Labs Help and Advice

Pharma / TRT Testosterone Replacement
1

My annual physical is next week. Last year I asked for my T to be tested and the doctor said it was on the low side of “norm”. This year I’m having my bloodwork done prior to the physical and hope to be more proactive in the discussion. What prompted me to ask to have my T tested was that after spending 3-5 days/week working out HARD I wasn’t seeing the results I thought I should.

The first lab panel came back with
Total Testosterone 256 (250-1100)
Free T 58.1 (35.0-155)
Total Cholesterol 209
HDL 25
Triglycerides 311 - I eat a low fat diet, don’t use butter, very light salad dressings, no sauces, no condiments, this seems very odd.
HDLC Ratio 8.4
Alkaline phosphatase 327
Platelet count 134
T Free % 2.27

Based on this result I’m now having my FSH and LH tested before the physical and should have those results by the end of week.

Background info:
age - 45
height - 5’9"
weight - 210
waist size - 36/37

where do you carry fat, how changed - chest and abdomen

mood changes - irritable
how do you sleep and how changed - terrible sleeper, been on sleeping pills for 6 years, stopped taking them 1 month ago. Can fall asleep till 1am, wake up at 6am and sleepy all day

any loss in peripheral vision, check each eye
other visual field disturbances - nothing noticed

feeling hotter or colder - very sensitive to heat, sweat very easy, also after eating hot food, if I drink coffee in the morning I can sweat for 30 minutes. If I use a hair dryer same issue.

how are you affected by stress, how changed - stress is constantly high

stress events ever leave you feeling physically unwell - yes, very much so

brain fog - sometime I can’t remember what someone said 10 minutes ago

word finding - very difficult to find the “right” word at times

key board skills declined - no impact

short tempered - yes, my wife has brought this to my attention

changes in emotional reactions - hot headed
social avoidance - have become withdrawn from social situations

changes in activities - withdrawn
loss of morning wood - yes
loss of nocturnal wood - yes
great looking women are interesting as art objects VS objects of lust - somewhat
any foreign travel prior to the changes 6 months ago - no
any testicular pain or ache and time line - left nut pain every few months, diagnosed as prostitis
changes to sweating - sweat very easy
bloating - yes
changes to urination or urine flow - flow has diminished greatly in past 2 years
list drugs, OTC and Rx, supplements, alcohol, tobacco and changes re 6 months ago

  • lunesta or ambien up until 1 month ago
  • sertraline 100mg for past 12 months
  • advair for asthma
  • multi vitamin
  • fish oil
  • been using kosher salt for last 5 years (dam that Alton Brown)
  • occasional alcohol use
  • no tobacco or illegal drugs
  • heavy workouts 4 x week plus 1 or 2 2+hour bike rides @17mph
  • protein powder several times per day
  • waxy maize post workout
  • lots of protein (chicken breast, fish, turkey)
  • plenty of water intake or water + accelerade

When I get the FSH and LH numbers I will post.

Thanks in advance for reviewing this and getting the dialogue going.

2

welcome onboard.

great job being proactive with the tests.

please read the blood test sticky. You need a lot more blood tests including Cortisol, Thyroid (free T4, free T3, TSH), Estradiol, Pregnenolone, DHT, PSA, B12, Vitamin D, and ferritin just to start.

don’t jump into HRT when you could have a Thyroid or Cortisol problem which could be lowering your T. Get everything checked out before you start any treatment program - learn from those of us who didn’t do that and wish we could have.

High CHOL could be your body trying to compensate for low T by providing “raw material” to the hormone production line.

3

@PureChance - thanks for the reply. I’ve read the stickies, but having a challenge trying to comprehend it all. When I meet with the DR next week I’m going to ask about these other tests. Any advice on how I should handle that conversation? Can I just ask for test X,Y, and Z? Re:CHOL - yes, that is what I’m thinking - there seems to be a correlation between low T and high Triglycerides.

4

Your low-fat diet may be the cause of your high triglycerides. A moderate amount of saturated fat is healthy, as are omega 3’s. Try incorporating fats from lean meats, butter (preferably organic), coconut oil, olive oil, salmon and other fatty fish, avacados, and nuts.

Saturated fat is also essential for the production of testosterone.

5

it depends on your doctor. It seems like 95% of doctors are clueless when it comes to HRT. just read through the threads here to see all of the bad advice/treatments that doctors have used on people here.

If you have a good doctor then he would ask for all of those tests. If he doesn’t ask or doesn’t see the need for those tests then you know he is out of his element, and you need to go find a new doctor (but they are few and far between).

You can tell him that you have read that people with Testosterone issues also normally have disruptions with other hormone/adrenal systems (like Cortisol, Vitamin D, Thyroid, etc., etc. etc.), and before you jump into HRT you want to confirm what the base cause is for your Low T and so you would like to test for these (and hand him a list from the blood test sticky). If he says, low LH causes low T - yes, but what is causing the low LH? - some disruption to the HPA If your cortisol and Thyroid are off, simply fixing those can drive up your T levels in some cases.

also read the finding a doctor sticky for how to describe your symptoms and why you believe those tests would be beneficial.

6

@pcdude - thanks for the info. I should have clarified that its a low bad fat diet. I consume salmon 2 x week, take fish oil every day, I’ve been using coconut oil to cook with, and have forced myself to develop a taste for avacodo. I will pickup some organic butter - that is a good tip.

7

Lab update. I received my Vit D results back today and here is what they are:
Vit D, 25 OH, Total 27 Low Reference Range 30-100 / ng/mL
Vit D, 25 OH, D2 < 4
Vit D, 25 OH, D3 27

Explanation:
25-OHD3 indicates both endogenous production and supplementation. 25-OHD2 is an indicator of eogenous sources such as diet or supplementation. Therapy is based on measurement of Totatl 25-OHD with level <20 ng/mL and 30 ng/mL suggest insufficiency. Optimal levela are >=30 ng/mL

Doc’s notes:
Vit D level are low-normal and slightly worse compared to previous values. Vit D is important for bone, cardiac and mental health and appears imporant fo rmulitpe other med conditions. You can improve this thru mild increased sun exposure 20 min 3-4 times per week and Vit D supplementation 2000 IU/day

8

vit-D3 should be oil based caps, take with oily food or supplements, not with high fiber, 2000iu is not typically enough, depends on climate and sun exposure too. Suggest 4000 - 6000iu

You should check thyroid levels and adrenals. Heat intolerance suggests hypothyroid, but that is contradicted by waist size.

FT is not that great relative to 155 top end. Note that range for some labs is way different from others.

HDL sucks.

9

Here are some follow up lab results. Happy for any feedback

Thyroid Panel
T3 Uptake 37 22-35%
T4 (Thyroxine), total 5.5 4.5-12.5 mcg/dL
Free T4 Index (T7) 2.0 1.4-3.8
TSH, 3rd Generation 2.38 0.40-4.5 mIU/L
Methylmalonic 107 87-318 nmol/L
Vitamin B12 (REFL) > 2000 200-1100 pg/mL
Estradiol 37 13-54 pg/mL

T3 Uptake noted as High
Vit B12 noted as High

I’m being referred to an Endo Doc next. Any suggestions on what I should ask when I see him considering my low T, high Triglycerides, and poor HDL?

10

You have have hypothyroidism, subclinical, check your waking body temp, You want T4 near 8.5

You have hypogonadism, but I cannot see where you posted LH/FSH.

You have strong symptoms of adrenal fatigue. You need a 4 sample saliva cortisol test. You workouts may be too much. We would not be surprised if your DHEA-S is low. At your age and condition, you should take 50mg in any case.

You need to start supporting/ building your adrenals before thyroid meds and TRT.

You are very estrogen dominant. You will probably need Arimidex/anastrozole.

There are supplements that will build HDL.

This is starting to look at panhypopituitarism, but that diagnosis does not help as there is not “pill for that”.

11

Not sure why the doc didn’t test for Free T3 which is more important than Free T4.

You really need Free T3, Reverse T3, and AM Cortisol to get a better big picture view of what is happening.

plus you should check your Aldosterone levels (since you stated you sweat very easily - I exude sweat when it is slightly warm, when I have sex, or workout, and I have low Aldosterone). Plus low Aldosterone usually means electrolyte imbalances - coffee and alcohol can make that imbalance even worse (you said how coffee makes you sweat).

There is a “newer?” CHOL panel, I think, called VAP panel that gives you a better breakdown of your results. With your high numbers, it may be helpful to get more defined results.

12

Thanks again guys for looking at my tests and responding. There are a few lab results that I don’t have back yet.

I’m going to search thru the site here to see what I can start doing to build my adrenals. Also, as soon as I get the other results I’ll post.

The endo doc I’ve been referred to has a 6 week waiting list. I’m going to see if I can find another.

Thanks,

13

Read this: http://www.amazon.com/Adrenal-Fatigue-Century-Stress-Syndrome/dp/1890572152/ref=sr_1_1?ie=UTF8&s=books

Are you taking B-12 vitamin?

Sleep: Suggest 3mg time release melatonin and you might try 50mg trazodone which is very effective and neural transmitter friendly.

14

KSman,

Ordered the book, seeing an endo this week.

Regarding B-12, I see that its in my multi-vitamin at 1,000% of recommended dose. I take 2 per day.

Regarding your statement about hypothyroidism, hypogonadism and estrogen dominant - can you tell me what points you to that conclusion? I have read the stickies, but maybe just overwhelmed by the volume of data and interactions.

PS - I’ll have the LH and FSH numbers tomorrow but was told “they are in range” (I know you love that phrase)

15

Your T and thyroid hormones are both low, hypo X2

Your E2:T ratio has E2 dominating your body. Partly from the direct effects of E2 and in part from E2 blocking your [lower] T levels at the T receptors.

When I had TRT without anastrozole, my TT was 1000 and I had E2=37. That was very messed up for me.

Seems quite simple really. I am trying to call you to action. Life will be a lot better when you get some of these problems resolved. Sorry if I seem abrupt.

16

Ksman
Thanks again. No worries on being abrupt. I am taking control of these issues much in part due to the info that is available here. From a call to action perspective. I’m typing this from the waiting room at the endos office.

Thanks for the clarification

17

Here’s the update.

LH is 1.2
FHS IS 2.4
Since my Free T is 58 range 35-155
The Endo has prescribed the following blood tests:
Total T
SHBG
Prolactin
LH
FSH

His thinking is that my Free T is fine and wants to see what’s up with my LH.

Any thoughts?

18

You still look like you have hypothyroidism. T4 is way too low. Hypothyroidism can lower T levels.

When will you get that treated or retest?

Part of your low T level is HPTA repression from E2=37

Any signs of gyno?

19

KSman,

Just had the followup blood test today for Total T, SHBG, Prolactin, LH and FSH.

After I hear back from Endo re:results I’ll post 'em here and then see what advice you have. I can’t follow up w/him until these results are back and then I’ll be in a position to formulate a holistic plan.

20

Here’s the latest results (LabCorp)

LH 2.0 (1.7-8.6)
T Serum 237 (280-800)
Prolactin 8.4 (4.0-15.2)
FSH Serum 2.6 (1.5-12.4)
SHBG 32.4 (14.5-48.4)
Calculated Free T 23.4

Endo’s recommendation was 5mg Testim per day. When I asked about injecting, adding an AI and hCG I got shut down and told try this for 2 mos and we’ll retest. There are a lot of misleading information on the internet.

I went back to my GP and he is against injections and wants to see what effect the Testim has.

I was able to have another doc prescribe cypionate for me and I’ve filled that script but trying to decide whether to run out the Testim for 3 weeks and test blood or start doing the 2 x week injections and then retest.

My biggest concern is after 5 days on Testim I seem to be gaining weight despite the lack of appetite/food intake. I’m able to workout hard and with more endurance but my waist size is increasing.

Thoughts? My E2-37 from my blood panel last month. Could the Testim being converted to E?