T Nation

Bozworths Follow Up Blood Test from Labcorp

33" waist
Hairy legs, thick facial hair, no hair on back
Always a little extra weight right around waist but not excess
Just more tired, low libido, and some ed issues
Was on lexapro on and off for years for anxiety, have been off several months
Diet fairly healthy, splurge from time to time
Worked out my whole life. I coach football so it gets tough during the season. I always put on a little weight during the season.
Rarely ever have morning erections anymore unless I wake up having to piss

I have been on trt for a little over 3 mos. 100mg test cyp e 3.5 days sq, .350 hcg m,w,f. Have been trying not to use anastrozole but obvioulsy by follow up labs that was a mistake.

I have zero libido and zero er. workouts are good
how much anastrozole should I start with and would you recommend dropping test dosage.

Im loving the way my body is changing but the libido issues and ed is a nightmare.

-TT- 1658 264-916
-FT- 26.1 8.7-25.1
-E2- 88.6 8-35
-Prolactin- 15.2 4-15.2
-LH- .2 1.7-8.6
FSH- .2 1.5-12.4
-PSA- 1.0 0-4
DHEA-SULFATE- 108.3 102.6-416.3
TSH- 2.59 .450-4.5
HEMATOCRIT- 50 37.5-51

You have an e2 problem so that’s most likely causing the Ed issues. The recommendation is 1mg anastrozole per 100 mg of t on day on injections.
However, you need to further investigate your thyroid since your tsh is not close to 1. Over 2 should be checked further. Get free t3 free t4 and reverse t3. And retake tsh.

I was on a similar protocol months ago no AI, never had libido consistently until I started injecting EOD, been reducing my dose last couple of weeks and erections and libido are smiling at me now. Whenever you put a guy on TRT with no AI, most of the time he’s going to convert more of his T–>E2 and that means no erections or libido.

so are you on AI now also

No AI, injecting EOD has it’s advantages of possibly keeping T high enough that E2 is within range without the use of an AI. Im injecting 17.5mg EOD and I’m only 2 weeks into my 4-6 week period where my levels are still in flux and I’m feeling great.

TEST OVER 1600!!! I believe that Im on too high of a dose (especially without AI)

Im dropping down and going to use an AI

I wouldnt drop the test down. Just add the AI.

I know alot of guys will disagree with me on this but my test is consistently over 1500 and my E2 is below 25 and i feel great, have awesome erections and raging libido. I’m 52 years old.

IMO, the high test will help you cut BF and change your insulin sensitivity. Dont over react too soon. Just add the arimidex and see what happens

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With a TT that high, you will likely run into other issues with your blood as well. I think its smart to lower your dose a little.

Its really up to you. If you want to keep your testosterone in that range you will end up needing to deal with the side effects. (E2 control, Phlebotomy) and some guys do well that way and thrive. Obviously you would get better results in the gym too.

A lot of guys talk about having their TT in that range, and then feeling way better when they came down into the 1000 TT or even a little lower range.

Also be advised that HCG can cause some guys to have e2 problems.

I can only speak from my own experience. I’ve had test levels as high as 5300 during a blast. And, yes it has taken me a while to dial everything in but keeping my test high and working out has changed my body for the better over time. I do regularly give blood too.

I self administer and have been doing so for about 4 years. In all that time, I have regular physicals. My dr has no idea i self treat and and has found no issues of concern.

I completely agree. But in the context of actual “TRT” Testosterone “replacement”. I think over 1500 goes beyond replacing it. No judgment though, everyone has their own journey.

T dose is high, TT is high.
FT is not high, so T dose is appropriate

FT is been reduced by:

  • FT–>E2
  • FT–>FT+SHBG which is not bioavailable
    High FT+SHBG inflates TT so that TT overstates your T status. Do not expect doc to understand.
    Your high SHBG is easily inferred from your labs and higher E2 causes liver to produce more SHBG.

As E2 is not high, FT–>E2 rates should not be high. Then we are left with the prospect that E2 may be high from impaired liver clearance. Liver problems can do this and AST/ALT labs may be useful. Some medications, Rx or OTC, supplements, weed etc can impair E2 clearance.

Anastrozole is needed and one could be tempted to suggest 1mg twice a week at time of injections. But this should be tempered with the fact that FT is not high. Ypu can try 3/4mg at time of injections and should feel profound benefits in 5-7 days. Do not make short term adjustments on how you feel because the delays and half-life will bite you. If you feel better then crash, or crash and/or joints ache, your E2 has crashed and we then assume that you are an anastrozole over-responder and then you stop for 5-6 days and resume at 1/4th the dose and go from there.

If you get near E2=22pg/ml, we would expect to see FT increase from less FT–>E2. But SHBG will also reduce, but that can be slow and that will also increase FT. So this may all take time. SHBG does in some guys refuse to obey the rules.

Prolactin is a concern as it can drive secondary hypogonadism. Test again to confirm. Avoid orgasm for a few days as well as cuddling {babies | kittens | puppies} as these also cause prolactin release. Some drugs can do this too.


Do not waste time+$ testing LH/FSH as we expect -->zero.

More CBC? RBC, MCV, ferritin
Blood pressure changed?

Hematocrit=50 needs to be watched. Do not take vitamins listing iron, those are suited to cycling women who have iron losses. Note that many breads, cereals, pasta, flour, pancake mixes etc are iron fortified.

Get 25mg DHEA from USA vitamin shelves. Do not take with high fiber foods, better with meals that have more fats and oils. Ditto fish oils and Vit-D3. Most need 5000iu Vit-D3 to get optimal VitD-25 labs.

TSH is clearly a problem, should be closer to 1.0
Problem may be from not using iodized salt and/or vitamins listing 150mcg iodine and 150-200mcg selenium.
Eval your thyroid function via oral body temps, see below.
Low thyroid function has most of the same effects as low T.

Training with low-T and low thyroid function typically means that adrenalin is compensating for low energy and adrenal fatigue can be expected from this stress. Then rT3 is elevated and rT3 block some effect of fT3. fT3 is the only active thyroid hormone.

Low thyroid can also lead to:

  • feeling cold easier
  • fat gain
  • lethargy
  • sparse outer eyebrows
  • thyroid nodules and other problems in future
  • dry skin

I would expect that getting near target of E2=22pg/ml will over time reduce PSA a bit. E2 is a risk factor for prostate problems.

Post your body temperatures.

Just to be more explicit.

Your TT is fine as it is dominated by non-bioavailable FT+SHBG. We only need to look at FT to see what your status really is and FT number is not too high.

As lower E2 leads to lower SHBG and FT increases, this perspective may change.

And if you do not get thyroid turned around, you will not feel great even if TT, FT, E2 and SHBG seem perfect.

RBC 5.47 4.14-5.8
MVC 91 79-97
AST 26 0-40
ALT 29 0-44
TOTAL CHOL 161 100-199
TRIGL 51 0-149
HDL 63 >39
LDL 88 0-99

I have had cold hands my whole life. feel cold when others dont.

My TSH was 4.37 on OCT 5th and is down to 2.59 now.

What are your suggestions moving forwrd?

TRT affects the cardiovascular system that supplies blood to the extremities, whenever I increase dosages I got hot and whenever I decrease dosage I get cold hands and feel, you also have had an underactive thyroid which is a double whammy.

Get the thyroid under control and get TSH closer to 1.0. Track morning and afternoon body temperatures with a mercury thermometer, should 97.7 upon waking and 98.6 in the afternoon.

Best way to lower TSH?
It has dropped from 4.37 to 2.59 in 3 months and I havent done anything but the TRT regimine.

Some guys are hypo when their T is low, my TSH was .580, T4 almost midrange, fT4 midrange and fT3 unknown but body temps (98.7) indicate optimal. Also everytime I lower my dose I catch cold and get sick, body gets freezing cold.

You could use iodine and selenium to bring down TSH, iodine tell thyroid to increase thyroid hormones. Track body temps in absence of labs.

What r your thoughts/advice on the prolactin issue?

RBC 5.47 4.14-5.8
MVC 91 79-97
AST 26 0-40
ALT 29 0-44
TOTAL CHOL 161 100-199
TRIGL 51 0-149
HDL 63 >39
LDL 88 0-99

I have had cold hands my whole life. feel cold when others dont.

My TSH was 4.37 on OCT 5th and is down to 2.59 now.

What are your suggestions moving forwrd?