Consultation done, we covered a LOT of ground. Just gotta say
Dr Saya is awesome. Thank you sir!
-He is pleased with where the HCT is, I'm also grateful, but would like to see it another point or two lower. With the trend and life span of red blood cells at @120 days, we may still see a bit further lowering. Such natural changes in RBC numbers take a long time. The ferritin is up, but a donation would put 20 it points lower again, so we're going to wait it out, and not do a donation.
-We're both concerned about high E2 symptoms, and he (I too) would prefer to still avoid an AI, instead we will tweak other factors first.
-So the main theme to me in deciding protocol changes was how many variables to change at once and potentially better predictability vs uncertainty from such changes down the road.
-We discussed the possibility of going to daily dosing of T cyp without changing total weekly dose. He was open to going to daily, but did not want to also reduce dose as it is changing too much at once. From a few anecdotes on the forum, to me this seems to raise the possibility of increasing T, E2 and HCT levels, so less risky/more predictable to just lowering total dosage while staying on E3D. Might revisit this consideration at a later date. Going to daily would actually be convenient for me in several ways.
-Also discussed the possibility of going to HCG daily vs E3D. Same deal in terms of changing too much at once.
-I chose the more conservative plan with theoretically more predictable outcomes of lowering HCT and E2: Lower T cyp dose, monitor for symptoms and get labs if any negative changes in symptoms. Otherwise give it 3 months. So lowering T cyp from 42mg E3D to 36 E3D for a total of 84mg/week, a reduction of 10%.
-Also decreasing DHEA by half.
-Aw crap I forgot why, but he also wants me to increase D3 supplementation from 2000 to 5000/day.
-I still have some problems with recovery from exercise, and based on my history with low T before TRT and what has happened while on TRT it seems that My TT and FT levels are probably just fine. So we talked a bit about IGF-1. However, I declined any treatment due to the prostate issue since higher IGF-1 can promote growth of cancer cells. Jury is still out on my prostate, but I don't want to do anything more to provoke it.
-With the changes in diet I have made due to the prostate issue, I have decreased total protein intake, which I think may be contributing to my decreased recovery from exercise. I have also made a minor shift from animal based to plant based proteins. I am going to revisit this thinking, and probably increase protein intake a bit but continue the trend of more plant based sources. Animal proteins and especially dairy, which I have already cut down drastically raise IGF-1 and multiple studies show a relationship with animal protein fueling cancer, and specifically prostate cancer.
-Thyroid looking good, numbers indicate I am converting T4 to T3 well, not pooling to RT3 and T3 level is very good as long as I don't have hyperthyroid symptoms mornings to midday. We did not speak about the TG antibody which has been mildly high for years.
-He's referring me for hematologist regarding lymphocyte changes. I have had slowly increasing absolute lymphs over a few years and last labs are first time over normal range, plus atypical lymphocytes observed in latest (May) and last January labs. Could just be my immune system fending off viruses etc, but changes in absolute lymphs can also point to leukemia. I may defer hematologist consult until after next CBC. If still elevated then, will definitely consult.
So to sum up the new protocol and changes:
T cyp 36mg E3D (84mg/week total)
HCG 420iu E3D
DHEA 12.5mg/day
Pregnenelone 25mg/day
Same supplements but increase D3 to5000iu/day
Increase protein intake while raising plant based percentage.
