10.8 x10E3/uL
RBC 4.92 4.14-5.80 x10E6/uL
Hemoglobin 14.7 12.6-17.7 g/dL
Hematocrit 44.2 37.5-51.0 %
MCV 90 79-97 fL
MCH 29.9 26.6-33.0
MCHC 33.3 31.5-35.7 g/dL
RDW 13.9 12.3-15.4 %
Platelets 170 150-379 x10E3/uL
Neutrophils (Absolute) 5.7 1.4-7.0 x10E3/uL
Lymphs (Absolute) 2.5 0.7-3.1 x10E3/uL
Monocytes(Absolute) 0.8 0.1-0.9 x10E3/uL
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL
Glucose, Serum 86 65-99 mg/dL
BUN 16 6-24 mg/dL
Creatinine, Serum 0.98 0.76-1.27 mg/dL
eGFR If NonAfricn Am 93 >59 mL/min/1.73
eGFR If Africn Am 107 >59 mL/min/1.73
BUN/Creatinine Ratio 16 9-20
Sodium, Serum 141 134-144 mmol/L
Potassium, Serum 5.0 3.5-5.2 mmol/L
Chloride, Serum 99 97-108 mmol/L
Carbon Dioxide, Total 27 18-29 mmol/L
Calcium, Serum 9.3 8.7-10.2 mg/dL
Protein, Total, Serum 6.7 6.0-8.5 g/dL
Albumin, Serum 4.6 3.5-5.5 g/dL
Globulin, Total 2.1 1.5-4.5 g/dL
A/G Ratio 2.2 1.1-2.5
Bilirubin, Total 0.4 0.0-1.2 mg/dL
Alkaline Phosphatase, S 74 39-117 IU/L
AST (SGOT) 32 0-40 IU/L
ALT (SGPT) 37 0-44 IU/L
Testosterone, Serum 1048 348-1197 ng/dL
LH 1.7 1.7-8.6 mIU/mL
FSH 1.4 LOW 1.5-12.4 mIU/mL
Estradiol 18.8 7.6-42.6 pg/mL

Happy with the Total Test level and dialing in the Estadiol (currently taking 6 drops Adex EOD which equates to ~.375 mg Adex).

I’ll pull another lab in 2 weeks to see what the Estadiol is.

Any feedback/comments? Thanks!

E2=19 is not bad. So you are wanting to adjust dose to get closer to E2=22pg/m? If so, adjust dose by factor of 18.8/22 and you will be there and can skip the lab work.

When you increase T dose, you need to increase anastrozole dose by the same factor. Do these two changes cancel each other out?

Your labs look very nice - at first glance.

What is the status of your IR? Completed? Whats going on with your body temperatures.

Are you getting enough protein in your diet?

Hematocrit 44.2 seems low considering your T levels.

  • do you have digestive problems?
  • ever had an occult blood test - detected blood in stool [that you cannot see by the eye]

Pre TRT you had high LH/FSH and middling T levels. Sort of suggested primary hypogonadism. But still did not make sense.
Now you are on TRT with high TT and LH/FSH should be near zero but are not. FT labs would be very useful here.

I am concerned that there might be something abnormal in your hypothalamus-pituitary function. Typically when we see FSH not at zero while on TRT we suspect a testicular tumor. But then LH would typically be zero. So I suspect the top end of the HPTA. As long as we are looking for pituitary abnormalities, we should have lab data for prolactin. Get testes examined and test prolactin. If prolactin elevated, we have a reason to justify MRI to check for a pituitary adinoma.

The LH/FSH also calls for that. If there is a pituitary adinoma, we do not want to see it getting large enough to press on the optic nerves. If that happens, there can be visual artifacts, primarily a loss of width of peripheral vision which can be near 180 degrees. If there is a prolactin secreting adinoma, it can be managed with 0.5mg/week cabergoline in divided doses.

Sorry to rain on your parade. You need to get these things looked at.

As for lab work; you seem to be doing labs too soon after dose changes. Let your body adjust longer before doing labs. When you change T or E2 levels, the liver will take time before it changes your SHBG levels, which affects fT levels and fT levels affect the liver and SHBG.

KSman, thank you for taking the time to read my lab and post feedback. Answers to your questions are below:

[quote]KSman wrote:
When you increase T dose, you need to increase anastrozole dose by the same factor. Do these two changes cancel each other out?
[/quote]

Yes, I increased the anastrozole dosage by the same factor and the changes seem to have canceled each other (I feel the same).

The body temperatures have improved dramatically. Before IR I would awake with temps in the low to mid 96F range. Now the are in the low 97F.

Mid morning is high 97F to low 98F. Afternoon reach 98.4-6.F

The IR continues, currently taking 6 mg I daily. I will continue this for another six weeks or so until I go back for my follow-up physical. Then I will have my iodine tested (urinalysis). If no deficiency is noted at that time, the plan is to reduce the dosage to 6 mg/week I.

Yes, I am eating 1.2 grams/lb of my body weight (1/2 fish/chicken/red meat, 1/2 supplemental protein powder).

No digestion problems. I tolerate most foods well (I generally avoid grains, high-glycemic fruit, dairy). I had an occult blood test 4 weeks ago during my annual physical. It was negative. Frequent bowel movements (1-2x/day) and stool is normal color, etc.

** Is it possible a blood donation could have effected the Hematocrit levels? I donated blood the week before the last lab.

I assume FT is Free Testosterone. I will add this the next time I have a blood panel.

[quote] we should have lab data for prolactin. Get testes examined and test prolactin. If prolactin elevated, we have a reason to justify MRI to check for a pituitary adinoma.
[/quote]

The testes examination happened during my annual physical 4 weeks ago. The doctor noted they were normal. He also explained the procedure for self-examination which I do monthly.

I’ll add prolactin to the next blood panel, also.

No rain, I’m a lot further along than I was 8 weeks ago :slight_smile: I’m feeling better and my blood work shows improvement. I immensely appreciate the help in improving my health and quality of life.

What is the ideal time to wait? 20 days? 30?

Thanks again.

Q: What is the ideal time to wait? 20 days? 30?

A: Three weeks should capture most of the changes.

I’ll pull a lab in 3 weeks then. Thanks.

Current dosage EOD for the past 10 days

43 mg Test C
250 IU HCG
.25 mg Adex

Thing is ever since I’ve been on this amount I feel I’ve put on 7-10 lbs of water weight. Also feel lethargic/fatigued a bit, too.

Should I try increasing the Adex amount? If so, how much?
(or should I just continue this dosing and see what the lab says in anther 10 days)?

Need labs to see where E2 is at.

You are taking 0.975 mg anastrozole per week against 150mg T

What was the calculated anastrozole dose for this amount of T, there were two calculated factors.

I’m at .875 mg anastrozole for 150m T weekly.

That was based upon my increase from 100 mg T and .375 mg anastrozole weekly. (E2 was at 27)

Here’s my lab from yesterday afternoon (9/23).

Testosterone, Serum 880 348-1197 ng/dL
LH 1.0 LOW 1.7-8.6 mIU/mL
FSH 1.0 LOW 1.5-12.4 mIU/mL
Estradiol 13.5 7.6-42.6 pg/mL

I’ve redoubled my effort to drink more water and eat clean (no sugar, minimal fruit, etc) to help alleviate the bloating.

Thoughts?

LH and FSH should be near 0.0, not 1.0

  • typo?

You can change anastrozole dose by 13.5/22

How long on new protocol before this new lab result? Time to get balanced?

Lab from 10/2

Testosterone, Serum 1054 348-1197 ng/dL 01
LH <0.2 LOW 1.7-8.6 mIU/mL 01
FSH 0.5 LOW 1.5-12.4 mIU/mL 01
Estradiol 16.2 7.6-42.6 pg/mL 01

Current protocol:

42 mg Test EOD
.25 mg Adex EOD

My thoughts: Total T is at a good range, LH and FSH continue to lower towards 0 (much lower than prior 2 labs), Estradiol good. Starting today I’ve adjusted the Adex dosage from .25 mg EOD to .23 mg EOD attempting to raise the Estradiol into the low 20s.

I generally feel good (sleeping well, morning wood, good appetite, etc).

Feedback?

Looks good. Glad to hear that you feel good.
You have good energy and initiative as well?

To get to E2=22, new dose is .25 * 16.2/22 18.5
The relationship is very linear.

[quote]KSman wrote:
Looks good. Glad to hear that you feel good.
You have good energy and initiative as well?

To get to E2=22, new dose is .25 * 16.2/22 18.5
The relationship is very linear.
[/quote]

Yes, energy and initiative is good! More important they have been consistent for 10 days or so.

The decision I made to temporarily stop HCG while I fine tune the Test and anastrozole seems to be helpful. Only dealing with two factors, not three.

Once they’re optimum, I’ll start back with the HCG, see how it affects me and go from there.

A work-in-progress but heartfelt thanks and appreciation for all the information shared here. Definitely has helped me accelerate getting where I am.

Interesting lab results yesterday vs 2 weeks ago:

Lab from 10/2

Testosterone, Serum 1054 348-1197 ng/dL 01
LH <0.2 LOW 1.7-8.6 mIU/mL 01
FSH 0.5 LOW 1.5-12.4 mIU/mL 01
Estradiol 16.2 7.6-42.6 pg/mL 01

Lab from 10/14

Testosterone, Serum 711 348-1197 ng/dL 01
LH <0.3 LOW 1.7-8.6 mIU/mL 01
FSH 0.8 LOW 1.5-12.4 mIU/mL 01
Estradiol 15.8 7.6-42.6 pg/mL 01
Free Testosterone (Direct) 19.7 6.8-21.5 pg/mL 01

I took both labs mid way point between injections and the dosage didn’t change over the last 6 weeks.

Why the drop in TT almost 300 points (E stayed practically the same)?

My Free Test seems to be in a good place and I understand that’s more important than TT. Is that correct?

Thoughts? Thanks.

Your testes were producing T while on hCG then you stopped?

When you resume hCG and T increases, your anastrozole dose will need to be changed again.

Those lab ranges probably age adjusted, higher, above range would be good and youthful.

Thank you for the reply. Yes, stopped the HCG to get the Test and E2 levels a bit more stable.

So you recommend I restart HCG and increase my anastrozole dosage? If so, is there a formula to figure out how much to adjust the anastrozole?

As a guess, increase hCG by 1054/711 then decrease by 15.8/22 which is close to 1.0, so get back on hCG and leave the anastrozole dose unchanged.

As of 11/2 my protocol is

130 mg T weekly (divided into EOD dosing)
250 iu HCG EOD
330 iu Liquidex (1 mg/ml) EOD

I’ll pull a lab in 3-4 weeks to see how things are.

Over the last 6-8 weeks I’ve experienced some testicular atrophy. Any guess as to how long the before the HCG kicks in and the testes return to normal size?

Thanks!

Can you comment about your body temp and iodine use? Did your body temp return to normal? Did you notice any beneficial effects or would that be too hard to decouple since you were on TRT before starting iodine. Thanks.