Do I Have Any Issues?

Pharma / TRT Testosterone Replacement
1

Age 42
Height - 6ft.
Waist - 35in.
Weight - 185#
Body Type - Very lean arms/legs/glutes, carry all fat in belly & back

Diet - Fat kid thru teenage years. Hit my 20s at 255# and lost weight thru excercise & diet. Have maintained 180-190# for over 15 years. Diet has been decent with recent years eating a light breakfast (oatmeal & bannana), lunch (protein shake or small meal), some type of peri-workout nutrition, and typically a big dinner (whatever the wife makes). I have for the past month been doing the Pulse Feast as prescribed by CT on this website and am very happy with it thus far.

Training - have lifted for years with minimal cardio. Currently doing HP Mass 5 days/week @ 1.5 hours/day in the afternoons. 1-2 long walks/week

Current Supplements - probiotoc, fish oil, HCL w/pepsin (for digestion), Vitamin D, Creatine, MAG-10, Whey Protein

Health conditions
Sex drive SUCKS but no problems with getting erections
Can’t lose the fat around my belly and back
Struggle to make substantial muscle or strength gains

Blood work is from a couple of months ago when I went in for a physical.

Lipid Panal
Cholesterol, Total 169 ( 125-200 mg/dl )
HDL Cholesterol 46 ( >or= 40 mg/dl )
Triglycerides 58 ( <150 mg/dl )
LDL-Cholesterol 111 ( <130 mg/dl )
CHOL/HDLC Ratio 3.7 ( < or = 5.0 )
Comp. Metabolic
Glucose 89 ( 65-99 mg/dl )
UREA Nitrogen (BUN) 23 (7-25 mg/dl )
Creatinine 0.85 ( 0.78 � 1.34 mg/dl )
Sodium 140 ( 135-146 mmol/L )
Potassium 4.5 ( 3.5-5.3 mmol/L )
Chloride 103 ( 98-110 mmol/L )
Carbon Dioxide 26 ( 21-33 mmol/L )
Calcium 9.4 ( 8.6-10.2 mg/dl )
Protein, total 7 ( 6.2-8.3 g/dl )
Albumin 4.2 ( 3.6-5.1 g/dl )
Globulin 2.8 ( 2.1-3.7 g/dl )
Albumin/Globulin Ratio 1.5 ( 1.0-2.1 calc )
Bilirubin, total 0.6 ( 0.2-1.2 mg/dl )
Alkaline Phosphate 67 ( 40-115 U/L )
AST 21 ( 10-40 U/L )
ALT 18 ( 9-60 U/L )
Hemoglobin A1c 5.5 ( <5.7% of total Hgb )
Vitamin D, 25 HYDROXY,
LC/MS/MS
Vitamin D, 25-OH, TOTAL 28 (30-100 ng/ml)

25-OHD3 indicates both endogenous product on and supplementation. 25-OHD2 IS AN INDICATOR OF EXOGENOUS SOURCES, SUCH AS DIET OR SUPPLEMENTATION. Therapy is based on measurement of total 25-OHD, with levels <20 ng/ml indicative of vitamin D deficiency, while levels between 20 ng/ml and 30 ng/ml suggest insufficiency. Optimal levels are > or = 0 ng/ml.

Vitamin D, 25-OH, D3 28 (ng/ml)
Vitamin D, 25-OH, D2 <4 (ng/ml)
Creatine Kinase, total 136 ( 44-196 U/L )
TSH, 3rd Gen. 1.48 ( 0.40-4.50 Miu/L )
T4, Free 1.1 ( 0.8-1.8 ng/dl)
T3, Free 3.3 ( 2.3-4.2 pg/Ml )
Thyroglobulin Antibodies <20 ( <20 IU/ml )
Thyroid Peroxidase Antibodies <10 ( <35 IU/ml)
Dihydrotesterone 49 ( 25-75 ng/dl)
Estrogen, Total, Serum 69 ( pg/ml ) 130 or less
CBC
White Blood Cell 5.9 ( 3.8-10.8 thousand/ul )
Red Blood Cell 5.02 ( 4.20-5.80 million/ul )
Hemoglobin 15.8 ( 13.2-17.1 g/dl )
Hematocrit 47.5 ( 38.5-50.0% )
MCV 94.6 ( 80-100 fl )
MCH 31.5 ( 27-33 pg )
MCHC 33.3 ( 32-36 g/dl )
RDW 13.3 (11-15% )
Platelet Count 283 ( 140-400 thousand/ul )
Absolute Neutrophils 3640 ( 1500-7800 cells/ul )
Absolute Lymphocytes 1634 ( 850-3900 cells/ul )
Absolute Monocytes 496 ( 200-950 cells/ul )
Absolute Eosinophils 83 (15-500 cells/ul )
Absolute Basophils 47 ( 0-200 cells/ul)
Neutrophils 61.7 ( % )
Lymphocytes 27.7 ( % )
Monocytes 8.4 ( % )
Eosinophils 1.4 ( % )
Basophils 0.8 ( % )
Iron and Total Iron
Binding Capacity
Iron, Total 84 ( 45-170 mcg/dl )
Iron binding capacity 362 ( 250-425 mcg/dl )
% Saturation 23 ( 20-50% CALC )
Ferritin 38 ( 20-380 ng/ml )
Vitamin B12 772 ( 200-1100 pg/ml )
DHEA Sulfate 62 ( 45-345 mcg/dl )
FSH 1.6 ( 1.6-8 miu/ml )
LH 4.8 ( 1.5-9.3 miu/ml )
Progesterone <0.5 ( <1.4 ng/ml )
PSA, Total 1.7 ( < or = 4 ng/ml )
Testosterone, Free and Total, LC/MS/MS
Testosterone, Total, LC/MS/MS 651 ( 250-1100 ng/dl)
Free Testosterone 106.1 ( 35-155 pg/ml )
Urinalysis
Specific Gravity 1.025 (1.001-1.035 )
PH 5.5 ( 5-8 )

Overall my health is pretty good. I would like to identify any causes of concern and see what if anything can/needs to be done to assist in improving my conditioning efforts. I have read all the stickies and many posts which has given me a wealth of information. I appreciate any thoughts you guys might have.

2

Some things I notice:

-Low Vit D–start supplementing at around 6k iu/day…get a good brand
-Estrogen test is pretty useless…you need E2 (estradiol) 4021x is the code for Quest, not sure about other labs
-DHEA looks a little low, which is surprising considering your good CHOL levels and decent test levels…probably wouldn’t worry about it too much
-FSH and LH are a little low, but seem to be getting the job done with Test…your boys seem to respond well to those values…
-Your T4 and T3 values could be improved with iodine supplementation…T4 is a little low but T3 is what really gets to the job done, so that isn’t too bad…iodine would probably optimize it…

Overall, it looks to me like you are in pretty good shape…I would think your symptoms could be related to your poor diet…oatmeal & banana is NOT a balanced healthy breakfast…a protein shake for lunch is not either…your only real source of food seems to be dinner…some (younger) guys can probably get away with this and Fasting and whatever else is the flavor of the month on this website…most guys can’t…

3

Using iodized salt? Eat much sea food.

Start DHEA 25mg, if that is well tolerated, double up later on and see how that goes. DHEA may be low as a result of low pregnenolone.

Check waking body temp and a few times during the day, record for a while and report.

Progesterone is low, needed to make cortisol. Describe energy level patterns through the day.

FSH has a longer half life than LH and is a better overall indicator. Your T levels do not make sense with low FSH and DHEA.

What is the problem with your digestion?

What OTC and Rx meds?
What conditions or illnesses?

Get a high potency B-complex multi-vit with iodine.

Breakfast is nothing but sugar and starch.
How do you react to major stress? How stressful are things now? Any major stressful events in last few years?

4

Thanks for the comments - its greatly appreciated. My follow up info is below.

I started taking Vitamin D supplement (D3) last month.

Based on your suggestion, I will begin DHEA supplementation.

I will begin to monitor waking body temp. (and thru the day) and will report back after a week.

For one thing I now I dont get enough sleep. Mon thru Fri I wake up at 3:30am, work at 4:30am to approx 3pm. Hit the gym by 4pm & then home. Typically going to bed between 9 to 10pm. Sat. & Sun I do get a good nights sleep. This has been my schedule for well over 20 years. Going to bed any earlier during the week is just about impossible (family time). Energy levels are ok but could be better. I have no problems getting up in the morning, but do sometimes hit a hard wall in the early afternoons. I certainly do feel fatigued at times & have always just chalked it up to not getting enough sleep. Im also sure my diet has played a roll in that as well but Im working on that. Overall, I probably feel more drained then I do fully energized.

You mention my T levels dont make sense with low FSH and DHEA. Is this cause for concern?

Have suffered for years with what doctors said was irritable bowl syndrome. Severe bloating after eating & constipation. 5 years ago I started doing colonics on about a monthly basis and that really helped. I think most of my issues were diet related & I have cut out a lot of foods that irritated me. I am now feeling the best then I ever had in this area. Having regular bowel movements and have had only one colonic this year. I do still suffer from severe bloating at times when eating which has inhibited me in getting the amount of calories I need. I had read that taking HCL w/Pepsin prior to eating can help with that & I believe it has. Ive been taking it only prior to dinner as its my biggest meal of the day.

No OTC or Rx meds

Only major condition/illness was having my spleen removed in 1998. Otherwise no issues outside of whats mentioned above.

I am getting better in regards to nutrition/supplementation and am learning a lot here at T-Nation.

In regards to stress, externally I react to it very well. Those that know me would describe me as a very calm handles pressure well type of guy. Internally is a different story, I am pretty stressed & over-worry about things (mostly all work related issues & self-imposed). I can get mentally tied up pretty easy (analyzing & reanalyzing certain things) which on a bigger scale results in a lack of focus. This has also disrupted my sleep at times. I certainly worry or stress myself out too much & for no great reason!

There has been no major stressful events recently or in the past few years.

Thanks Again

5

ferritin is very low… ideal for men is 150 I think.

How much D3 are you taking?

Your thyroid looks generally ok, but you should really check your 8am Cortisol levels given your symptoms. a 4 times a day saliva test might be warranted. Checking for Estradiol could be helpful.

how is the HCL working for you?

any physical symptoms like excess sweating, swollen ankles, etc?

6

I have been taking 5000 IU of D3 a day for 2 months.

Overall, I feel that taking the HCL has helped. I use it only at dinner time and take 3 capsules (250 mg. each). Sometimes I do still get quickly bloated though. Even at this dose I do not feel any burning sensation.

I have checked my waking body temp for the past week and it hovers in 95.7 to 96.5 range. I have begun to read that this low a temp could be a sign of a thyroid issue? I have not monitored it thru the day but will do so this week.

I will sometimes get a bad case of the sweats during the middle of the night. Never at any other time though.
No other physical issues such as whats been asked. Only other thing that is that my scalp (I’m mostly bald) gets very, very oily. Maybe its sweat - its just very oily & slimy. It stains my pillow cases badly & drives my wife nuts.

So its sounds like the next time I get blood work I should get my Estradiol checked. Any other tests other than what got tested before?

Do I have to see a Dr. in regards to the saliva tests?

As always - Thanks for your help!

7

!!!
Using iodized salt? Eat much sea food?

We need to know if you might have an iodine deficiency.
!!!

With IBS you could be loosing iron from blood loss. IBS can reduce vit-B12 levels.

Get a high potency B-complex multi-vit with iodine.

8

KSman:

I do not use iodized salt nor do I hardly ever eat seafood. Maybe only a handful times a year. Will certainly add the Multi-Vit. w/Iodine to the list.

My longtime IBS/digestive issues have really turned around the past couple of months. Having regular bowel movements, less severe bloating, and have not felt the need to have to get a Colonic in over 2 months. Hard to say why though as there have been many changes made within a 3-4 month window.

  • Stopped drinking milk (always had 2 large glasses of it at dinner since a kid)
  • Using new probiotic (refrigerated type)
  • Using new fish oil supplement (Flameout)
  • Using HCL w/Pepsin at dinner
  • Eating better

What do you think about my waking temp. numbers? Starting today I will be tracking it thru the day.

I reread all your stickies this weekend and am slowly getting better informed thanks to you. Its alot to take in so its very much appreciated the time you and others like PureChance give in helping guys like me.

Thank you

9

Keep in mind that IBS is frequenty misdiagnoses Celiacs disease. Do you have any idea how you react to gluten? If you have cleaned up your diet recently, you may have inadvertently been avoiding gluten (it is in a lot of bad foods) which could possibly explain your newfound relief.

You may want to keep this in the back of your mind if your symptoms regress and you can’t figure out why.

Celiacs can cause all sorts of nasty issues in your body…high cortisol since your body is always attacking foreign “invaders”…vitamin deficiency due to poor absorption in the gut…uncomfortable bloating…

You don’t have to be celiacs to have a gluten intolerance that can also contribute to all these symptoms.

You can’t test for celiacs/gluten sensitivity markers if you are following a gluten free diet, so if you ever test for it, make sure to eat plenty of gluten in the weeks leading up to the test…

10

waking body temps look below ideal levels of 97.3 (or 97.6 depending on who you ask). more details about body temps in a link in the blood test sticky.

sweating in the middle of the night could be several things, two quick possibilities are: first - low cortisol which leads to an adrenaline rush (low cortisol leads to low blood sugar, once blood sugar gets too low, the body reacts by pumping out adrenaline to force blood sugar up which disrupts sleep paterns, etc.) second possibility is low aldosterone which deals with salt renention. too little salt = water retention, high blood pressure, higher heart rate, and excess sweating.

what is your typical blood pressure and resting heart rate?

11

So, you have by definition an iodine deficiency ID. You need to start IR, iodine replenishment. The RDA of 150mcg is treading water. You need substantial amounts. An adult body can store 1.5 grams, yes grams of iodine. So you can see how long it would take typical amounts to make any difference.

You are not alone, almost 90% of Americans are considered iodine deficient. Iodine was removed from bread in the 1960’s and now many prefer sea salt, which does not contain iodine.

We are seeing that, of the guys that land here, it seems like most of them have thyroid problems.

12

Just wanted to give an update as to how things are going. Thus far I have been dealing with my General Practitioner and it seems I’ll have to look elsewhere to get the help I think I need. On a follow up visit this week I shared all the info Ive learned here from you guys (stickies and your comments) as it relates to my symptoms and previous bloodwork.

Well lets just say that my Dr. was far from impressed and or interested in what I was saying. But I did convince him to do another round of bloodwork where this time will include testing Estradiol and Selenium. And would you believe hes testing me for a bunch of other crap like Limes Disease, Lupus, and HIV!!! All because he really wants to get to the bottom of the cause of my symptoms.

So anyway - I’ll have the bloodwork done this Tuesday. After that experience I did some research on Drs in the area and found a Compounding Pharmacy nearby that does HRT counseling/treatment. Since they offered a free HRT consultation - I met with a Clinical Pharmacist and shared my previous bloodwork results and discussed my symptoms. I hesitated to share what Ive learned here so as to first hear what she had to say. And it was refreshing to hear that she began to identify the exact same things you have all mentioned thus far. After sharing with her what I have learned she asked me for the web address for T-Nation so she could check it out for herself.

Her advisement was to wait for the bloodwork to come back (to see estradiol and selenium), test for Iodine difficiency, and do a 4x/day saliva test. She gave me a bottle of Iodine Tincture (2% Iodine) which I was to brush a 3 inch stain on my belly and see if it disappears in less than 24 hours. Ive done it for a week and the stain does not last 12 hours.
I did the saliva test on April 28
She advised on waiting to supplement with DEHA until all test results come back.

VTBalla34 - I do more times than not react poorly to Gluten. It seems to have worsened with age? Where I once drank beer with no problem, I can hardly stomach it at all these days. Same goes for pasta. The weird thing is that it is sometimes inconsistant - as sometimes I have a bad reaction (instant bloating) and sometimes I dont.

PureChance - At my Drs visit this week BP was 146/90 and HR was 70. The nurse said it was consistant with previous visits. And thanks for sharing the link to the Thyroid Madness site - alot of good info there.

Thanks guys - I’ll share the test results when I get them.

13

[quote]
She gave me a bottle of Iodine Tincture (2% Iodine) which I was to brush a 3 inch stain on my belly and see if it disappears in less than 24 hours. Ive done it for a week and the stain does not last 12 hours.[/quote]

What is this test called? I’ve not heard of it and am curious…what is it supposed to detect? Is 12 hours good or bad?

14

With the bottle of Iodine, she also gave me a print out from www.ehow regarding Lugols Iodine Thyroid Test. It says to use an eyedropper or brush to paint a 3 inch stain on your belly or upper thigh. Check frequently during a 24 hour period. If the stain disappears in less than 24 hours, its because the body and thyroid are craving iodine meaning your iodine deficient.
This same test can then be used to correct your bodys iodine levels. Simply keep reapplying the stain everytime it disappers. Gradually, as your body absorbs enough iodine, the stain will take longer to diappear. Once the patch is still evident after 24 hourse, stop the test. Your body should then have enough iodine to aid in proper thyroid hormone production or use of supplemental thyroid hormones.

15

The idea is that with iodine deficiency [ID] iodine applied to the skin will absorb fast. If iodine levels are adequate, absorption is slower. I have run across this many times before.

This was my story:

Your body temps are a better guide than iodine stains on your skin.

16

Also, the people behind Iodoral do not believe the skin absorption test is reliable either. Quoted from Dr Abraham’s website www.optimox.com:

“From the published data, the skin iodine patch test is not a reliable method to assess whole body sufficiency for iodine. Many factors play a role in the disappearance of the yellow color of iodine from the surface of the skin. … The iodine/iodide loading test (4) is much more accurate…”

17

KSman, what’s your opinion on the claim that iodine supplementation can trigger Hashimoto’s? There’s a lot of information that highlights those risks.

18

We know that low iodine can increase TSH, create goiter when severe or chronic, that can lead to nodules, some perhaps cancerous, and hyperthyroidism from T4 producing nodules that have become TSH independent. Low iodine also leads to problems that seem to be independent of thyroid hormone effects.

Iodine deficiency [ID] is not going to be resolved with RDAs, iodine replenishment [IR] is required. During IR, iodine levels in circulation will be above normal. This is acute, not chronic. There are not long term studies on short duration acute IR, as this is impossible.

The human body can store up to 1.5 GRAMS of iodine. 150mcg will not resolve ID withing a reasonable time frame. Most iodine goes to the thyroid. The next largest store, for women, is breast tissues, perhaps to provide iodine for nursing babies. Low iodine during pregnancy is associated with a lot of problems. And note that ID is associated with fibrotic breast disease, which can be resolved with IR [and for some, elimination of coffee can be very helpful].

Most people are ID from using sea salt, kosher salt, low salt diets, eating prepared foods or restaurant meals that typically do not use iodized salt.

So what is the problem, ID or IR? Many areas in China are iodine deficient. So when you take a chronic ID population and provide IR, are the increased incidents of thyroid auto immune problems rooted in the chronic ID or the IR. Does IR in mild ID cases cause problems? Is there any data for that?

Are cases of hashi’s delayed by low iodine and then released when iodine levels are normalized? Again, do these population studies of severe chronic ID applicable here?

There is a separate issue. Should ID be resolved with IR, or are we better off with ID?

The video talks about people with low thyroid hormones that need medical treatment. My position is that when TSH is moderately elevated and body temps are low, one should try IR and see how body temps respond with IR. In most such cases we see here, guys have some worrying thyroid lab results that their doctors are not concerned with at all. If the doc will not fix it, do you take action or be passive/stupid?

The video also implies that ID is never a concern.

19

Great response, thanks! I just wanted to hear your opinion as the iodine-triggers-Hashimoto’s-theory pops up quite often when reading about high-dose iodine supplementation.

20

UPDATE:

Had bloodwork done 2 days ago and made sure to test this time for for Estradiol and Selenium. I will share results when I get them.

I met today with the Pharmacist at the Compound Pharmacy to review the Saliva Test results.

Cortisol Morning 3.3 ng/ml (Range 3.7 - 9.5)
Cortisol Noon 2.8 ng/ml (Range 1.2-3)
Cortisol Evening 1.2 ng/ml (Range 0.6-1.9)
Cortisol Night 0.3 ng/ml (Range 0.4-1.0)

She said these results show the reason I have stress issues and fatigue. While there she also tested me for Zinc. She had me put some liquid in my mouth, swoosh it around and then just let it sit in my mouth for 30 seconds. After spitting it out she asked what I tasted. I did not taste anything at all - seemed as if it was just plain water. She said that this meant I was Zinc Deficient. If I wasn’t, it would have tasted bad right away.

So aside for waiting for the bloodwork to come back, her suggestions are;

Continue Iodine Supplementation
Continue taking D3
DEHA - 25mg per day
Reacted Zinc 54mg per day

And for the low Cortisol issue:

Drenamin
3 tablets 2x per day
Serving size - 3 tablets
Vitamin C 9mg
Riboflavin 1mg
Niacin 12mg
Vitamin B6 0.3mg
Proprietary Blend 730mg (26 different all-natural ingrediants)

and

Cataplex B
2 tablets 2x per day
Serving Size - 2 tablets
Thiamine 1mg
Niacin 20mg
Vitamin B6 1mg
Proprietary Blend 590mg (20 different all-natural ingrediants)

I didn’t list all the Proprietary items due to the amount of items but I can if need be. What do you think about my Cortisol levels and using these products? Is this sufficient or should I be supplementing with Cortisol?

I’d appreciate any thoughts on her suggestions. Thank You