T Nation

Need Help with Labs from Ksman


#1

Ksman, I am 45 years old and have been on trt for 10 year with great success, but for a year I have had some issues including fatigue, brain fog, erection problems, no desire in sex (ouch), and for the last 6 months have been having prostate issues such as after dribble. I hope you can help me interpret an area that I may have a problem.

TESTOSTERONE

TT 835 250-1100 ng/dl
FT 337.5 46-224 pg/ml
Testosterone bioavailable 679.5 110=575 ng/dl
SHBG 5 10-50 nmol/L
ALBIMIN SERUM 4.4 3.6-5.1 g/dl
ESTRODIOL 26 < or equal to 39 pg/ml
PROGESTERONE 1.2 <1.4 ng/ml
PSA .6 <or =to 4.0 ng/ml

TSH .86 .40-4.50 ml U/L

LIPID PANEL

CHOLESTEROL TOTAL 159 125-200 mg/dl
HDL 25 >or equal to 40
TRIGLYCERIDES 170 < 150 mg/dl
LDL 100 <130 mg/dl

HEPATIC FUNCTION
PROTEIN TOTAL 7.7 6.1-8.1 g/dl
ALBUMIN 4.4 3.6-5.1 g/dl
GLOBULIN 3.3 1.9-3.7 g/dl
ALBUMIN/GLOBULIN RATIO 1.3 1.0-2.5 calc
BILIRUBIN TOTAL .5 .2-1.2 mg/dl
BILIRUBIN DIRECT .1 .<or equal to .2 mg/dl
BILIRUBIN INDIRECT .4 2-1.2 mg/dl
ALKALINE PHOSPHATE 86 4.-115 U/L
AST 24 10-40 U/L
ALT 29 9-46 U/L

WHITE BLOOD COUNT 3.7 3.8=10.8 thousand/uL
RED BLOOD COUNT 5.87 4.20-5.80 Million/uL
HEMOGLOBIN 17.9 13.2-17.1 g/dl
HEMOTOCRIT 53.4 38.5-50.0%

I inject 50 mg of testosterone cyponate eod with 12.5 mg Arimidex and 250 IU hcg.
morning wood 3 out of 7 days weekly

I will appreciate any advice that you can provide for me as I follow your advice on here already,

Thanks in advance.


#2

[quote=“Talman, post:1, topic:230085”]HDL 25 >or equal to 40
[/quote] HDL is a problem, but doesn’t have symptoms that I know of.
A prostate-specific antigen (PSA) test might be helpful addition to the other bloodwork.
Low white cell count may signify infection, but sometimes 3.5 is considered low end for normal range.

[quote=“Talman, post:1, topic:230085”]SHBG 5 10-50 nmol/L[/quote]Check thyroid.


#3

your TRT protocol:

  • 50mg EOD, 175mg/week
  • lab timing re prior injection
  • AI=12.5mg EOD Arimidex <<<<<<<< does not make any sense at all
  • hCG 250iu EOD

HDL:
fish oil
Might easily need 25mg DHEA at your age labs would be for DHEA-S
high potency B-complex multi-vit with trace elements including 150mcg iodine and 150-200mcg selenium. MUST be without iron! Natural source Vit-E, Vit-C 1000-2000mg per day, healthy fats and oils.

Avoid iron fortified: vitamins, bread, flour, rice
RBC is too high
Hematocrit to way too high - many health risks
take mini aspirin to assist blood flow
donate blood

Hematocrit: T levels may need to be reduced. Inject more often to avoid peaks, suggest twice a week.

Deeper and deeper: If hematocrit is liming flow in vascular organs [brain, penis etc], lack of O2 in kidneys increase EPO leading to more blood cells, making blood thicker - self worsening. https://en.wikipedia.org/wiki/Erythropoietin

Do you every feel short of breath, dizzy or light headed? Feel pulse pounding in you ears? Headaches?

TSH looks good, but there can be problems nonetheless. Please check overall thyroid function via last paragraph in this post.
Have you ever not used iodized salt?

SHBG is very low. Sometimes guys are simply like that. However, low SHBG is also the calling card of diabetes. I do not see A1C or fasting glucose. Your low SHBG is increasing FT and reducing SHBG+T which means that your T status is higher than TT indicates.

Prostate:
Cialis can help with urine flow and ED.
PSA looks good.
Is urine flow good? Post peeing dribble is a different concern.

Task list:

  1. If you are able to donate blood, note any changes in how you feel after that. Or ask for therapeutic blood removal.
  2. Get suggested supplements and list what using already
  3. Post the two sets of requested oral body temperatures.
  4. Respond to SHBG diabetes and glucose issue.

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
  • finding a TRT doc

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.


#4

Thanks for the advice Ksman,

I had my labs done 2 days after T injection and donated blood 3 days after that which I do every 60 days.
I have split arimedex into 1/8 mg which I know is not accurate but figure it’s close to .125 mg and I don’t know how to get liquid adex.
I will follow advice on HDL recovery and get DHEA-S checked .
I am taking 81 mg aspirin as I have been concerned about hemotocrit and will see about getting set up for medically necessary phlebotomy.

I do have issues with being short of breath and lightheaded even thought I work out. I have started having a hard heartbeat and have mentioned to PDoc with no thoughts of his own. I also have been having more joint pain which could be from high hemotocrit.

I use salt but not much.
I will get A1c checked.
My urine flow is good with the after dribble being the issue which I think is related to the high levels of FT effecting prostate.

Are you saying that I should only inject twice weekly instead of EOD and advice on Adex?

I will lower my Trt to 30 mg EOD if you believe would be a good option and then retest?


#5

Sorry… stick to T EOD, then you can do anastrozole/Arimidex EOD as well.

Dissolve anastrozole in vodka 1mg/ml in a dropper bottle. Count drops per ml and dispense by the drop. [You may find that 1mg/2ml doses better.] If you reduce T dose, then reduce anastrozole buy the same factor.

With your low SHBG, I think that a lower T dose is a good idea.

Please stop ignoring requests for body temperatures. So many who come here have thyroid issues. With great T numbers, low thyroid function can have most of the same symptoms as low-T. While TSH looks good, looks can be deceiving.