T Nation

Got Labs - What Now?

Here’s the particulars - 46 yrs old, 18% bodyfat - most all in midsection, weight 174 (down from 197 in Dec).

Blood Tests from pre-employment physical :
Glucose, serum 96 mg/dL 65- 99
triglycerides 63 0-149 best ever!
HDL 40 >39
LDL 112 0- 99 high
TSH 2.402 uIU/mL 0.450-4.500
lots of other stuff

Queast Blood Test (unfasted) :
Total Test 402 ng/dL 250-1100
Free Test 79.6 pg/mL 46.0-224.0
Bioavailable Test 177.5 ng/dL 110.0-575.0
SHBG 18 nmol/L 9-45
Albumin, Serum 4.9 g/dL 3.6-5.1
DHEA, Sulfate 61 45-345 mcg/dL
LH 1.7 1.5-9.3 mIU/mL
Estradiol 34 13-54 pg/mL
PSA, total 0.9 < OR = 4.0 ng/mL
T3, Free 298 230-420 pg/dL

Initial phone discussion - will be putting me on 2/wk test injections along with HCG. Additional each day - 200mg DIM, 5k-7k IU vitamin D, resveratrol 300mg, & 60-100mg coenzyme Q10. Will retest in ~30 days. Isn’t going to treat E2 initially, but wait to see what next test indicates.

I should hear from him in the next week for specifics. As such, is there anything I should be asking him?? It appears to the uneducated me, that I just don’t produce much Test, rather than it being blocked.

Any help would be appreciated…

Last try for comments - appreciate any help.

[quote]derf wrote:
Last try for comments - appreciate any help.[/quote]

2 things:

  1. how long have you been dieting? and what is your current diet like? (cals and quick overview)
  2. Your Glucose was high, any testing for pre-diabetes?

Dieting since Dec 1 2008. Started at 2500 cal/day (50g C, 250g P, 125g F), for the last 2 months been at 2000 cal/day (75g C, 200g P, 110g F) - additional carbs during after 3d/wk lifting. Diet is very clean, cals don’t include many green veggies. Fats are EVOO, nuts, 16g fish oil/day, etc.

No testing for pre-diabetes - and no comments from other doc regarding same on review of blood work. Diabetes does run in my mother’s family (her father).

Weight Train : Tues/legs, Fri/back&biceps, Sat/Chest,Tris,shoulders
Hike in mountains with 40# pack 3d/wk - ~2hr each

The prescriptions have arrived :

  • Testostrerone Cypionate inject 0.5 ml 2/week (SUBSTITUTE FOR ENANTHATE. THERE IS AN
  • DHEA 50mg caps 1/day
  • desicated Thyroid 65mg 1/day morning
  • HCG mix w/10ml diluent & inject 0.6ml
  • DIM 100-200mg per day
  • Resveratrol 300mg/day
  • Vitamin D 5000/day

I will be calling into for instructions on injections next week. Any comments/questions that should be addressed, I’d appreciate the help.

All my blood testing will be on Friday’s - what days would be optimal to work with testing?

If it was me, I would inject on Monday evening and after the blood test on Friday mornings. That way you have the greatest time between shots to get your levels as “low” as possible.

Is the resveratrol “trans-resveratrol” or do you know? The Rez-V and the DIM are there to help control E2 levels, and seeing as yours are a little high to start with, I hope you have positive results.

As far as the HCG goes, how many iu’s of powder came with the 10ml’s of water? You also weren’t specific about how many days a week you will inject the HCG, unless you meant twice a week along with the T shots…

With your last E2 test coming in at 34, and 22 being optimum for most men, you may have a battle on your hands especially by adding the HCG as it stimulates the testes to produce not only T, but even more E2 as well!

Get your doctor to run the “extra sensitive” E2 test next time, because the test that was used last time doesn’t register below 32, even though the range shows it goes to zero.

KNB, good catch on the Queast lab!

He will have to switch once on anastrozole.

Derf, you doc seems to know what he is doing. I would have started anastrozole from day one as E2=34 is enough to affect mood, energy, fat and libido. Your levels are consistent with your age. But still good to review drugs, Rx and OTC for endocrine distruption side effects.

You really do need the DHEA and low DHEA may have had an effect as a rate limiter on T production levels.

LH release is pulsatile [less so with age] and has a short half life. So a single lab make catch a peak or valley - you can’t tell. But that number is consistent with your TT. FSH levels are steadier and are useful. But, once you start to inject, your HPTA is shutdown and LH/FSH will track towards zero. Thus such labs have no further use in TRT, except that that a FSH level that does not drop can indicate testicular cancer… which tends to affect younger men.

hCG 250iu SC EOD maintains baseline testosterone production in the [health] testes. 500iu increased levels by 17%, diminishing returns. Learn to understand dose as iu’s not mls! I assume that your T is 200mg/ml, not 100mg/ml.

Test cyp and eth are completely interchangeable!

Some inject T and hCG EOD, every other day. With the then small volumes, you can inject that with #29 .5ml .5" insulin syringes in the vastus lateralis [front outer quadrant of the quads]. You do not need to use huge needles. Some is 1ml #25 1" and insert 3/4". Some of this depends on how much fat you need to get through to get into the muscle. Canadian clinical results show that SC injections provide steadier levels.

You do not need to inject hCG IM, SC works perfectly well, as shown in the 250iu SC EOD research.

Best testing accuracy is 1/2 way between injections. Some will test before their injection due the day of the tests so the numbers will be less high… seeking a higher dose.

This all sounds expensive! What kind of doc/clinic?

I can help you as well with injection Q’s etc.

DHEA is made mostly in your adrenals from pregnenolone. Pregnenolone is made in your testes. Either your adrenals are DHEA insufficient or they are rate limited by low pregnenolone levels. If the testes are not producing much pregnenolone, you might feel that your testes are smaller or soft now. Start feeling them now and try to note size changes and firmness from the hCG. If they get bigger and firmer, they are LH responsive and pregnenolone may increase. Some who supplement with pregnenolone capsules or transdermals find that that increases DHEA. DHEA oral absorption varies greatly. Some are poor absorbers… such as myself. I take a measure of bulk DHEA powder to get my levels up. DHEA is not water soluble, as with all of the typical steroid hormones. DHEA oil caps absorb better and best to take with an oil meal. DHEA in alcohol, dispensed into water than drank is way better than any powder.

Get “The Testosterone Syndrome” - Eugene Shippen from Amazon.com or elsewhere. Note that it is way off re injections and predates Arimidex for men, but still the best read if you are only going to read one book.

You need a DRE before starting TRT and PSA [done] a repeat PSA at month 3 and a repeat DRE at 6 months then once a year thereafter.

Your higher albumin level is good. Most T is going to be SHBG or albumin bound. Albumin bound T is the largest component of bio-T.

When is you next lab? If libido peaks then drops, along with energy etc, then your E2 is probably to blame. I would push for an early lab to resolve that and ask for an Arimidex script right away with labs to follow for confirmation. Elevated E2 can spoil everything and you E2 is already too high now. I would like to see you on 1mg/week in divided doses now.

It sounds very expensive to get DHEA and supplements as medical supplies. You can shop around for those.

No description for the resveratrol. I’ve ordered some Rez-V.
HCG - 10,000 units. No directions on how often to use - I assume that will come when I call in for instructions next week.

In our initial coversation, he was concerned about the E2 and said we’d keep a very close eye on it and associated symptoms once treatment started.

Don’t know where the last post went but :
10,000 units on the HCG. Did not specify on the resveratrol, but ordered some Rez-V.

KSman -
Vial on test says inject 0.5ml intramuscular 2/week.

Needles provided are 1ml 25Gx5/8" B-D and 5ml 20Gx1".

I’ve gone through Renewman for the therapy. Doc is 4hrs travel to SLC, UT. I got the PSA and DRE my first visit to him last month. I’m scheduled for next visit Aug. 13, with labs Aug.7.
I call in next week for specific instructions now that everything has arrived.

The doc at Renewman mentioned to be very vigilant for the first 30 days for the signs you describe for E2. The DHEA is the only supplement that is provided, the others I can/have bought in bulk. Is there any concern on bulk DHEA quality?

Thanks again for the help

[quote]derf wrote:
No description for the resveratrol. I’ve ordered some Rez-V.
HCG - 10,000 units. No directions on how often to use - I assume that will come when I call in for instructions next week.

In our initial coversation, he was concerned about the E2 and said we’d keep a very close eye on it and associated symptoms once treatment started.

Here’s the deal on HCG… if you have 10,000 iu’s and you mix it with 10ml’s of water, then each ml is 1000 iu’s. Get it? So if you have used all 10ml’s of the water, then 250 iu’s is .25ml’s. Get it? As KSman has said, most inject 250 iu’s EOD.

Update and question.

Have been on TRT for 5 months now. Got second blood test in Aug, T was good, E2 at 46. Started Anastrazol @ 0.25mg, 2xweek. Next blood work end January.

Somewhere in the forums I read high E2 effects joints, but don’t recall any detail. Currently have bad rotator cuff tendonitis on left shoulder, and right groin pain - even after several week layoff from weights with little improvement.

Question is - can high (or low) E2 be the cause and/or contributing factor? I have been unable to find any detail in my searches.

Low E causes joint aches.

You need a low inflammatory diet. Fish oil caps, anti-oxidants etc.

What has happened to your libido? If fine, you have not killed E levels. Social withdrawal and other mood problems come with low E. I guess that the issue is whether you are an anastrozole over-responder.

If you are a normal anastrozole responder, you will not do well on 0.5mg/wk. You really need 1.0mg/wk.

If you get a liquid anastrozole product you will be able to dose things properly.

Injecting? How often?

What areas of fat loss from TRT are not happening?

I have both liquid and caps, I can up the dosage to 1.0 mg/wk.

I inject EOD, both test and HCG. No problem with libido.

Still adjusting diet for fat loss. Just cut 200/day from 2000 to 1800 cal. Roughly 80 F, 160 P, 100 C, grams each. Carbs AM or workout. I’ve not seen any fat loss since starting TRT. At 47, its mostly belly fat.

I do take 10-12 fish oil/Flameout per day, 6,000 IU vit D, ALC, green tea, & circumin.

Derf, Sounds like you found a pretty decent doc. Care to IM me and share his info?