New TRT doctor, blood work attached

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    New TRT doctor, blood work attached


    Hi all,

    I'm 37 years old, I'm 6'2", and currently weigh 328 lbs, at (I'm guessing) around 18-20% BF.

    I have been on some form of TRT for about 7 years. I started out with Androgel, then went through Androderm and Striant before ending up with Test E injections (for whatever reasons, we could never get decent blood levels with the non-injectables).

    For about the last 4 years, I was on 300mg of Test E, every two weeks. This moved me into the mid range (400's I think) for free test. My doctor was open minded enough to give me test, but didn't see any need to get me higher in the range. Nor did he ever test for E2. I asked about armidex once, and he just said that unless I had tenderness in the nipples, that was unnecessary.

    About a month ago, I started researching other facilities, and found a place in Florida that seemed legit. Their protocol consisted of Test, arimidex and HCG. Dosage to be determined by blood work.

    They ordered up the blood work, via labcorp (report attached), and based on the results, have me on the following regimin:

    1cc of 300 mg/ml Test E weekly
    1 mg arimidex weekly (dosage keeps changing...see below)
    500 iu of HCG, twice per week.

    All but HCG were compounded at the pharmacy.

    Dosage seemed a little high, but considering my bloodwork was done 2 weeks after 300 mg of test e, and total test was 167, that dosage obviously wasn't working. Since then, I've become a little concerned about the outfit behind all of this.

    My biggest concern has been on the arimidex. Initially, they sent me 22 1mg caps, and the label said take 1 every monday and thursday. This was supposed to be a 6 month supply, so I called. Then they said that my E2 levels weren't that high, so 1 per week would be fine. That was still only a 22 week supply, not 28. They then sent me 6 more caps, but this time they were 1/2 mg, and it still said twice a week. Not inspiring confidence.

    So, I'm looking for a new Doctor. My primary care is far from up to date on TRT, so he's out. I'm interviewing some others via email and phone currently.

    In the meantime, I have what I believe to be solid blood work (LabCorp is pretty reputable) and a bunch of meds. My plan is to use the test and HCG as they instructed, and then have more bloodwork done in 3 months, to see where the E2 is going, before I address the adex.

    Since my FSH was nearly non-existant, and probably has been for some time, I'm not sure how much good the HCG will do. And while my e2 was 'low' at 30, that was with a Free test of 167...seems that I have a lot of enzyme activity, and might need to work in Adex sooner rather than later.

    Other than that, everything looks pretty straight forward, at least to me. Does anyone else see anything that jumps out? I am scheduled to give blood soon, to hopefully address the hematocrit situation (and its a good thing to do).

    I feel really good...morning wood is back (didn't really realize it was gone) and testicles seem to have increased in size, and hang a little lower. Sex drive / erections have never really been a problem, and still aren't. I have lost about 6 lbs in two weeks (started Palumbo style keto diet about the same time, so that could be weight loss) and most of it seems to have come from around mid section...always my fatest area, and I seem to have more energy in the gym and out. I've had little bouts of shoulder and back acne, so I'm thinking test levels are up.

    Any advice is appreciated,

    Toby

    EDIT: For whatever reason, it won't let me attach the .pdf...it is only 2.1mb, so it doesn't seem to be too big. I'll post up what I feel are the most pertinent numbers, until I figure it out...

    total test 167 ng/dl
    E2 30 pg/ml
    FSH <1.0

    Total cholesterol 207 (working on this)
    HDL 30
    LDL 133
    triglycerides 218

    Hematocrit 48.2%
    RCB 5.41 x 10 e6 UL
    Hemoglobin 16.8 g/dl

    BUN 26 mg/dl (I eat about 300 gms protein a day)
    Creatinine 1 mg/dl (protein combined with weight training)
    Est GFR >59

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    You fell victim to the magic cook book forumila that all newbies fall into.
    I be more concerned with metabolic syndrome then your testosterone !!

    niacin 500 mgs BID increasing it after 2 weeks to TID
    fish oils 1 tsp a day

    300 mgs of testosterone is ridiculous
    being 328 lbs you better be using 1.5 inch needle to get through the extra layer offat to get to muscle
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    I read this and was all set to pm you for who they are, until I saw the rest :P
    About a month ago, I started researching other facilities, and found a place in Florida that seemed legit. Their protocol consisted of Test, arimidex and HCG. Dosage to be determined by blood work.
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    Quote Originally Posted by The Matrix View Post
    You fell victim to the magic cook book forumila that all newbies fall into.
    I be more concerned with metabolic syndrome then your testosterone !!

    niacin 500 mgs BID increasing it after 2 weeks to TID
    fish oils 1 tsp a day

    300 mgs of testosterone is ridiculous
    being 328 lbs you better be using 1.5 inch needle to get through the extra layer offat to get to muscle
    Ok, but wouldn't getting my test levels up, and my estrogen levels down help with metabolic syndrome?

    If 300mg is 'ridiculous'...what would you suggest? 300mg every two weeks got me to a whopping 167 ng / dl

    Not my cookbook...this is what they recommended. I questioned it as well, hence the post.

    I just started taking fish oil again...couldn't take it for the past 6 months, due to being on coumadin from back to back afib ablations. That laid me out for a while, leading to some of the other issues.

    What purpose does the niacin serve? Not being arrogant...I would really like to know.

    And as for the 1.5 inch needle...thanks for the advice, but just because I am 328 lbs., doesn't mean that I don't have quite a bit of muscle, or that I have a 'thick layer of fat' everywhere.

    Toby
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    6'2" and 328# make sure that your waist is no more than 34-36"
    Replace all wheat, rye, potatos, rice in your diet with green vegetables.
    That should help you loose weight.
    --------
    Transdermal testosterone was not working for you because there is good likelyhood that you have thyroid problems, possibly also adrenals.

    With your weight it would also be a good idea to check glucose/insuline situation.
    --------
    300mg of test every two weeks.
    That is most likely just right amount of testosterone or at least real good place to start.
    real good news is that you have E2=30 pg/ml
    Real problem is that you are taking shots way too far apart.
    Do not worry about nay-sayers telling you to use big long needles to get into muscles, lots of bs.
    (When others use transdermals that have to go thru fat too.)
    You have to divide your 300mg into 7 (seven) portions and do shots every other day (EOD).
    Assuming that you are using the most common 200mg/mL testosterone
    300mg/7=43mg per shot=~22units on insuline syringe
    That is exactly what I am using (69yo, 155#)

    Use smallest needle that is available.
    This needle is very tiny, not bigger than mosquito's beak.
    Use only this needle for any shots that you will ever do.
    Now testosterone.
    Latter possibly you will add HCG.

    http://hocks.com/Merchant2/merchant....Category_Code=
    BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b

    Frequent (EOD) injections are conducive to keeping E2 low.
    Do not use any Arimidex until next blood test.

    If you will need Arimidex, most likely it will be small amount and have to be used frequently.
    Best is to get LiquiDex, you can use one of those little syringes (above). Cut out the needle and use it to precise measure small dose of Liquidex.

    When you are going to draw blood for the test, wait at least 2 months while on schedule that I described. Draw blood on the day of T-shot right before T-shot.

    Use 500mg Niacin twice a day, that should help your cholesterol.
    Hope that you do not use any statins.

    That will be it for now, lets see if you are able to attach your blood test.
    You can scan each page and attach it that way.

    Do not worry about your FreeT, they are always wrong.
    If you will need I can post for you a set of tests that you should do.
    My complete list you can see at post #44 here, between blue lines:
    Jan's BloodTest April13/2007

    If you need to do blood tests with out scripts look at my post #101
    Jan's BloodTest April13/2007


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    just re-read my first post...free test should have been total test. Free was 5.1 pg/ml

    JanSz...the diet mods you suggest are basically the ones I made about two weeks ago...I'm down about 6 lbs., and feel a whole lot better. I plan to lose about 50-60 lbs. Not sure if the revision of my first post (free test should have been total) makes a difference in your 300mg every two weeks suggestion, or not. Frequent dosing seems to make a lot of sense.

    Is the E2=30 still ok, even though it is only 5 to one total test to e2? My thought was that since test was so low, I must have lots of aromatase around to make e2 so high. Next blood test will tell, I guess.

    Thyroid levels were as follows:

    TSH 1.786 uIU/ml
    T4 6.3 ug/dl
    T3 uptake 34%
    Free Thyroxine Index 2.1

    I don't use any statins, and will add in Niacin.

    I'll try scanning each page of the blood work, and posting that way.

    Thanks,

    Toby
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    Quote Originally Posted by TobyJ View Post
    just re-read my first post...free test should have been total test. Free was 5.1 pg/ml

    JanSz...the diet mods you suggest are basically the ones I made about two weeks ago...I'm down about 6 lbs., and feel a whole lot better. I plan to lose about 50-60 lbs. Not sure if the revision of my first post (free test should have been total) makes a difference in your 300mg every two weeks suggestion, or not. Frequent dosing seems to make a lot of sense.

    Is the E2=30 still ok, even though it is only 5 to one total test to e2? My thought was that since test was so low, I must have lots of aromatase around to make e2 so high. Next blood test will tell, I guess.

    Thyroid levels were as follows:

    TSH 1.786 uIU/ml
    T4 6.3 ug/dl
    T3 uptake 34%
    Free Thyroxine Index 2.1

    I don't use any statins, and will add in Niacin.

    I'll try scanning each page of the blood work, and posting that way.

    Thanks,

    Toby
    I am guessing range, you always have to post range
    T4-free thyroxine index =2.1(0.8-1.8)ng/dL
    That would be high. Better check rest of your thyroid situation.

    You do not do T/E2 ratio
    On the bottom I will post set of tests to do if you are on TRT and what to aim when adjusting medicines.
    E2=30 is real good, lets hope that you can keep it that way.

    Your TotalTest=167 ng/dl

    is real low. That was on 300mg testosterone shot two weeks before.
    By the time you draw blood the shot is long long gone.
    You should learn two things from this experience.
    1# your body natural production is very low
    2# you have to do shots EOD to make them effective

    Many people do shots once a week because it is impossible to do EOD shots for long time when large needle is used.
    ============================== =====================
    tests to do while on TRT

    42 DHEA sulfate
    43 Prolactin - (746X)
    46 Progesterone, LC/MS/MS - (17183X)
    47 Pregnenolone, LC/MS/MS (31493X)
    48 Estradiol, Ultrasensitive, LC/MS/MS (30289X)
    50 Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
    51 Dihydrotestosterone (204X)

    Goals

    DHEAs(500-640)mcg/dL
    Progesterone(0.9-1.2)ng/mL
    E2(25-29)pg/mL
    DHT(50-90) ng/dL
    ============================== =========

    Thyroid tests (17-23 are also for hemachromatosis):

    7 Iodine Panel - (2503)
    8 Selenium
    9 Copper, serum
    10 Zinc
    17 Iron and Iron Binding Capacity (7573X) - (356N)
    18 Iron, Total (571X) - (24984P)
    19 Ferritin (457X) - (22764P)
    20 Transferrin (891X) - (30346P)
    21 Folate, RBC & Hematocrit - (1768N)
    22 Hemoglobin A1c (496X) - (45484P)
    23 Hemoglobin, Plasma (514X) - (7211P)
    27 T3, Total (859X)
    28 T4, Total (Thyroxine)
    29 T3 Free
    30 T4,Free
    31 T3, Reverse (967X)
    32 Ultrasensitive TSH
    33 Thyroid Peroxidase and Thyroglobulin Antibodies (7260X)
    ============================== ==========================


    You are saying that your GP is not into TRT.
    You are having all kind of problems with other doctors or clinics.
    If your GP can give you scripts for any blood tests that you will ask and a script for testosterone, you may not need better doctor.
    Or at least you can be choosy looking for a good one.

    ============================== ==========================
    ------------------------------
    If you are not using HCG, your FSH and LH will be close to zero.
    Most men see their balls and scrotum athrophy.
    Mine were down completely.
    You are not fertile in that situation.
    Also you are missing on any hormonal production. Other than testosterone and sperm testicles producing other good stuff.
    In the skim of things, fertility and cosmetics is usually the bigest reason that makes guys use HCG.
    We can discuss any more details latter if you wish.
    -------------------------------
    You saying "I am scheduled to give blood soon, to hopefully address the hematocrit situation"
    Are you giving blood regularly?
    Your hematocrit=48.2% is that with blood letting?
    You may want to read up on iron overload, go and check up on this board:
    http://www.ironoverload.org/diagnosis.html

    This is a good list of tests to do at least once:

    17 Iron and Iron Binding Capacity (7573X) - (356N)
    18 Iron, Total (571X) - (24984P)
    19 Ferritin (457X) - (22764P)
    20 Transferrin (891X) - (30346P)
    21 Folate, RBC & Hematocrit - (1768N)
    22 Hemoglobin A1c (496X) - (45484P)
    23 Hemoglobin, Plasma (514X) - (7211P)
    ============================== ==========================
    .
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  8. The horror
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    My doc took me off of niacin. He said it lowers good cholesterol too. Instead he recommended 1200 mg of red yeast rice (at bedtime) and fish oils with at least two grams of EPA. That was three years ago and I've had no issues since. In fact, now I only use fish oils, but I've also modified my diet.

    Quote Originally Posted by JanSz View Post
    6'2" and 328# make sure that your waist is no more than 34-36"
    Replace all wheat, rye, potatos, rice in your diet with green vegetables.
    That should help you loose weight.
    --------
    Transdermal testosterone was not working for you because there is good likelyhood that you have thyroid problems, possibly also adrenals.

    With your weight it would also be a good idea to check glucose/insuline situation.
    --------
    300mg of test every two weeks.
    That is most likely just right amount of testosterone or at least real good place to start.
    real good news is that you have E2=30 pg/ml
    Real problem is that you are taking shots way too far apart.
    Do not worry about nay-sayers telling you to use big long needles to get into muscles, lots of bs.
    (When others use transdermals that have to go thru fat too.)
    You have to divide your 300mg into 7 (seven) portions and do shots every other day (EOD).
    Assuming that you are using the most common 200mg/mL testosterone
    300mg/7=43mg per shot=~22units on insuline syringe
    That is exactly what I am using (69yo, 155#)

    Use smallest needle that is available.
    This needle is very tiny, not bigger than mosquito's beak.
    Use only this needle for any shots that you will ever do.
    Now testosterone.
    Latter possibly you will add HCG.

    http://hocks.com/Merchant2/merchant....Category_Code=
    BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b

    Frequent (EOD) injections are conducive to keeping E2 low.
    Do not use any Arimidex until next blood test.

    If you will need Arimidex, most likely it will be small amount and have to be used frequently.
    Best is to get LiquiDex, you can use one of those little syringes (above). Cut out the needle and use it to precise measure small dose of Liquidex.

    When you are going to draw blood for the test, wait at least 2 months while on schedule that I described. Draw blood on the day of T-shot right before T-shot.

    Use 500mg Niacin twice a day, that should help your cholesterol.
    Hope that you do not use any statins.

    That will be it for now, lets see if you are able to attach your blood test.
    You can scan each page and attach it that way.

    Do not worry about your FreeT, they are always wrong.
    If you will need I can post for you a set of tests that you should do.
    My complete list you can see at post #44 here, between blue lines:
    Jan's BloodTest April13/2007

    If you need to do blood tests with out scripts look at my post #101
    Jan's BloodTest April13/2007


    .
    .
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    Quote Originally Posted by colkurtz_spf View Post
    My doc took me off of niacin. He said it lowers good cholesterol too. Instead he recommended 1200 mg of red yeast rice (at bedtime) and fish oils with at least two grams of EPA. That was three years ago and I've had no issues since.
    3 years ago ryr still have lovastatin in it, so far as I know there are no brands of ryr sold in the US any longer that do.
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    HDL 30
    LDL 133
    triglycerides 218

    These numbers need a little work via diet.
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    Thanks again to all.

    Jansz:

    Thyroid all showed within range...sorry, didn't post the ranges...

    T4 6.3 ug/Dl range 4.5-12.0

    T3 Uptake 34% range 24-39

    Free Throxine index 2.1 range 1.2-4.9

    From this, it would seem my thyroid is ok, but I will get other tests done next time, using your suggestions.

    As for the hematocrit and blood letting...no I have not been giving blood regularly. I actually have not donated in several years. Since my diet used to have lots of red meat in it, I wouldn't doubt it if I had iron issues. I've cut back much of the red meat, and will start donating blood regularly...if nothing else, it is a good thing to do.

    Toby
  12. The horror
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    Quote Originally Posted by EasyEJL View Post
    3 years ago ryr still have lovastatin in it, so far as I know there are no brands of ryr sold in the US any longer that do.
    As I stated, I no longer use it. That still doesn't change the fact that niacin lowers good cholesterol. A lot of people here worry about that. It seems to be one of the concerns about Adex.

    I use oils and watch my diet. My last test total cholesterol was 168 - not my lowest. Triglycerides were 68 - hdl 51 - ldl 102. About fours years ago my total was over 220. I used niacin for about a year until my doc took my off. I used ryr for about another. I quit when I realized the oils and diet were enough. Recently I discovered that ryr is a statin. It may not be the best method for reducing cholesterol, but it works quickly.

    FYI, Vitamin Shoppe has its own brand and it inexpensive. Quite a few other brands are available too.
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    300mg of cyp is good for a while, but if ur gonna be on long term, i would drop that to 200mg or so.
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    Did my first sub q shot, per JanSz's suggestion. Took a little while to draw up the .15cc (I'm using 300mg/ml Test e, so 1/7 worked out to roughly .15cc), but not what I'd consider inconvenient at all. Stuck needle in delt, injected, done. So far, no evidence of any sort of bump, itching, or anything else.

    I'll see how this feels for a couple of months, and then get some blood work. I did find lots of stuff via google on this method, including a medical study, and testimony of some TRT doctors, including lab results. Seems like a really good idea. I had no problems with IM...have even had to go 21ga in the past when the Walgreen's didn't have anything else...no big deal. But, going eod is going to be much easier with a 30 ga.

    Toby
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    Sub Q around the abdominal area is good for smaller amounts of test. I've been doing Sub Q recently and so much easier. Limited risk of hitting a vein and less scar tissue.

    Quote Originally Posted by TobyJ View Post
    Did my first sub q shot, per JanSz's suggestion. Took a little while to draw up the .15cc (I'm using 300mg/ml Test e, so 1/7 worked out to roughly .15cc), but not what I'd consider inconvenient at all. Stuck needle in delt, injected, done. So far, no evidence of any sort of bump, itching, or anything else.

    I'll see how this feels for a couple of months, and then get some blood work. I did find lots of stuff via google on this method, including a medical study, and testimony of some TRT doctors, including lab results. Seems like a really good idea. I had no problems with IM...have even had to go 21ga in the past when the Walgreen's didn't have anything else...no big deal. But, going eod is going to be much easier with a 30 ga.

    Toby
  

  
 

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