Help Low Test and Concerning FBC

Pharma / TRT Testosterone Replacement
1

-age 29
-height 173cm
-waist 34"
-weight 177lbs

-describe body and facial hair: Normal facial hair, maybe not as thick as many people my age. Body hair on torso/back/neck etc.

-describe where you carry fat and how changed: Fat focused on waist/stomach/hips.

-health conditions, symptoms: loss of one testicle in my teens, possibly mild neutropenia but this has only recently been diagnosed.

-Rx and OTC drugs, any hair loss drugs or prostate drugs: No

-lab results with ranges: see below

-describe diet: Oatmeal, eggs, rice, sweet potato, chicken, white fish, lean beef. Currently eating around 2300kcal to lose some fat. Slowly been reduced from 3000kcal.
-describe training: 5 days intense weight training per week with a few light cardio sessions.

-testes ache, ever, with a fever: No

-how have morning wood and nocturnal erections changed: Possibly reduced over time but have not been very regular for as long as i can remember.

Hi KSman - hoping you might be able to help me understand this.

I first had my serum testosterone checked 12 months ago. Came back as 11nmol/L (8.0-31)

I got results back from a second test today which came back at 9nmol/L (8.0-31)

This was after finishing 6 weeks of nolva approx 8 weeks ago. I will request that we check LH and E2 when i see the Doc on Friday.

Also did a FBC which is concerning

FBC 424 - mild neutropenia
Haemoglobin conc. 163 g/l (130-180)
mean cell volume 90.2(80-100)
platelet count 185 (140-400)
total white blood cell count 4.1(3.6-11)
Neutrophil Count 1.57 (1.8-7.5) BELOW RANGE
lymphocyte count 2.02 (1.0-4.0)
monocyte count 0.43 (0.2-0.8)
eosinophil count 0.09 (0.1-0.4) BELOW RANGE
basophil count 0.01 (0.02-0.1) BELOW RANGE
red blood cell count 5.53 (4.5-6.5)
Haematocrit 0.498 (0.4-0.54)
mean cell haemoglobin 29.5 (27-32)

Thanks

Edited to add opening information at start of post

2

Your HTC is rather high relative to your low T levels.
You may need to avoid iron in vitamins and iron fortified foods.
Iron is added to breads and cereals.

Please read/review theses stickies:

  • advice for new guys
  • things that damage your hormones

Please eval your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky.

How much nolvadex and how did you taper off of it?
How did you feel while on nolvadex?

Labs: -that you may not be able to get
TT
FT
E2
LH/FSH
prolactin
TSH
fT3
fT4
AST/ALT
DHEA-S

3

Thanks for the reply

Nolvadex was 6 weeks

20/20/20/10/10/5
with arimidex for 7 weeks at 0.25mg eod.

No real change in how i felt when doing this.

Regarding HTC - would there be concern then that as testosterone levels increase that this may get too high?

Do you have any thoughts on Mild Neutropenia and the 3 references below range? Any chance this could be linked to Low T?

I should also add that i lost my left testicle in my teens. I am 29 now - Is there any link between this and primary/secondary Hypogonadism?

I will have a look at the thyroid sticky.

Thanks again.

4

Also to add- Will be talking to the Doctor on Friday so will discuss labs then.

regarding Iron - I have very little in my diet as far as i can tell.

I basically eat oatmeal, eggs, peanut butter, rice, sweet potatoe, chicken, white fish, lean beef, olive oil and minimal protein powder.

Supplements- BCAA, ZMA, D3, Multivitamin (no iron) Fish oil, Creatine

5

I managed to see the doctor this morning.

They also tested my thyroid, kidney and liver. Thyroid and kidney are OK although i haven’t seen the results. A few liver values were above range so the Doctor wants to retest at the end of the month and look further into liver. Reluctant to do any more labs regarding hormones until this is resolved. Agreed to to LH for me but not until January 27th.

6

Please get those labs.

HTC will go up with TRT.

Liver issues ‘could’ lead to lower E2 clearance rates and that would decrease LH/FSH and T.
AST/ALT can be increased by have sore muscles from exercise or bruising.

7

Hi KSman - Quick update on my situation.

Called my Doc today to dicuss some concerns i had about testosterone and planned labs etc. On the 27th of this month we will be doing

TT
LH/FSH
Prolactin

Along with some more extensive liver work due to previously elevated ALT

Will not do E2 at this stage or DHEA-S.

Have already done Thyroid but only TSH.

TSH = 2.6 As this is in range will not test FT3/FT4 at this Stage.

ALT has been checked and came up just out of range - high 50’s i believe. I asked about weight training effecting this but did not really get much of a response. Doc doesn’t see how this would be possible.

We have also done Serum B12 1132ng/l (180-1000)
Serum Folate Level 11.7ug/l (>4.0)

I received my oral thermometer in the post today so can start tracking temperature from tomorrow morning. I did a quick reading just now (17.30) which came out at 97.5 (low?)

There is a good chance i am iodine deficient as i am in the UK and although i use table salt i discovered today that this is not generally iodised here. Would it be a good idea to get some iodoral and take at 25/50mg per day before getting my next set of labs done?

If you could please give me your thoughts on the TSH, temperature/iodine and if you think we will have enough to work with after getting the planned labs at the end of the month it would be greatly appreciated.

Thanks.

8

The lab ranges are useless. TSH should be nearer to 1.0 and many with TSH>2 have problems - and low body temperatures. Get more reading and we can review what to do next. Iodine would be helpful and hopefully that would be all that you need for thyroid function. You need selenium when you take iodine supplements.

Sore or bruised muscles can increase AST/ALT.

9

I will have to wait until after my next set of labs before i can attempt discussing others - I have pressed the issue already and although i am not getting everything needed my Doctor is still being very helpful as far as NHS GP’s go. I don’t want to risk offending a so far fairly open GP. I have only had a few appointments with them and these have been productive.

I have had a few others previously and everything just gets dismissed as in range.

After we do the next set of labs if more are needed and i cannot get them i will explore getting them done privately.

Morning temperature 96.3F
Afteroon Temperatur 98.1

I am thinking to starting supplementing Iodine immediately along with iodised salt, monitor temps throughout the month and see how things go.

I take a multi vitamin 2x Daily and this contains 80ug selenium per serving. Is this adequate and should i take at the same time as Iodine? what do you suggest as a starting dose for iodine - 50mg/day as per the sticky?

Thanks for the advice thus far.

10

You can try 50mg. If guts get upset, use less.
50mg for two weeks, or 25mg for 4.

80ug selenium is a lot less than I have seen. But I do not know what is adequate.

That morning temp really is low.
I am going through some issues myself right now. Iodine did not help this time and T4+T3 med did not either. Finding that T3 alone gets my temperatures up. My labs showed nothing wrong, fT3, fT4 were good. So rT3 suspected. So sometimes iodine is not the answer.

11

i got some more labs in today

RBC 5.43 (4.5-6.5)
Haematocrit 0.49 (0.4-0.54)
Haemoglobin concentration 160g/l (130-180)
Mean Haemoglobin Level 29.5 (27-32)

Serum T 11nmol (8-31)
LH 4iu/l (1-8)
FSH 2iu// (1-7)
Serum Prolactin 374miu/l (<325) HIGH

Serum Cholestrol 4 nmol
HDL 1.6
cholestrol/HDL ratio 2.5
LDL 2
Triglceride 0.9nmol (0.6-1.9)
serum non high density lipoprotein cholestrol 2.4nmol

Serum protein 78g/l (60-80)
Serum albumin 45g/l (35-50)
alkaline phosphatase 94u/l (30-130)
Alanine aminotransferase level 60u/l (<41) HIGH
Bilrubin 15umol (<21)
Serum gamma-glutamyl transferase 15u/l (<61)
Plasma Viscosity 1.79mpa.s (1.5-1.72) HIGH

Would not test E2 or FT3/4 because as mentioned the doctor could not understand the reason to do so.

My temperatures are starting to improve since supplementing iodine - i started on a low dose of 2mg but this has no effect. i have been taking 25mg daily for the last 5 days and this already appears to be helping. Appetite seems to be increasing also. I can get up to 98F in the afternoon now.

Testosterone is slightly higher than last time at 11nmol. This is the highest reading i have seen over 3 readings and it still very low.

Prolactin appears elevated and LH FSH quite low.

As mentioned in the first post i tried a restart with nolvadex not too long ago.

Is high prolactin causing secondary hypogonadism?

The doctor has marked everything as OK and as i am in the UK working with the NHS no further action will be taken. i can hopefully get an appointment to discuss the prolactin.

If TRT is on the card i will have to self medicate as NHS will not treat it at these levels. I can discuss any plans with the doctor in the hope of getting a private prescription so that i have access to a pharmacy.

What are your thoughts? opinion on the liver function would also be appreciated.

Thanks.

12

yes, probably a prolactin secreting pituitary adinoma and a MRI can confirm. In any case, can be easily managed with 0.5mg/week Dostinex/cabergoline in divided doses. Your dopamine and mood could be depressed not and Dostinex should correct dopamine function.

Doctors are the biggest problem here. You may have to go outside the NHS.

Good new re iodine. Expect that you have some improvement in metal clarity, but other factors still at play.

Try to resolve the elevated prolactin issue and then see how your HPTA responds.

13

Hi KSman,

Thanks for the continued help.

I can get some Destinox tomorrow - in order to dose this in small amounts would you dissolve into a solution? I believe i have seen you explain how to does this with arimidex but cannot remember the exact procedure.

I assume this will bring prolactin down whilst we find the cause, but dicontinuing use without finding the problem would result in prolactin increasing again?

Could anything other than a pituitary adinoma cause this? (obviously 19nor steroid variants but they are not relevant here)

Do you have any thoughts on the Liver function results? This was done in response to low neutrophils and elevated ALT. I have had a horrible virus recently and that combined with weight training could have possible affected these results? I am getting better now and the blood work appears to have improved from last time regarding the white blood cells.

Thanks.

14

Dostinex is typically a low dose drug. So your question seems odd.
Have not considered how to dissolve.

Dostinex can be expected to shrink an adinoma, so you may reduce ability to diagnose with a MRI. But, from my perspective, the way that Dostinex works, I would consider a drop in prolactin levels to be a diagnostic itself. But I don’t think that dogmatic docs would see that.

If you need it, its is for life as far as I know.

Do not know any other organic cause.

Virus: Did you take any drugs for that? Duration and dose?

AST and Alanine Aminotransferase (ALT) are both easily high from training. My wife once did labs after a dumb workout where she had numerous sore muscle groups and has some of the highest numbers I have ever seen.

15

Hi KSman

I am using Cabaser 1mg cabergoline tablets. These are easy to break in half but trying to go smaller than that may be difficult.

So the solution to the adinoma is cabergoline for life and it cannot be ‘cured’?

I mentioned that ALT could be elevated to the doctor after the first set of bloodwork but they did not believe this to be possible. White blood cells were also low but these appear to be improving since getting over this virus.

Medication was just paracetamol & phenylephrine for 1 week.

Thanks again

16

Sorry i should have asked - How long after taking caber would you recommend waiting before more blood work? 4 weeks?

Thanks.

17

My waking temperature is still very low and on further monitoring PM temps are not getting high enough.

Morning Temps are generally 96.4-96.7
PM temps is around 97.5

I thought this was improving but not yet - maybe continued iodine use will help.

I want to get some further thyroid labs done.

TSH
FT3
FT4
rT3

I also researched Prolactinoma’s further so have a better understanding of this now. I did come across some references that suggest thyroid can cause prolactin issues - have you ever come across this?

Thanks.

18

Cabergoline can work quite fast, but I don’t know where to find anything definitive. Shrinking an adinoma takes time and perhaps longer term benefit is possible.

My body temperatures went low and iodine did not work this time. 1 grain desiccated thyroid did not work, body temps still low. Assumed a rT3 problem and T3 working up to 100mcg per day, watching body temps for 3 weeks. Then 1 grain desiccated thyroid worked and now down to 1/2 grain. rT3 would depress TSH and T4, stopping T4–>T3 for a while.

So things can get complex. I have the knowledge and instincts to do such things, but this is beyond most cookie cutter physicians. Maybe I can get normal thyroid function again. There were stress factors…

For lack of a better term, it was a ‘slow metabolism T3 reset’. It would have been better if I had time release or sustained release T3. Appears that that is only from compounding pharmacies here.

19

Hi KSman,

Quick update on this.

NHS Endocrinology said that they would not look at my case as labs are within range but did suggest testing SHBG to get a more ‘complete’ picture.

Blood was taken to test this on Tuesday and results came back today.

Serum T 7nmol/l (8-31)
SHBG 34.2 nmol/l (15-64)

So this was taken just after two weeks of taking caber to reduce prolactin - unfortuntely that was not tested as i am sourcing the caber myself and it is not prescribed.

Lowest T reading so far. I think i average 275ng/dl across 4 tests. All tests taken very close to 9am.

I have been continuing with Iodine at 25mg per day. Not much change in bodytemps, however with the combination of caber and iodine i think mood has approved.

My doctor is very helpful but does not have a lot of options. She is going to raise this with the NHS endo dept. again and i have also been referred to a private endo at my request. Unfortunately i cannot get an appointment before the 25th March at the earliest.

Trying to calculate my free T using previous Albumin reading and today’s TT and SHBG.

FT 0.128 nmol/L (1.83%)
Bioavailable T 3.14nmol/L (44.8%)

Does this tell us anything?

20

Ranges do not make any sense to me.