I Am Out of Range - Help

Pharma / TRT Testosterone Replacement
1

-age 47

-height 5’ 9"

-waist 45

-weight 217

-describe body and facial hair: Normal no thinning, more body hair since starting TRT

-describe where you carry fat and how changed: Mostly around stomach

-health conditions, symptoms [history]: Type 2 diabetes,insomnia, osteoporosis

-Rx and OTC drugs: Terazosin, metformin, a recent run of amoxicillin/clav and corticosteroid drops for an ear infection

-any hair loss drugs or prostate drugs ever: Terazosin

-describe diet High protein, moderate fat low carb

-describe training four days a week of the big five.

-testes ache, ever, with a fever? no.

-how have morning wood and nocturnal erections changed: non existent.

lab results with ranges
Test serum 680 ng/dl 348 - 1197
Free Test (direct) 15.4 pg/ml 6.8 - 21.5
e2 sensitive 7.7 pg/ml 8.0 - 35.0

Current protocol is 50mg test cyp IM every other day, and liquidex dosed at .30mg day of injections.

I recently lost 29LBS

Insomnia has been really bad, I fall asleep easily however maintenance is terrible. I get 5 to 6 hours a night

Libido is down, ED however I can perform with liquid cia.

knees crack like crazy when squatting, however I have no joint pain or discomfort.

Body temps are down, 96.4 upon rising - 97.8 3pm this drop in body temps is new as I have checked periodically in the past.

I have been supplementing iodine, however not very much. I have been using lugols 2% a few drops every other day and 100mcg selenium. Apparently not enough judging by body temps and iodine patch test(all color is gone in a couple of hours)

I have stopped the AI for four days as of today and have increased iodine to 50mg and selenium to 300mcg a day for two days.

First question is, it seems after taking iodine at 50mg for two days body temps have somewhat recovered(still 96.4 upon waking, 98.6 late afternoon, 97.4 early evening) and I am feeling better despite lack of sleep. Is it possible to see these kind of positive results in just two days?

What is a good maintenance dose for IR? Selenium?

Next I am at a loss where anastrozole dosing is concerned I’ve lost some weight so I understand that has had an affect, .80 to 1mg a week has tanked my E2 so how much should I take when I start again? When should I start AI again and when should I test blood to check E2 after I resume AI?

Any other thoughts?

2

You appear to be a hyper-metabolizer and typically we see that guys like this need 300mg T/week to get where others are at 100mg/week.

You need to change AI dose by a factor of 7.7/22 which will get you near 22 pg/ml.
After 5 days, you can resume at this dose.

Calculate your % increase in T dose, then increase AI by that amount to get final AI dose.

After you finish IT, go to maintenance dose, 1mg/day for 2-3 weeks then do TSH, fT3, fT4 labs.
Any stress issues as discussed in the thyroid basics sticky.

Prostate needs controlled E2.
Joint problems may be from low E2.
Low libido can be from low E2, as well as thyroid issues.

Sleep: Suggest 5-6mg TIME RELEASE melatonin and Rx trazodone 150mg. Start trazodone at 50mg then work your way up as your body adjusts its response. A calcium/magnesium supplement would be good and 100mg vit-C.

Cialis/tadalafil improves BPH symptoms while helping erections.

I had a good IR response once. Search for “ksman has a thyroid proble” here or via Google.

3

Eureka, I think.

Body temps have improved,

Today- 97.4 upon rising, 97.9 mid day and 98.5 at 4PM.

This is after 11 days of Iodine replacement @ 50mg and another 11 days @ 100MG and 400mcg selenium daily.

The extreme fatigue is gone. And I feel warmer now.

The past three nights I have slept pretty good 7.5hrs, a little difficult falling asleep now, but not bad. I havenâ??t needed any assistance with the sleep, as in no drugs or supplements. Melatonin was ineffective as was ambien. Trazadone has worked for me in the past, but leaves me even more groggy in the morning.

I cut AI dose to .15mg eod, libido dead, no wood and am now getting irritable and feel sluggish, tired during the day even though sleep has improved.

Should I continue current AI dose for awhile and see what happens or bump it up a bit?

I donâ??t understand the recommendation of 1mg iodine maintenance dose as the liquid I use has 3.1mg per drop.

As for the question of stress, its been a constant since the economy went south. I’m a contractor and work has been scarce for a long while now, my family has decided that I am not worth the trouble, so there is that. Although I am coming to accept this.

Thanks for you guidance KSman.

4

That iodine is strong. You do not need to take every day.

E2 labs would be useful.
Dose changes take at least a week to play out.

Your changed thyroid status can change many things.

What dose of traz?
Time release melatonin 5-6mg?
Magnesium supplements and vitamin C seems to also help me.
caffeine effects?

5

[quote]KSman wrote:
That iodine is strong. You do not need to take every day.

E2 labs would be useful.
Dose changes take at least a week to play out.

Your changed thyroid status can change many things.

What dose of traz?
Time release melatonin 5-6mg?
Magnesium supplements and vitamin C seems to also help me.
caffeine effects?[/quote]

Iodine is Lugal’s 2%, one drop is supposed to be 3.125 mg’s of iodine/potassium iodide.

I’ll reduce to one drop EOD.

I’ll get labs ASAP.

Trazadone was 50mg.
Melatonin is 5mg time release.
Strong Coffee all day until 3pm.

6

Traz=50mg seems to be a useful starting dose and one needs more later on.
You still feel drag over if taking only Traz?

Caffeine could easily be a factor here and you might be using caffeine to compensate for something else. Thyroid function seems to be resolving. Maybe you do not need as much caffeine now, but its also now a habit. Lower T levels and/or lower cortisol levels might also be factors.

7

Drat,

Reduced iodine and body temps fell immediately. Started IR again temps back up, I have read that Io balance may take up to a year?

I have had a marked increase in acne, irritability, BPH like symptoms, sleep is bad again as I am getting up to pee five to six times a night despite 10 mg of terazosin nightly.

I am beginning to think that I’ll never be able to balance E2 with arimidex. I have tried every conceivable combination.

Considering a switch to liquistane, can anyone help me out with their experience with aromasin?

This four year Anastrozole/test yoyo has got to stop, at this point it seems I may as well drop TRT as I feel like crap either way

8

I noticed you have osteoporosis.How bad is it ? Did you have a dexa scan ? Has your doctor pinpointed the reason for the osteoporosis ?

9

Terazosin seems to reduce thyroid function in a small number of people. The data is sparse and some animal studies have investigated this, but often such things to not apply.

Can you speculate on how some conditions started or became worse with introduction of terazosin?

E2 labs?

10

Its not a problem any longer. I used to smoke and had terrible coughing fits, during one of these fits I broke three ribs from the coughing. Having no other explanation for the broken ribs, PA sent me for bone scan. Scan confirmed reduced bone density…

I quit smoking.

Was prescribed fosamax, though I didn’t take it for long. This was maybe seven years ago, haven’t had a broken bone since.

11

I didn’t even consider that Terazosin maybe a problem, it seemed to help initially with BPH symptoms.

But now that I think about it I was having these symptoms on and off even though I was taking the med religiously.

I don’t think that Terazosin has made things worse, although body temps went south while I was taking terazosin.

I’m betting that its been high E2 all along. I have some liquid Cia, I’ll switch to that and see if things improve.

Any thoughts on aromasin?

I have an appt with yet another new NP at the VA on Monday, I sure labs will be done( this happens every time they see I am on 200mg of test a week) though I’ll have to get E2 done on my own. I’ll report back with results.

Thanks for the heads up on the terazosin, its obviously not working. So I’ll discontinue and try the cialis I have.

12

Bone loss in males is mostly driven be low T and TRT and Vit-D3 and trace elements should lead to increased bone density.

fosamax stops bone tear down so the imbalance of tear down and build up is favorable. But one then accumulated old bone that is more brittle.

https://www.google.com/search?q=fosamax+side+effects+brittle+bone

13

`Latest bloods,

BASOPHILS/100 LEUKOCYTES 	                        0.2 	        % 		
BASOPHILS/100 LEUKOCYTES 	                        0.0 Low 	K/uL 	0.01-0.10 	
EOSINOPHILS 	                                        0.0 Low 	K/uL 	0.01-0.57 	
EOSINOPHILS/100 LEUKOCYTES 	                        0.0 	% 		
ERYTHROCYTE DISTRIBUTION WIDTH 	                        13.2 	% 	13-15 	
ERYTHROCYTE DISTRIBUTION WIDTH 	                        40.8 	fL 	35.1-46.3 	
ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN 	        28.4 	pg 	26-31 	
ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION 	33.1 	g/dL 	32-36 	
ERYTHROCYTES 	                                        5.38 	M/uL 	4.7-5.6 	
ERYTHROCYTES.NUCLEATED/100 ERYTHROCYTES 	        0.0 	/100 WBC 	0.0-1.0 	
ERYTHROCYTES.NUCLEATED/100 ERYTHROCYTES 	        0.0 	K/uL 	0-0.012 	
GRANULOCYTES.IMMATURE/100 LEUKOCYTES 	                1.0 	% 		
HEMATOCRIT 	                                        46.2 	% 	38-52 	
HEMOGLOBIN 	                                        15.3 	g/dL 	12.4-17.4 	
IG # 	                                                0.1 High 	K/uL 	0.0-0.07 	
LEUKOCYTES 	                                        8.9 	K/uL 	4.8-10.8 	
LYMPHOCYTES 	                                        0.9 	K/uL 	0.73-3.44 	
LYMPHOCYTES/100 LEUKOCYTES 	                        10.3 	% 	
MEAN CORPUSCULAR VOLUME 	                        85.9 	fL 	80-100 
MONOCYTES 	                                        0.5 	K/uL 	0.25-0.97 	
MONOCYTES/100 LEUKOCYTES 	                        5.2 	% 	
NEUTROPHILS.SEGMENTED 	                                7.4 High 	K/uL 	2.24-6.46 	
NEUTROPHILS.SEGMENTED/100 LEUKOCYTES 	                83.3 	% 		
PLATELET MEAN VOLUME 	                                10.4 	fL 	9.1-12.5 	
PLATELETS 	                                        208 	K/uL 	140-400


ALANINE AMINOTRANSFERASE 	                        35 	IU/L 	10-40 	
ALBUMIN 	                                        3.8 	g/dL 	3.2-4.6 
ALKALINE PHOSPHATASE 	                                49 	IU/L 	38-126 	
ANION GAP 	                                        11 	mMol/L 	6-15 	
ASPARTATE AMINOTRANSFERASE 	                        25 	IU/L 	10-35 	
BILIRUBIN.GLUCURONIDATED/BILIRUBIN.TOTAL 	        0.7 	mg/dL 	0.4-1.2 
BILIRUBIN.GLUCURONIDATED+BILIRUBIN.ALBUMIN BOUND 	0.2 	mg/dL 	0-0.2 	
CALCIUM 	                                        8.9 	mg/dL 	8.5-10.4
CARBON DIOXIDE 	                                        26 	mMol/L 	24-31 	
CHLORIDE 	                                        102 	mMol/L 	95-106 	
CHOLESTEROL 	                                        148 	mg/dL 	140-240 
CHOLESTEROL.IN HDL 	                                 36 	mg/dL 	>36 	
CHOLESTEROL.IN LDL 	                                105 	mg/dl 	3-130 	
COBALAMINS 	                                        708 	pg/mL 	210-1020
CORTISOL~MORNING 	                                13.8 	ug/dL 	6-23 	
CREATININE 	                                        0.90 	mg/dL 	0.6-1.3 
GLOMERULAR FILTRATION RATE.PREDICTED 	                90 Low 		94-140 	
GLUCOSE 	                                        109 High 	mg/dL 	70-99
POTASSIUM 	                                        4.5 	mMol/L 	3.5-5.0 	
PROSTATE SPECIFIC AG 	                                9.18 High 	ng/mL 	0.0-4.0 
PROTEIN 	                                        5.9 Low 	g/dL 	6.0-8.0 
SODIUM 	                                                139 	mMol/L 	135-145 	
THYROTROPIN 	                                        2.06 	mIU/mL 	0.49-4.67 	
TRIGLYCERIDE 	                                        35 	mg/dL 	<150 	
UREA NITROGEN 	                                        16 	mg/dL 	

HEMOGLOBIN A1C/HEMOGLOBIN.TOTAL 	                4.8 	% 	4.8-6.2`

And of course stupid PA didn’t check TEST even though that was the reason for calling me in in the first place.

I’ll post results for e2, test as soon as possible.

BPH symptoms have improved some, PA prescribed tamsulosin. Think I’ll wait on this and see if stabilized E2 resolves BPH.

14

Cholesterol would be better nearer to 180.

Below 160 is associated with increased all-cause morality.

Low protein and HTC=46 seems odd for taking 200mg T/week!
T may be low.

Have you ever had an occult blood test?

Glucose=109: Was that fasting?
You may need to do A1C lab to see how bad this is.

15

What to do about cholesterol? HDL has always been low, the 36 shown is an improvement.

I did give blood about a month ago, might be why HTC low?

Never have done occult blood test, I’ll ask for one.

The 109 was fasting, A1C 4.8 %, 4.8-6.2`, best I’ve had in awhile. Usually 5.2 - 5.6

16

Glucose 109 was fasting?
A1C=4.8 is really good. So we have conflicting signals. A1C wins!

HTC should recover completely well before one month. At lease that is my expectation. Maybe I am wrong on that.

So there might be a problem. Ferritin can take time to recover.

http://jama.jamanetwork.com/article.aspx?articleid=2108889

Maybe we are seeing HTC affected by that blood donation.
So I withdraw my connection to occult blood test, but that still may be a valid health screening measure.

17

I no longer have access to an AI. What is the best way to quit TRT?

I would think reduce dose slowly to nothing. Just looking to make the transition as painless as possible.