Help with Bloodwork and Symptoms

Pharma / TRT Testosterone Replacement
1

I am brand new to the forum and welcome feedback and advice on my symptoms and blood work. I have had the symptoms outlined below, to varying degrees, since my early twenties (around 22-23). However, things have worsened over the past year. For a while, I thought that I was just “getting older”; a couple years ago, my then-PCP reminded me that I was “25, not 15 any more”.

It is only recently that I have begun to suspect that actual hormonal issues may be at play. I am just now starting to do significant research into the Low T / Hormone ‘space’. I have an appointment with Dr. Saya of Defy Medical in about 3 weeks, and am trying to learn as much as I can to prepare questions for the appointment. The most recent set of bloodwork below (08/04) contains the labs ordered by Defy.

I greatly appreciate advice and feedback.

  • age: 27
  • height: 5’8.5
  • weight: 163 lbs.
  • Bodyfat%: 15% (per July 2018 DEXA Scan)

Symptoms: have had the symptoms outlined below, to varying degrees, since my early twenties (around 22-23).
Sexual

  • Very, very low libido.

  • Inability to achieve strong erections when I do have sex or masturbate. Cannot get hard enough to physically have sex after the first round.

Cognitive

  • Omnipresent mental haze. It’s like this “foggy” feeling, sort of like when you wake up in the middle of the night and you have to go to the bathroom and you’re not fully conscious. It isn’t quite as bad as that, but similar, and it’s always there.

  • Moderate to significant difficulty concentrating. I have tried mindfulness mediation, various Smartphone apps, etc., in attempt to build up my ability to focus with little success.

Psychological

  • Flat affect.
  • Persistent depressive mood. My happiness ‘set point’ is just generally very low.
  • Highly prone to neurotic reactions when little things don’t go as planned, my ‘routine’ is interrupted, etc.
  • Frequently experience distressing / anxious thoughts.

Physical

  • My hair has thinned dramatically since high school (Norwood 2) and has gotten worse recently My scalp hair is very thin; I am not balding at the crown. Hair loss does not run in my family; my 60 year old father has a thicker head of hair than me. I recently started Minoxidil 5%.

  • describe body and facial hair: Moderately hairy throughout chest, back, abdomen, and limbs. Normal facial hair. No unusual changes.

  • describe where you carry fat and how changed: Lower abdomen and obliques. No major changes in body fat distribution.

  • Rx and OTC drugs: Flonase, Zyzal, Allergy Shots / Injections, Minoxidil 5% (Foam), Ketoconazole 2%, ketotifen fumarate , Vitamin D3, Fish Oil. I used to use Creatine Monohydrate and Whey Protein (2012 - June 2018). I have never used steroids, or any sort of “testosterone product” available at nutrition stores.

  • Describe diet: I eat 2800 to 2900 calories per day: high protein, high carb, moderate fat. About 165g protein, 65g fat, and 400-425g carb. My maintenance calories are relatively high in relation to my bodyweight. 4-5 servings of fruit per day, 2-4 servings of vegetables per day, lots of lean chicken and beef, oats, eggs and egg whites, greek yogurt, rice, pasta, and potatoes. High sodium intake (4000-5000mg). Fiber intake between 25-50g per day. Drink 72-96 oz of water per day. 24 oz. of coffee per day. Occasionally drink green/white tea.

  • Exercise: I lift weights 4-5 times per week and do cardiovascular exercise (incline treadmill walking) 1-2 times per week. Have made some gains from starting point, but stalling out at a relatively beginner level of strength and muscular development.

  • testes ache, ever, with a fever? No.

  • how have morning wood and nocturnal erections changed? I don’t really get either. I occasionally wake up semi-erect.

  • lab results with ranges

08/04/2018 10AM Blood Test, Non-Fasting: Labcorp

  1. Hormone Panel
  • Testosterone, Serum: 334.0 ng/dL (264 - 916)
  • Free Testosterone (Direct): 7.8 pg/mL (9.3 - 26.5) (FLAG - LOW)
  • DHEA - Sulfate: 572.9 ug/dL (138.5 - 475.2) (FLAG - HIGH)
  • Cortisol: 9.2 ug/dL (Cortisol AM: 6.2 - 19.4 / Cortisol PM: 2.3 - 11.9 )
  • TSH (Thyroid Stimulating Hormone): 2.070 uIU/mL (0.450 - 4.500)
  • Luteinizing Hormone (LH), S: 4.1 mIU/mL (1.7 - 8.6)
  • Prostate- Specific Ag, Serum: 0.5 ng/mL (0.0 - 4.0)
  • IGF-1 (Insulin-Like Growth Factor I): 287.0 ng/mL (98 - 282) (FLAG - HIGH)
  • Estradiol, Sensitive: 11.5 pg/mL (8.0 - 35)
  • Sex Horm Binding Glob, Serum (SHBG): 46.7 nmol/L (16.5 - 55.9)
  1. Lipid Panel
  • Cholesterol, Total: 137.0mg/dL (100 - 199)
  • Triglycerides: 58.0mg/dL (0 - 149)
  • HDL Cholesterol: 53.0mg/dL (> 39)
  • VLDL Cholesterol Cal: 12.0mg/dL (5 - 40)
  • LDL Cholesterol Calc: 72.0mg/dL (0 - 99)
  • T. Chol. / HDL Ratio: 2.6 (N/A)
  1. Comprehensive Metabolic Panel
  • Glucose: 92.0 mg/dl (65 - 99)
  • BUN: 22.0 mg/dl (6-20) (FLAG - HIGH)
  • Creatinine: 1.1 mg/dl (0.76 - 1.27)
  • eGFR (non African-American): 92.0 mL/min/1.73 (> 59)
  • eGFR (African-American): 106.0 mL/min/1.73 (> 59)
  • BUN/Creatinine ratio: 20.0 (9 - 20)
  • Sodium:141.0 mmol/L (134 - 144)
  • Potassium: 4.6 mmol/L (3.5 - 5.2)
  • Chloride: 100.0 mmol/L (96 - 106)
  • Carbon Dixoide, Total: 26.0 mmol/L (20 - 29)
  • Calcium: 9.8 mg/dL (8.7 - 10.2)
  • Protein, Total: 7.1 g/dL (6.0 - 8.5)
  • Albumin: 5.0 g/dL (3.5 - 5.5)
  • Globulin, Total: 2.1 g/dL (1.5 - 4.5)
  • A/G Ratio: 2.4 (1.2-2.2) (FLAG - HIGH)
  • Biliburin, Total: 0.7 mg/dL (0.0 - 1.2)
  • Alkaline Phosphatase: 57.0 IU/L (39 - 117)
  • AST (SGOT): 36.0 IU/L (0 - 40)
  • ALT (SGPT): 46.0 IU/L (0 - 44) (FLAG - HIGH)

07/14/2018 10:15AM Blood Test, Non-Fasting: Quest

  1. TESTOSTERONE,FR (DIALYSIS) AND TOTAL (LC/MS/MS)
  • TESTOSTERONE, TOTAL, LC/MS/MS: 342 (Reference Range: 250-1100 ng/dL)
  • FREE TESTOSTERONE: 50.6 (Reference Range: 35.0-155.0 pg/mL)
  • TSH: 1.85 (Reference Range: 0.40 - 4.50 mIU/L)
  • T4, FREE: 1.2 (Reference Range: 0.8 - 1.8 ng/dL)
  • IRON, TOTAL: 119 (Reference Range: 50 - 195 mcg/dL)
  • IRON BINDING CAPACITY: 338 (Reference Range: 250 - 425 mcg/dL (calc))
  • % SATURATION: 35 (Reference Range: 15 - 60 % (calc))
  • FERRITIN: 197 (Reference Range: 20 - 345 ng/mL)
  • DHEA SULFATE: 481 (Reference Range: 85 - 690 mcg/dL)
  1. QUEST ASSURED 25-OH VIT D, (D2,D3), LC/MS/MS
  • VITAMIN D, 25 OH, TOTAL: 71 (Reference Range: 30 - 100 ng/mL)
  • VITAMIN D, 25 OH, D3: 71 (Reference Range: Not establish ng/mL)
  • VITAMIN D, 25 OH, D2: <4 (Reference Range: Not establish ng/mL)
  • ZINC: 78 (Reference Range: 60 - 130 mcg/dL)
  1. Basic Metabolic Panel
  • GLUCOSE: 89 (Reference Range: 65 - 139 mg/dL; Non-fasting reference interval)
  • UREA NITROGEN (BUN): 20 (Reference Range: 7 - 25 mg/dL)
  • CREATININE: 1.21 (Reference Range: 0.60 - 1.35 mg/dL)
  • eGFR NON-AFR. AMERICAN: 82 (Reference Range: > OR = 60 mL/min/1.73m2)
  • eGFR AFRICAN AMERICAN: 95 (Reference Range: > OR = 60 mL/min/1.73m2)
  • BUN/CREATININE RATIO: NOT APPLICABLE (Reference Range: 6 - 22 (calc))
  • SODIUM: 140 (Reference Range: 135 - 146 mmol/L)
  • POTASSIUM: 4.4 (Reference Range: 3.5 - 5.3 mmol/L)
  • CHLORIDE: 102 (Reference Range: 98 - 110 mmol/L)
  • CARBON DIOXIDE: 29 (Reference Range: 20 - 31 mmol/L)
  • CALCIUM: 10.2 (Reference Range: 8.6 - 10.3 mg/dL)
  1. Hepatic Function Panel
  • PROTEIN, TOTAL: 6.8 (Reference Range: 6.1 - 8.1 g/dL)
  • ALBUMIN: 4.9 (Reference Range: 3.6-5.1 g/dL)
  • GLOBULIN: 1.9 (Reference Range: 1.9-3.7 g/dL (calc))
  • ALBUMIN/GLOBULIN RATIO: 2.6 H (Reference Range: 1.0 - 2.5 (calc)) (FLAG: HIGH)
  • BILIRUBIN, TOTAL: 0.8 (Reference Range: 0.2 - 1.2 mg/dL)
  • BILIRUBIN, DIRECT: 0.2 (Reference Range: < OR = 0.2 mg/dL)
  • BILIRUBIN, INDIRECT: 0.6 (Reference Range: 0.2 - 1.2 mg/dL (calc))
  • ALKALINE PHOSPHATASE: 56 (Reference Range: 40 - 115 U/L)
  • AST: 35 (Reference Range: 10 - 40 U/L)
  • ALT: 47 H (Reference Range: 9 - 46 U/L) (FLAG - HIGH)

03/03/2018 9:01AM, Non-Fasting: Mercy Diagnostics

  1. Comprehensive Metabolic Panel w/eGFR
  • Glucose: 67 mg/dL (Reference Range: < 100)
  • BUN: 25 mg/dL (Reference Range: 7 - 25)
  • Creatinine: 1.21 mg/dL (Reference Range: .60 - 1.21) (FLAG: HIGH)
  • BUN / Creatinine Ratio: 20.7 Ratio (Reference Range: 6.0 - 21.0)
  • eGFR African American: 94 mL/min/1.73m2 (Reference Range: > 60)
  • eGFR Non-African American: 81 mL/min/1.73m2 (Reference Range: > 60)
  • Sodium: 140 mmol/L (Reference Range: 135-145)
  • Potassium: 4.6 mmol/L (Reference Range: 3.5 - 5.1)
  • Chloride: 100 mmol/L (Reference Range: 98 - 107)
  • Carbon Dioxide: 29 mmol/L (Reference Range: 21 - 31)
  • Anion Gap: 11 mEq/L (Reference Range: 5 - 15)
  • Calcium: 10.3 mg/dL (Reference Range: 8.6 - 10.3)
  • Total Protein: 7.6 g/dL (Reference Range: 6.4 - 8.9)
  • Albumin: 5.4 g/dL (Reference Range: 3.5 - 5.7)
  • Globulin: 2.2 g/dL (Reference Range: 1.9 - 3.5)
  • A/G Ratio: 2.5 Ratio (Reference Range: 0.8 - 2.0) (FLAG: HIGH)
  • Tbili: 1.0 mg/dL (Reference Range: 0.1 - 1.5)
  • Alk. Phosphatase: 66 IU/L (Reference Range: 45 - 115)
  • AST: 34 IU/L (Reference Range: 13 - 39)
  • ALT: 42 IU/L (Reference Range: 7 - 52)
  1. Urinalysis
  • U COL: YELLOW (Reference Range: Straw - Yellow)
  • U CLARITY: CLEAR (Reference Range: Clear)
  • U SG: 1.005 (Reference Range: 1.010 - 1.030) (FLAG: LOW)
  • U pH: 6.0 (Reference Range: 4.8 - 8.0)
  • U PRO: Negative (Reference Range: Negative)
  • U GLUC: Negative (Reference Range: Negative)
  • U KET: Negative (Reference Range: Negative)
  • U BILI: Negative (Reference Range: Negative)
  • U BLD: Negative (Reference Range: Negative)
  • U URO: 0.2 E.U./dL (Reference Range: 0.2 - 1.0)
  • U NIT: Negative (Reference Range: Negative)
  • U LEUK: Negative (Reference Range: Negative)
  1. Complete Blood Count (Hemogram)
  • WBC Count: 6.2 10^3/uL (Reference Range: 4.0 - 11.0)
  • RBC Count: 5.01 10^6/uL (Reference Range: 4.00 - 6.00)
  • Hemoglobin: 15.6 g/dL (Reference Range: 13.5 - 18.0)
  • Hematocrit: 45.7% (Reference Range: 42.0 - 52.0)
  • Mean Cell Volume: 91.2 fL (Reference Range: 78.0 - 100.0)
  • Mean Cell Hemoglobin: 31.1 pg (Reference Range: 25.0 - 35.0)
  • Mean Cell Hemoglobin Concentration: 34.1 g/DL (Reference Range: 30.0 - 37.0)
  • Red Cell Distribution Width 13.0% (Reference Range: 11.5 - 14.5)
  • Platelet Count: 182 10^3/uL (Reference Range: 150 - 450)
  • Mean Platelet Volume; 9.8 fL (Reference Range: 6.8 - 10.4)

02/02/2018 10:30AM Non-Fasting Blood Test: Quest

  1. Heart Function
  • Triglycerides: 46 mg/dL (Reference Range: < 150)
  • Total Cholesterol: 153 mg/dL (Reference Range: 125 - 199)
  • HDL Cholesterol: 50 mg/dL (Reference Range: > or = 40)
  • LDL Cholesterol: 89 mg/dL calc (Reference Range: < 130)
  1. Kidney Function
  • Creatinine: 1.4 mg/dL (Reference Range: 0.60 - 1.35) (FLAG: HIGH)
  • eGFR Non-African American: 68 mL/min/1.73m2 (Reference Range: > or = 60)
  • eGFR African American: 79 mL/min/1.73m2 (Reference Range: > or = 60)
  1. Pancreatic Function
  • Hemoglobin A1C: 4.9% of total Hgb (Reference Range: 4.0 - 5.6)
2

Bump

3

Testosterone is being overstated do to slightly higher SHBG which is why Free T is low. TSH along isn’t enough, you can check thyroid function by measuring morning and afternoon oral body temps and you should reach 97.8 in the morning and 98.6 by 2pm.

If temps are low then you would then need Free T3, Reverse T3 and antibodies tested. We see a lot of men who have both low thyroid function and low testosterone, in normal range is a problem and these ranges are thought to be too wide and doesn’t mean you should feel normal just because you are within them.

Free T3 needs to be midrange or better to feel good while Reverse T3 needs to be under 15 ng/dL or it could negate good Free T3 levels since they both compete for the same receptors.

Levels of IGF -1 that are higher than normal may also be caused by hypothyroidism, or low thyroid hormone levels, liver disease, uncontrolled diabetes mellitus. Estrogen is low because testosterone is low.

I had low Vit D when T was low, restoring T restored Vit D. You have a few other hormone out of ranges and may be from other systems not functioning optimally. Glucose and A1C look well controlled, 4.9 A1C is good.

Elevated creatinine level signifies impaired kidney function or kidney disease.

4

@systemlord Cushing’s disease is NOT caused from overactive adrenal glands. Cushing’s disease causes the adrenal glands to become overactive relating to the production of cortisol from increased ACTH from a pituitary tumor typically. This guys cortisol is nowhere near cushings numbers. Jeez man. Also -temperature testing has been proven over and over to be ridiculously unreliable to discern thyroid status. For instance - my morning body temps are around 96.9-97.1 yet my thyroid is optimal. Body temp is mostly a function of serotonin - not thyroid. Stop this BS already.

2 Likes
6

Thanks for your reply. Do you have any other insight based on my labs and symptoms?

7

Hows your sleep, stress, and emotions?

8

I get 7-8 hours of sleep per night. My psychological state and emotions are characterized by a flat affect, persistent depressive mood, frequent distressing / anxious thoughts, and a general proclivity towards neuroticism. I wouldn’t say I have a particularly stressful life, but I don’t deal with stressors well at all.

9

Have you had any brain injuries? Any major stressors in adolescence? Any imaging work?

10

No to all 3.

11

With those numbers from 8/4/18 it’s no wonder you feel like crap buddy. With that ft and e2 you must feel terrible. I feel sorry for you and I hope you find resolution soon. Dont give up.

12

I’m curious to what you think as my numbers are the same except shbg is 22 and I have a varicocele