Husband starting an AI, latest test results

[ReillyJ]

Hey all, i posted in my original thread but i'm making a new post, you all have been incredibly helpful and supportive to me in the past in helping my husband on his TRT journey. Reason i am posting is he doesn't even know how to type or is pretty clueless on all of this and i feel it's my job to help him manage and learn as much as i can..

He's a young 70, health issues include non alcoholic liver cirrhosis (mild, had Hep C) on low amount of opioids for pain management, on NDT for thyroid. Has been on TRT since October 2017 when he tested out around 300 and below normal Free T. Went on standard 100 mg and shot twice weekly. Went to 3x weekly and BW showed minor improvement (500's and still below normal FT) got SHGB tested and it was high normal so on advise from the gentlemen in this group, went back to twice weekly shots which would hopefully bring up FT which indeed it did but low normal.
Doc rx'd 150 mg/wk and on more advice from this group, decided to go slow at 140 mg/wk and he felt better, had better libido, energy. Still has ED and has to use Viagra or Cialis.

Decide to use the full 150/mg wk and oddly enough libido decreased along with energy and sleeplessness increased. ED probably worsened a bit. Just got BW done and low and behold his E2 (sensitive) is high at 41.0, 35.0 being the highest range. What was shocking to me was his T results. Also to be clear he has other issues, his thyroid is within normal but low range for being on NDT so we are slightly raising that and his sleeplessness in part is due to chronic pain, etc.

Anyway, his labs on 140 mg/wk in May of last year (this was Discounted Labs as docs didn't want to test)

Total T: 691 ng/dl (lab range 264-916)
Free T : 9.5 pg/ml (lab range 6.6-18.1)
Estradiol Sensitive: 27.5 (lab range 8.0-35.0)

Latest labs (different lab as insurance paid and ordered by doc except the E2 which we paid for ourselves)

Total T: 986 ng/dl (lab range 250-1100)
Free T: 122.9 pg/ml (lab range 30.0-135)
Estradiol Sensitive: 41.0 (lab upper limit 35.0)

His doc rx'd Anastrazole 1 mg tablet to be taken as ONE QUARTER tab every 3 days. I'll start him on 1/4 the day after injection or something like that and we'll see. I have read extensively about AI's and to be careful. Some think they are the devil and others who take them judiciously say they are very helpful.

MY question is, do we stay on the same dosage with the latest lab numbers and see what an AI does OR..go back down to 140/mg wk and stay there? Obviously that was just one test on the 140/mg wk so he may have had better numbers after months of being on it, we just couldn't afford the self pay at that time but am going to be more diligent...i know to retest in 6 weeks with any change in his routine. (He is not overweight, takes DIM, Zinc, etc.)

Thanks in advance for any advice and input

Susie

 

[fifty]

Agree.

If he feels good at 140 then i might stay there. Screw the numbers especially if they’re from the trough. If his trough is a bit low rest assured his levels are higher the rest of the week.

Also be wary of apples to apples comparisons between different labs.

 

[Systemlord]

Those 2nd set of labs look great minus the slightly high estrogen, You wouldn't want to do anything that lowers the Free T, if anything you would want it higher.

You need optimal Free T3 in order to metabolize testosterone. Need to get Free T3 midrange or higher. Having Free T3 on the lower end will make TRT less effective.

 

[ReillyJ]

OH no...okay... his labs were on Thursday morning and he shoots Thursday night/Sunday morning so yes in a trough so wouldn't that make his total and free pretty darned high?

i had to get E2 from discounted labs as his doc wouldn't order that, you know how docs are, i had to ASK for Free T. An interesting note..his thyroid numbers came back a little low for NDT (natural dessicated thyroid) i'm on a huge thyroid list and they want Free T4 in mid range and Free T3 in upper range and both of his are lower so i am upping his NDT and he already is feeling better. Also because of his ED, he is on daily cialis (10 mg) and it wasn't sufficient..enough for penetration (sorry for TMI) but not hard enough and his libido had gone down, without my knowledge, he had taken 20-40 mgs a few times and had an excellent erection but i freaked when i found out about it and surmised that maybe his recent profound fatigue, etc., was due to over dosing on Cialis (if you do a Google search, it is one of the symptoms some men were having, in addition to back/leg pain). So i stopped Cialis Saturday and upped his thyroid and he's doing much better as of today especially.

he took 60 mg Sildenafil the other day and erection was not sufficient enough so today i put him back on daily Cialis, this time 5 mg as we plan on using Viagra on those days we'll be intimate. SO MUCH coming into play with all of this and balancing act. (i may put him back on Citrulline, he was on it months ago but no real change, TRT has done wonders for libido except lately but no real change w/ED)

Wondering if i should just go back to the 140 mg/wk. The BW looks so much better on 150 mg/wk but i guess it doesn't matter...

I will not start the AI on your guys advice....

Susie

 

[ReillyJ]

Those 2nd set of labs look great minus the slightly high estrogen, You wouldn't want to do anything that lowers the Free T, if anything you would want it higher.

You need optimal Free T3 in order to metabolize testosterone. Need to get Free T3 midrange or higher. Having Free T3 on the lower end will make TRT less effective.

Systemlord do you mean thyroid numbers (Free T3)? Because i just posted that his Free T3 (on NDT) came back low normal. So we are adjusting that..but then we have to think about RT3 possibly and my head starts spinning with all of this.

Susie

 

[fifty]

Can you inject Monday morning and Thursday night? That would be even spacing between injections.

The way you’re doing it your blood test is 4 days after the prior injection. Also your injections are 4.5 and 2.5 days apart.

 

[Systemlord]

Yes I mean Free T3, it's where the rubber meets the road. Increasing injection frequencies would really lower his estrogen, when I was injecting twice weekly estrogen was 70, now injecting smaller doses every 2 days I feel tremendously better with no AI. I'm do for labs Monday and don't expect to see it anywhere near 70.

 

[ReillyJ]

Yes I mean Free T3, it's where the rubber meets the road. Increasing injection frequencies would really lower his estrogen, when I was injecting twice weekly estrogen was 70, now injecting smaller doses every 2 days I feel tremendously better with no AI. I'm do for labs Monday and don't expect to see it anywhere near 70.

The reason why we dropped to twice weekly is on advice from this forum, his SHBG was high normal and binding his Free T, we noticed better results dropping to two times a week and obviously..look at his Free T now! BUT... maybe someone can weigh in on that, we didn't have his SHBG tested again but being an older male i bet it probably is still high.

I'll up his thyroid and idk whether i should stay at 150 mg/wk or drop it back down to 140 mg/wk..it isn't much difference in the syringe, LOL.

 

[Systemlord]

I would get Free T3 up and see what happens, Free T3 speeds up every cell in your body, even the livers clearance of estrogen.

As long as his Free T is high normal, SHBG doesn't really matter.

 

[Cataceous]

I would caution against relying too much on standard free T tests. Unless the test method is equilibrium dialysis or LC/MS, results will be very "noisy" and also have accuracy problems. And you've seen that results from different labs cannot be directly compared. Much better is to instead measure SHBG along with total testosterone and then generate calculated free T.

 

[Gman86]

I would go back down to 140mg/ week if that’s where he felt better. I can almost guarantee that if you had him retested at 140mg that his labs would look closer to his most recent labs he had done at 150mg, than the first set of labs. So I would go to 140mg, and retest in 6 weeks.

So what dose of NDT is he on, what brand, and how many times a day is he taking it?

Also, just wanted to say that I think what you’re doing for him is absolutely amazing! He is very lucky to have a wife that cares this much. You’re doing a great job.

 

[ReillyJ]

I would caution against relying too much on standard free T tests. Unless the test method is equilibrium dialysis or LC/MS, results will be very "noisy" and also have accuracy problems. And you've seen that results from different labs cannot be directly compared. Much better is to instead measure SHBG along with total testosterone and then generate calculated free T.

Thank you, that's very interesting.

When he gets labs in 6 weeks, should i just order Total T, SHBG, and E2?

 

[ReillyJ]

I would go back down to 140mg/ week if that’s where he felt better. I can almost guarantee that if you had him retested at 140mg that his labs would look closer to his most recent labs he had done at 150mg, than the first set of labs. So I would go to 140mg, and retest in 6 weeks.

So what dose of NDT is he on, what brand, and how many times a day is he taking it?

Also, just wanted to say that I think what you’re doing for him is absolutely amazing! He is very lucky to have a wife that cares this much. You’re doing a great job.

Gman, i think you're right, i was pondering all of this and was betting that his numbers were better on 140 mg/wk than the first results because that was taken 6-8 wks after going up from 100 mg to 140 and no further testing after that so i'm betting they were indeed closer to the second set and we will go back down to 140 rather than taking the AI, i am so grateful for this forum.

He was on Nature-Throid which is impossible for us to find now because of the manufacturer so we switched to NP which is generic Armour. I am thinking he absorbed Nature-Throid better as when he was on 3 grains, his Free T3 (just one test..) was high so we dropped back down. On NP, his latest test was Free T4 just barely within normal range and Free T3 was just under mid range if i remember correctly and FT4 should be mid range, FT3 should be upper range. I bumped him up 1/2 grain (30 mg) to 3 1/4 on the NP and that was a couple days ago and he's already feeling better. I know that iron, cortisol, selenium, etc., all play a part and it's as complicated as TRT. Will sit on all of this and retest all in 6 wks or so. Oh, he takes his NDT 2 x a day. I'm really concerned because there may be an issue of pooling RT3 and that really concerns me. Because that will mean dropping everything and going on just T3 for 12 weeks, i fear any destabilization in him (or me for that matter) but i guess one step at a time and we'll see.

Also thank you so much for the compliment. I feel that is my job so i'm always surprised at when someone says something like that. He takes care of me, he provides for me and is a really good man. He's 14 yrs older than i am, we married when i was 19 and he was 32 and you can imagine no one thought we would last.

Susie

 

[Gman86]

That’s sweet that you think that it’s just your duty as a wife. Unfortunately, I can’t think of anyone in my personal life that would go above and beyond like you are and voluntarily learn all this stuff, and spend time on a forum like this, to try and help their significant other in regards to hormone optimization. Not even my own mother, who is the best mom/ person ever. Her current boyfriend is on TRT, but is struggling big time, and doesn’t do any research on his own about it. It hasn’t even crossed her mind to learn about what’s going on with him, and to try to learn how to help him with things. What you’re doing is truly amazing.

And yes, this whole shortage on NDT thing is insane. I recently started on NDT, and it’s been a huge pain. Can’t believe his numbers came back so much lower on NP thyroid, while basically being on the same dose of around 3 grains.

But yes, 140mg should be good. And you definitely want to keep him off an ai if possible. Only use it as a last resort.

 

[Cataceous]

...
When he gets labs in 6 weeks, should i just order Total T, SHBG, and E2?

That's good for the basics. Here's a free T calculator. It won't make too big of a difference, but if you want to be more precise you can order a CMP (complete metabolic panel) to get current albumin—or just use his most recent value, or the default of 4.3 g/dL. If you need to pay for more lab work then do comparison shopping at Life Extension Foundation. I tend to mix-and-match from various providers in order to pay the least.

I believe the normal range for calculated free T is about 5-21 ng/dL. We've noticed that some guys will start having problems with levels around or below 10 ng/dL. On TRT we're usually approaching or above the top of the range.

 

[Tgrappler]

I would strongly advise against Anastrozole/AI, especially at such a high dosage. 41 E2 is not that high, there is absolutely no need for an AI here.

I don't know why people are so obsessed about any specific number. I believe (and have proven to myself through painful trial and error) that T:E2 ratio is much more important. This is not just my theory, there are many endocrinologists and TRT experts that will not look at any number in isolation. Our bodies do not function on a single hormone, so why consider only E2 in this case?

Based on the labs you posted the numbers look good. There could be some other factors at play as it relates to mood/libido, rather than *very slightly* elevated E2.

 

[ReillyJ]

I would strongly advise against Anastrozole/AI, especially at such a high dosage. 41 E2 is not that high, there is absolutely no need for an AI here.

I don't know why people are so obsessed about any specific number. I believe (and have proven to myself through painful trial and error) that T:E2 ratio is much more important. This is not just my theory, there are many endocrinologists and TRT experts that will not look at any number in isolation. Our bodies do not function on a single hormone, so why consider only E2 in this case?

Based on the labs you posted the numbers look good. There could be some other factors at play as it relates to mood/libido, rather than *very slightly* elevated E2.

Thanks, the AI sits on the shelf gathering dust. Thankful for this forum. Working on his thyroid numbers right now and have decided to titrate down slightly on the T injections back to 140 mg/wk. I should know better than to focus on a number, probably am because the tests aren't taken regularly, too bad we don't have unlimited funds for them. I do know that his chronic pain plays a huge factor in everything.

OH, one thing..he does take DIM (Smokey Mountain) 200 mg, i don't know if it's advised to double that amount...

Susie

 

[Tgrappler]

Thanks, the AI sits on the shelf gathering dust. Thankful for this forum. Working on his thyroid numbers right now and have decided to titrate down slightly on the T injections back to 140 mg/wk. I should know better than to focus on a number, probably am because the tests aren't taken regularly, too bad we don't have unlimited funds for them. I do know that his chronic pain plays a huge factor in everything.

OH, one thing..he does take DIM (Smokey Mountain) 200 mg, i don't know if it's advised to double that amount...

Susie

Good decision, IMHO.

As far as DIM goes 200mg should be fine. It's not an estrogen inhibitor, but may help with conversion issues. I'd say there is no need to increase the dosage.

As matter of fact consider this podcast/blog. It's pretty good.

Episode 59 - don't be a DIM wit! — ATP Science USA

Just one thing to point out, these guys make a supplement (I think it's called alpha prime), which is also an estradiol regulator.

By the way I did use both DIM and ATP science supplements and found them to be helpful.

Cheers.

 

[Logan24]

Yes I mean Free T3, it's where the rubber meets the road. Increasing injection frequencies would really lower his estrogen, when I was injecting twice weekly estrogen was 70, now injecting smaller doses every 2 days I feel tremendously better with no AI. I'm do for labs Monday and don't expect to see it anywhere near 70.

Hey man I’m curious about the more frequent injection schedule. Do you mind if I ask what your shbg is and did e2 drop like you expected ?

 

[Systemlord]

Hey man I’m curious about the more frequent injection schedule. Do you mind if I ask what your shbg is and did e2 drop like you expected ?

My SHBG fluctuates between 16-22 and going from twice weekly to an EOD protocol dropped estrogen considerably! The large injections will cause larger spikes in estrogen in men who are easily susceptible to elevate estrogen on injectable testosterone.

Daily dosing dropped estrogen even further, huge difference.