September 21, 2026 Comprehensive Lab Analysis & 3-Month Plan
2026-10-02
Date of labs: September 21, 2026
Analysis date: October 2, 2026
Plan: October–December 2026
Comparisons: February 24 full panel, April 21 spot check, November 2025 lipids; other dates identified below.
Executive Summary
Your smaller supplement routine is holding up well. Roughly ten weeks after stopping everything except vitamin D, the major foundations remain strong: ApoB 61, LDL 60, triglycerides 55, hs-CRP 0.78, good glucose control, reassuring kidney function, and hematocrit back at 47%. There is no broad deterioration that argues for rebuilding the old stack.
The next quarter has four priorities: finish the TRT assessment, complete colorectal screening, confirm the homocysteine drift, and get the missing vitamin D result. The statin/ezetimibe combination continues to serve your highest-priority prevention goal. The main hormone question is whether 140 mg/week of testosterone and the remaining anastrozole are the right balance for how you feel and train. September cannot answer that because both testosterone tests failed.
For performance, creatine is the strongest supplement to reconsider. Most of the old stack can stay off. That fits your health approach: protect long-term function, support the biology with food and training, and use targeted interventions where they earn their place. Success in December means clear hormone data, screening handled, strong training and daily energy, and a routine that stays manageable.
Draw context: Fasting; light training in the preceding two days; a couple of glasses of water, no electrolytes. No reported symptoms. BP three days earlier: 127/84. Current regimen: testosterone 140 mg/week split twice weekly, HCG approximately 500 IU/week, anastrozole 0.5 mg Monday only, tadalafil 2.5 mg/day, rosuvastatin 10 mg/day, ezetimibe 10 mg/day, vitamin D3 2,000 IU/day. No other peptides or daily supplements.
I. Complete Biomarker Review
Cardiovascular: the medication strategy is working
| Marker | September 21 | February 24 | Assessment |
|---|---|---|---|
| ApoB | 61 mg/dL | 56 | Essentially at your personal <60 goal. Follow the trend. |
| LDL-C | 60 mg/dL | 70 | Improved. Strong control. |
| Non-HDL-C | 72 mg/dL | 81 | Improved; calculated from total minus HDL. |
| HDL-C | 73 mg/dL | 80 | Favorable. No need to chase the earlier high. |
| Triglycerides | 55 mg/dL | 56 | Excellent and stable. |
| Total cholesterol | 145 mg/dL | 161 | Lower, with favorable particle markers. |
| hs-CRP | 0.78 mg/L | 0.29 | Still below 1. No clear need for an anti-inflammatory supplement. |
| Lp-PLA2 activity | 98 nmol/min/mL | Test failed | Within the assay's 0–224 range. |
The important result is sustained low ApoB on unchanged medication. It is roughly half your earlier baseline around 120. The rise from 56 to 61 is small, while LDL and non-HDL improved. Keep rosuvastatin 10 mg and ezetimibe 10 mg; this draw does not make a case for stronger medication or another lipid supplement.
Your <60 ApoB target remains useful. If repeat readings stay above the agreed goal, test a modest food change: replace some butter/tallow or fattier meat with olive oil, fish, avocado or leaner protein. Preserve protein and training calories. There is no need to overhaul your food lifestyle over one point.
The CRP rise does not prove that removing curcumin or fish oil caused harm. Likewise, HDL 73 does not establish HDL function or cancel ApoB-related risk. Historical context remains favorable: Lp(a) 31.2 nmol/L in February; coronary calcium score 0 in October 2025. Calcium scoring does not exclude noncalcified plaque.
TRT, hormones and prostate: reassuring safety markers, unfinished dose assessment
| Marker | September 21 | February 24 | Assessment |
|---|---|---|---|
| Total testosterone | Not performed | 1,699 ng/dL | Repeat. February was above a physiologic replacement range. |
| Free testosterone | Not performed | >34.80 ng/dL | Repeat with the proper assay and comparable timing. |
| Sensitive estradiol | 20 pg/mL | 19 | In the lab range; below your personal 25–35 preference. |
| SHBG | 30.4 nmol/L | 42.1 | In range; useful alongside the missing T results. |
| PSA | 0.7 ng/mL | 0.7 | Stable. |
| DHEA-S | 238 µg/dL | 170 | In range. No case for DHEA. |
| Prolactin | 4.2 ng/mL | 7.0 | In range. |
| IGF-1 | 118 ng/mL | 137 | In the age-adjusted range. No reason here to add a GH peptide. |
| Morning cortisol | 14.1 µg/dL | 13.9 | Stable and in range; not a measure of overall recovery. |
The next useful adjustment may be simplifying estrogen suppression. DIM is already off and anastrozole is down to once weekly, yet E2 remains near February's level. Once total/free T are available, ask the prescriber whether anastrozole still treats a clear problem. Interpret E2 with libido, erections, joint comfort, mood and recovery; 20 alone does not establish deficiency.
The dose listed in the regimen cannot tell us your actual testosterone exposure. Record injection-to-draw timing and assess the current 140 mg/week before making a change. Replacement monitoring generally aims for physiologic exposure, with dose decisions based on symptoms and adverse effects as well as the number. TRT monitoring guidance
If fertility is an active goal, HCG use alone does not establish preserved fertility; semen testing answers that question more directly. If anastrozole remains a long-term prescription, include bone health in the review.
Hematology: a meaningful improvement from February
| Marker | September 21 | February 24 | Assessment |
|---|---|---|---|
| Hematocrit | 47.0% | 51.3 | Prior elevation resolved. |
| Hemoglobin | 15.7 g/dL | 16.4 | Normal. |
| MCV | 97 fL | 101 | At the lab's upper limit, no longer elevated. |
| WBC | 6.0 ×10³/µL | 4.4 | Normal; differential reassuring. |
| RBC | 4.85 ×10⁶/µL | 5.09 | Normal. |
| Platelets | 229 ×10³/µL | 237 | Normal and stable. |
| RDW | 12.1% | 14.1 | Normal. |
No current blood-count reason for donation or phlebotomy. Hematocrit had already improved in April, before the supplement pause. Keep monitoring it with TRT; the improvement does not establish that testosterone exposure is appropriate.
MCV is also better. High B12 is not an established cause of large red cells, so do not treat B12 reduction as the proven explanation. If MCV rises again, investigate the cause instead of automatically adding folate/B6.
Liver and statin tolerance: one small flag to resolve
| Marker | September 21 | February / April | Assessment |
|---|---|---|---|
| AST | 42 IU/L | 32 / 60 | Barely above the 40 upper limit; improved from April. |
| ALT | 27 IU/L | 30 / 65 | Normalized. |
| GGT | 29 IU/L | Not measured | Normal. |
| Total bilirubin | 0.8 mg/dL | 1.4 / 1.1 | Normalized. |
| Direct bilirubin | 0.27 mg/dL | 0.48 / 0.32 | Normalized. |
| Alkaline phosphatase | 74 IU/L | 71 / 68 | Normal. |
These results do not support stopping either lipid prescription. AST can come from muscle as well as liver. Training is a plausible contributor, but two light days do not settle the source. Repeat CMP with a one-time CK during a recovery period. If AST normalizes, close the issue; if it persists, review it with the clinician. There is no symptom-based case for routine CoQ10 at present. Exercise and enzyme elevations
Metabolic and kidney health: strong foundation for training
| Marker | September 21 | February 24 | Assessment |
|---|---|---|---|
| Fasting glucose | 85 mg/dL | 72 | Favorable. |
| HbA1c | 5.3% | 5.2 | Within your <5.4 preference; small change. |
| Fasting insulin | 2.2 µIU/mL | 1.4 | Low with normal glucose. No need to raise it artificially. |
| Creatinine | 1.06 mg/dL | 1.17 | Improved. |
| Creatinine eGFR | 88 mL/min/1.73 m² | 79 | Improved; muscle mass affects interpretation. |
| Cystatin C | 0.74 mg/L | 0.84 | Reassuring. |
| Combined eGFR | 106 mL/min/1.73 m² | Not reported | Reassuring filtration using both markers. |
| Urine albumin/creatinine | <11 mg/g | Not compared | No albuminuria signal. |
| BUN | 18 mg/dL | 18 | Stable. |
| Uric acid | 4.9 mg/dL | 5.1 | Favorable. |
Urinalysis was clear of protein, blood, glucose, ketones and infection markers. The combined kidney findings do not support a declining-kidney-function narrative. They also provide reassuring context if you restart creatine.
Keep carbohydrates and total energy matched to lifting and running. Insulin 2.2 does not diagnose inadequate muscle-building signals, and A1c 5.3 does not justify more carbohydrate restriction. Strength progression, actual food intake, recovery and body composition are the useful checks on your fueling.
Thyroid, nutrients and methylation: mostly stable without the stack
| Marker | September 21 | Earlier comparison | Assessment |
|---|---|---|---|
| TSH | 1.48 mIU/L | 1.98 February | Reassuring. |
| Free T4 | 1.36 ng/dL | 1.08 February | Improved. |
| Free T3 | 2.8 pg/mL | 2.8 February | Stable. |
| TPO antibodies | <9 IU/mL | 13 February | Both normal. |
| 25-OH vitamin D | Not performed | 49 ng/mL January | Repeat before changing 2,000 IU/day. |
| B12 | 1,162 pg/mL | 1,374 January | High-normal for this assay; no supplementation need shown. |
| Folate | >20 ng/mL | 19.4 October 2025 | Ample measured folate. |
| Homocysteine | 10.9 µmol/L | 9.1 February | Above your personal <8 preference; confirm. |
| Whole-blood glutathione | 241 µg/mL | 255 February | Both within the 176–323 range. |
| Magnesium | 2.1 mg/dL | 2.2 February | Normal. |
| Ferritin | 269 ng/mL | 230 February | Follow the trend; not iron overload by itself. |
| Iron / saturation | 80 µg/dL / 25% | 97 / 30% February | Adequate iron availability. |
Homocysteine is the clearest supplement-related yellow flag. The rise could relate to removing the methylation products, but the long interval between tests prevents assigning a cause. Repeat it fasting. If it persists, consider methylmalonic acid and B6/PLP with the clinician before choosing an intervention, especially given the earlier note of high B6.
Keep <8 as an optimization preference, with the tradeoff explicit: lowering homocysteine has not consistently improved cardiovascular outcomes. It should not outrank ApoB control or justify restoring three products at once. HOPE-2 trial
The thyroid results give selenium no clear job. T4 improved, TSH is lower, and antibodies remain normal. Glutathione also does not show a deficiency; the older target was built partly on a unit mismatch. There is no measured reason to restore the antioxidant stack.
Other chemistry is reassuring: potassium 4.3, CO2 24, calcium 9.5, total protein 6.9, albumin 4.8, globulin 2.1; TIBC 315 and UIBC 235. Sodium 131 and chloride 94 remain known physician-managed flags; sodium goal ≥135 mmol/L within the agreed normal range.
Cancer screening and blood pressure
CEA improved from 4.5 to 3.5 ng/mL, below the assay's nonsmoker cutoff. That closes the earlier borderline finding, but CEA cannot replace colorectal screening. At 45, scheduling a screening colonoscopy is a practical next step in your cancer-prevention plan. ACG screening guidance
BP 127/84 needs an average. Take two seated readings a minute apart, morning and evening for seven days, after five quiet minutes. A persistent diastolic average ≥80 belongs in the clinician discussion. Also confirm that the earlier AF episode and CT findings have had their planned follow-up. Lipid control does not answer those questions. Home BP measurement
II. Areas of Concern, Ranked by Priority
| Priority | Flag | What to do |
|---|---|---|
| 1. Incomplete TRT assessment | Total/free T missing; E2 20 on anastrozole | Complete a timed panel and review both prescriptions together. |
| 2. Colorectal screening | Prevention gap unless already current | Arrange the screening colonoscopy you decided to pursue. |
| 3. Homocysteine 10.9 | Up from 9.1; above personal target | Confirm before restarting methylation products. |
| 4. Missing vitamin D | Lower-dose routine remains untested | Obtain 25-OH D and set the maintenance dose from the result. |
| 5. AST 42 and BP 127/84 | Mild enzyme elevation; single diastolic reading above goal | Rested CMP/CK and a seven-day BP average. |
These are specific follow-ups. The panel does not reveal a broad failure of your current approach.
III. Areas of Opportunity
- Keep the cardiovascular win. ApoB remains near your ambitious goal without the old herbal/supplement stack.
- Resolve the hormone tradeoff. Better dose information and a clear reason for anastrozole matter more than adding hormone-support products.
- Support muscular development directly. Creatine has a stronger performance case than most of the removed supplements.
- Keep food doing the work. Preserve protein and training fuel; check actual fiber and calcium intake before adding products.
- Measure the life you want these labs to support. Track strength, running capacity, daily energy, sleep and libido alongside the numbers. Avoid adding a protocol that makes those worse without a compelling benefit.
IV. Supplement Review & Recommendations
Current routine remains vitamin D3 only. The changes below are recommendations, not changes already made to your regimen.
Keep
Vitamin D3, 2,000 IU/day with food. Complete the missing test first. A working discussion range around 30–50 ng/mL is reasonable; the personal target should account for bone health and the clinician's assessment. There is no demonstrated advantage here to chasing the old 70–75 goal with high doses. Vitamin D dose trial
Strongest restart candidate
Creatine monohydrate, 5 g/day after the baseline draw. It directly supports repeated high-intensity work and your muscle/strength goals. Use a quality-tested product, without a loading phase. Assess training output and tolerance over 8–12 weeks. Early water-related weight gain is not fat gain or entirely new muscle; note use when interpreting future creatinine. Keep to the existing hydration plan. Creatine evidence review
Conditional tools
| Supplement and original purpose | Recommendation |
|---|---|
| Psyllium: fiber and ApoB | Consider if food intake leaves a fiber gap or ApoB remains above goal. Start 3–5 g/day, assess tolerance, and separate from oral medications by at least two hours after checking with the pharmacist. Follow product fluid instructions. |
| Fish oil: cardiovascular/brain support | Stay off for now. Sardines/salmon may cover the need; an RBC Omega-3 Index could settle the question. Prior AF makes high-dose supplementation less attractive. |
| 5-MTHF, P-5-P, TMG: homocysteine | Hold pending repeat testing. Avoid empiric B6/B12. If a single-agent trial becomes justified, track homocysteine and ApoB together; TMG can affect lipids. |
| Magnesium glycinate, glycine, theanine: sleep/recovery | Reserve for a specific need and test one at a time. Better sleep or next-day function should justify continued use. |
| Curcumin/saffron: joints, mood, inflammation | Consider only for a defined symptom with a noticeable response. CRP 0.78 alone does not justify restarting. |
Psyllium has human trial evidence for modest lipid lowering, though your response on two lipid drugs may be smaller. Omega-3 decisions should account for the AF signal in supplementation trials. Psyllium meta-analysis, omega-3 and AF meta-analysis
Leave off
| Former supplement | Why it currently lacks a clear job |
|---|---|
| CoQ10 | No reported muscle symptoms; no need to supplement automatically because you take a statin. Revisit if symptoms emerge. |
| Selenium | Thyroid markers are reassuring without it. |
| NAC, broccoli extract, liposomal glutathione | Normal measured glutathione; no demonstrated benefit from restoring three overlapping products. |
| Magnesium L-threonate | No reported cognitive decline that warrants returning to twice-daily use. |
| Taurine | No established human longevity benefit or current problem requiring it. |
| K2 | No specific bone/nutrition indication established by this panel. |
| Seed synbiotic | No reported GI problem after stopping. |
| Astaxanthin | Optional skin preference; no lab-driven reason to restart. |
| Organ capsules, iron, zinc | No demonstrated need; iron and B12 supply are already ample. |
| DIM | Adds estrogen-directed intervention when E2 is already at the low end of your preference. |
| Berberine, ALA, red yeast rice, other lipid herbs | Glucose and lipid management are already strong; little rationale for overlap. |
| Chlorella/binders | No relevant exposure or clinical indication demonstrated here. |
No new daily longevity supplement earns a recommendation from this panel. The experiment supports keeping the baseline small, with creatine as the strongest performance add-back. It does not prove every removed product was useless or establish long-term nutrient adequacy after only ten weeks.
V. Doctor Discussion Prep
Bring the September report, fresh labs, current doses, injection times and home BP average. Focus the visit on:
- TRT exposure: Is 140 mg/week producing appropriate total/free T with good function and tolerable effects?
- Anastrozole: With E2 20, what ongoing problem requires it, and could the regimen be simplified under supervision?
- Lipid treatment: Preserve the current success; interpret repeat AST/CK before attributing the small enzyme flag to medication.
- Colonoscopy: Arrange referral and preparation. Give the GI team the medication list, AF history and existing electrolyte-management plan so they can choose the prep appropriately.
- Bone/fertility goals: Review dietary calcium and vitamin D; consider diagnostic bone-density assessment if indicated by continued aromatase inhibition. Use semen testing if fertility preservation is an active objective.
- Cardiac follow-up: Review the BP average and confirm the prior AF/CT follow-up is complete.
VI. Three-Month Goals: October–December 2026
Personal optimization goals below are distinct from laboratory limits or medication-intervention thresholds.
| Goal | Current | By year-end | Main action |
|---|---|---|---|
| TRT balance | T missing; E2 20 | Documented physiologic exposure, good function, clear AI decision | Timed draw and prescriber review |
| ApoB | 61 mg/dL | Sustain around your <60 goal | Maintain medications; act on a repeat trend |
| Hematocrit | 47% | Stay stable; personal watch point <51% | CBC monitoring; no donation indicated now |
| Vitamin D | Unknown on 2,000 IU | Measured sufficiency on a sustainable dose | Complete test; adjust only if needed |
| Homocysteine | 10.9 µmol/L | Confirm trend and resolve a cause if found; retain <8 as preference | Repeat first; targeted action if justified |
| Liver/muscle enzymes | AST 42 | Normalize or explain persistent elevation | Rested CMP/CK |
| Blood pressure | One reading, 127/84 | Reliable average; discuss ≥130/80, including diastolic ≥80 | Seven-day log |
| Cancer prevention | Screening status unresolved | Colonoscopy completed or firmly scheduled | GI referral |
| Performance and energy | Assess from actual training and daily experience | Progress without more routine burden | Adequate fuel, recovery, optional creatine trial |
VII. Retest Plan
Now: complete the draw and TRT renewal packet
The order-ready list is in [[2026-10-02-trt-retest-and-renewal-lab-request]] and in the Todoist task Order TRT follow-up labs.
- Hormones: total/free testosterone by LC/MS-MS/equilibrium dialysis, sensitive estradiol, SHBG.
- Monitoring: CBC with differential, CMP, total PSA.
- Outstanding questions: 25-OH vitamin D, lipid panel with ApoB, one-time CK, homocysteine.
This covers the principal renewal domains plus the specific September gaps. The clinic may accept September's PSA/lipids instead of repeating them. Its administrative requirements remain clinic-specific; the broader September endocrine, thyroid, kidney and metabolic results should accompany the new panel.
Collection: Keep the prescribed regimen stable. Use the clinic's injection timing; if none is specified, agree on a mid-interval sample and record testosterone, HCG and anastrozole timing. Fast overnight, avoid hard training for 48–72 hours, and follow the existing fluid plan. Tell the collection team testosterone and vitamin D failed for insufficient specimen last time. Detailed assay and timing instructions remain in the linked order document.
Six to eight weeks after any hormone change
Repeat total/free T, sensitive E2 and CBC, with other tests guided by the change. Use comparable injection timing. If treatment stays unchanged, follow the clinic's regular schedule rather than adding a draw automatically.
Late December: three-month review
- Core: CBC, CMP, lipid panel/ApoB, hs-CRP, HbA1c.
- Unresolved or treated markers: homocysteine; 25-OH D if dose changed or still uncertain; CK/GGT if enzymes remain abnormal.
- Trend checks: ferritin/iron saturation and B12 if their trends remain relevant; cystatin C/combined eGFR if creatinine changes or creatine complicates interpretation.
- Hormones: coordinate with the clinic's follow-up to avoid duplicate testing.
- Optional: RBC Omega-3 Index if the result would change the fish-oil decision.
No routine repeat CEA, glutathione or Lp-PLA2 is needed to judge this plan. Repeat thyroid testing for new symptoms or at the next broader interval rather than to chase a higher free T3.
VIII. Action Plan
This week
- Complete the ordered labs with documented dose timing.
- Start the seven-day BP log.
- Request the screening colonoscopy appointment.
- Keep medications and the vitamin D-only baseline stable pending results.
October, after results
- Review testosterone/anastrozole with the prescriber and settle the vitamin D plan.
- Decide whether to restart creatine at 5 g/day; keep other supplement changes separate.
- Resolve persistent AST or homocysteine findings with targeted follow-up.
November
- Complete the hormone recheck if a prescription changed.
- Assess any supplement trial against training output, sleep, energy and tolerance.
- Complete screening or confirm its scheduled date.
Late December
- Review the selected follow-up labs and the three-month goals.
- Keep only the interventions that have a clear purpose and useful results.
Records: [[2026-09-21-Comprehensive Labs.pdf]], [[2026-02-24-Comprehensive Blood Tests.pdf]], [[2026-04-21-Spot Check Labs.pdf]], [[2025-11-23-Lipid Panel Bloodwork.pdf]], January 22 vitamin D/B12 report, October 2025 calcium CT, and Zach's October 2 clarifications. Interpretation follows [[How I Approach Health]], [[Health Pillars]], [[Health Operating System]], [[Current Supplements]] and [[Current Peptide-TRT-Performance Regimen]]. Prescription changes belong with the treating clinician.