T Nation

Need Help Interpreting Bloodwork 8-Weeks In


#1

Hi,

I was wondering if KSMAN and all could take a look at my bloodwork results after being on TRT for 8 weeks. The protocol I've been using is 200 mg/wk test cyp, 250 IU HCG/eod, and 1 mg of Adex/wk (broken into 2 doses).

My CBC, Metabolic panel, and lipid panel all came back normal with the exception that my A/G ratio was a little high (2.9). What concerns me is my E2 came back low, barely within "normal range" (8.1). Doc really didn't offer much help. Full results below:

TSH: 2.570 uIU/mL
T4: 7.2 ug/dL
T3 Uptake: 35 %
Free Thyroxine Index 2.5

Testosterone, serum >1500 high ng/dL
Free Testosterone (Direct) 17.9 pg/mL

Estradiol (Roche ECLIA mehodology): 8.1 pg/mL

Normally I would just cut the Adex dose down. But I notice when I do that my joints get creaky and I get sensitive nipples. Any advice would be great. My current plan is to cut the Adex dose for a month+ and get bloodwork done again. I'm wondering if I'm that sensitive to Adex that even getting bloodwork the day after I took some would bring me down that fast and that much???


#2

Your dose of T is very high hence the off the charts reading of T. You should cut both your T down and your anti E. You need to get your estrogen in the 20s for ideal feeling.


#3

Any suggestion as to the test cyp dose? Try 150 mg/wk?


#4

Anastrozole dose needs to match your FT/Bio-T levels.

Typical is 1mg for every 100mg T cyp/eth

So you were under dosed. But you are not typical, you are an over responder.

Based on current labs, you can get near the target of E2=22pg/ml with:
1mg/week X 8.1/22 = 0.36mg/week

To manage such small doses you need to dissolve anastrozole in vodka, 1mg/ml and dispense by volume or by the drop.

Inject twice a week to get steady T levels for anastrozole to work best
Take .18mg anastrozole at time of injections
250iu hCG EOD
Do labs half way between injections - always

Your weekly injections are allowing for a lot of unknowns.

Test E2 later and maybe correct again as your weekly injections may have yielded some E2 results that are not solid.

If you reduce T dose, reduce anastrozole again by same factor. You can stack both corrections.

Based on FT=18, I would not reduce T dose without some doubts. Your TT may be strongly weighted by high SHBG that is creating a lot of T+SHBG. High SHBG with lower E2 does not make sense. More FT wound reduce SHBG. Something is not right.

Another possibility would be that SHBG is inflating TT and that you are a hyper metabolizer of T. But we really need the above changes and new labs to get a clearer picture. Can you also directly check SHBG?

"""
SHBG levels increase with estrogenic states (oral contraceptives), pregnancy, hyperthyroidism, cirrhosis, anorexia nervosa, and certain drugs. Long-term calorie restriction of more than 50 percent increases SHBG, while lowering free and total testosterone and estradiol.
"""


#5

Thanks KSMAN!

I should have been more clear. I'm dosing the test cyp and HCG EOD. The
test cyp is 200 mg/ml so I dose at about 0.28 ml/dose eod. I was taking
the Adex at 1/4 pill EOD which works out to a little less than 1mg/week.
I'll dose the Adex per your suggestion. I might try 1/4 pill 2 times a
week before attempting to make a suspension.

The SHBG facts you posted I don't think apply to me. I'm definitely not
cutting right now so the calorie restriction doesn't apply either.

Regarding my next labs - I can get anything run. So SHBG as well as
anything else?


#6

Warning - Brain Dump:

SHBG is made in the liver. Stress/adrenals seem to have some influence. But I don't think that the factors are well understood at all after seeing many extremes in guys with no patterns explaining high or low readings.

In this case, I am looking for what may support the conjecture that your T status is as low as FT suggests and that SHBG is high and thus increasing TT in a disproportionate fashion. Anything that may be affecting the liver is of interest. AST/ALT might be elevated in these circumstances.

But we do know that E2 is low, and low FT-->E2 is the primary reason for that and nothing seems to be impeding E2 clearance by the liver.

So while you suggested less T, in the back of my mind I am ware of guys who hyper-metabolize T and they need around 300mg to get where most are on 100mg. So while we do see that your low E2 cannot be increasing SHBG, we also see that low FT is not helpful and recognized that high-normal FT or above would be expected to reduce SHBG.

So perhaps a hyper-metabolizer with high SHBG.

You will not find doctors who will view these things the way that I do. It is problem solving that needs an engineer!

Joints get bad with low E2, so yours is reverse?
Other than that, how are you feeling with TRT?


#7

I feel awesome on TRT! Originally, my free test was just above 300. They
didn't run the FT unfortunately. The second time which was before starting
TRT my TT was 834 and my FT was 7.5 (low). Would this also lend support to
your hypothesis that I'm an over-metabolizer? Are there negative effects
of having TT off the charts while FT is in normal range?

Regarding the joints - since I was overdosing the AI I'm now wondering if I
could really determine if my joint pain was/is from high or low E2. My
plan is to start dosing the Adex per your suggestion for a while and keep
everything else the same. I'll then make another note on how my joints
feel. Next time I get bloodwork, what should I get checked beyond SHBG?

My AST was 22 and ALT was 24 on my last bloodwork. I'm on no other
prescription drugs other than TRT. Not really sure what to do about the
SHBG. I generally do eat a low carb diet and rarely drink alcohol. Not
sure what other options I have.


#8

Your TT is greatly T+SHBG and T+SHBG is trash waiting for the liver to clean it up. Liver creates SHBG to scavenge steroid hormones [that is estrogens too]. So high TT does not create any problems, but most doctors can't read the writing on the wall. The issue is really about bio-available T and T+SHBG is not.

Labs on TRT:
TT
FT
E2
FSH one time, if elevated then testicular caner is suspected
PSA if >40, looking for acceleration

Where are your oral body temperatures?


#9

Do I take the oral temp at other times than first thing in the AM?

I looked in the stickies and couldn't find anything.


#10

I took my temp right before I went to bed and it was 98.0 F.

First thing this AM right when I woke up it was 97.7 F.

Is this the correct procedure? If so, I'll continue tracking over the next
few days.


#11

Oh, my Thyroid Panel with TSH on my last blood work was:

TSH 2.57 uIU/mL
Thyroxine (T4) 7.2 ug/dL
T3 Uptake 35%
Free Thyroxine Index 2.5

Not sure if pertinent or not


#12

TSH should be closer to 1.0
T4, T3, fT3, fT4 should be mid-range or a bit higher - need those lab ranges

The stickies are found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

advice for new guys
things that damage your hormones
protocol for injections
thyroid basics <-- temperatures here
finding a TRT doc

Need waking temperatures and also want to see what your peak temperature is, mid-afternoon is good.

TSH could be up because you have not been using iodized salt. At least that is the best outcome.
Are your outer eyebrows sparse?


#13

Waking temps have been 97.7 consistently. I was only able to measure my mid-afternoon temp once 98.4. My temp when going to bed has been 98.0 consistently.

My outer eyebrows are not sparse. They are really full. I have been supplementing with Iodrol (one a day) per Dr.'s instruction. The total dose of Iodrol is 12.5 mg per tablet. Is that perhaps too much Iodine?

Also, I get night sweats that is primarily on my scalp. Not HIV+ and I've had them since I was a teen. The only thing that varies is their frequency. They've been pretty frequent since I've been on TRT.

Latest Thyroid Panel:

TSH 2.57 uIU/mL 0.45 - 4.5
Thyroxine (T4) 7.2 ug/dL 4.5-12
T3 Uptake 35% 24-39
Free Thyroxine Index 2.5 1.2-4.9


#14

TSH=2.57 may be indicating a lack of iodine, but thyroid delivering good body temperatures
fT3 and fT4 are definitely more useful than the other labs.

TSH can be increased by iodine supplements.
T4 is below mid-range, not optimal.

You doc needs a kick into this millennium!

"""
* T3 Uptake: This test is mentioned only as a warning not to use it. In
fact, it does not measure T3 levels at all – the name is misleading. It
is an old test designed with a purpose of indirectly measuring T4! It
was developed before we were able to accurately measure T4 levels. The
assumption was that if the patient had a high T4 level, the blood
proteins would be saturated with it. Therefore when mixed with T3 (which
is easier to measure), the blood proteins would take up very little T3.
Thus a low T3 uptake implies elevated T4 levels and vice versa. Thus
the T3 Uptake test is actually an antiquated, inaccurate way to measure
T4 levels.
"""


#15

Any suggestions before I get blood work done again in the next 10 weeks?
Should I up or decrease the Iodine dose in your opinion. Right now I'm at
12.5 mg a day. The night sweats are what's the annoying thing. I always
thought it was maybe a insulin thing because my dad was a notorious night
eater. I get the same feeling when I wake up do to something like night
sweats. But being committed to diet and exercise I don't eat. Could it be
'high' estrogen? I do have mild sleep apnea but I have a dental device and
have sleep tested back into normal ranges.

Just spit balling. Any thoughts I can try until then?

So far I should ask for these labs (my doc said he'll run whatever test I
ask for):

TT
FT
E2
FSH on time
SBHG???

Free T3
Free T4
TSH

Is that right?


#16

TT
FT
E2
FSH one time, should be near zero
SBHG

Free T3
Free T4
TSH

Note that your iodine supplement will make TSH go up, not down. So testing it is really not going to be helpful until you are off of high dose iodine for a few weeks. Right now, watching your body temperatures may be more useful.

Over 40? Should have pre and post PSA looking for acceleration of PSA levels.


#17

Just turned 39. My initial thought in my reading is to drop the iodine
dose to ~500 mcgs. My temp sitting at my desk right now is 97.8. Weird.


#18

Go to that maintenance dose then take some time before thyroid labs so TSH can normalize.

If you are now known iodine sufficient, there may be other layers to the onion.