15 months TRT - protocol - labs

[GenXAAS]

I've been on TRT for about 15 months now.
My current TRT protocol is: Test-P 2x/wk @ 70mg; Anastrozole (AI) 4x/wk @ .25mg; HCG 2x/wk @ .35ML & 2x/wk @ .17ML

Labs (test - result - range):

Glucose, Serum 91 mg/dL 65 - 99
BUN 23 mg/dL 6 - 24
Creatinine, Serum 1.51 High mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 55 Low mL/min/1.73 >59
BUN/Creatinine Ratio 15 9 - 20
Sodium, Serum 142 mmol/L 134 - 144
Potassium, Serum 4.2 mmol/L 3.5 - 5.2
Chloride, Serum 102 mmol/L 96 - 106
Carbon Dioxide, Total 22 mmol/L 18 - 29
Calcium, Serum 9.4 mg/dL 8.7 - 10.2
Protein, Total, Serum 6.9 g/dL 6.0 - 8.5
Albumin, Serum 4.5 g/dL 3.5 - 5.5
Globulin, Total 2.4 g/dL 1.5 - 4.5
A/G Ratio 1.9 1.1 - 2.5
Bilirubin, Total 0.5 mg/dL 0.0 - 1.2
Alkaline Phosphatase, S 56 IU/L 39 - 117
AST (SGOT) 23 IU/L 0 - 40
ALT (SGPT) 16 IU/L 0 - 44
Cholesterol, Total 190 mg/dL 100 - 199
Triglycerides 96 mg/dL 0 - 149
HDL Cholesterol 44 mg/dL >39
VLDL Cholesterol Cal 19 mg/dL 5 - 40
LDL Cholesterol Calc 127 High mg/dL 0 - 99
Prostate Specific Ag, Serum 1.0 ng/mL 0.0 - 4.0
Testosterone , Serum 1057 ng/dL 348 - 1197
Free Testosterone(Direct) 27.6 High pg/mL 6.8 - 21.5
Estradiol 12.8 pg/mL 7.6 - 42.6
LH <0.2 Low mIU/mL 1.7 - 8.6
FSH <0.2 Low mIU/mL 1.5 - 12.41
Prolactin 4.2 ng/mL 4.0 - 15.2
WBC 5.0 x10E3/uL 3.4 - 10.8
RBC 5.08 x10E6/uL 4.14 - 5.80
Hemoglobin 15.8 g/dL 12.6 - 17.7
Hematocrit 47.8 % 37.5 - 51.0
MCV 94 fL 79 - 97
MCH 31.1 pg 26.6 - 33.0
MCHC 33.1 g/dL 31.5 - 35.7
RDW 13.3 % 12.3 - 15.4
Platelets 248 x10E3/uL 150 - 379
Neutrophils 59 %
Lymphs 30 %
Monocytes 9 %
Eos 1 %
Basos 1 %
Neutrophils (Absolute) 3.0 x10E3/uL 1.4 - 7.0
Lymphs (Absolute) 1.5 x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.4 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0 – 0.1

[GenXAAS]

One of the primary reasons I began TRT was to help sexual function. I have mild/moderate ED, low libido, & low dick sensitivity. TRT has not helped with any of those symptoms. I'm very disappointed about that.

My theory is that my lowered sexual function is due to low prolactin. There are some studies that correlate low prolactin with lowered sex function. I recently tried an oxcytocin intranasal spray to attempt to raise my prolactin with no success.

[hammerheart]

My theory is that my lowered sexual function is due to low prolactin. There are some studies that correlate low prolactin with lowered sex function.

Link?

Your estradiol is on the very low side and that is more of a valid explanation for poor sexual functioning.

[Couchlock]

That's seems like a lot of AI for 140 mg a week. Even more spread over 2 shots.

.25mg eod is usually good for 500mg to 600mg test per week.

Cut back on it to 2x a week see what happens

[GenXAAS]

That's seems like a lot of AI for 140 mg a week. Even more spread over 2 shots.

.25mg eod is usually good for 500mg to 600mg test per week.

Cut back on it to 2x a week see what happens

My past estradiol labs (date - result - range - test type):
1-24-17: 12.8 pg/mL 7.6 - 42.6 Roche ECLIA methodology
5-26-16: 6.5 pg/mL 8.0 - 35.0 E sensitive LC/MS/MS
3-25-16: 31 pg/mL <= 29 E sensitive LC/MS/MS
12-7-15: 65.4 pg/mL 8.0 - 35.0 E sensitive LC/MS/MS

My Dr. started my TRT on 200mg T. Thus, my first E lab was too high. My T Rx was reduced after the first 3 months.

[GenXAAS]

...

Your estradiol is on the very low side and that is more of a valid explanation for poor sexual functioning.

I had these symptoms PRIOR to TRT:

One of the primary reasons I began TRT was to help sexual function. I have mild/moderate ED, low libido, & low dick sensitivity [prior to TRT]. TRT has not helped with any of those symptoms.

[GenXAAS]

My theory is that my lowered sexual function is due to low prolactin. There are some studies that correlate low prolactin with lowered sex function.

Link?

Low prolactin correlated with "reduced enjoyment of orgasmic experiences":
http://www.ncbi.nlm.nih.gov/pubmed/24345293

Low prolactin correlated with erectile dysfunction (ED):
http://www.ncbi.nlm.nih.gov/pubmed/19210705

As with many hormones: too much AND too little causes problems.
http://www.livescience.com/41322-low...mpairment.html

Low prolactin associated with reduced ejaculate and sperm, ED, PE, METs, anxiety, depression:
http://www.ncbi.nlm.nih.gov/pubmed/26542707

low prolactin (aka hypoprolactinemia) as problematic as high prolactin:
http://www.musclechemistry.com/uploa...e-concern.html

[kelkel]

Highly doubt prolactin's your issue, despite the above links. Agree with Biz that you should look more toward E as the culprit. Especially since standard estradiol testing is really not that accurate in men. Another thing to consider is the mental aspect of it all. Don't talk yourself into ED like so many men do.

[hammerheart]

Low prolactin correlated with "reduced enjoyment of orgasmic experiences":
http://www.ncbi.nlm.nih.gov/pubmed/24345293

Low prolactin correlated with erectile dysfunction (ED):
http://www.ncbi.nlm.nih.gov/pubmed/19210705

As with many hormones: too much AND too little causes problems.
Men's Sexual Problems Linked to Low Prolactin Levels

Low prolactin associated with reduced ejaculate and sperm, ED, PE, METs, anxiety, depression:
http://www.ncbi.nlm.nih.gov/pubmed/26542707

low prolactin (aka hypoprolactinemia) as problematic as high prolactin:
A New Look at Prolactin : HYPO Prolactinemia (Low Prolactin) Cause for Concern?

The primary association cited in those studies is with metabolic syndrome (a complex entity on its own) and arteriogenic ED in middle aged-to-elderly man, not sexual dysfunction, which also can be well correlated with MetS directly and not hypoprolactinemia.

Do you suffer from obesity, diabetes, CV disease? What is your age?

This is one quote from one of the above:

Deficient Prolactin in men induces low DHT levels and lower Androgen levels.

This is a very interesting statement and one I feel you should look further into: ever tested your DHT levels?

Also this one points to hyposerotoninergia as a culprit for low PRL, this means the etiology, rather than hypoprolactinemia itself, it's to regarded as a trigger for symptoms.

Low serotonin is associated with anxiety and depressive issues. Do you experience any of those?


Serotonin can be increased with supplements - trypthophan, 5-HTP, Zinc; or antidepressant medications (SSRIs). There are rather notorious for inducing sexual dysfunction.

Prolactin release can be safely elicited with peripherally-selective DA antagonist, these are drugs used as GI prokinetics, antidiarrhoidal meds and galactogogues, and also by trans men trying to get gyno together with HRT.

[hammerheart]

Deficient Prolactin in men induces low DHT levels and lower Androgen levels.

Ok digged a bit further into this and found a couple of 30-years old studies about PRL and 5-AR expression

https://www.ncbi.nlm.nih.gov/pubmed/3486119

https://www.ncbi.nlm.nih.gov/pubmed/3486119


However they speak of testicular 5-ar activity stimulated by PRL in the presence of LH:

The present findings demonstrate for the first time that PRL directly stimulates LH-induced 5 alpha-reductase activity in the testes

and also that

On the other hand, hyperprolactinemia was associated with a significant inhibition

This on study is only about 5-AR inhibition induced by hyper-PRL:

https://www.ncbi.nlm.nih.gov/pubmed/2943108


So duh, in conclusion both low and high prolactin can lead to impaired 5-AR activity in the testes.