March 2016 Bloodwork

[DaveFoster]

Here's my bloodwork for a period after I recovered from low estrogen and rebound estrogen from letrozole, along with low sodium levels and rebound hypertension from clonidine. I then stupidly took caffeine (200 mg) without tolerance, along with very rich hot chocolate made with lots of cocoa powder which dehydrated me, deprived me of sleep, and killed my appetite, so I'm currently just trying to get calories through plenty of milk, orange juice, and coconut oil with added sugar for caloric density. If I had to guess, the theobromine and caffeine together dehydrated me.

They did not test everything that the doctor ordered, and I'm not sure if the tests are still coming, or if they brushed them off.

If anything comes to mind about these labs, please let me know.

Prolactin 5.0 ng/mL 2.1 - 17.7 ng/mL
TESTOSTERONE TOTAL 566 ng/dL 302 - 1096 ng/dL
TESTOSTERONE FREE 149 pg/mL 47 - 244 pg/mL
Testosterone, Free Pct 2.6 % 1.6 - 2.9 %
Sex Hormone Binding Globulin 22 nmol/L 13 - 110 nmol/L
LH 11.6 mIU/mL 0.5 - 76.3 mIU/mL
TSH 2.34 uIU/mL 0.33 - 4.70 uIU/mL
Hemoglobin A1c 5.4 % 4.0 - 6.0 %

CBC W/ DIFFERENTIAL
WBC 6.6 10^9/L 4.5 - 13.0 10^9/L
RBC: 4.87 10^12/L 3.80 - 5.20 10^12/L
Hgb 14.9 g/dL 13.0 - 16.0 g/dL
Hct, Final 44.6 % 37.0 - 49.0 %
MCV 91.5 fL 78.0 - 98.0 fL
MCH 30.5 pg 26.3 - 33.8 pg
MCHC 33.4 g/dL 31.5 - 36.3 g/dL
RDW-CV 14.1 % 11.5 - 14.5 %
Platelet Count 266 10^9/L 140 - 444 10^9/L
MPV 8.4 fL 6.8 - 10.8 fL
NEUTROPHILS % 47.0 % 34.0 - 64.0 %
LYMPHOCYTES % 39.5 % 20.0 - 53.0 %
MONOCYTES % 9.9 % 1.0 - 10.0 %
EOSINOPHILS % 2.8 % 0.0 - 6.0 %
BASOPHILS % 0.8 % 0.0 - 2.0 %
NEUTROPHILS ABS 3.1 10^9/L 1.0 - 8.0 10^9/L
LYMPHOCYTES ABS 2.6 10^9/L 1.2 - 5.2 10^9/L
MONOCYTES ABSOLUTE 0.7 10^9/L 0.0 - 0.8 10^9/L
EOSINOPHILS ABSOLUTE 0.2 10^9/L 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.1 10^9/L 0.0 - 0.2 10^9/L

Sodium, Urine 65 mmol/L

OSMO URINE 260 mOsm/kg 250 - 1300 mOsm/kg

FERRITIN 22 ng/mL 22 - 322 ng/mL


Morning temp: 36.9 C
Morning pulse: 142/73, pulse of 97, pulse pressure of 69

Symptoms: High adrenaline feelings, including cold hands and feet, anxiety, fluttering heart rate, nausea, no appetite, panic attacks followed by vomiting, (although cyproheptadine controls both of these, allowed for by doctor), weight loss, poor sleep, receding hairline

 

[Diokine]

Your TSH is slightly elevated. Monocytes are also at the upper end of reference. Did you get a metabolic panel done, including liver enzymes? Do you have any lymph node swelling? How are your sinuses? I might suspect some kind of infection.

Your systolic BP is high, along with your pulse. Diastolic pressure is low, heart tone is over-excited. Adrenergic activity is high. How much clonidine were you taking and for how long? Do you take exogenous thyroid hormone? T3, T4? Holding some honey or something in the mouth may help with the high adrenaline feelings. I've also had great success with Tulsi (Holy Basil) tea for reducing anxiety of this type.

Almost all of these symptoms can be caused by endotoxin challenge, have you ruled that out?

 

[DaveFoster]

Your TSH is slightly elevated. Monocytes are also at the upper end of reference. Did you get a metabolic panel done, including liver enzymes? Do you have any lymph node swelling? How are your sinuses? I might suspect some kind of infection.

Your systolic BP is high, along with your pulse. Diastolic pressure is low, heart tone is over-excited. Adrenergic activity is high. How much clonidine were you taking and for how long? Do you take exogenous thyroid hormone? T3, T4? Holding some honey or something in the mouth may help with the high adrenaline feelings. I've also had great success with Tulsi (Holy Basil) tea for reducing anxiety of this type.

Almost all of these symptoms can be caused by endotoxin challenge, have you ruled that out?

I have not, although the doctor ordered more labs than are on here including a Comprehensive Metabolic Panel, AM Cortisol readings, fractionated Estrogens, and iron and iron binding capacity tests. My lymph nodes do seem a little bit swollen but more sensitive than anything.

I only took about 100 mcg; a week before that I took about 50 mcg before I worked out and was fine. I took the later dose with cyproheptadine, which dehydrated me, and I overhydrated, which diluted my sodium level (separate labs for this).

I regularly take NDT (around one grain per day), but I haven't taken any for a couple weeks.

Thank you for taking the time to respond. I'll try to get some honey and look into holy basil.

I definitely have a histamine reaction; cyproheptadine helps quite a bit. Since I started Peating, I haven't even gotten close to sick, but maybe it is related to the immune system.

 

[meatbag]

.

 

[DaveFoster]

Any improvement in gynecomastia? Just wondering because your prolactin is lower than mine

It may be smaller, but it's fibrous at this point and very difficult to get rid of it. I'm looking into surgery.

 

[superhuman]

before you do, try exastamine or what the estrogen killer is name. It works wonders for people.

 

[Diokine]

Are you taking drugs that suppress fatty acid oxidation? The major ones would be aspirin and niacinamide. I see a pattern of metabolic stress, if you severely suppress fatty acid oxidation during this kind of stress it can lead to worsening symptoms. The panic attacks followed by vomiting are indicative of severe autonomic dysregulation, which points to sizable metabolic dysfunction.

Do you take cyproheptadine often? It's a theraputic drug but if you've been using it for a long time or in high doses you may be introducing a variable that your body has a hard time compensating for, especially as it concerns the serotonin system and autonomic nervous system. I would also look for environmental factors, chemical exposure, etc...

Why do you say you have a histamine reaction? Do you sneeze a lot?

 

[DaveFoster]

Are you taking drugs that suppress fatty acid oxidation? The major ones would be aspirin and niacinamide. I see a pattern of metabolic stress, if you severely suppress fatty acid oxidation during this kind of stress it can lead to worsening symptoms. The panic attacks followed by vomiting are indicative of severe autonomic dysregulation, which points to sizable metabolic dysfunction.

Do you take cyproheptadine often? It's a theraputic drug but if you've been using it for a long time or in high doses you may be introducing a variable that your body has a hard time compensating for, especially as it concerns the serotonin system and autonomic nervous system. I would also look for environmental factors, chemical exposure, etc...

Why do you say you have a histamine reaction? Do you sneeze a lot?

I say histamine because I'm congested, itchy and watery eyes, difficulty yawning, etc; basically all the symptoms. Cyproheptadine is greatly helping the situation; I feel about 70% right now.

I think the majority of the problem was the adrenaline release that stopped adequate caloric consumption, which prompted even more adrenaline. No vomiting today, but I had nausea in the morning prior to taking 4 mg cyproheptadine.

@superhuman
Letrozole and raloxifene did nothing together, so I don't see why exemestane would.

 

[tallglass13]

@DaveFoster, how low was your estrogen before? Im wondering what is the most optimal estradiol level for males

 

[DaveFoster]

@DaveFoster, how low was your estrogen before? Im wondering what is the most optimal estradiol level for males

I have no clue. As for recommended amounts, low estrogen is associated with high mortality.

Here's an article:

Why Estrogen Balance is Critical to Aging Men – Life Extension

You should only have to worry about pushing estrogen too low with medications; it becomes increasingly unlikely as you get older.

 

[CarbAppreciator]

When I have signs of stress, I've noticed increased salt intake is the most safe, simple, and reliable way to reduce leakiness symptoms and make my urine clear.

IMHO : I think suppressed appetite and high histamine are probably indicative of your body oscillating between different extreme states as it returns to homeostasis. If your body does not feel ready for food, don't give it food. My advice is to stick with the simplest therapies; salt, broth, niacinamide, aspirin... the broad-range systemically protective substances with little to no side effects. I think back to when I used to get really sick with stomach flu... terrible vomiting all day long, a very serious condition now that I look back, and yet after a few days of just drinking water I would recover. The body can work through tremendous adversity without external input.

I think nuanced and specialized substances(hormones, pharmaceuticals) require a great deal of intelligence and precision to get right, especially when employing multiple ones at once. You can have all the intelligence in the world, but if you don't have a way to precisely monitor intra and extra cellular environments 24/7, you are likely to eventually run into problems when using these.

Maybe in the future there will exist a technology that allows humans that precise monitoring, but now the best we have is blood tests, mri's and vitals. This might be the biggest limiting factor in medicine now. There are plenty of good drugs out there, we just need to learn how to maximize them through accurate data

 

[Koveras]

Letrozole and raloxifene did nothing together, so I don't see why exemestane would.

Maybe it has some slight additional androgenic effects through it's similarity to androstenedione, maybe not. I think I big issue with those research chemical companies, and the underground market in general, is that you never really know what you're getting (compound and/or dose).

Liver health is key to improving gynecomastia. Anything that increases SHBG (including hyperthyroidism) can result in pseudogynecomastia (excess fat storage around the breast, without fibrous tissue) - due to SHBGs preference for testosterone over estrogen, and the impact that has on the T/E ratio at the tissue level. Although there are some discussions about the activity of bound vs "free" hormones, and there is maybe a case for the value of bound thyroid, so far it seems with testosterone that the unbound hormone is the more relevant one to look at.

You mentioned you did have some fibrous tissue there however, which would indicate the involvement of estrogen, serotonin, and prolactin - and perhaps the counter-regulatory stress hormones cortisol and adrenaline.

SERMS such as tamoxifen, toremifene, raloxifene, clomiphene, etc. are common pharmaceutical options - but as you are aware there are many risks and side effects due to their estrogenic nature in some tissues.

Aromatase inhibitors like letrozole, anastrozole, exemestane, etc. are other common options - probably less dangerous as a whole but with many risks and side effects as well. Absence of gynecomastia is a bit of an empty reward if you have no libido. I know you had a bad experience with letrozole. I think one key for any AI is maybe lower and less frequent doses, for mild estrogen reduction, not complete elimination.

DHT seems to have a variety of antiestrogenic effects and is used sometimes for this purpose. If you were able to find bioidentical DHT and apply a low dose topically, that would probably be ideal, but is likely to be hard to source and expensive. Mesterolone is an analogue that supposedly has only minor inhibition on the HPTA, so is appealing for that reason, but again you never really know what you're getting underground or online. More suppressive synthetic DHT analogues would be fluoxymesterone, methyldrostanolone, drostanolone, methenolone. Of course with suppressive options, if they are legitimate, you run into issue of rebound afterwards which could re-aggravate the situation. hCG is used sometimes to speed recovery from suppressive AAS but is itself a common cause or factor in gynecomastia. If the DHT-based AAS were substituted by the provider for other AAS (knowingly or unknowingly) then you could suffer from further estrogenic effects. Also with the oral AAS you put additional strain on the liver which could contribute to issues. With injectable AAS you're injecting cottonseed or other polyunsaturated oils, various solvents and unknown byproducts.

Danazol is a synthetic progestin that has been used for this purpose. Many unknowns and not in common use anymore.

Of course with any of the above options, and even surgery which you mentioned, there is the real issue of recurrence if the underlying issue is not resolved.

With that in mind, your best options are lifestyle modifications that are gentle and sustainable long term.

I think you are heavy on the peat diet, so I won't rehash that.

Weight loss, unless you are already quite lean, is likely to have one of the biggest positive impacts on the appearance of your pecs.

Cyproheptadine may have some value, and you are already on that.

Dopamine agonists such as bromocriptine, cabergoline, lisuride, etc may have some value. Your prolactin is already <7 however, so I'm not sure that suppressing it further would do much good. Discuss with your doctor if you think it may be worthwhile.

DHT may have some value, but a natural topical form is likely hard to come by. The avoidance or addition of some things in the diet may help optimize your levels - you're likely on top of this as well.

Since you had a bad experience with synthetic AIs, natural substances that perform this function or have some antiestrogenic effects are probably a better option (maybe the fat soluble vitamins, caffeine, aspirin).

Stress reduction is another thing to consider, and given your experience probably non-pharmaceutical options as well. I have yet to see something pharmaceutical, aside from maybe cyproheptadine, that might be appropriate for use beyond a few days.

With all that said, I thought your 'paradigm shift' was insightful, and don't want to encourage a cavalier attitude towards your body.

I think all of the supplements and pharma can be quite a stress in and of themselves - to the digestive system, systemically, financially.

Less is more.

Be in it for the long game.

Don't expect or try to force major changes in your tissues in less than 3 months, and often longer.

If you do try to force things, be prepared for consequences - mentally prepared to deal with the consequences, not prepared with other substances to deal with the issues from the first substance(s), heh

Be content with the body you have, while you work towards gradual changes or "improvements"

While your body may be a good starting point to attract sexual interest, unless you are partying with your shirt off and hoping for a one night stand, then looking half decent in clothes will get you as far as you need. The rest is likely done through conversation, and any individual you can develop genuine interest in (them towards you, presumably mutual), is not likely to bothered by some minor physical peculiarities.

 

[DaveFoster]

@Koveras All very true and good advice.

MORE LABS (just came in today):

Cortisol - AM 25 ug/dL 4 - 22 ug/dL
IRON 83 ug/dL 50 - 160 ug/dL
TIBC 453 ug/dL 246 - 436 ug/dL
% SATURATION 18 % 13 - 50 %
FERRITIN (reposted) 22 ng/mL 22 - 322 ng/mL


NA 138 mmol/L 135 - 144 mmol/L
K 3.6 mmol/L 3.7 - 5.5 mmol/L
CL 101 mmol/L 99 - 110 mmol/L
CO2 31 mmol/L 20 - 31 mmol/L
ANION GAP 6 4 - 13
GLUCOSE 89 mg/dL 60 - 99 mg/dL
BUN 9 mg/dL 6 - 23 mg/dL
CREA 0.72 mg/dL 0.60 - 1.30 mg/dL
Bun/Creatinine 12.5
Calcium 9.9 mg/dL 8.3 - 10.4 mg/dL
ALK PHOS 86 IU/L 32 - 110 IU/L
BILIRUBIN TOTAL 0.7 mg/dL 0.2 - 1.2 mg/dL
AST (SGOT) (REF) 38 IU/L 11 - 39 IU/L
ALT (SGPT) (REF) 19 IU/L 6 - 42 IU/L
Total protein 7.8 g/dL 6.1 - 8.0 g/dL
ALBUMIN 4.8 g/dL 3.2 - 4.9 g/dL
GLOBULIN 3.0 g/dL 1.6 - 4.0 g/dL
Albumin/Globulin Ratio 2.0 0.6 - 2.8
Fasting? Yes
EGFR IF NOT AFRICAN AMERICAN >60 mL/min/1.73 m2 >=60 mL/min/1.73 m2

Cortisol is very high, so I think I see the problem. Any input?

 

[James_001]

Are you exercising? If so I would suggest stopping until you regain you sleep.

 

[Koveras]

Cortisol is very high, so I think I see the problem. Any input?

Do nothing?

Have just been through a very stressful period.

Continue eating well, living well, relax.

Retest in 3-6 months.

 

[DaveFoster]

@James_001 No exercise for me.

@Koveras Yeah, I've been trying to take it easy.

I'm cutting out all supplements except for cyproheptadine for sleep. I talked with my doctor, and he said this is a good approach.

@Diokine I think you may be right about fatty acid suppression not being helpful in my case. In the short-term, deactivating the stress response radically makes life horrible, and I do believe that the excess of calories and niacinamide have worsened my chest pain.

 

[tara]

The rest is likely done through conversation, and any individual you can develop genuine interest in (them towards you, presumably mutual), is not likely to bothered by some minor physical peculiarities.

+1

K 3.6 mmol/L 3.7 - 5.5 mmol/L

When your appetite returns, more fruit, less refined sugar?

 

[ravster02]

Have you had parathyroid hormone tested? It'll let you know if you need more calcium in your diet.

 

[DaveFoster]

@tara Good idea; it might just be from the aldosterone wasting potassium, but I'm trading sugar for orange juice.

@ravster02 I get about 5 grams/day without supplements, 8 grams with supplements.

 

[tara]

@ravster02 I get about 5 grams/day without supplements, 8 grams with supplements.

If you are getting 5g from food that seems like plenty. Why supplement to get extreme?