T Nation

Bloodwork and TRT and Sermorelin/GHRP-6

I am about to start TRT and hormone therapy. I am 44 years old, 5’9 and 170lbs about 15% BF.

My lab results were not too bad (as far as I understand):
Testosterone, Total 712 ng/ml (range 348 -1197)
Testosterone, Free (direct) 12.6 pg/ml (range 6.8 - 21.5)
TSH 1.38 uIU/mL (range 0.450 - 4.500)
Triiodothyrine, free, serum 3.3 pg/mL (range 2.0 - 4.4)
T4, Free (direct) 1.21 ng/dL (0.82 - 1.77)
LH 7.6 miU/mL (1.7 -8.6)
FSH 14.5 miU/mL (1.5 - 12.4) HIGH
Estradiol (Roche ECLIA methodology) 36.3 pg/mL (7.6 - 42.6) High?
IGF-1 195 ng/mL (75 - 216)
DHEA sulfate 225.2 ug/dL (102.6 - 416.3)

I’m bit surprised that I was prescribed TRT but a little boost can’t be bad?
The therapy is as follows:
Sermorelin/GHRP-6: 30mcg/day
Testosterone cypionate: 200mg/week (I assume I should take it 100mcg E3D?)
HCG: 1000 units / week
B-12 metyhlcobalamin: 1.5ml E4D
Arimidex: 0.5mg E3D

(not sure about E3D or E4D yet)

My first question relates to FSH as it is out of range, I haven’t found a real explanation what high FSH means (as my t-levels seems to be quite ok). Any comment on it?

Also my IGF-1 seems to be ok according to range, but is it ok? Should it be btw 200-300 and higher is better? As I understand Sermorelin would mainly increase IGF-1 levels so it seems ok?

About testosterone, I cleaned up my diet and increased rest and by doing that my total T level rose from 550 to 712 (and was year ago 650) so it seems that good diet can influence t-levels significantly? With relatively low T-injection I understand my natural T production is reduced and HCG should fix that by emulating LH? Again my LH seems to be at higher end of the range already - would that make any impact?

Estradiol seems high, would I benefit on just estrogen blocker alone?
Also as I was able to increase my T levels with proper diet and rest, is there any natural ways (diet) to decrease estradiol levels?

As you can see I am complete novice in this TRT so all comments are welcome and appreciated.

Your bloodwork is near perfect, for a 44YO, its probably in the 95th percentile.
TRT will screw your whole system up should you ever want to
return to natural.

What makes you want TRT ? What is your ailment / goals ?
If you’re looking to get ripped, or add size and strength, run a simple 500mg
Test cycle with a proper pct…but the TRT thing will hurt you more than help
in the long run.

Sermorelin/GHRP-6, run a search on this site, and read the results before you
go the peptide path. Lots of marginal results reported with these.

The one thing you could try is DIM to lower your E2.

Good Luck.

[quote]PKNY wrote:
Your bloodwork is near perfect, for a 44YO, its probably in the 95th percentile.
TRT will screw your whole system up should you ever want to
return to natural.

What makes you want TRT ? What is your ailment / goals ?
If you’re looking to get ripped, or add size and strength, run a simple 500mg
Test cycle with a proper pct…but the TRT thing will hurt you more than help
in the long run.

Sermorelin/GHRP-6, run a search on this site, and read the results before you
go the peptide path. Lots of marginal results reported with these.[/quote]

Thanks, yeah I definitely want to get ripped and bit more lean muscle. My prescription is for a 10 week treatment for T and 6 months for Sermorelin. I see it so that the boost for T can’t be bad and wouldn’t it be easier to return back to natural after low dose T treatment than from high dose?

I was actually most interested in HGH but I think it would be illegal for them to prescribe it based on my bloodwork. For sermorelin I see much less risks than with T (beyond losing $$$), but I need to do more research on side effects.

I’m not expecting to see a huge jump in results due to this but a little boost and improved recovery from training. I train like animal every second day (full body) and it is bit too much, I feel like I would need 1.2 rest days in between workout days (meaning 3 training days per week and 4 rest days).

But what about trying just AI alone (to reduce estradiol), seems that that could give a double benefit in my case?

200mg will shut down your natural production of T as much as 50mg or 500mg.
200mg will reduce what your body makes to near zero, and will take your T level
to around 1100-1400, which for you isn’t going to be the difference maker you want
based on your starting point.

If you are going to run a cycle, 500mg is a great place to start. If you go that route,
request T-prop, not Cyp or Enth. It will work faster, and you’ll hold less water.
Lots of HRT clinics are prescribing blends which are half prop, half cyp…which is
better for your purpose.

Whether you do 200mg, or 500mg you need to run a PCT that will get you back (or close to)
baseline. Keep in mind that most never return to exactly where they were pre-cycle
but they can get close.

I’ve read a lot about HGH and had been interested too (I’m 45), but every thread I’ve read
seems to say things like: My skin was tighter, I had a little more energy, I had slight fat loss,
I recovered faster after a workout. And, the results we’re very slow to manifest.
I’ve yet to find one instance of it being called a mass adding, shredder.

I’d still avoid the peptide thing, it’s expensive and marginal.
With 500mg test in your body, you will recover faster, and your protein synthesis
will pick up considerably. The added muscle will also burn more calories passively.

Body fat is more a function of what you eat vs. what gear you take.
The rule I’ve read over and over is DIET, REST, WORKOUT, GEAR in that order to
get ripped.

To your question, You could try an AI alone, if you do I’d say get Aromasin vs Adex.
Aromasin has some steroidal properties by itself. Be aware though, stand alone AI
use is seldom successful…YMMY based on your baseline #'s.

Let me know what you do, and the results.

I’d say you’re playing with fire if you don’t know what you’re doing. There’s a real risk you will not return to normal, or it will end up being a real pain in the ass to return to normal. Using HCG throughout should minimize that risk.

If you’re going to do a cycle, do a cycle. 200mg/week isn’t going to be earh-shattering given where you are already. I’d say more of a pain in the ass then it’s worth. There’s a lot of tweaking involved to feel right. If you’re going deal with libido, ED, depression, anxiety etc. for 10 weeks, might as well go big.

If I were you I would increase DHEA and decrease E2. This should raise T, Free T and provide a modest gain. 25mg of micronized DHEA daily. To get E2 down, you could try the natural route. If you’re going to use Arimidex, best to dissolve it in some vodka and use a graduated dropper to dose. Or just get some from a research chem company that’s already in liquid form, liquidex.

If you’re going to do peptides, probably need a bit more than 30mcg. I’m doing 100mcg of Mod GRF and GHRP-2 at night. Mostly to see if i can improve sleep and get a mild boost. If you’re going to do a cycle, most would do 100/100 3x daily.

Getting prescribed TRT with a reading of T = 712 ng/dL is a crime. It can only cause more problems that it would solve. And any doctor or clinic who would do that is very iffy.

[quote]dhickey wrote:
I’d say you’re playing with fire if you don’t know what you’re doing. There’s a real risk you will not return to normal, or it will end up being a real pain in the ass to return to normal. Using HCG throughout should minimize that risk.

If you’re going to do a cycle, do a cycle. 200mg/week isn’t going to be earh-shattering given where you are already. I’d say more of a pain in the ass then it’s worth. There’s a lot of tweaking involved to feel right. If you’re going deal with libido, ED, depression, anxiety etc. for 10 weeks, might as well go big.

If I were you I would increase DHEA and decrease E2. This should raise T, Free T and provide a modest gain. 25mg of micronized DHEA daily. To get E2 down, you could try the natural route. If you’re going to use Arimidex, best to dissolve it in some vodka and use a graduated dropper to dose. Or just get some from a research chem company that’s already in liquid form, liquidex.

If you’re going to do peptides, probably need a bit more than 30mcg. I’m doing 100mcg of Mod GRF and GHRP-2 at night. Mostly to see if i can improve sleep and get a mild boost. If you’re going to do a cycle, most would do 100/100 3x daily.[/quote]

Thanks for everybody. I really appreciate your input. I think I will save T for later and maybe get another 10-week prescription and do a cycle (10 weeks 400mg/week). Peptides I am still considering as I haven’t seen so much risk or discussion about side effects with those.

I have extremely clean diet and I think my T levels can improve more with it (Dec 15th total T was 550 now (Jan 15th) 712). I try to get E2 level down. I haven’t used DIM or Calcium Gloconate but I should get those within a couple a days. Is there anything spefic instructions when to take these and what to eat / not to eat with them? I used to take DHEA but I stopped taking it - maybe I will start it again as well.

I ordered the medicine already so I will get it anyhow and I will use Arimidex to lower E2 with a low dose as I don’t want E2 to get too low. If I dissolve it to vodka, I should still take it orally, right?

My strength has been increasing with my diet and training at much faster rate than I expected so I don’t really know why I ordered the stuff, my fault is that I am not the most patient person…

Also how soon the changes in E2 level are expected to take place? I want to check my levels ASAP after the treatment so I can adjust the dosage and base it on science and not thoughts.

Of course staying natural would make the achievements feel more rewarding and part of me wants to see how much I can improve my levels by diet and rest and exercise and 160 pts improvement in T level in a month (or actually 2 weeks on strict diet) is pretty amazing, another 160 pts improvement would be stellar. And to get IGF-1 over 200 and E2 to 15-20 (I assume that is about ideal level?) would be more than I could really hope for.

It could have been from diet but just keep in mind that fluctuations of 160 points or more are common from one day to the next day even if blood is taken at exactly the same time, and fluctuations of 300 points would be common between morning and aftenoon samples. On top of that even testing the same sample twice can easily give a difference of 50 points - the tests are not very accurate.

[quote]seekonk wrote:
It could have been from diet but just keep in mind that fluctuations of 160 points or more are common from one day to the next day even if blood is taken at exactly the same time, and fluctuations of 300 points would be common between morning and aftenoon samples. On top of that even testing the same sample twice can easily give a difference of 50 points - the tests are not very accurate. [/quote]

Thanks - good to know. Definitely Dec test was after overtraining (morning) and Jan test was on morning after rest day. Last spring the test value was 690 and Free T 116? I plan to have next test (just T, Free T, E2, DHEA-s) on or about Feb 12th.

You can also try magnesium oil to increase DHEA. Something about taking magnesium transdermally increased it quite a bit for me. I would do this first. Extra Mag might give you a little boost in T if you were deficient before. Good to take at night before bed.

I would get E2 to match Free T. That seems to work best for me. Getting E2 down a bit should provide a modest gain in Free T. I feel best when it’s around 20. Arimidex is always taken orally. You won’t need much and it can be a little tricky to dial in. I would probably try Boron, Calcium d-Glucarate and DIM first. All of those things provide other benefit.

If you get E2 down and DHEA up, and free T is still not close to 20, you could do a low dose SERM. That’s what I’m attempting to do now after a year and half on TRT. I was really low when starting.

Thanks again, I think I start with Arimidex at 1/16th pill E4D (dissolving 1/4 or 1/2 of pill to vodka to make it somehow possible to administer the dosage) and DIM, DHEA and Calcium d-Glocarate. My Magnesium level was (Dec 15th) at 2.3mg/dL which seems to be ok. I already eat about a cup of broccoli a cup of spinach every day as part of my diet which is pretty strict and healthy, so I don’t expect a lot from the supplements. I will save the other stuff for later and see after the bloodtest on or about Feb 12th what are the results and plan further after that. Of course if I end up with unwanted side effects like loss of night/morning wood, I will stop it (arimidex). Sounds ok?

Got my stuff today, Anastrozole is not Arimdex but a generic version (patent expired in 2010). The pills (0.5mg each) contain white powder, I will dissolve them (one by one) to vodka and take 1/8th of a pill (0.0625mg) E3D and see results (feelings and bloodtest in 3 weeks). Is there any reason not to dissolve it to - say 1dL of vodka and drink 0.125dL E3D instead of dissolving it to tiny bit of vodka?

It is easier and more accurate to divide into eight portions if dissolved into larger amount of vodka. On the other threads I have seen proposals to dissolve it to 10mL of vodka which would mean administering it on a drop accuracy, why not use larger amount of vodka (I drink vodka sometimes for recreational purposes as well :wink: ? Also the amount of medicine left to residual vodka in containers is smaller if dissolved into larger amount.

You can dissolve it in gallons of vodka if you want :slight_smile: it doesn’t matter.


Here is what I will do:
I will take 0.125mg Anastrozole per week but I take fraction of it once a day with vodka. Ie. I take 0.017857143mg per day.

I take today 4 times the normal dosage and after that normal dosage every day.

My semi scientific reasoning for this is as follows:

  1. Estradiol has half-life 13-17 hours (wiki)
  2. I aim to half me estradiol from 36 to 18.
  3. I make assumption that my Anastrozole at steady state content in body will cut half my estradiol production. (Just a quess but would only impact on the steady state result)
  4. Half life for Anastrozole is 46.8hours
  5. I assume the decoy to follow X*power(0.5,hours/halflife) for both estradiol and anastrozole.

In the attached image the amount of anastrozole in body as function of time (days) is estimated for different first day dosages. With this daily dosage the steady state amount in body would be about 0.06mg. Without multiple dose in first day, it would take about a week to reach stedy state amount in body. With intial dosage the steady state is reached from above (first more anastrozole content in body is higher than steady state and is gradually lowering to the steady state.

I will post another post to explain the other part of my logic, the amount of estradiol in body (as I don’t know how to attach 2 images).


The image in this post shows estimated estradiol in body.

The assumption is that after reaching steady state with medication some amount of estradiol is produced in the body and the same amount is decoying in liver. It does not matter what is the exact value of the remaining estradiol (for timing and front loading). Medication blocks some amount of creation of estradiol (“Excess Estradiol”) and some amount is sustained (“Sustained estradiol”) total estradiol is sum of these two.
Wiki claims 13-17 hours half life, I used 15 hours.
At day one it is assumed that the steady state amount of blocking medicine is in the circulation and body generates the sustained rate estradiol.

After 6 days the estradiol should reach the steady state value with the medication (Note! if medication is taken for instance daily without front loading, the build-up for medication takes about a week).

The rule for frontloading is to start with twice (not 4 times) the amount you would normally take during whatever is the half life of the drug. So if the half life is two days, just double the doses during the first two days.

This way serum levels are stable from the first day.

If 1 represents the amount you take during a half life, then WITHOUT frontloading, your levels build up approximately like

1 initially
1/2 (left from previous) + 1 (new dose) after a half life
1/4 + 1/2 (left from previous doses) + 1 (new dose) after 2 half lifes

This builds up to 2, since the infinite sum 1 + 1/2 + 1/4 + 1/8 + 1/16 + … = 2

WITH doubling of the doses during the first half life, your levels are approximately

2 initially
1 (left from previous) + 1 (new dose) = 2 after a half life
1 + 1 = 2 after two half lives

So you see you get stable levels from the start by doubling doses during the first half life.

[quote]seekonk wrote:
The rule for frontloading is to start with twice (not 4 times) the amount you would normally take during whatever is the half life of the drug. So if the half life is two days, just double the doses during the first two days.

This way serum levels are stable from the first day.

If 1 represents the amount you take during a half life, then WITHOUT frontloading, your levels build up approximately like

1 initially
1/2 (left from previous) + 1 (new dose) after a half life
1/4 + 1/2 (left from previous doses) + 1 (new dose) after 2 half lifes

This builds up to 2, since the infinite sum 1 + 1/2 + 1/4 + 1/8 + 1/16 + … = 2

WITH doubling of the doses during the first half life, your levels are approximately

2 initially
1 (left from previous) + 1 (new dose) = 2 after a half life
1 + 1 = 2 after two half lives

So you see you get stable levels from the start by doubling doses during the first half life. [/quote]

Within reason, or approximation, we are in full agreement.
Since Anastrozole half life is 46.8h - in 24 hour series it goes like this (assuming exponential decay)
1.000 0.701 0.491 0.344 0.241 0.169 0.119

And in my case i used 4 times is the daily dose and the half life is about 2 days this is equal to 2 times the dose in half life.

Since estradiol, the one that we try to control, has shorter half life it reacts fast to changes in the anastrozole levels.
Assuming 15 hour half life for estradiol the excess amount decreases (24 hour intervals): 1.000 0.330 0.109 0.036 0.012

Now if Anastrozole is not taken daily, the serum levels vary quite a bit (in each case the weekly dosage is 7):
4xf 4.00 3.80 3.67 3.57 3.50 3.45 3.42 3.40 (daily with 4 times the daily dosage on first day)
E3D 3.00 2.10 1.47 4.03 2.83 1.98 4.39 3.08
E4D 4.00 2.80 1.96 1.38 4.97 3.48 2.44 1.71
E7D 7.00 4.91 3.44 2.41 1.69 1.18 0.83 7.58
Each average out in long term to about 3.2 (if half life would be 48 hours would average to 4).

I dissolved 0.5mg anastrozole to 1.4dL vodka and my daily dose is tsp (ie. 1/4*0.5mg per week). Now if I need to increase the dosage add vodka and keep the dose as tsp, if I need to decrease the dose I reduce vodka (add anastrozole pill ad add less then 1.4dL vodka) and keep dose at tsp. This way it is easy to adjust the dosage and easy to remember to take the dose every morning.

With less frequent anastrozole the serum levels will always oscillate day to day (see attached for different frequencies) and estradiol correspondingly even more. This could be reason why finding right dosage seems to be very difficult? With T injections the situation will of course become more complicated as T has half life of 8 days? Although, in first approximation T level (if injected 2/week could be assumed constant and need adjusting daily anastrozole dosage slightly could lead to stable estradiol levels, maybe 1.5* daily dose on day of T and 2* on day after T-injection?

I am not expert on this but just based on the half lifes and my background (trained scientist) - I can’t stop thinking.

[quote]johnsmith1970 wrote:

Within reason, or approximation, we are in full agreement.

And in my case i used 4 times is the daily dose and the half life is about 2 days this is equal to 2 times the dose in half life. [/quote]

Oh I see what you mean. Yes, I am in agreement.

Should I feel some results already?

My dosage is 1/4 0.5mg per week which I started to take as 1/28*0.5mg daily dose.
I started taking this:

  • Thursday afternoon: took 4 times daily dose (1/7*0.5mg)
  • Friday morning 1/28*0.5mg
  • Saturday morning 1/28*0.5mg
    At least last night I had nocturnal woods, but that is not that uncommon (if not happening every night). Based on the thoughts in previous posts I should be close to steady state serum anastrozole and estradiol levels already. I can’t say I feel any difference.

Shouldn’t this rule out that I am overreacting to anastrozole?

Since the dosage is very low (equal to 1/70.5mg E4D) should I increase dosage a little bit? Maybe to 1/3 * 0.5mg per week (1/210.5mg daily)? or even higher?

Your E2 isn’t that elevated (some would argue that it isn’t elevated at all). So it is possible you won’t feel anything from lowering it.

A fact that is little discussed is that in most men FREE estradiol drops with age even if total estradiol rises. You can google or pubmed studies on his if you want. (Thus, for example, the apparently paradoxical loss of bone mass with aging despite increasing total E2.) If this is the case, reducing E2 with an AI may not be good for health, rather the opposite.

In any case, very few men report any significant improvement with arimidex monotherapy. If your goal is faster recovery, I really doubt you will achieve that with arimidex.