Blood Test Results... Feedback please!

[Bud]

New to Excelmale.com, what a great resource!

52yr old 6'0 197lbs about 11% BF.

I have been on TRT since April 2016. Currently weekly injections of 200mg of T Cypionate. Overall feeling great. Everything working as it should. But the TRT clinic only does bi monthly tests of Total T and PSA, so I wanted to get my own complete panel done to make sure everything is okay.

Here are the results please let me know what you all think. Thanks!

 

[johndoesmith]

When were these taken relative to injection? Did you have a cold or flu when these were taken?

I'd consider donating blood soon, HCT is 50 so within a few weeks.

I hope you didn't test at trough, total, free, and E2 are all pretty high with E2 being the concerning one. I'm amazed your SHBG is 54 after being on 200mg per week for a while.

What was your SHBG before starting TRT?

 

[CoastWatcher]

Welcome to Excelmale, Bud. Your testosterone is being injected in one dose, once weekly? And those labs are trough readings, just prio to the next injection? If that is the case, I wonder if you would do better splitting that dose in two and injecting 100mg every 3.5 days. That could lower that sky high testosterone value and bring your estradiol into line.

 

[Bud]

Thanks for the replies.

This was at trough, taken the day before my scheduled injection. No cold or flu (that I know of) Allergies have been kicking up lately. I was surprised at the high WBC too.

HCT has been slowly rising it was 45.8 before starting TRT. I will look to donate some blood soon.

I was also surprised at the T and E2 levels.

Over the summer they had me on Anastrozole 1mg EOD but it ended up crushing my E2 to <5. They prescribed it based on symptoms and without a E2 test so I cant tell you what it was before the Anastrozole.

All the T tests prior to this one were done "in house" at the clinic and they don't test for FreeT just total. When I started in April, according to the clinic my T was extremely low at 58 and E2 was 21.

I ordered this current test through Discounted Labs because the more I was reading the more I felt that they really arent doing enough testing during my treatment.

This is my first SHBG test that I have done.

I dont think they will do less the 1 week intervals on injections. Originally they were injecting 200 every two weeks, then 300 but and I was crashing between injections. After a few requests to go to a weekly protocol they switched me to 200 per week.

 

[johndoesmith]

Thanks for the replies.

This was at trough, taken the day before my scheduled injection. No cold or flu (that I know of) Allergies have been kicking up lately. I was surprised at the high WBC too.

HCT has been slowly rising it was 45.8 before starting TRT. I will look to donate some blood soon.

I was also surprised at the T and E2 levels.

Over the summer they had me on Anastrozole 1mg EOD but it ended up crushing my E2 to <5. They prescribed it based on symptoms and without a E2 test so I cant tell you what it was before the Anastrozole.

All the T tests prior to this one were done "in house" at the clinic and they don't test for FreeT just total. When I started in April, according to the clinic my T was extremely low at 58 and E2 was 21.

I ordered this current test through Discounted Labs because the more I was reading the more I felt that they really arent doing enough testing during my treatment.

This is my first SHBG test that I have done.

I dont think they will do less the 1 week intervals on injections. Originally they were injecting 200 every two weeks, then 300 but and I was crashing between injections. After a few requests to go to a weekly protocol they switched me to 200 per week.

Holy crap, that is some of the WORST care I've heard from a clinic, they're usually good about actually knowing what they're doing.

Your testosterone and E2 are sky high, if that's your trough, your running a nice blast there without AI. How you haven't developed high E2 symptoms is beyond me, maybe T/E2 ratio does work like nelson says.

 

[madman]

That level is ridiculous for a trough way too high hence the sky high estrogen....sure you may feel good and overall bloods look good but a 1663 trough those levels are far from natural to be considered optimal trt. I understand you said your levels were extremely low pre trt but why would the clinic start you on 200mg/week off the hop............lowering your dose and you would have more reasonable tt/ft and better e at 100 mg/week. A healthy young male in his prime is maybe peaking at 800 tt never ceases to amaze me that people want to maintain high numbers thinking that it is better..........200mg/week for most would be a mild steroid cycle and sure some need a higher dosage but it is not the norm!

 

[CoastWatcher]

Thanks for the replies.

This was at trough, taken the day before my scheduled injection. No cold or flu (that I know of) Allergies have been kicking up lately. I was surprised at the high WBC too.

HCT has been slowly rising it was 45.8 before starting TRT. I will look to donate some blood soon.

I was also surprised at the T and E2 levels.

Over the summer they had me on Anastrozole 1mg EOD but it ended up crushing my E2 to <5. They prescribed it based on symptoms and without a E2 test so I cant tell you what it was before the Anastrozole.

All the T tests prior to this one were done "in house" at the clinic and they don't test for FreeT just total. When I started in April, according to the clinic my T was extremely low at 58 and E2 was 21.

I ordered this current test through Discounted Labs because the more I was reading the more I felt that they really arent doing enough testing during my treatment.

This is my first SHBG test that I have done.

I dont think they will do less the 1 week intervals on injections. Originally they were injecting 200 every two weeks, then 300 but and I was crashing between injections. After a few requests to go to a weekly protocol they switched me to 200 per week.

You're clearly receiving poor care. You sensed that, hence your decision to self-test (and to open a discussion here at EM). So many TRT clinics hand out mega doses of testosterone, run the patient up fast so he'll feel something, toss in an AI in the blind hope that estradiol won't knock him sideways, collect their money and wish him well. As Nelson has posted here, and Dr. Saya (medical director of Defy Medical) has written, far too many of these clinics are giving legitimate TRT practitioners a bad name. You got stuck with one.

Your next step should be finding a new doctor. You may be fortunate and locate someone locally who knows what they are doing, but don't be surprised if that's not how it plays out. Defy Medical and Prime Body are sponsors of this site (I'm not a patient of either, but I respect their model and the results they obtain for many of our members). Even a weekly injection of 200mg a week of testosterone, if given as a single dose, may well cause you problems. Check with Defy, or see if Prime Body operates in your area.

 

[Bud]

Thanks again all. Yes that was my feeling too that they were not very good.

Unfortunately I signed a one year contract with them so I am going to try and manage it being my own advocate and working with my PCP who I talked to about this during my annual physical last month. Now after seeing that TRT is working for me she said she could administer it after the contract is up.... Wish she had said that a year ago vs just prescribing anti depressants and ed drugs which is what led me to the TRT clinic in the first place.

They didnt start me at the 200/ week. Originally they started me on 200 EOW and then when I was saying how I felt lousy the second week they increased it to 300 EOW. I started getting E2 Symptoms so they added in 1mg of Anastrozole EOD. That ended up crushing my E2. When I went back I said everything I have read said weekly should be the minimum for T injections and that most find even more frequent better. They then moved me to 200mg/ week. I have been at that for about 3 months.

At this point I am under a one year contract with them. I can see about getting out of that. I am assuming that it is going to be a bit challenging as I am sure they are way probably way better at collecting money then they are at managing care.

Thanks again for the feedback and confirming what I was thinking.

 

[CoastWatcher]

Thanks again all. Yes that was my feeling too that they were not very good.

Unfortunately I signed a one year contract with them so I am going to try and manage it being my own advocate and working with my PCP who I talked to about this during my annual physical last month. Now after seeing that TRT is working for me she said she could administer it after the contract is up.... Wish she had said that a year ago vs just prescribing anti depressants and ed drugs which is what led me to the TRT clinic in the first place.

They didnt start me at the 200/ week. Originally they started me on 200 EOW and then when I was saying how I felt lousy the second week they increased it to 300 EOW. I started getting E2 Symptoms so they added in 1mg of Anastrozole EOD. That ended up crushing my E2. When I went back I said everything I have read said weekly should be the minimum for T injections and that most find even more frequent better. They then moved me to 200mg/ week. I have been at that for about 3 months.

At this point I am under a one year contract with them. I can see about getting out of that. I am assuming that it is going to be a bit challenging as I am sure they are way probably way better at collecting money then they are at managing care.

Thanks again for the feedback and confirming what I was thinking.

You aren't the first, and you won't be the last, fellow who falls into a terrible treatment plan with a doctor not really qualified to manage a TRT protocol. Are they requiring that you report to them for your injections, or are you self-injecting? If the latter, and I hope that's the case, you and your primary care doctor can take things further, splitting your dose into even smaller injections, adjusting the amount of testosterone in each injection, taking a more active hand in the process.

A word of caution - some shady clinics include a clause in their contracts that require you, the patient, to opt out as renewal approaches. It is on you to act and avoid automatic extension. Even worse, I am aware of one clinic that mandated the patient to opt out, to exercise the non-renewal clause, six months prior to the contract's termination. Nobody thinks to check that until it's too late. Check the wording carefully.

 

[johndoesmith]

Thanks again all. Yes that was my feeling too that they were not very good.

Unfortunately I signed a one year contract with them so I am going to try and manage it being my own advocate and working with my PCP who I talked to about this during my annual physical last month. Now after seeing that TRT is working for me she said she could administer it after the contract is up.... Wish she had said that a year ago vs just prescribing anti depressants and ed drugs which is what led me to the TRT clinic in the first place.

They didnt start me at the 200/ week. Originally they started me on 200 EOW and then when I was saying how I felt lousy the second week they increased it to 300 EOW. I started getting E2 Symptoms so they added in 1mg of Anastrozole EOD. That ended up crushing my E2. When I went back I said everything I have read said weekly should be the minimum for T injections and that most find even more frequent better. They then moved me to 200mg/ week. I have been at that for about 3 months.

At this point I am under a one year contract with them. I can see about getting out of that. I am assuming that it is going to be a bit challenging as I am sure they are way probably way better at collecting money then they are at managing care.

Thanks again for the feedback and confirming what I was thinking.

The way I see it, regarding the contract is that you paid upfront or are on automatic monthly payments, and want to get your moneys worth.

That's understandable, but look up what a "sunk cost" is. The money is already spent, regardless of if you use the service or not. I imagine going to your PCP would be covered under insurance, and therefore not expensive.

Also, no contract can force you to continue a treatment plan, you as a patient have rights that supercede any contract in the world. You have a right to refuse medical treatment so long as you're competent.

In fact, you may be doing damage to yourself by sticking with them until your contract is up. I'd take the loss and go to your PCP.

 

[Bud]

Updated Tests 90 days later - Feedback please

Here are follow up labs about 90 days later. I donated blood after last tests. Only other change is addition of .5 mg anastrozole E3 days. Overall feeling very good and everything working as it should. I weight and cross train pretty intensely 5-6 days per week so I think that is accounting for the elevated AST/ALT and Creatine.

Any other feedback?

 

[madman]

The AI is lowering your estradiol to the bottom end? You need to work on improving your blood sugar levels!

If 1250 is your trough I would lower your dose of testosterone a little, will more than likely improve your hematocrit further in the long run and you could eliminate the AI.

 

[johndoesmith]

Here are follow up labs about 90 days later. I donated blood after last tests. Only other change is addition of .5 mg anastrozole E3 days. Overall feeling very good and everything working as it should. I weight and cross train pretty intensely 5-6 days per week so I think that is accounting for the elevated AST/ALT and Creatine.

Any other feedback?


View attachment 3226View attachment 3225View attachment 3224

''

Congrats, you've crashed E2 to almost nothing.

I am shocked you feel good at those levels, with E2 literally the lowest it can be, and SHBG about as high as it can be. I'd think you have some low E2 symptoms.

Either way, that E2 is pretty low, low enough where I'd start thinking about long term consequences of it, osteoporosis, depression, and dry skin. The first being the most serious.


Plus, if that's trough, then your dose is a bit high.

 

[madman]

''

Congrats, you've crashed E2 to almost nothing.

I am shocked you feel good at those levels, with E2 literally the lowest it can be, and SHBG about as high as it can be. I'd think you have some low E2 symptoms.

Either way, that E2 is pretty low, low enough where I'd start thinking about long term consequences of it, osteoporosis, depression, and dry skin. The first being the most serious.


Plus, if that's trough, then your dose is a bit high.

Bud take JDS advice seriously as he has a deep understanding/first hand experience regarding this!

 

[ERO]

What is stopping you from twice weekly injections - do you have to drive in every week to the clinic for your weekly injection? I mean, if you are already doing the one a week on your own, just switch to one every 3.5 days. Remember, they work for you - you are the customer and you are paying them, not the other way around.

 

[CoastWatcher]

Here are follow up labs about 90 days later. I donated blood after last tests. Only other change is addition of .5 mg anastrozole E3 days. Overall feeling very good and everything working as it should. I weight and cross train pretty intensely 5-6 days per week so I think that is accounting for the elevated AST/ALT and Creatine.

Any other feedback?


View attachment 3226View attachment 3225View attachment 3224

That is a dangerously low level of estradiol. It, e2, is not a waste product that men need to eliminate, it's a hormone necessary for health, particularly sexual and skeletal health. For years, prior to staring TRT, my estradiol hovered near the level you just posted. Of course, I didn't know that - I only knew I felt miserable. I am glad you don't seem to have any of the subjective symptoms associated with low estradiol, but you are at risk. In my own case, I lost height, compressed vertebrae, and saw a thinning of the bones in my hips. I remember low estradiol every step I take.

Anastrozole is a good drug, a necessary drug - but is it necessary in your case? You simply don't know. A very subtle manipulation of your protocol may well eliminate the need for it, lower your total testosterone, and result in your feeling better. Please consider what a number of us here have said.