Latest bloodwork on new regimen with Defy

[CoastWatcher]

I was having hot flashes and some water retention and moodiness BEFORE the change when it was 46, but now with the protocol change all of that is gone and it still went up to 49. So the T/E ratio must be the explanation there.

Dr. Saya posted this last week on the T:E ratio.

Let's also keep in mind, fellas, that the T:E ratio should only be used as a "common sense" variable...in the sense that I hope most can logically agree (and I have stated several times here) that an E2 level >35 pg/mL on the sensitive E2 assay is NEVER a low estradiol reading for a male regardless of the concurrent T levels. In other words, the relationship with the T:E ratio cannot be viewed concretely, but more abstractly, and it is not linear in the sense that it loses some degree of validity as T levels get to the extremes.

 

[Helboi]

So then the ratio might not mean much? I'll be interested to hear Dr. Saya's explanation on my E level and why it went up, but I still feel better.

 

[CoastWatcher]

So then the ratio might not mean much? I'll be interested to hear Dr. Saya's explanation on my E level and why it went up, but I still feel better.

The ratio is one variable that the patient and doctor factor into their work together. It is valuable, but it is an hypothesis, and should be used as a reference point in discussions you and Dr. Saya have. You feel good, emphasize that, by all means, when you discuss your situation with Dr. Saya. It will be interesting to see what the two of you do. Will you keep us posted?

 

[CoastWatcher]

Did you run a CBC? Or did I miss it?

 

[Helboi]

Did you run a CBC? Or did I miss it?

Yes, here are the numbers from that:

January 2015:
Hemoglobin 18.4 g/dL (range 12.6-17.7)
Hematocrit 53.7% (range 37.5-51)

March 2015:
Hemoglobin 18.6 g/dL (range 12.6-17.7)
Hematocrit 54.0% (range 37.5-51)

I have typically had a high hematocrit even before I started TRT (it was 51.3 before I began treatment). This is likely due to living at high elevation (6,500 feet) and Dr. Saya has agreed that we shouldn't fight my body since it tends to run high anyway and we wouldn't worry about therapeutic phlebotomy (I cannot donate) until 55 or so. Not sure if he'll have me get one, or wait and see since it seems to be stable and not moving much.

 

[Helboi]

It will be interesting to see what the two of you do. Will you keep us posted?

Yes, most definitely.

 

[John O'Connor]

Thanks for mentioning the high altitude. I live in Denver and only started TRT 3 months ago, so I will watch for that and share that info with my doctor. I now its common for patients to have lower room air O2 saturation levels at altitude. Normal SaO2 = 94-99%, but its very common, to see healthy patients with levels at 91-93% in Denver.

 

[Helboi]

Thanks for mentioning the high altitude. I live in Denver and only started TRT 3 months ago, so I will watch for that and share that info with my doctor. I now its common for patients to have lower room air O2 saturation levels at altitude. Normal SaO2 = 94-99%, but its very common, to see healthy patients with levels at 91-93% in Denver.

I'm just outside of the Denver metro, so a bit higher at 6,500. It's definitely a factor, so for sure mention it to your doc. What was your hematocrit before starting TRT? And after?

 

[John O'Connor]

Helboi - I started TRT 12/9/15, on 80mg/week at time of 2nd blood draw.

On 11/25/15 Pre-TRT
HGB 16.4 (14.0 - 18.0)
HCT 47.2% (41 - 54%)

On 2/22/16
HGB 17.7 (14.0 - 18.8)
HCT 50.8% (41 -54%)

So it went up a little. I'm actually off TRT right now (last injection 3/17) just to get full baselines again, we didn't get a lot of numbers prior to starting TRT (Free T, SHBG, DHEA-S, Estradiol Sensitive, etc.) I also started a new medication, so I want to be sure my baseline numbers are known as I move forward.. I get blood drawn 4/13, then will restart on E3.5D injections. I'll hopefully start HCG at same time. Still need to fully discuss that option with my doctor.

 

[Helboi]

Helboi - I started TRT 12/9/15, on 80mg/week at time of 2nd blood draw.

On 11/25/15 Pre-TRT
HGB 16.4 (14.0 - 18.0)
HCT 47.2% (41 - 54%)

On 2/22/16
HGB 17.7 (14.0 - 18.8)
HCT 50.8% (41 -54%)

So it went up a little. I'm actually off TRT right now (last injection 3/17) just to get full baselines again, we didn't get a lot of numbers prior to starting TRT (Free T, SHBG, DHEA-S, Estradiol Sensitive, etc.) I also started a new medication, so I want to be sure my baseline numbers are known as I move forward.. I get blood drawn 4/13, then will restart on E3.5D injections. I'll hopefully start HCG at same time. Still need to fully discuss that option with my doctor.

You're still in a good place with HCT, but definitely mention the altitude factor. Glad you're getting baselines, those are important!

 

[Helboi]

So I had my consult with Dr. Saya as a follow up to the last bloodwork I posted above. Here's the plan for now: try to lower my E2 slightly, while maintaining my T levels as much as possible.

To do this we won't be using an AI, thankfully. We're going to adjust my T dose ever so slightly (taking 50mg/EOD now, if I had to make a wild ass guess I'd say the new dose is around 45mg/EOD...adjusting it from .25CC/EOD to .23CC/EOD). In addition, I'll be taking 1,000mg/day of calcium d-gluconate. These two things we hope will be enough to bring my E2 where it needs to be (he says he thinks I'm close to my sweet spot there) without dropping T much lower than 1,000-1100. I already take DIM 200mg/day, so we'll keep that as well.

I think I'm finally getting close to dialed in. We'll see how the next 3 months go. So happy with the care I'm getting with Defy!