T Nation

49. Daily Test Protocol. No AI or HCG... Really?


#1

Ok; guys brand new here and read all the stickies as ssuggested.

On TRT for 2 weeks now - 140 per week with daily .1 subQ injections. No HCG and No AI. Now, I have sore nipples - is that common? (seems like no from what i have read). Should I give it some more time before asking Doc for AI? Was hoping daily Test would help with estradiol issues…

49 years Old
6’00"
34 inch waist
190Lbs
normal body and facial hair
Carry a bit of fat in the gut - 21% body fat
Health is "fine - other than fatigue, lack of drive, weak sex drive, brittle nails, dry skin, piss poor attitude, no gains in gym.
No drugs for prostate, hair loss. Full head of hair.
Diet pretty good - Paleo-esq
Crossfit pretty consistently.
No testes ache; morning wood is “meh”

You will see in labs below couple of standout things (to me anyway) and the Dr…Test low on absolute basis and free. LH is low; Cholesterol is high. IGF -1 is high. Estradiol is low (which i think is good, but i cant tell if this was done with the proper test). PSA needs to be tracked. Vitamin D is low (on suplements for that). I dont use much iodized salt; but i will take my temperature. What else do you see guys? What am i missing… KSMan etc…
Your help is greatly appreciated.

CMP14+LP+6AC+CBC/D/Plt+TIBC…

Glucose, Serum 95 mg/dL 65 - 99
Hemoglobin A1c 5.5 % 4.8 - 5.6

Uric Acid, Serum 4.5 mg/dL 3.7 - 8.6

BUN 17 mg/dL 6 - 24
Creatinine, Serum 0.98 mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 91 mL/min/1.73 >59
eGFR If Africn Am 105 mL/min/1.73 >59
BUN/Creatinine Ratio 17 9 - 20
Sodium, Serum 142 mmol/L 134 - 144 01
Potassium, Serum 4.5 mmol/L 3.5 - 5.2
Chloride, Serum 103 mmol/L 96 - 106
Carbon Dioxide, Total 23 mmol/L 18 - 29
Calcium, Serum 9.1 mg/dL 8.7 - 10.2
Phosphorus, Serum 3.5 mg/dL 2.5 - 4.5
Protein, Total, Serum 6.9 g/dL 6.0 - 8.5
Albumin, Serum 4.3 g/dL 3.5 - 5.5
Globulin, Total 2.6 g/dL 1.5 - 4.5
A/G Ratio 1.7 1.1 - 2.5
Bilirubin, Total 0.4 mg/dL 0.0 - 1.2
Bilirubin, Direct 0.07 mg/dL 0.00 - 0.40
Please note reference interval change
Alkaline Phosphatase, S 44 IU/L 39 - 117 01
LDH 144 IU/L 121 - 224

AST (SGOT) 19 IU/L 0 - 40
ALT (SGPT) 25 IU/L 0 - 44
GGT 15 IU/L 0 - 65
Iron Bind.Cap.(TIBC) 307 ug/dL 250 - 450
UIBC 242 ug/dL 111 - 343 01
Iron, Serum 65 ug/dL 38 - 169
Iron Saturation 21 % 15 - 55
Ferritin, Serum 429 High ng/mL 30 - 400

Lipids 01
Cholesterol, Total 239 High mg/dL 100 - 199
Triglycerides 112 mg/dL 0 - 149
HDL Cholesterol 63 mg/dL >39
VLDL Cholesterol Cal 22 mg/dL 5 - 40
LDL Cholesterol Calc 154 High mg/dL 0 - 99
T. Chol/HDL Ratio 3.8 ratio units 0.0 - 5.0

C-Reactive Protein, Cardiac 0.76 mg/L 0.00 - 3.00 01

Homocyst(e)ine, Plasma 7.3 umol/L 0.0 - 15.0

CBC, Platelet Ct, and Diff 01
WBC 5.8 x10E3/uL 3.4 - 10.8
RBC 4.88 x10E6/uL 4.14 - 5.80
Hemoglobin 15.3 g/dL 12.6 - 17.7
Hematocrit 45.9 % 37.5 - 51.0
MCV 94 fL 79 - 97
MCH 31.4 pg 26.6 - 33.0
MCHC 33.3 g/dL 31.5 - 35.7
RDW 13.9 % 12.3 - 15.4 01
Platelets 201 x10E3/uL 150 - 379
Neutrophils 66 %
Lymphs 17 %
Monocytes 16 %
Eos 1 %

Basos 0 %
Neutrophils (Absolute) 3.8 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 1x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.9 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Prl+Insul+IGF1+IGFBP3+V D25
Insulin-Like Growth Factor I 230 High ng/mL 67 - 205
IGF-BP3 4721 ug/L 2374 - 5891
Prolactin 9.0 ng/mL 4.0 - 15.2
Insulin 5.6 uIU/mL 2.6 - 24.9
Vitamin D, 25-Hydroxy 31.6 ng/mL 30.0 - 100.0 01

T4+TSH+TestT+LH+DHEA S+E2+S…
TSH-ICMA 1.6 uU/mL
Reference Range:
Pubertal Children and Adults:
0.5 - 4.8
Thyroxine (T-4), Serum 6.6 ug/dL
Reference Range:
Adults: 4.2 - 13.0
Free T-3 3.1 pg/mL
Reference Range:

=20y: 2.0 - 4.4
Testosterone, Serum (Total) 237 Low ng/dL 03
Reference Range:
Adult Males
18 years 348 - 1197
Free Testosterone, Serum 33 Low pg/mL
Reference Range:
Adult Males: 52 - 280
% Free Testosterone (Dialysis)
1.4 Low %
1.00
T
Adult Males: 1.5 - 3.2 Luteinizing Hormone (LH) ECL 1.5 mIU/ml
Reference Range:
Adult Males: 1.5 - 9
DHEA-Sulfate, LCMS 242 ug/dL
Reference Range:
Adult Males (41 - 50y): 16 - 390
Sex Hormone Binding Globulin 44.0 nmol/L
Reference Range:
Pubertal: 16.0 - 100.0
20 - 49y: 16.5 - 55.9
49y: 19.3 - 76.4
Estrone Sulfate 27 ng/dL
Reference Range:
Adult Males: <10 - 138
Estradiol, Serum, MS 11 pg/mL
Reference Range:
Adult Males: 8.0 - 35
PSA Total+% Free
Prostate Specific Ag, Serum 1.6 ng/mL 0.0 - 4.0
Roche ECLIA methodology.

PSA, Free 0.42 ng/mL N/A
Roche ECLIA methodology.
% Free PSA 26.3 %

Coenzyme Q10, Total
Coenzyme Q10, Total 0.78 ug/mL 0.37 - 2.20 02
1.00

Cortisol - AM 11.5 ug/dL 6.2 - 19.4


#2

T is low, LH/FSH not tested, but at 59YO we can assume age related.

Have you been using iodized salt to support thyroid hormone production? - timeline please. Check package, easy to pick other type on the shelf.

You will do equally well injecting EOD or perhaps twice a week.

Get E2 tested after week three. After that, you need to fight with your doc or find a different doc.

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

140 mg is likely too much medicine for most. For many, if there T is within normal range their estradiol will be in normal range. I haven’t used an AI in all the fifteen years I’ve been on TRT. But estradiol values are a must and any doc worth his salt checks it!

I didn’t start HCG until two years ago and now I’m expecting a kid in August. HCG isn’t a must for all, but I certainly think it has leant to my well being.

100 mg T is what most need. Using too much T causes problems and unnecessary need for other medication.


#4

Thanks Brickhead. Will have the 100 discussion with the Dr. I am sure Dr. will check estradiol on next labs, which are due week 5 (maybe week 6).


#5

Thank you KSman. Have not been using iodized salt (sea salt). Will be doing the thyroid temp check as per the sticky but do not know myself to run low temperature, but will check it. By timeline, do you mean how long have I been using non-iodized salt? I guess for 20 years. How long feeling like shit?; 2 years How long on TRT?; 8 days now. Started last weekend and sensitivity started Friday ( day 6) a bit less yesterday (day 7) and better still today (day 8). Dr. will give me whatever I ask for (my belief) just trying to stay ahead of any potential problems (as this protocol is not your recommended protocol of Tes/Ai/Hcg; Though I am happy to stay on as few drugs as possible…will contact Dr. office tomorrow and will revert after speaking to them and temp check.

Appreciate it KSman, tell me if I am not answering your questions.


#6

Good point and definitely part of sore nipples which is indicating E2 levels that are too high [for you].


#7

Your whole household has been iodine deficient. Check body temps all around. You cannot recover very well adding iodized salt, simply too little. Heed advice re selenium, very critical in this situation. You were using vitamins that listed: iodine? selenium?

Low iodine can also lead to fibrotic breast disease and iodine can resolve.


#8

Iodine in my multi…,but I am only one in the house that takes one…going to check the squad. Went to the store and bought proper salt. Good call.


#9

Iodine in the multi does explain a lot for me. Please check quad body temps.

The issues that are expected are low energy and mood problems.

Long term effects show up as sparse outer eyebrows.


#10

1 month in.
Took temp 4 times in morning;98 degrees each time.
Sensitivity gradually decreased but still call it level 2 (1-10 scale, 10 being worst). Have started to get more rosacea as day progresses (had mild case); now pretty red with burning as day progresses. In addition, just not feel as good as first two weeks, broadly.

Workouts strong, recovery speed light years better. Joints, nagging injuries healing. This part has been truly a gift for me. Sex good, wood good.

Called Dr. last week, he said “sounds like your estradiol is high, let’s do blood work, maybe you need aromatase inhibitor”. Glad he said that.

I skipped an injection this week to see if it helped with late afternoon flushing, it did on the margin. Something going on here.

While I am in good shape, my body fat % is high at 22%. I think that has something to do with conversion of test to estrogen.

As a side benefit, I have become super focused on my diet and sources of my inflammation and hope to improve overall health including;

  1. My high cholesterol
  2. My high ldl cholesterol
  3. My cortisol levels.
  4. Low overall fiber intake
  5. High serum ferritin.
  6. My low vitamin D.

These issues suggest I am doing something wrong/ something going on with diet etc.

I am hoping all of this including my workouts /stress management lead to optimal health.

Blood work on Monday, including thyroid, hormones, and psa.

Let’s see how it goes.


#11

Ferritin high: Avoid iron fortified breads, pasta, rice, flour and supplements should be found that do not list iron - male formula.

Cortisol was borderline low.
Cholesterol is not bad with your high HDL.

With TRT and if you can get body temps recovered, many things may improve.

Do not take fish oil, vitamin E or D with high fiber foods as that will reduce absorption.

Body temps were 98F 98.0F ?
It is good to see that someone else can hit 98.6F to have confidence in the thermometer.


#12

Ok, finally got my labs back and will be speaking to Dr. tomorrow.
Testosterone, Serum (Total)
937
Reference Range: Adult Males >18 years 348 - 1197
Sex Hormone Binding Globulin
37.0
Reference Range: Pubertal: 16.0 - 100.0 20 - 49y: 16.5 - 55.9 >49y: 19.3 - 76.4
TSH-ICMA
1.1
Reference Range: Pubertal Children and Adults: 0.5 - 4.8
Thyroxine (T-4), Serum
6.0
Reference Range: Adults: 4.2 - 13.0
Free T-3
3.4
Reference Range: >=20y: 2.0 - 4.4
% Free Testosterone (Dialysis)
2.0
Reference Range: Adult Males: 1.5 - 3.2
Free Testosterone, Serum
187
Reference Range: Adult Males: 52 - 280
Estrone Sulfate
87
Reference Range: Adult Males: <10 - 138
Estradiol, Serum, MS
42
Reference Range: Adult Males: 8.0 - 35
DHEA-Sulfate, LCMS
229
Reference Range: Adult Males (41 - 50y): 16 - 390

Symptoms related to nipple soreness has gotten much better over last 3-4 weeks( as in mostly gone)
Have def not been feeling as good generally, hard to describe, just not as strong mentally/physically., and while rosacea was really picking up steam it seems to be gradually getting a bit better (still pretty bad though). I have seen research discussing high estradiol levels in men exacerbating rosacea.

So, on my call with Dr. tomorrow I am going to request a low dose of arimidex…to get to the targeted 20-30 that you have mentioned in other posts…(from current 42 reading). i think this makes sense for me…do you disagree?


#13

Dr. Said not yet with AI…" i am not taking it off the table, just not yet." He lowered dose to 120 a week vs 140 to see how it goes. Another set of labs in 6 weeks. Rosacea at about a 7…focused on diet and lower does to help.


#14

If he lowers T dose to get E2 just inside the range, you are screwed. No quality of life there. [for almost all males]

Body temperature: There is a big difference 98.0 VS 98.6, I was asking for clarification.
Your fT3=3.4 vs midrange=3.2 appears great. But you you are not getting above 98.0, there is a problem that may be elevated rT3 involving stress and adrenal issues.

Specifically looking for 97.7 or better when you wake up AND 98.6 mid-afternoon.

You do not seem to be getting all of my points and considerations.


#15

Understood and thank you KSMan; will revert.


#16

Just went to the store and bought a new thermometer. It’s almost 6:00 in the evening and temp is 97%. …took it three times…that’s odd…will monitor morning/ during day and come back KSman…


#17

Read your sticky on thyroid again and yet again. My morning temp has been 97.1; 97.2; 97. Never gets higher than 97.6 during day; in fact it trends lower. Clocked in at 95.9 yesterday afternoon. Seems not great. Thoughts ksman?


#18

Exactly what KSman said. If he wants to get you into E2 range, say E2=40 then yes you are screwed still. If he will not budge, find another doctor that understands the importance of having E2 closer to 22. If it comes down to it, you can do a search for research chemicals to find a liquid anastrozole… Can’t say more than that unfortunately :blush:


#19

Thank you Mr. Phoenix for your comment. I hear you both loud and clear. If, after next blood test, issue is not resolved by Dr., I will make a change (either new Dr. or your suggestion). In the meantime I have ordered some iodine and selenium supplements and waiting on a KSman comments on the temp issue…


#20

With low body temps and low use of iodized salt, getting more iodine can make a huge difference in energy levels. And if that does not work as well as expected, you can then look for other issues. T4 is strongly suggestive of iodine deficiency. Some feel an improvement in mood, energy and clarity of thought in a few days.