T Nation

Looking for Bloodwork/Protocol Advice

hey everyone ive learned alot from here. and theres stilla few things i need to do like start taking my body temperature at certain times of day which ill start soon. Ive been on TRT for almost a year now. last summer i crashed my e2 had horrible joint aches from 1mg anastrozole once a week on 100mg testosterone cyp. I also now take a whole food vitamin and Vitamin D after finding out i was low in a few things which ill post my lab work results. i recently was in the hospital due to fast hear rate and i had low ferritin of 19.9 and it was 60 six months ago. was short of breath. well im still not feeling the best. my estrogen climbed to 60. and put me on anastrozole again at 0.5mg twice weekly. well in two weeks my estrogen is now 5. i feel like shit. hot flashes fast heart rate bad bad anxiety. is this all due to low estrogen? ive had chest xrays ultrasounds ctscans and stress test. all norma. heart rate runs about 95-110 and my blood pressure is anywhere from 130/80 to 140s over 90s. any help will be appreciated. i now take an iron supplement and my ferritin is now 44. i also am donating blood in 2 days due to my hematocrit. im 31 years old. 6 foot and weigh 217 pounds. i weighed about 250 last spring. had gall bladder removed. put on alot of weight before that. 2 years ago i weighed 200. im about back to my normal weight. my doctor is stumped now wants me to take 0.5 mg every other injection… i pay out of pocket every doctor visit at victory mens health. so anything that will prevent multiple visits or can even help the doctor i will discuss with them. they seem to work with me and everyone different based off results instead of going by government guidlines like my previous joke of a doctor who wanted every other week injections and said no reason at all to check estrogen. so i found tnation and switched doctors immediately and have been doing great until this point. ill also post the only previous records that i know of as well.

WBC 6.8 (4-10)
RBC 5.9 (4.31 - 6.4)
hemoglobin 17.2 (13.6 - 18 g/dl)
Hematocrit 52.3 (39.8-52)
platelet 12.8 (11.5 -15)
sodium 139 (136-145 meq/l)
potassiuim 4.3 (3.5-5.1)
Co2 29 (21-31)
total protein 7 (6.4 - 8.9)
Triglyceride 100 (48-150 mg/dl)
cholesterol 146 (136-239 mg/dl)
HDL Chol. 39 Low (40-92)
LDL Chol. 87 (75-159 mg/dl)

Cholesterol/HDL ratio 3.74 (0-3.5) high
non-HDL cholesterol 107 (0-160 mg/dl)

Iron 107 (50-212 ug/dl) 138
TIBC 419 high (250-400)
Ferritin 44 (23.9- 336.2 ug/L)
folate 12.4 (4-20 )

vitamin b12 270 low (180-914 pg/ml) previous 268
hemoglobin A1C 5.5 (4-6)

Vitamin D 26.3 low (30-100) previous 27.22
Cortisol 5.62 low (6.7 - 22.6 ug/dl) this is rising. previous was 4.22
SHBG 18 (10-50 nmol/l)
hGH 0.08 (0.01-0.97)
Estradiol 5 low (10-40 pg/ml) id like to be around 25. im 31 years old
FSH 0.79 low (1-18 miu/ml)
LH <0.2 low (1.24-8.62 miu/ml)
Total T 486 (240-950 ng/dl before trt my Total T was 3.51ng/dl not a typo
Free T 13.1 (4.85 - 19 ng/dl) this was 0.0977 before trt
PSA 0.54 (0-4 ng/ml previous 0.57
TSH 0.85 (0.3- 4.2 ulu/mo)
T4 0.81 (0.6-1.3 ng/dl)
T3 3.79 (2.1-4.3 pg/ml)
IGF-1 230 (41-246 ng/ml) previous 174
IGFBP-3 5.54 (3.5-7 ug/ml) previous 5.66
Prolactin 5.27 (2.64- 13.13 ng/ml)

magnesium 1.6 low (1.7-2.3 mg/dl)

i have a few more results. dont know if they pertain to this just let me know. according to ranges nothing else is low and is in their ranges. im concerned. very weak, Tired, fast heart rate. hot flashes, headaches thats came on in last few weeks. feel like im going through menopause. felt like a machine 6 weeks ago. now i feel like an old rusty beater. since these thanks guys.

Your protocol can be improved upon, once weekly injections induces large spikes in testosterone and estrogen, levels are higher 24-48 hours after injection and in you case decrease quickly. The majority of guys inject T two or more times per week to keep levels elevated and from dropping too low.

The name of the game is the smaller the injection, the smaller the testosterone and estrogen spikes and over time these smaller spikes in estrogen will allow estrogen to decrease significantly and you may be able to remove the anastrozole from your TRT protocol.

I have the same problem with estrogen and started out 200mg every 3 weeks, then 75mg once weekly, 50mg twice weekly, 20mg EOD and found out I was able to get rid of the anastrozole injecting 10mg daily using 29 gauge insulin syringes in the shoulders and quads. When my estrogen is high or low I have high blood pressure, when it’s in a range good for me, my blood pressure is also normal.

I don’t see many guys with TSH below 1.0, a low TSH is a sign thyroid is cranking out hormones just fine. My SHBG hovers between 16-22, lower SHBG men do much better on multiple doses per week and those having estrogen issues daily is best if you want off this anastrozole roller coaster.

My second best protocol is 20mg EOD, I see a Total T of 500 and Free T is at the top of the ranges and estrogen 43. When I was on my daily protocol, estrogen was 26. So you see estrogen came down while testosterone stayed elevated.

If an AI is absolutely needed you may consider aromasin, it’s not as hash as anastrozole and is slower acting, it doesn’t have the terrible E2 rebound effect after stopping it. I cut up aromasin into 10 pieces and take one once weekly or as needed.

If in the US you might consider Defy Medical, a telemedicine anti-aging clinic. They have knowledgeable hormone doctors.

On a once weekly protocol you should be doing labs right before your injection, this is known as your trough or lowest point.

When are you doing labs in relation to your injections?

Dam Justin I don’t know about the doc you have.
You need to get your HCT under control, you need to get your ferritin under control, you need to get your E2 under control and you need to drop your T dose because that is causing all your issues.

IMO and I am not a doctor and I don’t even try to play one on the internet. With an SHGB of 18 you need to stop the AI and drop your T injections to about 60mg/wk until everything stablizes. No AI and Take your iron and C pills for the next 3 months then get new bloods.
Best of luck.

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thanks guys i live in illinois. any good doctors closer to me?? and the lab work is taken 4 days after my weekly injection. i just dont know where to go from here. im not rich so isnt like i can just hop skip and jump to florida or places like that. is there anything i can ask my doctor or call these doctors like you recommend and ask? thanks

whats a good level ferritin and iron for me to be at?

When I crashed my ferritin to 15 from frequent blood donations my doc wanted to see 80-100 to say I was back. I would not worry about iron unless you’ve been told you were/are anemic.

How did you get yours back up? Iron supplements? Thats what they got me taking. What was your symptoms with crashed ferritin?

My TRT doc had me buy Feosol Carbonyl Iron pills. They told me to take 45mg everyday with 1g of vit C for 6 months. I was not allowed to donate blood and they cut my T script to 60mg/wk. It took me 8 months to get my ferritin back up to 110.
On that blood test my script was doubled to 120mg/wk and I can only donate blood twice a year and my HCT must remain below 51.5 or they will cut my script again.
I am not mad about this it is me and my dam body my doc is just doing her job to up my T and not kill me in the process. I trust her.

Its hard for me to keep my hematocrit down. I’ve had 2 phloebotomies in one month before trying to keep it down. I can’t wait to get my dose lowered or a bi weekly or eod injection.

I don’t understand. Do you not do your own shots? maybe I missed it in that wall of text.

They pre-fill my syringes… wont let me fill my own.

The FDA is cracking down on this practice of prefilled syringes, inform your doctor that what he’s doing can get him in trouble. I hate doctors who treat us men like we are retarded and unable to fill our own syringe.

Your protocol needs to be tailored to you, meaning everyone’s dosage and injection frequency will be different.

You need to stand up to this doctor and put your foot down, or find another doctor.

I feel like a broken record lately but dude get off the fucking AI. That is some scary shit.

Systems im not telling this doctor anything. He won’t listen to me about my treatment now. So i care about his well being as much as they care about mine. I give it like i get it. My new doctor is Justin saya. Thank you again for getting me this doctor.