Hi JJ, hope all is well. I took a look at your labs and thought I would offer my opinion, which may differ somewhat from others. First, on the basics of the labs, keep an I on your Glucose. it isn't dangerously high or anything but I rather see it be lower. Have you had your A1C checked lately? It gives you more of an average of what your sugar is over the last 3 to 4 months and is really a better indicator of your Glucose. The "Glucose" showing on the lab work is basically just a snapshot of what it is at that day and time. Like everything else it will fluctuate based on what we are eating and our water intake.
Sodium is borderline high so keep an eye on your salt intake.
LDL is real good but your triglycerides are on the high side even though just above the top of the range. High triglycerides are worse for you than high LDL. Your HDL is low and TRT can effect it and bring it down a little bit.
Your TT T and Free T look good for being at trough but they could both be a little high. I'd probably like to see your Free T up closer to the top of the range, around 24. That will mean your TT will also go up but the important reading is the Free T as you already know. Your E2 looks good to me at 30.4 with a top of the range at 35. But it will go up some if you increase your Free T. E follows T. Are you feeling any high E2 symptoms? I don't think the way you are feeling in the "mood" summary is E2 related. It seems many of those feelings you had before starting TRT.
You have good SHBG (almost middle of the range) so you don't have too much of it binding up your T. I'd be curious what your DHT levels are. Have you ever had it tested? I don't see a real problem there and I wouldn't suggest you run get it tested because it is about $90. I do think men should have it tested occasionally or at least once to get a baseline or see where it is. It is a very strong male hormone, down stream from testosterone, but much more powerful in many regards.
Your DHEA is low and I believe it should be much higher. You may have low Pregnenolone and Progesterone. These could be where the mood issues. Some believe the best way to back fill the pathways is through HCG. I believe there is truth to that for some people. I tried HCG and don't believe it helped me back fill the pathways. That was confirmed by test results that showed no increase in DHEA, Pregnenolone, or Progesterone after 6 months on HCG. But it does work for many people. I did not see any improvement in my labs and sense of well being and mood until I started supplementing with DHEA and Pregnenolone. My DHEA was similar to yours at 64 and my Pregnenolone did not register nor did my Progesterone register. Basically they were zero. On my last blood work in September my DHEA was 351 (344 top of range), Pregnenolone was 101 (150 top of range), and Progesterone was 0.4 (0.5 top of range). I have always been a hard charger, not anxiety, but always going 100 MPH. While I can still put a foot in someone's tail end, I have never felt this calm since I can remember.
Some say Pregnenolone test can be inconclusive and inaccurate. That may be true but I know that my test came back twice with goose eggs for Preg and Prog and now I have substantially high results and I know how I feel.
Some people can not take DHEA because it can raise your E2 in men. Although it can convert down different hormonal pathways, it has a strong affinity to convert to E2 in men. Pregnenolone, considered the grandmother of all hormones, would be a good way to go. Below is the hormonal cascade.
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If it were me, I would probably bump my testosterone dose a bit. I would try 65 mg E3.5 days. That's a 30 mg increase per week but your 100 mg is really on the low side. I would also either try HCG (250IU to 500IU twice a week) or try supplementing with Pregnenolone or DHEA, or both. I would probably start off low at 10 mg per day and increase depending on how you start feeling. I am taking 25 mg of DHEA and 25 mg of Pregnenolone at night (sublingual).
I would not take an AI unless you had real symptoms of high E2 but if you needed an AI I would take it in the smallest dose possible that would work for me. I do not take an AI but would if I had to. Some say just reduce your testosterone and you won't have to worry about taking an AI. I agree with that in part, but sometimes you need to raise your testosterone to optimize how you feel and in doing so it raises your E2 just a little too high and a small does of an AI would eliminate the high E2 and keep your testosterone optimized.
Many of the prominent doctors in the TRT field recommend Pregnenolone and DHEA for a reason. Several doctors on the TRT Rountable recommend 100 mg of Pregnenolone a day.
I should stop now. I did not realize I was rambling on so much.
