53 Y/O, Metabolic Syndrome, Diabetic, Considering TRT

That is a lot of medication.

Big factors for metabolic health:

  • testosterone and optimal E2
  • cortisol, get AM cortisol, test at 8AM or 1 hour after waking up
  • thyroid function and iodine
  • IGF-1 as a measure of growth hormone status, do not test GH directly

5000iu Vit-D3?

Blood pressure has too major influences.

One is arterial muscle tone.

There are three factors for that. Low magnesium can limit ability of arterial muscles to relax to receive and dilate for the next pulse of blood, the muscles then contract behind it. Get a good magnesium product. There is ZMA sold on this site’s store. If you get leg or muscle cramps or you muscles can lock up when tightened, you gave a magnesium deficiency. Most people are deficient.

Another factor that can mess up muscle tone is a CoQ10 deficiency and that can be caused by a Statin drug. When this happens there can be muscle pain or a persistent cough as left ventricle weakness causes pressure build up in the lungs and fluid leaks int the airways.

And low T can affect muscle tone and TRT sometimes lowers blood pressure.

Other source of high BP from accumulated damage and scaring from endothelial dysfunction. If labs for homocysteine are high the one cell layer thick endothelium that separates blood from arterial wall is inflamed and disease process is there.

Get homocysteine tested. Try 50mg Ubiquinol form of CoQ10 and see if you feel better. Do not get the Ubiquinone form!

CRP is a generalize inflammory marker and not cardio specific, although that was wrongly once though to be the case.

Suggest high potency B-complex multi-vit with trace elements including 150mcg iodine and 150-200mcg selenium. Most guys do not need iron and should not have iron in their vitamins. If wife still cycling, she need iron. Your CBC: hematocrit, RBC, ferritin, hemoglobin would be useful to settle your iron issue. When men need iron, something is typically wrong. Should also contain chromium picolinate [insulin sensitivity].

TRT can/may improve insulin sensitivity.

Test prolactin and see if lowering.

Feeling a bit overwhelmed. I do appreciate all your input.

My D3 dosage is currently 2000IU. I can easily up it if you think I need more.

I have magnesium citrate on hand from when I was having muscle twitching/tremors. Stopped after I figured out the bupropion was the cause. I can go back on it, or should I test first?

I’m back on a low dose of bupropion (half what I was taking before) and already feeling better. Wonder if it’s lowered prolactin - how long before I retest that?

Will look into getting an updated CBC. Not sure if I can just walk into my MD’s office and give them your list, but if that fails I’ll just get it done on my own.

Thanks.

How do you think I feel trying to stay on top of all of this traffic. No one has bought me a beer in the last year! [sob]

More Vit-D may be helpful.

Everyone needs supplemental magnesium unless they drink large amounts of milk. So never any signs of muscle cramps or tightening? But with high BP, a good idea.

It takes more than one read to get through my posts and links! You will get there, absorb and enjoy!

I will up my vit D and go back on the mag citrate. I haven’t had any muscle cramps/tightening but it couldn’t hurt to try it.

As a point of information, my BP has dropped 10 points since stopping medical MJ last September. I’m hoping to reduce my BP meds at my next physical.

Now that I’m back on the bupropion, when do you think I can retest prolactin to see if it’s coming down?

When to test? If you are feeling great there is no urgency.

@KSman As you suggested, here are my temperature readings over the past week or so:

AM	PM
97.6	98.5
---	98.5
98.1	98.9
97.8	---
97.4	98.4
98.1	99.1

Also, the doctor did a thyroid panel on me about two years ago and ruled that out. I know these are old results, but the labs showed T4 free = 1.2 ng/dL (0.8-1.8), T3 free = 3.0 pg/mL (2.3-4.2).

@KSMan

Have retested prolactin, with the following results:

Prolactin = 18.9 ng/mL (HIGH) (4.0-15.2)

Previous results from 5/17/17:

Prolactin = 21.5 ng/mL (HIGH) (4.0-15.2)

For about a month, I’ve been back on bupropion but at a lower dose (75mg/day) than before I quit. Had hoped the additional dopamine would push my prolactin down further.

Am now debating trying cabergoline

Have also read that taking estrogen can raise prolactin (see here). Wondering if it might be fixed simply by lowering my high estrogen with an arimidex?

@KSMan Update with new lab results:

As a first attempt to balance hormones, I started anastrozole 0.3mg E3D on 7/2/17. Retested my hormone levels on 7/11/17 with these results. (Most recent previous values shown to the right.)

Testosterone, Serum        = 566 ng/dL (348-1197)         was 504
Free Testosterone (direct) = 13.6 pg/mL (7.2-24.0)        was 12.1
DHEA-S                     = 143.4 ug/dL (71.6-375.4)     was 181.7
Prolactin                  = 16.1 ng/mL (HIGH) (4.0-15.2) was 18.9
Estradiol                  = 27.0 pg/mL (7.6-42.6)        was 41.5
PSA                        = 0.9 ng/mL (0.0-4.0)          was 0.8

Note that I didn’t do a full panel since I’m just measuring progress of the anastrozole as I increase my dosage.

In the week since that test was done, I have increased my dosage to 0.5mg E3D. I am now starting to feel improvement, such as increased energy and some return of libido. I am also sleeping better now, not sure if that’s related.

Since I was at E=27 before my dosage increase, my plan is not to increase again until I’ve done more blood work.

Any input is appreciated.

Update with new lab results:

These show the results of my latest blood tests taken 8/4/17. This is after increasing my dosage of anastrozole to 0.25mg E2D from 0.3mg E3D (25% increase).

                          8/4/17                     7/11/17    5/17/17
    Testosterone, Serum = 496 ng/dL (264-916)        566*       504* (348-1197)
    Free Test (direct)  = 11.5 pg/mL (7.2-24.0)      13.6       12.1
    DHEA-S              = 175.5 ug/dL (71.6-375.4)   143.4      181.7
    Prolactin           = 10.9 ng/mL (4.0-15.2)      16.1       18.9
    Estradiol           = 17.0 pg/mL (7.6-42.6)      27.0       41.5
    PSA                 = 1.0 ng/mL (0.0-4.0)        0.9        0.8
    LH                  = 8.2 mIU/mL (1.7-8.6)         -        7.0
    FSH                 = 10.0 mIU/mL (1.5-12.4)       -        8.6

*Note that the previous T values were against a different, higher reference range. Not sure if that means the 496 in the new test should be interpreted to be higher than it seems?

Other than that, it seems like I’m narrowing in on the correct dosage. I’ve been feeling dramatically better - energy level and motivation returned, erections more easily, sex drive increased. Perhaps a tiny bit unfocused, but thinking a slight decrease of my dosage could help that.

  • Many have gone to Anastrozole dosing by the drop once we know E2 number after being on anastrozole for some time

  • Formula for calculating Ana dosage (if not an over-responder) ==> E2 number / 22 = mg of ana/wk

  • Given that your new E2 number is lower than the commonly accepted optimal of 22pg/mL, you need to lower your dosing of Ana

  • Recommended dosage would be 17/22 = .772mg Ana / week ==> new dose = old dose(e2/22)

  • You were taking .25mg EOD/E2D so that equals .875mg Ana/week (old dose)

  • New dose = .875(17/22) .676mg

  • To get .676mg go to dosing by the drop as cutting will not be accurate

  • Dissolve 1mg pill in 1mL of vodka, or 2mg in 2mL, 3mg in 3mL, etc.

  • Using graduated dropper, draw 1mL into dropper and count how many drops it take to dispense

  • Use the # of drops per mL multiplied by .676 to get your weekly dosage and then divide by 3.5 if you are going to do that E2D.

Example:
  • Your dropper measures 33 drops per mL (each dropper is different so you’ll have to determine your actual number)
  • 33 drops x .676 = 22.3 drops of Anastrozole per week
  • 22.3 divided by 3.5 days = 6.37 drops E2D
  • 6 or 7 drops E2D would get you where you want to be (or very close to 22pg/mL)

@cdmac24
Thanks for the great info. As I’ve been adjusting my dosage, I’ve been thinking in terms of mg/day, since I’ve been adjusting the amount and the frequency, but mg/wk gives you bigger numbers so I can see how that would be convenient! What I’ve seen so far is 0.3mg E3D (0.700mg/wk) brought me to E2=27, and 0.25mg E2D (0.875mg/wk) resulted in E2=17. My thinking after the most recent labs was to split the difference, i.e. 0.787mg/wk. I figured I’d skip a couple of days to let my number rise a bit then start the new dosage.

Based on your recommendation, I’m now wondering. It would have me taking less than I was at the start. This would certainly bring my E2 up from 17, but wouldn’t it then continue to rise above the desired 22? Thoughts?

I think either way works (using the math but also just splitting the difference).

  • There may have been some variability in the E2 numbers based on timing of labs
  • I think I would do as you suggest: split the difference and retest in 3-4 weeks (if feasible)
  • Seems like some can dial in right to 22 but others have more variance in their E2

Looking forward to your next labs (as well as my own) to see if you get it dialed in, and if getting it dialed in helps with your symptoms

I’m currently in a state where I think I’m Hypothyroid and/or have adrenal fatigue so I’m not sure getting my E2 dialed in is going to relieve all my symptoms just yet

Just thinking out loud here:

  • you were doing .7mg/week when you were on .3 E3D

  • You increased to .875 mg/ week

  • You obviously understand the change there and I’m just wondering if your older dose (.7mg/wk) may not have had enough time (just 9 days between labs) to balance out your numbers like it would have if you had been on that dose for a longer time period.

  • More simply, would the .3 E3D eventually brought your E2 down past the 27.0 number reported on the 7/11 labs

  • This may account for the yo-yo effect you see in your numbers

You’re reading my mind here! This did occur to me, and I honestly won’t be surprised if I end up back at 0.7mg/wk again when all is said and done.

I feel that my symptoms are drastically better. To the point where I’m feeling energy and motivation I haven’t had in a decade. It’s frustrating when doctors won’t engage on the topic of hormones, because plainly they make a HUGE difference. All this time I thought “I’m overweight and aging, so of course I feel like crap”. Who knew?

I hope you get your situation figured out. Stick with it!

1 Like

Thanks @keigwin

I’ve just started so all of this is very new to me and I’m trying to digest all the information.

There have been about 5-6 days since March 30th that I’ve thought, “man, this (TRT) is awesome!”

The rest of the days I’ve been impatiently dealing with sides of some sort and wondering if the sides are worth it.

To be honest, the increased libido and sexual performance benefits are why I haven’t scrapped TRT all together. I just need to get thyroid and adrenals figured out then dial in my TRT and I hope I’ll be a success story.

I’m nowhere near as lethargic and apathetic as I was before starting TRT so that’s the good news.

ft3=3 was below mid range 3.25
Doctors and ‘normal’ thyroid labs are a problem.

Unknown. You can try and see.

T lab ranges can be age adjusted.

Are you saying this is low enough to indicate a problem?



I’ve been taking anastrozole since that old post from June. It’s made a big difference in E2 and prolactin. My subsequent posts have the updated lab work.

TT and FT going down as LH/FSH increases. Looks very strongly like primary hypogonadism.

Is FT3 a problem? Not by looking at your oral body temperatures.

Looks to me as if TT is flat going as far back as 2/17/15 (was 495ng/dL [250-1100]). However, in that same test, FT was 59.2pg/mL [35.0-155.0]. The reference interval is much higher, so I’m not sure how this equates to current numbers.

According to Mayo Clinic, primary hypogonadism would be caused by:

  1. Genetic causes (eg, Klinefelter syndrome, XX males)
  2. Developmental causes (eg, testicular maldescent)
  3. Testicular trauma or ischemia (eg, testicular torsion, surgical mishap during hernia operations)
  4. Infections (eg, mumps)
  5. Autoimmune diseases (eg, autoimmune polyglandular endocrine failure)
  6. Metabolic disorders (eg, hemochromatosis, liver failure)
  7. Orchidectomy

I would rule out 1, 2, 4 and 7. 3 and 6 seem most likely.

#3 - Had a left epididymectomy several years ago, and a revision a year later. Could possibly have resulted in trauma to the testicle, but I’m not aware of it if it did.
#6 - Fatty liver resulting in high AST/ALT? Perhaps some aspect of metabolic syndrome?

EDIT: Been reading about the (high) correlation between low T and metabolic syndrome, which includes fatty liver disease. It occurs to me that at the time of my 7/11/17 blood test, I had been eating very strictly low carb for about a month and lost nearly 10 lbs. After that, have been eating more carbs and weight loss has stopped. Could the spike in TT in July be due to the weight loss?

Updated lab result history. As of 7/12/18:

Range Units 7/12/2018 2/23/2018 8/4/2017 7/11/2017 6/14/2017 5/17/2017
T, Serum 264-916 ng/dL 581 663 496
" 348-1197 ng/dL 566 504
Free T (Direct) 7.2-24.0 pg/mL 17.8 21.7 11.5 13.6 12.1
Estradiol 7.6-42.6 pg/mL 25.1 28.1 17.0 27.0 41.5
" (Sensitive) 8.0-35.0 pg/mL 15.3 24.9
Prolactin 4.0-15.2 ng/mL 8.9 0.6 10.9 16.1 18.9 21.5
LH 1.7-8.6 mIU/mL 7.4 11.8 8.2 7.0
FSH 1.5-12.4 mIU/mL 10.2 13.3 10.0 8.6
DHEA-S 71.6-375.4 ug/dL 166.5 196.7 175.5 143.4 181.7
PSA, Serum 0.0-4.0 ng/mL 1.2 1.0 1.0 0.9 0.8

Current dosing:
anastrozole - 0.2mg E2D
cabergoline - 0.08mg E3D