T Nation

Lab Results and Help?

Hey Guys! I’m the latest lost soul looking for help!

Cliff Notes: My problem is I’m weepy with a lack of aggression, motivation, and sexual desire. I want to be how I was in my 30’s. Skip to lab results.

Long version:

I presently 51 and started feeling kinda blah without any motivation or drive at about age 47. Sexual desire is pretty low or only in the morning after being a hounddog for most of my life. I love my wife who is attractive, fit and twenty years younger than me.

GP had me tested and put me on Anastrozole at 1 mg per week and Chlomid at 50 mg per day. I read up on all the posts about Chlomid and Anastrozole on this site as well as others and did the following: 1. 0.25 mg of Anastrozole M/F and 2. Chomid 25 mg MF. Over time I increased the Chlomid to the present dose of 50 mg MF and 25 mg W. I dropped the Anastrozle after my November 2019 lab work as I was getting arm pain and elbow joint pain at night which I thought was a side from the Anastrozole. After droppping the Anastrozole and increasing the Chlomid I was weepy as little girl at just about any slightly sad situation on the tv or at a movie. It got really ridiculous. Estradol shot up. Now its not too bad (the emotional stuff).

Doc is always on me about high cholesterol and high glucose.Initially prescribed me a statin for the cholesterol which dropped by cholesterol dramatically but my muscles where constantly sore after/when lifting weights. Very painful so dropped the statin and my cholesterol shot up to what it is today.

I’m 6’ and weigh 210 lbs with approximately 18-20% bodyfat level and cutting for the summer. My maximum lifts are 300 B, 300 S, and 350 DL. I train three days per week full body and squat 3 times per week.

LAB RESULTS for both my initial test in February 2018 and my latest test March 2020. I test every three months:

Test February 2018 March 2020 Standard

Cholesteral, Total 272 mg/dl 226 Norm<200
Triglycerides 202 mg/dl 128 Norm <150
LDL, Cholesterol 202 mg/dl 164 Norm<100
Glucose 95 mg/dl 101 Norm<99
Hemoglobin 5.6% 5.7% Norm<5.7%

Testosterone, total 415 ng/dl 648 Norm 250-1100
Testosterone, free 62.8 pg/ML* Norm 46-224
Test, bioavailable N/A 137 ng/dl Norm 110-575
SHBG N/A 43 nmol/L Norm 10-50
Estradol ** 33 pg/ml 39 pg/ml Norm <39
PAS 0.7 ng/ml 0.7 ng/ml Norm<4.0

*Test included on August 2018 lab work
**Estradol tested consistently at 24 when while taking 0.25 mg Anastrozole

TSH 2.97 mIU/L 1.77 Norm 0.4-4.5
T4 1.3 ng/dl 1.2 Norm 0.8-1.8
FSH 4.4 mIu/ml 4.5 Norm 1.6-8.0
LH 3.7 mlu/ml 4.6 Norm 1.5 - 9.3

My problem: weepy with a lack of aggression, motivation, and sexual desire. I want to be how I was in my 30’s.

Looking for suggestions based on experience for adjusting my meds (anastrozole and chlomid) which I have on hand to optimize or TRT direction taking into account I would like to have a couple more kids over the next three years or so.

Thank you for your help and attention!

Dimitri

Middle aged men with low-T are more likely to develop type 2 diabetes, months after my endocrine system suddenly crashed I found myself losing glucose management. There are ways to deal with fertility on TRT, adding HCG and FSH can be a real game changer or stopping TRT and starting clomid will do the trick.

Clomid isn’t going to get you where you want to be, it will create moods more typical of a women, after all it’s a female fertility drugs used off label for men. I don’t think you can’t really optimize clomid and anastrozole any further, it’s a dead end road and you are in limbo waiting to start TRT.

You could start TRT, HCG which will keep the testicles functioning and could add FSH later to boost sperm production or even stop TRT and restart your clomid protocol when looking to have children.

Thanks for the reply SystemLord.

I will make an appointment with my GP to go over the results…usually his office calls because of the high cholesterol…but wanted to get some ideas to put forward to him or go over with him. He’s not too knowledgeable about TRT but he seems to be pretty open minded and understanding. A bit frantic for a doc but okay.

Based on my labs do any of you guys have any protocols that I could suggest to my doc? Pretty sure he will give me a prescription to Test but would like to have an idea if the amount he prescribes is worth it or should go to another doc. Heard some docs give miniscule amounts of test that do more harm and waste time. I’ve been messing with the Chlomid and Anastrozole for two years so I’m ready for some results and so is my wife.

If you doc follows guidelines he will prescribe 200mg every 2 weeks which is to be avoided at all costs, a good starting place is 120mg weekly splitting it up once-twice weekly or more. The thing about TRT that some docs don’t understand is optimal dosing and frequency of shots will be different for everyone.

You also have those who are sensitive to hormonal fluctuations and need more smaller injections per week.

Okay, a couple of things up front. You’re not diabetic, worrying about it or getting more labs done is a waste of your time and money.
I don’t know what your actual lifting is, so what you did tell us about it may be fine, but it doesn’t really look great.
Now the important stuff. Throw away the anastrozole. Just throw it away and don’t get more. It’s a terrible drug to combine with Clomid for several reasons. You may feel better in about two weeks with just that action alone.
Why are you on Clomid? When are you supposed to come off of it? ARE you supposed to come off of it? It’s not a long term drug, not ideally. You would be much happier on JUST test. 100 mg a week is a good starting point, but an unlikely dose to end up at. Depending on you, you will probably end up more in the 150 mg range once you get settled in.

Gotcha. Thanks.

Update:

I met with my GP this past March and he refused to even discuss TRT other than Clomid. I met with my wife’s GP (male doctor) and he thought I was a candidate for TRT and gave me battery of tests to take. Next meeting in May was with Nurse Practiciioner who signed me up for colonoscopy and Urologist. Finally got on the schedule for the Urologist and had my meeting with him today i.e. 8 months later from initial meeting with new GP.

Quickly and briefly gave the Urologists my hormone profile background/history all confirmed with quarterly testing on Quest. U says I’m in my 50’s and shouldn’t expect to have the same energy, sexual desire, strength of a nineteen year old… so I immediately knew where this meeting was going. U says my test is too high for TRT (703 total test and 113 free test). Informed him this was because I take 50 mg of Clomid M/W/F but the clomid was elevating my Estradiol (44) which was making me extremely moody, low energy, and emotional basket case. Said I would need to go two months clean from clomid and have back to back hormone testing to see if I was really low in T in order to get TRT and indicated unless I was below 200 I wouldn’t be getting anything from him but would probably need to go to a endocrinologist.

I didn’t take it too well after eight months trying to get this issue addressed. Eight months of waiting to get a 15 minute visit to have a guy pass the buck to someone else. Reading between the lines I get the impression that this guy has a pretty good practice treating people for other stuff so doesn’t want to handle any TRT stuff although the clinic advertises and promotes TRT. Very upsetting.

Anybody got any ideas? Thanks.

Stats as of November 18th (reflecting 50 mg of clomid M/W/F):

Estradiol 44
Total Test 703
Free Test 113.2
FSH 5.8
LH 4.3
Prolactin 5.1

I think you are thinking too much about estradiol.

It could be the actual clomid medication that is not making you feel good.

If you have not stopped clomid yet, you can stop and see how you feel and if you can maintain the testosterone levels. Retake labs after 2 months of stopping.

Haven’t heard of too many being on clomid long-term. You can even also try to take 25 Monday Wednesday Friday instead of 50.

My clomid prescription expired and the new doctor categorically refused to re-prescribe so without any alternative I will be off it. Last pill was taken this past Wednesday.

100%

100%. Almost NO ONE feels good on Clomid. I don’t know why, something with how it messes with estrogen receptors I imagine. SHBG also tends to go up, so free T isn’t great even if total T is somewhat reasonable.

At this point, if I am you, I’d probably be looking at a TRT clinic of some sort to stop the bouncing between doctors bs that you’re seeing now. It’s total bullshit how high (or low, I guess) the bar is for getting TRT. I’d bet any of those doctors would have been happy to prescribe anti depressants if you had asked for those.

You’re in the US? Just call one of the literally thousands of TRT clinics and you’ll be on test in a week, tops

2 Likes

Going to a garden variety endocrinologist is likely a waste of your time. Time to find someone private who lives and breathes TRT having lots of experience, not someone in the sick care system going by the book with a disregard for the symptoms.

There are doctors who believe the referance ranges are useless because everyone has varying androgen receptor sensitivity.

Also the resistance your are facing is most likely because providers are hesitant to prescribe TRT do to the belief TRT causes heart attacks, strokes and prostate cancer.

I’ll look into the TRT clinics but I would feel more comfortable with a reference to a one vs. a blind shot in the dark. You would think the GP or the Urogist would have pointed me in the right direction but I guess they only do business within a “club” or something. Seems ridiculous.

I agree with you that the endocrinolgist direction is a waste of time locally without a reference. Just more passing the buck and billing fees for it. I’m in Northwest, Florida and it seems the docs in this area are pretty conservative. Today’s Urologist mentioned all the negatives you mentioned and the referenced ranges. Said 250 T (where I started) was good to go regardless of how I felt, symptoms, etc. He also mentioned sorta under his breath that only Doctors in South Florida do TRT as if it was voodo or something. The Doc I went to wasn’t ancient either (early 50’s).

Thanks everybody for your input.

If you want my clinic is great, in Florida, run by Dr Ruterbush (sp), he’s well regarded in the TRT world. $150/mo for everything

Thanks.

You qualify for TRT according to the endocrine guidelines which is below 300 ng/dL but it is known that the symptoms of low-T occur well above this threshold.

I use dr Saya @ defy medical. There are a ton of them that are probably cheaper but he’s been fine for me