Bloodwork & TRT Cheatsheet

Pharma TRT
101

Diagnosis confirmed…my Orchiectomy is scheduled for 28th March…

From a quick search online, I’ve seen some sites that say an orchiectomy will slightly lower T levels, but overall they should be able to recover…the problem is that mine weren’t all that high to begin with! Does anyone have any experience with this?

Also curious if the tumor is the likely cause of my current lowish T (and other hormone levels)? I know it is at least a contributing factor, but is it the “smoking gun”? Could I actually see an INCREASE in T (and other hormones) once the defective nut is removed?

102

I realize that most of my labs at this point in time are pretty useless, but the engineer in me is ever curious…got the latest round back today, which included cancer markers:

Bloodwork - March 2011

Gliadin (deamidated peptide) AB (IGG): 5 (<20 [n/a]
Gliadin (deamidated peptide) AB (IGA): 3 (<20) [n/a]
Gliadin AB (IGA): <3 U/mL (<11 = Negative) [n/a]
Gliadin AB (IGG): 69 U/mL (>17 = Positive) [-7]

Vitamin A: 81 mcg/dL (38-98) [n/a]

Estradiol: 27 pg/mL (13-54) [-14]

[i]*Prolactin: 18.8 ng/mL (2-18) [+11.8][/i]

*Glutamine (Amino Acid Urinalysis): 17 mmol/mol creat (21-182)
*Ethanolamine (Amino Acid Urinalysis): 15 mmol/mol creat (21-65)
Note: All values in my amino acid profile (~38 markers) were at the bottom ends of the range, not one was near the upper end…these were the two out of range low

WBC: 8.5 k/uL (3.8-10.8) [+2.3]
RBC: 5.36 M/uL (4.2-5.8) [-0.14]
Hemoglobin: 17.1 g/dL (13.2-17.1) [-0.3]
*Hematocrit: 50.3 (38.5-50.0) [-0.5]
MPV: 7.8 fL (7.5-11.5) [-0.5]

*AST : 41 U/L (10-40) [+15]
ALT: 50 U/L (9-60) [+15]
Creatinine: 1.29 mg/dL (0.8-1.3) [-0.05]

Alpha Fetoprotein: 2.0 ng/mL (<6.1) [n/a]
HCG, QN: 2 mIU/mL (<5) [n/a]
LDH: 206 U/L (100-220) [n/a]

Of note:

  1. Only one gliadin/celiac marker is high, which was also high on my last test…the deamidated peptides, which I understand are the most useful for diagnosing celiacs, are all well below range
  2. E2 has fallen 14 points since my last blood test in January, even though in January I was taking Arimidex and had stopped and wasn’t taking anything for estrogen control at the time of this test…weird
  3. Prolactin has skyrocketed from my test in late 2009–possibly secretions from the tumor?
  4. Lower amino acids across the board
  5. White blood cell counts show a marked increase–tumor…
  6. AST and ALT had a high increase, but not sure what these markers indicate
  7. All my cancer markers (AFP, HCG, LDH) were in range…possible indication that the tissue damage isn’t very sever yet and we have caught things early?

Not expecting any advice since it seems my thread has grown well beyond the scope of this forum, but if anyone has anything to offer, lets discuss…

103

[quote]VTBalla34 wrote:
I realize that most of my labs at this point in time are pretty useless, but the engineer in me is ever curious…got the latest round back today, which included cancer markers:

Bloodwork - March 2011

Gliadin (deamidated peptide) AB (IGG): 5 (<20 [n/a]
Gliadin (deamidated peptide) AB (IGA): 3 (<20) [n/a]
Gliadin AB (IGA): <3 U/mL (<11 = Negative) [n/a]
Gliadin AB (IGG): 69 U/mL (>17 = Positive) [-7]

Vitamin A: 81 mcg/dL (38-98) [n/a]

Estradiol: 27 pg/mL (13-54) [-14]

[i]*Prolactin: 18.8 ng/mL (2-18) [+11.8][/i]

*Glutamine (Amino Acid Urinalysis): 17 mmol/mol creat (21-182)
*Ethanolamine (Amino Acid Urinalysis): 15 mmol/mol creat (21-65)
Note: All values in my amino acid profile (~38 markers) were at the bottom ends of the range, not one was near the upper end…these were the two out of range low

WBC: 8.5 k/uL (3.8-10.8) [+2.3]
RBC: 5.36 M/uL (4.2-5.8) [-0.14]
Hemoglobin: 17.1 g/dL (13.2-17.1) [-0.3]
*Hematocrit: 50.3 (38.5-50.0) [-0.5]
MPV: 7.8 fL (7.5-11.5) [-0.5]

*AST : 41 U/L (10-40) [+15]
ALT: 50 U/L (9-60) [+15]
Creatinine: 1.29 mg/dL (0.8-1.3) [-0.05]

Alpha Fetoprotein: 2.0 ng/mL (<6.1) [n/a]
HCG, QN: 2 mIU/mL (<5) [n/a]
LDH: 206 U/L (100-220) [n/a]

Of note:

  1. Only one gliadin/celiac marker is high, which was also high on my last test…the deamidated peptides, which I understand are the most useful for diagnosing celiacs, are all well below range
  2. E2 has fallen 14 points since my last blood test in January, even though in January I was taking Arimidex and had stopped and wasn’t taking anything for estrogen control at the time of this test…weird
  3. Prolactin has skyrocketed from my test in late 2009–possibly secretions from the tumor?
  4. Lower amino acids across the board
  5. White blood cell counts show a marked increase–tumor…
  6. AST and ALT had a high increase, but not sure what these markers indicate
  7. All my cancer markers (AFP, HCG, LDH) were in range…possible indication that the tissue damage isn’t very sever yet and we have caught things early?

Not expecting any advice since it seems my thread has grown well beyond the scope of this forum, but if anyone has anything to offer, lets discuss…

[/quote]
Once I get the testing results then I will be able to get a better indication of what is going on. Low Amino acid just reinforces the fact about malaborption/ hyperpermeability issue that may be occuring. Low glutamine would mean your gut is using it at high rate which could being pulled from muscle if it is not being supplied through diet. Celiac has been known to lead into other imbalances such as cancer. The sad thing is that 1 out of 9 people across the planet may have celiac not even knowning it or showing symptoms before it is too late.
Prolactin increases if you have had intercourse the night before, hypothyroidism, low dopamine levels, or as you mentioned some kind of tumor indication with in the body.

104

I had the surgery today…including registration, pre-op, op, and recovery, I was in and out of the hospital in 3 hours…it was one of the easiest thing I’ve ever done…

Was able to walk to my car 2 blocks away post surgery with little issue, took a nap, and went out to eat with my folks and g/f this evening…some pain since it was a groin incision, and its getting stiffer, but right now I feel fine…still going to take it easy the rest of the week and let it heal up, but I’m not expecting a long recovery time…

The tumor was sent off for inspection and my follow up appointment is next week’s Wednesday, so I will know then what further treatment is necessary, if any at all…

I’m going to stop all the meds I’m currently on to try and get back to baseline and go from there–very hopeful this was the root of my problems, but need to make sure…

105

TAPER… don’t stop anything cold turkey… especially if you are on multiple medications and/or supplements…

106

Just got back from my follow-up appointment, and I don’t think it could have gone much better. Basically:

-The tumor was a pure seminoma, which is the most treatable and curable cancers
-It showed no signs of metastasizing outside of the removed testis

One thing that I was a little disappointed with though was the uro doesn’t think the tumor was causing my high LH and other issues…personally, I just don’t see how it couldn’t be playing somewhat of a role, but who knows…he admittedly is not a hormone specialist, so at least he recognizes that weakness…

So basically, I have a CT scan on Friday and if that shows nothing, I can pretty much assume everything is cleared up…

However, I may still opt for 2 rounds of chemo regardless of the CT outcome…I’ve read several studies that have shown in 3 separate trials with multiple hundreds of people who underwent 2 rounds of chemo after seminoma orchiectomy, the 5 year recurrence rate went from 15% (with just monitoring and maintenance) to ZERO percent…literally not a single participant had a recurrence…

Now I know 15% is small, but I think I would probably sleep much easier at night for the rest of my 20’s and early 30’s if I know that there is nothing to worry about…I think the ease of mind is well worth the misery of chemo for a few days…

107

wow. great news (except for the mixed blessing regarding chemo).

stay strong.

108

Got my blood back taken a couple weeks ago. 10 days later–looks like Quest is finally getting off the dime and getting results back to people in an acceptable timeframe. Not a good news story though…

[u]Bloodwork - April 2011[/u]

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

Pregnenolone: n/a
Progesterone: n/a
DHEA-S: 166 mcg/dL (110-510)[-5]
DHEA, Urine: n/a

*LH: 16.4 mIU/mL (1.5-9.3)[+7.3]
*FSH: 26.5 mIU/mL (1.6-8.0)[n/a]
Testosterone, Total: 263 ng/dL (250-1100)[-173]
*Testosterone, Free: 41.2 pg/mL (46-224)[-25.2]
*Testosterone, Bioavailable: 82.9 ng/dL (110-575)[-50.8]
SHBG: 25 nmol/L (7-49)[-3]
*DHT: 16 ng/dL (25-75)[-17]
E2: 41 pg/mL (13-54)[+14]**Note: Since March test
Testosterone, Urine: n/a
Testosterone, Urine: n/a

ACTH: 12 pg/mL (7-50)[+1]
Cortisol, Total: 13.4 mcg/dL (4.6-20.6)[8.3]
Cortisol, Free: 0.32 mcg/dL (0.07-0.93)[+.23]
Cortisol, PM: 14.0 mcg/dL (3.0-17.0)[n/a] **Not sure why they did the PM test vice AM test, but it looks good in the range

TSH: 2.86 mIU/L (0.4-4.5)[+0.77]
T3, Total: n/a
T3, Free: 360 pg/dL (230-420)[-40]
T4, Total: n/a
T4, Free: 1.2 ng/dL (0.8-2.7)[+0.1]
T3, Reverse: 20 ng/dL (11-32)[-4]

Vitamin D, 25OH: n/a
Vitamin B12, Serum: n/a

Creatinine urine: n/a
Iodine, Urine: n/a
Albumin: 4.4 g/dL (3.6-5.1)[0]
Ferritin: 60 ng/mL (20-345)[+2]
Folate: n/a

Total Cholesterol: n/a
LDL: n/a
HDL: n/a (>40)
Total/HDL Ratio: n/a
Triglycerides: n/a (<150)
Glucose: n/a (<100)

The following hematology had previously been out of range but has fallen back into range. All other markers were “in range”:
Hemoglobin: 16.2 g/dL (13.2-17.1) [-1.2]
Hematocrit: 47.1% (38.5-50.0) [-3.7]

The following chemistry was out of range, also included markers that had previously been out of range. All other markers were “in range”:
AST: 38 U/L (10-40)[-3]
*BUN: 26 mg/dL (7-25)[+11]
*Creatinine: 1.4 mg/dL (0.8-1.3)[+0.11]

-One bright spot is that it looks like my cortisol is finally improving…not having cancer and recovering from the suppression of the Cortef probably helps
-BUT obviously my androgen levels have fallen over the cliff since the relatively good numbers I enjoyed in October 2010…test has fallen close to 500 since then and I’m borderline now…it doesn’t appear that my remaining testicle is able to keep up with the demands (have we waited long enough since surgery?)
-LH and FSH are SKY HIGH…body wants to make more test, but testicle is not cooperating
-Estrogen is back on the rise. Have not been taking anything for that recently so this should be baseline.
-Thyroid numbers got slightly worse even though I’ve been supplementing with iodine (12.5 mg/day)
-Anything in the hematology and chemistry to be worried about? I think most of those out of range specs can be attributed to weight training…thoughts?

I am a mess…

109

VT:

I just caught up on this thread, your dx, and your surgery. I wanted to wish you a quick and easy recovery. There is a strong heriditary component to testicular cancer, so if you have any brothers, please remind them to perform testicular self-exams monthly.

110

[quote]VTBalla34 wrote:
TSH: 2.86 mIU/L (0.4-4.5)[+0.77]
T3, Total: n/a
T3, Free: 360 pg/dL (230-420)[-40]
T4, Total: n/a
T4, Free: 1.2 ng/dL (0.8-2.7)[+0.1]
T3, Reverse: 20 ng/dL (11-32)[-4]

-Thyroid numbers got slightly worse even though I’ve been supplementing with iodine (12.5 mg/day)
[/quote]

Your iodine supplementation may be contributing to your higher TSH numbers.

In a New England Journal study, researchers, led by Dr. Weiping Teng, of China Medical University in Shenyang, looked at the thyroid effects of giving supplemental to three separate groups: people who were mildly iodine-deficient, those with adequate iodine intake, and those with excessive iodine intake. They found that giving iodine to people who had adequate or excessive iodine intake could lead to hypothyroidism autoimmune thyroiditis.

They also found that the key risk factors for new subclinical hypothyroidism in people who started with normal thyroid function included:

TSH level greater than 2
High antithyroid antibody levels

[i] A shift in iodine intake from mildly deficient to more than adequate, or excessive iodine intake [/i] (emphasis mine)

Teng, Weiping M.D., et. al. “Effect of Iodine Intake on Thyroid Diseases in China” New England Journal of Medicine, Volume 354:2783-2793, June 29, 2006, Number 26

111

[quote]VTBalla34 wrote:
TSH: 2.86 mIU/L (0.4-4.5)[+0.77]
T3, Total: n/a
T3, Free: 360 pg/dL (230-420)[-40]
T4, Total: n/a
T4, Free: 1.2 ng/dL (0.8-2.7)[+0.1]
T3, Reverse: 20 ng/dL (11-32)[-4]

-Thyroid numbers got slightly worse even though I’ve been supplementing with iodine (12.5 mg/day)
[/quote]

Also, from the AACE website:

Subclinical hypothyroidism refers to mildly increased
serum TSH levels in the setting of normal free T4 and T3
estimates. Although subclinical hypothyroidism may represent
early thyroid failure, it may occur in the presence
or absence of symptoms. It is a common disorder, the
prevalence ranging from 1 to 10% of the adult population
with increasing frequency in women, in patients with
advanced age, [i]and in those with greater dietary iodine
intake.[/i] (again, emphasis mine.)

112

DRP: Thanks for the well wishes my man…recovery is basically complete as far as the surgery and TC itself goes–I’m back to doing things that I have always done…actually set a lifetime PR yesterday in Deadlift despite having the surgery exactly one month ago to the day and ensuing low T levels…pretty excited about that…only thing I can’t really do yet is core work because it puts too much pressure on the incision, but that should be good in a couple weeks tops I’d think…

Thanks for the info about iodine…I agree too much is bad, but I really have a hard time thinking that is what’s contributing to my thyroid worsening giving the stress, fatigue, and ensuing low T levels my body has experienced over the past few months…Definitely something to keep an eye on and in the back of my mind going forward, but I think the main problem right now is the glaring primary hypogonadism…

113

cortisol looks good. could stand to be a tad higher, but still not bad at all.

agree with the probable primary hypogonadism with very high LH/FSH and little testosterone plus high estradiol.

your TSH is really high, but your free T3 and RT3 look good. you tested negative for the antibodies before so not sure what to make of it. could be the iodine. my recent test showed I have TSH of 1.5 while on 30mg T3 only meds and ft3 of 4.8 (2.3 - 4.2 range) and rt3 of 12 (11-32 range). I am also taking 12.5mg Iodine. I am not sure if it is the iodine or if it the timing of my meds (i.e. my T3 wears off at night, my thyroid/TSH kicks in to make up the difference, I take my meds in the morning and then get blood drawn so the test shows the TSH trying to pick up for the night before it can lower itself with the new meds in my system.)

ferritin seems low (I think the ideal is like 150 for men?), but if your hemoglobin or hemacrit was over the range earlier I’m not sure if you should supplement iron.

seems like you may need to start on Testosterone along with something to bring down your Estradiol levels.

114

Blood was taken at almost 10 am, so I’m assuming the cortisol at 8 am was a bit higher, which seems fine to me…

I’ve talked with my doc and we are probably going to move to TRT w/adex here very soon…I’m going to do another round of blood tests on Tuesday just as a final sanity check, and then we’ll probably move on to that…

I have a couple questions:
-What about DHEA? My DHEA-S is consistently low…what are the benefits of supplementing DHEA while on TRT?
-Do I need hcg? It seems my LH/FSH is already sky high with no appreciable response from the testis…I know LH/FSH would go to zero on TRT, but is there any need to use the hcg to mimic them since they aren’t doing anything now?

115

It seems odd that your E2 would be so high with low amounts of T to armomatize. The E2 will be inhibiting the top end of your HPTA. But with higher levels of LH/FSH now, if you lowered E2, I would expect to see even higher levels of LH/FSH. Perhaps your adrenals are producing E2.

Your testicular pregnenolone production is reduced. If the remaining teste is getting smaller and softer, then I would expect that the pregnenolone production would be quite low or nil. As your LH/FSH levels are good now, a replacement dose of hCG will probably not change the situation.

Pregnenolone might be a good thing to take and that would support pregnenolone–>DHEA in the adrenals. But that might lead to more E2 from the adrenals. In any case, it appears that you will need anastrozole in any case.

Added pregnenolone also supports pregnenolone–>progesterone–>cortisol.

You can improve your mitochondrial pregnenolone production with fish oil and other EFAs, ACL, lipoic acid, anti-oxidants, adequate vitamins, CoQ10 and probably some other things that I have omitted.

You can try DHEA, but watch E2 response. T production in the testes will not be a major DHEA sink.

Low iodine leads to increased TSH, the higher levels of TSH can lead to goiter and nodules. The nodules can be T4 producing, independent of TSH control, as T4 from the nodules increases, TSH levels drop in an effort to control the situation. TSH can eventually get near zero and one has hypothyroidism. If one replentishes iodine [IR] somewhere during all of this, it can resolve the problem if done soon enough, or is too late to prevent hypo and the IR is not the cause of that outcome.

Docs want to find something alarming about folks supplementing iodine, but they are happy to put folks on sodium reduced diets that cause iodine depletion. There is no tidy package for all of this.

Edit: It is also well known that stimulation of target tissues that produce LH, FSH and HCG are cross coupled to some degree. So the oddly high LH/FSH may be creating some increase in FSH as well, but perhaps not by a significant amount.

116

Thanks KS…you and I are on the same track of thinking I believe here…

I talked to HAN today and we are going to do a consult tomorrow, but generally what I’m going to push for is one last ditch effort to bootstrap everything before going onto HRT…we are going to try something similar to the following protocol for a few weeks, monitor symptoms, and retest…if no improvements, then we will move to HRT…

We are going to support androgens and thyroid with:
-DHEA: 25-50 mg/day
-Pregnenolone: 50-100 mg/day in 2-4 divided doses
-Iron (w/vitamin C & folic acid): 100-150 mg/day

Going to start with lower doses and monitor response and adjust upwards as needed

This is in addition to my current meds/supplements:
-Aromasin: 12.5 mg/E3D
-Fish Oils: 3-15 g/day, depending on my diet (high carb or low carb days…this is outside of HRT)
-Multi Vitamin
-Vit D3: 10k iu/day
-Vit B12: 1000 mcg/day
-B Complex (heavy B6)
-Ioddoral: 12.5 mg/day
-ZMA
-Melatonin (for sleep): 5 mg

In addition, I will be following a gluten free diet to help rule out any gut absorption issues tied to gluten sensitivity…

Have a stress free few weeks coming up, so that shouldn’t be an issue…also vacation, so sleep should be good for at least the final week before retest…

It will also be about 10 weeks since my surgery by the time we retest, so that should be plenty of time for anything that is going to happen to actually happen

Any thoughts on what I’m trying to do here? I know its a lot at once, but if I respond, it can be fine tuned later–I’m not really worrying about isolating symptoms or anything just yet, I just want to see if I can avoid TRT and I think this sounds like a good game plan to do that…in theory…but like I’ve said before, I become a retard when its time to plan my own course of action…

Also, something to note, I have had a couple dermatological problems for years now…Basically I have a lot of little bumps that look like skin tags or zits underneath my arms…I went to a dermatologist a long time ago about these and they said its nothing to worry about (that was back when I trusted docs)…I haven’t researched this at all…

But I also have had athletes foot on my left foot for the better part of 5 years now as well…it seems to have gotten worse recently, despite my increase inc ortisol…but I’ve tried all sorts of OTC meds for it and nothing seems to have helped…I basically have just learned to live with it…

But my question is, and I know this is a reach, could any of my issues be a result of these skin conditions? Or are the skin conditions indicative of something more imbedded? Or am I just being a hypochondriac and they are not at all related?

I suspect the latter…

117

1st - 5mg of Melatonin is a pretty massive dose (from the very limited research I’ve done). I thought anything over 3mg was pushing it, and that Melatonin should only be used for 30 days at a time before an extended break because of potential suppression issues?

2nd - lol. gotta love this group in a isn’t life full of coincidences type way. I have basically the exact same question about skin conditions. I don’t have the bumps, but a heat rash type issue and had some stafe infection hair follicles on my head a couple of years ago, and am trying to figure out any possible connection between those and my hormone balance.

I know there is a connection between harmful bacteria and helpful bacteria on the skin and in the gut and hormones have to have some impact on these as well, but how, why, and to what degree, I am clueless.

118

PC: I tried the 3 mg for a while and didn’t feel an effect but the 5 mg has had a really noticeable improvement on my sleep quality and ability to wind down at night…I will probably cycle it (time on = time off) between bottles.

I just had my consult with HAN and we are going to implement the Preg (100 mg/day) and Iron (50 mg/day) components of my proposal, as well as Selenium at 200 mcg/day. No DHEA for now because that can have a negative effect on people with cancer (also why we are keeping the iron low). Will also be maintaining gluten free diet to make sure absorption isn’t being affected and seeing a dermatologist about my skin issues, but those are remotely small possibilities.

I have a bloodtest soon for Androgen levels, as well as some gut absorption tests (fatty acid, amino acids). Depending on how that turns out, we will make the decision to either start TRT or try and treat existing issues in case of malabsorption.

119

I got my most recent bloodwork back today, and consolidated all my previous bloodworks and this one into a spreadsheet, which now resides on google docs. Here is the link:

https://spreadsheets.google.com/spreadsheet/ccc?key=0Akmuyi4-pdXKdDl1Qk1PYmYyVnRsbTlxZ2VOTHQ2VFE&hl=en_US&authkey=CN6whbYE

I’ve hidden some of the columns (dates that didn’t have much corresponding bloodwork and just took up a lot of room) as well as rows that I didn’t find particularly useful anymore (celiacs panel, urinalysis, etc.). If you want to unhide them all and look at them, knock yourself out.

My thoughts:

-Androgens are back into range, but barely. Fortunately, this does not affect my doctor’s opinion that HRT is needed but I still have to clear the hurdle with my urologist before I can commence HRT.

-E2 has responded pretty well to the Aromasin. I can’t remember how consistently I was taking it when I got the blood done though. Regardless, I think I’m going to switch to Adex for HRT. Aromasin is just too expensive to take regularly since it has to be compounded and adex doesn’t.

-My LH/FSH are still screaming but no response. I notice my already low DHEA has now fallen out of range as well–could part of my problem be not enough DHEA to meet my LH/FSH demands, or has the testicle actually failed rendering me primary?

-I appear to not be absorbing the Pregnenolone at all.

-Prolactin has fallen back into normal range. I think I had banged my girlfriend a short time before the last test so that would explain why it was high.

-Cortisol is looking decent. Blood was taken at around 10 am, so 8 am was probably higher. It is just impossible to get into a Quest in DC at 8 am though unless you book weeks in advance.

-Iodine urine is over 12x the upper range (12.5 mg/day of Ioddoral). I’m going to cut this back drastically. I think its safe to say that my iodine has been replinished.

-Cholesterol has improved a bit, but a less bad train wreck is still a train wreck…triglycerdies have improved tremendously, which I was happy about. The Vit B complex (high niacin) I have been taking appears to have done fuck all for my HDL.

-Amino Acid profile is still not very good. I don’t know what to make of this or what to do about it. Not really sure why we’re even testing it because I haven’t been given any advice on what to do to improve it. Going to bring this up at the next appointment.

So where does this leave me? I’m not really sure. I’m hoping to see an improvement in most of these areas once I commence HRT–I think that is the biggest hurdle to clear right now. I will work on the other things once I have that lined out and hopefully will have a big piece of the puzzle out of the way.

Feedback is appreciated.

Edit: New link for speradsheet

120

Holy crap! Harsh news, man. If it is any consolation, you are probably in the top 1% so far as patient involvement & knowledge are concerned. This plus a good team should result in you kicking this things ass.

Best wishes for a speedy recovery!