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Amoeba's TRT in Progress with Lab Results, Need Advice


#1

Hi, I have been following T replacement forum since September 2016. I found this forum is very informative and helpful.

I choose amoeba as username only because other names I can think of have been taken. I will keep all my test results and questions in this thread. Thanks for reading this long post. Please give me advice and suggestions.

Background of me:

I am 49 years old male as year 2017, having been living in San Francisco bay area for 25 years as an engineer of semiconductor chip designer. I mainly work in front of computers. I keep very active life style enjoying all kinds of sports and weight training throughout my life. Six years ago at age of 43, I started serious weight training with my trainer and went to NPC NoCal bodybuilding show two years in a row at age of 45 and 46. I was no where near those pros and probably the only one who is nature to go to the show. I was just brave enough to pose on the stage.

I have been eating clean and on strict diet for six years. No calories intake from drinks except very minimum alcohol intake in few social occasions. Avoid processed food as much as I can. No fast food, no pizza, cake, hot dogs… I keep my carb:protein:fat ratio as 2:2:1.

I am 5’10". Currently weight 188lbs with 14% body fat. I weight almost the same as I was in my junior year of college of senior year of high school.

I still do serious workout 5 to 6 days per week. Currently I do weight training as well as crossfit.

Since I had my second child at age of 39, my libido started to decline a lot. I started to have ED problem at age of early 40s and had become serious after age 45. I talked to my primary care doctor and was prescribed viagra. Unfortunately viagra doesn’t work for me at all. Last year I had a new primary care doctor. During annual physical exam in October 2016, he added testosterone test but the result shows TT=459 (I will list detail lab report below). I was told by my doctor that my T is within normal range and he referred me to urologist. At this point, I have been reading this forum and equipped myself with some knowledge. The urologist didn’t even want to look at my T or E2 or any lab numbers. He was just willing to prescribe cialias.

I understand there are many factors attribute to low libido and ED. I am totally fine without brain fog nor mood swing. I started to look into things like thyroid. I bought and read the book of adrenal fatigue. I changed my life style further by reducing caffeine consumption and force myself to go to bed by 10:30pm.

Since November 2016, I started my TRT by working with a local T clinic. The goal is to ‘fix’ my T number and hopefully it can help my libido and ED. I am going to post progress and lab report in detail below.

My physique:

Muscular at 5’10". medium build frame. almost no facial nor body hair. Maybe because I am Asian. Maybe because my T had been in “normal low” range for long time.

14% body fat, almost no accumulation on abs. Somehow I don’t feel well if I try to lower my body fat below 14%.

I feel good going to the gym most of the time except I didn’t have good sleep a night before.

My diet:

Carb:Protein: Fat ratio 2:2:1. I eat lots of animal protein from red meat and fish. I take brown rice, sweet potato as carb source. combined with vegies. I also take fish oil as supplement. I used to keep strict diet and kept food journal.

Medication and over the counter medicine:

None except testosterone C, HCG and anastrozole since my TRT.

Supplement:

Daily Centrum, with additional B complex, D, Calcium, C and glucosamine.

I used to take creatine and branched chain amino acid but haven’t been taken it for a year.

My TRT:

Here is the lab result done at 7:58am 11/21/16 (fasting) ordered by my primary care doctor, Before TRT:

TSH 1.99 ulU/ml (0.34 - 4.82 ulU/ml) (I know this is not optimal, I started to take iodine/selenium supplement even I am taking Centrum, the number has been improving, see below)

TT 459 ng/dl (250 - 1100 ng/dl)
FT 85.4 pg/ml (35 - 155 pg/ml)

Total Cholesterol 181 mg/dl (< 200 mg/dl)
Triglyceride 81 mg/dl (< 150 mg/dl)
HDL Cholesterol 56 mg/dl (> 40 mg/dl)
LDL Calculated 109 mg/dl (<130 mg/dl)

Cholesterol to HDL ratio = 3.2 (<5.0)

Hemoglobin A1c 5.9% (4.8 - 5.6) (My family has history of high blood sugar. I’ve been in 5.9% for years)
Average Glucose 123 mg/dl

Metabolic panel:

Blood Cell Count:

Here is blood test report done by local T clinic done at 4:33pm 10/28/2016 (no fasting) (before TRT)

BP:120/65
HR: 64/BPM

Hemoglobin: 15.90 (13.8 to 17.2 g/dL)
Hematocrit: 47.70 (40.7 to 50.3 %)
Total Testosterone: 292.19 (300 to 1200 ng/dL)
SHBG: 25.98 (20 to 60 nmol/L)
Free Testosterone: 6.57 (9 to 30 ng/dL)
Estradiol: 22.59 (10 to 50 pg/mL)
Progesterone: 0.25 (0 to 1 ng/mL)
Cortisol: 9.78 (6 to 23 mcg/dL)

Total T3: 105.80 (100 to 200)
Total T4: 8.32 (4.5 to 11.2 mcg/dL)
Vitamin D: 49.15 (30.0 to 74.0 ng/mL)
Vitamin B12: 1159.73 (200 to 900 pg/mL)
DHEA-S: 314.01 (20 to 380 ug/dL)
PSA: 0.81 (Below 50 Range: 0 to 2.5 ng/mL)

Here is blood test report done by labcorp ordered by 2nd T clinic (for second opinion) at 9am 11/5/2016 (fasting) (before TRT):

DHEA-sulfate 348.7 (71.6 - 375.4 ug/dl)
LH 7.8 (1.7 - 8.6 mIU/ml)
FSH 8.1 (1.5 - 12.4 mIU/ml)
Prostate-specific Ag, serum 0.8 (0.0 - 4.0 ng/ml)
Estradiol, sensitive 25.4 (8.0 - 35.0 pg/ml)
progesterone 0.2 (0.0 - 0.1 ng/ml) flagged high

Starting TRT dosage and protocol (from 11/14/2016)

Testosterone C 75 mg twice a week (total 150 mg per week).
Anastrozole 0.5 mg twice a week taken at the time of T injection.
HCG 250 IU EOD

I followed the prescription of T clinic doctor with a bit higher T dosage. I felt very good in the first two weeks. Morning wood woke me up every night, testicles were so full and my sexual function is back. I felt I was in my early 30s!! From third week of TRT, I started to feel very tight scrotum and test pain. Nipples were swollen and sore. I guessed it’s sign of higher E2 so I talked to the T clinic doctor and she agreed to adjust my anastrozole dosage from 0.5 mg with T injection to 0.75 mg. Magically the tight scrotum was loosen in few days but nipples were still swollen. Libido and sexual function were down a notch but still ok.

I ran out of HCG in 6 weeks near new years holidays. When I received my second bottle of HCG, the ice pack in the package was already warm. I wasn’t sure if the HCG is good but still taking it. I also traveled outside of the country for few days. I felt pretty bad in the first two weeks of New year. The T clinic ordered blood test at 1/8/17.

Here is the blood test results, samples taken at 3pm 1/11/17 (no fasting)

Hemoglobin: 18.70 (13.8 to 17.2 g/dL) (flagged high, I kind of expect it due to TRT)
Hematocrit: 56.10 (40.7 to 50.3 %)
Total Testosterone: 1047.79 (300 to 1200 ng/dL)
SHBG: 20.07 (20 to 60 nmol/L)
Free Testosterone: 31.90 (9 to 30 ng/dL)
Estradiol: 15.17 (10 to 50 pg/mL)
Progesterone: 0.34 (0 to 1 ng/mL)
Cortisol: 14.40 (6 to 23 mcg/dL)

Total T3: 120.38 (100 to 200)
Total T4: 8.20 (4.5 to 11.2 mcg/dL)
Vitamin D: 41.46 (30.0 to 74.0 ng/mL)
Vitamin B12: 1052.76 (200 to 900 pg/mL)
DHEA-S: 323.59 (20 to 380 ug/dL)
PSA: 1.17 (Below 50 Range: 0 to 2.5 ng/mL)

Obviously E2 is the cause of problem! After talking to my T clinic doctor, She decided to change my TRT dosage and protocol as follows:

Starting from 1/20/17

Testosterone C 62.25 mg twice a week (total 125 mg per week).
Anastrozole 0.5 mg twice a week taken at the time of T injection.
HCG 250 IU EOD

She wanted to keep my totoal T lower a bit. Even I have low E2, I still have morning wood. still have sexual function but erection doesn’t keep as long during sex. At that time I thought HCG could be the problem because I may be using bad HCG. HCG makes tests to produce T. If I have bad HCG which causes less T, my E2 could be lower with same anastrozole dosage.

Things wasn’t getting better so I ordered labcorp test myself at 2/23/17. Here is the blood test result samples taken at 9 am 2/23/17 (fasting) (note that I take test C every Monday and Thursday, 2/23 is Thursday which is three days after my T injection)

E2 is 16.2 (8 - 35 pg/ml) It’s labcorp report. The range is different from my local T clinic’s. I think I am anastrozole over responder. I make an appointment with my T clinic doctor. From 3/2, I am going to stop anastrozole for 7 to 10 days then start to dose 1/4 of regular dosage. Hopefully my E2 will go back to good range.

My TSH is down from 1.99 to 1.39. It’s probably a good thing I guess.

Overall I still feel ok, my gym performance is crazy. I was already muscular and lifted heavy before TRT. Now I feel it’s insane but awesome. Just a side note. My main goal is to fix my libido and ED.

Here are my questions:

  1. My T clinic doctor keeps telling me I have to “cycle” HCG. Basically to be on and off HCG every 45 days. I never see anything like this in this forum. I also feel HCG could stimulate production of other hormones in tests. I argued this with the doctor and she agreed to keep me on HCG for this period of time but eventually she wants me to cycle it. Please give me advice on this.

  2. Should we adjust anastrozole dosage with or without HCG because HCG stimulates natural T production in tests.

  3. Is it better to get HCG powder to make HCG of my own instead of getting mixed HCG from pharmacy? I suspect I had a bad bottle of HCG during transportation. Does it make sense to order powder?


#2

E2 objective is 22pg/ml
E2=16.2, you are not an over-responder.
Decrease anastrozole dose by a factor of 16.2/22
Yes it is that easy.

Nice to see HTC down. Do not get dehydrated for your labs.
Avoid supplements that list iron. Avoid iron fortified breads, pasta, rice, cereals etc.

CO2: When I see high range, I often wonder if one is holding their breath during the needle stick.

TSH much better. I assume that you were not using iodized salt. You are not going to get iodine from sauces, sea salt, restaurants. Your family can easily be iodine deficient. Check everyone’s body temps as per the last paragraph in this post.

Get iodized salt into your home. Sea salt is ruining lives.

Thyroid: Do labs for TSH, fT3, fT4 - do not use T3 uptake or index labs, those are obsolete now that fT3 can be tested directly.

Thyroid lab ranges are bogus. TSH should be nearer to 1.0, fT3, fT4, T3, T4 should be near mid-range or a bit higher. Get those body temps so we can see whats really going on.

Nice to see AM cortisol improved, great for energy levels.

Vit-D25: Should be nearer to 60, 60-80 is optimal. You may be OK in the summer months. Also your “darker” skin limits your ability to make your own Vit-D3 from sun exposure on your skin. Find and take 5,000iu Vit-D3, tiny oil based gel caps. Take 25,000 for first 5 days. Good for others in your home as well.

Glucose appears improved.
Total cholesterol=180 is considered idea.
< 160 is associated with increased all-cause mortality, don’t get too low.

You should not cycle hCG, there is no basis for that. Should natural guys have there LH/FSH turned off every 45 days? Have her show you science that supports her notion. Hopefully she is not going off of a practice from the “hCG diet” idiots.

Try to get hCG shipped dry and reconstitute it your self. This will eliminate shipping damage which does happen, not theoretical. [And wet hormones should never be shipped on days what will involve dead time on a weekend.] hCG should be recon with BA water, 0.9% benzyl alcohol, never sterile water.

As for hCG and generated T levels, your earlier labs suggested that you had primary hypogonadism. That been the case, your testicular response to hCG would be substantially low.

Libido is affected by FT, E2 and thyroid function. So do not neglect thyroid.

Do not think that there is no cost to really low body fat levels. Do not neglect overall quality of life.


#3

And a great and well informed first post!


#4

KSman, Thank you so much for the reply. very valuable information.

I have been changing my anastrozole dosage and will get blood tested again in few weeks.

I went to my annual eye exam last week. My optometrist found two bleeding spots on my routine fundus photo and she referred me to a retinal specialist, I’ve never had those spots before and I am sure I don’t have any vascular issues. It could be caused by heavy weight lifting. Hopefully there’s nothing to do with my recent high HTC.

I bought a new thermometer and started to measure my morning body temperature right after waking up, It’s consistent showing temperature around 98.2 or 98.3 degrees F in last four days. I do have iodized salt in my kitchen but I use soy sauce to cook a lot. I am taking Thyroid supplement with iodine and selenium everyday. I am checking body temps of my kids.

I have ordered fT3 and fT4 tests, will report results when available.

8 days ago I went to bed very late in consecutive two days. I also felt stressful due to work. My libido became very bad back to pre-TRT condition even I know I have high T, slightly low E2, probably not too bad thyroid function. I insisted going to bed early in last few days and my libido is back but not fully restored. I guess I have adrenal fatigue issue, just don’t know how severe it is.

It seems I am not able to get prescription of HCG after this “cycle”. My T clinic doctor has decided to give me 45 days break due to her concern of “reducing sensitivity of HCG if not cycled”. Even I’ve argued with her. I really need to find an alternative source.