Total T Too High

My search found one forum that discussed high Total testosterone, though it did not help to resolve my situation. The post was over my head, and focused on the specific conditions of the person who posted it, which is logical and good. So here goes for my questions, predicament.

I need a lot knowledgeable input.

I am 55 years old. Low T, hormones, endocrinology a mess. Suffering terribly, highly debilitated (mentally, emotionally and physically). Many conditions, symptoms, complex situation. Long story. I can tell you what you wish. I run into road blocks with something, my medications or what, each time I try to go forward to try heal these conditions.

Thanks for your patience with the complexity of my situation. I wish to focus my post on low T, hormonal, endocrinology and related topics.

Main question: How can I lower my high Total testosterone? It looks far too high, double what it should, dangerous - is it? I cannot raise up my low Free testosterone without raising my Total testosterone far too much. To lower my Total testosterone to 1,000 ng/dL, I would have to lower my Free testosterone to low 100 pg/ml, or lower than 100 pg/ml.

This is a constant guessing game of trying to keep my Estradiol within safe range with gauging how much Anastrozole to compound, and how much T cypionate to inject.

What are the healthy ranges?
I thought that, for TRT, healthy range (despite what most doctors or testing places say) is:
Free T: 250 to ? pg/mL.
Total T: 800 to 1100 ng/dL.
Estradiol: 20 pg/mL to mid 20â??s, with low mid 20â??s ideal

All tests are done by ordinary blood testing facility (not sure if I can say the name, so I will leave it out.) I can supply more data from test results if you ask for specifics, and can test for what you wish with my future tests. Just ask, say what to test.

My body responds a lot to tiny changes in doses of T, and Anastrozole, making it particularly hard to balance. After months, I can get a balance, but then Free T is too low or Total T is too high, a mess.

I am sure a lot of my other hormones and endocrinology are all off.
I also have adrenal exhaustion (not from blood tests but from how trainers have to told me; a symptom diagnosis sheet that a naturopathic uses for all his patients shows I have the highest, severe adrenal exhaustion. Road block: I cannot take most or all herbs or supplements for adrenal exhaustion, or other conditions, from serious interactions with my other medications).

Present Dose of Testosterone Cypionate (since February 27, 2015, which is since March)
(my testosterone bottle says 2,000 mg/10mL or 200mg/mL):
1 injection (front thigh) every 3 days
per injection: 35 mg = 0.175ml = 0.18 ml (I draw my syringe to 0.19ml)

Present Dose of Anastrozole: (since May 19, 2015)
1 compounded capsule every 3 days, same day and time I take my T injection
1 compounded capsule - 0.3125 mg (or 5/16 of 1mg pill, or 1/16 more than 1/4 of a 1 mg pill.

June 29, 2015, 8:02 AM test results (fasted from 12:00PM prior night, 8 hours)
Total T… 2143 ng/dL
Free T… 225.6 pg/mL
Bioavailable T…522.8 ng/dL
SHBG…64 nmol/L
Albumin, serum… 5.1 g/dL
Hemoglobin…17 g/dL
Hematocrit… 51.9 %
DHEA sulfate… 89 mcg/dL
Estradiol… 24 pg/mL

I am speaking to my Dr. in the following days about this. I think he wants me (and I also want) to get a therapeutic phlebotomy (at the Red Cross, which will not let me donate, so I have to get a therapeutic phlebotomy) to bring down Hemoglobin, Hematocrit, as I have done at times this year.

I am not sure but suspect that my doctor will ask me to cut down on my T cypionate dose, which means to cut down on my Estradiol…to our guess of what…fraction of a fraction of a small pill to be compounded. If I Iower my T dose just slightly, my Free T drops many points, so then we wait, and watch, then raise it with the same problems.

This is what we are doing, playing games just going back and forth raising my T because it leaves me with so little energy and symptoms with unhealthy low T…though I still have little energy and symptoms on my present dose of T; and then lowering my T when my Total T is too much for my doctor (and me, scares me that high). I am not getting anywhere and still am symptomatic. I must lay in my bed 11 or 12 hours a day from how tired my body is, and my worst symptoms are in the morning (actual terror, and other symptoms, which last 24 hours a day though are most torturous as the morning progresses).

(FYI. I cannot afford doctors who know how to treat low T and male hormonal, anti-aging conditions; I am on disability, only have Medicare/Medicaid. Someone suggested an affordable Dr. who I cannot go to for other reasons. My present doctor is smart, though this is not his area of expertise, and he does not know what to say about my low T, like most other doctors. I also do not know what to say or do. My doctor is the best I can find who, past my staring T cypionate injections, at least listened to finally let me take Anastrozole to lower my Estradiol. He told me to get therapeutic phlebotomies for my hemoglobin and Hematocrit when I asked if we could do something other back and forth lowering my T dose and raising it to control Hematocrit. All other doctors I went to, including the best endocrinologists, were highly ignorant, clueless, and cared little or not at all. So, I must work with what I have, to do my research, which I am limited to from my conditions, and try to work with my doctor, and hope somehow my my low T, hormones and endocrinology and health will work out successfully.)

Thanks so much for reading my post.

Have you read the stickies? Can you get the other tests that are recommended there done? See recommended labs. Everything is listed very clearly.

Testosterone and Estrogen are just a small part of a constellation of things happening in your body. If your other things are not balanced, trying to balance your test and estrogen is going to be way more difficult/IMPOSSIBLE.

You have to make sure you don’t have thyroid issues, or ADRENAL issues, or are not missing some other essential vitamin or mineral.

Your body doesn’t work on just Testosterone. You are not going to fix other adrenal issues by injecting T and taking some anastrozole.

Your symptoms may not have been solely due to low T or due to low T at all.

What were your labs before you started TRT? Did you get your LH and FSH tested?

If you are dosing properly (and it looks like you are), then, and I’m just guessing here, it would appear your body is still producing Test despite your exogenous injections, which suggest some sort of signal-ing problem. That could be highly concerning. Did your doctor examine your testes?

I would start with the basics first though. Get the other labs recommended done.

And provide your pre-TRT bloodwork.

MagisterO6, thank you so much for your reply.

Wow. I am still working on reading the stickies…and pages of responses to each one. I know some of it, but it is mostly…overwhelming to take that all in. It’s going to take time, especially with my conditions.

I wrote never expecting that just T and Anastrozole would solve my problems. About 4 or 5 years ago or so, I started doing research online, reading about low T, TRT, HRT, anti-aging, and realized that MANY hormonal, endocrine, and other facts, are as critical to my health and survival, and MUST be thoroughly, knowledgeably and safely checked, addressed, and treated. I mentioned my Adrenals. I know it’s FAR, FAR, FAR more, and all of it is important. Though they should as doctors, what doctor is going to do this for me? (You know what I am saying.) I wrote about doctors, and my situation. With so many critical factors to watch for, and with my continued and more quickly increasing debilitation, (which is profoundly affecting me mentally and emotionally also), I don’t know how I’m going to do this or keep up with it. This is scary because all of the many factors are CRITICAL to my health and survival. So I am writing to T-Nation. I try my most.

My doctor once told me he didn’t think my testes were producing much of anything now. (FYI, if HCG is important to keep my testes - my body, me - healthy, and it if right for me to take it, I want to. How would I ever get that, the price takes up my monthly disability check. Maybe I can get my Dr. to dispute that Medicare or Part D or what doesn’t cover it. HCG discussion for a later time, I guess.) I’d really like my Dr. to read all of my posts and replies to my posts. I’m not sure if he would find time or interest.

I will have my Dr. check my testes at my next appointment, Sept 9. (I can’t visit my doctor too often; it’s money, his group and I worked out a deal when he went of Medicare, because I’m a long time client.)

I will look for and get all the tests you think I should take.

One practical question or thought. When I get the lab results you spoke of plus with my pre TRT lab work, that’s a lot of lab work and space - plus say future lab work, and for notes of my stats, information, conditions, that people ask me for. Is there some place on this site that a member can put all this information for himself or herself, like a separate file on this site for Tim data, so people who reply to my posts may refer to, especially as I make more posts? (A place where each member has their own separate file of their data for the same reason.) That’s a lot of space for the site. I wish so. I’m going to be making posting lots of pages just providing my pre TRT, and my lab work you wish me to. Is this usual for this site, to post pages of data?

Please use the [edit] in lower right hand corner of your first post and add lab ranges to what you have listed.

What was lab timing relative to prior injection.

FT lab ranges vary a lot from one lab to another. Quest ranges are very high.

Target levels are high-normal youthful levels, not age adjusted. Lab ranges are age adjusted down in lab reports. So most older guys need levels that are over-range to get good results.

You are taking 81.6 mg T per week and your T levels are quite high. That is very unusual and you are going to have to find out what to do by reducing doses and doing labs again. I can advice better when you post lab ranges. Please tag me in the ‘KSman is here thread’ when ready.

What medications do you take?

DHEA-S may be low. I don’t memorized lab ranges…

Total T has a lot of T+SHBG that is not bioavailable. So one can have high TT and lowering that would take FT too low [lower than optimal]. If SHBG is elevated, this can happen. Higher E2 leads to more SHBG. Liver problems can reduce clearance rates for SHBG+T and E2.

Don’t need a lot of pre-TRT labs from a TRT requirement at your age, you have age related low-T. But a lot of something else is going on.

With TRT expecting to reverse/halt bone loss, with TRT, your serum and urine calcium levels should be normalizing. So check that.

Please provide lab ranges.
Provide TSH, T3, T4, fT3, fT4 CRP, homocysteine, AST/ALT, AM cortisol if available.
How are you feeling? What is better? What is worse or not improved?
Energy levels?
How do does your body feel with major stress events?
How much vitamin-D3 do you take and for how long?
Do you use iodized salt and if not, for how long have you been iodine deficient?

Please check your overall thyroid function as follows: <=== important
Check oral body temperature when you first wake up. 97.7-98.8 is OK, higher is better, 97.3 is too low.
Also check that you hit 98.6 mid-afternoon.

Please look at causes: Osteoporosis in Men | NIH Osteoporosis and Related Bone Diseases National Resource Center
Hypercalciuria - Wikipedia

List medications.

Please to not miss requests for info above.

It will take me time to supply you what you what you wish, and I can’t predict how long. This reply is part why, and I do speak of low T at the end. Thanks for understanding.

People who know me understand that I am someone who wants to get on this faster that anyone, faster than ASAP; and that from my conditions and many factors, my body and brain and time make it so frustratingly slow. I hate that. I work HARD and at my most, exhaustively. For example, I spent four or what hours just trying to write this reply.

The following, among many factors, also slows me, and which you should know. I did not know until recently that I am at risk for Lyme and associated diseases and co-infections, and was at risk throughout my life since I was a kid. (Associated diseases and co-infections often come with Lyme, and are not Lyme, but many function like Lyme.) I may or may not have it/them. It’s as important as my low T, a major priority, a serious disease. I must find out, also ASAP - but it isn’t at all as easy as finding out if you have low T with a blood test. Without the following would be the same as a man writing to a doctor to test and diagnose for low T or what, and to treat the man if the doctor says he have low T or what, without any information about the man at all.

I MUST write a life history, from my birth to today, of all of my symptoms, conditions, so forth “from head to toe: physical, mental and emotional,” and places I went in my life (far and near), and other risk factors and information - and dates for all - to test for and diagnose if I have Lyme and associated diseases, and to treat me if I do. It is overwhelming, particularly for me, takes up a lot of time and work, but is critical and necessary. This is also what is slowing me with providing information for this site.

The report required of me is the protocol of ILADS, International Lyme and Associated Disease Society, the doctors and medical professionals who are knowledgeable and through, the doctors to go to. They are few, and with the help of a couple of Lyme information and prevention associations, they found only ONE in my vicinity of states that I can afford, an APRN, who I am preparing my report for my first visit, after what time I finish my report. That’s lucky and not lucky. Diagnosing this disease and associated diseases is complex, and I should get at least 2 or 3 opinions from other doctors. Even the top doctors could miss a critical co-infection, associated disease or form of Lyme. If that is the case, I’d have Lyme and or associated diseases that would be making symptoms, other diseases and suffering and getting worse for the rest of my life (from misdiagnosed, mistreatments, that will not help but make worse), and my doctors and I would not know. I hope the APRN I go to works out!

Why compile and write that report? How you write of with low T, hormonal and endocrine issues for men, that most all doctors are “idiots,” including specialists - is the SAME OR WORSE for Lyme and associated diseases. The dangerous, ignorant doctors are most all doctors. Here’s just a couple of many reasons why. Most all doctors use tests (the wrong tests) which are proven up to and usually 50% unreliable and insensitive to Lyme, giving false negatives literally at the flip of a coin; doctors don’t know what to test for, what to look for, how to diagnose, how to treat, or about Lyme and associated diseases to start - though they think they do, particularly if they are specialists. Result: people with Lyme (and associated diseases) are ignored, misdiagnosed, mistreated and get worse from the Lyme worsening, and worse from the mistreatments: drugs, treatments given that will not help, and make people worse.) Only treating the Lyme (or other) infection(s) cures the symptoms and disease(s) (though most people still have Lyme in your system through your life.) It is estimated recently that Lyme is 10 times worse than what is reported - multiply it 10 times!, and this doesn’t mention how many people reported to be diagnosed with Lyme are not being treated safely, thoroughly, so forth.

Lyme is also known to cause low T. In fact, Lyme is known as the “Great Imitator,” because it imitates diseases that are not coming AT ALL from those diseases and symptoms, but from the Lyme infection itself, and frequently accompanied by other “co-infections” that are not Lyme but operate like Lyme - all “simply” infections. Lyme and associated diseases symptoms, cover so much, and depend on the Lyme associated diseases, the person. The symptoms may be one or a combination of physical, mental and emotional problems “from head to toe.”

Thanks for reading this.

I am aware of those Lyme disease issues, relating to someone who lost a battle with atypical ALS that others and wanted to be Lyme so there was hope of a cure.

You don’t need to over analyze with TRT as there is not a dysfunctional disease, only a hormone imbalance. The recommendations and guidelines are easy, only need to deal with the doctors. Simpler that a disease that can kill you and doctors who are like minded.

[quote]KSman wrote:
I am aware of those Lyme disease issues, relating to someone who lost a battle with atypical ALS that others and wanted to be Lyme so there was hope of a cure.

You don’t need to over analyze with TRT as there is not a dysfunctional disease, only a hormone imbalance. The recommendations and guidelines are easy, only need to deal with the doctors. Simpler that a disease that can kill you and doctors who are like minded.[/quote]

I take what you wrote seriously, horrible about the person with ALS. That’s the problem with TRT, doctors. Mine at least listens, to some of it, got him give me Anastrozole after some push, but we are stuck. Not sure how far he will listen, limited access to him.

FYI, my tests from Quest.

Again, thanks, KSMan.