Blood work, can someone take a look at it please

[dova]

Good morning,

I'm now in my second month of TRT. I take 175MG sustanon/week.
Here is my blood work. Can someone take a look at it please.
I started TRT for Generalized Anxiety Disorder and a low libido.
I feel good in my head, but the libido is not what i expected of it. It works when it's needed but that's all
Because my E2 = 36 i started arimidex at 0,25 EOD.
Full blood work in attachment.
RBC = 5240000 (4500000 - 6000000)
Hematocrit = 46,9 (40-54)
WBC = 4900 (4000 - 9000)
Creatinine = 1,02 (0,47 - 1,38)
Free T4 = 13,3 (12 - 22)
TSH = 1,89 (0,27 - 4,20)
T3 = not available because T4 and TSH are in range
Cortisol = 10,3 (5 - 23)
Prolactine = 7,18 (4,04 - 15,20)
E2 = 36,4 (7,6 - 42,6)
Testosterone = 813 (200 - 700)
Free testosterone = 26,7 (4 - 15)
DHT = 109 (25 - 99)
SHBG = 0,4 (0,5 - 1,5)
DHEA = 145 (120 - 380)

Thanks for your time

[BoneDaddy]

From my untrained eye, your numbers look good to me. Where's the Vitamen D panel? A lot of people overlook vitamin D and a deficiency can cause a lack of libido. Jel would be able to help you far more than I, I'm sure he will pop in soon.

[ironjulius]

what else are you taking? age? im on trt and had the same problems not so much low libido that i knew of at the time but after my first couple shots libido increased a lot and you might want to ask about doing test cypionate or enanthate 150mg a week

[dova]

No vitamin D panel, but i take it as a supplement 5 days out of 7 at 5000iu/day

So, i am 38 years old.
Cyp or enanthate are not available here, only sustanon.
What do i take,
Medications :
sustanon 175mg/week
since last week arimidex 0,25 eod, because E2 = 36
omeprazol 40mg/day (stomach)
resolor (prucalopride) 1mg/day (stomach)
seroquel (quetiapine) 200mg/day before bed
Supplements :
animal pak 5 days out of 7 (morning)
vit D 5000iu 5 days out of 7 (morning)
GABA, 2 in the morning, 2 in the afternoon, 3 before bed
omega-3, 2 in the morning, 2 before bed (5 days out of 7)
animal Pm, before bed
digestive enzymes, 1 after each meal
liver tablets, 2 after each meal.

When i started trt, we begin at 125mg/week of sustanon, with no results
then we did a kickstart with 250mg sustanon, that was great. The libido was fenomenal.
We did bloodwork and test was at 1500 (way too high) and E2 was 30.
Because test was too high we dropped sustanon to 175mg/week and the results of my blood work are in my first post above. Libido started to decrease. I mean, i'ts difficult to find the drive. There is wood, but not as hard as it should be. Maybe because of higher E2 and lower SHBG?? But the arimidex does not help me for the moment.
The problem here is, that doctors don't know anything about trt. Even endo's don't know anything about it.
The doctor will help me with te medications, but i have to figure it out all by my self.

Thanks for helping me!

[weekend]

Drop seroquel and omeprazole. Both are terrible for libido. Perhaps try to get aromasin instead of anastrozole.

[ironjulius]

Yea i agree with weekend wing urself off the psych meds see if that helps. I did and feel great on just trt. Im at work but maybe tonight i can see if anything else comes to mind. Glad to see you researching. Have you tried viagra or cialis?

[ironjulius]

Can you pin yourself? Try sustanon 2x aweek at 100mg that will keep t levels level

[Jelisej]

You did not mention your injection frequency- it should be 2X or 3X a week, 3X week is best
You did not say if you are primary or secondary? It looks like you are secondary? If your secondary than you should use HCG, 250 IU 3X a week- unless you are primary- HCG would have a number of benefits, as it stimulate adrenals as well as thyroid- and you are lacking in both areas, also if starting HCG it would be wise to add some pregnenolone, preferably transdermal- later on you should start monitor progesterone levels

your ferritin levels are on low side- ferritin is basically storage of iron and is better figure than iron itself to see "iron situation"; question is if you are vegetarian or this is side effect of stomach problems/medication- in any case with low ferritin (and vit b) thyroid cannot function properly, this needs to be addressed

back to hormones- you aromatise a lot because low SHBG, and thats one of reasons why despite high-er dosage you test is in mid range (with that amount you should be in upper range)
your SHBG is low because your thyroid hormones are low plus steroid hormones also lower SHBG- answer is to boost your thyroid- HCG should do that to some extent, but its likely that you may need some thyroid maybe even some adrenal support.

It does take time to tune things a bit.... And lot of bloodworks. Another thing is- it would be wise to monitor your body temperature- first thing at morning, than few times during a day for a few weeks- that will give us a good idea how your thyroid and adrenal glands are functioning- if thyroid levels are not sufficient temp will be lower, and if adrenals are struggling blood temperature will be erratic.
Also heart rate will give some clues.

[dova]

These are some answers to think about.
It's not possible to drop omeprazole. I have had an operation on my stomach 10 years ago. It was an operation for the backflow of acid from the stomach.
I still need the medication, otherwise i still have big problems from the backflow. (sorry, i can't find a descend translation for my problem, Dutch-Englisch).
Seroquel, i still keep in. I allready dropped 3 other psych meds. (cymbalta (ssri), rilatine, dipiperon(pipamperon)).

I pin allready 2 times a week (2 x 87,5mg).

If i'm primary or secondary? I don't know. I know my test levels allways are in the 400's.
We started trt because the psych meds are not working good for me. I read that trt could solve some psych problems. That's why the doctor want to give it a try.
I'm not a vegetarian. I eat lots of protein from eggs, beaf, fisch, cheese, whey, soy milk (i don't digest lactose). My carbs are from brown rice, brown pasta, brown bread. I don't eat vegtables. I cannot eat more than 300gr in one meal(6 times a day), due to my stomach problems. So, with my proteins and carbs, it's 300gr. No room for vegetables if i want my calories high enough to maintain muscle mass.

I aromatise a lot, that's what i taught and why i added the anastrazole at 0.25mg eod. If i start the hcg, will i not aromatise more? Should i drop the anastrazole, or keep it in? Or should i use mesterolone or nolva?
I start monitoring my body temperature and post it here.

I give you another story, so maybe you can see more of my problems.
I did a cycle of testosterone at the end of 2010. It was 500mg/week. I felt great, but after a couple of weeks i completely crashed. (to much aromatisation?). So, i quit everything. Damn, after months, i still was not recovered. I really was depressed, suicidal, lack of libido. I went to an endo. he kicked my out, i don't want to help you! The second endo did bloodwork. My test was around 330. Ok, you are in range, everything is fine. It's all in your head. 1 year later he did bloodwork again. these where my values.
RBC : 4000000 (4500000 - 6000000)
WBC : 3800 (4000 - 9000)
hematocrit : 36 (40 - 54)
TSH : 1,83 ( 0,27 - 4,20)
Free T4 : 15,4 (12 - 22)
LH : 10,3 (1,7 - 8,6)
FSH : 6,7 (1,5 - 12,4)
Prolactine : 5,07 (4,04 - 15,20)
Growth Hormone : 0,33 (<0,8)
Cortisol : 7,6 (5 - 23)
DHEA : 107 (120 - 380)
Testosterone : 238,4 (200 - 700)
The answer from the endo : Everything is fine, maybe you have had some virus!!

[Jelisej]

The answer from your endo: "Everything is fine" could not be further from the truth, as nothing is fine-
the reason why you crashed on 500 mg testosterone, is because your body could not handle higher test. levels- basically when you topped your levels up- the demand for cortisol and thyroid hormones was higher but your body did not produce enough so you became depleted and you crashed- similar thing is happening at the moment- only bit slower.
As for "psych" problems- lot of it will be solved once you tune your hormones which will then improve neurotransmitters which will improve your mood.

One thing that bugs me; is it possible on top of your problems you're also losing blood somewhere? maybe bleeding in your stomach or/and somewhere else?
Stop taking soy milk- soy is not good. Can you eat goats milk- its much easier on stomach. I like to eat bacon- maybe it would work for you as well, it has lot of calories in 300 grams.
I beleive your digestion will improve somewhat once you tune thyroid hormones a bit.

Secondary or primary is the question, it looks like you are both- it seems that your pituary is not sending signals to adrenals to produce more adrenal hormones (your cortisol is low to the point that you're reduced to bare existence ), on other hand TSH is ok but thyroid is not producing enough, and pituary seems to be capable of raising LH but testicles dont use it efficiently- I'm bit confused to be honest... LH does come in peaks so maybe your blood was drawng during one of those episodes?

Try to add 3 X 250 IU HCG ,mon-wed-fri ( you will aromatise more with HCG so you'll need to increase AI a bit)- we dont know if that will work for you, if testicles dont work than it wont have much effect.
Also I would suggest you to decrease your testosterone dosage, try injecting 3X 40 mg for time being before or after HCG, (or alternatively you can go with 2X 60 mg)

Start taking pregnenolone, 50 mg few times a day, preferably transdermal- that should help adrenals a bit but it may help with "psych" problems- most of these problems probably stem from insufficient adrenal hormones

at some point you may try adding DHEA as well


After you try new routine, you'll have to do blood tests again after few weeks, than you may need add some thyroid hormones and maybe some more adrenal support.
Also at some point in future we may try with peptides (GHRP-s).
Also, can you get hold of aromasine/exemestane, I found its easier to control E2 than with arimidex.