Bloodwork & TRT Cheatsheet

Pharma TRT
81

Thanks to all for all the advice and information.

Reading some of these things rang a bell with me…its weird how when helping other people with their issues, one has the uncanny ability to recall all of this and think in a very objective manner…but as soon as dealing with yourself, you seem to lose all focus and start evaluating subjectively…maybe its just me…

Tyson: My numbers have always been less than ideal, even when I cut weight…when I was 230 and “skinny fat”, they were still bad…last year I got back down to about 255 and HDL had fallen to 27 and LDL wasn’t much better…

I’m not claiming to be Mr. Olympia or anything here, but I’m not the same 285 that you are probably seeing in most of your patients…I train my ass off…but regardless, after my meet in March I plan to take 3 months to get my weight down and shed some fat, so we’ll see what happens then…

I’m glad to have you on this board, I think you are a very helpful asset…

HAN: Thanks man. Keep in mind my HDL and triglycerides were also bad…HDL is always too low, tris are normally better and are high right now directly as a function of diet since I have been force feeding shit to try and break through my recent weight and strength plateau…now that I’ve gotten past it, I’ll be cleaning the diet up a bit…

KSMAN: Thanks for the info on cell health…I take a lot of steps to ensure everything is going well at the cellular level, including fish oils (Flameout from this site) and antioxidants (Biotest Superfood)…diet is also very high in antioxidant rich veggies…I will keep the CoQ10 info in the back pocket for now…I really believe that once all my hormone issues are rectified that the cholesterol will follow…

82

Purechance and Akaji,

In the interest of full disclosure, I have not vetted all of the information on STTM and so will not damn the entire site since that would be unfair. Before I give a few specific examples that I pulled from the first page I came to when I visited the site let me take a second to make a few general statements about medical information in general and some situations in which skepticism should be the default:

  1. The site is moderated/written by a person/group with an agenda i.e. revenge against tendentious and intellectually lazy western medicine (like STTM’s stated raison d’etre)

  2. The site is maintained by people with no medical background. This is a classic case of a wiki expert who knows just enough to be dangerous and make some valid points while not understanding the complexity of the system.

  3. The site promotes one malady as the “real reason” for just about all that ails you. They take non-specific symptoms i.e. fatigue, brain fog, depression, weight gain, etc., which can be caused by about 1000 other disease states and blame them all on one underlying problem. I think everyone on the this board with TRT experience can vouch for the inaccuracy of this position. If hypothyroid isn’t your thing try looking up heavy metal toxicity, vaccine fearmongers, qui-gong practitioners, etc. They all sound almost exactly the same.

  4. They move the goal posts constantly. So if your numbers are out of whack there’s your problem, if they are perfect you still have a problem and the stupid doctors are missing the details somewhere. The pet issue (hypothyroid) is always to blame for unimproving symptoms regardless of the evidence to the contrary.

Now, do these things make the information incorrect and negate every point the site makes? Of course not. Some of what I’ve seen on the STTM site is valid, for instance. This makes it all the more insidious for the lay person because there is enough correct information that it obfuscates the incorrect/oversimplified material and confuses the reader.

For a few particulars, and again this is just what I pulled from the first page I saw and I’m extrapolating to the rest of the site so grain of salt…

The claim that the TSH test alone is ALWAYS inadequate. This is simply false. The TSH level has been validated so many times as an excellent marker for thyroid function that it hardly bears argument. Remember that there are a HUGE number of extremely intelligent people who do this for a living i.e. practicing specialist, that vet the literature constantly looking for new ways to help their patients, that to conclude that the consensus of medical science is so naive as to have missed this cornerstone of diagnosis is quite a bold statement. The few doctors the author quotes are in the minority and they still use the test. Are there situations which make a TSH level ALONE inadequate? Absolutely…that’s why we run more tests. The thyroid is not that complicated in the scheme of things and there are a select number of places that things can possibly go wrong so if a person is symptomatic despite a “normal” TSH, no physician would withhold further testing because the lab said the person was “fine”. That’s a strawman.

Another example surrounds the sites interpretation of adrenal labs. The author really muffed this one and it is a great example of a person reading a text/wiki and then posting information without really understanding it. DHEA is not the mother of all hormones/steroids and is therefore not the end all marker for adrenal/steroidal function as is the claim. The ACTH stim (cort stim test) does not require fasting, can be done at anytime of day, does not require a doubling of cortisol for a normal reading, etc. etc. I could go on but I really don’t have time right now. If there are any specific questions I would be glad to field them.

And I don’t call these sites malpractice since they aren’t run by practitioners, just to clarify.

VT, I applaud your open mindedness concerning these personal problems. You are completely right about staying objective when it’s you. I read a quote by Dave Tate the other day that said that Dave can program other people down to the smallest detail and peak them perfectly but when it comes to his own training it’s like he doesn’t know anything and prefers to have someone else write his routines for him. It’s universal and we all have the same problem. I appreciate the fact that you are willing to try and see what happens. After all, who gives a shit if I’m right or wrong, I just want you to be healthy and see these problems taken care of. If there is ever anything you think I can help you with I would be more than glad to try so please don’t hesitate to ask questions.

Good luck.

83

Thank you for the response, Tyson. I appreciate the info.

Regarding the TSH test - what is your opinion on the controversy re: the correct lab ranges? E.g. there’s the AACE 2003 report stating that 0.3-3.0 should be the range, and the NACB 2002 report stating that 0.3-2.5 is likely to be the range in the future; there are also studies saying that a TSH over 2.0 indicates a significantly higher risk of hypothyroidism developing later in life. On the other side of the issue, many boards, groups, studies, etc. are claiming a TSH of 4.5 or 5.0 should be the high range, and some even say that a TSH below 10.0 should never be treated… it’s a very confusing situation to me.

84

[quote]Akaji wrote:
Thank you for the response, Tyson. I appreciate the info.

Regarding the TSH test - what is your opinion on the controversy re: the correct lab ranges? E.g. there’s the AACE 2003 report stating that 0.3-3.0 should be the range, and the NACB 2002 report stating that 0.3-2.5 is likely to be the range in the future; there are also studies saying that a TSH over 2.0 indicates a significantly higher risk of hypothyroidism developing later in life. On the other side of the issue, many boards, groups, studies, etc. are claiming a TSH of 4.5 or 5.0 should be the high range, and some even say that a TSH below 10.0 should never be treated… it’s a very confusing situation to me.[/quote]

This may be better asked as a separate post so others not following my thread can benefit, and to avoid general broad range discussions in specific threads…

85

Sorry, you’re right VT. I’m starting another thread. Mind posting in the other one, Tyson?

Edit: here’s the thread (needs to be approved before it will be on the topics list) – Thyroid Discussion - Testosterone Replacement - Forums - T Nation

86

Wellbutrin:

Yes it can be a stimulant. I used it a couple of years ago and while it did do good things, after a while it tired me out from the stimulation. I have written about that a number of times.

I have read a few things suggesting that it increases cortisol. I do not know if that is true, perhaps it has effects like cortisol. Some will need this and some will not find that it is good. In any case, when stopping, apart from the usual spectrum of discontinuation effects, that are highly variable, one might be expected feel a let down from the lack of stimulation and may then feel like they have little energy.

Now after my surgical disaster and near death, I have not had the same vitality. This turned into a depression a few months ago. I tries a bit of my wife’s low dose Armour thyroid. That really did not seem to have any effect. Then a half of her cortef tablet. That really turned me around, that was a test only. [Making adrenal fatigue probable.]

As things progressed and I became aware that my lack of vitality had become a depression, I found my old Wellbutrin. That has made a huge difference for me in many ways. I can take 100 or 200mg per day and do not feel over stimulated, but more like I was before the surgery. So in my case, I have changed from intolerance of the stimulant effects of Wellbutrin to need it.

This sort of explains why Wellbutrin stimulant effects are good for some and not others. And this can change for an individual in some circumstances. That indicates that these effects are not intrinsic to the drug. And not totally intrinsic to how the drug is processed by one individual’s body, as the drug can have different results/effects on the same person if the person changes.

The effects of some stimulants might be an hint of a person’s cortisol status or other things out of balance.

BTW, I find that Wellbutrin promotes fat loss [for me]. I am quite lean and have a 31" waist. Which for me translates to loss of fat in the areas that are fat loss resistant. My activity has increased, as one would expect, and I am gaining strength and muscle mass. Lately my training has been hours of snow shoveling. So I am not only loosing fat, but gaining muscle and strength. The balance is actually showing up as a net weight loss. Over all, I am feeling a lot better about everything, even my next surgery to correct the incisional hernia created by the disaster last July.

87

Great to hear you’re feeling better big man.

88

I just got completely spun up on this thread and everything it has to offer- there is a lot of information in these 4 pages.

Keep us updated on your labs when they come in. I’m very interested to see what everything looks like compared to the original ones we had done in June. I’ll probably update my thread at the same time. I’m actually thinking I may be close to coming completely off adex and riding solely on 4-5 supplements. Curious as to what the next step is for both of us though.

I will admit environmental factors have definitely wreaked havoc- I’ve gone from jobless, helpless depression to more responsibilities than I could know what to do with and my mood has lifted. Energy still needs some tweaking. haha

I’m going to buy a gallon of Test and just inject that directly into my testes- want to go in on a group buy?

89

I’m about to hop on a plane for Scotland and grabbed some mail on my way out the door with some blood test results. Quest is again taking their sweet ass time getting my results out.

Pregnenolone was only test here and it was 24 (13-208). I forgot the ranges but holy fck this is low. This is after taking compounded TD preg for over 2 months at 25 mg/day. Wondering if this might be a smoking gun?

ACTH was in the lowest 10% of range as welll though I don’t remember the numbers

90

I have written about how you can increase pregnenolone levels by improving mitochondrial function. Have you trying any of the recommendation?

91

as you know some people just can’t absorb transdermal medications.

other doctors say that Transdermal does not impact blood levels of pregnenolone (which I say is BS).

other doctors say that you would have to take massive amounts of Transdermal pregnenolone for it to actually show up on blood tests (seems more reasonable).

some people on other forums have had success with taking lipid matrix micronized pregnenolone (available OTC online). the lipid matrix version is suppose to skip the first-pass through the liver so you end up with higher levels. people take anywhere from 50mg to 300mg.

92

[quote]KSman wrote:
I have written about how you can increase pregnenolone levels by improving mitochondrial function. Have you trying any of the recommendation? [/quote]

Are you talking about:

To which I responded:

[quote]VTBalla34 wrote:
KSMAN: Thanks for the info on cell health…I take a lot of steps to ensure everything is going well at the cellular level, including fish oils (Flameout from this site) and antioxidants (Biotest Superfood)…diet is also very high in antioxidant rich veggies…I will keep the CoQ10 info in the back pocket for now…I really believe that once all my hormone issues are rectified that the cholesterol will follow…
[/quote]

?

I’ve not tried any of the additional supplement recommendations as this is the first blood test I’ve had with pregnenolone, so I didn’t know of a potential problem before. I was only taking it for the past couple months to aid in backfilling cortisol pathways while coming off the Cortef.

Gonna wait till the rest of my bloodwork is in before making any changes. That unfortunately won’t be for a couple weeks since I’m OOC for work.

One theory that HAN suggested is that the serum levels are low because the preg is being immediately converted into the downstream hormones. I’ve tested DHEA and Progesterone on this test, so that should confirm or deny that theory.

As PC mentioned, its also possible that I wasn’t absorbing, especially since I have been diagnosed secondary hypothyroid anyway.

93

I just wanted to capture this here for posterity in case I forget somewhere down the line.

I stopped taking the adex after my blood test on 26 January. I had been having sore joints and ED issues that I thought may be from too high of adex (0.7 mg/week in EOD doses). Its been a couple weeks and erections are a bit better and joint pain is gone, so it would seem my suspicions are confirmed.

Whether it degrades from here, continues to get better, or flatlines still remains to be seen.

I ordered some tadalafil (20 mg) online and that seems to help the ED immensely. But would certainly rather not have to rely on that.

On 12 February, I began taking Rez-V from Biotest as part of my supplements. Recommended does at 3 caps per day. Will report back on any changes I notice from that.

94

VTB, can you edit your glossary to remove the junk created by cut and past from a word processor? [The way to avoid this is to save as .txt, then open that file with notepad.exe and cut/paste from that.]

95

[quote]KSman wrote:
VTB, can you edit your glossary to remove the junk created by cut and past from a word processor? [The way to avoid this is to save as .txt, then open that file with notepad.exe and cut/paste from that.][/quote]

Done

96

Testicle Pain & Adex

I wrote this in hipsr4runnin’s thread on testicle pain + adex:

[quote]VTBalla34 wrote:
My story is dissimilar from OP, but does involve testicle pain and adex, so I thought I would share…

When I decided to embark on correcting my issues in June 2010, one of my symptoms was occasional dull aching of one of my testicles…when I started taking Adex in June, the pain pretty much disappeared…I started out at 0.5 mg/week and eventually bumped up to 0.7 mg/week…

Thinking I may my E2 aromatization issues under control, I stopped taking adex entirely at the end of January…

A couple weeks later, my left testicle developed the same dull pain, that seems to spike upon deep breaths…This has been ongoing for the past couple weeks…

It seems more pronounced after I take my Rez-V for the day, but that could just be in my head or a function of med timing…

Take this for what its worth, but I thought it interesting and somewhat relevant…

[/quote]

Basically I was having testicle pain before starting Adex, it went away, now that I’ve stopped Adex, it seems to have come back…

I’ve felt around for lumps, and am a bit concerned, so I am going to schedule an appointment with a doc in the next couple weeks to have the boys checked out…

On good news, they’ve been checked out as part of my first-visit routine by two different doctors over the past 8 months, and nothing was obviously amiss, so I’m optimistic that nothing is wrong…but better safe than sorry…

I also called Quest Friday and they told me all my labs had been completed and results mailed out to me on Wednesday…so they’re probably at home now, but I’m on travel until next Sunday so won’t get a chance to view them until then…

I really wish Virginia would get with the program and allow results released directly to patients–I would be able to view them directly on my blackberry remotely…

97

Just got all the final bloodwork in

[u]Bloodwork - January 2011[/u]

Note: Changes from October test are noted in brackets, when available

Pregnenolone: 24 ng/dL (13-208)[n/a]
Progesterone: <0.5 ng/mL (<1.4)[?]
DHEA-S: 171 mcg/dL (110-510)[-6]
DHEA, Urine: 537 mcg/24h (21-2710)[+215]
DHEA, Urine: 130 mcg/g creat (24-1640)[+56]

LH: 9.1 mIU/mL (1.5-9.3)[+0.1]
[i]Testosterone, Total: 436 ng/dL (250-1100)[-194][/i] <<–WTF???
Testosterone, Free: 66.4 pg/mL (46-224)[-34.7]
Testosterone, Bioavailable: 133.7 ng/dL (110-575)[-105]
SHBG: 28 nmol/L (7-49)[+4]
DHT: 33 ng/dL (25-75)[+8]
[i]E2: 41 pg/mL (13-54)[+12][/i] <<–WTF???
Testosterone, Urine: n/a
Testosterone, Urine: n/a

ACTH: 11 pg/mL (7-50)[n/a]
Cortisol, Total: 5.1 mcg/dL (4.6-20.6)[-.4]
Cortisol, Free: 0.09 mcg/dL (0.07-0.93)[+.01]
Cortisol, AM: n/a

TSH: 2.09 mIU/L (0.4-4.5)[-0.01]
T3, Total: 130 ng/dL (76-181)[+20]
T3, Free: 400 pg/dL (230-420)[+20]
T4, Total: 6.7 mcg/dL (4.5-12.5)[+0.6]
T4, Free: 1.1 ng/dL (0.8-2.7)[-0.3]
T3, Reverse: 24 ng/dL (11-32)[+4]

Vitamin D, 25OH: 84 ng/mL (30-100)[+13]
Vitamin B12, Serum: 818 pg/mL (200-1100)[+513] <<–After supplementing B12

Creatinine urine: n/a
*Iodine, Urine: 1619 mcg/L (34-523)[+1539]<–After supplementing iodine
Albumin: 4.4 g/dL (3.6-5.1)
Ferritin: 58 ng/mL (20-345)[+7]
Folate: 22.9 ng/mL (>5.4)[n/a]

*Total Cholesterol: 220 (<200)
*LDL: 144 (<100)
*HDL: 31 (>40)
*Total/HDL Ratio: 7.1
*Triglycerides: 226 (<150)
*Glucose: 102 (<100)

The following hematology was marked out of range, as usual…all other hematology were “in range”:
*Hemoglobin: 17.4 g/dL (13.2-17.1)
*Hematocrit: 50.8% (38.5-50.0)

Some things I note from the labs:
-Test (total, free, bioA) are heading in the wrong direction…200 drop in free T???
-Estradiol had large increase, even though taking 0.7 mg/week Rx arimidex
-LH has been constantly high on 4 blood tests now…significant?
-Cortisol markers look terrible
-Iodine supplementation needs to be cut back on considerably
-I was taking liver tabs to try and increase ferritin, and that has no appreciable effect…
-Lipids are in the toilet

To say that I am growing discouraged would be a huge understatement…

98

I had my consult yesterday with HAN and Dr. O…it went well and we are on the same page and I think we have a good game plan going forward…

We are going to look at Celiacs…more blood testing and I am going to schedule a biopsy for confirmation…

In the meantime, we are increasing my pregnenolone dose from 25 mg/day to 100 mg/day (25 mg 4x). Hopefully this will get my preg up and other downstream hormones brought online…Retest in 2 weeks of DHEA (Sulfate serum and DHEA urine) and Progesterone, as well as E2 and testosterone to see if I am absorbing. If no improvement, we are going to look at replacing the Rx pregnenolone with a different brand (more gel based).

As for managing E2 in the meantime, we are switching to Aromasin. We’re thinking the compounded adex caps I was using was either a poor product or wasn’t being absorbed if I have gut issues…the liquid should be absorbed better by my body

I’ve got a blood test set up Monday for more celiacs markers, as well as E2, Vitamin A, and prolactin…I stopped taking the adex over a month ago, so if there are no changes in E2 then that would point to an issue with my adex product…

I will also be doing the Genova Nutra-Eval once I can find a place to draw the blood…my Quest location has refused, but apparently others will…

99

Glad to hear you’ve got a solid game plan to move forward with. Keep your chin up, brother; we’re all pulling for you here.

Best of luck with all this.

100

I found out today that there is a good chance (90%) that I have testicular cancer…

I had been having pain on and off for about 8 months now and did a self-exam last week and noticed firmness and a lump in my left one…scheduled an appointment with a urologist who agreed with both and scheduled me for an ultrasound…

Ultrasound confirmed 3 (!) “lesions” in that testicle (right one was fine)…one of which was 2 cm long…the other two were smaller…

I have a follow up with the uro tomorrow to get a confirmation, but based on the sonogram lady’s reaction and discussion, I’m pretty sure I know the answer…

The good news: This proibably explains all my issues…