T Nation

Help Dialing in Dosages (3 Lab "Snapshots" over a year)


#1

Lab #1 (pre-TRT):

TT: 264
FT: 15.2 (4.3 - 30.4)

Thyroid:
fT3: 4.4
ft4: 1.1
TSH 1.36

Lab #2: While on 100mg test cyp/week divided + 250 mg HCG + .5 anastrozole 3x/week (lab taken at low point - might’ve been underdosing the T accidently - see following labs for much higer T at assumedly the same dose)

total T: 660 (348-1197)
free T: 23.7 (9.3 - 26.5)
RT3 15.2 (9.2-24.1)
E2 13.1 (7.6 -42.6)

CORTISOL
AM 19 (13-24)
Afternoon 3 (5-10)
Evening 2 (3-8)
Midnight 1 (1-4)

Lab #3: 9 months later (labs taken on off day):

100mg/week EOD in divided doses
NO AI
250iu HCG EOD
Labs:
ft: 321 (35-155)
tt: 1005
e2: 51

I stopped the AI ‘cause I felt better when I didn’t take it. Then slowly slipped into feeling bad and low energy. I went from low-T and low-E to high T and high E. I think I started injecting properly and it made a difference (injecting downwards, putting my finger on the injection site a for around five seconds after injection)

My doctor wants to me injecting 30mg test cyp E3D (70mg/week), 250iu HCG E3D and .33mg anastrazole a week. Basically, he didn’t want me to change dosages, just to keep the same dose and do E3D.

Thoughts? Help? So far it feels fine on day one and two. Day three feels better than pre-TRT but don’t have that ‘amped’/good feeling.


#2

Going to be difficult getting into cruise control if you keep drastically changing your protocol.

If you are injecting 100mg of T cyp/week in divided doses, you’ll get plenty of T. This usually takes 1mg of adex to control the E2 which you’ve seen is the key to feeling better. The hcg protocol is good.

Whatever protocol you decide on, you’ll need to ride that for about four weeks then run some labs halfway between T shots and adjust the protocol based on labs and symptoms.


#3

Yeah, but I’m 25.

The real thing that throws me off is I had 13.1 E2 when I was doing 1/2-mg/week anastrazole (adex) but it produced 600 total T. The 13.1 E2 felt low and I/my doctor made the stupid assumption that since I am young I don’t need an AI at all. On the other hand, when I was supposedly doing the SAME 100mg/week t dose but without an AI I had wildly high FT: 321 - where the range only went up to 155. So, there’s the confusion. At what seems to be the same dose I had too low and too high. 15.1 E2 with 600 TT sound like an OK ratio of E2:TT, so supposidly I’d just have to dose higher. But my doctor felt like 100mg/week was giving me WAY too high FT levels (again, this 321 FT).


#4

Several concerns especially at your age. Very high TT/FT will lead to dangerous HCT, HGB and RBC. Also, the ratio of T to E may not be the key to feeling better. I’d be more concerned with the actual E2 levels. Too high and too low are both problems.


#5

@KSman ?

Is this how we summon you these days?


#6

You were taking 1.5mg anastrozole per week. To get near target of E2=22pg/ml, new dose is 1.5mg/week * 13.3/22 = 0.9mg/week

You may have felt bad because E2 was too low.

Do dose that:
Inject 50mg T twice a week
take 0.5mg anastrozole at time of injections
finer dose control would need a liquid solution in vodka dispensed by the drop.
Do labs half way between injections always.

Read these stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones

Before TRT, were these labs done?
LH/FSH
prolactin

On TRT, you also need to test:
CBC
AST/ALT
hematocrit

Please repost thyroid labs with lab ranges.


#7

Thanks, KSMan. So I need to clarify, and sorry for not posting things clearly.

The .5mg Anastrazole was in divided doses per week dissolved in vodka. So at .5mg anastrazole my E2 was 17.

The thing that is confusing me that on 100mg test/ .5mg anastrazole a week I was getting 600 total T but on 100mg test with no AI I was getting 1005 total T and really high free T - 321 (on a range of 35-155). These labs were both taken on off days.

I can’t explain why on the same dose of test I was getting varying results when it came to total and free T.

As far as labs go, unfortunately I didn’t get LH/FSH before TRT. Prolactin was within normal range.

Current labs:

hemacrit 45%
RBC 5.12 M/uL
WBC 11.4K/uL
MCV: 89.5fL
MHC 30.0pg
RDW 12.2%
MCHC 33.6%
Lymphocytes 41.1%
Monocytles 6.2%
Eosinophils 3.1%

How important is an AST/ALT test? Something I should get immediately, or wait when I get my next labs for Total T/Free T/ E2?

How long do I have to wait until I redo labs?

If 100mg is a safe dose I’ll go ahead and switch to it. Somehow I was getting 321FT (35 - 155) with that which concerned my doctor. I don’t feel good on the third day doing this E3D dosing of 30mg T/dose. So if you concur I’m switching to 28mg T +.14mg anastrazole + 250IU HCG EOD.


#8

That does seem right. In a few weeks you would be able to get some new numbers for anastrozole course corrections. If you are feeling good, no need to hurry.


#9

Awesome. Thank you. @KSman

Can I ask you a somewhat related question?

I like to float in float sensory deprivation tanks, which I use for relaxation/introspection, but the float tanks have chlorine in them. The concentration is 130g/l of chlorine (sodium hypochlorite). Is this enough to cause thyroid issues? What you were mentioning in your thyroid article about displacement of stored iodine?


#10

So KSMan, I’ve made this change and I feel worse. I feel utterly exhausted. Complete fatigue. Really don’t know what to do. If this is closer to ‘right’, as I suspect it is, then why does it make me feel worse?


#11

Please check oral body temperatures as per the thyroid basics sticky and we can see if low thyroid function might be a factor.

With the fine tuning if anastrozole dose, it would be odd if E2 was really low. You could stop anastrozole for 4-6 days and note how you feel day to day and that might tell us what territory you are in.

Cortisol was good.

Chlorine: If you are breathing air over that water, could be a problem. We have a lot of chlorine ions in our body at all times that are not displacing or interfering with iodine metabolism. That is an assumption on my part. Perhaps things are more complex than that. So a quick search on the internet indicates that chlorine in drinking water might reduce iodine absorption in the gut. Check body temperatures.


#12

Body temperatures are low. Not sure what do do about that. I’ve done the iodoral several times, but can try again…

The float tank place said there is a very low concentration of chlorine in the air in the tank, even though you can smell it. But also I’m not sure if you’re saying chlorine in the drinking water is the same as it being absorbed through the skin.

I’m trying CPAP. Seems to be helping with energy levels. I tested with a sleep study having an AHI of 10, but my CPAP machine says it’s more like a 5. Think it might take time for the better sleep to help with recovering adrenals. Not sure how it’ll affect my thyroid.


#13

Can you repost thyroid lab results with lab ranges?


#14

This was a year ago:

fT3: 4.4
ft4: 1.1
TSH 1.36

Sorry, I didn’t save the ranges.


#15

So not know if fT3 is high or low [SI units].


#16

Looks like the problem might have been e2. I was taking 250mcg of it EOD and my e2 was negligible (undetectable). Without an AI my e2 was 40. I’ve been trialing 125mcg for nearly four weeks now and I still have virtually nonexistant libido…


#17

It’s almost like ANY anastrazole brings it down too low, but without anastrazole I have an e2 of ~40. Is 1/16mg even a reasonable dose? Even 1/8mg seems too high (I see none of the benefits I was getting when I wasn’t using an AI: higher sex drive, more energy, more dominant; etc.)


#18

You can try aromasin in small doses and that might be more compatible with your unique features.

You probably have some mutated enzymes that are mostly not causing any problems. But be concerned that you could have some bad results from other medications some day.


#19

Ok, thanks KSMan.

You have any tips? I can’t seem to quit coffee. I’m gone off cold turkey for a few weeks a couple of times and get insanely tired, depressed, unable to do work; etc. I’m trying to heal adrenal fatigue 'cause that’s what we concluded in my original thread. IDK, a part of me wants to go off of TRT because I feel less like myself and less sexually active than ever before and I feel in a rut of adrenal fatigue that it’s keeping me in because it amps me up and makes me always driven even when I don’t have energy. Wellbutrin seems to improve my mood but no matter what I’m super fatigued. Being 25 I feel like I still might have a chance of getting off of TRT. It definitely makes my adrenal fatigue worse and also sex doesn’t feel that good - makes it very difficult to orgasm.

IDK if going on TRT for adrenal fatigue was the right choice. I feel like no matter what I’ll be stressed in life, which will undermine my T levels. But I’m beginning to think mid-low range T naturally produced is better than TRT.


#20

With adrenal fatigue, you need to stop fT4–>rT3 and to do that you need to take enough T3 to depress TSH so less T4 is made. Only source of time release T3 in USA is compounding pharmacies.

Taking high dose iodine does not work with adrenal fatigue and Armour Thyroid, T4 meds and Nature Thyroid can be blocked.