Test Results Back - Confused

Pharma / TRT Testosterone Replacement
1

Hi All,

I posted back in January about some tests I had run after suspecting low T levels. For reference, I’m 30 years old, 5’7", and ~150lbs.

The levels I had tested about 8 months ago came out as follows (reference ranges in parentheses):

TSH = 2.04 (0.04-4.50 mIU/L)
Total T = 365 (250-1100 ng/dL)
Free T = 82.0 (35.0-155.0 pg/mL)
FSH = 1.8 (1.6-8.0 mIU/mL)
LH = 1.9 (1.5-9.3 mIU/mL)
Estradiol = 27 (< or = 39 pg/mL)

After not taking any more action for about 6 months, I managed to find an Doc in town who is an andrology / HRT / urology specialist. I actually found his name on another forum - I believe bodybuilding. His resume checked out pretty good and was covered by my insurance, so I called to make an appointment 2 months out (this was the wait time).

Anyway, I went in and showed him my prior results and told him about symptoms, so he ran a few additional tests that came out as follows (once again, reference ranges in parentheses):

Albumin = 4.9 (3.5 - 5.7 g/dL)
Prolactin = 7.9 (2.6 - 13.1 ng/mL)
SHBG = 19 (10 - 50 nmol/L)
Total T = 321 (250 - 1100 ng/dL)
Free T = 62.6 (35 - 155 pg/mL)

He called me to discuss the results about a week later, and said my levels were within normal ranges so I’m “fine.”

I suppose I should just take him at his word and not be posting for second opinions here, but something still bugs me about this to some degree. I guess I just don’t understand why there’s such a huge range of T levels that are considered “fine.” I’m not sure if I need to be concerned about a number or not. Perhaps I’m looking for some sort of solution to a problem that is more mental than anything?

Any thoughts are appreciated.

Best,
-Dirk

2

[quote]ddiggles wrote:
Hi All,

I posted back in January about some tests I had run after suspecting low T levels. For reference, I’m 30 years old, 5’7", and ~150lbs.

The levels I had tested about 8 months ago came out as follows (reference ranges in parentheses):

TSH = 2.04 (0.04-4.50 mIU/L)
Total T = 365 (250-1100 ng/dL)
Free T = 82.0 (35.0-155.0 pg/mL)
FSH = 1.8 (1.6-8.0 mIU/mL)
LH = 1.9 (1.5-9.3 mIU/mL)
Estradiol = 27 (< or = 39 pg/mL)

After not taking any more action for about 6 months, I managed to find an Doc in town who is an andrology / HRT / urology specialist. I actually found his name on another forum - I believe bodybuilding. His resume checked out pretty good and was covered by my insurance, so I called to make an appointment 2 months out (this was the wait time).

Anyway, I went in and showed him my prior results and told him about symptoms, so he ran a few additional tests that came out as follows (once again, reference ranges in parentheses):

Albumin = 4.9 (3.5 - 5.7 g/dL)
Prolactin = 7.9 (2.6 - 13.1 ng/mL)
SHBG = 19 (10 - 50 nmol/L)
Total T = 321 (250 - 1100 ng/dL)
Free T = 62.6 (35 - 155 pg/mL)

He called me to discuss the results about a week later, and said my levels were within normal ranges so I’m “fine.”

I suppose I should just take him at his word and not be posting for second opinions here, but something still bugs me about this to some degree. I guess I just don’t understand why there’s such a huge range of T levels that are considered “fine.” I’m not sure if I need to be concerned about a number or not. Perhaps I’m looking for some sort of solution to a problem that is more mental than anything?

Any thoughts are appreciated.

Best,
-Dirk[/quote]

Well put it this way if you were 80 and had the same levels as you have now the doctor would say you are fine, which would be fair considering the age.

But at 30 with T levels of a 70-80 year old you have to ask yourself do you want to accept that? From what I have read it seems people of a higher age with low test have more success than younger guys. The you are too young to be treated is such bs. Do they expect the younger guys to live 30-40 years with shitty levels and then at old age say you can have treatment now. Just so wrong and stupid.

Not saying you should jump on TRT but rather look deeper at possible causes first.

Just by looking at your lh,fsh nunbers they are borderline low. So it would lead me to say secondary just by that observation, but by all means not conclusive.

Your doctor just wants you out of his office without digging deeper, hence the you are in range cya…

Take a read of the stickies and might be a good idea to post your symptoms.

If you want to dig deeper more tests will need to be done and maybe some experiments.

Any prolactin results? Pituitary MRI by any chance? Hard knocks to the head?

Frankly your T levels suck for 30.

3

[quote]iroczinoz wrote:
Well put it this way if you were 80 and had the same levels as you have now the doctor would say you are fine, which would be fair considering the age.

But at 30 with T levels of a 70-80 year old you have to ask yourself do you want to accept that? From what I have read it seems people of a higher age with low test have more success than younger guys. The you are too young to be treated is such bs. Do they expect the younger guys to live 30-40 years with shitty levels and then at old age say you can have treatment now. Just so wrong and stupid.

Not saying you should jump on TRT but rather look deeper at possible causes first.

Just by looking at your lh,fsh nunbers they are borderline low. So it would lead me to say secondary just by that observation, but by all means not conclusive.

Your doctor just wants you out of his office without digging deeper, hence the you are in range cya…

Take a read of the stickies and might be a good idea to post your symptoms.

If you want to dig deeper more tests will need to be done and maybe some experiments.

Any prolactin results? Pituitary MRI by any chance? Hard knocks to the head?

Frankly your T levels suck for 30.[/quote]

Thanks for your reply Iroc.

My symptoms have been high difficulty gaining muscle mass, general trouble sleeping (I’m a very light sleeper; get woken up at pretty much any noise), extremely stubborn abdominal fat, trouble concentrating (wandering imagination?), semi-low sex drive, shyness, low general motivation). I exercise 3x per week, typically compound/heavy lifts and light cardio, and have a generally balanced & protein-heavy / lowish carb diet w/ a multivitamin, fish oil and D supplement daily.

I’ve never had an MRI nor any knocks to the head that I can recall. I’ve been healthy most of my life and never gone to the hospital for any sort of disorder or sickness.

Prolactin results were above - Prolactin = 7.9 (2.6 - 13.1 ng/mL). Not sure what these indicate.

Honestly I thought this doc was going to be different due to his specializtion, but I think my positive demeanor, healthy appearance, optimism, and honesty with him influenced him to diagnose me as fine (I told him I don’t want HRT unless I need it, because I understand it’s a life-long battle, so to speak).

I wanted to at least attempt some sort of trial of TRT to see if it made me feel any different or relieve systems, but I didn’t suggest that to him.

4

I forgot you had the prolactin listed on you post. It looks ok,

might want to look into getting a more complete thyroid panel that includes

tsh
ft3
ft4
might as well try and get the antibodies test while you are at it.

along with

morning cortisol 8 am or the 4x day saliva test
cholesterol
cbc
ferritin

Check the sticky if I missed anything.

5

I am 37 and was moody, irritable, poor sleep, night sweats, no drive, no energy and no libido. The family doc said it was anxiety/depression. I took 3 years of meds before a complication with a past hernia/vasectomy forced doctors to run labs. My Total T 312 and Free T 82 were close to your results. My Endo put me on trt 8 months ago. Last week had labs. Now Total T 841 and Free T 345. What a world of difference this makes on quality of life. I have drive, energy, and libido. I no longer take meds. I feel for guys who get no help from their docs. My 57 yr old dad has results the same as yours and his doc will not help. Best of luck to you. I would find a doc who will help. It changed my life.

6

[quote]iroczinoz wrote:
I forgot you had the prolactin listed on you post. It looks ok,

might want to look into getting a more complete thyroid panel that includes

tsh
ft3
ft4
might as well try and get the antibodies test while you are at it.

along with

morning cortisol 8 am or the 4x day saliva test
cholesterol
cbc
ferritin

Check the sticky if I missed anything.[/quote]

Just for reference, I did TSH, FSH & Cholesterol a while back, results:

TSH = 2.04 (0.04-4.50 mIU/L)
FSH = 1.8 (1.6-8.0 mIU/mL)

Cholesterol, Total = 173 (125-200 mg/dL)
HDL Cholesterol = 51 (> or = 40 mg/dL)
LDL Cholesterol = 104 (<130 mg/dL)
Triglycerides = 90 (<150 mg/dL)
Chol/HDLC Ratio = 3.4 (< or = 5)

Not sure how to interpret these; the cholesterol numbers were part of a routine physical / blood test. Doctor thought they were fine.

7

I cannot layout the path or tell you how to investigate your low T, but others on here definitely can. DO IT before starting. You want to look at everything and try to find a solution before TRT. TRT works and changes lives - you will read about it on here - but it still should be your last resort.

Based on your low LH and FSH, try a SERM restart.

8

I’m not so sure a SERM would do much to re-start with LH and FSH levels that low, and E2 slightly elevated. If E2 was >35 then perhaps it could.

My numbers aren’t too far off from yours. I’m going to get a brain MRI soon to rule out a pituitary adenoma. Also, ask a doc for a sample of Androgel or Axiron or some other topical TRT for a month - just to see if it has a positive effect on you. That way you’ll know how much of an impact it will have.

9

[quote]Master_P wrote:
I’m not so sure a SERM would do much to re-start with LH and FSH levels that low, and E2 slightly elevated. If E2 was >35 then perhaps it could.

My numbers aren’t too far off from yours. I’m going to get a brain MRI soon to rule out a pituitary adenoma. Also, ask a doc for a sample of Androgel or Axiron or some other topical TRT for a month - just to see if it has a positive effect on you. That way you’ll know how much of an impact it will have.[/quote]

I actually have a month’s worth of Testim that my GP prescribed me a while back (it hasn’t expired yet). He told me to take it to see if it had an impact, but I was unsure if I should take it or not b/c of my test results - thinking I had some form of secondary hypogonadism (for which a topical cream wouldn’t be the proper solution).

I could still use it to see how it makes me feel. Is there any risk associated with using it for a month? I just don’t want to do any damage to other systems (I know that it would technically make my LH drop off and my nuts would stop producing T temporarily).

EDIT: My doc just called and left a voicemail - my Bioavailable T level is 206 ng/DL, which he said is normal for my age range (30-39 years; range being 128 to 430 ng/DL).

10

It is normal to find low values in the population. Those with those normally seen low values are having a normal or optimal life.

Read the advice for new guys stick and watch for thyroid, body temp and iodine issues. Thyroid problems can lower T levels and visa versa, then one gets stuck.

You have estrogen dominance. Find a liquid anastrozole product and take EOD doses for a total of 1/2mg per week. That might be 4 drops. Search here and understand ‘anastrozole over-responders’.

Would be good to know if DHEA-S is low.

Low cholesterol can lower all of your steroid hormones, eat some eggs.

Fish oil, 25mg DHEA, high potency B complex multi-vits that also have some iodine, 4-5000iu vit D-3 per day.

11

[quote]KSman wrote:

You have estrogen dominance. Find a liquid anastrozole product and take EOD doses for a total of 1/2mg per week. That might be 4 drops. Search here and understand ‘anastrozole over-responders’.

Fish oil, 25mg DHEA, high potency B complex multi-vits that also have some iodine, 4-5000iu vit D-3 per day.[/quote]

Hi KSMan,

I appreciate your insight! I do currently take 4000-6000 IU of vit D-3 per day, and a tablespoon of “Nature’s Answer Liquid Omega 3 Deep Sea Fish Oil Epa/dha.”

Do you have any recommendations for the B complex vitamin you mentioned?

Also - I am curious about the safety of dosing liquid anastrozole. Not so much the amount, but moreso - after using it, will I physically / psychologically “notice it” ? I’ll do some searching here in the meantime to read about others’ experiences.

Thanks!
-Dirk

12

When someone has had estrogen poisoning for a few months, anastrozole can be a life transformation. If elevated estradiol levels have been shorter term and the problem is not yet major, the problems can be avoided, but that is not so dramatic.

Anastrozole does not seem to have any direct side effects. You feel high estrogen and if anastrozole dose is too high, low estradiol can feel quite bad.

Visit a good health food store.

13

[quote]KSman wrote:
When someone has had estrogen poisoning for a few months, anastrozole can be a life transformation. If elevated estradiol levels have been shorter term and the problem is not yet major, the problems can be avoided, but that is not so dramatic.

Anastrozole does not seem to have any direct side effects. You feel high estrogen and if anastrozole dose is too high, low estradiol can feel quite bad.

Visit a good health food store. [/quote]

Thanks KSMan.

I found and ordered a liquid anastrozole product. Before I begin dosing, what would you recommend for keeping track of my E2 levels to make sure they don’t drop too low, not low enough, etc.?

An Estradiol test a week after beginning dosing? 2 weeks after? Also - to be safe - would it be of any harm to halve your suggested dose (0.5mg / week = ~4 drops EOD), then test E2 levels? I’d just like to avoid any issues with E2 plummeting in case I am an over-responder (in other words, would prefer not to feel like crap for 2 months in the case that I am).

14

If you were an over-responder, and no way to know in advance, you would need to cut dose to a forth of the expected dose. You would not feed crappy for two months, stop the anastrozole for 5 days then resume at one forth. So there are unknowns, aka risks. Few are over-responders, but they are not rare.

If things work as expected, you will feel benefits in 7-10 days. In your case, the effects will be less profound than recovering from TRT with estrogen poisoning. If you feel better, you know you are in good territory. From there you can add one drop and test the waters, when you are ready, do the lab work.

A steady dose of anastrozole takes 5-6 days to get to steady state levels. That is typical of a longer half life drug. So you really are not playing with a full deck for almost a week. Then a balance between E2 removal by the liver and reduced E2 production takes time to occur.

That would be the end of the story for a guy on TRT. However, in your case as we attempt to shift the balance of your HPTA, things can take a while to happen. We are hoping for less E2, which will happen, more LH and T, less SHBG and more FT. The changes in T and E2 levels are going to change gene expression in your cells, then different protein and enzyme activity changes how the cell works and then bulk tissue changes start to occur. What happens in brain is that brain patterns change and evolve, then you become aware of change. So you can see that there is not need to rush into labwork. If you feel some benefit, there is more coming down the track, just see where that goes, and note that changes to anastrozole dose can take a while too. That is the best wishful thinking that I can come up with, you will just have to see where this goes. Good nutrients, including vit-D and fish oil as well as other supplements and good sleep always facilitates change. With TRT guys, I like to point out that during the transformation of the brain and new thought/mental processes, that a positive mental attitude can shape the circuits before the mortar sets.

15

[quote]KSman wrote:
If you were an over-responder, and no way to know in advance, you would need to cut dose to a forth of the expected dose. You would not feed crappy for two months, stop the anastrozole for 5 days then resume at one forth. So there are unknowns, aka risks. Few are over-responders, but they are not rare.
[/quote]

Thanks again for your prompt replies KSMan.

If I am understanding you correctly, couldn’t I just begin dosing at 1/4 your recommended dose, wait 7-10 days, and see how I feel after that? If no changes, add a drop each time, try again (until I get to the 0.5 mg / week dose)?

I could also do an E2 test after each “trial” (would cost me ~$50, not a huge deal to be safe) to monitor levels.

I understand that this ‘reverse’ method might take longer to notice the effects, but then I would also avoid a possible plummeting of E2 levels if starting at the full 0.5mg / week dose, in the unlikely but possible case that I am an over-responder.

Would this be correct?

16

Yes, but I don’t think that any would advise that route. You will feel when E2 is in the right ball park, then do one lab and we can calculate your dose from there.

Lets assume that things work, increasing T makes more E2 and there is this time delay and increasing LH can be making physical and functional changes in your testes, and more E2 is made there. Everything affects everything else. Testing soon is not wise. Your body needs to find a new balance.

17

Hi KSMan,

So I’m just about ready to begin l-anastrozole dosing trials. A few questions before I begin:

You mentioned I should “feel the benefits” within 7-10 days.

  1. Is there a particular set of benefits / effects I should be looking for and/or monitoring?
    1A) With that, would they be psychological, physiological, and/or physical? (i.e. sense of well-being, confidence, stamina, decrease in anxiety, etc.)?

  2. Also, in the case that I am an over-responder, what effects should I look out for? How soon would I notice these?

The reason I am asking is I’d like to approach this “experiment” as scientifically and as detailed as possible, taking notes and monitoring everything very carefully.

Thank you again for all your help thus far!

Best regards,
-Dirk

[quote]KSman wrote:
Yes, but I don’t think that any would advise that route. You will feel when E2 is in the right ball park, then do one lab and we can calculate your dose from there.

Lets assume that things work, increasing T makes more E2 and there is this time delay and increasing LH can be making physical and functional changes in your testes, and more E2 is made there. Everything affects everything else. Testing soon is not wise. Your body needs to find a new balance. [/quote]

18

Update:

Took first dose of liquid anastrozole this morning. Note that I’ve been feeling a bit depressed / anxious / stuck as of late due to job situation (off topic, general dissatisfaction, in need of soul searching, etc.).

Anyway, I dosed about ~2 drops (came out to 0.05 mL), approx. half of KSMan?s recommended dose. Felt fine all morning, however this afternoon I have been feeling like complete sh*t. No joint pains, but extremely lethargic, sad, depressed, incredibly unmotivated. Moreso than other days this week. Not sure if this is due to the azole or not. I understand I should give it a week but not if I feel like this. Perhaps I?ll wait a few days and see how I feel on next dose.

19

See what happens.

More info here: Estradiol: Why You Should Care - Testosterone Replacement - Forums - T Nation

20

So … picking this thread up after a good amount of time off.

To be honest, when I first dosed the a-dex (2 drops as a precaution), I felt so incredibly shitty / depressed the 2nd half of that day (unnaturally so), it scared me off from trying the a-dex again.

Anyway, I finally decided to try again, starting last week.

I dosed 1 drop on Wednesday morning, and noted that by the late afternoon / evening, I felt nothing negative at all, in fact I felt quite good / energetic.

That night, however, I had a lot of trouble sleeping, and was extremely hot (sweating in my bed).

Next day, didn’t dose, felt fine all day, once again quite energetic in the evening / night hours, and again had trouble sleeping and woke up hot at night. Had morning wood both the first & second mornings.

I also noticed each night that my resting heart rate was a bit elevated (probably 80+ bpm, rather than the usual ~60), and the beats themselves were extremely evident (heart felt like it was beating quite hard). No morning wood.

The 3rd day, I dosed 0.5 drops to keep the level of A-dex steady in my system (half life ~ 48h, so half of the first dose of 1 drop would have been left), and once again, seemingly elevated energy levels in the evening / night, and still trouble sleeping.

Also was having crazy dreams.

So anyway, after 5 days, I decided to not dose again (yesterday would have been the day), and last night slept much better, heart was beating normally. Still had a crazy dream though.

I’m going to lower my ‘dose’ to 1/4 of a drop total and see how it plays out. Right now, the elevated evening / night energy level isn’t worth it to me if I’m going to feel like my heart is going to explode at night, and have a lot of trouble sleeping / staying asleep.

will report back if I find anything else interesting. I find it unfortunate that I’m having these side effects from the A-dex but oh well!