50 Yr Old - Test Levels & Optimization

Pharma / TRT Testosterone Replacement
1

Hello,

thanks for some excellent reading.

I’d like to see what you guys think of my recent testosterone blood test results.

I’ve been experiencing symptoms of low testosterone for, probably, the last 5 years. I score high on all symptoms (subjective, I know). It was only suggested to me that low test might be the problem about a year ago, and finally I went for a blood test and consultation this week with a men’s health specialist (private in the UK).

The test results were surprising - I scored 21.5 at the age of 51. Which means I’m slightly higher than the ‘normal’ charts say I should be, for a man of my age. Despite this, after a full assessment of my symptoms, the dr suggested I try testosterone supplementation just to see if it improved things, which I agreed to.

The main symptom affecting me is fatigue and brain fog. But the others line up behind.

I’ve been prescribed Tostran 2% gel, 1 squirt a day (0.5g = 10mg) applied to my scrotum each morning. With the goal of moving me up towards a testosterone level of 30.

I’m 51 years, 6’2" tall, 113kg, no family history of any ‘notable’ health issues and none personally either. I’ve been fortunate in my life: apart from this I am, and always have been, in good health. My GP hardly knows me.

I had a cold for the week prior to the blood test which, apparently, shows up in it somewhere.

I asked the dr - since my test levels are fine, is there any other explanation for my symptoms? He didn’t really answer that one. I wonder if you guys could?

NAME: LEVEL: MEASURE: HI/LOW* LAB RANGE:
Direct Bilirubin 7.000 umol/L High 0.0 - 8.6
Follicle Stimulating H. (FSH) 2.500 mIU/mL Low 0.95 - 11.95
Luteinising Hormone 2.000 mIU/mL Low 1.14 - 8.75
Oestradiol 122.000 pmol/L High 40 - 160
Testosterone 21.500 nmol/L Med 9.00 - 30.00
Sex Hormone Binding Globulin 25.000 nmol/L Low 18 - 50
Free Androgen Index 86.000 Med 25 - 130

Sodium 139.000 mmol/L Med 135 - 145
Potassium 4.400 mmol/L Med 3.5 - 5.3
Urea 4.800 mmol/L Med 2.5 - 7.8
Creatinine 82.000 umol/L Med 64 - 104
Uric Acid 0.350 mmol/L High 0.21 - 0.42
Calcium 2.500 mmol/L High 2.23 - 2.50
Magnesium 0.900 mmol/L High 0.7 - 1.0
Phosphate 1.000 mmol/L Low 0.8 - 1.5
Albumin 42.000 g/L Med 35 - 50
Total Protein 79.000 g/L High 60 - 80
Globulin 37.000 g/L V High 25 - 30
Total Bilirubin 18.900 umol/L High 1.0 - 21.0
Lactate dehydrogenase (LDH) 123.000 IU/L V Low 125 - 243
Alanine aminotransferase (ALT) 28.000 IU/L Med 0 - 55
Aspartate aminotransferase (AST) 41.000 IU/L High 5 - 45
y-Glutamyl transferase (GGT) 32.000 IU/L Med 12 - 64
Alkaline phosphatase (ALP) 84.000 U/L Med 30 - 150
Cholesterol 4.530 mmol/L
HDL-Cholesterol 1.550 mmol/L
LDL-Cholesterol 2.240 mmol/L
Cholesterol / HDL Ratio 2.920 Med 0 - 5.0
Triglyceride 1.620 mmol/L High 0.10 - 2.0
Glucose 6.000 mmol/L High 3.9 - 6.0
Iron 40.800 umol/L V High 8.0 - 26.0
Prostate Specific Ag. (PSA) 0.500 ng/mL Low 0.0 - 4.0
Free PSA 0.100 ng/mL V Low 0.15 - 0.50
Thyroid Stimulating H. (TSH) 3.720 uIU/mL High 0.35 - 4.94

Haematology

Haemoglobin 163.000 g/L Med 135 - 180
Red blood cells 5.050 X 10^12/L Med 4.5 - 5.5
Haematocrit 0.455 Med 0.40 - 0.50
MCV 90.000 fL Med 80 - 100
MCH 32.300 pg V High 27.0 - 32.0
MCHC 359.000 g/L High 310 - 360
RDW 11.800 % Low 10.9 - 15.7
White Blood Cells 7.100 X 10^9/L Med 4.0 - 11.0
Neutrophils 4.100 X 10^9/L 2.0 - 7.5
Lymphocytes 2.200 X 10^9/L 1.5 - 4.0
Monocytes 0.490 X 10^9/L 0.4 - 1.0
Eosinophils 0.200 X 10^9/L 0.04 - 0.40
Basophils 0.080 X 10^9/L 0 - 0.10
Platelets 379.000 X 10^9/L High 150 - 400
MPV 6.800
ESR 27.000 mm/hour V High 1 - 12

HI/LOW = in the report, there is a column which seems to corresond to a high/low range. It has 5 different indicators: (—) (–) (--) (–) (—) which I have interpreted as meaning v low, low, med, high, v high.

EDIT: I added a bunch of tabs in there to make it easier to read but the forum seems to have subtracted them and squashed it all together.

2

Can’t [easily] work without lab ranges. Please use the [edit in corner] to alter the post above.

TSH is high, should be closer to 1.0, the ranges are useless

Need these labs: - you have some now
TT
FT
E2
LH /FSH
TSH
fT3
fT4 [please not T3, T4]

Read these stickies: - a lot of reading

  • advice for new guys
  • thyroid basics
  • protocol for injections

Back to thyroid:

  • have you always used iodized salt? -otherwise could be deficient
  • check your oral body temps and post in C/F
    – when you first wake up
    – mid-afternoon

I think that your thyroid state may block transdermal T and then you must inject.
Alcohol in T-gel may sting scrotum, worse if you have to shave off hair to get that done.

3

First, thanks for your reply and thank you for your help.

[quote]KSman wrote:
Can’t [easily] work without lab ranges. Please use the [edit in corner] to alter the post above.[/quote]

I’ve added the remainder of the readings, does that provide what’s necessary?

Which one is TSH?

[quote]KSman wrote:Need these labs: - you have some now
TT
FT
E2
LH /FSH
TSH
fT3
fT4 [please not T3, T4][/quote]

Everything in my reports is in my post now. What are these?
The only other thing I have is my urine test results but that doesn’t contain anything much.

[quote]KSman wrote:Read these stickies: - a lot of reading

  • advice for new guys
  • thyroid basics
  • protocol for injections[/quote]

Thanks, I’ve read through those.

[quote]KSman wrote:Back to thyroid:

  • have you always used iodized salt? -otherwise could be deficient
  • check your oral body temps and post in C/F
    – when you first wake up
    – mid-afternoon

I think that your thyroid state may block transdermal T and then you must inject.
Alcohol in T-gel may sting scrotum, worse if you have to shave off hair to get that done.
[/quote]

As for Thyroid, I don’t ‘think’ that’s an issue.
From what I read in the thyroid post I don’t recognise any of those issues. As for temperature, I get hot quickly. I break into a sweat within 50 yards at walking pace no matter what the temperature. I’m more usually hot at night than cold and often wake with sweat drenching my pillow and anything touching my neck/upper chest.

In general I don’t add salt to anything. Most of the time I don’t even own any. Although I do have a packet of sea salt in the cupboard at home I don’t remember the last time I used it. When I’m working out I try to remember to add it, but haven’t been much lately. Probably my main salt intake is from processed foods, though.

I used the gel for the first time this morning, so this is early days.

The DR also offered a ‘new pill’ which was still in testing phase (as I understood him). He said it did something to stop the brain from negatively affecting test production, or something, and therefore didn’t affect fertility.

I know I’m 51, but I haven’t totally ruled out having a child so the infertility thing is a bit of a concern - the DR said not to worry too much about it, though.

I wonder if it’s worth having a fertility test now, just to see where I stand at the moment. What do you think? Is it too late already as I’ve already started using the gel (for one day).

4

TSH: Thyroid Stimulating H. (TSH) 3.720 uIU/mL High 0.35 - 4.94

Check your temperatures, sweating can be an unrelated issue. Same for night sweats… did you tell your doctor about that?
You sound like you should be iodine deficient.
There is no iodine in sea salt.
Prepared foods typically do not use iodized salt.

Please do not tell me what you think about your thyroid. There is a process here.

You gave secondary hypogonadism, low LH/FSH and low T. At your age, it is assumed that this is typical age related decline.

TRT will shut off LH/FSH completely and that will mostly make your testes become small and threaten fertility. At your age, you have a greater risk of birth defects. So think about that. hCG injections will preserver your testes. Doctor may be talking about pills, SERMs, clomid or nolvadex. Those will increase LH/FSH if the hypothalamus and pituitary are able, then you don’t need hCG. hCG is an natural human hormone, SERMs are not and they can have some issues. So you can try either.

Your E2,estradiol, is too high and is partly responsible for your low LH/FSH.

Oestradiol 122.000 pmol/L High 40 - 160
Should be closer to 80 pmol/L. With TRT it can only get worse.

Transdermal T, creams and gels.
Absorption is typically 10% at best. You need 10mg absorbed per day and that means that you have to apply 100mg/day. What you are doing seems trivial. You cannot apply 100mg to your scrotum. I have serious doubts about your doctor. Again, with your high TSH, you may not absorb T.

Were you using the T-gel for the labs that you posted? T seems too high for low LH/FSH. If on TRT, dose is tiny and LH/FSH are not repressed. You need to understand that you cannot just add a little T to increase your levels as your body then reduces your production. If you have labs from before TRT, please post TT, FT, LH, FSH, E2

5

Thanks again for posting.
I sincerely appreciate the time and consideration you have given me.

[quote]KSman wrote:
TSH: Thyroid Stimulating H. (TSH) 3.720 uIU/mL High 0.35 - 4.94

Check your temperatures, sweating can be an unrelated issue. Same for night sweats… did you tell your doctor about that?
You sound like you should be iodine deficient.
There is no iodine in sea salt.
Prepared foods typically do not use iodized salt.

Please do not tell me what you think about your thyroid. There is a process here.

You gave secondary hypogonadism, low LH/FSH and low T. At your age, it is assumed that this is typical age related decline.

TRT will shut off LH/FSH completely and that will mostly make your testes become small and threaten fertility. At your age, you have a greater risk of birth defects. So think about that. hCG injections will preserver your testes. Doctor may be talking about pills, SERMs, clomid or nolvadex. Those will increase LH/FSH if the hypothalamus and pituitary are able, then you don’t need hCG. hCG is an natural human hormone, SERMs are not and they can have some issues. So you can try either.

Your E2,estradiol, is too high and is partly responsible for your low LH/FSH.

Oestradiol 122.000 pmol/L High 40 - 160
Should be closer to 80 pmol/L. With TRT it can only get worse.

Transdermal T, creams and gels.
Absorption is typically 10% at best. You need 10mg absorbed per day and that means that you have to apply 100mg/day. What you are doing seems trivial. You cannot apply 100mg to your scrotum. I have serious doubts about your doctor. Again, with your high TSH, you may not absorb T.[/quote]

The majority of this is new to me, so I’m going to take a bit of time trying to understand what you’ve written here, and in the stickies. Basically, I’ve followed advice, and I’ve consulted with a friend who has been through this exact same process and used this health center - to be honest, this is probably one of the only places in the UK where you can get this kind of consultation. My friend is younger than me and had lower test levels than me but was put on a similar level of gel and benefitted from it. So I suppose his absorption was better than 10%.

And yes, I did tell the DR about the sweating.

No, the results I have posted are from the blood test I had PRIOR to being prescribed the Tostran gel. So the results are an accurate depiction of my natural state.

This was the blood test requested by the specialist, so I assumed it would have everything you are referring to but it sounds like it doesn’t. If you are asking for more info, I have no more.

Based on what you are saying, I am seriously considering not continuing with the gel application just now. I applied it once - this morning. So if I don’t apply it again then I shouldn’t be too much affected by it. And if, as you say, only 10% is likely to be absorbed, then that’s just 1mg. Which I agree, seems futile - although such a small amount would surely have equally minor negative affects.

But you’ve given me enough doubt to put the treatment on hold for now, anyway, while I try to digest the information on this board.

EDIT: just one more thought - the DR instructed me to apply the gel to my scrotum because absorption rates were higher. He specifically pointed that out when I raised the issue of absorption. So which area of the body is that 10% you mention related to in terms of absorption?

6

Follicle Stimulating H. (FSH) 2.500 mIU/mL Low 0.95 - 11.95
Luteinising Hormone 2.000 mIU/mL Low 1.14 - 8.75
Oestradiol 122.000 pmol/L High 40 - 160
Testosterone 21.500 nmol/L Med 9.00 - 30.00
Sex Hormone Binding Globulin 25.000 nmol/L Low 18 - 50
Free Androgen Index 86.000 Med 25 - 130

Looking this I see T levels that are not bad and I don’t know why you were put on TRT.
But LH/FSH say hypogonadism
So this is very confusing.

What is clear is that your TSH is too high. Please work with me on the thyroid related issues.

Many of the symptoms of hypothyroidism are the same as hypogonadism. So don’t have T-Tunnel vision.

Yes there is a lot to learn and read. Yes, you need to know more that most doctors - which, unfortunately, is easy.

I am trying to lead you through this and you are avoiding issues and questions that I present to you.

Note total T levels [TT] can be higher from more T been in the form of T+SHBG, which is not active. But SHBG seems OK. But TT can then be high if the liver is not clearing T+SHBG. Then we look at the liver an see this:
Aspartate aminotransferase (AST) 41.000 IU/L High 5 - 45

What drugs, OTC and Rx are you taking and since when. Alcohol, weed? These can interfere with clearance of E2 and SHBG+T
I do ask about these things in the advice for new guys sticky. What other health issues? Digestive issues or changes? Pulse? Blood pressure?

I need more information. And try to go through my posts point-by-point

What is your mate doing for TRT and how is that working for him?

7

Thanks again for your help, KSman.
All your input is much appreciated.

[quote]KSman wrote:
Follicle Stimulating H. (FSH) 2.500 mIU/mL Low 0.95 - 11.95
Luteinising Hormone 2.000 mIU/mL Low 1.14 - 8.75
Oestradiol 122.000 pmol/L High 40 - 160
Testosterone 21.500 nmol/L Med 9.00 - 30.00
Sex Hormone Binding Globulin 25.000 nmol/L Low 18 - 50
Free Androgen Index 86.000 Med 25 - 130

Looking this I see T levels that are not bad and I don’t know why you were put on TRT.
But LH/FSH say hypogonadism
So this is very confusing.
[/quote]

I did point out that the levels were good - BUT that the DR put me on TRT based on my symptoms.

[quote]KSman wrote:
What is clear is that your TSH is too high. Please work with me on the thyroid related issues.
[/quote]

Indeed, I am - I read what you said about salt. In fact, after searching Google I see articles on iodine deficiency in the UK because we don’t have it in salt - but I also see that dairy products are a good source. I probably drink, on average about 2 pints of milk per day.

[quote]KSman wrote:
Many of the symptoms of hypothyroidism are the same as hypogonadism. So don’t have T-Tunnel vision.
[/quote]

No, I don’t - hence I am not going to continue with the TRT until I have chased this down.

[quote]KSman wrote:
Yes there is a lot to learn and read. Yes, you need to know more that most doctors - which, unfortunately, is easy.

I am trying to lead you through this and you are avoiding issues and questions that I present to you.
[/quote]

I’m not avoiding anything, I am perhaps slow to understand.

[quote]KSman wrote:
Note total T levels [TT] can be higher from more T been in the form of T+SHBG, which is not active. But SHBG seems OK. But TT can then be high if the liver is not clearing T+SHBG. Then we look at the liver an see this:
Aspartate aminotransferase (AST) 41.000 IU/L High 5 - 45

What drugs, OTC and Rx are you taking and since when. Alcohol, weed? These can interfere with clearance of E2 and SHBG+T
[/quote]

I don’t smoke weed. I don’t know what OTC or Rx are but I don’t take anything except aspirin, paracetamol and ibuprofen - when required. I occasionally drink alcohol. Admittedly, in the couple of weeks prior to this test I was drinking more than usual for various social reasons. Normally, I only drink, say, once a week - although periods pass where I might not have anything for a few weeks or months.

I did also point out that I’d had a heavy cold for the whole week prior to taking the blood test, during which time I was taking paracetamol and ibuprofen daily. The DR did say that was reflected in the results - though I don’t know where.

Perhaps you are picking up on one of these - a higher alcohol intake than usual plus a heavy cold plus over the counter medication, plus poor sleep and travel. Not a great way to treat my body, admittedly, but not usual. But yes, it probably affected my results and maybe that’s what you’re seeing.

[quote]KSman wrote:
I do ask about these things in the advice for new guys sticky. What other health issues? Digestive issues or changes? Pulse? Blood pressure?
[/quote]

I’m sorry if I missed that. It’s a lot of info and I’m not inventing the ‘brain fog’ I find stuff like this difficult to process. And I still haven’t shaken that d@mned cold!

As for digestive issues, pulse, blood pressure, I don’t know of any problems. The DR did take blood pressure at the consultation and said it was ‘normal’, or ok or whatever.

Thanks again.

[quote]KSman wrote:
I need more information. And try to go through my posts point-by-point

What is your mate doing for TRT and how is that working for him?
[/quote]

As I said - my mate went through the same process and was put on gel. His levels were about 10. Somehow the gel got him up from that and he reported improvements across all symptoms as a result. Now he’s on injections, simply because they are cheaper and less hassle, but in principle he had no objection to the gel. He’s up around 20 now, I believe and far happier.

EDIT:
Ok, I’ve read your Thyroid sticky 3 or 4 times now and it’s beginning to sink in. I figure my next step is to buy an oral fever thermometer and take my temperature. And maybe get some thyroid-related blood tests?

Also, as stated earlier, I am going to delay the TRT - at least until I’ve figured out if it’s thyroid related. That’s beginning to make more sense to me just now and I’m not overly keen on TRT, I just want some energy back.

8

Get the body temps and we can eval need for more labs then. Hopefully without your having the cold virus…

There are issues with iodine in the UK, many are deficient. I see your point about the milk that you do drink. In North America, changes in dairy practice have reduced the amount of iodine in milk. Teats used to be washed with an iodine cleanser, not now and iodine levels in milk have dropped. This might also be from less use of iodine salt blocks [cow licks]. We also had iodine in bread and that was stopped. And sea salt and other salts became fashionable so many are now iodine deficient. Iodized salt was introduced here in 1924 and doctors now have collective amnesia about this. Switzerland actually lead the way with iodized salt.

You should be getting a decent amount if vitamin D with the milk.

You also need selenium to prevent some bad chemistry in your thyroid that can lead to thyroid autoimmune diseases.

TSH can be increased from:

  • lack of iodine
  • thyroid autoimmune diseases
  • elevated rT3 - refer to stress, adrenal fatigue
  • combinations of the above

You are overweight. Is that recent with the decline in energy and libido. Thyroid and/or low-T can do that. Weight gain can be both a symptom and a cause of problems.

9

Hi,
thanks again for your input.

In answer to your last post, regarding being overweight. Two years ago I was about 120kg, but lifting 160kg. Last summer I was down to 105kg - which was my lightest since I was in my 20’s. I’m around 110kg right now. I don’t consider weight to be the issue since I am strong and have a fairly good cardio capacity too, and no one looking at me would suggest I was overweight. Although I do understand that if you’re using the ’ BMI index’ then I should probably lose 10kg+ - but I tend to consider that a nonsense, for similar reasons as any ‘normalisation’ stats might be.

I’ve been taking my temperature periodically, over the last week and here is the range of results:
NOTE: the flat I’m staying in has rather warm central heating which means I always feel warm enough or a bit too warm (hence the ‘sweating’ notes. ALL readings are done in this warm environment. I do a lot of work (writing) from home at a computer.
I used 2 different thermometers, as I was unsure of the readings on the first one as the ‘beeper’ (telling me when the reading was done) didn’t seem to work. The first few days are from thermometer #1 and the last few days #2. They both showed temps in celsius so I’ve included the original reading with the conversion.

Mon 30th - 4.50pm: recently returned home after shopping:
36.2 = 97.16

Then again, after sitting for 15 mins
36.9 = 98.42

6.55pm after sitting at computer for the afternoon:
36.8 = 98.24

then again to double check:
36.6 = 97.88

10:36pm just in from gym, sweating, feeling hot, and the room is hot:
36.4 = 97.52

Tue 31st - taking temp on waking up: 7.30am
36.2 = 97.16

Tue 31st - took late morning nap and took temp again on wake Up at 12 midday:
36.1 = 96.98

Later, having been sitting working and recently eaten food 1.30pm
36.6 = 97.88

Evening 6pm-ish sitting working all afternoon:
36.9 = 98.42

8pm sitting and working but feeling hot, sweating:
36.3 = 97.34

Then again, to double check:
36.6 = 97.88

Wed 1st Apr - Next morning, upon wake up in bed:
36.6 = 97.88

New thermometer 1st April:
13.55 pm sitting and working:
36.6 = 97.88

Later that day sitting and working, slight sweat on 4.15pm
37 = 98.6

2nd April (forgot morning tempt) 13.55 after moving around in the flat (feeling warm):
35.55 = 95.99

Then again, to double check:
35.8 = 96.44

Hot, just in from shops, sweating and opened window to cool down:
35.8 = 96.44

3rd April, late night reading and slept in (public holiday), temp after lying awake for half and hour-ish @11am?
36 = 96.8

As a final note - I started eating 2x Brazil nuts every day for selenium, for the last week. I also bought some sea kelp pills as an iodine supplement yesterday, to see if they made any difference.
sea Kelp pills x3 per day = 150 micrograms per pill