Some Help with Bloodwork

Pharma / TRT Testosterone Replacement
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-age 35
-height 180cm
-waist 34"
-weight 85kg
-describe body and facial hair - Little to no body hair, patchy facial hair
-describe where you carry fat and how changed = Mid section and breast area
-health conditions, symptoms [history] - No conditions
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - None

-lab results with ranges

-describe diet - Typical diet, rarely eat red meat, mainly chicken and fish, vegetables, just drink water
-describe training - mainly strength training, compound movements 4 days a week. I used to compete oly lifting years ago at a regional level. These days I just try and maintain as much strength as I can.
-testes ache, ever, with a fever? - No
-how have morning wood and nocturnal erections changed - I dont get morning woods, difficult to get an erection however once gf has aroused me enough I can get the job done. I had one instance a few months ago which led me down this path, I couldnt get an erection and the gf made me go to the doctor the next day, I tested at 260ng/dl (9nmol/l) and doctor told me I had low T.

Much research and a couple more blood tests later and my latest test returned a level of 231ng/dl (8nmol/l), strangely the reference range was 5 - 25nmol/l wheras the other tests had always had a reference range of 10 - 30. Have they just suddenly lowered the testosterone reference ranges or something?

If the lab states that this is normal, what about my other blood work that they have reported as being ‘normal’? Can anyone see any issues with other values?

I have typical symptoms I guess that go along with low T, most notably no desire for anything, I feel like i simply exist. Hope that makes sense.

Any input would be appreciated.

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I can only put 1 image per post, so I will continue with the rest of the bloodwork

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Your facial hair indicates that you have never been fully virilized by testosterone.

Thyroid lab ranges are bogus and hide many problems.
TSH should be nearer to 1.0
T3, T4, fT3, fT4 should be mid-range or a bit higher.
You can eval your overall thyroid function by checking your oral body temperatures:

  • when you first wake up, should be 97.7-87.8F, higher is OK, 97.3 is a problem
  • also check 37C/98.6F mid-afternoon

If body temps are low:

  • this can be caused by iodine deficiency
  • do you use iodized salt?
  • what is iodized there? salt? bread? dairy?

In the 2nd post of the 1st forum thread, follow these links:

  • advice for new guys
  • things that damage your hormones
  • thyroid basics explained
  • finding a TRT doc

Labs, please fill in what is missing:
TT= 8nmol/L 5.0-25
FT
E2
LH=5
FSH
prolactin=3, quite low
TSH=1.7
fT3
fT4
CBC - done
cholesterol - done

LH is low and T is consistent with that.
Prolactin is not a cause
E2 [estradiol] might be, lab not done

Hypopituitarism:
Need to see what else is going on:
LH/FSH
TSH
AM cortisol [at 8AM please]

Low T, low thyroid function can take away your energy and both have many symptoms in common which can compound the problem. [Low cortisol simply slows you down - unknown]

Different labs have different ranges. Or you had a birthday and dropped into a different age adjusted range. From a TRT point of view, you want youthful levels, not age adjusted.

Your description of how you feel speaks to testosterone and thyroid levels. AM cortisol should be tested.

Sometimes correction of a thyroid problem can allow for some T recovery.

Please follow and read the suggested links.

How has stress shaped your life?
Any major accidents, illnesses, crisis, surgeries, infections?
Over training and starvation diets can be harmful.

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Thanks for the reply, appreciate it greatly.

I haven’t really had anything major over the years with the exception of a high speed car accident when I was 19. Suffered whiplash and walked away from it, so no real injuries.

I am getting more labs done next Wednesday so I will chase up the missing values.

Over training isn’t an issue, nor is crash dieting etc, I’m normally sitting around maintenance with regards to caloric intake.

No notable stresses, work has its ups and downs but I wouldnt consider it an overly stressful occupation.

I’ll look into iodine, with regards to dairy etc, i don’t really use salt that often.

I will get some body temps

Thanks again

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Looking at the food standards Australia website I am confident that I get over the required 150 micrograms per day of iodine. I have a fairly high dairy intake and eat at least 2 slices of read per day. Bread is required for bakers to use iodised salt here, so it seems it’s a good source.

I would consume on average 1 litre of milk per day which would amount to around 220 micrograms just on its own.

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The problem with Australia is that TRT is only available on the Pharmacy Benefits System (PBS) if [total testosterone is below 6 nmol/L / 170 ng/dL] (https://www.mja.com.au/insight/2015/11/testosterone-changes-necessary).

I don’t know what the situation is like for private patients, and I’d be curious to see what @tobbakim uncovers.

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You are right Graemsay…

I give up, seen a specialist today that said my levels are fine and are within range, he said there is nothing wrong with my bloodwork and refused to do any more bloodwork.

Ill also add that I had another test in December through a different lab that isn’t listed on the blood work above with total test at 6nmol/L (170ng/dl) I dont have a copy of that lab result however.

KSMan, I checked my temps over 3 days and they were fine.

Feels like I’m banging my head against a wall, Its hopeless. Specialist said to me “everyone is different, this is just the way you are”, he even offered me a script for viagra at the end of the session…I honestly felt like pimp slapping him.

I feel so lost, I just want to feel normal, 4 doctors and 2 specialists later…

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It might be worth having a chat to Dr Michael Serafin at Complementary Compounding Services. He might be able to point you in the right direction. He’s been mentioned in discussions of TRT in Australia.

Recomp in Melbourne might be able to help too.

I don’t know if there are options for TRT privately. The PBS (for readers outside Oz) is for subsidised medicines, but injectable testosterone comes under the price cap threshold, so it wouldn’t make any difference.

I’m not on TRT myself, so I’ve got no clue about accessing it over here.

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It is all about the money:
“It is possible for the doctor to prescribe testosterone treatment without the PBS subsidy in which case the patient will have to pay the full cost of treatment”
https://www.andrologyaustralia.org/wp-content/uploads/PBS-testosterone-implementation-2015.pdf

Meanwhile is now known that higher T levels mean less: high blood pressure, diabetes, heart attacks and strokes and higher survival of heart attacks and strokes. Harvard Medical School reported that and vast data from US VA treatment data showed ~30% less heart attacks and strokes.

There has never been any data to support the notion that TRT causes heart attacks. It has always been a myth since a doc at a conference was asked why men had more middle age heart attacks than women. He stated, ~“men have more testosterone, that may be the reason”. In reality, its men with low T and estrogen dominance that are having major health problems.

The problem with socialized medicine is that they are always worried about costs of anything new. You wonder why growth hormone is so very restricted! TRT would lower health costs. The cost of treating a heart attack can be huge.

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The PBS subsidy caps the cost of a medicine to $38. I believe that the injectable forms are around $35, so unaffected, whilst Androgel is $70 or $80. It probably doesn’t make a huge amount of difference to the budget.

I suspect it’s more about making it seem as though something is being done about a perceived problem. I’m not sure if the claims that it’s a way for bodybuilders and doormen to obtain steroids hold much water. Half the people at my gym (a Fitness First) look like they’re taking something, so it’s not as though they’re hard to get hold of.

What might make things more difficult is that GPs need to refer the patient to a specialist before they can make a prescription.

Here’s a counterpoint from a doctor in Melbourne, though I suspect he’s preaching to the converted. (@tobbakim - he might be worth a call.)

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If you pay for the medications yourself, you can skip the specialist who is the cost control gateway.