Update on my most recent labs. See earlier posts for more extensive lab test and medication history.
History: A couple of months ago Dr. M switched me from 1200 units subcutaneous injections of HCG EOD to 160mg intramuscular injections of testosterone cypionate 1x per week plus 250 IUs of HCG (subcutaneous) each day on the two days before my testosterone cypionate injection. The previous HCG alone regimen had bumped up my testosterone to 633 ng/dL, but estradiol also went to 36 pg/mL, so Dr. M wanted to give testosterone cypionate a try.
I felt pretty good the first 4-6 weeks with better libido and okay morning erections. However, for the past few weeks libido has dropped and no morning erections.
For the sake of brevity, I'm only posting a portion of my most recent lab results (bloodwork by Quest Diagnostics):
Total testosterone is at 736 ng/dL [range 241-827 ng/dL] up from 633 ng/dL on HCG only. But see below for estradiol issues.
Estradiol has dropped significantly to 16 pg/mL from 36 pg/mL after switching from HCG alone to testosterone cypionate + some HCG. Dr. M said he likes to see a total testosterone to estradiol ratio of somewhere between 20-30:1, so now my estradiol is actually too low. I guess I don't convert testoserone-cypionate to estrogen very well. More on how to deal with this below.
Cholesterol levels have dropped quite a bit:
Cholesterol: 153 mg/dL [down from a high of 226]
Triglycerides: 115 mg/dL [down from a high of 161]
VLDL Cholesterol: 23 mg/dL [about the same]
LDL Cholesterol: 94 mg/dL [down from a high of 159]
HDL Cholesterol: 36 mg/dL
My dad and brother have good cholesterol numbers (no testosterone problems though) but their HDL is low like me. Dr. M said he liked to see total cholesterol above 140 mg/dL but with a higher HDL. My brother takes prescription time release niacin, but Dr. M didn't want me on that until we get other stuff balanced out. Overall my cholesterol numbers are good, so the HDL can wait.
Vitamin D is at 66 ng/mL up from a low of 22.3 ng/mL [range 20-100 ng/mL]. I'm currently taking about 12,000 units of a high quality vitamin D supplement from Life Extension Foundation. Dr. M. says he likes to see a vitamin D level of at least 60 ng/mL, so I might bump up another 5,000 units on my daily vitamin D intake. Dr. M mentioned that he sees an awful lot of folks with vitamin D deficiency who take a vitamin D supplement (typically 1,000 units/day) but never actually measure their vitamin D levels, and they wind up being very low because 1,000 units isn't nearly enough - - - case in point I need at least 13x that amount.
DHEA is too high at 669 mcg/dL [range 45-345 mcg/dL]. I've been taking 100 mg/day of DHEA from Life Extension Foundation, so I'll drop that down to 50-75 mg/day.
Progesterone is high at 2.6 ng/mL [range < 1.4 ng/mL] up from the previous measurement of 0.8 ng/mL. I think Dr. M said this was a little odd given the low estradiol number. He guessed there might be a conversion pathway between DHEA and progesterone, so we'll see if this drops when I lower my DHEA intake.
Ferritin is still low at 26 ng/mL [previous measurement 18 ng/mL, range 20-380 ng/mL] after taking 30 mg/day of a high quality iron supplement for several months now. I think Dr. M might have missed this previously as my earlier ferritin test was done by another doc and Dr. M probably didn't notice the low number when reviewing my lab history. Dr. M said this is a big problem and has instructed me to take 325 mg/day of ferrous sulfate or ferrous glutanate to raise my ferritin level. He said it will take approximately 6 months for this to happen, and that out of all my lab test results, the ferritin stood out as the worst problem. Apparently he sees a lot of iron deficiency in his patients.
Cortisol is a little high at 17.8 mcg/dL, up from 14.7 mcg/dL.
Vitamin A is at 56 mcg/dL [range 38-98 mcg/dL]. Dr. M said he thought this was low and recommended adding 10,000 units supplementation to whatever I am currently getting from the Life Extension Foundation multivitamin. My back and shoulders have been breaking out more lately, and Dr. M said increased vitamin A could help with that.
Treatment changes:
Keep testosterone cypionate dosage the same but increase dosage of HCG to 500 units 2x week to bring up estradiol levels to a range of 25-35 pg/mL. Dr. M recommended injecting the HCG on the same day as my testosterone-cypionate shot and then 4 days later. He said I might try splitting my testosterone cyptionate into (2) doses during the week to and adjust the HCG timing accordingly.
Maybe increase vitamin D intake to 17,000 units/day.
Lower DHEA supplementation to 50mg/day to lower DHEA and hopefully progesterone levels.
Begin taking 325mg/day of ferrous sulfate or ferrous glutanate to bring up ferritin levels.
Increase supplementation of vitamin A by 10,000 units/day.
