Griff_62's Journey

Pharma / TRT Testosterone Replacement
1

Updated to summarize all lab work to date.

TT 273 ng/dL [241-827] March 2012, 9am
TT 273 ng/dL [241-827] April 2012, 9am
TT 739 ng/dL [250-1100] June 2012, 9am
TT 453 ng/dL [348-1197] April 2013, 10am
TT 329 ng/dL [348-1197] May 2013, 4pm

FT 26.0 pg/mL [46.0-224.0] March 2012, 9am
FT .65 ng/dL [.95-4.3] April 2012, 9am
FT 73.6 pg/mL [46-224] June 2012, 9am
FT 9.3 pg/mL [8.7-25.1] April 2013, 10am
FT 5.8 pg/mL [8.7-25.1] May 2013, 4pm

F+WB T 50.8 ng/dL [40.0-250] April 2013, 10am

Bio T 164.1 ng/dL [110-575] June 2012, 9am

SHBG 49 nmol/L [10-50] June 2012, 9am
SHBG 57.4 nmol/L [14.5-48.4] May 2013, 4pm

LH 1.50 mIU/mL [2-12] March 2012, 9am
LH 3.3 mIU/mL [2-12] April 2012, 9am
LH 3.1 mIU/mL [1.7-8.6] May 2013, 4pm

E2 11.8 pg/mL [11.6-41.2] March 2012, 9am

DHT 29 ng/dL [16-79] March 2012, 9am

PROL 4.4 ng/mL [1.6-18.7] March 2012, 9am

Cortisol 16.0 ug/dL [6.0-30.0] March 2012, 9am.
Cortisol 15.2 ug/dL [2.3-11.9] May 2013, 4pm

FSH 7.1 mIU/mL [1.0-18.0] March 2012, 9am
FSH 7.9 mIU/mL [1.0-18.0] April 2012, 9am
FSH 6.5 mIU/mL [1.5-12.4] May 2013, 4pm

PSA 0.4 ng/mL [0-4.0] May 2013, 4pm

TSH 1.37 uIU/mL [0.4-5] March 2012, 9am
TSH 1.93 [.4-5] April 2013, 10am
TSH 3.87 uIU/mL [.45-4.5] May 2013, 4pm

FT4 1.13 ng/dL [0.75-1.76] March 2012, 9am
FT4 1.21 ng/dL [.82-1.77] April 2013, 10am
FT4 1.2 ng/dL [.82-1.77] May 2013, 4pm

FT3 2.6 pg/mL [2.3-4.2] March 2012, 9am
FT3 2.5 pg/mL [2-4.4] April 2013, 10am

VitD 31.5 ng/mL [33.0-100.0] March 2012, 9am
VitD 62.4 ng/mL [30-100] April 2013, 10am

B12 984 pg/mL [187-1059] March 2012, 9am
FOL >20.7 ng/mL [>5.4] March 2012, 9am

Albumin 5.2 g/dL [3.4-5.0] March 2012, 9am
Albumin 4.3 g/dL [3.4-5.0] May 2012, 9am
Albumin 4.9 g/dL [3.6-5.1] June 2012, 9am
Albumin 1.9 g/dL [3.5-5.5] May 2013, 4pm

Alk Phos 75 U/L [25-136] March 2012, 9am
Alk Phos 86 [<140] May 2012, 9am
Alk Phos 66 [<140] April 2013, 10am

ALT-SGPT 102 U/L [25-65] March 2012, 9am
ALT 47 [<65] May 2012, 9am
ALT 67 [<65] April 2013, 10am

AST-SGOT 44 U/L [10-45] March 2012, 9am
AST 19 [<37] May 2012, 9am
AST 31 [<37] April 2013, 10am

Bilirubin 0.6 mg/dL [.2-1.2] March 2012, 9am
Bilirubin 0.5 [<1.0] May 2012, 9am
Bilirubin 0.7 [<1.0] April 2013, 10am

BUN 17.0 mg/dL [6-23] March 2012, 9am
BUN 17 mg/dL [6-20] May 2013, 4pm

Calcium 9.5 mg/dL [8.5-10.5] March 2012, 9am
Calcium 9.2 [8.5-10.1] May 2012, 9am
Calcium 9.1 [8.5-10.1] April 2013, 10am
Calcium 9.9 mg/dL [8.7-10.2] May 2013, 4pm

Phosphorus 3.9 mg/dL [2.5-4.5] May 2013, 4pm

Chloride 99 mEq/L [98-111] March 2012, 9am
Chloride 103 mEq/L [97-108] May 2013, 4pm

C02 30 mEq/L [20-36] March 2012, 9am
C02 26 mmol/L [20-32] May 2013, 4pm

Creatinine 0.8 mg/dL [.9-1.5] March 2012, 9am
Creatinine 1 mg/dL [<1.4] May 2012, 9am
Creatinine 1 [<1.4] April 2013, 10am
Creatinine .94 mg/dL [.76-1.27] May 2013, 4pm

Potassium 4.4 mEq/L [3.5-5.4] March 2012, 9am
Potassium 4.8 [3.5-5.3] May 2012, 9am
Potassium 4.9 meEq/L [3.5-5.2] May 2013, 4pm

Sodium 139 mEq/L [135-145] March 2012, 9am
Sodium 141 mEq/L [135-145] May 2012, 9am
Sodium 142 mEq/L [134-144] May 2013, 4pm

Total Protein 8.5 g/dL [6.4-8.4] March 2012, 9am
Total Protein 7.2 g/dL [6.4-8.4] May 2012, 9am

Glucose 81 mg/dL [70-100] March 2012, 9am
Glucose 86 [<100] May 2012, 9am
Glucose 91 [<100] April 2013, 10am

A/G 1.6 mg/dL [.8-2.0] March 2012, 9am

eGFR 121…5 [>60] March 2012, 9am

Iron 139 ug/dL [50-165] March 2012, 9am

Transferrin 275 mg/dL [220-380] March 2012, 9am

TIBC 341 ug/dL [230-430] March 2012, 9am

Iron Sat. 41% [20-55] March 2012, 9am

Cholesterol 188 mg/dL [150-200] March 2012, 9am
Cholesterol 156 [<200] April 2013, 10am

HDL 74 mg/dL [>40] March 2012, 9am
HDL 72 [>40] April 2013, 10am

Triglyceride 79 mg/dL [0-150] March 2012, 9am
Triglyceride 28 [<150] April 2013, 10am

LDL (calc) 98 mg/dL [0-130] March 2012, 9am
LDL 78 [<130] April 2013, 10am

LDL/H 1.32 Ratio March 2012, 9am

CHOL/HDL 2.54 Ratio March 2012, 9am

RISK 2.50 [0-5] March 2012, 9am

WBC 2.70 K/uL [4-11] March 2012, 9am
WBC 3.60 K/uL [4-11] May 2012, 9am
WBC 4.1 K/uL [4-11] June 2012, 3pm
WBC 2.9 [4-11] April 2013, 10am
WBC 5.7 th/mm3 [4-10.5] May 2013, 4pm

RBC 4.90 10*6/ul [4.3-5.7] March 2012, 9am
RBC 4.65 mil/mm3 [4.14-5.8] May 2013, 4pm

HGB 15.1 g/dL [13.7-16.7] March 2012, 9am
HGB 13.9 g/dL [12.6-17.7] May 2013, 4pm

HCT 43.8% [40-50] March 2012, 9am
HCT 41.3% [36-55] May 2012, 9am
HCT 39.2% [36-55] April 2013, 10am
HCT 42.3% [37.5-51] May 2013, 4pm

MCV 89.4 fL [80-97] March 2012, 9am
MCV 91 fL [79-97] May 2013, 4pm

MCH 30.8 pg [26-33] March 2012, 9am
MCH 29.9 pg [26.6-33] May 2013, 4pm

MCHC 34.5 g/dL [32-36] March 2012, 9am
MCHC 32.9 g/dL [31.5-35.7] May 2013, 4pm

Platelet 193 103/uL [150-450] March 2012, 9am
Platelet 200 103/uL [140-440] May 2012, 9am
Platelet 191 [140-440] April 2013, 10am
Platelet 255 bil/L [140-415] May 2013, 4pm

30 years old
210 lbs
Have had symptoms sine losing weight (120 lbs over a 3 year period) in 2011. Lowest BW was 190.
Fatigue
Low labido
Weak erections
Brain fog
Cold sensitivity

Had my first lab work done in 2012. Followed up with an endo, and after TT showing a positive response to weight gain in mid 2012, I thought we had found the culprit. 1 year later, and I’m still struggling with all the same symptoms, and have updated labs showing low t.

2

Vitamin D is abysmal. Start supplementing with a good bioavailable brand. I use Biotics Emulsified Vit D3 drops that I bought off of amazon. You need to start with 15k iu/day for a couple weeks, and lower down to 6-8k iu/day for maintenance.

Cholesterol is perfect. CBC looks good.

Is CORT = Cortisol? I have never seen a range up to 30.0. Are you sure you typed that correctly?

One thing I notice is that your thyroid hormones (FT3 specifically) are on the low side, but doesn’t seem to have increased your TSH at all. This along with low LH indicates some degree of pituitary laziness. FSH doesn’t really seem to fit into that though.

It’s possible this is a result of your extreme dieting and calorie restriction.

If I were you, I would get LH, FSH, Prolactin, and TSH done again (pituitary hormones) to make sure they are around the same levels as this bloodwork and nothing screwey going on. After that, I would talk to my doc about a SERM restart to see if you can increase LH.

3

Thanks for the response!

I’ve already begun Vit D supplementation. I will up it to 6k iu/day.

CORT = Cortisol. According to my lab the ranges are as follows:
A.M. Specimen (7am-9am) [6.0-30.0 ug/dL]
P.M. Specimen (3pm-5pm) [3.1-16.7 ug/dL]

Would you recommend an immediate retest? I guess it’s already been 4 weeks since this test was done.

I will investigate the SERM restart approach.

4

Sooner the better…it is mostly just to confirm suspicions though…you would probably be ok tryin the SERM restart without it…but honestly, we don’t see a lot of this issue where the whole pituitary output is lazy, usually just one or two hormones (Lh/FSH)…it seems downregulated overall though, which I speculated from your extreme weight loss

Hopefully the restart will bring things back online.

5

[quote]VTBalla34 wrote:
Sooner the better…it is mostly just to confirm suspicions though…you would probably be ok tryin the SERM restart without it…but honestly, we don’t see a lot of this issue where the whole pituitary output is lazy, usually just one or two hormones (Lh/FSH)…it seems downregulated overall though, which I speculated from your extreme weight loss

Hopefully the restart will bring things back online.[/quote]

I’ve got an appt. scheduled for 8am next Tuesday. I’ll request a retest for the hormones you mentioned. Anything else worth checking while I’m there?

Also, do you have any recommended reading on SERM restarts for someone NOT coming off a cycle?

6

Second Round of lab results:

Total Test 273 ng/dL [241-827]
Free Test 0.65 ng/dL [0.95-4.30]
FSH 7.9 mIU/mL [1.0-18.0]
LH 3.30 mIU/mL [2.00-12.00]

Been taking 2k-4k IU Vit D daily since the original test. Been eating ~3300 cals/day. Still training 3days/week.

7

First appt. with my Endo today. His plan is to retest the following to rule out abnormalities:
-Retest T
-Retest CBC (he was concerned about WBC from original lab)
-An MRI may be in order…

If T is unchanged from original labs, he is ready to administer HRT in one of the following fashions:
-HCG only if I want to remain fertile
OR
-T injections only

He wasn’t interested in HCG+T protocol. His view is that you choose one or the other. If fertility is a concern I have the HCG only option, but he suggested this wouldn’t be covered by insurance. If fertility is not a concern I would use T-replacement only. He suggested there was no benefit of adding HCG to T if I didn’t want to do an HCG only therapy.

Thoughts?

8

What’s his plan if you are primary hypogonadal and the hcg is ineffective at producing T but you still want to remain fertile? AFAIK, they are two different processes.

Maybe get a new doctor?

Why didn’t you investigate the SERM restart?

9

[quote]VTBalla34 wrote:
What’s his plan if you are primary hypogonadal and the hcg is ineffective at producing T but you still want to remain fertile? AFAIK, they are two different processes.

Maybe get a new doctor?

Why didn’t you investigate the SERM restart?[/quote]

I’ve been diagnosed as secondary (low normal LH), which is the reason for the hcg only option.

I mentioned the SERM restart, but he said he wasn’t familiar with the research. I’ll be sure and request he familiarize himself with the research before our next meeting.

10

Having low LH doesn’t exclude primary. It just means that you are indeed secondary, but not confirmed primary. The two are not mutually exclusive.

11

[quote]VTBalla34 wrote:
Having low LH doesn’t exclude primary. It just means that you are indeed secondary, but not confirmed primary. The two are not mutually exclusive.[/quote]

Good point. Doc didn’t mention this possibility. It seems like starting with HCG to see if my boys still work makes sense then.

What’s this forums consensus on HCG as sole TRT replacement in secondary cases? Depends on the person right?

12

Additional lab results:

WBC 3.6 <4-11> —> Improved but still low.
HCT 41.3 <36-55>
Platelet count 200 <140-440>
Sodium 141 <135-145>
Potassium 4.8 <3.5-5.3>
Creatinine 1.0 <less than 1.4>
AST Liver Enzyme 19 <under 37>
ALT Liver Enzyme 47 <under 65>
Alk Phos liver Enz 86 <under 140>
Blood Glucose 86 <under 100>
Calcium 9.2 <8.5-10.1>

Note at the bottom ‘Testosterone levels were good’. No data included. Dumb GP!

These are the tests ordered by my Endo after a first time review of the lab work done by my GP. He’s trying to diagnose the underlying cause of my low T.

13

Update. All signs pointing to my diet being the cause of my low T. My latest lab results from 6/5/12 after gaining ~13 lbs.

Total T 739 ng/dL [250-1100]
Free T 73.6 pg/mL [46-224]
Bio T 164.1 ng/dL [110-575]
SHBG 49 nmol/L [10-50]
Albumin 4.9 g/dL [3.6-5.1]

My symptoms have definitely been improving. I’d say I feel about 80%. What do you guys think about the numbers? My doc recommends maintaining weight and monitoring symptoms.

14

It’s been roughly 11 months since my last blood work, and have been dealing with Low labido, infrequent weak erections, low body temp and general low energy. Out of those 11 months I spent 3 months gaining weight, 5 months dieting, and the rest maintaining weight. Currently holding at 205 lbs.
My GP did the testing, as I’m no longer seeing an endo. I’m fairly confident my GP won’t be able to do much for me at this point. Do you guys think my numbers could still be nutrition related even though I’ve maintained my weight with a very consistent/balanced diet for the last 4 months? Do you think my symptoms can be explained by my labs?

Total Cholesterol: 156 (range: under 200)
Triglyceride: 28 (range: under 150)
HDL: 72 (range: over 40)
LDL: 78 (range: under 130)
WBC: 2.9 (range: 4-11) low again
HCT: 39.2 (range: 36-55)
Platelet: 191 (range: 140-440)
Vit D: 62.4 (range: 33-100)
TSH: 1.93 (range: .4-5)
T4: 1.21 ng/dL (range: 0.82-1.77)
Free Triiodothyronine: 2.5 pg/mL (range: 2-4.4)
Serum T: 438 ng/dL (range: 348-1197)
Free+WB T: 11.6% (range: 9-46)
50.8 ng/dL (range: 40-250)
Total T: 453 ng/dL (range: 348-1197)
Free T: 9.3 pg/mL (range: 8.7-25.1)

15

LH moves around alot FSH tells a better story… From what I see you are not deprived…shbg is high and so free T is low. You brought your total T to from 231 to739 and now it’s back down to 493? Also could I maybe suggest lowering your time in the gym to 45 mins? working yourself into exhuastion is prolly not very good for your T levels or building muscle… How much protein are you getting per day? Over training can kill T levels. a little readin and i found this low wbc count can cause hormone issues…

16

[quote]iw84aces wrote:
LH moves around alot FSH tells a better story… From what I see you are not deprived…shbg is high and so free T is low. You brought your total T to from 231 to739 and now it’s back down to 493? Also could I maybe suggest lowering your time in the gym to 45 mins? working yourself into exhuastion is prolly not very good for your T levels or building muscle… How much protein are you getting per day? Over training can kill T levels. a little readin and i found this low wbc count can cause hormone issues…

http://digitalnaturopath.com/cond/C269841.html[/quote]

Overreaching/training sounds plausible. My sessions in the gym are regularly 1hr+ four times a week. Intensity has consistently been high, although my strength has been stale as of late (2 or 3 weeks) despite a recent deload. The most frustrating part of this situation is that I’m not strong, 5RM squat is 265, 5RM bench is 210, 5RM DL 315. I know, EAT MORE!

I certainly want to get my TT back up in the 700s, and figure out how to get my SHBG down so that FT can recover. Time off only? Supplements?

Protein never drops below 200g. I’ll have to double check my spreadsheet, but I guess avg protein has been ~225g for the better part of the last few years.

Thanks for the feedback and linked information. Any and all help is greatly appreciated!

17

I was leaving this for Ksman cause i’m not educated enough to be running around telling you to try a SERM but it could tell a story and possibly raise your E2 which is pretty low… any idea why E2 is low? low E2 and high shbg is wierd to me but the labs were taken at different times so hard to tell… I’m not sure what estrogens bind to shbg but it may be that because serum T is low and shbg is high that most of your hormones are bound to shbg… this is to complicated for me as I’m only new to this stuff myself…

You need to get ksman or tuna pancake on board for this thread. I dot know how it is possible to lower shbg in this situation. it is not something we are able to move around alot… normally lowering E2 may have some effect but from your labs this is not at option so i have no Idea?? did you use steroids? are you on an AI? sorry i can’t be of more help… have you had your thyroid antibodies checked?

suite101.com/article/what-are-thyroid-antibodies-a147421

18

[quote]iw84aces wrote:
I was leaving this for Ksman cause i’m not educated enough to be running around telling you to try a SERM but it could tell a story and possibly raise your E2 which is pretty low… any idea why E2 is low? low E2 and high shbg is wierd to me but the labs were taken at different times so hard to tell… I’m not sure what estrogens bind to shbg but it may be that because serum T is low and shbg is high that most of your hormones are bound to shbg… this is to complicated for me as I’m only new to this stuff myself…

You need to get ksman or tuna pancake on board for this thread. I dot know how it is possible to lower shbg in this situation. it is not something we are able to move around alot… normally lowering E2 may have some effect but from your labs this is not at option so i have no Idea?? did you use steroids? are you on an AI? sorry i can’t be of more help… have you had your thyroid antibodies checked?

suite101.com/article/what-are-thyroid-antibodies-a147421[/quote]

I’d love for Ksman to chime in. Should I pm him?

I don’t take any meds, never taken steroids, no AI. I haven’t had thyroid antibodies checked.

19

So I visited a new Endo last week and here are the results.

CBC came back clean
TSH 3.87 uIU/mL (.45-4.5)
Thyroxine Free 1.2 ng/dL (.82-1.77)
Free-androgen index 19.9 (24-122) L
PSA total .4 ng/dL (0-4)
SHBG 57.4 nmol/L (14.5-48.4) H
LH 3.1 mIU/mL (1.7-8.6)
FSH 6.5 mIU/mL (1.5-12.4)
Cortisol 15.2 ug/dL (2.3-11.9) H
Total T 329 ng/dL (348-1197) L
Free T 5.8 pg/mL (8.7-25.1)

I’ll be taking a 24hr urine sample over the weekend. I really like the doc. He understands that I want a diagnosis before jumping into treatment. I believe he will do just that.

20

1st post updated to show comprehensive summary of all my lab work to date.