T Nation

On The Right Path?

Hello there! I am new to the forum and this looks like a great place to get information on what has worked for others and to perhaps double check protocols (although everyone reacts differently I know).

I just received my blood-work back yesterday and the doctor has prescribed my therapy but I was hoping to get some feedback from some of you just to make sure it all looks like I heading down the right path.

My blood work (done by Lab Corp) does not seem to have all the info that some of you list but I will give what I have. Here is my info…

Age: 41
Height: 6’
Weight” 210lbs

Testosterone Serum: 416 (Reference 264-916 ng/dL)
Free Testosterone: 11.0 (Reference 6.8-21.5 pg/mL)
Estradiol: 23.8 (Reference 7.6-42.6 pg/mL)
Prostate Specific Ag. Serum: 0.9 (Reference 0.0-4.0 ng/mL)
SHBGS: 40.6 (Reference 16.5-55.9 nmol/L)
TSH: 1.130 (Reference 0.450-4.500 uIU/mL)
Thyroxine (T4): 7.6 (Reference 4.5-12.0 ug/dL)
T3 Uptake: 28 (Reference 24-39%)
Free Thyroxine Index: 2.1 (Reference 1.2-4.9)

What I am being prescribed is 160 a week of Testosterone administered SC twice per week (80 per shot) along with HCG. They said they were starting me off at this dose to see how I reacted and may bump it from there depending on my levels at my next blood draw in a couple months.

I will also be receiving AI with my meds but they do not want me to take it until I see if there are side effects or how my estrogen levels are in a couple months…this is something I am curious about. I don’t know a lot about all of this but I am trying to learn as I go BUT it seems like my Estradiol is high naturally so I am concerned that it will definitely go up from the treatment - but again I need advice here. Is there a downside to taking the AI (Arimidex I believe) before my next blood panel since I will already have it in my meds package? I would just really like to avoid the potential side effects (mood, gyro, etc.) associated with it and I don’t know how quickly you have to act on these (mostly gyno) before it is irreversible.

I am sure I will have more questions after your feedback but I really appreciate any guidance.

Hey boss. I’m not an expert here. I’m still learning as I go but one thing I just learned yesterday is related to estrogen. My doc has been using labcorp and the ECLIA METHODOLOGY for estradiol. This is not for men. It says so on their website. They gave you the ECLIA METHODOLOGY as well. I can tell by the reference ranges. Based on this test your estradiol is near perfect. In reality, your estradiol is most certainly below that which would be consistent with your low normal TT and below normal FT. Be careful taking AI without accurate estradiol measurements which would come from an estradiol sensitive test. Your estradiol is most likely at the bottom range of normal based on that test. Just fyi…

what made you decide to take hcg with the t?

This is exactly why I wanted to become active on this forum; I’m not sure I would have ever caught the different methodology in testing. I just assumed it would’ve been the “norm”.

So based on what you are saying, I DO want to hold off using any AI until after my next blood test to see how my levels are affected, correct? Also, do I need to ask for a different / specific estrogen test and is that test an option from Lab Corp? Because I believe this is the only lab they use.

I apologize for not including it in my original post but the reason I am starting HCG along with my testosterone is because my wife and I plan on trying to have a baby (probably in the next year) and I / my doctor wanted to keep my natural production going versus trying to jump-start it once the time came.

I’m not necessarily saying hold off or go ahead. I can’t make that call but insure you have an accurate picture of your hormonal profile. Labcorp does have the correct test. If you look up the labcorp Roche ECLIA method it says in the description that it is not for men. Labcorp offers the correct test which is the estradiol sensitive. Look these up and print them out. Hand them to your doctor. Your low estradiol is contributing to the symptoms that you feel. I’ve been dealing with this a while.

Unless you doctor specifies E2 sensitive assay the labs will alway use the familiar female E2 test.

I will definitely print that out and ask for that specific test for my follow up blood draw. Thank you.

from lab corp
Estradiol, Sensitive, LC/MS
TEST: 140244 Test number copied CPT: 82670

Test Details
Recommended for clinical situations in which increased sensitivity of E2 levels is appropriate, including postmenopausal women, men, and children and adolescents
Estradiol levels tend to fluctuate dramatically during the perimenopausal transition.1 There is significant overlap of the expected range in menopausal women with values observed during normal menstrual cycles. Estradiol results obtained with different assay methods cannot be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor serial patient results.
Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

From the ECLIA LABCORP Page…

E2 levels in children, postmenopausal women, and men are much lower than in women of reproductive age. The increased sensitivity and specificity that are achieved by LC/MS-MS are the more appropriate choice for these clinical situations than the electrochemiluminescence immunoassay (ECLIA) method.1,2 See Estradiol, Sensitive, LC/MS [140244]. LC/MS-MS offers superior analytical sensitivity, specificity and a larger dynamic range than immunoassays.1 The clinical applications benefiting from highly sensitive E2 measurement include the assessment of congenital defects in sex steroid metabolism and disorders of puberty. This sensitive assay also has application in the evaluation of estrogen deficiency in men and menopausal women, fracture risk assessment in these populations, and increasingly, in therapeutic drug monitoring of low-dose female hormone replacement therapy or antiestrogen treatment."

Thank you both for sharing that info. I have that test bookmarked now so it’ll be simple to take with me.

I am looking forward to the next several weeks to see how my symptoms react to the treatment and dialing things in. I know it won’t be instantaneous but hopefully I’ll start feeling the results in weeks and not months.

Just so I know the S.O.P. around these forums…Do I continue to post updates and questions in this same thread or do I start new ones as the different issues present themselves?

Stick with this one. Your updates can help others learn.

If you make multiple threads you will lose people, please keep everything in one thread that way we don’t have to go on an Easter egg hunt for information.

I agree. It’s nice to be able to read through an issue from start to (hopefully) resolution.

So I woke up this morning and my lower / base of my neck was sore. Almost as if I had worked out my traps heavily yesterday but I did not. I also have a bit of a sore throat and a slight headache. This may all be unrelated as I have had neck stiffness occasionally for many years BUT that also may have been a symptom of something else all these years but I just assumed it was “sleeping wrong” or too many hours working at a computer.

Just FYI: on my visit Monday they administered my entire weekly dose and said my meds should arrive by Friday (today) and I would go to twice weekly, SC injections from there.

Not sure any of this is relevant as I am just beginning to scratch the surface on how to get my body back to functioning optimally.

So I have a follow-up tomorrow (my prescriptions arrived) and I wanted to double check for any areas that I need to discuss with them. I have a couple of areas I am personally curious about…

  • AI - After more reading around here it seems as most people have issues and do need to take AI on shot days BUT it was suggested to me that I should wait a couple of months before starting the AI. I have a strong aversion to any sort of the estrogen side effects (bloating, gyno, etc.) as I have known some guys that have had strong side effects in these areas and I honestly don’t know how much time I have to “wrangle” those back in before they are too far gone. Hopefully someone here can help advise me on this or even @KSman will weigh in.

  • I was also told that they wouldn’t run my follow-up blood tests for 2-3 months and from reading it seems like maybe I should try to have them done closer to the 6-8 week mark - is this correct?

  • Besides requesting the Estradiol Sensitive Test what other test should I be asking for? As mentioned in my original post, Lab Corp is the company - if that changes anything. My original, pre-TRT test did not provide the extended thyroid info I see others posting or any sort of IGF/HGH testing that I saw - so should I be asking for those?

  • Syringes - I know they say that they will supply the syringes, wipes, etc. and that they are insulin needles but what size should I be either asking for OR I can just buy my own if they don’t have what is best. I’ve read 28-30g and 1/2 - 5/16" around the forums and of course I would prefer the smallest/shortest that will get the job done properly. I’ve even wondered about some sort of auto-injector (if there is such a thing that works well) since I am not a fan of needles but will do what is needed to feel better. Below I will list out what my original prescription is in case that that impacts things…

  • Test Cyp 200mg/ml - 0.4ml twice weekly (SC)

  • HCG - 0.25ml twice weekly (SC)

  • Anastrozole 1mg tablet - Take 1/2 one time per week

For the injections I think they are directing me to draw both into the same syringe and inject both in a single injection but I will confirm that tomorrow. For the AI it seems like the dosage is what most of you recommend BUT splitting that dosage in half (2 x 0.25) and administering on injection days.

Again, I am still learning but hopefully you will have some advice or directions.

Update: Had my appointment yesterday and was told to take AI @ .25mg twice per week - which I did after my injection (see dosage above). I think it may have crashed my estrogen based on what I’ve read (zero energy, no MW, very low libido compared to my other days after my first injection, eyes are very tired).

All that said, I don’t know if I should or want to take the AI on my next injection day (this coming Friday)…I would really appreciate any input.

Your E2 was low and you took an AI. Yep. You probably crashed. I have my appointment with the endo at 10:40am today. Hopefully she finally puts me on trt. If she does I won’t be taking an AI immediately because I want my E2 levels to increase. That will automatically resolve many of my symptoms. It was probably just to soon for you. Just a thought.

For sure! My own stupidity I suppose but I won’t be taking anymore until I see the results of my 6wk blood work. Crashed E2 is horrible! The more I learn about all of this I wonder if some of my issues are just a much from from low E2 as low T.

Thank you for the reply. I hope all goes well at your appointment. Where is your thread? I’d like to follow your progress as well.

Yes it is horrible. It’s probably a combination of both btw. Your E2 is low because your T is low. You can’t win at that game. Your further along in your treatment than I am. If you click on my name it will lead you to my summary and just click on “post created”.