First bloods pre trt advice please.

[JBC]

Just had my first bloods done with a view to going on trt.

45 year old male
5Ft 10"
11 stone
11.1% bf
117/63 blood pressure

Good wholefood diet. Lost 7 stone since June 2023.

While being in a deficit i noticed a loss of morning wood and libido (not eating enough fat)Wasn't to bothered at the time as the goal was fat loss. Around 6 month ago after reaching my goal weight i increased calories and have been eating around 85g of mostly healthy fats (avacado, nuts).
My libido and morning elections haven't returned. Only when I significantly increase calories/fat do they return but so does my body fat. So looking at trt.
Have been weight training through out and have a decent physique now but muscle building has been really slow so hoping trt can help with that.

Anyway got my bloods done and this is my results. High mcv 101.1, eGFR 102 and low oestradiol 38. Everything else seems in the health range.

I feel great both mentally and physically except for what I think is tendinitis in both elbow joints. I now think this could possibly related to low e2.



Any advice would be greatly appreciated as I'm new to all this.

Thanks

 

[buck]

Seems like a fairly low body weight for that height.
You T levels are to the lower side then some like.
The low E2 level could be where the libido issue is stemming form.
May want to post you diet for others to see.

 

[malfeasance]

You are a little anemic. Try to add iron and vitamin c to your diet.

Otherwise, your health markers are excellent. FYI, eGFR "high" kind of cracks me up. That is an excellent number and does not indicate a problem. Do not be concerned about that at all. If you go TRT, go easy. A little goes a long way. Don't mess up what is otherwise excellent health. Watch your lipids and eGFR and blood pressure, especially.

 

[JBC]

Seems like a fairly low body weight for that height.
You T levels are to the lower side then some like.
The low E2 level could be where the libido issue is stemming form.
May want to post you diet for others to see.

A typical day would be

I eat a lot of mixed veg with my dinner and lunch (peppers, tomato, cucumber, onions, raddish). Just don't track them.

 

[malfeasance]

MCV and MCHC indicate iron deficiency, is what I was getting at.

 

[JBC]

MCV and MCHC indicate iron deficiency, is what I was getting at.

Thanks mate I'll look into adding some.

Could that be causing low e2?

 

[buck]

A lot of your protein is from low quality sources that are not complete and are not as bioavailable as those from animal sources. I only count high quality protein when figuring out my macro's.

 

[JBC]

A lot of your protein is from low quality sources that are not complete and are not as bioavailable as those from animal sources. I only count high quality protein when figuring out my macro's.

70g from eggs and chicken and nearly 100g from greek yogurt. Are those not good sources of protein? I was under the impression they were.

 

[Jin23]

You are a little anemic. Try to add iron and vitamin c to your diet.

Otherwise, your health markers are excellent. FYI, eGFR "high" kind of cracks me up. That is an excellent number and does not indicate a problem. Do not be concerned about that at all. If you go TRT, go easy. A little goes a long way. Don't mess up what is otherwise excellent health. Watch your lipids and eGFR and blood pressure, especially.

He shouldn't add any iron. His serum iron is normal as is his TSAT, right where you want it. He even has an issue with high ferritin. So no, @JBC do not take any iron and it would be prudent of you to try and lower that feritin, you want it at around 100. And your hemoglobin is low because your free sex hormones are low, definitely not because of low iron, which again, if anything, it's too high.

 

[JBC]

He shouldn't add any iron. His serum iron is normal as is his TSAT, right where you want it. He even has an issue with high ferritin. So no, @JBC do not take any iron and it would be prudent of you to try and lower that feritin, you want it at around 100. And your hemoglobin is low because your free sex hormones are low, definitely not because of low iron, which again, if anything, it's too high.

After a quick Google it seems the amount of apples I eat is possibly causing this. I eat around 8 a day. It's my go to snack. Going to have to cut back

 

[Jin23]

After a quick Google it seems the amount of apples I eat is possibly causing this. I eat around 8 a day. It's my go to snack. Going to have to cut back

Why would apples increase ferritin? Do they somehow increase hepcidin expression? Your ferritin is probably high due to increased iron intake and possibly due to higher hepcidin expression because of low grade inflammation; crp around 1.5, 2 ... Much higher then that and you'd likely be suffering from anemia of chronic inflammation, as your serum iron would also drop.

I'm surprised you don't have any inflammation markers (besides ferritin ofc). Go and measure hsCRP.

 

[Jin23]

Oh, and check B12 and folate. Your "anemia" is macrocytic, and there's a good chance its megaloblastic. Forgot about the high mcv ... There's other reasons/contributing factors too however, low fT can also contribute for instance. Google high mcv a bit, do some research on it and ferritin/iron. Good things to know if planning on messing with your sex hormones as both (erythropoiesis and iron management) are affected by them.

 

[JBC]

Why would apples increase ferritin? Do they somehow increase hepcidin expression? Your ferritin is probably high due to increased iron intake and possibly due to higher hepcidin expression because of low grade inflammation; crp around 1.5, 2 ... Much higher then that and you'd likely be suffering from anemia of chronic inflammation, as your serum iron would also drop.

I'm surprised you don't have any inflammation markers (besides ferritin ofc). Go and measure hsCRP.

From google

apples can affect ferritin levels because they contain phenolic acids, which can inhibit iron absorption. However, apples are also a good source of iron, and can help prevent anemia.

Also from google

While apples do contain some iron, eating too many apples is unlikely to significantly increase your ferritin levels due to the presence of polyphenols in apples which can inhibit iron absorption, meaning your body won't absorb a large amount of the iron they contain.

So it's unclear and needs more looking into


so I should get my hsCRP checked and also B12 & folate? Would probably be better to increase B12 and folate then get them checked in a few weeks?

Is it advisable to get all this in check before starting trt?
I was going to self administer trt but thinking it probably better going through a clinic now. I've got a lot to learn first.

 

[Jin23]

From google

apples can affect ferritin levels because they contain phenolic acids, which can inhibit iron absorption. However, apples are also a good source of iron, and can help prevent anemia.

Also from google

While apples do contain some iron, eating too many apples is unlikely to significantly increase your ferritin levels due to the presence of polyphenols in apples which can inhibit iron absorption, meaning your body won't absorb a large amount of the iron they contain.

So it's unclear and needs more looking into


so I should get my hsCRP checked and also B12 & folate? Would probably be better to increase B12 and folate then get them checked in a few weeks?

Is it advisable to get all this in check before starting trt?
I was going to self administer trt but thinking it probably better going through a clinic now. I've got a lot to learn first.

Asses first, then take action.

Definitely learn more about endocrinology before starting trt yourself.

 

[buck]

70g from eggs and chicken and nearly 100g from greek yogurt. Are those not good sources of protein? I was under the impression they were.

A lot of people think 1 gram per pound of body weight is all that is needed. I grew my best at 1.5 grams/pound of quality protein.

 

[glpfun]

There are other more obvious reasons to not eat 8 apples a day… eating a bit of fruit daily is good but not 8 of them, that’s a lot of sugar and calories to waste on apples. That being said I do love apples myself, I could probably eat 8 honeycrisp apples a day.

 

[buck]

As all carbohydrates are sugar molecules i am not sure how to avoid sugar with most diets.

Carbohydrates: MedlinePlus

Carbohydrates are one of the basic food groups. Learn how to incorporate carbohydrates into a healthy diet.

medlineplus.gov

 

[glpfun]

As all carbohydrates are sugar molecules i am not sure how to avoid sugar with most diets.

Carbohydrates: MedlinePlus

Carbohydrates are one of the basic food groups. Learn how to incorporate carbohydrates into a healthy diet.

medlineplus.gov

They are but not all carbohydrates are equal. Your simple carbs you’d get from a candy bar vs complex carbs you’d get from ezekiel bread. Think of complex carbs like a time release carb, it takes longer to break down so your insulin response is less dramatic whereas simple carbs are going to spike your blood sugar. Complex carbs also increase satiety due to fiber content. So while all carbs are eventually broken down to sugar, the way in which it happens has an impact on your long term health. Fruit is somewhere in between imo, they are simple carbs but also nutrient rich and have some fiber.

 

[buck]

They are but not all carbohydrates are equal. Your simple carbs you’d get from a candy bar vs complex carbs you’d get from ezekiel bread. Think of complex carbs like a time release carb, it takes longer to break down so your insulin response is less dramatic whereas simple carbs are going to spike your blood sugar. Complex carbs also increase satiety due to fiber content. So while all carbs are eventually broken down to sugar, the way in which it happens has an impact on your long term health. Fruit is somewhere in between imo, they are simple carbs but also nutrient rich and have some fiber.

I totally understand the glycemic index, nutrition and all that. My point was all carbohydrates are sugars. And as fruit can have a great deal of nutrition avoiding them to avoid sugar is not in my plan. And i find it rare that people eat whole grains. As most have been ground up speeding their release into the blood stream. . So table sugar gets in the blood stream and at about the same rate as white bread, white rice and white potatoes

 

[UncleBuns]

If you decide to do TRT my advice is:

- Start at a reasonable dose, maybe 100mg per week
- Have money set aside to do blood work multiple times for the first year
- Know that getting your protocol dialed in may be easy, but it may be complicated and a big hassle. It varies by individual.
- When to get blood work will depend on ester choice
- Have an AI on hand before you start and I would highly suggest utilizing HCG right away with the TRT. Not only are there benefits to using HCG but if you decide to end the TRT this will make it much easier to come off of it

Are you going to do this through Dr. Supervision or on your own?