'Some' Lab Results, Any Advice?

Pharma / TRT Testosterone Replacement
1

So I am beginning down this path of checking hormones, and I must admit it seems my battery of tests is lacking after looking around here a bit. However, I’m hoping maybe we can start this dialogue albeit perhaps premature.

Let me first try to give profile and symptoms:
5’9"
210lb +/-
47" chest
17.5" flexed arm
37" waist (ugh! had been 36" recently which WAS all-time high)
40" hips
26" thigh
17" calf

body hair is probably moderate- normal hairy legs/arms. arm hair trails off at the elbows. normal medium hairy chest. very light back hair on erectors that has sprung up past few years. heavy beard. hairline receded in the corners, been doing this slowly last few years, actually seems to have come to a stop past year or so, though I can’t be sure.

Symptoms:
Pretty constant fatigue- physical and mental
memory sucks as my wife tells me
low motivation
poor sleep
possible decrease in sex drive? I used to want sex all the time/whenever, now a lot of times I feel “too tired” and fall more along the lines of “if you (she) want to”- where in my head I’m thinking more like “I’m too fucking tired and hopefully you are too”. don’t know if this is decreased sex drive or just falls under fatigue?
longer recovery between workouts
*no ED/erection problems despite possible lower drive. possibly lower “stamina”?

Strength at times has been decent, but seems to hit a wall and not make progress recently (one of my symptoms actually).

numbers, if it helps:

Squat: 425 about two years ago, had herniated disc and setbacks, been spinning my wheels in the low 300s range for months now, just feel now power in my legs.

Bench: 365 same time as the squat. numbers have fluctuated also, usually lower-mid 300s. about two months ago I had a good day at 305x8, then last week 285x7 was quite difficult.

Deadlift: 600 at time of 425/365 sq/bench, dipped down significantly in the following months, lost my groove for a while, in the past couple months I have done 445x10 and 450x9.

Military press: have had 1rm of at least 225 past year or two, 6-8 months ago i hit 245 and was very close to 250. About a month ago 205x8, last week 185x7 was difficult.

Now, reading that, it could seem I’m just burnt out. I follow 5/3/1 and Deload every 7th week.

Now, after some significant internet searching for a Doctor, I found a urologist that “specializes” in HRT that was highly recommended. I set up an appointment for consult/labs. While the doc seemed open minded and receptive, I’m on the fence as to how much he really knows, or perhaps his normal clientele for this is usually older. Anyhow, I explained to him how I had been feeling for the past year or so, and that I suspected either high cortisol levels or low T, perhaps a combination. This is where things took a turn that I wasn’t thrilled with. He sent me home with a self-test kit for Cortisol (saliva 4x) and Total Testosterone (blood spot). A friend of mine on TRT said that seemed lazy and the doc could have done it himself, but I digress.

From some reading on here I knew that Estradiol level would be another helpful figure in this search, so I added that to the blood test.

I’ve just gotten the results faxed to me and immediately wanted to rip someone’s face off, as it appeared a mistake was made, as my results were showing Cortisol, Estradiol, and PROGESTERONE levels! No T!

I called the doc and they verified that they had no other results, called the lab and they admitted their error and said the blood was still viable and they would get on it, and that I would receive the results Wednesday or Thursday this week. While it frustrates me, I have a follow up with the doc on Friday so at least I should have the T result by then.

But the results confuse me a bit:

Cortisol saliva test
morning: 2.5 range: 3.7-9.5ng/mL
noon: 1.7 range: 1.2-3.0ng/mL
evening: 2.1 range: 0.6-1.9ng/mL
night: 1.4 range: 0.4-1.0ng/mL

This doesn’t surprise me, as I almost always have a hard time getting out of bed, preceded by usually a tough time falling asleep.

Estradiol blood spot
result: 22 range 12-56pg/mL

So I guess that’s good?

Progesterone blood spot
result: 2.0 range <0.1-0.8ng/mL

This one, although not requested, confuses me. The conclusion of this test says usually due to progesterone supplementation or exposure to a partner using topical progesterone. Neither of these apply in my case. I am confused about the cause and effect of this raised level.

Lastly, it seems as though the doctor I’ve seen may only do Testopel (if it comes down to that), which I am not sure I’m a fan of. It seems the best results are had with something like 100mg Test Cyp/week split into two injections, with possible inclusion of HCG and Anti-E. Between the two, if it’s determined that’s what I need, I’d much rather the injections, but I guess that’s a bridge I will have to cross when I get to it.

Another thing the doctor said was that at my age, and with kids in mind, Test would be the last thing he would do. So I asked him what the first thing he would do was and he said. HCG injections, as a stand-alone treatment. Through some google searching, it seems some have had success with that, but it’s a real mixed bag. Additionally, I have read a lot that HCG is given along with the Test Cyp for the very reason of keeping the testes going strong, so if that’s the case, why couldn’t I just have the T Cyp and. HCG?

Hopefully someone can look at this all and provide some sort of feedback on the few labs that I have posted. I will update with the T # as soon as I get the results.

2

Research adrenal fatigue. Your cortisol is too low in the AM which is giving you hard time getting up in the morning. Not surprisingly your evening cortisol is above range, keeping you up at night. Do you feel like you have more energy and more alert in the evening? This requires lifestyle changes to correct, diet, stress management, sleep, overtraining, etc.

Did you read the thyroid sticky by KSMan? Could be attributing factor. Read it and observe your body temperatures. Could be combination of sluggish thyroid and adrenal burnout.

3

I haven’t read that sticky, I will take a look at it now, thanks.

As far as feeling more alert at night…I believe that I used to feel this way. Lately at night a lot of times my body feels crushed, like I am so exhausted, which doesn’t have me feeling very alert. I do have the racing thoughts at night which often makes it difficult to sleep, and I am probably hyper-sensitive to noise at this time.

It sucks, but on worknights 6-6.5hrs is the most sleep I can manage- get home, eat dinner, get baby to bed at 8, then shower and try to unwind a little, lights out at 10. While it would be wonderful in theory to have lights out at 9, and possibly get 7-7.5hrs sleep, I know it doesn’t work for me. After moving all day, I need some time to feel myself sitting still, relaxing.

4

You don’t know if your T is low. If it is, you MUST have LH/FSH tested before you do anything to increase your T levels.

Read these stickies:

  • advice for new guys - great basic and advanced info
  • finding a TRT doc
  • thyroid basics
    – note that many of the symptoms of functional hypothyroidism are the same as low testosterone.
    – VERY IMPORTANT THAT YOU EVAL YOUR IODINE INTAKE AND CHECK YOUR BODY TEMPERATURES
5

KSMan,

I have read all of those stickies at least once, I admit even at the “101” level it gets to be a lot of info and goes over my head- but I will try to digest what pertains specifically to LH/FSH. I am aware, in basic terms, that both are released from the pituitary gland to stimulate the testes and produce T.

As far as iodine intake, I have no real idea how I would track that or figure it out. I read the sticky earlier, and I understand that using iodized salt at home wouldn’t be enough for those that are deficient. Iodized salt is what I use at home, when using salt. This is always added to my eggs, sometimes dinner, etc. However, that may be my only source as I don’t supplement with it or anything like that. Having said that, this morning I did take my temperature and it was 98.2. That was about an hour after I woke up, so perhaps not very accurate, but I will continue to check. I am skeptical that I will find low body temperatures in myself though, as it is pretty rare for me to be cold, I’m usually the one that’s hot in the room while everyone else is comfortable. But, I will check.

Thanks.

6

got the total T results today: 401, range of 400-1200mg/mL

(I’m assuming on those units as it was told to me over the phone and she didn’t say the units of measure).

7

E2=22 is good, with higher T levels. With TT=401 and FT unknown, you are estrogen dominant to some degree.

So:
Cortisol profile is not good
T is low
Thyroid? - more temperature data?

Low T does not explain: " Lately at night a lot of times my body feels crushed, like I am so exhausted, which doesn’t have me feeling very alert. "

I think that it is safe to say that you metabolism is messed up. You need to address low T, possible thyroid/iodine issues and cortisol/stress.
You will need a doctor who knows how to address these issues.

Need CBC with fasting cholesterol and fasting glucose.
Any thyroid issues in the family?
Any diabetes in the family?
How are others doing in your home? They are eating the same diet as you?
Are you eating a lot of fast food?

Any panic attacks?
Want to fall asleep after meals?

I was very sensitive to noise before my TRT and then also getting E2=37–>22

In the advice for new guys sticky, use control F [Cntl F, ^F] and look for content related stress

8

LH was 6.4 range was 1.4 - 9 (9 something, don’t remember exact)
FSH was 5.8 range was 1.5-18

For body temps I was getting 97-97.6, 98.1 once, but I was also sick for a day and figured that could
interfere. then my wife told me that her doctor said those little thermeters can be off by as much as 2 degrees, so for the time
being I found it kind of pointless. Averaging what I was getting, if I assumed it was accurate, would’ve been slightly below 98.

my mother does have thyroid issues and is currently on synthroid. with my
mother though, bad eating habits and always needing to be thin, I’d guess her thyroid issues are more self induced than anything- but again, that’s just my observation.

the comment I made about being tired at night but often unable to sleep/sleep well was meant to be about the high cortisol level at night, not the low T.

the good news: Doc said he did not expect my T level to be as low as it was and that he wanted to get it up to at least 700 or so. he said he would like to start me on HCG. I explained to him that I had been doing a lot of reading (mostly here) and that it seems a lot are having success with 100mg Test C/week along with HCG. he agreed that it would be a great plan and we could give it a try.

so I have Test C and HCG en route to me, I am hoping it arrives by Wednesday or so as I am anxious to get feeling better.

I did not ask for an anti-E just yet because I am getting labs done 4-5 weeks after I start and I want to see what happens with the E2 over the first month. if it remains at 22 (maybe unlikely) then maybe we will leave it alone until it starts going up. if it’s up from the first month I will ask about arimidex. he’s been pretty good so far, contrary to my expectation he did not try to push the pellets although he prefers them- so I don’t think he would fight me on an anti-E. if he disagreed however, i would track down the research chems.

anyway, that’s where I’m at. I know I don’t have ALL of the labs done, but to me is seems like enough to get started.

I picked up 2 out of the 3 syringes he prescribed, had a very hard time finding those 3. he said 18, 22, and 27- all 1cc. the 27 he said to use for the HCG, subQ in the love handle area.

for the T he said to draw it up with the 18, then put the 22 needle on it to inject. I told him I was interested in doing 50mg twice a week subQ but he said it wasn’t necessary and I could just do the 100mg at once IM. I could do either, but with the needles I have, once a week IM would be easier. still trying to research if there’s a real difference. I know around here 50mg subQ is the choice. the problem is, I don’t know if I can get the 18’s, and if I have to use the 22 to pull it in and inject, the 22 is a 3cc syringe and doesn’t have the smaller markings of the 1cc- I would have to eyeball 50mg. with the Test being 200mg/mL, that’s .25mL per shot, so eyeballing between the .2 and .3 lines. not the end of the world, I know.

thanks

9

Those syringes are a waste of time and blood. Also do not need the scaring.

Read the protocol for injections sticky.
Get 0.5ml 1/2" #29 insulin syringes, 100 for $14 at Sam’s or Walmart, ReLion house brand.
Use these for injecting T cyp and hCG [not in same syringe]

10

I’ve read it, which is the reason I was conflicted. Doc saying one thing, sticky saying another- seemingly popular opinion. I’ll follow the sticky. Thanks so much for everything you’re doing here.

11

After reading some of the “Protocol for injections” sticky again, I’ve placed an order for Anastrozole. Assuming a concentration of 1mg/ml, as it seems that is common, then the price for a 30ml bottle was too cheap to not be proactive with it. Little hiccup with the HCG not being covered by my insurance, or at least hard to get it to go through- in the interest of time I’ve gone back through the doc for that and should have it next week.

12

so I’m on week 3 and I have sore nipples.

I now have Test cyp, HCG, and anastrozole- I did not have all of this from the start, so here is what I’ve done so far:

Mon Oct 6 inject 200mg Test Cyp…(read about a heavier first “loading dose”)
Sun Oct 12 inject 50mg Test Cyp…(switched to subQ 2x, sun/wed works best)
Wed Oct 15 inject 50mg Test Cyp
Fri Oct 17 .25mg Anastrozole orally
Sun Oct 19 inject 50 mg Test Cyp
.25mg Anastrozole orally
Tues Oct 21 inject 250iu HCG
.25mg Anastrozole orally
Wed Oct 22 inject 50mg Test Cyp
Thurs Oct 23 inject 250iu HCG
.50mg Anastrozole orally (worrying about the nipples)
Friday Oct 24 .25mg anastrozole (more worrying)
Sat Oct 25 inject 250iu HCG

aside from the nipple issue, the schedule above is a little screwed because I wanted to start the HCG and anastrozole as soon as I got them. I would like to come up with a better schedule that is easier to remember such as HCG and Anastrozole m/w/f at 300-350mg?

thanks for help

13

also-

im injecting the HCG subQ in the lovehandle area, and it is uncomfortable. I don’t know if the skin is “thicker” there or what, but it’s a bit of a pinch before the needle breaks in. does it matter where I inject this? can I use the thighs just as I’m doing the Test? I can’t imagine there’s something magically about the lovehandle area.

thanks

14

Makes no difference.

15

Your schedule is a pain:

This is what I and some others do to accommodate hCG EOD.

Inject T and hCG EOD at the same time and also take anastrozole at the same time.

or

hCG and anastrozole EOD and take T every other EOD at the same time [E4D].

Its really whatever works best for you.

Some find that belly fat injections create lumps and legs do not. Some vice-versa. So experiment.

16

Thanks.

Any advice on the nipple soreness?

17

Nips: That is from increased estrogens. You probably need an aromatase inhibitor. You could also use some Nolvadex with the AI for a short time. Your nips and breast tissue will also be sensitive to transients so can over-react at first. If you probe your chest firmly with finger tips, do you feel structures like grains of rice [breast tissue]?

The longer half life of anastrozole means that it takes 6-7 days for a given dose to reach final serum levels. So you can’t be making little short term adjustments.

Anastrozole needs to match T levels and you are paying for "Mon Oct 6 inject 200mg Test Cyp…(read about a heavier first “loading dose”) "

Is that Rx anastrozole or RC?

Suggest that you stick to 100mg T per week and 1mg anastrozole per week and let things get settled. Then see whats happening and maybe do labs after 3 weeks.

18

ok, that makes sense about the Anastrozole levels needing to build up and reacting to that first 200mg dose.

I do not feel “grains of rice”.

I will continue 100mg Test and .25mg of Anastrozole (and HCG 250iu) EOD.

I was going to get labs next week but I can push to the following week.

19

KSMan,

I’m kinda freakin out now, and I need help.

Following your response, I tried to calm down and stick to the protocol, that lasted a few days and the nips seem to be getting worse. My anastrozole is RC, btw.

So, I did the math and saw that dosing .25mg EOD yielded .875mg/wk averaged over 2 weeks. .5 EOD yielded 1.75/wk. So, in a panic I have done the last three doses at .5mg.

Now, the nips haven’t improved, they are puffy, sore, etc. I ordered Tamoxifen (RC), it arrived today, and I took first dose of 20mg.

Also today, I noticed my joints aching, and I’ve been tired the last couple days- seems to me I have driven the E2 too low, but if that is true I don’t understand what’s going on with my nipples.

Doc wanted blood so I got drawn yesterday and have a follow up for results Friday morning. I want to go in there with ideas of how I should proceed if the T is too high or low, and same with E2.

I’m hoping this tamoxifen takes care of the nipples, but assuming it does, will it just come right back after I stop the tamoxifen?

I am conceding that I should’ve stuck with the .25mg anastrozole as you suggested, and will go back to that at this point, but I’m just very worried about these nipples.

Please help, I’m freaking out here.

For what it’s worth, these are the tests doc ordered:
Test- total, serum, free
Estradiol, ultra sensitive (I believe I’ve read sensitive is better, hopefully we can work with this)
LH and FSH (not sure why, perhaps misunderstanding)
SHBH

20

Estradiol, ultra sensitive: this is lab specific, you need to know what lab is involved for such “recommendations”

LH/SFH: on TRT, both should be zero. If FSH is not, can be indicating a FSH secreting testicular tumor.

Your serum anastrozole levels and E2 levels were moving so you will not get numbers that indicate E2 levels for any steady anastrozole dose, so labs will not allow for a calculate dose correction.