T Nation

Thoughts on Pre-TRT Bloodwork

Hey guys, first time poster here and I’ve been very impressed with this sub-forum for awhile. I’m 33 years old and have been lifting for around 16 years. I weigh around 215 lbs @ ~15% bodyfat $ ~34" waist. I’m italian and have always had a decent amount of body hair, but it seems of late that it does not grow as quickly and coarse as it used to. I can grow a full beard quite easily, but I feel that my beard is growing slower lately as well. I don’t carry much fat, but I’d say it’s mostly in my midsection and butt. I also feel that my testicles are somewhat smaller than they used to be. I rarely get morning wood anymore and very rarely to a wake up with a hard on. I’d say my sex drive has decreased the past year as well.

I just started taking Vitamin D3, Vitamin K2, and fish oils recently. I was near deficient in Vitamin D, but that number came up quickly with the above supplementation. I just take allergy meds occasionally. I do use Nizoral “ketoconazole” shampoo once a week. But, I’ve used that on and off for a long time. I work odd hours and my diet isn’t the greatest. Lots of fast food, sugars and protein. I try to stick to water, but occasionally drink pop.

I focus more on powerlifting, but like to maintain an aesthetic physique too. I follow a 5/3/1 routine for the past few years: 4 days a week. My 1RM’s are as follows: Squat: ~600 (Single Ply Wraps + Belt), Deadlift: 550, & Bench 370.

For around the past year, I’ve noticed my energy levels and just general motivation have decreased. Thanks to caffeine and the occasional combo w/ ephedra, I’ve been able to stick to my training routine and actually gain on it. It should be noted that a somewhat recent LGD-4033 cycle contributed slightly to some of my recent strength gains, but I had been gaining strenght before then as well. I did a proper pct w/ clomid and am around 3 months past my PCT. I recalled seeing numerous people online complain of lethargy while on LGD, but I didn’t seem to notice a difference.

Around 3 weeks ago, I finally had a routine checkup with my doctor and actually had my first physical in about 10 years. The doctor did a routine prostate exam and thought that my prostate seemed large for my age. I told my doctor how I had been feeling and requested bloodwork. The results of my 2/25/16 bloodwork:

Total T: 355 ng/dl (Range 348 - 1197)
Free T: 8.4 pg/ml (8.7 - 25.1)

Unfortunately, the Dr. did not order up E2 or SHGB in those tests. I was actually somewhat shocked to hear the numbers, because I always felt like I used to have high testosterone. The last time I actually had it checked was around 7 years ago and I think it was in the 800 range. Anyway, I decided to get my bloodwork drawn again around 2 weeks later. I had to talk the Dr. into checking my E2, SHGB, and Prostate Specific Androgen (PSA) levels. I told the Dr. that I saw some research that indicated high estrogen could cause the prostate to enlarge. The results from my latest bloodwork results were given to me over the phone earlier today:

Total T: 252 ng/dl
Free T: 5.6
PSA : 0
E2: 174 !!
SHGB: 28.7
LH and FSH: Within normal limits (I’ll get the results mailed to me)

Holy shit!! I don’t think I’ve ever seen anyone post bloodwork with an estrogen level that high. I definitely could be wrong, but fuck that’s high! So, I have a horrible T to E ratio and it’s no wonder that I feel like shit. My question is though – how the fuck did I gain strength the past year with these numbers? I could understand the LGD helping, but that only put on around 30-40 lbs on my big lifts tops.

I told the nurse that I wanted a followup appointment in a week and she said the Dr. would discuss putting me on TRT. Obviously I’m going to request Arimidex, Hcg, and Test Injections; hopefully get a good starting dose of Test Cyp. I’m just worried that my Dr. doesn’t know what she’s doing and will try to put me on creams and other BS first. Ideally, I’d like to be able to pin myself every 3.5 days, but realize that’ll probably be a tough sell at first.

I just can’t wrap my head around those number and just want some feedback from some of you vets on here about these numbers. Has anyone ever had estrogen levels this high? If so, how did you feel? I’ve read posts around the web with numbers better than mine and some of these guys have felt borderline suicidal. I don’t feel great by any means, but I don’t feel like my life is over or anything. I looked up the symptoms of high estrogen and I feel like I have every symptom. I just can’t wait to see how I will feel on TRT, considering I’m apparently used to the brain fog I have now.


At your age, prolactin is another possible factor.

E2 is created by fT–>E2. E2 levels are a balance of E2 creation and E2 clearance.

As your FT is very low, I suspect that your liver is not clearing E2 properly.

You need to test AST/ALT which can detect some liver problems.

E2 clearance can also be reduced by some drugs/meds that make demands on the same enzyme pathways that clear E2.

Please follow and read these links in 2nd post of 1st forum topic:

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

At your age, low=T is not the disease, it is a symptom.

prolactin if young and LH/FSH are low

You could take an AI now and lower E2, but that only affects the supply side and ignores/masks the problem with impair liver clearance of E2.

Any signs of gyno?

Please list all meds/drugs/supplements, OTC and Rx.

Explain to doc that you train intensely and that you will sweat off transdermals. There is also the issue of the expense of transdermals. If you have a thyroid function problem, you might not be able to absorb transdermals.

Do not ignore the fact that your high E2 can be a symptom of a liver problem. Your doc need to walk that path.

Brain fog can be from low-T and/or high E2. Low thyroid function can also contribute.

If your low-T is from low LH/FSH, you need to consider that that may simply be the normal repression of the HPTA by high E2. If you can fix the low E2 clearance, your T levels could recover.

If you go on TRT, your poor E2 clearance could lead to trouble.

I updated my OP after reading the advice for new guys post and posted more information about myself that could help. I also attached my first blood work results. My ALT was high, so my doc had me do a liver ultrasound. They didn’t find anything abnormal on the ultrasound.

I have a small amount of gyno on one side, which I think I’ve had since puberty. It occasionally flares up. I’ve taken Raloxifene in the past and that always reduces the sensitivity of it and temporarily shrinks it. Lately it has been more sensitive and I haven’t been on any SERMS or AI’s.

I don’t have the exact numbers for my LH/FSH from my 2nd test yet, but the nurse told me on the phone that they were in the normal range. I’m having them mailed to me and will post the blood work when they come.

Thanks for getting back to me. Let me know what you think of my blood work when you get a chance.


Your total proteins were low and I first suspected a GI bleed. But your RBC and hematocrit definitely contratics that.

AST/ALT are fine, consistent with your training level.

In USA, you can order your own labs in most states.

TSH looks good. Please check body temperatures as per the thyroid basics explained link/sticky.
Low thyroid function can promote weight gain, as can low-T

Not worried about total cholesterol, but concerned with HDL.
EFA’s: Fish oil, nuts, flax seed oil/meal
DHEA should be OK at your age - you can test DHEA-S
high potency B-complex multi-vits with trace elements including iodine+selenium
Vit-D3 5000iu

TRT often improves cholesterol.
Were your labs fasting?
Vit-C 1000mg once or twice a day

Raloxifene masks E2 levels, does not lower serum E2 and may increase serum E2.

I was concerned as well. I’ve had poor lipids for awhile, but I’ve actually brought my HDL up from the last few tests. I just started taking the old school flush version of Niacin yesterday. 500mg in morning and night. Took first dose ever at 500 mg yesterday. That was actually kinda fun.

Yes, around 10-11 hours or so.

I’ll add Vitamin C to my routine. Do you happen to know if Vitamin C goes bad? I have a 5 year old bottle laying around somewhere.

Do you think my enlarged prostate could be estrogen related. Since researching the symptoms of BPH, I do recognize that my urine stream isn’t as strong as before. Will my prostate return to normal size once E2 is regulated?

Woke up today and got the reading of 97.2 twice in a row on an oral thermometer.

3:30 P.M. - 97.6

Sorry, that should have been 1000mg vit-C, corrected my post above.
Vit-C is probably stable.

E2 and prostate: No hard data, but mine improved with E2 management and 8 years of TRT. E2 is a known BPH factor.

Increased orgasms can be important for prostate health.

IIRC, my temps have always been in the 97.5 range since I was a kid. Should I start supplementing with Iodoral tabs, 50mg ED and see what happens to my temps?

My temp was 96.5 when I woke up this morning. Worried I might have a thyroid issue now.

You can try 50mg for two weeks, or 25 for four etc.

Does not always work, but at least take iodine deficiency of the table.

You need selenium with IR !!!

Thanks. I just bought Iodoral online tonight. Do you recommend a selenium product and dosage/timing.

Get a good high potency B-complex multi-vit with trace elements, including iodine+selenium.

Good news with some odd happenings, but I saw my doc again today. She initially wanted to put me on androgel, but I talked her into letting me inject myself twice a week at home. Great news! She was unsure on what dosage to put me on and I told her that from what I researched it usually runs 100-200mg per week. She said she would put me on 100mg to start. I was unsure if she meant per injection or for the week. But I figured 200mg a week would give me wiggle room with my dosage. I plan on starting prolly at 100 mg a week. She said she would consider a AI for me based on my upcoming bloodwork. The estrogen number I gave earlier in the post was inaccurate. It was actually for Estrone (E1) not E2, so I have no idea what my E2 level is right now.

So I went to CVS to pick up my testosterone and syringes and found out that my insurance won’t cover the testosterone at that high of a dosage. The CVS lady said the script was written at 1ml 3 times a week. So 600mg / week! Obviously an error. Also, the syringes on the Rx were listed as 20ga 1". Those would be terrible, so I need the doc to correct the prescription and have it be hopefully 100 mg 2x a week and I’ll request smaller needles. Unfortunately, the office was closed and I’ll have to wait till tomorrow to get everything resolved.

I also got my temp taken orally at the dr’s office and it came back at 98.3. Once I got home, I used the same oral thermometer I’ve been using and got 96.3. I think mine is bad and need to get a new one. I just got my Iodoral in the mail today, but I think I should hold off until I get a better idea of what my accurate temps are.

Oral temperatures. Avoid exercise, talking, eating etc.

You can inject with #29, 0.5ml [50iu] 1/2" insulin syringes.
100 for $14 at USA Walmart “ReLion” house brand.
No Rx needed in most USA/CDN jurisdictions.

Not trying to cause trouble, but just wondering what your thoughts are on this youtube video Iodine & Thyroid. This has me a bit freaked out to start iodine supplementation.