T Nation

Blood Levels Don't Seem to Add Up


#1

I’ve been on trt for roughly 3 years after my family doctor tested my t level at my request and found it to be below 250. I’m 36, about 210lbs. Doc administered 320 mg (working up to that based on labs) once every 2 weeks; I found this forum and began self administering twice weekly because I was bouncing back and forth.

I am currently following this protocol:

80mg T-Cyp Sub-Q E4D
250-300iu HCG EOD
1/4mg anastrozole EOD

I just got labs back, taken on injection day, prior to injection.

Total T = 621ng/dL (249-836)
E2 (LCMSMS) = 10pg/ml (14-51)

My question is, given the amount of testosterone + HCG I’m injecting, shouldn’t I have higher total T? I have tried IM injections in delts, with about the same results 500 TT with 55 e2 (why I added anastrozole).

I will be getting a lab that shows free T, e2, TSH, T3, and T4 in the next few weeks. Does this level seem right to you guys? It seems like everyone says 100mg a week (50 if E4D) should put me right at or slightly above normal. On top of that, HCG… where is it going? From what I understand, even if it’s binding to SHBG, it would still be included on TT. Plus, with e2 of 10, it doesn’t seem to be converting… where’s it going, or is this normal?


#2

For reasons unknown, some metabolize T more rapidly than others.

Your T half life also reduced.


Suggest 110 mg T twice a week [220/week]. You are currently on 140mg/week.

This will get you near TT=975

This should increase E2=10 to 10*220/140 = 15.71 - some uncertainty down near E2=10

E2 target is 22pg/ml. New anastrozole dose is .25mg EOD * 15.71/22 = 0.178 mg EOD. You can’t split pills that way. Dissolve anastrozole in vodka, 1mg/ml and dispense by volume or by the drop from a dropper bottle. You respond to anastrozole more than others and your dose needs to be smaller.

E2=10 is not healthy for mind, libido or body. A change of dose takes 5-7 days to reach final serum levels in the body.

You can make both changes at once if doc will change Rx. Without change in T, you should cut anastrozole dose in half and stop for 4 days to speed up the process then resume at the lower dose.

You could change anastrozole to twice a week at time of injections. Some math required to get the dose. That way T and anastrozole doses rise and fall together. Your choice. Also, with your shorter half-life of T, you could switch to T EOD and have the simplicity of everything EOD.

How to manage EOD? You can have a EOD reminder in your computer calendar or dose on odd days of the month and make a jump at ends of months that end on an odd day, or swap to even days the next month.

In the future, try to do labs halfway between injections to reduce lab timing artifacts. Doing labs at time of office visit not a good idea.

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

Re your thyroid labs:
You can check overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Most common cause of low thyroid function is not using iodized salt. If temperatures are good, thyroid labs may not be needed.

If you do thyroid labs, please do TSH, fT3, fT4 [not T3, T4]
It is fT3 that is the active thyroid hormone.


#3

Everybody responds differently. That’s why I laugh when “big guys” come in saying they need more for their size when in fact they may respond kindly to standard doses.


#4

I’m the same way 80 mg twice a week plus 200 iu of hcg twice a week. My level has been mid 500 when injecting in stomach and 611 when injecting in glute. I really don’t want to increase my dose any higher bc I feel it’s high already. Frustrating…


#5

KSman,

I just got some labs back. These were pretty comprehensive. I changed my protocol as you suggested, and this is what I have been doing the same since the beginning of February:

110-120mg Test Cyp E4D (using a 3ml syringe, so between the .5 and .6 ml line)
.356 mg anastrozole at time of shot (I came up with this number using .178 from EOD X 4, divided by 2)
250iu HCG EOD
Pregnenolone 75mg micronized ED

These are the lab results. The only other thing I changed was that after doing the first couple of shots sub-q, I switched to IM in delts. The items out of range are starred. I included everything I thought relevant and everything that was out of range.

*Homocysteine: 19.0 (<11.4)
*AST: 69 (10-40)
*ALT: 93 (9-46)
*Hematocrit: 51.4 (38.5-50)
*Progesterone: 1.5 (<1.4)
*Estradiaol: 45 (<39)
*DHEA Sulfate: 544 (106-464)
*Testosterone Total: 2439 (250-1100)
*Free Testosterone: 603.9 (35-155)
SHBG 27 (10-50)
TSH 1.3 (0.8-1.8)
T4 Free 1.4 (0.8-1.8)
T3 Free 4.1 (2.3-4.2)
Prolactin 3.5 (2.0-18.0)

Can you please take a look at this and suggest a route back to the goal (of high normal and in range e2)? I would really appreciate any suggestions. Regarding the high liver markers and homocysteine, I’ve gotten into the habit of drinking a shit-ton of vodka every night. I will get a handle on that post-haste.


#6

What was lab timing? - day 3

Your T dose is too high for your body and HTC=51.4 may get progressively worse. That is also thought to be driven by T peaks, so IM is worse than SC. Please inject SC!

E4D is stretching half-life considerations. IM makes that worse.

T dose adjustment seems to have backfired!

Pregnenolone EOD will work for you, you absorb very well.

Very odd for age=36: Homocysteine suggests heart disease process. This inflammatory marker is indicating inflammation of the endothelium, the one cell thick layer that separates blood from arterial wall. Please list all medications, Rx and OTC, could be a factor.

E2=45 is bad!
Is anastrozole from a pharmacy?

High AST/ALT:
Could increase E2 from reduced liver clearance if E2/
AST/ALT can be high from sore muscles or recent training.
Again, could be meds, but can be a real liver issue too.

High DHEA-S may be from your high pregnenolone which you will reduces.
Some guys can freely convert DHEA–>E2 in their adrenals.

SHBG=27 does not raise any issues, but lower E2 should lower SHBG.

TSH better near 1.0
fT4 is a bit above midrange
fT3 is way above midrange

I suspect rT3 interfering with fT3 and that your body temperatures will be low.
You gave not posted the requested body temperatures.


#7

Please study this: https://en.wikipedia.org/wiki/Hyperhomocysteinemia

Get a high potency B-complex multi-vit with trace elements including selenium 200mcg and iodine 150mcg.

Find: sublingual methylcobalamin


#8

KSman,

Thank you for helping me out, man. When I have something intelligent to say, I promise to pay it forward.

Got the multivitamin today; the sublingual methylcoblamin will be here Wednesday, as will the thermometer. I will post the temp results asap. Labs were done Friday morning, last pin was Wednesday morning. Wanted to get it halfway through.

Other Meds:
Adderal, 20mg IR, 3 x day
Prazosin 2mg, 1 x night (not every night, though)
Selegeline 2.5 mg 1 in am, 1 in Pm
10,000 II vitamin d in am
2-3 Alpha brain, 2 in am, sometimes a 3rd in evening
Usually try to take a baby aspirin in the morning.
Occasional phenibut, 1/8-1/4 tsp.
I was taking a cortico-steroid inhaler for a respiratory thing when I took the lab, but finished it that week.

My labs usually come back all good, except the occasional borderline cholesterol. Those markers looked great this time. The other numbers are freaking me out, though; I may not make the best health decisions, but I feel like I’m bouncing back and forth trying to find a protocol that works. I haven’t felt like doing much, and I’m hoping to snap out of it this summer.

When you say ‘stretching the half-life’, are you saying that more frequent doses than E4D would be preferable? I will go back to sub-q, but should I change dosing schedule, and should I just cut the amount in half, or gradually lower the dose? I’ve most often tested at around 500-600 TT. This was the first FT with SHBG blood test I’ve had.

The AI is from a pharmacy, but I mixed it in vodka, and was taking it on the day of my shot, at half of what I calculated for a week.

I am also recovering from a broken humorus surgery, and this was the day after my second exercise session of any kind in a few months, and I’ve also been fighting off a cough, with something that feels like inflammation in my upper respiratory system that also seems to be related to discomfort under both collar bones. The homocysteine and elevated ast and alt could be a combination of those things, along with the drinking.


#9
  • yes

How do you break a humorus bone, not funny, in the gym.
Your TRT for 3 years should allow for good bone density.

If you want to get near E2=22pg/ml, you need to increase dose by a factor of 45/22.
Do not know if these labs skewed by medications.

Please get a high potency B-complex multi-vit with trace elements including 150mgc iodine and 150-200mgc selenium. Oops, already suggested that.

Still need body temperatures to eval thyroid.


#10

I did not, in fact, break it in the gym; I broke it celebrating after a baseball game (I was not playing, either). As much as I hate to admit it, I was just wound up and jumped up to hang from a crossbeam that was a little thicker than I thought, landed on my arm, and hilarity ensued. Was mentioning it because I only recently started to do any kind of workout. Started back up two days before labs were taken, but definitely not at high intensity. Maybe wishful thinking, but possibly related to elevated AST and ALT?

In any case, I started a

multi vitamin once a day with all of the ingredients at the dosage you suggested (see attached), as well as a sublingual methylcobalamin, also taken once a day.

I just got the right kind of thermometer. Day one results:

6:11am: 97.1
11:40am: 97.3
11:39pm: 98.1

Just one day, but I will begin iodine supplementation.

Changed protocol to the following:

-55mg test cyp, sub-q EOD (rotating injection sites)
-.20mg anastrozole mixed in vodka EOD at time of injection.
250iu HCG EOD, opposite test cyp day
-pregnogelone 75mg micronized EOD.

Concerned that anastrozole dose may need to be lowered, as the .25mg EOD with 80mg test E4D resulted in TT of 621 with an e2 level of 10. TT levels have always tested much lower when administering sub-q, but have never done EOD before.

Concerned about temp results, too, but it would explain a lot. Do I need to see an endo for this, or should I try the iodine for awhile, first?

How long before repeating labs, and do you think I’m on the right track with the above protocol?


#11

I’ve been taking the iosol formula II for about 12 days now. I started with 1830mcg a day, but then went to 7,320 for several days, then 12,810mcg for the last 2 or 3 days. Today, I woke up feeling like something was stuck on my voice box or something when I swallowed. I was standing up with my head tilted down and swallowed, and damn if it didn’t feel like I broke my throat. It’s been hurting pretty bad all day, and I’m wondering whether this is related or not.

I’m on the road this week, working with a National Guard unit that’s out in the field, so I haven’t kept up taking my temperatures. The last time I did check was on Wednesday of last week, and I was up to 98.5 by 11:00am. I’ve felt pretty good, and my girl says my skin and face looks better. This throat thing could be my thyroid freaking out, right, or bromine/bromide detox?

I’ve got these cracked corner of my lips and my hands are dry as hell and cracked… Something is up; I never really get sick, but something weird is going on with my health lately. It’s subtle for now, and I feel pretty good most of the time, but it’s enough that I have a pretty strong feeling I’ve got something not right. I wish there was some kind of one-stop-shop that could test the shit out of everything at once, and go, ‘take this, don’t take this… do this, and stay away from that… and this is your baseline for how you’re supposed to feel’.

Just rambling and frustrated that I can’t test all of my own blood and body. Insides are complicated.


#12

I explained how to adjust AI dose earlier. And that dose can be modified again by your weekly dose change factor of the T.

Are you taking the two specified vitamin capsules?

Give yourself a break and do T+AI+hCG all on the same day. Injecting becomes less fun and exciting.