Here are a few recent labs, indicating okay TT but low free T. I have been having terrible recovery and resulting loss of strength and muscle mass over the past 18 months (lost 30 lbs muscle). Injuries are partly to blame, but the fact that these are so chronic suggests that they may be an additional symptom of hormonal issues.
Would TRT be a possible or desirable option for someone like me? TT would seem to exclude it, but maybe the low free T is behind my symptoms…
7/17/09 7:30 am
total T = 600 (241-827)
free T (direct) = 10.7 (6.8-21.5)
estradiol = 36 (0-53)
DHT = 38 (25-75)
9/4/09 7:30 am
Total T = 478 (241-827)
Free T (direct) = 8.2 (6.8-21.5)
estradiol = 34 (0-53)
LH = 8.9 (1.5-9.3)
10/10/09 7:30 am
Testosterone, total 690 (241-827)
DHT 47 (25-75)
SHBG 32 (9-45)
Free T (calculated) 14.7
[quote]Bricknyce wrote:
Your free and total T level aren’t abnormally low in any case. I can almost guarantee that NO doc will prescribe T for you. [/quote]
Dr. Morgentaler in his book “Testosterone for Life” considers free T below 15 to be abnormally low and to be an indication for TRT if symptoms are present. My free T is significantly lower than 15 in 2 out of the three tests, namely 10.7 and 8.2 respectively.
You are estrogen dominant and I expect that you have some flab issues.
TT is meaningless. It is a measure of mostly SHBG bound T that is functionally inert. E2 is blocking much of the effects of what FT you have. Your HPTA should be inhibited by the E2 and is partly responsible for your low T. Your LH looks decent, but it releases in pulses and in the AM and you probably caught a peak. FSH is a better indicator of gonadotrophin output as it has a longer half life.
Your LH does suggest the possibility that the problem is in your testes. Any ache or discomfort there?
You appear to be a good candidate for using Arimidex/anastrozole to lower E2 levels by itself. Otherwise, you do appear to be heading towards TRT.
Questions:
Age
height
waist
weight
where do you carry fat and how changing
how much body and facial hair
loss of hair below the knees
PM me with drugs/meds, Rx and OTC. These can increase E levels.
high blood pressure
any blows to the head or whiplash around two years ago
Do you have any problems with serum glucose?
Read about hypothyroidism and see if any of the symptoms fit. Many are common to hypogonadism. So pay attention to skin dryness, fat gain, feeling tired in the afternoon feeling cold easy. Check for waking body temp 97 degrees or lower. Are you using iodized salt?
[quote]KSman wrote:
You are estrogen dominant and I expect that you have some flab issues.
[/quote]
No, I have very low bodyfat.
Given that I probably have high SHBG, how do we know if free E is also high? Could free E be low despite high total E (thus causing high LH)? I am still confused by this issue…
Had a varicocele as an adolescent that was repaired then. Flared up again badly maybe 5 years ago but pain went away on its own after 3 months. But since total T is respectable, doesn’t this mean testes are functioning more or less okay?
Yes, I have been looking at that as well, but I was worried about the total E/free E issue mentioned above. I am prone to the kind of joint pains described by people low on E, and worry about lowering E for that reason.
If you take anastrozole, it will be to modulate serum E2 levels to get near E2=22pg/ml. There are no joint issues when doing that. If joints ache or you get mood problems, then E2 is clearly too low and you would adjust the dose. If you are one of the few who are anastrozole over-responders, you would need to cut your dose by a factor of 4. Those guys get symptoms fast and strong. No way to know in advance and if this was managed by a doctor none of that would change and very few doctors understand this issue anyways. You would find a dose that feels comfortable and use that for a while and your body would make some adjustments, then you would refine the dose after getting serum E2 lab work.
You have low body fat, low TSH and T4 levels at or near top range. You need to watch for signs that you could become hyperthyroid. Doc can palpate for nodules and thickening of the thyroid. Low iodine intake can lead to some of this after a few years in a few cases.
I would not focus on free E or free E2 numbers, will not be of use now.
It is odd that E2 is up and you are so lean. This does suggest something changed with how your liver’s P450 enzyme pathways have diminished capacity to remove estrogens from the blood. That is where OTC and Rx drugs need to be screened and liver markers on blood tests need to be reviewed. Another possibility is that you have some bad bacteria in your gut that liberate estrogens from their metabolized form in the liver bile that allows the freed estrogens to be [re] absorbed by the gut and returned to the liver by the portal vein. That first [re]pass processing in the liver could be expected to create an exaggerated SHBG response in the same way that oral estradiol does the same with women on HRT. You should try a high quality probiotic. Not junk on the shelf. Would be refrigerated capsules in a dedicated vitamin or whole foods shop.
[quote]KSman wrote:
You have low body fat, low TSH and T4 levels at or near top range. You need to watch for signs that you could become hyperthyroid. Doc can palpate for nodules and thickening of the thyroid. Low iodine intake can lead to some of this after a few years in a few cases.
[/quote]
Hmm, thank you for pointing that out. In addition to high T4, I have developed these weird smooth bald patches on my shins. After some reading, it is kind of starting to look suggestive of Grave’s disease, especially combined with the weight loss, muscle wasting and insomnia. Apparently high SHBG is also associated with Grave’s disease. I’ll try to convince my doctor to screen for Grave’s, but I don’t have high hopes on that, given that he already told me my thyroid was fine.
I ordered anastrozole tablets. In your experience, should 0.25 mg twice a week give sufficiently even levels in most cases? It might be hard to further subdivide them (unless, of course, I dissolve them in a bottle of Lagavulin, haha).