GP's HRT bloodwork V1 - please help me tweak my HRT

[Gutterpump]

This is the first full bloodwork panel I've done since starting HRT. I've done some small interim tests to see where certain values are, but not as full as this testing done here.

I would love to get some input here since I haven't really tweaked my protocol since switching from shots to t-cream. I have only been on real TRT/ HRT for 1 year now.

Was previously taking shots, but DHT was too low (bottom of range). Also, I had a hunch reverse T3 was high (thanks to Jan + The Matrix) so I started taking T3-only for thyroid for the past 3 months.

Currently my protocol for the past 3 months has been:

Test:

20% Compounded t-cream (phlo-gel) 200mg/ml, 1ml per day
- applying half of this to forearms and half to scrotum in the AM only
- was told on here that applying to scrotum will boost DHT - it works!!

Arimidex (compounded) .5mg - 5 times per week
- I was really hoping these current labs would help me tweak this dosage

HCG - I am not always diligent with my dosing, and now that I am on T-cream I often forget a dose here and there, so I will average it out and say my dosiing schedule looks like this:

- normally 1000iu per week, split over 2 doses
- my actual HCG dose averages out to more like 500-600iu per week recently before this bloodwork

Adrenals:

Hydrocortisone - 20-25mg per day
- am not taking florinef or DHEA/PREG
- might need more HC

Thyroid

T3 - sublingually taking 40mcg per day, split into 4 doses (10mcg x4)
- trying to reduce reverse T3 levels for past few months
- might need to increase T3 dosage to further lower RT3??


And now here are my results:


Glucose, Fasting ----- 96 mg/dL ----- (range 65-99)

To me this value seems high...I think I might have some glucose issues, need to look further into this, but I need to clean up the diet soon anyhow

Sodium ----- 138 mmol/L ----- (range 135-146)
Potassium ----- 4.4 mmol/L ----- (range 3.5-5.3)
Chloride ----- 103 mmol/L ----- (98-110)
Urea Nitrogen ----- 21 mg/dL ----- (7-25)
Creatinine ----- 1.07 mg/dL ----- (0.79-1.33)
Uric Acid ----- 6.0 mg/dL ----- (4.0-8.0)
Phosphorus ----- 2.8 mg/dL ----- (2.5-4.5)
Calcium ----- 9.3 mg/dL ----- (8.6-10.2)

Some of the above values are a bit high, I admit I don't drink enough water and am often dehydrated.

Cholesterol, Total ----- 129 mg/dL ----- (125-200)
HDL ----- 50 mg/dL ----- (>=40)
LDL ----- 67 mg/dL ----- (<130)
Chol/HDL Ratio ----- 2.6 ----- (<=5.0)
Triglycerides ----- 60 mg/dL ----- (<130)

My LDL/HDL seems skewed/reversed. I always had higher HDL readings than LDL, so I guess I need to look into boosting my HDL. More cardio and olive oil, etc.

Protein, Total ----- 7.3 g/dL ----- (6.2-8.3)
Albumin ----- 4.7 g/dL ----- (3.6-5.1)
Globulin, Calculated ----- 2.6 g/dL ----- (2.1-3.7)
A/G Ratio ----- 1.8 ----- (1.0-2.1)

Bilirubin, Total ----- 0.8 mg/dL ----- (0.2-1.2)
Bilirubin, Direct ----- 0.2 mg/dL ----- (<=0.2)
Alkaline Phosphatase ----- 70 U/L ----- (40-115)
GGT ----- 27 U/L ----- (3-90)
AST ----- 24 U/L ----- (10-40)
ALT ----- 27 U/L ----- (9-60)
LD ----- 165 U/L ----- (100-220)

No idea why my liver values seem elevated compared to how they normally are. I don't like this, so today I started Liv.52 + sam-e again. I wonder what is causing this, since I am not taking many oral meds at the moment.

Iron, Total ----- 99 mcg/dL ----- (45-170)
Ferritin ----- 45 ng/mL ----- (20-345)

T4, FREE -----[L] 0.7 ng/dL ----- (0.8-1.8) - as expected on T3 only supplementation
T3, TOTAL ----- 173 ng/dL ----- (76-181)
T3, FREE ----- [H] 552 pg/dL ----- (230-420)
T3, REVERSE ----- 20ng/dL ----- (11-32) - why is this still high after 3 months?

Prolactin ----- 3.2 ng/mL ----- (2.0-18.0)

Cortisol (AM) ----- 12.7 mcg/dL (4.0-22.0) ----- (This test was 3 hours after taking 10mg HC)

DHEA Sulfate ----- [L] 72 mcg/dL ----- (110-370) ( Currently not supplementing DHEA )

Vitamin D, 25-OH, TOTAL ----- 48 ng/mL ----- (20-100)
supplementing 8,000iu Vitamin D3 daily

DHT - DIHYDROTESTOSTERONE [H] ----- 170 ng/dL ----- (25-75)

Testosterone TOTAL ----- [H] 1596 ng/dL ----- (250-1100)
Testosterone FREE ----- [H] 347.9 pg/mL ----- (46.0-224.0)
Testosterone BIOAVAILABLE ----- [H] 776.0 ng/dL ----- (110-575)

SHBG ----- 26 nmol/L ----- (8-48)
Albumin, SERUM ----- 4.9 g/dL ----- (3.6-5.1)

ESTRADIOL, FREE, LC/MS/MS (41772N)
Estradiol, FREE ----- 0.30 pg/mL ----- (<=0.45)
Estradiol, % FREE ----- [H] 2.50% ----- (1.25-1.85)
Estradiol, ----- 12 pg/mL -----(<=29)


Overall, the T-Cream looks like it's doing it's job, but I might need to lower the dose. I can't get anything from that estradiol test, and I guess I need to re-test this unless anyone can translate that for me. I am not familiar with this specific test, only the sensitive one which I had asked for.

Thanks for any input and help! Always trying to learn..

 

[Gutterpump]

Forgot to add:

HEMATOCRIT ----- 48.1% ----- 38.5-50
HEMOGLOBIN ----- 16.6 g/dL ----- 13.2-17.1

Not sure if the rest of my CBC is necessary to post

 

[Philec48]

If concerned about blood glucose, get an A1C. That will give you a three month blood sugar average.

Cholesterol is fine. Vast majority of people have LDL higher than HDL. If anything
your LDL could be a little higher. The body needs cholesterol to make its various
hormones. This may be why your DHEA is low. You can try supplementing 30-50mg pregnenolone per day to see if it will help boost DHEA. This will also help support adrenals.

Liver tests look good. They may be a little higher than usual for you since you're now taking oral HC. Just retest in 3 to 6 months, and don't lose any sleep over it.

Your ferritin is low. That will hurt your T4 to T3 conversion. Your RT3 is not terribly high. 3 months is not a long time when working on resolving RT3.

Vitamin D is still low. Try to get it up to 65 ng/ml. Go for 10000iu supplementation.

DHT is too high - reduce or stop applying T-gel to gonads.

Estradiol looks fine.

Hematocrit is fine, just remember to stay well hydrated.

 

[JanSz]

This is the first full bloodwork panel I've done since starting HRT. I've done some small interim tests to see where certain values are, but not as full as this testing done here.

I would love to get some input here since I haven't really tweaked my protocol since switching from shots to t-cream. I have only been on real TRT/ HRT for 1 year now.

Was previously taking shots, but DHT was too low (bottom of range). Also, I had a hunch reverse T3 was high (thanks to Jan + The Matrix) so I started taking T3-only for thyroid for the past 3 months.

Currently my protocol for the past 3 months has been:

Test:

20% Compounded t-cream (phlo-gel) 200mg/ml, 1ml per day
- applying half of this to forearms and half to scrotum in the AM only
- was told on here that applying to scrotum will boost DHT - it works!!

Arimidex (compounded) .5mg - 5 times per week
- I was really hoping these current labs would help me tweak this dosage

HCG - I am not always diligent with my dosing, and now that I am on T-cream I often forget a dose here and there, so I will average it out and say my dosiing schedule looks like this:

- normally 1000iu per week, split over 2 doses
- my actual HCG dose averages out to more like 500-600iu per week recently before this bloodwork

Adrenals:

Hydrocortisone - 20-25mg per day
- am not taking florinef or DHEA/PREG
- might need more HC

Thyroid

T3 - sublingually taking 40mcg per day, split into 4 doses (10mcg x4)
- trying to reduce reverse T3 levels for past few months
- might need to increase T3 dosage to further lower RT3??


And now here are my results:


Glucose, Fasting ----- 96 mg/dL ----- (range 65-99)

To me this value seems high...I think I might have some glucose issues, need to look further into this, but I need to clean up the diet soon anyhow

Sodium ----- 138 mmol/L ----- (range 135-146)
Potassium ----- 4.4 mmol/L ----- (range 3.5-5.3)
Chloride ----- 103 mmol/L ----- (98-110)
Urea Nitrogen ----- 21 mg/dL ----- (7-25)
Creatinine ----- 1.07 mg/dL ----- (0.79-1.33)
Uric Acid ----- 6.0 mg/dL ----- (4.0-8.0)
Phosphorus ----- 2.8 mg/dL ----- (2.5-4.5)
Calcium ----- 9.3 mg/dL ----- (8.6-10.2)

Some of the above values are a bit high, I admit I don't drink enough water and am often dehydrated.

Cholesterol, Total ----- 129 mg/dL ----- (125-200)
HDL ----- 50 mg/dL ----- (>=40)
LDL ----- 67 mg/dL ----- (<130)
Chol/HDL Ratio ----- 2.6 ----- (<=5.0)
Triglycerides ----- 60 mg/dL ----- (<130)

My LDL/HDL seems skewed/reversed. I always had higher HDL readings than LDL, so I guess I need to look into boosting my HDL. More cardio and olive oil, etc.

Protein, Total ----- 7.3 g/dL ----- (6.2-8.3)
Albumin ----- 4.7 g/dL ----- (3.6-5.1)
Globulin, Calculated ----- 2.6 g/dL ----- (2.1-3.7)
A/G Ratio ----- 1.8 ----- (1.0-2.1)

Bilirubin, Total ----- 0.8 mg/dL ----- (0.2-1.2)
Bilirubin, Direct ----- 0.2 mg/dL ----- (<=0.2)
Alkaline Phosphatase ----- 70 U/L ----- (40-115)
GGT ----- 27 U/L ----- (3-90)
AST ----- 24 U/L ----- (10-40)
ALT ----- 27 U/L ----- (9-60)
LD ----- 165 U/L ----- (100-220)

No idea why my liver values seem elevated compared to how they normally are. I don't like this, so today I started Liv.52 + sam-e again. I wonder what is causing this, since I am not taking many oral meds at the moment.

Iron, Total ----- 99 mcg/dL ----- (45-170)
Ferritin ----- 45 ng/mL ----- (20-345)

T4, FREE -----[L] 0.7 ng/dL ----- (0.8-1.8) - as expected on T3 only supplementation
T3, TOTAL ----- 173 ng/dL ----- (76-181)
T3, FREE ----- [H] 552 pg/dL ----- (230-420)
T3, REVERSE ----- 20ng/dL ----- (11-32) - why is this still high after 3 months?

Prolactin ----- 3.2 ng/mL ----- (2.0-18.0)

Cortisol (AM) ----- 12.7 mcg/dL (4.0-22.0) ----- (This test was 3 hours after taking 10mg HC)

DHEA Sulfate ----- [L] 72 mcg/dL ----- (110-370) ( Currently not supplementing DHEA )

Vitamin D, 25-OH, TOTAL ----- 48 ng/mL ----- (20-100)
supplementing 8,000iu Vitamin D3 daily

DHT - DIHYDROTESTOSTERONE [H] ----- 170 ng/dL ----- (25-75)

Testosterone TOTAL ----- [H] 1596 ng/dL ----- (250-1100)
Testosterone FREE ----- [H] 347.9 pg/mL ----- (46.0-224.0)
Testosterone BIOAVAILABLE ----- [H] 776.0 ng/dL ----- (110-575)

SHBG ----- 26 nmol/L ----- (8-48)
Albumin, SERUM ----- 4.9 g/dL ----- (3.6-5.1)

ESTRADIOL, FREE, LC/MS/MS (41772N)
Estradiol, FREE ----- 0.30 pg/mL ----- (<=0.45)
Estradiol, % FREE ----- [H] 2.50% ----- (1.25-1.85)
Estradiol, ----- 12 pg/mL -----(<=29)


Overall, the T-Cream looks like it's doing it's job, but I might need to lower the dose. I can't get anything from that estradiol test, and I guess I need to re-test this unless anyone can translate that for me. I am not familiar with this specific test, only the sensitive one which I had asked for.

Thanks for any input and help! Always trying to learn..

Vit D---10000iu/day
do not put T-cream on scrotum (if able, reduce to (0.8-0.9)mL)
increase fats, better, do fatty acid analysis, you will use results to improve on cholesterol
reduce, almost eliminate carbohydrates
UNI-LIVER-10tabs/day
30mg/day-HC
Arimidex (compounded) .5mg - 3 times per week
T3-50-75mcg/day(or no change at all)

..............

 

[Gutterpump]

Philec48 wrote:

If concerned about blood glucose, get an A1C. That will give you a three month blood sugar average.

Yes, I need to look into this, but I have also been planning to switch back to a low carb diet. I've always felt great on these. The holidays usually ruin this diet for me. I used to do carb cycling (CKD), but this time around I will look into a TKD, so that I will only have simple sugars around my workouts (weights) while doing my morning cardio in a fasted state.

Philec48 wrote:

Cholesterol is fine. Vast majority of people have LDL higher than HDL. If anything your LDL could be a little higher. The body needs cholesterol to make its various hormones. This may be why your DHEA is low. You can try supplementing 30-50mg pregnenolone per day to see if it will help boost DHEA. This will also help support adrenals.

Preg in the past has raised my progesterone levels, so I'm cautious about that. Cholesterol has always been a problem for me regardless of diet and enzymes, etc. I definitely know it is one of my contributing factors to lower hormone levels. I need to fix my gut and also support my liver more. I have a feeling that since cholesterol is produced in the liver, that possibly there are some issues there. I've been looking into going on a Candida diet. Since I am used to a low carb diet, this should be easy to do and help out a lot. I also want to switch to an alkaline diet. My blood is definitely acidic and I am sure this has an impact on overall energy levels too. Not sure how to raise my cholesterol though. The Matrix once recommended cholesterol pills for me which I need to look into with him again. The low carb, high protein, higher fat diet should help a lot though too.

Philec48 wrote:

Liver tests look good. They may be a little higher than usual for you since you're now taking oral HC. Just retest in 3 to 6 months, and don't lose any sleep over it.

Well the thing is, my liver values have always been much lower even while on HC. I was getting liver tests monthly while on accutane this past year. I am used to single digit liver values (before accutane), or maybe in the teens. These values that I am seeing now are almost identical to the levels when I was on accutane (however I was supporting my liver while on that drug, was taking liv.52 and sam-e the whole time, and for a while after.. it really helped keep those enzyme numbers down in mid-range)

Philec48 wrote:

Your ferritin is low. That will hurt your T4 to T3 conversion. Your RT3 is not terribly high. 3 months is not a long time when working on resolving RT3.

Increase my beef intake? I have a lot of baby spinach everyday, I figured this would be good enough for iron. But yes lately I haven't been eating much red meat. Maybe I will look into iron supplementation as well.

Vitamin D is still low. Try to get it up to 65 ng/ml. Go for 10000iu supplementation.

DHT is too high - reduce or stop applying T-gel to gonads.

Estradiol looks fine.

Hematocrit is fine, just remember to stay well hydrated.

-----------------

Thanks for the comments!

 

[Gutterpump]

Vit D---10000iu/day
do not put T-cream on scrotum (if able, reduce to (0.8-0.9)mL)
increase fats, better, do fatty acid analysis, you will use results to improve on cholesterol
reduce, almost eliminate carbohydrates
UNI-LIVER-10tabs/day
30mg/day-HC
Arimidex (compounded) .5mg - 3 times per week
T3-50-75mcg/day(or no change at all)

..............

Thanks! Yes I have been looking into uni-liver and also increasing HC. Arimidex, ok, this sounds about right. T3, I might raise my dose a little, for a few more months. I only put t-cream on gonads because my DHT was very low and I didn't think t-cream on the forearms will result in much DHT conversion. I will just put a tiny bit on the nads maybe a few times per week now instead of everyday. Eliminating carbs, will be doing.. I am trying to create a combination diet which will fight Candida and also be alkaline. I am not sure if I have candida, but it is safe to say I have some symptoms and this diet is definitely beneficial regardless.

 

[Philec48]

If you have adrenal issues, consider 10-20mg pregnenolone per day. It may help keep adrenals healthy, and shouldn't impact progesterone much, if at all.

Eating more eggs should help raise cholesterol.

Spinach as your main source of iron is not the best. I read somewhere that spinach, while having iron, also has an enzyme that counteracts iron absorption. Either more beef, or a low dose iron supplement will help.

If your blood is acidic, super low carb diet is not good as it contributes to lower blood ph. If you don't have insulin issues, no need for low carb. That doesn't mean go high carb either. Healthy complex carbs in moderation will help maintain an anabolic state. Being anabolic isn't all about protein, though that is critical as well.

Try to eat close to equivalent of 1gm protein per lb of weight.

 

[thenxtgrt1]

Wow that 20% gel seems to be packing a powerful punch! How do you feel with Total Test at that level? How is libido?

Concerning liver enzymes, did you consume any alcohol the day before labs. This actually happened to me recently and Dr advised that elevated enzymes could be attributed to liquor consumption.

I agree with Janz on the Uni-Liver tabs. I love this supplement. I don't have any labs to corroborate but I definitely believe that these make me feel better. I usually always have cold hands/feet but this has been greatly improved. I usually pop about 10 a day.

You might want to chill out on applying to scrotum daily. DHT is skyhigh, as you already know. Have you thought about using a different strength compounded gel? A different option might get you out of the supraphysiological range.

 

[Gutterpump]

If you have adrenal issues, consider 10-20mg pregnenolone per day. It may help keep adrenals healthy, and shouldn't impact progesterone much, if at all.

Eating more eggs should help raise cholesterol.

Spinach as your main source of iron is not the best. I read somewhere that spinach, while having iron, also has an enzyme that counteracts iron absorption. Either more beef, or a low dose iron supplement will help.

If your blood is acidic, super low carb diet is not good as it contributes to lower blood ph. If you don't have insulin issues, no need for low carb. That doesn't mean go high carb either. Healthy complex carbs in moderation will help maintain an anabolic state. Being anabolic isn't all about protein, though that is critical as well.

Try to eat close to equivalent of 1gm protein per lb of weight.

I'll try the PREG again, I might have been taking too much before, along with high dose resveratrol. I've heard that RES can raise PROG as well. I don't take it anymore.

Yeah I heard that about spinach as well, will need more red meat. I also eat a lot of eggs normally and take enzymes with ox bile when I eat them.

Hrm I will have trouble with the alkaline diet then. I eat a lot of protein. I try to get a minimum of 1 gram per pound of body weight. I normally eat more like 1.5g per pnd. I definitely want to do the low carb diet again though since I always feel great on it. I don't think I will stay in ketosis this time though since I want to include simple carbs around my weight training. I might be able to maintain an alkaline diet with the use of apple cider vinegar though, but I have to do more research on this... I don't want to lower the acidity of my stomach and cause digestion issues. I think ACV might lower stomach acidity when taken with food. I know it improves the GI-level of foods though when taken with a meal.

I'm not doing this now because I've slacked a bit on my training the past few weeks, but typically on higher carb meals I use NA-RALA as a nutrient partitioner, but I have some yellow gold I want to try with it now too. That and I may get some low dose g l u c o p h a g e that I might try. I am almost sure that I must have some insulin resistance since I always felt great on a low carb diet, and my SHBG was always low before TRT.

 

[Gutterpump]

Wow that 20% gel seems to be packing a powerful punch! How do you feel with Total Test at that level? How is libido?

Concerning liver enzymes, did you consume any alcohol the day before labs. This actually happened to me recently and Dr advised that elevated enzymes could be attributed to liquor consumption.

I agree with Janz on the Uni-Liver tabs. I love this supplement. I don't have any labs to corroborate but I definitely believe that these make me feel better. I usually always have cold hands/feet but this has been greatly improved. I usually pop about 10 a day.

You might want to chill out on applying to scrotum daily. DHT is skyhigh, as you already know. Have you thought about using a different strength compounded gel? A different option might get you out of the supraphysiological range.

Yes, I'm told that 20% cream is the equivalent to using 200mg of test-cyp per week. Also, it could be the HCG that's boosting my levels up higher as well. I am not sure how well HCG on it's own works for me since I did not get bloodwork when I tried it. I stopped HCG mono due to serious bacne that it caused me. I lowered my amount of HCG and added T-cyp at that point in the past. I am sure that applying the t-cream to my forearms and scrotum is really helping me get the most out of it too.. but I need to stop applying to my nads since that DHT level is so high lol.

I rarely drink any alcohol, so it couldn't be that. I'm back on liv.52 again and sam-e so the levels should go back down.

I'll try the liver tabs I think.

I feel pretty good at this level as long as I keep estrogen under control. I feel far more stable and less edgy than before, less anxiety as long as I keep the stim use low, and definitely feeling more assertive than before. Sex drive is strong, wood is strong, refractory period is low again, even better than when I was younger... only slight problem that I have is that I can lose wood quicker than I'd like if it's not getting attention. But maybe it's normal, and I was just used to the way I'd perform and always be ready at attention when I used to always use cialis. I'm not using any cialis atm. I notice this effect fluctuate as well. Some days I feel like I've taken a little cialis and other days it goes away too quickly (however, still functions perfectly fine on both days). Probably comes down to getting E2 tweaked, as I'm sure that a venus leak would be more severe in it's effects.

edit: BP is borderline hypertensive - 120/88. Looking into ARBs atm. My BP was not much better before HRT though. In fact, I think I have managed to lower the first number since starting HRT, but that 2nd number hasn't changed in years for me.

 

[Philec48]

I forgot to mention, with eating that much protein try to drink at least a gallon of water a day. High protein will tax kidneys, but the extra water will help keep them healthy.

If stomach acid is low, consider betaine-hcl, one or two caps with each meal.

 

[Gutterpump]

I forgot to mention, with eating that much protein try to drink at least a gallon of water a day. High protein will tax kidneys, but the extra water will help keep them healthy.

If stomach acid is low, consider betaine-hcl, one or two caps with each meal.

Yeah my water intake has been too low =( I am aiming to get 1 gallon per day, but would like to get in 2 gallons. I think I need to buy some Xtend (flavoured BCAA+ mix) again to make the water more appealing lol.

I'm taking betaine-hcl though. With a large meal I try to take about 8 caps! And without burning! lol :Eyecrazy: I try to double up on my enzyme intake too.

 

[cumkwakka]

Gutterpump:

I suppose you started with 1 ml of 100 mg per day?

I am on that same dose now and not noticing morning erections, still have ED.

Did you have the same experience, or did upping the dose to 200 mg daily help?

Or was it really the HCG that did the trick libido/ED wise?

Thanks.

 

[Gutterpump]

I started with test-cyp, about 150mg per week and then 200mg, then 250mg, but never got my DHT into the top of range. I switched to the 200mg (1mL) t-cream without trying the lower concentration. I was on hcg before the cream, and switching to the cream seemed to make the most difference. E2 went down with daily applications, and DHT shot up.

 

[Gutterpump]

I should mention that during some extremely busy weeks (and especially since I am using t-cream now), I completely forget to do my HCG shot or I may only remember to take one shot. I can definitely feel a boost in energy, etc once I remember to do my HCG again. I never used to notice this too much before when I was on test-cyp and shooting hcg 2-3 times per week.

 

[Gutterpump]

I should probably also mention that I am doing a few things on the side of my HRT, to help boost libido, dopamine, etc. I am taking 50-100mg P5P, 400mg sam-e, low dose deprenyl (2.5-5mg per week), and occasionally some of the instant release welbutrin (not the XR). My prolactin is at the bottom of range now, and I am assuming dopamine is higher than before.