Advice on Lab Results

Pharma / TRT Testosterone Replacement
1

Hey guys, hoping you can help me out understanding my lab results.

First off, I’d been experiencing some symptoms that got me wondering about my T levels. Libido has definitely dropped. Sense of well-being is just not there; I’m not depressed, its more like I’m anxious about stuff a lot; more than I can remember. Irritable, mood swings. With that, I’m pretty consistent with my workouts, my diet is good, I keep a food log – just can’t seem to drop any body fat; and in fact, my body fat seems to creeping higher over the last 6 months. Sister was diagnosed with hypothyroidism, so I thought that might have something to do with as well.

So went to my GP and described my symptoms – she was open to getting blood work done to see where I’m at. Unfortunately (but I’m not surprised) she was reluctant to do all the tests I wanted. She was only going to prescribe Total T; I had to convince her to do Free T as well. I had to explain that I wanted E2; she had to figure out how to ‘code’ the test, so my insurance would pay for it – she asked about gyno; so of course I said ‘sure’ in order to the the test. In any case, I will likely have to ask her for more tests. My doc mailed the results to me; T looks low, E2 looks high – as expected, doc notes my results are ‘normal’, since there within range. She mentioned during my visit, that even though result may be in range, she’s willing to listen to me on how feel rather than only looking at the results. So that’s good. Before I consider TRT, I’d like to try to figure out what could be causing the low T. I’m pretty sure I need further blood work, but I wasn’t sure how to convince my GP to prescribe them.

So here goes:

-age
39 years old

-height
5ft. 11 in.

-waist
44 in.

-weight
235 lbs (~22% Body Fat, 3 site method)

-describe body and facial hair
barrel chest & belly, thinner limbs; facial hair seems normal

-describe where you carry fat and how changed carry fat generally on my midsection
belly, love handles, chest. lately, I’ve been developing more fat ‘internally’ as in, under the stomach muscle wall.

-health conditions, symptoms [history]
have always had slightly high blood pressure, family history of heart disease, sister diagnosed with hypothyroidism

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
not taking any persciption or OTC drugs, never taken any
hair loss or prostate drugs

-lab results with ranges

Total T 312; 250-1100 ng/dl
Free T 50.9; 35.0-155.0 pg/ml

Vit D 25 hydroxy 31; 30-100 ng/ml
Vit D 25-OH, D2 <4
Vit D 25-OH, D3 31

E2
17 Beta Estridiol 30.49; 7.63-42.60 pg/ml

TSH 1.660; 0.270-4.200 uiu/ml
T3 uptake 31.6; 27.8-40.7%
T4 10.2; 5.0-12.0 ug/dl
FTI 3.2; 1.2-4.3

Vit B-12 1214.0; 243.0-894.0 pg/ml

Aldosterone 16; no range listed (adult reference range listed ‘Upright 8:00-10:00am < or = 28 ng/dl’)

DHEA-S 171.60; 88.90-427.00 ug/dl

I also have CBC and Chem metabolic profile; wasn’t sure if you need all those.

-describe diet [some create substantial damage with starvation diets]

diet is lower carb, higher protein; I’m usually pretty strict, 6 meals a day; avg ~2400 cal/day usually over 1g of protein/lb; keep carbs in the 100-200 g/day range. take fish oil, protein supps

-describe training [some ruin there hormones by over training]

Lift 3 times a week, cardio 2 times a week.
-testes ache, ever, with a fever?

testes never had ached, ever

-how have morning wood and nocturnal erections changed

no longer get morning wood, occasional nocturnal wood – both of which are much less frequent than it used to be a couple years ago.

Thanks for any insight you can give.

2

Your Vit D is very low…I try to stay in the 80 range myself…Vit D supplementation will help you in many areas, and may help your T & E2 a bit…

Do you supplement B12? Wondering why it was above range high…

But overall, your results are about what I would expect for the average 39 year old…

I’m no doctor, but I would be very surprised if there was anything else to look for here…your symptoms are very in line with what I would expect someone your age to be…you are no spring chicken anymore mate, and I know at these levels at 39 I would push for TRT and not look back…

3

Thanks for the insight, VT. I thought the same thing about the Vit-D.

After reading your thread, and given my family history of hypothyroidism, I began supplementing Vit D and B-12 a couple of days prior to getting the blood draw. I was surprised to see the B-12 so high. I’ll probably back off a bit. (was taking 2500mcg x2 a day)

The Vit-D; I’ve been taking 10,000 IU a day for about a week. Front loaded the first two days with 20,000-30,000 IUs. Saw what your endo prescribed, figured I’d go with that. Do you have any idea on how quickly Vit-D levels would rise? Is it something that’s slow? I just read somebody else’s post on being sure to take with with fatty foods – you think taking it at the same time I take a couple of Flameout would be good?

4

I take Biotics Brand Vit D, which is emulsified drops so there is no need to take it with fat–it is highly bioavailable on its own…its also pretty cheap and you can buy it on amazon. It costs about $20 and lasts for around 6 months taking 10,000 iu/day:

If you don’t want to go that route, taking it with Flameout will probably be fine (as long as it is a GOOD vit D product–dont buy it from walmart)…

They should rise to saturation in less than a month…

Your Vit B-12 results are skewed since you took it leading up to the tests…you need to cut it out 4-5 days before test to get an accurate measure…I take about 1k mcg/day and that took me from bottom range to upper levels of range, which I think is ideal…your mileage may vary…

5

Please post fasting glucose and cholesterol.

ALT/AST
TSH
hematocrit
RBC
BP
pulse
iron
ferritin
CRP
Homocysteine
Can you afford to do some labs at your own out-of-pocked expense?

thyroid:
your labs are not very useful
feel cold easily?
hair/skin/nail changes
using iodized salt?
how much iodine in your vitamins?
check waking body temps and through the day, record and come back with numbers

How do you react to stress?
Major stress events? wrecks, deaths, job, finances, relationships, illnesses, surgeries can have negative consequences
Do you have energy crashes at certain parts of the day? how/when changed
Do you how have trouble getting started in morning? how/when changed

How are you sleeping? Snoring? More?

How is your gut? Taking antacids?

How long do you feel that this decline as been going on?
Fast or slow onset?

E2 is high relative to T, creating some degree of estrogen dominance, creates CV and insulin risks, as well as making other aspects of life crappy.

6

Hey KSman – appreciate you looking at the lab results.

Cholesterol 192; 0-200 mg/dl
Glucose 99; 70-100 mg/dl

ALT 56; 0-40 U/L
Doc notes this liver funtion test is high; suggests avoiding excessive tylenol use or alcohol consumption.

AST 28; 0-37 U/L

TSH 1.660; 0.270-4.200 UIU/ml

hematocrit 46.6; 40.0-50.0%

RBC 5.15; 4.10-5.50 Million/Cu. mm.

BP 142/86

pulse - don’t remember what she measured

iron - no data
ferritin - no data
CRP - no data
Homocysteine - no data

Can you afford to do some labs at your own out-of-pocked expense?
Well, I guess I might have to, if I want the full picture. I’d rather not spend the 300-400 at lef.org if I can avoid it.

feel cold easily? – no, not really.
hair/skin/nail changes – no, not that I’ve noticed
using iodized salt? yes.
how much iodine in your vitamins? I don’t take a multi-vitamin;

check waking body temps and through the day, record and come back with numbers – will do.

How do you react to stress? I use to stay pretty calm in stressful situations, but lately I’ve been more wound-up, and anxious.

Major stress events? wrecks, deaths, job, finances, relationships, illnesses, surgeries can have negative consequences

I’d say my job and my boss have been quite stressful. More than it should be – to the point where I’ve been looking for a new job (over the last 2.5 years). no illnesses or surgeries; stable relationship; my dog died a couple of months ago, bummed me out, but I’m okay about it. He lived a long, good life.

Do you have energy crashes at certain parts of the day? not really, other than the general low-energy feeling by the time I get home from work. I’ve got two young kids who want to play, all I want to do is chill.

Do you how have trouble getting started in morning? how/when changed
Have always needed caffeine to get me going; has not really changed much over time.

How are you sleeping? Snoring? More?
sleeping okay, ocassional snoring – no noticeable changes.

How is your gut? Taking antacids?
gut is fine; interestingly, when I went to a lower carb diet, I had much less indigestion. Hasn’t been a problem lately. Seems when I eat carbs I tend to get indigestion.

How long do you feel that this decline as been going on?
Fast or slow onset?

I’d say its probably been happening over the last 10-12 months. I mean, my T has probably been dropping with age, but it seems much more pronounced over the last year or so.

7

KSman – here’s the body temp info, so far. Thanks.

Body temps:

3/25
evening = 98.3

3/26
waking = 97.4
mid-day = 98.2
evening = 97.7

3/27
waking = 97.4
mid-day = 98.5
evening = 99.0

3/28
waking = 97.7

8

assuming the same conditions and times for taking your body temperature, then you have avg temperatures that are just barely too low (avg should be close to 98.6) and seem to fluctuate day to day (97.7 then 99 in the evening).

if so, that could possibly indicate less than ideal cortisol levels and less than ideal free T3 levels (and/or high Reverse T3 levels) - among many other possibilities.

complete guess here, but I would say that if you tested your 8am cortisol levels that it would come back at less than 15. a four times daily saliva test might give you a good idea of what is going on as well.

9

AST and ALT are NOT liver specific. Sore or bruised muscles can do this. Cam you recall if muscles were sore at the time?

Your BP is a problem, Flameout or other quality EFAs are needed, plus a high potency B-complex multi-vit [WITH IODINE] which will help HDL increase.

Do you have HDL data?

TSH=1.6, may come down with increased iodine intake. I had an iodine deficiency and low temps, temps now are normal. It will be interesting to see where my TSH=1.6 goes.

OTC drugs: things like Tylenol - what else?

10

No, I wasn’t sore when I had the blood draw; I read a previous case where you indicated that soreness could alter results. Made sure I wasn’t sore.

I hadn’t been taking any OTC meds at the time of blood draw. (or even a week before) But, in general, I do take NSAIDs (tylenol, ibuprofen, naproxen) when needed. Cough medicines, I suppose, but I haven’t been sick for a while.

I have been taking Flameout – 4 caps a day, consistently over the last 4-6 months. The B-12 I started taking doesn’t have iodine, so maybe I should look into that.

HDL = 45; 40-60mg/dl
LDL = 123; 0-100mg/dl

The evening temps may vary, but the waking and mid-day temps seem relatively consistent.

11

by which you are saying that you believe you are fine and don’t need to test or possibly treat your thyroid or cortisol??

yes, your waking and mid-day seem consistent. Mid-day is a bit low (again your temp should avg around 98.6) and being stable day to day in the morning and afternoon shows us that your cortisol can keep up more or less until the evening when it starts to run low and your temperatures start to fluctuate. this is just speculation as you really need more data and more blood tests. Have you checked out the links at the end of the blood test sticky that talk about body temps?

and I am just trying to give you possible options to look at. no real skin off my nose if you want to ignore it and go a different direction.

12

To improve HDL, you need a B-complex. B12 is not enought

NSAIDs load up the same enzyme pathways in the liver that clear estrogens.

13

PureChance – I probably do need a cortisol test…my comment about the temps has more to do with the lack of accuracy of my thermometer. I’ve got a temporal artery thermometer and I suspect those aren’t as accurate as an oral thermometer.

14

Finally had a chance to speak to my GP about my results – she decided to punt, and wants to refer me to an endocrinologist. She kept saying my results were “normal”. I tried to suggest that perhaps my symptoms were a result of a shift in my results, there by not being “normal” for me. She said she wasn’t comfortable with diagnosing anything based on the “normal” results, but acknowledged that since I’m still having symptoms that perhaps an endo could help with indentifying something that was missed.

So, I was going to review the finding a TRT doc sticky and ask for a specific referral.

After getting test results and feedback from KSman, Purechance, and VTBalla, I’ve been supplementing with Vit. D-3 (10,000 IU/day), B-complex (1 tablet/day), and resveratrol (600mg/day), and ZMA (3 caps/every 2-3 days). Dropped my intake to 2000 cal/day; 100-125g carbs/day; 200+ g protein/day. Continue to take Flameout, 4 caps/day. Staying away from NSAIDs

My blood pressure has dropped to 126/80.

I’m hoping to get LH/FSH and 4 sample cortisol tests done with the endo; I’ll see if I can get free t3 and free t4 as well. By the time I get in with an endo, maybe it’ll be a good time to get the all my tests again. It would be interesting to see the effects of the resveratrol on E2.

15

Shoot for getting all tests done again - it never hurts to have more information.

16

- I would recommend cutting out any herbal supplement and just stick with the vitamins/minerals until you get your system balanced.

resveratrol works for some and has different reactions for others. I personally was a huge believer in herbal supplements and tried almost everything under the sun, but my results have been all over the place with uncontrollable side effects and no way to know for sure what was causing what so I had to cut all of them out until I could rebalance and possible add them back in one at a time to monitor their impact. everyone reacts differently and there are so many variables in simple HRT cases that adding another level of uncertainity is usually not a good thing.