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On TRT 5 Years. Help Analyzing Recent Blood Results

32 years old. 5’09 200 lbs. I have excess fat in my stomach area. Not in great shape right now. Plenty of body hair and thick beard. Been on TRT for approx 5 years. Current protocol is I inject every other day (EOD) in my deltoid with an insulin syringe. (I am taking 200mg a week). My test oil is 200mg test cypionate and 50mg of test propionate per mL. So I am taking a mix of test cyp and test prop, for a total of 200mg a week. I have never taken any hCg or AI with my test.

Lately I have been having issues with my libido and energy levels. I also have pretty severe acne on my back, shoulders and upper arms. I have had this acne for several years.

Here are my blood test results, with included ranges:

test, total (MS): 1045 (range) 250-1100 ng/dL

test, free: 328.7 (range) 35-155 pg/mL

estradiol, ultrasensitive LC/MS: 41 (range) < or = 29 pg/mL

TSH: 4.86 (range) .40 - 4.50 mlU/L

t4, free: 1.2 (range) .8 - 1.8 ng/dL

t3, free: 3.6 (range) 2.3 - 4.2 pg/mL

SHBG: 14 (range) 10 - 50 nmol/L

DHEA-S: 514 (range) 106 - 464 mcg/dL

DHT: 56 (range) 12 - 65 ng/dL

prolactin: 14.2 (range) 2.0 - 18.0 ng/mL

cortisol: 18.1 (range) 4.0 - 22.0 mcg/dL

progesterone: .9 (range) < 1.4 ng/mL

ferritin: 47 (range) 38-380 ng/mL

I have a lot of questions about my high TSH, high DHEA and low SHBG. Also my free test seems to be extremely high. Is my E2 at 41 concerning?

Thanks for taking the time.

As for the high TSH are you taking iodine supplements?

The low SHBG is linked to thyroid problems, diabetes/metabolic syndrome or may be genetic.

TRT will supress SHBG in just about everyone. As for your high Free T the solution is simple, lower the dosage.

I’m surprised your E2 isn’t higher given your very high Free T. It should come down when you lower your dosage to a reasonable level.

I believe you issues are from excessive T and not so much E2. The higher T will drive up your DHT and therefore cause acne.

Your ferritin levels are a bit on the lower end, keep and eye on it. Again I believe the very high T may be to blame for suppressing the ferritin.

Where are your CBC labs?

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Thank you for the response.

Not supplementing iodine. What is the best way to address thyroid problems?

I thought my E2 was going to be much higher as well. This was honestly my first time ever testing E2 because I had never really had symptoms of high E2 until recently.

Let me post some additional blood test results. I don’t know how to just post a picture of everything so I’m stuck typing out. Let me know what other results would be helpful.

red blood cell: 6.13 H (range) 4.2 - 5.8 million/uL

hemoglobin: 16.5 (range) 13.2 - 17.1 g/dL

hemocrit: 50.7 (range) 38.5 - 50%

MCH: 26.9 L (range) 27 - 33 pg

glucose: 88 (range) 65 - 99 mg/dL

lGF 1 LC/MS: 164 (range) 53 - 331 ng/mL

I donate blood every 3-4 months to keep my hemocrit down. I’m about to go donate today because I have not done it in quite awhile. But I know that donating will lower my ferritin even lower.

Any recommendations on increasing ferritin and getting my TSH / thyroid in check?

Thanks for your time @systemlord

@KSman
@dextermorgan
@dbossa

I would also appreciate any insights y’all have. I lurk here frequently and always see good insight from y’all and systemlord.

That’s a little high, odd that you would only be experiencing symptoms now when you’ve been on for five years

Your Free T3 are good and therefore no thyroid problem.

I think you’re iron deficient and that this is your problem. I’ve been iron deficient twice and my MCH was below ranges each time even though my hemoglobin was normal which is why my doctors missed it.

Doctors are taught iron deficiency occurs when hemoglobin is low, this is not true in all cases.

Your MCHC is more than likely going to mirror your MCH. I would test iron saturation, MCHC to confirm iron deficiency.

Reducing your T dosage may correct the iron problem and also adding more iron to your diet wouldn’t hurt.

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I had sex approx 10 hours before the blood draw. I know that could effect it but i’m not sure how much so.

I will order some additional tests for iron def. Thanks for the suggestion.

@systemlord

Additional blood results:

MCHC: 32.5 (range) 32 - 36 g/dL

MCV: 82.7 (range) 80 - 100 fL

Could raise PRL levels, other than that not aware of any issue

Sorry if this is against the rules but I would really like some additional perspectives. Bump.

@KSman
@dextermorgan
@dbossa

Two of those guys aren’t on here anymore and one doesn’t come around much. You might be waiting a while