T Nation

Lab Review - Switched Docs, New Protocol

Hey everyone. Not to bore you with the minutiae, but I switched to a new doc/clinic and they put me on a new protocol based on my labs. My old doc was (what seemed to me) very green to TRT, refused to look at anything other than total and free t, never checked my E2 levels, etc, had me on 80mg/week (odd dose) and overall was very conservative. For reference, I am 36 and relatively fit (6’ 220# about 15% bf, workout (crossfit) 4 to 5x week).

So, new doc is in the ‘I want to optimize you’ line of thinking. I’m good with that. He takes labs and based on what they see they put me on 120/wk test cypionate, 500iu HCG and 0.5 anastrozole. I started their protocol with the following regimen-

Sunday 250iu HCG
Monday 60mg cyp
Thursday 250iu HCG
Friday 60mg cyp
Saturday .5 anastrozole

After a month I had new labs drawn and got the following results (apparently i’m pretty sensitive to anastrozole)

T (Total) 1089 ng/dL
T (Free) Serum 174 pg/mL
E2 <5
Sex Horm Binding Glob, Serum 58.6

So, we decided to stop the anastrozole for the time being (will recheck at the end of the month). I brought up that my joints were feeling achy, and my libido was not really there, which from the looks of it was due to the low e2. We will see where I am at in a few weeks.

I’ve attached my full labs (anonymized) for review. How’s it look?

Your SHBG is a problem creating low Free T, in essence binding up all free T. You might require larger doses of T to bring it down, T is the only treatment able to effect SHBG.

I agree with your post, but his Total T levels are already quite high. You are also vitamin d deficient. Start taking 5000 ius of vitamin d3 per day. When your e2 climbs back up, your libido should improve. I wouldn’t make additional changed until e2 is stabilised to control one variable at a time. Your shbg may reduce during your next round of labs. If it doesn’t, you may need to start looking at strategies of reduction since that’s going to keep your free T numbers lower than they otherwise would be.

Yes, my doc told me to start with 10000iu of D3 until my next blood draw at the end of this month. That along with a good multivitamin with zinc (i currently don’t take a multi vitamin…shame shame shame)

I will talk with them about getting the e2 in check and once that is done we can think of options to bring down shbg although i’m not sure exactly what that would entail. I would honestly rather not have to be at 1100 total to have my free T be in the range it is, for longevity purposes.

Thanks for the reply!

Anastrozole needs to be dosed twice a week. Once a week makes lab results bogus as result depends on lab timing.

Suggest 1/8th mg anastrozole at time of injections, your target is 22pg/ml.

You can inject T with #29 1/2" 0.5ml insulin syringes and avoid decades of muscle damage with subq injections.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
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Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.