New to TRT / Questions about what to test next....

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    New to TRT / Questions about what to test next....


    37 yo. Just started TRT, doc put me on 5g of 1% Testim ED. I do still have some lingering concerns about transfer risk, but for now I think I will stay with the transdermals. Currently using rubber gloves to apply and using a loofa on areas where I apply (chest, shoulders and inner thigh).

    Most recent bloodwork:
    shbg 13.3 nmol/L (13-71)
    test, total 189 ng/dL (262-1593)
    albumin - 4.6 g/dL (3.5-5.0)
    estradiol - 44.1 pg/mL (11-41)
    FSH - 3.8 mU/mL (1-18)
    LH - 3.0 mIU/mL ( <10)
    T4, free 1.08 ng/dL (0.82-1.77)
    TSH - 2.82 uIU/mL (0.45-4.5)
    Aldosterone - 4.0 ng/dL (0-30)
    Vit D - 29.6 ng/mL (32-100)
    AST - 43 (15-46)
    ALT - 59 (13-69)
    Inhibin B 113 (47-308)
    Glucose, Serum 85 (65 - 99)

    I've been reading around and I have some concerns with the E2 levels, and the SBHG levels. My thinking is I will need to watch E2 closely. I'm scheduled for follow up bloodwork the end of March. Also, was wondering if I may want to look into Thyroid and/ or Andrenal Insufficiency given some of the things I have read on Aldosterone, and given the relateively low level in my bloodwork.. Also, at 189 total t I feel just about as bad as I did with high 300's (with just a slight improvement in sex drive at high 300s). Additionally, I have so far noticed an improvement in sex drive, but not so much in the energy department (I realize I need to give it more time to fully access). So I'm beginning to wonder if I may need to treat multiple issues. I changed my diet 2 months ago since the bloodwork (better fats, better carbs, less carbs, no refined cards or gluten, better protein sources - grass fed beef, omega eggs). In terms of the diet, the only benefit I have felt is the lack of need for OTC prilosec, which I have taken for the last three years (prior mild ulcer).

    The liver enzymes are a little elevated as well. I drink about once a week now (2-3 beers), but during my college years through early 30s I did drink quite heavily.

    I also tested about 5-6 years ago for Rheumatoid Factor. When to a specialist who basically said if I had no symptoms, there is nothing to worry about . {insert sarcastic font here} Thanks Doc!

    I am also taking 4000 IU of D3 daily to improve the Vitamin D levels.

    If you see anything in the bloodwork, or have any feedback that would be great. I would like to pursue the root cause if at all possible, but also need some short term relief in the form of therapy. So was wondering what tests I should ask for next (saliva, liver ultrasound, more complete thyroid panel, etc.)

    Thanks!

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    Looking at your profile, you need to change your life style and probably drop a few lbs since your profile is showing signs of potential hypo metabolism. High e2 has many causes some complex some simple. Go with simple one first loose body weight and provide the body the nutrients to help keep metaboism in check. Since your are 37 HRT would be an option recommended to Dr's, however one needs to dig digger before committing one to HRT when there may be hidden factors which need to be resolved first before starting. Adrenals and thyroid are showing potential signs of imbalance here, but need to be validated by proper evaluation. For proper evaluation look at my Lab testing getting to the core thread which will give you a nice set of comprehensive labs to get you started. Again one needs to treat the person and use the labs as a diagnostic tool in order to base decisions off of, but not end all be all. For now go with the obvious, but there are other hidden factors which needs to be explored such as insulin, hypothyroid, adrenal imbalance. With out the proper information one can not even begin to look at underlying pathology.
    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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    Thanks for the input! I would assume that weight is not as important as reducing fat mass in terms of hypo metabolism? If so, is there a target BF pct? Somewhere around 15 percent a good target?
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    Quote Originally Posted by blubbard View Post
    Thanks for the input! I would assume that weight is not as important as reducing fat mass in terms of hypo metabolism? If so, is there a target BF pct? Somewhere around 15 percent a good target?
    It not over all weight but muscle/fat which is the most crucial factor. One can not predict where the natural set point is to get the designatated biological response
    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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