Iron Health

Date of Labs: February 24, 2026 Analysis Date: March 14, 2026 Previous Comparison: Biomarkers Report 02/18/2026, Oct 2025, Nov 2025 draws

Executive Summary

This is one of the strongest overall panels you've pulled. Cardiovascular risk markers remain elite (CRP 0.29, LDL-P 574, calcium score 0). The statin + ezetimibe combination is delivering exceptional results on particle number even though ApoB ticked up from its November low. Several items improved — glutathione, homocysteine, ferritin, liver enzymes, platelets, and HDL all moved in the right direction. However, there are six areas that need attention over the next 90 days: hematocrit is now above range (TRT-driven), MCV remains stubbornly elevated despite folate + B6, estradiol may have been driven too low by anastrozole + DIM, kidney filtration is trending downward, Vitamin D hasn't reached target despite doubling the dose, and fasting insulin remains below the functional floor. The CEA result also warrants a conversation with your doctor.

I. Complete Biomarker Review

Cardiovascular Panel — For Doctor Discussion

Marker	Feb 24, 2026	Previous	Trend	Assessment
ApoB	56 mg/dL	45 (Nov 21)	+11 ↑	Still desirable (<90). Rose from elite low. See discussion below.
LDL-C	70 mg/dL	53 (Nov 21)	+17 ↑	Within range (0-99). Rose in parallel with ApoB.
HDL-C	80 mg/dL	55 (Nov 21)	+25 ↑	Excellent. Biggest positive move on the panel.
Total Cholesterol	161 mg/dL	122 (Nov 21)	+39 ↑	In range. Rise driven largely by HDL increase.
Triglycerides	56 mg/dL	66 (Nov 21)	-10 ↓	Excellent. Low TG + high HDL = ideal metabolic signature.
VLDL	11 mg/dL	14 (Nov 21)	-3 ↓	Low. Good.
LDL-P	574 nmol/L	1407 (Oct 2023)	-833 ↓	LOW — below 20th percentile. This is the real win.
Lp(a)	31.2 nmol/L	24.5 (Jun 2025)	+6.7 ↑	Safe (<75). Lp(a) is genetically fixed; variation is assay noise.
hs-CRP	0.29 mg/L	0.32 (Nov 2024)	-0.03 ↓	Low risk (<1.00). Outstanding.
ApoA-1	200 mg/dL	210 (Oct 2023)	—	Flagged high (ref 101-178) but reflects excellent HDL function.
Fibrinogen	297 mg/dL	294 (Oct 2025)	+3	Normal (193-507). Stable.
Lp-PLA2	Not performed	—	—	Specimen deteriorated. Reorder on next draw.

ApoB Discussion Points for Your Doctor:

The November 21 draw showed ApoB at 45 mg/dL — elite by any standard. This draw shows 56 mg/dL. A few things to discuss:

Non-fasting vs. fasting matters. The Feb 24 draw was marked "Fasting: Not Given." If you ate before this draw, postprandial lipoproteins (chylomicron remnants) can elevate ApoB by 5-15 mg/dL transiently. The November draw was also not definitively fasting. This alone could explain the delta.
56 is still desirable. Even at 56, you're well below the <90 target for high-risk patients and below the <80 target for very high risk. You're in the 1st-5th percentile on LDL-P at 574.
The HDL surge is notable. HDL jumped from 55 to 80 — a 45% increase. This could reflect improved endothelial function (taurine addition?), better training adaptation, or seasonal variation. The Total:HDL ratio at 2.01 and Trig:HDL ratio at 0.70 are both elite.
Hold current medications. Rosuvastatin 10mg + ezetimibe 10mg is delivering an exceptional particle profile. There is no indication to increase doses or add PCSK9 inhibitors. The original decision tree (ApoB ≤90 → hold) is clearly satisfied.
Request fasting draw next time to remove dietary confounding.

Hematology & CBC

Marker	Feb 24, 2026	Previous	Ref Range	Assessment
Hematocrit	51.3% ⚠️	46.5 (Dec 2), 49.0 (Nov 21)	37.5-51.0	HIGH — above range. TRT-driven erythrocytosis.
MCV	101 fL ⚠️	99 (Dec 2), 101 (Nov 21)	79-97	HIGH — macrocytosis persists. Not improving despite 5-MTHF + P-5-P.
Hemoglobin	16.4 g/dL	15.7 (Dec 2)	13.0-17.7	Normal but trending up with hematocrit.
RBC	5.09	4.72 (Dec 2)	4.14-5.80	Normal.
WBC	4.4	6.7 (Dec 2)	3.4-10.8	Normal-low. Consistent with your pattern.
Platelets	237	172 (Dec 2), 152 (Jan 22)	150-450	Improved significantly. Normalized after dipping low.
Reticulocyte Count	1.5%	—	0.6-2.6	Normal. Bone marrow function is fine.
MCH	32.2 pg	33.3 (Dec 2)	26.6-33.0	Borderline. Consistent with macrocytosis.
RDW	14.1%	12.4 (Dec 2)	11.6-15.4	Normal but widening slightly — some red cell size variation.

Hematocrit 51.3% — Action Required:

This is the most actionable flag on the panel. At 51.3%, you've just crossed the upper reference limit. For men on TRT, hematocrit above 52-54% carries increased viscosity/thrombotic risk. You're not in danger territory yet, but the trend line from 44.9 → 46.5 → 49.0 → 51.3 over 4 months is a clear upward trajectory.

Discussion items: hydration status at draw time, whether TRT dose has been adjusted recently, and whether therapeutic phlebotomy or dose reduction should be considered if the next draw is ≥52%.

MCV 101 fL — Persistent Macrocytosis:

This has been stubbornly elevated despite adding 5-MTHF 800µg and P-5-P 25mg in November 2025. B12 is still high at 1374 pg/mL (Jan 22 draw). The most common causes in your context: B12 excess (you're oversaturated), medication effects (neither rosuvastatin nor ezetimibe typically cause this), alcohol (not applicable), or hypothyroidism (thyroid is borderline — see below).

The folate/B6 intervention hasn't moved MCV. The reticulocyte count is normal so this isn't a production issue. The most likely explanation remains B12 oversaturation combined with your naturally large red cells. Consider whether beef organ tabs at even 1x/day plus your B12-rich diet (red meat, oysters) is keeping B12 too high for MCV to normalize.

Metabolic Panel

Marker	Feb 24, 2026	Previous	Ref Range	Assessment
Glucose (fasting)	72 mg/dL	97 (Dec 2)	70-99	Excellent. Tight control.
Insulin	1.4 µIU/mL ⚠️	1.2 (Oct 2025)	2.6-24.9	LOW — still below range. Barely moved.
HbA1c	5.2%	5.2 (Nov 23)	—	Excellent.
BUN	18 mg/dL	29 (Dec 2)	6-24	Normalized from previous high.
Creatinine	1.17 mg/dL	1.02 (Dec 2), 1.08 (Nov 21)	0.76-1.27	In range but trending up.
eGFR	79 mL/min ⚠️	93 (Dec 2), 87 (Nov 21)	>59	Declining trend: 93 → 87 → 79. Needs monitoring.
Cystatin C	0.84 mg/L	—	0.60-1.00	Normal. Better kidney marker than creatinine for muscular athletes.
Uric Acid	5.1 mg/dL	5.0 (Feb 2025)	3.8-8.4	Normal.

Insulin at 1.4 µIU/mL — Persistently Low:

This has been a known issue. Alpha-lipoic acid was removed in June 2025, the bedtime casein + honey was added, and it's barely budged from 1.2 to 1.4. Your glucose-insulin ratio suggests extreme insulin sensitivity, which in isolation is good — but a fasting insulin this low can indicate insufficient anabolic signaling for muscle protein synthesis and recovery, especially at your training volume.

eGFR Declining — Context Matters:

eGFR at 79 looks concerning in isolation, but Cystatin C at 0.84 is reassuring. Creatinine-based eGFR is notoriously unreliable in muscular athletes — high muscle mass and creatine supplementation (10g/day) both inflate serum creatinine, artificially lowering eGFR. Cystatin C is not affected by muscle mass and your result is solidly mid-range. That said, the creatinine trend (1.02 → 1.08 → 1.17) warrants confirmation. Ask your doctor about a Cystatin C-based eGFR calculation, which would likely show you in the 90+ range.

Liver Function

Marker	Feb 24, 2026	Previous	Ref Range	Assessment
AST (SGOT)	32 IU/L	41 (Dec 2)	0-40	Improved. Normal.
ALT (SGPT)	30 IU/L	49 (Dec 2)	0-44	Significantly improved. Was above range.
Bilirubin Total	1.4 mg/dL ⚠️	1.1 (Dec 2)	0.0-1.2	Mildly elevated. Likely Gilbert's syndrome.
Bilirubin Direct	0.48 mg/dL ⚠️	0.40 (Nov 21)	0.00-0.40	Slightly high.
ALP	71 IU/L	69 (Dec 2)	47-123	Normal.
LDH	191 IU/L	—	121-224	Normal.
GGT	57 IU/L	— (Oct 2025)	—	Was elevated previously. Not retested with precision here.

Liver enzymes are moving in the right direction. The statin + ezetimibe combination is not causing hepatotoxicity. Mildly elevated bilirubin is very common and usually reflects Gilbert's syndrome (benign) — this is consistent with your pattern across multiple draws.

Hormones & Endocrine

Marker	Feb 24, 2026	Previous	Ref Range	Assessment
Total Testosterone (LC/MS)	1699 ng/dL	1870.5 (Oct 2025)	264-916	High. Expected on TRT.
Free Testosterone	>34.80 ng/dL	46.2 (Oct 2025)	5.00-21.00	High. Expected on TRT.
SHBG	42.1 nmol/L	44.3 (Oct 2025)	—	Stable. Good range.
Estradiol (Sensitive)	19.0 pg/mL ⚠️	47.8 (Oct 2025)	8.0-35.0	Dropped 60%. Possibly over-suppressed.
DHEA-Sulfate	170 µg/dL	226 (Oct 2025)	102.6-416.3	Declined. Normal but worth watching.
Cortisol AM	13.9 µg/dL	11.5 (Oct 2025)	6.2-19.4	Normal. Healthy morning rise.
Prolactin	7.0 ng/mL	10.3 (Feb 2025)	3.9-22.7	Improved. Normal.
IGF-1	137 ng/mL	135 (Oct 2025)	84-270	Stable. Lower half of range.
TSH	1.98 mIU/mL	1.59 (Oct 2025)	0.450-4.500	Normal but rising.
Free T4	1.08 ng/dL	1.36 (Oct 2025)	0.82-1.77	Declining. Lower third of range.
Free T3	2.8 pg/mL	3.0 (Oct 2025)	2.0-4.4	Declining. Lower third of range.
Reverse T3	17.7 ng/dL	—	9.2-24.1	Normal. Not elevated (rules out conversion block).
TPO Antibodies	13 IU/mL	<9 (Oct 2023)	0-34	Within range but rising from undetectable. Watch.
Thyroglobulin Ab	<1.0 IU/mL	<1.0 (Oct 2023)	0.0-0.9	Normal.
PSA	0.7 ng/mL	0.6 (Dec 2025)	0.0-4.0	Normal. Minimal TRT effect.
CEA	4.5 ng/mL ⚠️	—	0.0-4.7 (nonsmokers <3.9)	Borderline. See discussion.

Estradiol at 19.0 pg/mL — Likely Over-Suppressed:

This is the biggest hormonal finding. Estradiol dropped from 47.8 to 19.0 pg/mL — a 60% reduction. You're currently running anastrozole 0.5mg Mon/Thu plus DIM 100mg daily. The October value of 47.8 was slightly above your 20-40 target, but the response to intervention was overcorrection.

Estradiol below 20 pg/mL in men on TRT is associated with: joint pain/stiffness, reduced bone mineral density, worse lipid profiles, lower libido, mood changes, and impaired cognitive function. Many TRT-optimization physicians target 20-40 pg/mL as the sweet spot.

Recommendation: Discuss with your doctor reducing anastrozole to 0.25mg Mon/Thu or switching to Mon-only dosing. Consider dropping DIM temporarily since it's adding additional estrogen clearance on top of the AI. Retest estradiol in 4-6 weeks after adjustment.

Thyroid Trending Down:

Free T4 (1.08) and Free T3 (2.8) have both declined from their October values and are now in the lower third of their ranges. TSH rising from 1.59 to 1.98 is the pituitary's response — it's asking the thyroid to work harder. Reverse T3 at 17.7 is normal, so this isn't a conversion problem. TPO antibodies at 13 (from <9 previously) are still within range but the direction warrants monitoring.

This isn't clinical hypothyroidism yet, but subclinical thyroid decline could contribute to: persistent macrocytosis (MCV), lower metabolic rate, reduced training recovery, and lipid changes. Iodine and selenium status should be ensured.

CEA at 4.5 ng/mL — Needs Discussion:

CEA is a tumor marker most associated with colorectal cancer but also elevated in smokers, inflammatory bowel conditions, and some benign states. The general reference is <4.7, but for nonsmokers the threshold is <3.9, which puts you slightly above. This is very likely benign — you have no GI symptoms, your CRP is 0.29, and this is a single datapoint. However, given your Four Horsemen framework with cancer as priority #2, this warrants: confirming your colonoscopy screening is current, retesting CEA in 3 months, and a brief conversation with your doctor.

Oxidative Stress & Methylation

Marker	Feb 24, 2026	Previous	Target	Assessment
Glutathione	255 µg/mL	229 (Oct 2025)	>320	Improved +26 but still short of target.
Homocysteine	9.1 µmol/L	10.3 (Oct 2025)	<8.0	Improved. Moving in right direction.
CoQ10	2.73 µg/mL	—	0.37-2.20	Above range. Supplementation + statin offset working well.

Glutathione at 255 — Improving but Slowly:

The broccoli seed extract increase (2 caps → 5 caps/day) moved glutathione from 229 to 255 over ~4 months. That's an 11% improvement, but you're still 65 points below the 320 target. The Nrf2-only approach is working but slowly. Current NAC dose (500mg AM + 600mg PM = 1,100mg/day) plus glycine 3g at bedtime provides precursors, but the endogenous production pathway may be rate-limited by training-induced oxidative turnover.

Homocysteine at 9.1 — Good Progress:

Down from 10.3, the 5-MTHF increase to 800µg is working. You're 1.1 points from target. Continuing current protocol should get you there. Consider whether adding TMG (trimethylglycine/betaine) 500mg would close the gap faster via the alternative BHMT pathway — this was previously declined to keep variables minimal, but you could revisit now that folate efficacy is confirmed.

CoQ10 at 2.73 — Supraphysiologic:

This is above the reference range, which means your 200mg/day CoQ10 supplementation is more than offsetting statin-induced depletion. This is not a problem — supraphysiologic CoQ10 is well-tolerated and may offer additional mitochondrial protection. However, if you wanted to simplify, you could reduce to 100mg/day (one dose instead of two) and retest.

Vitamins, Minerals & Iron

Marker	Feb 24 / Jan 22, 2026	Previous	Target	Assessment
Vitamin D	49 ng/mL (Jan 22)	46.9 (Oct 2025)	70-75	Barely moved despite doubling to 10k IU.
B12	1374 pg/mL (Jan 22)	903 (Oct 2025)	600-900	Surged. Back above target range.
Folate	19.4 ng/mL (Oct 2025)	—	—	Adequate.
Magnesium	2.2 mg/dL	—	1.6-2.3	Normal.
Ferritin	230 ng/mL	313 (Oct 2025)	—	Improved. Reducing beef organs worked.
Iron	97 µg/dL	82 (Oct 2025)	38-169	Normal.
Iron Saturation	30%	28% (Oct 2025)	15-55	Normal.

Vitamin D at 49 — Not Reaching Target:

You doubled from 5,000 to 10,000 IU in November 2025, and 3 months later you've gone from 46.9 to 49 — only 2.1 ng/mL improvement. At this rate, reaching 70-75 would take years. Possible explanations: absorption issue (are you taking it with a fat-containing meal?), increased utilization from training, genetic VDR variants, or body composition (more muscle mass = more volume of distribution).

B12 at 1374 — Over-Target Again:

Despite reducing beef organ to 1x/day, B12 surged back to 1374 from 903. Your diet (red meat, organs, oysters) is extremely B12-rich. Consider whether the single daily beef organ tab is still needed at all, or whether you can take it every other day.

II. Areas of Concern (Ranked by Priority)

1. Hematocrit 51.3% — TRT Safety Concern

Risk: Increased blood viscosity, thrombotic events. Action: Discuss with prescribing physician. May need TRT dose reduction, more frequent phlebotomy/donation, or increased hydration protocol. Retest in 6-8 weeks. Threshold for intervention is typically 52-54%.

2. Estradiol Over-Suppression (19.0 pg/mL)

Risk: Joint health, bone density, lipid profile, mood, cognition. Action: Reduce anastrozole and/or drop DIM. See specific recommendations below.

3. MCV Persistent Macrocytosis (101 fL)

Risk: Indicates ongoing B12 oversaturation or early thyroid insufficiency. Action: Further reduce B12 intake. Monitor thyroid. If MCV doesn't improve in 3 months, deeper workup.

4. eGFR Declining (79)

Risk: Kidney function concern (though Cystatin C is reassuring). Action: Get Cystatin C-based eGFR calculation. Consider creatine's contribution. Ensure adequate hydration.

5. Vitamin D Stalled (49 ng/mL)

Risk: Not reaching optimal range for immune function, bone health, cancer prevention. Action: Absorption troubleshooting. Possible dose increase or formulation change.

6. CEA Borderline (4.5 ng/mL)

Risk: Low probability but relevant to cancer screening per Four Horsemen framework. Action: Confirm colonoscopy is current. Retest in 3 months. Discuss with doctor.

III. Areas of Opportunity (Positive Trends)

HDL at 80 mg/dL — remarkable jump. Trig:HDL ratio of 0.70 is metabolically elite.
LDL-P at 574 — below 20th percentile. The rosuvastatin + ezetimibe is crushing particle number.
hs-CRP at 0.29 — near-zero systemic inflammation. Your anti-inflammatory stack is working.
Homocysteine trending down (10.3 → 9.1) — methylation protocol is effective.
Glutathione improving (229 → 255) — Nrf2 upregulation working, just slowly.
Ferritin normalizing (313 → 230) — beef organ reduction achieved the goal.
Liver enzymes improved — AST and ALT both back in range after prior elevation.
Platelets recovered (152 → 237) — whatever caused the dip has resolved.
Prolactin normalized (10.3 → 7.0).

IV. Supplement Stack Review & Recommendations

Keep Unchanged

Turmeric/Curcumin + Saffron — CRP at 0.29 validates this.
Magnesium L-Threonate (AM + PM) — Cognitive + recovery. Serum mag normal.
Omega-3 (Carlson 2g) — CV support. Contributing to HDL improvement.
Astaxanthin 10mg — Antioxidant layer. No reason to change.
5-MTHF 800µg — Working for homocysteine. Continue.
P-5-P 25mg — Paired with folate for methylation.
Broccoli Seed Extract (3 AM + 2 PM) — Glutathione improving. Continue.
Taurine 1g AM — Endothelial support. May be contributing to HDL surge.
Glycine 3g bedtime — Glutathione precursor + sleep.
NAC (500mg AM + 600mg PM) — Glutathione precursor. Continue.
Creatine 10g — Saturation dose. Cognitive + muscle.
Cadence Sleep — Working per your report.
Zinc Picolinate — Supports T and methylation. No excess on labs.

Recommended Changes

1. DIM 100mg → STOP (temporarily)

Rationale: Estradiol dropped to 19.0. DIM is adding estrogen clearance on top of anastrozole, creating over-suppression. Remove DIM first (it's the supplement lever), then reassess. If estradiol is still low after 4-6 weeks, reduce anastrozole dose.

2. Anastrozole 0.5mg Mon/Thu → Discuss with doctor reducing to 0.5mg Mon only OR 0.25mg Mon/Thu

Rationale: E2 at 19 is below the 20-40 target range. The combination of AI + DIM was too aggressive. Dropping DIM alone may be sufficient, but discuss the pharmaceutical dose with your prescribing physician.

3. Vitamin D3 10,000 IU → Consider switching formulation or adding emulsified/liquid D3

Rationale: 10k IU for 3+ months with only 2 ng/mL improvement suggests absorption issue. Confirm you're taking it with your fattiest meal. If compliance is solid, consider: liquid drops (better absorption in some individuals), or a short loading protocol of 50k IU/week for 8 weeks under physician guidance, then retest.

4. Beef Organ Tabs 1x/day → Every other day OR stop temporarily

Rationale: B12 at 1374 is well above target range despite reducing to 1x. Your meat-heavy diet provides ample B12, retinol, iron, and choline. The beef organ tab may be purely additive at this point. Trial 3-4x/week and retest.

5. CoQ10 200mg/day → Consider reducing to 100mg/day (AM only, drop PM dose)

Rationale: CoQ10 at 2.73 is above reference range. You have clear evidence of supraphysiologic levels. One dose maintains statin offset; the second may be unnecessary. This simplifies the stack.

6. Consider adding: TMG (Trimethylglycine/Betaine) 500mg

Rationale: Homocysteine at 9.1 is moving in the right direction but hasn't reached <8.0 target. TMG provides an alternative methylation pathway (BHMT) that could close the remaining gap. Previously declined to keep variables minimal — now that folate efficacy is confirmed, adding one targeted lever is reasonable.

7. Consider adding: Selenium 200µg (or 2 Brazil nuts/day consistently)

Rationale: Thyroid function is declining (T4 and T3 both down, TSH rising, TPO antibodies creeping up). Selenium is critical for thyroid peroxidase function and T4→T3 conversion. If you're not consistently eating Brazil nuts, a supplement or deliberate daily intake would support thyroid health.

8. Monitor but no change: Iodine intake

Rationale: TSH rising + T4 declining could reflect subclinical iodine insufficiency. Your protocol mentioned nori 1-2x/week — confirm this is actually happening. Iodine is essential for thyroid hormone synthesis.

V. Doctor Discussion Prep — Cardiovascular Panel

Key points to cover:

ApoB at 56 — still excellent. The rise from 45 to 56 may reflect non-fasting state. No medication changes needed. Rosuvastatin 10mg + ezetimibe 10mg is the right combination.
LDL-P at 574 — the most important number on this panel. This is particle number by NMR, and at 574 you're below the 20th percentile. Even among statin-treated populations, this is exceptional. LDL-P is a better predictor of cardiovascular events than LDL-C or even ApoB in some studies.
HDL at 80 — ask about significance. This is a major positive shift. ApoA-1 at 200 confirms excellent HDL functionality. High HDL in the context of low LDL-P and low CRP is strongly protective.
Lp(a) at 31.2 — genetically determined, no action needed. Well below the 75 nmol/L risk threshold.
Lp-PLA2 test failed — specimen deteriorated. Reorder on next draw. This is a vascular inflammation marker that would complement your CRP.
CEA at 4.5 — bring this up. Ask whether screening colonoscopy is due and whether retest is warranted.
Hematocrit at 51.3% — need their input on TRT management given the trend.
eGFR at 79 — discuss Cystatin C-based calculation given creatine supplementation and muscle mass.

VI. Three-Month Goals (March–June 2026)

Primary Targets

Goal	Current	Target by June	Intervention
Hematocrit	51.3%	<50%	TRT dose review, hydration, possible phlebotomy
Estradiol	19.0 pg/mL	25-35 pg/mL	Stop DIM, reduce anastrozole
Homocysteine	9.1 µmol/L	<8.0 µmol/L	Continue 5-MTHF 800µg + P-5-P. Consider TMG.
Vitamin D	49 ng/mL	60+ ng/mL	Formulation change or loading protocol
Glutathione	255 µg/mL	>300 µg/mL	Continue broccoli seed extract + NAC + glycine
MCV	101 fL	<98 fL	Reduce B12 load (cut beef organs), monitor thyroid

Secondary Targets

Goal	Current	Target	Intervention
Fasting Insulin	1.4 µIU/mL	>2.5 µIU/mL	Post-workout carb loading, bedtime protein+carb
Free T3	2.8 pg/mL	>3.2 pg/mL	Selenium, iodine, thyroid monitoring
B12	1374 pg/mL	<1000 pg/mL	Reduce beef organ frequency
CEA	4.5 ng/mL	<3.5 ng/mL	Retest to confirm (likely benign)

VII. Retest Plan

6-Week Retest (Early May 2026)

Focus: Safety markers after hormonal adjustments.

Hematocrit + CBC (TRT safety)
Estradiol (sensitive) — confirm recovery after stopping DIM / reducing AI
Free T3 + Free T4 + TSH (thyroid trend)

12-Week Retest (Mid-June 2026)

Focus: Full reassessment of all optimization targets.

Cardiovascular: ApoB, full lipid panel, Lp-PLA2 (reorder), hs-CRP — FASTING draw
Hematology: CBC with differential (hematocrit, MCV)
Metabolic: Fasting glucose, insulin, HbA1c, Cystatin C
Hormones: Total T (LC/MS), Free T, Estradiol (sensitive), SHBG, Free T3, Free T4, TSH, TPO Ab
Methylation/Oxidative: Homocysteine, glutathione (whole blood)
Vitamins: Vitamin D (25-OH), B12
Cancer Screening: CEA (retest)
Liver: AST, ALT, GGT
Kidney: Creatinine, BUN, Cystatin C-based eGFR

VIII. Summary of Action Items

Immediate (This Week)

Stop DIM 100mg — remove from morning stack
Schedule doctor call to discuss: hematocrit management, anastrozole dose reduction, CEA result, eGFR/Cystatin C interpretation
Confirm Vitamin D is being taken with fat-containing meal

Within 2 Weeks

Reduce beef organ tabs to every other day (or 3x/week)
Add selenium — either supplement 200µg or commit to 2 Brazil nuts daily
Consider CoQ10 reduction to 100mg/day (AM only)
Confirm iodine intake — nori or kelp consumption happening consistently?

Within 4 Weeks

Consider adding TMG 500mg if doctor approves, to accelerate homocysteine reduction
Evaluate Vitamin D formulation — if still taking capsules, trial liquid drops

At 6 Weeks

Draw interim labs (hematocrit, estradiol, thyroid panel)

At 12 Weeks

Full retest panel (see Retest Plan above)