I just thought I would post a follow up on my yearly checkup with my local Uro. The short answer: he is happy, no changes at all. And ... I'm good to go for another year. Your mileage may vary ...
The goal: present the local doc(s) with nice clean blood work so that they do not mess with anything or otherwise conduct an investigation into my TRT. My local Uro sends my blood test results to my regular doc. If either doc sees an issue, they start asking questions, order more tests and try to "fix" the problem. This is what we want to prevent. No good can come from either doc messing with my TRT protocol. If I do my job right, they should never see any problems. I'm not trying to fake anything here. I'm just trying to keep my ducks in a row.
I typically run 100mg 2x per week and 0.5AI Eod (no HCG). The basic issues with this large of a dose are: 1) T levels are too high for the local docs; 2) Hemoglobin/Hematocrit can get too high - blood gets thick very fast; and 3) liver can get a bit stressed - perhaps from heavy protein intake, too much exercise or TRT in general (who knows).
My local Uro checks Hemoglobin, Hematocrit, PSA levels and does a prostate exam, liver function, T levels (Free and Total). My Uro is looking for T levels in the 400-800 range (from his perspective 600 is pretty much perfect) and Hemo 15 or under. I'm sure my local doc is looking for the same basic levels. These are all good things to check. I also want all these numbers to be good (particularly at checkup time). Of course, running 100mg 2x per week means I have to adjust the timing of my blood test and stay on top of the Hemo levels.
Here are the results from the blood test two weeks ago:
Test Total: ~600 ng/dl (250-1100 ng/dl)
Test Free: ~100 pg/ml (35-155 pg/ml)
Hemoglobin: 14.2 (13.2 - 17.1 g/dl)
Hematocrit: 43 (38.5 - 50%)
All other numbers were nicely in the normal range - liver panel, CBC, Prolactin. BP was 130 over 70. Pretty much everything is on-track.
T levels
I know from my own blood work that if I pin 100mg and wait exactly 8 days, my T levels will be about 700 (2013 - T level for local Uro was ~680). I started adjusting the T levels 1 month early and dropped the dose to 80mg 2x per week in an effort to hit that 600 number. After being on this dose for a month, I am ready for my yearly blood test. Basically, I skip one injection and wait one extra day - then do blood work. I pin on Thursday, skip my Monday injection and then do my blood work on Friday morning. Net result, the T levels were pretty much exactly 600 this year - bingo!
Hemo
My Hemo was ~17 about 6 weeks before my yearly blood test. This is not a good thing from a timing standpoint. I had planned to donate right before my blood test, but could not risk waiting another month. Basically, I screwed up and forgot to donate a month earlier.
Trust me on this, if your Uro and/or your regular doctor sees your Hemo is 17+ you are in trouble (plus it's bad for your health). My Uro sends all his blood test results to my regular doc. So they would have to take steps to fix the problem. You can't blame them, they would just be doing their job. You may be able to talk your way out of it (twice actually - once with your Uro and then again with your regular doc) but they may just try to cut your dose or otherwise mess with the protocol. You just don't want to go there.
So I did what I had to do. I ended up donating twice within 6 weeks. The last donation was 10 days before my blood test. And the Hemo came in at 14.2 - bingo! This is what the docs want to see, and all is right with the world.
I know this is not in strict accordance with the 56 day rule. But a single donation was not going to get this done. I would have come in around 16 with just a single donation. That would have been a tad high and the docs would start asking questions. A double red donation with Hemo at 17+ is probably a no go as well (machine does not work well with thick blood). So two single donations about 5 weeks apart were needed to get the job done. This first donation knocked the levels down to about 15+ which rises to about 16 within a month. The second donation drops the levels to 14+, just in time for the blood work. Donation every 2 months keeps the levels between 14.5 and 16.5.
I don't recommend two donations this quickly, but when you are on TRT you are making a ton of red blood cells. I doubt the 56 day rule was written with TRT in mind. Normal folks don't make red blood cells at the same rate. If I had just donated on schedule, this would not have been needed.
There actually was one blood value that that was a little off. Red blood cell distribution width (RDW) is a measure of red blood cell size variation. My RDW was just a little over 15 and the reference range is 11-15%. My Uro never even mentioned it. It could have something to do with donating blood fairly often, perhaps some extra "new" or smaller red blood cells in the mix pushed the percentage a bit higher. High RDW can also be an indication of iron deficiency anemia. With all the blood donations, the iron stores probably do take a hit. Not sure, but this is all the more reason to stay on top of donations and not violate the 56 day rule.
Liver values
All the liver values were dead solid perfect this year. I take 600mg NAC twice a day. I also try to stay well hydrated. This seems to do the trick. I did have some elevated levels of Alkaline Phosphatase. This happened on several occasions, I'm not sure why. I also had some slightly elevated AST and ALT on occasion (I saw all this on my own blood work). Once I saw this, I started taking NAC. The levels have been perfect ever since.
Next blood test for the local docs in one year - end of 2015. Of course, I will run my own blood work when needed just to keep everything in check.
The goal: present the local doc(s) with nice clean blood work so that they do not mess with anything or otherwise conduct an investigation into my TRT. My local Uro sends my blood test results to my regular doc. If either doc sees an issue, they start asking questions, order more tests and try to "fix" the problem. This is what we want to prevent. No good can come from either doc messing with my TRT protocol. If I do my job right, they should never see any problems. I'm not trying to fake anything here. I'm just trying to keep my ducks in a row.
I typically run 100mg 2x per week and 0.5AI Eod (no HCG). The basic issues with this large of a dose are: 1) T levels are too high for the local docs; 2) Hemoglobin/Hematocrit can get too high - blood gets thick very fast; and 3) liver can get a bit stressed - perhaps from heavy protein intake, too much exercise or TRT in general (who knows).
My local Uro checks Hemoglobin, Hematocrit, PSA levels and does a prostate exam, liver function, T levels (Free and Total). My Uro is looking for T levels in the 400-800 range (from his perspective 600 is pretty much perfect) and Hemo 15 or under. I'm sure my local doc is looking for the same basic levels. These are all good things to check. I also want all these numbers to be good (particularly at checkup time). Of course, running 100mg 2x per week means I have to adjust the timing of my blood test and stay on top of the Hemo levels.
Here are the results from the blood test two weeks ago:
Test Total: ~600 ng/dl (250-1100 ng/dl)
Test Free: ~100 pg/ml (35-155 pg/ml)
Hemoglobin: 14.2 (13.2 - 17.1 g/dl)
Hematocrit: 43 (38.5 - 50%)
All other numbers were nicely in the normal range - liver panel, CBC, Prolactin. BP was 130 over 70. Pretty much everything is on-track.
T levels
I know from my own blood work that if I pin 100mg and wait exactly 8 days, my T levels will be about 700 (2013 - T level for local Uro was ~680). I started adjusting the T levels 1 month early and dropped the dose to 80mg 2x per week in an effort to hit that 600 number. After being on this dose for a month, I am ready for my yearly blood test. Basically, I skip one injection and wait one extra day - then do blood work. I pin on Thursday, skip my Monday injection and then do my blood work on Friday morning. Net result, the T levels were pretty much exactly 600 this year - bingo!
Hemo
My Hemo was ~17 about 6 weeks before my yearly blood test. This is not a good thing from a timing standpoint. I had planned to donate right before my blood test, but could not risk waiting another month. Basically, I screwed up and forgot to donate a month earlier.
Trust me on this, if your Uro and/or your regular doctor sees your Hemo is 17+ you are in trouble (plus it's bad for your health). My Uro sends all his blood test results to my regular doc. So they would have to take steps to fix the problem. You can't blame them, they would just be doing their job. You may be able to talk your way out of it (twice actually - once with your Uro and then again with your regular doc) but they may just try to cut your dose or otherwise mess with the protocol. You just don't want to go there.
So I did what I had to do. I ended up donating twice within 6 weeks. The last donation was 10 days before my blood test. And the Hemo came in at 14.2 - bingo! This is what the docs want to see, and all is right with the world.
I know this is not in strict accordance with the 56 day rule. But a single donation was not going to get this done. I would have come in around 16 with just a single donation. That would have been a tad high and the docs would start asking questions. A double red donation with Hemo at 17+ is probably a no go as well (machine does not work well with thick blood). So two single donations about 5 weeks apart were needed to get the job done. This first donation knocked the levels down to about 15+ which rises to about 16 within a month. The second donation drops the levels to 14+, just in time for the blood work. Donation every 2 months keeps the levels between 14.5 and 16.5.
I don't recommend two donations this quickly, but when you are on TRT you are making a ton of red blood cells. I doubt the 56 day rule was written with TRT in mind. Normal folks don't make red blood cells at the same rate. If I had just donated on schedule, this would not have been needed.
There actually was one blood value that that was a little off. Red blood cell distribution width (RDW) is a measure of red blood cell size variation. My RDW was just a little over 15 and the reference range is 11-15%. My Uro never even mentioned it. It could have something to do with donating blood fairly often, perhaps some extra "new" or smaller red blood cells in the mix pushed the percentage a bit higher. High RDW can also be an indication of iron deficiency anemia. With all the blood donations, the iron stores probably do take a hit. Not sure, but this is all the more reason to stay on top of donations and not violate the 56 day rule.
Liver values
All the liver values were dead solid perfect this year. I take 600mg NAC twice a day. I also try to stay well hydrated. This seems to do the trick. I did have some elevated levels of Alkaline Phosphatase. This happened on several occasions, I'm not sure why. I also had some slightly elevated AST and ALT on occasion (I saw all this on my own blood work). Once I saw this, I started taking NAC. The levels have been perfect ever since.
Next blood test for the local docs in one year - end of 2015. Of course, I will run my own blood work when needed just to keep everything in check.
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