Annual Bloodwork - Thoughts?

Pharma / TRT Testosterone Replacement
1

Howdy y’all, long time no see.

I am actually on HCG Monotherapy rather than TRT, but I imagine many of these things apply regardless. I’ve been on for about six years now, after being on clomid for three years and not being able to get estrogen under control.

Anyway, I got my annual blood work done last week and there’s a few things that either look abnormal to me or are flagged as abnormal, and I’d like a few extra sets of eyes so I know what to discuss with my doctor in case I am missing anything.

Total T is 378ng/dL (last year it was 627ng/dL and it tends to be in the 550-650 range)
e2 17ng/mL (this seems fine but is important for context)

PSA 1.54 ng/mL (this seems high as early onset prostate cancer runs in my family but I could just be overthinking it for that reason)

Liver values for alkaline phostphatase, bilirubin total and direct, protein, albumin, and globulin are all on the lower side of normal or right in the middle, except for:
ALT, 72iu/L (high, range tops out at 54)
AST 49iu/L (slightly high, range tops out at 48)

Cholesterol is 205mg/dL (High, range tops out at 199)
HDL is 41mg/dL (fine)
Triglycerides 100 mg/dL
LDL is 144mg/dL (High, range tops out at 99)

Complete Blood Count is also all in the middle range for normal, except for:
Hemoglobin 17.6g/dL (very slightly high, range tops out at 17.5)
Hematocrit: 54.4g/dL (slightly high, range tops out at 53)

Context: I am 34. This was fasted at around 9:30am. I had had maybe one to two drinks the night before as I was working a bartending shift. I drink maybe two times a week, almost never more than two drinks in one day - usually one beer while cooking dinner and another with dinner on weekends, rarely more than that. I do not smoke or use drugs and never have.

Additionally, I was getting over COVID. I mention this because I was, one, sleep before this blood work was not optimal, and, two, I think the one or two beers and the cocktail of nyquil, paxlovid, etc could be responsible for the higher liver enzymes. I am also slightly overweight - I’ve kept 80lbs off for a decade, but I’m still sitting at around 22% body fat per a bodpod scan. I lift weights 3x a week but could stand to work more cardio in as I work a sedentary job.

So, my thought is that the above is what’s happening here, but I figure a few extra sets of eyes before my appointment on Thursday can’t hurt.

I generally feel fine - I make progress in the gym, I have plenty of energy, my sex drive is pretty high, I don’t feel like I did when I started treatment all those years ago - but I don’t love the 378ng/dL number.

Anything I’m missing or should be looking at?

Cheers!

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FT sir. Did you test it? What’s your SHBG?

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For reasons I don’t fully understand, it doesn’t appear that free test and SHBG were tested - they usually are, though my doctor has retired and this will be my first time seeing his successor, as it were. Thank you. Duh. That is an incredibly obvious omission. I will ask why those weren’t tested.

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Lab timing is critical, especially when dealing with shorter half-lives. Testing at the same time post-injection, every time, is critical to getting as consistent results as one can ask for.

TRT is not a panacea, your health is going to continue to decline if you don’t change some things! A single glass of whine will hamper fat loss for 48-72 hours. Alcohol will also increase the sub Q layer in the fat, without actually changing the weight on the scale, making you look fatter.

You’re only 34 years old, you shouldn’t be having these health problems this early in life! TRT is a tool to achieving a healthy mind and body and you’re not using that tool to its fullest potential.

Obese men have a significantly greater chance of dying of prostate cancer than non-obese men.

You need to get your body fat down, or you’re just asking for it.

Free testosterone in the bottom 25 percentile = increased risk of prostate cancer and reoccurrence. Free T at the top 25 percentile = a 53% decreased risk of prostate cancer and or delaying the disease and those that get prostate cancer, less aggressive cases and reoccurrence rates plummet!

You’re either dehydrated (alcohol) or you have sleep apnea. My hemoglobin is a little higher than yours, and my hematocrit is only 51%.

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The decrease in Total T over time may have an explanation, what is your A1C and fasting glucose?

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Respectfully - and I mean that sincerely, because I’m aware that I asked for advice or input so I’m not trying to hassle anyone for offering the advice I asked for - I am not sure that one or two beers once or twice a week (at the most, I rarely drink even that much) is causing me any significant problems. I realize that an ideal amount of alcohol to consume for absolutely optimal health is “zero” but, y’know, you choose your vices. Mine is twelve ounces of a nice pilsner or IPA with my dinner on Saturdays and/or Sundays. So it goes.

COVID, eh, it is what it is, it can get ya at any age. I dodged it for years and it finally got me. First time I’d been sick in ten years.

I have had sleep studies done, I do not have sleep apnea - dehydrated is very possible first thing in the morning.

I do not know my A1C or fasting glucose, I have not had these tested but it’s something I’ve considered due to this last 15 or so pounds being so unbelievably stubborn even at a caloric deficit (I do not drink alcohol at all when I am trying to lose weight). That may be a discussion for another thread, though.

I appreciate you taking the time!

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Just as a quick follow up - my tentative plan that I will propose to the doctor is to really get serious about dropping these last few pounds, which I’ve finally accepted is going to require a lot more cardio, and re-test with free test, SHBG, and thyroid function included in a few months. If anything is still out of whack at that point we can reassess, but I am not sure the current blood work is a complete enough picture to make any big medical decisions with.

Again, all input is welcomed, even if I push back on it a tiny bit. :wink:

why did that emoji show up so big? Sorry.

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Good plan! What @systemlord mentioned about being consistent on lab draw timing is super important too. Always try to do the same day/time following your injection on comparative draws.

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Noted, thank you both! I used to be very specific about that kind of thing, taking notes and everything, and may have fallen off the wagon, so I will do that going forward as well.

re cardio, I’ve tried to drop this weight with every bit of diet and then finally had the revelation of: “I lost 80lbs doing cardio with very minimal diet changes. I have lost almost nothing not doing cardio but with major diet changes. I have to do cardio.” But, again, that may be for another thread.

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Cardio is a terrible way to lose weight and keep it off. Cardio, the moment you stop your cardio, you stop burning calories. Lifting weights, you continue to burn calories for the next 48 hours, even while sleeping.

Also, if you really want the fat to drop off easily, even without exercise, carnivore diet!

Supercharge your body, meat is low in calories, no carbs, get your body to use fat, not sugar, or carbs for energy.

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Alright folks, well, met with both my urologist and my primary yesterday - urologist says the liver and hematocrit are likely normal or attributed to dehydration, but since I was gonna see my primary later in the day she asked me to get a second opinion. She’s not worried about PSA since that’s about where it’s been every time I’ve gotten blood work done for the past decade.

Primary care doc does not believe my alcohol consumption is problematic - I’ve been seeing him for a decade and he knows me and my health very well - but he would like me to completely abstain from drinking and “live like a monk” for the next month just to rule that out as far as liver enzymes goes.

Both of them basically agree that if I do more cardio (just for general health purposes) and drop a few pounds of fat everything else should clear up. We are going to re-test all of these values in a month and test for thyroid, SHBG, prolactin, and free test this time around.

EDIT: @systemlord, you had mentioned A1C and fasting glucose. Is there an easy and cheap way for me to track this? I realize that a CGM would likely be ideal but those are wildly expensive and/or all require a prescription as best I can tell. Cheers!

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Considering type 2 diabetes is so common (1 in 10), and for the fact 75% of the population is overweight, A1C and fasting glucose should be apart of annual bloodwork!

A glucose meter sold at places like CVS, other than that your doctor shouldn’t put up a fight requesting these tests.

Another thing about weight loss, the more muscle you have, the more calories you burn, that’s why lifting weights is king of fat loss.

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Meh, cardio is fine for general health but a fool’s errand for significant fat loss. The more cardio you do, the more efficient your body gets at it, the more you have to do for the same energy expenditure. If you do it, you want to do things that exploit inefficiency, like changing up the type of cardio relatively often. Once you get sort of “good” at cardio X, switch to cardio Y, and so on.

Losing blubber is all about diet and manipulating your insulin response i.e. keeping your blood glucose levels low on average with spikes only around your training time period. Take psyllium before meals, drink apple cider vinegar, eat fibrous veggies and protein before starchy carbs, refrigerate starchy carbs overnight to reduce available carb calories. There’s a bunch of ways to manage your insulin response that are relatively low effort. And of course you need a calorie deficit.

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I 100% agree. Every time I order my own labs, this is always apart. They’re cheap tests and help understand insulin sensitivity.

I got my Dr to prescribe a CGM just based on having diabetes in the family and I was concerned. I wore it for ~2 weeks and tried what foods spiked my glucose, testing a lot on an empty stomach initially, but stacking common combinations. It was interesting, but not earth shattering knowledge.

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Alright, we are BACK. I am down 5lbs so far on a pretty significant caloric deficit, and I totally abstained from alcohol for six weeks just to see how it would impact my liver values. ALT actually went up slightly, everything else continued to drop, but ALT is still on a downward trend YoY. Lipids also went up a little bit, CBC also went down to normal range. I can post the specifics if needed, but the hormones are what we are here for.

Here’s what we are looking at.

Total T: 340ng/dL (continuing to decrease)
Free T: 88pg/mL
% Free Test: 2.6
SHBG: 14nmol/L (low)
E2: 2pg/mL (Yes, 2. I am fairly confident that this is wrong)
Prolactin: 5.9ng/mL

So, what are we thinking here?

I feel like, pretty alright, generally. I do not have any performance issues in the bedroom, I am continuing to recomp, my mood is… well, my mood is crappy but that’s situational as I’m under a huge amount of stress. Anyway, I certainly don’t feel bad enough that I want to get on T, whereas when I first started seeking treatment I actively felt like I was dying.

My thought here is that I am on a pretty low dose of HCG - 2000iu a week - so I’m thinking the first order of business (other than continuing to lose weight) should be to up that a bit, which is a bummer because it’s doubled in price over the past year. Obviously that’s my doctor’s call, he was recommended to me on this forum a decade ago and I trust him, I am really just looking for any insight so that I can have an informed conversation with the doctor.

Cheers!