Realistic TRT Recomp Progress

This all seems great, particularly the orthorexia shift! Not sure about the vertical diet (I know very little about it) but tagging my favourite RD @QuadQueen

@bkb333 Can you tell us what an average day of eating/food look like for you? I might be able to figure out whatā€™s driving the LDL up and give you a few suggestions!

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What happened to test prop???

Honestly I think this right here has some validity.

You canā€™t trust that direct free T test youā€™ve got on there. Thatā€™s not an accurate form of the test like equilibrium dialysis.

That leaves a Vermeulen calculation as your best option and that says your free T is 58 ng/dL. That is really way up there. Iā€™m personally not concerned about LDL or apoB in the context of a lean, insulin sensitive, low inflammation, low BP, metabolically healthy person. I would be more concerned about left ventricular hypertrophy running free T that high, if youā€™re planning to stay there long-term.

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Go get a CAC done. See if you have any plaque build up. The lipids are showing you have bad sticking type cholesterol. Ease your mind or find out if you have issues before itā€™s too late.

I had a weird experience. I switched from cyp to prop and couldnā€™t sleep for a month. I have no idea how to explain it ā€“ I had straight-up insomnia. I was trying all the supplements and nothing helped.

After I switched back, it took about a week, and then sleep returned to normalcy. I guess my body wouldā€™ve acclimated, or something else could be the explanatory variable, but I was miserable and couldnā€™t continue dealing with the lack of sleep. Super odd, I know.

This is probably a good idea. Iā€™m going to talk to Saya (next week) and see what he thinks. My LDL has always been high, even pre-TRT, but this result was crazy.

Attia far prefers CT angiogram to CAC, so I would push for that.

I know, man, this is frustrating. I specifically asked for EQD and it was on my script. The tech messed it up. Also ordered some wrong tests and failed to order the Apolipoprotein tests.

Thatā€™s encouraging. My insulin resistance score was 35, which is actually an improvement over the 57 I had 1.5 years ago.

Iā€™ve heard this before. Iā€™m guessing the CT angiogram would provide an indication of early LVH.

SHBG is generally above 100 when I lower the dose. I know SHBG isnā€™t necessarily a problem but I see that as super high. Hence why I was exploring the use of a low-dose oral. But Iā€™m guessing all of those would be bad for lipids. Iā€™m curious what Saya will say.

One thing I forgot to mention is that Iā€™ve been on a low-dose AI (0.125 mg 3x/week). I hadnā€™t used one in years prior to this test. I wonder if that played a role.

Thanks so much :slight_smile:

I mostly follow the Vertical Diet. Breakfast would be eggs and egg whites with spinach, turkey bacon or chicken sausage, cheese, and sourdough toast. Protein shake post workout.

Lunch would be a salad with lean meat and rice.

If I eat a snack after lunch, itā€™s fruit and yogurt.

Dinner, similar to lunch.

Then for a snack after dinner, Iā€™ll often have FF Greek yogurt with powdered peanut butter and sugar free Goya cookies. I eat too many of those. Those are my weakness. And really the only processed carbs in my diet. They havenā€™t hindered my body composition ā€“ still about 10% BF ā€“ but couldā€™ve impacted the LDL for sure.

Overall, youā€™re not doing too bad but the thing with the Vertical Diet that might be catching you up is the simple carbs/sugars. The toast, rice, yogurt (if itā€™s sweetened) and the cookies are all refined/simple carbs. My suggestion would be to maybe veer away from the vertical approach and focus on getting more non-starchy veggies and fiber containing carbs (sweet potatoes, potatoes with skin on, oats, etc.). Also, consider adding some healthy fat choices - olive oil, avocado, moderate amounts of nuts/seeds. These small changes might help bring the LDL down a bit.

Another factor that might be at play here is genetics. Do you have a family history of high cholesterol/LDL cholesterol?

Thank you very much for getting back to me.

I was thinking this might be the case. The Vertical Diet has been awesome for me overcoming orthorexia. I used to be obsessed with low-carb, and Stanā€™s approach has helped a lot from a mental perspective. Iā€™ve realized all the benefits of carbs. But Iā€™ve probably gone too far on the carb-heavy side of things and need to refocus on good carbs, especially veggies. I do eat a lot of sweet potatoes! I was thinking Iā€™d work more oatmeal, EVOO, and brown rice/quinoa into my diet, less bread and white rice.

Thank God, I do not. Really good genetics, actually. My dad has done everything possible to wreck his health and somehow has not succeeded lol.

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Updated protocol after my consult:

  • 225 mg T-cyp/week (down from 300)
  • 11.5 mg oxandrolone ED (the pharmacy sells 11.5 and not 10) ā€“ aim is lowering SHBG without harming lipids
  • Add pregnenolone, 50 mg/day at bedtime ā€“ my DHEA was only 265 despite taking 50 mg/day, which I will continue
  • Maintain anastrozole, 0.125 mg 3x/week
  • Bump fish oil from 3.6 g/day to 4.8
  • Bump zinc from 50 mg/day to 75

No CT angiogram or CAC for now. I can provide more context later if folks have questions.

This is perfect. Whole grain and vegetable based carbs along with a good dose of healthy fats should help move those numbers! Carbs arenā€™t evil, but as with all things, some are more optimal than others.

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This seems alarming to me 50mg is already in potentially toxic levels, and one thing zinc toxicity can do is skew lipids.

Warning the above is from my unprofessional & uneducated opinion.

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Given that I was on the low end of the range, though, this shouldnā€™t be an issue, right? It would only be an issue if your zinc got too high?

Good to know! I wasnā€™t aware.

Really not sure sorry, but Iā€™d guess not, weird that youā€™re at the low end given 50mg per day.

You can cause a deficiency in copper by taking that much zinc, even if you arenā€™t seeing high Zinc on a blood test. In fact, blood tests of zinc are not a reliable indicator of zinc deficiency, so you may be treating a deficiency you do not have and creating a real deficiency of copper as a side effect.