Latest blood work.....opinions please

[Oldhighlander]

54 years old
6'4" tall
283 LBS (started at 347 LBS 9/11 when I firste tested for low T)
BF% 20 (guessing)
Gym monday, wednesday, friday.30 mins eliptical and 1 hour weights.Compete in the highland games throughout the summer with 2 days a week practice.
Current protocol 50mg of test cyp 200mg/ml every 3.5 days (thursday morning,sunday evening)

I started on the patch and it did next to nothing.Went to 200mg test cyp once every 2 weeks and got better results but not dialed in yet.Then 100mg once a week.Close but no cigar.Then 50mg twice a week and got a good test level but my E is high.


Here is the test results prior to my latest results.This was on 100mg once a week.


Collected 4/14/12

Component - Result Units Flag Range
% FREE TESTOSTERONE 2.5 % 1.6-2.9


SEX HORMONE BIND 20 NMOLIL 11-80
GLOB
TESTOSTER FREE 159 PGIML 47-244
TESTOSTER TOT 64 NGIDL 300-890
ESTRADIOL 56.10 PGIML H 7.63- 42.60



This is my latest result drawn on sunday before injecting that day.So 3.5 days injection prior to draw.




test name result units ref.range
BUN 11 mg/dl 6-20
calcium 8.8 mg/dl 8.6-10.6
chloride 104 mmol/l 98-107
co2 30 mmol/l 22-32
creatine .91 mg/dl .70-1.2
glucose 88 mg/dl 65-99
potassium 3.7 mmol/l 3.5-5.0
sodium 140 mmol/l 132-143
estrodial 67.06 pg/ml 7.63-42.6
FSH .1 minter unit 1.5-12.4
est.av.gluc 117 mg/dl
HGB A1C 5.7 % 4.8-5.9
LH <0.1 minter unit 1.7-8.6
chol ratio 3.8 <=5.0
chol 144 mg/dl <=200
HDL 38 mg/dl >=40
LDL calcu 95 mg/dl <=129
triglycerides 57 mg/dl <=200
VLDL calcu 11 mg/dl 10-30
% free test 2.6 % 1.6-2.9
sex hormone
bind glob 19 nmol/l 11-80
test free 207 pg/ml 47-244
test total 805 ng/dl 300-890
250H vit D 29.4 ng/ml 30.0-100.0


As you can see there is a nice jump in total T and free T but a not so nice jump in E.The doc wants me to cut back to 40mg twice a week to bring the T down a little and we talked about an AI.She is going to give me a script but I don't know what dosage it will be.I will post it when I get the info.I am liking my T levels and really don't want to bring it down but with an AI and a lower dose of test cyp would my T levels stay near the same with a drop in E?I am making progress in the gym and don't want to give that up but I am still not dialed in yet with optimal numbers and I am still having energy issues.Energy issues may be linked to sleep apnea.I have a cpap but need to get that dilaed in as well.Any opinons would be appreciated as far as dosage for the AI(armidex) and what you think might happen with a lower test dosage and the AI combo.

[kelkel]

Hi O.H.! Like you stated, your numbers are much improved with the exception of your E and D. % Free is great! By adding the AI it will raise your levels without question. So, you should be able to drop your T dosage somewhat and still maintain that level. Less is more here and it appears to be working for you! A basic goal with your E would be between 20-30 but it is subjective and how you feel should be the main criteria.

Your D is low and if you've been reading here lately there has been a load of posts on Vit D and its positive effects. Begin supplementing and it will lower your shbg (not that yours is bad, it's not) which in turn will free up more T for use.

Are you also on an hcg protocol?

[Oldhighlander]

I have been reading about D and plan to supplement.No HCG .I do have some shrinkage but it is tolerable.On the old protocol I did have some sensitivity but it is gone now.I want to get my E down to see if I do feel better.I can tell you right now my libido is thru the roof.Morning noon and night wood is back.Had issues keeping wood during sex before but I'm sure that would not be the case now.No way to know unfortunatly cuz there's no sex going on at home anymore.I always thought it was a running joke that married people don't have sex.I'm here to tell you it's no joke.So the good news is my TRT is working and the bad news is my TRT is working.Any advice on AI dosage?How much?How often?How long would I take it?Etc.......

[bass]

copy Kel! but why dose the doc want to cut your dose when your levels are in the normal range?! she should only lower it if its out of range. your blood work does look good with the exception of e2 and D as kel noted. i take 10,000 iu and my last test showed 97 on scale 30-100, i was 32 before supplementing. nothing beats more frequent protocol, i was doing 30mgs eod day and my total was above 800, free was way above normal, so I cut back to 26 mgs eod, but also taking hCG and AI. just did blood work last Thursday to see how the 91 mgs per week is working, I'll post it as soon as get the results.

[Oldhighlander]

Not sure why she wants to cut the dose.Maybe in anticipation of raising the levels out of range with the AI.I think she was a little surprised by my every 3.5 days protocol.When I told her she was like you are doing what?I explained that I wouldn't have the roller coaster effect and still stay at a fairly low dose.I got the idea that she didn't quit know what to think about it.She asked me how I felt and about the wood situation and I told her that I was doing pretty good,definately better then last blood work but I would still like to get my E down.So all in all I don't really know why she wants me to lower the dose.Any suggestions on the AI?

[Vettester]

Any suggestions on the AI?

Real easy, just go with Arimidex . You can easily get Liquidex from our sponsor, AR-R , at the top of the page.

[Oldhighlander]

I am supposed to get arimidex .She said she did not have much experiance with it for men and needed to do some research on it before she gave it to me.I was wondering more along the lines of typical dosage.I don't want to crash my E and I told her I wanted to start real conservative.So what are the guys on an AI taking dose wise and how often?

[kelkel]

Everyone is different relative to how much AI is needed. Some more, some less. I don't need any at 60 x 2 per week. I would start out at the minimum of .25 x 2 per week. Keep it simple and take it the day after each shot. It has about a 46hr half life. Your doc does not seem that bad to me. Willing to learn at least. Sometimes we have to educate them unfortunately. Read up on hcg and consider adding that to your protocol. Does more than just keep your boys from shrinking.

So the good news is my TRT is working and the bad news is my TRT is working.

^^Now that's funny!

[Oldhighlander]

It's funny when it's someone else.Almost wished I didn't start TRT.I am so F'N horny I can't stand it.I really want to field test my equipment to see if TRT is really working.Thanks for the info on the AI.It will be interesting to see what she prescribes.I have brought up hcg and I didn't get a good response plus I really don't want to add more drugs into the mix if I can help it.Not crazy about the AI but it looks like I don't have a choice.

[Vettester]

It's kind of guesswork at this stage to figure out what dose you really need. I personally don't think 1/2mg/wk will get your E2 down in the 20's or 30's, but maybe it will. I'd suggest going at least .25mg x 3/wk, or possibly .5 x 2/wk for one month, then run your E2 lab. If your E2 is where you want it, you can look at .25mg x 2/wk as a possible maintenance dose.

[Oldhighlander]

Thanks Vette.When I get the AI I will post what the doc prescribed.

[Oldhighlander]

The doc called today and told me she wasn't comfortable giving me the AI since it was off label and she had no experience with it.I am so totally disappointed beyond words.She said she has been doing research and could find none that really addressed lowering E only in raising T.And she said in raising T it also raises E but no one seems to do anything about it.I told her about DR.Crisler and his website and she said she would check it out.I want to give her more info because she said she is willing to learn because she is getting more and more patients with this problem of ours.Can anyone sight any papers or other doctors that she can check into?She also said she may send me to an endo.I told her about the horror stories on this board about guys being bounced around and not getting any help.I also told her that there is no gaurantee the endo will know anymore then she does.She said she will give me some endo's and that I can call them to see if they specialize in this.I asked her why she wanted to lower my dose of test and she said that I was at the high end of the range but I should be around 650 like my last BW showed.I told her I felt much better at the 805 then I did at 650.Plus she wanted me to lower it in hopes of lowering my E.I see her logic but I wouldn't be feeling any better at 650.So I am frustrated beyond belief.Just when I thought I was getting this dialed in the shit hits the fan.Any help would be much appreciated.Right now I feel like I'm pissing in the wind.

[Oldhighlander]

Ok there's my rant.I am not showing any symptoms of gyno.Do I really need an AI?Would it make me feel better with lower E?Maybe I can do without it.

[steroid.com 1]

Don't know why you couldn't go to Crisler's site and print this out yourself.

Send this link to your Doctor ASAP and tell her to study it:
http://www.allthingsmale.com/word_docs/TRT.doc


This:
ESTRADIOL

There are several reasons why this assay is VERY important, and should not be ignored in ANY hypogonadism work-up (or subsequent regimen). First, you definitely need to draw a baseline. There are cases where T is adequate, yet E elevated or merely disproportionate. Elevated estrogen (in absolute value or proportion) can, in and of itself, explain hypogonadal symptomology. If E is elevated, controlling serum concentrations (usually with an aromatase inhibitor, which prevents conversion of T into E; or withdrawal of estrogen mimics such as soy or flax seed) may, in very rare cases, suffice in clearing the symptoms of hypogonadism. And finally, rechecking estradiol after beginning the initial dose of testosterone will give the astute physician valuable information as to how the patient’s individual hormonal system functions, as well as making sure estrogen does not elevate inappropriately secondary to testosterone supplementation. This provides a very rough form of receptor mapping, if you will.
E2 is the major player of interest in foundational TRT. Evaluation of the other members of the hormonal class “estrogen” (E1, E3, as well as other estrogen metabolites), via 24 hour urine panel, may help explain gynocomastia or water retention in the face of acceptable E2, indicate relative cancer risk, etc.

Unless you specify a ‘sensitive’ assay for your male patients, the lab will default to the standard estradiol designed for females, which is useless for our purposes here. I have run the standard assay and the sensitive assay concurrently on a number of my patients, and the two results may be as night and day. However, patient symptomology is best described by the sensitive assay. The reason is the bell curve from which the test is designed sits well within the “normal” range for females; therefore the hormonal concentration range appropriate to adult males falls on a very flat slope of said bell curve. The same holds for Total Estrogens. Laboratory testing is best when small changes in concentrations result in large changes in subsequent reported result.

Some practitioners believe it is only the T/E ratio which is significant, and therefore, as long as E only “appropriately” rises with elevations in T, all is well. However, the absolute concentration of E is of concern, too, especially in light of new information pointing to elevated estrogen as cause, or adjunctively encouraging, several serious disease processes, including numerous cancers, as well as significant potential for induction of sexual dysfunction (no matter the accompanying androgen load). Therefore T/E ratio is only useful for describing the cause of symptoms, not as a treatment goal.

Estrogen is absolutely necessary for our physical health. Of note, same also provides the emotional component of a mature gentleman’s sexual being. This is why estrogens must be evaluated and, when necessary, controlled. The “sweet spot” E concentration depends upon SHBG. Rule of thumb is mid-range for both.

[Oldhighlander]

I did direct her there as you can see in my last post.I was looking for other ammo to give her.

[Brohim]

Dude PRINT the papers out and hand deliver them to her or email them. Obviously she did not read he info. Tell her that is the cutting edge of science if she wants to get up to date info like she claims.

[Oldhighlander]

Probably not a bad idea.I will do it.I looked around for other info and couldn't find anything really current .Does anyone know of anything current?I found a Dr.shippen but his stuff is from the 90's and the doc said most of the stuff she found was from that era.

[Brohim]

Bud that paper GD posted for you is from 2009 and is the cutting edge of TRT. What else could you ask for? Print it out and give it to her.

[steroid.com 1]

She didn't read it Brohim or else his outcome with her would have been different.

Most anti aging sites where they outline TRT protocols will discuss the use of an AI in combating the aromatization cycle.

She just isn't trained yet is prescribing treatment...criminal in my opinion.

More:

Aromatase Inhibitor Therapy for Erectile Dysfunction
Aromatase inhibitor therapy may be helpful for some men with erectile dysfunction (ED). Aromatase is an enzyme, especially found in the liver, ovary and adipose tissue, required for the conversion of androgens to estrogens. Specifically, aromatase is responsible for the conversion of the androgens androstenedione and testosterone into the estrogens estrone (E1) and estradiol (E2), respectively. In women, the great majority of testosterone is converted to estradiol and estrone, whereas in men, most of the testosterone stays as testosterone, and only a small percentage is converted to estradiol and estrone.

Aromatase inhibitors prevent the action of the enzyme aromatase. Thus, in the presence of an aromatase inhibitor, the body produces less estradiol (E2) and estrone (E1) and maintains a higher level of testosterone. Aromatase inhibitors have been traditionally used as second-line therapy (after tamoxifen ) for the treatment of breast cancer, tumors that usually depend on estrogen for growth.

In men, the effect of 2.5 mg of the aromatase inhibior letrozole suppressed plasma estradiol to concentrations less than 50% of pretreatment values after 2 days, with recovery to approximately pretreatment values after 6 days. These decreases were accompanied by increased gonadotrophin (luteininzing hormone - LH and follicle stimulating hormone - FSH) concentrations, with resultant increases of approximately 50% in plasma testosterone.

In men, aromatase activity appears to increase with age. This is particularly so in men with a high body mass index. Increased aromatase activity in men results in conversion of testosterone into higher levels of estradiol. This is especially a problem if men are taking exogenous testosterone (intramuscular testosterone enanthate or cypionate, or topical 1% testosterone as a hydroalcolic gel) for treatment of hypogonadism. Under such conditions, raising the testosterone in a man with a high aromatase level will elevate the serum estradiol. It is controversial but several investigators believe that elevated estradiol values in men are responsible, in part, for causing persistence of many of the symptoms of "androgen insufficiency", despite receiving testosterone treatment. Some investigators also believe that higher estradiol values are associated with prostate enlargement and there is increasing discussion of the role of estrogen in abnormal prostate tissue growth. High levels of estrogen are also thought to result in male hair loss. Thus there appears to be a role ("off-label" as it concerns FDA government indications) in the use of aromatase inhibitors in some men with sexual dysfunction and elevated estradiol values.

[Oldhighlander]

Guys I won't call her criminal just yet.She called yesterday and I gave her Crislers site then.I need to give her a chance to read his stuff before I write her off.I will make sure that she reads the stuff and then go from there.I hope she see's the light because I don't want to be passed around to a bunch of other doc's who don't know jack and start this process all over again and maybe get worse treatment.She admitted to me that she isn't up on all of this stuff and that she is willing to learn.To me that says a lot.Gdevine I know the first paper you posted was Crislers,Is the second post his also?If not can you tell me who it is so I can pass the whole thing along to her including the name of the person who wrote it?Thank you guys for the advice.I truly do appreciate it.

[kelkel]

O.H. Give her this too. Mainstream, very current and an easy read. Kinda covers it all briefly:

http://www.lef.org/magazine/mag2012/...ey=june%202012

[Oldhighlander]

Thanks KelKel .I will pass it along.I hope she changes her mind about this.I don't want to start from scratch with another doc.

[steroid.com 1]

Guys I won't call her criminal just yet.She called yesterday and I gave her Crislers site then.I need to give her a chance to read his stuff before I write her off.I will make sure that she reads the stuff and then go from there.I hope she see's the light because I don't want to be passed around to a bunch of other doc's who don't know jack and start this process all over again and maybe get worse treatment.She admitted to me that she isn't up on all of this stuff and that she is willing to learn.To me that says a lot.Gdevine I know the first paper you posted was Crislers,Is the second post his also?If not can you tell me who it is so I can pass the whole thing along to her including the name of the person who wrote it?Thank you guys for the advice.I truly do appreciate it.

Not Crisler.

I just did a quick Google search and this appeared right at the the top...so I just grabbed it.
http://www.sandiegosexualmedicine.co...ibitor-therapy

Kel's link is a good one as well.

Glade your Doc is willing to learn...or at least say she is...you will know the truth because you now understand.

I still think a consult with someone like Drs. Crisler or Gaines is a good idea to be honest.

[Oldhighlander]

I am not familiar with Dr.gaines.Who is he and where is he from?Thanks for the link.

[steroid.com 1]

I am not familiar with Dr.gaines.Who is he and where is he from?Thanks for the link.

There are many but IMO he's one of the better and truly cares for his guys.

Dr. Richard Gains Fort Lauderdale FL.

He does many phone consults if you're interested.

[Oldhighlander]

OK I gave my doc all the print outs you guys suggested.Now I wait and see.I may see if she would be willing to do a phone consult with DR.Crisler.We are in chicago area so he is probably the closest to us.Might be worth the money if she is still not on board.I will post when I hear from her and let everyone know what happens.

[Oldhighlander]

Update.My wife went to the doc (we use the same one) and asked about her reading the info I gave her.She said she has read a little of it but not all cuz they are a doc short in the practice and she is crazy busy.She said she would finish in the next week or so and get back to me.So there is still hope.In the mean time I have ordered Dr. Shippens book The Testosterone Syndrome: The Critical Factor for Energy, Health, and Sexuality--Reversing the Male Menopause because I have heard it addresses E2 problems.After I read it I plan to pass it along to the doc.Anybody read it?If yes thoughts on it?

I am still retaining a little water but my weight has dropped some more.Now at 279 LBS.Just 4 LBS from the initial goal.Now that I am close It looks like I still need to drop some more to get the rest of the jelly off of my belly.