Seeing the doc tomorrow…

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    mobiuskoan's Avatar
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    Seeing the doc tomorrow…


    Sure could use some advice!

    age: 49
    height: 6' 2"
    waist: 30
    weight: 174
    body hair: have lost almost all the hair on my lower legs and much on my upper legs.
    facial hair: thick in the mustache and goatee areas, sparse elsewhere. I've noticed no changes.
    body fat: I had a DEXA scan in March 2012. 16% body fat, most carried around my navel. Has increased recently, probably to 17%.
    health conditions: low libido, low energy, low motivation since my early 30s.
    diet: cyclic low-carb paleo. Nutrient-dense, low toxin. Mostly shrimp, pastured eggs and bacon, grass-fed beef and liverwurst, smoothies made with kale, celery, wild blueberries, whey concentrate.
    training: brief heavy weightlifting sessions or HIIT every 3-7 days. Walking 2-6 days per week.
    My testes have never ached, but I do suffer from periodic epididymitis. It has bothered me off and on for close to 20 years.
    Morning wood: sporadic before AI, then every morning, and now sporadic again.

    Labs, Free Cortisol Rhythm - Saliva (collected 4/12/2013):

    06:00 - 08:00 AM: 14 (13-24 nM)
    11:00 - 1:00 PM: 5 (5-10 nM)
    04:00 - 05:00 PM: 4 (3-8 nM)
    10:00 - Midnight: 5 (1-4 nM) elevated

    Cortisol Load: 28 (22-46 nM)

    Labs (collected 3/7/2013):

    TSH: 1.66 (0.450-4.500 uIU/mL)
    Thyroid Peroxidase (TPO) Ab: 10 (0-34 IU/mL)
    Reverse T3, Serum: 3.0 (2.0-4.4 pg/ml)
    Antithyroglobulin Ab: <20 (0-40 IU/ml)
    T4, Free (Direct): 1.30 (0.82-1.77 ng/dL)

    PSA, Serum: 1.1 (0.0-4.0 ng/mL)

    Glucose, Serum: 83 (65-99 mg/dL)
    BUN: 24 (6-24 mg/dL)
    Creatinine/Serum: 0.94 (0.76-1.27 mg/dL)
    eGFR If NonAfricn Am: 95 (>59 mL/min/1.73)
    BUN/Creatinine Ratio: 26 (9-20)
    Sodium, Serum: 142 (134-144 mmol/L)
    Potassium, Serum: 4.8 (3.5-5.2 mmol/L)
    Chloride, Serum: 103 (97-108 mmol/L)
    Carbon Dioxide, Total: 27 (20-32 mmol/L)
    Calcium, Serum: 9.8 (8.7-10.2 mg/dL)
    Protein, Total, Serum: 7.0 (6.0-8.5 g/dL)
    Albumin, Serum: 4.5 (3.5-5.5 g/dL)
    Globulin, Total: 2.5 (1.5-4.5 g/dL)
    A/G Ratio: 1.8 (1.1-2.5)
    Bilirubin, Total: 0.6 (0.0-1.2 mg/dL)
    Alkaline Phosphatase, S: 59 (25-150 IU/L)
    AST (SGOT): 27 (0-40 IU/L)
    ALT (SGPT): 33 (0-44 IU/L)

    Immature Granulocytes: 0 (0-2%)
    Immature Grans (Abs): 0.0 (0.0-0.1 x10E3/uL)
    Baso (Absolute): 0.0 (0.0-0.2 x10E3/uL)
    Eos (Absolute): 0.2 (0.0-0.4 x10E3/uL)
    WBC: 6.6 (4.0-10.5 x10E3/uL)
    RBC: 4.62 (4.14-5.0 x10E6/uL)
    Hemoglobin: 14.2 (12.6-17.7 g/dL)
    Hematocrit: 43.1 (37.5-51.0 %)
    Lymphs (Absolute): 2.1 (0.7-4.5 x10E3/uL)
    Monocytes (Absolute): 0.5 (0.1-1.0 x10E3/uL)
    MCV: 93 (79-97 fL)
    MCH: 30.7 (26.6-33.0 pg)
    MCHC: 32.9 (31.5-35.7 g/dL)
    Platelets: 292 (140-415 x10E3/uL)
    Neutrophils: 58 (40-74 %)
    Lymphs: 32 (14-46 %)
    Monocytes: 8 (4-13 %)
    Eos: 2 (0-7 %)
    Basos: 0 (0-3 %)
    Neutrophils (Absolute): 3.8 (1.8-7.8 x10E3/uL)
    RDW: 13.5 (12.3-15.4 %)

    Vitamin D, 25-Hydroxy: 56.0 (3.0-100.0 ng/mL)

    Labs, Male Hormone Panel - Saliva (collected 3/7/2013):

    DHEA/S: 4 (3-10 ng/ml)
    Progesterone: 33 (5-95 PG/ML)
    Androstenedione: 107 (151-350 pg/ml)
    Estrone: 27 (30-58 PG/ML)
    testosterone: 34 (40-70 PG/ML)
    estradiol: 4 (1-3 PG/ML)
    DHT: 38 (52-123 PG/ML)

    Labs (collected 5/21/2012):

    Testosterone, Total, LC/MS/MS: 634 (250-1100 ng/dL)
    Testosterone, Free: 52.2 (35.0-155.0 pg/mL)
    Cortisol, Total 13.2 (4.0-22.0 mcg/dL)
    DHEA Sulfate: 248 (45-3 45 mcg/dL)
    Estradiol: <15 (< OR = 39 PG/ML)
    SHBG: 79 (10-50 nmol/L)

    Here's my history:

    Been on anastrozole since 2007.
    For a few months in 2010 I tried bio identical testosterone cream at 75 mg/mL daily. It improved my total and free testosterone somewhat, but I noticed no improvement in libido, energy, etc. The only thing I noticed was extra sensitivity and periodic tingling in my nipples, despite the fact that my estradiol only got as high as 9. So the treatment was somewhat effective, but I certainly wouldn't say that it worked. I lost confidence in that doctor and was sufficiently creeped out by the nipple sensations that I lost interest in HRT (lab numbers below).

    Total testosterone: 576 before, 682 after (range: 280-800)
    Free testosterone: 8.6 before, 14.46 after (range 5-21)
    estradiol: <5.1 before, 9 after (range: 3-70)

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    E2 needs to be measured using 7-42 range not 3-70 its invalid. Quest only goes to <15 not below..
    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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    Quote Originally Posted by The Matrix View Post
    E2 needs to be measured using 7-42 range not 3-70 its invalid. Quest only goes to <15 not below..
    Well, the lab was Lab Corp., not Quest. I double checked it and the range is definitely 3-70.

    Anyway, the doctor prescribed 1/2 mL of depo testosterone every 2 weeks. I mentioned to her that the wisdom of the Internet advocates injecting twice a week or every other day. She said she was fine with me spreading out the injections anyway I liked. I go in Monday to have her physician's assistant instructor me on how to do my first injection.

    The doctor hadn't heard anything about using hCG to avoid testicular issues.

    Any other advice is greatly appreciated.
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    Quote Originally Posted by mobiuskoan View Post
    Well, the lab was Lab Corp., not Quest. I double checked it and the range is definitely 3-70.

    Anyway, the doctor prescribed 1/2 mL of depo testosterone every 2 weeks. I mentioned to her that the wisdom of the Internet advocates injecting twice a week or every other day. She said she was fine with me spreading out the injections anyway I liked. I go in Monday to have her physician's assistant instructor me on how to do my first injection.

    The doctor hadn't heard anything about using hCG to avoid testicular issues.

    Any other advice is greatly appreciated.
    1/2 ml every two weeks is 50mgs per week she is starting you out very very slow.

    Good luck on doing a 1/4 ml twice per week, some do small doses so not impossible.
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    Quote Originally Posted by rfarns01 View Post
    1/2 ml every two weeks is 50mgs per week she is starting you out very very slow.

    Good luck on doing a 1/4 ml twice per week, some do small doses so not impossible.
    Thanks. I'm also wondering if I should bump up my anastrozole at the same time I start.
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    So I picked up everything from the pharmacy today and went to see my doctor's medical assistant and the first thing she noticed was that I was going to have to use the same needle to insert into the vial and inject said that means it's not going to be as sharp when I use it to inject.

    We got to talking and I explained to her that I had read/heard about the advantages of subcutaneous injections anyway. I also talked to her about injecting hCG EOD and how many antiaging clinics nowadays start men off with testosterone, hCG, and an AI. I also mentioned that I was concerned that the testosterone dose prescribed by the doctor wasn't enough and could possibly be counterproductive. The doctor was not in, so the MA asked me to write down my questions for the doctor and she would make sure she got them.

    I've decided to push hard for the subcutaneous injections and hCG. And since the vial of T is a six-month supply, I'm thinking I could dose at 100 mg per week instead of the 50 she prescribed.

    Thoughts?
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    OK, I seem to be mostly talking with myself here, but here's an update anyway LOL. My doctor has agreed to allow me to do subcutaneous EOD injections instead of intramuscular and she is going to allow me to try hCG at the same time.

    One thing I'm wondering about is if I should increase my anastrozole dose at the time I start TRT.

    Any thoughts or advice appreciated.
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    Quote Originally Posted by mobiuskoan View Post
    OK, I seem to be mostly talking with myself here, but here's an update anyway LOL. My doctor has agreed to allow me to do subcutaneous EOD injections instead of intramuscular and she is going to allow me to try hCG at the same time.

    One thing I'm wondering about is if I should increase my anastrozole dose at the time I start TRT.

    Any thoughts or advice appreciated.
    Why are taking an ai on such a small dose? And what is your dose going to be sub q?
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    My AI dose is so low because I am an over responder to anastrozole. When I take more, my E2 can drop to immeasurable lows.

    Now that I'm starting TRT, I'm assuming I'll need to increase it, but have no idea how much. Guess I'll need to experiment…
  

  
 

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