T Nation

Help with My Labs and Protocol - Added Updated Week 5 Labs


#1

Hi, New here, looking for your advice on the protocol below, attaching my labs and the questioner.

Protocol, very standard I was told: testosterone Cypionate - 200mg/week, anastrozole and hCG.

Age: 42
Height: 5’11”
Waist: 37
Weight: 225lb
Body Hair: legs. thin on arms
Facial Hair: mustache and chin, patchy on cheeks
Carry Fat: mainly midsection and leggs
Health conditions: typical low T symptoms, hard to recover from workouts, fatigue, brain fog, weakness, anxiety, shoulder/elbow pain started 6 month ago
Diet: consistent. morning – Paleo, Bulletproof, not consistent
Rx drugs: n/a
OTC drugs: Krill oil, Calcium D-Glucarate, Pentax Ginseng. Allergy relief, Selenium, Magnesium, Vit d3, Vit C, Potassium, Pycnogenol, CoQ-10, Zinc, L-Arginine, Shilajit

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#2

Sorry correction on the diet - inconsistent diet, mostly try Bulletproof. Skip breakfast and workout in fasted state. Drink too much, carb load on weekends.


#3

I do not see SHGB on your labs. If it was I would guess that it is low. You are producing well on FSH and your free test is great. Also I do not thyroid function on here TSH, fT3 and fT4. If we did I would guess your TSH would be higher than one would like by inference of your labs. High insulin levels lower SHGB (one can argue chicken or egg on that) but high TSH (hypothroidism) is also known to lower SHGB.

For the protocol pick your is the dosage test c 1ml of 200mg E7 days (if so expect SHGB to decline from baseline). What is the dosage suggested for anastrazole and HCG? Typicly the rule of thumb for anastrazole is 1mg per week for each 100mg weekly. In your case, the rule of thumb would be 2mg weekly divided into 2 or 3 dosages (depending if you do injections E3.5 or 7 days). For HCG the recommended protocol here seems to be 250IU EOD. Also if @KSman responds he would refer you to the stickies and likely recomend you complete the balance of the blood work prior to considering (or starting) any protocol. Once a protocol is started you can not go back in time and get your baseline data.

Also if at all possible, get “E2 sensitive” using LC-MS/MS. the ECLIA method is not designed for men. From LabCorp:

“Adult male. The use of a sensitive, LC/MS assay for serum E2 measurement in males is preferred over direct immunoassays because of its greater sensitivity and lesser interference by other steroids.28 See LabCorp test Estradiol, Sensitive (LC/MS) [140244]. In males, estradiol is present at low concentrations in blood, but it is extraordinarily high in semen.3 Estradiol plays an important role in epididymal function and sperm maturation and is essential for normal spermatogenesis and sperm motility.3”

https://www.labcorp.com/test-menu/24856/estradiol


#4

That’s far from standard dosing and is at the upper limit for weekly doses. Unless you’re a hyper T metabolizer mean you go through your test fast, you will find 200mg weekly to be too much and will end up converting too much of your test into estrogen. The fact that you haven’t even had SHBG tested tells me you’re dealing with a doctor’s who doesn’t have much experience. Your SHBG level will indicate which protocol will most likely work for you, low and you’ll require smaller multiple weekly shots, high and you’ll need large shots. Whenever SHBG isn’t tested, it’s considered a red flag that your doctor is not skilled enough to manage your hormones.


#5

I asked the doctor… here is his response

SHBG would not be helpful, though thyroid function should be added but many people have had that checked at some point before testing.

The doses are 200mg testosterone , 500 units hcg Twice weekly, and anastrazole 0.5 mg weekly.

Should I be warred?


#6

1ML of 200MG Test 400-500IU hcg and 0.5mg anastrazole weekly seems to be the local clinic starter kit everywhere. Nothing to be worried about except that will all need adjustments. 200mg of test c a week will crash SHBG which is not good. 200mg a week will put you in excess of 2000ng/dl on total and and beyond double the range of free test. .5 ml of 100mg (50mg) E3.5 days will likely keep levels of tt between 750-1000ng/dl without crashing SHBG and (reducing T–>E) in keeping free t ≥75% percentile of the range without extreme peaks and valleys. 500IU E3.5 days will maintain the testicles. Current advise here is 250IU EOD. HCG maintains a terminal half life of 24.6 hours (±6 hours based on hepatic function) so by twice a week you are in excess of 3 half lives of the drug (3-5 half lives is considered therapeutic limitation). In the case of HCG, studies have show its metabolites (bHCG) detectable for only 4 days and that was at dosages in excess of 11,000IU. Sorry tot he point. 3.5 days on HCG is outside the therapeutic window, if that 12 hours bothers you is entirely personal (and based on hepatic function). As for the anastrazole, the rule of thumb is 1mg per week per 100mg of depot testosterone. so .5mg per week for 200mg will not likely result in E2 level near the 22 mark we all strive for. You will likely find 2MG per week (1MG twive per week) as the ideal dosage.


#7

Thank you all very much. I am requesting Thyroid Panel and SHBG Panel before I start the protocol. I will post my results here for more suggestions in a few days.

THANKS AGAIN!


#8

Here is the additional blood test that you guys suggested… what do you think?


#9

I’m surprised your SHBG is that high based on your Free T in the above labs. You would be better of starting on the typical protocol listed in the stickies. 100mg pinned 2x week. If you had lower SHBG as we expected but didn’t see, then you would need to pin EOD.


#10

So, it has been two weeks. I feel about the same and gained 6-8lbs… what should I do? Get another set of blood tests?


#11

Here is updated blood tests… the doc want me to keep the same protocol… PLEASE ADVICE!!!

Week 5 I did not feel good at all. Lots of ups and downs. Had an ED episode that I have not had in a long time. WTF!? This is suppose to make me feel good, not bad!



#12

Sounds like everything is proceeding normally, you HPTA is shutdown which can take a couple of weeks and now you must wait for the medicine to start working. Your doctor is struggling by running LH and FSH while on TRT, I just don’t see how he will be able to manage your hormones, eventually you’ll tire of him and move on. He didn’t even test TT, obvious that FT is high.


#13

You need to donate blood.
Your Hematocrit is getting high.


#14

so, do you think I should keep going with the same dosage and ED is expected part of this?


#15

Changing dosages will only delay the time it takes for your body to adjust and adapt, lot’s of guys get impatient and try to micromanage based off symptoms, they soon learn this doesn’t work. It could be months before you get you erections back, the inside of your penis must be rebuilt.