T Nation

Starting HRT - Low T

52 year old male
5’11
190 lbs.
33 in. waist
22% body fat
hairy but waxed regularly
moderate beard
balding, shaved head
BP 130/70
I recently went to an Age Management doc. I am including my labs in the body of this post.
He established the following protocol:
1cc test cyp 210 mg once a week IM with 23 gauge x 1.5 needle
1 tamoxifen 20 mg tab 4x’s per week
1 anastrazole 1mg tax 2x’s per week
all the above for 10 week cycle
Week 11 alternate tamoxifen and anastrazole for 6 days
Week 12 alternate tamoxifen and anastrazole for 6 days in addition
1200 units HCG and 1 55mg clomiphene capsule for 10 days beginning week 12

TESTOSTERONE, TOT.,S. 738.7 193.0-740.0 ng/dL
SEX HORM.BIND.GLOB. 72 HI 10-57 nmol/L
TESTOSTERONE, FREE, SERUM 4.76 3.84-34.17 pg/mL
% FREE TESTOSTERONE 0.6 LO 2.0-4.8 %
LH 4.0 1.7-8.6 mIU/mL
FSH 11.1 1.5-12.4 mIU/mL
ESTRADIOL 20.37 7.63-42.60 pg/mL
IGF-I (SOMATOMEDIN-C) 118 81-238 ng/mL

Total Protein 7.3 5.9-8.4 g/dL
Albumin 4.5 3.5-5.2 g/dL
Globulin 2.8 1.7-3.7 g/dL
A/G Ratio 1.6 1.1-2.9
Glucose 99 70-99 mg/dL
Sodium 138 133-145 mmol/L
Potassium 4.7 3.3-5.3 mmol/L
Chloride 101 96-108 mmol/L
CO2 30 HI 22-29 mmol/L
BUN 12 6-20 mg/dL
Creatinine 0.96 0.90-1.30 mg/dL
e-GFR 82 >60 mL/min
e-GFR, African American 99 >60 mL/min
BUN/Creat Ratio 12.5 10.0-28.0
Calcium 9.4 8.6-10.2 mg/dL
Bilirubin, Total 0.3 0.1-1.0 mg/dL
Alk Phos 78 40-156 U/L
AST 35 <40 U/L
ALT 48 HI <41 U/L
-* CARDIOVASCULAR/LIPIDS
Cholesterol 211 HI <200 mg/dL
Triglycerides 206 HI <150 mg/dL
HDL CHOL., DIRECT 45 >40
HDL as % of Cholesterol 21 >14 %
Evaluation: AVERAGE RISK
Chol/HDL Ratio 4.7 <7.4
Evaluation: AVERAGE RISK
LDL/HDL Ratio 2.78 <3.56
LDL Cholesterol 125 HI <100 mg/dL
VLDL, CALCULATED 41 HI 7-32 mg/dL
------
HEMATOLOGY --------
WBC 5.43 3.40-11.80 x10(3)/uL
RBC 4.61 4.20-5.90 x10(6)/uL
HGB 14.4 12.3-17.0 gm/dL
HCT 42.1 39.3-52.5 %
MCV 91.3 80.0-100.0 fL
MCH 31.2 25.0-34.1 pg
MCHC 34.2 29.0-35.0 gm/dL
RDW 13.5 10.9-16.9 %
POLYS 54.2 36.0-78.0 %
LYMPHS 30.0 12.0-48.0 %
MONOS 8.5 0.0-13.0 %
EOS 6.4 0.0-8.0 %
BASOS 0.7 0.0-2.0 %
IMMATURE GRANULOCYTES 0.2 0.0-1.6 %
Platelet Count 129 LO 144-400 x10(3)/uL
MPV 10.2 8.2-11.9 fL
-----
MISCELLANEOUS *------
TSH 3.950 0.270-4.200 uIU/mL
PSA 3rd. GEN. 0.48 <4.00 ng/mL

Any input would be greatly appreciated!!

What were you taking for those labs?

You may have a thyroid problem

  • read the thyroid basics sticky and come back with iodine and body temp info

Read the advice for new guys sticky and come back with more info about you, including when things started to go wrong and what else was involved.

What are your OTC and Rx drugs?

Liver is showing some issues that might be related to estrogens.

Cycle? What happens afterwards?
Your protocol is very weird in a bad way, read the protocol for injections sticky.

I have not started on my protocol yet.
my labs were done first thing in the morning after a 12 hour fast.
i am not on any Rx drugs but do take OTC antihistamines.
I was diagnosed as a carrier for HepB approx. 25 years ago. My PCP monitors my levels. My viral load is undetectable and am not under any meds for it.
i use iodized salt in my diet as i do 99% of my own meal prep. I read the thyroid sticky last night. My body temp this morning was slightly under 98.6 and was right on 98.6 about 1 hour ago.
I started to notice my diminished sex drive approx 6 months ago. I do not experience morning wood. I would have to guess this has been going on for about 6 mos. as well. I would exercise regularly ( 3 days a week with weight and 2 days biking) nothing major in the way of exercising but i did stay active. Past 8 mos. or so, i have had zero desire to exercise. Have had a hard time getting thru my workouts.
Let me clarify my protocol
My test and ancillary drugs come from a compounding pharmacy.
i am scheduled to be on 1cc of 210mg test cyp IM every 7 days along with alternating days of tamoxifen and anastrazole for 10 weeks
weel 11 is just tamoxifen and anastrazole for 6 days
the HCG kicks in week 12

What!!! This is insane :frowning: new clinic please lol… If I were you I wouldn’t start any protocol!! You almost positively have a thyroid problem …where do you carry body fat? What time were these labs done? Are you stressed and tired a lot? Does it take you a long time to wake up? Are you more awake at night and up till two am? Do you sleep through the night? Are you up in the middle of the night having to urinate or urinating frequently? Excessive thirst?

Even being new to all this, I am very apprehensive about starting with this amount of drugs. Can you be more specific in you opinion. I really appreciate some guidance!!

body fat concentrated on waistline, slight belly and love handles

labs done 9 am after a 12 hour fast

definitely stressed and tired alot. I drink alot of water as a dietary aid as much as a 1/2 gallon a day. I usually drink most of my water in the evening, so i do get up from time to time during the night to urinate. i would not consider it frequent

http://www.youtube.com/watch?v=uP0rsxGeeCs just a thought… this one may be better for ya

other thoughts :)…Prediabetes

Increased glucose levels may fall short of the diabetes diagnosis, but can still cause harm; this condition is referred to as prediabetes. When an increase of insulin occurs, triglycerides in the bloodstream increase, causing damage to blood vessels and arteries. According to the American Diabetes Association, 79 million Americans have prediabetes. The ADA says a healthy diet and exercise routine can delay or prevent type 2 diabetes. People who are age 45 or older, overweight or have high blood pressure, high LDL cholesterol or low HDL cholesterol or have a family history of diabetes should be checked for prediabete

I also found this very informative… take note… I am just a regular guy with his own struggles and I am trying to learn myself

Metabolic Syndrome

A combination of high cholesterol, insulin resistance, high blood pressure and excessive abdominal fat, more than 35 inches for women and 40 inches for men, is a condition referred to as metabolic syndrome, which increases your risk of heart disease, diabetes and stroke. Having just one of these metabolic conditions puts you at a higher risk for having any of the others. Symptoms for these conditions usually go unnoticed; see your physician for a thorough evaluation to determine your health risk. Fortunately, a change in lifestyle habits can reduce your risk for serious conditions and may even prevent them.

Thanks! Going to see my PCP for physical in 2 weeks. Will discuss all the above with him. In hindsight, I should have been more aware, being a jaded NYer and all lol
I have been dealing with the Vitality Mgmt team from the Age doc’s office. Should have been a red flag!
Now I’m stuck with all this, but Thank you!

I would focus on getting a full set of labs:http://www.lef.org/Vitamins-Supplements/ItemLC100010/Male-Comprehensive-Hormone-Panel-Blood-Test.html?source=search&key=hormone%20panel

you need a thyroid panel:http://www.lef.org/Vitamins-Supplements/ItemLC100018/Comprehensive-Thyroid-Panel-Blood-Test.html?source=search&key=thyroid%20panel

who is your Doc? DR.Gordon?
ksman asked you what you were on for that lab work?

[quote]KSman wrote:
What were you taking for those labs?

You may have a thyroid problem

  • read the thyroid basics sticky and come back with iodine and body temp info

Read the advice for new guys sticky and come back with more info about you, including when things started to go wrong and what else was involved.

What are your OTC and Rx drugs?

Liver is showing some issues that might be related to estrogens.

pay attention to this^^ edit your profile using the edit feature…

Cycle? What happens afterwards?
Your protocol is very weird in a bad way, read the protocol for injections sticky.
[/quote]

I don’t understand, I wasn’t on anything when I took those labs. I had taken a zantac more than 24 hours before and a zyrtec in the morning the day before my labs.
Went to see Dr. Ruttner @ NY Vitality HRt

Your testosterone is almost at the peak of those ranges… free testosterone is low but shbg is very high which makes sense. like i said I know nothing but I would think you would need a very high dose of testosterone to bring your free testosterone up… suggest taking good care of that liver…

I have doubled the dose of milk thistle and it seems to have lowered my liver enzymes if that helps me or not i have no idea lol. Have you had an ultrasound done on the liver? Do you drink? I don’t think anyone knows how to lower shbg but before even considering trt fix the thyroid and possible adrenal issues… the good thing is you are in the states and can order your blood work without fighting for it!! I can’t :(…

That protocol is crazy and i’ve never heard of anything like it… I don’t understand why he would introduce T in the first place if the plan was to take you off? seems like a science experiment…

From my conversations first with the doc and then with the “management” team, i was assured that the dosages and frequency was what was needed to raise my free test. I told them of my concerns regarding the protocol they outlined.

The plan was to run in 13 week "cycles’ for lack of a better term. levels checked every 5 weeks to monitor all necessary functions and any adjustments would be made to dosage and frequency.

I am starting to think that I have gotten involved in a “testosterone mill”.
You have certainly opened my eyes and plan on having an in depth visit with my PCP.
Thanks for your observations! I will keep you posted.