lowTengineer looking for help

[lowTengineer]

I have been on TRT for a year now. I was diagnosed secondary hypogonadism. I started at 100mg e7d. Doc raised me to 150mg e7d. Then raised to 100mg e3.5d. Both of those times the increase was due to my complaint of the weekly roller coaster. The 2x weekly dose helped with the roller coaster feeling but what I still had in a constant feeling of below average “meh” all day everyday. Defy switched me to 60mg 3x weekly. Still pretty much feel the same.

I still don’t feel great after 9 weeks of this change. I think the ups and downs that I was experiencing have gone away. Now I just sometimes have a feeling of tiredness. Libido is pretty low. Recently my joints mostly knees/legs are sore. I hurt my back maybe 5 months ago so my deadlift/squatting has been very minimal and I do no running.

I try to spread the injections evenly so I do wednesday morning, friday evening, sun night. I hate the inconsistent schedule timing. I feel like I would like the consistency for my routine to do EOD. Maybe this would help reduce the peak e2 enough to get rid of the AI. I would also be willing to think about going back to e3.5d however I'm hesitant due to my past results.

I think my total t, free t, and e2 look great on paper. I've seen a bunch of iron and thyroid discussion on this site recently. Is it possible my low iron is still causing me grief? I've never donated blood.

I have included a list of labs below. One file is my history of labs. The other just shows the recent results if you don't want to see everything.

Do you have any ideas or suggestions I should be working on?

Current meds:
60mg test cyp SQ 3x weekly
300iu hcg SQ 3x weekly
0.125mg anastrozole 3x weekly
500mg metformin 2x daily
iron supplement and extra vit c

height: 5’ 11"
weight: 185lb
BF: ~25-28%
age: 34
I go to the gym 5 days a week. 3 days weightlifting, 2 days cardio. Pretty active on the weekend with kids.

 

[Weasel]

looks like your dosage is way to high. FT and BioT are double the top of range. cut your dose, ditch the AI (lowering dose should allow you to do that) and I bet you'll feel better.

 

[lowTengineer]

looks like your dosage is way to high. FT and BioT are double the top of range. cut your dose, ditch the AI (lowering dose should allow you to do that) and I bet you'll feel better.

Does having high free t really make someone feel bad? It seems counterintuitive to me.
Defy told me in my last appointment that he thought a target free t of 30 would probably be good. I'm not sure if the lab they typically use has a different range than mine.

 

[Vince]

Are these Labs old before you started with defy Medical. They don't look like LabCorp labs and looks like you had the wrong estradiol test?

 

[lowTengineer]

Are these Labs old before you started with defy Medical. They don't look like LabCorp labs and looks like you had the wrong estradiol test?

These are not labcorp labs. I use my local doctor to order tests and send them to defy. Everything but the cmp, CBC, and iron panel were sent to mayo laboratory.

The one I labeled estradiol sensitive is lc/ms. I have called the lab to confirm and had to have it changed in the past.

 

[Vince]

These are not labcorp labs. I use my local doctor to order tests and send them to defy. Everything but the cmp, CBC, and iron panel were sent to mayo laboratory.

The one I labeled estradiol sensitive is lc/ms. I have called the lab to confirm and had to have it changed in the past.

The only thing I can see is your reverse T3 is a little high but not bad.

 

[Vince]

Pregnenolone 101: What You Need to Know About this Precursor Hormone

 

[lowTengineer]

Pregnenolone 101: What You Need to Know About this Precursor Hormone

I have read about this recently and wonder if it's something to check into. I heard a Jay Campbell podcast recently that one of the docs said he doesn't test for it, just uses it with symptoms.

The only thing I can see is your reverse T3 is a little high but not bad.

Does this improve with iron and ferritin?

 

[Vince]

I have read about this recently and wonder if it's something to check into. I heard a Jay Campbell podcast recently that one of the docs said he doesn't test for it, just uses it with symptoms.


Does this improve with iron and ferritin?

Do you have low iron because of donating blood?

 

[lowTengineer]

Do you have low iron because of donating blood?

Nope, never done it. I did do a occult stool test to check for blood and it came back negative.

 

[Vince]

Your reverse T3 should be below 15, but I'm only nitpicking now. Your levels look good, don't know what you need to change.

 

[lowTengineer]

I had an appointment today. The main takeaway is that possibly my free e is elevated with my free t. I was suggested to switch to EOD to solve my previous dosing schedule hatred.

My new protocol to try is:
48mg test cyp eod
240iu hcg eod
0.125mg anastrozole eod

It was suggested that I alternate hcg and test days to help not forget that it is injection day or not. Has anyone else done this?

I also have a slight concern about the anastrozole. I really dont want to take it or increase the dose. My preference is to be off it if I can. Any input on this?

Happy to see my iron and ferritin go up. Still supplementing for 3 more months and rechecking.

 

[lowTengineer]

Anybody have any thoughts on my revised protocol? especially the AI usage.

Has anybody done EOD injections while alternating hcg and test days? Is this more of a hassle doing it everyday?

 

[minihatt]

why not consider Nebido every 10w?

 

[Vince]

I would drop your testosterone to 40 mg every other day and leave the rest alone.

 

[lowTengineer]

I would drop your testosterone to 40 mg every other day and leave the rest alone.

Do you think that drop should also include the increased anastrozole?

 

[Vince]

Think I would continue to AI until you have labs on your new protocol.

 

[lowTengineer]

It's been about 16 weeks of my EOD protocol. I've been doing:
48mg test cyp eod
240iu hcg eod
0.125mg anastrozole eod
25mg DHEA
iron supplement

Here are my recent labs. I have some questions relating to some changes so I included the last 2 sets.

test	units	range	7/2/2018	9/19/2018	1/21/2019
			90mg e3.5d SQ	60mg 3x SQ	48mg EOD IM
			injection day	injection day	injection day
weight	lb		187	184	178
BP			144/68		145/62
Cholesterol	mg/dL	100-200	178		159
Trigl	mg/dL	0-150	57		71
HDL	mg/dL	40-60	46		43
LDLc	mg/dL	0.0-130.0	120.2		101.9
Total Chol/HDL		<5	3.9		3.7
Sodium	mEq/l	134-145	138	137	136
Potassium	mEq/l	3.6-5.1	3.7	3.8	4.1
Chloride	mEq/l	98-110	103	102	101
CO2	mEq/l	21-32	26	27	31
Anion	mmol/L		12.7	11.8
Glucose	mg/dL	70-105	110	107	113
Calcium	mg/dL	8.4-10.2	9.2	9.2	9.2
ALT	u/l	7-52	21	17	24
AST	u/l	12-48	20	23	27
Albumin	g/dl	3.5-5.7	4.8	4.7	4.9
ALP	u/l	29-119	55	48	46
Protein	g/dl	6.4-8.9	7.5	7.3	7.4
Bilirub	mg/dL	0.3-1.3	0.5	1	0.9
BUN	mg/dL	7-25	16	18	20
Creatine	mg/dL	0.70-1.30	1.08	1.16	1.17
Creatinine+eGFR	>=60		78	72	81
WBC	K/UL	4.0-11.0	5	4.6	4
RBC	K/UL	3.50-5.50	5.71	5.76	5.77
Hgb	g/dl	12.0-18.0	16.8	17	17.1
Hct	%	42.0-52.0	46.9	48	48.2
MCV	fL	75.0-100.0	82.1	83.3	83.5
MCH	pg	25.0-35.0	29.4	29.5	29.6
MCHC	g/dl	31.0-38.0	35.8	35.4	35.5
RDW	%	11.0-16.0	11.8	11.9	12
A1C	%	4.0-6.0			5.3
DHEA-S	ug/dL	89-457	152	404	489
PSA	ng/mL	0-4	0.459
IGF-1	ng/mL	54-310	224
IGF-1 z-score	st dev	-2 to +2	1.05
Testost	ng/dl	262.0-1,070.0	627.1		1331
Test Free - calculated	ng/dL		14.8		25.6
Test total	ng/dl	240-950		1020	1120
Test Free	ng/dl	4.85-19.0		34.7
Test bioavailable	ng/dL	72-235		541	526
SHBG	nmol/L	10-57	25	27	33
Estradiol Enhanced	pg/mL	10-40		42	31
Estrone	pg/mL	10-60		43	30
LH	miU/ml	1.24-8.62	0
thyroid tests
T4Free	ng/dl	0.79-1.77	1.19
T3Free	pg/ml	2.30-4.20	3.44
T3Reverse		9.0-27.0	16.7
TSH	miU/ml	0.300-4.000	1.745		3.051
FT3:Rt3 ratio			20.6
Iron	ug/dL	50.00-212.00	47	101
Iron-Satn			12.18	27.08
Iron+TIBC		250.00-450.00	386	373
Ferritin	ng/ml	23.9-336.2	33.8	48.4	75.9
Vitamin B12	pg/ml	211-911			768
Folate	ng/ml	>4.0			13.8

I still would not describe myself as feeling great. I will say my gym performance is the best it ever has been. I still feel tired occasionally. Libido is kind of low. Erection problems sometimes occur during sex.

My lipid panel looks like it took a huge hit. Where did this come from?

In July I was told that my thyroid looks pretty ok although reverse t3 is starting to get high. At that time my iron and ferritin was super low. I've been supplementing iron and it has come way up. I was also suggested to not test thyroid when my iron is low since it will be changing.

This time I decided to add TSH to see where it sits. To my surprise it went way up. Is my ferritin up high enough? Is there a time I need to wait for it to stabilize? Is it time now to repeat my previous thyroid tests?

I can't decide if I should make my appointment with Defy now and then be told I need more tests. Does anyone know, when they get those results would I need to make another appointment to discuss?

 

[Weasel]

What exactly are you seeing that took a huge hit lipids wise? Other than triglycerides taking a small jump i don't see much that really stands out.

 

[lowTengineer]

What exactly are you seeing that took a huge hit lipids wise? Other than triglycerides taking a small jump i don't see much that really stands out.

I thought the triglycerides going up and everything else down wasn't that great.