Seekonk labs - any insight?

[seekonk]

Attached are my Rhein urine labs. I am 43, natural, and have been having chronic musculoskeletal problems for over a year now (chronic pain from sore joints/tendons, LBP, stiffness, and no recovery from exercise or injuries - injuries just get worse over time). The best way to describe it is that I went from feeling like a strong teenager to feeling like a weak 90 year old in my body in a year. I lost 30lbs of lean muscle from inability to properly exercise.

I don't want to be blinded by the fact that I used to take finasteride but I did stop it around the time my problems began. I had taken it for 10 years with no problems. On these labs, it does appear that 5a-THF/THF and 5a-THB/THB are very low. Lower limits of the reference ranges for these ratios are 0.48 and 0.84 respectively, and I am well below that. However, musculoskeletal issues are not really one of the main known post-finasteride symptoms, and I am not aware of any mechanism for connecting finasteride to musculoskeletal pain.

The following serum tests were done the next day:

Testosterone, total 690 (241-827)
DHT 47 (25-75)
SHBG 32 (9-45)
IGF-1 232 (this was before starting ghrp-6).

After these labs I started administering GHRP-6. Two months of this has made no difference, I might as well be injecting saline.

Any comments welcome.

[JanSz]

Attached are my Rhein urine labs. I am 43, natural, and have been having chronic musculoskeletal problems for over a year now (chronic pain from sore joints/tendons, LBP, stiffness, and no recovery from exercise or injuries - injuries just get worse over time). The best way to describe it is that I went from feeling like a strong teenager to feeling like a weak 90 year old in my body in a year. I lost 30lbs of lean muscle from inability to properly exercise.

I don't want to be blinded by the fact that I used to take finasteride but I did stop it around the time my problems began. I had taken it for 10 years with no problems. On these labs, it does appear that 5a-THF/THF and 5a-THB/THB are very low. Lower limits of the reference ranges for these ratios are 0.48 and 0.84 respectively, and I am well below that. However, musculoskeletal issues are not really one of the main known post-finasteride symptoms, and I am not aware of any mechanism for connecting finasteride to musculoskeletal pain.

The following serum tests were done the next day:

Testosterone, total 690 (241-827)
DHT 47 (25-75)
SHBG 32 (9-45)
IGF-1 232 (this was before starting ghrp-6).

After these labs I started administering GHRP-6. Two months of this has made no difference, I might as well be injecting saline.

Any comments welcome.

Cortisol(F)=173(35-168)mcg/24hrs HIGH

Too much stress, wonder if that would be one reson.


How is your 4xsaliva

Also E1 &E2 are on the low end (too much AI??).

Are you using Testosterone, how much, what kind, how often?

/////////////////

Is this just part of the picture, what is the deal with adrenals & thyroid?

......

[seekonk]

Cortisol(F)=173(35-168)mcg/24hrs HIGH

Too much stress, wonder if that would be one reson.



Yes, the cortisol was probably an anomaly. I went off pain meds for the duration of the test so I was in a lot of pain and didn't sleep well.



Also E1 &E2 are on the low end (too much AI??).

Are you using Testosterone, how much, what kind, how often?


No, I don't take testosterone or AIs. These tests are au naturel.

[Wise Guy]

A few notes

Note the low DHEA.

Often synonymous w/ high cortisol.

Mid to Upper 1/3 of range DHEA needed for GHRT, especially w/ peptides, to work properly. Not sure of exact science but it has been presented by many, including Dr John.

Symptoms of low DHEA are often synonymous w/ low androgenic hormones, including GH and T, and the ones you are having - chronic pain from sore joints/tendons, LBP, stiffness, and no recovery from exercise or injuries - injuries just get worse over time

Note the low estrogens.


Dr Mark Gordon likes his GHRT guys with mid range estrogens or even a tad higher.

Dr John likes all his TRT and GHRT guys w/ at least mid range estrogens as well.

Mid range Estrogens needed for proper GHRT. Not sure of exact science behind this but it has been noted by many, including Dr John and Dr Gordon.

Symptoms of low estrogens are often synonymous w/ low androgenic hormones, including GH and T, and the ones you are having - chronic pain from sore joints/tendons, LBP, stiffness, and no recovery from exercise or injuries - injuries just get worse over time

You are deficient in the aromatase enzyme. W/ a T level that high and an E level that low, that is glaring.

I suspect you could just naturally be this way.

I also suspect the finasteride may have lead to this. This is just a hypothesis based on random thoughts in my head. However, fin has been known to disrupt natural hormonal pathways.

Thyroid levels can have a profound impact on energy and QOL. Get them.

Hope this helped.

[seekonk]

So DHEA supplementation might be something to explore to help improve both low DHEA and low E?

I used to feel better on Propecia, maybe because it raises E/DHT ratio?

[JanSz]

So DHEA supplementation might be something to explore to help improve both low DHEA and low E?

I used to feel better on Propecia, maybe because it raises E/DHT ratio?

The way is going your use of ghrp-6 will/may impact TT levels.

Even right now you have

TT=690
SHBG=32
---->FreeT<160
that is borderline value

You may be heading toward supplementing/improving your TT.
If that time comes
I suggest first to use HCG

You may benefit with somewhat higher HCG dose, hopefully that would increase your E2.
But start first with HCG-shot=250iu (EOD) and reasess.


........

[seekonk]

What causes low DHEA?

Would DHEA supplementation have an adverse effect on endogenous testosterone production? I can't seem to find a clear answer.

This is an interesting avenue for me to explore, since there seems to be some connection between low DHEA and chronic musculoskeletal pain.

[seekonk]

The way is going your use of ghrp-6 will/may impact TT levels.


No, I won't allow that to happen. I'd rather stop GHRP-6.



You may be heading toward supplementing/improving your TT.


But what does it mean that my urinary Testosterone is so high, in fact well above range?

[JanSz]

No, I won't allow that to happen. I'd rather stop GHRP-6.

That would not be very smart.


But what does it mean that my urinary Testosterone is so high, in fact well above range?

Not sure, my guess,
you are lucky, you testicles are producing lots of testosterone.

But you are fast metabolizer, have a hard time to hold on to it.

Eventually what counts is
BAT (BioAvailableTestosterone)

You are getting marginal there.
...

[seekonk]

That would not be very smart.


I don't understand. IGF-1 was 232 before peptides. This is pretty much in the middle of the reference range for 19-30 y/o (126-382), and is above range for my age group (86-220). In other words, my IGF-1 was already good enough.

Furthermore, I perceive no benefits at all after 2 months of peptides, and testing showed peptides did not increase IGF-1, so I think the GHRP-6 is, for me, a wash.

[Wise Guy]

What causes low DHEA?

Would DHEA supplementation have an adverse effect on endogenous testosterone production? I can't seem to find a clear answer.

This is an interesting avenue for me to explore, since there seems to be some connection between low DHEA and chronic musculoskeletal pain.

Low DHEA? Many things. Simple aging. It starts a decline at 25.

Perhaps the propecia. Perhaps stress. Stess = Cortisol = Low DHEA.

Perhaps burned out adrenals.

You might be beneficial to stick w/ GHRP-6.

You might be beneficial to look to picking up a DHEA/Pregnenolone based transdermal compounded cream.

This will supply a rush of upstream parent hormones. The combo will boost hormones.

DHEA is known to boost estrogens. It is known to boost libido. It is known to boost GH. It works in synchrony with GHRT.

Just opinions. I would suggest finding a competent medical adviser who can interpret these kinds of labs. I have Dr. John. You might want to do same.

[JanSz]

I don't understand. IGF-1 was 232 before peptides. This is pretty much in the middle of the reference range for 19-30 y/o (126-382), and is above range for my age group (86-220). In other words, my IGF-1 was already good enough.

Furthermore, I perceive no benefits at all after 2 months of peptides, and testing showed peptides did not increase IGF-1, so I think the GHRP-6 is, for me, a wash.

Then you had plenty and should have investigated and worked on improving all other health areas.

Anyhow, IGF-1 & IGFBP-3
should be (even seriously looked at) only after all else is in the best shape possible.

...

[chilln]

I am 43, natural, and have been having chronic musculoskeletal problems for over a year now (chronic pain from sore joints/tendons, LBP, stiffness, and no recovery from exercise or injuries - injuries just get worse over time).


noted



I don't want to be blinded by the fact that I used to take finasteride but I did stop it around the time my problems began.


Perhaps you noted the symptoms first, then stopped taking finasteride ?



I had taken it for 10 years with no problems. On these labs, it does appear that 5a-THF/THF and 5a-THB/THB are very low.


I know you did not measure your 5a-THF/THF and 5a-THB/THB before you started taking finasteride.

If your DHT metabolism was high before you started taking finasteride, and warranted the use of finasteride to keep it in check, then your 5a-THF/THF and 5a-THB/THB were previously high.

After you've stopped taking finasteride, your 5a-THF/THF and 5a-THB/THB are way too low, ie: your DHT metabolism hasn't recovered, despite your relatively OK T levels.

That spells that you do have the long term finasteride problem. This spells that your low DHT metabolism is not a side effect of your other symptoms or hormone balance.




However, musculoskeletal issues are not really one of the main known post-finasteride symptoms, and I am not aware of any mechanism for connecting finasteride to musculoskeletal pain.


I have a couple of differing suggestions / approaches to consider:

1) The main finasteride debilitation issue is that the body does not react to normal testosterone levels in a normal way.

The main finasteride debilitation issue is that the body behaves as if it is desensitized to normal T levels, but doesn't produce any more T to compensate.

The desensitization to T results in insufficient triggering of repairs, and insufficient conversion of T into DHT, and insufficient conversion of T into E2.

The inadequate repairs, and inadequate E2, can result in your musculoskeletal issues.

I'm not guaranteeing this, due to the scarcity of understanding of the root cause of the finasteride long term issue problem, but I believe it to be true in your case

###

2) The lack of DHT metabolism is probably affecting your neurotransmitter metabolism and driving your cortisol too high.

Too high cortisol definitely downregulates our tissues response to the levels of T already present.

In your case, I'm not sure your cortisol would necessarily reduce via the normal means of boosting the other hormones (T, thyroid hormone T3, GH). In your case you and your medical professional adviser may need to suppress the excess cortisol via PS (phosphatidylserine).




The following serum tests were done the next day:

Testosterone, total 690 (241-827)
DHT 47 (25-75)
SHBG 32 (9-45)
IGF-1 232 (this was before starting ghrp-6).


The high SHBG is definitely diminishing the effectiveness of your T levels, and combined with your high cortisol, your T levels are not enough to counter these two issues.

Thus high SHBG is also contributing to your musculoskeletal issues.

High SHBG is not something you treat directly. It's an indicator of issues with thyroid hormone imbalance, or insulin resistance, and in your case, you're probably experiencing insulin resistance from your too high cortisol.

But please do not attempt to let your medical professional adviser treat high SHBG directly, this was discussed here:

http://musclechatroom.com/forum/showpost.php?p=56034&postcount=8

...and here:

http://musclechatroom.com/forum/showpost.php?p=56374&postcount=29





After these labs I started administering GHRP-6. Two months of this has made no difference, I might as well be injecting saline.


If boosting GH were the cure for the long term finasteride side effects, then the problem would not be the enigma that it is.

[seekonk]

If your DHT metabolism was high before you started taking finasteride, and warranted the use of finasteride to keep it in check, then your 5a-THF/THF and 5a-THB/THB were previously high.

After you've stopped taking finasteride, your 5a-THF/THF and 5a-THB/THB are way too low, ie: your DHT metabolism hasn't recovered, despite your relatively OK T levels.


Hmm... I'm balding more, though, and growing fur like an orang-utan, including out of most orifices. I shudder to think what I would look like with more active DHT... :)

[seekonk]

The high SHBG is definitely diminishing the effectiveness of your T levels, and combined with your high cortisol, your T levels are not enough to counter these two issues.

Thus high SHBG is also contributing to your musculoskeletal issues.


Why do you say SHBG is high?

My testosterone of 690 is higher and SHBG of 32 is lower than average for the lowest age group in this study, even though I am 43...



Age Total Testosterone SHBG (nmol/L.)
25-34 617 35.5
35-44 668 40.1
45-54 606 44.6
55-64 562 45.5
65-74 524 48.7
75-84 471 51
85-100 376 65.9


(from Vermeulen A. Declining androgens with age - an overview, In: Androgens and the ageing male. Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996)

[JanSz]

Why do you say SHBG is high?

My testosterone of 690 is higher and SHBG of 32 is lower than average for the lowest age group in this study, even though I am 43...



Age Total Testosterone SHBG (nmol/L.)
25-34 617 35.5
35-44 668 40.1
45-54 606 44.6
55-64 562 45.5
65-74 524 48.7
75-84 471 51
85-100 376 65.9


(from Vermeulen A. Declining androgens with age - an overview, In: Androgens and the ageing male. Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996)

If you started using (HCG & T) in trying to get desirable BAT & FreeT levels,
I would advice you to aim at:

TotalTestosterone (1150-1325)ng/dL

using
SHBG=32
and
FreeT(300-350)
and getting TT value from:
Dr Vermulen's chart
here:
http://www.andropause.org.uk/nomo_tas.pdf



///

[seekonk]

If you started using (HCG & T) in trying to get desirable BAT & FreeT levels,
I would advice you to aim at...

So are you saying that the average 25-34 y/o values as listed in the table I posted are actually not very good, even though they have not yet hit andropause?

[JanSz]

So are you saying that the average 25-34 y/o values as listed in the table I posted are actually not very good, even though they have not yet hit andropause?

I am not really sure what to think.
But let me try.
I think that average healthy (today's) young males have rather low BAT levels.
Lower than their fathers or specially grandfathers.

but

probably

lots of very high performing and natural young males still have very high BAT levels.

One of them is brandO's brother.

===============
I think that SHBG(15-20) is ideal


Also,
and this is very important,
many young and healthy males have very well balanced hormonal picture.

Good overall hormonal balance is probably worth much more that very high individual hormone and no balance.


...

[seekonk]

I am not really sure what to think.
But let me try.
I think that average healthy (today's) young males have rather low BAT levels.
Lower than their fathers or specially grandfathers.


There is probably something to this.

Haven't sperm counts dropped by 50% or so since 50 years ago? Disturbing.

[chilln]

Why do you say SHBG is high?


Because the lab which measured your SHBG used a method where the range is 9 thru 45 (for mature males, ie: children are not included).

The definition of those ranges is that, using the labs technology, 5% of males have SHBG levels below 9, and and another 5% of mature males have SHBG levels above 45, with some sort of distribution in between (eg: bell curve).

Since your SHBG was 32, that puts you in the relatively high category, with respect to the technology used by your lab. Ie: half way would be approx 25.

###



My testosterone of 690 is higher and SHBG of 32 is lower than average for the lowest age group in this study, even though I am 43...



Age Total Testosterone SHBG (nmol/L.)
25-34 617 35.5
35-44 668 40.1
45-54 606 44.6
55-64 562 45.5
65-74 524 48.7
75-84 471 51
85-100 376 65.9


(from Vermeulen A. Declining androgens with age - an overview, In: Androgens and the ageing male. Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996)


Unfortunately your lab didn't use the same technology to measure SHBG as Vermeulen, for mature males.

We know this because Vermeulen's range for SHBG is not the same as your lab's range for SHBG for mature males, because the extremes of Vermeulen's range are different to the extremes of your lab's range, for mature males.

Therefore your numbers don't correlate with Vermeulen's SHBG distribution.

.

[seekonk]

Ah thanks!

Any other insight into the very high urine T levels?

Am I perhaps just excreting everything instead of metabolizing it in the appropriate tissues.

Receptor downregulation perhaps?

If that is the case, would T supplementation even help? I already seem to be producing supraphysiological amounts of T...

[seekonk]

If you started using (HCG & T) in trying to get desirable BAT & FreeT levels,
I would advice you to aim at:

TotalTestosterone (1150-1325)ng/dL

using
SHBG=32
and
FreeT(300-350)
and getting TT value from:
Dr Vermulen's chart
here:
http://www.andropause.org.uk/nomo_tas.pdf


Okay thanks, this calculation shows that I need TT = 475 only for free T = 350. I already have TT = 690, which works out to Free T = 525 pmol/l, much higher than the desirable value. (I assume you meant pmol/l, since pg/ml would give values off the chart even for very low SHBG values.)

As another check, I calculated Bioavailable testosterone from Albumin - 4.8, SHBG = 32, and TT = 690, which gives BAT = 382 ng/dL = 55.4 %.

Do you know what would be a desirable value for BAT?

[JanSz]

Okay thanks, this calculation shows that I need TT = 475 only for free T = 350. I already have TT = 690, which works out to Free T = 525 pmol/l, much higher than the desirable value. (I assume you meant pmol/l, since pg/ml would give values off the chart even for very low SHBG values.)

As another check, I calculated Bioavailable testosterone from Albumin - 4.8, SHBG = 32, and TT = 690, which gives BAT = 382 ng/dL = 55.4 %.

Do you know what would be a desirable value for BAT?

If someone understands what he wrote, please translate this for me.

..

[seekonk]

If someone understands what he wrote, please translate this for me.

..

Sorry if I wasn't clear.

I ran the Vermeulen calculation that you posted. This calculation shows that with my SHBG = 32 and my TT = 690, my Vermeulen calculated Free T = 525 pmol/l, much higher than your recommended value of 350.

However, as Chilln pointed out, Vermeulen's reference ranges are different than Quest's, so the value of this may be doubtful.

As another check, I calculated Bioavailable testosterone using an online calculator found via Google. Given Albumin = 4.8, SHBG = 32, and TT = 690, the online calculator gives BAT = 382 ng/dL.

Anybody know what would be a desirable BAT using Quest's reference ranges?

[JanSz]

Sorry if I wasn't clear.

I ran the Vermeulen calculation that you posted. This calculation shows that with my SHBG = 32 and my TT = 690, my Vermeulen calculated Free T = 525 pmol/l, much higher than your recommended value of 350.


I attached chart to my post
http://musclechatroom.com/forum/showthread.php?p=75865#post75865

possibly it will clarify how
starting with
SHBG=32
and aiming at FreeT(300-350)
I arrived with
TotalTestosterone (1150-1325)ng/dL





As another check, I calculated Bioavailable testosterone using an online calculator found via Google. Given Albumin = 4.8, SHBG = 32, and TT = 690, the online calculator gives BAT = 382 ng/dL.

Please post link to calculator provided by Google.



Anybody know what would be a desirable BAT using Quest's reference ranges?

Using exclusively this test and no other test,
Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X


I use a goal of BAT(575-650)

575 is a top of range on that test.
I use 575 and higher number
because
I have seen dr Gordon using higher values that would roughly correspond to 650 on this test.
......

[seekonk]

I attached chart to my post
http://musclechatroom.com/forum/showthread.php?p=75865#post75865

possibly it will clarify how
starting with
SHBG=32
and aiming at FreeT(300-350)
I arrived with
TotalTestosterone (1150-1325)ng/dL



OK thanks. I did my calculation using the pmol/l scale instead of ng/dl.



Please post link to calculator provided by Google.


Here is the link:

http://www.issam.ch/freetesto.htm



I use a goal of BAT(575-650)

575 is a top of range on that test.
I use 575 and higher number
because
I have seen dr Gordon using higher values that would roughly correspond to 650 on this test.
......

I can see why Dr. Gordon is popular. :thumbup1:

Thank you for the advice so far. If it seems like I am playing devil's advocate, it is only because I want to be very sure that TRT will help me before going on it. I am really pretty desperate to feel better, but something like this is of course a major health decision with the possibility of unintended consequences.

I wish TRT were something one could try and then stop if it doesn't deliver results.

[JanSz]

Here is the link:

http://www.issam.ch/freetesto.htm

I would rather if you forgot that link (for your benefit).


If it seems like I am playing devil's advocate, it is only because I want to be very sure that TRT will help me before going on it.

I feel that TRT, and specially the Test part of TRT should be evaluated and stabilized within 2-3 months, top.

There is so many other health problems, but most people get stuck at square #1.

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

[chilln]

Ah thanks!

Any other insight into the very high urine T levels?

Am I perhaps just excreting everything instead of metabolizing it in the appropriate tissues.

Receptor downregulation perhaps?

If that is the case, would T supplementation even help? I already seem to be producing supraphysiological amounts of T...


Since your SHBG is relatively high, and you are experiencing symptoms of inadequate T, yet your urinary T level was high, I suspect either of the following:

a) your body processes your T not via the usual ratio of urinary metabolites, but by more of some metabolites and less of others. (more on this later)

b) You are a fast hyperexcreter of T, but not a hypermetabolizer of T.

###

The labs don't measure every single metabolite of T. They take a short cut and measure the most predominant urinary metabolites, and then estimate the remainder. In your case you may not have any of the "remainder", and you may be excreting all of your urinary T metabolites only as the main metabolites. When the lab adds the "remainder", you're too high.

Some people also have the opposite of this problem, where they excrete most of their T as the "remainder" and too little as the normal metabolites.

It's rare, but it happens.

If you're in this category, you'll need to stick with serum to measure your T levels.

###

No matter whether you're a hyperexcreter of T, or your urinary metabolites of T aren't in the usual ratio, serum bioavailable T testing, and sensitive E2 testing, should be a better indication of your T and E2 metabolism, and you'll most likely find that your bioavailable T will be too low. And you may even find that your E2 needs a boost too (this is not obvious, but keep an open mind).

[seekonk]

I discussed these labs with my doctor. He says they show that my testosterone is already excellent.

He does not deny that I may have post-finasteride issues, but says testosterone levels are not the problem.

[JanSz]

I discussed these labs with my doctor. He says they show that my testosterone is already excellent.

He does not deny that I may have post-finasteride issues, but says testosterone levels are not the problem.

"My testosterone of 690 is higher and SHBG of 32"

Excellent when comparing to what?


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

[chilln]

I discussed these labs with my doctor. He says they show that my testosterone is already excellent.

He does not deny that I may have post-finasteride issues, but says testosterone levels are not the problem.

Technically he's correct about the problem, in that normal T levels can be present in serum or urine, but they're not being "used optimally".

Ie: there's something else going on which means T metabolism within cells is not triggering the end-to-end repairs which T normally triggers. Dr Crisler doesn't yet know what it is, but he definitely has solutions.

Unfortunately there's no one-size-fits all solution to a persons's post-finasteride problem.

In the following post from Dr Crisler, copied from hairlosstalk by JanSz, Dr Crisler confirms that he uses several techniques to improve his post-finasteride patients.

http://musclechatroom.com/forum/showpost.php?p=46327&postcount=33

.

[seekonk]

I have dug up some earlier results: Both are 7:30 am test results:

7/17/09

total T = 600 (241-827)
free T = 10.7 (6.8-21.5)

9/4/09

Total T = 478 (241-827)
Free T = 8.2 (6.8-21.5)

SHBG was not measured at those times. However, both times free T appears very low, indicating, as far as I understand it, high SHBG.

I think a consistent picture is emerging from the serum tests. The urine panel is still a bit of a mystery.

What causes high SHBG? I am very lean, very low bodyfat, fasting glucose in the lower tertile, eat a clean diet.

In cases like this (TT not too bad, but probably high SHBG), what are the options? Is there anything short of full TRT that can be done to address low levels of free T despite okay TT levels?

It seems a pity to shut down okay natural TT levels, as well as shut down LH and FSH, with TRT just because SHBG is high. There has to be a better way.

[chilln]

I have dug up some earlier results: Both are 7:30 am test results:

7/17/09

total T = 600 (241-827)
free T = 10.7 (6.8-21.5)

9/4/09

Total T = 478 (241-827)
Free T = 8.2 (6.8-21.5)

SHBG was not measured at those times. However, both times free T appears very low, indicating, as far as I understand it, high SHBG.

I think a consistent picture is emerging from the serum tests. The urine panel is still a bit of a mystery.

What causes high SHBG? I am very lean, very low bodyfat, fasting glucose in the lower tertile, eat a clean diet.

In cases like this (TT not too bad, but probably high SHBG), what are the options? Is there anything short of full TRT that can be done to address low levels of free T despite okay TT levels?

It seems a pity to shut down okay natural TT levels, as well as shut down LH and FSH, with TRT just because SHBG is high. There has to be a better way.

To naturally lower high SHBG, to free up more T, is easiest if it's due to excess thyroid hormone T3 (stop supplementing), or insulin resistance (back off the high GI carbs and/or excess fats and oils).

But otherwise, you need to boost T and suppress E2 like the rest of us.

If we could correct our hormones without life-long supplementation, then we would do that for sure. But we can't. So most of us are here discussing how to tune our life-long hormone modulation therapy.

.

[seekonk]

starting with
SHBG=32
and aiming at FreeT(300-350)
I arrived with
TotalTestosterone (1150-1325)ng/dL


To get an idea of the type of therapy options:

Is TT=1150-1325 ng/dL plausibly/easily attainable with transdermal T plus HcG?
Is TT=1150-1325 ng/dL plausibly/easily attainable with frequent SubQ T injections plus HcG?

(I don't think I have the balls for IM injections... :ack2:)

What option would be best for estrogen control? I seem to remember Dr J saying TD, which is counterintuitive to me, but maybe I am remembering wrong.

[seekonk]

To naturally lower high SHBG, to free up more T, is easiest if it's due to excess thyroid hormone T3 (stop supplementing).

Are these results indicative of high T3? If so, how would one lower it?

9/4/09 Thyroid panel:

TSH 1.110 (0.45-4.5)
T4 9.8 (4.5-12)
T3 uptake 36 (24-39)
Free Thyroxine index 3.5 (1.2-4.9)

Also, if one lowers SHBG, won't the HPTA just adjust to give the same (low) free T, since AFAICR the HPTA feedback is just based on free T anyway?

[seekonk]

I have had this problem for years. On days that I weight train, I have great difficulty falling asleep at night, and sleep is terrible. This happens even when I train in the morning or lunchtime, so it is not that I train too late.

Of course this interferes with recovery. Anyone have any insight into this?

[invictus]

Do you take any workout supplements, like NO-Xplode or anything like that? NO-Xplode has a large amount of caffeine.

[seekonk]

Do you take any workout supplements, like NO-Xplode or anything like that? NO-Xplode has a large amount of caffeine.

No, no workout supplements except creatine, which I also take on off days when I sleep better.

[LeanGuy]

Weight training induces a stress response in the body which increases the sympathetic nervous system. If your body can't make enough cortisol and dhea to combat the stress, you'll get adrenaline/noradrenaline instead which is not good for sleeping. Mine has gotten better since taking hydrocortisone before workouts. Rhodiola also helps.

[diesiel]

yep, same problem here. Would wake up with a stiff back and bloodshot eyes after every workout day. must be stress related.

[Bob45]

What is your routine like? Do you completely exhaust yourself? Maybe do less but more often?

[seekonk]

What is your routine like? Do you completely exhaust yourself? Maybe do less but more often?

No, at the moment I stop very far from exhausting myself. I already cut back a lot from what I used to do... To give an idea, yesterday I did some light core (bridges etc.) and 3 sets of bicep curls with 15 pounds dumbbells only. That was enough to keep me awake most of last night.

[Bob45]

It's not coincidental? How many days a week do you try to train? What about other physical stuff. Does everything physical do it? We get some different type problems on this board don't we? At least this is where you hear it all. It sure is a good place to have.

[seekonk]

Mine has gotten better since taking hydrocortisone before workouts.

How does that affect recovery? I understand cortisone is catabolic.

[LowT]

How does that affect recovery? I understand cortisone is catabolic.

If you are suffering from too low a cortisol level to support normal recovery it can only help.

The physiological doses used with HC would do no harm even if they weren't needed.

Lots of bodybuilding sites talk about cortisol like it is not needed but chronically high levels of cortisol typically come from overtraining, not reasonable workouts with proper adrenal support.

Hence most people with adrenal insufficiency suffer weight loss and muscle wasting.

[chilln]

Are these results indicative of high T3? If so, how would one lower it?

9/4/09 Thyroid panel:

TSH 1.110 (0.45-4.5)
T4 9.8 (4.5-12)
T3 uptake 36 (24-39)
Free Thyroxine index 3.5 (1.2-4.9)

Also, if one lowers SHBG, won't the HPTA just adjust to give the same (low) free T, since AFAICR the HPTA feedback is just based on free T anyway?

The T3 uptake and Free Thyroxine index are not helpful (ie: unreliable).
You and your medical professional adviser still need to do the following reliable thyroid tests:
a) thyroid hormone antibodies, ie: thyroid peroxidase antibodies, and TSH antibodies
b) free T4
c) free T3
d) reverse T3.

###

But a discussion of thyroid hormones, in isolation to cortisol, is dangerous in your case.

ie: you and your medical professional adviser need to monitor and address both cortisol and thyroid.

.

[chilln]

I have had this problem for years. On days that I weight train, I have great difficulty falling asleep at night, and sleep is terrible. This happens even when I train in the morning or lunchtime, so it is not that I train too late.

Of course this interferes with recovery. Anyone have any insight into this?

Too low or too high cortisol.

In your case too high (see your previous thread re labs).

[seekonk]

Too low or too high cortisol.

In your case too low (see your previous thread re labs).
[chilln edit: mistake - should have been "too high", corrected after seekonk submitted this post


Okay, now I am seriously confused.

My Rhein test at the beginning of this thread says 24h cortisol is high at 173 (35-168).

I am about to give up on making sense of these damn tests, they are all over the map! :huh:

[JanSz]

Okay, now I am seriously confused.

My Rhein test at the beginning of this thread says 24h cortisol is high at 173 (35-168).

I am about to give up on making sense of these damn tests, they are all over the map! :huh:

Pls re-read my post #2 on this thread,
and
relpy.

ok, you did.

..

Yes, the cortisol was probably an anomaly. I went off pain meds for the duration of the test so I was in a lot of pain and didn't sleep well.



No, I don't take testosterone or AIs. These tests are au naturel.

You probably should

Redo 24 hr urine test and do 4x saliva

to get idea where you stand on your cortisol on long term basis.

[seekonk]

The main reason why I am wary of TRT is that, despite all my problems, libido-wise I am doing okay a lot of the time (even if not not all the time), at least better than a lot of guys here seem to be doing on TRT. It appears that a lot of guys here have a seemingly never-ending struggle with tuning E and libido. For some guys it never seems to stabilize. That is probably my biggest worry if I were to consider TRT.

How common is this problem, though? It seems to be a problem for a lot of guys here, but maybe the ones with no problem feel no need to participate here.

[chilln]

Okay, now I am seriously confused.

My Rhein test at the beginning of this thread says 24h cortisol is high at 173 (35-168).

I am about to give up on making sense of these damn tests, they are all over the map! :huh:

Sorry my bad - I meant "high" but I was skipping between posts. I corrected my original post too, so I don't make the same mistake when I revise what I've said before, when I'm assessing your situation next time around.

.

[seekonk]

Okay, I guess you can add "wasting" to my symptoms.

Over the past 18 months I went from 190 lbs of solid muscle to a skinny 160 lbs. I am 6' tall. I eat all I want and never put on fat. I just cannot increase my exercise level, which is restricted to a few pushups and 10 lb dumbbell exercises. I used to lift heavy weights. Now any attempt to increase weights and I feel like was hit by a bus for the rest of the week.

One problem is that I am absolutely dependent on opioid painkillers to get through the night due to a back injury. This has been going on for 9 months. I know things might improve endogenously if I could get off the painkillers but I don't think that is going to be possible anytime soon.

So I am between a rock and a hard place. Do I go on TRT temporarily to help recovery to where I could maybe get off painkillers and then try restarting, or do nothing and stay natural but maybe keep deteriorating? I have done a lot of research and can find no guarantee that restarts work. Even on this forum there are restart threads where restarts appeared to work temporarily, but they never seems to stick...

[Dadoo]

Okay, I guess you can add "wasting" to my symptoms.

Over the past 18 months I went from 190 lbs of solid muscle to a skinny 160 lbs. I am 6' tall. I eat all I want and never put on fat. I just cannot increase my exercise level, which is restricted to a few pushups and 10 lb dumbbell exercises. I used to lift heavy weights. Now any attempt to increase weights and I feel like was hit by a bus for the rest.
this is also what i thought all my life until I tried an experriment for 4 months. I just ate like crazy, as soon as my stomech was ready to get food, I ate, no matter whether I wanted or not. I went from 65 kg to 82 kg.
now back again at 71, life is hard))

[seekonk]

You are deficient in the aromatase enzyme. W/ a T level that high and an E level that low, that is glaring.


Or maybe aromatase is fine but free testosterone is just really low, so there is little available to convert to E (I am assuming urine T reflects the production rate of T, which is indeed high, but probably most of that T gets mopped up by my high SHBG). Does that make sense?

Serum E2 tends to be high, specifically high 30s (I know it is with the wrong test, but the result was repeatable). If this is true, and serum E is high while urine E is low, it seems body is just hanging onto E (maybe SHBG-bound) but neither metabolizing nor excreting much of it. Would that be consistent with low-E symptoms despite high serum E?

I had been interested in the possibility of AI-only therapy to raise T, which made sense given my high serum E readings, but since the urine E is so low, this confuses the issue significantly.

[seekonk]

Okay, I took the plunge and am doing a trial of TRT. Here are some preliminary results after 4 weeks:

Before TRT:

7/17/09

total T = 600 (241-827)
free T = 10.7 (6.8-21.5)
Estradiol = 36 (0-53)
DHT = 38

9/4/09

Total T = 478 (241-827)
Free T = 8.2 (6.8-21.5)
Estradiol = 34 (0-53)
SHBG = 32

Preliminary results after 4 weeks TRT:

Total T = 1120 (280-800)
Free T (direct) 26.5 (6.8 - 21.5)
Estradiol = 10.2 (7.6 - 42.6)
SHBG = 35 (14.5 - 48.4)
Albumin 4.6 (3.5-5.5)
Prolactin 10.3 (4.0-15.2)

Above is standard estradiol test. I also ordered separate free estradiol test that (I believe) includes a sensitive E2 test. See how different E2 numbers are!


Estradiol, serum, MS = 22 (8-35)
Free estradiol, percent = 3.2% (1.7-5.4)
Free estradiol = 0.7 (0.2-1.5)


Blood taken at time of injections, before injections (3.5 days after T injection, 2 days after HCG injection, 2 days after 0.25 mg arimidex pill).

T numbers pretty much where Jansz recommended, given my high SHBG.

Regimen is:

200 mg T cyp/week in 2 split doses of 100 mg every 3.5 days.
250 IU HCG EOD
0.25 mg Arimidex EOD (started because of high E symptoms)

Results:

Gained back 10 lbs lean muscle (not fat or bloat) in 3 weeks (had lost 30 lbs muscle).
Exercise recovery dramatically improved from a week to recover before TRT to a day to recover with TRT for similar work.
More energy and motivation to do things in the evenings.
Chronic trigger point pain in muscles around my shoulder blades for two years has improved like magic.
Spurts of great libido, but also periods of little libido and some ED (new).
Nocturnal erections pretty good, but they were not bad before.
Little or no improvement in chronic lower back pain due to bulging discs.
Scrotum has been worryingly tight.

[JanSz]

Okay, I took the plunge and am doing a trial of TRT. Here are some preliminary results after 4 weeks:

Before TRT:

7/17/09

total T = 600 (241-827)
free T = 10.7 (6.8-21.5)
Estradiol = 36 (0-53)
DHT = 38

9/4/09

Total T = 478 (241-827)
Free T = 8.2 (6.8-21.5)
Estradiol = 34 (0-53)
SHBG = 32

Preliminary results after 4 weeks TRT:

Total T = 1120 (280-800)
Free T (direct) 26.5 (6.8 - 21.5)
Estradiol = 10.2 (7.6 - 42.6)
SHBG = 35 (14.5 - 48.4)
Albumin 4.6 (3.5-5.5)
Prolactin 10.3 (4.0-15.2)

Blood taken at time of injections, before injections (3.5 days after T injection, 2 days after HCG injection, 2 days after 0.25 mg arimidex pill).

T numbers pretty much where Jansz recommended, given my high SHBG.

Regimen is:

200 mg T cyp/week in 2 split doses of 100 mg every 3.5 days.
250 IU HCG EOD
0.25 mg Arimidex EOD (started because of high E symptoms)

Results:

Gained back 10 lbs lean muscle (not fat or bloat) in 3 weeks (had lost 30 lbs muscle).
Exercise recovery dramatically improved from a week before TRT to a day with TRT for similar work.
More energy and motivation to do things in the evenings.
Chronic trigger point pain in muscles around my shoulder blades for two years has improved like magic.
Spurts of great libido, but also periods of little libido and some ED (new).
Nocturnal erections pretty good, but they were not bad before.
Little or no improvement in chronic lower back pain due to bulging discs.
Scrotum has been worryingly tight.

I am glad to hear you using words
Gained back
dramatically improved
More energy and motivation

For the next 6 months I suggest that you do:

Everything on EOD schedule (HCG, T, AI)all one day next day free
T-shot=30units=60mg=210mg/week
HCG-350iu

----------------------
When testing get

1 --------- Comprehensive Metabolic Panel w/EGFR
2 --------- CBC w/ diff/PLT
14 --------- Ferritin
39 --------- Prolactin
40 --------- Progesterone
41 --------- Pregnenolone
42 --------- Androstenedione
43 --------- Estradiol, sensitive 140244
44 --------- Estrone, Serum
45 --------- Total Testosterone
46 --------- SHBG

48 --------- Dihydrotestosterone
49 --------- 3a-Androstanediol Glucuronide

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

There is a possibility that at 6 mo your SHBG will get little lower.
Do not reduce test dose, keep it until you reach SHBG(15-20).
If your SHBG does not get lower at all, add additional 40-50 mg/week.

..
..

[seekonk]

Thank you.

According to the Vermeulen chart, my BAT is now at 270. A little lower than what you like to recommend. But it is unlikely I can get prescribed more T/week, so for now this will just have to be okay. Hopefully I can get SHBG a little lower.

I guess we have established that I excrete T pretty fast.

I wonder if this is a trough value for T. I guess it is difficult to know.

E2 seems low. Funny, I thought I felt like E2 was a little high when I went for the test.

After that test I increased HCG to 400 IU EOD because of tight scrotum. Seems to help a little bit. But at what dose does one start to worry about irreversible desensitization?

B.t.w., what is a good prolactin?

[JanSz]

Thank you.

According to the Vermeulen chart, my BAT is now at 270. A little lower than what you like to recommend. But it is unlikely I can get prescribed more T/week, so for now this will just have to be okay. Hopefully I can get SHBG a little lower.

I guess we have established that I excrete T pretty fast.

I wonder if this is a trough value for T. I guess it is difficult to know.

E2 seems low. Funny, I thought I felt like E2 was a little high when I went for the test.

After that test I increased HCG to 400 IU EOD because of tight scrotum. Seems to help a little bit. But at what dose does one start to worry about irreversible desensitization?

B.t.w., what is a good prolactin?

You should be close to good when your FreeT=270

The "problem" is that you will (most likely) keep your high SHBG.
SHBG tends to go down when you have higher TT levels.

SHBG=35
is not a really big problem, so no big deal.

Good luck.

[seekonk]

Interesting. I got additional result for free estradiol that (I believe) includes a sensitive E2 test. See how different E2 numbers are!


Estradiol, serum, MS = 22 (8-35)
Free estradiol, percent = 3.2% (1.7-5.4)
Free estradiol = 0.7 (0.2-1.5)


With standard test:


Estradiol = 10.2 (7.6 - 42.6)

[JanSz]

Interesting. I got additional result for free estradiol that (I believe) includes a sensitive E2 test. See how different E2 numbers are!


Estradiol, serum, MS = 22 (8-35)
Free estradiol, percent = 3.2% (1.7-5.4)
Free estradiol = 0.7 (0.2-1.5)


With standard test:


Estradiol = 10.2 (7.6 - 42.6)

Easy to explain if these are tests from Quest Diagnostics.

Quest have a bogus tests.
The technology sounds good but Quest have absolutely no handle on results from those tests.

I had about the same experience with those tests.

Interestingly my e2 values were also different by multiple of 2.

Quest should return money they charged for those tests and also pay for inconveniencing 100's of patients.
//////////
Specifically I am referring to this two tests:

http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=30289N.html&labCode=SJC

Estradiol, Ultrasensitive, LC/MS/MS (30289X)

/////////

http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=41772N.html&labCode=SJC

Estradiol, Free, LC/MS/MS (36169X)

=================

Per Quest's description

Estradiol testing in both tests is identical,
only
the Free and %% part is additionally included in bottom test.

[seekonk]

Easy to explain if these are tests from Quest Diagnostics.

Quest have a bogus tests.
The technology sounds good but Quest have absolutely no handle on results from those tests.

I had about the same experience with those tests.

Interestingly my e2 values were also different by multiple of 2.

Quest should return money they charged for those tests and also pay for inconveniencing 100's of patients.
//////////
Specifically I am referring to this two tests:

http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=30289N.html&labCode=SJC

Estradiol, Ultrasensitive, LC/MS/MS (30289X)

/////////

http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=41772N.html&labCode=SJC

Estradiol, Free, LC/MS/MS (36169X)

=================

Per Quest's description

Estradiol testing in both tests is identical,
only
the Free and %% part is additionally included in bottom test.

No, it was done through Labcorp, self-ordered via Directlabs.com.

Directlabs.com does not have an option for sensitive E2 test.

The standard E2 test = 10.2 (7.6 - 42.6) was done by Labcorp itself, I believe.

The free E2 test that included Estradiol, serum, MS = 22 (8-35) took a long time and was sent by the lab to be done by Esoterix endocrinology, I believe.

So which one is to be believed?

[JanSz]

No, it was done through Labcorp, self-ordered via Directlabs.com.

Directlabs.com does not have an option for sensitive E2 test.

The standard E2 test = 10.2 (7.6 - 42.6) was done by Labcorp itself, I believe.

The free E2 test that included Estradiol, serum, MS = 22 (8-35) took a long time and was sent by the lab to be done by Esoterix endocrinology, I believe.

So which one is to be believed?

Since you are self ordering, consider this:

Estradiol, Sensitive $68.49

http://www.privatemdlabs.com/lab_tests.php?view=all

I am assuming that it is a same test as

Estradiol, sensitive 140244

when done directly thru LabCorp.


////////////////////////

[chilln]

Spurts of great libido, but also periods of little libido and some ED (new).


E2 fluctuates a little when T levels are kept stable, while the rest of your hormones fluctuate naturally.

E2 levels are affected as a result of the body's requirement for T, in conjunction with your supply of T.

So even while you nail the dose of T, the body's requirement for T changes.

Eg: when the body's requirement of T is reduced due to less physical or mental stressors, then the excess T is shed as E2 and DHT.

( That's because T metabolism is downregulated by increased levels of cortisol. So when you're under more physical and or mental stress, you actually need more T, and it won't convert into so much E2. )

You need to try to anticipate when your T requirements are high and low, and adjust T accordingly.




Little or no improvement in chronic lower back pain due to bulging discs.


Since your T levels seem to be closer to optimal, with no improvement here, therefore this is going to need a boost to your GH (growth hormone) to trigger these repairs.

.

[seekonk]

Okay this week I crashed big-time. The improvements I saw in the first 3 weeks



Exercise recovery dramatically improved from a week before TRT to a day with TRT for similar work.
More energy and motivation to do things in the evenings.
Chronic trigger point pain in muscles around my shoulder blades for two years has improved like magic.


are gone. Muscle aches and pains ad stiffness are back. Major back pain again. Haven't yet recovered from exercise from a week ago. Tired in bed by 8 pm. Feeling of strength in first weeks replaced by feeling weak.

I feel the same as before starting TRT, if not worse.

I thought E2 might be the problem, and Arimidex seemed to help a little, but no major improvement. Morning wood and libido are better than it has been in years, so E2 would appear to be okay, but body feels like crap and can't do anything with libido because sex just makes everything hurt more.

[Dadoo]

why don't you reduce your T injections to 100mg per week?

[seekonk]

why don't you reduce your T injections to 100mg per week?

Because T is close to optimal given my high SHBG.

[Dadoo]

Because T is close to optimal given my high SHBG.
Your SHBG did increase on that dose..

[JanSz]

Okay this week I crashed big-time. The improvements I saw in the first 3 weeks



are gone. Muscle aches and pains ad stiffness are back. Major back pain again. Haven't yet recovered from exercise from a week ago. Tired in bed by 8 pm. Feeling of strength in first weeks replaced by feeling weak.

I feel the same as before starting TRT, if not worse.

I thought E2 might be the problem, and Arimidex seemed to help a little, but no major improvement. Morning wood and libido are better than it has been in years, so E2 would appear to be okay, but body feels like crap and can't do anything with libido because sex just makes everything hurt more.

If your testosterone was about right (BAT~575),
keep it steady, do not change.

But you must inspect at least

E2
DHT possibly
cortisol, blood, saliva, urine
Aldosterone, Renin, sodium, potasium
glucose/insulin
...

[Dadoo]

And your Arimidex dosing might be not optimal. 0,25 EOD is not too little. Some people get bad sideeffects on that dose. And remember that you began taking it due to high E2, which is probably a result of 200mg T per week.

I would not run after the high BAT, when it's done by that high dose of T, which is bringing you high E2, which you have to control with a lot of Arimidex, which might give you the side effects (additional to high E2).

[chilln]

Okay this week I crashed big-time. The improvements I saw in the first 3 weeks



are gone. Muscle aches and pains ad stiffness are back. Major back pain again. Haven't yet recovered from exercise from a week ago. Tired in bed by 8 pm. Feeling of strength in first weeks replaced by feeling weak.

I feel the same as before starting TRT, if not worse.

I thought E2 might be the problem, and Arimidex seemed to help a little, but no major improvement. Morning wood and libido are better than it has been in years, so E2 would appear to be okay, but body feels like crap and can't do anything with libido because sex just makes everything hurt more.

Remember to ask y our medical professional adviser for compounded arimidex, per this explanation here:

http://musclechatroom.com/forum/showpost.php?p=59066&postcount=31

It takes months of practice using low dose arimidex to get tuned. You have to work out how to "anticipate" what your T dose needs to be, because too much T requires more arimidex, as teh excess T dumps into more E2.

In the end, if you find you can't "tune into" your T <--> E2 feedback loops, then you'll need to reduce your T dosage and boost your GH, because the GH triggers similar repairs to those triggered by testosterone (not 100% overlap).

.

[seekonk]

My latest results, after 8 weeks TRT:

Blood taken at time of injection, 1/2 day before injection (3 days after T injection, 2 days after HCG injection, 3 days after 0.5 mg arimidex pill).

Results after 8 weeks TRT: (Labcorp)

Total T > 1500 (280-800) - don't know what happened, since after 4 weeks it was only 1120.
Free T (direct) 36.9 (6.8 - 21.5)
Estradiol, sensitive = 14 (3-70) - note discrepancy with next
Estradiol = 39.6 (7.6 - 42.6)
SHBG = 33.5 (14.5 - 48.4)
IGF-1 = 233 (101-267)

Regimen is:

200 mg T cyp/week in 2 split doses of 100 mg every 3.5 days.
250 IU HCG EOD
0.5 mg Arimidex E3D

Results:


Lately not feeling as good a first 4 weeks. Exercise recovery inconsistent, sometimes good, sometimes bad.
Chronic trigger point pain in muscles around my shoulder blades initially improved like magic, but lately has been inconsistent. It seems like more adex = less pain.
Libido very inconsistent. Spurts of great libido every now and then, but mostly periods of little libido and some ED (new).
Nocturnal erections very good.
Little or no improvement in chronic lower back pain due to bulging discs, although it seems that more adex = less pain.
Scrotum had been worryingly tight. Looser lately. It seems like more adex = looser scrotum.

[chilln]

My latest results, after 8 weeks TRT:


Nice summary.

seekonk, please donate, if you haven't already. You're getting some great advice from this forum, let's keep it operational.

[Wise Guy]

[COLOR="Red"]Total T > 1500 (280-800) - don't know what happened, since after 4 weeks it was only 1120.
.

Because your injecting 200mg per week. Probably took time for it to catch up

[JanSz]

My latest results, after 8 weeks TRT:

Blood taken at time of injection, 1/2 day before injection (3 days after T injection, 2 days after HCG injection, 3 days after 0.5 mg arimidex pill).

Results after 8 weeks TRT: (Labcorp)

Total T > 1500 (280-800) - don't know what happened, since after 4 weeks it was only 1120.
Free T (direct) 36.9 (6.8 - 21.5)
Estradiol, sensitive = 14 (3-70) - note discrepancy with next
Estradiol = 39.6 (7.6 - 42.6)
SHBG = 33.5 (14.5 - 48.4)
IGF-1 = 233 (101-267)

Regimen is:

200 mg T cyp/week in 2 split doses of 100 mg every 3.5 days.
250 IU HCG EOD
0.5 mg Arimidex E3D

Results:


Lately not feeling as good a first 4 weeks. Exercise recovery inconsistent, sometimes good, sometimes bad.
Chronic trigger point pain in muscles around my shoulder blades initially improved like magic, but lately has been inconsistent. It seems like more adex = less pain.
Libido very inconsistent. Spurts of great libido every now and then, but mostly periods of little libido and some ED (new).
Nocturnal erections very good.
Little or no improvement in chronic lower back pain due to bulging discs, although it seems that more adex = less pain.
Scrotum had been worryingly tight. Looser lately. It seems like more adex = looser scrotum.

You did your testing at LabCorp.
I assume that
Estradiol, sensitive = 14 (3-70)
is the correct test.

http://img535.imageshack.us/img535/2074/image1do.jpg

Your current E2 level is too low.
Stop using Arimidex.

Relatively to previous tests, your SHBG is steady.
That tells me that your current testosterone dose is not too high.

I propose that you change your protocol to
-------------
EOD
both shots (6-8AM)
T-shot=30iu=60mg=210mg/week
HCG-shot=200iu
Arimidex=Anastrozole=Liquidex-------none, do not use any

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

To make better approximation next time, make sure that you have an input to all variables in my spreadsheet.
Ask for these tests at the same blood draw.
Do blood draw 7-8AM
On the day of the shots, before shots

T_tot (ng/dL)
DHT_tot (ng/dL)
E2_tot (pg/mL)
E1_tot (pg/mL)
Cortisol (ug/dL)
Alb_tot (g/dL)
SHBG_tot (nmol/L)
CBG (mg/dL)

==============================
37 --------- Cortisol Binding Globulin (Transcortin)
38 --------- 8AM/4PM/10PM---Cortisol, Free and Total
43 --------- Estradiol, sensitive 140244 (3-70)
44 --------- Estrone, Serum
45 --------- Total Testosterone
46 --------- SHBG
47 --------- Albumin
48 --------- Dihydrotestosterone
49 --------- 3a-Androstanediol Glucuronide
==============================

.

[seekonk]

Guys, I am strongly questioning whether my T dose is enough. Currently my TT=1120 and shbg=35, which seems high enough, however ...

However, I just can't hold on to mass. I am still 15 lbs below my normal weight, and even though I lift frequently and lately have been eating well, I just can't move that weight upwards. On the contrary, whenever I skip workout days, I lose muscle mass extremely rapidly.

In the first 2 weeks on TRT I did gain 10 lbs, but after that, nothing for the past 12 weeks.

I am an ectomorph, but this is ridiculous, I can't even gain back my normal weight.

[seekonk]

Also, libido has been getting worse and worse. It has been nonexistent the past two weeks. Playing around with adex dosage does not seem to make any difference.

Morning wood is great, but libido is not there and lots of ED when I try.

It wasn't great pre-TRT but at least it was serviceable and mostly no ED.

[JanSz]

Guys, I am strongly questioning whether my T dose is enough. Currently my TT=1120 and shbg=35, which seems high enough, however ...


If you are on testosterone supplementation for extended period of time,
you should not have SHBG=35

You should keep increasing your TT until you see downward move in SHBG.

===========================================

Goal of testosterone supplementation

#1 to get SHBG(15-25)

#2 to get BAT~575 (on test from Quest)
BAT-BioAvailableTestosterone
or
when Quest is not used
FreeT(300-350) on this chart

http://www.andropause.org.uk/nomo_tas.pdf

----------
If SHBG>25
aim at BAT~650
or FreeT~400
high BAT should get SHBG lower
newer use Danazol or Stanozolol (Winny)

if SHBG<15
aim at BAT~350
or
FreeT~250

fixing thyroid, glucose/insulin, helps getting SHBG into better range up or down
---------------

With SHBG=35
and a goal of FreeT=400
you will have to get
TT=1550

Think of daily T-shot=25units=50mg=350mg/week
using
BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b

minimum amount of HCG
HCG-shot=150iu E4D
increase that amount only if you see overly thight scrotum
.
.
Note, this is a hight T dose, you should expect your SHBG to start moving down.
As it does, you will have to monitor it rather often.
You do not want to overshoot the mark.
When SHBG reaches around 20, you will have to lighten up on T.

..

[seekonk]

Once SHBG has been lowered, will it then stay lower even if I reduce the T dose?

[chilln]

Once SHBG has been lowered, will it then stay lower even if I reduce the T dose?


Only if your thryoid hormone T3 optimizes, and your E2 optimizes, and your insulin sensitivity optimizes.

Don't assume this will happen.

It takes a lot of hormone tweaking to get your thyroid hormone T3 optimized, and your E2 optimized, and your insulin sensitivity optimized.

.

[seekonk]

Only if your thryoid hormone T3 optimizes, and your E2 optimizes, and your insulin sensitivity optimizes.


I know low SHBG = low insulin sensitivity.

So could high SHBG = too high insulin sensitivity?

[Wise Guy]

I know low SHBG = low insulin sensitivity.

So could high SHBG = too high insulin sensitivity?

I don't think so, because young people who have very, very sensitive cells to insulin obviously don't have high SHBG.

I think the body often elevates SHBG when it is lower on T, in an effort to preserve the testosterone.

[seekonk]

I think I am going to have to try something else.

Sexual function and libido has only deteriorated on Testosterone, from okay before TRT, to bad, to almost nonexistent. Muscle aches and pains, and back pain, may have improved just a little, if at all. It is hard to tell. SHBG has stayed high.

I thought I'd give it a three month trial run to get things like libido sorted out. It has been 4 months and I have tried various different arimidex dosing schemes without success.

I think it is time to try a restart. Hopefully I'll regain at least the libido I had before TRT.

Once that has been accomplished, I may consider controlling SHBG and E2 (and increasing free T) with arimidex or aromasin only as monotherapy.

[chilln]

I think I am going to have to try something else.

Sexual function and libido has only deteriorated on Testosterone, from okay before TRT, to bad, to almost nonexistent. Muscle aches and pains, and back pain, may have improved just a little, if at all. It is hard to tell. SHBG has stayed high.

I thought I'd give it a three month trial run to get things like libido sorted out. It has been 4 months and I have tried various different arimidex dosing schemes without success.

I think it is time to try a restart. Hopefully I'll regain at least the libido I had before TRT.

Once that has been accomplished, I may consider controlling SHBG and E2 (and increasing free T) with arimidex or aromasin only as monotherapy.


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But there's still a day to donate. Please donate. We need to keep this place operational.

Thanks.

[seekonk]

If you are on testosterone supplementation for extended period of time,
you should not have SHBG=35

You should keep increasing your TT until you see downward move in SHBG.

With SHBG=35
and a goal of FreeT=400
you will have to get
TT=1550

Think of daily T-shot=25units=50mg=350mg/week
using
BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b

Note, this is a hight T dose, you should expect your SHBG to start moving down.
As it does, you will have to monitor it rather often.
You do not want to overshoot the mark.
When SHBG reaches around 20, you will have to lighten up on T.


Jansz, I followed your advice and have been injecting 350 mg T per week for about three weeks now.

I also added 2mg finasteride per week. I never had problems when I was on it for 10 years, so I just thought let's try and see how it goes. I am tired of losing hair.

Finally, my libido is good!! And it keeps improving. I've been having the urge at least once a day, and some days even twice. :party:

How often to monitor SHBG?

[JanSz]

Jansz, I followed your advice and have been injecting 350 mg T per week for about three weeks now.

I also added 2mg finasteride per week. I never had problems when I was on it for 10 years, so I just thought let's try and see how it goes. I am tired of losing hair.

Finally, my libido is good!! And it keeps improving. I've been having the urge at least once a day, and some days even twice. :party:

How often to monitor SHBG?

Good for you.
I take good news any day.

You figure it out how often to test, make first test within 5 weeks, then see where you are make next guess
if $$ is a problem, skip TT & Albumin and test just SHBG
make sure that you do not go below SHBG=15

I am thinking of not testing testosterone.
I have it figured out already and it is steady.
But my TT~1150
always make my doctor nervous.

In your case, on 350mg/week, your doctor will go wild.
Unless this is his project, then you have a jewel for a doc.

Just go by SHBG, when it gets there, reduce test dose.

I you sure that you need finasteride?
On injections??

Hopefully you are dosing it carefully so your DHT stays closer to high range.
I am looking at my 5y old Proscar pills, they are 5mg
How are you dosing them so you came to 2mg/week??

You must be careful about E2.

Where is your iron, at least check Hg, if Hg>17, cut down testosterone, do better check around testosterone and iron indicators, have phlebotomy

Hopefully you are doing your shots EOD or ED.
.
------------- ED-weekly ------- EOD-weekly
units --------- average -------- average
10 ------------- 140 ------------- 70
11 ------------- 154 ------------- 77
12 ------------- 168 ------------- 84
13 ------------- 182 ------------- 91
14 ------------- 196 ------------- 98
15 ------------- 210 ------------- 105
16 ------------- 224 ------------- 112
17 ------------- 238 ------------- 119
18 ------------- 252 ------------- 126
19 ------------- 266 ------------- 133
20 ------------- 280 ------------- 140
21 ------------- 294 ------------- 147
22 ------------- 308 ------------- 154
23 ------------- 322 ------------- 161
24 ------------- 336 ------------- 168
25 ------------- 350 ------------- 175
26 ------------- 364 ------------- 182
27 ------------- 378 ------------- 189
28 ------------- 392 ------------- 196
29 ------------- 406 ------------- 203
30 ------------- 420 ------------- 210
31 ------------- 434 ------------- 217
32 ------------- 448 ------------- 224
33 ------------- 462 ------------- 231
34 ------------- 476 ------------- 238
35 ------------- 490 ------------- 245
36 ------------- 504 ------------- 252
37 ------------- 518 ------------- 259
38 ------------- 532 ------------- 266
39 ------------- 546 ------------- 273
40 ------------- 560 ------------- 280

================================================== =======
Now, please help me solve my urinary urgencies and high pulse.

...

[mmg44]

Jansz, I followed your advice and have been injecting 350 mg T per week for about three weeks now.

I also added 2mg finasteride per week. I never had problems when I was on it for 10 years, so I just thought let's try and see how it goes. I am tired of losing hair.

Finally, my libido is good!! And it keeps improving. I've been having the urge at least once a day, and some days even twice. :party:

How often to monitor SHBG?

350 T per week. Wow. My SHBG is exactly the same as yours.. How often are you dosing/splitting your shots? Eod, 3times per week? Thanks.

[seekonk]

350 T per week. Wow. My SHBG is exactly the same as yours.. How often are you dosing/splitting your shots? Eod, 3times per week? Thanks.

This is only temporary until SHBG comes down a little. I inject twice a week using 31g insulin needle but IM not SQ.