Recent labs: HIGH Estradiol. Causing sleep issues?

[Reason]

Had my consult and got more labs back. Here's an update.

Spoke with a NP who recommended:

- Start .125 Anastrozole 2x week, increase to 3x week if necessary
- If the AI does not ameliorate symptoms, remove HCG and re-evaluate
- If symptoms subside, add HCG back slowly to find ideal dose

This is if I want to maintain my current T/FT levels, which are right on the money (T~950, FT~25) for where we wanted them to be during my initial consult: T ~1000, FT 18-30. And I was feeling really good before week 6.

I will also switch to a daily injection schedule @ 20mg/day which will put me at 140mg/week.

If all of this goes well, I will consider re-introducing Pregnenolone and then DHEA one at a time and slowly.

New labs:

Highlights:
- FT3: 3.9pg/mL (2.0-4.4)
- TSH: 4.130 uIU/mL (0.450-4.500), up from 2.190 pre-treatment
- IGF-1 333ng/mL (83-233), included for free, never tested before (HIGH)

HCT went up slightly, 43.5 -> 46.4
PSA went up slightly, 0.7 -> 0.8

Everything else looks good and stable.

Although this isn't a full thyroid panel, I'm not seeing much reason for worry here. Still thinking my symptoms are either the E2 or the T.

Questions:

How do I inject HCG on a daily schedule? Can I just do HCG MWF in the morning?

Should I be worried about the elevation in TSH and the elevated IGF-1?

 

[1Draw]

Although your E2 is elevated a bit, your TSH went from 2.190 pre treatment to 4.130 last lab test. You definitely have something going on with your thyroid that needs further blood test to identify the problem. Low T and Hypothroidism symptoms are like twins.... Good link here:

https://www.restartmed.com/thyroid-symptoms-men/

I would at least run a Reverse T3 and Iron/Ferritin blood test and go from there. Surprised your NP at Defy didn't comment on the rise in TSH which is a clear indicator of a thyroid problem. Optimal levels are at a minimum less than 2.

 

[Reason]

I know you keep banging on the hypothyroidism drum but I didn’t experience many of the classic hypothyroidism symptoms pre-TRT. Hypogonadism fit better and was confirmed through blood tests. Pre-treatment my T and FT levels were the only anomalies on my labs. My E2 is almost double where it should be. Fits better for the current symptoms.

And another option is: TSH is a pituitary-produced hormone and that combined with optimum FT3 levels plus my hypognadism likely being secondary could indicate a pituitary issue. TRT messes with the HPTA axis.

Or the pituitary is fine and has to pump out more TSH for a now broken thyroid (because of TRT???) to produce normal levels of hormones? Seems strange.

To check into this I’m going to have to go through my regular doctor and the Kaiser bureaucracy because I don’t have the means to pay out of pocket for 2 hormonal treatments with all the associated tests.

Hopefully they’ll work with me without trying to mess with my TRT. My doctor was VERY against me going into TRT citing all the myths to back up her concerns...

 

[Reason]

Quick update:

After adding an AI, issues improved a lot but sleep still bad.

Just got labs back and my TSH, FT3/FT4 levels are either at or near optimal.

T, FT, and E2 are still high so I'm planning on reducing my dose slightly.

I've a follow-up consult on 07/05, we'll see what they say then.