TRT Protocol - 4 Yrs, Please Advise

[carlos_anton]

@KSman

Sir, could you please review values. I’ve noticed a decline in mood lately from my protocol. Just feeling blah. Not as intense in mood as previous. Initial doctor was prescribing 200mg/wk (E7D) but estradiol was high, and had occurence of back acne, and nipple started to get puffy (had pubescent gyno). After reading your stickies I switched down to 100mg/wk but split injections E3D due to work schedule. This was going on for last couple years.

I inject Test Cyp 50mg (0.25cc) E3D subq. Arimidex was 0.5mg E6D.
I also follow up with ZMA, 900mcg ED Iodine (Kelp), 90mg Potassium, 10000iu D3, 50mg DHEA.

EDIT: Following in regards to initial post profile guidelines:
-age: 35
-height: 72"
-waist: 36.5"
-weight: 234lbs, approx 22% BF (electronic scale, I know not accurate)
-Moderate body hair on arms, chest, abdomen, back. Thin, straighter.
-Still carry lower abdominal fat, always have since puberty, even when dieting down to 180. Never got really lean, lost weight, but almost skinny fat around midsection. PL training and heavy ab work makes it a bit better now with abdominal tone, but still carry most fat around midsection, some chest.
-Initially had low test levels when rotated back from Iraq in '09. Tested in low 240s @ 26 years old. Military, shift work, suffered a heavy concussion due to motorcycle racing accident. Was unconscious, but awoke on my own. Only noticed heavy mental fog due to concussion syndrome, lasted about 1 month.
-Higher protein, moderate fat, limited carb intake, focus on fibrous veggies. Paleo for a little while, but had to have rice and beans every once in while to feel normal. And that tortellini tho…
-Heavy PL training, 5/3/1 method, limited cardio, lower volume work.
-No testicular pain, but they have seemed to gotten smaller. No longer interested in fertility, have one child now and done.
-Arousal seems normal during the day, no issues with libido during waking hours, rarely wake with morning wood, maybe twice a month? Only when sleeping more than 5hs that I usually sleep.
-I work for FD, FFPM, so 24h on/48h off, with 24h period with broken irregular sleep, if I can get sleep on shift, it’s still limited at 5-6 hours uninterrupted. Was previously sleeping 4-5 hours a night 6 days a week at previous job (military).

Cholesterol Total - 188
HDL -29
Triglycerides - 119
LDL - 136
HDL ratio - 6.5
NON-HDL - 159
BGL - 100
Sodium - 137
Potassium - 4.3
Chloride - 102

TSH - 4.88
Iodine, Serum/Plasma - 57 (waking temps 95.5, 96, raises to 97.3 highest mid afternoon)
T3 - 2.8
T4 - 1.1

Test Total - 844 (Labs taken before injecting for the day)
Test Free - 133.9
Test Bio - 240.4
SHBG - 33
Prolactin - 8
Estradiol - 20

Estrogen control has been issue with me in the past, but E3D injections have seemed to help. Also recently source liquid anastrozole to dose 0.5mg E3D along with injection schedule.

Thank you for all the information you have provided on this topic. Your research has made my results for TRT treatment much more predictable and manageable. My GP and my “TRT” doctor have little background, and never spent any effort into the pharmacokinetics of these substances.

[KSman]

Please repost thyroid labs and T results with ranges.

Glad to see change in anastrozole dose from E6D to E3.5D.
Need to test E2 again with this dosing.

TSH is very high.
Body temps are very low.
You should have a multi-vit that lists selenium.
Should be testing fT3 and fT4, not T3, T4.
fT3 is low or rT3 is elevated and blocking some effects of fT3
Please read the thyroid basics sticky.
You can also get a thyroid autoimmune panel.
Your low body temperatures identify source of you “blah”.

FSH has nothing to do with prostate cancer, but does with most testicular cancers. No need to test LH/FSH again. Suspect that you were going to post PSA data.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

• advice for new guys - need more info about you
• things that damage your hormones
• protocol for injections
• finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

[carlos_anton]

TSH is very high.
Body temps are very low.
You should have a multi-vit that lists selenium.
Should be testing fT3 and fT4, not T3, T4.
fT3 is low or rT3 is elevated and blocking some effects of fT3
Please read the thyroid basics sticky.
You can also get a thyroid autoimmune panel.
Your low body temperatures identify source of you “blah”.

According to Quest Diag, it was Free T3, T4.

I will retest again with GP to look at ft3, ft4, rt3, rt4.

T results with ranges for Quest.

Yes, I forgot to post PSA numbers. Showed nominal, 0.6 Total PSA.

Thank you again, I will review the stickies on thyroid basics.

[carlos_anton]

Confirmed Multi-vitamin did not have selenium. Buying additional supplement. 200mcg, ED.

Also looking into Iodoral 12.5mg for Iodine replacement therapy.
@KSman, how often do you have to comply with an IR protocol? Also, since I have this dietary condition, should I have my wife and daughter looked into as well? My wife has a “hyper” sensitive palate, very sensitive to salt content in food. I do most of the cooking, and have tailored our food to limited salt amounts, and also using “boutique” salts, such as pink salt.

Are there ways increasing iodine supplementation as a household, without having everyone necessarily dosing pills all the time?

[KSman]

in 1922 iodized salt was introduced to Canada and USA. It was one of the largest improvements in public health ever. But the medical community has fallen to sleep and now “natural” salts are fashionable.

Check oral body temps of family members and see.

Iodine is critical during pregnancy, breast feeding and child development. Pre-natal vitamins have 200-220 mcg iodine. Stop using non-iodized salt. There used to be iodine in bread as a dough conditioner - gone. There used to be a lot more iodine in dairy from iodine based teat wash - going away. There is a general trend that has many negative effects.