Hello all, I have been reading and researching TRT with the help of forums such as this along with reading the different protocols of some of the most well-respected clinicians in hormone therapy. I wanted to post my situation to see if anyone with solid knowledge of hormone therapy to give me advice to my plan.
I am an athletic 34yr old male 6’2” 200lbs. About 2 years ago upon returning from deployment I began exhibiting symptoms of chronic fatigue, depression, muscle loss despite continued exercise, low to no libido, and increased abdominal fat. I wasn’t sure what was going on with me until I was turned onto TRT by fellow coworkers. I went to my PCP at the VA and she agreed to run a hormone panel. I have an extensive medical background however I did not do my due diligence to research what tests were actually needed. The only tests she ran was a CBC, B12, Vit D, and Total Testosterone. The labs are as follows.
WBC 4.07 K/uL (4.0-11.0)
RBC 5.52 M/uL
HGB 17.3 g/dL (14-18)
HCT 49.6 % (39-52.5
MCV 89.9 fL (85-102
MCH 31.3 pg (28-38)
MCHC 34.9 g/dL (32-36)
RDW-CV 11.7 % (11-14
PLT 178 K/uL (128-412)
MPV 11.6 fL (8.69-12.56)
Lymph % 34.2 % (24-39)
NEUT % 56.0 % (50-68)
MONO % 6.6 % (4.4-12)
NEUT # 2.28 K/ul (2.0-7.5
MONO # 0.27 K/ul (0.18-1.3)
LYMPH # 1.39 K/ul (1-4.3)
BASO # 0.04 K/ul (0-0.1)
EOSIN # 0.08 K/ul (0.0-0.6)
EOS % 2.0 % (0-5)
BASO % 1.0 % (0.0-1.0)
IG # 0.01 K/uL (0-0.04)
IG % 0.2 % (0-1)
CHOLESTEROL 143 mg/dL (140-200)
HDL 64 mg/dL (35-67)
LDL 71 mg/dL (<119)
TRIGLYCERIDE 48 mg/dL (35-200)
BILIRUBIN, DIRECT 0.5 High mg/dL (0-0.2)
GLUCOSE 102 mg/dL (70-109
UREA NITROGEN 17 mg/dL (8-25)
CREATININE, SERUM 1.0 mg/dL (0.7-1.3
SODIUM 138 mmol/L (136-146)
POTASSIUM 4.7 mmol/L (3.6-5.3
CHLORIDE 103 mmol/L (102-114)
CO2 28 mmol/L (24-32
CALCIUM 10.0 mg/dL (8.8-10.3)
PROTEIN, TOTAL 7.6 g/dL (5.9-7.9)
ALBUMIN 5.0 High gm/dL (3.5-4.7)
T. BILIRUBIN 3.2 High mg/dL (0.4-1.3
ALKALINE PHOSPHATASE 55 IU/L (37-108
AST (SGOT) 14 IU/L (13-33)
ALT (SGPT) 12 IU/L (7-31)
ANION GAP 12 mmol/L (8-16
PO4 3.4 mg/dL (2.2-4.3
EGFR 86 mL/min (>60)
TESTOSTERONE TOTAL 319.7 ng/dL (225-972)
TSH 1.89 uIU/mL (0.35-5.00)
B12 261 pg/mL (250-1100
FOLATE 15.6 ng/mL (2.8-20.0)
25 OH VITAMIN D 32.5 ng/mL (30-100)
My PCP would not pursue TRT since my Total T was “normal” I then went to what I now will call a “Doc in the Box” for TRT treatment. This guy used the labs above without requesting additional labs and started me on 200mg/wk. Test cyp. I was on that regiment for 4 weeks and I felt amazing however I had started to do my research and was concerned that this doctor did not care about my health at all. I found a doctor in my area that had the right credentials for TRT treatment and from what I see now follows the current treatment protocols. He ordered repeat labs as he was concerned with my current dose of test. The labs after 1 month of 200mg/wk. are as follows.
WHITE BLOOD CELL COUNT 5.9 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.61 4.20-5.80 Million/uL
HEMOGLOBIN 18.4 H 13.2-17.1 g/dL
HEMATOCRIT 50.5 H 38.5-50.0 %
MCV 90.1 80.0-100.0 fL
MCH 32.7 27.0-33.0 pg
MCHC 36.3 H 32.0-36.0 g/dL
RDW 13.4 11.0-15.0 %
PLATELET COUNT 180 140-400 Thousand/uL
MPV 9.0 7.5-12.5 fL
ESTRADIOL 73 H < OR = 39 pg/mL QAW
TESTOSTERONE, TOTAL, LC/MS/MS 999 250-1100 ng/dL
FREE TESTOSTERONE 186.8 H 35.0-155.0 pg/mL
HOMOCYSTEINE 11.4 umol/L
IGF 1, LC/MS 206 ng/ml
Z SCORE (MALE) 0.8
THYROID PEROXIDASE ANTIBODIES 1 IU/ml
C-REACTIVE PROTEIN 0.5 mg/l
INSULIN 2.2 uIU/ml
Based on these labs the new doctor lowered my dose of Test Cyp. To 100mg/wk. and added 1mg/wk. anastrozole. I began this protocol and then was accepted to an Endocrinologist at the VA. I also went and donated blood based on my H/H levels
Upon meeting with the ENDO at the VA he wanted me to quit the Test Cyp for 6 wks. and then get new baseline labs. I agreed as I wanted to know if I had primary or secondary hypogonadism. I went the 6wks and the crash was rough. The labs at 6wks of no Test are as follows.
ESTRADIOL 40 pg/mL (0-57)
HOMOCYSTEINE 10.2 umol/L (>< 11.4)
FSH 11.32 mIU/mL (1.27-19.26)
PROLACTIN 4.95 ng/mL (2.64-13.13 ng/mL)
TESTOSTERONE TOTAL 314.8 ng/dL (225-972)
SHBG 25.4 nmol/L (13.3-89.5)
TESTOSTERONE FREE INDEX% 43 %
LH 4.78 mIU/mL (1.24-8.62)
BILIRUBIN, DIRECT 0.3 High mg/dL (0-0.2)
CHOLESTEROL 134 Low mg/dL (140-200)
HDL 62 mg/dL (35-67
LDL- 66 mg/dL (<119)
TRIGLYCERIDE 37 mg/dL (35-200)
GLUCOSE 95 mg/dL (70-109)
UREA NITROGEN 16 mg/dL (8-25)
CREATININE, SERUM 1.1 mg/dL (0.7-1.3
SODIUM 137 mmol/L (136-146)
POTASSIUM 4.4 mmol/L (3.6-5.3)
CHLORIDE 103 mmol/L (102-114
CO2 26 mmol/L (24-32)
CALCIUM 9.9 mg/dL (8.8-10.3
PROTEIN, TOTAL 7.6 g/dL (5.9-7.9
ALBUMIN 4.6 gm/dL (3.5-4.7)
T. BILIRUBIN 1.6 High mg/dL (0.4-1.3
ALKALINE PHOSPHATASE 62 IU/L (37-108
AST (SGOT) 15 IU/L (13-33
ALT (SGPT) 12 IU/L (7-31)
ANION GAP 12 mmol/L (8-16
PO4 3.7 mg/dL (2.2-4.3)
EGFR 77 mL/min (>60)
TSH 2.20 uIU/mL (0.35-5.00)
WBC 5.06 K/uL (4.0-11.0)
RBC 5.24 M/uL (4.7-6.1)
HGB 16.4 g/dL (14-18)
HCT 46.0 % (39-52.5)
MCV 87.8 fL (85-102
MCH 31.3 pg (28-38
MCHC 35.7 g/dL (32-36
RDW-CV 11.6 % (11-14
PLT 242 K/uL (128-412
MPV 10.0 fL (8.69-12.56
Lymph % 35.0 % (24-39
NEUT % 53.9 % (50-68
MONO % 8.5 % (4.4-12
NEUT # 2.73 K/ul (2.0-7.5)
MONO # 0.43 K/ul (0.18-1.3
LYMPH # 1.77 K/ul (1-4.3
BASO # 0.04 K/ul (0-0.1)
EOSIN # 0.08 K/ul (0.0-0.6)
EOS % 1.6 % (0-5
BASO % 0.8 % (0.0-1.0)
IG # 0.01 K/uL (0-0.04)
IG % 0.2 % (0-1)
Then a follow up lab done at 8wks was done and here are the results
PSA (Since 6/13/98) 0.32 ng/mL (0-4.0)
TSH 1.73 uIU/mL (0.35-5.00)
ESTRADIOL 45 pg/mL (0-57)
LH 3.64 mIU/mL (1.24-8.62)
FSH 7.25 mIU/mL (1.27-19.26)
PROLACTIN 5.98 ng/mL
TESTOSTERONE TOTAL 342.8 ng/dL (225-972
SHBG 31.3 nmol/L (13.3-89.5
TESTOSTERONE FREE INDEX% 38 %
WBC 3.47 Low K/uL (4.0-11.0)
RBC 5.14 M/uL (4.7-6.1)
HGB 16.3 g/dL (14-18
HCT 45.8 % (39-52.5
MCV 89.1 fL (85-102
MCH 31.7 pg (28-38)
MCHC 35.6 g/dL (32-36)
RDW-CV 12.6 % (11-14)
PLT 212 K/uL (128-412
MPV 10.3 fL (8.69-12.56)
Lymph % 35.7 % (24-39)
NEUT % 53.6 % (50-68
MONO % 8.1 % (4.4-12
NEUT # 1.86 Low K/ul (2.0-7.5)
MONO # 0.28 K/ul (0.18-1.3)
LYMPH # 1.24 K/ul (1-4.3
BASO # 0.04 K/ul (0-0.1
EOSIN # 0.05 K/ul (0.0-0.6)
EOS % 1.4 % (0-5)
BASO % 1.2 High % (0.0-1.0
IG # 0.00 K/uL (0-0.04
IG % 0.0 % (0-1)
CHOLESTEROL 124 Low mg/dL (140-200
HDL 62 mg/dL (35-67
LDL 56 mg/dL (<119
TRIGLYCERIDE 37 mg/dL (35-200) Final
BILIRUBIN, DIRECT 0.4 High mg/dL (0-0.2)
GLUCOSE 86 mg/dL (70-109
UREA NITROGEN 14 mg/dL (8-25
CREATININE, SERUM 1.1 mg/dL (0.7-1.3
SODIUM 138 mmol/L (136-146)
POTASSIUM 4.1 mmol/L (3.6-5.3
CHLORIDE 102 mmol/L (102-114)
CO2 30 mmol/L (24-32
CALCIUM 9.7 mg/dL (8.8-10.3)
PROTEIN, TOTAL 6.9 g/dL (5.9-7.9
ALBUMIN 4.7 gm/dL (3.5-4.7)
T. BILIRUBIN 3.2 High mg/dL (0.4-1.3)
ALKALINE PHOSPHATASE 56 IU/L (37-108
AST (SGOT) 14 IU/L (13-33
ALT (SGPT) 12 IU/L (7-31)
ANION GAP 10 mmol/L (8-16
PO4 3.4 mg/dL (2.2-4.3)
EGFR 77 mL/min (>60)
Upon receipt of these labs companied by my history the Endo Doc diagnosed me with Primary Hypogonadism and prescribed Test Cyp. 100/mg/wk. And Anastrozole 1mg/wk. I began that protocol with biweekly SubQ shots and split my anastrozole into 0.5mg twice a week with both shots and pills on Mon and Thursday. I remained on this for 5weeks with little to no change and had a follow up lab done the results are as follows
TESTOSTERONE TOTAL 351.8 ng/dL (225-972)
ESTRADIOL 33 pg/ml
So, on 100mg/wk. my Total T hasn’t changed much at all, my E2 seems controlled with the 1mg Anastrozole. I really like Dr. Crislers protocols and requested possibly adding HCG to the treatment to keep the natural pathways open and contribute to testicular health also hoping maybe it would boost my test levels without much change to my test cyp. Dose. I also asked if I needed to make a dose change for the Test Cyp. As my numbers were still low. The Endo now wants me to keep my Test dose the same and wants to ad Clomid 50mg 3 times a week. I explained to him that Clomid and Testosterone are competing drugs as one is suppressing the HPTA and the other attempting to restart it. I also went into detail about how the pathways work and so on as I understand he is not super familiar with TRT therapy. He continued to say Clomid and HCG are the same, so this became a waste of an argument. At this point I have increased my Test Cyp to 140mg/wk. and was thinking of going back to the TRT doctor I trust to ask for his recommendations or prescription for Hcg. The main reason I use the VA is there is no cost to me for the meds and labs.
I apologize for the lengthy post but it seems those who post the maximum amount of data get better feedback from all of you. Any advice is greatly appreciated. Thank you.