following trt protocol, feeling like crap.. brain fog, etc

[Joseph956]

it's hard for me to get labs done so I'm having to go by how I'm feeling and adjust accordingly.. I'm on .60mg depot test split into 2 subq shots Sunday/Wednesday, 250iu HCG Tuesday/Thurs/Saturday and .15 ARR liquidex Monday/Thursday

Been feeling some brain fog sporadically and a lot of stress although nothing in my schedule has changed.. getting some anxiety but I think it's because of the brain fog.. I've also been having some bloat and extreme nipple tenderness but only on my left one (odd?)

it's hard for me to get time off work to get BW done and even when I can my Dr won't run sensitive assay for E so I'm wondering if anyone has any opinions on what I should do.. as always thanks!

[FRDave]

No way to help without blood work as this tells all. Clearly it sounds like you need to up your dosage or Arimidex , but this is based on the sole fact you said "I've also been having some bloat and extreme nipple tenderness but only on my left one".

And the sensitive essay is not necessary, couple good threads lately explaining why. There is a good article on the LEF web site as well explaining how the sensitive essay is only more accurate below 7, which is pointless since you would know your low at that point... Get a normal e2 test and adjust accordingly.


Estradiol, Sensitive Blood Test

This test is generally NOT suggested over the regular estradiol test (LC004515).

The only difference between this test and the regular estradiol test (offered in Life Extension panels) is better detection at the lower limits of the range. For example, the lower end of the range for estradiol is 7.6 pg/mL while the lower limit for the sensitive estradiol is 3 pg/mL. This test does not provide a more accurate result at normal ranges, it is only more accurate at very low levels of estradiol.

Since Life Extension advocates higher levels of hormones, it would be very rare to use this test for its greater sensitivity at the low end of the range. Remember that men also need a certain level of estrogen (estradiol) and that studies are showing that if the estradiol level for a man is below the 18-20 pg/mL range there is increased risk for osteoporosis.

[Joseph956]

I'll try and go in this Saturday, thanks for your reply!

No way to help without blood work as this tells all. Clearly it sounds like you need to up your dosage or Arimidex , but this is based on the sole fact you said "I've also been having some bloat and extreme nipple tenderness but only on my left one".

And the sensitive essay is not necessary, couple good threads lately explaining why. There is a good article on the LEF web site as well explaining how the sensitive essay is only more accurate below 7, which is pointless since you would know your low at that point... Get a normal e2 test and adjust accordingly.


Estradiol, Sensitive Blood Test

[bass]

it's hard for me to get labs done so I'm having to go by how I'm feeling and adjust accordingly.. I'm on .60mg depot test split into 2 subq shots Sunday/Wednesday, 250iu HCG Tuesday/Thurs/Saturday and .15 ARR liquidex Monday/Thursday

Been feeling some brain fog sporadically and a lot of stress although nothing in my schedule has changed.. getting some anxiety but I think it's because of the brain fog.. I've also been having some bloat and extreme nipple tenderness but only on my left one (odd?)

it's hard for me to get time off work to get BW done and even when I can my Dr won't run sensitive assay for E so I'm wondering if anyone has any opinions on what I should do.. as always thanks!

have you donated blood recently? you can always buy lab requisition from "private md labs . com" no need to rely on your doc for that. but as stated by FRDave BW is the only way to be sure.

[Joseph956]

It's against my religion to donate blood so no I haven't..

anyway, I'm feeling a lot better as far as the fog goes and the nipple sensitivity could just be from too much foreplay I am feeling bloated though after having eaten a fruit cup..

I'm keeping the water flowing and I'll have a small protein filled lunch to minimize the carbs,

Man, I wish there was a machine you could buy that would measure your test/e2 levels like the blood sugar monitors!

[redhawk01]

So to save a life, or even your own, you won't donate blood? What happens when your hematocrit elevates, and you get more brain fog, what are you suppose to do then?

[JohnGalt]

So I'm assuming you are JW. If I understand correctly with that religion the belief is based around Acts 15:29, which (in their interpretation) prohibits accepting blood, so by extension you should not donate the blood. If you are actually in a different religion I'd be interested but JW are the only ones I am aware of.

There is another procedure you could discuss with your church or community (I forget what they call their meeting hall) which is a therapeutic phlebotomy. Exactly like a donation expect the blood will not be available for transfusions in anyone else so with just a cursory review of the JW beliefs and Acts might be an option that your religion would not be opposed to.

If that's still not an option than long-term TRT might not be a good fit for you in managing RBC will be difficult.

[JohnGalt]

I did find an interesting article in the "American Journal of Hematology" discussing how a Dr was able to use Phlebotomy with a Witness patient to manage hemochromatosis. While slightly different blood disorder to treat, the fact that he was able to use this method in accordance with the patient's beliefs could be promising.

Management of hemochromatosis in a Jehovah's Witness - Barton - 2004 - American Journal of Hematology - Wiley Online Library

Management of Hemochromatosis in a Jehovah’s
Witness
To the Editor: The choice not to receive blood and certain blood derivatives
is sometimes a central issue in the medical management of Jehovah’s
Witnesses. In contrast, we report the case of a Jehovah’s Witness diagnosed
to have hemochromatosis, and we discuss concerns that arose about his
therapeutic phlebotomy program.
A 40-year-old white man was referred for evaluation of chronic fatigue,
transferrin saturation of 96%, and serum ferritin of 767 ng/mL (reference
range 22–322 ng/mL). Complete blood count (CBC) was normal except for
mean corpuscular hemoglobin (33.7 pg; reference range 26.0–32.0 pg). His
serum alanine aminotransferase (ALT) concentration was elevated (51 IU/L;
reference range 0–40 IU/L); this value was unexplained by conditions
other than iron overload. HFE mutation analysis revealed the genotype
C282Y/C282Y. There was no evidence of diabetes mellitus, arthropathy,
or other complication of iron overload. It was recommended that he undergo
treatment with phlebotomy. However, we found no guidelines pertinent
to therapeutic phlebotomy for Jehovah’s Witnesses by reviewing an
authoritative source [1] and performing a computerized medical literature
search.
The patient stipulated that we discard his blood that was removed by
phlebotomy in accordance with his beliefs as a Jehovah’s Witness [2]. We
reasoned that the iron depletion induced by therapeutic phlebotomy [3]
would be a liability for him if he were to sustain further blood loss due to
unexpected illness, surgery, or trauma. Therefore, we sought to reduce this
patient’s iron stores, estimated by serum ferritin measurement, to a level
typical of men without hemochromatosis. Over 4 months, 4,350 mL of
blood (1.7 g Fe) was removed by phlebotomy and discarded. His fatigue
resolved. His post-phlebotomy serum ferritin level was 102 ng/mL, and his
serum ALT level was 20 IU/mL.
Blood from persons with hemochromatosis undergoing iron depletion
therapy can augment the supply of blood and blood derivatives for
allogeneic transfusion [4]. However, it is necessary to comply with the
right of Jehovah’s Witnesses to direct that their blood removed by therapeutic phlebotomy be discarded [2]. The post-phlebotomy serum ferritin
level and CBC in the present patient indicate that he retained sufficient iron
stores to synthesize 2–3 units of erythrocytes [5]. In summary, it is prudent
to ascertain whether persons who require therapeutic phlebotomy are
Jehovah’s Witnesses and to avoid inducing severe iron depletion in
Jehovah’s Witnesses who are treated with phlebotomy.
JAMES C. BARTON1,2
SHELBRA SUBLETT3
GARY L. BOYD3

[Joseph956]

Do you guys believe it could be high hematocrit?

I'm actually feeling tons better just bloated but I have bad digestion so that's a given. Either way I'll check for sure on Saturday.

Yes I am a JW and that's all I'm saying so as not to get off topic or start a debate.

[JohnGalt]

It could be a number of things, and until there's BW to show we will never know for sure. If you read through a lot of the stories and logs here in the HRT section you will notice alot of the symptoms you describe (mainly foggy head) are often associated with high red blood counts so I think that's why that was the first question asked. As you may know most anabolic steroids will cause the body to create more RBC until it starts to get to high and unsafe levels and most control that with regular donations.

I didn't want to start a debate on your beliefs as I love meeting new JW simply because I find some of the beliefs absolutely fascinating (even if I don't believe them). So if the BW does show elevated RBC levels and you cannot donate that leaves you with a major problem and health risks so hopefully if needed you can look into the phlebotomy as a means to control your levels.

[redhawk01]

Do you guys believe it could be high hematocrit?

I'm actually feeling tons better just bloated but I have bad digestion so that's a given. Either way I'll check for sure on Saturday.

Yes I am a JW and that's all I'm saying so as not to get off topic or start a debate.

It is one of the bad sides on TRT. Normally I was around 41-44%, but after being on TRT for a few months , it was close to 51%. I can donate blood, so I can maintain my levels around 46%.

Blood pressure may also rise as the blood thickens. So you may want to check into this as well.
Good luck

[Joseph956]

My last hematocrit while on TRT already was sitting at 41-44% I can't recall the exact amount..

What I'm wondering about is how much adding 250iu HCG MWF is going to affect those levels..

Is there anything that can be taken for maintence purposes or preventative measures to protect against high hematocrit levels? I'm taking hawthorn berry and 5mg cialis and a baby aspirin daily..

[JohnGalt]

for now just monitor it, and let's get some bloodwork to see where your problems are. If there is a high red blood cell count then talk with your doc about and your religious concerns. I did a quick google for ways to lower rbc and one site listed about medicines that can lower it but I don't know anything about them so I would leave that up to your doc. I saw one of the experts here mention to someone a couple weeks back to drink plenty of water as dehydration can raise the levels so stay hydrated.

From what I know so far, hcg will not directly effect red blood cell counts. It will all depend on how well your testicles respond to it and "wake up" after being on TRT. If they start producing natural testosterone again then that test in your system may contribute to your body increasing red cell production. to what extent that MAY happen I am simply not informed enough to answer and defer to anyone smarter than me

[Joseph956]

John, I appreciate all your great info and response!

I will definitely monitor it and keep track of my BP as well,

The HCG is a whole other thread completely.. been having aching testicles regardless of the 250iu's I started last week.. gonna get home and test the HCG using a pregnancy test and go from there,

thanks again for all your awesome insight!

[Trific]

Is there anything that can be taken for maintence purposes or preventative measures to protect against high hematocrit levels?

Trying to keep your TT higher than your body wants can result in too high of hematocrit.
Some guys limit how much test they take so they don't drive their hematocrit too high....they do that so they don't need to donate.