T Nation

TRT History and a Question


#1

For KSman and any of the other pro's in the forum, I would like to give you a bit of my background and solicit your input for the next time I see my Doc (I'm lucky enough to have found one that will work with me).

I'm a 54 year old man with some ongoing osteoporosis (likely genetic) and low-grade anemia. Within past 10 years also had Lyme and an aneurysm - fully recovered from both, but took a while. I exercise regularly, mostly running (even a few marathons) - not too much time at the gym though. Low bodyfat due to the running. When I really started to drag early this year, I went to see an osteopath, who based on the following test results recommended TRT. June 2010 Labs:

TT 330 ng/dL (250 - 1100)
FT 53.1 pg/mL (35 - 155)
E2 33 pg/mL (13 - 54)
Prolactin 4.4 ng/mL (2 - 18)
PSA .7 ng/mL (0 - 4)
TSH 2.35 mIU/L (.4 - 4.5)
T3f 290 pg/dL (230 - 420)
T4f 1.1 ng/dL (.8 - 1.8)
DHEA-S 129 mcg/dL (25 - 240)
Vit-D 55 ng/mL (30 - 100)
Hematocrit 39.3% (38.5 - 50)
Homocysteine 9.0 umol/L (< 11.4)
IGF-1 ECL 209 ng/mL (46 - 284)
Creatinine 1.06 mg/dL (.76 - 1.46)

Other blood chemistry and cholesterol tests were all within range and on the good side for cholesterol. At my request, the Doc started me at a minimal level of 5 mg/day Androgel, 50mg DHEA, and 1 mg of Melatonin at nite. I have been on 5000 IU D3/day for 2 years (for the osteoporosis) which I kept taking. I felt an immediate improvement, but I did have a couple of down days in the next month. Next set of labs in Aug 2010 were:

TT 858 ng/dL (250 - 1100)
FT 220 pg/mL (35 - 155)
E2 44 pg/mL (13 - 54)
DHT 150 ng/dL (25 - 75)
PSA 1.6 ng/mL (0 - 4)
Hematocrit 39.3% (38.5 - 50)

Rest of the CBC was normal. Based on some research on this forum and others, I was not surprised by the increase in E2 and DHT, and FT results looked good to me. With Doc's concurrence, I kept on the same level of Androgel and started .5 mg/2x week Avodart to reduce the DHT and .5 mg Arimidex/2x week for the E2. By next test in Oct 2010 I was feeling good - stable, positive mood, no down days with following lab results:

TT 831 ng/dL (250 - 1100)
FT 180 pg/mL (35 - 155)
E2 27 pg/mL (13 - 54)
DHT 21 ng/dL (25 - 75)
PSA 1.6 ng/mL (0 - 4)
DHEA-S 384 mcg/dL (25 - 240)
Hematocrit 41.4% (38.5 - 50)

I backed off on Avodart to one .5 mg/week and kept the 5 mg/day Androgel and .5 mg Arimidex 2x/week. So far, so good and waiting to see what my next labs will look like.

My specific question is: should I now be looking at adding hCG, or possibly pregnenolone; and what additional labs should I ask for? I don't seem to be having any testicular problems (e.g. some, but not excessive shrinkage) on my current regimen, but as I read thru the posts and other literature, the long term impact of TRT on my adrenal glands is a concern to me.

Thanks in advance, and I greatly appreciate the insight I have gained from this forum - particularly from KSman.


#2

The increased metabolism that comes with TRT, compared to the prior state, can cause problems if the thyroid or adrenal functions can't meet demands. If thyroid and adrenals are in good shape, then there will not be a problem of that type. Do not insinuate that TRT has such impacts as there is no cause and effect relationship of the type that you imply.

You need DHT for libido and maintenance of your sex organs. Estrogens are a bigger threat to the prostate than DHT or T. There are less damaging products that you can take. 5-alpha reductase inhibitors are steroidal drugs that are transported to the cell nuclei where things can go very wrong for some guys. From that point of view, such drugs need to be classified as xeno testosterones.

Your Arimidex needed to be increased by a factor of 27/22=.23

Arimidex/anastrozole does not have a half life that supports dosing twice a week. So your E2 levels are moving around a lot. You lab result changes can be very dominated by lab timing.

When were labs done relative to prior doses of T and anastrozole? FT levels are very volatile with transdermal, making the results less useful.

If you applied a 10-15% T compounded cream to smaller skin surface areas, you would have less E2 and DHT produced.

Your thyroid levels are suspect. Are you using iodized salt, eating sea food or have iodine in your vitamins?

Homocysteine is too high. You need a potent vit-B complex vitamin. Are you taking fish oil and have other friendly fats in your diet?

Hematocrit seems low. You should check or post serum iron, ferritin, RBC etc. Any digestive problems?

Low cholesterol can be the root of many problems. Ideal is 180 and 160 or lower is becoming a problem.

Test pregnenolone level.