April 21, 2026 Spot Check Lab Analysis
2026-04-21
Date of Labs: April 21, 2026 Analysis Date: April 29, 2026 Previous Comparison: February 24, 2026 (full panel) Purpose: 6-week interim retest of safety markers and hormonal adjustments per Feb 24 plan Ordering Physician: A. Oshun (Call on Doctor)
Executive Summary
This was a targeted 6-week safety/recovery panel after the Feb 24 plan triggered hormonal and supplement changes. Three of the six tracked markers are clear wins: hematocrit pulled back from 51.3% to 46.4% (resolving the TRT safety flag), MCV dropped to 96 (in range for the first time in this entire arc, validating the beef organ removal), and bilirubin total + direct both normalized. Estradiol partially recovered (19.0 → 22.3) — out of the over-suppression zone but still beneath the 25–35 sweet spot, suggesting one more anastrozole adjustment is warranted. Thyroid is unchanged — Free T4 and Free T3 still drifting in the lower third of range, though selenium has only been on board for ~5 weeks. The new finding is AST 60 / ALT 65, both above range — almost certainly explained by a 10-mile run the day before the draw plus 10g/day creatine, but warrants a rested confirmation.
I. What We Wanted vs. What We Got
| Marker | Feb 24 | Apr 21 | Target | Verdict |
|---|---|---|---|---|
| Hematocrit | 51.3% (HIGH) | 46.4% | <50% | ✅ Hit target. Strong response. |
| Hemoglobin | 16.4 | 15.5 | — | ✅ Pulled back proportionally. |
| MCV | 101 (HIGH) | 96 | <98 | ✅ In range first time in this arc. |
| Estradiol (sens.) | 19.0 | 22.3 | 25–35 | ⚠️ Partial recovery. Still below target. |
| Free T4 | 1.08 | 0.99 | mid-range | ⚠️ Still drifting (lower third). |
| Free T3 | 2.8 | 2.7 | >3.2 | ⚠️ Functionally flat. |
| TSH | 1.98 | 1.61 | — | 🤔 Came down despite low T4/T3. |
| Bilirubin Total | 1.4 (HIGH) | 1.1 | <1.2 | ✅ Back in range. |
| Bilirubin Direct | 0.48 (HIGH) | 0.32 | <0.40 | ✅ Back in range. |
| AST | 32 (in range) | 60 HIGH | <40 | 🚨 New flag. Likely exercise-induced. |
| ALT | 30 (in range) | 65 HIGH | <44 | 🚨 New flag. Likely exercise-induced. |
II. The Three Wins
Hematocrit: 51.3 → 46.4
The single most actionable safety flag from Feb 24 is fully resolved. Trajectory was concerning (44.9 → 46.5 → 49.0 → 51.3), and a single draw shows it back into the comfortable middle of the range. No phlebotomy required, no TRT dose change visible in the supplement file. Likely some combination of: hydration improvement, normal regression toward the mean, and the cumulative effect of letting things settle. This buys runway on TRT management — but the cycle of creep should be watched at June 15.
MCV: 101 → 96
This is the first in-range MCV reading in the entire saga. The hypothesis from Feb 24 was that B12 oversaturation (1374 pg/mL) was the driver, not folate/B6 deficiency. Removing the beef organ tabs entirely on 3/14 was the intervention. Six weeks later, MCV is at 96 — a 5-point drop. This validates the read. The corollary: B12 should retest meaningfully lower at June 15 (target <1000). If it does, the methylation/macrocytosis work is essentially done.
Bilirubin: Total 1.4 → 1.1, Direct 0.48 → 0.32
Both back in range. Consistent with the Gilbert's-syndrome-plus-noise interpretation. Notable because if the AST/ALT spike were structural hepatocellular injury, conjugated bilirubin would typically drift up, not normalize. The direction here is mildly reassuring on the liver question.
III. The Three Open Items
Estradiol 22.3 — Partial Recovery
The DIM stop on 3/14 moved E2 from 19.0 → 22.3. That's a recovery of roughly half the gap to the 25–35 target. The plan from Feb 24 was: stop DIM first (the supplement lever), reassess, then reduce anastrozole if needed. We're now at the "reassess" gate. The question for Dr. Oshun is whether to make the anastrozole adjustment now or wait for the June 15 panel.
Argument for adjusting now: E2 at 22.3 is still beneath the optimization sweet spot. The risks of sustained low E2 (joint, bone density, lipids, mood, cognition) accrue over time. AI dose changes have a fast feedback loop (~2–3 weeks to steady state), so making the change now means the June 15 panel reads the new equilibrium.
Argument for waiting: Trend is in the right direction. One more six-week observation window costs little, isolates the DIM-stop as a clean variable, and the June panel will read the natural drift.
Recommendation: discuss reducing anastrozole to 0.25mg Mon/Thu or 0.5mg Mon-only with Dr. Oshun. The DIM-only intervention has done its work; the next move is the pharmaceutical lever.
Thyroid — Same Picture, Different Numbers
Free T4 ticked down again (1.08 → 0.99). Free T3 essentially flat (2.8 → 2.7). The mildly interesting wrinkle is TSH coming down (1.98 → 1.61) — that's not the pattern of a pituitary asking for more thyroid output. Three plausible reads:
- Selenium is starting to work. It was added 3/14, so this draw catches the first ~5 weeks of selenium support. Selenium primarily supports T4→T3 conversion via deiodinase, not T4 production. The pattern (TSH down, T4 still low, T3 still low) doesn't strongly fit this — but it's only 5 weeks in.
- Feb 24 TSH was a transient bump. The 1.59 → 1.98 → 1.61 trajectory across Oct/Feb/Apr is well within normal HPT-axis variability.
- Subclinical decline has stabilized at a new lower set point. T4 hovering ~1.0 and T3 ~2.7 — neither pathological, neither optimal.
Action: hold the line until June 15. Selenium needs more runway. If thyroid is unchanged at the 12-week panel, that's the conversation about iodine status, TPO antibody trend, and possibly a more thorough thyroid workup.
AST 60 / ALT 65 — Almost Certainly Exercise + Creatine
Both walked from comfortably in range to ~1.5x ULN. The AST:ALT ratio of ~0.92 doesn't fit alcoholic injury (you don't drink) and doesn't cleanly fit pure muscle leak (which usually has AST disproportionately high vs ALT).
What it does fit: a heavy endurance session within the 24-hour window of the draw. A 10-mile run the day prior, layered on top of 10g/day creatine, is a textbook setup for transient AST + ALT elevation in athletes. Both enzymes leak from skeletal muscle (not just liver), and creatine supplementation is well-documented to elevate baseline serum creatinine and contribute to mild, persistent transaminase elevation. The pattern of elevation here (both up, both ~1.5x ULN, ratio near 1, bilirubin direction normalizing, no GGT to confirm) is consistent with that read.
Less likely but possible:
- TMG at 500mg/day — added 3/14. TMG is not commonly hepatotoxic but in rare cases can elevate ALT.
- Selenium at 200mcg/day — clean tolerability profile, very unlikely culprit.
- Liposomal glutathione added 4/2 — no known hepatotoxicity.
- Statin/ezetimibe — unchanged from Feb 24 when liver enzymes were normal, so unlikely the cause of a new spike.
Action: Confirm at June 15 with the draw protocoled to be fasting + rested (no heavy training 48–72 hours prior). If AST/ALT normalize on a rested draw, the question is closed. If they stay elevated rested, that's a real workup conversation (GGT, abdominal ultrasound, hep panel, etc.).
IV. Supplement Stack Variables Active Since Feb 24
For interpretation context — these are all the changes between the Feb 24 panel and the Apr 21 panel:
| Date | Change | Driver |
|---|---|---|
| 3/14 | Removed DIM | E2 over-suppression |
| 3/14 | Removed beef organ tabs | B12 oversaturation, MCV |
| 3/14 | CoQ10 2x → 1x | Supraphysiologic at 2.73 µg/mL |
| 3/14 | Vitamin D3 reformulated to NatureWise softgels, split AM/PM | Failed absorption |
| 3/14 | Added K2 MK-7 standalone | Replacement for combined D3+K2 |
| 3/14 | Added TMG 500mg | Homocysteine still 9.1 |
| 3/14 | Added Selenium 200mcg | Thyroid drift |
| 4/2 | Added Liposomal Glutathione | Glutathione 255, Nrf2 alone too slow |
| 4/3 | Added Seed Synbiotic | Gut foundation |
| 4/3 | Removed Zinc Picolinate | Diet covers it |
Variables to watch for cleanly attributing future changes:
- Glutathione at June 15: combined Nrf2 + exogenous test
- Homocysteine at June 15: TMG efficacy test
- Vitamin D at June 15: reformulation + split-dose absorption test
- B12 at June 15: confirmation of MCV normalization mechanism
V. June 15 12-Week Panel — Recommendations
The full retest is on the calendar. The original Feb 24 plan covered the bulk of what's needed. Two recommended additions / protocol notes based on this Apr 21 draw:
Add to panel:
- GGT — to triangulate AST/ALT. If AST and ALT normalize and GGT is also normal, the exercise-induced read is fully confirmed.
- B12 — to confirm beef-organ-removal mechanism for MCV normalization.
- Ferritin — useful liver context if AST/ALT are still elevated.
Confirm on panel (already in Feb 24 plan):
- ApoB, full lipid panel, hs-CRP, Lp-PLA2 (reorder — specimen failed last time)
- CBC with differential
- Fasting glucose, insulin, HbA1c, Cystatin C (for muscle-adjusted eGFR)
- Total T (LC/MS), Free T, Estradiol (sensitive), SHBG, Free T3/T4, TSH, TPO Ab
- Homocysteine, glutathione (whole blood)
- Vitamin D 25-OH
- CEA retest (for the borderline 4.5 from Feb)
- AST, ALT, GGT, bilirubin
- Creatinine, BUN
Draw protocol:
- Fasting (Feb 24 was non-fasting and confounded ApoB read)
- Rested — no heavy training 48–72hr prior to remove the AST/ALT confound
- Schedule the draw on a Mon AM after a planned light Sat + full Sun rest day if possible
VI. Near-Term Actionable Items (Before June 15)
This Week
- Send these results to Dr. Oshun with a note flagging:
- Confirm hematocrit recovery acceptable (no TRT dose action needed)
- Discuss anastrozole reduction now vs. waiting for June 15 (recommendation: 0.25mg Mon/Thu or 0.5mg Mon-only)
- Note AST/ALT and the 10-mile run context — get his read on rested confirmation timing
Within 2 Weeks
- If Dr. Oshun approves anastrozole reduction, implement and log in the change log. The dose change reaches steady state in ~2–3 weeks, so a 4–5 week runway before June 15 is sufficient.
Standing
- Hold all current supplements stable through June 15 to keep variables clean. Specifically: do not add or remove anything new between now and the next draw, even if tempted, so the 12-week panel reads the full effect of TMG, selenium, liposomal glutathione, and the D3 reformulation.
June 13–15 (Draw Prep)
- Pre-draw protocol:
- 12+ hour fast
- 48–72 hours of light/rest training (no long runs, no heavy lifts)
- Solid hydration the day before
- AM draw if possible (cortisol, testosterone diurnal pattern)
- Confirm full panel order with Dr. Oshun ahead of time including the additions noted in Section V.
VII. Open Questions for Dr. Oshun
- Anastrozole reduction timing — make the change now (favored) vs. wait for June 15 to read DIM-stop in isolation?
- Hematocrit follow-up cadence — given the recovery, is a single 12-week confirmation sufficient or does he want more frequent monitoring?
- AST/ALT — comfortable with the exercise-induced read pending rested confirmation at June 15, or does he want an interim rested draw sooner?
- CEA timing — original plan was retest at 12 weeks. Still on track, or any change given the rest of the panel?
Companion analysis to 2026-02-24 Lab Analysis & 3-Month Plan.md. All medication changes pending physician approval.