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.