Bloodwork & TRT Cheatsheet

Pharma TRT
41

Blood Results from 6/29/10

First the boring stuff…

Catecholamines, total: 276 pg/mL (Supine: 123-671, upright: 242-1125)
*Hemoglobin: 17.5 g/dL (13.2-17.1)
*Hematocrit: 50.8% (38.5-50)
*MPV: 7.4 fL (7.5-11.5)
*Creatinine: 1.34 mg/dL (.8-1.3)

*LDL: 148 mg/dL (<130)
*HDL: 40 mg/dL (>=40)
*Total Cholesterol: 226 mg/dL (<200)
*Triglycerides-direct: 179 mg/dL (<150)

C-Reactive Protein: 1 mg/L (<8)
*Remnant Lipoproteins: 32 mg/dL (<30)
Albumin: 4.7 g/dL (3.6-5.1)
Homocysteine, Serum: 8.0 umol/L (<11.4)
IGF Binding Protein-3: 6.3 mg/L (3.4-7.8)
IGF-1 ECL: 283 ng/mL (88-374)

Now the good stuff…

Vitamin B12: 315 pg/mL (200-1100, with a caveat that people between 200-400 may experience neuropsychiatric and hematologic abnormalities due to occult B12 deficiency)
Vitamin D3: 46 ng/mL (30-100)

Testosterone, Total: 562 ng/dL (241-827)
Testosterone, Total: 546 ng/dL (250-1100)
Testosterone, Free: 101.1 pg/mL (46-224)
Testosterone, Free: 146.3 pg/mL (35-155)
*Testosterone, Free %: 2.68 (1.5-2.2)
DHT: 60 ng/dL (25-75)

E2: 30 pg/mL (13-54)
Progesterone: 0.6 ng/mL (<1.4)

*LH: 12.7 mIU/mL (1.5-9.3)
Ferritin: 54 ng/mL (20-345)
DHEA Sulfate: 177 mcg/dL (110-510)
SHBG: 22 nmol/L (7-49)

TSH: 2.25 mIU/L (0.4-4.5)
T3, Free: 392 pg/dL (230-420)
T4, Free: 1.7 ng/dL (0.8-2.7)
T3, Reverse: 26 ng/dL (11-32)
Thyroid Peroxidase AB: 12 IU/mL (<35)
Thyroglobulin AB: <20 IU/mL (<20)

42

I had my follow-up phone consult this evening with Dr. Overbeck and Shawn and it went very well. From my bloodwork (above) and my saliva cortisol test (which I haven’t yet posted) they were able to diagnose me as having hypothyroidism, coupled with weak adrenals. More specifically, secondary hypothyroidism. My cortisol levels were in the tank and my bloodwork associated with thyroid (ferritin, lipids, etc.) were pretty weak as a result.

Still have a lot of reading to do on the subject, but I believe they made the right call from what little I know about it. I was prescribed Cortef which is a hydro-cortisone and will be supplementing it with Dr. James Wilson Herbal-HSA for Adrenal Fatigue (10 drops day). This is in addition to my current Vit D3, Vit B-12, Fish Oil, anastrozole (hope to discontinue at some point when I’m healed up), multi-vitamin, mineral support (zinc/magnesium), and Biotest’s Superfood (great stuff there!).

The treatment idea is to get my adrenals back online and hopefully induce a feedback response to my thyroid, improving both as the other improves.

I hope to begin tomorrow.

We will retest in 6 weeks and have a follow-up consult 2 weeks after that.

So that’s that. While I was disappointed to realize that I have hypothyroidism, I am glad that Dr. Overbeck and Shawn were able to isolate the problem without a long drawn out guessing game and move for a quick resolution. I owe them a lot and would not hesitate to refer anyone going through what I was to them. They truly are first class and the best around.

I will probably drop back in this thread periodically just to give an update, but I probably won’t be as active here as I have been. I truly appreciate all the advice you experienced guys have offered–I have learned a ton. I hope all of you that are going through a difficult time find the help that you need and can quickly resolve your problems. I wish you all the best.

-34-

43

I am finally glad that we are getting down to the root of your issue and finding to help you get over this hump in your life. The information presented yesterday has been seen in numerous of peoples simular to yours with hidden low adrenals and high ft3 levels. This is known as pooling and with out cortisol and iron then the thyroid can not reach the cell to tell the body to stop kicking out more TSH.

Once you send the thyroid to the tissue with appropriate iron and cortisol this will cause the TSH to drop resulting in the response which we are looking for driving the thyroid into the cell to get the metabolic response. As your thyroid comes up so will your ferritin as enzyme that control uptake of iron from the blood to the storage is driven by the thyroid it self.

44

So the good folks at Quest diagnostics finally sent me some more blood tests today. This was very kind of them since I had my blood tested in June (!) so over 2 months for results. Nice going Quest. I had completely forgotten about them.

If anyone has any thoughts, I’d appreciate them.

Insulin, Serum: 4 uIU/mL (<17)
Insulin, Free: 7.0 uIU/mL (1.5-14.9)
Cortisol, AM: 12.8 mcg/dL (4-22)
C-Peptide: 2.2 ng/mL (0.8-3.1)
Prealbumin: 34.4 mg/dL (21-43)
Aldosterone, LC-MS-MS: 19 ng/dL (<=28 upright, 3-16 supine)
Ceruloplasm: 26 mg/dL (18-36)
Iodine, Random urine: 80 mcg/L (34-523)
*Gliadin AB, IGG: 76 U/mL (<11)
Tissue Transglutaminase: <3 U/mL (<5)
IGA, Serum: 272 mg/dL (81-463)

The gliadin was sky high, which I understand is a potential indicator of Celiac disease, but the IGA Serum seems to be ok, which is also correlated. I don’t know what to make of those numbers as this is something that I’m not very familiar with. Should I consider a gluten-free diet as a result of the gliadin?

Iodine also looks low to me. What are “good” ranges for that?

45

Can anyone chime in on the iodine and gliadin results?

46

wish I could help, but I am not knowledgable on those topics.

47

Since my blood test in June, I have been on the following protocol:

Cortef: 10 mg/day (started on 26 July 2010)
Wellbutrin: 300 mg/day (started on 4 September 2010)
Arimidex: 0.7 mg/week (MWF dosing) based on E2=30 to try for E2=22
Vit D3 (emulsified under tongue): 6k iu/day
Vit B-12: 2000 ug/day
Biotest Flameout & FA-3: 4 capsules of each/day
Biotest Elite Mineral Support: 7 caps/day

As an update, I’m feeling a lot better. More energy, less stress, less anger issues, higher sex drive & more consistent erections. Most of these happened after I started the Wellbutrin.

Got another round of blood tests done on 11 October 2010 (with changes from June test in brackets)

Cortisol, Total: 5.5 mcg/dL (4.6-20.6)
Cortisol, Free: 0.08 mcg/dL (0.07-0.93)
Cortisol, AM: 4.6 mcg/dL (4.0-22)[-8.2] <<<<!!!

Vitamin D, 25OH: 71 ng/mL (30-100)[+25]

Testosterone, Total: 630 ng/dL (250-1100)[+84]
Testosterone, Free: 101.1 pg/mL (46-224)[+12.6]
Testosterone, Bioavailable: 238.7 ng/dL (110-575)[+22]
SHBG: 24 nmol/L (7-49)[+2]
DHT: 27 ng/dL (25-75)[-33] <<<<!!!

DHEA, Urine: 322 mcg/24h (21-2710)
DHEA, Urine: 74 mcg/g creat (24-1640)
*Testosterone, Urine: 200 mcg/24h (20-170)
Testosterone, Urine: 46 mcg/g creat (13-110)
*Creatinine urine: 4.31 g/24h (0.63-2.5)

E2: 29 pg/mL (13-54)[-1]
Progesterone: <0.5 ng/mL (<1.4)[unknown]

LH: 9.0 mIU/mL (1.5-9.3)[-3.7]
Ferritin: 51 ng/mL (20-345)[-3]

TSH: 2.10 mIU/L (0.4-4.5)[-0.15]
T3, Total: 110 ng/dL (76-181)[untested]
T3, Free: 380 pg/dL (230-420)[-12]
T4, Total: 6.1 mcg/dL (4.5-12.5)[untested]
T4, Free: 1.4 ng/dL (0.8-2.7)[-0.3]
T3, Reverse: 20 ng/dL (11-32)[-6]

Bloodwork didn’t show much improvement outside of Total T and Vit D-3. Pretty discouraging. Based on the blood tests, I can’t really attribute any of the positive changes I’ve noticed to anything but the Wellbutrin, D-3, and mineral support.

Some items got much worse, like cortisol dropping by more than half (which is more discouraging considering my diagnosis is actually adrenal fatigue and I wasn’t producing enough cortisol to begin with) and DHT dropping by half.

Thyroid, LH, Ferritin levels had no appreciable change and don’t look good.

E2 didn’t change much even though I adjusted my previous adex dose accordingly for an E2=22 ratio (maybe I have a bad batch?)

No idea how to interpret the urine tests, but found it strange that my testosterone was so high, creatinine was nearly double the upper limit, and DHEA was abysmally low.

If anyone has any thoughts on the above, I’d appreciate it.

Got another consult coming up with HAN & Dr. O soon.

48

Have you done anything to increase iodine and iron intake?

49

[quote]KSman wrote:
Have you done anything to increase iodine and iron intake?[/quote]

No, I haven’t yet.

From talking with the doc, I understood my problems to be primarily related to low cortisol production, and once my cortisol was under control, ferritin would rise (since it would be in higher demand) and TSH would lower (because we were delivering TSH with the right ancillary minerals to stimulate the receptor).

Those effects may not be happening since my cortisol has actually decreased, not sure.

I’ll be sure to ask about the need to supplement with these at my consult.

My iodine level on the June test was 80 mcg on a scale of 34-523, so definitely on the low end.

50

Update

I spoke with my doc before Thanksgiving and we agreed to start on Rx pregnenolone and Rx adex to backfill my cortisol passageways and help with estrogen control, respectively. Also will be taking iodine to help support thyroid, and liver tabs to help raise ferritin.

Been on the following protocol since 11/23:

Transdermal pregnenolone @ 25 mg/day (morning)
Adex @ .7 mg/week (took only 0.35 mg first week then upped dose)
Ioddoral @ 12.5 mg/day (morning & am dose)
Have not yet received the liver tabs I ordered4

Still taking fishoil, FA-3, Vit D3, Vit B12, multi, Zinc/magnesium, and superfood.

This is in addition to the 10 mg/day (am/pm) Cortef (which I hope to wean off of once pregnenolone levels are up).

Also still taking my Wellbutrin (300 mg/day) prescribed by my primary doc.

Have been feeling a bit rundown. Poor appetite (have trouble eating 3x/day compared to my normal 4500 calorie diet). Craving shitty foods (big macs, sodas, shakes, chocolate). Put on some extra weight despite the reduced meal frequency (probably from giving in to my cravings). No morning wood and inconsistent libido. Been a bit more quick tempered lately.

Motivation to train is very high, which is strange.

I just want to get off these meds and return to a [hopefully healthier] baseline.

Plan is to take blood after 4 weeks of meds, which would put me at the end of this month, and reassess. Will also be measuring DHEA, Progesterone, and metabolites by way of 24 hour urine test (I may have written this down wrong in my notes).

Not sure when the plan is to wean off cortef, hopefully soon. I’d also like to cut back and eliminate the wellbutrin.

51

This is a great thread – thanks for keeping us updated!

I was surprised to see you credit Wellbutrin with helping with a lot of your symptoms, even though you said you weren’t depressed before taking it. I’m in the same boat, and now wondering if I should ask my doc about it. Would you recommend trying it?

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[quote]hakrjak wrote:
This is a great thread – thanks for keeping us updated!

I was surprised to see you credit Wellbutrin with helping with a lot of your symptoms, even though you said you weren’t depressed before taking it. I’m in the same boat, and now wondering if I should ask my doc about it. Would you recommend trying it?[/quote]

That’s awesome to hear man, I’m glad you found my thread helpful. That is why I put the “cheatsheet” on the front page with a lot of the terms and what you want to be looking out for. It took me forever to research that, and I’m happy someone else can make use of it.

Re: Wellbutrin - I’m probably not just that alone, but it certainly helped. When I got my first bloodwork, my Vit D levels were in the tank, my estradiol was sky high, cortisol output was flatlined, and my test levels were embarassing. I started the adex, cortef, and Vit B12 & D supplements, and started seeing improvements, but it seemed that it all came together when I started on the Wellbutrin.

This may have just been coincidence, but my follow up bloodwork indicates that not much had changed in the blood department (with the exception of Vit D and Test), and some things had tanked (DHT and Cortisol). So it can be reasonable to assume that the increase in dopamine and neurotransmitter function led to a lot of my improvements.

If you read enough around this forum and others, you will quickly learn that its rarely just “one game in town” that contributes to your overall health. Wellbutrin was just one of many improvements that led to me feeling better.

Now if I can start to pull off these meds and shit, I’d be really happy!

53

Good info. You have given me some insight into some of my own issues.

Question: Did you ever start using the Biotest Rez-7? If so how has it worked?

54

[quote]xvorlonx wrote:
Good info. You have given me some insight into some of my own issues.

Question: Did you ever start using the Biotest Rez-7? If so how has it worked? [/quote]

Awesome man–glad to hear it. If you have any questions, fire away. If I can’t answer them, some of the other guys here probably can.

I didn’t start on the Rez-V (I think the product with ‘7’ in it is something else, maybe one of their fat burners?). I will eventually–have two full bottles sitting on my desk. I think it will be a great supplement once I am all healed up, but for now, I think the prescription adex is the best estrogen antagonist and I dont see a need to combine the two given the cost discrepancy and desire to not introduce yet another variable into the equation.

55

[quote]VTBalla34 wrote:

[quote]xvorlonx wrote:
Good info. You have given me some insight into some of my own issues.

Question: Did you ever start using the Biotest Rez-7? If so how has it worked? [/quote]

Awesome man–glad to hear it. If you have any questions, fire away. If I can’t answer them, some of the other guys here probably can.

I didn’t start on the Rez-V (I think the product with ‘7’ in it is something else, maybe one of their fat burners?). I will eventually–have two full bottles sitting on my desk. I think it will be a great supplement once I am all healed up, but for now, I think the prescription adex is the best estrogen antagonist and I dont see a need to combine the two given the cost discrepancy and desire to not introduce yet another variable into the equation.[/quote]

Arimidex is a competitive inhibitor for the aromatase enzyme, not an estradiol receptor antagonist.

56

[quote]chemman wrote:

Arimidex is a competitive inhibitor for the aromatase enzyme, not an estradiol receptor antagonist. [/quote]

correct…but irrelevant to the discussion. Thanks for pointing out the error of my ways though.

57

Update

I convinced my doc to let me start weaning off the Cortef…I think he wanted to wait a bit longer, but after 5 months of the hydrocortisone roller coaster, I am ready to just take a chance and see if everything comes back online…I think the 10 mg/day of Cortef has suppressed a lot of my natural output (ACTH feedback inhibition) and I am fine during the day when I am taking the cortef, but my last dose is at around 1 pm usually and by the evening I have been feeling real beat up and strange…

Eyelids twitching, pupils not staying constricted when light is shone on them, very itchy, and general lethargy…having no nocturnal erections…

So the plan is to cut back 2.5 mg every 10 days, so I started that today.

I also ran out of wellbutrin and am 2,500 miles awy from home right now so I wont have chance to get that filled until Monday…may not get it refilled at all depending on how I feel these next few days…

Still taking all the other supps & meds as prescribed…will report back in 10 days or so with any updates…

58

I came across this link for optimal lab ranges on STTM this afternoon and thought it would be a great resource for some of us on here to reference. Not comprehensive by any means, but a good start.

I took the liberty to add it to the Lab Work stickey as well.

59

Update

I weaned off the Cortef from 10 mg/day to 0 by dropping 2.5 mgs/day every 10 days…my last dose was on 13 January and I have felt much better since then…energy is high and mood is good…kicking ass in the gym and setting PRs on the regular…gaining weight, mostly muscle I think but a lot of fat due to diet rich in mcdonalds…libido is there, but erection quality is not…

I stopped taking the wellbutrin in mid-December since I ran out while on travel and didnt have the means to refill it while I was away for a few days…stopping that cold turkey was rough and I wouldn’t recommend it to anyone…for about 2 weeks I felt like a bag of wet assholes and was very depressed and irritable…the fact that it was around christmastime, which I hate and is a very stressful time for me, probably contributed…

Still on TD pregenolone at 25 mg/day…I think this has made a big difference in my energy levels, but I still am having trouble going to sleep at a reasonable hour (don’t get tired, second wind, etc.) and having trouble getting up in the mornings, although that part seems to be getting better…

Im getting tired around mid afternoon and early evening, which could be related to lack of sleep or exhausted pregneolone stores and subsequent lowered cortisol…not sure about that yet

I have a 4 sample saliva test coming up to check cortisol output

Was on arimidex at .1 mg/day but I stopped that today as I think it may be partly to blame for the erection issues…I’m hoping now that my balls are “awake” and producing T, and that I’ve seemingly taken my E2 to as low as my body wants it to go (around 30) that it will not rise upon stopping the AI…

Got a blood test done today, similar to my last one, and will post results when they come in…

Other supplements right now include:
-Men’s One-A-Day MultiVitamin
-Vitamin B complex
-Vitamin B12 (1k mcg/day)
-Vitamin D3 (10k iu/day)
-Ioddoral (12.5 mg/day)
-Biotest Flameout & FA-3 (4 caps/each per day)
-Biotest Superfood
-Biotest ZMA (3 caps at bedtime)

60

Did you find Wellbutrin amped you up at all? I am very interested in trying it, but as a guy prone to anxiety, have shied away.