New Blood Work, looking for input

[Max1911]

I have been on HRT for about one year. My doctor monitors levels slightly different than what I commonly see on this board, example: Total Estrogen vs E2. Based on a board members recommendation I ran my own BW and hoped to get some input form some HRT veterans. Any input would be welcome.

Current protocol
Test cyp 100 mg/ml wk (one pin per week)
Anastrozole 4 mg wk ( .5 mg day 1-6, 1mg day7) (script is for 1mg tabs)
DHEA 100 mg per day

CBC With Differential/Platelet
WBC 9.4 N x10E3/uL 4.0-10.5
RBC 5.47 N x10E6/uL 4.14-5.80
Hemoglobin 16.8 N g/dL 12.6-17.7
Hematocrit 48.9 N % 37.5-51.0
MCV 89 N fL 79-97
MCH 30.7 N pg 26.6-33.0
MCHC 34.4 N g/dL 31.5-35.7
RDW 13.9 N % 12.3-15.4
Platelets 241 N x10E3/uL 140-415
Neutrophils 59 N % 40-74
Lymphs 29 N % 14-46
Monocytes 8 N % 4-13
Eos 4 N % 0-7
Basos 0 N % 0-3
Immature Cells N
Neutrophils (Absolute) 5.5 N x10E3/uL 1.8-7.8
Lymphs (Absolute) 2.7 N x10E3/uL 0.7-4.5
Monocytes(Absolute) 0.8 N x10E3/uL 0.1-1.0
Eos (Absolute) 0.3 N x10E3/uL 0.0-0.4
Baso (Absolute) 0.0 N x10E3/uL 0.0-0.2
Immature Granulocytes 0 N % 0-2
Immature Grans (Abs) 0.0 N x10E3/uL 0.0-0.1
Immature Cells N
Neutrophils (Absolute) 5.5 N x10E3/uL 1.8-7.8
Lymphs (Absolute) 2.7 N x10E3/uL 0.7-4.5
Monocytes(Absolute) 0.8 N x10E3/uL 0.1-1.0
Eos (Absolute) 0.3 N x10E3/uL 0.0-0.4
Baso (Absolute) 0.0 N x10E3/uL 0.0-0.2
Immature Granulocytes 0 N % 0-2
Immature Grans (Abs) 0.0 N x10E3/uL 0.0-0.1

Comp. Metabolic Panel (14)
Glucose, Serum 91 N mg/dL 65-99
BUN 23 N mg/dL 6-24
Creatinine, Serum 0.90 N mg/dL 0.76-1.27
eGFR If NonAfricn Am 102 N mL/min/1.73 >59
eGFR If Africn Am 118 N mL/min/1.73 >59
BUN/Creatinine Ratio 26 H 9-20
Sodium, Serum 139 N mmol/L 134-144
Potassium, Serum 4.6 N mmol/L 3.5-5.2
Chloride, Serum 101 N mmol/L 97-108
Carbon Dioxide, Total 24 N mmol/L 19-28
Calcium, Serum 9.4 N mg/dL 8.7-10.2
Protein, Total, Serum 6.9 N g/dL 6.0-8.5
Albumin, Serum 4.4 N g/dL 3.5-5.5
Globulin, Total 2.5 N g/dL 1.5-4.5
A/G Ratio 1.8 N 1.1-2.5
Bilirubin, Total 0.7 N mg/dL 0.0-1.2
Alkaline Phosphatase, S 56 N IU/L 44-102
AST (SGOT) 31 N IU/L 0-40
ALT (SGPT) 37 N IU/L 0-44

DHEA-Sulfate
DHEA-Sulfate 441.5 H ug/dL 44.3-331.0

Estradiol, Sensitive
Estradiol, Sensitive 9 N pg/mL 3-70

Lipid Panel With LDL/HDL Ratio
Cholesterol, Total 184 N mg/dL 100-199
Triglycerides 136 N mg/dL 0-149
HDL Cholesterol 42 N mg/dL >39
VLDL Cholesterol Cal 27 N mg/dL 5-40
LDL Cholesterol Calc 115 H mg/dL 0-99
LDL/HDL Ratio 2.7 N ratio units 0.0-3.6

Sex Horm Binding Glob, Serum
Sex Horm Binding Glob, Serum 48.7 N nmol/L 16.5-55.9

Testosterone , Free/Tot Equilib
Testosterone, Serum 768 N ng/dL 348-1197
Testosterone,Free 21.66 H ng/dL 5.00-21.00
% Free Testosterone 2.82 N % 1.50-4.20

Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.20 N ng/dL 0.82-1.77

Thyroid Profile
TSH 1.153 N ulU/ml 0.340-5.600
T3, Free 3.63 N pg/ml 2.39-6.79

Prostate Specific Antigen
Prostate Specific Antigen 1.073 N ng/ml .008-4.000

[kelkel]

Hi Max. Your should not be on that much adex. It's basically a breast cancer dosage which is ridiculous for TRT. Good move getting your own blood work done, especially the sensitive assay. As you see, you're low. I'll also bet your joints are beginning to hurt and libido is not what is used to be. Both are just two of the signs of low E. Keep that dosage going and you will crash totally. You won't like that at all.

Here's an example for you. Guys who cycle 500mg test a week normally use .25mg adex EOD. Do the math on that and compare it to what you are doing. Estrogen is a needed hormone for many things such as bone density, libido, etc. So in other words, you need to titrate back big time. With adex less is more. The least amount you can get by with is what you want. The Life Extension Foundation recommends a level between 20-30, but this is subjective and should be based on how you feel. Some feel better a bit higher. It takes time to dial it in.

You should also be on HCG to keep your testicals functioning as HCG mimics LH. There is a sticky thread at the top of this forum that you should read concerning the need for HCG. Your DHEA is up there. You can probably get by at 50mg in the morning. 100 is usually not necessary. Save the money. If taking DHEA I'm guessing your taking micronized pregnenolone as well? If not, you should. Vit D3 should be in your arsenal as well as most everyone is low in north america. It's one of the best vitamines (hormones) you can take.

Your Test panel looks great BTW. Only thing that jumps out, other than E and adex, is your shbg level. It increases with age. Test suppresses it but that's not a means to an end. Theories go both ways on whether once or twice weekly injection protocols are better so I won't discuss that unless you want to. Do know that having a good D3 level will help to reduce your shbg and elevate free T (nice, huh.) Stinging nettle and/or avena cosides also can help. The only prescription drug that I know helps to reduce it is Danazol. But again, it's only temporary.

Fix that E. Stop all that adex!

[Vettester]

Agree completely with Kel! 4mg of AI is just flat out dangerous. I know a member on this site, who was down and out for several months due to way too much AI, and if not mistaken he was at 3mg/wk with anastrozole. I can't imagine what negative impact 4mg will have on an individual over time. A healthy level of estrogen is beneficial for the immune system, cardiovascular health, cognitive function, osteopathic support, ... The good news is that you haven't crashed (yet), but I assure you it will be hard to sustain a balanced program for the long-haul with that protocol. Through trial and error, I have personally felt the downside of letting my E2 go too low. Luckily, I let the rebound process kick-in, and it is true that the body will try to find homeostasis.

IMO, I think your DHEA dosage is too much, and that can also lead to additional imbalances downstream. If I could throw out a suggestion ... Schedule a sit down visit with your physician and see if there's room to refine and improve your program. If your physician won't hear it then maybe evaluate your situation and consider aligning with someone who will respond as a partner with you. If this was my lab results, I might talk to my doctor about ...
- Decreasing DHEA to 50mg/day, and adding 50mg/day of Pregnenolone
- Breaking up test cyp dosage to 2x week. Possibly reduce dosage amount and implement HCG as noted by Kel, which would hopefully offset with some endogenous production
- Discuss the drastic reduction of AI to allow your estradiol level to come up to a healthy value. What is healthy or normal(?), it varies with each person, but I personally seem to do great in the mid 20's, and libido is at its best for me in the low 30's.
- Discuss the Vitamin D subject like Kel mentioned, and also look at B12, Iron (review TIBC and ferritin), and additional calcium while your E2 improves.

Lastly, the one area that is puzzling me is your SHBG. Based on your posted albumin and SHBG results, your free test should be more like 1.82%, not 2.82%. The amount of free test you have is (IMO) pretty close to ideal, but again, technically there shouldn't be that much free/bio available test when production of SHBG is at that level. Just wondering if one of the labs maybe had an error on it?

[kelkel]

Lastly, the one area that is puzzling me is your SHBG. Based on your posted albumin and SHBG results, your free test should be more like 1.82%, not 2.82%. The amount of free test you have is (IMO) pretty close to ideal, but again, technically there shouldn't be that much free/bio available test when production of SHBG is at that level. Just wondering if one of the labs maybe had an error on it?

Good point vette.

[Max1911]

Thanks for the feedback, it is greatly appreciated.

I did not think to write it in my protocol, but I do supplement D3 (50,000 UI/wk), Stinging Nettle (1000 mg/wk) and a multi-vitamin. I am going to do some more reading on the suggestions, adjust what I can and set up a time to sit down with my doctor.

I am immediately stopping the adex. It may explain my joint discomfort with lifting and running and hopefully the reason for the dry and cracking skin.
I will assume that I should wait at least 6 weeks to retest BW after any change in protocol…?

Again thanks for the direction

[kelkel]

Low E kills joints. Don't know if I'd totally stop the adex. I'd consider .25mg the day after injection only. Slow change is best here, not rapid swings. Re-test in 4 weeks should be fine.