First Follow-Up Blood Work Since Starting TRT

[johnt]

I got my first follow-up blood work since starting TRT on March 15th and would appreciate any thoughts/insights.

To get an idea of where I started see posts #43, #44, and #61 in:

https://www.excelmale.com/forum/sho...to-Urologist-Today-Your-Thoughts-Please/page3

My protocol for the past 12 weeks has been:

1ML of Testosterone Cypionate injected once per week (25g 1") into glutes.
0.25 AI once per week, generally taken 3rd day after injection.
500MG Metformin twice per day.

When I started my main complaints were: Fatigue, Irritability, Moments of Sadness, Anxiety, etc.

How I feel now: Anxiety has decreased significantly, moments of sadness not as often, and went from having morning wood a couple of times per week to morning wood every day, and seeing good gains in the gym.

I have not felt any changes in irritability; however, my wife says she has seen a change for the better yet I do not feel it is any better perhaps a little worse. And still have afternoon fatigue.

The doc did prescribe me Armour Thyroid 60MG when I first met with him but I did take it because I did not want to add something else into my system until I seen how I felt on T, AI, and Metformin.

Below is my first follow-up blood work. It was actually drawn the morning before I had my 12th injection. I discussed with PA this morning and she recommended no changes with my protocol. She is very happy with the blood work. Only change is she wants me to increase Metformin to 1000MG twice per day instead of 500MG twice per day and she would like me to start the Armour Thyroid.

I am considering dividing my dose into two injections per week and perhaps even lowering to 160 MG even though doctor's office said I can stay at 200MG. What are your overall thoughts?

 

[Vettester Chris]

I see your Free T3 was checked, at 2.9pg/ml ... Do you have any other supporting thyroid labs before starting your 1 grain of Armour?, i.e., Free T4, TSH, Reverse T3, and Antibodies TPO, TgAb?

One (1) grain is usually on the lower end of dosages for a lot of men, but for some it works fine. With what you're describing with the "afternoon fatigue" and such, I'd really make sure the Reverse T3 ratio with FT3 isn't too low (?).

 

[johnt]

I see your Free T3 was checked, at 2.9pg/ml ... Do you have any other supporting thyroid labs before starting your 1 grain of Armour?, i.e., Free T4, TSH, Reverse T3, and Antibodies TPO, TgAb?

One (1) grain is usually on the lower end of dosages for a lot of men, but for some it works fine. With what you're describing with the "afternoon fatigue" and such, I'd really make sure the Reverse T3 ratio with FT3 isn't too low (?).

Here is my blood work from March pertaining to Thyroid:

 

[johnt]

@Vettester Chris I am still a little hesitant to take the Thyroid medicine. Wonder if I really need it.

 

[madman]

I got my first follow-up blood work since starting TRT on March 15th and would appreciate any thoughts/insights.

To get an idea of where I started see posts #43, #44, and #61 in:

https://www.excelmale.com/forum/sho...to-Urologist-Today-Your-Thoughts-Please/page3

My protocol for the past 12 weeks has been:

1ML of Testosterone Cypionate injected once per week (25g 1") into glutes.
0.25 AI once per week, generally taken 3rd day after injection.
500MG Metformin twice per day.

When I started my main complaints were: Fatigue, Irritability, Moments of Sadness, Anxiety, etc.

How I feel now: Anxiety has decreased significantly, moments of sadness not as often, and went from having morning wood a couple of times per week to morning wood every day, and seeing good gains in the gym.

I have not felt any changes in irritability; however, my wife says she has seen a change for the better yet I do not feel it is any better perhaps a little worse. And still have afternoon fatigue.

The doc did prescribe me Armour Thyroid 60MG when I first met with him but I did take it because I did not want to add something else into my system until I seen how I felt on T, AI, and Metformin.

Below is my first follow-up blood work. It was actually drawn the morning before I had my 12th injection. I discussed with PA this morning and she recommended no changes with my protocol. She is very happy with the blood work. Only change is she wants me to increase Metformin to 1000MG twice per day instead of 500MG twice per day and she would like me to start the Armour Thyroid.

I am considering dividing my dose into two injections per week and perhaps even lowering to 160 MG even though doctor's office said I can stay at 200MG. What are your overall thoughts?

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Where is your cbc and how is your hemoglobin/hematocrit? 1200 ng/dL is pretty high for a trough 7 days after your injection as 200mg is a fairly high dose. If you drop down to 160mg and split 80mg twice weekly you may be able to drop the AI and improve your ldl which is high. Just noticed hematocrit 48 still in range but went from 43 pre trt to 48 now and may creep up over time on 200mg/week.

 

[Vince]

I agree about splitting your dose into two weekly injections. I would drop the AI, you would probably feel better and healthier with higher estradiol levels.

 

[Vettester Chris]

@Vettester Chris I am still a little hesitant to take the Thyroid medicine. Wonder if I really need it.

Based on your reported symptoms, fatigue and such, it might be the route? Your Free T3 is at 37.5% (actually 25% on your 2nd lab post) of the reference range, usually in most cases things are optimal in the 50% to 80%tile of reference range. However, other areas like the adrenals could be part of the story line, so that should be reviewed before proceeding IMO? Also, treatment could be problematic and counterproductive if Reverse T3 demand is high, due to contributing factors like cortisol, iron, or serious electrolyte imbalances. So, again, maybe a few bases to cover just to be safe.

It would also be good to see some body temp readings/log throughout the course of 5 days ... One method, just measure at waking in the morning ... If below 97.8F, especially notably in the low 97's or 96'sF, that's a good indicator of hypothyroidism if/when also experiencing other hypothyroid related symptoms ...

Another more 'detailed' method geared a bit more towards the adrenals is tracking it 3 times per day if possible ... 3 hours after waking, 3 hours after that, and 3 hours thereafter. That would provide a good log, and obtaining the daily average for all 5 days, and comparing could help know a bit more on your current situation. Plus, variations of .3F or more from one day to the next could be a key indicator of adrenal deficiencies according to Dr. Bruce Rind (in his excerpts and credits on STTM). A 4x Saliva cortisol w/ DHEA correlation analysis is the gold standard if you look at getting labs taken to give you the circadian overview of your adrenals.til

Again, 1 grain isn't a major dosage. It would take approx. a week before you would really start seeing some initial results, if any? Again, patients tend to titrate up 1/2 grain from there each week until desire results are achieved.

 

[johnt]

Thanks @Vettester Chris