Lab Work, Blood Testing and Symptoms

Pharma TRT
61

Hello KSman,

I was referred to you from someone that you recently helped a great deal. Thanks in advance for support that you give to everyone. Below are my abnormal ranges. The Dr says that my total test levels are good so there is not a need for test treatment, when it is obvious that my free test is low. Additionally, he is aiming to treat my cortisol levels instead of test. Please let me know your advice on the following. Is the Dr right for his treatment decisions?

Thanks again
Ranges
Cortisol - AM
Cortisol - AM L 6.1 (ug/dL) 6.2-19.4 01

Vitamin D, 25-Hydroxy L 24.9(ng/mL) 30.0-100.0

Testosterone, Serum 629 (ng/dL) 348-1197

Free Testosterone(Direct) L 7.3(pg/mL) 8.7-25.1

62

Your SHBG is elevated, reducing FT and exaggerating TT and much of that is T_SHBG which is inert.

You need to find out why SHBG is high. The most obvious reason would be high E2 which would also show up in body fat patterns, libido issues, mood issues and possible gyno.

Prolactin might be a player.

Vit-D3: Get tiny 5,000iu oil based vit-D3 caps and take 25,000iu for 5-7 days then 5,000iu thereafter.

AM cortisol would be better around 10.0 and yours is low. Read advice for new guys sticky and thyroid basics and look for references to adrenal fatigue, rT3, stress etc.

Please create your own thread and repeat your question there, post all labs and ranges and post more info as per the advice for new guys sticky. You need your own thread for your case which should not be in a sticky.

Your doc is wrong about this, you have a fT deficiency and low cortisol. You should not start TRT until you have more diagnostic work to figure out why you have the symptom of low T.

You need these labs:
TT
FT
E2
TSH
fT3
fT4
prolactin
DHEA-S
CBC
cholesterol [even if young in case cholesterol is low]
PSA if older

end of this post please…

63

Is it advisable to discontinue supplements prior to baseline lab work?
If so how long? Specifically DHEA and creatine.
I am also curious but not as concerned with others like vit d, zinc, magnesium, etc.
I am worried that self medicating with supplements may hide underlying problems.

64

If your DHEA levels are low, you need DHEA and testing DHEA-S will inform you if that dose is appropriate. If your DHEA levels are not low, no need or benefit from using it. If you are one of the few who have a lot of DHEA–>E2 in their adrenals, you need to be taking DHEA and your E2 tests will disclose that DHEA–>E2 issue.

Creatine can be stopped.

65

Great list of symptoms! Loss of hair on lower legs - is that indicative of anything specific or just a sign that something is whack? I have this and it does not appear to want to grow back. Lost the damn hair on my head too. Have a sore inside my left nostril that will not completely heal as well. Any correlation?

66

It is common to see hairless lower legs in older men and it really seems to be a symptom of long term low T levels. In the summer time when there are gatherings, you can observe this. [You will find less older people at the beach.]

Those sores in your nose can easily be cleared up, that I have seen, with some OTC antibiotic cream or solution [ear/eye drops].

General hair loss can be from different causes, as well as hypothyroidism.

Thanks for the feedback!

67

Really nice job answering questions for so many. I don’t see how you do it, but I know it is appreciated.

I do need to get something for my nose. Had it checked out by a doc several years ago and he said pretty much the same you have on using an over-the-counter cream. I did for a while, but then got slack on it. It seems to return.

I know what you mean about older hairless men. Damn, I’ve become one! Except I have too much hair in some places - nose, ears. What do you do…

Thanks

68

Tweezers for the ears and blunt end scissors for the nose.

69

Would you be able to help me figure out why I would have no libido with the following numbers? Dihydrotesterone 135
Dhea 277 SHBG 73 total test 1560 free test 203.2 and estradiol 30 I have had zero libido for close to 20 years now and in spite of raising my test to these levels it is ruining my life. I get no pleasure from even looking at girls any more and that was my favorite thing to do.

70

This a lab work sticky. Please create your own thread for your case and keep all of you posts in that thread so we have context as time goes by. Before you post, please read the advice for new guys sticky.

71

Interesting Clinical Commentary submitted at the 2015 Proceedings on UCLA Healthcare. Pretty bold for a UCLA endocrinologist, and favorable in my view. Link to commentary and excerpt below:

http://www.med.ucla.edu/modules/xfsection/cache/uploaded/786765.pdf

"But one may ask if there is no or little risk, at least from a cardiovascular standpoint (and probably other perspectives which are beyond the discussion in this paper), why not just prescribe the testosterone on request? Well, there is just one very inconvenient truth that precludes doing so, and that is that testosterone is a schedule III substance. A schedule III substance is defined as drugs with a (moderate to low) potential for physical and psychological dependence and includes products containing less than 90 milligrams of codeine per dosage unit, ketamine, anabolic steroids, testosterone on the DEA website. The nature of the potential physical or psychological dependence of testosterone is not identified; why this substance should be classified with drugs containing codeine while benzodiazepines, tramadol,carisoprodol, propoxyphene, and LSD are classified as schedule IV substances is not comprehensible. The history of this classification is apparently related to the public outrage at the use of testosterone as a performance enhancing substance
in competitive sports in the 1980s. However, why that should be translated into the idea that testosterone is a dangerous substance that needs to be controlled, or the idea that men should not be able to obtain it to improve their sense of well being and subjective sense of sexual capability without making low testosterone levels into a disease that we cannot define, is not evident.

So let’s stop the hypocrisy. Let’s admit that we are not sure of the relationship between testosterone levels and the purported symptoms of androgen deficiency in middle aged men. Let’s stop talking about the problems of aging as if they constitute a medical disease. Let’s take this apparently safe drug and declassify it as a controlled substance; let’s consider making it available in low doses over the counter so that men can get it or doctors can prescribe it without worrying about the legal consequences of doing so. Let’s put a stake through the heart of the monster that roams the earth intimidating would be prescribers of testosterone and end, once and for all, the unwarranted obstacles to testosterone usage."

72

That fits in the the theme that I was on about a few years ago; that doctors live in fear. If a doc starts to do a lot of hormone work that creates a patient base that will take hormones for most of their remaining life, they will be attacked by the medical establishment.

Insurance companies such as BCBS who have seats on State medical boards create a situation where a doctor is investigated for unnecessary medication etc. After a while the doctor changes his/her ways or drops out of the insurance systems. And when the insurance participation is dropped, the State medical board investigations stop. Perhaps now that TRT is been marketed as main-stream , this may change a bit.

And as controls on schedule III drugs are tightened in an attempt to control the epidemic of Rx pain med abuse, there are new burdens on men obtaining Rx T. So I am hearing that I will not be able to get 180 days of T, now restricted to 90. Getting 2000mg of T in one vial does not fit 90 days for me. So I will need to double or triple my pharmacy transactions. [I do not get T via medical insurance, so I have not been constrained by insurance restrictions quantities delivered.]

Many docs are also hand tied by the medical perceptions that T causes rage, cancers, liver damage and heart attacks; all false. So they also have fear generated by their individual and collective ignorance. So if doctors are constrained by ignorance; what hope can we have that a bunch of elected flunkies will change legislation that criminalized testosterone. It is obvious that the risks of anabolic steroids to major league baseball should trump all other considerations.

73

Hey everyone! I made a separate thread for my personal situation but I’m new to this site and learning how things work (Post proper questions in proper threads I take it?)
I’m 27, been on trt with an urologist for about six months now. my doc doesn’t test for FT or E2. Only TT and prolactin level. This is how my first labs came back

Fyi it’s from Lab"C" (not sure if I can say the “whole name” of the lab where I get my bloods taken).

(PAGE ONE)

TESTS - RESULT

WBC - 7.1
RBC - 4.95

Hemoglobin - 15.1
Hematocrit - 44.6

MCV - 90
MCH - 30.5

MCHC - 33.9
RDW - 12.5

Platelets - 219
Neutrophils - 45

Lymphs - 43
Monocytes - 8

EOS - 3
Basos - 1

Neutrophils (Absolute) - 3.2
Lymphs (Absolute) - 3.1

Monocytes (Absolute) - 0.6
EOS (Absolute) - 0.2

Baso (Absolute) - 0.0
Immature Granulocytes - 0

Immature Grans (Abs) - 0.0

(BOTTOM OF PAGE ONE)

Comp. Metabolic Panel (14)
Glucose, serum - 80

BUN - 21 “High”
creatinine, serum - 1.12

(PAGE TWO)

TESTS - RESULTS

eGFR If NonAfrican Am - 90
eGFR If African Am - 104

BUN/ Creatinine Ratio - 19
Sodium, serum - 142

Potassium, Serum - 4.0
Chloride, Serum - 100

Carbon Dioxide, Total - 25
Calcium, Serum - 9.7

Protein, Total, Serum - 6.6
Albumin, Serum - 4.2

Globulin, Total - 2.4
A/G Ratio - 1.8

Bilirubin, Total - 0.2
Alkaline Phosphatase, S - 54

AST (SGOT) - 25
ALT (SGPT) - 30

Testosterone, Serum - 146 Low
TSH - 4.080

Thyroxine (T4) - 5.4

Side note, Urologist says my thyroid is healthy so it’s not thyroid problem. As for prolactin, he says I DON’T have a tumor so he doesn’t know why it’s slightly high (says it should be 15 but it’s 18.3)

currently on 200mg test cyp per week, no AI, no hcg etc. I want to get my FT and E2 levels checked without my Urologist knowing. Is this possible to have bloods done without him knowing?

74

Btw, at 200mg test cyp per week why are my TT at only 630? I thought 200mg would get me up much higher (originally was 146). side note, doc won’t test for FT or E2 so i’m experiencing HIGH estrogen sides…

75

Oops. Duh. Edit: Ignore some of the below. You were posting your ORIGINAL labs. Still would be good to have units and Vit D. Post TRT 630, assuming ng/dL, is fine dude, plus once you get your E2 right your T will go up.

Second edit: When are your results 630? Peak? Trough? In the middle? Makes a big difference. Apologies if all this is clarified in your own thread.

I think your posts and my reply will get moved to your own thread (I couldn’t find it), but I’ll post just a quick initial response here:

When you wrote “146 Low” is the “low” stated in the results or is that your own comment? I ask because the problem with the above is that I don’t see any of the units of measurement. I have to assume that T serum is not ng/ml or nmol/l, because if it is, it would be insanely high. So just edit and add in the measurement units for each value above. Assuming 146 is ng/dL, then yeah, that’s stupid low.

Also, maybe you have this in your own thread, but what is your vitamin D level? I don’t think it should matter in terms of your reaction to TRT, but it definitely does pre-TRT, and for health, and, in my experience, for energy and even libido. I also wouldn’t be surprised if it matters in terms of reaction to things like Hcg that trigger your own production mechanisms.

On E2, not testing for that is retarded. You need that. Get a new doctor or request testing through someplace like LEF, assuming it’s legal where you are (it is in the U.S.).

Also, I know I’m in the minority here, but I prefer transdermal TRT like Androgel. Maybe that would work better for you. My insurance (which sucks on coverage for a lot of things) covers Androgel. I don’t get too hung up on Free T, because from what I understand there’s not a lot you can do about it once T is in range (I could be wrong BTW), but for what it’s worth, transdermal, for me, has always gotten me within good range. And Free T is another thing you can have tested through LEF, and there are some other places that offer the same, LEF is just the one I use when my doc won’t order something I want tested.

Good luck.

76

Not replying to the above out of place posts.

77

@NeverAlone
@KSman

Hey, sorry for the confusion guys. I’m very new to this site and forums in general but I thought I was suppposes to post this here since I wasn’t getting any feed back on my thread I made. I re edited it on my thread here BTW the (LOW) and (HIGH) is what THEY printed next to the scores.