T Nation

A Few Months into TRT and Labs


#1

Hello,
I am a 31 year old Dad, been battling chronic fatigue type symptoms for about 10 years. No labido, extremely tired, especially mornings, weight gain, brain fog, ability to handle stress had gotten very low. Weight climbed from 180s to 240s from about 18 to 26 years old. Started to exercise and count calories about 4 years ago. I am now pretty fit, at about 170lbs. Complained of symptoms to GP for many years till I finally got him to run these first labs the beginning of 2010

first labs 2/1/2010

Sodium 143 ref range(136-145 )
Potassium 4.5 ref range(3.5-5.1 )
Chloride 108 (98-107 )
Carbon Dioxide 31 (23-30 )
Anion Gap 4 (5-15 )
Glucose 97 (60-99 )
Creatinine 0.9 (0.8-1.5 )
BUN 13 (8-23 )
Calcium 9.1 (8.5-10.5 )
Albumin 4.3 (3.5-4.5 )
Total protein 7.3 (6-8 )
Alkaline Phosphatase 120 (45-122 )
AST 22 (10-40 )
ALT 62 (30-65 )
Total Bilirubin 0.5 ( 0.2-1.0)
Cholesterol 199 (<200 )
HDL cholesterol 61 (>=60 )
Triglycerides 52 ( <150)
LDL cholesterol, calc. 128 (<=100 )
TSH 0.770 ( 0.35-5.5)
Free T4 1.0 (0.89-1.76 )
Free T3 3.0 (2.3-4.2 )
Total testosterone 481 (262-1593 )
25-OH Vitamin D total 21.8 (30-80 )
WBC 4.8 (3-11 )
RBC 5.06 (4.5-5.9 )
Hgb 15 (13.5-17.5 )
Hct 43.5% (39-51 )
MCV 85.9 (79-96 )
MCH 29.6 (26-34 )
MCHC 34.5 (31-37 )
RDW 13.9% (11.5-14.5 )
Pit count 183 (150-450 )
Gran % 54.7% (37-92 )
Lymph % 40.1% (10-58.5 )
Mid range % 5.2% (0.1-24 )
Gran # 2.6 (1.3-9.2 )
Lymph # 1.9 (0.3-4.9 )
Mid range # 0.2 (0.2-2.7 )

At this time Doctor prescribed 50,000 IU Vit D once a week for 3 months, and a antidepressant which I declined.


Found a HRT clinic in florida that ordered more labs, the following from labcorp.

Second labs 8/18/2010

Chemistries-----------
Glucose serum 82 (65-99)
BUN 10 (5-26)
Creatinine 0.88 (0.76-1.27)
BUN/Creatinine ratio 11 (8-27)
Sodium 141 (135-145)
Potassium 4.4 (3.5-5.2)
Chloride 100 (97-108)
Carbon Dioxide 29 (20-32)
Calcium 9.6 (8.7-10.2)
Protein 7.1 (6-8.5)
Albumin 4.7 (3.5-5.5)
Globulin 2.4 (1.5-4.5)
A/G ratio 2.0 (1.1-2.5)
Bilirubin 0.7 (0-1.2)
Alkaline Phosphatase 93 (25-150)
AST 38 (0-40)
ALT 31 (0-55)

Lipids--------------------------
cholesterol, total 194 ref range(100-199)
triglycerides 55 ref range(0-149)
HDL cholesterol 69 ref range(>39)
VLDL chol. calc. 11 ref range(5-40)
LDL chol. calc. 114 ref range(0-99)
LDL/HDL ratio 1.7 (0-3.6)

Thyroid----------------
TSH 0.739 (0.45-4.5)
thyroxine(T4) 7.5 (4.5-12)
T3 uptake 35 (24-39)
Free thyroxine index 2.6 (1.2-4.9)

Immunoassay---------------
insulinlike growth factor I 118 (115-307)
testosterone, serum 492 (280-800)
free testosterone(Direct) 8.7 (8.7-25.1)

CBC, Platelet Ct, and Diff--------------
WBC 5.3 (4-10.5)
RBC 4.62 (4.1-5.6)
Hemoglobin 14.4 (12.5-17)
Hematocrit 41.7 (36-50)
MCV 90 (80-98)
MCH 31.2 (27-34)
MCHC 34.6 (32-36)
RDW 14 (11.7-15)
Platelets 159 (140-415)
Neutrophils 40 (40-74)
Lymphs 47 (14-46)
Monocytes 7 (4-13)
Eos 5 (0-7)
Basos 1 (0-3)
Neutrophils, absolute 2.1 (1.8-7.8)
Lymphs, aboslute 2.5 (0.7-4.5)
Monocytes, absolute 0.4 (0.1-1.0)
Eos, absolute 0.3 (0-0.4)
Baso, absolute 0.1 (0-0.2)

FSH 2.7 (1.5-12.4)
LH 1.6 (1.7-8.6)
PSA 0.9 (0-4.0)
estradiol 31.8 (7.6-42.6)
Triiodothyronine 3.2 (2-4.4)
SHBG serum 61.9 (14.5-48.4)

They offered me 500mg of test a week for 10 weeks, was tempted to try and see how I felt on the high level of test, but decided against it and found another HRT clinic closer to home. They ordered the following tests which were missing from previous labs.

10/26/10

Dihydrotestosterone 53 (25-75)
C-reactive protein <0.10 (<0.80)
DHEA sulfate 181 (110-370)
Insulin <2 (<17)
Prolactin 2.6 (2-18)

Cortisol Morning 5.1 (3.7-9.5)
Noon 1.8 (1.2-3.0)
Evening 2.3 (0.6-1.9)
Night 1.9 (0.4-1.0)

They prescibed me 100 mg of test cyp a week, split into 50mg monday, and 50mg thurs, 250 units of HCG 2x weekly, and 25mg a day of DHEA. I started this protocol in november 2010, stayed with it for a couple weeks, then nipples started swelling. Doc prescribed anastrazole 0.5mg twice a week. Nipple swelling did not go away completely and anxiety symptoms were terrible, especially in the morning.

Doc dropped HCG and now I am doing 35mg of test EOD along with 0.25mg anastrozole, and 12.5mg DHEA.Feel pretty good on anxiety side of things, and all symptoms seem slightly better than before HRT, but energy levels still seem very low. I feel like something is still not quite right, no matter how much sleep I get, always feel sluggish, ready for a nap. Not sure if I am missing a piece of the puzzle with thyroid or something?

Diet consists of lean meats and eggs, brown rice, olive oil, vegetables, and berries. Severe gluten intolerances force a limited selection.

Training is daily pullups and pushups, 3 day a week compound lifts, and one day yoga.

Supplements are 10g cod liver oil, ADAM multi, 5000IU vit D, Cal-Mag, Vit C, digestive enzymes.
Thanks for reading, any help is appreciated!
Josh


#2

When will be doing next lab work?

Your TSH and thyroid levels are lowish together, that is unexpected.
Iodine in your salt or vitamins?
Do you get cold easily?
Check body temp as soon as you wake up, record for a while and post back here.

Your E2:FT was a problem and SHBG was very high. As I said last August.

Have you read the stickies?

You really should not have split your case across two threads!!!!!

Always maintain a single thread so we have the full picture and are not repeating ourselves.


#3

your saliva cortisol results look a bit low on some and way too high for the evening. (but I am not 100% sure, I am still not sure how to read those things). You may want to request an 8am Cortisol blood test. It seems to show some weird changes.

too low cortisol signals your system to dump extra T into E2. Good Cortisol = better aromatase control.

might be something to check out.

or you could stop the DHEA and see how your system reacts. taking DHEA caused me countless problems as it seemed to convert directly to estrogen in me.


#4

Ditto to the dhea raising E2, try using pregnenolone to raise dhea, it will also help with cortisol and maybe help then with E2.


#5

When will be doing next lab work?

  Will be going in for next labs in the next week or two, have my followup appt. with doc beginning of march.

Your TSH and thyroid levels are lowish together, that is unexpected.
Iodine in your salt or vitamins?

  Yes I use Iodized salt, and there is 225mcg in my multivitamin

Do you get cold easily?

  Yes, and find that I get cold extremities especially

Check body temp as soon as you wake up, record for a while and post back here.

  Will do that and get back with results, last time i did that was a few years ago and    never was over 96

Have you read the stickies?

  Yes I have, kind of got OCD about reading on HRT boards. Not saying I understand it though

You really should not have split your case across two threads!!!!!

   Will keep updating this thread only.

PureChance and Danny880, I will try dropping the DHEA, I do notice it really plays with my anxiety levels when I change dosing, and post back results. I did try Life Flo Pregnonolone for a few days and could not feel any difference, but now that things have leveled out for about 6weeks I should try it again.

Have some worries about no HCG, but while I was taking it I would nearly have a panic attack having to make the family breakfast Lol, really messed me up. I read Hardasnails on a couple boards saying he was an advacate of dropping it sometimes.


#6

Many do not have any issues with DHEA. So this is just another example of how different we can all be. I am not ready to discourage all from using DHEA


#7

HCG mimics TSH and can cause hyperthyroid symptoms.

I had panic attacks when I tried taking 500iu HCG + 120mg Armour. It was not pleasant at all. Now I am taking 250iu HCG and T3 only medication.

you may want to try lowering your HCG dosage.

I also strongly advise to get your 8am blood Cortisol levels checked and confirmed (and treated if below 15).


#8

When on TRT, the 'recommended LH replacement dose of hCG' can easily be way more than what is required to keep the testes healthy. Serum T levels are supported by refined T doses in any case. We really do not know what the minimum doses are to support the testes. And if we did, it would probably be highly variable from one guy to another, due to different intrinsic differences and varying amounts of age impaired function.

So an individual would need to try different doses even if we had good data. The hCG research from 2005 showed that 125iu produced ITT 25% less than baseline *. 125iu would probably be a good dose to try if one has any negative issues from hCG; one of which might be the cost. 125iu with a 10,000iu vial would last too long, one would need to use 5,000iu vials.


#9

I will start with Dropping DHEA and trying the pregnonolone again which i did today. Will get waking temps for next few days starting tomorrow and report back with #'s. Would love to get blood cortisol test done, but am self financing this whole venture, and pretty tapped at the moment. Will have to wait a few months to build up some reserves.