Protocol Suggestions

Background history: Used anabolics (poorly designed cycles) on and off when I was 19 and 20. No pct. During that time built up from 140 to 173lbs. May not sound like a lot but there was little fat (mainly muscle), plus I’m 5’5’’ with tiny joints. Never was the same. Continued training but lost most of my gains. Evaluated by multiple endos in my early 20’s. testosterone always came back low or low normal. The endos tried restarts but never took. I was told to just give it time. Continued training but turned up going to grad school. Just lived with it, continued training and watching my diet. Fast forward to turning 40. Got ahold of some test cup. Injected 100mg and felt like my old self.

Got with a trt doc who way overcharged me and thought he was God’s gift. Tried all different protocols. Used the 100mg test cyp once per week with Hcg 250 units two days in a row prior to next test injection. Arimidex 1/2 twice per week .Caused too high rbcs, fluctuating estradiol and high Shbg(I HAVE ALWAYS HAD HIGH SHBG) TT high with FT normal range. Turned to splitting test dose in half (50mg) twice per week. Hcg twice per week 250 units day before each test injection with various arimidex doses based on labs. Still didn’t feel right. Could never get stable labs. Now I’m 57 and still trying to get it right!!! Loosing ground. Decreased appetite, not motivated to train, hard to keep weight up. Two years ago went to EOD test cop injections 25mg per injection alternate with Hcg 250units and arimidex (1/8th) of a 1mg tab (thats hard to do!). This dosing helped stabilize my levels, keep my estrogen and hgb easier to control. My SHBG is still high. My latest labs are a mess. I just don’t know what to do. Take a look: Quest Labs

Total cholesterol 197. 125-200 mg/dl
HDL 62. > or= 40mg/dl
Triglycerides. 99. <150 mg/dl
LDL. 115. < 130 mg/dl

Glucose. 76. 65-99 mg/dl
Creatinine. 1.19. 0.70-1.33 mg/dl
AST. 35. 10-35 U/L
ALT. 38. 9-46 U/L
The rest of the metabolic panel is normal
Hemoglobin. 16. 13.2-17.1 g/dl
Hematocrit. 49.5. 38.5-50.0 %
The rest of the CBC is normal
Estradiol, ultrasensensitive 64. HIGH. <or= 29
DHT. 347. HIGH. 16-79 ng/dl
PSA. 1.0. <or= 4.0 ng/ml
SHBG. 85. HIGH. 22-77 nmol/L
Tot Test 4204. HIGH. 250-1100ng/dl
FT. 699.8. HIGH. 35-155 pg/ml
T3 uptake. 38. HIGH. 22-35%
T4 total. 4.1. LOW. 4.5-12 mcg/ dl
TSH. 1.79. 0.4-4.50 mIU/L

Some unique facts about my labs: certainly don’t look hypothyroid!!! I have a history of having slightly “off” thyroid function test which normalize later. I’ve also read that total 4 levels will frequently show low on labs when you are taking androgens.

My SHBG is always high. I have driven my estradiol into single digits for months an my SHBG still stays elevated. Increasing testosterone doesn’t reduce it.

My dilemma is that if I space the test injections (using SQ method) further apart, like you should with a high SHBG, my estrogen an Hgb become hard to control. If I use the EOD method my levels seem more stable and in the past my estradiol levels were easier to control. Now my estradiol levels are harder to control and my TT levels are through the roof. Remember I’m only taking 25mg EOD test cyp. When I drop to 20mgEOD my TT levels start to get unstable. Any ideas???

Wow! I’m not sure I’ve seen T numbers like that! No wonder you’re having trouble. I have no great suggestions. If it were me, I’d want to lower those numbers and get the E2’down to near 22.

With high SHBG, there is then a lot more SHBG+T in TT and TT number in inflated. So you need to be guided by FT or bio-T, ignoring TT.

What exactly was your protocol for the lab work and how long-steady on that before the labs?

Liver may be odd, not clearing hormones. Liver is producing lots of SHBG but not cleaning up the mess. AST/ALT do not show a liver pathology.

TSH should be closer to 1.0
T4 is way too low.
This suggests that you are not using iodized salt to support thyroid function.

Please eval thyroid function by checking oral body temperatures as per the thyroid basics sticky.
Are your outer eyebrows sparse?

Thyroid labs should be:
fT4 [not T3, T4 or obsolete T3 uptake]

High FT, Bio-T is driving high RBC and HTC, so that can be sorted out.

Dissolve Arimidex/anastrozole 1mg/ml in vodka and dispense by drops or volume. Or find research chemical anastrozole that is already a solution.

Thank you so much for the email. I really need your help. No change in eyebrows. Clinically I'm not hypothyroid. I've checked thyroid function many times in the past. I've noticed that when androgen serum levels get high your thyroid function starts to look funky without having clinical symptoms. When the androgen levels come down the thyroid normalizes without treatment. Even if I was hypothyroid, adding thyroid would just drive my SHBG higher!!! I dose the test cyp EOD. The Hcg is dosed between the test cyp injections (i.e. T-H-T-H-T). Arimidex is taken on the same day as the Hcg. I always have labs done in the morning of the Hcg/arimidex day PRIOR to Hcg and arimidex. So many issues. It's like my body doesn't have a chance metabolize one injection before the the next injection. My injections are stacking. This tells me to decrease the frequency of injections but I'm still trying to keep stable levels. What would you suggest.

Injections are meant to overlap and this does not cause your problems.

I cannot support these statements as been in any way generally true. I can’t imaging what is going on.

With high SHBG, there is then a lot more SHBG+T in TT and TT number in inflated. So you need to be guided by FT or bio-T, ignoring TT.

Refine anastrozole dose. Effects take a week, so you cannot be making fast changes based on how you feel in short term. Changes to T dose will affect anastrozole requirements. Reduce T dose to get normal FT.