One month on TRT. Got bloodwork. What the heck is going on here?

To summarize my post history: 27 year old male, 5' 11" 200 lbs, I have been experimenting with ways fix the following problems:
• Fatigue, lack of motivation, depression, social anxiety
• Puffy nipples/gynecomastia

There's also male pattern balding and belly fat gain, but those have been less important/worrisome to me than the issues above.

And I have had bloodwork that shows I have problems with:
• high prolactin
• high cortisol
• low testosterone
• sub-clincal hypothyroid (slightly high TSH with normal T3 & T4)

After previous experiments with DHT gel and Aromatase Inhibitors, a major revelation for me was how much better I felt (more energy/motivation, way less depression & social anxiety) with higher testosterone. So I decide to try testosterone replacement therapy via intra-muscular Testosterone Enanthate injections.

Before these latest lab results, I had been self-medicating with the following:
• 1 grain thyroid ED
• 1 Month of TRT: 125mg E5D (175mg/week)
• 10 Days of 2.5mg Letrozole ED

Here are my bloodwork results:



Here are my big questions/concerns:

High cholesterol.

I had a hunch I would have this considering it fits the profile of a balding male, as so often explained by Danny Roddy. I had not had this tested before, but I assume it was probably high before too. I'm not sure if my temporarily supernormal testosterone made it worse or not.

Haidut made a post about cholesterol that cited a study that said:

[highlight=#ffffff]"We proposed that, since cholesterol is responsible for the production of the steroid hormones, the human physiology is designed to increase the production of cholesterol to balance or attempt to reverse declining hormones. As a result, the cholesterol level rises in a way negative feedback loops work to compensate for the low steroid hormones. Unfortunately, in the aging body the enzymatic system is less efficient and, therefore, these hormones never quite reach the “normal” youthful level. This is how we arrive at the picture of hypercholesterolemia and steroidopenia. Cholesterol elevation should, therefore, be seen as a marker for steroid hormone deficiency."[/highlight]

So mainstream medicine might put me on statins, but I think I will pursue a strategy more in tune with the hormone therapy this study used, which sounds a lot like what Peat describes and includes supplementation of pregnenolone and DHEA.

Though, I'm guessing that low pregnenolone, low DHEA, low Testosterone, high Estrogen are all inter-related here. But now I know for sure it's not for lack of cholesterol (the cholesterol being high to promote steroid synthesis according to the aforementioned theory), but other factors limiting steroid synthesis.

High Red Blood Cell (RBC) and Hematocrit

Tests showed RBC 5.89 and Hematocrit 51.6% — both slightly high. I'm aware this is a known side-effect of testosterone use. I was not intending to have supra-physioloical testosterone. I was just aiming for normal or high-normal. So I will at least be lowering the dose and spacing it out a little more. I may even stop injecting T... more on that later.

The labs said my Testosterone was >1,500 so I don't even know how much higher than 1,500 it was. I had read that a good estimate of your Testosterone levels when on TRT would be 5-7x your weekly dose, so I was assuming I'd have something between 175 x 5 = 875 and 175 x 7 = 1225. But apparently it was higher than that.

This plus the fact that I had LH of 21 and FSH of 10 (and the observation of no testicle shrinkage) makes me think I'm actually producing my own testosterone in addition to the injected Test. But that's not supposed to happen...

I'm using exogenous Testosterone. My LH and FSH should be shut down. Instead my LH is super high! What the hell?

I'm guessing that this must have something to do with taking Letrozole, which has brought my estrogen down to a 6. I started with 2.5mg/day even though I knew Letro to be a strong because A) I assumed I was a "high aromatizer" which I still think is true and B) I had no negative symptoms of low estrogen — no dry joints, no erectile dysfunction.

I got blood work a month ago, this was before any TRT. I was on 25mg of exemestane (Xtane/Aromasin) every day. That alone raised my test to 537 and my LH to 17.6 with an Estradiol level of 25.

So it's as if my estrogen level is the most powerful signal in the negative feedback loop and without a high or normal estrogen level, my hypothalamus is not getting the signal to lower GnRH.

UDPATE: So I did some research and I've actually found some studies in men taking letrozole that it does indeed raise LH along with raising Test and lowering Estradiol. This study of obese males given 2.5mg/week of Letro for 6 weeks had a 2.5x rise in LH and a 3.3x rise in Test and a 53% reduction in E2.

There's also this one which says:

[highlight=#FFFFFF]"It is well known from experimental evidence and from clinical observations that estradiol has powerful effects on gonadotropin release in men. Modulation of plasma estradiol levels within the male physiological range is associated with strong effects on plasma levels of LH through an effect at the level of the pituitary gland [32]. Lowering estradiol levels, by administering an aromatase inhibitor, is associated with an increase in levels of LH, follicle-stimulating hormone (FSH) and testosterone [28,29]. Aromatase inhibitors, therefore, have been suggested as a tool to increase testosterone levels in men with low testosterone levels."[/highlight]

Should I keep doing TRT, or switch to AI's only, or something else entirely?

I might just stop the injections and switch back to using AI's. Letrozole seems to be super effective. Also, T injections are a pain the **** – no pun intended – dealing with needles and soreness and the demands of proper and hygienic technique. Much easier to take a pill. Also the T injections might still cause high RBC even if I lower the dose to normal ranges. But I don't even know what that dose should be on top of my endogenous production.

Also, the problem that people have coming off T happens because endogenous production has been shut down — which for me, thanks to Letro, is not the case. I would like to find out what my levels are like on just 2.5mg EOD of Letro and no Testosterone injections. So yeah, much to think about ...

My Questions

• Should I do anything about my high RBC and hematocrit besides lowering my Test to physiological levels?
• What should I do about my high cholesterol and triglycerides?
• Why are my LH and FSH high even while on TRT? UPDATE: The answer is letrozole.

Did TRT increase you hair loss ?
A TT of 500+ isn't to bad... its basically normal

You could try clomid as TRT, its cheap and very effective for some men

http://jeffreydachmd.com/clomid-for-low ... -part-one/

slayers said:

Did TRT increase you hair loss ?

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If anything changed, I did not notice it.

slayers said:

A TT of 500+ isn't to bad... its basically normal

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Doing nothing, my TT is in the low 300s. When I was on 12.5mg exemestane ED it was 537. When I was on 2.5mg Letrozole ED + 175mg TestE per week it was 1,500+.

I didn't really notice a difference between 537 and 1,500+ but there is a big difference between 300 and 500.

slayers said:

You could try clomid as TRT

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Perhaps, but I like the idea of AI's more than SERM's. Both exemestane and letrozole seem to work for TRT for me.

letro is a suicide inhibitor, its not a joke. stop that one.. you probably got a big spike in test from the Combo of test and the AI, you kick that estro out and a rise happens.
the Ai and serms do this. don't drop test and do only AI, toxic and a world of hurt will enter your world.
if you repay are only using that much test as you say and you have those levels then back down the AI and watch test levels go down too. if you stop test, you will crash and the estro will rise fast and manboob may visit.
You may be better going on another forum and getting someone with lots of experience with Test and ancillaries to look at you bloodwork. Bodybuilders read this differently than and endo Dr.
when you come off test you will need a good exit plan for pct. good luck.

Onehumin said:

https://raypeatforum.com/forums/posts/94510/ don't drop test and do only AI, toxic and a world of hurt will enter your world... if you stop test, you will crash and the estro will rise fast and manboob may visit.

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Welp, that's exactly what I did. Don't be offended — I didn't even see your post.

I stop T injections & continued with Letro 2.5mg/ED. I did not notice any loss of energy/motivation/confidence.

But about 2 weeks in I started getting an ache in my jaw on one side. I hypothesized that that was a sign my estrogen was super low, and my body was de-calcifying — having read that one of the dangers of low Estro is osteoporosis.

But that's the only negative side effect I ever got from 2.5mg Letro ED. I never had dry or painful joints. I never lost the ability to get an erection. And I actually felt good psychologically — which seems to correlate with my Test levels more than it does with my Estro.

So I switched to 2.5mg Letro EOD. But after a couple days of that I experienced what I believe was a "Letro rebound". I already have the beginnings of gynecomastia — that's one of the main things I'm trying to reverse — so I could feel more nipple sensitivity and a more bloated look in the nipple area.

So I got back on 2.5mg Letro ED and recently I have started tapering off Letro and onto Aromasin, with Nolva and Clomid available if needed as well.

The AI as TRT approach seems to be working for me in terms of T levels because I think the main reason for my Low T is high aromatization.

I am concerned about the toxicity of sticking with AI's long term. But the problem is that even if I do T injections I think I'll need to constantly run AI's with it to keep estrogen normal and prevent further gyno development.

And then the T and AI's combine to raise my T higher than necessary — just like my bloodwork showed.

My plan for the future is to just get regular bloodwork and try to get a consistent AI dose all dialed in.

I would personally see a qualified doctor who's able to treat you with hormones instead of self medicating which is dangerous.

Bromocriptine 2.5mg ED for 2 months did wonders for my prolactin.
If you have high aromatase, the test will convert to estrogen and cause other imbalances. :2cents

Usually high cortisol and high prostaglandins cause high aromatase. AI are notorious as they effect pituitary signaling. Try aspirin, sugar and vitamin K2 instead.

Sele did you have any side effects on Bromocriptine? how did you start it did you slowly ramp up and ramp down. I have been considering trying it but have read of some bad experiences.

Fetch said:

Sele did you have any side effects on Bromocriptine? how did you start it did you slowly ramp up and ramp down. I have been considering trying it but have read of some bad experiences.

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I had stuffy nose and minor headache for the first week. I started with 1/4 of 2.5mg tablet. Increased it every 3 days. Tapered down on the last week before quitting. Drinking some coffee helps with the headache. I think drugs should be used as a crutch for a short term if needed.

Latest update: viewtopic.php?f=15&t=6584&p=106012#p106012

+1 on the clomiphene. I use 25mg per day. It perks me right up. My sleep gets better, my libido gets better, my mood gets better. TRT doesn't get any more convenient.

I remember a case study of a 30year old ex-bodybuilder with secondary hypogonadism restoring his testicular function after 100mg of clomiphene daily for 3 months. Follow up 6 months later confirmed it was a permanent recovery. Drastic measure, but I really place a lot of faith in clomiphene.

mujuro said:

+1 on the clomiphene. I use 25mg per day. It perks me right up. My sleep gets better, my libido gets better, my mood gets better. TRT doesn't get any more convenient.

I remember a case study of a 30year old ex-bodybuilder with secondary hypogonadism restoring his testicular function after 100mg of clomiphene daily for 3 months. Follow up 6 months later confirmed it was a permanent recovery. Drastic measure, but I really place a lot of faith in clomiphene.

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In a different thread Haidut said about Clomid:

Why are you taking clomid or tamoxifen? Do you know how estrogenic they are? Peat's website has articles on both. They are both synthetic estrogens with slightly modified function to make them somewhat anti-estrogenic in specific tissues but overall they are still synthetic estrogens. Clomid is highly estrogenic to brain and bones, do not get fooled by studies showing it can increase T. People with MS, a brain condition from high estrogen, have died from taking clomid. Both clomid and tamofixen will fry your liver, as they are both estrogens. Exemestane is probably OK, but not until you figure the issue with prolactin.

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I could not find an article on raypeat.com about clomiphene but I did find this snippet about tamoxifen:

Tamoxifen, an "anti-estrogen," competes with ordinary estrogens for binding sites on the "estrogen receptor" (though it has other actions), and its value in protecting breast tissue against estrogen's effects is recognized. However, it causes uterine cancer, and is also toxic to the liver and other tissues.

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Source: http://raypeat.com/articles/articles/pd ... xplain.pdf

Anyway, I don't take clomifene or tamoxifen anymore, and I have only been using exemestane.

I understand the dilemma. Haidut is right in his warning, but I am only relaying experiences from the bodybuilding world, where guys consistently bring onto themselves secondary hypogonadism, sometimes primary, and clomiphene plus HCG seems to be the best hope. There is no telling how much significance these individuals place on thyroid status, pregnanes and progesterone... probably nil for all of them, so I can't assert with surety that clomiphene and HCG is necessarily the best hope for all cases.

This actually reminds me of a phone call I got yesterday. I have a friend in another state who called to tell me that one of his clients, who'd been using hormones for years and had undetectable FSH and LH, was trying to conceive with his wife. He was referred to an endo who issued him a course (whatever that is) of HCG, which did not improve any of the hormonal parameters, including sperm count. This may sound like a salesman's pitch, but this friend of mine places great faith in holistic and naturopathic treatments. He had him try the products Alpha Mars and Alpha Venus from ATP Science, which work to boost testosterone and increase estrogen elimination, respectively. According to the client, after 3 weeks his wife is pregnant. Fluke? I don't know. He hasn't had any bloods done but he is planning on doing so and is continuing to take the supplements so that we can see how they affected his hormones and if it was any way related. Worth a shot I think.

EDIT - I lift quite heavy 5 times per week, so I am going to give them a try for myself and see how they go.
2nd EDIT - wow. If you go to the ATP Science home page and for each product, view the Technical Data tab. I must say I'm quite impressed that they went to such detail.

I have been on / off clomiphene for 10 years

I would only recommend low dosage of clomid such as 10mg 3x a week or EOD... which would highly reduce any bad sides; a typical dosage prescribed would be 50mg daily.. which is 350mg a week vs 30mg.

I believe they now market the trans-isomer of clomiphene as Androxal. Studies seem to generally favor enclomiphene over the cis-isomer and support it as an estrogen antagonist. A search for zuclomiphene yielded nothing relevant to human males.

This study had this to say about it.
At the time of publication, there were no data of in vitrostudies examining GnRH response to enclomiphene using hypothalamic human cell lines. Studies using cells from animal tissues have demonstrated highly variable responses to enclomiphene, zuclomiphene and clomiphene citrate, leading to the conclusion that there was little reliable information regarding the anticipated effects of human hypothalamic cells in vivo. In a study in immature male rats, enclomiphene suppressed LH and testosterone secretion; paradoxically, in humans, the drug would be expected to enhance levels of these hormones.

I found another study done in chickens and sheep, and the authors said in so many words "if it isn't done in humans why bother? these results don't tell us anything".

Data from the pharmaceutical company making it have demonstrated that in baboons zuclomiphene has no measurable effect on T, while both enclomiphene and clomiphene significantly increased T (1144ng/dl and 559ng/dl respectively, from 170ng/dl baseline). If this is to be believed it seems that the cis-isomer is the bad apple.