Please help interpret lab results.

[Mdrive]

Please help me interpret my lab results.
Age 43
Been on TRT about 15 months
Prescription is TRT 200mg per week and 1 mg the following day of AI.
Weight 189 lbs, 6 ft tall; (8 lb muscle weight gain since starting TRT)
BMI is high-normal, unsure about body fat composition
No smoking, no alcohol
Lifting 4-5 days per week
Diet is relatively clean, medium to high protein intake
Supplements consist of Fish Oil, 2000 mg Vitamin D3, 50 mg Zinc, Multivitamin
Creatine and Whey/Casein protein shakes a few times a week
No previous gear use
No medical problems or medications
Sleep study was performed about 6 months ago – slight apnea but not enough episodes to require CPAP. Sleep quality is not optimal. I wake up frequently throughout the night.
Since starting TRT, my lifestyle changes have been positive. I have more energy, improved nutrition, and I’m in the gym at least 4-5 times per week.
Donated blood 1 time about 6 weeks ago.
Labwork drawn in the afternoon of day 7 since last TRT – to avoid coming in too high.
Please help me interpret my lab results:

Hemoglobin 15.7 (12.6-17.7)
Hematocrit 45.5 (37.5-51.0)
Vitamin D 46.7 (30-100)
Serum Testosterone 1082 (348-1197)
Free Testosterone High @ 27.8 (6.8-21.5)
TSH 1.610 (0.450-4.500)
Free T4 1.31 (0.82-1.77)
Thyroxine 7.8 (4.5-12.0)
Total Protein 7.0 (6.0-8.5)
Bilirubin 0.27 (0.00-0.40)
Ast (Sgot) High @ 44 (0-40)
Alt (Sgpt) High @ 47 (0-44)
Lh Low @ <0.2 (1.7-8.6)
Fsh Low @ <0.2 (1.5-12.4)
Estradiol 28 (3-70)

Any input or advice will be greatly appreciated as my doctor never had the chance to go over the results with me.

 

[Chiefy]

The fact that your total and free testosterone are still so high 7 days after your injection indicates that your dose of testosterone is too high. Those are very high trough values. Have you ever had your peak values measured?

I'd consider lowering your dose of T, and also splitting your dose into injections every 3.5 days to keep levels as stable as possible. You may not even need an AI if you bring the dose down to something more reasonable.

 

[Megatron28]

Everything looks good to me except your liver. You should consider taking NAC. About 1000mg daily.

I would like to see how your kidneys look. Where are your creatinine and eGFR results?

You might want to bump your D3 up to 4000iu daily too.

 

[Mprtz]

Looks pretty good for high-dose TRT. Not sure why your ALT, AST are high with no alcohol or medications. You might consider supplementing with NAC to bring those down.

I'm also surprised that your hct is so stable on 200mg/week. Everything else looks really good.

Are you testing PSA and lipids?

EDIT: mega beat me to it

 

[Alpin]

I doubt you are obese with 189lbs at 6 feet tall.
for day 7 brother.....
personally it's kind of high. Do what feels right to you though.
I'm not preaching or hating....
1mg of adex is a pretty high dose to take all at once.
its half life is 48 hours and after 72 hours estradiol starts to rebound. If i were you i would start splitting up your dose just use 70-80 mg E3D man and do labs on that and see how you feel. 800 mg a month is giving you upper stratosphere peak T levels. ...
lets be reasonable here and try to minimize the sides that will come...

 

[Mdrive]

Everything looks good to me except your liver. You should consider taking NAC. About 1000mg daily.

I would like to see how your kidneys look. Where are your creatinine and eGFR results?

You might want to bump your D3 up to 4000iu daily too.

Kidneys - BUN is 23; Creatinine is 1.19; Egfr is 74; BUN/Creatinine ratio is 19. I will bump up the D3.

 

[Mdrive]

Looks pretty good for high-dose TRT. Not sure why your ALT, AST are high with no alcohol or medications. You might consider supplementing with NAC to bring those down.

I'm also surprised that your hct is so stable on 200mg/week. Everything else looks really good.

Are you testing PSA and lipids?

EDIT: mega beat me to it

Yes. PSA is 1.0. I did not get a lipid panel this time but in the past it has always been within normal limits. I've never had high cholesterol. I donated blood about 6 weeks ago.

 

[Mdrive]

I doubt you are obese with 189lbs at 6 feet tall.
for day 7 brother.....
personally it's kind of high. Do what feels right to you though.
I'm not preaching or hating....
1mg of adex is a pretty high dose to take all at once.
its half life is 48 hours and after 72 hours estradiol starts to rebound. If i were you i would start splitting up your dose just use 70-80 mg E3D man and do labs on that and see how you feel. 800 mg a month is giving you upper stratosphere peak T levels. ...
lets be reasonable here and try to minimize the sides that will come...

Ok. I will consider splitting the dose and do 80mg twice a week. Should I also split the AI and take 1/2 twice a week? No, I'm not obese. BMI is within normal range. Adjusting without getting my doctor involved will help me have some extra Test on hand if needed later.

 

[Mdrive]

The fact that your total and free testosterone are still so high 7 days after your injection indicates that your dose of testosterone is too high. Those are very high trough values. Have you ever had your peak values measured?

I'd consider lowering your dose of T, and also splitting your dose into injections every 3.5 days to keep levels as stable as possible. You may not even need an AI if you bring the dose down to something more reasonable.

I have never had peak values drawn because I figured they would be high and the doctor would try to cut my dose. Was hoping the high levels would help me build more muscle.

 

[Megatron28]

Ok. I will consider splitting the dose and do 80mg twice a week. Should I also split the AI and take 1/2 twice a week? No, I'm not obese. BMI is within normal range. Adjusting without getting my doctor involved will help me have some extra Test on hand if needed later.

If you feel good I wouldn't change anything. Your numbers look good other than liver.

As for getting your peak checked, it would be a good idea next time just to make sure your estradiol and everything else is OK. See my signature line below for how to get your own blood work that your doc won't see.

 

[Alpin]

If you feel fine....
its up to you if you want to change the dosing schedule.
You probably could and maybe try take a QUARTER adex tab day of or after your T shot and do blood labs on that 48 hours from dose.
you are not losing any T amount really if you look at it.
if you do 80 mg E3D it still comes out to 800 mg/month.
200 mg a week still totals to 800 mg/month.
you're just bringing down your estradiol level and using more stable doses to avoid those high peaks.
looks like you got the sensitive assay for estradiol as well.
I'd be curious to see where the regular assay for Estradiol is.

 

[Mdrive]

I like the once a week schedule because it is easy to keep track. I don't really notice peaks and troughs in how I feel. What about cutting down to 160 or 180 once per week and 1/2 of the AI? Maybe that will help avoid such high peaks. Now let me ask a dumb question - will I still get the same muscle building benefits from a lower dose? I can tell the TRT dose is helping me build muscle, so I want to keep my gains but not cause side effects. Maybe I could consider a blast in the future if needed. Thanks for all the input guys. Roll Tide!

 

[Alpin]

I like the once a week schedule because it is easy to keep track. I don't really notice peaks and troughs in how I feel. What about cutting down to 160 or 180 once per week and 1/2 of the AI? Maybe that will help avoid such high peaks. Now let me ask a dumb question - will I still get the same muscle building benefits from a lower dose? I can tell the TRT dose is helping me build muscle, so I want to keep my gains but not cause side effects. Maybe I could consider a blast in the future if needed. Thanks for all the input guys. Roll Tide!

I don't see why you can't make gains splitting up the dose and minimizing e2 and maybe needing less drug in your system (which is always better.)
As for making gains you can't really put an exact number on it. That has a lot to do with genetics as well.
I dont think you would suffer staying at 850-1000 ng/dl TT.

 

[halfwit]

I like the once a week schedule because it is easy to keep track. I don't really notice peaks and troughs in how I feel. What about cutting down to 160 or 180 once per week and 1/2 of the AI? Maybe that will help avoid such high peaks. Now let me ask a dumb question - will I still get the same muscle building benefits from a lower dose? I can tell the TRT dose is helping me build muscle, so I want to keep my gains but not cause side effects. Maybe I could consider a blast in the future if needed. Thanks for all the input guys. Roll Tide!

Labs are fantastic, just hop on 1g of NAC ED to bring those liver values down. E3.5D can reduce the need for so much adex, but not necessary by any means.

My .02c

 

[RR88]

I disagree your test levels look fantastic but like mega said your liver values are in need of the NAC! Both ast n alt plus 40 is nothing to freak about but def work on getten em to low 30s at least.

 

[Chiefy]

I have never had peak values drawn because I figured they would be high and the doctor would try to cut my dose. Was hoping the high levels would help me build more muscle.

If you feel good and your doctor doesn't have an issue with your values being so high, it's probably not the end of the world to remain at this dose as long as you keep an eye on your bloodwork through frequent testing.

It's just a little out of the ordinary for TRT. Most good doctors aim to keep their patient's values near the top of the range without going too far out of it. At your peak, your values are going to be well out of range.

Many guys just like to keep their values stable and within a reasonable range in an effort to minimize side effects (short and long term).

If I were in your position I'd probably back off the testosterone a little bit and split my doses, and hopefully eliminate the AI completely. If I can take less medication and still feel great, that's ideal for me.

 

[THE-DET-OAK]

your free t is too high and your E2 could come up a bit.