Lab results, thoughts?

[ab037]

Okay, hopefully some TRT vets can give me some thoughts. Been on TRT since late 2012, initially my labs showed TSH @ 7.4 and total test @ 230( back in 2012). Found a (what I thought) reputable Dr, and followed his protocol ever since. He took his time initially ( 3-4 months), he did a 30 day run of HCG to see if my body could produce Testosterone on its own, labs showed Test levels were mid 600's, then he had me take 30 days of Clomid (which libido went into the tank) and Test levels were similar after those labs, followed by another 30 days of HCG.
After this he starts me on 150mg Test Cyp/week, as well as HCG every 3 days. We messed around a bit with arimidex manipulating my E2 levels, I injected twice a week (split dosage), subq and ended up not really needing any AI, as my E2 stayed around 25.

Unfortunately, I never asked "WHY" I was being put on Test, (yes hindsight is a mofo), started thinking that all of it could have been simply my thyroid shutting me down. Recently have moved to another state and no longer see that Dr, but tried to do a restart with Nolva 40/20/20/20 and Clomid 100/50/50/50.. So these labs I am posting are POST restart attempt, would love to have some input/thoughts.. should I try and ride it out a few more months without Test and pull labs again in hopes that my HPTA can recover? its only been about 6 weeks, or face the reality of the weekly harpoon =D..

Thanks

Ill make it easy

LH =1.4 range 1.2 - 7.8
Progesterone =0.2 range 0.15 - 1.15
E2 =19
FSH 2.0 range 1.3 - 11.4
Total Testosterone =163 range 300 - 850
Free testosterone =3.6 range 4.8 - 25.7
SHBG =24 range 16.5 - 55.9
Vitamin D =59
Free T3 =2.6 range 2.3 - 4.2
T4 = 7 range 4.4 - 12.4
Free T4 =1.25 range .73 - 1.95
TSH =3.1 range 0.5 - 4.7
Cortisol AM =21 range 2 - 25
Thyroid Peroxidase AB =14 range <9

[kelkel]

It's a shame your initial doc missed the obvious. Two things many doc's don't understand, hormones and thyroid.
How long "post" pct are these labs?
And yes, your thyroid still may need attention. A more modern range is .3 - 3.0.

[ab037]

6 weeks post pct

[kelkel]

Well, obviously your goal is to come off and six weeks is really not much time. I would think your LH would be higher but I'd consider giving it more time and retesting in another couple months. In the meantime dig deeper into your thyroid and see if that can be tweaked into performing better. All that said, three years or so is a long time to be shut down and returning to normal (relatively optimal) levels non-TRT may be difficult.

How old are you ab?

[ab037]

42 yrs old.. yeah, was afraid the shut down was probably too long to rebound from.

Thanks for input..
I have a follow up with Dr next week to review these labs. Will see how he wants to address these..

[kelkel]

Best of luck. Hammer him about thyroid. Spend some time reading at Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment as well. You'll definitely need a lot of patience to follow through with this. Please update this thread as it could impact many guys.

[ab037]

Alrighty, wanted to update the thread after Dr visit while everything is fresh.

After reviewing those labs, I'll start with the Thyroid, Dr agreed and am switching back over to Armour Desiccated Thyroid meds. Not sure why I was changed from that originally to the Levothyroxine. Also this would be my third thyroid antibody test confirming Hashimoto's. So hopefully changing to Armour and adjusting until symptoms clear should be a good start there. (was pending when I posted labs previously but reverse T3 was top of the range) so my body does not convert the T4 worth a shhhhtt.

Had a conversation I had forgot about with previous Dr, and that was regarding any head trauma. Which I did in fact have during a motorcycle crash back in 09. Which (both Dr's) now believe caused my pituitary to either not send or send enough LH hormone. Which is causing me to be secondary.
Also have high cortisol morning and afternoon which equates to adrenals being taxed, which correlates with low thyroid function... ie stress

Dr. wants to put me on HCG oral, (would be a first) 1000iu twice a week. I asked him about over blasting with HCG causing desensatizing of the leydig cells..ie trying to treat secondary but causing primary. I dont think he is up on that, but basically said he would look into it. I may need to do some research and bring it to him next visit.
Also Dr, wants to put me on Testosterone cream/gel 50mg topical daily...
Asked him about possible elevated E2, and if he planned to address that now. Just said he does monitor that, but recommended a couple of natural supplements ( saw palmetto, quercitin) and said they compete or something with the aromatose and should help prevent elevated E2.

I have been on test cyp, with HCG and adex for the past 2.5 years with another Dr, so I know that is the preferred protocol from most on this board. This new Dr's approach is a bit different, but am willing to give him a shot.
But lets here any thoughts or questions on this.
Thanks!

[jasondd1]

I doubt 50 mg a day will do much. Best absorptions Ive heard of are 10% so that would mean 35 mg a week best case. I don't think an AI on creams is usally necessary. HCG oral Ive heard doesn't work however Ive also heard there are new advances in the oral so I don't know

Most or all I just said is based solely on bro science i am no expert.

Alrighty, wanted to update the thread after Dr visit while everything is fresh.

After reviewing those labs, I'll start with the Thyroid, Dr agreed and am switching back over to Armour Desiccated Thyroid meds. Not sure why I was changed from that originally to the Levothyroxine. Also this would be my third thyroid antibody test confirming Hashimoto's. So hopefully changing to Armour and adjusting until symptoms clear should be a good start there. (was pending when I posted labs previously but reverse T3 was top of the range) so my body does not convert the T4 worth a shhhhtt.

Had a conversation I had forgot about with previous Dr, and that was regarding any head trauma. Which I did in fact have during a motorcycle crash back in 09. Which (both Dr's) now believe caused my pituitary to either not send or send enough LH hormone. Which is causing me to be secondary.
Also have high cortisol morning and afternoon which equates to adrenals being taxed, which correlates with low thyroid function... ie stress

Dr. wants to put me on HCG oral, (would be a first) 1000iu twice a week. I asked him about over blasting with HCG causing desensatizing of the leydig cells..ie trying to treat secondary but causing primary. I dont think he is up on that, but basically said he would look into it. I may need to do some research and bring it to him next visit.
Also Dr, wants to put me on Testosterone cream/gel 50mg topical daily...
Asked him about possible elevated E2, and if he planned to address that now. Just said he does monitor that, but recommended a couple of natural supplements ( saw palmetto, quercitin) and said they compete or something with the aromatose and should help prevent elevated E2.

I have been on test cyp, with HCG and adex for the past 2.5 years with another Dr, so I know that is the preferred protocol from most on this board. This new Dr's approach is a bit different, but am willing to give him a shot.
But lets here any thoughts or questions on this.
Thanks!

[ab037]

Yeah, the Dr said absorption rate would probably be 10-15%. He's a believer of trying to mimic the natural release of Test, and says the gels/creams are better and give a more stable serum level versus injecting a large dosage (say 150mg, previous) and having it taper down over a week or two.. He has stated he doesn't subscribe to injectable test, so will see, I am willing to give him a shot, but if I dont feel better on this protocol I will be switching for sure.. I had already spoke with LowT.com and been accepted, was just hoping I could get insurance to cover some of this if possible.

[kelkel]

More issues with creams than gels. Yes, they can mimic the diurnal nature of testosterone more closely but lifestyle comes into play as well. I did gels for a period of time. Never again when I can spend a couple minutes twice per week for an injection and be done with it. When it comes to injections and your comment "taper down over a week or two," test needs to be weekly at a minimum. Never every two weeks.

Why does he not subscribe to test? It's the exact same thing as your body used to produce naturally! Cream, injections, gels, pellets, it's all testosterone just with different delivery systems. I'm curious, does this doc sell the cream or connected to the pharmacy that does? Many doc's like to stick to gels / creams as it's easier for them, not necessarily better for the patient.

You won't have much luck with Saw Palmetto or Quercitin, inho.

And HCG oral? No, just no. I don't really like what this doc is selling.

[ab037]

I hear ya Kel. You know as well as i do how alot of These Dr's can be stubborn and opinionated. I thought the same thing in regards to the gel/cream that he must have some kind of deal or something. But he just wrote the script and didn't recommended a particular pharmacy, so idk.
I agree its much easier to inj subq twice a week and not worry about all of the possible " contact" issues.
When i told him the protocol of previous Dr he made a face like that was crazy and dhe doesnt do injectables.
Yeah ive never even heard of oral hcg.
Do you think this is even worth the attempt?

[kelkel]

Do you think this is even worth the attempt?

Not to me. Sounds very old school.

[ab037]

Have appointment tomorrow AM with Crisler.... I'm sure his protocol and direction will be on point.. but will update after..

[kelkel]

Let me know how it goes please. PM or post.

[bigdil511]

Let me know how it goes please. PM or post.

I'd like to know as well good luck dude.

[ab037]

Update:

Dr Crisler agreed that crash in 09 and head trauma (rocking of Pituitary gland) is cause of secondary failure. So his recommendation for protocol is as follows:

75mg Test cyp twice/week SubQ (starting here probably because that's what previous Dr had me at idk)
100iu/ day HCG SubQ wants to mimic natural LH as much as possible since mine is suppressed..

going to monitor E2, previously did not need adex

regarding thyroid:
I recently switched back to Armour Desiccated thyroid and have already felt a huge difference, so we are going to maintain current dosage and check levels at follow up labs.

but in addition
3grams of omega 3's /day - to help balance cholesterol better
iron supplement - helps inhibit T4 to T3 conversion (which I have been having issue with due to T4 only previous meds, as well as being in a calorie deficit for some time)
DHEA- says 25mg twice/ day

Follow up labs in 30 days to adjust anything as needed..

I must say it was nice speaking with a Dr that new wtf was going on, that understood thyroid, hormones, as well as diet.. very pleasant to talk to, asks if I have questions throughout, reviewed protocol plan and proposed treatment.

This looks much better than the previous Dr, at any rate any and all opinions are welcome.

[kelkel]

Good stuff ab! Glad it went well. Look forward to seeing how you do with your upcoming labs!
Going from memory elemental iron absorbs best when taken with vit c.

[ab037]

Yessir me too. I will grab some Vit C to go along with TY. Will post follow up in a month.
Thx for feedback

[ab037]

Well, its been 4-6 weeks since picking up this protocol and this is the resulting labs.. any thoughts?

I will repost the protocol to refresh memories.

75mg Test cyp/ twice a week
250iu HCG / twice a week

No AI currently

1.5 grains Armour daily
DHEA, Iron, various other supps..

494 TT I am not crazy about, but Free T is in the upper range.. Overall feel fine. E2 at 45, TBH I feel fine, I havent noticed any symptoms really, maybe a little tired if anything.
TSH is still up there, and I want to address that with Dr, so more than likely will be increasing that..

And labs were pulled 3 days after injection, basically 1 day before next injection.. tried to get it in the trough

But, any and all thoughts ideas welcome..
TY

[kelkel]

Hi ab! Thanks for refreshing us with your protocol. Always nice to not have to re-read an entire thread.
Don't worry about your TT at all, means nothing. Your FT is great.
I'd like to see your E2 brought down a bit, which in turn will elevate your T a bit. You could try some DIM, zinc/copper for a minimal impact.
I'm guessing your shbg runs low? Next time be sure to check it as it's a good thing to monitor.

[ab037]

Hey Kel,

Yessir, its easier to just put the relevant info right there to get the responses =D

Will def give those supps a look. As far as SHBG, my labs from July has it at 24 on a range of 16-55... But they did not order them this go round, will def add it in next time..

My lab review was supposed to be next week, but was able to get it moved up and just had it..

Their recommendations were to:

increase from 75mg to 100mg twice a week test cyp.
increase from 250iu to 500iu twice a week HCG
I asked about my Free T being the more important factor, they just said "most" feel better in the 700-1000 range TT, and that 20 was the sweet spot for FT..

increase my DHEA supp from 25mg to 50mg daily

They put a note for AI, if I begin to experience any related symptoms... (I suppose its up to me on that end, as I mentioned I havent noticed any negative effects yet, but def will be paying attention)

They said my Free T3 & T4 looked good and wouldnt recommend an increase in DTH yet.. even with TSH being 3.7 IDK about this one. Overall I feel fine so maybe I just give it more time and see..

[kelkel]

They seem hooked on TT as their guide. So be it.
I would not jump to 500 iu HCG x 2 per week. Totally unnecessary and could very well exacerbate your E2 issue. If anything, go to 250 x 3 per week.
50 mgs DHEA (micronized) is fine. It can increase E2 as well. Next BW take this supp a few hours prior to your BW and check results. Then you'll know....

When it comes to E2. Most side effects are internal and manifest over time. Do not use gyno / nip issues as a guide. Increasing your dose of test and possibly HCG while E2 is already over scale will elevate this even more. Use caution.

Post up your next BW please.

[ab037]

will do.. muchas gracias for input...
Ya, its Defy medical, Dr Crisler is one of the 2 Dr's on staff there... They give you the option to have your review with one of the Dr's for X$ or with a Nurse for half as much.. I opted for the nurse, I would assume that should would be consulting with the Drs before but next time I think I will stick to Crisler just to be certain.

Would you just start a low dose AI, or would you take the " wait and see" approach?

And TBH I was finishing up the bottle of UGL HCG I had before starting the RX, so very possible it was bunk or underdosed I imagine.. who knows.. Def know and agree that any increase in Test will accompany E2..

[kelkel]

Well Defy is a good place and I would never contradict Dr. Crisler. He's in a completely different stratosphere when it comes to his level of knowledge. He practices what he preaches.