T Nation

45 Yr/Old. Hormones are a Mess After System Crash


#1

Age:45
Height: 5’11
Waist: 32" inches
Weight: 150 lbs
Body Hair: Very light - thinned outer eyebrows, losing hair on lower of calves last three months and fairly good on head - typical reseeding but good overall.
RX List:
T4 - Levothyroxine 75mcg (Compounded)
Started TRT Jan 27, 2017 - 5% compounded cream daily. (30 days no results - stopped)
Started March 24, 2017 Testosterone Cypionate 100mg Every 6 days - Intramuscular (gluts)
Supplements: Daily
Curcumin 880 mg daily
Resveartrol 500 mg Daily
Selenium - 200 mg daily
Zinc 15mg, B6 4mg, Vit C 60mg
Vitamin D3 - 5000 IU Daily.
Diet: 90% Paleo Diet adherence - Fresh Food Daily - meats, vegetables, fruits. NO dairy, soy, eggs, wheat or grains (with the exception of white rice) and pretty much everything processed. There is the exceptional break during Holiday meals but even then I have been very strict for 4 years. Do not drink alcohol except at special occasions and its a few drinks at most.
Training: Walk multiple times a day for 10 to 20 mins - attempted to start weight training again but it seems to send my system crashing.
Health Conditions: Fistula Surgery October 2012 (approx. 4.5 yrs ago.) Prior to Fistula Surgery 4 years ago I was 195lbs, ate whatever I wanted, drank somewhat heavily, smoked, generally unhealthy lifestyle but with no significant symptoms of anything. Also I multiple food sensitivies that have mostly cleared up since changing my diet 4 years ago but have once again returned during this last crash.
This link is a complete history of my lab work prior to surgery and post surgery where I was diagnosed with Hashimotos.
https://drive.google.com/file/d/0B58wrfVpQLxadzVhcXpqakhuSmc/view?usp=sharing

Post surgery is where my journey begins.
After Surgery on October 2012 I began to go downhill very quickly. By December I was super fatigued, brain fog, cold, gaining weight, anxiety, mild depression ect… all the typical hypothyroid symptoms. (Father also died February 2013 during all of this) so was dealing with systemic stress from the surgery, father dying and still trying to work a stressful job. None of the doctors had any explanations for why this was happening but wanted to bandaid the symptoms with Levothyroxine, anti-depressants, anti anxiety (Xanax) I declined except for the Thyroxine. There were some noticed improvements within a month of starting Levothyroxine. Ran a brain MRI came back negative, ultrasound on the thyroid which confirmed mild Hashimoto Thyroiditis along with the elevated TPO. UCLA Grad Endo (idiot) ran TSH and T4 free got them within range but I was still suffering major symptoms that he could not explain because “My labs were within range” Fired his ass.

July 2013 - Found a Functional MD who worked with thyroid, sex hormones, diet and lifestyle changes (stress).
Spent an two hours with him going over everything and came up with a game plan. Get the blood sugar under control, Eat Paleo, get the thyroid functioning correctly and see where the sex hormones land maybe self correcting. If you review my labs starting October 2013 you can see a significant improvement in ALL lab areas including sex hormones, lost 50 pounds. After all of these great improvements sex hormones were still lacking and I was having “mild to moderate” symptoms still, but nothing really effecting my daily functioning but I still was not the man I was prior to surgery. We made several attempts to restart the HPTA, tried HCG stand alone no results, tried Clomid for 3 months and looking at the labs on 8/3/2015 It worked. I felt like a million bucks again, no stress bothered me, libido was in full action ( wife couldn’t keep up) energy levels off the charts, personality in full effect. Stopped the Clomid to see if the jumpstart would hold. following labs showed a pull back and the symptoms returned.

Fast forward to now
I have had a complete crash / breakdown (December 2016) and have been on temporary disability for 4 months due to significant work stress, significant family stress, diet breakdowns, drank again this summer, started smoking…this all crashed the endocrine system again causing everything to go out of whack, Depression, fatigue, debilitating anxiety and panic attacks, loss of libido ect…

I have been working my ass off to get this mess cleaned up again. perfect diet, no alcohol for six months now ( last drink was Election day…lol) perfect diet, none of that seemed to work aswell this time around. In February I was still battling all these symptoms and cried twice during a movie and said fuck this and so I found a new ND Naturopath doctor and started TRT 5% cream for 30 days with no relief of symptoms, Labs on 3/15/2017 actually got worse. Both thyroid & sex hormones, some lipids, liver alt and ast moved to top of range or slightly out. what is really throwing me for a loop is the really low TSH at .17 and really low T4 Free at .4, the T3Free didn’t budge.

So based on that series of labs on 3/15/2016 we have reduce my Levothyroxine to half, now 75mcg EOD and started TRT with self injection from home ( wife actually injecting IM for me). Test Cypionate 100mg every 6 days IM. This doctor is real great in terms of working with me in almost anything I want to do, not sure he’s all that great with knowledge and protocols with what is discussed in these forums. I’m not sure what to make of the Thyroid hormones now and unsure if the Doctor knows aswell.

First three weeks on the Test Cyp. and have been feeling amazing but I still have symptoms. most of the anxiety is gone, the brain fog is on and off, lots of insomnia in the last week, libido has come back slightly but still way off, testes have shrunk about 30% or so. First few days after injection feel great or “limitless” like from the movie, but seems to fade so i will be switching to a twice weekly SC injection. Labs were drawn last Thursday 4/20/2017 and I will be seeing the doctor and checking where things are since starting Test cyp. 4 weeks ago. I have also printed off KSman’s protocols with HCG and Arimdex to discuss with him.

So bottom line is i’m pulling out of the crash / breakdown just not sure what to do with the thyroid hormone situation and not sure If I’m missing anything else.

I appreciate any insights and help.

Thanks, Tim


#2

We see guys with thyroid problems unable to absorb transdermal T all of the time. Always? Might be. Have not see a doc who understands that so far.

You really do need those more frequent injections. You seem aware of the suggested protocol, so I will not repeat. You should try injecting with #29 1/2" 0.5ml syringes, SC/SQ upper leg. This will provide steady FT for AI to work best.

Do labs half way between injections always. Labs at time of Dr visit can be wrong. Need to eliminate lab timing artifacts. Also, need to do similar re thyroid meds and labs.

What happened with last lab where TSH crashed? Took meds twice?

fT3 should support good body temps, see last paragraph below to check. With what you have written, adrenal fatigue seems quite possible now and then lower body temps are expected. If rT3 elevated, you take T3 meds, time release is a compounding pharmacy item, and that lowers TSH and T4, reducing T4–>T3. TSH needs to go low to reduce T4 production.

Body temps can be a guide to thyroid med dosing. But throwing more T4 at adrenal fatigue would make that worse.

Glad to see you are onto selenium.

Using/used iodized salt to support thyroid function?

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

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

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.


#3

I did not take any (T4) Levothyroxine the morning of the labs and almost never miss my morning dose.

Body Temps last two mornings were 97.7 and moved to 98.6 in the afternoons.

After 1 month of Test Cyp. (100mg Every 6 days, NO HCG or Anastrozole)
Also reduced my T4 Levothyroxine to 37.5 mcg daily.
https://drive.google.com/file/d/0B58wrfVpQLxadzVhcXpqakhuSmc/view?usp=sharing

Results with the changes:
Labs dated 4/25/2017
TSH - 2.08 (.4-4.5)
T4Free - .4 (2.3-4.2) * Below Range
T3Free - 2.6 (2.3-4.2)
RT3 - 7 (8-25) *Below Range
Thyroglobulin Antibodies 1 (< or = 1)

My Interpretation of these labs compared to the last series of labs is the order/request from my Pituitary via TSH is for more T4/T3. (T3Free has moved down for the first time in 4 years.)

My RT3 is below the range indicating that my T3 is not being locked down.

I started with Test Cream two months ago (no effect) and now Test Cyp for 1 month maybe the TRT is doing things to my thyroid?

I was going to try Iodine supplements with some hesitancy based on some other research.

Those Thyroid labs seem somewhat confusing to me also after reviewing previous labs from spreadsheet.
My Doctor is a little unsure of them as well so we decided to increase my increase my T4 Levo to 50 mcg daily. After next series of labs in 5 weeks we may move to a compounded T4 with slow release T3. Thoughts?

Total Testosterone: 1059 (250-1100) was 388 one month ago.
TFree and TBioAvail: Quest butchered my sample and I did not receive results.
SHBG: 48 (10-50)
Prolactin: 6.2 (2.0-18)
Estradiol Ultra Sensitive: 34 ( < 29 pg/ml) @KSman Next lab series I will run the Quest Estradiol Labs not sure which one should be run the codes 4021 or 4021X based on your recommendation?

So after reviewing those labs and bringing my doctor printed out protocols and information I learned from these forums (read the sticky posts guys…like 3 times over i’m alittle slow =))
He wants to move me to Test Cyp 40mg every 4 days ( 80 mg a week basically) SQ injections to bring down my Total test closer to 800 to 900. He also thinks by doing that it will lower my Estradiol from 34 pg/ml back down below 29 pg/ml. But I was able to get him to agree to .25 mg Anastrozle every 8 days.

Do you think I should be using more Anastrozole like .25 mg every 4 days at time of injection or see how reducing the Test Cyp with .25 mg Anastrozole works out after 5 weeks?

My Doctor also agreed to HCG 300iu three times weekly (Mon. Wed. Fri for my ease of scheduling)
I’m thinking that should be close enough than EOD. (900 IU weekly).

Any thoughts or input?

Next set of labs I will be running:
TSH
T4Free
T3Free
RT3
TPO
TT
TF & Bio Avail
Estradiol
DHT
Pregnenolone
DHEA-S
PSA
C-Reactive Protein
CBC
CMP

For guys reading this and the rest of the forums, the knowledge here is amazing from the stickies and from contriubtors @KSman. There are many people out there struggling to get shit right in there mind and bodies so keep fighting through the idiots, read the sticky posts a few times take action.

Thanks for any comments or suggestions on my fight.


#4

SHBG is very high, eroding FT and inflating TT with non-bioavailable SHBG+T
Your “high” TT may be inflated.
Need FT lab work or Bio-T, do not redirect on TT alone.

No need to test prolactin again.

You need anastrozole.

Good body temps are hard to argue with. I agree with your thinking re fT3&rT3.

TSH says you need more thyroid med or iodine.

Are you getting any iodine now?
You are also slowly acquiring some iodine from your thyroid hormones.
The concern re increased iodine intake is mostly selenium deficiency.


#5

Got an update on my labs and progress. Energy levels have pretty much fully restored, mood and overall sense of well being have significantly increased, anxiety and panic attacks have almost completely disappeared. Libido has come back slightly but still kind of in the tank. Testicular shrinkage, a lot I think for 30 days.

Body temps last two days have been 97.7 on waking and reaching 98.6 during the day.
With my last few sets of thyroid labs that is still a little confusing to me. Earlier this year I was having serious temperature problems but have gone away except on cold days where I still seem to have cold sensitivity issued. (Hands and Feet)

I have replenished the kitchen with Iodized salt and ordered Kelp Idione supplement 325mcg.
Wife body temps are normal but I’m still introducing to her Selenium and the Iodine supplement.
Also I eat one can of Sardines daily which has a ton of goodness both Iodine and Selenium and a ton more. http://www.whfoods.com/genpage.php?tname=foodspice&dbid=147 What an amazing vitamin and mineral profile for such a small amount of food.

Newest TRT labs: 4/25/17
TT 1059 ng/dl (250-1100) was 388
FT 127.9 ng/dl (46-224) was 27.6
BT 268.5 ng/dl (110-575) was 66.9
ES Ultra Sens 34 ( <29 pg/ml) was 27
SHBG 48 nmol/L (10-50) was 47

Protocol change since those labs:
40mg Test. Cypionate every 4 days SQ (was 100mg one week)
.25 Anastrozole at time of injection. (NEW)
300 iu HCG - Mon. Wed. Fri. (NEW).
Added 25 mg DHEA (NEW) Daily (last lab was 133 mcg/dl (70-495)
Added 25 mg Pregnenolone (NEW) Daily (last lab was 20 ng/dl (10-200)
Both of those from previous of labs have been at the low end of the ranges

Thoughts on the protocol Changes?
So i’m still having low Libido issues?
Thryoid labs still show issues?
My Doc has been running the Quest Estradiol Ultra Sensitive and I have a years worth of labs history with it. Do I still try and target ES 22 using that lab test?

Any input on those last four items would be appreciated…other than that I think I’m getting things dialed in with significant improvements in the last 6 weeks.

Thanks,
Tim


#6

Quick update and latest thyroid labs. Reducing my Levothyroxine from 75 to 37.5 based on TSH was a bad choice. After these last set up labs and more extensive research I met with my doctor yesterday and started on WP Thyroid (NDT) 1 gram and will titrate upwards at 1/2 gram in 10- 14 days based on pulse rate and body temps until a new set of labs in a few weeks. I’m thinking that my body is not properly converting synthentic T4 the way it used to so this change was needed. plus ive been back to having some hypo symptoms last 7-10 days even though my body temps were not confirming.

TSH 2.08 (.4 - 4.5 mIU/L ) Was .17
T4F .4 (.8 - 1.8 ng/dl ) same as before
T3F 2.6 (2.3 - 4.2 pg/ml) was 3.3
RT3 7 (8 - 25 nd/dl) New

@KSman Thoughts? Also there were a couple of questions on my previous post"

“Thoughts on the protocol Changes?
So i’m still having low Libido issues?
My Doc has been running the Quest Estradiol Ultra Sensitive and I have a years worth of labs history with it. Do I still try and target ES 22 using that lab test?”

Also per my previous post I have added Idione salt along with Iodine supplement 225mcg daily (potassium Iodide per your recommendation.) I’m taking it slowly with the iodine since I already have Hashimotos and some loss of thyroid gland confirmed by an ultrasound.

Next lab series:
TT, FT, Bio FT, ES Ultra Sens, DHEA-S, Pregnenolone, DHT, Progesterone. Vit D
TSH, FT4, FT3, RT3, TPO
CBC, CMP


#7

Making some nice progress….New labs in today.

Glucose 87 65-99 mg/dl
AST 21 10-40 U/L
ALT 28 9-46 U/L

Thyroid Labs
TSH .85 (.4-4.5) Was 2.08
T4F .8 (.8-1.8 ng/dl) Was .4
T3F 2.9 (2.3-4.2 pg/ml) Was 2.6
Rt3 19 (8-25 ng/dl) Was 7 Moved up a lot.
TPO 37 HIGH (<9) was 55
Cortisol 8 A.M. 14.4 (4-22 mcg/dl) Taken right at 8 A.M.
ACTH 19 (6-50 pg/ml)

Body Temps last three days

On waking: 97,97,97
At 3.PM. 97.6, 98.2, 98.4
Blood Pressure has moved down from low 140’s / high 130’s to low 130’s high 120’s.
I attribute that to now receiving T3 directly from the Desiccated Thyroid,
Also Cold sensitivity has gone mostly gone away.
This is after 1 week of Desiccated Thyroid 1 Grain and 1 month of minimum dosage of Iodine 225 daily along with Iodine table salt used daily.
I started 1.5 Grains this week so I’m hoping to improve the last of my symptoms and get that T3F past 3.5 to the top of the range.
TPO is still dropping which is a good sign…I was little concerned with the new thyroid medication and adding Iodine that it would further my Hashimotos Autoimmune attack.
Still having some fatigue and lack of libido that has not comeback which I attribute to the low T3F levels?
Rt3 moved up but I don’t think it is a concern as of yet? Adrenals I still think are recovering from December. Not sure if that Cortisol is a decent number for 8 A.M.?

Current TRT Protocol after two months.
Test Cyp 40mg E4D SQ injection
HCG 300 IU M,W,F.
.5 Anastrozole E4D at time of injection.

TT 1044 (250-1100 ng/dl) Was 1089
FT 120.1 ( 46-224 pg/ml) Was 127.9
TBio 247 (110-575 ng/dl) Was 268.5
SHBG 47 (10-50 nmol/L) Was 48 …last time I test that.
E2 Ultra 23 (<29) was 34
Hemoglobin 17.7 HIGH (13.2-17.1)
Hematocrit 50.2 HIGH (38.5-50%)
Platelets 124 LOW (140-400) was 121 . Been low same level since 2012 don’t know what to do about that.
DHEA-S 179 (70-495 mcg/dl) Still to low I’m thinking
Pregnenolone 95 (22-237 ng/dl) Was 20
Progesterone <0.5 (<1.4 ng/ml) Needs to higher I thought? LOW?
DHT 45 (16-79 ng/dl)
PSA .5 (<or= 4.0 ng/dl) Was .5 Scheduled a DRE in 3 months.
C-Reactive Protein <.10 (<.80 mg/dl)
Vitamin D 42 (30-100 ngml)

TRT looks to be in a good place although Hemocrit and Hemoglobin went high out of range. Stopped by the Blood bank on the way home and donated 1 pint. Scheduled another Donation in 10 weeks.
My anxiety has nearly disappeared no panic attack atleast, libido still in the crapper mostly, fatigue sets in early afternoon. I’m still pointing those problems towards the Thyroid.
Does anything stand out at you guys with DHEA, Progesterone, Pregnenolone or DHT contributing to the last group of symptoms?
Was going to add 25 MG of DHEA and Pregnenolone daily to boost up those levels?

Thanks for the time.


#8

200mg selenium I hope.

Some are poor at T4–>T3, low ferritin can impede that. Some simply need T3 in their meds. Often there is a need to push TSH very low to get things working right.

TSH: You should not have freaked out. Although many doctors do the same thing out of lack of knowledge.

Not understanding why you reduced T dose to 70mg/week.
High HTC?
Injecting once a week was making lab results subject to timing effects.

SHBG still too high and FT may yet reduce that.
E2=34 part of that problem.
[ E2=37 made my life hell ]

NDT is one grain, not gram!

Looking at your fT3:fT4 ratio, you may do fine.

E2=23 is nice. When you reduce T dose

Libido can easily be low from low thyroid function and E2=34

As you get to lower E2 levels, you need sensitive so you do not see E2=16 shown as E2<17 or whatever the cut off is. I do not remember lab company specifics.

With T every 4 days, lab timing affects results.

rT3 is great, no need to repeat frequently.

Your thyroid dose plan driven by how you feel and body temps seems perfect, doc has you in charge.

HCG should fix your testes rapidly, perhaps improve mood.

Sorry, my response is quite disorganized.


#9

Do you supplement magnesium? You are likely magnesium deficient from vitamin D3 supplementation if you are not eating a lot of leafy greens or ~2.5 cups of spinach a day. Supplementing vitamin D3 can create magnesium deficiency. Your vitamin D 25-OH could be a little higher - 60-70 ng/mL is ideal. Vitamin D is involved in over 1000 gene expressions and magnesium in over 300 physiological processes - these are very important micronutrients.

Do not underestimate the need for fT4 and get hung up only on fT3. fT4 is still metabolically active and accounts for ~20% of the metabolism with fT3 ~80%. Ferritin and also imbalanced gut flora can effect fT4–>fT3.


#10

I do not believe that there is a T4 receptor.

Wikipedia: The thyroid hormones function via a well-studied set of nuclear receptors, termed the thyroid hormone receptors. These receptors, together with corepressor molecules, bind DNA regions called thyroid hormone response elements (TREs) near genes. This receptor-corepressor-DNA complex can block gene transcription. When triiodothyronine (T3) binds a receptor, it induces a conformational change in the receptor, displacing the corepressor from the complex. This leads to recruitment of coactivator proteins and RNA polymerase, activating transcription of the gene. [20] Although this general functional model has considerable experimental support, there remain many open questions. [21]

There is contradictory information and other things that are poorly written which do not provide clarity.

Magnesium is not a micro nutrient when you take 400-500mg per day. If you are magnesium deficient, added Vit-D3 can shift how magnesium is utilized, perhaps leaving some processes with reduced available magnesium [competition], even as magnesium intake is unchanged.

To get larger/optimal amounts of magnesium, most will need a supplement. T-nation’s BioTest store sells ZMA.


#11

I am always very hesitant before I post so as not to regurgitate nonsense that causes confusion. I’ve read so much shit about hormones that I cannot remember the original source(s) where I read that fT4 is 20% and fT3 is 80% ‘metabolically active.’

I found these quotes but they are not from peer reviewed publications so take them for what they are. It may be bad context like you’re saying but I don’t know.

“They are both heavily involved in energy management and a variety of biochemical and metabolic reactions and functions throughout the body. While T4 is more abundant in the bloodstream, it is T3 (which is derived from the conversion of T4 in the kidneys and liver) that possesses the most potency and is thus responsible for most metabolic activity.” - By: AutoimmuneMom Contributor, Reviewed by Gary Rothbard, MD, MS in Graves’ Thyroid1

“The normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the hormone “strength” as T4.” - Robert M. Sargis MD, PhD

“A normal thyroid gland produces 80% of T4 and 20% of T3. Anyhow, the most active form of thyroid hormone is T3 and therefore, most of the T4 is converted into T3. The T3 hormone is 4 times more active than the T4 hormone.”

“Although T3 is secreted in significantly smaller quantities, it is about four times as potent as T4.”


#12

Lab and symptom update.

Current Protocol:

40mg of Test Cyp E3.5 Days (SQ)
300 IU of HCG Mon, Wed, Fri. (SQ)
NO Anastrozole for last 5 weeks.
2 Grains of WP Thyroid split dosed (1 grain in the morning, 1 grain early afternoon.) Lowered dose from 2.5 Grains

Daily Supplements:
Lugols liquid Iodine 12.5 mg (added to decaf coffee) 2 months now
Trace Minerals
B Complex
Acetyl L-Carnitine 500 mg
Alpha-Lipoic Acid 300 mg
CoQ10 200mg
Magnesium 450 mg
Vitamin C 2500 mg
Sublingual Vit D / Vit K combo
Vit D 5000 IU
K2 680 mcg
MK-4 500 mcg
MK-7 180 mcg
Protein Drink with BCCA’s

Labwork: 8/9/2017

TT 1093 (250-1100 ng/dl) was 1044
FT 144 (46-224 pg/ml) was 120
Bio T 284 (110-575 ng/ml) Was 247
SHBG 42 (10-50 nmol/l) Was 47 - dropped 5 points
E2 40 (<29)

TSH .03 (.40-4.5) was .03
T4F .9 (.8-1.8 ng/dl) was 1.0
T3F 3.9 (2.3-4.2 pg/ml) was 4.5
RT3 17 (8-25 ng/dl) was 17
TPOa 42 (<9 ) was 35

Donated Blood 10 days Prior to lab draw

Hemoglobin 17.1 (13.2-17.1 g/dl)
Hematocrit 48.7 (38.5-50.0 %)
RBC 5.49 (4.20-5.80)
Iron 161 (50-180) was 145
Ferritin 32 (20-380 ng/ml) Was 48

Glucose 90 (65-99) was 87
Hemo A1c 4.7 (<5.7) was 5.1
Cholesterol 167 ( 125-200) Was 201
LDL 96 (<130) was 119
HDL 54 (>40) was 71

Libido is back in the tank…
Taking .5 mg of Anastrozole at time of injection was to much for me and lowered my E2 to 13 pg/ml so I stopped taking it for 5 weeks to see where my TRT protocol changes landed me. its now back up to 40. There was about a week and half during that time as my E2 moved through the sweet spot my libido was fantastic. Not sure exactly how much Anastrozole I need to take so
I am having the pharmacy compound my Anastrozole at .125 mg per pill and I plan on taking that at time of injection and retesting after two weeks. Seems I might be more sensitive to Anastrozole then most. I’m also taking only 80 mg of test per week and I’m at the top of the range for TT and mid range in FT and BioT. Really like how my SHBG dropped a few points boosting up my FT and BioT. .

I need some advice on trying to dose my Anastrozole?

I’m most concerned now trying to manage my Hemo’s. I’ve donated whole blood twice and ferritin is now dropping lower and lower. This will likely turn into an issue for me and start affecting my thyroid at some point.

I cannot seem to keep my blood pressure below the 130’s. Reading some information from another forum I had my doctor write me a prescription for Losartan which according to a study also seems to lower the Hemo’s along with blood pressure. I’m also trying one grapefruit a day. If I have too i’ll eventually lower my Test Cyp if I cant get it balanced.

I need some advice on trying to dose my Anastrozole?

I’d appreciate any input on my current set of labs or supplements …maybe i’m missing something?

Thanks,
Tim