28 Y/O. Help With Labs, How to Proceed?

Pharma / TRT Testosterone Replacement
1

Hello Everybody. This is a quest for help I never thought I would be on. Small amount of background: I’ve was always the fat kid, coming into adult hood I was 327lbs, massively out of shape. I had a motorcycle wreck at age 21, fractured some vertebrae, suffered some brain trauma & nerve damage. I came out of that well, but couldn’t climb a flight of stairs without being out of breath and nauseous.

A friend of mine got me motivated and helped me discover lifting. Overall I feel that he saved my life. I dropped to 239lbs from 330lbs+ @ 6’0’’ tall. Put on a huge amount of muscle and looked and felt great. I lifted for 3 years, getting healthier, and improving numbers. I was going hard and loved it. I loved how I looked, felt and loved life.

Sometime in December 2016 - Jan 17’ something happened. I had no energy, i was an emotional mess, i started having what I now realize was problems with Anxiety (like having a shaky voice and hands and emotionally free falling while leading a team at work). I would get to the gym and be so anxious that i could barely lift. My strength plummeted, as well as my libido, energy and i felt awful.

So I scheduled an appointment with a new DR. (Because I had moved states previous to the issues). I described my symptoms, which included anxiety, mild depression, ED, Libido Issues, No Energy and Mood Issues. I was happy she wanted to look at any physiological causes instead of just writing me anxiety or depression meds. She did a full CBC with a testosterone test. I will post those below these were performed at around 12PM EST and NOT FASTED (She said that would skew the Cholesterol portion). My question is the Total T and Free T numbers appear to be on the low-end of that spectrum while everything else is mid-level or slightly elevated.

I understand where my BMI is, the effect weight has on testosterone and well-being but I was at a much healthier BMI & Exercise level when this all started. I trust Dr’s but I also pride myself on at least attempting to be educated about my health. I handle stress and trauma well, and actually used lifting as a coping mechanism/stress relief instead of drinking or other stuff. I miss the way I use to feel. My question is, is that T-level low for a 28 year old whom had a mostly healthy lifestyle prior to these issues?

Height 72 in
BMI 40

Chem Profiles:
Sodium-Na: 142 mEq/L (134 mEq/L - 144 mEq/L)
Potassium-K: 5.0 mEq/L (3.5 mEq/L - 5.3 mEq/L)
Chloride-Cl: 100 mEq/L (98 mEq/L - 109 mEq/L )
CO2: 30 mEq/L (20 mEq/L - 32 mEq/L )
BUN: 12 mg/dL (7 mg/dL - 25 mg/dL )
Creatinine: 0.84 mg/dL (.76 mg/dL - 1.27 mg/dL )
Glucose Level: 95 mg/dL (70 mg/dL - 99 mg/dL)
Calcium-Ca: : 9.6 mg/dL (8.7 mg/dL - 10.3 mg/dL )
Albumin: 4.9 g/dL (3.5 g/dL - 5.2 g/dL)
Total Protein: 7.3 g/dL (6.0 g/dL - 8.5 g/dL)
Total Bili: 0.8 mg/dL (0.0 mg/dL - 1.2 mg/dL)
Alk Phosphatase: 91 units/L (25 units/L - 150 units/L)
SGOT AST: 18 units/L (5 units/L - 34 units/L)
SGPT ALT: 30 units/L (0 units/L - 55 units/L)

Lipids (Not fast, I had breakfast & lunch before the draw, was unscheduled)
Cholestorol: 203 mg/dL (100mg/dL - 199 mg/dL)
HDL Cholesterol: 50 mg/dL ( >40 mg/dL )
LDL Cholesterol: 136 mg/dL (<100 mg/dL)
Triglycerides: 87 mg/dL ( 0 mg/dL - 150 mg/ dL)
VLDL Calc: 17 mg/dL (5 mg/dL - 40 mg/dL)
LDL/HDL Ratio: 2.7 Ratio (0.0 - 3.6 Ratio)

Calc Values /Osm
BUN / Creat Ratio: 14 Ratio (8 Ratio - 27 Ratio)
GFR - Nonblack Race: 109 GFR ( > 59 GFR )
GFR - Black Race: 132 GFR (>59 GFR)
Globulin, Total: 2.4 g/DL (1.5 g/dL - 4.5 g/dL)

CBC
Hemoglobin: 15.4 g/dL (12.6 g/dL - 17.7 g/dL)
Hematocrit: 47.9% (37.5% - 51% )
WBC : 8.4 x 10-3 (4.0x10-3 - 10.5 x 10-3)
Platelet: 278x10-3 (140x10-3 - 415x10-3)
Neut% : 66.0% (37% - 80%)
Lymph%: 23% (10% - 50%)
Mono%: 7% (0 - 12%)
Eos%: 4.0% (0 - 7.0%)
Baso%: 0% (0% - 2.5%)
Imm Gran %: 0.0%
Neut Ct: 5.6x10-3 (1.8x10-3 - 7.8 x10-3)
Lymph Ct: 1.9x10-3 (0.7x10-3 - 4.5x10-3)
Mono Ct: 0.6x10-3 (0.1x10-3 - 1.0x10-3)
EOS Ct: 0.3 x 10-3 (0.0x10-3 - 0.4x10-3)
Baso Ct: 0.0x10-3 (0.0x10-3 - 0.2x10-3)
Imm Gran Ct: 0.0x10-3
MCV 91.0 fL (79 fL - 97fL)
MPV 11.0 fL (7 fL - 10fL )
RDW: 13% (12.3 - 15.4%)
MCH: 29.2 pg (26.6 pg - 33 pg)
MCHC: 32.2 g/dL (31.5 g/dL - 35.7 g/dL)
RBC: 5.27x10-6 (4.14x10-6 - 5.80 x10-6)
Nucleated RBC’s: 0.0x10-3

OTHER HEMO
Vitamin B12: 897 pg/mL (213 pg/mL - 816 pg/mL)

ENDOCRINE:
25-OH Vit D: 20.4 ng/mL (30 ng/mL - 100 ng/mL)
T4 Free: 1.12 ng/dL (.82 ng/dL - 1.77 ng/dL)
Testo-Free: 10.6 pg/mL (9.3 pg/mL - 26.5 pg/mL)
Testosterone, Total: 315 ng/dL (264 ng/dL - 916 ng/dL)

2

You can live a healthy lifestyle all you want and you will still find it’s not enough, reason is we all live in a toxic wasteland filled with noxious chemicals, food preservatives and drink out of PCB plastic bottles. All of these bombard our endocrine systems, then doctors create these normal ranges collected from sick, obese people who live unhealthy lifestyles. To an inexperienced doctor they will always chase the numbers ignoring your symptoms because they have little experience diagnosing low testosterone, most endo’s out there are clueless about how to diagnose and treat low testosterone. You asked if your low T, our president who is 71 years old has higher testosterone levels (441 ng/dL) than a 28 year old young man. This puts things into perspective doesn’t it?

No SHBG tested, this is a big red flag you’re dealing with a clueless doctor, sex hormone binding globulin is the foundation of all your sex hormones and regulates your free testosterone and it was ignored! Your current doctor will unlikely be able to help you if she doesn’t understand the relationship of SHBG, epic failure! A lot of guys that end up here also have undiagnosed thyroid issues that go untreated, if your thyroid is lagging behind TRT won’t do anything for you and could even make you feel worse.

https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/

4

Holy shit… yes it does. Honestly, I googled around, looked and was actually terrified of that answer. I have spent quit a bit of time avoiding Dr’s , prescriptions and up to this point I have been healthy and happy (or at least happy with no interruption to quality of life). The idea that something may not be right actually is very unpleasant.

5

I really appreciate the information. I am going to do some reading and try to remember as much as I can. The big idea was to try an get a litmus of if I should ask questions regarding test levels. This was the first time I have seen her, and the Test lab was her suggestion tacked on near the end of the visit. I will raise test lab numbers, SHBG and thyroid issues with her when I go back in a week and see her. I have no issues changing Dr’s, honestly whatever it takes to go back to feeling like I used to. This has been about the 6 shittiest months in my life.

6

Coming back to update this post. Hopefully this help someone a little later, or at least won’t be such a dead end if someone happens upon it.

I went back to the PCP to review the bloodwork. First red-flag was she high-lighted the T-levels on her labs prior to the appointment, then proceeded to gloss over it when reviewing the bloodwork. (She handed me her copy to look at while we were talking). When I raised the question if “that was optimal levels for a male my age”, she said “I wouldn’t worry about it”.

Second red flag was, directly after glossing over that value, she wrote a prescription for an SSRI or Depression medicine. (I had thoroughly explained that I had some depression feelings, but it was mostly due to the issues I was having and loss of energy, passion and progress I had made in my fitness journey.

After some coercing (and really mean looks from her) she gave me a referral to a urologist.

When I met the urologist, they seemed WAAAY more genuinely concerned with my symptoms and well being. We discussed what I had been dealing with, how it’s impacted my life and they immediately did lab work following the appointment (About 8:00AM EST).

These results came back via Electronic Records, I am going soon to discuss.

LH - 4.4 mIU/ML Reference: 1.7 - 8.6
FSH - 3.2 mIU/ML Reference: 1.5 - 12.4
Testosterone, Serum - 260 ng/dL Reference: 264 - 916 LOW

I will update soon with what is being done (if anything, it’s beginning to feel hopeless after a few months of waiting on appointments, lab results, etc).