T Nation

Started TRT, First Results are Back, Need Advice

I got my labs tested at 4 weeks into TRT, protocol has been:

  • Test Cyp @ 50mg 2x per week
  • HCG @ 350iu 3x per week
  • Anastrozole @ 0.25 3x per week.

Aside from low E2 (based on non-sensitive E2 test, the sensitve E2 test is pending results, should be back sometime next wee), my results show anemia, which I have an history of Iron Deficient Anemia. I will be seeing a hematologist again for iron infusions in the near future.

Based on the non-sensitive E2 test being so low its undetected, is it safe to say I should drop my AI at least until my next labs in about 4 weeks?

Also, it seems my free and bioavailable test are in a good spot, is this the case?

I am still extremely fatigued, and without libido, probably because of the Anemia and E2, so my bigger question is, should I stop TRT until i get the anemia sorted out, could TRT be hurting me, or is it only helping me at this point?

New Labs:

Previous labs before TRT:
Total T LC/MS/MS: 271 (250 - 1100)
Free T: 29.1 (46 - 224)
Bioavailable T: 53.6 (110 - 575)
SHBG: 41(10-50)
FSH: 2.5 (1.6-8)
LH: 1.7 (1.5 - 9.3)
E2 (non-sensitive): 29pg/mL (<=39 is OK)
Hemoglobin: 12.2 (13.2 - 17.1)
Hematocrit: 37.8 (38-50)

Males typically need to avoid added iron because they hoard iron. In a case like this we need to know if not aborbing iron or loosing it. Please get an occult blood test to detect any blood in your poop from a GI bleed. Treat this as important, your blood-iron labs are a strong symptom. While RBC can be down with low-T, your numbers strongly exceed that. We also expect TRT to improve RBC and HTC, after 4 weeks, there is no evidence of that.

Ask if you can get T dose increased 50% to 75mg 2x per week

E2 < 5 is bad. Lets assume now that you are an anastrozole over-responder. Stop anastrozole for 5-6 days to allow to wash out, note how you feel as E2 increases. Then resume taking 1/8th mg at time of injections. Do manage small doses, dissolve anastrozole 1mg/ml inn vodka and dispense by volume or by drops. A graduated dropper bottle is good.

Always to labs halfway between injections so changes are not lab timing artifacts. Doing labs at doctor office visits may not be workable.

LH/FSH should not be tested again on TRT as they -->zero.

TSH=3.18 is horrible. Thyroid lab ranges are useless.TSH should be closer to 1.0
TSH may be elevated by not using iodized salt. Please see last paragraph in this post to self-eval overall thyroid function.

Please find 5000iu Vit-D3, tiny oil based capsules. Take 5000iu per day and do not take with high fiber foods. Take 25,000 for first few days.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


Greatly appreciate your quick response.

Regarding GI issues, I have quite a few :slight_smile: I have chrons/Ulcerative Colitis, with a full-colectomy to a j-pouch, which means they stretched out my small intestine to form a makeshift colon. This can cause mal-absorption. In addition to mal-absorption, I have been having some slight inflammation of this j-pouch, known as pouchitis, but recently it seemed to be under control, and the hematologist and surgeon say my low iron is probably a combo of both. I’ve had low iron issues for about 4 years now, resulting in a iron infusion once a year, but my last infusion was only 7 months ago, so looks like whatever is causing it is accelerating the iron issue.

Any thoughts on this?

Also, after the results came back, I started doing subq test cyp injections, does the 75mg 2x per week still apply?

Please clarify.

I can see why your iron is low. You probably have multiple deficiencies. But still good to see if GI bleed contributing.

Any leg or foot cramps? That would be a lack of magnesium.

Do you take a good multi-vit with trace elements including iodine+selenium? In this case, find one that does have added iron which means not a men’s formula.

And cholesterol is getting too low, 180 is ideal, <160 causes problems as there is an association with increased all-cause mortality.

Have you ever had B-12 tested?

All cause mortality, this sounds scary :(. How does one raise his cholesterol?

No leg or foot cramps that come to mind, but I’ll keep a better eye out

I do not take a multi vitamin, anyone you recommend? Oral iron wrecks havoc on my GI Tract (whats left of it), which is why I go for the infusions.

I have not had b12 tested any time recently, I’ll add that to my next labs.

Anything else that I can provide?

You should look for a high potency B-complex multi-vit with a good complement of trace elements. Most ?all? enzymes have a metal atom in the reaction site that enables the catalytic actions. You can look at the ingredients here: lifeextension.com/Vitamins-Supplements/item02114/Two-Per-Day-Capsules as a reference for a good product. There are other products that are similar, but many products are simply not very good.

Some iron products do not have the classic GI problems, constipation. But that may never be your problem. [My mom died 53YO and had no lower intestine, and lost some upper. I think that she died of malnutrition and medicine awareness of nutrition simply was lacking in the early 1970’s.]

My compound hCG has B12 in it. Doc wrote labs for B-12 and it was very high and he was surprised and then I told him it was nuts to have even tested it. Maybe hCG+b12 would be useful for you.

Cholesterol: Can you tolerate more bacon, eggs and animal fats?

Jesus, KSman. You are scaring the shit out of me.

What do you recommend my next steps be? I assume I should probably take some pretty swift action, as I feel like complete shit, and have never really felt this bad before (with the exception of GI pain/GI symptoms). What Dr’s do I need to make appointments with?

I’m physically exhausted after waking up in the morning and could sleep all day.I made my final decision to go on TRT at 28 y/o based on how awful I felt, thinking it would help, but I don’t think low-t is the driving force of me feeling like shit.

Edit: just ordered the multi you linked to. Will be here Monday. :). Any oral thermometer should do?

What to do? There is a need to try to understand what nutritional steps are needed to compensate for your condition. Not so scary.

Thyroid can be a huge factor. Go for the low hanging fruit and post those body temps I suggested above.

What type of oral iron supplements have you tried?

Not exactly sure of the brand, the pharmacist ordered it for me. Pills were red I believe. It caused some serious damage to my pouch though, so oral is definitely a no go, the infusions should provide the same , if not better relief right? Or am I missing something by not taking oral?

Oral iron is low cost.
“NOW” brand makes an iron complex.

Vit C
Iron bisglycinate
other stuff

That form of iron is highly bio-available and non-constipating.
So worth a try. We had it here because my wife was getting anemic [HTC=32] from heavy bleeding caused by fibroids. She since has had the lining of her uterus removed and the fibroids, so she does not need added iron. She did not have any of the classic issues from taking large amounts of iron with this form.

97.4 degrees in the morning before getting out of bed

What iodine supplement do you recommend, whatever you recommend I will try to get? Keep in mind I began taking the two a day vitamins you recommended, which contains 150mcg of iodine per serving (serving size is two capsules)

That is a good maintenance dose, but often not enough to dig out of the hole when iodine stores are low. Have you read the thyroid basics sticky where this is discussed?

Is there a brand of IR that you recommend?

The most widely available large dose iodine in tablet form is Iodoral. There are some others that are essentially the same, but not that I can direct you to.

See amazon.com/OPTIMOX-Iodoral-Potency-Potassium-Supplement then see what alternate products might be displayed lower on this page and see what potencys and values are there.

With high dose IR, selenium warnings are stronger, you must have selenium.

Been on test cyp+ hCG for 12 weeks now, with the below results taken at the 11 week mark. 7 weeks before this test my E2 was completely crashed (<2 on sensitive test) so I went off Anastrozole completely. The reason for the lack of other testing is because I got these labs ordered from my Hematologist with other labs. My full workup by my urologist will be done next week.

I’m worried my E2 levels at 38 will lead to gyno. My doctor thinks I’m doing just fine and doesn’t recommend an AI with these levels.

Also, at 8 weeks with my current dose, do you think the 38 E2 levels is stabilized?

I’m thinking of lowering my dose from 140mg of Test Cyp per week to 120mg per week (in divided doses 3.5 days apart). Thoughts on that?

Also, regarding my anemia. I completed my iron infusions 3 weeks ago, and got my CBC and Ferritin taken. Looks like things are on the up and up there, still a little ways to go with the Hemoglobin.

Current dose (new labs - 7 weeks) 140mg Test Cyp per week and 1050iu hCG per week, all in divided doses (Subq Test Cyp E3.5D, Subq HCG 3x per week)

Previous dose (older labs 4 weeks): 100mg test cyp, 1050iu hCG, .25mg Anastrozole per week, all in divided doses (IM Test Cyp E3.5D, Subq HCG 3x per week)

All labs taken at the trough of a E3.5D regimen
New labs: https://imgur.com/a/6qkFE
Old labs (had another sensitive e2 test taken right after this that showed <2): https://imgur.com/a/0eaWr

Iron etc: Ferritin is very low, need >60-80 to support thyroid T4–>T3 generation. HTC still very low. RBC looks OK, but the cells do not have much hemoglobin. TRT is not fixing this!

Occult blood test needed!

E2=38pg/ml is horrible. This will impact anabolic effects, libido, energy, sexual performance, mood/depression, intolerance and fat amounts/patterns, gyno risk and possible bloating. But your E2 is normal, be happy. Another doctor who does not know the meaning of “normal” range.

Thanks for the information.

My ferritin should still be increasing from the infusions I had correct? Or is this fully representative of those infusions? I see my Hematologist on Friday, and he’s pretty legit, so I hope he knows what to do. He said I may need a 3rd infusion to top me off depending on results.

Regarding the E2, what do you recommend I do? Lower test cyp dose from 140 to 120, or go on low dose Anastrozole?

Also, I assume my test levels are Ok?

Do 140mg with anastrozole.

You are missing the point that you may have blood and iron loss from a gastrointestinal bleed. What do I need to do to make you follow up on that?

I’m confused, as im well aware of the GI bleed, as I have Chrohns disease (for 15 years) mentioned in my previous posts above, which is being managed separately. A GI is very much involved. Not much more I can do about a disease that I have.

Also, is there a dose of Anastrozole that you recommend? 0.25mg E3.5D crashed my E2 to <2