New Labs, Help Please from the TRT Geniuses

Hey all, I just got my new labs and was hoping for some input from the resident trt geniuses here (where are you KSMan et al). I’ve been running 160mg Test Cypionate a week divided into two shots. No HCG or AI yet. Hopefully my photo will attach correctly but here are some highlights (note I know the E2 test is not the ideal one – from now on he’ll be using the right one but this is what I have to work with at this point):
Age: 49
Note – I take finasteride for mpb if that matters.
Test total: 1146 (175-781)
Test Free: 20.7 (4.25-30.3)
Estradiol, non-preg: 84 (0-47)
Hemoglobin: 18.2 (14-18)
Hematocrit: 54.6 (42-52)
Prolactin: 17.92 (2.64-13.13)
He did not test SBHG or anything else.
My incompetent doc recommended I keep test dose here and add 1mg Anastrozole 2xweek. Do you guys think a competent trt doc would just lower Test dose and wait on the AI or is my estradiol so high that even at a lower t it’s prob worth adding? What might be a good test dose I should try given these results? This is the Dr. that put me on 240mg a week to start (which oddly enough, only put my test total at 890 and my E2 at 77) until I came here and got properly schooled in how high a starting dose that was. After the board’s advice I went down to 160 for 4 weeks and the blood work you see here is the result. I feel “ok” – not as good as when I was at 240mg but better than I was when I had no trt (no sex drive). I have anxiety a couple days after injections. I’m not expecting medical advice, just looking for everyone’s opinion on what they think a competent trt doc would do. Thanks in advance all!

  1. Stop taking Finasteride.

  2. Lower your dose. Your H/H are high, and your e2 is high. Your TT can afford to come down a little.

Then again, its up to you… That’s just what I would do.

Taken on trough?

I second stopping Finasteride. You’re redlining an you need to come down, it’s not healthy long term. You also need a new doctor.

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Is that free test direct or calculated? With that number, I think I’d leave the dose at 160mg. You might have high SHBG. I’d bring E2 down and see if you feel better. Also, what’s with the elevated prolactin?

You don’t need to check FSH and LH anymore. I’d donate blood. Platelets are good, maybe take a baby aspirin.

I’m not sure which free test that is. I’m not sure what’s going on with my prolactin - does something need to be done about that?

As far as finasteride - it’s made a huge difference in hair regrowth so I’m not easily gonna give that up. Why do you all think that’s so important?

I’m thinking of lowering test to150 and adding arimidex .5mg 2x week. That might be low on the AI based on what I’ve read on the forum, but I’d rather be safe and not crash my e2. Any thoughts? Thanks again.

There are reasons why finasteride is a bad idea, you’re playing with fire. The question is will you get burned. You’re gambling with the life you know all for your hair. I’ll shave my head before I take finasteride!

Post-Finasteride Syndrome (PFS) was recently added to the US National Institutes of Health (NIH) list of genetic and rare diseases1,2*. Finasteride is a 5-alpha reductase type II enzyme inhibitor used to treat hair loss (eg, Propecia, Profal and ReGen) or enlarged prostate (eg, Proscar, Finasteride Rex and Fintral).

PFS includes sexual, physical, and mental and neurological symptoms in patients who have taken finasteride (Table 1). Symptoms often persist after the patient has stopped taking finasteride.

I would drop T to 50mg twice per week and see if you can get away with no AI. The less chemical load the better you’ll feel. Your high hematocrit will make your blood thicker and more viscous increasing your chance of stroke and blood clots. High hematocrit is increased by higher T levels. It took me years to accept lowering my T dose to feel better.

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