T Nation

Newbie Help - Review Labs

Hello,

I started TRT with HCG about the end of June. I previously had seen a local endo for elevated prolactin and am on 1mg of Dostinex/cabergoline per week. I had low energy and libido and a mri showed possible micro endima. Dostinex previously brought down prolactin level to within norm. (now with trt it is back up.)

I had some labs done by TRT doc in September as a follow up. Then went to my primary for general physical and then local endo for prolactin review. All labs follow herein with draw dates.

First off I feel like night and day compared before trt treatment. I was lethargic and libido came and went. No regrets so far, I just want to make sure I am balanced and am starting to suspect I am not. I know from google foo my test is high. The TRT doc is trying to adjust. I have some recent breast swelling, last 3 weeks, nothing crazy, it just feels more tender and I have a history of fatty tissue in the breast area to begin with so I am super self conscious to start.

I know I already have to do something about the hemacrit level and will likely donate blood. After these results in September the TRT doc put me on an additional 1mg amrimidex per week to control E.

Male
45yrs old
5’-9"
179lbs

TRT script is
200mg Testosterone Cypionate infused with .5 anastrozole - 1 ml once a week
50 units HCG 2x a week
1mg Arimedex tablet 1x a week

This bank is from my TRT doctor
Test results 9/17/18

CBC With Differential/Platelet; Testosterone, Serum; Estradiol; Venipuncture
TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB
CBC With Differential/Platelet
WBC 7.0 x10E3/uL 3.4 - 10.8 01
RBC 5.08 x10E6/uL 4.14 - 5.80 01
Hemoglobin 15.6 g/dL 13.0 - 17.7 01
Hematocrit 44.9 % 37.5 - 51.0 01
MCV 88 fL 79 - 97 01
MCH 30.7 pg 26.6 - 33.0 01
MCHC 34.7 g/dL 31.5 - 35.7 01
RDW 13.0 % 12.3 - 15.4 01
Platelets 200 x10E3/uL 150 - 379 01
Neutrophils 68 % Not Estab. 01
Lymphs 22 % Not Estab. 01
Monocytes 9 % Not Estab. 01
Eos 1 % Not Estab. 01
Basos 0 % Not Estab. 01
Neutrophils (Absolute) 4.7 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 1.6 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.6 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % Not Estab. 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Testosterone, Serum 1173 High ng/dL 264 - 916 01
Adult male reference interval is based on a population of
healthy nonobese males (BMI <30) between 19 and 39 years old.
Travison, et.al. JCEM 2017,102;1161-1173. PMID: 28324103.
Estradiol 51.7 High pg/mL 7.6 - 42.6 01
Roche ECLIA methodology

This is from my Primary Care
11/1/18
LIPID PANEL, STANDARD
CHOLESTEROL, TOTAL 188
HDL CHOLESTEROL 34 L
TRIGLYCERIDES 81
LDL-CHOLESTEROL 136 H
CHOL/HDLC RATIO 5.5 H
NON HDL CHOLESTEROL 154 H

TESTOSTERONE, FREE, BIO AND TOTAL, MS
TESTOSTERONE, TOTAL, MS 1862 H
TESTOSTERONE, FREE 668.1 H
TESTOSTERONE,BIOAVAILABLE 1257.7 H
SEX HORMONE BINDING GLOBULIN 15
ALBUMIN,SERUM 4.1

CBC (INCLUDES DIFF/PLT)
WHITE BLOOD CELL COUNT 5.7
RED BLOOD CELL COUNT 5.92 H
HEMOGLOBIN 17.6 H
HEMATOCRIT 51.0 H
MCV 86.1
MCH 29.7
MCHC 34.5
RDW 12.8
PLATELET COUNT 236
MPV 9.7
ABSOLUTE NEUTROPHILS 3808
ABSOLUTE LYMPHOCYTES 1368
ABSOLUTE MONOCYTES 399
ABSOLUTE EOSINOPHILS 108
ABSOLUTE BASOPHILS 17
NEUTROPHILS 66.8
LYMPHOCYTES 24.0
MONOCYTES 7.0
EOSINOPHILS 1.9
BASOPHILS 0.3

COMPREHENSIVE METABOLIC PANEL
GLUCOSE 85
UREA NITROGEN (BUN) 14
CREATININE 1.06
eGFR NON-AFR. AMERICAN 85
eGFR AFRICAN AMERICAN 98
BUN/CREATININE RATIO NOT APPLICABLE
SODIUM 139
POTASSIUM 4.4
CHLORIDE 104
CARBON DIOXIDE 28
CALCIUM 9.3
PROTEIN, TOTAL 6.8
ALBUMIN 4.1
GLOBULIN 2.7
ALBUMIN/GLOBULIN RATIO 1.5
BILIRUBIN, TOTAL 0.9
ALKALINE PHOSPHATASE 55
AST 22
ALT 28

REFLEXIVE URINE CULTURE
NO CULTURE INDICATED
HEMOGLOBIN A1c 5.0

VITAMIN D,25-OH,TOTAL,IA 46
Vitamin D Status 25-OH Vitamin D:
URIC ACID 5.0
TSH W/REFLEX TO FT4 1.78
VITAMIN B12 681
PSA, TOTAL 1.2

This is from my local Endo
FSH 0.7 L
LH 0.2 L
PROLACTIN 27.8 H
TESTOSTERONE, TOTAL, MS 1585 H
TESTOSTERONE, FREE 480.3 H
TSH 1.36

Please help me understand what is going on if you can and what if anything I should change or do. It is greatly appreciated. It took a long time to find a doctor that would listen to my complaints about how I feel and get the ball rolling. I had seen endo after endo and now after a long time understand the difficulty men have finding treatment. I wish I had started treatment 5 years ago because I feel I missed out on doing a lot in life because of how I previously felt.

Thank you in advance for your time and help.

IMO and opinions are like buttholes we all got one and some stink more than others, haha. Here’s my suggestions.
With an SHGB of 15 your weekly T injection should be around 75 to 80/wk NOT 200.
Your HCT TT and Free T is telling us that. You can not run your Free T over range for very long before E2 prolactin and HCT start going out of control. You can only donate blood a half a dozen times before you will crash your ferritin.
Yes I am sure TT of 1500-1800 feels really good but it is not healthy long term.

In case you did not know anastrozole and Arimedex is the same drug. So you are taking way too much AI. That is another clue your T dose is way over the top.

Here’s my suggestion. But you can’t use the infused T cyp. You need standard T cyp 200mg/ml with nothing else in it. Its ~60 bucks a bottle for 10ml at any grocery store pharmacy.
90mg/wk T cyp divided into 3 shots M/W/F draw .15 on your syringe (30mg) I like the 27 ga 1/2" easytouch injected sub-Q to the left or right of the navel in the belly fat. If you don’t have any belly fat then pull the skin up off your muscle and poke it in.
Take no anastrozole or any other AI until your first blood test 5 weeks after you start this protocol. If you need an AI try to get your pills in micro doses like 0.125mg. My guess will be you will never need more that .25/wk and that is only when you notice high E2 symptoms.

HTH best of luck.

Thank you very much for your input. I realize this will garner a lot of bro science but I will not be ignoring my doctor, just trying to supplement his advice and have something to discuss with him. So you are saying cut back on the 1ml a week of the test? The test cyp comes as 200mg infused from the pharmacy. Don’t really know how to change that. I can definately start drawing less than prescribed, ie: .70 ml instead of 1ml per week. (or do you mean literally only draw .15 on the syringe per injection?).

Since this is still within the first 6 month of TRT, ie: started late June 18 do you think I screwed up my endocrine system?

No that won’t work because if you take 75-90mg/wk you will not need an AI and your T has an AI infused in it. You will crash your E2 forsure. No good TRT doctor would do that only the T mill doc’s do that. NO doctor can determine how much AI one need until you are stable and have a good E2 measurement. Then it will still be at least an educated guess. But if the guess is wrong you can’t adjust the dose without changing the amount of T you are injecting. Does that make sense? Are you following?
This is not bro-science my friend its the facts on how all this works.

NO you are fine you just need a better doc or one that will change his protocol to something close to what I have suggested.

1 Like

Thanks I am in fact following. I have a consult set up with the doc to review this week and will discuss this with him. Thanks for the advice.

You are welcome. This info cost me over 3 years of experimenting thousands of dollars in doc consults and blood tests. I hope it will help you. You might not want to mention you heard this from a random on the internet he/she will give you that evileye haha. Doc’s hate the internet.
Just tell him you were talking with other guys on TRT from the gym. Say this is what they are doing and ask if he will support you trying this. Tell him you want to start low and work your way up not the other way around.
I hope you will post back on this thread how it went. An I’ll still be here if you need help should you get the new protocol.

Testosterone infused with anastrozole is TRT done horribly wrong. Your SHBG is 15 and your SHBG should be considered when designing a protocol.

My SHBG is only a little higher than yours and I do very well on 18-20mg EOD, low SHBG guys who have problems controlling estrogen do much better on frequent injections. Usually for me high Free T means high Free estrogen as well.

Im pretty new to trt so take everything I have to say with a grain of salt but it certainly seems like you’re on really big doses of T and Arimedex, especially given your shbg of 15

For comparison, my shbg is 80 and Im taking 180mg/week and no Arimedex, right now I feel great.

You have high free T, high hematocrit and presumably high e2, all related to test doses that are too high.

And fwiw, a hematocrit of 51% is high but not insanely so. Stay well hydrated, that alone can help drop the number a bit.