Introduction

[JohnGalt]

Hi all!

I have been lurking around this site for the past couple months for insights on my lowt diagnosis and informing myself as much as possible. I don't really have much in the way of questions at the moment so just wanted to say hello and give some basic information about myself. 36yo Male | 5'6 | 16-lbs, current diagnosis include hypogonad, insulin resistant, dysmetabolic syndrome-x, unspecified vitamin D deficiency. scrotum/thyroid ultrasounds both clean.

current protocol:
100mg test-c weekly (plan to discuss biweekly option after the next follow up bw)
D3 - 5kiu
omega 3 4gm
chromium 500 mcg
alpha lipoic acid 600mg
gymnema 800mg 2xday


labs:
CBC W/DIFF,W/PLT PAZ
WBC 4.9 4.0-11.0 k/mm3
RBC 5.04 4.30-6.00 m/mm3
HEMOGLOBIN 15.6 13.0-18.0 g/dL
HEMATOCRIT 45.8 40.0-53.0 %
MCV 91 78-100 fL
MCH 31.0 27.0-34.0 pg
MCHC 34.1 31.0-37.0 g/dL
RDW(cv) 12.6 12.1-18.2 %
RDW(sd) 41.5 36.0-55.0 fL
PLATELET COUNT 157 130-450 k/mm3
MPV 12.7 7.5-14.0 fL
SEGMENTED NEUTROPHILS 61 40-85 %
LYMPHOCYTES 29 10-45 %
MONOCYTES 7 3-15 %
EOSINOPHILS 3 0-7 %
BASOPHILS 1 0-2 %
ABSOLUTE NEUTROPHIL 3.0 1.6-9.3 k/uL
ABSOLUTE LYMPHOCYTE 1.4 0.6-5.5 k/uL
ABSOLUTE MONOCYTE 0.3 0.1-1.6 k/uL
ABSOLUTE EOSINOPHIL 0.2 0.0-0.7 k/uL
ABSOLUTE BASOPHIL 0.0 0.0-0.2 k/uL
DIFFERENTIAL TYPE Automated
GLUCOSE 106 H 65-99 mg/dL
UREA NITROGEN (BUN) 14 8-25 mg/dL
CREATININE 1.26 0.60-1.50 mg/dL
GFR ESTIMATED 73 >60 mL/min/1.73m2
BUN/CREAT RATIO 11.1 10.0-28.0
SODIUM 140 135-145 mmol/L
POTASSIUM 4.4 3.5-5.2 mmol/L
CHLORIDE 105 96-110 mmol/L
CARBON DIOXIDE (CO2) 23 19-31 mmol/L
ANION GAP 12 4-18
PROTEIN,TOTAL 7.0 6.0-8.0 g/dL
ALBUMIN 4.6 3.3-4.9 g/dL
GLOBULIN 2.4 2.0-3.7 g/dL
ALB/GLOB RATIO 1.9 1.0-2.0
CALCIUM 9.2 8.7-10.5 mg/dL
ALKALINE PHOSPHATASE 88 40-129 IU/L
ALT 21 5-60 IU/L
AST 20 10-50 IU/L
BILIRUBIN, TOTAL 0.7 0.2-1.3 mg/dL
TSH 1.15 0.45-4.50 mU/L
T4 FREE NON-DIALYSIS 1.3 0.8-1.7 ng/dL
PSA, TOTAL 0.6 <4.1 ng/mL
HEMOGLOBIN A1c 5.6 <5.7 %
MICROSOMAL TPO-Ab <10 <35 IU/mL
THYROGLOBULIN ANTIBODIES <20 <41 IU/mL
TESTOSTERONE, TOTAL, LC/MS/MS 324 250-1100 ng/dL
TESTOSTERONE, FREE 62.1 35.0-155.0 pg/mL
T3 REVERSE, LC/MS/MS 26 11-32 ng/dL
T3 FREE NON-DIALYSIS 3.6 2.0-4.8 pg/mL PAZ
VITAMIN D, 25-HYDROXY, TOTAL 9.2 L 30.1-100.0 ng/mL
LDL-P 1547 H <1000 nmol/L
LDL-C (Calculated) 55 <100 mg/dL
HDL-C 27 L >=40 mg/dL
TRIGLYCERIDES 270 H <150 mg/dL
TOTAL CHOLESTEROL 136 <200 mg/dL
LDL AND HDL PARTICLES
HDL-P (Total) 18.7 L >= 30.5 umol/L
SMALL LDL-P 1413 H <= 527 nmol/L
LDL SIZE 19.5 L > 20.5 nm
INSULIN RESISTANCE SCORE
LP-IR SCORE 61 H <= 45

[GeriatricOne]

You've got a lot of Free T for a fairly low Total T. Wish I could do that! How long have you been on TRT? Your RBC and Hematocrit is getting high. My be time to donate a pint go whole blood...

[JohnGalt]

You've got a lot of Free T for a fairly low Total T. Wish I could do that! How long have you been on TRT? Your RBC and Hematocrit is getting high. My be time to donate a pint go whole blood...

My doc's goals for my age, he wants to get me to ~800 Total and the free number he's looking for would be closer to 120. I have been on treatment for 5 weeks now and no complaints. I thought about the donations, but other than adding glucomsamine/chondrodine(sp) with MSM to my routine so I can be more effective with cardio to work on the cholesterol issues I'm trying not to do anything without his approval and instruction.

[JohnGalt]

I take that back, I do have 1 small question lol...

I am very happy with the GP I have and his approach, from some of his comments I am under the impression that he is on HRT himself so I trust his opinions so far. However I do see that lowtcom here does have an office in Snottsdale and for economic reasons was curious if anyone had dealings with that office and their impressions with the staff there.

[bass]

unless I missed it unfortunately some important test were not done, SHBG, E2 sensitive assay, LH, FSH. biweekly is a terrible idea unless you meant to say twice a week. I would increase vit. D to 10,000 ius daily, you're pretty load and 5000 iu won't do much. did he discuss AI's and hCG with you?

[JohnGalt]

those tests weren't included before I found this site. Looking at the order form in front of me for the next round they seem to be there. Yes I meant 2xWeek for biweekly. I have given serious consideration on the D3 bump after reading through a couple recent threads here on D3, I want to see what the next round of blood says before I go shift his recommendations around. He did discuss hCG with me, but mainly as it relates to fertility which I wasn't too concerned with and he mentioned the atrophy. He didn't mention there might be pain associated with the atrophy so I didn't think it was all that important to start, so I'm leaning heavily towards adding it into the mix once we get a better picture of my levels on his starting routine. AI's were not brought up, so at this point I want to see where my estrogen sits and try to control it more with the more frequent IM shots and save any AI's as a last resort since I don't want to tank that one lol.

[JohnGalt]

Latest blood work drawn 7/23/13. I have an appointment scheduled for Monday for him to review the results with me. There feels to be far few results for 8 vials of blood being pulled lol. I don't see my A1c, Vit-D, AST/ALT results, so we'll see what he says about those tests not on here.

Looks like my Cholesterol ratios are just getting worse minus Tri's dropping from 270 to 99.

E2 is elevated, I'm hoping to try to switch to 2xWeek injection versus weekly to try to control that a bit more and try to avoid adding any AI's.
SHBG is in range, but still looks to be on the low end, not sure if I should or how to try to raise that.

100mg weekly, and TT and Free went very high would like to try to get that more around 800-900 range and free closer to about 150ish.

any other thoughts?

CBC W/DIFF,W/PLT PAZ
WBC 5.2 4.0-11.0 k/mm3
RBC 5.04 4.30-6.00 m/mm3
HEMOGLOBIN 15.5 13.0-18.0 g/dL
HEMATOCRIT 46.0 40.0-53.0 %
MCV 91 78-100 fL
MCH 30.8 27.0-34.0 pg
MCHC 33.7 31.0-37.0 g/dL
RDW(cv) 12.9 12.1-18.2 %
RDW(sd) 43.1 36.0-55.0 fL
PLATELET COUNT 173 130-450 k/mm3
MPV 12.7 7.5-14.0 fL
SEGMENTED NEUTROPHILS 60 40-85 %
LYMPHOCYTES 28 10-45 %
MONOCYTES 8 3-15 %
EOSINOPHILS 3 0-7 %
BASOPHILS 0 0-2 %
ABSOLUTE NEUTROPHIL 3.1 1.6-9.3 k/uL
ABSOLUTE LYMPHOCYTE 1.5 0.6-5.5 k/uL
ABSOLUTE MONOCYTE 0.4 0.1-1.6 k/uL
ABSOLUTE EOSINOPHIL 0.2 0.0-0.7 k/uL
ABSOLUTE BASOPHIL 0.0 0.0-0.2 k/uL
DIFFERENTIAL TYPE Automated

GLUCOSE 105 H 65-99 mg/dL

TSH, HIGH SENSITIVITY PAZ
TSH 1.15 0.45-4.50 mU/L
T4 FREE NON-DIALYSIS 1.2 0.8-1.7 ng/dL PAZ
T3 FREE NON-DIALYSIS 3.2 2.0-4.8 pg/mL PAZ
PSA, TOTAL 0.6 PAZ<4.1 ng/mL

ESTRADIOL 70 H PAZ8-43 pg/mL
THYROID ANTIBODY PROFILE
THYROID ANTIBODY PROFILE PAZ
MICROSOMAL TPO-Ab 11 <35 IU/mL
THYROID ANTIBODY PROFILE PAZ
THYROGLOBULIN ANTIBODIES <20 <41 IU/mL
TESTOSTERONE, TOTAL and FREE QN
TESTOSTERONE, TOTAL, LC/MS/MS 1223 H 250-1100 ng/dL
TESTOSTERONE, FREE 351.7 H 35.0-155.0 pg/mL
DIHYDROTESTOSTERONE, LC/MS/MS 92 H QN16-79 ng/dL

SHBG 21 10-50 nmol/LQN

NMR LIPOPROFILE TEST (W/LIPIDS)
LDL PARTICLE NUMBER
LDL-P 2443 H
LDL-C (Calculated) 135 H <100 mg/dL
HDL-C 26 L >=40 mg/dL
TRIGLYCERIDES 99 <150 mg/dL
TOTAL CHOLESTEROL 181 <200 mg/dL
LDL AND HDL PARTICLES
HDL-P (Total) 15.2 L >= 30.5 umol/L
SMALL LDL-P 2184 H <= 527 nmol/L
LDL SIZE 19.4 L > 20.5 nm
INSULIN RESISTANCE SCORE
LP-IR SCORE 52 H <= 45

[bass]

when was the blood drawn in relation to your last T shot? you really need to take AI's to lower your e2, splitting your dose to twice a week can help but I doubt its enough to bring it in range.

[JohnGalt]

draw was right at 72 hours since last shot. I take shots around 9:30 -10 am on Sat (or when I wake up and get coffee) and draw was done in the 9am hour on Tuesday.

If the E2 was lower than he might let me try to control it with smaller more frequent shots, but I am planning that he will add an AI

[bass]

well you can't judge your T levels based on the timing of this BW, you pretty much drew blood at your peak, so you don't know where you might be at until your next shot! BTW, when doing lipid panels you shouldn't drink anything except for water.

[JohnGalt]

Interesting, well the Doc asked for the draw to be midway through the protocol so that's why I scheduled it there. Since this was also a fasting test because he's worried about the Insulin resistance I didn't drink/eat anything (including water) for about 14 hours before the draw since the glucose reading was what I didn't want to skew.As far as the T being peak, that was what I was expecting to see, and am less concerned with that reading. From "self assessing" how I felt over the last few weeks as far as hormones were concerned I think I'm roughly where I should be, Libido is a little weak and reaching orgasm is the only issue so I was fairly sure the E2 reading would be a culprit, so I have a feeling getting that reading balanced is the next target. I'm still upset that I don't see my D levels, because that's the reading that has me the most concerned from the initial BW

[bass]

regarding fasting i was referring to the coffee you mentioned. i agree, your priority is balancing e2.

[JohnGalt]

Ahh yeah no I went for the draw after morning conference calls so I could have my coffee that morning. I was talking about the timing that I perform my shot is after I have had my coffee. So the lipid panels are still fasted levels before the draw

[JohnGalt]

Well the Doc has decided he doesn't want to start on an AI just yet. He said normally if it was just the E2 that was elevated he would look at an AI, or if DHT alone was elevated then he would look to stop 5-Alpha conversion, but with E2 and DHT elevated and the T levels high he wants to just start off by reducing down to 60 mg test-C first and see if the DHT and E follow downward. Not extremely happy, but I can understand his logic that testing on the peak the test and other numbers from hormones converted from Test are a bit skewed so not blindly chaing the numbers down a rabbit hole I can understand.

Big surprise though he seems worried about the lipid panel lol. My BP was much higher than normal when I saw him (136/90) so he also ran an EKG but said those all look fine. So he is going to focus on the lipid panel and added 10mg M/W/F of lipitor for now to see if we can get the ratios better and with a lower T see if we can balance things out better.

[bass]

these lipid medication are more harmful than good in my opinion, they not only lower total cholesterol but they also lower HDL! did BW while on Cialis (CIA from ARR) and my total went down without effecting HDL. try talking your doc into prescribing Cialis 5mgs daily, or twice a day. whole lot more benefits from Cialis than lipid meds.